As human beings, we have grown to learn the essence and necessity of medicine in our daily lives. While the word “medication” has been deemed as a mere derogatory term, we have noticed more often times than not that it leads to the cure and lifesaving moments of people worldwide. Ketamine is of these revolutionary medicines of this century and in recent years has been used quite often with great success for refractory depression, pain relief, antidepressant effects, breakthrough anxiety, OCD treatment, depression, bipolar disorder, treatment of PTSD and others. All of the treatment forms and dosage forms of ketamine can be compounded at Enovex pharmacy.
Ketamine
used for
- Pain relief
- Treatment resistant depression
- Antidepressant effects
- Anxiety
- Bipolar disorder
- Depression
- OCD treatment
- Many others
At Enovex Pharmacy in Glendale, CA we most commonly use oral ketamine in troche form (dissolves in your mouth) and we make 100mg troches that can be divided into 4 parts for ease of up or down titration. The other very common form used by most ketamine clinics MD’s in Los Angeles is the use of ketamine nasal spray. The most common form is the 100mg/ml strength and the patients would start with a 1 spray (10mg) in one nostril up to 4 times a day. They can gradually and carefully increase the dose to 2 sprays in each nostril (40mg) every 4 to 6 hours as needed. We have noticed that surprisingly there are no withdrawal reactions and that our patients are able to safely taper off any opiate medication that they are on for pain without major opiate withdrawal side effects. Ketamine is a great asset in the fight to reduce opiate burden for our patients. Its dual effect of controlling pain and treating depression is very useful in most patients as those 2 conditions are usually interrelated and occur concurrently in a lot of patients.
If you are looking to treat one of the endless list of diseases we see in this world with the essential use of ketamine, look no further than the ENOVEX pharmacy- a compounding pharmacy located centrally in metropolitan Los Angeles in Glendale. Enovex pharmacy has proven itself in the Glendale, Pasadena, north Hollywood, Burbank and the greater Los Angeles community for numerous years in providing individualized, compounded ketamine, psychiatric compounding, custom compounded ketamine for the benefit and use of its patients. To look more closely at the use of Ketamine compounded in ENOVEX pharmacy and its importance in the pharmacy world, we look at the numerous studies that have proven time after time the benefits of ketamine use.
1. “Zarate et al conducted a randomized, placebo-controlled, double-blind crossover study of ketamine 0.5 mg/kg versus saline in 18 patients (12 men and 6 women) with TRD. Seventeen (94%) patients receiving ketamine demonstrated significant improvement in depression within 110 minutes of the infusion through 7 days versus the 14 patients who received placebo”
2. “in 2000, Berman et al published the first double-blind, placebo-controlled, crossover trial evaluating the use a single dose of 0.5 mg/kg ketamine over 40 minutes in eight patients with recurrent unipolar major depression and one with bipolar disorder, which showed progressive decreases in depressive symptoms within 3 days of treatment.
The roots of Ketamine begin with its synthetization in 1962 by a Parke David, a lab pharmacist eager to understand the effects of many drugs and medicines. Beginning in 1965, the presence of Ketamine was mostly seen and used as an anesthetics drug and recreational use in the club setting. As the threshold and understanding of this essential drug was becoming more well known, in the late 1960s, the United States army used Ketamine mainly as an anesthetic in the Vietnam War. As with the constant use and effects of many medications, Ketamine also was placed under scrutiny when the drug was used constantly as a recreational drug worldwide. With the fight of the public and constant legal battle of people overdosing on this essential medication, the DEA was forced in 1999 to put Ketamine as a Schedule III substance, due mostly to its characteristics similar to PCP, stemming from the fact that it comes from the arylcyclohexylamine group.
Most commonly, Ketamine is used for pain relief, ketamine for treatment resistant depression, ketamine for antidepressant effects, ketamine for breakthrough anxiety, ketamine for OCD treatment, ketamine for depression, ketamine for bipolar disorder and others. Of course, the list goes on, since the essential use of this medication has been proven time after time to treat patients from ailments stemming from these and other conditions. Ketamine can also reduce opioid consumption in reduction of acute tolerance to the analgesic effect of opioids. With the use of any medication, there comes the risk of adverse effects, in which some in this case would be increased heart rate, at times depressed heart rate, impaired motor coordination, fear, paranoia, euphoria, confusion, bladder health issue and Nausea and Vomiting
The administration of Ketamine comes in three main routes, notably oral ketamine, intranasal ketamine and intramuscular ketamine. Oral ketamine is usually dosed at 1-4mg/lb, which comes out to be 100-500 mg, lasting roughly around 90 min – 2 hours (onset of 10-30 min). Intranasal ketamine dose is dosed about 0.15-1 mg/lb, which translates to a dose about 25-250 mg, with a total effect ranging from 45-60 min (onset of 5-15 min). Finally, intramuscular ketamine injection is dosed at 0.15-0.75 mg/lb, which turns out to be about 25-125 mg, having an effect of 30-60 min (onset of 1 to 5 mins). The concurrent use of anticholinergics, alcohol, opioids, benzos, barbiturates, and other CNS depressants is usually contraindicated, and thus not recommended.
In conclusion, the use of ketamine can be clearly underlined and witnessed in numerous and infinite occasions from patient to patient. While the drug has been used illegally in the recreational field, its use in the medical field has proven to be beneficial to millions of patients worldwide. From the vast area of ailments noted above, depression has been the most recent and the most important condition proven to be treated with Ketamine. The date in this field has proven to show that the drug is not a “miracle drug”, but rather one that at times can work clinically better than medicines that have been used constantly for dozens of years. With pharmacies such as ENOVEX pharmacy, the use of compounded ketamine can be publicized and patients can be consulted on a daily basis on the importance and necessity of ketamine in their daily regimen. With public awareness and knowledge comes the development and basis for vitality and the real purpose of such medications in our world.
References:
Hvizdos, Andrew J. “The Use of Ketamine in the Acute Management of Depression.” US PHARMACIST 41.11 (2016): HS28-HS32.
Kissin, Igor, Cheryl A. Bright, and Edwin L. Bradley Jr. “The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations?.” Anesthesia & Analgesia 91.6 (2000): 1483-1488.
Sanacora, Gerard, et al. “A consensus statement on the use of ketamine in the treatment of mood disorders.” Jama psychiatry74.4 (2017): 399-405.
McGirr, A., et al. “A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes.” Psychological medicine 45.4 (2015): 693-704.
Murrough, James W., et al. “Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial.” American Journal of Psychiatry 170.10 (2013): 1134-1142.
Schmid, Roger L., Alan N. Sandler, and Joel Katz. “Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes.” Pain 82.2 (1999): 111-125.
Serafini, Gianluca et al. “ The Role of Ketamine in Treatment-Resistant Depression: A Systematic Review .” Current Neuropharmacology 12.5 (2014): 444–461. PMC. Web. 3 Nov. 2017.
Persson, Jan. “Ketamine in pain management.” CNS neuroscience & therapeutics 19.6 (2013): 396-402.
Dolgin, Elie. “Rapid antidepressant effects of ketamine ignite drug discovery.” (2013): 8-8.
Niesters, M., et al. “Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept study.” British journal of anaesthesia 110.6 (2013): 1010-1016.
McGhee, Laura L., et al. “The correlation between ketamine and posttraumatic stress disorder in burned service members.” Journal of Trauma and Acute Care Surgery 64.2 (2008): S195-S199.
Subramaniam, Kathirvel, Balachundhar Subramaniam, and Richard A. Steinbrook. “Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review.” Anesthesia & Analgesia 99.2 (2004): 482-495.
Suppa, E., et al. “A study of low-dose S-ketamine infusion as” preventive” pain treatment for cesarean section with spinal anesthesia: benefits and side effects.” Minerva anestesiologica78.7 (2012): 774-781.
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