Ketamine nasal spray

[metadr]

I am taking over mgmt of a WC patient previously managed at BWH whose treatment included intranasal ketamine filled from a compounding pharmacy… I have not ever prescribed ketamine for outpatient management. Got me thinking… Anyone using SPRAVATO off label for pain mgmt?

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[deleted131481]

I am taking over mgmt of a WC patient previously managed at BWH whose treatment included intranasal ketamine filled from a compounding pharmacy… I have not ever prescribed ketamine for outpatient management. Got me thinking… Anyone using SPRAVATO off label for pain mgmt?

Tried this once and did not work. Spravato dosing is kind of odd, I did a smaller daily dose. I think ketamine is potentially a better and safer near last resort option than opioids, and potentially helpful for psych comorbidities.

Still, it is an off-label use of a controlled medication that can be abused. And psych comorbidities is also a very good reason not to prescribe it.

Doubt I will use again until some better literature to support it.

 

[Ferrismonk]

I've seen people come in my office who used prescribed ketamine powder in his vape as prescribed. "It was the only thing that worked". Hard pass.

Intranasal controlled substances used as needed are only a reasonable possibility if the patient can't open their mouth.

 

[nvrsumr]

Academic places can get away with treatments that I wouldn’t consider in PP. I would feel zero obligation to continue.

 

[callmeanesthesia]

Yikes. Hard pass. Any idea if the toxicity of intranasal ketamine is similar to IV? Liver failure, hemorrhagic cystitis, all that good stuff? I’d be at least occasionally checking LFTs, and checking for blood in the urine in addition to u-tox.
I don’t know why I’m saying “I would” though - I’d have rejected that transfer of care with extreme prejudice. If they want crazy treatments they can go to the doctor crazy enough to start them on it. On a Work comp patient, no less!

 

[Agast]

Psychiatrists are administering Sprivato in-office as a weekly treatment where the patient is monitored. They’re not sending them home with the stuff, if you’re worried about the IVDU part.

 

[No Pain All gain]

I do this from time to time in appropriate patients. It’s a fire extinguisher to keep them out of ER. Compounding pharmacy makes it for them. Not off label. Much cheaper than Spravato without the REMS.

 

[NJPAIN]

I do this from time to time in appropriate patients. It’s a fire extinguisher to keep them out of ER. Compounding pharmacy makes it for them. Not off label. Much cheaper than Spravato without the REMS.

For what conditions?
When are they instructed to use their fire extinguisher?

 

[DrMDAware]

I do this from time to time in appropriate patients. It’s a fire extinguisher to keep them out of ER.

Curious - is this cost prohibitive for most people? I assume it is all out of pocket...

 

[No Pain All gain]

Costs about $90 for 20mL at compounding pharmacy.

Mostly use it for cluster, trigeminal neuralgia, CRPS.

Instructions are 1-4 sprays every 45 minutes for extreme pain.

 

[No Pain All gain]

Yikes. Hard pass. Any idea if the toxicity of intranasal ketamine is similar to IV? Liver failure, hemorrhagic cystitis, all that good stuff? I’d be at least occasionally checking LFTs, and checking for blood in the urine in addition to u-tox.
I don’t know why I’m saying “I would” though - I’d have rejected that transfer of care with extreme prejudice. If they want crazy treatments they can go to the doctor crazy enough to start them on it. On a Work comp patient, no less!

Really not that crazy. It’s a WHO essential medicine and effective.

 

[lobelsteve]

Really not that crazy. It’s a WHO essential medicine and effective.

You getting UDS on all these folks?

 

[DrMDAware]

Costs about $90 for 20mL at compounding pharmacy.

Mostly use it for cluster, trigeminal neuralgia, CRPS.

Instructions are 1-4 sprays every 45 minutes for extreme pain.

Thanks. How long does this usually last patients?

 

[No Pain All gain]

You getting UDS on all these folks?

Of course. All standard stuff.
Typically lasts 1-3 months. Compounded to 15mg per dose.

 

[Ferrismonk]

Costs about $90 for 20mL at compounding pharmacy.

Mostly use it for cluster, trigeminal neuralgia, CRPS.

Instructions are 1-4 sprays every 45 minutes for need to escape life for a bit

Fixed it for you

Really not that crazy. It’s a WHO essential medicine and effective.

For anesthesia...