First night using troches

This will be my first night using the troches after my series of iv infusions. Quite anxious about it. They are 150mg. Any advice?

Yeah. Relax. Troches are given to be used in an unsupervised environment, so they will be nowhere near as potent.

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I will be going home with them after my 6th infusion. I was advised to take them in the evening. Which works for me as I also have muscle relaxers I take at bedtime. It will be nice to get in a new bedtime routine with less pain and have the torches when needed to combat flares.

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A few bits of advice (apologies if any of this repeats what you doctor may have already told you):

  • 150mg isn’t a high dose, so while I totally understand being nervous about trying it at home for the first time, you should have nothing to worry about. I was prescribed 100mg troches and the first time I tried one, all it did was make me tired and lethargic; it was nothing at all like the infusions (nowhere near dissociation, not even any visuals). Granted your dose is 50% higher than mine, and the depth of any given experience partly depends on other factors in addition to dosage (whether you’re hydrated or not, how recently you’ve eaten, your mindset going into it, etc.) but I would be surprised if you experience anything approaching what the infusions are like via a 150mg troche. If you’re really nervous about it, you could always cut a troche in half and do 75mg for your first try, then work your way up to 150mg on subsequent occasions as you get comfortable.

  • In terms of how to actually use them: let the troche melt / dissolve under your tongue, and for about 20 minutes, hold the saliva that builds up in your mouth without swallowing and swish it around some as it collects. Bioavailability of ketamine via troche is lousy; I’ve read slightly different numbers in various places, but generally speaking the sublingual bioavailability is around 30% - 35% vs. more like 20% - 25% via the digestive system after swallowing. So, if you keep the saliva in your mouth for a while, it allows more of the ketamine to pass through the membranes in your mouth with less of it getting destroyed by first-pass metabolism in your digestive system. It can get kind of uncomfortable to have that much saliva in your mouth for that long, and if you have to swallow some, don’t worry about it.

  • As with the infusions, the more you can relax and allow yourself to let go and be immersed in the experience, the more positive and enjoyable it should be. Try to ensure that you can’t be interrupted for a couple of hours, put on your headphones with a good ketamine playlist, and get as comfortable physically and mentally as you can. I find a darkened room helps, and good eyeshades that allow you to keep your eyes open behind them help even more (I tried a few different ones and I can’t recommend this one highly enough: https://mantasleep.com/products/manta-sleep-mask

  • As another resource, the Therapeutic Ketamine subreddit (https://www.reddit.com/r/TherapeuticKetamine/) has lots of questions & answers about troche use as well as all other aspects of ketamine therapy.

Hope you have good results from the troches. Let us know how it goes.

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Great advice in this thread!

I have my 2nd Ketamine treatment this Thursday. It will be administered with an IM injection. I have been told I will be sent home with Lozenge. The dosage for the lozenge will be finalized after the IM session (estimated to be between 100 - 200 mg). It has been advised I take them in the evening. How do people feel the next morning? I need to be able to go to work and I am a bit concerned about “lay over” fatigue. My job requires quite a bit of physical activity.

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I’ve been on the lozenges for about 6 months now, and as long as I can get to sleep, my quality of sleep seems normal. The only difficulty I’ve had is if I take them too close to bed time it can keep me awake because there’s still some low level psychedelic visions that are really distracting. To avoid that, take them at least 3 hours before bed, closer to 4 hours.

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Thank you so much for the great advice, Entropy. I typically have a horrid time trying to sleep so the advice to take the med at least 3 hours before bed will be crucial for me. Thanks again.

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