From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For ketamine troches, a typical starting dose is 25-50 mg sublingual troche, as supported by the most recent and highest quality study 1.
Key Considerations
- The dose range of 25-50 mg is based on the study by 1, which demonstrated the safety and efficacy of sublingual ketamine troches in chronic non-malignant pain management.
- The study found that there was no association between the dosage or duration of treatment and frequency of side-effects, and that the 'safe' dose may be higher than the previous consensus.
- It is essential to start at the lower end of the dose range and titrate up as tolerated, instructing the patient to place the troche under their tongue and allow it to dissolve completely over 15-20 minutes, swishing the saliva around before swallowing.
Administration and Monitoring
- Patients should be in a calm, comfortable environment during administration, and avoid driving or operating machinery for at least 6 hours after dosing.
- Common side effects include dissociation, dizziness, and nausea, and regular reassessment is crucial to determine ongoing efficacy and safety.
- Ketamine works as an NMDA receptor antagonist, potentially promoting neuroplasticity and modulating glutamate signaling to provide rapid antidepressant effects.
Comparison with Other Studies
- While other studies, such as 2 and 3, provide information on ketamine dosing and administration, they are not directly applicable to the starting dose for ketamine troches.
- The study by 1 is the most recent and highest quality study, and its findings should be prioritized when determining the starting dose for ketamine troches.