Enantiomers are a pair of mirror images that make up many molecules. Despite having identical chemical structures, they reflect one another, similar to the left and right hands. Ketamine comprises two enantiomers, a left-handed one called (S)-Ketamine and a right-handed one called (R)-Ketamine. Spravato consists of the left-handed (S) molecule, while ketamine is a racemic mixture of both molecules.

Ketamine has been FDA-approved for anesthesia for more than half a century, so it cannot be patented as a treatment for depression. However, Ketamine is not unusual in this regard, as roughly 70% of medications are used for conditions outside their FDA-approved indications. However, if a pharmaceutical company can demonstrate the effectiveness of a compound's enantiomers in treating a particular illness, they can receive FDA approval. Consequently, (S)-Ketamine was introduced to the market as a new agent for treating depression.

Obtaining FDA approval for a medication is a costly endeavor for pharmaceutical companies, resulting in a price range of $590 to $885 per session for (S)-Ketamine, exclusive of office visit expenses. Despite this, many find comfort in using an FDA-approved drug, and insurance companies may cover a significant portion of the cost. To comply with FDA regulations, (S)-Ketamine must be administered in fixed doses of either 56 mg or 84 mg, and patients must be monitored for at least two hours. The only available form of (S)-Ketamine is intranasal (IN), while ketamine can be administered through multiple routes, each having differing levels of bioavailability.

KETAMINE THERAPY

KETAMINE VS CONVENTIONAL THERAPIES

NEUROPLASTICITY

DIFFERENCES BETWEEN SPRAVATO AND KETAMINE

BIOAVAILABILITY

WHY WE USE INTRAMUSCULAR IN ADDITION TO SPRAVATO