SUBLINGUAL KETAMINE: HOW IT DIFFERS FROM OTHER FORMS
Understanding Ketamine’s Growing Role in Mental Health Care
In recent years, ketamine has gained widespread attention for its transformative effects on treatment-resistant depression, anxiety, PTSD, and chronic pain. While intravenous (IV) infusions remain the most common method of administration, sublingual ketamine has emerged as a more accessible, less invasive alternative.
This blog explores sublingual ketamine: how it differs from other forms, and what patients and clinicians in Switzerland and around the world should understand about this option in 2025.
WHAT IS SUBLINGUAL KETAMINE?
Defining the Sublingual Route
Sublingual ketamine refers to a form of the drug that dissolves under the tongue. Typically delivered as lozenges or troches, this method allows the medication to absorb directly into the bloodstream through the oral mucosa.
Customized Compounding
Pharmacies that specialize in compounding prepare ketamine lozenges based on the doctor’s prescription. They tailor the dosage, formulation, and flavor according to the patient’s individual needs. This approach gives prescribers more flexibility and ensures patients get the most appropriate formulation for their condition.
HOW SUBLINGUAL KETAMINE WORKS IN THE BODY
The Absorption Process
Once the patient places the lozenge under the tongue, the ketamine absorbs through mucosal membranes in the mouth. This bypasses the digestive system and reduces the drug’s breakdown by the liver (first-pass metabolism).
Consequently, more of the active compound reaches the bloodstream directly, creating a fast onset of effects—though not as rapid as IV infusion.
Onset and Duration
With sublingual use, patients typically begin to feel the effects within 15 to 30 minutes. The peak usually occurs within an hour, and the experience may last between 1.5 and 2.5 hours.
Although the onset is slower than injection or nasal spray, many patients still describe the effects as profound and therapeutic.
KEY DIFFERENCES FROM OTHER ADMINISTRATION ROUTES
Comparing with IV Infusion
IV infusion delivers ketamine directly into the bloodstream through a vein. As a result, this route has the fastest onset and offers the most controlled dosing. Clinics in Switzerland and globally often favor IV infusions for patients with severe depression or suicidal ideation due to the precision it offers.
In contrast, sublingual ketamine works well for ongoing maintenance, especially after a successful series of infusions.
Comparing with Intramuscular (IM) and Nasal Spray
IM injections, like IV infusions, have a rapid onset and are administered in clinical settings. Nasal sprays (including esketamine/Spravato) offer a middle ground between clinical supervision and ease of use.
Sublingual ketamine stands out for its potential to be administered at home under proper medical guidance, especially in follow-up phases of treatment.
Comparing with Oral Tablets
Swallowing ketamine in tablet or capsule form results in lower bioavailability. The liver breaks down much of the drug before it reaches the bloodstream. Sublingual administration improves on this by allowing the drug to enter the bloodstream more directly.
WHY CHOOSE SUBLINGUAL KETAMINE?
Greater Convenience and Flexibility
One of the most appealing aspects of sublingual ketamine is the flexibility it offers. After a proper evaluation and stabilization through infusions or supervised doses, patients may transition to at-home sublingual use. This shift reduces the burden of frequent clinic visits.
Lower Cost in Long-Term Maintenance
Infusions can be expensive due to the need for medical supervision and IV equipment. Sublingual lozenges, while still a prescription item, generally cost less over time. This makes them a more sustainable option for long-term mental health care.
Minimal Invasiveness
Some patients dislike needles or experience anxiety around medical procedures. Sublingual delivery eliminates this barrier, improving treatment adherence.
SAFETY AND MONITORING REQUIREMENTS
Medical Oversight Still Matters
Even though sublingual ketamine offers at-home use potential, medical supervision remains crucial. Patients need thorough psychiatric evaluation before starting treatment. Doctors must also monitor side effects and therapeutic response on an ongoing basis.
Managing Side Effects
Like other forms of ketamine, the sublingual version may cause dizziness, dissociation, nausea, or temporary increases in blood pressure. However, most side effects subside quickly.
By using lower doses and adjusting frequency, doctors can help patients minimize discomfort while still benefiting from the antidepressant effects.
WHO BENEFITS MOST FROM SUBLINGUAL KETAMINE?
Treatment-Resistant Depression
Patients who have not responded to SSRIs, SNRIs, or traditional talk therapy often turn to ketamine as a breakthrough solution. For those who improve with infusions, sublingual ketamine can help maintain results between sessions.
Anxiety and PTSD
Studies suggest that ketamine may modulate glutamate pathways involved in fear processing and trauma. Sublingual use provides a lower-risk maintenance strategy for PTSD patients after initial stabilization with more intensive treatments.
Chronic Pain Patients
Although primarily used for mental health, ketamine also helps manage complex pain conditions such as fibromyalgia and neuropathic pain. Sublingual delivery makes ongoing use more manageable than repeated infusions or injections.
LEGAL STATUS IN SWITZERLAND
Prescription Requirement
In Switzerland, ketamine remains a controlled substance. Only licensed physicians can prescribe it. Patients must undergo psychiatric evaluation, and treatment usually begins in a clinic before transitioning to at-home options.
Compounded vs. Commercial Products
Unlike esketamine (Spravato), which has marketing authorization, sublingual ketamine lozenges are compounded individually and do not come as commercial products. This means their use requires a prescription for “off-label” treatment.
PSYCHOTHERAPY INTEGRATION
Enhancing Outcomes Through Therapy
Combining ketamine with psychotherapy, especially in sublingual form, enhances long-term outcomes. Therapists can work with patients during or shortly after the lozenge session to help process emotional insights, shift behavioral patterns, or reduce trauma symptoms.
Growing Support in Swiss Clinics
In Switzerland, an increasing number of clinics now offer integrated treatment models. These include preparatory therapy sessions, monitored sublingual dosing, and post-session integration work.
FINAL THOUGHTS: WHAT MAKES SUBLINGUAL KETAMINE UNIQUE?
Sublingual ketamine represents a unique bridge between the clinical power of IV therapy and the practicality of at-home maintenance. It empowers patients with more flexibility while maintaining therapeutic benefits.
As awareness spreads and regulations evolve, more Swiss residents may access this form of ketamine to manage chronic mental health conditions in a safe, supervised, and sustainable manner.