A ketamine troche is a small, dissolvable lozenge containing ketamine that you place under your tongue, where it absorbs through the lining of your mouth. Troches are one of the most common forms of at-home ketamine used for conditions like treatment-resistant depression, PTSD, and chronic pain. They are not FDA-approved products. Instead, they are made by compounding pharmacies and prescribed off-label by individual providers.
How a Troche Works in Your Body
The word “troche” (pronounced TRO-kee) simply means a medicated lozenge designed to dissolve slowly in the mouth. Ketamine troches are formulated so the drug passes directly through the thin tissue under your tongue and inside your cheeks into your bloodstream. This bypasses much of the digestive system, which matters because ketamine that gets swallowed and processed through the liver loses most of its potency. Oral ketamine that goes straight to the stomach has only about 10 to 20% bioavailability, meaning the vast majority of the drug never reaches the brain. Sublingual absorption roughly doubles that to around 30%.
That 30% figure is still much lower than intravenous ketamine, which delivers 100% of the dose to the bloodstream. But the troche format trades some potency for convenience: you can use it at home rather than sitting in a clinic with an IV in your arm.
What Troches Are Prescribed For
Ketamine’s only FDA-approved use is as an injectable anesthetic for surgery. However, providers increasingly prescribe compounded ketamine troches off-label for psychiatric and pain conditions. The most common use is treatment-resistant depression, where a growing body of evidence supports ketamine’s ability to produce rapid improvements in mood, sometimes within hours rather than the weeks typical of standard antidepressants.
Troches are also prescribed for PTSD, anxiety, and chronic pain. Research on oral ketamine for PTSD, while still limited compared to depression studies, has shown promising results. One retrospective analysis found that outpatient oral ketamine reduced psychiatric hospital admissions by roughly 70% per patient among people with PTSD, with significant decreases in both the number of admissions and length of hospital stays. Ketamine also appears to reduce depressive symptoms that commonly accompany PTSD.
How to Take a Ketamine Troche
The process is straightforward but specific. You place the troche under your tongue and let it dissolve completely without chewing or swallowing. Once dissolved, you hold the liquid and any saliva that accumulates in your mouth for at least 15 minutes. This extended contact time allows more of the drug to absorb through the oral tissue. After 15 minutes, you spit the remaining liquid out. Swallowing it is not dangerous, but it can cause nausea and stomach upset, and the swallowed portion is much less effective anyway. Sitting forward slightly can help you avoid the urge to swallow during the hold period.
Most people are instructed to use the troche at home in a calm, comfortable environment, often in the evening. You should not drive, operate machinery, or make important decisions while under its effects.
What the Experience Feels Like
Sublingual absorption is relatively fast. You may begin noticing effects within 10 to 20 minutes. At the doses typically prescribed for psychiatric conditions (well below surgical anesthesia levels), common experiences include a feeling of mild dissociation, a sense of floating or detachment from your body, dizziness, and changes in how you perceive time or your surroundings. Some people describe a dreamlike or meditative state.
Side effects can include nausea, increased salivation, elevated heart rate and blood pressure, confusion, slurred speech, and anxiety or paranoia. These effects are dose-dependent and generally resolve within one to several hours, depending on the dose and your individual metabolism. Nausea is one of the most frequently reported complaints, and some providers prescribe anti-nausea medication to take beforehand.
How Troches Differ From Spravato
Spravato is an FDA-approved nasal spray that contains esketamine, one of the two mirror-image molecules that make up standard ketamine. The esketamine component is considered roughly four times more potent than its counterpart. Spravato must be administered under direct medical supervision in a certified clinic, and patients are monitored for at least two hours after each dose. It went through the full FDA approval process, meaning its safety, effectiveness, and quality were formally evaluated.
Ketamine troches, by contrast, contain racemic ketamine (both molecular forms together). They are compounded, meaning a pharmacy mixes them to order based on a provider’s prescription. They can be used at home without in-person supervision. This accessibility is part of their appeal, but it also means no standardized federal oversight of the product’s formulation or the monitoring patients receive.
The Regulatory Situation
The FDA has issued specific warnings about compounded ketamine products, including oral formulations used for psychiatric conditions. Because troches are compounded rather than commercially manufactured, they have not been evaluated by the FDA for safety, effectiveness, or quality. They are not covered by the Risk Evaluation and Mitigation Strategy (REMS) program that governs Spravato, which requires in-clinic monitoring and restricts distribution.
Ketamine itself is a Schedule III controlled substance, so troches do require a prescription. Many people obtain them through telehealth platforms that connect patients with prescribers and compounding pharmacies. The FDA has noted concern that patients receiving ketamine this way may not get adequate information about potential risks, particularly around unsupervised use, the possibility of dependence, and urinary tract problems that can develop with repeated ketamine exposure over time.
None of this means troches are inherently unsafe, but it does mean the responsibility for proper dosing, monitoring, and risk assessment falls more heavily on the individual prescriber and patient than it would with an FDA-approved medication.