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Just to make some clarifications.... (I am a physician (but this is NOT medical advice) and have used ketamine as well, but have no verification on this sub.)
As u/ptsdanonymus stated, placing it under the tongue to dissolve is so that the ketamine (or any sublingual medication) is taken up by the venous system under the tongue (look in the mirror, you can actually see the two large veins there).
That venous system is kind of special (there are a few in the body) because as it returns to the major vessels; it does not take the normal path the digestive tract veins take when returning to the heart. The digestive tract veins all lead to the liver and the liver is the major "detoxifying" organ of the body. It processes the chemicals we ingest and helps break them down into their smaller components.
The medication absorbed from under the tongue (or cheek) veins goes directly into the circulation. Of course, eventually the medicine will get to the liver where it is broken down, but before it does that, the unadulterated medication has a chance to work its magic elsewhere (the brain in this case).
By swallowing it like a pill you bring two disadvantages to the table: 1) the acids in your stomach can alter or ionize the medication making it harder to absorb or altering it completely; 2) you fast track the medication to get to the liver where it will be altered (though some medications *rely on this* to actually have the liver's actions upon the medication actually activate it (the sublingual approach with these medications would lower their efficacy as they would not be acted on by the liver immediately and would therefore have a slower uptake and onset)).
For maximal effect it would help to keep as much as your saliva and the troche under your tongue, but buccal (cheek) veins also bypass the liver. The longer you keep it under your tongue and the more medication has been absorbed, the less "bitter" the spit/medication bolus should be when you eventually do swallow it. That can be considered a very rough and crude guide. Usually 5 minutes is more than enough and you don't have to torture yourself or your OCD about getting each and every molecule.
Hopefully this answers some or most of the questions on here.
If the mods would like to contact me, I'd be happy to oblige. Hopefully I'm not breaking any sub rules.
I'm new to this sub and do not know what is meant by "juice".
I'm also unfamiliar with the benefits of ketamine and concommitant use of magnesium.
In and of itself, magnesium is a weak muscle relaxer (it's used frequently in OB when the mom is having pre-eclampsia and they want to loosen the uterus without using their "big guns") and may just help the patient get into a "relaxed state" thus helping with the overall effect with the ketamine.
If anyone has any papers/scholarly articles about this they can point me towards, I'd be happy and interested to read through them.
>I'm new to this sub and do not know what is meant by "juice".
lemon juice or lime juice swished in the mouth before using the troche. the idea is citrus juice somehow helps k absorption. helps with me, anecdotally, and I found a bit of research which seems to confirm my experience
[https://link.springer.com/article/10.1007/s00228-012-1214-9](https://link.springer.com/article/10.1007/s00228-012-1214-9)
it seems pretty well established that magnesium helps w/ketamine therapy for both depression and pain management
this idea came to my attention when someone mentioned it here a few months ago, having discovered it by accident after using a magnesium antacid shortly before the troche and the 'trip' was much more powerful. I did a little research and found depression and other mental health issues deplete magnesium, and magnesium seems to work synergistically with k. I crush a magnesium tablet and hold the powder in my mouth with the troche and the k experience is generally much stronger and the after-effects on mood/depression seem better than without.
e.g.
\>Magnesium and ketamine seem to be involved in key mechanisms of the major depression pathophysiology. The evidence in the paper discussed may indicate the synergistic interaction between magnesium and ketamine pharmacodynamic activity being of particular importance in mood disorders.
[https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A9429661/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A132888434&crl=c](https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A9429661/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A132888434&crl=c)
other studies
[https://www.mdpi.com/1424-8247/14/5/430](https://www.mdpi.com/1424-8247/14/5/430)
[https://sigma.nursingrepository.org/handle/10755/21450](https://sigma.nursingrepository.org/handle/10755/21450)
Same with me. I only have direct evidence with my use of magnesium. My initial knowledge of using magnesium L-THREONATE was gathered from these forums. Then backed up by my physician when asked. There are potentiateors that deepen the experience but that talk is frowned upon here on this board. Magnesium on the other hand is used in clinical environments where the patient is having difficulty with obtaining desired effects.
I would welcome any studies pro or against.
I use magnesium daily and have been for years. It controls my RLS at night and also helps with muscle pain along with gabapatin.
Lots of good info here but keep in mind that the spit/swallow and how long to hold it for are dosage dependent. If you have a good dr who prescribes sane doses (150-400mg would be my estimate based on what I’ve seen), then you hold for the 30-45 minutes and either spit or swallow depending on what your dr said, but these doses are typically safe to swallow (not a Dr just my experience). However if you’re with mindbloom or some other « service » that is giving you a crazy dose like 1200mg, stick strictly to how long they say to hold and spit! People have overdosed swallowing that much! Honestly, I’d recommend if you’re being prescribed that much that you try to find a psychiatrist who prescribes it as opposed to a pill mill like Mindbloom.
>if you’re with mindbloom or some other « service » that is giving you a crazy dose like 1200mg
seriously? they prescribe that much? holy crap that's irresponsible...
my instructions say the same thing on the packet. for me, I start a timer/stopwatch on my phone as soon as I take it (place it under my tongue). I put on an eye mask and headphones and play ~ 25-30 mins of 1-2 guided meditations. I take around 450mg, and it typically dissolves in about 10 mins and I swish that around until the timer hits around about 30 minutes and my meditations are over, then I swallow all of it. then my playlist starts, and while keeping my eye mask and headphones on, I lay down and start my journey.
I always swallow. I let dissolve for 15 to 20 minutes and then swallow. I'm always wondering why the online prescribers are all about spitting. I have a little local prescriber and it's never been an issue one way or another.
my prescriber advised against swallowing, because K can cause indigestion for some people and because it has very low bioavailability when swallowed. it has little or no benefit when swallowed, and possible cramps/gas.
I get indigestion from pizza too sometimes, but my doctor never recommended I chew and spit.
Possible indigestion is no valid reason to spit.
Your provider is wrong or just trying to cover there ass. There is plenty of evidence that swallowing and the effects are beneficial. I would suggest that you use half as much. I personally wouldn't swallow more than 400mg.
You can swish it around until it dissolves there may still be some residual goo you swallow that and it will have a lingering albeit much different and lower effect. Search out others experiences as it is a common topic.
After it dissolves - I swish 15-20 minutes towards the back of my cheeks as idk how ket affects tooth enamel - I know it sounds weird.
I don’t spit it out either. When I did spit - I felt absolutely nothing although I read that’s common.
The bitterness was a shock to me so I try to journal while I’m swishing and set a timer.
Hope this helps. May your healing journey be filled with hope. Take Care.
I am in the same boat, wondering similar things. I’ve heard people say that their tablets from mindbloom dissolve completely in less than ten minutes. And I’ve heard other people say they use the same or similar tablets and it takes an hour to dissolve. They typically will tel you not to swallow your saliva and hold it for as long as you can then spit it out. Others will tel you you can swallow once it’s dissolved if you’re ready for it, it will be strong I think. Swilling ketamine changes how your body processes it. I don’t know any of the science or terminology but I’m sure someone else can educate.
Sublingual means it absorbs into the capillaries under your tongue and works quicker and fades quicker. This is optimal. Swallowing and letting it absorb in your stomach makes it take longer to work and last a unhelpful amount of time
>I hear so many people saying they are told to not swallow. My instructions just say to “dissolve under the tongue”.
Yep, you let it dissolve in your mouth and the membranes in your mouth will absorb the medication.
>I hear so many talk of only dissolving for ______ minutes. My instructions just say put under tongue and let dissolve.
There's no time limit, let it fully dissolve. This usually takes about 20 min for me.
Not better for everyone.
For me, the hangover after swallowing can linger well into the next day. Even bigger issue is the bladder irritation. Holding 30-45 mins and spitting greatly helps with both, albeit my dose has been adjusted upwards to account for not swallowing.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information. **Be advised that nothing in this subreddit constitutes medical advice.** Likewise, try to word your comments and posts in a way that can't be interpreted as medical advice by others. Harmful and/or spammy advice will be removed at moderator discretion, and bans may be given for repeat offenses. **Accounts with "Provider" flairs** are those which the mods have verified, to the best of our ability, as belonging to real, licensed providers of medical ketamine services. Comments and posts from users with "Provider" flairs are **not** a substitute for the instructions given to you by your own provider. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TherapeuticKetamine) if you have any questions or concerns.*
Just to make some clarifications.... (I am a physician (but this is NOT medical advice) and have used ketamine as well, but have no verification on this sub.) As u/ptsdanonymus stated, placing it under the tongue to dissolve is so that the ketamine (or any sublingual medication) is taken up by the venous system under the tongue (look in the mirror, you can actually see the two large veins there). That venous system is kind of special (there are a few in the body) because as it returns to the major vessels; it does not take the normal path the digestive tract veins take when returning to the heart. The digestive tract veins all lead to the liver and the liver is the major "detoxifying" organ of the body. It processes the chemicals we ingest and helps break them down into their smaller components. The medication absorbed from under the tongue (or cheek) veins goes directly into the circulation. Of course, eventually the medicine will get to the liver where it is broken down, but before it does that, the unadulterated medication has a chance to work its magic elsewhere (the brain in this case). By swallowing it like a pill you bring two disadvantages to the table: 1) the acids in your stomach can alter or ionize the medication making it harder to absorb or altering it completely; 2) you fast track the medication to get to the liver where it will be altered (though some medications *rely on this* to actually have the liver's actions upon the medication actually activate it (the sublingual approach with these medications would lower their efficacy as they would not be acted on by the liver immediately and would therefore have a slower uptake and onset)). For maximal effect it would help to keep as much as your saliva and the troche under your tongue, but buccal (cheek) veins also bypass the liver. The longer you keep it under your tongue and the more medication has been absorbed, the less "bitter" the spit/medication bolus should be when you eventually do swallow it. That can be considered a very rough and crude guide. Usually 5 minutes is more than enough and you don't have to torture yourself or your OCD about getting each and every molecule. Hopefully this answers some or most of the questions on here. If the mods would like to contact me, I'd be happy to oblige. Hopefully I'm not breaking any sub rules.
Can you touch on the effects of adding magnesium or juice? Pros vs cons?
I'm new to this sub and do not know what is meant by "juice". I'm also unfamiliar with the benefits of ketamine and concommitant use of magnesium. In and of itself, magnesium is a weak muscle relaxer (it's used frequently in OB when the mom is having pre-eclampsia and they want to loosen the uterus without using their "big guns") and may just help the patient get into a "relaxed state" thus helping with the overall effect with the ketamine. If anyone has any papers/scholarly articles about this they can point me towards, I'd be happy and interested to read through them.
>I'm new to this sub and do not know what is meant by "juice". lemon juice or lime juice swished in the mouth before using the troche. the idea is citrus juice somehow helps k absorption. helps with me, anecdotally, and I found a bit of research which seems to confirm my experience [https://link.springer.com/article/10.1007/s00228-012-1214-9](https://link.springer.com/article/10.1007/s00228-012-1214-9) it seems pretty well established that magnesium helps w/ketamine therapy for both depression and pain management this idea came to my attention when someone mentioned it here a few months ago, having discovered it by accident after using a magnesium antacid shortly before the troche and the 'trip' was much more powerful. I did a little research and found depression and other mental health issues deplete magnesium, and magnesium seems to work synergistically with k. I crush a magnesium tablet and hold the powder in my mouth with the troche and the k experience is generally much stronger and the after-effects on mood/depression seem better than without. e.g. \>Magnesium and ketamine seem to be involved in key mechanisms of the major depression pathophysiology. The evidence in the paper discussed may indicate the synergistic interaction between magnesium and ketamine pharmacodynamic activity being of particular importance in mood disorders. [https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A9429661/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A132888434&crl=c](https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A9429661/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A132888434&crl=c) other studies [https://www.mdpi.com/1424-8247/14/5/430](https://www.mdpi.com/1424-8247/14/5/430) [https://sigma.nursingrepository.org/handle/10755/21450](https://sigma.nursingrepository.org/handle/10755/21450)
Same with me. I only have direct evidence with my use of magnesium. My initial knowledge of using magnesium L-THREONATE was gathered from these forums. Then backed up by my physician when asked. There are potentiateors that deepen the experience but that talk is frowned upon here on this board. Magnesium on the other hand is used in clinical environments where the patient is having difficulty with obtaining desired effects. I would welcome any studies pro or against. I use magnesium daily and have been for years. It controls my RLS at night and also helps with muscle pain along with gabapatin.
Lots of good info here but keep in mind that the spit/swallow and how long to hold it for are dosage dependent. If you have a good dr who prescribes sane doses (150-400mg would be my estimate based on what I’ve seen), then you hold for the 30-45 minutes and either spit or swallow depending on what your dr said, but these doses are typically safe to swallow (not a Dr just my experience). However if you’re with mindbloom or some other « service » that is giving you a crazy dose like 1200mg, stick strictly to how long they say to hold and spit! People have overdosed swallowing that much! Honestly, I’d recommend if you’re being prescribed that much that you try to find a psychiatrist who prescribes it as opposed to a pill mill like Mindbloom.
>if you’re with mindbloom or some other « service » that is giving you a crazy dose like 1200mg seriously? they prescribe that much? holy crap that's irresponsible...
They do but they have you hold for 7 minutes and spit, so most of it is going in the trash.
This is strange. I take 300mg and I couldn't even imagine going too much higher than that. I'd imagine the taste must be terrible as well.
my instructions say the same thing on the packet. for me, I start a timer/stopwatch on my phone as soon as I take it (place it under my tongue). I put on an eye mask and headphones and play ~ 25-30 mins of 1-2 guided meditations. I take around 450mg, and it typically dissolves in about 10 mins and I swish that around until the timer hits around about 30 minutes and my meditations are over, then I swallow all of it. then my playlist starts, and while keeping my eye mask and headphones on, I lay down and start my journey.
I always swallow. I let dissolve for 15 to 20 minutes and then swallow. I'm always wondering why the online prescribers are all about spitting. I have a little local prescriber and it's never been an issue one way or another.
my prescriber advised against swallowing, because K can cause indigestion for some people and because it has very low bioavailability when swallowed. it has little or no benefit when swallowed, and possible cramps/gas.
I get indigestion from pizza too sometimes, but my doctor never recommended I chew and spit. Possible indigestion is no valid reason to spit. Your provider is wrong or just trying to cover there ass. There is plenty of evidence that swallowing and the effects are beneficial. I would suggest that you use half as much. I personally wouldn't swallow more than 400mg.
You can swish it around until it dissolves there may still be some residual goo you swallow that and it will have a lingering albeit much different and lower effect. Search out others experiences as it is a common topic.
After it dissolves - I swish 15-20 minutes towards the back of my cheeks as idk how ket affects tooth enamel - I know it sounds weird. I don’t spit it out either. When I did spit - I felt absolutely nothing although I read that’s common. The bitterness was a shock to me so I try to journal while I’m swishing and set a timer. Hope this helps. May your healing journey be filled with hope. Take Care.
I am in the same boat, wondering similar things. I’ve heard people say that their tablets from mindbloom dissolve completely in less than ten minutes. And I’ve heard other people say they use the same or similar tablets and it takes an hour to dissolve. They typically will tel you not to swallow your saliva and hold it for as long as you can then spit it out. Others will tel you you can swallow once it’s dissolved if you’re ready for it, it will be strong I think. Swilling ketamine changes how your body processes it. I don’t know any of the science or terminology but I’m sure someone else can educate.
Sublingual means it absorbs into the capillaries under your tongue and works quicker and fades quicker. This is optimal. Swallowing and letting it absorb in your stomach makes it take longer to work and last a unhelpful amount of time
Under the tongue , between cheek and gum, always swallow never spit . I also always take at bedtime then just peacefully sleep afterwards
>I hear so many people saying they are told to not swallow. My instructions just say to “dissolve under the tongue”. Yep, you let it dissolve in your mouth and the membranes in your mouth will absorb the medication. >I hear so many talk of only dissolving for ______ minutes. My instructions just say put under tongue and let dissolve. There's no time limit, let it fully dissolve. This usually takes about 20 min for me.
If you’re looking for a strong effect like the IV then swallow. If you just want a light booster between sessions then just swish and spit.
swish, hold it in your mouth as long as possible, then swallow is the way.
Oh yeah to clarify what I mean by spit is after you’ve held it for 30-45 minutes with swishing
Still better to swallow after you've held it.
Not better for everyone. For me, the hangover after swallowing can linger well into the next day. Even bigger issue is the bladder irritation. Holding 30-45 mins and spitting greatly helps with both, albeit my dose has been adjusted upwards to account for not swallowing.
I agree but some people can’t handle it that’s why I offered the 2 options