At-Home Ketamine vs. IV Ketamine: What Texans Should Know

My clinical perspective on at-home IV ketamine for mood disorders and chronic pain, why provider experience matters, and why I prefer a monitored office setting at HILLMED in Plano, Texas.

By Jerron C. Hill, M.D., Anesthesiologist and Founder of HILLMED

Patients often ask me about ketamine treatment at home. Many at-home programs use oral tablets or sublingual lozenges; others use injections. These routes should not be confused with an intravenous infusion. My particular concern is whether IV ketamine should be administered at home for mood disorders or chronic pain.

I do not advocate at-home IV ketamine for these conditions. As an anesthesiologist accustomed to responding to changes in blood pressure, heart rate, breathing, and other hemodynamic conditions in the operating room, I prefer patients to receive IV ketamine in a controlled clinical environment. Unexpected side effects can occur, and immediate access to an experienced provider, emergency medications, equipment, and trained staff matters.

Two very different ways to take the same medicine

Ketamine can be given several ways, and the route changes how much of the drug actually reaches your bloodstream. Reviews of ketamine's pharmacology report roughly:

• Intravenous (IV): 100%, delivered at a controlled rate

• Intramuscular or subcutaneous injection: about 64–93%

• Nasal spray: about 43–48%

• Under the tongue (sublingual): about 29–32%

• Swallowed (oral): possibly only 20–25%

[1, 2]

Lower absorption isn't automatically a problem, because doses can be adjusted. But absorption by mouth also varies from person to person, so the same dose can affect two people differently. With IV ketamine, the physician controls exactly how much you receive and can slow or stop the infusion at any moment. [1]

Most at-home programs use ketamine prepared by compounding pharmacies, which is different from the FDA-approved nasal spray esketamine (Spravato). Our guide to IV ketamine and Spravato explains how those two compare.

What the research shows about at-home ketamine

The evidence for at-home ketamine is growing:

• A 2022 study followed 1,247 adults with moderate to severe depression and anxiety who took sublingual ketamine at home over four weeks, with telehealth support and remote monitoring. About 63% reported at least a 50% improvement in symptoms, and serious problems were uncommon. [3]

• A 2026 study reviewed records from 3,870 patients across 38 states who used at-home ketamine injections under a structured telehealth program, including peer monitoring and home blood pressure checks. About 80–85% had a meaningful improvement in symptoms after six sessions, and adverse events were reported in about 3% of patients. [4]

These findings describe selected patients receiving sublingual or subcutaneous ketamine, not at-home IV infusions. Both studies used data from telehealth programs, lacked a comparison group receiving placebo or another treatment, and enrolled patients screened for home use. They do not establish that at-home IV ketamine is as safe or effective as office-based IV treatment. My preference for monitored clinical care remains unchanged.

The FDA's caution

Ketamine is not FDA-approved for any psychiatric condition. In October 2023, the FDA warned patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, used to treat psychiatric disorders. [5] Without medical monitoring, side effects such as heavy sedation, dissociation, and increases in blood pressure can go unnoticed.

Why monitoring matters

During an IV ketamine infusion, clinical judgment involves much more than starting an IV and administering a medication. My anesthesia experience informs how I assess patients, individualize treatment, interpret changes in vital signs, and respond to unexpected reactions. At HILLMED, a physician monitors blood pressure, heart rate, and oxygen saturation throughout the infusion, and patients remain under observation until they are ready for discharge. Close monitoring is particularly important for people who:

• Have high blood pressure, heart disease, or other medical conditions

• Take medications that can interact with ketamine

• Have a history of substance misuse

• Have severe depression or thoughts of suicide, where close follow-up is essential

• Have tried other treatments without success and need carefully adjusted dosing

• Are being treated for chronic pain, where IV ketamine is the best-studied route

Should IV ketamine be used at home for mood disorders and chronic pain

From my clinical point of view, I am not an advocate of at-home IV ketamine. An appropriately equipped office provides a more controlled setting, with emergency drugs, monitoring equipment, and staff available to help if a patient develops a complication. The ability to slow or stop an infusion is valuable, but it does not replace the ability to recognize and treat an adverse reaction promptly.

In-clinic IV ketamine is often the better fit for treatment-resistant depression, PTSD, chronic pain conditions, people with medical risk factors, and anyone who wants precise dosing with a physician present. If you're new to IV treatment, here is what to expect at your first infusion, and more about ketamine for treatment-resistant depression.

Provider experience is central to my approach. Ketamine is taught and used during anesthesiology residency and emergency medicine training, and certified registered nurse anesthetists (CRNAs) also receive training in anesthetic medications and patient monitoring. Patients should ask who will actually administer their infusion, what specific training and experience that person has, and who is immediately available to manage an emergency. A professional title alone does not establish proficiency in ketamine treatment.

Some patients receive ketamine from nurse practitioners or physician assistants whose training may not include the same depth of anesthesia or emergency care. I encourage patients to ask about the treating clinician’s relevant experience, physician supervision, and ability to manage airway or cardiovascular complications. These questions matter for every provider, including physicians.

One concern I hear from patients is that IV ketamine did not work for them. In my clinical view, provider skill is a key part of successful IV ketamine infusion (IVKI) care, including patient selection, individualized dosing, monitoring, and follow-up. Limited experience may affect how treatment is delivered, but a lack of benefit does not by itself prove that a provider was inexperienced. Response varies, and even carefully delivered treatment does not help every patient.

Questions to ask any ketamine provider

• Who evaluates me, who administers my infusion, and what anesthesia, emergency medicine, or ketamine-specific training and experience do they have?

• Who monitors my blood pressure, heart rate, oxygen level, and breathing, and who is immediately available to respond to a complication?

• Where does the ketamine come from, and how is the dose decided?

• What emergency medications, equipment, trained staff, and transfer arrangements are available if I have side effects? Who follows up if my mood gets worse?

• How is my care coordinated with my psychiatrist or primary care doctor?

The HILLMED approach

At HILLMED, we provide physician-supervised IV ketamine therapy at our Plano clinic. Every patient starts with a medical and psychiatric evaluation, infusions are monitored from start to finish, and we coordinate with your other physicians.

Safety

Common ketamine side effects include dissociation, temporary increases in blood pressure and heart rate, nausea, vomiting, dizziness, and sedation. Less common but serious complications can include respiratory depression and airway problems, particularly with other sedating medications or higher doses. Repeated exposure also warrants attention to misuse, urinary or bladder symptoms, and liver problems. [5, 6] These risks are part of why I favor a monitored clinical setting. Never drive after a ketamine dose, and do not take ketamine prescribed for someone else.

If you are having thoughts of suicide, call or text 988 for the Suicide & Crisis Lifeline, or call 911.

Frequently asked questions

Is at-home ketamine legal in Texas?

Ketamine is a prescription controlled substance, and oral or sublingual home treatment must be distinguished from at-home IV ketamine. As of October 14, 2026, the Texas Medical Board’s public rule-changes page lists its parenteral ketamine standards as proposed rules, rather than a final ruling on at-home IV treatment. [7] Proposed rules should not be described as an adopted ban or as approval of home IV infusions. Providers must still comply with applicable prescribing, licensing, and medical-practice requirements. Regardless of the regulatory status, I do not advocate at-home IV ketamine for mood disorders or chronic pain.

Is at-home ketamine as effective as IV ketamine?

The studies discussed here evaluated at-home sublingual or subcutaneous treatment, not home IV infusions, and did not directly compare those programs with office-based IV ketamine. [3, 4] IV administration allows precise dosing and adjustment during treatment. I consider the provider’s clinical skill and the monitoring environment important when assessing treatment options, but no route guarantees a response.

Why does IV ketamine cost more?

IV treatment includes physician time, medical monitoring and a clinical setting for every session. Contact HILLMED for current pricing and payment information.

Can I switch from at-home ketamine to IV treatment?

Yes. Bring a list of your current medications and your at-home treatment history to your consultation, and we'll decide together whether IV ketamine is appropriate.

Is Spravato the same as at-home ketamine?

No. Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression, given in a certified clinic with monitoring. Most at-home ketamine is compounded racemic ketamine taken without in-person monitoring.

Does insurance cover ketamine?

Coverage varies by plan, and IV ketamine is often not covered. Contact HILLMED for current pricing and payment information, and check coverage directly with your insurer.

Learning more about treatment

My recommendation is to consider IV ketamine in an appropriately equipped clinical setting with an experienced provider, trained staff, and immediate access to emergency care. At HILLMED, my goal is to combine individualized treatment with the clinical judgment and monitoring informed by my anesthesia experience. For mood disorders and chronic pain, I do not advocate at-home IV ketamine.

To learn more, book a complimentary teleconference consultation online or call HILLMED at 972.212.4341. We serve patients in Plano and throughout Dallas–Fort Worth, including Dallas, Frisco, Richardson, and McKinney.

About the author

Jerron C. Hill, M.D., is an anesthesiologist and the founder of HILLMED in Plano, Texas, and Dr. CBD & Nutrition Centers in University Park. He brings decades of anesthesia experience and nine years of clinical experience treating patients with IV ketamine to individualized, physician-supervised care, and personally formulates the Dr. CBD line of third-party-tested CBD products and supplements.

Selected references

1. Andrade C. Oral Ketamine for Depression, 1: Pharmacologic Considerations and Clinical Evidence. J Clin Psychiatry. 2019;80(2):19f12820.

2. Pak TK, et al. Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications. Focus (Am Psychiatr Publ). 2026;24(2):127–139.

3. Hull TD, et al. At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression. J Affect Disord. 2022;314:59–67.

4. Parks AC, et al. At-Home Telehealth-Supported Subcutaneous Ketamine Therapy: Retrospective Cohort Study. J Med Internet Res. 2026;28:e92647.

5. U.S. Food and Drug Administration. Compounding Risk Alerts (October 10, 2023: compounded ketamine).

6. Pfizer. Ketamine Hydrochloride Injection prescribing information.

7. Texas Medical Board. Rule Changes and proposed Parenteral Ketamine Therapy Standards. Accessed October 14, 2026.

This article is for education only and is not medical advice. Talk with your physician before starting or changing any treatment.