What is the difference between IV infusion and IM ketamine administration?

As ketamine is such a safe drug, the medical world has been able to experiment with many different routes of administration over the years, depending on the setting and for whom it’s being used.  It can be given in pills and creams, lozenges, intramuscular injections (into your arm), and intravenous (IV) infusions.

Intravenous (IV) infusions

Many clinics offering ketamine for the treatment of mental health use intravenous (IV) infusions. This is when a cannula (a thin, plastic tube) is put into a vein in the hand or arm. The cannula is then connected to a longer, wider tube which, in turn, is joined to a bag containing the ketamine. This bag is attached to a machine, which helps to make sure the correct amount of ketamine is given.

When given this way, 100% of the ketamine is absorbed into the bloodstream, and the onset and intensity of the physical and psychological effects can be controlled more easily. Because the intensity of the experience can be titrated, it can help when people might be anxious about what it will be like, allowing them to build up slowly. Clinics often point out that the ‘side effects’ of ketamine can be better controlled using IV.

Intramuscular (IM) injections

This is all true, and controlling the side effects can be especially helpful when ketamine is used as an antidepressant, with no therapy alongside the dosings. But at Klearwell, we consider these ‘side effects’ to be rich and potentially helpful aspects of the ketamine experience. This is partly why we use an intramuscular (IM) injection: a needle in the upper arm, like when you’re getting vaccinated. The injection is all over in a matter of seconds. The uptake of ketamine in your bloodstream is 93% using this route- still high compared with routes like lozenges or pills. 

There is a huge variety of experiences reported by our clients after having the injection – from being shot out into space, feeling separated from their body, and a sense of oneness with the universe, to milder experiences like realising their worries no longer need to control them, or feelings of love and connection to others. Many find these experiences pleasurable, but for others, they are challenging and scary moments. For some, it comes with a more neutral emotional tone. Most find it hard to describe in words – the ‘ineffable’ quality of psychedelics.   

With IM, the effects come on strongly after a few minutes. They then reach a peak after about 15 minutes and plateau before coming down slowly as the ketamine wears off after about 45 minutes. That’s why we spend two sessions helping clients to prepare for their first dosing – getting to know the therapist who will support their entire journey, setting intentions, and being guided into how they might navigate that intensity so that they can harness their experience for insights and learning which can help promote new ways of being in the world. 

Depending on that first dose, we can increase the dose over the remaining sessions 2-4 if the client and therapist feel that’s likely to be helpful.

With both IM and IV, there are some other possible side effects—the most common being raised blood pressure and heart rate, headache, nausea, or feeling tired or woozy for a while after the dose. We help prepare our clients for these eventualities, for example, recommending they prioritise rest and reflection after the dose. 

Choosing between intravenous (IV) infusion and intramuscular (IM) injection to administer ketamine involves considering factors like how quickly and strongly the effects are desired alongside individual preferences and therapeutic aims.IV infusion allows for swift and precise absorption of ketamine into the bloodstream, allowing for controlled experiences that can be gradually adjusted. On the other hand, IM injection provides a powerful and transformative experience,  supported by rapid absorption that encourages deep introspection and profound emotional exploration.

At Klearwell, we embrace the diverse outcomes of ketamine treatment and recognise their importance in the therapeutic journey. We place a strong emphasis on personalised support and preparation, empowering clients to navigate their experiences with insight and integration and facilitating lasting changes in their life outlook.

Ready to start your Ketamine journey? Fill out our self-referral form and one of our clinical team will be in touch.