Can't find Ketamine at the pharmacy? Here are real alternatives for depression, pain, and anesthesia that your doctor may recommend instead.
You need Ketamine, but the pharmacy doesn't have it. Maybe you've been told it's on backorder, or that the manufacturer has discontinued the concentration you need. Whatever the reason, you're stuck — and you need to know what your options are.
The Ketamine shortage has been affecting patients since the early 2020s, and supply remains tight in 2026. But depending on why you take Ketamine, there are legitimate alternatives worth discussing with your doctor.
This article covers what Ketamine is, how it works, and the most commonly recommended alternatives for each of its major uses.
Ketamine is a dissociative anesthetic that was first FDA-approved in 1970. It's classified as a Schedule III controlled substance and is manufactured as an injectable solution under the brand name Ketalar. It's also available through compounding pharmacies as oral lozenges, sublingual tablets, and nasal sprays.
Ketamine is FDA-approved for:
It is widely used off-label for:
To learn more about Ketamine's uses and dosing, see our complete guide: What Is Ketamine? Uses, Dosage, and What You Need to Know.
Ketamine works primarily by blocking NMDA (N-methyl-D-aspartate) receptors in the brain. These receptors play a key role in pain signaling, mood regulation, and neural plasticity.
At anesthetic doses, this blockade produces a unique "dissociative" state — the patient is sedated and feels no pain, but may maintain airway reflexes and spontaneous breathing. This makes Ketamine especially useful in emergency settings and for patients who can't tolerate other anesthetics.
At lower, sub-anesthetic doses used for depression treatment, Ketamine triggers a burst of glutamate (a brain signaling chemical) that promotes the growth of new neural connections. This is thought to be why Ketamine can produce rapid antidepressant effects — sometimes within hours — compared to traditional antidepressants that take weeks to work.
For a deeper dive, read: How Does Ketamine Work? Mechanism of Action Explained.
The right alternative depends on what you're using Ketamine for. Here are the most commonly recommended options for each use case.
What it is: Spravato is a nasal spray containing Esketamine, which is the S-enantiomer (one of two mirror-image forms) of Ketamine. It was FDA-approved in 2019 for treatment-resistant depression and in 2020 for major depressive disorder with acute suicidal ideation.
How it works: Like Ketamine, Esketamine blocks NMDA receptors and triggers rapid antidepressant effects. Because it's FDA-approved for depression (unlike generic Ketamine), it has a clearer regulatory pathway and is more widely available.
How it's given: Spravato is self-administered as a nasal spray under direct supervision at a certified REMS healthcare setting. You cannot use it at home. Each session lasts about 2 hours, including a monitoring period. Typical dosing is 56–84 mg twice weekly for four weeks, then tapered.
Cost: Without insurance, Spravato costs about $800–$1,200 per session. Most major insurers cover it with prior authorization, often requiring that you've failed at least two other antidepressants first. Janssen offers a savings program that can reduce copays to as low as $10 per session.
Key difference from Ketamine: Spravato is FDA-approved for depression, covered by insurance, and administered in a clinical setting. Generic Ketamine infusions for depression are off-label, typically not covered by insurance, and cost $400–$800 per session out of pocket.
What it is: Auvelity is an FDA-approved oral medication for major depressive disorder that was approved in 2022. It combines dextromethorphan (an NMDA receptor modulator) with bupropion (which slows the breakdown of dextromethorphan and is itself an antidepressant).
How it works: Like Ketamine, dextromethorphan modulates NMDA receptors, though through a different mechanism. It also affects sigma-1 receptors and serotonin transporters. Clinical trials showed faster onset of antidepressant effects compared to traditional antidepressants.
How it's given: Auvelity is a pill taken by mouth at home — no clinic visits, no IV infusions, no monitoring required. The typical dose is one tablet twice daily.
Cost: The retail price for Auvelity is approximately $900–$1,100 per month without insurance. Most commercial insurers cover it with prior authorization. The manufacturer offers a savings card for eligible patients.
Key difference from Ketamine: Auvelity is an oral pill you take at home, making it far more convenient than Ketamine infusions. However, it may not be as rapidly effective for acute suicidal ideation or severe treatment-resistant depression.
What it is: Propofol is an intravenous general anesthetic widely used for induction and maintenance of anesthesia and for procedural sedation.
How it works: Unlike Ketamine, Propofol works by enhancing GABA receptor activity, producing rapid onset of sedation and anesthesia. It does not have dissociative or analgesic properties.
Key considerations: Propofol causes deeper respiratory depression than Ketamine and requires more intensive monitoring. It does not maintain airway reflexes the way Ketamine does. It's an excellent anesthetic alternative, but your anesthesiologist will determine if it's appropriate for your specific procedure.
What it is: Midazolam is a benzodiazepine commonly used for procedural sedation, pre-anesthetic anxiety, and conscious sedation in emergency departments.
How it works: Midazolam enhances GABA receptor activity, producing anxiolysis (anxiety relief), amnesia, and sedation. It does not provide the dissociative anesthesia or analgesia that Ketamine does.
Key considerations: Midazolam is often combined with an opioid analgesic (like Fentanyl) for procedural sedation to provide both sedation and pain control. It has a shorter duration of action than Ketamine and may require supplemental doses.
If you use Ketamine for chronic pain or CRPS, your pain specialist may recommend:
None of these work exactly like Ketamine, but they may provide relief while Ketamine is unavailable.
If you can't fill your Ketamine prescription, don't give up. There are real alternatives that may work for your condition — especially Spravato for depression and Auvelity for a more convenient oral option. For anesthesia and procedural sedation, your medical team has multiple alternatives to choose from.
Start by talking to your prescriber about which option makes the most sense for you. And if you haven't checked whether Ketamine is available at other pharmacies nearby, try Medfinder first — you may still be able to find Ketamine in stock near you.
You focus on staying healthy. We'll handle the rest.
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