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Re:Behind the Buzz: How Ketamine Changes the Depressed Patie... by car on Saturday April 13, 2019 @03:23AM (#19651554)
Doc here. Sublingual application bypasses the liver, which removes drugs from the bloodstream. Same reason why nitro is applied here.
Re:Behind the Buzz: How Ketamine Changes the Depressed Patie... by atomical on Saturday April 13, 2019 @09:12AM (#19652817)
Some of the drug will always be absorbed orally and travel to the liver through the the portal vein.

The liver will eventually remove ketamine from the bloodstream regardless of which route is used.

That's my understanding at least.

Re:Behind the Buzz: How Ketamine Changes the Depressed Patie... by behindmyscreen on Saturday April 13, 2019 @07:44AM (#19652404)
That’s interesting. What’s the mechanism for that? Uninformed intuition would lead one to think there would not be a difference.
Re:Behind the Buzz: How Ketamine Changes the Depressed Patie... by car on Saturday April 13, 2019 @12:27PM (#19653932)
It's a function of anatomy. The sublingual veins drain into the jugular and then vena cava. For drugs this avoids the first-pass effect, which is exploited when giving nitroglycerin for angina pectoris. Other ways to achieve this are suppositories (rectal veins) and intravenous (i.v.) or intramuscular (i.m.) injection.

https://en.wikipedia.org/wiki/Lingual_veins

https://en.wikipedia.org/wiki/First_pass_effect