Ketamine lozenges (commonly called troches) are custom-compounded prescription medications used sublingually or buccally to manage treatment-resistant depression, severe anxiety, PTSD, and chronic pain. Unlike FDA-approved clinical options like Spravato nasal spray or intravenous (IV) infusions, oral ketamine lozenges are prescribed off-label and are typically prepared by specialized compounding pharmacies for at-home use under medical oversight.

• The Legal Status: Ketamine is approved in Germany as an anesthetic and pain medication. Off-label use for treating psychiatric conditions like severe depression, PTSD, and anxiety is entirely legal and has been steadily expanding since roughly 2017. 
• Medicine Act Regulation: Because ketamine is not technically listed under the German Narcotics Act (Betäubungsmittelgesetz – BtMG), possession with a valid prescription is legal. Instead, it is governed by the German Medicines Act (Arzneimittelgesetz – AMG). Unlawful distribution or possession without a prescription carries strict legal penalties. [1]

• Ketamine Infusion Therapy (IV): This is the most common method for treating psychiatric disorders in Germany. Private clinics across major hubs offer specialized Ketamine-Assisted Psychotherapy (KAP).  
• Esketamine Nasal Spray (Spravato): This FDA- and European Medicines Agency (EMA)-approved variant is legally prescribed in Germany for treatment-resistant major depressive disorder. By regulation, patients must self-administer the spray inside a doctor’s office or hospital and remain under observation for at least two hours. 

• Compounding Restrictions: German pharmacies (Apotheken) can legally compound customized medications under a physician’s specific order. However, German guidelines are heavily biased toward the highly predictable bioavailability of IV and nasal methods.
• Risk Avoidance: Because oral lozenges are taken at home, German physicians rarely prescribe them due to concerns regarding patient safety, fluctuating absorption rates, and the increased risk of unauthorized recreational diversion.