I've been using it daily for last 6 months or so rubbing it on the perianal area and I do feel much better. Though I've been doing other therapies as well I feel the cream had the most to do with the improvement cause other things I was doing earlier as well. I am using up one tube a week. One tube is 15g volume and has amitriptyline (4%) ketamine (2%). That's 40 mg ketamine daily for me.
I also heard about the side-effects of ketamine but I have not felt anything different really since I've been using it. My doctor didn't point those out when I began using it but someone else did lately. I'm going to be asking my doc when I meet him next. So I googled and Wikipedia does talk of some nasty side-effects including "Chronic use of ketamine may lead to cognitive impairments including memory problems" which is scary. But with the cream you're taking ketamine topically and not orally or intravenously, so systemic absorption is lower. The NIH study done for the cream http://www.ncbi.nlm.nih.gov/pubmed/16202956 also reports there was no significant systemic absorption of ketamine or amitriptyline, and in that study patients used the cream for 6-12 months. I also checked with another doctor here who was of the same opinion. You could take more opinions if you want to start off with the cream, and let me know too if you find anything significant for side-effects.
I only know one manufacturer that is in India. In fact when I was making inquiries sometimes in 2010 I figured there was no such product anywhere in the world and only this Indian company was doing clinical trials for it. I'm not sure if it's been launched somewhere else already. But if you want to buy it from here, I can help you. In fact I did manage to send a lot of 10 tubes to Laura in America and she sent me a cheque. I addressed the parcel to myself and attached my own prescription. But if you can get a prescription, that is better. I was even thinking of asking the manufacturer if they can send it directly to those interested.
You can also ask a compounding pharmacy near you to make it for you (sadly they're very rare in India). Oh and there is the option of making it at home. Mary Lynch the researcher in Canada who did that study recommended the PLO gel to me which you can buy online http://www.plo-gel.com/Main/store.php and mix amitriptyline and ketamine into it. Their product literature has the measurements. You'll have to buy amitriptyline and ketamine tablets and grind them with a mortar and pestle and mix it all up. You could add gabapentin too, and if you want you can keep the ketamine out.
The Ketriplin tubes that I have mention its for external use only. But you can ask Mary Lynch if it can be used internally. She did answer all my questions when I was researching about the cream. http://www.canadianpainsociety.ca/en/contact.html
Let me know if you want to buy it from here. You can return the favors some other time
Siddharth
