Ketamine, Longevity, and the Science of Delivery: Lessons from Dr. Janakan Krishnarajah

What happens when a physician walks away from the bedside to enter the high-stakes world of first-in-human drug trials? For Dr. Janakan Krishnarajah, the pivot wasn’t about leaving patients behind—it was about rethinking how medicine itself is created, delivered, and ultimately used to change lives.

This isn’t a story about buzzwords like biohacking or wellness hacks. It’s about the gritty mechanics of clinical pharmacology, the failures that happen when drugs fall short in their design or delivery, and the breakthroughs that emerge when someone is willing to bridge the gap between bench science and human survival.

From Bedside Medicine to First-in-Human Trials

Dr. Krishnarajah’s early career was rooted in internal medicine and pharmacology, but his trajectory bent sharply when he began overseeing Phase I clinical trials in Australia. This is where “potential drugs” make their first leap into humans—the most dangerous and uncertain stage in drug development.

He describes it as standing at the edge of a translational cliff: the first patient anywhere in the world receiving a compound that has never been tried outside of animal models. High-stakes, nerve-tightening science. And yet, it was here that he discovered his passion for drug development—not simply treating symptoms, but building the very therapies that physicians could one day use.

The Bali Bombing and the Birth of Sublingual Ketamine

The turning point came in 2002, after the Bali terrorist bombing, when hundreds of burn victims were airlifted to hospitals in Western Australia. Treating the agonizing pain of dressing changes required ketamine—but the hospital lacked enough IV pumps.

The solution? A crude but brilliant workaround: mix ketamine into orange juice and deliver it sublingually.

The results were profound. Patients received effective analgesia without the need for invasive pumps. What began as improvisation revealed a larger truth: the route of administration can matter as much as the drug itself.

That realization would lead to Dr. Krishnarajah’s work with IX Biopharma, developing wafer-based sublingual technologies capable of delivering fragile molecules—like ketamine, CBD, NAD⁺, and glutathione—more consistently and predictably than swallowing or injecting them.

Ketamine: Beyond the Party Drug

In the popular imagination, ketamine is either a “club drug” or a miracle cure for PTSD. The truth, as always, is more nuanced.

At sub-anesthetic doses, ketamine acts as an NMDA receptor antagonist, interrupting nerve “wind-up” and blocking the progression of chronic neuropathic pain. Compared to opioids, its profile is striking:
 

• No respiratory depression at therapeutic doses.

• Opioid-sparing, allowing clinicians to use less narcotic burden.

• Life-changing relief for select patients who fail conventional treatments.
   

This isn’t hype—it’s data. Over one million sublingual doses have been administered in Australia over the last decade, across more than 100 hospitals, without significant diversion or abuse signals.

The message: ketamine, used judiciously and delivered intelligently, is not a party trick. It is one of the most promising non-opioid analgesics in modern medicine.

GLP-1s and the Muscle Problem

No discussion of modern pharmacology would be complete without touching on the GLP-1 revolution—semaglutide, tirzepatide, and beyond. These drugs are rewriting obesity treatment and even showing cardiometabolic and renal benefits.

But here’s the catch: weight loss without muscle preservation is a trap. Patients on GLP-1s can lose up to 30% lean mass, and when the drug is discontinued, fat often returns without the muscle. Net effect? Metabolically worse than before.

Dr. Krishnarajah’s take echoes what thoughtful physicians know: GLP-1s are not a panacea. They are a tool—a powerful nudge—that must be paired with resistance training, protein-forward nutrition, sleep, and daily activity.

Without that, you’re not buying health. You’re renting results.

Longevity at the Cellular Level: NAD⁺ and Glutathione

When the conversation turns to longevity, Dr. Krishnarajah avoids fairy tales and focuses on molecules with first-principle biology:
 

• NAD⁺: essential for mitochondrial energy production, DNA repair (via PARPs), and the activation of sirtuins—the so-called longevity genes. Levels drop by half from your 20s to your 50s. Boosting NAD⁺ through lifestyle, diet, or effective supplementation may keep cellular “engines” from sputtering.
   

• Glutathione: the “master antioxidant,” maintaining redox balance and defending against oxidative stress—the slow cellular rusting driven by poor diet, pollution, alcohol, and chronic inflammation. Oral glutathione is poorly absorbed; sublingual delivery offers a bypass to actually raise systemic levels.
   

Together, these aren’t magic bullets. They are foundational levers—ways to preserve cellular health so the body’s own machinery can fight disease, repair damage, and maintain resilience.

The Takeaway
 

• Ketamine, properly used, is a non-opioid lifeline for chronic pain, not a recreational crutch.

• Drug delivery is not a detail—it’s the therapy. Sublingual technology is rewriting the rules of absorption, onset, and consistency.

• GLP-1s are transformative, but conditional. Without muscle-centric behaviors, they risk long-term metabolic harm.

• Longevity is cellular before it’s clinical. NAD⁺ and glutathione may help preserve the architecture of health—but only if paired with the “boring basics” of sleep, exercise, nutrition, and stress management.
   

The future of medicine isn’t one miracle molecule. It’s precision in delivery, mechanism, and application.

Watch and subscribe to the full Crackin’ Backs Podcast episode on YouTube: Click here

Listen and download the show on your favorite podcast platform: Click here