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Esketamine (nasal)

Generic name: Esketamine (nasal). [ Es-KET-ah-meen]

Brand names: Spavato
Dosage forms: Nasal spray (28 mg (56 mg dose), 28 mg (84 mg dose).
Class of drugs: antidepressants

What is Esketamine?

Esketamine nasal spray is combined with an antidepressant taken orally (by mouth) to treat adults who have depression and are resistant to treatment.

Esketamine can be used in conjunction with antidepressants taken orally to treat depression symptoms among adults who suffer from major mood disorders and have suicidal feelings. Esketamine isn't known to prevent or reduce suicide thoughts.Esketamine can only be used in healthcare settings. Esketamine cannot be used at home.Esketamine can only be used under special circumstances. The program requires that you be registered and fully understand both the benefits and risks of the medicine.Esketamine can be used in other ways not mentioned in the medication guide.

Side effects of Esketamine

If you experience any of the following symptoms of an allergy: difficulty breathing, hives, swelling in your lips, face, throat, or tongueYou will have to check your blood pressure before and after using esketamine. Esketamine may increase blood pressure for several hours following each dose. Inform your doctor immediately if you experience chest pains, difficulty breathing, a severe migraine, or blurred vision.You should tell your doctor if any symptoms worsen or change, including changes in mood, behavior, anxiety, or panic attacks; or if you are feeling impulsive or hyperactive, restless or hyperactive, mentally or physically, more depressed, or thinking about harming yourself or committing suicide.

Call your doctor immediately if:

  • Feeling like you're going to pass out or extreme sleepiness;
  • Feelings of dizziness, nausea, or floating are all symptoms that can be severe.
  • Problems with memory or thinking;
  • Flashbacks are memories that can be unpleasant or unusual.
  • Hallucinations or feeling "spaced out" are examples of hallucinations.
  • Urination issues (urine problems, painful urination, or increased need to urinate)

Esketamine can have a variety of side effects.

  • Dissociation, feeling drunk;
  • Increased blood pressure
  • Lack of energy, drowsiness
  • Dizziness, spinning sensation;
  • Feeling anxious
  • Nausea, vomiting,
  • Sensations (touch, or any other senses) that are reduced

There may be other side effects. For medical advice on side effects, call your doctor. Report side effects by calling the FDA at 1-800-FDA-1088.


Esketamine may cause extreme drowsiness or a feeling of disconnection from the body, thoughts, or environment. Esketamine should only be used in healthcare settings where the patient can be closely monitored for 2 hours following each dose. After using esketamine, you will need someone to take you home.Esketamine can cause some people to have suicidal thoughts. Be aware of any changes in your mood or symptoms. Inform your doctor if you experience any changes in symptoms or a new one.

Before you take this drug

If you're allergic to esketamine, ketamine, or have any of the following:

  • A blood vessel disease that affects your arms, legs, brain, chest, or stomach
  • Aneurysms in the past
  • A history of brain bleeding;
  • A condition that causes an abnormal vein-artery connection (also known as arteriovenous malformation)

If you've ever:

  • Heart problems, such as failure of the heart or chest pain;
  • You fainted because of slow heartbeats.
  • High blood pressure
  • A stroke, or an attack of the heart.
  • A head injury or an increase in pressure within your brain.
  • Mental illness, or psychosis.
  • A family history of depression
  • Alcoholism, or drug addiction
  • Liver Disease.

Some people experience suicidal thoughts when they first start taking an antidepressant. Regular visits to your doctor are a good way for you and your doctor to monitor the progress of treatment. You or your family members should be aware of any changes you may experience in mood or symptoms.If you're pregnant, do not take this medication. Esketamine can harm an unborn child.You may find your name on a registry for pregnant women to monitor the effects of esketamine.Breastfeeding is not recommended while taking esketamine.

How to take Esketamine?

Esketamine nasal spray is used by healthcare professionals. The nasal spray will be administered by you under the supervision of a health professional.Esketamine may cause nausea or vomiting. Eat nothing for 2 hours prior to using esketamine. Drinking liquids 30 minutes prior to using the medication is not recommended.Please read and follow all instructions for use that you receive. If you don't understand the instructions, ask your doctor or caretaker.After using esketamine, you will need to be closely monitored for 2 hours.You will be told by your caregivers when to go home after taking this medication. Someone will have to drive you back home. Do not drive anywhere before the following day.Esketamine can be given twice a week initially, then every one to two weeks. You will be told by your doctor how frequently you should use esketamine.Your doctor might want to treat you for depression at a hospital, even if you feel better after taking the first ketamine dose.

What happens if I miss the dose?

If you forget to take your esketamine dosage, call your doctor.

What happens if I overdose?

Overdoses are unlikely because esketamine will be administered by healthcare professionals in a medical environment.

Avoid this

Use esketamine spray within an hour of using other nasal medications.You should not drive or perform any other activity that would require you to be alert and awake until one day after taking esketamine.

Interaction with other drug

Inform your doctor of all other medications, including:

  • Opioid medication
  • A sleeping pill or muscle relaxer
  • Medicines for anxiety such as Diazepam, Valium, Xanax, and others
  • Stimulant medicines, such as diet pills or ADHD medications like Adderall or Ritalin, are available.
  • Medicine to treat narcolepsy
  • MAO-inhibitors include isocarboxazid (linezolid), phenelzine (phenelzine injection), rasagiline (selegiline), tranylcypromine, and other MAO-inhibitors.

The list below is not exhaustive. Esketamine can be affected by other drugs, such as vitamins and herbs. This list does not include all possible drug interactions.