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esketamine (Spravato)

Indications: - treatment-resistant depression in combination with an oral antidepressant - not helpful in the elderly [4] Contraindications: - intracranial disease - intracranial hemorrhage - myocardial infarction - cardiac arrhythmia - hypertension [5] Dosage: - intranasal 56-84 mg/dose twice weekly - 28-84 mg/dose in elderly * nasal spray is administered in a healthcare facility (not at home) [7] - FDA approved for use only in conjunction with an oral antidepressant Adverse effects: - nausea, vertigo, dizziness, metallic taste, headaches, drowsiness, blurred vision, paresthesia, dissociation & anxiety, generally on the day of dosing. Mechanism of action: - chirally pure enantiomer of the anesthetic agent ketamine - NMDA receptor antagonist Notes: - $590-$885 for 2 doses (2019)

Interactions

drug adverse effects of antidepressants

General

ketamine (Ketalar, special K) antidepressant nasal agent

Database Correlations

PUBCHEM correlations

References

  1. Monaco K Intranasal Esketamine Succeeds in Depression Trial 4-point cut in MADRS scores versus placebo after 4 weeks. MedPage Today. May 09, 2018 https://www.medpagetoday.com/meetingcoverage/apa/72795 - Alphs L, et al Clinical efficacy and safety of flexibly dosed intranasal esketamine in a U.S. population of patients with treatment- resistant depression. American Psychiatric Association (APA) 2018; Abstract P8-049. - Alphs L, et al Clinical efficacy and safety of intranasal esketamine in a U.S. population of geriatric patients with treatment-resistant depression. American Psychiatric Association (APA) 2018; Abstract P8-052. - FDA Advisory Committee Recommends Approval of SPRAVATO (esketamine) Nasal Spray CIII for Adults with Treatment-Resistant Depression. Janssen Pharmaceuticals. Jan 12, 2019 https://www.prnewswire.com/news-releases/fda-advisory-committee-recommends-approval-of-spravato-esketamine-nasal-spray-ciii-for-adults-with-treatment-resistant-depression-300794493.html
  2. Cassels C FDA Approves Esketamine Nasal Spray for Resistant Depression. Medscape - Mar 05, 2019. https://www.medscape.com/viewarticle/909933 - FDA News Release. March 05, 2019. FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor's office or clinic. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm
  3. Kim J, Farchione T, Potter A et al Esketamine for Treatment-Resistant DepressionEsketamine for Treatment- Resistant Depression - First FDA-Approved Antidepressant in a New Class. N Engl J Med. May 22, 2019 PMID: 31116916 https://www.nejm.org/doi/full/10.1056/NEJMp1903305
  4. Ochs-Ross R, Daly EJ, Zhang Y, et al. Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression. - TRANSFORM-3. Am J Geriatr Psychiatry 2020 Feb; 28:121. PMID: 31734084 Free Article https://www.sciencedirect.com/science/article/pii/S1064748119305330
  5. Aftab A, Lam JA, Liu F, Ghosh A, Sajatovic M. Recent developments in geriatric psychopharmacology Expert Rev Clin Pharmacol. 2021 Mar;14(3):341-355 PMID: 33499693 Review
  6. HIGHLIGHTS OF PRESCRIBING INFORMATION SPRAVATO (esketamine) nasal spray, CIII
  7. Reif A et al. Esketamine nasal spray versus quetiapine for treatment-resistant depression. N Engl J Med 2023 Oct 5; 389:1298. PMID: 37792613 https://www.nejm.org/doi/10.1056/NEJMoa2304145