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NERVOUS SYSTEM › ANESTHETICS › ANESTHETICS, GENERAL › Other general anesthetics
esketamine
N01AX14
Forms & Strengths
- Nasal spray: 28 mg per device
Adult Dosing
- Treatment-resistant depression: 56 mg to 84 mg intranasally twice weekly for weeks 1-4
- Maintenance (weeks 5-8): 56 mg or 84 mg once weekly
- Maintenance (after week 9): 56 mg or 84 mg every 2 weeks or once weekly based on efficacy
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment-resistant depression (TRD) in adults, used in conjunction with an oral antidepressant
- Depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior
Mechanism of Action
- Non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor
- Modulates glutamate transmission, leading to downstream increases in synaptogenesis and neuroplasticity
Contraindications
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels)
- Arteriovenous malformation
- History of intracerebral hemorrhage
- Hypersensitivity to esketamine, ketamine, or any excipient
Adverse Reactions
- Dissociation
- Dizziness
- Nausea
- Sedation
- Vertigo
- Hypoesthesia
- Anxiety
- Lethergy
- Blood pressure increased
- Vomiting
- Feeling drunk
Drug Interactions
- Central nervous system (CNS) depressants (e.g., alcohol, benzodiazepines, opioids): Increased risk of sedation
- Psychostimulants (e.g., amphetamines, methylphenidate): May increase blood pressure
- Monoamine oxidase inhibitors (MAOIs): May increase blood pressure
Curated Content: Needs Vetting Before Put to Clinical Use