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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Other antidepressants
esketamine
N06AX27
Forms & Strengths
- Nasal spray: 28 mg per device
Adult Dosing
- Treatment-resistant depression: Induction (Weeks 1-4) 56 mg to 84 mg twice weekly; Maintenance (Weeks 5-8) 56 mg or 84 mg once weekly; Maintenance (Week 9 onwards) 56 mg or 84 mg every 2 weeks
- Depressive symptoms with acute suicidal ideation or behavior: 84 mg twice weekly for 4 weeks; may reduce to 56 mg based on efficacy and tolerability
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment-resistant depression (TRD) in adults, in conjunction with an oral antidepressant
- Depressive symptoms in adults with acute suicidal ideation or behavior
Mechanism of Action
- Non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, leading to an increase in synaptogenesis and restoration of synaptic connections in brain areas involved in mood regulation
Contraindications
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels)
- History of intracerebral hemorrhage
- Hypersensitivity to esketamine, ketamine, or any excipient
Adverse Reactions
- Dissociation
- Dizziness
- Nausea
- Sedation
- Vertigo
- Hypogeusia
- Anxiety
- Lethargy
- Blood pressure increased
- Vomiting
Drug Interactions
- Central nervous system (CNS) depressants (e.g., alcohol, benzodiazepines, opioids): Increased risk of sedation
- Psychostimulants (e.g., amphetamines, methylphenidate): May potentiate blood pressure-increasing effects
- Monoamine oxidase inhibitors (MAOIs): May potentiate blood pressure-increasing effects
Curated Content: Needs Vetting Before Put to Clinical Use