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Medications

Esketamine nasal spray

What is this medicine?

Esketamine (Es KEE ta meen) is an antidepressant used in combination with other antidepressants for treating depression that has not responded to other therapies. Esketamine is only given in a healthcare setting, such as a clinic or hospital.

How should I use this medicine?

This medicine is for use in the nose. You will take it yourself under the supervision of a healthcare provider in a healthcare setting. Your provider will show you how to use the nasal spray device, how much to take, and when to take it. During and after each treatment, you will be checked by a healthcare provider who will decide when you can go home. You will need to plan for a caregiver or family member to drive you home each time after taking the medicine. Do not drive or perform other tasks that require complete mental alertness until the day following your treatment after a restful sleep. Because this medicine can cause nausea and vomiting, you should not eat for at least 2 hours before taking this medicine or drink liquids for at least 30 minutes before taking this medicine. If you take a nasal corticosteroid or nasal decongestant, take these medicines at least 1 hour before your treatment. Do not stop your treatment except on your doctor's advice.

A special MedGuide will be given to you by the pharmacist with each prescription. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. This medicine is not approved for use in children.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching and hives; swelling of the face, lips, or tongue

  • altered sense of time and space

  • confusion

  • disconnected from yourself, your thoughts, or your feelings

  • fast heartbeat

  • hallucinations, loss of contact with reality

  • loss of balance or coordination

  • loss of consciousness

  • loss of memory

  • reduced sense of touch or sensation, spinning sensation

  • signs and symptoms of bladder or urinary tract problems like frequent or urgent urination; frequently urinating at night; painful urinating; blood in urine

  • signs and symptoms of a dangerous increase in blood pressure like chest pain; shortness of breath; sudden severe headache; vision disturbances; seizures; decreased consciousness

  • signs and symptoms of a stroke like changes in vision; confusion; trouble speaking or understanding; severe headaches; sudden numbness or weakness of the face, arm or leg; trouble walking; dizziness; loss of balance or coordination

  • suicidal thoughts, mood changes

  • vomiting

Side effects that usually do not require medical attention (report these to your doctor or health care professional if they continue or are bothersome):

  • drowsiness

  • dry mouth

  • lack of energy

  • nausea

  • trouble sleeping

What may interact with this medicine?

This medicine may interact with the following medications:

  • alcohol

  • antihistamines for allergy, cough, and cold

  • certain medicines for anxiety or sleep

  • certain medicines for depression like amitriptyline, fluoxetine, sertraline

  • certain medicines for seizures like phenobarbital, primidone

  • general anesthetics like halothane, isoflurane, methoxyflurane, propofol

  • ketamine

  • local anesthetics like lidocaine, pramoxine, tetracaine

  • MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate

  • medicines that relax muscles for surgery

  • narcotic medicines for pain

  • phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine

  • psychostimulants like amphetamines, methylphenidate, dexmethylphenidate, modafinil, or armodafinil

What if I miss a dose?

Keep appointments for follow-up doses. It is important not to miss your dose. Call your doctor or healthcare professional if you are unable to keep an appointment.

Where should I keep my medicine?

This medicine is given in a hospital or clinic and will not be stored at home.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • bleeding in the brain

  • blood vessel disease (including in the brain, chest, arms, legs, or other areas of the body)

  • dementia

  • heart disease

  • high blood pressure

  • history of drug abuse or alcohol abuse problem

  • history of head injury

  • history of irregular heartbeat

  • history of stroke

  • liver disease

  • schizophrenia or other thought disorder

  • suicidal thoughts, plans or attempt; a previous suicide by you or a family member

  • an unusual or allergic reaction to esketamine, ketamine, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine. Tell your healthcare professional if your symptoms do not start to get better or if they get worse.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until the day following your treatment after a restful sleep. Do not stand up or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Avoid alcoholic drinks; they can make you dizzier.

There is a risk for abuse and dependence when using this medicine. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with this medicine. Your healthcare provider can tell you more about the difference between dependence and drug addiction.

Your healthcare provider must monitor you for serious side effects for at least 2 hours after each treatment with this medicine. Your healthcare provider will decide when you are ready to leave the healthcare setting and return home. Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Women should not breast-feed their infant while taking this medicine. This medicine passes into breast milk and may cause harm to a nursing infant.


NOTE:This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider. Copyright© 2019 Elsevier