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Esketamine Nasal Spray

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It’s possible to experience sleepiness, fainting, dizziness, anxiety, a spinning sensation, or a sense of being separated from your body, thoughts, emotions, space, and time after using esketamine nasal spray. In a medical setting, you will administer esketamine nasal spray on your own, but your physician will keep an eye on you prior to, throughout, and for at least two hours after your treatment. After using esketamine, you must arrange for a family member or caretaker to drive you home. After using esketamine nasal spray, wait until the next day after a sound night’s sleep before engaging in any activity that requires total alertness, such as driving a car or operating machinery. If you experience excessive fatigue, fainting, chest discomfort, shortness of breath, a sudden, severe headache, vision changes, uncontrollable shaking of a part of your body, or a seizure, call your doctor straight once.

Esketamine may lead to addiction. Inform your doctor if you or any members of your family regularly use excessive amounts of alcohol, use street drugs, or abuse prescription pharmaceuticals.

A tiny number of kids, teenagers, and young adults (up to 24 years old) who took antidepressants (also known as “mood elevators”) during clinical research developed suicide thoughts (i.e., planning or actually acting on such thoughts). Antidepressants may increase the risk of suicidality in children, adolescents, and young adults who are depressed or suffering from other mental diseases as compared to those who do not take these medications. To what extent this risk should be taken into account when determining whether or not a kid or adolescent should take an antidepressant, however, is unclear to experts. Esketamine usage is not advised for kids.

Even if you are an adult above the age of 24, you should be aware that using esketamine or other antidepressants may cause your mental health to change in unexpected ways. Suicidal thoughts may come to mind, especially at the start of treatment and whenever your dose is altered. Any of the following symptoms should prompt you, your family, or your caregiver to call your doctor immediately away: Depression that is either new or getting worse, thoughts of self-harm or suicide, plans or attempts to do so, excessive worry, agitation, panic attacks, trouble falling or staying asleep, aggressive behavior, irritability, acting without thinking, extreme restlessness, and frenzied abnormal excitement. Make sure your family or caregiver is aware of any symptoms that could be significant so they can contact the doctor on your behalf if you are unable to call for help.

Esketamine is only accessible through a unique, restricted distribution method due to the risks associated with this medicine. the Risk Evaluation and Mitigation Strategies (REMS) initiative from Spravato. Before receiving this drug, you, your doctor, and your pharmacy must all be signed up for the Spravato REMS program. You will use esketamine nasal spray in a healthcare setting while being observed by a doctor or other medical expert.

Keep all of your appointments with your physician and the lab. Each time you use esketamine, your doctor will check your blood pressure before you use it and at least two hours after.

When you start esketamine therapy and each time you refill your prescription, your doctor or pharmacist will give you the manufacturer’s patient information leaflet (Medication Guide). If you have any questions, thoroughly read the material, then consult your physician or pharmacist. To obtain the Medication Guide, you can alternatively go to the manufacturer’s or the Food and Drug Administration (FDA) website.

Why is this medication prescribed?

To treat individuals with treatment-resistant depression (TRD; depression that does not get better with medication), esketamine nasal spray is combined with another antidepressant that is taken orally. In adults with major depressive disorder (MDD) and suicidal thoughts or behaviors, it is also used in combination with another antidepressant that is taken orally to treat depressive symptoms. Esketamine belongs to a group of drugs known as NMDA receptor antagonists. It functions by altering the way that a few organic brain chemicals behave.

How should this medicine be used?

Esketamine is sold as a liquid solution that can be sprayed into the nose. It is often sprayed into the nose twice weekly during weeks 1-4, once weekly during weeks 5-8, and then once weekly or once every two weeks during weeks 9 and beyond for the management of treatment-resistant depression. It is often sprayed into the nose twice a week for up to 4 weeks to treat depressed symptoms in individuals with major depressive disorder and suicidal thoughts or actions. Esketamine must be administered in a hospital setting.

Before taking esketamine nasal spray, wait at least two hours and 30 minutes to eat or drink anything.

Two sprays are provided by each nasal sprayer, one for each nostril. On the gadget, two green dots mean the nasal spray is full, one green dot means you’ve used one spray, and no green dots mean you’ve used the recommended two sprays.

Other uses for this medicine

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

What special precautions should I follow?

Before using esketamine nasal spray,

  • If you have an allergy to esketamine, ketamine, any other drugs, or any of the ingredients in esketamine nasal spray, let your doctor and pharmacist know right once. For a list of the ingredients, consult the Medication Guide or speak with your pharmacist.
  • Inform your doctor and pharmacist about any additional prescription and over-the-counter medications, vitamins, herbal items, nutritional supplements, and any drugs you are now taking or intend to take. Any of the following should be mentioned: medicines for anxiety, armodafinil (Nuvigil), phenelzine (Nardil), procarbazine (Matulane), amphetamines, other drugs for mental illness include methylphenidate (Aptension, Jornay, Metadate, and others), modafanil, and tranylcypromine (Parnate), sedatives, sleeping aids, tranquilizers, and opioid (narcotic) drugs for pain and seizures. You should let your doctor know if you’ve lately taken any of these drugs.
  • Use a nasal decongestant such as oxymetazoline (Afrin) or phenylephrine (Neosynephrine) or a nasal corticosteroid such as ciclesonide (Alvesco, Omnaris, Zetonna) and mometasone (Asmanex) at least an hour before taking an esketamine nasal spray.
  • Inform your physician if you have any blood vessel conditions in your brain, chest, stomach, arms, or legs; if your veins and arteries are connected abnormally (arteriovenous malformation); or if you have ever experienced brain bleeding. Most likely, your doctor will advise against using esketamine nasal spray.
  • If you have ever experienced a stroke, heart attack, brain damage, or any other condition that increases brain pressure, be sure to let your doctor know. Inform your doctor if you have any unusual sensations or have beliefs that are not supported by the facts. Additionally, let your doctor know if you now or ever had liver or heart disease, heart disease, a slow or irregular heartbeat, heart failure, hypertension (high blood pressure), shortness of breath, chest pain, or any other condition.
  • If you are pregnant or plan to become pregnant, let your doctor know. Call your doctor right away if you become pregnant while using esketamine nasal spray. The fetus could be harmed by esketamine nasal spray.
  • Inform your doctor if you are nursing a baby. Using esketamine nasal spray during nursing is not advised.
  • Inform the surgeon or dentist that you are using esketamine nasal spray if you are having surgery, including dental surgery.

What special dietary instructions should I follow?

Keep eating normally unless your doctor instructs you otherwise.

What should I do if I forget a dose?

If you miss a treatment session, call your doctor as soon as possible to make up the missed appointment. Your doctor might need to adjust your dose or treatment schedule if you skip a dose and your depression worsens.

What side effects can this medication cause?

Nasal spray esketamine might have negative effects. If any of these symptoms are severe or do not go away, let your doctor know right once:

  • Frequent, throbbing, painful, or urgent urinating
  • Constipation
  • Diarrhea
  • Mouth ache
  • Nausea
  • Vomiting
  • Impaired judgment or feeling inebriated
  • Headache
  • Strange or metallic aftertaste
  • Nasal ache
  • Throat discomfort
  • Increased perspiration

Some adverse effects can be very harmful. Call your doctor right away or seek emergency medical attention if you develop any of the signs and symptoms mentioned in the IMPORTANT WARNING.

Other negative effects of esketamine nasal spray may occur. If you experience any strange issues while taking this drug, call your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online at or by phone at 1-800-332-1088 if you have a serious side event.

In case of emergency/overdose

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Additionally, information can be found online at Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

What other information should I know?

You should keep a written record of every drug you take, including prescription and nonprescription (over-the-counter) medications, vitamins, minerals, and other dietary supplements. Every time you see a doctor or are admitted to the hospital, you should carry this list with you. Additionally, it is crucial to have this knowledge on hand in case of emergency.

Brand names

  • Spravato®
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