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Esketamine Nasal Spray

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Esketamine nasal spray is a medication used to treat depression, particularly in cases where other antidepressants have not been effective. However, like any medication, it comes with risks. Here are some of the potential risks associated with taking Esketamine nasal spray:

  • Psychiatric Effects: Esketamine can cause dissociation, which is a feeling of being disconnected from reality or oneself. It may also lead to hallucinations or delusions, particularly at higher doses.
  • Abuse Potential: Because esketamine is related to ketamine, a known recreational drug with hallucinogenic effects, there’s a risk of misuse or abuse. It’s classified as a Schedule III controlled substance in the United States due to its potential for abuse.
  • Cognitive Effects: Some individuals may experience cognitive impairment, including difficulties with attention, memory, and judgment, especially immediately after administration.
  • Cardiovascular Effects: Esketamine can cause increases in blood pressure and heart rate. Individuals with pre-existing cardiovascular conditions may be at higher risk of experiencing adverse effects.
  • Transient Sedation: Sedation is a common side effect of esketamine, which can impair the ability to perform tasks requiring full mental alertness, such as driving or operating machinery.
  • Potential for Dependency: Long-term use of esketamine may lead to tolerance and dependence, where individuals may require higher doses to achieve the same effects or experience withdrawal symptoms upon discontinuation.
  • Interactions with Other Medications: Esketamine may interact with other medications, particularly those that affect serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs), increasing the risk of serotonin syndrome.
  • Safety Concerns in Specific Populations: The safety and efficacy of esketamine in certain populations, such as pregnant or breastfeeding women, children, and the elderly, have not been adequately studied.

It’s important for individuals considering esketamine treatment to discuss the potential risks and benefits with their healthcare provider, and to be closely monitored throughout the course of treatment.

Why is this medication prescribed?

Esketamine nasal spray is prescribed primarily for the treatment of treatment-resistant depression (TRD) in adults. Treatment-resistant depression refers to depression that hasn’t responded adequately to at least two different antidepressant medications of adequate dose and duration in the current episode.

How should this medicine be used?

Here’s how Esketamine nasal spray is typically used:

  • Administration: Esketamine nasal spray is self-administered by the patient under the supervision of a healthcare provider in a certified treatment center or clinic.
  • Dosage: The dosage prescribed may vary depending on individual factors such as the severity of depression and the patient’s response to treatment. Typically, the initial dose is administered in the healthcare provider’s office and subsequent doses may be administered by the patient at home, following training and instructions provided by the healthcare provider.
  • Frequency: The frequency of administration also varies, but typically patients receive esketamine nasal spray twice a week during the induction phase of treatment, which usually lasts for about four weeks. After the induction phase, the frequency of dosing may be reduced to once weekly or less frequently, depending on the patient’s response.
  • Monitoring: Throughout the course of treatment, patients are closely monitored for any adverse effects, including psychiatric symptoms, cognitive impairment, and changes in vital signs such as blood pressure and heart rate.
  • Adjunctive Therapy: Esketamine nasal spray is usually prescribed as an adjunctive therapy, meaning it’s used in addition to oral antidepressant medications, rather than as a standalone treatment.
  • Duration of Treatment: The duration of treatment with esketamine nasal spray may vary depending on the individual’s response to treatment and the healthcare provider’s assessment. Some patients may benefit from ongoing treatment, while others may be able to gradually taper off esketamine after achieving remission of depression symptoms.

It’s important for patients to follow their healthcare provider’s instructions carefully and to report any concerns or side effects experienced during treatment with esketamine nasal spray. Additionally, regular follow-up appointments with the healthcare provider are essential to monitor progress and adjust treatment as needed.

Other uses for this medicine

While Esketamine Nasal Spray is primarily indicated for treatment-resistant depression, it may have potential applications in other psychiatric disorders such as bipolar depression, post-traumatic stress disorder (PTSD), and certain anxiety disorders. However, these uses are still under investigation and not officially approved.

What special precautions should I follow?

As for special precautions to follow when using Esketamine nasal spray, here are some important considerations:

  • Administration: Esketamine nasal spray should only be administered under the supervision of a qualified healthcare provider in a certified treatment center or clinic.
  • Monitoring: Patients should be closely monitored for adverse effects, particularly during and after administration of esketamine nasal spray. This includes monitoring for psychiatric symptoms, cognitive impairment, changes in blood pressure and heart rate, and signs of misuse or abuse.
  • Contraindications: Esketamine nasal spray is contraindicated in individuals with a history of psychosis, substance use disorder, or hypertensive crisis. It should also be used with caution in patients with a history of cardiovascular disease, as it may increase blood pressure and heart rate.
  • Pregnancy and Breastfeeding: The safety of esketamine nasal spray during pregnancy and breastfeeding has not been established, and it should be used with caution in these populations.
  • Drug Interactions: Esketamine may interact with other medications, particularly those that affect serotonin levels, such as SSRIs, MAOIs, or SNRIs. Patients should inform their healthcare provider of all medications they are taking before starting treatment with esketamine nasal spray.
  • Driving and Operating Machinery: Patients should be advised that esketamine nasal spray may cause sedation and cognitive impairment, which can affect their ability to drive or operate machinery. They should be cautioned against engaging in these activities until they know how esketamine affects them.

Patients should discuss any questions or concerns about Esketamine nasal spray with their healthcare provider before starting treatment.

What special dietary instructions should I follow?

Regarding special dietary instructions, there are no specific dietary restrictions associated with Esketamine nasal spray. However, maintaining a balanced diet and staying hydrated is generally advisable for overall health and well-being.

What should I do if I forget a dose?

If you forget a dose of Esketamine nasal spray, contact your healthcare provider for guidance. They can provide instructions on whether to take the missed dose or how to adjust your dosing schedule. It’s important not to double dose or make any changes to your treatment regimen without consulting your healthcare provider.

What side effects can this medication cause?

Esketamine nasal spray, like any medication, can cause side effects. Common side effects may include:

  • Dissociation: Feeling disconnected from oneself or reality.
  • Dizziness: Feeling lightheaded or unsteady.
  • Sedation: Feeling drowsy or sleepy.
  • Nausea: Feeling the urge to vomit.
  • Vertigo: Sensation of spinning or dizziness.
  • Increased Blood Pressure: Higher than normal blood pressure readings.
  • Headache: Pain or discomfort in the head or scalp.
  • Vomiting: Expelling the contents of the stomach through the mouth.
  • Blurred Vision: Difficulty seeing clearly.
  • Taste Disturbance: Changes in how things taste.
  • Feeling of Drunkenness: Sensation of being intoxicated.
  • Anxiety: Feeling of worry or unease.
  • Sweating Increased: Excessive sweating.
  • Numbness: Loss of sensation in a part of the body.
  • Tachycardia: Rapid heartbeat.
  • Blood Pressure Increased: Elevated blood pressure.
  • Feeling Hot: Sensation of warmth or heat.

It’s essential to note that not all individuals will experience these side effects, and some may experience side effects not listed here. Additionally, some side effects may diminish over time as the body adjusts to the medication. If any side effects persist or worsen, it’s important to inform your healthcare provider. They can provide guidance on managing side effects or adjusting your treatment regimen if necessary.

What should I know about storage and disposal of this medication?

Regarding storage and disposal of Esketamine Nasal Spray, here’s what you should know:


  • Store Esketamine Nasal Spray at room temperature between 20°C to 25°C (68°F to 77°F).
  • Keep the bottle tightly closed when not in use.
  • Protect from light.
  • Do not freeze.
  • Keep out of reach of children and pets.


  • Dispose of Esketamine Nasal Spray properly according to local regulations.
  • Do not flush it down the toilet or pour it down the drain unless instructed to do so.
  • Consult your healthcare provider or pharmacist for guidance on how to properly dispose of unused or expired medication.

In case of emergency/overdose

In case of emergency or overdose of Esketamine Nasal Spray:

  • If you suspect an overdose or experience severe side effects such as difficulty breathing, loss of consciousness, or seizures, seek immediate medical attention or contact your local poison control center.
  • Provide the healthcare professionals with as much information as possible, including the amount of medication taken and any other relevant details.

What other information should I know?

  • Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with Esketamine Nasal Spray.
  • Attend all follow-up appointments with your healthcare provider for monitoring and adjustments to your treatment plan.
  • Avoid consuming alcohol while using Esketamine Nasal Spray, as it may increase the risk of side effects such as dizziness and drowsiness.
  • Do not drive or operate machinery until you know how Esketamine Nasal Spray affects you, as it may cause dizziness, sedation, or other impairments.
  • Inform your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding, as the safety of Esketamine Nasal Spray in these situations is not well-established.
  • Report any new or worsening symptoms to your healthcare provider, as they may indicate a need for adjustments to your treatment plan.

It’s important to follow your healthcare provider’s instructions and guidance for the safe and effective use of Esketamine Nasal Spray.

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