esketamine (Spravato)
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Indications
- treatment-resistant depression in combination with an oral antidepressant
- not helpful in the elderly[4]
Contraindications
Dosage
- intranasal 56-84 mg/dose twice weekly
- 28-84 mg/dose in elderly
* nasal spray is administered in a healthcare facility (not at home)[7]
- FDA approved for use only in conjunction with an oral antidepressant
Adverse effects
- nausea, vertigo, dizziness, metallic taste, headaches, drowsiness, blurred vision, paresthesia, dissociation & anxiety, generally on the day of dosing.
Mechanism of action
- chirally pure enantiomer of the anesthetic agent ketamine
- NMDA receptor antagonist
Notes
- $590-$885 for 2 doses (2019)
More general terms
References
- ↑ Monaco K Intranasal Esketamine Succeeds in Depression Trial 4-point cut in MADRS scores versus placebo after 4 weeks. MedPage Today. May 09, 2018 https://www.medpagetoday.com/meetingcoverage/apa/72795
Alphs L, et al Clinical efficacy and safety of flexibly dosed intranasal esketamine in a U.S. population of patients with treatment- resistant depression. American Psychiatric Association (APA) 2018; Abstract P8-049.
Alphs L, et al Clinical efficacy and safety of intranasal esketamine in a U.S. population of geriatric patients with treatment-resistant depression. American Psychiatric Association (APA) 2018; Abstract P8-052.
FDA Advisory Committee Recommends Approval of SPRAVATO (esketamine) Nasal Spray CIII for Adults with Treatment-Resistant Depression. Janssen Pharmaceuticals. Jan 12, 2019 https://www.prnewswire.com/news-releases/fda-advisory-committee-recommends-approval-of-spravato-esketamine-nasal-spray-ciii-for-adults-with-treatment-resistant-depression-300794493.html - ↑ Cassels C FDA Approves Esketamine Nasal Spray for Resistant Depression. Medscape - Mar 05, 2019. https://www.medscape.com/viewarticle/909933
FDA News Release. March 05, 2019. FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor's office or clinic. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm - ↑ Kim J, Farchione T, Potter A et al Esketamine for Treatment-Resistant DepressionEsketamine for Treatment- Resistant Depression - First FDA-Approved Antidepressant in a New Class. N Engl J Med. May 22, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31116916 https://www.nejm.org/doi/full/10.1056/NEJMp1903305
- ↑ 4.0 4.1 Ochs-Ross R, Daly EJ, Zhang Y, et al. Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression.
TRANSFORM-3. Am J Geriatr Psychiatry 2020 Feb; 28:121. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31734084 Free Article https://www.sciencedirect.com/science/article/pii/S1064748119305330 - ↑ 5.0 5.1 Aftab A, Lam JA, Liu F, Ghosh A, Sajatovic M. Recent developments in geriatric psychopharmacology Expert Rev Clin Pharmacol. 2021 Mar;14(3):341-355 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33499693 Review
- ↑ HIGHLIGHTS OF PRESCRIBING INFORMATION SPRAVATO (esketamine) nasal spray, CIII
- ↑ 7.0 7.1 Reif A et al. Esketamine nasal spray versus quetiapine for treatment-resistant depression. N Engl J Med 2023 Oct 5; 389:1298. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37792613 https://www.nejm.org/doi/10.1056/NEJMoa2304145