Therapeutic Classification: antidepressants
Pharmacologic Classification: n methyl d aspartate antagonist
REMS
Absorption: 48% absorbed following nasal administration.
Distribution: Extensively distributed to tissues.
Half-Life: 712 hr.
Contraindicated in:
Use Cautiously in:
CV: ↑BP, tachycardia
Derm: ↑sweating
EENT: nasal irritation, throat irritation
GI: nausea, vomiting, constipation, diarrhea, dry mouth
Neuro: anxiety, depersonalization, derealization, dissociative changes, dizziness, dysgeusia, fatigue, headache, hypoesthesia, sedation, vertigo, cognitive impairment, insomnia, loss of consciousness, slurred/slow speech, SUICIDAL THOUGHTS/BEHAVIORS, tremor
Resp: RESPIRATORY DEPRESSION
Misc: physical dependence, psychological dependence, tolerance
Drug-drug:
Treatment-Resistant Depression
Depressive Symptoms in Patients With Major Depressive Disorder With Acute Suicidal Ideation or Behavior
Due to risks of serious adverse outcomes from sedation, dissociation, and abuse and misuse, available only through a restricted program under Spravato REMS. Health care settings and pharmacies must be certified, and patients must be enrolled in REMS program. Esketamine is only administered in health care settings under direct observation of health care professional, and patients must be monitored for at least 2 hr after administration.
Explain purpose of esketamine, administration procedure, and Spravato REMS program to patient.
Advise patient to read Medication Guide before starting therapy. If a treatment session is missed and no worsening of depressive symptoms occurs, continue current dosing schedule. If depressive symptoms worsen, may return to previous dosing schedule.