Esketamine nasal spray [C-III]

Brand Name


Pharmacological Class

N-methyl D-aspartate (NMDA) receptor antagonist


Treatment-resistant depression (adjunctive therapy)$

Agents with Similar Pharmacology


Further Reading in Goodman & Gilman
Additional Notes

Esketamine is the S-enantiomer of racemic ketamine. It is FDA-approved for administration to adults, in a controlled healthcare environment, with post-administration clinical observation (for >2 hours) and subsequent activity limits (driving and operation of machinery).63 Due to an association with excessive sedation, dissociation, suicidal thoughts/behaviors, and the potential for abuse/misuse, it is only available through the SPRAVATO REMS restricted access program, which requires enrollment of healthcare facilities, pharmacies, and patients.63 The recommended dosage regimen consists of twice-weekly administration during the first month of therapy followed by weekly dosing during the second month and individualized dosing thereafter to the lowest frequency necessary to maintain remission/response.63 Tolerance is expected with long-term use and patients should be monitored for symptoms of withdrawal following discontinuation of therapy. The drug cost is expected to be $590–$885 per dose.66,67