Esketamine nasal spray is used along with another antidepressant, taken by mouth, to manage treatment-resistant depression (TRD; depression that does not improve with treatment) in adults. It is also used along with another antidepressant, taken by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) and suicidal thoughts or actions. Esketamine is in a class of medications called NMDA receptor antagonists. It works by changing the activity of certain natural substances in the brain.

Meanwhile, esketamine comes as a solution (liquid) to spray into the nose. For the management of treatment-resistant depression. It is usually sprayed into the nose twice a week during weeks 1–4. Once weekly during weeks 5–8, and then once a week or once every 2 weeks during weeks 9 and beyond. For the treatment of depressive symptoms in adults with major depressive disorder and suicidal thoughts or actions. More still, it is usually sprayed into the nose twice a week for up to 4 weeks. Ketamine nasal spray compounded must be used in a medical facility.

Do not eat for at least 2 hours or drink liquids for at least 30 minutes before using ketamine nasal spray.

What special precautions should I follow?

Tell your doctor and pharmacist if you are allergic to esketamine, ketamine, any other medications, or any of the ingredients in esketamine nasal spray. Ask your pharmacist or check the Medication Guide for a list of the ingredients.

Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amphetamines, medications for anxiety, armodafinil (Nuvigil), MAO inhibitors such as phenelzine (Nardil), procarbazine (Matulane), tranylcypromine (Parnate), and selegiline (Eldepryl, Emsam, and Zelapar); other medications for mental illness, methylphenidate (Aptension, Jornay, Metadate, and others), modafanil, opioid (narcotic) medications for pain, medications for seizures, sedatives, sleeping pills, and tranquilizers Tell your doctor if you have recently taken any of these medications.

Furthermore, if you are using a nasal corticosteroid such as ciclesonide (Alvesco, Omnaris, Zetonna) and mometasone (Asmanex) or a nasal decongestant such as oxymetazoline (Afrin) and phenylephrine (Neosynephrine), use it at least 1 hour before using esketamine nasal spray.

Tell your doctor if you have a blood vessel disease in the brain, chest, stomach area, arms, or legs; have an arteriovenous malformation (an abnormal connection between your veins and arteries); or have a history of bleeding in your brain. Your doctor will probably tell you not to use esketamine nasal spray.

Tell your doctor if you have ever had a stroke, heart attack, brain injury, or any condition that causes increased brain pressure. Tell your doctor if you see, feel, or hear things that are not there, or believe in things that are not true.

Esketamine nasal spray may harm the fetus.

Tell your doctor if you are breast-feeding. If you are having surgery, including dental surgery, tell the doctor or dentist