esketamine hydrochloride at a glance
Medicine class
NMDA receptor antagonist; the nasal formulation is classified as an antidepressant and the injectable formulation as a general anaesthetic.
Licensed roles
Selected adults with major depression; general anaesthesia and pain relief in anaesthetic or emergency settings.
Administration
The nasal spray is self-administered under direct healthcare supervision. Injection or infusion is given by, or under the supervision of, an anaesthetic specialist.
After administration
Sedation, altered perception, dizziness and increased blood pressure can occur. Observation and driving restrictions are required.
What is esketamine hydrochloride used for?
The formulations have distinct licensed uses:
Nasal esketamine alongside antidepressant treatment for certain adults with treatment-resistant major depressive disorder.
Nasal esketamine alongside oral antidepressant therapy for rapid reduction of depressive symptoms where a moderate-to-severe major depressive episode constitutes a psychiatric emergency.
Injectable esketamine for general anaesthesia, anaesthesia and analgesia in emergency medicine, and supplementation of regional or local anaesthesia.
How does esketamine hydrochloride work?
Esketamine blocks NMDA receptors involved in glutamate signalling. In depression, downstream signalling may help restore synaptic function in mood-related brain networks. At anaesthetic exposure, it produces dissociative anaesthesia, analgesia, amnesia and separation of awareness from sensory input.
esketamine hydrochloride preparations and strengths
Nasal preparation
Route: Nasal
Strengths: 28 mg
Injection
Route: Parenteral
Strengths: 5 mg/mL, 25 mg/mL
How to take esketamine hydrochloride
Nasal esketamine is used in an appropriate clinical setting. The patient uses the single-use device under direct supervision, without priming it, and remains under observation until clinically stable. Injectable esketamine is administered by appropriately trained clinicians in hospital or pre-hospital emergency care, with resuscitation equipment available.
Do not take the nasal device home or use it without supervision.
If you sneeze immediately after spraying, do not use a replacement device unless clinical staff instruct otherwise.
Tell staff about alcohol, medicines, other substances and nasal treatments.
Follow the treatment team’s instructions about food, drink, transport and driving.
esketamine hydrochloride side effects
Common or expected effects
- Dizziness, vertigo or sleepiness
- Feeling detached from yourself or your surroundings, altered perception or unusual sensations
- Nausea, vomiting or headache
- Changed taste or reduced sensation
- Temporary increase in blood pressure or heart rate
- After injection: vivid dreams, restlessness, blurred vision, increased saliva or recovery reactions
Get urgent medical advice
- Severe sedation, loss of consciousness or respiratory depression
- Severe allergic reaction, including anaphylaxis
- Marked or persistent blood-pressure elevation with concerning symptoms
- Seizures, serious heart-rhythm disturbance or respiratory arrest
- Laryngospasm or significant breathing difficulty during anaesthesia
- New or worsening suicidal thoughts or behaviour
esketamine hydrochloride in pregnancy
Nasal esketamine is not recommended during pregnancy or where effective contraception is not being used; pregnancy requires prompt specialist review. Injectable esketamine should be used only after weighing maternal benefit against potential fetal risk. It crosses the placenta and may depress neonatal breathing when used during delivery.
esketamine hydrochloride while breastfeeding
Advice differs by formulation. With nasal esketamine, human milk transfer is unknown and risk to the infant cannot be excluded. Injectable esketamine enters breast milk, although its product information considers an effect on the child unlikely at therapeutic exposure. Seek specialist advice.
esketamine hydrochloride interactions
Provide a complete list of medicines, alcohol and other substances because interactions differ by formulation.
Benzodiazepines, opioids, alcohol and other CNS depressants
Sedation and respiratory impairment may increase, requiring closer observation and potentially longer recovery.
Psychostimulants such as methylphenidate, amphetamines or modafinil
Blood-pressure increases may be enhanced during nasal treatment.
MAO inhibitors and other medicines that raise blood pressure
Common questions about esketamine hydrochloride
Answers are fully visible for fast scanning and source review.
Is esketamine hydrochloride the same as ketamine?
Esketamine is the S-enantiomer, or one mirror-image component, of racemic ketamine. They are related but are not identical licensed products.
Is it an antidepressant or an anaesthetic?
It can be either: the nasal product is an antidepressant treatment, while the injectable product is an anaesthetic and analgesic.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.