II. Background
III. Indications
-
Refractory Depression Management (adults)
- Adjunctive in combination with oral Antidepressants
- See Ketamine for other indications (analgesia, Anesthesia)
- Esketamine (Spravato) is not intended for use for analgesia or Anesthesia
IV. Contraindications
- Ketamine Hypersensitivity
- Aneurysmal vascular disease or other vascular abnormalities
- Thoracic Aortic Aneurysm
- Abdominal Aortic Aneurysm
- Intracranial Aneurysm
- Arteriovenous malformation
- Intracerebral Hemorrhage history
V. Dosing
- Used in combination with Antidepressants
- Esketamine (Spravato) is administered twice weekly for 4 weeks then once every 1-2 weeks
- Observe patient for 2 hours after each dose for Hypertension, sedation, dissociation
- Titrate over 1-9 weeks to maximum dose of 84 mg per week
VI. Adverse Effects
- See Ketamine
- Dissociative Reaction (altered cognition, judgment, attention)
- Anxiety
- Suicidality
- Dizziness or Vertigo
- Sedation or lethargy
- Nausea or Vomiting
- Hypoesthesia
- Hypertension
- Ketamine Abuse
VII. Precautions
- Expensive ($900/dose)
- Potential for Ketamine Abuse (hence the REMS program)
- Avoid in pregnancy
VIII. References
- (2019) Presc Lett 26(5)
- LoVecchio (2019) Crit Dec Emerg Med 33(6): 28
