Esketamine is used together with other medicines to treat depression.
It is used for those who have not responded to at least 2 other treatments and for those who have suicidal thoughts or behaviour.
Use Esketamine exactly as directed by your doctor. Do not use more or less than instructed by your doctor.
You will be using the nasal spray by yourself, with the guidance of your doctor or other healthcare professional in a healthcare setting (e.g. doctor’s clinic or office).
Your doctor may advise you to avoid eating at least 2 hours before the treatment and avoid drinking of liquids at least 30 minutes before the scheduled treatment as this medicine may cause nausea and vomiting.
If you are using nasal steroid or decongestant, your doctor may advise you to use these medicines at least 1 hour before the scheduled treatment of Esketamine.
To use the nasal spray, your doctor or a healthcare professional will instruct you to do these steps:
- Blow your nose gently to clean your nostrils before using the spray.
- Wait for the doctor or the healthcare professional to prepare the nasal spray.
- Hold the nasal spray by putting the thumb gently on the plunger. Do not press the plunger.
- With your head tilted at least 45 degrees, insert the tip of the nasal spray into the 1st nostril and make sure that the nose rest is touching the skin between the nostrils.
- Close the other nostril with your finger then carefully push the plunger until it stops while breathing in gently through the nose. Sniff gently after using the spray.
- Your doctor or the healthcare professional will let you rest for at least 5 minutes before spraying onto the other nostril.
- Repeat the same steps to deliver the 2nd spray or the rest of your dose.
Make sure you understand the instructions on using your nasal spray. If you have problems or do not understand the instructions, ask your doctor or the healthcare professional.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the type and severity of your condition.
Ensure that you keep all appointments with your doctor or healthcare professional so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Esketamine.
If you miss an appointment, alert your doctor or the healthcare professional. You will be advised about your current treatment schedule.
Alert your doctor if you have the following conditions:
- aneurysmal vascular disease (an abnormal bulging of an artery due to the weakness of the artery wall)
- arteriovenous malformation (a condition where there is a tangle of abnormal blood vessels connecting the arteries and veins)
- history of intracerebral haemorrhage (a condition where there is bleeding inside the brain)
- recent (within 6 weeks) heart attack
as Esketamine may not be suitable for you.
Inform your doctor if you have the following conditions:
- uncontrolled high blood pressure
- poorly treated hyperthyroidism (overactive thyroid gland)
- conditions related to high pressure in the brain e.g. hypertensive encephalopathy
- current or history of psychosis (a serious mental condition where the person has lost contact with reality)
- current or history of mania or bipolar disorder (mood changes between feeling very high and very low)
- history of drug abuse or dependence
- stroke or other conditions that affect the blood vessels and blood supply to the brain
- history of suicidal tendencies
- sleep apnoea (sleep disorder that causes interrupted breathing during sleep) and extremely overweight
- lung problems causing breathing difficulty
- liver disease
- heart problem e.g. poor blood flow in the blood vessels of the heart, heart failure
Let your doctor know if you are pregnant or breastfeeding.
It is important that you do not get pregnant while being treated with Esketamine. You may wish to discuss birth control methods with your doctor or pharmacist.
Be sure to check with your doctor or pharmacist before using this medicine to the elderly. Elderly people may be more sensitive to the side effects.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Your blood pressure may rise to unsafe levels without you noticing it. Your healthcare provider will monitor your blood pressure before, during and after treatment.
- Regular monitoring of signs of adverse reactions may also be needed after each treatment session.
Medicines for depression such as Esketamine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately.
What lifestyle changes should I make to cope with depression?
Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness.
Esketamine may cause drowsiness, dizziness, reduced alertness and suddenly falling asleep during daily activities such as eating and watching television. If affected, do not drive or take part in any activity in which you need to be alert or need to see clearly.
Other side effects include any of the following: headache, nausea, vomiting, altered taste, dry mouth, throat discomfort, tiredness, dizziness with sensation of spinning, nasal discomfort, nasal dryness, nasal pruritus, ringing in the ears, rash, and excessive sweating.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- unusual changes in mood or behaviour (being too depressed, agitated, or having compulsive and impulsive behaviour)
- having thoughts of self-harm
- hallucinations (seeing, hearing or feeling things that are not existent)
- slurring of speech
- pain, burning or stinging sensation during urination, persistent urge to urinate, frequent urination
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Inform your doctor and pharmacist if you are taking any of these medicines:
- medicines for sleep disorder or anxiety e.g. alprazolam, diazepam, lorazepam
- strong painkillers e.g. morphine, fentanyl, oxycodone
- medicines to treat hyperactivity disorders e.g. methylphenidate
- other medicines to treat depression e.g. phenelzine, tranylcypromine
- ergometrine (medicine used to treat bleeding after childbirth or abortion)
- medicines for thyroid disorders
- asthma medicines e.g. theophylline, aminophylline
- clarithromycin (antibiotic)
- rifampicin (medicine for tuberculosis or TB)
This list does not include all medicines that may interact with Esketamine.
Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Esketamine.
Store in a cool, dry place away from the reach of children.
Medicines must not be used past the expiry date.
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