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Esketamine for treatment-resistant depression


Generic name: Esketamine hydrochloride

Brand name: Spravato

Formulation: 28mg in 0.2ml nasal spray solution

Market Authorisation holder: Janssen-Cilag International NV

Indication: Treatment resistant major depressive disorder in adults who have failed to respond to at least two different antidepressants during the current moderate to severe episode. To be used in combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI).

Dose: The starting dose is 56 mg for adults aged <65 years and 28 mg for adults aged ≥65 years1. Subsequent doses (56 mg or 84 mg for those <65 years; 28 mg, 56 mg or 84 mg for those ≥65 years) are given twice a week for 4 weeks, followed by once a week for 4 weeks, and then once a week or once every 2 weeks from week 9. Treatment is recommended for at least 6 months after symptoms improve.

Cost: £163 for 28 mg (one device)

Classification: Prescription only medicine (POM) subject to additional monitoring (▼). Controlled drug schedule 2.

  • Secondary Care
  • Depression
  • Mental Health
  • Therapeutics

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  • Competing interests None declared.

  • Provenance and peer review Written by the DTB team; externally peer reviewed.

  • For patients of Japanese ancestry, initial dose is 28 mg esketamine. Subsequent doses should be increased in increments of 28 mg up to 56 mg or 84 mg, based on efficacy and tolerability.