#22: esketamine (Spravato) | A REMS Drug Used for Major & Treatment-Resistant Depression

Esketamine is a REMS program drug that is currently brand only known as Spravato. It is a Non-Selective Non-Competitive NMDA Receptor Antagonist and typically administered in a healthcare setting that is enrolled in the REMS program. Spravato is used along with an antidepressant when treating patients with treatment-resistant depression or a major depressive disorder with acute suicidal ideation and behavior. It is not recommended for pediatric use and the efficacy in reducing and preventing suicide or suicidal behavior has not been proven. Spravato comes in a nasal spray in a 56 mg and 84 mg strength. In addition to the more common CYP pathways, Spravato is primarily metabolized via the CYP2B6 pathway. Esketamine is the S-enantiomer of racemic ketamine. Spravto should be administered by the patient under the supervision of a healthcare provider.

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