Esketamine
Esketamine is a nasal spray medication used to treat treatment-resistant depression and acute suicidal thoughts in adults. It works by blocking NMDA receptors in the brain, providing rapid antidepressant effects when other treatments have failed. This medication is only available through restricted programs due to its potential for abuse and serious side effects.
Esketamine is an NMDA receptor antagonist nasal spray for treatment-resistant depression and acute suicidal ideation, requiring supervised administration.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N01AX14
- RxNorm
- 2119365
- Generic
- Esketamine
- Class
- atc-n01
- Brands
- Spravato
- Availability
- rx
- Lactation
- unknown
- Routes
- nasal
- Forms
- spray
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Treatment-resistant depression in adults who have not responded to at least two other antidepressants, and for acute suicidal ideation or behavior. Administered alongside an oral antidepressant.
Esketamine is the S-enantiomer of ketamine and works as a non-selective, non-competitive antagonist of the NMDA (N-methyl-D-aspartate) receptor, an ionotropic glutamate receptor. This mechanism is thought to contribute to its rapid antidepressant effects, though the exact pathway is not fully understood.
Only available through a restricted distribution program (REMS). Patients must be monitored for at least 2 hours after administration due to risk of sedation, dissociation, and elevated blood pressure. May cause abuse potential and fetal harm. Not recommended for use in pregnant or breastfeeding women.
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy