Spravato

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abuse: People who have a history of misusing drugs or alcohol may be more likely to experience addiction or psychological dependence with this medication. If you have had problems with misusing medications in the past, talk to your doctor about any special monitoring that may be beneficial while you are using this medication.

Alcohol and other medications that cause drowsiness: Do not combine this medication with alcohol or other medications (e.g., antidepressants, sleeping pills, anxiety medications) that cause drowsiness, since additional drowsiness, sedation, coma, and possibly death can occur. Avoid drinking alcohol for at least 24 hours before and after each treatment with esketamine.

Blood pressure: Esketamine can cause severe and potentially dangerous increases in blood pressure. Your doctor will want you to remain at the office or clinic for at least two hours after receiving this medication or until your blood pressure has returned to normal.

Difficulty breathing: Esketamine can cause serious and life-threatening breathing problems. If you experience slowed, shallow, or difficulty breathing, seek immediate medical attention. If you are taking other medications that can slow breathing (e.g., anxiety medications, sleeping pills) are a senior, have chronic bronchitis or emphysema that is not severe, or are obese and have sleep apnea you are more at risk of experiencing these symptoms.

Drowsiness/reduced alertness: Esketamine is likely to cause drowsiness, dizziness, and reduced awareness, affecting your ability to drive or operate machinery safely. It is important to avoid driving or operating machinery after using esketamine until the next day. Arrange to have someone pick you up from your appointment to receive this medication.

Food and drink: Nausea and vomiting are possible side effects of nasal esketamine. It is important to avoid eating anything for at least 2 hours before receiving esketamine. Avoid drinking anything for at least 30 minutes before receiving your dose of esketamine.

Heart problems: This medication may cause increased blood pressure and heart rate which can worsen symptoms of heart disease. If you have heart disease such as angina, congestive heart failure, or arrhythmia, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Contact your doctor as soon as possible if you develop symptoms of heart problems such as shortness of breath, chest pain, rapid heartbeat, or swollen ankles.

Liver function:  Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Mania: Esketamine may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.

Other nasal sprays: If you use prescription or non-prescription nasal sprays, use them at least 1 hour before receiving esketamine.

Perception changes: Esketamine can cause your perception of yourself and your surroundings to change temporarily. This can lead to behaving in ways that are dangerous or not normal for you. Your doctor will have you rest at the office or clinic to monitor your feelings of drowsiness or perception until your thinking has returned to normal.

Suicidal or self-harm behaviour: People with depression are more likely to experience thoughts and behaviour associated with suicide. This is more likely to occur in the early stages of recovery from depression and may be further increased by using this medication. These symptoms may occur within several weeks after starting this medication. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Thyroid disease: The safety and effectiveness of this medication when used by people with an overactive thyroid gland have not been determined. Esketamine may cause increased symptoms of an overactive thyroid gland, such as increased blood pressure and heart rate. If you have thyroid problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary tract problems: Esketamine may cause inflammation of the bladder and may cause ulcers to form in the bladder. If you have bladder problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Symptoms of bladder inflammation include painful urination, increased urgency to urinate and increased urination at night. If you experience these symptoms or blood in the urine, contact your doctor as soon as possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. Women who may become pregnant should use effective birth control while using this medication and for 6 weeks after stopping the esketamine. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if esketamine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children and adolescents less than 17 years of age.

Seniors: The safety and effectiveness of this medication have not been determined for people over the age of 65. Seniors may be more sensitive to the effects of this medication and it is generally not recommended for people in this age group.