Esketamine: uses, dosing, side effects & brands

Esketamine is a medicine sold in the U.S. under one brand, for treatment-resistant depressive disorder. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.

By the pharmaranks editorial teamReviewed against the FDA (openFDA label, NDC Directory & Enforcement) sourcesUpdated Jul 24, 2026How we research

Key facts

Treats: Treatment-Resistant Depressive Disorder
Available as: Solution
Sold as: Spravato
Prescription?: Prescription only
Generic available?: Not in our catalog
Boxed warning: Boxed warning

How esketamine is dosed

From the FDA label for Spravato (application NDA211243). Other esketamine products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.

Administer SPRAVATO intranasally under the supervision of a healthcare provider. ( 2.1 ) Assess blood pressure prior to and after administration. ( 2.1 ) TRD: Evidence of therapeutic benefit should be evaluated at the end of the 4-week induction phase to determine need for continued treatment. ( 2.2 ) Depressive symptoms in MDD with acute suicidal ideation or behavior : Evidence of therapeutic benefit should be evaluated after 4 weeks to determine need for continued treatment. Treatment beyond 4 weeks has not been systematically evaluated. ( 2.3 ) See Full Prescribing Information for recommended dosage. ( 2.2 , 2.3 ) See Full Prescribing Information for important administration instructions. ( 2.4 ) 2.1 Important Considerations Prior to Initiating and During Therapy SPRAVATO must be administered under the direct supervision of a healthcare provider. A treatment session consists of nasal administration of SPRAVATO and post-administration observation under supervision. Respiratory Status Assessment During Treatment Monitor patients for changes in respiratory status for at least 2 hours (including pulse oximetry) at each treatment session [see Warnings and Precautions (5.3) ] . Blood Pressure Assessment Before and After Treatment Assess blood pressure prior to dosing with SPRAVATO [see Warnings and Precautions (5.7) ] . If baseline blood pressure is elevated (e.g., >140 mmHg…

Esketamine side effects

The following adverse reactions are discussed in more detail in other sections of the labeling: Sedation [see Warnings and Precautions (5.1) ] Dissociation [see Warnings and Precautions (5.2) ] Respiratory Depression [see Warnings and Precautions (5.3) ] Increase in Blood Pressure [see Warnings and Precautions (5.7) ] Cognitive Impairment [see Warnings and Precautions (5.8) ] Impaired Ability to Drive and Operate Machinery [see Warnings and Precautions (5.9) ] Ulcerative or Interstitial Cystitis [see Warnings and Precautions (5.10) ] Embryo-fetal Toxicity [see Warnings and Precautions (5.11) ] The most commonly observed adverse reactions (incidence ≥5% and at least twice that of placebo): TRD: dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, blood pressure increased, vomiting, feeling drunk, and headache. ( 6 ) Treatment of depressive symptoms in adults with MDD with acute suicidal ideation or behavior: dissociation, dizziness, sedation, blood pressure increased, hypoesthesia, vomiting, euphoric mood, and vertigo. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Janssen Pharmaceuticals, Inc. at 1-800-JANSSEN (1-800-526-7736) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug…

Who shouldn’t take esketamine

SPRAVATO is contraindicated in patients with: Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels) or arteriovenous malformation [see Warnings and Precautions (5.7) ] History of intracerebral hemorrhage [see Warnings and Precautions (5.7) ] Hypersensitivity to esketamine, ketamine, or any of the excipients. Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation. ( 4 ) Intracerebral hemorrhage. ( 4 ) Hypersensitivity to esketamine, ketamine, or any of the excipients. ( 4 )

Esketamine drug interactions

7.1 Central Nervous System Depressants Concomitant use with CNS depressants (e.g., benzodiazepines, opioids, alcohol) may increase sedation [see Warnings and Precautions (5.1) ] . Closely monitor for sedation with concomitant use of SPRAVATO with CNS depressants. 7.2 Psychostimulants Concomitant use with psychostimulants (e.g., amphetamines, methylphenidate, modafinil, armodafinil) may increase blood pressure [see Warnings and Precautions (5.7) ] . Closely monitor blood pressure with concomitant use of SPRAVATO with psychostimulants. 7.3 Monoamine Oxidase Inhibitors (MAOIs) Concomitant use with monoamine oxidase inhibitors (MAOIs) may increase blood pressure [see Warnings and Precautions (5.7) ] . Closely monitor blood pressure with concomitant use of SPRAVATO with MAOIs.

Every esketamine product we track (1)

Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.

Only one: Spravato.

Esketamine and breastfeeding

From LactMed, the US National Library of Medicine’s Drugs and Lactation Database — quoted, not rewritten.

Esketamine is the more potent S-isomer of the racemic drug, ketamine. Single doses or infusions of intravenous esketamine during or after cesarean section delivery may not affect the breastfed infant and may improve the onset of lactation. Esketamine nasal spray used as an antidepressant has not been studied during breastfeeding. Until more data are available, repeated doses esketamine nasal spray should probably be avoided during breastfeeding.

Full LactMed record for esketamine: levels in milk, effects in breastfed infants, and the drugs it would consider instead

National Institute of Child Health and Human Development, record revised April 15, 2026. LactMed states its information is not a substitute for professional judgement.

What people report to the FDA about esketamine

The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 40 reports naming esketamine, and the FDA flagged 98% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:

anaphylactic shock11 reports
agitation4 reports
constipation4 reports
functional gastrointestinal disorder4 reports
urinary hesitation4 reports
urinary retention4 reports
weight increased4 reports
drug level decreased3 reports

Read these as a signal, not a rate. A report does not mean esketamine caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.

Source: openFDA drug/event (FAERS), retrieved July 25, 2026.

Related calculators

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Frequently asked questions

What is esketamine?

SPRAVATO ® contains esketamine hydrochloride, a non-competitive N -methyl- D -aspartate (NMDA) receptor antagonist. Esketamine is the S-enantiomer of racemic ketamine.

Can you take esketamine with other medicines?

It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run esketamine against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.

What forms does esketamine come in?

Across the brands we track, esketamine is currently marketed as solution, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.

Is there a generic esketamine?

We do not currently list a generic-labelled esketamine product. That does not always mean none exists — it means none appears under a generic name in the FDA data we track. Ask your pharmacist.

Cite this page

APA: pharmaranks. (2026, July 24). Esketamine: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/esketamine
MLA: “Esketamine: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/esketamine.

We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.

Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.

Read the full FDA label for esketamine on DailyMed (NIH) ↗ — including its boxed warning in full.