NMDA receptor antagonist (S-enantiomer of ketamine)
Noncompetitive NMDA receptor antagonist leading to rapid glutamatergic modulation and synaptic plasticity enhancement, which may underlie its rapid antidepressant effects
Treatment-resistant depression (TRD); depressive symptoms in major depressive disorder (MDD) with acute suicidal ideation or behavior
Augmentation in treatment-resistant bipolar depression; adjunctive treatment in other mood disorders
Intranasal spray
56 mg intranasally 1–2 times weekly during induction, titrated to 84 mg as tolerated; maintenance dosing typically weekly to biweekly
56–84 mg intranasally per administration
Rapid absorption intranasally with peak plasma concentration within 20–40 minutes; short half-life (~7–12 hours)
Dissociation, dizziness, nausea, sedation, increased blood pressure, headache
Potential for abuse; hypertension; sedation-related falls
Administer only in certified REMS clinics; monitor blood pressure and mental status for at least 2 hours post-dose
Risk of sedation and dissociation; potential for abuse and misuse
Limited evidence for use in traumatic brain injury (TBI) and neurodegenerative disorders; caution advised due to risk of sedation and blood pressure fluctuations. Avoid in patients with uncontrolled hypertension, significant cardiovascular disease, or aneurysmal vascular disease. Use cautiously in elderly patients given increased sensitivity to sedation and cardiovascular effects.