Esketamine - Revision history

CategoryClaude: Sentence-case category link per house style (NMDA_Receptor_Antagonists → NMDA_receptor_antagonists)

2026-05-23T05:02:21Z

Sentence-case category link per house style (NMDA_Receptor_Antagonists → NMDA_receptor_antagonists)

← Older revision		Revision as of 05:02, 23 May 2026
Line 26:		Line 26:
	[[Category:Dissociative Anesthetics]]		[[Category:Dissociative Anesthetics]]
	[[Category:General (IV) Anesthetics]]		[[Category:General (IV) Anesthetics]]
	[[Category:NMDA ~~Receptor Antagonists~~]]		[[Category:NMDA receptor antagonists]]
	[[Category:Antidepressants]]		[[Category:Antidepressants]]
	[[Category:Dissociatives]]		[[Category:Dissociatives]]

Maintenance script: Terminology sweep: drug/medication → medicine

2026-05-16T02:27:26Z

Terminology sweep: drug/medication → medicine

← Older revision		Revision as of 02:27, 16 May 2026
Line 14:		Line 14:
	\| pregnancy = Avoid; may cause fetal harm		\| pregnancy = Avoid; may cause fetal harm
	\| legal = Rx, Schedule III (US). REMS program required.		\| legal = Rx, Schedule III (US). REMS program required.
	\| intro = '''Esketamine''' (brand name Spravato) is the S-enantiomer of ketamine, FDA-approved as an intranasal ~~medication~~ for treatment-resistant depression (March 2019) and for major depression with acute suicidal ideation or behavior (August 2020). The S-enantiomer has approximately 4-fold higher NMDA receptor affinity than the R-enantiomer; Spravato delivers it via a nasal spray under direct medical supervision in a REMS-certified setting due to risks of dissociation, sedation, and abuse.		\| intro = '''Esketamine''' (brand name Spravato) is the S-enantiomer of ketamine, FDA-approved as an intranasal medicine for treatment-resistant depression (March 2019) and for major depression with acute suicidal ideation or behavior (August 2020). The S-enantiomer has approximately 4-fold higher NMDA receptor affinity than the R-enantiomer; Spravato delivers it via a nasal spray under direct medical supervision in a REMS-certified setting due to risks of dissociation, sedation, and abuse.

	Mechanism: uncompetitive NMDA receptor antagonism on GABA interneurons disinhibits glutamatergic output, leading to AMPA receptor activation, BDNF/VEGF release, and rapid synaptogenesis through mTOR pathway activation. Antidepressant onset within hours is striking compared to monoaminergic antidepressants (4-6 weeks). Patients must be monitored ≥2 hours after dose due to dissociation, sedation, and blood pressure elevation.		Mechanism: uncompetitive NMDA receptor antagonism on GABA interneurons disinhibits glutamatergic output, leading to AMPA receptor activation, BDNF/VEGF release, and rapid synaptogenesis through mTOR pathway activation. Antidepressant onset within hours is striking compared to monoaminergic antidepressants (4-6 weeks). Patients must be monitored ≥2 hours after dose due to dissociation, sedation, and blood pressure elevation.

Maintenance script: Expand Esketamine with Stahl-sourced detail (with skepticism)

2026-05-16T02:03:45Z

Expand Esketamine with Stahl-sourced detail (with skepticism)

← Older revision		Revision as of 02:03, 16 May 2026
Line 1:		Line 1:
	{{MedTemplate		{{MedTemplate
	~~\| generic = Esketamine~~		\| brand = Spravato
	\| brand = Spravato		\| classes = NMDA receptor antagonist (uncompetitive), dissociative
	~~\| structure =~~		\| mechanism = The S-enantiomer of racemic ketamine. Uncompetitive NMDA receptor antagonist (binds open channel). Proposed antidepressant mechanism: NMDA blockade on GABA interneurons disinhibits glutamate burst → AMPA receptor activation → BDNF/VEGF release → mTOR-mediated synaptogenesis and dendritic spine formation within hours. Also binds sigma-1, opioid receptors (controversial μ-opioid contribution to antidepressant effect debated).
	\| classes = ~~Dissociative, Anesthetic~~, ~~Antidepressant~~		\| uses = Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020).
	\| mechanism = NMDA receptor antagonist (S-~~enantiomer of ketamine~~)		\| starting_dose = Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site.
	\| uses =		\| preparations = 28 mg/device (each dose uses 2 devices)
	\| starting_dose =		\| fda_max = 84 mg per session
	\| preparations =		\| routes = Intranasal (under direct medical supervision)
	\| fda_max =		\| onset = Within hours of first administration
	\| routes =		\| duration = Acute effect ~24 hours; cumulative effect builds with repeated dosing
	\| onset =		\| halflife = ~7-12 hours
	\| duration =		\| bioavailability = ~48% intranasal
	\| halflife =		\| pregnancy = Avoid; may cause fetal harm
	\| bioavailability =		\| legal = Rx, Schedule III (US). REMS program required.
	\| pregnancy =		\| intro = '''Esketamine''' (brand name Spravato) is the S-enantiomer of ketamine, FDA-approved as an intranasal medication for treatment-resistant depression (March 2019) and for major depression with acute suicidal ideation or behavior (August 2020). The S-enantiomer has approximately 4-fold higher NMDA receptor affinity than the R-enantiomer; Spravato delivers it via a nasal spray under direct medical supervision in a REMS-certified setting due to risks of dissociation, sedation, and abuse.
	\| legal =
	\| intro =		Mechanism: uncompetitive NMDA receptor antagonism on GABA interneurons disinhibits glutamatergic output, leading to AMPA receptor activation, BDNF/VEGF release, and rapid synaptogenesis through mTOR pathway activation. Antidepressant onset within hours is striking compared to monoaminergic antidepressants (4-6 weeks). Patients must be monitored ≥2 hours after dose due to dissociation, sedation, and blood pressure elevation.
	~~\| pharmacokinetics =~~		\| pharmacodynamics= Uncompetitive NMDA receptor antagonist with channel-trapping action. Sigma-1 receptor binding. Possible weak μ-opioid agonism (mechanism contribution debated; naltrexone-blockade studies have given conflicting results).
	\| pharmacodynamics =		\| effects = Dissociation, sedation, dizziness, nausea, vertigo, blood pressure elevation, anxiety, sedation. Long-term risks include abuse/dependence, cognitive effects.
	\| ~~indications~~ =		\| interactions = <pharmaInteractions/>
	~~\| dosing =~~
	\| effects =
	\| interactions = <pharmaInteractions/>
	~~\| pregnancy_details =~~
	~~\| monitoring =~~
	~~\| counseling =~~
	~~\| anecdotes =~~
	~~\| seealso =~~
	~~\| references =~~
	}}		}}

Line 37:		Line 28:
	[[Category:NMDA Receptor Antagonists]]		[[Category:NMDA Receptor Antagonists]]
	[[Category:Antidepressants]]		[[Category:Antidepressants]]
			[[Category:Dissociatives]]

MDElliottMD: Comprehensive categorization: +Arylcyclohexylamines, Dissociative Anesthetics, General (IV) Anesthetics, NMDA Receptor Antagonists, Antidepressants

2026-05-15T18:42:16Z

Comprehensive categorization: +Arylcyclohexylamines, Dissociative Anesthetics, General (IV) Anesthetics, NMDA Receptor Antagonists, Antidepressants

← Older revision		Revision as of 18:42, 15 May 2026
Line 32:		Line 32:

	[[Category:Anesthetics]]		[[Category:Anesthetics]]
			[[Category:Arylcyclohexylamines]]
			[[Category:Dissociative Anesthetics]]
			[[Category:General (IV) Anesthetics]]
			[[Category:NMDA Receptor Antagonists]]
			[[Category:Antidepressants]]

MDElliottMD: Pharmacopedia: add

2026-05-14T03:30:51Z

Pharmacopedia: add <pharmaInteractions/>

← Older revision		Revision as of 03:30, 14 May 2026
Line 22:		Line 22:
	\| dosing =		\| dosing =
	\| effects =		\| effects =
	\| interactions =		\| interactions = <pharmaInteractions/>
	\| pregnancy_details =		\| pregnancy_details =
	\| monitoring =		\| monitoring =

MDElliottMD: Pharmacopedia: remove contraindications parameter

2026-05-14T02:40:33Z

Pharmacopedia: remove contraindications parameter

← Older revision		Revision as of 02:40, 14 May 2026
Line 22:		Line 22:
	\| dosing =		\| dosing =
	\| effects =		\| effects =
	~~\| contraindications =~~
	\| interactions =		\| interactions =
	\| pregnancy_details =		\| pregnancy_details =

MDElliottMD: Added empty fda_max parameter to MedTemplate call

2026-05-13T02:32:54Z

Added empty fda_max parameter to MedTemplate call

← Older revision		Revision as of 02:32, 13 May 2026
Line 8:		Line 8:
	\| starting_dose =		\| starting_dose =
	\| preparations =		\| preparations =
			\| fda_max =
	\| routes =		\| routes =
	\| onset =		\| onset =
Line 32:		Line 33:

	[[Category:Anesthetics]]		[[Category:Anesthetics]]

MDElliottMD: Expand stub to full MedTemplate parameter set

2026-05-13T01:00:00Z

Expand stub to full MedTemplate parameter set

@@ Line 1: / Line 1: @@
 {{MedTemplate
-| generic           = Esketamine
+| generic            = Esketamine
-| brand             = Spravato
+| brand              = Spravato
-| classes           = Dissociative, Anesthetic, Antidepressant
+| structure          =
-| mechanism         = NMDA receptor antagonist (S-enantiomer of ketamine)
+| classes            = Dissociative, Anesthetic, Antidepressant
 }}
 [[Category:Anesthetics]]

MDElliottMD: Auto-created stub

2026-05-13T00:00:00Z

Auto-created stub

New page

{{MedTemplate
| generic = Esketamine
| brand = Spravato
| classes = Dissociative, Anesthetic, Antidepressant
| mechanism = NMDA receptor antagonist (S-enantiomer of ketamine)
}}
[[Category:Anesthetics]]