Esketamine

The Basics

What is Esketamine?

Administered via nasal spray and approved to treat depression that hasn’t responded to other treatment.

Brand names for Esketamine

N/A

How Esketamine is classified

Antidepressive Agents, Antidepressants

Esketamine During Pregnancy

Esketamine pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Esketamine while pregnant

N/A

Taking Esketamine While Breastfeeding

What are recommendations for lactation if you're taking Esketamine?

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

Maternal / infant drug levels

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

Possible effects of Esketamine on milk supply

A pregnant woman sustained 28% body surface area burns near term. She underwent an emergency cesarean section on her due date under ketamine anesthesia. Although the infant required vigorous resuscitation, the infant began breastfeeding immediately. The infant had transient jaundice that resolved in a few days.[2]

A study compared women undergoing cesarean section who received either placebo or S-ketamine (esketamine) 0.5 mg/kg intramuscularly, followed by a continuous infusion of 2 mcg/kg/minute for 12 hours. This low dose was used to enhance analgesia and reduce residual pain rather than to provide anesthesia. All women received intraspinal bupivacaine 8 to10 mg and sufentanil 5 mcg for analgesia, as well as midazolam 0.02 mg/kg intravenously before the S-ketamine or placebo injection. Postoperatively, patients received patient-controlled intravenous morphine for 24 hours, followed by acetaminophen, oral ketorolac and a single dose of ondansetron 8 mg intravenously as needed. Of the 56 patients enrolled in the study (28 in each group), 13 in each group were contacted at 3 years postpartum. Patients who received placebo reported breastfeeding for an average of 10.5 months and those who received S-ketamine reported breastfeeding for an average of 8 months; however, the difference was not statistically significant.[3]

A randomized, double-blind study compared the effects of intravenous propofol 0.25 mg/kg, ketamine 0.25 mg/kg, ketamine 25 mg plus propofol 25 mg, and saline placebo for pain control in mothers post-cesarean section. A single dose was given immediately after clamping of the umbilical cord. The time to the first breastfeeding was 58 minutes in those who received placebo, 31.9 minutes with ketamine and 25.8 minutes with propofol plus ketamine. The time was significantly shorter than the other groups with the combination.[4]

Possible alternatives to Esketamine

None listed