to a friend, relative, colleague or yourself. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Because esketamine increases systolic and/or diastolic blood pressure at all recommended doses, the drug is also contraindicated in patients for whom an increase in blood pressure or intracranial pressure poses a serious risk. Codeine; Promethazine: (Major) Closely monitor patients receiving esketamine and promethazine for sedation and other CNS depressant effects. Zaleplon: (Major) Use of zaleplon during treatment with esketamine may increase sedation and complex sleep-related behaviors (e.g., driving, talking, eating, or performing other activities while not fully awake). Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. During Week 9 and thereafter, administer 56 mg or 84 mg once every 2 weeks or once weekly. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. Dexmedetomidine: (Moderate) Closely monitor patients receiving esketamine and dexmedetomidine for sedation and other CNS depressant effects. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Guanfacine: (Moderate) Closely monitor patients receiving esketamine and guanfacine for sedation and other CNS depressant effects. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. (Major) Closely monitor patients receiving esketamine and barbiturates for sedation and other CNS depressant effects. Meperidine; Promethazine: (Major) Closely monitor patients receiving esketamine and promethazine for sedation and other CNS depressant effects. Butorphanol: (Major) Closely monitor patients receiving esketamine and butorphanol for sedation and other CNS depressant effects. Acetaminophen; Butalbital: (Major) Closely monitor patients receiving esketamine and barbiturates for sedation and other CNS depressant effects. Hydrocodone; Ibuprofen: (Major) Concomitant use of opioid agonists with esketamine may cause excessive sedation and somnolence. During the maintenance phase, esketamine dosing should be individualised to the lowest frequency to maintain remission/response. Esketamine has modest induction effects on CYP2B6 and CYP3A4 in human hepatocytes. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. On Week 9 and thereafter, the dosing frequency should be individualized to the least frequent dosing to maintain remission/response (either every 2 weeks or once weekly) at a dose of 56 mg or 84 mg. Separate multiple email address with a comma. Patients who receive a dose of esketamine should not drive or engage in other activities requiring alertness until the next day after a restful sleep. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Pentobarbital: (Major) Closely monitor patients receiving esketamine and barbiturates for sedation and other CNS depressant effects. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. Limit the use of opioid pain medication with esketamine to only patients for whom alternative treatment options are inadequate. Primidone: (Major) Closely monitor patients receiving esketamine and barbiturates for sedation and other CNS depressant effects. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Limit the use of opioid pain medication with esketamine to only patients for whom alternative treatment options are inadequate. • SPRAVATO® does not require daily dosing and should be administered in conjunction with an oral AD *Evidence of therapeutic benefit should be evaluated at the end of the induction phase to determine need for continued treatment. Chlorpheniramine; Hydrocodone: (Major) Concomitant use of opioid agonists with esketamine may cause excessive sedation and somnolence. Coadministration of psychostimulants, such as dexmethylphenidate, with esketamine may increase blood pressure, including the possibility of hypertensive crisis. Dopaminergic agents have also been associated with sudden sleep onset during activities of daily living such as driving, which has resulted in accidents in some cases. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Major) Closely monitor blood pressure during concomitant use of esketamine and caffeine. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. Esketamine acts primarily as a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Thiothixene: (Moderate) Closely monitor patients receiving esketamine and thiothixene for sedation and other CNS depressant effects. Educate patients about the risks and symptoms of excessive CNS depression. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Limit the use of opioid pain medication with esketamine to only patients for whom alternative treatment options are inadequate. Coadministration of psychostimulants, such as caffeine, with esketamine may increase blood pressure. Scopolamine: (Moderate) Closely monitor patients receiving esketamine and scopolamine for sedation and other CNS depressant effects. After 4 weeks of treatment, evaluate the therapeutic benefit to determine the need for continued therapy. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. (Moderate) Closely monitor patients receiving esketamine and brompheniramine for sedation and other CNS depressant effects. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. The nasal spray device delivers a total of 28 mg of esketamine. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Educate patients about the risks and symptoms of excessive CNS depression. Orphenadrine: (Major) Closely monitor patients receiving esketamine and skeletal muscle relaxants for sedation and other CNS depressant effects. Fluoxetine; Olanzapine: (Major) Closely monitor patients receiving esketamine and olanzapine for sedation and other CNS depressant effects. (Major) Closely monitor patients receiving esketamine and skeletal muscle relaxants for sedation and other CNS depressant effects. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Closely monitor blood pressure during concomitant use of esketamine and caffeine. It comes as a nasal spray that's taken … Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Aspirin, ASA; Carisoprodol: (Major) Closely monitor patients receiving esketamine and skeletal muscle relaxants for sedation and other CNS depressant effects. Carbetapentane; Chlorpheniramine; Phenylephrine: (Moderate) Closely monitor patients receiving esketamine and chlorpheniramine for sedation and other CNS depressant effects. Treatment Time-Frame Results from animal studies using maternally toxic doses of intranasal ketamine (a racemic mixture containing esketamine) showed fetal harm including skeletal malformations and animal studies using intranasal esketamine at similar doses to the maximum recommended human dose (MRHD) during pregnancy and lactation showed a delay in sensorimotor development in offspring during the preweaning period and a decrease in motor activity in the post-weaning period. Barbiturates: (Major) Closely monitor patients receiving esketamine and barbiturates for sedation and other CNS depressant effects. Patients who receive a dose of esketamine should not drive or engage in other activities requiring alertness until the next day after a restful sleep. Educate patients about the risks and symptoms of excessive CNS depression. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. frequency to maintain remission/response. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Spravato . Prescribers should re-assess patients for drowsiness or sleepiness regularly throughout treatment, especially since events may occur well after the start of treatment. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. Register Now. Diphenhydramine; Ibuprofen: (Moderate) Closely monitor patients receiving esketamine and diphenhydramine for sedation and other CNS depressant effects. Patients who have received a dose of esketamine should be instructed not to drive or engage in other activities requiring complete mental alertness until the next day after a restful sleep. Patients with moderate hepatic impairment have a higher mean AUC and half-life than those with normal hepatic function; therefore, a longer duration of monitoring for adverse reactions from esketamine administration may be required in this population. Instruct patients who receive a dose of esketamine not to drive or engage in other activities requiring alertness until the next day after a restful sleep. Rotigotine: (Major) Because of the possibility of additive sedative effects, caution is advisable during concurrent use of dopaminergic agents, such as rotigotine, and CNS depressants, such as esketamine. Isoflurane: (Major) Although CNS depression is a desired effect of general anesthetics, patients also receiving esketamine should be closely monitored for additive effects that may prolong recovery after administration of a general anesthetic.

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