Drug interactions
Esketamine + Propofol
Severity: Major
Esketamine and Propofol: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Propofol is a potent general anesthetic and sedative, and combining it with esketamine increases depth of sedation and the risk of respiratory depression and hemodynamic changes. Esketamine may reduce propofol requirements, while the combination can cause unexpected loss of airway reflexes.
What this interaction means in plain words
Esketamine and Propofol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Esketamine belongs to Central Nervous System; Propofol belongs to Central Nervous System.
Why it happens
Additive CNS depression through GABA-A potentiation by propofol and NMDA receptor antagonism by esketamine.
What to do
Give only where airway management and continuous monitoring of oxygenation, ventilation and blood pressure are available. Titrate propofol to effect, usually at reduced doses.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
- Esketamine 25 mg/ml solution for injection/infusion - SmPC sections 4.3/4.5 (class statement: hypnotics; "In combination with hypnotics, benzodiazepines or antipsychotics, there is a reduction in adverse effects but also a prolongation of the duration of effect of e") — electronic medicines compendium (UK SmPC)
Other interactions of Esketamine
Other interactions of Propofol
Frequently asked questions
Can I take Esketamine with Propofol?
MediHelp rates the interaction as major. Esketamine and Propofol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Propofol is a potent general anesthetic and sedative, and combining it with esketamine increases depth of sedation and the risk of respiratory depression and hemodynamic changes. Esketamine may reduce propofol requirements, while the combination can cause unexpected loss of airway reflexes.
How serious is the interaction between Esketamine and Propofol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Give only where airway management and continuous monitoring of oxygenation, ventilation and blood pressure are available. Titrate propofol to effect, usually at reduced doses.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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