Drug interactions
Esketamine intranasal + Ketamine
Severity: Major
Esketamine intranasal and Ketamine: major interaction.
Last updated
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
Esketamine is the S-enantiomer of ketamine, so the two share the same pharmacology and effects are duplicated. Combining them can cause excess sedation, dissociation, hypertension and abuse potential.
What this interaction means in plain words
Esketamine intranasal and Ketamine 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.
Why it happens
Therapeutic duplication with additive NMDA receptor antagonism.
What to do
Avoid concurrent use except under specialist supervision. If ketamine anesthesia is required for a patient on esketamine, monitor blood pressure and sedation closely.
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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Other interactions of Ketamine
Frequently asked questions
Can I take Esketamine intranasal with Ketamine?
MediHelp rates the interaction as major. Esketamine intranasal and Ketamine 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 is the S-enantiomer of ketamine, so the two share the same pharmacology and effects are duplicated. Combining them can cause excess sedation, dissociation, hypertension and abuse potential.
How serious is the interaction between Esketamine intranasal and Ketamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use except under specialist supervision. If ketamine anesthesia is required for a patient on esketamine, monitor blood pressure and sedation closely.
What other medicines interact with Ketamine?
MediHelp also lists interactions of Ketamine with, for example, Benzhydrocodone / acetaminophen, Brexanolone, Buprenorphine buccal. The full list is on the Ketamine page.
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