Drug Action
Esketamine is an isomer of ketamine that blocks N-methyl-D-aspartate (NMDA) receptors and interrupts the association pathways of the brain, resulting in dissociative anaesthesia and analgesia.
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Drug reference
Esketamine is an isomer of ketamine that blocks N-methyl-D-aspartate (NMDA) receptors and interrupts the association pathways of the brain, resulting in dissociative anaesthesia and analgesia.
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Induction and maintenance of anaesthesia (specialist use only) ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 0.5–1 mg/kg, then maintenance 0.25–0.5 mg/kg every 10–15 minutes, adjusted according to response ▶BY INTRAMUSCULAR INJECTION ▶Adult: 2–4 mg/kg, then maintenance 1–2 mg/kg every 10–15 minutes, adjusted according to response ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: 0.5–3 mg/kg/hour, adjusted according to response Analgesic supplementation of regional and local anaesthesia (specialist use only) ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: 0.125–0.25 mg/kg/hour, adjusted according to response Analgesia in emergency medicine (specialist use only) ▶BY INTRAMUSCULAR INJECTION ▶Adult: 0.25–0.5 mg/kg, adjusted according to response ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 0.125–0.25 mg/kg, adjusted according to response
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Acute porphyrias p. 1120. eclampsia. ischaemic cardiac disorders (when used as sole anaesthetic agent). patients in whom hypertension or raised intracranial pressure forms a serious risk. pre- eclampsia
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Chronic or acute alcohol consumption. decompensated cardiac failure. hypertension. increased cerebrospinal fluid pressure. patients with multiple injuries or in poor condition—consult product literature. prolapsed umbilical cord. raised intra-ocular pressure. raised intracranial pressure. severe psychotic disorders. thyroid dysfunction. unstable angina pectoris. uterine rupture
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Esketamine should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available. Anaesthesia
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→Appendix 1: esketamine
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▶Common or very common Arrhythmias. dizziness. hypersalivation. movement disorders. nausea. respiratory disorders. respiratory secretion increased. sleep disorders . vision disorders. vomiting ▶Uncommon Muscle tone increased. nystagmus. skin reactions ▶Rare or very rare Hypotension ▶Frequency not known Anxiety. disorientation. drug- induced liver injury. dysphoria. hallucination
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Manufacturer advises use only if potential benefit outweighs risk—may depress neonatal respiration if used during delivery.
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Manufacturer advises present in milk— not thought to be harmful at therapeutic doses.
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Manufacturer advises caution (risk of prolonged action). Dose adjustments Manufacturer advises consider dose reduction.
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Manufacturer advises solution can be diluted with Glucose 5% or Sodium Chloride 0.9%.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Vesierra (Pfizer Ltd) Esketamine (as Esketamine hydrochloride) 5 mg per 1 ml Vesierra 25mg/5ml solution for injection ampoules | 10 ampoule P £18.98 (Hospital only) b Esketamine (as Esketamine hydrochloride) 25 mg per 1 ml Vesierra 50mg/2ml solution for injection ampoules | 10 ampoule P £26.31 (Hospital only) b ANAESTHETICS, LOCAL
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Driving and skilled tasks Patients given sedatives and analgesics during minor outpatient procedures should be very carefully warned about the risk of driving or undertaking skilled tasks afterwards. For a short general anaesthetic the risk extends to at least 24 hours after administration. Responsible persons should be available to take patients home. The dangers of taking alcohol should also be emphasised. For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including ketamine which has similar pharmacokinetic properties to esketamine, see Drugs and driving under Guidance on prescribing p. 1.
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0.5–1 mg/kg, then maintenance 0.25–0.5 mg/kg
First-line fragment. Read the complete Indications and Dose section above.
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2–4 mg/kg, then maintenance 1–2 mg/kg every
First-line fragment. Read the complete Indications and Dose section above.
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0.5–3 mg/kg/hour, adjusted according to
First-line fragment. Read the complete Indications and Dose section above.
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0.125–0.25 mg/kg/hour, adjusted according to
First-line fragment. Read the complete Indications and Dose section above.
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0.25–0.5 mg/kg, adjusted according to response
First-line fragment. Read the complete Indications and Dose section above.
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0.125–0.25 mg/kg, adjusted according to
First-line fragment. Read the complete Indications and Dose section above.
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