Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C13H16ClNO |
Molecular Weight | 237.725 |
Optical Activity | ( + ) |
Defined Stereocenters | 1 / 1 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
CN[C@@]1(CCCCC1=O)C2=C(Cl)C=CC=C2
InChI
InChIKey=YQEZLKZALYSWHR-ZDUSSCGKSA-N
InChI=1S/C13H16ClNO/c1-15-13(9-5-4-8-12(13)16)10-6-2-3-7-11(10)14/h2-3,6-7,15H,4-5,8-9H2,1H3/t13-/m0/s1
Esketamine is an S(+)-enantiomer of ketamine. It is a nonselective, noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptor. A nasal spray, containing esketamine, was approved in 2019 for the treatment of treatment-resistant depression in adults, in conjunction with an oral antidepressant, and is marketed under tradename SPARAVATO. Esketamine is a schedule III drug product in the USA.
Approval Year
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
153 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.7 mg/kg single, respiratory dose: 0.7 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
NORKETAMINE, (S)- plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
52 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.35 mg/kg single, respiratory dose: 0.35 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
NORKETAMINE, (S)- plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
97 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.5 mg/kg single, respiratory dose: 0.5 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
NORKETAMINE, (S)- plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
2277.6 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/31827320/ |
0.5 mg/kg single, intramuscular dose: 0.5 mg/kg route of administration: Intramuscular experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
|
128 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.35 mg/kg single, respiratory dose: 0.35 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
180 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.5 mg/kg single, respiratory dose: 0.5 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
227 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/28100533/ |
0.7 mg/kg single, respiratory dose: 0.7 mg/kg route of administration: Respiratory experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
475.2 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/31827320/ |
0.5 mg/kg single, intramuscular dose: 0.5 mg/kg route of administration: Intramuscular experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
7.5 h |
single, respiratory |
NORKETAMINE, (S)- plasma | Homo sapiens population: UNKNOWN age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
287.5 min EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/31827320/ |
0.5 mg/kg single, intramuscular dose: 0.5 mg/kg route of administration: Intramuscular experiment type: SINGLE co-administered: |
ESKETAMINE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
|
11.1 h |
single, respiratory |
ESKETAMINE plasma | Homo sapiens population: UNKNOWN age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
56% |
ESKETAMINE plasma | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Other AEs: Vomiting... |
40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Other AEs: Dissociation, Dizziness... Other AEs: Dissociation (17%) Sources: Dizziness (3%) Dry mouth (7%) Headache (23%) Nasopharyngitis (7%) Nausea (10%) Oropharyngeal pain (3%) Paresthesia (7%) Vertigo (7%) |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Disc. AE: Depression, Blood pressure increased... AEs leading to discontinuation/dose reduction: Depression (0.9%) Sources: Blood pressure increased (0.6%) Dizziness (0.6%) Suicidal ideation (0.5%) Dissociation (0.4%) Nausea (0.4%) Vomiting (0.4%) Headache (0.3%) Muscular weakness (0.3%) Vertigo (0.2%) Hypertension (0.2%) Panic attack (0.2%) Sedation (0.2%) |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant(oral) Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Disc. AE: Anxiety... AEs leading to discontinuation/dose reduction: Anxiety (1.2%) Sources: |
10 mg 1 times / day multiple, oral (starting) Dose: 10 mg, 1 times / day Route: oral Route: multiple Dose: 10 mg, 1 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: treatment resistant depression Age Group: adult Sex: M+F Sources: |
|
28 mg single, intravenous Dose: 28 mg Route: intravenous Route: single Dose: 28 mg Sources: Page: p. 43 |
unhealthy|healthy n = 18 Health Status: unhealthy|healthy Condition: treatment-resistant depression Population Size: 18 Sources: Page: p. 43 |
|
84 mg single, oral Dose: 84 mg Route: oral Route: single Dose: 84 mg Sources: Page: p. 43 |
unhealthy|healthy n = 14 Health Status: unhealthy|healthy Condition: treatment-resistant depression Sex: M+F Population Size: 14 Sources: Page: p. 43 |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Vomiting | 3% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Nausea | 10% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Dissociation | 17% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Headache | 23% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Dizziness | 3% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Oropharyngeal pain | 3% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Dry mouth | 7% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Nasopharyngitis | 7% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Paresthesia | 7% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Vertigo | 7% | 40 mg/kg 2 times / week multiple, intravenous Dose: 40 mg/kg, 2 times / week Route: intravenous Route: multiple Dose: 40 mg/kg, 2 times / week Sources: |
unhealthy, 41.8 years (range: 11 - 63 years) n = 11 Health Status: unhealthy Condition: treatment resistant depression Age Group: 41.8 years (range: 11 - 63 years) Sex: M+F Population Size: 11 Sources: |
Hypertension | 0.2% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Panic attack | 0.2% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Sedation | 0.2% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Vertigo | 0.2% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Headache | 0.3% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Muscular weakness | 0.3% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Dissociation | 0.4% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Nausea | 0.4% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Vomiting | 0.4% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Suicidal ideation | 0.5% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Blood pressure increased | 0.6% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Dizziness | 0.6% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Depression | 0.9% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Anxiety | 1.2% Disc. AE |
56 mg 2 times / week steady, intranasal (starting) Recommended Dose: 56 mg, 2 times / week Route: intranasal Route: steady Dose: 56 mg, 2 times / week Co-administed with:: antidepressant(oral) Sources: |
unhealthy, adult Health Status: unhealthy Condition: major depressive disorder Age Group: adult Sex: M+F Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33,36,37 |
major | weak (co-administration study) Comment: pretreatment with ticlopidine (inhibitor) had no effect on the mean esketamine Cmax following a 56-mg nasal dose, whereas the AUC of esketamine was increased by 29%; Cmax, AUClast, and AUCinf of esketamine were approximately 17%, 31%, and 28% lower, respectively, when subjects were pretreated with rifampicin (inducer); Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33,36,37 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33,36,37 |
major | weak (co-administration study) Comment: esketamine Cmax and AUCinf were increased by 11% and 4%, respectively, when coadministered with clarithromycin; Cmax, AUClast, and AUCinf of esketamine were approximately 17%, 31%, and 28% lower, respectively, when subjects were pretreated with rifampicin (inducer); Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33,36,37 |
||
minor | ||||
minor | ||||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf#page=33 Page: 33.0 |
no |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000PharmR.pdf#page=25 Page: 25.0 |
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Classification Tree | Code System | Code | ||
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WHO-ATC |
N01AX14
Created by
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NCI_THESAURUS |
C245
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WHO-VATC |
QN01AX14
Created by
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Code System | Code | Type | Description | ||
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60799
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PRIMARY | |||
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ESKETAMINE
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Esketamine
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100000089754
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4468
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2119365
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7884
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DB11823
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SUB25825
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DTXSID6047810
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50LFG02TXD
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CHEMBL395091
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33643-46-8
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50LFG02TXD
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AB-57
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182137
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C81400
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ACTIVE MOIETY
SALT/SOLVATE (PARENT)