esketamine
Used for Depression
NowPatient helps you obtain your esketamine prescription for free or at low-cost. Drug savings programs are suitable for individuals who are insured, don't have insurance or are underinsured and can't afford your medicine.
Manufactured by various FDA-approved generic manufacturers.
*You can pay as little as $0 per fill using Drug Coupons or Patient Assistance Programs. Subject to applicability & eligibility requirements.
This content is intended for US audiences only
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esketamine key facts
What dosages is esketamine available in?
esketamine is available as 28 mg of esketamine per device. Each nasal spray device delivers two sprays containing a total of 28 mg of esketamine.
What is esketamine used for?
esketamine is a NMDA receptor antagonist and is used for the following:
- Treatment-resistant depression (TRD) in adults
- Major depressive disorder in adults with suicidal ideation or behavior (MDSI)
How does esketamine work?
esketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist. It’s not exactly known how the medication works to help with depression. But it’s thought to balance the chemicals and signaling pathways in your brain that are involved with regulating your mood.
How do I take esketamine?
esketamine is given as a spray into the nose at a provider’s treatment center. Each device contains 1 spray for each nostril and a total of 28 mg of esketamine.
- esketamine is typically used along with an antidepressant that’s taken by mouth
Treatment-resistant depression (TRD):
- Weeks 1 to 4: The typical starting dose is 56 mg sprayed into the nose on day 1. After the first day, the dose is 56 mg or 84 mg twice per week.
- Weeks 5 to 8: The typical dose is 56 mg or 84 mg sprayed into the nose once per week
- Week 9 and beyond: The typical dose is 56 mg or 84 mg sprayed into the nose once every week or every other week, depending on how you respond to the medication
- Major depressive disorder with suicidal ideation or behavior (MDSI): The recommended dose is 84 mg sprayed into the nose twice per week for 4 weeks (1 month). The dose can be lowered to 56 mg twice per week if you’re having side effects. After 1 month of treatment, your provider will decide whether you should continue treatment with esketamine based on how well you’re responding to the medication
Is it safe for me to take esketamine?
esketamine is a safe and effective treatment when used for FDA licensed indications. However, like all medications, they may give you unwanted side effects. You should always discuss potential side effects with your physician to ensure the medication is suitable and right for you. You should not use this medication in the following:
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation.
Intracerebral hemorrhage - Hypersensitivity to esketamine, ketamine, or any of the excipients
esketamine Common Side Effects
Common side effects of esketamine:
- Dissociation
- Dizziness
- Nausea
- Sleepiness
- Vertigo
- Headache
- Changes in taste
- Numbness
- Anxiety
- Feeling sluggish
- Higher blood pressure
esketamine Serious Side Effects
Serious side effects are rare with esketamine. Contact your healthcare provider immediately if you experience any of the following.
- Extreme sleepiness
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Suicidal thoughts and behaviors: anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness
- Extremely high blood pressure: chest pain, shortness of breath, severe headache, visual changes
Effects of other drugs, drug classes and over-the-counter products on esketamine
The following medications may interact with esketamine:
- Concomitant use with CNS depressants (e.g., benzodiazepines, opioids, alcohol) may increase sedation. Closely monitor for sedation with concomitant use of esketamine with CNS depressants
- Concomitant use with psychostimulants (e.g., amphetamines, methylphenidate modafinil, armodafinil) may increase blood pressure. Closely monitor blood pressure with concomitant use of
- esketamine with psychostimulants
- Concomitant use with monoamine oxidase inhibitors (MAOIs) may increase blood pressure. Closely monitor blood pressure with concomitant use of esketamine with MAOIs
Who makes esketamine?
Various FDA-approved generic manufacturers
Is esketamine safe in pregnancy?
esketamine is not recommended during pregnancy. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including esketamine, during pregnancy. Healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at women’s health
The FDA's medical product safety reporting program for health professionals, patients and consumers.
Learn more about reporting side effects in the USDrug Savings Guide
A practical guide to saving money and receiving support with prescription costs
How can NowPatient help me to lower the cost of my esketamine prescription?
After you create a FREE account with NowPatient, you will have access to 4 programs that can help lower the cost of your esketamine prescription
Applicability to each program will be dependent on your insurance status.
How do the NowPatient esketamine savings programs work?
After you have created your FREE account with NowPatient, you can access the various programs from your account dashboard. Each program has clear instructions on how to check your eligibility. You can see how the process works by clicking on the feature link below and seeing the ‘How it works’ steps.
Drug Coupon and Patient Assistance Programs require an eligibility quiz to be completed.
Are the NowPatient esketamine savings programs suitable for everyone, regardless of insurance status?
No. Each program has its own eligibility and applicability requirements. The table below shows if a program is available to you, based on your insurance status.
| Rx Advantage Card* for esketamine | Canadian Prescription Savings* for esketamine | esketamine Drug Coupon* | esketamine Patient Assistance Program* | |
| Insured (federal, state or government) | Available | Available | Not Available | Available If Offered by Pharmaceutical Company |
| Insured (Commercial or Private) | Available | Available | Available If Offered by Pharmaceutical Company | Available If Offered by Pharmaceutical Company |
| Uninsured | Available | Available | Not Available | Available If Offered by Pharmaceutical Company |
| Insured but without pharmacy benefit or drug coverage | Available | Available | Not Available | Available If Offered by Pharmaceutical Company |
*This is not insurance.
Are the NowPatient drug savings programs suitable for brand and generic versions of esketamine?
No. Each program has applicability requirements. Please see below
| Rx Advantage Card* for esketamine | Canadian Prescription Savings* for esketamine | esketamine Drug Coupon* | esketamine Patient Assistance Program* | |
| Brand | Yes | Yes | Yes, If Offered by Pharmaceutical Company | Yes, If Offered by Pharmaceutical Company |
| Generic | Yes | Yes | No | No |
*This is not insurance.
If you have Medicare Part D or Medicare Advantage and none of the esketamine savings options are applicable or affordable for me, what can you do?
If you are insured with Medicare and the esketamine drug savings options are not applicable to you and still remain unaffordable, then you can check Medicaid eligibility in your state by following the instructions at HealthCare.gov.
The government site is easy to use and after you have selected your state, it will navigate you to the appropriate contact point to make the application. State Medicaid programs may cover the full cost of your medication.
People who qualify for both Medicare and Medicaid are called ‘dual eligibles’.
If you are denied Medicaid for esketamine, and you are still unable to afford your copay or co-insurance element (for example if you are in the coverage gap or Donut Hole) then you may be eligible for a federal support program like Low Income Subsidy. To be eligible for Low Income Subsidy, you need to be a resident in one of the 50 States or the District of Columbia. You can check eligibility online at SSA Medicare D Extra Help. You can also call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
I am uninsured or underinsured and none of the esketamine prescription saving options are applicable or affordable for me, what can I do?
If you are uninsured or underinsured (for example, esketamine is not covered by your plan) and the drug savings options are not applicable or still unaffordable, then you can check Medicaid eligibility in your state by following the instructions at HealthCare.gov.
The government site is easy to use and you can select your state and it will navigate you to the appropriate contact point to make the application. State Medicaid programs may cover the full cost of your medication.
If you are denied and all else fails, and if you have been prescribed esketamine for an FDA-approved indication, you can call the pharmaceutical company to see if they have any other assistance programs.
I am commercially or privately insured and none of the esketamine prescription saving options are applicable or affordable for me, what can I do?
If your medication is not covered by your plan, you can appeal your insurance company’s decision. Sometimes, a formal appeal can result in the drug being covered if it is deemed medically necessary.
If you cannot afford your copay contribution, then you can check Medicaid eligibility in your state by following the instructions at HealthCare.gov.
However, being privately insured might complicate your eligibility for Medicaid, as having private insurance may be considered in the financial eligibility assessment.
The government site is easy to use and you can select your state and it will navigate you to the appropriate contact point to make the application. If you qualify, state Medicaid may cover the full cost of your medication.
If I have federal, state or commercial insurance and none of the esketamine prescription saving options are applicable or affordable for me, are there any other support organisations that can help me with my co-insurance or copay contributions?
If you have already tried Medicaid and received a denial letter or if you are insured with Medicare and have been denied Low-Income Subsidy, then you can try one of the following organizational support programs:
1. Patient Access Network Foundation (PAN) assistance for esketamine
If you are having trouble paying for your esketamine medication due to unaffordable copays or deductibles, the Patient Access Network Foundation (PAN), may be able to assist you. To qualify for PAN assistance for esketamine you will need to meet one or all of the following criteria:
- Your income is below 400% of the federal poverty level
- esketamine is prescribed for an approved FDA indication
- You live in and receive treatment in the United States or U.S. territories, even if you do not have U.S. citizenship
- You have Medicare insurance coverage that covers esketamine
- If esketamine is listed on PAN’s list of covered medications
You can check the Patient Access Network Foundation Website for more information.
2. HealthWell Foundation Copay Program for esketamine
If you are having trouble paying for your esketamine medication due to unaffordable copays or deductibles, the HealthWell Foundation Copay Program may be able to assist you. To qualify for assistance for esketamine you will need to meet the following criteria:
- You live in and are being treated in the United States
- You are insured and your plan covers esketamine
- If esketamine is listed on the HealthWell Foundation’s list of covered medications
You can check the HealthWell Foundation Website for more information.
3. Patient Advocate Foundation Co-Pay Relief Program for esketamine
Patient Advocate Foundation’s Co-Pay Relief program exists to help reduce the financial distress you or your family may face when paying for your esketamine treatment. If you qualify and can demonstrate the need, the foundation will provide you with direct payment covering co-pays, co-insurance, and deductibles. To qualify for assistance for esketamine you will need to meet the following criteria:
- You must be currently insured and have coverage for esketamine
- You must have a confirmed diagnosis and treatment plan
- You must reside and receive treatment in the United States
- Your Income must fall at or below 300% or 400% of the Federal Poverty Guideline (FPG) with consideration for the Cost of Living Index (COLI) and number in the household
- Applications can also be completed by contacting the program sponsor, toll-free at 866-512-3861.
You can check the Patient Advocate Foundation Website for more information.
Medical Disclaimer
NowPatient has taken all reasonable steps to ensure that all material is factually accurate, complete, and current. However, the knowledge and experience of a qualified healthcare professional should always be sought after instead of using the information on this page. Before taking any drug, you should always speak to your doctor or another qualified healthcare provider.
The information provided here about medications is subject to change and is not meant to include all uses, precautions, warnings, directions, drug interactions, allergic reactions, or negative effects. The absence of warnings or other information for a particular medication does not imply that the medication or medication combination is appropriate for all patients or for all possible purposes.
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