Can esketamine cause tachycardia (elevated heart rate)?

From the Guidelines

Esketamine can cause tachycardia (elevated heart rate) due to its sympathomimetic properties that stimulate the cardiovascular system. This is a known side effect of the medication, which is similar to ketamine, as both belong to the same class of drugs 1. The effects of ketamine, including tachycardia and arrhythmias, occur within 20 minutes and last for less than 3 hours 1. Although the provided study does not directly discuss esketamine, its similarity to ketamine in terms of pharmacological properties suggests that esketamine would have similar cardiovascular effects.

Key points to consider:

• Esketamine's sympathomimetic properties can lead to increased heart rate and blood pressure
• Patients with certain cardiovascular conditions may not be suitable candidates for esketamine therapy
• Healthcare providers should monitor vital signs, including heart rate, before and after administration
• Patients should be informed about the potential side effect of tachycardia and advised to report any concerning symptoms

It is essential to weigh the potential benefits of esketamine therapy against the risks, particularly in patients with pre-existing cardiovascular conditions. By closely monitoring patients and providing proper education, healthcare providers can minimize the risks associated with esketamine-induced tachycardia.

From the FDA Drug Label

The effect of SPRAVATO (84 mg nasal spray and 0. 8 mg/kg esketamine intravenously infused over 40 minutes) on the QTc interval was evaluated in a randomized, double-blind, placebo-, and positive-controlled (moxifloxacin 400 mg), 4-period, crossover study in 60 healthy subjects. A large increase in heart rate (i.e., > 10 bpm) was observed in both intranasal and intravenous esketamine treatment groups.

Esketamine can cause an increase in heart rate. According to the study, a large increase in heart rate (> 10 bpm) was observed in both intranasal and intravenous esketamine treatment groups 2. This suggests that tachycardia (elevated heart rate) is a possible effect of esketamine.

From the Research

Esketamine and Elevated Heart Rate

• Esketamine, used in the treatment of treatment-resistant depression, has been associated with transient cardiovascular stimulatory effects, including increased heart rate and blood pressure 3.
• Studies have shown that the increase in heart rate is generally mild and well-tolerated, with a mean increase in heart rate of less than 5% above predose values 4.
• The increase in heart rate is typically dose-dependent and begins shortly after administration, peaking at around 30 to 50 minutes, and resolving at approximately 2 to 4 hours after the dose administration 5.
• Adverse events related to abnormal heart rate were reported in 3.0% of all esketamine-treated patients, with an odds ratio of 1.9 [0.5-8.6] compared to placebo 3.
• Monitoring of heart rate and blood pressure is recommended after esketamine dosing, particularly in patients with cardiovascular comorbidities, as 14/70 patients experienced treatment-emergent transient hypertension in one study 4.

Factors Influencing Heart Rate Response

• The pharmacokinetic profile of esketamine can be affected by co-administered antidepressants, with some medications inhibiting cytochrome-P450 (CYP450) isoforms and increasing esketamine levels 6.
• Changes in systolic blood pressure in response to esketamine positively correlated with serum esketamine levels, suggesting a potential reduction in esketamine dose in patients with cardiovascular comorbidity under treatment with certain antidepressants 6.
• The route of administration, such as subcutaneous or intranasal, may also influence the heart rate response to esketamine, with subcutaneous administration showing mild and well-tolerated increases in blood pressure 4.

Clinical Implications

• Esketamine's adverse effects, including increased heart rate and blood pressure, should be carefully monitored and managed in clinical practice 7.
• Patients with cardiovascular comorbidities, such as hypertension or heart disease, should be closely monitored and may require dose adjustments or alternative treatments 5, 4.
• The benefits and risks of esketamine treatment should be carefully weighed, considering the potential for increased heart rate and blood pressure, as well as the efficacy of the treatment in reducing depressive symptoms 3, 7.