From the Research
Spravato (esketamine) is contraindicated in patients with aneurysmal vascular disease, arteriovenous malformation, or history of intracerebral hemorrhage, as well as those with hypersensitivity to esketamine, ketamine, or any components of the formulation, pregnant women, patients with psychotic disorders, uncontrolled hypertension, severe hepatic impairment, and active substance use disorders. The contraindications for Spravato (esketamine) are based on the potential risks of the medication, including increased blood pressure, dissociation, sedation, and abuse potential 1. Some of the key contraindications include:
- Aneurysmal vascular disease, arteriovenous malformation, or history of intracerebral hemorrhage due to the risk of bleeding from increased blood pressure
- Hypersensitivity to esketamine, ketamine, or any components of the formulation
- Pregnancy, as it may harm the developing fetus
- Psychotic disorders, such as schizophrenia, as it may worsen symptoms
- Uncontrolled hypertension, as it can significantly increase blood pressure
- Severe hepatic impairment (Child-Pugh class C), due to potential drug accumulation
- Active substance use disorders, as it may trigger cravings or worsen addiction These contraindications are supported by the most recent and highest quality study available, which highlights the importance of careful patient selection and monitoring in a certified healthcare setting under the REMS program 2. It is essential to note that the use of Spravato (esketamine) should be carefully considered in patients with a history of substance abuse or those who are at risk of developing substance use disorders, as it has the potential for abuse and dependence 3. Additionally, patients should be monitored for potential side effects, including dissociation, sedation, and increased blood pressure, and the medication should only be administered in a certified healthcare setting under the supervision of a healthcare provider 4, 5.