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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.
Search results for:

esketamine

esketamine
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Spravato SPRAY, NASAL 28 mg/device (56 mg dose); 28 mg/device (84 mg dose)      

VIEW MORE NMDA Antagonists
CLASS
28160406

Additional Information and Links

Limited trial:

Non-formulary (NF) but approved for use in Lafayette region during a 6-month validation period

Non-formulary (NF) but approved for use at NOMH for 6-month validation with same restriction/criteria of use:

esketamine (Spravato) intranasal use restricted to:

  • Indication: in conjunction with an oral antidepressant, for the treatment of treatment-resistant depression (TRD) or depressive symptoms with major depressive disorder (MDD) with acute suicidal ideation or behavior.
  • Service line: Psychiatry
  • Formulary location: Outpatient
  • Service location: Outpatient
  • Patient population: Adults
  • Prior authorization required: Yes
  • Restriction/criteria of use (all will apply unless specified):
    • For diagnosis of treatment-resistant depression: confirmed by trial and failure of more than one moderately-dosed (i.e. half maximum dose or greater) antidepressant from at least 2 different classes for at least 8 weeks each for a single depressive episode.
        • OR
    • For major depressive disorder (MDD) with acute suicidal ideation or behavior: confirmed in conjunction with at least one oral antidepressant.
      • Female at age of reproduction: negative pregnancy test.
      • Patient does not have diagnosis of psychotic disorder.
      • Patient does not have any of the following contraindications:
        • Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels).
        • History of intracerebral hemorrhage.
        • Hypersensitivity to esketamine, ketamine, or any of the excipients.
      • Comply with SPRAVATO REMS requirements (https://www.spravatorems.com):
        • Outpatient healthcare setting must be certified in the SPRAVATO REMS.
        • Pharmacies must be certified in the SPRAVATO REMS to dispense to outpatient setting
        • Patients treated in outpatient setting must be enrolled in the SPRAVATO REMS

Last updated: Jun. 12, 2025


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