Ketamine nasal spray is a fairly new product that became FDA-approved in 2019 to treat depression. In this medicinal form, it’s called esketamine. Because the nasal spray is FDA-approved there’s a chance that it may be covered by insurance policies. After each dosage of the nasal spray, there is a 2-hour monitoring period to ensure the patient isn’t suffering any negative side effects.

 Ketamine Nasal Spray is identified as a Schedule III controlled substance under the Controlled Substances Act and therefore has a low to moderate risk of psychological and physical dependence.927 Physicians should carefully analyze an individual’s risk of substance dependency, including alcohol, before prescribing and administering intranasal ketamine and should continuously monitor patients for signs of psychological and physical dependence throughout the treatment course.

Ketamine Nasal Spray is contraindicated in patients with schizophrenia. Ketamine may increase symptoms of psychosis and may exacerbate the symptoms of schizophrenia.14

Intranasal ketamine is contraindicated for patients with severe hepatic impairment.23

ketamine nasal spray causes a temporary increase in blood pressure and is, therefore, contraindicated in patients with hypertension. ketamine nasal spray is contraindicated in patients with conditions that, with an increase in blood pressure, pose a serious health risk, including aneurysmal vascular disease, history of intracerebral hemorrhage, and arteriovenous malformation)

Ketamine infusions are used for acute pain treatment in emergency departments and in the perioperative period in individuals with refractory pain. The doses are lower than those used for anesthesia; they are usually referred to as sub-anesthetic doses. Adjunctive to morphine or on its own, ketamine reduces morphine use, pain level, nausea, and vomiting after surgery. Ketamine is likely to be most beneficial for surgical patients when severe post-operative pain is expected and for opioid-tolerant patients