Hey everyone, I just want to share with you about 5 things that you gotta know about intranasal
esketamine.
Before we begin talking about esketamine, I want to share with you a bit about ketamine
in general.
Ketamine consists of 2 enantiomers.
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What is an enantiomer?
2 molecular structures that are mirror images of each other but are not superimposable on
one another.
Now let's get back to the video.
One is called the (R)-Ketamine, and the other is called (S)-Ketamine.
And when you combine both of those enantiomers together, it's called the "racemic mixture."
It is the generic form of ketamine that is currently available.
Recently, Johnson & Johnson took half of that drug, (S)-Ketamine, and patented it, and made
it into an intranasal spray.
It's called Spravato.
You might have heard some things on the news about this intranasal spray.
So, let's get on to point #1: Intranasal ketamine has actually been around for quite some time.
It's basically the generic version of ketamine that has been made into a spray at a compounding
pharmacy.
And, it might actually be more effective than (S)-Ketamine alone.
But it's already available, it's here, and it has been here for over 50 years.
#2: The bioavailability of intranasal ketamine is actually quite low.
Some studies show it's between 25-50% that is actually delivered to the bloodstream.
Now what's cool about intravenous ketamine is it's actually 100% bioavailable, meaning
that all the ketamine that goes into the bloodstream is distributed peripherally.
And, when you're using ketamine, you only need to use the minimal effective dose.
Ketamine is a very safe drug, but it's better to use the lowest amount possible.
#3: One study actually showed that (R)-Ketamine is more potent than (S)-Ketamine in producing
its antidepressant effects.
And this study was done on an animal model; they gave 2 groups of mice either (R)-Ketamine
or (S)-Ketamine, and they found that the mice who received (R)-Ketamine actually had a sustained
antidepressant effect, and it was more longer lasting when they looked at them 1 week later
compared to (S)-Ketamine.
#4: There was one study that actually showed intranasal ketamine may actually not be an
effective treatment for depression.
One of the conclusions that they reached was that there was poor bioavailability, the patients
had a hard time administering the medication to themselves, and it was unclear whether
all of that got absorbed directly into the bloodstream.
So their conclusion was, in that study, that intranasal ketamine was not effective.
The studies from the (S)-Ketamine are showing that they were slightly better than placebo
for the Johnson & Johnson studies, but because treatment-resistant depression is such a huge
problem in the United States, the FDA did allow its approval.
#5: Intranasal esketamine will actually require healthcare monitoring.
It will not be directly dispensed to patients, so there is no take-home use.
And once a patient receives their intranasal esketamine, they have to wait in the clinic
for 2 hours to be observed and monitored as part of the risk-evaluation-and-mitigation
strategies that the FDA is requiring for any patient who receives this new drug.
According to the New York Times, the cost of 1 month of Spravato, or the intranasal
esketamine will cost anywhere between $4200 to $6700.
And the patients will need repeated intranasal sprays over a prolonged period of time.
So then the question remains, what will be the actual cost be for the patient with health insurance?
And we don't know that because each health insurance company is different, and there's
the additional cost of the healthcare monitoring that's going to be required.
So it's still unclear.
The bottom line is that now, intranasal esketamine is approved.
More people will be helped, and that's what's most important.
Also, more people will know that generic intravenous ketamine is also available, and can be very
effective for treatment-resistant depression, anxiety, PTSD, OCD, and neuropathic chronic pain.
So to wrap up: Really appreciate you watching me, if you have any questions, comments, please
leave me a message below.