Ketamine nasal spray: are we likely to see it in the UK?

Spravato (Janssen Pharmaceuticals, Inc.) is the first ketamine nasal spray formulation  approved by the FDA for use in treatment resistant-depression In USA. Spravato contains esketamine.

What is esketamine?

Esketamine, the drug used in Spravato is ‘enantiomer’ of ketamine, meaning it has the same chemical formula, however it is a ‘mirror image’ of ketamine. To put it in simple terms, if ketamine is represented by our right hand, esketamine would be our left hand.

Esketamine, like ketamine is a general anaesthetic with similar uses for both drugs. In terms of depression treatment, both drugs are fast acting with esketamine being more potent.

Because of potential for abuse esketamine is only available in US trough special distribution centers and not directly to patients.

How esketamine treat depression (video)

How likely that we will see ketamine nasal spray in the UK?

With price tag of £3500-£5200 per month of initial treatment it is highly unlikely that NICE approves ketamine nasal spray for treatment of depression in the UK. According to NICE guidelines, moderate to severe depression is managed with an antidepressant drug.  A selective serotonin reuptake inhibitor (SSRI) is prefered, first line treatment of depression. Citalopram and sertraline (SSRIs) are the most commonly used antidepressants in the UK. Read more about most common prescribed drugs in the UK in my separate post.

Is ketamine available for treatment of depression in UK?

Ketamine is available in UK for treatment of depression which has not responded to other treatments. Oxford Health NHS doundaion trust provides a private service with treatment of ketamine, only for patients referred to the service by their GP or psychiatrist. Low dose of ketamine is infused directly into your body over 40 minutes. The initial treatment of 3 infusion costs £215 per infusion.

Ketamine is currently classified as class B controlled drug in UK and carries penalties for possession, prison sentence and / or unlimited fine. Popularity of ketamine as drug of abuse has fallen in recent years with estimated 94000 adults who used it in 2016 (DrugWise, 2016).

References:

DrugWise (2016). Ketamine. Available at https://www.drugwise.org.uk/ketamine/ Accessed on 09/03/2019