2 Information about esketamine

Marketing authorisation indication

2.1 Esketamine nasal spray (Spravato, Janssen) with a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), is indicated 'for adults with treatment-resistant major depressive disorder who have not responded to at least 2 different treatments with antidepressants in the current moderate to severe depressive episode'. The scope of this appraisal is only for this indication.

Dosage in the marketing authorisation

2.2 The dosage schedule for esketamine is available in the summary of product characteristics for esketamine.


2.3 The device is single use and delivers 28 mg of esketamine in 2 sprays, one 14 mg spray per nostril. The list prices are as follows (excluding VAT; BNF online, accessed April 2022):

  • £163 for a 28 mg dose (one 28 mg device)

  • £326 for a 56 mg dose (two 28 mg devices)

  • £489 for an 84 mg dose (three 28 mg devices).

    The company had a commercial arrangement, which would have applied if the technology had been recommended.