Last update July 3, 2022

N01AX14; N06AX27

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Esketamine is the S isomer of the anesthetic ketamine. It is administered intravenously or intramuscularly for the induction and maintenance of general anesthesia and as a supplement to regional and local anesthesia, and to provide analgesia in the emergency care. Intranasal esketamine is being investigated for treatment-resistant depression. The pharmacokinetics of esketamine is very similar to that of ketamine. (Martindale)

At latest update no published data on excretion into breast milk were found.

No problems have been observed in infants of mothers treated with ketamine. (Gilder 2021, Ortega 1999)

List of WHO essential medicines: ketamine is compatible with breastfeeding. (WHO-UNICEF 2002)

Until more published data regarding breastfeeding is available, the use of a known and safer alternative drug should be preferred, especially during the neonatal period and/or in case of premature infant.


See below the information of these related products:

  • (General Anesthesia) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Maternal Depression (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Alternatives

  • Dexmedetomidine Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Etomidate ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Fentanyl ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Methohexital ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Propofol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Sertraline Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Thiopental Sodium ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

N01AX14; N06AX27 is Esketamine Hydrochloride in ATC Code/s.

Is written in other languages:

N01AX14; N06AX27 is also known as

Groups

N01AX14; N06AX27 belongs to these groups or families:

Tradenames

Main tradenames from several countries containing N01AX14; N06AX27 in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. Intranasal: 48 %
Molecular weight 274 daltons
Protein Binding 43 - 45 %
VD 10.1 l/Kg
pKa 19.77 -
Tmax 0.3 - 0.7 hours
7 - 12 hours

References

  1. NIH. Natinal Institute on drug abuse Drogas psicodélicas y disociativas. - 2023 Consulted on July 10, 2023 Full text (link to original source)
  2. Royal Pharmaceutical Society. Martindale: The Complete Drug Reference Medicines Complete. available online from: https://www.medicinescomplete.com 2022 Abstract
  3. Gilder ME, Tun NW, Carter A, Tan FFSL, Min AM, Eh H, Aye P, Carrara VI, Angkurawaranon C, McGready R. Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting. BMC Pregnancy Childbirth. 2021 Feb 9;21(1):121. Abstract Full text (link to original source)
  4. Janssen. Esketamine Nasal Spray. Drug Summary. 2020 Full text (link to original source) Full text (in our servers)
  5. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Abstract Full text (link to original source) Full text (in our servers)
  6. Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999 Abstract

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