Real-world approach to managing dysgeusia following the use of esketamine nasal spray: a case report

BACKGROUND: Patients with depression who are treated with esketamine nasal spray may commonly experience dysgeusia (bad/metallic/bitter taste) and related side effects such as nausea and vomiting. While pretreatment with antiemetics can mitigate or prevent nausea and vomiting, it may not address dysgeusia as a contributing factor. Alternative interventions could help to manage vomiting due to dysgeusia following administration of esketamine nasal spray in those patients who are affected. CASE PRESENTATION: A 40-year-old man presented to the emergency department with depression and started treatment with an oral antidepressant. After providing informed consent to participate in a clinical trial evaluating the efficacy and safety of esketamine for major depressive disorder with active suicidal ideation with intent, he received 84 mg of esketamine nasal spray twice per week for 4 weeks. On the first 2 days of esketamine administration, the patient reported dysgeusia lasting several hours and intermittent retching lasting approximately 20 min. The patient was then given a fruit punch–flavored powdered drink (Crystal Light Fruit Punch™) approximately 25 min after nasal spray administration during the study period. The use of a fruit punch drink resulted in notable improvement of dysgeusia and associated vomiting, with time to resolution occurring within 30 min of the report of the adverse event. CONCLUSIONS: A fruit punch–flavored powdered drink mix taken shortly after administration of esketamine nasal spray may rapidly manage and prevent vomiting due to dysgeusia.