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Intranasal Spravato (Esketamine)

What is Spravato™

(Esketamine)? Spravato™ (esketamine) is the first and only NMDA receptor antagonist approved for the treatment of TRD (Treatment-Resistant Depression) in adults. The FDA has approved Spravato™ (esketamine) nasal spray, in conjunction with an oral antidepressant, for the treatment of depression in adults who have tried other antidepressant medicines but have not benefited from them (treatment-resistant depression). Spravato™ has not been studied as an anesthetic or pain medication and is not approved for use in children or adolescents. The most common side effects experienced by patients treated with Spravato™ are dissociation, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity (hypoesthesia), anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Patients should avoid eating 2 hours prior and drinking 30 minutes before the treatment.


Recommended Dosage for SPRAVATO for Treatment-Resistant Depression in Adults
Induction Phase
Weeks 1 to 4: Day 1 starting dose: 56 mg. Administer twice per week. Subsequent doses: 56 mg or 84 mg
Maintenance Phase
Weeks 5 to 8: Administer once weekly 56 mg or 84 mg.
Week 9 and after Administer every 2 weeks or once weekly 56 mg or 84 mg

The recommended dosage of SPRAVATO for the treatment of depressive symptoms in adults with Major Depressive Disorder with acute suicidal ideation.
Induction Phase
Weeks 1 to 4: Starting dose: 84 mg twice weekly for 4 weeks. The dosage may be reduced to 56 mg twice weekly based on tolerability
Maintenance Phase
Weeks 5 to 8: Administer once weekly 56 mg or 84 mg. Week 9 and after: Administer every 2 weeks or once weekly 56 mg or 84 mg

What to Expect with Treatment

A relaxing, comforting, and safe environment is key to a pleasant experience, and we’ve been working to perfect it. Patients are provided warm and weighted blankets, noise-canceling headphones, blindfolds, special music playlists, and other items to help enhance the treatment.

We are the most experienced treatment facility in the state. The most commonly observed adverse reactions*

  • Dissociation
  • Dizziness
  • Nausea
  • Sedation
  • Vertigo
  • Hypoesthesia
  • Anxiety
  • Lethargy
  • Blood pressure increased
  • Vomiting
  • Feeling drunk

SPRAVATO™ is contraindicated in patients with Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation History of intracerebral hemorrhage Hypersensitivity to esketamine, ketamine, or any of the excipients

Insurance Coverage

Our office is happy to verify benefits and provide an estimate of treatment cost with SPRAVATO™. Patients may begin the process by calling our office to initiate care. Treatment with Spravato™ (esketamine) is typically covered by health insurance but depends on insurance approval and plan coverage. Insurance companies established criteria a patient must meet to initiate and continue this treatment. A patient must have depression that is severe and resistant to treatment (failed traditional antidepressants) to meet approval criteria. In addition, patients must demonstrate a response to treatment to continue. If patients do not have adequate evidence of symptom improvement or are not compliant with recommendations, insurance companies may not cover continued treatment.

Important Information about SPRAVATO™

Do not take SPRAVATO™ if you:
  • have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms, and legs)
  • have an abnormal connection between your veins and arteries (arteriovenous malformation)
  • have a history of bleeding in the brain
  • are allergic to esketamine, ketamine, or any other ingredients in SPRAVATO™.

If you are unsure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO™.

Before you take SPRAVATO™, tell your healthcare provider about all your medical conditions, including if you:

Have heart or brain problems, including:
  • high blood pressure (hypertension)
  • slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness, or fainting
  • history of heart attack
  • history of stroke
  • heart valve disease or heart failure
  • history of brain injury or any condition where there is increased pressure in the brain
  • have liver problems
  • have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believing in things that are not true).
  • are pregnant or plan to become pregnant. SPRAVATO™ may harm your baby. You should not take SPRAVATO™ if you are pregnant

Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO™.

If you can become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO™. If you are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO™.

Tell your healthcare provider about all the medicines that you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking SPRAVATO™ with certain medicines may cause side effects. Especially tell your healthcare provider if you take Central Nervous System (CNS) depressants, psychostimulants, or Monoamine oxidase inhibitors (MAOIs) medicines.

Side Effects of SPRAVATO™
How Will I Take SPRAVATO™?
  • You will take SPRAVATO™ nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting.
  • Your healthcare provider will show you how to use the SPRAVATO™ nasal spray device.
  • Your healthcare provider will tell you how much SPRAVATO™ you will take and when you will take it.
  • Follow your SPRAVATO™ treatment schedule exactly as your healthcare provider tells you to. During and after each use of the SPRAVATO™ nasal spray device, you will be checked by a healthcare provider who will decide when you are ready to leave the healthcare setting.
  • You will need to plan for a caregiver or family member to drive you home after taking SPRAVATO™.
  • If you miss a SPRAVATO™ treatment, your healthcare provider may change your dose and treatment schedule. Some people taking SPRAVATO™ get nausea and vomiting.
  • You should not eat for at least 2 hours before taking SPRAVATO™ and not drink liquids at least 30 minutes before taking SPRAVATO™.
  • If you take a nasal corticosteroid or nasal decongestant medicine, take these medicines at least 1 hour before taking SPRAVATO™.
  • What should I avoid while taking SPRAVATO™?
  • Do not drive, operate machinery, or do anything where you need to be completely alert after taking SPRAVATO™.
  • Do not take part in these activities until the next day, following a restful sleep.
What Are the Possible Side Effects of SPRAVATO™?

SPRAVATO™ may cause serious side effects, including:

  • Increased blood pressure. SPRAVATO™ can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO™ and for at least 2 hours after you take SPRAVATO™. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO™.
  • Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering.
  • Bladder problems.

Tell your healthcare provider if you develop trouble urinating, such as a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.

The most common side effects of SPRAVATO™, when used along with an ntidepressant taken by mouth, include dissociation, dizziness, nausea, sedation, spinning sensation, reduced sense of touch and sensation, anxiety, lack of energy, increased blood pressure, vomiting, and feeling drunk.

If these common side effects occur, they usually happen right after taking SPRAVATO™ and go away the same day. These are not all the possible side effects of SPRAVATO™.