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Spravato is the brand name for esketamine and is available as a nasal spray.

Spravato is available as 28 mg of esketamine per device. Each nasal spray device delivers two sprays containing a total of 28 mg of esketamine.

Spravato is a NMDA receptor antagonist and is used for the following:

• Treatment-resistant depression (TRD) in adults
• Major depressive disorder in adults with suicidal ideation or behavior (MDSI)

Spravato is a N-methyl-D-aspartate (NMDA) receptor antagonist. It’s not exactly known how the medication works to help with depression. But it’s thought to balance the chemicals and signaling pathways in your brain that are involved with regulating your mood.

Spravato is given as a spray into the nose at a provider’s treatment center. Each device contains 1 spray for each nostril and a total of 28 mg of esketamine.

• Spravato is typically used along with an antidepressant that’s taken by mouth

Treatment-resistant depression (TRD):

• Weeks 1 to 4: The typical starting dose is 56 mg sprayed into the nose on day 1. After the first day, the dose is 56 mg or 84 mg twice per week.
• Weeks 5 to 8: The typical dose is 56 mg or 84 mg sprayed into the nose once per week
• Week 9 and beyond: The typical dose is 56 mg or 84 mg sprayed into the nose once every week or every other week, depending on how you respond to the medication
• Major depressive disorder with suicidal ideation or behavior (MDSI): The recommended dose is 84 mg sprayed into the nose twice per week for 4 weeks (1 month). The dose can be lowered to 56 mg twice per week if you’re having side effects. After 1 month of treatment, your provider will decide whether you should continue treatment with Spravato based on how well you’re responding to the medication

Spravato is a safe and effective treatment when used for FDA licensed indications. However, like all medications, they may give you unwanted side effects. You should always discuss potential side effects with your physician to ensure the medication is suitable and right for you. You should not use this medication in the following:

• Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation.
  Intracerebral hemorrhage
• Hypersensitivity to esketamine, ketamine, or any of the excipients

Common side effects of Spravato:

• Dissociation
• Dizziness
• Nausea
• Sleepiness
• Vertigo
• Headache
• Changes in taste
• Numbness
• Anxiety
• Feeling sluggish
• Higher blood pressure

Serious side effects are rare with Spravato. Contact your healthcare provider immediately if you experience any of the following.

• Extreme sleepiness
• Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
• Suicidal thoughts and behaviors: anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness
• Extremely high blood pressure: chest pain, shortness of breath, severe headache, visual changes

The following medications may interact with Spravato:

• Concomitant use with CNS depressants (e.g., benzodiazepines, opioids, alcohol) may increase sedation. Closely monitor for sedation with concomitant use of Spravato with CNS depressants
• Concomitant use with psychostimulants (e.g., amphetamines, methylphenidate modafinil, armodafinil) may increase blood pressure. Closely monitor blood pressure with concomitant use of
• Spravato with psychostimulants
• Concomitant use with monoamine oxidase inhibitors (MAOIs) may increase blood pressure. Closely monitor blood pressure with concomitant use of Spravato with MAOIs

Janssen Pharmaceuticals

Spravato is not recommended during pregnancy. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including Spravato, during pregnancy. Healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at women’s health

• Esketamine