Spravato Nasal Spray: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Spravato Nasal Spray (esketamine) is a prescription medicine used to treat certain forms of depression in adults. It belongs to the miscellaneous antidepressant class and works as an NMDA receptor antagonist. Because of its side effects, it is given only in certified clinics under medical supervision, usually alongside an antidepressant taken by mouth.

What is Spravato Nasal Spray

Spravato is a prescription nasal spray medicine used to treat depression. It is given only in certified clinics under medical supervision because of its side effects.

Spravato Nasal Spray uses

• Treats adults with treatment-resistant depression (TRD), with or without an antidepressant taken by mouth
• Treats depressive symptoms in adults with major depressive disorder (MDD) who have suicidal thoughts or actions, used together with an antidepressant taken by mouth

Benefits of Spravato Nasal Spray

• May bring relief faster than standard antidepressants, sometimes within hours or days instead of weeks
• Can help when other antidepressants have not worked

How Spravato Nasal Spray works

Spravato works differently from standard antidepressants. Instead of acting on serotonin, it blocks a brain receptor called the NMDA receptor, which affects a brain chemical called glutamate that plays a role in mood. This may help explain why it can work faster than typical antidepressants.

Spravato Nasal Spray dosage

You give yourself the nasal spray while a healthcare provider supervises you in a certified clinic setting. You will be watched by a healthcare provider for at least 2 hours after each use, and you will need someone to drive you home after each treatment session.

Do not eat for at least 2 hours before your dose, and do not drink liquids for at least 30 minutes before your dose, because this medicine can cause nausea and vomiting. If you use a nasal corticosteroid or nasal decongestant, use it at least 1 hour before using Spravato.

Follow your treatment schedule exactly as your healthcare provider tells you; treatments are usually given twice a week at first, then less often over time. Do not drive, operate machinery, or do anything requiring full alertness until the day after treatment, following a full night's sleep. This medicine is not approved for use in children. If you miss a treatment, your healthcare provider may change your dose and schedule.

Available forms and strengths

• Nasal spray

Side effects of Spravato Nasal Spray

Common

• Feeling disconnected from yourself, your thoughts, feelings, and surroundings (dissociation)
• Dizziness
• Nausea
• Feeling sleepy (sedation)
• Spinning sensation (vertigo)
• Numbness (decreased feeling of sensitivity)
• Feeling anxious
• Lack of energy
• Increased blood pressure
• Vomiting
• Feeling drunk
• Headache
• Feeling very happy or excited

Serious

• Sedation severe enough to prevent staying awake, or fainting
• Respiratory depression or stopped breathing
• Severe dissociation or feelings of floating
• Sustained increases in blood pressure, chest pain, shortness of breath, severe headache, change in vision, or seizures
• Problems with thinking clearly or memory
• Bladder problems such as frequent, urgent, or painful urination
• Allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, or throat
• New or worsening suicidal thoughts or behavior
• Signs of abuse, misuse, or dependence

Warnings and precautions

• Spravato can cause sleepiness, fainting, or a sense of being disconnected from yourself, and can cause breathing problems, including slowed or stopped breathing. You must be monitored by a healthcare provider for at least 2 hours after each dose.
• There is a risk of abuse and misuse with this medicine, which may lead to physical and psychological dependence. Your healthcare provider should check for signs of abuse, misuse, and dependence before and during treatment.
• Because of the risks of sedation, dissociation, breathing problems, and misuse, Spravato is only available through a restricted program of certified healthcare settings, and patients must be enrolled in this safety program.
• Antidepressant medicines, including Spravato, may increase suicidal thoughts and actions in some people age 24 and younger, especially in the first few months of treatment or when the dose changes. Spravato is not approved for use in children.
• Do not take Spravato if you have a history of aneurysm or certain blood vessel conditions, an abnormal connection between veins and arteries, a history of bleeding in the brain, or an allergy to esketamine or ketamine.
• Spravato is not a substitute for hospitalization if your healthcare provider decides hospitalization is needed, even if you feel better after your first dose.
• Do not use Spravato if you are pregnant, as it may harm an unborn baby. Tell your healthcare provider right away if you become pregnant during treatment.
• Do not breastfeed while using Spravato, since the medicine passes into breast milk.
• Tell your healthcare provider if you have liver problems before starting Spravato.
• Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs, since this affects your risk of misuse or dependence with Spravato.
• Do not drive, operate machinery, or do anything that requires you to be fully alert after taking Spravato. Wait until the next day after a full night's sleep, and arrange for someone to drive you home after each treatment.

Storage

• Store at 20–25°C
• Keep in the original packaging
• Protect from light
• Do not freeze
• Keep out of reach of children

When to see a doctor

• Tell your healthcare provider or get emergency help right away if you or a family member have thoughts about suicide or dying, new or worse depression, extreme agitation or restlessness, trouble sleeping, aggressive or violent behavior, mania, suicide attempts, new or worse anxiety, panic attacks, new or worse irritability, acting on dangerous impulses, or other unusual changes in mood or behavior.
• Tell your healthcare provider right away if you feel like you cannot stay awake or feel like you are going to pass out.
• Tell your healthcare provider right away if you get chest pain, shortness of breath, a sudden severe headache, a change in vision, or a seizure after taking Spravato.
• Get emergency medical help if you have signs of an allergic reaction such as hives, difficulty breathing, or swelling of your face, lips, tongue, or throat.

Alternatives

• Trintellix
• Auvelity
• Ketamine