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SPRAVATO® (esketamine) CIII nasal spray

SPRAVATO® for treatment-resistant depression

SPRAVATO® is an FDA-approved nasal spray for adults with depression that has not responded to other antidepressants. You take it yourself in our office, under supervision, and stay with us for at least two hours afterward.

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How it works

What SPRAVATO® is

SPRAVATO® contains esketamine, which works on the brain's glutamate system. That is a different pathway from most oral antidepressants, which act mainly on serotonin, norepinephrine or dopamine.

It is FDA approved for adults with treatment-resistant depression, which is usually defined as depression that has not improved enough after at least two antidepressants, each tried at an adequate dose for long enough. It can be used on its own or together with an oral antidepressant.

Because of the risk of sedation, dissociation and misuse, SPRAVATO® is only available through a restricted FDA program called the SPRAVATO® REMS. It is never sent home with patients. Every dose is taken in a certified healthcare setting like ours.

What to expect

A treatment visit

  1. Before you arrive

    Don't eat for 2 hours or drink liquids for 30 minutes before your appointment. Arrange for someone to drive you home.

  2. Check-in

    We check your blood pressure and how you're feeling before your dose.

  3. Your dose

    You use the nasal spray yourself while a member of our staff watches. Each dose takes a few minutes.

  4. Monitoring

    You rest in our monitoring area for at least two hours while we check on you and your blood pressure. Then you go home with your ride.

Weeks 1–4
Twice a week
Weeks 5–8
Once a week
Week 9 onward
Weekly or every other week, based on how you're doing

Plan on about two and a half to three hours per visit. You should not drive or operate machinery until the next day, after a night's sleep.

Who it's for

Is SPRAVATO® right for you?

During your evaluation we review your treatment history, blood pressure, other medical conditions and substance use to decide whether SPRAVATO® is a safe and reasonable option for you.

It may be a fit if you

  • Are an adult with major depression
  • Have tried at least two antidepressants without enough benefit
  • Can arrange a ride home after each visit

You should not take SPRAVATO® if you have

An aneurysm or other aneurysmal blood vessel disease, an arteriovenous malformation, a history of bleeding in the brain, or an allergy to esketamine or ketamine. Tell us if you are pregnant, planning a pregnancy or breastfeeding.

Safety

Side effects

The most common side effects include feeling disconnected from yourself or your surroundings (dissociation), dizziness, nausea, sleepiness, a spinning sensation, numbness, anxiety, low energy, higher blood pressure, vomiting, feeling drunk and headache. They usually start soon after the dose and ease the same day.

This is why we monitor you for at least two hours and why you can't drive until the next day.

Important safety information

SPRAVATO® has a boxed warning, the FDA's most serious type of warning, for:

  • Sedation, dissociation and respiratory depression. You may feel very sleepy, feel disconnected, or have slowed breathing. You will be monitored for at least two hours after each dose.
  • Abuse and misuse. SPRAVATO® is a controlled substance. We check for risk of misuse before and during treatment.
  • Suicidal thoughts and behaviors. Antidepressants can increase suicidal thoughts and behaviors in some young adults. Tell us right away about new or worsening depression or thoughts of suicide.

This is not a complete list. Read the full Prescribing Information and Medication Guide (FDA), and ask us about anything you're unsure of.

Insurance

Coverage for SPRAVATO®

Coverage for SPRAVATO® depends on your plan and usually includes both the medication and the monitored office visit. Call us at (484) 212-6067 and we'll check your benefits and explain your costs before you start. More about insurance

Questions

Frequently asked questions

Is SPRAVATO® the same as ketamine?
No. Esketamine is related to ketamine, but SPRAVATO® is a specific FDA-approved nasal spray with its own dosing, safety program and monitoring requirements. We do not offer IV ketamine.
Can I bring something to do during monitoring?
Yes. Many people rest, listen to music or watch something calm. Some prefer to close their eyes. Having something familiar can help if you feel dissociation.
Can I take a rideshare or taxi home?
It's best to have a friend or family member pick you up. Please talk with us before your first visit if that's hard to arrange.
Do I have to stop my current antidepressant?
Not necessarily. SPRAVATO® can be used alone or with an oral antidepressant. We'll review all your medications, including any that could interact, during your evaluation.
How is SPRAVATO® different from Deep TMS?
SPRAVATO® is a medication with fewer visits per week but longer visits and no driving afterward. Deep TMS is a device treatment with shorter daily visits and no sedation. We can help you compare them.

If you are in crisis or thinking about harming yourself, call or text 988 or call 911. Our office is not set up for emergencies.

Ask whether SPRAVATO® is right for you

Monday–Friday, 9:00 a.m.–5:00 p.m.

Call (484) 212-6067