What is Spravato? Spravato is a prescription nasal spray for esketamine treatments, a drug used as a general anesthetic and also effectively for treatment-resistant depression (TRD) or Major Depressive Disorder (MDD) with suicidal thoughts. Spravato is a self-administered nasal spray, normally under the supervision of a healthcare provider in a healthcare setting. While initially developed due to the positive results of ketamine injections, Spravato is considered an alternative due to its ingredients and the way it is administered to patients.
Spravato is self-administered as two to three sprays in five-minute increments and is a good alternative for patients who would prefer to avoid an IV or who have anxiety surrounding IV needles. It must be administered in combination with an oral antidepressant. The patient’s healthcare provider will determine exactly how much Spravato the patient will take and when they will administer it.
Depending on how long a healthcare provider recommends for the patient to take the drug, here is a typical prescription schedule:
Weeks 1 to 4: Spravato esketamine treatments are administered twice a week, eight times in total.
Weeks 5 to 8: One treatment weekly
Week 9 and after: Every 2 weeks or as needed, depending on the patient’s response.
In 2019, the Esketamine nasal spray Spravato was approved by the FDA for the treatment of MDD that is treatment resistant or includes suicidal thoughts. With its approval, patients now have the choice between Ketamine IV infusions or esketamine treatments in the form of a nasal spray for MDD.
Clinical trials reveal that Spravato can have a positive effect on depressive symptoms by lowering the frequency of suicidal thoughts, and also by strengthening or repairing damaged or weakened neurotransmitters that can cause depression in the first place – thereby potentially helping develop new cell connections in the brain.
The most commonly seen side effects of Spravato esketamine treatments are:
More serious side effects Spravato include:
Please note: Spravato esketamine treatments cannot be used for pain relief or any other diagnosis and may not be prescribed to minors.
The FDA-approved drug esketamine is one version of the ketamine molecule, and makes up half of what is found in the commonly used anesthetic form of the drug, ketamine. It works similarly to ketamine but its chemical makeup allows it to bind more tightly to the NMDA glutamate receptors, making it two to five times more potent. This means that patients need a lower dose of esketamine than they do ketamine to experience positive results. The nasal spray (Spravato) allows the drug to be taken more easily in an outpatient treatment setting (under the supervision of a doctor), making it more accessible for patients than the IV treatments currently required to deliver ketamine. For more information, see this Yale Medicine article.
Almost all insurance providers will cover Spravato™ if they deem the patient to meets the criteria for treatment. We pre-authorize every patient before treatment to ensure they will know the cost ahead of time. Patients with Medicaid who approved by their insurance will owe $0 per treatment. We also help patients with private health insurance apply for a Janssen’s CarePath Account, which could result in co-pays as little as $10 for each Spravato treatment.
Spravato was developed because of the promising scientific results IV Ketamine infusions have shown in treating Major Depressive Disorder. It only contains S-Ketamine, while IV Ketamine infusions include a mixture of S-Ketamine and R-Ketamine. Spravato is also administered as a nasal spray while ketamine is administered via IV infusions at New Pathways Clinic. For a more detailed comparison see: Spravato Vs. Ketamine
There are two different types of Ketamine: R-Ketamine and S-Ketamine. While they are nearly identical molecules, they have slightly different effects on the brain. The type of Ketamine used in IV infusions is racemic, which means that is a mixture of R-Ketamine and S-Ketamine. Meanwhile, Esketamine (Spravato) is isolated to only contain S-Ketamine, which makes Spravato unique for Esketamine treatments.
Early scientific evidence suggests that both are effective treatments. IV Ketamine infusions of racemic Ketamine may present better outcomes due to a number of factors such as delivery method, dosage, and chemistry.
The following information is provided by Janssen Pharmaceuticals:
Spravato™ can cause serious side effects, including:
Abuse and misuse. There is a risk for abuse and physical and psychological dependence with Spravato™ Your healthcare provider should check you for signs of abuse and dependence before and during treatment with Spravato™.
Spravato™ Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, Spravato™ is only available through a restricted program called the Spravato™ Risk Evaluation and Mitigation Strategy (REMS) Program. Spravato™ can only be administered at healthcare settings certified in the Spravato™ REMS Program and to patients enrolled in the program.
Increased risk of suicidal thoughts or actions. Spravato™ may cause worsening of depression and suicidal thoughts and behaviors, especially during the first few months of treatment and when the dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.
How can I watch for and try to prevent suicidal thoughts and actions?
Tell your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
Spravato™ is not for use in children.
Please talk to your primary healthcare provider if you have concerns about any of the stated conditions.
Tell your primary healthcare provider about all medical conditions, particularly if you have:
Tell your primary healthcare provider about all the medicines that you take, including supplements. Spravato™ esketamine treatments may cause side effects when combined with other medicines.
Central Nervous System (CNS) depressants, psychostimulants, or Monoamine oxidase inhibitors (MAOIs) are of particular concern.
At New Pathways Clinic, we are always sensitive to each patient’s unique history and needs. We will never make you feel uncomfortable or unwelcome in our care. Reach out to us today to find out if Spravato Nasal Spray is the right option for you. We look forward to being of assistance!