Spravato™ Nasal Spray

Introducing an Effective Alternative to Ketamine IV Injections – No Needles Required

Spravato™ Nasal Spray

What is Spravato?

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 vs Ketamine – what’s the difference?

How is Spravato Administered?

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.

Spravato logo

Spravato Esketamine Treatments as An Alternative Treatment for MDD

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.

Discover the differences and value of both Ketamine infusions and Spravato nasal spray here.

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.

Spravato nasal spray is Esketamine for depression treatment

What Are the Possible Side Effects of Spravato?

The most commonly seen side effects of Spravato esketamine treatments are:

  • Dissociation
  • Dizziness
  • Nausea
  • Sedation
  • Spinning sensation
  • Reduced sense of touch and sensation
  • Anxiety
  • Lack of energy
  • Increased blood pressure
  • Vomiting
  • Feeling drunk/inebriated

More serious side effects Spravato include: 

  • Increased blood pressure
  • Problems with thinking clearly
  • Bladder problems

Please note: Spravato esketamine treatments cannot be used for pain relief or any other diagnosis and may not be prescribed to minors. 

Click here for more Spravato frequently asked questions and answers (FAQs).

Please click the boxes to the right of each question below to learn the answers to these popular Spravato FAQs.

  • What Is Esketamine?
  • As a Provider, How Can I Refer a Patient to Your Spravato Clinic?
  • Is Spravato Covered by My Insurance?
  • What Is the Difference Between Spravato and Ketamine Infusions?
  • What Is the Difference between Ketamine and Esketamine?
  • What is Important to Know About Spravato?
  • What Should I Avoid After Spravato Esketamine Treatments?
  • What Preexisting Conditions Would Prevent Use of Spravato?
  • What Should I do Before Taking Spravato?
  • Where Can I Find More Information About Spravato Esketamine Treatments?
  • Is There More Than One New Pathways Spravato Clinic Location?
What Is Esketamine?

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.

As a Provider, How Can I Refer a Patient to Your Spravato Clinic?

If you are provider interested in referring a patient, please see our Electronic Patient Referral or Referring Provider Form

Is Spravato Covered by My Insurance?

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. 

What Is the Difference Between Spravato and Ketamine Infusions?

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

What Is the Difference between Ketamine and Esketamine?

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.

What is Important to Know About Spravato?

The following information is provided by Janssen Pharmaceuticals:

Spravato™ can cause serious side effects, including: 

    • Sedation and dissociation. Spravato™ may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation). 
    • Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out. 
    • Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking Spravato™. Your healthcare provider will decide when you are ready to leave the healthcare setting. 

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™. 

    • Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs. 
    • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction. 

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? 

    • Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions. 
    • Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings. 
    • Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms. 

Tell your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you: 

    • attempts to commit suicide 
    • worsening depression 
    • thoughts about suicide or dying 
    • other unusual changes in behavior or mood 

Spravato™ is not for use in children. 

What Should I Avoid After Spravato Esketamine Treatments?
  • Activities are not recommended until the next day – following a restful sleep. 
  • Do not drive, operate machinery, or perform any action that requires absolute alertness after taking Spravato™. 
What Preexisting Conditions Would Prevent Use of Spravato?
  • Aneurysmal vascular (blood vessel) disease  
  • Arteriovenous malformation – an abnormal connection between your veins and arteries 
  • History of brain bleeds 
  • Serious cardiac, liver, kidney, or respiratory conditions
  • Allergic history with esketamine, ketamine, or any of the other ingredients in Spravato™. 

Please talk to your primary healthcare provider if you have concerns about any of the stated conditions. 

What Should I do Before Taking Spravato?

Tell your primary healthcare provider about all medical conditions, particularly if you have: 

  • Psychotic Episodes 
  • Hypertension (high blood pressure) 
  • Slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness, or fainting 
  • History of heart attack, stroke, or liver problems 
  • Heart valve disease or heart failure 
  • History of brain injury or pressure 
  • A pregnancy or a plan for pregnancy. Spravato™ is not approved for pregnant patients 
  • An active breastfeeding plan 

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. 

Where Can I Find More Information About Spravato Esketamine Treatments?

Please reference Janssen Pharmaceuticals’ Prescribing Information and Medication Guide or visit www.SPRAVATO.com. 

If you are a patient, please talk with your primary mental health provider for more information. 

Is There More Than One New Pathways Spravato Clinic Location?

Yes! New Pathways has expanded our services to central Ohio and now has a Columbus Spravato clinic in metropolitan Columbus , serving central and southern Ohio residents. We offer the same clinical services as at our Cleveland location.

Contact New Pathways Clinic in Cleveland to Get Started with Spravato Esketamine Nasal Spray

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!


At New Pathways Clinic our heartfelt mission is to establish a holistic mental wellness campus that touches the lives of individuals in the greater Cleveland, Columbus, and Cincinnati regions. We are dedicated to combining state-of-the-art mental health treatments, like Ketamine therapy infusions and Spravato nasal spray, with the expertise of compassionate mental health professionals to treat depression, anxiety, PTSD, migraines, and bipolar disorder.

Our unwavering commitment drives us to continuously evolve and adapt as the scientific landscape of ketamine research expands and diversifies, leading to innovative mental health treatments. We are determined to pave the way for a healthier future for Cleveland, central Ohio, and southern Ohio.

New Pathways Clinic also offers Semaglutide & Tirzepatide weight-loss shots, ketamine-assisted psychotherapy, and  ketamine/Spravato support groups for patients.

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