SPRAVATO™ FAQS

Spravato™ is a prescription nasal spray of esketamine, used for treatment-resistant depression (TRD) or Major Depressive Disorder (MDD) with suicidal thoughts.

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.

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

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 patient’s healthcare provider will determine how much Spravato™ the patient will take and when they will take it. 
• Spravato™ is self-administered as a nasal spray, under the supervision of a healthcare provider in a healthcare setting. The use of the nasal spray will be demonstrated to the patient.  
• Some patients experience nausea and vomiting with Spravato™. It is recommended to avoid eating for at least 2 hours and drinking liquids at least 30 minutes before treatments. 
• If a patient uses a nasal corticosteroid or a nasal decongestant, they should take those medicines at least 1 hour before taking Spravato™. 
• During and after each use of the Spravato™ nasal spray device, the patient will be checked by a healthcare provider who will decide when they are ready to leave the healthcare setting. 

• The patient will need to plan for a caregiver or family member to drive them home after each of the Spravato esketamine treatments.

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. 

• 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™. 

Most commonly seen side effects of Spravato™ are: dissociation, dizziness, nausea, sedation, spinning sensation, reduced sense of touch and sensation, anxiety, lack of energy, increased blood pressure, vomiting, and feeling drunk. 

The most serious side effects Spravato™ can cause include: 

• Increased blood pressure. Spravato™ can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your provider will check your blood pressure before taking Spravato™ and for at least 2 hours after. Please notify your provider immediately if you experience chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking Spravato™.   
• Problems with thinking clearly. Please notify your healthcare provider if you have issues thinking or remembering. 
• Bladder problems. Please notify your healthcare provider if you experience issues urinating, such as a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night. 
• Other very rare side effects of Spravato™ exist. 

• 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. 

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. 

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. 

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.