Uses
What is Spravato used for?
Spravato (esketamine) is commonly used to treat certain types of depression.
Learn more about managing depression with Spravto.
Spravato may also be used for other conditions as determined by your healthcare provider.
How does Spravato work (mechanism of action)?
Spravato blocks a receptor in your brain called N-methyl-D-aspartate (NDMA) receptor which may improve symptoms of depression.
How is Spravato supplied (dosage forms)?
Spravato is available as a 28 mg/two sprays intranasal solution in a 56 mg dose kit and a 84 mg dose kit that is sprayed into the nose.
How should I store Spravato?
Spravato is usually given by a healthcare provider in a hospital or clinic. If you will store Spravato at home, follow the instructions given by your healthcare provider.
Side Effects
What are the most common side effects of Spravato?
The most common side effects of Spravato are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Dissociation, which is feeling disconnected from your thoughts, feelings, or surroundings
- Dizziness
- Nausea or vomiting
- Sleepiness or lack of energy
- Spinning sensation
- Numbness
- Increased blood pressure
- Feeling anxious
- Feeling drunk
- Feeling very happy or excited
There may be other side effects of Spravato that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of Spravato?
While less common, the most serious side effects of Spravato are described below, along with what to do if they happen.
Severe Allergic Reactions. Spravato may cause allergic reactions, which can be serious. Stop using Spravato and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Breathing Problems. Spravato may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your healthcare provider if you develop severe sleepiness or trouble breathing, especially when you start Spravato or when your dose is increased. Get emergency help if you have any of the following symptoms.
- Changes in the color of your skin, including bluish color to your lips and fingernails
- Confusion
- Shortness of breath
- Feeling dizzy, lightheaded, or fainting
- Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
- Slow or shallow breathing
- Excessive sleepiness or trouble staying awake
Suicidal Thoughts or Actions. Spravato or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of people 24 years old and younger, especially in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.
- New or increased thoughts of suicide or death
- Suicide attempt
- New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior
Memory or Thinking Problems. Spravato may cause problems with your memory or thinking. Tell your healthcare provider if you have any of the following symptoms.
- Trouble concentrating or paying attention
- Unusual changes in your judgment or decision making
- Trouble remembering things
Decreased Alertness or Coordination. Spravato can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Spravato affects you.
Increased Blood Pressure (Hypertension). Spravato may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while taking this medicine.
If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea/vomiting
- Blurry or other changes to vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heartbeats
Bladder Problems. Spravato may cause problems with your bladder or urinating (peeing). Tell your healthcare provider if you have any of the following symptoms of bladder problems.
- Frequent peeing
- Urgent need to pee
- Feeling pain when you pee
- Frequent peeing at night
Warnings & Precautions
Allergies to Ingredients. People who are allergic to any of the following should not use Spravato.
- Spravato
- Esketamine
- Ketamine
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in Spravato.
Health Conditions. People who have any of the following health conditions should not use Spravato.
- Aneurysmal vascular disease, which is a blood vessel disease that can affect your brain, chest, abdominal aorta, arms, or legs
- Arteriovenous malformation, which is an abnormal connection between your veins and arteries
- HIstory of bleeding in your brain
What should I know about Spravato before using it?
Do not use Spravato unless it has been prescribed to you by a healthcare provider. Use it as prescribed.
Do not share Spravato with other people, even if they have the same condition as you. It may harm them.
Keep Spravato out of the reach of children. Spravato is a controlled substance because it can be misused or lead to dependence. Store Spravato in a safe place to protect it from theft. It is illegal to sell or give away this medicine.
You will use Spravato under your healthcare provider’s supervision in a clinic or medical office. Your healthcare provider will monitor you for at least 2 hours after using Spravato. They will decide when you are ready to leave the clinic. Your caregiver or family member will need to drive you home after you receive Spravato.
Some people get nausea and vomiting when they use Spravato. Before your dose of Spravato, do not eat for at least 2 hours and do not drink liquids for at least 30 minutes.
Spravato can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Spravato affects you.
What should I tell my healthcare provider before using Spravato?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if Spravato is right for you.
In particular, make sure that you discuss any of the following.
Mental Health Problems. Tell your healthcare provider about your recent and current mental health problems, especially if you have had any of the following.
- Thoughts of suicide or dying, or have ever attempted suicide
- Seeing, feeling, or hearing things that are not there, also called psychosis
Substance Use Disorder. Spravato is a controlled substance and may be misused or lead to dependence. Tell your healthcare provider if you have a history of a drug or alcohol disorder, or if you have ever abused or been dependent on alcohol, prescription medicines, or illicit or street drugs.
Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
- Shortness of breath
- Chest pain
- Feeling lightheaded or fainting
- Heart attack
- Stroke
- Heart valve problems
- Heart failure
- Brain injury or increased pressure in your brain
- Liver problems
Pregnancy. Do not use Spravato while you are pregnant. Spravato may cause harm to an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant, stop using Spravato and contact your healthcare provider right away. If you are able to become pregnant, talk to your healthcare provider about the best way to prevent pregnancy during treatment with Spravato. If you become pregnant during treatment with Spravato, you can register for a pregnancy safety study by calling 844-405-6185 or at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
Breastfeeding. Do not use Spravato while you are breastfeeding. Spravato can pass into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed.
How can I get more information about Spravato?
For more information about Spravato, you can visit the manufacturer’s website at www.spravato.com or call them at 800-526-7736.
Interactions
Does Spravato interact with foods or drinks?
There are no known interactions between Spravato and foods or drinks.
It is unknown if drinking alcohol will affect Spravato. The risk of dizziness and sleepiness may be increased if you drink alcohol while taking Spravato.
Does Spravato interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before using Spravato.
- Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
- Psychostimulants, such as amphetamine and dextroamphetamine (Adderall) or methylphenidate (Ritalin), which are used for attention deficit hyperactivity disorder (ADHD)
- Modafinil (Provigil) or armodafinil (Nuvigil), which are used for certain sleep disorders
- A monoamine oxidase inhibitor (MAOI), which is a medicine usually used for depression or Parkinson’s disease
- A nasal corticosteroid or nasal decongestant medicine
This may not be a complete list of medicines that can interact with Spravato. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much Spravato?
If you or someone else has used too much Spravato, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of Spravato?
Spravato is given by a healthcare provider. Your healthcare provider will make sure you are receiving Spravato as scheduled.
If you miss an appointment to get your Spravato dose, call to make another appointment as soon as possible.