SPRAVATO®

You’ll hear buzz about the new controlled Rx Spravato (esketamine) nasal spray for adults with resistant depression.

Some experts already use low-dose IV ketamine infusions in these patients…since growing data suggest this may “jump-start” improvement.

Spravato is the active isomer of ketamine. Both block N-methyl-D-aspartate (NMDA) receptors.

Spravato is given intranasally twice a week for 4 weeks…then once every 1 or 2 weeks. There isn’t much evidence for use past 1 year.

And not all studies show a benefit. But some patients may start to see improvement within 24 hours of the first Spravato dose…and continued use may maintain improvement or remission longer than placebo.

Expect patients to self-administer Spravato, but only at a prescriber’s office or clinic…due to misuse and abuse risk. Plus patients must be monitored for at least 2 hours after EACH dose…due to transient BP spikes, sedation, hallucinations, et

Advise saving Spravato as a last-line option for resistant depression, such as patients not responding to at least two different optimized regimens.

Ensure Spravato patients also continue on an oral antidepressant…either an SSRI or SNRI.

Advise not to eat for at least 2 hours before or drink 30 minutes before a dose of Spravato…since it may cause nausea and vomiting.

And tell patients they can’t drive until the next day after a good night’s sleep…since they may feel sleepy or disconnected.

Educate patients to report suicidal thoughts or warning signs (agitation, impulsivity, etc)…as you would with any antidepressant.