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Spravato (Esketamine) Information

Used in conjunction with an oral anti-depressant  for treatment resistant depression in adults (TRD). Spravato can only be administered at a 

REMS (Risk Evaluation and Mitigation Strategy) certified treatment center.

The goal of the REMS is to mitigate risks and abuse and misuse of Spravato ensuring that Spravato is only dispensed and administered to patients in a medically supervised healthcare setting that monitors these patients.

Each patient is informed about possible adverse outcomes resulting 

from sedation and disassociation and the need for monitoring.

Because of the possibility of delayed or prolonged sedation or 

dissociation in some cases, patients must be monitored by a healthcare professional for at least 2 hours following each treatment session, 

until the clinician determines the patient is safe to leave.


Weeks 1-4 :starting dose 56mg or 84mg twice weekly

Weeks 5-8 :56mg or 84mg once weekly

Weeks 9 and after: ( weekly or every 2 weeks ) 56mg or 8mg


 If doses are missed return to patients previous dosing schedule 

(per clinical judgement)

Spravato is a schedule III controlled substance and may 

be subject to abuse and diversion.


  • Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels) or arteriovenous malformation
  • History or intracerebral hemorrhage
  • Hypersensitivity to esketamine, Ketamine, or any of the excipients. No adverse effects of SPRAVATO nasal spray on cognitive functioning were observed in a one-year open-label safety study. They have not been evaluated beyond one year.
  • Not recommended for women who are pregnant or may become pregnant or women who are breastfeeding. SPRAVATO May cause fetal harm when administered to pregnant women.
  • The safety and effectiveness of SPRAVATO in pediatric patients have not been evaluated (17 and under)
  •  Safe for 65+

Before Administering SPRAVATO

  1.  Refrain from eating AT LEAST 2 hours in advance of administration. 
  2.  Refrain from drinking 30 minutes prior.
  3.  Patients who require a nasal corticosteroid or decongestant    should administer these  meds at least an hour before the SPRAVATO treatment.
  4. Do not drive or operate heavy equipment until following day and after a restful sleep.
  5. Arrange for a driver or UBER to take you to your appointment and home.


Learn More

The first and only NMDA receptor antagonist approved in conjunction with an oral AD for TRD in adults¹