Jeffrey Panko NP Psychiatry · Patient education
Esketamine
Spravato / Supervised intranasal treatment
A guide for adults receiving esketamine.
Follow your prescription and the treatment team’s recommendations.
Formulations: Spravato is a nasal spray used in a certified healthcare setting under supervision. It is different from compounded ketamine preparations and is not taken home for self-administration.
What it is used for
Spravato treats treatment-resistant depression in adults, either alone or with an oral antidepressant. It is also used with an oral antidepressant for depressive symptoms in adults with major depression and acute suicidal thoughts or behavior.
It has not been shown to prevent suicide and does not replace emergency assessment or hospitalization when needed.
How it works
Esketamine blocks NMDA receptors in glutamate signaling pathways. Its antidepressant effects can begin more quickly than those of many oral antidepressants, although response and duration vary.
What to expect over time
Some people notice improvement within a day, while others need repeated sessions. The clinic reviews response after the initial treatment period and adjusts maintenance frequency when appropriate.
Taking your medication
- Do not eat for at least two hours or drink liquids for at least 30 minutes before treatment. Follow the clinic’s other instructions.
- Use the nasal devices under staff supervision and remain for at least two hours of monitoring, longer if needed.
- Arrange a ride home. Do not drive until the next day after a restful sleep.
- Contact the clinic about a missed session; do not substitute another preparation.
When to get help
Emergency symptoms. Tell staff immediately about chest pain, severe headache, shortness of breath, visual changes, or inability to stay awake. After leaving, call 911 for severe symptoms.
Prompt medical advice. Contact the clinic for persistent distressing dissociation, worsening depression, bladder symptoms, or unexpected effects between sessions.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Feeling detached from your body or surroundings
- Dizziness, sleepiness, or a feeling of intoxication
- Nausea, vomiting, or headache
- A temporary increase in blood pressure
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Staff monitor blood pressure, breathing, alertness, and dissociation. Continue mood and safety follow-up between sessions. Report urinary symptoms or increasing difficulty with memory.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss aneurysms, vascular malformations, previous brain bleeding, uncontrolled blood pressure, heart disease, psychosis, substance use, and liver disease. Some vascular conditions rule out treatment. Discuss pregnancy, contraception, and breastfeeding before starting.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Opioids, benzodiazepines, alcohol, and other sedatives increase sedation. Stimulants and MAOIs may add blood-pressure effects. The clinic should review the full list before each treatment.
Everyday tips
Arrange transportation before each appointment.
Keep the treatment team’s contact information and your between-session safety plan available.
Your questions answered
Must it always be combined with an oral antidepressant?
Not for every indication. Current labeling allows treatment-resistant depression monotherapy. The acute-suicidal-symptom indication still requires an oral antidepressant.
Can I drive once the monitoring period ends?
No. Wait until the next day after a restful sleep, and longer if impaired.
Storage and safety
Spravato is stored and dispensed by the certified treatment setting. There is no home supply or catch-up dosing regimen.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.