SPRAVATO® (Esketamine)
Provider Summary
Uses
Treatment-Resistant Depression (TRD) in adults (may be used alone or with an oral antidepressant).
MDD with acute suicidal ideation/behavior in adults for depressive symptoms with an oral antidepressant (not proven to prevent suicide; higher-level care may still be needed).
Mechanism
NMDA receptor antagonist (glutamate modulator).
Pre-treatment Screening
NPO: No food ≥6 hours prior; no liquids ≥30 minutes prior.
If needed: nasal steroid/decongestant ≥1 hour before dosing.
Obtain baseline vitals with focus on BP; review CNS depressants/stimulants; confirm ride home.
Common side effects
Dissociation, dizziness, sedation/somnolence, Nausea/vomiting, headache, Anxiety, fatigue/ “feeling drunk”, Transient ↑BP, Unpleasant taste/nasal irritation
Adverse reactions / Warnings:
Sedation, dissociation
Respiratory depression (monitor with pulse oximetry)
Hypertension / hypertensive crisis symptoms (severe HA, chest pain, SOB, vision changes)
Abuse/misuse potential (CIII)
Worsening depression/suicidal thoughts; cognitive impairment
Contraindications
Aneurysmal vascular disease or AVM
History of intracerebral hemorrhage
Hypersensitivity to esketamine/ketamine or components
Monitoring
REMS required; administer only in certified healthcare setting; not for home use
Direct supervision; observe ≥2 hours post-dose
BP pre-dose and around ~40 minutes post-dose; monitor until stable
Discharge when clinically stable; no driving 24 hours
Patient Education
Given only in clinic; you must stay at least 2 hours for monitoring.
You may feel sleepy/dizzy or “disconnected” temporarily.
Bring a ride home; do not drive or do risky activities until the next day after a full night’s sleep.