esketamine (nasal)

Brand Names: Spravato

Generic Name: esketamine (nasal)

What is esketamine (Spravato)?

Esketamine is a nasal spray that is used together with medication taken by mouth to treat depression that is resistant to to other treatments.

Esketamine is used only in a healthcare setting. You will not be able to use this medicine at home.

Esketamine is for use only in adults under a special program. You must be registered in the program and understand the risks and benefits of this medicine.

Esketamine may also be used for purposes not listed in this medication guide.

What are the possible side effects of esketamine (Spravato)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Your blood pressure will need to be checked before and after you use esketamine. Esketamine can increase your blood pressure for several hours after each dose. Tell your doctor if you have chest pain, trouble breathing, severe headache, blurred vision, pounding in your neck or ears, or a seizure.

Also call your doctor at once if you have:

  • extreme drowsiness or feeling like you might pass out;
  • severe dizziness or feelings of floating;
  • unusual changes in mood or behavior;
  • thoughts of hurting yourself;
  • worsening depression;
  • sleep problems;
  • problems with thinking or memory;
  • unusual or unpleasant memories (flashbacks);
  • hallucinations, feeling "spaced out"; or
  • urination problems (painful urination, increased urination, urgent need to urinate).

Common side effects may include:

  • dissociation, feeling drunk;
  • increased blood pressure;
  • drowsiness, lack of energy;
  • dizziness, spinning sensation;
  • feeling anxious;
  • nausea, vomiting; or
  • decreased sensations (touch or other senses).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about esketamine (Spravato)?

Esketamine can cause severe drowsiness, or feelings of being disconnected from your body or thoughts or surroundings. Esketamine is used only in a healthcare setting where you can be watched closely for at least 2 hours after each dose.

You will need someone to drive you home after using esketamine.

Some people have thoughts about suicide while taking esketamine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

What should I discuss with my healthcare provider before using esketamine (Spravato)?

You should not use this medicine if you are allergic to esketamine or ketamine, or if you have:

  • a blood vessel disorder affecting your brain, chest, stomach, heart, or arms and legs;
  • a history of aneurysm;
  • a history of bleeding in your brain; or
  • an abnormal connection between your veins and arteries (a condition called arteriovenous malformation).

Tell your doctor if you have ever had:

Some people have thoughts about suicide when first using an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Do not use if you are pregnant. Esketamine may harm an unborn baby. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of esketamine on the baby.

Do not breastfeed while using this medicine.

How should I use esketamine (Spravato)?

Esketamine is a nasal spray that is used in a healthcare setting. You will give yourself the nasal spray while being supervised by a healthcare professional.

Esketamine may cause nausea or vomiting. You should not eat anything for at least 2 hours before using esketamine. Avoid drinking liquids within 30 minutes before using the medicine.

Read and carefully follow any Instructions for Use that are given to you. Ask your doctor or caregivers if you do not understand these instructions.

You will be watched closely for at least 2 hours after you use esketamine. This medicine can cause side effects such as severe drowsiness, or dissociation (a sense of being detached from your body or emotions, distortions in how you perceive things or people around you).

Your caregivers will decide when you are ready to leave after using this medicine. You will need someone to drive you home. You should not plan to drive yourself anywhere until the next day, after a full night's sleep.

Esketamine is usually given 2 times per week at first, and then once every 1 to 2 weeks. Your doctor will tell you how often you need to use the medicine.


Depression is a(n) __________ . See Answer

What happens if I miss a dose (Spravato)?

Call your doctor for instructions if you miss an appointment for your esketamine dose.

What happens if I overdose (Spravato)?

Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while using esketamine (Spravato)?

Avoid using any other nasal medicines within 1 hour before you use esketamine nasal spray.

Do not drive yourself or do anything that requires you to be awake and alert until the day after your esketamine dose.

What other drugs will affect esketamine (Spravato)?

Tell your doctor about all your other medicines, especially:

This list is not complete. Other drugs may affect esketamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information (Spravato)?

Your pharmacist can provide more information about esketamine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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Reviewed on 10/12/2022

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