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Spravato (56 MG Dose)
Spravato (generic name: esketamine) is a nasal spray used for the treatment of treatment-resistant depression (TRD) in adults and for depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or behaviors. Spravato is a derivative of ketamine, an NMDA receptor antagonist, which works differently from traditional antidepressants by restoring brain function and connections in areas involved in mood regulation. The 56 mg dose is typically used during the initial phase of treatment.
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Frequently Asked Questions
How quickly does Spravato start working?
Many patients experience significant improvements in depression symptoms within hours to days after starting Spravato, unlike traditional antidepressants, which can take weeks to become effective.
Can I take Spravato at home?
No, Spravato must be administered in a certified healthcare facility under medical supervision. Patients need to be monitored for at least 2 hours after each dose.
Will I feel "high" or hallucinate after using Spravato?
Some patients may experience dissociation, where they feel detached from their body or surroundings, but this is generally short-lived and monitored by medical staff during the session.
What should I do if I experience side effects like nausea or dizziness?
These side effects are common, particularly after the first few doses. The medical staff will monitor your condition, and you should report any concerning symptoms during your post-administration observation period.
How long does Spravato treatment last?
Spravato treatment typically starts with twice-weekly doses during the induction phase (about 4 weeks), followed by less frequent doses (weekly or every two weeks) during the maintenance phase. The duration of treatment depends on individual response and the severity of the condition.
Comprehensive Drug Guide
How Does Spravato (56 MG Dose) Work?
Spravato works by inhibiting the N-methyl-D-aspartate (NMDA) receptor, which plays a role in glutamate neurotransmission, an important process for mood regulation and synaptic plasticity. By blocking NMDA receptors, esketamine helps restore synaptic connections in the brain and improves depressive symptoms rapidly, often within hours. It also enhances the growth of new neural connections, which may contribute to long-term mood stabilization.
Common Dosages
- 56 mg or 84 mg of esketamine, depending on the dose.
Typical Dosing
- For treatment-resistant depression (TRD):
- Induction phase: The starting dose is typically 56 mg, administered twice a week for the first 4 weeks. After the initial dose, the maintenance dose is often increased to 84 mg per session.
- Maintenance phase: After the induction phase, patients continue to receive 84 mg (or 56 mg, if tolerated better) once a week for 4 weeks, then every 1 to 2 weeks thereafter.
- For MDD with suicidal ideation:
- The starting dose is 56 mg, followed by 84 mg per session twice a week for 4 weeks, in conjunction with an oral antidepressant.
Typical Dosing
FDA Approved Indications
- Treatment-resistant depression (TRD) in adults who have not responded adequately to at least two different antidepressant medications.
- Major depressive disorder (MDD) with acute suicidal ideation or behavior in adults, in conjunction with an oral antidepressant.
Who Shouldn't Take Spravato (56 MG Dose)?
- Aneurysmal vascular disease or arteriovenous malformation
- Intracerebral hemorrhage or history of bleeding disorders
- Hypersensitivity to esketamine or any of its components
Advice From The Pharmacist
- Spravato must be administered in a healthcare setting under the supervision of a certified provider due to its potential for side effects such as sedation and dissociation. Patients must remain in the facility for at least 2 hours after administration to monitor for any adverse reactions.
- Avoid eating or drinking for at least 2 hours before receiving Spravato to reduce the risk of nausea or vomiting.
- Patients should arrange for transportation home after each treatment session, as they will not be able to drive or operate heavy machinery for the rest of the day.
Side Effects of Spravato (56 MG Dose)
Common Side Effects
- Dissociation (feeling detached from reality)
- Dizziness
- Nausea or vomiting
- Sedation or drowsiness
- Elevated blood pressure
- Headache
Uncommon/Severe Side Effects
- Hypertension: Spravato can cause significant increases in blood pressure, particularly immediately after administration. Blood pressure should be monitored before and after each session.
- Cognitive impairment: Short-term memory issues and difficulties with concentration may occur during or after treatment.
- Suicidal thoughts: Although Spravato treats depression, there is a risk of suicidal thoughts or behaviors, especially during initial treatment.
Risks and Warnings of Spravato (56 MG Dose)
- Dissociation and Sedation: Spravato may cause dissociation (a feeling of detachment from reality) and sedation. Patients are monitored for at least 2 hours in the clinic following administration to ensure safety. Driving or operating machinery is not allowed until the following day.
- Increased Blood Pressure: Spravato can cause a temporary increase in blood pressure, which may be significant in patients with pre-existing hypertension. Blood pressure should be measured before and after each dose, and the medication should be used cautiously in patients with uncontrolled hypertension.
- Abuse Potential: As a derivative of ketamine, Spravato has potential for misuse and abuse, so it is classified as a controlled substance and only administered in certified medical facilities.
Interactions with Spravato (56 MG Dose)
Common Drug Interactions
- CNS depressants: Combining Spravato with other CNS depressants (e.g., benzodiazepines, opioids, alcohol) can increase the risk of excessive sedation, respiratory depression, or cognitive impairment.
- Stimulants: Medications that raise blood pressure, such as stimulants for ADHD, should be used cautiously with Spravato, as both can contribute to elevated blood pressure.
Alternatives to Spravato (56 MG Dose)
- Ketamine infusion: Intravenous ketamine is sometimes used off-label for the treatment of depression. While similar to esketamine, ketamine is not FDA-approved for depression and is administered intravenously in specialized settings.
- Electroconvulsive therapy (ECT): A treatment option for severe depression, particularly in patients who have not responded to medication.
- Transcranial magnetic stimulation (TMS): A non-invasive treatment option for depression that involves stimulating specific areas of the brain using magnetic fields.
- Antidepressants: Various classes of antidepressants, such as SSRIs, SNRIs, or tricyclic antidepressants, are often first-line treatments for major depressive disorder and treatment-resistant depression.
