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Spravato (84 MG Dose)
Spravato (generic name: esketamine) is a nasal spray used for the treatment of treatment-resistant depression (TRD) in adults. It is also approved for depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal ideation or behavior. Esketamine is a derivative of ketamine and works differently from traditional antidepressants by targeting NMDA (N-methyl-D-aspartate) receptors in the brain, leading to rapid antidepressant effects. Spravato is used alongside oral antidepressants.
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Frequently Asked Questions
How quickly does Spravato start working?
Spravato can start reducing depressive symptoms within 24 hours, making it a rapid-acting treatment option for patients with treatment-resistant depression or acute suicidal ideation.
Can I take Spravato at home?
No, Spravato must be administered in a certified healthcare setting under supervision due to the potential for side effects like sedation and dissociation, as well as the need for blood pressure monitoring.
How long do I need to be monitored after each dose of Spravato?
Patients are monitored for at least two hours after each dose of Spravato to watch for side effects like elevated blood pressure, dissociation, or sedation.
Can Spravato cause dependence?
Yes, Spravato contains esketamine, which has the potential for abuse and dependence. It is closely monitored in a healthcare setting to minimize this risk.
What should I avoid after taking Spravato?
You should avoid driving or operating heavy machinery for at least 24 hours after taking Spravato, as it can cause sedation and affect your ability to function safely.
Comprehensive Drug Guide
How Does Spravato (84 MG Dose) Work?
Spravato (esketamine) works by blocking NMDA receptors, which are involved in synaptic plasticity and mood regulation. This action helps restore the balance of neurotransmitters in the brain, leading to improvements in mood and a rapid reduction in depressive symptoms, especially in patients who have not responded well to other treatments. The exact mechanism by which esketamine produces its antidepressant effects is not fully understood but is thought to involve the stimulation of glutamate release.
Common Dosages
- Initial dose for treatment-resistant depression (TRD): 56 mg intranasally on Day 1, followed by 84 mg (three sprays of 28 mg) twice weekly.
- For depressive symptoms in MDD with suicidal ideation: Start with 84 mg twice weekly for 4 weeks.
Typical Dosing
- Treatment-resistant depression (TRD): After the initial dose of 56 mg, most patients are transitioned to 84 mg, administered twice a week for the first four weeks, followed by once a week or once every two weeks during the maintenance phase.
- MDD with acute suicidal ideation or behavior: The dose is 84 mg twice weekly for 4 weeks, alongside oral antidepressants.
Typical Dosing
FDA Approved Indications
- Treatment-resistant depression (TRD) in adults who have not responded adequately to at least two different antidepressants.
- Major depressive disorder (MDD) with acute suicidal ideation or behavior in adults, used in conjunction with oral antidepressant therapy.
Who Shouldn't Take Spravato (84 MG Dose)?
- Aneurysmal vascular disease (including cerebral aneurysms) or arteriovenous malformations.
- Intracerebral hemorrhage.
- Hypersensitivity to esketamine or any of the components in Spravato.
Advice From The Pharmacist
- Spravato must be administered in a certified healthcare setting under the supervision of a healthcare provider, who will monitor you for at least two hours after each dose due to potential side effects, such as sedation and dissociation.
- Do not drive or operate machinery for at least 24 hours after receiving Spravato, as it can impair your mental and physical abilities.
- Continue to take your oral antidepressant as prescribed by your doctor in combination with Spravato for the best therapeutic effect.
Side Effects of Spravato (84 MG Dose)
Common Side Effects
- Dissociation (feeling disconnected from reality)
- Dizziness
- Nausea or vomiting
- Sedation or drowsiness
- Increased blood pressure
- Anxiety
Uncommon/Severe Side Effects
- Elevated blood pressure: Increases in blood pressure are common and may be significant, particularly immediately after dosing.
- Suicidal thoughts: Though rare, antidepressants may increase the risk of suicidal thinking, particularly in young adults.
- Addiction and dependence: Esketamine has the potential for abuse and dependence.
Risks and Warnings of Spravato (84 MG Dose)
- Blood Pressure Increases: Spravato can cause significant increases in blood pressure that usually peak around 40 minutes after administration. Blood pressure should be monitored before and after each dose, and treatment may need to be delayed if blood pressure is too high.
- Sedation and Dissociation: Patients may experience dissociation (a feeling of being detached from themselves) or sedation after receiving Spravato. Because of this, patients must be monitored for at least two hours after each dose.
- Potential for Abuse: Esketamine is related to ketamine, which is known for its potential for abuse. Spravato should only be used in patients with a clear need for its antidepressant effects and monitored closely for signs of misuse.
Interactions with Spravato (84 MG Dose)
Common Drug Interactions
- CNS depressants: The concurrent use of other central nervous system depressants (such as benzodiazepines, opioids, or alcohol) can enhance the sedative effects of Spravato, increasing the risk of excessive sedation or respiratory depression.
- Stimulants: Medications like amphetamines or methylphenidate can increase the risk of high blood pressure when taken with Spravato.
Alternatives to Spravato (84 MG Dose)
- Ketamine infusion therapy: A closely related treatment using racemic ketamine, administered intravenously, for treatment-resistant depression.
- Electroconvulsive Therapy (ECT): Another treatment for treatment-resistant depression that uses electric stimulation of the brain to alleviate depressive symptoms.
- Vagus Nerve Stimulation (VNS): A neurostimulation technique sometimes used for treatment-resistant depression.
- Traditional antidepressants: Antidepressants such as SSRIs or SNRIs, used in combination with Spravato or as alternatives.
