Ketamine Nasal Spray – Spravato

Ketamine Nasal Spray – Spravato

A formulation of ketamine delivered intranasally; esketamine (the S-enantiomer) is approved in some countries as a prescription nasal spray for treatment-resistant depression (TRD) and depressive symptoms with acute suicidal ideation/behavior. Racemic ketamine can be given intranasally off-label in some settings but is less commonly approved.

• How it works: Rapid NMDA receptor antagonism leading to downstream glutamate surge, synaptogenesis, and rapid antidepressant effects (response often within hours to days). Exact mechanisms still under study.
• Indications: Primarily for adults with TRD after inadequate response to ≥2 antidepressant trials; some emergency/ inpatient use for severe suicidal ideation. Off-label uses include some chronic pain conditions and PTSD in research settings.
• Efficacy: Many trials show fast reduction in depressive symptoms and suicidality compared with placebo; effects can be rapid but may be transient, requiring repeated dosing or maintenance strategies.
• Administration & setting: Prescription-only; esketamine is administered under medical supervision in a clinic due to risks (blood pressure rise, dissociation, sedation). Patients are observed for ~2 hours post-dose; driving/operating heavy machinery is restricted for 24 hours after dosing.
• Typical side effects: Transient dissociation/derealization, dizziness, sedation, nausea, increased blood pressure/heart rate, headache, perceptual changes. Most are short-lived but can be significant.
• Risks & contraindications: Elevated cardiovascular risk (uncontrolled hypertension, recent stroke/MI), active substance use disorder (increased misuse risk), psychotic disorders (may worsen symptoms). Long-term safety data are limited; concerns exist about cognitive effects and bladder toxicity with high cumulative exposure seen in recreational use.
• Monitoring: Baseline cardiovascular assessment, blood pressure monitored before/during/after dosing; screening for substance use and psychosis; follow-up for mood and adverse effects. Maintenance planning (frequency of dosing, adjunct antidepressants, psychotherapy) individualized.
• Access & legal/coverage notes: Esketamine requires a prescriber and clinic certified under specific REMS-type programs in some countries; insurance coverage varies. Off-label racemic ketamine nasal use is less standardized and may be provided in specialized clinics.
• Practical advice: Only use under qualified medical supervision in approved programs; disclose medical history (cardiovascular disease, psychosis, substance use) and medications. Expect rapid onset but plan for supervised dosing and follow-up.

If you want: specific dosing schedules, evidence summary, differences between esketamine vs racemic ketamine, safety checklist for clinics, or local availability/coverage details (I can look that up).