Spravato (esketamine)

Product Name:

Spravato (esketamine)

Categories: Neurology

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Spravato (esketamine)

Product Category

Prescription Nasal Spray – NMDA Receptor Antagonist Antidepressant

Brand Name

Spravato

Generic Name or Biosimilar

Esketamine (no approved biosimilars currently available)

Active Ingredient

Esketamine hydrochloride

Prescription Status

Prescription-only (Rx). Restricted under REMS program.

Targeted Conditions

  • Treatment-resistant depression (TRD) in adults
  • Major depressive disorder (MDD) with suicidal ideation or behavior

Spravato is used in combination with an oral antidepressant for adults who have not responded to at least two prior antidepressants, or for rapid relief of depression with suicidal thoughts under close supervision.【344†Neurology】

Off-Label Usage

  • Bipolar depression (under study)
  • PTSD (post-traumatic stress disorder)
  • Obsessive-compulsive disorder (OCD)
  • Chronic suicidal thinking (specialist use only)

Off-label uses are reserved for select cases and always require specialist psychiatric oversight.【344†Neurology】

Drug Classification Overview

Spravato is a non-competitive NMDA receptor antagonist, chemically related to ketamine but using only the S-enantiomer (esketamine). By modulating glutamate signaling, it rapidly boosts BDNF and repairs synaptic connections affected by depression.【344†Neurology】

Manufacturer in the USA and Manufacturer in Mexico

USA: Janssen Pharmaceuticals, Johnson & Johnson
Mexico: Janssen-Cilag, S.A. de C.V.

Available Strengths and Dosage Forms – United States

  • Nasal spray: 28 mg (single device), 56 mg (two devices), 84 mg (three devices)

Available Strengths and Dosage Forms – Mexico

  • Nasal spray: 28 mg/device (administered in hospital/clinic)

Country Comparison – United States vs. Mexico

  • Identical active ingredient and clinical protocols
  • Strict REMS regulation in U.S. (certified clinics only)
  • Limited to specialty clinics/hospitals in Mexico
  • More affordable cost in Mexico for eligible patients

Average Retail Price (Monthly Treatment) USA vs. Mexico

Country Price per Month
USA $4,700–$6,800 USD
Mexico $2,500–$4,000 USD

Spravato is only administered in clinical settings. U.S. insurance and Medicaid may cover eligible patients; Mexico is more often private-pay.

Where to Buy USA

  • Certified REMS clinics only (not sold at retail pharmacies)
  • Find locations via official Spravato website or psychiatrist referral

Storage Requirements

  • Stored at controlled room temperature (68–77°F / 20–25°C)
  • Clinic staff handle all medication; patients do not store at home
  • Protect from light and moisture

Shipping

  • Shipped direct to clinics by specialty distributor
  • No home delivery allowed under REMS regulations

Key Benefits

  • Rapid symptom relief (within hours or days)
  • Reduces suicidal ideation in acute cases
  • Novel mechanism—targets glutamate pathway
  • Non-oral option for those who cannot take pills
  • Clinical setting maximizes safety and monitoring
  • Improves brain connectivity and neural plasticity

Spravato transforms the treatment landscape for patients with severe depression, offering a lifeline for those who need rapid, effective relief.【344†Neurology】

Usage Instructions

  • Administered only at certified clinic/hospital by healthcare provider
  • Weeks 1–4: Twice weekly; Weeks 5–8: Once weekly; After week 8: Every 2 weeks or as needed
  • Do not eat for 2 hours or drink for 30 minutes before each session
  • Patients monitored for at least 2 hours post-dose for side effects
  • No driving, machinery, or work for the rest of the day

Side Effects

  • Common: Dissociation, dizziness, nausea, sleepiness, increased blood pressure, anxiety
  • Serious: Suicidal thoughts, bladder/urinary issues (long-term), abuse potential, severe sedation/confusion

All patients are closely monitored after each dose in the clinic to ensure safety.【344†Neurology】

Warnings and Precautions

  • Not for at-home use—must be supervised in clinic
  • REMS restriction (certified centers only)
  • Not approved in children or teens
  • Pregnancy: avoid unless clearly needed
  • History of substance abuse requires close monitoring
  • Not a stand-alone treatment—always with oral antidepressant

Alternative Medications (by Indication)

For Treatment-Resistant Depression: IV ketamine, Abilify (aripiprazole), Rexulti (brexpiprazole), Symbyax (olanzapine/fluoxetine), ECT, TMS.

Selection depends on patient’s prior treatment history, medical profile, and access to specialty care.【344†Neurology】

Medication FAQs

Spravato (esketamine)

Spravato is used for treatment-resistant depression and major depressive disorder with suicidal thoughts in adults, alongside a daily oral antidepressant.

Many patients notice improvement within 24 hours of the first or second dose; it is one of the fastest-acting antidepressant options.

Spravato contains esketamine, a purified, more potent form of ketamine. It is FDA-approved and administered in controlled clinical settings.

It has the potential for abuse, but is only available under strict clinical supervision. Abuse is rare when used as prescribed.

Yes, Spravato is always used together with an oral antidepressant such as an SSRI or SNRI.

Not necessarily. After the first 8 weeks, your doctor will determine the best maintenance schedule or decide if it’s time to taper off.

In the U.S., many commercial and public plans cover Spravato for eligible patients. In Mexico, coverage varies and is often private-pay.

No. You must not drive or operate machinery until the next day. Arrange transportation home after each session.

Some people report dissociation, dream-like sensations, or a floating feeling. These usually fade within a few hours.

No. Plan to rest the day of treatment; fatigue, dissociation, and sedation are common.

No. Due to REMS regulation and abuse risk, it is only administered in certified clinical settings.

Contact your clinic to reschedule as soon as possible. Missing sessions can reduce effectiveness, especially early on.

Yes. Some patients remain on maintenance dosing for months or longer under supervision.

Physical withdrawal is not expected, but depression symptoms may return if stopped abruptly.