Spravato is a brand-name nasal spray that’s prescribed to treat certain types of depression. Spravato contains the active drug esketamine.

Spravato is FDA-approved for adults to treat:

  • Treatment-resistant depression (TRD). TRD is depression that has not improved after treatment with two or more antidepressants.
  • Major depressive disorder (MDD) with thoughts or actions of suicide. MDD is also called depression.

For either condition, doctors prescribe Spravato in combination with at least one other oral antidepressant medication.

Drug details

You’ll find key information about Spravato below.

  • Drug class: N-methyl-D-aspartate (NMDA) receptor antagonist
  • Drug form: nasal spray
  • Generic available? no
  • Prescription required? yes
  • Controlled substance? yes*
  • Year of FDA approval: 2019

* Spravato is classified by the FDA as a Schedule three (III) drug. A controlled substance is a drug the government regulates due to the risk of dependence or misuse. (With dependence, your body needs a drug in order to feel as usual. With misuse, a drug is taken in a way other than how it’s prescribed.)

Spravato is available only as a brand-name medication. It’s not currently available in generic form.

Spravato contains the drug esketamine.

The Food and Drug Administration (FDA) approves prescription drugs such as Spravato to treat certain conditions. Spravato may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Spravato is FDA-approved to treat:

It’s important to note that Spravato is not approved to treat pain. This drug has not been studied in clinical trials as a pain medication.

Spravato for treatment-resistant depression

Spravato is FDA-approved to treat a form of depression called treatment-resistant depression (TRD).

TRD is a type of depression that has not improved after you’ve tried at least two different antidepressant medications. Your doctor will determine if you have TRD based on your use of other antidepressants.

Spravato is approved for this use in adults. And it’s used in combination with at least one other oral antidepressant.

Effectiveness for treatment-resistant depression

In a clinical study lasting 4 weeks, Spravato reduced symptoms of depression in people taking the drug. One group was given Spravato and an oral antidepressant. The other group was given a placebo (treatment with no active drug) and an oral antidepressant.

People taking Spravato had fewer depression symptoms than people taking the placebo. The greatest improvement in symptoms occurred in the first 24 hours after people took Spravato.

After the 4-week trial, some people enrolled in a year-long study. These were people whose depression symptoms improved significantly during the first study.

In the year-long study, Spravato also reduced depression symptoms. During this study, people took an oral antidepressant with either Spravato or a placebo nasal spray. Those who took Spravato were less likely to relapse back to severe depression than those taking the placebo.

Spravato for depression with thoughts or actions of suicide

Spravato is FDA-approved to treat major depressive disorder (MDD), which is also called depression. Doctors prescribe it for MDD in people with thoughts or actions of suicide.

Spravato is approved for this use in adults. And it’s used in combination with at least one other oral antidepressant.

It’s unknown if Spravato helps prevent suicidal thoughts or actions. Your doctor will manage these symptoms as needed while you’re taking Spravato. For example, they may have you stay in the hospital if you’re having thoughts or actions of suicide.

Effectiveness for depression with thoughts or actions of suicide

In clinical studies, Spravato was effective in treating MDD in adults with thoughts or actions of suicide. For information on how the drug performed in clinical studies, see Spravato’s prescribing information.

The Food and Drug Administration (FDA) has approved Spravato to treat certain conditions. See the “Spravato for depression” section above to learn about its approved uses.

Long-term studies regarding the safety and effectiveness of Spravato are still taking place. The results of these studies will be helpful for doctors managing the conditions Spravato treats.

You may wonder if Spravato is used to treat other mental health conditions. The FDA has not approved Spravato to treat the conditions described below.

Spravato for anxiety (not an appropriate use)

Spravato isn’t approved to treat anxiety. Clinical studies haven’t looked at the use of Spravato for this purpose, but studies may take place in the future.

However, ketamine (a drug similar to Spravato) has been studied for use in treating anxiety disorders. These disorders include social anxiety disorder, anxiety in adolescents, and refractory anxiety. Some of these studies have shown promising results, but it’s unknown if similar results would be seen with Spravato.

More research is needed to determine whether Spravato or ketamine are safe or effective for treating anxiety.

Spravato for OCD (not an appropriate use)

Spravato isn’t approved to treat obsessive-compulsive disorder (OCD). No clinical studies have been done that would show whether Spravato is effective for treating OCD.

Ketamine (a drug similar to Spravato) has been looked at in several clinical studies as a treatment for OCD. The results of these studies were conflicting. It’s unknown whether similar results would be seen with Spravato as a treatment for OCD.

More studies are needed to know whether Spravato or ketamine are safe or effective for OCD treatment.

As with all medications, the cost of Spravato can vary. Your doctor’s office will purchase Spravato from a specialty pharmacy. Spravato isn’t available for you to purchase at a pharmacy.

Spravato’s treatment cost may have insurance coverage with your prescription or medical insurance plan. This will depend on your specific insurance plan.

Financial and insurance assistance

If you need financial support to pay for Spravato, or if you need help understanding your insurance coverage, help is available.

A program called Spravato withMe is available for Spravato. For more information and to find out if you’re eligible for support, call 844-4S-WITHME (844-479-4846) or visit the program website.

Spravato can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Spravato. This list does not include all possible side effects.

For more information on the possible side effects of Spravato or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Spravato can include:

Most of these side effects may go away within a few hours to a couple days. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

* For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Spravato aren’t common, but they can occur. Call your doctor right away if you have serious side effects after leaving the doctor’s office. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

* For more information about this side effect, see “Side effect details” below.
† Spravato has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “Spravato warnings” section below.
These effects can also occur in children. This drug is not approved for use in children.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may cause. For more information, refer to this in-depth article.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Spravato. It’s unknown how often this occurs in people taking Spravato. Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • angioedema (swelling under your skin, typically in your eyelids, lips, hands, or feet)
  • swelling of your tongue, mouth, or throat
  • difficulty breathing

You will stay in the doctor’s office for at least 2 hours after you take Spravato. Your healthcare professional will monitor you for side effects or allergic reactions.

Call your doctor right away if you have a severe allergic reaction to Spravato after leaving the office. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Increases in blood pressure

Increased blood pressure was commonly seen in people taking Spravato during clinical studies.

Your doctor will check your blood pressure before you take Spravato. If your blood pressure is high, they may recommend that you wait to take your dose of Spravato. You and your doctor can weigh the benefits and risks of using this drug at that time.

Your doctor will also check your blood pressure about 40 minutes after you take Spravato. They will have you stay at the healthcare facility at least 2 hours after taking Spravato. If your blood pressure is high after you take the drug, you may need to stay at the facility longer for monitoring or possible treatment.

If you have unmanaged high blood pressure before starting Spravato, your doctor may decide that you should not use this drug. (For more information, see “Spravato warnings” below.)

Here are answers to some frequently asked questions about Spravato.

Are reviews available from people who’ve taken Spravato?

Yes, the drug’s manufacturer offers patient stories from those who’ve taken this drug.

Check out this page to view stories from people who’ve taken Spravato for treatment-resistant depression. (To learn more about this condition, see the “Spravato for depression” section above.)

Keep in mind that Spravato may affect people in different ways. Be sure to talk with your doctor about whether this drug is right for you.

Does Spravato have long-term side effects?

That’s not known for sure. Long-term studies into the safety and effectiveness of Spavato are still taking place. The results of these studies will be helpful for doctors managing the conditions Spravato treats.

Why is this drug controversial?

Some people consider Spravato controversial for two main reasons:

  • it’s made from a drug called ketamine, and
  • it can cause severe side effects

The active drug in Spravato is called esketamine, which is made from ketamine. Ketamine is approved by the Food and Drug Administration (FDA) for use as an anesthetic. However, it’s also taken as a “party drug” that some people refer to as “Special K” and is sometimes misused. (With misuse, a drug is taken in a way other than how it’s prescribed.)

It’s important to note that Spravato and ketamine are not the same drug. (See the next question “What’s the difference between esketamine and ketamine?” for more details.) Both drugs are only available with a prescription from a healthcare professional. However, you can only receive Spravato at certified healthcare facilities, and you cannot purchase it for use at home.

As for the second concern about Spravato, it can cause serious side effects.* Examples of these include:

* Spravato has a boxed warning for these side effects and certain other risks. This is the most serious warning from the FDA. To learn more, see the “Spravato warnings” section below.

Because Spravato has these serious side effects, the FDA has placed restrictions on its use. It can only be given through a risk evaluation and mitigation strategies (REMS) at certified medical facilities. (See the question below called “What is a REMS?” for more details.)

The REMS requires that after taking your Spravato dose, a healthcare professional will monitor you for at least 2 hours. During this time, they’ll watch you for side effects. They’ll also make sure it’s safe for you to leave the facility.

You should not drive at all on the day of your Spravato treatment. You’ll need to have someone who can drive you home after your treatment. You’ll be able to resume driving the day following your treatment.

What’s the difference between esketamine and ketamine?

Esketamine (the active drug in Spravato) and ketamine are not the same drug, but they are similar chemicals. Esketamine is found in ketamine. It’s what’s called an enantiomer.

Ketamine contains a mixture of enantiomers, which are two chemicals that are mirror images of each other. Enantiomers look similar to each other but have different effects inside the body. Esketamine is one of these mirror images found within ketamine. Esketamine is made when it’s removed from ketamine.

It’s thought that ketamine and esketamine work differently because of their different structures. These drugs interact in different ways with nerves in your brain.

Spravato is approved for use in certain adults with depression. It’s used in combination with other oral antidepressant medications.

Ketamine is not approved to treat depression at this time. However, it’s approved for use as an anesthetic drug during surgeries or other medical procedures. Unlike Spravato, it may be given as an infusion into your vein.

Several small studies have looked at using ketamine to treat depression. These studies have had promising short-term results. However, more studies are needed to know if ketamine is safe and effective for long-term treatment of depression.

What is a REMS?

A REMS (risk evaluation and mitigation strategy) is a program created by the Food and Drug Administration (FDA). It’s used to reduce the risks related to prescribing certain drugs.

The FDA requires that some prescription drugs be given through REMS programs. This typically includes drugs that have serious side effects.

REMS programs help educate consumers on how to safely use certain medications. REMS programs also teach healthcare professionals how to prescribe certain drugs. This helps doctors know if the drug’s benefit outweighs its risk when used for medical treatment.

The Spravato REMS program requires that healthcare facilities that give Spravato have certification to administer the drug. Spravato is not available for purchase at your local pharmacy. You can only receive the drug at certified healthcare facilities.

Spravato REMS also requires that you’re fully informed of the risks before taking your Spravato dose. Risks can include serious side effects* such as:

* Spravato has a boxed warning for these side effects and certain other risks. This is the most serious warning from the FDA. To learn more, see the “Spravato warnings” section below.

If you’re taking Spravato, you’ll need to sign an enrollment form stating that you understand the following:

  • You’ll need to stay for at least 2 hours to be monitored for symptoms at the healthcare facility before you can leave and go home.
  • You’ll have someone else with you to safely drive you home after treatment.
  • You won’t drive or use heavy machinery until the day after your treatment.

You can find additional information about the REMS requirements for Spravato on the program website. You can also call 855-382-6022 to learn more.

Is esketamine also used as an anesthetic?

No, it’s not. The active drug in Spravato (esketamine) isn’t approved for use as an anesthetic for surgery. Ketamine (a drug similar to esketamine) is FDA-approved to be used as an anesthetic.

Does Spravato cause hallucinations?

Yes, Spravato can cause hallucinations in some people. This side effect is most likely to occur within minutes to hours after taking Spravato.

You’ll stay at your doctor’s office for at least 2 hours after you take Spravato. This allows the healthcare professionals to monitor you for any side effects, including hallucinations. Your healthcare professional will let you know when they feel you can safely go home.

The Spravato dosage your doctor prescribes will depend on how your body responds to Spravato.

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. Your doctor will determine the best dosage to suit your needs.

To learn more about dosages of Spravato, see this detailed article.

Drug forms and strengths

Spravato comes as a nasal spray. It’s given through a special device that sprays the drug into your nose.

Each device delivers two sprays of the medication, for a total of 28 milligrams (mg) per device. Each spray contains 14 mg of Spravato.

Depending on the dose your doctor prescribes, you will need to use either two or three devices each time you take Spravato.

Dosage for treatment-resistant depression

The dosage of Spravato for treatment-resistant depression is given in two phases:

  • an induction (starting) phase
  • a maintenance (ongoing) phase

You take each dose of Spravato under the supervision of your healthcare professional at a certified medical clinic. The healthcare professional will check your blood pressure before you take the drug. They will also monitor you for side effects and respiratory changes (such as high or low blood oxygen levels) for at least 2 hours after you take your Spravato dose.

Induction phase (weeks 1–4)

The induction phase lasts for the first 4 weeks of Spravato treatment. During this phase, you’ll take the drug two times each week.

The first dose of Spravato is 56 mg. Each dose after that is either 56 mg or 84 mg. Your doctor will prescribe your dose based on how well your body tolerates the drug.

At the end of the induction phase, you and your doctor will discuss whether you should continue to the maintenance phase. This decision depends on how well the drug works for you and if you’re tolerating any side effects.

Maintenance phase (week 5 and after)

The maintenance phase starts at the beginning of week 5 of using Spravato. During week 5 through week 8, you’ll take Spravato once each week.

During week 9 and after, you’ll take Spravato either once weekly or once every 2 weeks.

The dose during the maintenance phase is either 56 mg or 84 mg. Your doctor will advise how often you should use Spravato. This depends on how well your body tolerates the medication and if your symptoms improve. Ultimately, your doctor will prescribe the lowest dose that’s effective for you.

Dosage for depression with thoughts or actions of suicide

The dosage of Spravato for depression with thoughts or actions of suicide is 84 mg, given twice per week. In some cases, doctors may lower the dosage to 56 mg twice per week.

You will continue this dosing schedule for 4 weeks. You and your doctor will discuss whether you should continue treatment past 4 weeks. This decision depends on how well the drug works for you and if you’re tolerating any side effects.

You will take each dose of Spravato under the supervision of your healthcare professional at a certified medical clinic. The healthcare professional will check your blood pressure before you take the drug. They will also monitor you for side effects and breathing changes (such as high or low blood oxygen levels) for at least 2 hours after you take your Spravato dose.

What if I miss a dose?

If you miss an appointment for a Spravato dose, call your doctor’s office as soon as you remember. They will reschedule your appointment. They may also adjust your upcoming appointments to better fit your schedule. This helps you maintain a safe and effective dosing schedule.

Will I need to use this drug long term?

It depends. Your doctor may recommend that you take Spravato on a long-term basis if it’s safe, effective, and necessary for you. You and your doctor will make this decision together.

Spravato is a nasal spray that you’ll administer yourself. You will take your Spravato dose at a certified medical facility. Your doctor will show you how to use the nasal spray device. They’ll also monitor you while you take Spravato to make sure you don’t have any problems using the device.

Before your dose

You will be asked to blow your nose before you take the first spray of Spravato. This is to make sure the medication is not blocked by any congestion inside your nose.

Your healthcare professional will provide the correct number of devices needed for your treatment. The number of devices you’ll use depends on your specific dose. Each nasal spray device contains 28 milligrams (mg) of Spravato. If your dose is 56 mg, you’ll need to use two devices. If your dose is 84 mg, you’ll use three Spravato devices.

Your doctor will show you how to use the nasal spray device. Before you take the dose, you’ll recline to about a 45-degree angle. This helps the medication stay inside your nose so that your body can absorb it.

During and after your dose

Your healthcare professional will monitor you while you’re taking your Spravato dose. They’ll continue to watch you for at least 2 hours after your dose. This monitoring is done to make sure that you have no serious side effects after your treatment. Your doctor will advise when you can safely leave the clinic.

You’ll need to have someone drive you home after your Spravato treatment. You should not drive after taking the drug. You should also avoid taking part in activities that require coordination and mental alertness. You can usually resume all of your typical activities the day after your Spravato treatment.

When to take

You will typically take your Spravato doses once or twice per week. In some instances, you may take Spravato once every 2 weeks. Your doctor will recommend the dosing schedule that’s best for you.

Taking Spravato with food

Spravato may cause nausea and vomiting in some people. To help prevent these side effects:

  • do not eat food for at least 2 hours before your treatment, and
  • do not drink any liquids for at least 30 minutes before your treatment

Spravato is approved to treat depression in certain adults. See the “Spravato for depression” section above for details.

Depression is a complicated mood disorder. It’s thought to be caused in part by imbalanced levels of neurotransmitters in your brain. Neurotransmitters are chemical messengers in your body that help nerves communicate with each other. Examples of neurotransmitters include dopamine and serotonin.

Neurotransmitter levels can become imbalanced if they increase or decrease in activity. This can affect the body’s ability to function properly. An imbalance in neurotransmitter levels can affect moods and mental well-being. These imbalances may also be related to depression.

It’s not known exactly how Spravato helps improve depression symptoms. It may be related to how Spravato interacts with neurotransmitters.

Spravato blocks a neurotransmitter called glutamate from binding to a certain receptor (attachment site) on your nerves. The blocked receptor is called NMDA (N-methyl-D-aspartate) receptor. Blocking glutamate from attaching to this receptor may help regulate communication between nerve cells in the brain. This may help improve symptoms of depression.

How long does it take to work?

Spravato starts working very quickly. In clinical studies, many people who received Spravato treatment felt improved depression symptoms within 4 hours of taking the drug.

Other drugs are available that can treat your condition. Some may be better suited for you than others. If you’re interested in finding an alternative to Spravato, talk with your doctor to learn more about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat this condition.

Alternatives for depression

Depression is a very complicated disease that we’re still learning about. Because of its complexity, treating depression is often a process of trial and error. You may need to try several different medications before you find one that helps improve your symptoms.

There are many different medications available to treat depression. The following are examples of other drugs that may be used for depression:

Spravato is approved for use in combination with other antidepressant medications. A doctor should always prescribe it with at least one oral other antidepressant.

There are many different antidepressant medications that you can take with Spravato. Many of the treatment options listed above in “Alternatives to Spravato” can also be taken with Spravato.

You may wonder how Spravato compares to other medications that are prescribed for similar uses. Below are comparisons between Spravato and other medications.

Spravato vs. Abilify

Spravato contains the drug esketamine. Abilify contains the drug aripiprazole. These medications belong to different drug classes, but they’re both prescribed to treat depression.

Uses

Spravato is approved for adults to treat:

It’s approved to be given in combination with at least one other oral antidepressant medication.

Abilify is approved to treat depression in adults. It should also be used in combination with other antidepressant medications. It’s also approved to treat the following conditions:

Drug forms and administration

Spravato comes as a nasal spray. It’s given either once or twice each week. In some instances, Spravato may be given once every 2 weeks. It’s usually given in doses of 56 milligrams (mg) or 84 mg.

You’ll give Spravato to yourself at a certified healthcare facility. Healthcare professionals will monitor you for side effects during and after your treatment. You’ll stay at the facility for at least 2 hours after you receive your dose. Your doctor will let you know when it’s safe for you to go home.

Abilify comes as an oral tablet. Abilify is usually taken once per day by mouth when used to treat depression. The usual dosage range in adults is 2 mg to 15 mg. You can take this drug at home. It doesn’t need to be given at a certified healthcare facility.

Abilify is also available under different brand-name versions that come in other forms. These include the following:

  • Abilify MyCite, which is an oral tablet containing a sensor
  • Abilify Maintena and Abilify Asimtufii, which are intramuscular injections given by a healthcare professional

Each of these forms may be used for different conditions. This article does not describe these forms. To learn more about Abilify MyCite, Abilify Maintena, and Abilify Asimtufii, talk with your doctor or pharmacist.

Side effects and risks

Spravato and Abilify contain different drugs. So, these medications can cause different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Spravato, with Abilify, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Spravato, with Abilify, or with both drugs (when taken individually).

* Spravato and Abilify have boxed warnings for certain risks. This is the most serious warning from the FDA. To learn more about boxed warnings for Spravato, see the “Spravato warnings” section below. To learn more about boxed warnings for Abilify, see the drug’s prescribing information.

Effectiveness

Spravato and Abilify have different approved uses, but they’re both approved to treat types of depression. They’re given in combination with other antidepressant medications.

The use of Spravato and Abilify haven’t been directly compared in clinical studies. Studies have found that both Spravato and Abilify are effective for treating certain types of depression.

Costs

Spravato and Abilify are both brand-name drugs. There aren’t any generic forms of Spravato available. Abilify tablets and solutions are available in generic forms. Brand-name drugs usually cost more than generics.

The price you would pay for either drug depends on your dose, your insurance plan, your location, and the pharmacy you use.

Spravato vs. Symbyax

Spravato contains the drug esketamine. Symbyax contains two drugs: olanzapine and fluoxetine. These medications belong to different drug classes, but they’re both approved to treat depression.

Uses

Both Spravato and Symbyax are FDA-approved to treat a form of depression called treatment-resistant depression (TRD). Spravato is approved for adults in combination with at least one other antidepressant drug. Symbyax is approved to be given alone in adults with TRD.

Spravato is also approved to treat major depressive disorder (MDD) with thoughts or actions of suicide. And it’s given in combination with at least one other antidepressant drug.

Symbyax is also approved for acute depressive episodes caused by bipolar I disorder in adults and children ages 10 years and older.

Drug forms and administration

Spravato comes as a nasal spray. It’s given either once or twice each week. In some instances, you may receive Spravato once every 2 weeks. It’s usually given in doses of 56 mg or 84 mg.

Spravato is self-administered in a certified healthcare facility. Healthcare professionals will monitor you for side effects during and after your treatment. You’ll stay at the facility for at least 2 hours after your dose. Your doctor will advise when it’s safe for you to go home.

Symbyax comes as an oral capsule. You take it once daily, in the evening. You do not need to take this drug at a certified healthcare facility.

Symbyax capsules come in several different strengths:

  • 3 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/25 mg fluoxetine
  • 6 mg olanzapine/50 mg fluoxetine
  • 12 mg olanzapine/50 mg fluoxetine

Side effects and risks

Spravato and Symbyax contain different medications. So, they can cause different side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Spravato and with Symbyax (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Spravato, with Symbyax, or with both drugs (when taken individually).

* Spravatoand Symbyax have boxed warnings for certain risks. This is the most serious warning from the FDA. To learn more about boxed warnings for Spravato, see the “Spravato warnings” section below. To learn more about boxed warnings for Symbyax, see the drug’s prescribing information.

Effectiveness

Spravato and Symbyax have different approved uses, but they’re both prescribed to treat treatment-resistant depression (TRD).

These drugs haven’t been directly compared to each other in clinical studies. However, both Spravato and Symbyax were effective in treating depression symptoms during clinical studies.

Costs

Spravato and Symbyax are both brand-name drugs. There aren’t any generic forms of Spravato available. However, there is a generic form of Symbyax available. Brand-name medications usually cost more than generics.

The price you would pay for either drug depends on your dose, your insurance plan, your location, and the pharmacy you use.

Spravato shouldn’t be given with alcohol. Both Spravato and alcohol can cause sedation (excessive sleepiness, difficulty thinking clearly, inability to drive or use heavy machinery). Consuming them together can increase this risk.

If you have questions about the safety of drinking alcohol while taking Spravato, talk with your doctor or pharmacist.

Spravato can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Spravato and other medications

Below are lists of medications that can interact with Spravato. These lists do not contain all the drugs that may interact with Spravato.

Before starting Spravato, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Spravato and opioids

Spravato and opioids can both cause sedation. Taking Spravato doses together with opioid drugs can cause excessive sedation (sleepiness, difficulty thinking clearly, inability to drive or use heavy machinery).

If you’re taking an opioid pain medication and need Spravato treatment, talk with your doctor about your risk of sedation. They may need to monitor you for a longer time to make sure that you don’t feel sedated after your Spravato treatments.

Examples of opioids that can increase the risk of sedation if taken with Spravato include:

  • hydrocodone (Hysingla)
  • oxycodone (Oxycontin, Roxicodone, Xtampza ER)
  • codeine
  • morphine (MS Contin)
  • fentanyl (Duragesic, Fentora, Lazanda, Subsys)

Many pain relievers contain a combination of drugs, and one of those drugs may be an opioid. Be sure to tell your doctor about all medications you take. If you’re taking an opioid, they may recommend a different medication for you. This can help you avoid an increased risk of sedation.

Spravato and benzodiazepines

Spravato and benzodiazepines can both cause sedation. Taking Spravato doses and benzodiazepines together can cause excessive sedation (sleepiness, difficulty thinking clearly, inability to drive or use heavy machinery).

If you’re taking a benzodiazepine and considering Spravato treatment, talk with your doctor about the risk of sedation. They may need to monitor you for a longer time to make sure that you don’t feel sedated after your Spravato treatments.

Examples of benzodiazepines that can increase sedation if taken with Spravato include:

Spravato and sleep medication

Taking Spravato doses with medications that help you fall or stay asleep can cause prolonged or worsened sedation (sleepiness, difficulty thinking clearly, inability to drive or use heavy machinery).

Talk with your doctor if you take medications to help you sleep. They may recommend that you skip your sleep medication on the night before your Spravato dose.

If you take medications to help you sleep, you may need to be monitored for a longer time after your Spravato treatments. This will help make sure that you are not sedated after your treatment.

Examples of sleep medication that can increase sedation if taken with Spravato include:

Spravato and stimulant medications

Taking Spravato doses with stimulant medications may increase blood pressure more than either drug would alone. Increased blood pressure could cause serious complications with blood vessels in your heart or brain. These complications include heart attack, stroke, or swelling in your brain.

Examples of stimulant medications include:

If you are taking a stimulant medication, talk with your doctor about your risk of elevated blood pressure. They may need to monitor you more closely for high blood pressure that may be dangerous after your Spravato treatments.

Spravato and monoamine oxidase inhibitors

Taking Spravato doses with monoamine oxidase inhibitors (MAOIs) can cause an increase in blood pressure. Increased blood pressure could cause serious complications with blood vessels in your heart or brain. These complications include heart attack, stroke, or swelling in your brain.

MAOIs are a class of medications that treat depression. Examples of MAOIs that can cause high blood pressure if taken with Spravato include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam, Zelapar)
  • tranylcypromine (Parnate)

If you are taking an MAOI, talk with your doctor about your risk of elevated blood pressure. They may monitor you more closely for high blood pressure that may be dangerous after your Spravato treatments.

Nasal corticosteroids or nasal decongestants

Taking a nasal corticosteroid or nasal decongestant around the time of your Spravato dose may reduce how much Spravato your body absorbs. This could make the drug less effective for you.

To avoid this interaction, don’t use a nasal corticosteroid or nasal decongestant for at least 1 hour before your Spravato dose.

Spravato and foods

Eating or drinking certain things around the time of your Spravato dose may increase your risk of side effects.

Food and drink on the day of Spravato dose

Spravato can cause nausea and vomiting in some people. To reduce this risk:

  • don’t eat food for at least 2 hours before taking Spravato, and
  • don’t drink liquids for at least 30 minutes before taking Spravato

Spravato and caffeine

Caffeine, which is a stimulant, can increase your blood pressure. Spravato may also increase blood pressure. Taking Spravato doses with caffeine could increase your blood pressure to unsafe levels.

If you consume caffeine, talk with your doctor about how much is safe for you to consume on the day of your Spravato dose.

Spravato treatment is not recommended during pregnancy. In animal studies, pregnant females who received Spravato had offspring with brain and bone damage. However, it’s not known how Spravato use during pregnancy would affect humans.

If you are pregnant or may become pregnant, talk with your doctor about the safety of Spravato use during pregnancy.

If you receive Spravato treatment during pregnancy, you are encouraged to contact the National Pregnancy Registry for Antidepressants (NPRAD). This registry collects information about the safety of antidepressant use during pregnancy. You can register by calling 866-961-2388 or visiting the NPRAD website.

Spravato should not be given while breastfeeding.

It’s not known for sure how Spravato would affect humans who consume it in breast milk. However, it is known that the drug passes into human breast milk. In animal studies, Spravato passed into the breast milk of lactating females and caused brain damage when this milk was consumed by animals.

If you’re currently breastfeeding or planning to do so, talk with your doctor before receiving this medication. Your doctor may recommend other ways to feed your child during treatment with Spravato.

This drug comes with several warnings.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Risk of sedation. Spravato can cause sedation (excessive sleepiness, difficulty thinking clearly, inability to drive or operate heavy machinery) or loss of consciousness. This can make certain activities, such as driving, unsafe. Some people may also shows signs of diminished or less apparent breathing.

Sedation was a common side effect seen in clinical studies of Spravato. In rare cases, people lost consciousness after taking Spravato in the studies. This means there was a short period where they didn’t respond when their healthcare professional tried to wake them.

Some medications taken with Spravato can also cause symptoms of sedation. People using these medications may be at increased risk of sedation.

After taking Spravato, you’ll stay in the healthcare facility for at least 2 hours. Your doctor will monitor you for symptoms of sedation. They will advise when you can safely go home. You’ll need a trusted friend or family member to drive you home. You shouldn’t drive or operate heavy machinery until after you’ve had a full night’s sleep.

Risk of dissociation. Spravato can cause dissociation, which means you feel disconnected from time, space, and your own body or mind. It’s often described as having an “out-of-body” experience.

Symptoms of dissociation can include:

Dissociation was one of the most common side effects seen during clinical trials of Spravato. These symptoms, which were temporary, occurred on the day Spravato was taken.

During your appointment to receive Spravato, a healthcare professional will monitor you for at least 2 hours after you take the drug. They will check you for side effects including dissociation. They’ll let you know when it’s safe for you to go home.

Some people have a greater risk of dissociation after taking Spravato. If you have a history of psychosis, you may be at increased risk. Talk with your doctor about whether Spravato is safe for you.

Risk of respiratory depression. Some people being treated with Spravato have reported respiratory depression. This refers to a slow, shallow breathing rate. Respiratory depression wasn’t reported in clinical trials, but it has occurred since the drug was approved.

Symptoms of respiratory depression can include:

  • shortness of breath
  • frequent yawns
  • confusion
  • disorientation
  • dizziness
  • nausea

In rare cases, respiratory arrest has also been reported with Spravato treatment. With this condition, a person becomes unable to breathe.

To help decrease this risk, you’ll be monitored for respiratory changes (such as high or low blood oxygen levels) for at least 2 hours after you receive Spravato. A healthcare professional will assess you before you’re able to leave the facility.

Risk of misuse. Spravato has an increased risk of misuse. (With misuse, a drug is taken in a way other than how it’s prescribed.) Spravato is a controlled substance, which is a drug the government regulates due to the risk of dependence or misuse. (With dependence, your body needs a drug to feel as it usually does.)

Due to the risk of misuse and other warnings, doctors only prescribe Spravato through a drug safety program called risk evaluation and mitigation strategies (REMS). With Spravato REMS, the drug is given only by specially trained healthcare professionals and provided only at certified healthcare facilities.

Because of the risk of misuse, Spravato may not be right for people with a history of substance misuse. Talk with your doctor if you have questions about this risk or the REMS requirements for Spravato. You can find additional information about Spravato REMS by visiting the program website or calling 855-382-6022.

Risk of suicidal thoughts and behaviors. Like other antidepressants, Spravato may increase the risk of suicidal thoughts or behaviors in children and young adults, ages 24 years and younger. Spravato is not approved for use in children.

Symptoms can include:

  • worsening of depression
  • sudden thoughts of suicide
  • talking about suicide
  • attempting suicide

These symptoms are more likely to occur when you begin treatment and have a dosage change. Talk with your doctor if you notice symptoms of suicidal thoughts and behaviors. They may need to adjust your treatment plan to help with these symptoms.

Other precautions

Before starting treatment with Spravato, talk with your doctor about your health history. Spravato may not be right for you if you have certain medical conditions. These include:

  • Aneurysmal vascular disease or arteriovenous malformation. Spravato can cause increase blood pressure in the first few hours after taking the drug. There is a risk for serious bleeding events after taking Spravato. This risk is greater in people with a history of aneurysms and people who have malformations of their arteries. People with these risk factors should not use Spravato..
  • History of intracerebral hemorrhage. Spravato can increase your blood pressure. Increased blood pressure can increase the risk of intracerebral hemorrhage (bleeding inside your brain). People with a history of bleeding in the brain should not use Spravato.
  • History of psychosis. Spravato may cause dissociation (an “out-of-body” experience). People with a history of psychosis may be at greater risk for a severe dissociative or psychotic event. If you have a history of psychosis or psychotic events, talk with your doctor about whether Spravato is right for you.
  • History of substance use disorder. Spravato is a controlled substance that has an increased risk of misuse. Talk with your doctor about any history of substance use disorder, addiction, or misuse. (With addiction, a drug is used even if it’s causing harmful outcomes. With misuse, a drug is taken in a way other than how it’s prescribed.) Your doctor can help you decide if Spravato is right for you. See the “FDA warnings” section directly above for more information about the risk of misuse with Spravato treatment.
  • Hypertension (high blood pressure). Spravato can increase blood pressure. This puts increased strain on your heart, blood vessels, and brain. If you have high blood pressure, talk with your doctor about whether Spravato is safe for you.
  • Liver disease. People with liver disease may be at greater risk of side effects from Spravato. They may also be at risk for a longer period of time after taking the drug. If you have moderate liver disease, your doctor may monitor you in the healthcare facility for longer than the standard time.

Note: For more information about the potential negative effects of Spravato, see the “Spravato side effects” section above.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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