Spravato (esketamine) is a brand-name drug prescribed for certain types of depression. Spravato comes as a liquid nasal spray that you take in a healthcare facility. Dosages can vary depending on what condition it’s prescribed to help treat.

Spravato is approved* by the Food and Drug Administration (FDA) in adults for:

Spravato belongs to a group of medications called N-methyl-D-aspartate receptor antagonists. Spravato is not available in a generic version.

Keep reading for specific information about the dosage of Spravato, including its strengths and how to take the medication. For a comprehensive look at Spravato, see this article.

Note: This article describes typical dosages for Spravato provided by the drug’s manufacturer. When taking Spravato, always follow the dosage your doctor prescribes. You’ll take your Spravato doses with the guidance of a healthcare professional at a healthcare facility.

* Spravato is approved for these uses when it is given in combination with an oral antidepressant.

The following table summarizes Spravato’s dosage. Doctors prescribe Spravato in combination with an oral antidepressant. All doses are listed in milligrams (mg). Your doctor will determine the dosage that’s best for you.

Use for SpravatoDosage for weeks 1–4Maintenance dosage for weeks 5–8Maintenance dosage for week 9 and later
treatment-resistant depression (TRD)first dose of 56 mg followed by either 56 mg or 84 mg twice per week56 mg or 84 mg once per week56 mg or 84 mg once every 2 weeks or once per week
major depressive disorder (MDD)*84 mg twice per week for 4 weeks; may be reduced to 56 mg twice per week if neededtalk with your doctor† talk with your doctor†

* For MDD, Spravato is not typically given for more than 4 weeks.
† The manufacturer of Spravato recommends determining whether Spravato is working for you before you continue with the treatment. You will need to discuss the risks and benefits of Spravato with your doctor before you continue the treatment.

Read below for details about Spravato’s dosages for its approved uses.

Spravato form

Spravato comes as a nasal spray.

Spravato strength

Each Spravato spray contains 14 milligrams (mg) of the medication. There are two sprays in each device, making a total of 28 mg per device.

Typical dosages

The following information describes Spravato nasal spray dosages that are commonly taken or recommended. However, be sure to take the dosage that your doctor prescribes for you. Your doctor will determine the best dosing frequency to fit your needs.

Dosage for treatment-resistant depression (TRD)

The first dose of Spravato for TRD is 56 mg. For weeks 1–4 of treatment, you’ll receive 56 mg or 84 mg of Spravato twice per week.

At the start of week 5, you’ll receive 56 mg or 84 mg of Spravato once per week. This dosage will be the same for weeks 6–8. During week 9, you’ll receive 56 mg or 84 mg of Spravato once every 2 weeks or once per week.

Your doctor will determine how long you will need to receive Spravato.

Dosage for depressive symptoms of major depressive disorder (MDD)

The dosage of Spravato for MDD is 84 mg twice per week for a total of 4 weeks. Your doctor may reduce this amount to 56 mg two times per week if you have side effects that bother you.

Spravato treatment that lasts longer than 4 weeks has not been studied in people with MDD. You and your doctor will decide if you need to continue the treatment beyond 4 weeks.

Long-term treatment

Your doctor may recommend that you take Spravato in the long term if it’s safe, effective, and necessary for you. Talk with your doctor about whether Spravato is right for you as a long-term treatment.

For MDD, your doctor will typically not prescribe Spravato for longer than 4 weeks.

The Spravato dosage that your doctor prescribes will depend on several factors. These include:

  • the type and severity of depression that you’re using Spravato to treat
  • whether there are any side effects

Other medical conditions you have can also affect your Spravato dosage.

Dosage adjustments

If you have side effects of Spravato, your doctor may decrease your dosage. These side effects may include:

  • sedation (feeling sleepy, dizzy, or as if you may pass out)
  • dissociation (feeling disconnected from your thoughts, feelings, space, and time)
  • respiratory depression (breathing that is slow and shallow)

If you have side effects that bother you, talk with your doctor.

Spravato comes as a nasal spray. You’ll give yourself a dose at a certified medical facility under the guidance of a healthcare professional.

On the day of the treatment, avoid eating for 2 hours before your appointment. And avoid drinking anything for 30 minutes before your appointment.

Your doctor will show you how to use the nasal spray device. If your dose of Spravato is 56 milligrams (mg), you’ll need two devices (a total of 4 sprays). If your dose of Spravato is 84 mg, you’ll need three devices (a total of 6 sprays).

The healthcare professional will monitor you for 2 hours after you have your dose to make sure there are no side effects. They’ll monitor you for symptoms such as high blood pressure and breathing changes (including changes to your blood oxygen levels). Because Spravato can cause sedation (feeling sleepy, dizzy, or as if you may pass out), you’ll need someone to drive you home after your treatment.

Here are more detailed instructions about how to take Spravato:

  • Blow your nose before using the device.
  • Your doctor will tell you what dose to take. They’ll check the device before you use it.
  • You’ll hold the device and lay back to keep the medication in your nose after you’ve sprayed it.
  • Spray once in each nostril. Gently sniff after each spray to keep the medication in your nose.
  • Hand the device back to your doctor. They’ll make sure that it’s empty.
    • If you are using the 56-mg dose pack, you’ll wait 5 minutes and repeat the above steps with a new device.
    • If you are using the 84-mg dose pack, you’ll repeat the steps above twice, resting 5 minutes after emptying each device.

A video showing how to take Spravato is available from the manufacturer.

Accessible drug labels and containers

If you’re having trouble reading your prescription label, talk with your doctor or pharmacist. Some pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.

If you miss an appointment to have your dose of Spravato, call your doctor as soon as possible. They will reschedule your appointment. They may also change your dosage and treatment schedule. This can help ensure that the treatment is safe.

To help make sure that you don’t miss an appointment, try using a medication reminder. This can include setting an alarm or downloading a reminder app on your phone.

Spravato has a boxed warning about the risk of misuse. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Misuse refers to taking a drug other than how your doctor prescribed it. Because Spravato has the potential for misuse, be sure to tell your doctor if you’ve misused any drug in the past.

Spravato is only given through a risk evaluation and mitigation strategy (REMS) program called Spravato REMS. This means that you can only take it in a healthcare setting certified by the Spravato REMS program.

The dosages in this article are the typical ones provided by the drug’s manufacturer. If your doctor recommends Spravato for you, they will prescribe the dosage that’s right for you.

If you have questions about the dosage of Spravato that’s right for you, talk with your doctor.

Besides learning about dosages, you may want other information about Spravato. These additional articles might be helpful to you:

  • More about Spravato. For information about other aspects of Spravato, refer to this article.
  • Side effects. To learn about side effects of Spravato, see this article. You can also look at the Spravato prescribing information.
  • Drug comparison. To find out how Spravato compares with similar drugs, see the “Spravato vs. other drugs” section in this article.
  • Details about depression. For more information about your condition, see our mental health hub and this list of related articles.

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.