Spravato (esketamine) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved* it in adults for:
- treatment-resistant depression (TRD). This type of depression does not respond to antidepressants.
- symptoms of depression in major depressive disorder (MDD) that include suicidal thoughts or behaviors.
Spravato comes as a liquid nasal spray that you take in a healthcare facility with the guidance of a healthcare professional. It belongs to a group of medications called N-methyl-D-aspartate receptor antagonists. There is currently no generic version of Spravato.
* Spravato is approved for these uses when it is given in combination with an oral antidepressant.
Dosage summary
The following chart summarizes Spravato’s dosage. Spravato is prescribed in combination with an oral antidepressant. Milligrams is abbreviated as “mg.” Your doctor will determine the dosage that’s best for you.
| Spravato use | Dosage for weeks 1 through 4 | Maintenance dosage for weeks 5 through 8 | Maintenance dosage for week 9 and later |
| TRD | first dose of 56 mg followed by either 56 mg or 84 mg twice per week | 56 mg or 84 mg once per week | 56 mg or 84 mg once every 2 weeks or once per week |
| MDD* | 84 mg twice per week for 4 weeks; may be reduced to 56 mg twice per week if needed | talk with your doctor† | talk with your doctor† |
For information about the dosage of Spravato, including its strengths and how to take the drug, keep reading. For a comprehensive look at Spravato, see this article.
This article describes typical dosing schedules for Spravato provided by the drug’s manufacturer. But your doctor will prescribe the Spravato dosage that’s right for you.
* 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.
Below is important information about Spravato’s dosage for its approved uses. Spravato is used in combination with an oral antidepressant.
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 used 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 the first 4 weeks, 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 through 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 are bothersome.
Spravato use of longer than 4 weeks has not be studied in people with MDD. 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 sleepiness and dissociation. (Dissociation is when you feel disconnected from your thoughts, feelings, space, and time.)
If you have side effects that are bothersome, 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. Because Spravato can cause sleepiness, 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 it’s sprayed.
- Spray one spray 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 steps above 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 containersIf 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
Misuse refers to taking a drug other than how your doctor prescribed. 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 program called Spravato Risk Evaluation and Mitigation Strategy (REMS). This means that it can only be taken in a healthcare setting that is 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.
- Drug comparison. To find out how Spravato compares with similar drugs, see this article.
- Details about depression. For details about your condition, see our mental health hub, as well as 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.
