Indications for SPRAVATO:
In conjunction with an oral antidepressant, for treatment-resistant depression (TRD) in adults.
Limitations of Use:
Not approved as an anesthetic.
See full labeling. Avoid food (≥2hrs) and liquids (≥30mins) prior to use. Wait 5mins between use of each device. Evaluate for continued treatment after the induction phase. ≥18yrs: Induction phase (Weeks 1–4): Day 1 starting dose: 56mg; subsequent doses: 56mg or 84mg twice weekly. Maintenance phase (Weeks 5–8): 56mg or 84mg once weekly; (Weeks 9 and after): 56mg or 84mg every 2 weeks or once weekly (frequency should be individualized).
<18yrs: not established.
Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation. History of intracerebral hemorrhage. Hypersensitivity to ketamine.
Sedation. Dissociation. Abuse and misuse. Suicidal thoughts and behaviors.
Must be administered under supervision of a healthcare provider. Risk of sedation, dissociation; monitor for ≥2hrs at each treatment session and until clinically stable. Assess benefit/risk in those with psychosis prior to initiation. History of substance use disorder including alcohol; monitor for abuse or dependence. Monitor all patients for clinical worsening and emergence of suicidal thoughts and behaviors. Cardiovascular and cerebrovascular conditions. Assess BP prior to initiation; consider delaying therapy if >140/90mmHg. History of hypertensive encephalopathy; monitor frequently. Cognitive impairment. Impaired ability to drive. Ulcerative/interstitial cystitis: monitor for urinary tract and bladder symptoms during therapy. Hepatic impairment (moderate): monitor for longer time; (severe): not recommended. Embryo-fetal toxicity. Advise females of reproductive potential to consider pregnancy planning and prevention. Pregnancy, nursing mothers: not recommended.
NMDA receptor antagonist.
Concomitant CNS depressants (eg, benzodiazepines, opioids, alcohol) may increase sedation; monitor closely. Concomitant psychostimulants (eg, amphetamines, methylphenidate, modafanil, armodafinil) or MAOIs may increase blood pressure; monitor BP closely. Give concomitant nasal corticosteroid or decongestant ≥1hr before Spravato.
Dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, increased blood pressure, vomiting, feeling drunk.
Register pregnant patients in the National Pregnancy Registry for Antidepressants by calling (844) 405-6185.
Dose Kit 56mg—2; 84mg—3