Spravato (Esketamine) at a glance: schedule, half-life, and class
- Generic name
- Esketamine hydrochloride
- Brand names
- Spravato
- Drug class
- NMDA receptor antagonist
- US legal status
- Schedule III; restricted distribution (REMS)
- Approved uses
- Treatment-resistant depression (with an oral antidepressant or alone); major depression with suicidal thoughts or actions
- Forms
- Nasal spray device, 28 mg each
- Onset
- Within hours to days
- Monitoring
- At least 2 hours after each dose
- Half-life
- 7 to 12 hours
- Where it is given
- Certified healthcare settings only
Spravato uses: what esketamine is prescribed for
Esketamine is approved for adults with treatment-resistant depression, either with an oral antidepressant or, since January 2025, on its own, and with an oral antidepressant for major depression with acute suicidal thoughts or behavior.[1]
It is the S-form of ketamine. It works on the glutamate system rather than serotonin, which may explain why it can help people for whom standard antidepressants failed.
Spravato dosage: how esketamine is usually prescribed
Spravato is self-administered under the direct supervision of a clinician at a certified treatment center. The schedule below comes from the label and is not personal dosing advice.[1]
| Phase | Schedule | Dose |
|---|---|---|
| Induction (weeks 1 to 4) | Twice a week | 56 mg on day 1, then 56 or 84 mg |
| Maintenance (weeks 5 to 8) | Once a week | 56 or 84 mg |
| Maintenance (week 9 onward) | Every 1 to 2 weeks | Lowest frequency that maintains remission |
Patients must not drive or operate machinery until the next day after a restful sleep, and need someone to take them home.
Spravato (esketamine) side effects and risks
FDA boxed warnings
- Sedation, dissociation, and breathing depression; patients must be monitored for at least 2 hours after each dose.
- Potential for abuse and misuse.
- Increased risk of suicidal thoughts and behaviors in children, teens, and young adults taking antidepressants.
Common side effects include dissociation, dizziness, nausea, sedation, spinning sensation, numbness, anxiety, raised blood pressure, vomiting, and feeling drunk.[1]
Who should not use it: people with aneurysms or arteriovenous malformations, or a history of bleeding in the brain, because it raises blood pressure.[1]
Spravato interactions: what not to mix with esketamine
Choose what it would be combined with:
| Combined with | What happens | Label guidance |
|---|---|---|
| Benzodiazepines, opioids, alcohol | More sedation | Monitor closely |
| Stimulants, MAOIs | Raised blood pressure | Monitor blood pressure |
| Nasal steroids or decongestants | May change absorption | Use at least 1 hour before Spravato |
This is not a full list. A pharmacist can check a complete medication list, including supplements and over-the-counter products.[1]
What happens if someone gets too much esketamine?
Because it is only given under supervision in measured doses, overdose is rare. Excess effects would include heavy sedation, dissociation, and high blood pressure.[1]
If someone may have overdosed
- Call 911 if the person is unresponsive, breathing slowly, having a seizure, very hot, or violently agitated.
- Place an unresponsive person on their side so they do not choke if they vomit.
- Keep them away from roads, water, and heights. People on dissociatives often cannot feel pain or judge danger.
- If opioids could be involved, give naloxone. It will not harm the person.
What happens when esketamine treatment stops?
No withdrawal syndrome was seen in trials. Stopping maintenance treatment raises the risk of depression returning; trials showed relapse was more likely in patients who stopped than in those who continued.[1]
- WeeksWatch moodDepression can return gradually.
- MonthsRelapse riskHigher after stopping maintenance.
- OngoingPlan with the prescriberDecide together on frequency and duration.
How to get prescribed Spravato (esketamine) legally in the US
In the United States, esketamine is a Schedule III controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.[2]
- Refills: a Schedule III prescription can be refilled up to five times within six months of the date it was written. After that, a new prescription is needed.[3]
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.[4]
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
- Pharmacies: a legitimate pharmacy always requires a valid prescription, has a licensed pharmacist available, and is licensed in the state it ships to. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm a pharmacy is real.[5][6]
- Restricted program (REMS): Spravato is only dispensed to certified healthcare settings, and patients must be enrolled. Pharmacies do not give it to patients to take home.
- Cost: most insurers, including Medicare and many Medicaid programs, cover Spravato with prior authorization.
Traveling: keep the medicine in its original pharmacy container and carry a copy of the prescription. Check the rules of the destination country before travel, because many countries restrict controlled medicines or require a permit.
Can you get Spravato online?
No. Spravato cannot be ordered online or delivered to your home. A clinician can evaluate you by telehealth, but every dose must be taken at a certified treatment center under supervision. The manufacturer's website lists certified centers.[1]
Any website offering esketamine for home use is not legitimate.
Spravato price: how much does Spravato (esketamine) cost without insurance?
Most insurers, including Medicare and many Medicaid programs, cover Spravato with prior authorization.
What you pay depends on the strength, the number of doses, your insurance plan, and the pharmacy. Cash prices for the same prescription can differ several times over between pharmacies in the same town, so check current prices before you fill it.
Ways to pay less, legally:
- Ask the prescriber whether a generic esketamine is available. FDA-approved generics work the same way as the brand and usually cost much less.
- Compare cash prices between pharmacies before you fill the prescription.
- Use a free prescription discount card, such as GoodRx or SingleCare, when you pay cash. These cards cannot be combined with insurance on the same fill.
- For brand-name medicines, check the manufacturer's savings program or patient assistance program.
- Ask about a 90-day supply or your insurer's mail-order pharmacy, which often lowers the cost per dose when your prescriber agrees it is appropriate.
Warning: A price far below what licensed pharmacies charge, especially with no prescription required, is a strong sign of an illegal seller and counterfeit medicine.[5]
Is Spravato legal? Esketamine legal status in other countries
| Country | Status |
|---|---|
| European Union | Approved prescription medicine (Spravato) |
| United Kingdom | Licensed but not recommended by NICE; Class B |
| Canada | Approved prescription medicine |
| International | Not under UN control |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border.[7]
Common questions about Spravato (esketamine)
How fast does Spravato work?
Some people notice improvement within hours to days, faster than typical antidepressants, which take weeks.
Can I drive after Spravato?
No. You must not drive until the next day after a restful sleep.
Is Spravato the same as ketamine?
It is the S-form of ketamine, given as a nasal spray. Ketamine infusions for depression are off-label; Spravato is FDA-approved.
Can Spravato be used alone?
Yes. Since January 2025, it is approved without an oral antidepressant for treatment-resistant depression.
Can you buy Spravato (esketamine) without a prescription?
No. Spravato (esketamine) is a Schedule III controlled substance in the US, so it is illegal to buy or possess it without a valid prescription. Websites and social media sellers that offer it without one are not legal pharmacies, and the FDA warns that products sold this way are often counterfeit, contaminated, or the wrong strength. The legal route is a visit with a licensed clinician, in person or by telehealth, and a prescription filled at a state-licensed pharmacy. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm an online pharmacy is real.
Sources
- Spravato (esketamine) prescribing information. DailyMed, US National Library of Medicine.
- Controlled Substance Schedules. DEA Diversion Control Division.
- 21 CFR 1306.22, Refilling of prescriptions (Schedules III and IV). Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth. US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information. US Food and Drug Administration.
- Safe Pharmacy. National Association of Boards of Pharmacy.
- International drug control conventions. United Nations Office on Drugs and Crime.
