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Spravato® (Esketamine)

What is Spravato® (esketamine)?

Spravato® is a nasal spray formulation of esketamine, a glutamate receptor modulator. Approved by the FDA, Spravato® is indicated for the management of treatment-resistant depression (TRD) in adults who have not responded to conventional antidepressants.

How Does Spravato® Work?

Esketamine acts as a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, modulating glutamatergic neurotransmission. By blocking NMDA receptors, esketamine enhances synaptic plasticity and promotes the release of neurotransmitters associated with mood regulation, such as serotonin, dopamine, and noradrenaline. As part of a comprehensive treatment approach, Spravato® may be used in conjunction with psychotherapy and other adjunctive treatments for depression.

How is Spravato® administered?

Spravato® is administered intranasally under the supervision of a healthcare provider in a certified treatment facility. The recommended starting dose is 56 mg, with individualized dosing adjustments based on tolerability and clinical response. Treatment consists of an initial phase of twice-weekly doses for the first four weeks, followed by a maintenance phase of once-weekly or once-every-two-weeks doses, depending on patient response.

Clinical Efficacy of Spravato® (esketamine)

Clinical trials have demonstrated the efficacy of Spravato® in reducing depressive symptoms in patients with TRD. Improvement in depressive symptoms is typically observed within hours to days after initiation of treatment, offering rapid relief compared to traditional antidepressants. Maintenance therapy with Spravato® has been shown to sustain antidepressant effects and prevent relapse in responders.

Adverse Effects and Contra indications of Spravato® (esketamine) Common adverse reactions associated with Spravato® include dissociation, dizziness, sedation, nausea, and increased blood pressure. Due to the risk of sedation and dissociation, patients are monitored for at least two hours post-administration.

Spravato® is contraindicated in patients with a history of psychosis, substance abuse, or intracranial hypertension, and caution is advised in patients with cardiovascular risk factors.

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