Spravatotm is a prescription medicine, used along with an antidepressant taken by mouth, for treatment-resistant depression (TDR) in adults. Spravato (esketamine), the S-enantiomer of racemic ketamine, is a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor. The mechanism by which esketamine exerts its antidepressant effect is unknown. The major circulating metabolite of esketamine (noresketamine) demonstrated activity at the same receptor with less affinity.
Spravato is supplied as a spray for intranasal administration. The recommended dosage is as follows:
Introduction Phase Weeks 1 to 4: Administer twice per week; Day 1 starting dose: 56 mg followed by subsequent doses of 56 mg or 84 mg.
Maintenance Phase Weeks 5 to 8: Administer once weekly at 56 mg or 84 mg. Week 9 and after: Administer every 2 weeks or once weekly at 56 mg or 84 mg. Dosing frequency should be individualized to the least frequent dosing to maintain remission/response.
