Spravato Dosages for Adults: Your GoodRx Guide

When it comes to treating depression, there are several types of medication to consider. A newer treatment option, called Spravato (esketamine), contains an active ingredient that’s similar to ketamine (Ketalar). But they’re not the same thing, especially when it comes to how they’re administered.

Read on for more information about Spravato dosages and what makes it a unique treatment for certain types of depression.

How do you use Spravato nasal spray?

Spravato comes in single-use nasal spray devices that contain one spray for each side of your nose. The 2 sprays combined contain a total of 28 mg of esketamine. You’ll need to use two devices for a 56 mg dose, and three devices for an 84 mg dose. You should only use Spravato in a supervised healthcare setting.

Here are the steps for administering Spravato:

1. Blow your nose. 

2. Check the device indicator to make sure there are two green dots showing.

3. Tilt your head back at about a 45 degree angle.

4. Place the tip of the device into one side of your nose. (You’ll know the tip is in far enough when you feel the nose rest press against the skin between your nostrils).

5. Use your other hand to close the open nostril. Then gently breathe in while you push the plunger until it stops. Remove the device, then sniff gently to keep the medication in your nose.

6. Repeat in the other nostril with the same device.

7. Check to make sure the dots on the front of the device are no longer green.

8. Wait 5 minutes before using a second (or third) device. Do not blow your nose in-between devices.

You’ll need medical supervision for at least 2 hours after your Spravato dosage. And you shouldn't drive or engage in other activities that require alertness or coordination until the day after receiving Spravato.

What’s the typical Spravato dosage for adults?

Your Spravato dosage depends on what you’re receiving it for. As mentioned, Spravato is meant to be administered in the presence of a healthcare professional. It’s not something you should give yourself at home. 

It’s best to avoid eating for at least 2 hours before receiving Spravato and to avoid drinking for at least 30 minutes before your treatment. Your prescriber will also check your blood pressure before you receive Spravato to make sure it’s safe to administer.

As mentioned, a healthcare professional will monitor your breathing and blood pressure for at least 2 hours after every Spravato treatment. This way, serious Spravato side effects can be treated right away if they happen.

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Treatment-resistant depression

Spravato dosages for treatment-resistant depression have two phases: an induction (starting) phase and a maintenance phase.

During the induction phase, you’ll receive Spravato twice a week for 4 weeks (weeks 1 to 4). The first dose of Spravato starts at 56 mg (two devices). After that, your prescriber may keep the dose at 56 mg or increase it to 84 mg (three devices) based on how you respond to the medication.

If you respond well to the induction phase of Spravato, your prescriber may have you continue on to the maintenance phase. You’ll receive 54 mg or 84 mg of Spravato once a week for 4 more weeks (weeks 5 to 8). Starting at week 9, you can continue with the same weekly dose schedule, or your prescriber may reduce you to 54 mg or 84 mg once every 2 weeks.

In most cases, if you don’t respond well to the induction phase of Spravato, your prescriber will discontinue treatment. You can use Spravato on its own for treatment-resistant depression. But in some cases, your prescriber may have you take an oral antidepressant along with it.

Depression with suicidal thoughts or behavior

Spravato is also approved for those with depression and experiencing suicidal thoughts and behavior. The Spravato dosage for depression with suicidal symptoms is 84 mg twice a week for 4 weeks. If the 84 mg dose isn’t well tolerated, your prescriber may lower your dose to 56 mg twice a week.

Spravato is only approved for this use when you take an oral antidepressant along with it. Spravato hasn’t been studied for longer than 4 weeks for depression with suicidal symptoms. Your prescriber will determine how to proceed after 4 weeks based on your individual needs.

Are there any dosage adjustments for health conditions?

There aren’t any Spravato dosage adjustments needed based on your age, kidney function, or liver function. You may need to stay in your prescriber’s office longer than 2 hours if you have liver problems. But Spravato isn’t recommended if liver problems are severe. Your prescriber can advise you if this restriction applies to you based on your medical history.

What happens if you miss a dose of Spravato?

If you miss a treatment session, contact your prescriber to reschedule it as soon as possible. In most cases, you can continue with your current dosing schedule as long as your symptoms aren’t getting worse.

If you miss a treatment session and your symptoms are worsening, let your prescriber know. You may need more frequent treatments to get back on track.

Since you’ll administer Spravato in a healthcare professional’s office, the best way to avoid missing treatments is to schedule your appointments in advance. And be sure to call and reschedule right away if a conflict arises. It’s also a good idea to circle the date in red on your calendar or set an alarm on your smartphone as a reminder.

What should you do if you take too much Spravato?

It’s unlikely that you’ll administer more Spravato than prescribed, since it’s given in a healthcare professional’s office under medical supervision. But if it happens, there’s an increased risk of side effects, such as nausea, high blood pressure, and feeling dizzy or disconnected from yourself. 

Serious side effects, such as trouble breathing and suicidal thoughts, are also possible. But in most cases, these can be managed in your prescriber’s office if they occur.

If Spravato is administered outside of a healthcare setting (which isn’t recommended), contact Poison Control at 1-800-222-1222 or call 911.

How to save on Spravato

There are ways to save on Spravato, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $10 for each Spravato treatment session using a savings card from the manufacturer.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Spravato’s patient assistance program, which offers the medication free of cost.

Good to know: Spravato is administered in a healthcare setting. So it’s not a prescription you’ll pick up at your local pharmacy. And in some cases, it may be covered by your medical insurance plan instead of your pharmacy insurance plan. Your prescriber’s office can help you determine the best way to access Spravato and apply any available savings.  

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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