Avoid Mixing Spravato With Alcohol and 6 More Tips for Using Spravato Safely

Spravato (esketamine) is a prescription nasal spray that treats severe or treatment-resistant depression. But it’s not a medication you take on your own at home. Instead, you'll receive Spravato treatments in a healthcare setting.

Even though you’ll be using this medication at your prescriber’s office, there are a few things you should know before you start treatment. One of these is that you should avoid combining Spravato and alcohol. Below, we review the reason for this, along with six other tips to help you get the most out of your Spravato treatments.

1. Avoid eating and drinking before your Spravato treatments

Nausea and vomiting are common Spravato side effects. To help reduce the risk of these side effects and help you feel more comfortable, it’s recommended to limit food and liquids leading up to your Spravato appointments. You should avoid eating at least 2 hours before and drinking liquids at least 30 minutes before your Spravato doses.

EXPERT PICKS: WHAT TO READ NEXT

• Spravato dosages: Review how to use Spravato nasal spray and what the recommended dosage schedule looks like.

• Spravato versus ketamine: Learn about how these medications compare when it comes to treating certain types of depression.

• Treatment-resistant doesn’t mean untreatable. Explore the different options to help improve depression symptoms when other treatments haven’t worked.

2. Blow your nose before administering Spravato nasal spray

During each treatment session, blow your nose just before your first dose of Spravato. This helps make sure your nasal passages are clear so the medication can get into your system properly.

If you need to use more than one Spravato device to get your full dosage, you’ll need to wait 5 minutes in between using devices. But you shouldn’t blow your nose before any doses other than your first one.

You also shouldn’t blow your nose after using Spravato to avoid losing any medication. If you feel any liquid dripping out of your nose, it’s fine to dab it away gently with a tissue.

Good to know: If you use a steroid nasal spray such as Flonase (fluticasone) or a decongestant nasal spray such as Afrin (oxymetazoline), use it at least 1 hour before your Spravato treatment.

3. Only administer Spravato in the presence of a medical professional

Spravato is only approved for use in a healthcare setting. This means that you’ll go to a medical facility to receive and administer your doses. The medical staff at the facility will monitor you during and at least 2 hours after treatments. And they’ll let you know when it’s OK to leave the facility.

This may sound excessive, but it’s for your safety. Spravato can affect your cognition and alertness. In rare cases, it can cause you to see things that aren’t there or feel intense emotions. It can also raise your blood pressure and slow down your breathing. Having a healthcare professional nearby ensures that, if any serious side effects occur, you’ll receive prompt medical attention.

It’s not safe to use Spravato on your own without medical supervision. In fact, Spravato has a Risk Evaluation and Mitigation Strategy (REMS) program that ensures it’s used as directed. Both you and your prescriber are required to enroll in the Spravato REMS program in order for you to receive Spravato treatments.

4. Know what to bring to your Spravato treatments

There may be a few things you want to bring with you to your Spravato treatment sessions. Keep in mind that you’ll be at the appointments for at least 2 hours after receiving the medication. And a calm state of mind may help lessen negative side effects from Spravato. So think about things that help you relax and feel comfortable and safe. This might include:

• Headphones and a device to listen to music

• A book or magazine to read

• A tablet to play games on

• Crossword puzzles, sudoku, or word searches

• A knitting or crocheting project

• A comfortable neck pillow, blanket, and cozy pair of socks or slippers

It’s also a good idea to wear loose, comfortable clothing to your Spravato treatment sessions. The medication may make you more sensitive to rough or tight fabrics, so this can help you feel more relaxed.

5. Make sure someone can bring you home after your Spravato treatments

Spravato may leave you feeling dizzy, drowsy, or mentally disconnected for a while after you use the medication. For this reason, it isn’t safe for you to operate a vehicle or machinery on treatment days. So make sure to arrange for a friend or family member to drive you home from your appointments.

You should be able to drive again the day after you receive Spravato, once you’ve had a full night’s sleep.

6. Avoid combining Spravato and alcohol

As mentioned, Spravato can temporarily affect your mental state. It can make you feel dizzy and disoriented. Alcohol can worsen these effects, so it’s best to avoid alcohol on Spravato treatment days.

Keep in mind that alcohol can also worsen depression symptoms. So it’s a good idea to limit alcohol overall while you’re being treated for depression. Your prescriber can help you decide how much, if any, alcohol is safe for you to consume. They can also provide support if you’re having trouble cutting back on alcohol on your own.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

7. Spravato side effects can linger for hours after treatment

Most Spravato side effects will resolve in the 2 hours you’re under observation by a healthcare professional. But sometimes, they may linger after your treatment session. And in rare cases, they may last for a day or two.

On your Spravato treatment days, you may want to plan ahead for this. It may help to block off the rest of your day so you can rest and relax. Set the stage for a good night’s sleep by limiting caffeine and avoiding electronics before bedtime. You should be able to get back to your usual routine the next day. But let your prescriber know if you have side effects that don’t improve  or you’re not feeling like yourself after 24 hours have passed.

Tips for saving on Spravato

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

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

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

Good to know: As mentioned, Spravato is administered in a healthcare setting. In most cases, your prescriber will have the medication in the office when you get there. (It isn’t a medication you pick up at your local pharmacy.) So it may be covered by your medical insurance, instead of your prescription benefits. Your prescriber’s office will help you determine the best way to access Spravato and apply any available savings.

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Written by:

Jill Barat, PharmD

Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.

Edited 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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