From the Guidelines
The most common side effects of Spravato (esketamine) nasal spray include dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk.
Side Effects of Spravato (Esketamine)
The side effects of Spravato (esketamine) nasal spray can be significant, and it is essential to monitor patients closely during and after administration.
- Dissociation, which can include feelings of detachment from reality or altered perception, is particularly common and occurs in about 40% of patients 1.
- Sedation and dizziness each affect roughly 30% of patients.
- These side effects typically begin shortly after administration, peak within 1-2 hours, and generally resolve by the end of the monitoring period.
- Blood pressure increases are also common, typically peaking about 40 minutes after dosing and lasting for approximately 4 hours.
Monitoring and Administration
This is why Spravato must be administered in a healthcare setting with monitoring for at least 2 hours 1.
- The risk of these side effects is highest during and immediately following administration, which is why patients cannot drive or operate machinery until the day after treatment.
- Most side effects decrease in frequency with repeated treatments as patients develop tolerance to the medication.
- Patients with cardiovascular or cerebrovascular conditions should be monitored particularly carefully due to the blood pressure effects 1.
Special Considerations
It is crucial to weigh the benefits of Spravato against the risks of adverse effects, especially in patients with a history of substance abuse or those who are taking other medications that may interact with esketamine 1.
- The effectiveness of esketamine in preventing suicide or reducing suicidal ideation or behavior has not been established.
- Ketamine and esketamine are not recommended as initial treatment but are reserved for patients for whom previous therapies have failed or who have not tolerated previous therapies.
From the FDA Drug Label
The most common adverse reactions (≥5% and at least twice that of placebo nasal spray) were dissociation, nausea, dizziness, headache, anxiety, vomiting, feeling drunk, blood pressure increased, and sedation The most common side effects of SPRAVATO include: feeling disconnected from yourself, your thoughts, feelings and things around you dizziness nausea feeling sleepy spinning sensation decreased feeling of sensitivity (numbness) feeling anxious lack of energy increased blood pressure vomiting feeling drunk headache feeling very happy or excited
The most common side effects of Spravato (esketamine) are:
From the Research
Common Side Effects of Spravato (Esketamine)
The most common side effects of Spravato (esketamine) include:
- Dissociation 3, 4, 5, 6, 7
- Anxiety 3, 6
- Nausea 3, 4, 5, 7
- Increased blood pressure 3, 4, 5
- Headache 3, 4, 5
- Dizziness 5, 7
- Somnolence 5
- Hypoaesthesia 5
- Vertigo 5, 7
- Dysgeusia 7
- Lower urinary tract symptoms, such as dysuria or urgency 4
Severity and Duration of Side Effects
The majority of side effects are mild, transient, dose-dependent, and attenuate with subsequent treatments 3. However, some side effects, such as dissociative symptoms, can persist after treatment sessions and may be accompanied by anxiety 6.
Management of Side Effects
Patient selection, baseline physical and psychiatric assessments, and an appropriate setting are critical first steps in the prevention and mitigation of adverse events 3. Patient education and supportive interventions play central roles in the prevention and management of select adverse events 3. Severe and/or clinically significant adverse effects may necessitate the judicious use of adjunctive medications 3.