Spravato Dosage: Form, Strength & How to Take

by Jack | Mar 11, 2025 | Blog

Spravato (esketamine) is a brand name, prescription nasal spray used to treat certain types of depression, including:

Treatment-resistant depression (TRD), a type of depression that hasn’t responded to two or more antidepressants.
Major depressive disorder (MDD) with suicidal thoughts or behaviors.

Spravato belongs to a class of medications called N-methyl-D-aspartate receptor antagonists. Although it is FDA-approved, Spravato has potential risks. For that reason, it is only available through a controlled program and must be taken under medical supervision at a licensed healthcare facility. The exact dosage of Spravato can vary depending on the condition it’s prescribed to treat.

In this guide, we’ll walk you through everything you need to know about Spravato, including typical dosages, available strengths, how it’s taken, and what to expect during treatment.

Note: This guide will discuss typical dosages for Spravato according to the manufacturer. If you’re taking Spravato, always follow the dosage prescribed by your healthcare provider.

What form does Spravato come in?

Spravato comes as a liquid nasal spray. Each dose is administered by spraying the medication into your nose under the supervision of a healthcare provider.

Spravato strength

Each Spravato nasal spray contains 28 milligrams (mg) of medication. Depending on your prescribed dose, you may use:

56-mg dose pack that includes two 28-mg nasal sprays
84-mg dose pack that includes three 28-mg nasal sprays.

Your healthcare provider will determine the right dosage based on your condition and treatment plan.

Spravato dosage summary

Spravato is always taken alongside an oral antidepressant and only administered in a healthcare setting. The below table summarizes Spravato’s dosages in milligrams (mg), although the best dosage for you will depend on your condition and response to treatment.

SPRAVATO USE

DOSAGE

WEEKS 1 – 4

DOSAGE

WEEKS 5 – 8

DOSAGE

WEEK 9 +

Treatment-Resistant Depression (TRD)

First dose of 56-mg, followed by 56-mg or 84-mg twice per week

56-mg or 84-mg once a week

56-mg or 84-mg once every 2 weeks or once a week, depending on your provider’s recommendation

Major Depressive Disorder (MDD) with suicidal symptoms

84-mg twice per week (may be reduced to 56-mg if needed)

Your healthcare provider will assess whether Spravato is working for you and if you should continue treatment

Spravato is not typically prescribed for MDD beyond four weeks. If you’re considering long-term use, your healthcare provider will discuss the therapeutic benefit and any potential risks to help you make an informed decision.

Below, we’ll go into more detail about Spravato dosages for its approved uses.

Typical Spravato dosages

As we mentioned earlier, your healthcare provider will determine the best Spravato dosage and dosing frequency for you based on your condition, how you respond to treatment, and any potential side effects. That said, below we offer a general guide to the typical Spravato dosages given for its approved uses.

Note: Each Spravato nasal spray device delivers 28-mg of medication, with two sprays per device. Depending on your prescribed dose, you may need multiple devices per session.

Spravato dosage for Treatment-Resistant Depression (TRD)

TRD is depression that doesn’t improve after trying at least two different antidepressants. For this condition, Spravato treatment follows two phases:

Induction Phase (Weeks 1 to 4):

First dose: 56-mg
Following doses: 56-mg or 84-mg twice per week.

This phase helps determine the best dose for you.

Maintenance Phase (Weeks 5+):

Weeks 5 to 8: 56-mg or 84-mg once a week
Week 9+: 56-mg or 84-mg once every 1 or 2 weeks, depending on how you respond to treatment.

Spravato dosage for Major Depressive Disorder (MDD) with suicidal symptoms

Major Depressive Disorder (MDD) is more commonly known as depression. For some people, it can involve suicidal thoughts and behaviors.

Spravato dosage for this kind of depression involves taking 84-mg twice per week for four weeks. If any side effects occur, your healthcare provider may lower the dose to 56-mg twice per week.

Spravato isn’t typically prescribed beyond four weeks for MDD with suicidal symptoms. Your healthcare provider will assess whether continued treatment is necessary.

Long-term treatment

For TRD, long-term treatment may be an option if Spravato is effective for you. Again, your healthcare provider will determine the safest ongoing dosage.

For MDD with suicidal symptoms, Spravato is typically a short-term treatment.

In both cases, Spravato is always used alongside an oral antidepressant and only taken under direct supervision.

Keep Reading: Do Antidepressants Work and How Effective Are They?

What factors affect Spravato dosage?

Your healthcare provider will determine the best Spravato dosage for you based on several factors, including:

The type and severity of your condition: Whether you’re using Spravato for TRD or MDD with suicidal symptoms will affect your dosage and duration of treatment.

Your body’s response to treatment: If you experience side effects, your doctor may adjust your dosage to improve tolerability.

Other medications you’re taking: Spravato is always used alongside an oral antidepressant, and potential interactions may influence your dosage.

Your medical history: Certain conditions, such as high blood pressure or respiratory issues, may require dosage adjustments.

Spravato dosage adjustments

Your healthcare provider may lower your dosage if you experience side effects such as:

Sedation: Feeling excessively drowsy, dizzy, or faint

Dissociation: A sense of detachment from your thoughts, surroundings, or time

Respiratory depression: Slow or shallow breathing

Worsening depression: If your symptoms intensify instead of improve

High blood pressure: If you experience elevated blood pressure levels that require monitoring.

If you experience any side effects while taking Spravato, speak with your healthcare provider. They can adjust your treatment plan to ensure you receive the right balance of effectiveness and safety.

Learn More: What to Do When Antidepressants Don’t Work for You (and Why)

How to take Spravato

Spravato is a nasal spray that you take under medical supervision at a certified treatment center. Your healthcare provider will guide you through the process and monitor you for at least two hours after your dose to ensure safety.

Here’s what you can expect when taking Spravato.

Before your appointment

To minimize nausea, it’s best to avoid eating for at least 2 hours before treatment, and avoid drinking anything for 30 minutes before your dose.

During your treatment session

Your healthcare provider will show you how to use the nasal spray device. Below is an outline of the process:

Blow your nose before using the nasal spray
Your provider will confirm your dosage and check the spray device
Position the device in one nostril, tilt your head back slightly, and press your other nostril closed
Spray once and gently sniff to keep the medication in your nose
Repeat the process in your other nostril
Wait 5 minutes before using the next device, if required.

If your Spravato dose is 56-mg, you’ll need two devices (4 sprays total) and if your dose is 84-mg, you’ll need 3 devices (6 sprays total).

To see the process in action, you can watch this video on how to take Spravato.

After your treatment

Once you have taken your dose, your healthcare provider will monitor you for two hours to check for any side effects like high blood pressure, sedation, or breathing changes.

Because Spravato can cause drowsiness, you’ll need someone to drive you home after your appointment.

What happens if you miss a dose of Spravato?

If you miss a Spravato appointment, call your healthcare provider as soon as possible to reschedule. You may have your dosage or treatment schedule adjusted to ensure your treatment remains safe and effective.

To help you stay on track with your Spravato appointments, consider using medication reminders such as:

Setting an alarm on your phone
Using a reminder app for appointments
Marking your calendar with treatment dates.

Since Spravato is only administered under medical supervision, staying consistent with your appointments is key to getting the best results from your treatment.

Keep Reading: Persistent Depressive Disorder – Overview, Symptoms and Causes

Is there a risk of Spravato misuse?

Yes, Spravato carries a boxed warning – the most serious warning from the FDA – due to the risk of misuse and dependence. Misuse occurs when a drug is taken in a way other than prescribed, which can lead to dependence and addiction.

However, the risk of misusing Spravato is reduced because it is only available through a risk evaluation and mitigation strategy (REMS) program. This means you can only take it in a certified healthcare setting with a medical professional supervising each dose.

If you have a history of substance misuse, speak to your healthcare provider before starting Spravato.

Spravato withdrawal and dependence

Spravato is a controlled substance, which means it’s regulated due to the risk of misuse and dependence. Dependence occurs when your body adapts to a drug and might struggle to function normally without it.

That said, no withdrawal symptoms have been reported for up to four weeks after people stopped Spravato treatment in studies. It’s not yet known if withdrawal could occur after long-term or high-dose use.

Ketamine, which is a similar drug to Spravato, is known to cause withdrawal symptoms like anxiety, sleepiness, and loss of appetite, but these symptoms haven’t been reported with Spravato (esketamine).

If you’re concerned about the possible risk of dependence or withdrawal with Spravato, don’t hesitate to contact our team. We will be happy to answer any questions you have.

Is Spravato a long-term treatment?

Spravato may or may not be prescribed long-term, depending on your condition and how well you respond to treatment. Your healthcare provider will be able to provide more information about whether Spravato is a suitable ongoing treatment option for you.

Spravato FAQs

Below we answer some frequently asked questions about Spravato.

Is the dosing schedule for esketamine the same as for Spravato?

Yes, esketamine is the active ingredient in Spravato and there is no generic version available. That means the dosing schedule for Spravato is the only one currently approved.

What is the Spravato REMS program?

The risk evaluation and mitigation strategy (REMS) program is an FDA safety program designed to ensure that Spravato is used safely. Under REMS, patients and healthcare providers must follow certain rules, such as:

Staying in the healthcare facility for at least 2 hours after a Spravato dose
Having someone drive you home
Avoiding driving or operating heavy machinery for the rest of the day.

You can learn more about the program at the Spravato REMS website, or call 855-382-6022 for more information.

Is Spravato the same as ketamine?

No. Spravato contains esketamine, which is derived from ketamine, but they are not the same drug. They are chemically related, but their medical uses and administration are very different. For example:

Ketamine is often used as an anesthetic for surgery while esketamine (Spravato) is approved for treating depression.
Ketamine is given intravenously while Spravato is available as a nasal spray.

To learn more about the difference between ketamine and esketamine, read our article: The Difference Between Ketamine and Esketamine.

Can Spravato be taken with other medications?

Yes, Spravato can often be used alongside other medications, but it’s important to discuss this with your healthcare provider beforehand. Combining Spravato with other treatments requires careful consideration.

Before starting Spravato treatment, your provider will review your medical history, current medications, and any potential interactions or contraindications to determine the best treatment plan for you. For more information, schedule a consultation to determine Spravato’s suitability for you.

Explore Spravato treatment today

Spravato is an innovative treatment option that can provide relief when other depression treatments have not been effective. But just like any other medication, it’s important to know what’s involved and consider potential benefits, risks, and side effects before beginning treatment.

If you’re considering Spravato as a treatment option or would like to assess your suitability for this therapy, our team at BestMind Behavioral Health can help. We offer Spravato treatment at our licensed medical facilities in Oregon, Colorado, and Washington and accept a variety of health insurance plans.