SPRAVATO
How Spravato (Esketamine) Nasal Spray Came to Be
Spravato comes from ketamine. Ketamine is a racemic drug, which means it is made of equal amounts of two molecules that mirror each other. Plenty of medications on the market are racemic. A familiar psychiatric example is Celexa (citalopram). Its right-handed molecule, R-citalopram, does very little therapeutically. Nearly all of the antidepressant effect comes from the left-handed molecule, S-citalopram. As the Celexa patent got close to expiring, its maker, Forest Pharmaceuticals, separated out the active left-handed molecule and won FDA approval for it as a brand-new drug with separate patent protection. That drug is Lexapro. Since only half of each Celexa dose is the active molecule, a Lexapro dose is half the size of a Celexa dose. No single company can realistically take generic ketamine through FDA approval, because ketamine cannot be patented and there would be no way to earn back the cost.
Janssen Pharmaceuticals used the same strategy Forest had used with Celexa. The company isolated S-ketamine, the left-handed molecule, and won FDA approval for it under the name Spravato. Janssen probably picked a nasal spray because the drug is aimed at psychiatrists, and most psychiatry offices are not set up or staffed to give medications by IV.
Spravato Compared With IV Ketamine
In January 2021, a published study looked at research on generic IV ketamine and on nasal S-ketamine for treating depression. Its findings showed that generic IV ketamine worked better. Put simply, IV ketamine is more effective than Spravato nasal spray.
Why We Offer Spravato
If IV ketamine works better, why offer Spravato at all? The answer is insurance coverage. Insurers have repeatedly declined to pay for generic IV ketamine, even with strong evidence that it is safe and effective. Their reason is that it has no FDA indication for depression, so they label it experimental and off-label. Sadly, paying for IV ketamine out of pocket is not possible for many patients. Spravato is less effective than generic IV ketamine, but it can still give real benefit to people living with treatment-resistant depression. Since insurance now routinely covers it, we want our patients to have access to it.
Safety Requirements and Monitoring
SPRAVATO® can only be given at certified treatment centers that are enrolled in the FDA’s REMS program. Columbia Ketamine Center follows every required safety protocol. We screen each patient carefully, use structured dosing and monitor you closely at every visit. Book a confidential consultation to find out whether this treatment is a good choice for you.
Using Your Insurance for Spravato
All leading insurance plans cover Spravato®, although coverage depends on your provider and policy. Our staff will help verify your benefits and handle prior authorization, so you know whether you qualify and what you may pay out of pocket before you start.