Pharmacist here: Let’s talk about Spravato otherwise known as ketamine nasal spray.
THREAD/ theguardian.com/us-news/2019/j…
THREAD/ theguardian.com/us-news/2019/j…
Although ketamine has been saddled with a bad rap due to street abuse, it is classified federally as a schedule 3 medication. For reference, marijuana and bath salts are schedule 1 (meaning it has no medical purpose and not legal) and methamphetamine and cocaine are schedule 2...
(meaning high abuse potential but legal for restricted medical use). Ketamine has been around since 1970 as an IV anesthetic, but ended up only being used on children as it tends to give adults hallucinations, which is what it is abused for on the street. ...
Anecdotal data suggested it may be beneficial for depression, yet it took us years, until quite recently, to get it FDA approved to treat this. Alert: Big Pharma would rather patients to take their antidepressants daily for life. Spravato, the brand name for ketamine nasal ...
spray, is only taken twice a week at *most* in the very first week of treatment, and is titrated down from there to once weekly, then once every two weeks, and so on. The problem is that it’s currently only FDA approved for intractable depression - meaning your doctor must ...
certify that you have already trialed multiple other antidepressants to no effect. Note, conventional antidepressants take 8 weeks *at minimum* to show an effect, so you’re looking at a long time before you’d even be eligible for Spravato. ...
You also need to see a special doctor who’s been certified to prescribe Spravato, of which there are few. Your doctor must also have access to a pharmacy certified to dispense Spravato, of which there are few. It is illegal for that pharmacy to dispense ...
Spravato to you directly (due to the abuse potential), so the pharmacy must be able to coordinate with the doctor and deliver it during office hours, and keep every single receipt showing it was signed over to the doctor’s office, otherwise the pharmacy can lose their ...
certification to dispense Spravato. Once the Spravato labeled for the patient is in hand at the doctor’s office, you must have at minimum a four hour appointment in which a clinician administers the nasal spray (the number of sprays per nostril depends ...
on the dose the doctor prescribes) and then you both wait there the whole time while you are observed. During this time you may indeed have dilated pupils. However by the time the four hours is up, all effects of the medication will have worn off. The mechanism of action ...
is yet unproven as to how it treats depression given how short acting the Spravato is, but it is theorized that during this time, new neural connections are made. This is similar to how conventional antidepressants work, but over a much longer period of time and with much ...
worse side effects than Spravato’s temporary hallucinations - these include nausea (almost guaranteed when you first start taking), weight gain and sexual dysfunction. Even suicidal ideation. Thus I dispute the sensationalizing of this article’s headline, as Spravato has been
made legally impossible to abuse and is administered in a controlled environment for the duration of its hallucinogenic effect. Furthermore I argue that Spravato should be moved up closer to first line use in cases of severe depression and PTSD, in which someone may be at ...
a high risk of self harm in the immediate term, and do not have the time to wait around for multiple antidepressants to fail before they are even eligible (which would be at minimum a 6 month wait). Spravato should be first line for hospice patients, many of whom ...
can become depressed due to their terminal illness, and certainly do not have time to lose. Note that many patients feel the antidepressant effects of Spravato after only one session. ...
CONCLUSION: As a pharmacist w/ experience in dispensing it, intranasal ketamine (brand name: Spravato) is a safe & effective med for severe depression that yields nearly immediate results & is not controversial. Rather, its use should be expanded to help those who need it most.
PS/ Each spray device costs hundreds of dollars (one patient’s order can cost the pharmacy upwards of $1600) so the likelihood of any would-be drug dealer attempting to procure & sell this is not only low due to the aforementioned supply chain, but also bc it wouldn’t be worth it
