Spravato (esketamine) is a nasal spray you self-administer in a certified healthcare setting while a provider watches. You cannot take it home or use it on your own. Each treatment session involves spraying the medication into your nose, then staying at the clinic for at least two hours of monitoring before you’re cleared to leave. Here’s what the full process looks like from start to finish.
Why It Must Be Given in a Clinic
Spravato can cause sedation, dissociation (a feeling of being detached from your body or surroundings), and changes in blood pressure and breathing. Because of these effects, the FDA requires it to be administered only at certified healthcare settings through a program called REMS (Risk Evaluation and Mitigation Strategy). The medication is never dispensed for home use. Every dose must be given under direct observation by a healthcare provider, and every session includes a mandatory monitoring period afterward.
Before Your Appointment
Nausea and vomiting are common side effects, so you’ll need to avoid eating for at least two hours before your session and stop drinking liquids at least 30 minutes beforehand. Your care team will check your blood pressure before dosing. If your reading is above 140/90, they’ll weigh the risks of a temporary blood pressure spike against the benefits of treatment. If elevated blood pressure or increased pressure inside the skull poses a serious risk for you, the dose won’t be given that day.
How You Use the Nasal Spray Device
You administer the spray yourself, but your provider guides you through every step. Each device delivers two sprays, one into each nostril. You place the nose rest against the skin between your nostrils, close the opposite nostril with your finger, then press the plunger firmly all the way up while breathing in slowly through your nose. After the spray, you sniff gently. Then you repeat the process on the other side.
Depending on your dose, you may need to use a second or third device. If so, you wait five minutes between devices to let the medication absorb. If any liquid drips from your nose, you dab it with a tissue, but don’t blow your nose, as that can push the medication out before it’s absorbed.
The Two-Hour Monitoring Period
Once you’ve finished spraying, the clock starts on a minimum two-hour observation window. During this time, the clinic monitors your blood pressure, oxygen levels (via a pulse oximeter on your finger), and overall mental state. A blood pressure check typically happens around 40 minutes after dosing, with additional checks as needed until your readings come back down. Staff also watch for signs of excessive sedation, breathing changes, or prolonged dissociation.
At the end of the two hours, a provider assesses whether you’re clinically stable enough to leave. If your blood pressure is still elevated or you’re still feeling significantly sedated, you’ll stay longer until things settle.
What the Treatment Schedule Looks Like
Spravato treatment follows a structured timeline that starts intensive and tapers over time:
- Weeks 1 through 4 (induction): Twice per week, so you’ll be visiting the clinic roughly every three to four days.
- Weeks 5 through 8: Once per week.
- Week 9 onward: Once every one to two weeks, depending on how you’re responding.
Each of these visits follows the same format: arrive, get your blood pressure checked, self-administer the spray, stay for monitoring, and then leave once you’re cleared. During the induction phase, that means committing to two clinic visits of roughly two and a half to three hours each per week.
After You Leave the Clinic
Even after you’re cleared to go, Spravato’s effects haven’t fully worn off. You should not drive, operate heavy machinery, or do anything requiring full alertness for the rest of the day after treatment. You’ll need someone to drive you home. A driving study published in the Journal of Psychopharmacology found that esketamine did not impair driving performance the next morning (about 18 hours after a dose) or same-day at six hours post-treatment after repeated dosing. But for safety, the standard guidance is to avoid driving until the following day, especially early in treatment when you don’t yet know how the medication affects you.
Plan for each session to take up a significant chunk of your day. Between travel, the administration itself, the two-hour wait, and arranging a ride home, most people find it helpful to block off an entire morning or afternoon.