Ketamine nasal spray is a prescription medication for supervised medical use. It administers a form of ketamine through the nasal passages, which differs from ketamine used for anesthesia or illicit versions of the drug. The nasal spray delivery system allows for a different absorption profile than injections and is intended for use only within a structured healthcare environment to ensure patient safety and monitoring.
Medical Applications of Nasal Ketamine
The primary use for a ketamine-based nasal spray is for adults with treatment-resistant depression (TRD), a major depressive disorder that has not responded to at least two different oral antidepressants. The only formulation approved by the U.S. Food and Drug Administration (FDA) for this purpose is called Spravato.
The active ingredient in Spravato is esketamine, one of two molecules that make up the ketamine compound. Its application is also approved for adults with major depressive disorder who are experiencing acute suicidal ideation or behavior. In both scenarios, it is administered in conjunction with a daily oral antidepressant.
Beyond the FDA-approved product, some pharmacies create compounded ketamine nasal sprays. These are mixed “off-label” and are not FDA-approved, so their safety and effectiveness have not been formally evaluated by the agency. The FDA has issued warnings about the risks associated with these non-approved formulations, especially when dispensed for at-home use.
The Administration Process
The administration of FDA-approved esketamine nasal spray is highly regulated. Patients cannot pick up the medication from a pharmacy or use it at home. Treatment is restricted to certified healthcare settings approved through a specific safety program called a Risk Evaluation and Mitigation Strategy (REMS).
During a treatment session, the patient self-administers the nasal spray under the direct observation of a healthcare provider. Following administration, a mandatory observation period of at least two hours is required. This allows medical staff to monitor for immediate side effects like sedation, dissociation, and increases in blood pressure.
Because of the potential for drowsiness and impaired judgment, patients are not permitted to drive or operate heavy machinery for the rest of the day following treatment. They must arrange for transportation home in advance. Treatment schedules are more frequent at the start—often twice a week for the first month—before being reduced in frequency for maintenance.
Potential Side Effects and Nasal Health
Ketamine nasal spray is associated with a range of potential side effects. The most common systemic effects are dissociation (a feeling of detachment from oneself or reality), dizziness, nausea, sedation, and anxiety. A temporary increase in blood pressure is also a common reaction, which is why it is monitored during the observation period. These effects are short-lived and diminish within a couple of hours.
Because the medication is delivered directly into the nose, local side effects affecting the nasal and throat areas are also common. Patients may experience nasal discomfort, a burning sensation, or dryness. To minimize localized irritation, patients are instructed to alternate which nostril they use for each spray during a single treatment session.
With repeated, long-term use, there are considerations regarding the health of the nasal tissues. Chronic intranasal administration carries a risk of damage to the nasal mucosa or the septum. The protocol of alternating nostrils is a practical measure designed to mitigate constant irritation to one area. Patients are advised to report any persistent nasal pain to their healthcare provider.
Distinguishing Medical from Recreational Use
It is important to differentiate between supervised medical use and illicit recreational use of ketamine. Medically approved esketamine spray is a pharmaceutical-grade product with a precise dosage and sterile formulation. In contrast, recreational ketamine is an illicitly sourced substance of unknown purity and dosage, which may be contaminated.
Medical administration occurs in a certified clinic under a healthcare professional for a therapeutic purpose. Recreational use takes place in uncontrolled environments to induce a “high.” This unsupervised consumption at higher and more frequent doses significantly amplifies health risks.
Severe health problems like ulcerative cystitis (severe bladder damage), kidney problems, and memory loss are linked to chronic, high-dose recreational abuse. The structured, monitored, and lower-dose approach of medical esketamine therapy is designed to minimize these risks, creating a vastly different risk profile from that of uncontrolled abuse.