Spravato represents a novel, fast acting therapy for treatment resistant depression (TRD). Recently approved in March 2019, this enantiomer of ketamine is only available as a nasal spray. Its use is limited to a licensed doctor’s office or other approved medical facility. After inhaling the correct dose, the patient must remain under medical supervision for the following 2 hours and on discharge must be driven home by a relative, friend or commercial service such as Uber or Lyft.
During the first 4 weeks of treatment, the drug is administered twice a week. Assuming significant benefits, the dose schedule is reduced to once weekly for the subsequent month followed by prolonged therapy once every other week.
Proper technique guarantees administering the spray high into the nasal cavity rather than the area closest to the nasal tip. This allows rapid absorption into the nasal capillary network or possibly directly through branches of the nerves charged with the sense of smell.
In addition to the esketamine nasal spray, a traditional oral antidepressant remains an integral part of the program. The particular oral agent should be new to the individual and not one previously found to be unhelpful.
Success becomes clinically apparent within several hours as the mood lifts and spirits brighten - but only in a limited number of patients and typically only partially. It remains too early to predict the role for Spravato in the armamentarium of treatment for depression.
Side effects include a dramatic elevation in blood pressure during the first hour or so that in some instances may precipitate episodes of chest pain, shortness of breath, visual disturbances and seizures. Spravato can impair attention, judgment, thinking and motor skills. These usually self-correct during the several hours before the individual leaves the medical facility.
While many of the available therapies for depression are available as relatively inexpensive generics, Spravato will remain under patent for years. The current wholesale cost of Spravato for the first month ranges between $4720 - $6785 which translates to $169 - $242 every day of the month. During the second and subsequent months the price falls to $2360 -$3450 which still equates to a daily cost just for the drug of $84 - $123.
With an estimated 16 million individuals with suffering from depression of whom one quarter to one half are considered treatment resistant, the potential burden to society defies imagination. Interestingly a bottle of 5000 milligrams of intravenous ketamine carries a retail price of less than $50. The maximum first month dose of esketamine is limited to less than 700 milligrams. Prior to Spravato, clinics sprung up throughout the country offering intravenous treatment with ketamine and still providing noteworthy results. Whether the nasal spray offers sufficient advantages to warrant the horrendous price remains untested.
Негізгі бет Spravato - Esketamine
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