Spravato Side Effects: What the Label Says and What to Expect

Short answer: The most common Spravato side effects are dissociation, dizziness, nausea, sedation, and vertigo, along with numbness, anxiety, lethargy, a temporary rise in blood pressure, vomiting, and feeling drunk. According to the FDA label, most fade on the day of dosing, which is why every session includes at least two hours of in-clinic monitoring.

The most common Spravato side effects

Spravato (esketamine) is a nasal spray approved for adults with treatment-resistant depression, and for depressive symptoms in adults with major depression and acute suicidal thoughts or behavior. Our complete Spravato guide covers the basics.

In treatment-resistant depression trials, the FDA label lists these as the most common reactions (at least 5% of patients and at least twice the placebo rate): dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia (numbness or reduced sensation), anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk.

Dissociation is the headline effect, a temporary sense of detachment or altered time and space. It is usually described as strange rather than painful, and our explainer on what dissociation actually is walks through what it can feel like.

The boxed warning, in plain language

Spravato carries an FDA boxed warning, the agency's most prominent safety label, covering five risks:

• Sedation: In trials, roughly half or more of patients became noticeably sleepy, and a very small fraction briefly lost consciousness.

• Dissociation: Perceptual and dissociative changes, as above.

• Respiratory depression: Slowed breathing has been reported since approval, including rare respiratory arrest.

• Abuse and misuse: Esketamine is a controlled substance, and each patient's risk should be assessed.

• Suicidal thoughts in young people: Like all antidepressants, it warns of increased suicidal thoughts and behaviors in pediatric and young adult patients. Spravato is not approved for children.

A boxed warning does not mean a medication is unsafe for everyone. It means the risks need careful management, which for Spravato is built into delivery.

Why the 2-hour monitoring exists

Spravato is only available through a restricted FDA program called the SPRAVATO REMS (Risk Evaluation and Mitigation Strategy). Patients self-administer each dose under direct observation in a certified setting, then are monitored for at least two hours, including pulse oximetry, until a clinician confirms they are stable to leave.

Blood pressure is part of that watch. The label notes that Spravato raises blood pressure at all recommended doses, with increases peaking about 40 minutes after dosing and lasting roughly four hours. Blood pressure is checked before dosing and again around 40 minutes, and an elevated reading can mean holding treatment that day.

How long the effects last

The label describes dissociation as transient and occurring on the day of dosing, and most nausea and vomiting resolved the same day, usually within about an hour. In a healthy volunteer study, thinking speed dipped 40 minutes after a dose but matched placebo by two hours.

One label item is worth knowing in advance: the prescribing information states that patients should not drive or operate machinery until the next day after a restful sleep.

If you have had IV ketamine, much of this will sound familiar, and our overview of IV ketamine side effects shows how closely the two profiles overlap. The bigger differences are in delivery and dosing control, which ketamine vs. Spravato lays out side by side.

Who may not be a candidate

The label says Spravato should not be used by people with:

• Aneurysmal vascular disease (including the aorta and brain or peripheral arteries) or an arteriovenous malformation

• A history of intracerebral hemorrhage (bleeding in the brain)

• Hypersensitivity to esketamine, ketamine, or any of its ingredients

It also advises caution with elevated baseline blood pressure, certain heart and brain conditions, psychosis, pregnancy, and a history of substance misuse, which is why a thorough medical evaluation comes before the first dose.

This article is for educational purposes only and is not medical advice. Spravato and ketamine are controlled medications administered under medical supervision. Consult a licensed provider about your individual situation.

The bottom line

Spravato side effects are real but usually short-lived, mostly fading the same day, and the boxed warning and REMS monitoring exist so they are managed in a clinical setting. Ketamine Uplift offers Spravato alongside IV ketamine, and Dr. O'Neill can help you decide which fits. Call us at (310) 280-4440.

Frequently asked questions

What is the most common side effect of Spravato? Dissociation, a temporary sense of detachment or altered perception, is the most commonly reported effect in clinical trials. Dizziness, nausea, and sedation are also common.

How long do Spravato side effects last? Per the FDA label, dissociation occurs on the day of dosing and most nausea resolves the same day. Blood pressure increases peak around 40 minutes and last about four hours.

Why do you have to stay 2 hours after Spravato? The FDA requires at least two hours of monitoring after each dose because of sedation, dissociation, and breathing risks. A clinician confirms you are stable before you leave.

Can you drive after Spravato? The FDA label states that patients should not drive or operate machinery until the next day after a restful sleep.