Spravato Induction Phase Basics
Spravato (esketamine nasal spray) treats treatment-resistant depression in adults, combined with an oral antidepressant. The FDA-approved dosing regimen splits treatment into an induction phase followed by maintenance. Induction builds initial response quickly.[1]
How Many Treatments in Induction
The induction phase lasts 4 weeks with twice-weekly dosing, totaling 8 treatments. Each session involves 2 nasal sprays (28 mg per device, up to 84 mg total per dose) under medical supervision, with 1-hour monitoring afterward.[1][2]
Why Twice-Weekly During Induction
This schedule targets rapid symptom relief, as esketamine's effects peak within hours but wane quickly. Studies showed twice-weekly dosing improved MADRS scores faster than placebo in phase 3 trials.[2]
Transition to Maintenance
After 4 weeks (8 doses), patients shift to once-weekly for week 5, then every 2 weeks or weekly based on response. Remission often occurs by week 4 in responders.[1]
Common Patient Questions on Scheduling
- Missed dose? Resume at next scheduled time; do not double up.
- Duration varies? No—fixed 4-week induction for all approved uses (TRD or MDD with suicidal ideation).
- Duration for suicidal ideation? Same 8-dose induction, but with urgent symptom monitoring.[1][2]
[1]: FDA Spravato Label
[2]: Spravato.com Dosing