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When considering the use of Spravato at an 84 mg dose, it's important to be aware of several safety concerns:

Blood Pressure Increases: Spravato can cause a temporary rise in blood pressure, peaking around 40 minutes after administration and lasting up to four hours. This effect may be more pronounced in individuals with existing cardiovascular conditions. Therefore, it's crucial to monitor blood pressure before and after each dose. If you have a history of aneurysmal vascular disease, arteriovenous malformation, or intracerebral hemorrhage, Spravato may not be suitable for you.

Sedation and Dissociation: The medication can lead to sedation and dissociative experiences, such as feeling detached from reality or experiencing perceptual changes. These effects typically occur on the day of treatment and resolve afterward. Due to these potential effects, patients are monitored for at least two hours post-administration to ensure safety.

Respiratory Depression: Although rare, there have been reports of respiratory depression, including instances of respiratory arrest, following Spravato use. This risk underscores the importance of close monitoring during and after treatment sessions.

Potential for Abuse and Misuse: Spravato contains esketamine, a substance with potential for abuse and dependence. Individuals with a history of substance use disorders should discuss this with their healthcare provider before starting treatment.

Suicidal Thoughts and Behaviors: Antidepressants, including Spravato, have been associated with an increased risk of suicidal thoughts and behaviors, particularly in young adults. Close monitoring for any changes in mood or behavior is essential during treatment.

Use in Specific Populations: Spravato is not recommended for use during pregnancy or while breastfeeding due to potential risks to the fetus or infant. Its safety and effectiveness in pediatric patients have not been established. Elderly patients may have an increased risk of falls and should be monitored accordingly.

Driving and Operating Machinery: Due to potential impairments in attention, judgment, and motor skills, patients should avoid driving or operating machinery until the day after receiving Spravato.

Given these considerations, Spravato is administered under strict medical supervision, and patients are monitored closely to manage and mitigate these risks.

When using Spravato at the 84 mg dosage, patients may experience several side effects, most of which are temporary and occur shortly after administration. Common side effects include:

• Dissociation: Approximately 28% to 48% of patients report feelings of being disconnected from themselves or their surroundings. These sensations typically begin soon after dosing and usually resolve within two hours.
• Dizziness: Reported by 22% to 45% of patients, dizziness is more prevalent in individuals with depression accompanied by suicidal thoughts. This effect is generally short-lived.
• Sedation and Sleepiness: Between 6% and 29% of patients may feel drowsy or, in rare cases (0.3% to 0.4%), lose consciousness. Due to this, patients are monitored for at least two hours post-administration and are advised not to drive or operate machinery until the following day after a restful sleep.
• Nausea: Experienced by 25% to 32% of patients, nausea usually lasts less than an hour. Fasting before treatment can help reduce this side effect. Other common side effects include:
• Headache: Occurs in about 19% of patients.
• Altered Taste: Reported by 4% to 20% of patients.
• Anxiety: Affects 10% to 15% of patients.
• Temporary Thinking or Memory Problems: Experienced by 11% to 13% of patients, these issues typically resolve within two hours.
• Vomiting: Occurs in 6% to 12% of patients.
• Feeling Drunk: Reported by 4% to 7% of patients.
• Numbness or Tingling: Experienced by 4% to 13% of patients. Additionally, Spravato can cause a temporary increase in blood pressure, peaking around 40 minutes after dosing. The typical increase is 7 to 10 mmHg in systolic pressure and 4 to 6 mmHg in diastolic pressure. Blood pressure usually returns to normal within four hours. Patients are monitored before and after each dose, and treatment may be delayed if blood pressure is too high. Most side effects are transient and diminish with repeated treatments. However, if any side effects persist or become bothersome, it's important to inform your healthcare provider.

When using Spravato (esketamine) at an 84 mg dose, it's important to be aware of potential interactions with other substances:

• Central Nervous System (CNS) Depressants: Combining Spravato with medications or substances that depress the CNS—such as benzodiazepines, opioids, or alcohol—can enhance sedation effects. This may lead to increased drowsiness or dizziness. Therefore, it's crucial to closely monitor for signs of excessive sedation when these are used together.

• Psychostimulants: Concurrent use of Spravato with stimulant medications like amphetamines, Methylphenidate, Modafinil, or Armodafinil can result in elevated blood pressure. Regular blood pressure monitoring is recommended during such combined treatments to ensure safety.

• Monoamine Oxidase Inhibitors (MAOIs): Taking Spravato alongside MAOIs, a class of antidepressants, may also lead to increased blood pressure. It's advisable to monitor blood pressure closely when these medications are used together.

• Nasal Medications: If you're using nasal decongestants (like Oxymetazoline) or nasal corticosteroids (such as mometasone furoate), they should be administered at least one hour before taking Spravato. This timing helps minimize any potential impact on the absorption and effectiveness of Spravato.

Always inform your healthcare provider about all medications and supplements you're currently taking. They can provide guidance on managing potential interactions and ensure that your treatment plan is both safe and effective.