Spravato (Esketamine) Nasal Spray: Background and Development
Spravato is derived from ketamine. Ketamine is a racemic drug, meaning it is composed of equal parts of two molecules that are mirror images of one another. Many medications on the market are racemic. One well-known example in psychiatry is Celexa (citalopram). The right-handed molecule, R-citalopram, has minimal therapeutic effect. It is the left-handed molecule, S-citalopram, that provides virtually all of the antidepressant activity. When the patent on Celexa was nearing expiration, its manufacturer, Forest Pharmaceuticals, isolated the active left-handed molecule and brought it through the FDA approval process as a new drug with its own intellectual property protection. That drug became Lexapro. Because half of every dose of Celexa is the active molecule, the dose of Lexapro is half that of Celexa. Generic ketamine cannot realistically be taken through the FDA approval process by any single company — there would be no way to recoup the investment, since the drug is not patentable.
Janssen Pharmaceuticals took the same approach that Forest used with Celexa: they isolated S-ketamine, the left-handed molecule brought it through FDA approval as Spravato. Janssen likely chose the nasal route of administration because their target prescribers are psychiatrists, who typically do not have the infrastructure and expertise in their offices to administer intravenous Medications.
Effectiveness of Spravato vs. IV Ketamine
Why Spravato Is Offered
So why are we now offering Spravato? Because insurance covers it. Insurance companies have consistently refused to cover intravenous generic ketamine — despite strong evidence of its safety and efficacy — on the grounds that it has not received an FDA indication for depression, classifying it as experimental, off-label use. Unfortunately, the cost of IV ketamine without insurance coverage puts it out of reach for many patients. While Spravato is not as effective as generic IV ketamine, it can still provide meaningfully benefit to people suffering from treatment- resistant depression. Now that it is routinely covered by insurance, we want to make it available to our patients.
Safety and Monitoring
SPRAVATO® is available only through certified treatment centers enrolled in the FDA’s REMS program. Charleston Ketamine Center follows all required safety protocols, including careful screening, structured dosing, and close monitoring at every visit. Schedule a confidential consultation to learn whether this treatment option is right for you.
Insurance Coverage
Spravato® is covered by all leading insurance plans, though coverage varies by provider and policy. Our team will assist with benefit verification and prior authorization to help determine your eligibility and potential out-of-pocket costs before treatment begins.