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Dosing of SPRAVATO - Tapering Upon Discontinuation

Last Updated: 02/20/2025

SUMMARY

  • SPRAVATO nasal spray contains 28 mg of esketamine per device. The recommended maintenance dosing for treatment-resistant depression (TRD) is 56 mg or 84 mg every 2 weeks or weekly based on efficacy and tolerability.1
  • In accordance with good clinical practice, a decision to discontinue treatment with SPRAVATO should be determined based on clinical judgment and careful patient monitoring for worsening of mood.
  • In clinical trials with SPRAVATO for TRD, patients did not taper the SPRAVATO dose nor decrease the dosing frequency for the purposes of treatment discontinuation.
  • There was no evidence of withdrawal symptoms observed up to 4 weeks after cessation of SPRAVATO treatment in the phase 3 clinical trial program in TRD.2,3

Literature Search

A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 21 January 2025.

References

1 Center for Drug Evaluation and Research. Clinical pharmacology and biopharmaceutics review. NDA 211243 - SPRAVATO (esketamine) - Reference ID: 4398871. 2019- [cited 2025 January 21]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000ClinPharmR.pdf
2 Center for Drug Evaluation and Research. Other review. NDA 211243 - SPRAVATO (esketamine) - Reference ID: 4398871. 2019- [cited 2025 January 21]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211243Orig1s000OtherR.pdf
3 European Medicines Agency (EMA). Committee for Medicinal Products for Human Use (CHMP). SPRAVATO assessment report. Procedure No. EMEA/H/C/004535/0000. 2019- [cited 2025 January 21]. Available from: https://www.ema.europa.eu/en/documents/assessment-report/spravato-epar-public-assessment-report_en.pdf