What to Expect at Your First Spravato Appointment

Two instructions in the prescribing information affect the hours before your appointment: [FDA label]

• Avoid food for at least 2 hours before administration.
• Avoid liquids for at least 30 minutes before administration.
• If you use a nasal corticosteroid or nasal decongestant, take it at least 1 hour before Spravato.

Transportation is the other item to settle in advance. Because you cannot drive afterward, arrange a driver, a rideshare, or another way home before the day of treatment.

These are label instructions. Your treating clinic may add its own arrival-time or paperwork requirements — confirm those with the clinic directly.

Before a first dose, a clinician confirms that treatment is appropriate: reviewing diagnosis and treatment history, checking for the contraindications listed in the labeling, reviewing current medications, and discussing the expected effects and monitoring requirements. [FDA label]

Medication review matters more than it may seem. The labeling notes interactions of practical relevance — for example, concomitant use with central nervous system depressants may increase sedation, and psychostimulants or monoamine oxidase inhibitors may increase blood pressure. Bring a complete list, including over-the-counter products and supplements.

Eligibility questions are covered in more depth in who qualifies for Spravato.

Blood pressure is assessed before dosing. The labeling directs that if baseline blood pressure is elevated, the risks of short-term increases must be weighed against the benefit of treatment, and that patients with cardiovascular or cerebrovascular conditions warrant particular consideration. [FDA label]

After dosing, blood pressure is checked again at approximately 40 minutes, when the increase peaks, and monitored until values decline and the patient is clinically stable.

The mechanics are specified in the labeling:

1. A healthcare provider confirms the dose and prepares the single-use nasal spray devices.
2. You spray the medication yourself, under the direct observation of the provider — two devices for 56 mg, three devices for 84 mg.
3. There is a five-minute rest between devices.
4. The provider confirms the full dose was delivered and monitoring begins.

Self-administration under observation is a REMS requirement, not a stylistic choice: the medication is never handed over for use outside the certified setting. [SPRAVATO REMS]

The adverse reactions reported most commonly in trials of patients with treatment-resistant depression were dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia (reduced sensation), anxiety, lethargy, increased blood pressure, vomiting, feeling drunk, and headache. [FDA label]

Dissociation — a sense of detachment from yourself, your surroundings, or time — is among the most frequently reported effects and is one reason the monitoring period exists. Short-term cognitive effects have been measured around 40 minutes after dosing, with return toward baseline by two hours in the studies described in the labeling.

Experiences differ between individuals and between sessions. A fuller account is in Spravato side effects.

After administration you are monitored by a healthcare provider for at least two hours, and then assessed for clinical stability before discharge. [FDA label] Monitoring includes:

• blood pressure before the dose and at approximately 40 minutes, continuing until it declines and you are stable;
• sedation and dissociation, observed until they resolve;
• respiratory status, including pulse oximetry, for at least two hours.

Two hours is a floor. If effects have not resolved, monitoring continues — the labeling ties discharge to clinical stability rather than to the clock alone.

The labeling instructs patients not to drive or operate machinery until the next day, after a restful sleep. [FDA label] This applies after every session, not only the first, and it is not waived by feeling alert.

Plan for a driver, a rideshare, or public transportation. Some patients also arrange for someone to be with them for the rest of the day; whether that is necessary is worth discussing with your clinician.

The list below is practical preparation, not a label or REMS requirement. Confirm specifics with your treating clinic.

Once you are assessed as clinically stable you are discharged, with the driving restriction in effect until the next day after a restful sleep. The next session follows the labeled schedule for your indication — twice weekly during the induction phase for treatment-resistant depression. [FDA label] See how often treatment is given.

Between sessions, report new or worsening symptoms to your clinician. Any thought of harming yourself, or a medical symptom that feels urgent, warrants immediate contact with a clinician or emergency care — call 911, or call or text 988 for the Suicide & Crisis Lifeline.

The structure of a Spravato visit is set by the labeling and the REMS program: pre-dose checks, self-administration under observation, at least two hours of monitoring with blood pressure and respiratory checks, and a stability assessment before you leave. Food and liquid timing before the dose, and the no-driving rule after it, are also label instructions.

The parts that vary between clinics are logistical — scheduling, forms, room setup, and how the practice coordinates with your other clinicians. Ask your treating clinic about those specifics rather than assuming another clinic’s process applies.