Spravato (esketamine) is a prescription nasal spray that’s used to treat certain types of depression in adults. This drug can interact with alcohol and other medications. For example, Spravato can interact with opioids and stimulants.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Before you start using Spravato, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Spravato interacts with herbs or vitamins and supplements, see the “Are there other interactions with Spravato?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Spravato. Keep in mind that this table does not include all drugs that may interact with Spravato. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| central nervous system (CNS) depressants | • opioids • benzodiazepines • certain other antidepressants | can increase the risk of side effects from Spravato and the CNS depressant |
| stimulants | • amphetamines salts (Adderall) • methylphenidate (Ritalin) • modafinil (Provigil) • armodafinil (Nuvigil) | can increase the risk of high blood pressure |
Certain health conditions or other factors could raise your risk of harm if you use Spravato. In such cases, your doctor may not prescribe Spravato for you. These are known as contraindications. The list below includes contraindications of Spravato.
If you have a brain bleed: If you currently have or have had a brain bleed, you should not use Spravato. Spravato can increase your blood pressure, which can raise your risk of having another brain bleed. You can talk with your doctor about other treatment options.
If you have certain blood vessel problems, such as aneurysms: You should not use Spravato if you have certain blood vessel problems, such as aneurysms. Spravato can raise your blood pressure and increase your risk of having a serious bleeding event. Your doctor can tell you about other treatment options that may be safer for you.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Spravato or any of its ingredients, your doctor likely won’t prescribe Spravato for you. This is because using the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start using Spravato, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Spravato is safe for you to use.
Spravato and alcohol can cause some similar side effects, such as drowsiness and dizziness. Combining Spravato with alcohol can raise the risk of sedation, poor concentration, and confusion. If you drink alcohol, talk with your doctor about how much (if any) may be safe to drink during your Spravato treatment.
If you have questions about consuming alcohol during Spravato treatment, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Spravato.
Interaction with central nervous system (CNS) depressants
Spravato can interact with CNS depressants, which are used to treat a variety of conditions. These conditions include pain, anxiety, depression, and others.
Examples of CNS depressant medications include:
- opioids, such as oxycodone (Oxycontin) and tramadol (Ultram)
- benzodiazepines, such as alprazolam (Xanax) and clonazepam (Klonopin)
- certain other antidepressants, such as amitriptyline (Elavil) and nortriptyline (Pamelor)
What could happen
Taking Spravato with CNS depressants can raise your risk of side effects, including excessive drowsiness and dizziness.
What you can do
If you use Spravato with CNS depressants, your doctor may prescribe either a lower dosage of Spravato or of the CNS depressant. You should not take a higher dose of either medication than your doctor prescribes.
If you use Spravato and a CNS depressant together, tell your doctor right away if you have symptoms of severe drowsiness, dizziness, confusion, and memory problems.
If you use Spravato with an opioid, your doctor may also recommend that you have naloxone (Narcan) nasal spray on hand as a precaution. Narcan is used in an emergency situation to reverse the effects of opioids.
If you have questions about using Spravato with CNS depressants, talk with your doctor or pharmacist.
Interaction with stimulants
Spravato can interact with stimulants, which are used to used to treat attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD), and other conditions.
Examples of stimulant medications include:
What could happen
Taking Spravato with stimulants can increase your blood pressure.
What you can do
Before using Spravato, talk with your doctor about all health conditions you have and any medications you take, including over-the-counter drugs, vitamins, and supplements. Your doctor can determine whether Spravato is a safe treatment for you.
Your doctor will check your blood pressure right before you receive a Spravato dose. They’ll also monitor your blood pressure for at least 2 hours after your dose.
You should also monitor your blood pressure regularly at home while receiving Spravato treatment. Talk with your doctor about any high blood pressure readings you have or symptoms of high blood pressure you experience. These symptoms can include vision problems, shortness of breath, and headache.
If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.
Spravato may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Spravato.
Does Spravato interact with supplements?
Before you start using Spravato, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Spravato and herbs
There are currently no reports of Spravato interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while using Spravato.
Spravato and vitamins
There are currently no reports of Spravato interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while using Spravato.
Does Spravato interact with food or beverages?
There are currently no reports of Spravato interacting with food. However, using Spravato near the time you eat food or drink beverages may increase your risk of nausea and vomiting. See this article for more information on how to manage this side effect.
Limiting caffeine consumption while using Spravato may also be recommended. Both caffeine and Spravato can increase your blood pressure. See this article for more information on how caffeine affects your body.
If you have questions about eating certain foods during your treatment with Spravato, talk with your doctor.
Does Spravato interact with vaccines or lab tests?
There are currently no reports of Spravato interacting with vaccines or lab tests. If you have questions about receiving certain vaccines or having lab tests done during your Spravato treatment, talk with your doctor.
Does Spravato interact with cannabis or CBD?Cannabis(commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Spravato. Cannabis products can increase your risk of experiencing Spravato side effects.
Before you start treatment with Spravato, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Spravato. Before using Spravato, talk with your doctor about your health history. They’ll determine whether Spravato is right for you.
Health conditions or other factors that might interact with Spravato include:
High blood pressure: Using Spravato can raise your blood pressure. Your doctor will check your blood pressure right before you receive a dose of Spravato. They’ll also monitor your blood pressure for at least 2 hours after your dose. If you already have high blood pressure, talk with your doctor before starting Spravato treatment. They can help determine whether this drug is right for you.
Mental health conditions, such as dissociation: Spravato can cause certain mental health conditions, such as dissociation. Spravato has a boxed warning for the increased risk of suicidal thoughts and behaviors in children and young adults. It’s important to note that the drug is not approved for use in children. To learn more about this risk, see the “Boxed warnings” section at the beginning of this article.
If you have any mental health conditions, talk with your doctor before starting Spravato treatment.
Liver problems: If you have a liver problem, such as liver disease, Spravato levels could build up in your body. This raises your risk of side effects from the drug. If you have a liver problem, talk with your doctor before using Spravato. They may need to adjust your dosage, or they may prescribe a different medication for you.
Cognitive impairment: Spravato can cause cognitive impairment (difficulty with thinking, learning, remembering, and more). If you already experience cognitive impairment, talk with your doctor before starting Spravato. They may want to monitor you more closely for these symptoms or choose another medication.
Brain bleed: If you have or have had a brain bleed, Spravato may not be right for you. Spravato can raise your blood pressure, which increases the risk of another brain bleed. Talk with your doctor about your health history and the other available treatment options.
Certain blood vessel problems, such as aneurysms: Spravato is not recommended if you have or have had certain blood vessel problems, such as an aneurysm. Spravato can raise your blood pressure and increase your risk of having a serious bleeding event. Your doctor can tell you about other treatment options that may be safer for you.
Pregnancy: Spravato is not recommended during pregnancy. The drug may cause harm to a fetus. If you’re pregnant or planning a pregnancy, talk with your doctor before using Spravato.
If you do use Spravato while pregnant, consider enrolling in the drug’s pregnancy registry. This registry collects details about pregnancy issues reported with Spravato. For more details or to enroll, visit the registry website or call 866-961-2388. You can also talk with your doctor to learn more.
Breastfeeding: You should not use Spravato while breastfeeding. The drug passes into breast milk, but it isn’t known whether the drug may cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to do so, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Spravato or any of its ingredients, your doctor will likely not prescribe Spravato. This is because using the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Spravato. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a
medication list ) - what to do if you start taking a new drug during your Spravato treatment
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Using Spravato exactly as prescribed can also help prevent interactions.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.