Jupiter, Florida – July 18, 2019 – Lighthouse Health Florida is now Risk Evaluation and Mitigation Strategy (REMS) certified to provide SPRAVATO™ (esketamine) CIII, a nasal spray approved for use in conjunction with an oral antidepressant in adults with treatment-resistant depression (TRD).1 People who are currently struggling with major depressive disorder (MDD) may have TRD if they have not responded adequately to at least two different antidepressants of adequate dose and duration in the current depressive episode.2
According to the National Institute of Mental Health, MDD is one of the most common mental health disorders in the United States.3 For many people, treatments such as therapy, medicine, and lifestyle changes may help relieve symptoms.4 However, up to one-third of adults may have TRD, and continue to experience symptoms such as persistent feelings of sadness, sleep disturbances, low energy and thoughts of death or suicide, despite trying multiple treatments.5
SPRAVATO™ was approved by the U.S. Food & Drug Administration on March 5, 2019, and is only available to patients at REMS–certified treatment centers in the United States.
Once it is determined that SPRAVATO™ is an appropriate choice, patients will need to receive the medicine at a certified treatment center. If the healthcare provider recommends SPRAVATO™, they will discuss the side effects and benefits of the medicine and key considerations related to the administration. Patients will need to plan for transport to and from the treatment center as they should not drive or operate machinery until the day after a treatment session, following a restful sleep. Patients are monitored for at least two hours after treatment.
Because of the risks for sedation, dissociation (feeling disconnected from yourself, your thoughts, feelings, space and time), and abuse and misuse, SPRAVATO™ carries a Boxed WARNING and is only available through a restricted program called the SPRAVATO™ Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO™ can only be administered at healthcare settings certified in the SPRAVATO™ REMS Program and to patients enrolled in the REMS program.
For more information on SPRAVATO™, please refer to the manufacturer’s Prescribing Information and Medication Guide or visit www.SPRAVATO.com. If you are a patient, please speak to your healthcare provider for more information.
What is SPRAVATO™?
SPRAVATOTM is a prescription medicine, used along with an antidepressant taken by mouth, for treatment-resistant depression (TRD) in adults.
SPRAVATOTM is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATOTM is safe or effective as an anesthetic medicine.
It is not known if SPRAVATOTM is safe and effective in children.
IMPORTANT SAFETY INFORMATION
|What is the most important information I should know about SPRAVATO™?|
SPRAVATO™ can cause serious side effects, including:
· Sedation and dissociation. SPRAVATO™ may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).
· Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO™ treatment. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with SPRAVATO™.
o Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
o Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.
· SPRAVATO™ Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, SPRAVATO™ is only available through a restricted program called the SPRAVATO™ Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO™ can only be administered at healthcare settings certified in the SPRAVATO™ REMS Program and to patients enrolled in the program.
· Increased risk of suicidal thoughts or actions. SPRAVATO™ may cause worsening of depression and suicidal thoughts and behaviors, especially during the first few months of treatment and when the dose is changed. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.
· How can I watch for and try to prevent suicidal thoughts and actions?
· Tell your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
SPRAVATO™ is not for use in children.
Do not take SPRAVATO™ if you:
- have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs)
- have an abnormal connection between your veins and arteries (arteriovenous malformation)
- have a history of bleeding in the brain
- are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO™.
If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO™.
Before you take SPRAVATO™, tell your healthcare provider about all of your medical conditions, including if you:
- have heart or brain problems, including:
- high blood pressure (hypertension)
- slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness, or fainting
- history of heart attack
- history of stroke
- heart valve disease or heart failure
- history of brain injury or any condition where there is increased pressure in the brain
- have liver problems
- have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believe in things that are not true).
- are pregnant or plan to become pregnant. SPRAVATO™ may harm your baby. You should not take SPRAVATO™ if you are pregnant.
- Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO™.
- If you are able to become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO™.
- There is a pregnancy registry for women who are exposed to SPRAVATO™ during pregnancy. The purpose of the registry is to collect information about the health of women exposed to SPRAVATO™ and their baby. If you become pregnant during treatment with SPRAVATO™, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
- are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO™.
Tell your healthcare provider about all the medicines that you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO™ with certain medicine may cause side effects. Especially tell your healthcare provider if you take Central Nervous System (CNS) depressants, psychostimulants, or Monoamine oxidase inhibitors (MAOIs) medicines.
How will I take SPRAVATO™?
- You will take SPRAVATO™ nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting. Your healthcare provider will show you how to use the SPRAVATO™ nasal spray device.
- Your healthcare provider will tell you how much SPRAVATO™ you will take and when you will take it.
- Follow your SPRAVATO™ treatment schedule exactly as your healthcare provider tells you to.
- During and after each use of the SPRAVATO™ nasal spray device, you will be checked by a healthcare provider who will decide when you are ready to leave the healthcare setting.
- You will need to plan for a caregiver or family member to drive you home after taking SPRAVATO™.
- If you miss a SPRAVATO™ treatment, your healthcare provider may change your dose and treatment schedule.
- Some people taking SPRAVATO™ get nausea and vomiting. You should not eat for at least 2 hours before taking SPRAVATO™ and not drink liquids at least 30 minutes before taking SPRAVATO™.
- If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at least 1 hour before taking SPRAVATO™.
What should I avoid while taking SPRAVATO™?
Do not drive, operate machinery, or do anything where you need to be completely alert after taking SPRAVATO™. Do not take part in these activities until the next day following a restful sleep. See “What is the most important information I should know about SPRAVATO™?”
What are the possible side effects of SPRAVATO™?
SPRAVATO™ may cause serious side effects including:
- See “What is the most important information I should know about SPRAVATO™?”
- Increased blood pressure. SPRAVATO™ can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO™ and for at least 2 hours after you take SPRAVATO™. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO™.
- Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering.
- Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.
The most common side effects of SPRAVATO™ when used along with an antidepressant taken by mouth include: dissociation, dizziness, nausea, sedation, spinning sensation, reduced sense of touch and sensation, anxiety, lack of energy, increased blood pressure, vomiting, and feeling drunk.
These are not all the possible side effects of SPRAVATO™.
About Lighthouse Health Florida
At Lighthouse Health Group, our practice brings overall mental health counseling and wellness to one location. With our state-of-the-art, calming, and ‘easy on the eyes’ office space, you’ll love going to the psychiatrist or psychologist (we bet you never thought you would say that)!
- SPRAVATO™ [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc. May 2019.
- Agency for Healthcare Research and Quality. Treatment-Resistant Depression: A Narrative and Systematic Review of Definitions and Methods in Clinical Research Studies. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/trdepression-protocol-amendment.pdf. Accessed May 8, 2019.
- National Institute of Mental Health. Major depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Accessed May 8, 2019.
- Mental Health America. Dealing With Treatment-Resistant Depression: What to Do When Treatment Doesn’t Seem to Work. https://www.mentalhealthamerica.net/treatment-resistant-depression. Accessed May 8, 2019.
- Ionescu DF et al. Dialogues Clin Neurosci. 2015;17(2):111–126.