Spravato - Esketamine
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- Опубликовано: 14 май 2019
- Spravato represents a novel, fast acting therapy for treatment resistant depression (TRD). Recently approved in March 2019, this enantiomer of ketamine is only available as a nasal spray. Its use is limited to a licensed doctor’s office or other approved medical facility. After inhaling the correct dose, the patient must remain under medical supervision for the following 2 hours and on discharge must be driven home by a relative, friend or commercial service such as Uber or Lyft.
During the first 4 weeks of treatment, the drug is administered twice a week. Assuming significant benefits, the dose schedule is reduced to once weekly for the subsequent month followed by prolonged therapy once every other week.
Proper technique guarantees administering the spray high into the nasal cavity rather than the area closest to the nasal tip. This allows rapid absorption into the nasal capillary network or possibly directly through branches of the nerves charged with the sense of smell.
In addition to the esketamine nasal spray, a traditional oral antidepressant remains an integral part of the program. The particular oral agent should be new to the individual and not one previously found to be unhelpful.
Success becomes clinically apparent within several hours as the mood lifts and spirits brighten - but only in a limited number of patients and typically only partially. It remains too early to predict the role for Spravato in the armamentarium of treatment for depression.
Side effects include a dramatic elevation in blood pressure during the first hour or so that in some instances may precipitate episodes of chest pain, shortness of breath, visual disturbances and seizures. Spravato can impair attention, judgment, thinking and motor skills. These usually self-correct during the several hours before the individual leaves the medical facility.
While many of the available therapies for depression are available as relatively inexpensive generics, Spravato will remain under patent for years. The current wholesale cost of Spravato for the first month ranges between $4720 - $6785 which translates to $169 - $242 every day of the month. During the second and subsequent months the price falls to $2360 -$3450 which still equates to a daily cost just for the drug of $84 - $123.
With an estimated 16 million individuals with suffering from depression of whom one quarter to one half are considered treatment resistant, the potential burden to society defies imagination. Interestingly a bottle of 5000 milligrams of intravenous ketamine carries a retail price of less than $50. The maximum first month dose of esketamine is limited to less than 700 milligrams. Prior to Spravato, clinics sprung up throughout the country offering intravenous treatment with ketamine and still providing noteworthy results. Whether the nasal spray offers sufficient advantages to warrant the horrendous price remains untested.
I’m so sad on hearing of Dr. Landow’s passing away! This man was the best! I love his show he was an encyclopedic genius and explained everything even down to the cost of medicine. He made me watch about drugs I don’t even take I just love how he explained the biochemistry and pharmacology of the drugs. 😭😭
Took my third blast today. It’s straight up tripping people. My blood pressure did go up 30 points. The trip is lovely but I felt like hell afterwards the first two times. Today I just feel tired. BUT I’ve already begun to feel the benefits. After 50+ years of struggle....I’m optimistic.
When my doctor told me the price, my depression turned into manic laughter
Thank you, Dr. you by far have given the most comprehensive overview and explanation of the treatment and I am grateful.
It’s better to use the intravenous, it’s approximately 1,500 for four visits, it’s all you may need....cheaper than a root canal.
best dr on u tube!
At $850 CAD per treatment, where 4 is the minimum #, it is not feasible
🕊️Dr Landow is an angel in a lab coat. Translates complex pharmacology w/o dumbing it down. Wishing his family and friends my deepest condolences and thanks. He well have saved my life by educating me to accept the medical treatment for my suicidal depression.
3 years after this video was made there are IV clinics around and they are charging the intranasal prices for the IV therapy. It is still not covered by most insurance plans either. The profits being made on the sick in this country are atrocious.
I've contacted 5 places in my area that Spravato website and none are doing Spravato anymore
Lithium and Tyroid I heard that before please say more about this add on for Treat resirance
Ive done 56 84 84 so far no changes for severe depression anxiety
Anyone had Humana and how have they cover it? 🙏🏻🙏🏻🙏🏻🙏🏻😢🇺🇸🤬💔😢
2 hours whoop T Doo, there is no memory issues!
Where can I get this treatment in Europe?
Can esketamine lead to tinnitus or exacerbate it ?
hello doctor, my diagnosis is severe fibromyalgia, I tried many antidepressants, only Anafrani helped, he almost pulled me out of a serious illness, unfortunately, after a month it stopped working in the last hope for him, but unfortunately it stopped working, I read on the Internet if Anafranil and Spravato are taken together on the right will make work anafranil is it true doctor? waiting for your answer
Is this available in UK?
I have my second treatment tomorrow ❤️
Eskettit