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Out of curiously, has anyone heard/experienced how the new esketamine spray works? It was all the rage when it got approved but I haven’t heard anything since, odd since the expectations were so high. Maybe the docs haven’t set of the REMS practices yet? This also seems odd since there are existing ketamine clinics 

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2 hours ago, Iceberg said:

Out of curiously, has anyone heard/experienced how the new esketamine spray works? It was all the rage when it got approved but I haven’t heard anything since, odd since the expectations were so high. Maybe the docs haven’t set of the REMS practices yet? This also seems odd since there are existing ketamine clinics 

I haven't tried Spravato....My pdoc brought it up, but my insurance won't cover it, and it's very expensive, from what I've heard...

I'm guessing that a lot of insurance companies aren't covering it yet, due to it being so new. and so costly....Maybe that's why we haven't heard much yet?

Edited by CrazyRedhead

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Yeah. At this point I would just go back to the ketamine infusion clinic because the cost is probably similar and I know the IV works 

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I haven’t heard good things and it sounds like a huge PITA, I think you have to have it administered in the docs office and have someone drive you home?? Like every dose?

Its not racemic, a mix of the two enantiomers that make up ketamine, it’s only the left-handed “S” molecule, which has been shown to be less effective for depression than the right handed “R” molecule. 
 

I tried a compounded ketamine nasal spray... almost compounding pharmacies can make this and I don’t remember it being expensive, the only trick is finding a doc to prescribe it. Anyway it did nothing for me.

 

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36 minutes ago, climber47 said:

I haven’t heard good things and it sounds like a huge PITA, I think you have to have it administered in the docs office and have someone drive you home?? Like every dose?

Its not racemic, a mix of the two enantiomers that make up ketamine, it’s only the left-handed “S” molecule, which has been shown to be less effective for depression than the right handed “R” molecule. 
 

I tried a compounded ketamine nasal spray... almost compounding pharmacies can make this and I don’t remember it being expensive, the only trick is finding a doc to prescribe it. Anyway it did nothing for me.

 

I’ve wondered if it can take the place of the IV ketamine in regards to effectivness with less cost. So far, it doesn’t seem that way 

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On 12/29/2019 at 5:28 AM, Iceberg said:

Out of curiously, has anyone heard/experienced how the new esketamine spray works? It was all the rage when it got approved but I haven’t heard anything since, odd since the expectations were so high. Maybe the docs haven’t set of the REMS practices yet? This also seems odd since there are existing ketamine clinics 

Here's what Epocrates says:

SPRAY: 28 mg per device

Special Note
[strength clarification]
Info: each device delivers 2 sprays

major depressive disorder, tx-resistant
[induction phase]
Dose: 56 mg intranasally on day 1, then 56-84 mg intranasally 2x/wk x4wk; Info: use w/ oral antidepressant; alternate nostrils w/ each spray; give 5min rest between each device use; avoid food >2h and drink >30min before admin.

[maintenance phase]
Dose: 56-84 mg intranasally qwk x4wk, then 56-84 mg intranasally q1-2wk; Info: use w/ oral antidepressant; alternate nostrils w/ each spray; give 5min rest between each device use; avoid food >2h and drink >30min before admin.

 

I have brought it up to my pdoc and at first she considered it and the next session when I asked about it she said absolutely not. She thinks it would make me worse for some reason. She has been a pain in the neck though recently.

It is supposedly a tier 6 medicine on my insurance, but according to the website, it is 100% not covered at all, and the out of pocket is ridiculously high. How much it would cost to get treatments would be astronomical considering it's only 28 mg per device... that's a minimum of 2 devices per treatment, 4 devices per week in the first 4 weeks, etc., etc. You'd have to have very special insurance to get it covered. I don't remember how much each device costs per unit, but it's easily quadruple digits, very possibly quintuple digits, IIRC.

On 12/29/2019 at 8:01 AM, Iceberg said:

Yeah. At this point I would just go back to the ketamine infusion clinic because the cost is probably similar and I know the IV works 

If I could afford it, I would go to Georgia where the nearest ketamine clinic is (4 hours away) and just rent a hotel and stay there during the duration of the treatments. I have a friend I used to date who lives near that area I could hang out with I guess. But I have no money, and my family is broke.

My pdoc has credentials to prescribe pain meds, and ketamine is used intranasally with the syringe and an atomizer to take intranasally as an adjunct pain relief or opioid analgesic medication. Thing is, prescribing it for depression and saying it's for pain is fraudulent and she would be risking her license doing that.

Here's what Epocrates has to say about intranasal ketamine (it's off-label, but usable):

*pain, mod-severe acute
[intranasal route]
Dose: 0.5-1 mg/kg intranasally x1, may repeat 0.25-0.5 mg/kg intranasally x1 after 10-15min if no response; Info: for pain or opioid adjunct tx; refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril

*pain, mod-severe chronic
[intranasal route]
Dose: 10 mg intranasally q90sec prn up to 50 mg total dose; Alt: 25 mg intranasally q6h prn; Info: for pain or opioid adjunct tx; refer to institution protocols; use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril

So there'd probably be a quantity limit on it as to how much you could get per week/month/whatever/doesn't matter cuz no one would do it.

3 hours ago, climber47 said:

I haven’t heard good things and it sounds like a huge PITA, I think you have to have it administered in the docs office and have someone drive you home?? Like every dose?

Its not racemic, a mix of the two enantiomers that make up ketamine, it’s only the left-handed “S” molecule, which has been shown to be less effective for depression than the right handed “R” molecule. 
 

I tried a compounded ketamine nasal spray... almost compounding pharmacies can make this and I don’t remember it being expensive, the only trick is finding a doc to prescribe it. Anyway it did nothing for me.

 

It is, you do have to be in a hospital or doctor's office for it to be administered to you, and have to have someone drive you home. Every dose. That is correct. I don't remember where I read that (whether it be Epocrates or their website), but I read it when I was seriously considering it. I thought it would be too good to be true for them to prescribe it and just let you take it home to use it.

You're right about the enantiomers too. Why the chose the (S)-enantiomer is beyond me. I think it has less side effects like dissociative side effects and hallucinations or something.

Yeah, finding a doc to prescribe it is a crapshoot and you just have to know the right people to find the right pdoc who is willing to do it. Mine might be willing to do it if she weren't insisting that I stay on a combo that isn't working. I don't know what her deal is with me. I'd love to try it. I've tried almost every single medicine to every single medicine in every single class of antidepressant, antipsychotic, etc. of medications. There's a reason I took my past meds out of my signature and put it on my profile... It was taking up too much damn space. I'm sorry the IN ketamine didn't do anything for you, @climber47. I wish something worked for you. You seem to be in a similar boat as me, IIRC, except you have a pdoc who's willing to prescribe the outrageously off-label stuff like buprenorphine and stuff like that. I envy you and your pdoc.

2 hours ago, Iceberg said:

I’ve wondered if it can take the place of the IV ketamine in regards to effectivness with less cost. So far, it doesn’t seem that way 

Don't think so. I think even ketamine clinics may be cheaper than Spravato. I could be sorely mistaken though. I'm so desperate for relief there isn't a sufficient idiom or phrase to use to put right here...  I'm very close to being as close to nothing as I can be. I don't know what my pdoc is thinking not letting me do ECT at least, or at the very least retrying an MAOI with a stimulant yet again. Or going out of the box and trying buprenorphine/Suboxone/etc./whatever... She's just not willing to put in the effort for me anymore it seems. And going to a new pdoc? I'd have to get them to know me first before trying the big-guns off-label stuff if they'd even be willing to do that/have the credentials to do that. My current pdoc has more than enough credentials to do whatever she wants for me, she just is choosing not to for whatever reason.

Sorry, don't mean to complain. I've been doing that a lot about my pdoc. Forgive me. I'm feeling particularly abhorrent tonight.

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