Zulresso vs. Spravato

• Are Zulresso and Spravato the Same Thing?
• What Are Possible Side Effects of Zulresso?
• What Are Possible Side Effects of Spravato?
• What Is Zulresso?
• What Is Spravato?
• What Drugs Interact with Zulresso?
• What Drugs Interact with Spravato?
• How Should Zulresso Be Taken?
• How Should Spravato Be Taken?

Zulresso (brexanolone) Injection and Spravato (esketamine) Nasal Spray are antidepressants used to treat depression.

Zulresso is specifically used to treat postpartum depression (PPD) in adults. Zulresso is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the Zulresso REMS.

Spravato Nasal Spray is specifically used, in conjunction with an oral antidepressant, for the treatment of treatment-resistant depression (TRD) in adults.

Zulresso and Spravato Nasal Spray are different types of antidepressants. Zulresso is a neuroactive steroid gamma-aminobutyric acid (GABA) A receptor positive modulator and Spravato Nasal Spray is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist.

Side effects of Zulresso and Spravato Nasal Spray that are similar include sleepiness/sedation.

Side effects of Zulresso that are different from Spravato Nasal Spray include drowsiness, dry mouth, loss of consciousness, flushing, and hot flushes.

Side effects of Spravato Nasal Spray that are different from Zulresso include dissociation, dizziness, nausea, spinning sensation (vertigo), numbness, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk.

Both Zulresso and Spravato Nasal Spray may interact with other medicines that can make you sleepy (narcotics, sleeping pills, muscle relaxers, benzodiazepines, alcohol, and medicines for anxiety).

Zulresso may also interact with other antidepressants.

Spravato Nasal Spray may also interact with monoamine oxidase inhibitors (MAOIs), medicines to treat narcolepsy, and stimulant medicines, including diet pills or ADHD medications.

Common side effects of Zulresso include:

• nausea
• diarrhea
• dry mouth
• constipation
• vomiting
• gas
• dizziness
• abnormal dreams
• itching, and
• decreased sexual desire

Common side effects of Spravato include:

• dissociation,
• dizziness,
• nausea,
• sedation,
• spinning sensation (vertigo),
• numbness,
• anxiety,
• lethargy,
• increased blood pressure,
• vomiting, and
• feeling drunk

Zulresso (vortioxetine) tablets are an antidepressant indicated for the treatment of major depressive disorder (MDD).

Spravato (esketamine) is a prescription medicine, used along with an antidepressant taken by mouth, for treatment-resistant depression (TRD) in adults. Spravato nasal spray is designed to be administered by the patient under the supervision of a healthcare provider and should be given in conjunction with an oral antidepressant.

Spravato is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if Spravato is safe or effective as an anesthetic medicine.

It is not known if Spravato 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).
  • Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.
  • Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO™. Your healthcare provider will decide when you are ready to leave the healthcare setting.
• 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™.
  • Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
  • 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?
  • Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.
  • Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings.
  • Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.
• Tell your healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
  • attempts to commit suicide
  • thoughts about suicide or dying
  • worsening depression
  • other unusual changes in behavior or mood

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.

If these common side effects occur, they usually happen right after taking SPRAVATO™ and go away the same day.

These are not all the possible side effects of SPRAVATO™.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Please see full Prescribing Information, including Boxed WARNINGS, and Medication Guide for SPRAVATO™ and discuss any questions you may have with your healthcare provider.

Zulresso may interact with monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans, buspirone, tramadol, tryptophan products, NSAIDs, aspirin, warfarin, bupropion, fluoxetine, paroxetine, quinidine, rifampicin, carbamazepine, and phenytoin. Tell your doctor all medications and supplements you use.

Spravato may interact with CNS depressants (e.g., benzodiazepines, opioids, alcohol), psychostimulants (e.g., amphetamines, methylphenidate, modafanil, armodafinil), and monoamine oxidase inhibitors (MAOIs). Tell your doctor all medications and supplements you use.

Spravato may also interact with diuretics (water pills), linezolid, lithium, metoclopramide, midazolam, antibiotics, antifungals, blood pressure medications, or HIV/AIDS medicines.

The recommended starting dose of Zulresso is 10 mg administered orally once daily without regard to meals. Dosage should then be increased to 20 mg/day, as tolerated.

Spravato is delivered through a 28 mg disposable nasal spray device. Each device contains two sprays, one for each nostril. Recommended dosing is 56 mg dose kit (two devices) or 84 mg dose kit (three devices), which requires a five-minute rest between each device. During the first four weeks of treatment (induction phase), the recommended dosing frequency is twice weekly. During the subsequent maintenance phase, the dosing frequency is reduced to every two weeks or once weekly.