Ketamine Nasal Spray (Pharmaceutical Grade): Medical Use and Safety Guide
Pharmaceutical-grade ketamine nasal spray (e.g., Spravato® (esketamine)) is a FDA-approved prescription medication used under strict medical supervision for treatment-resistant depression (TRD) and major depressive disorder (MDD). It is not approved for recreational use. Here’s what you need to know:
1. 🏥 Approved Medical Use
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Indications:
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Treatment-resistant depression (TRD).
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Major depressive disorder (MDD) with acute suicidal ideation.
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Administration:
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Used only in certified medical facilities under healthcare supervision.
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Patients are monitored for at least 2 hours after dosing.
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Formula:
Contains esketamine, a more potent form of ketamine’s S-enantiomer.
2. ⚠️ Safety and Supervision
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Risks Requiring Medical Oversight:
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Dissociation: Altered perception, dizziness, or sedation.
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Blood pressure increase: Monitored during and after use.
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Nausea, vomiting, or anxiety.
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Contraindications:
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Not for use with certain medications (e.g., MAO inhibitors).
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Avoid in patients with uncontrolled hypertension, aneurysms, or substance use disorders.
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3. 🚨 Illicit vs. Pharmaceutical Ketamine Spray
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Illicit Ketamine Sprays:
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Unregulated and dangerous.
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Often have unknown concentration, purity, or additives.
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May contain harmful solvents or non-sterile ingredients.
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No medical oversight—high risk of overdose, infection, or misuse.
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Pharmaceutical Spray:
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Precisely dosed, sterile, and quality-controlled.
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Used only with a risk evaluation and mitigation strategy (REMS).
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4. 💊 Harm Reduction (For Illicit Products)
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Avoid Illicit Sprays:
Do not use non-prescription ketamine sprays—they are unsafe and illegal. -
Test if You Must:
Use reagent test kits (e.g., Morris, Mandelin) to check for ketamine and rule out fentanyl/other drugs. -
Never Use Alone:
Have a sober person present who can help in case of dissociation or overdose. -
Dose Cautiously:
Start with a tiny amount (1 spray) and wait 15+ minutes to assess effects.
5. ⚖️ Legal Status
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Pharmaceutical Spray:
Legal only with a prescription and administered in-clinic. -
Illicit Spray:
Ketamine is a Schedule III Controlled Substance. Unauthorized possession or use is illegal.






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