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Spravato for Depression and Breastfeeding

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  • Spravato for Depression and Breastfeeding

    Good evening,

    Spravato is a new medication recently approved by the FDA for treatment-resistant depression. The active ingredient is esketamine.

    Dr. Hale, what do you project the safety of this medicine to be when exclusively breastfeeding a full-term 3 month old baby with no medical concerns?

    I would be concerned about continuous exposure to the infant when treating depression versus a one time use as an anesthetic. What concerns do you foresee, if any?

    Thank you in advance.


  • #2

    We don't yet have any breastmilk levels reported in the literature. The good point is that it rapidly leaves the plasma compartment for adipose tissue with a half life of about 10-15 minutes. Hence very little is left in the plasma after ingested in about an hour.

    I'd think that within an hour, very little or no esketamine would be found in milk. So a brief waiting period after using intranasally, would largely reduce any exposure. But this is ALL THEORETICAL, and I don't know how this will turn out later on. Further, only about 20-30% is absorbed orally.

    Tom Hale Ph.d.