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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.


    • #3
      Dr. Hale,
      My doctor is going to put me on generic compounded intranasal ketamine spray. Would you expect that ketamine given intranasally would transfer less and/or be safer for baby than the ketamine given intravenously like during surgery. Ketamine intravenously when given as a apart of general anesthesia is wait at least 4 hours or awake enough to feed, correct? Do you think I could follow that same guideline, or even less time, for the intranasal ketamine since less seems to get into adipose tissue or absorb orally in those cases?

      Thanks again!


      • #4
        MNicole: we do not have any published data on ketamine and its transfer to milk. I assume via nasal administration, it is probably lower than the IV administration, but we don't know.

        Perhaps you might be willing to provide us milk samples when you start this therapy.

        I would suggest you wait about 4 hours after the administration to breastfeed.

        Tom Hale Ph.D.


        • #5
          Dr. Hale,

          Would you please let me know what the half-life of ketamine is, as well as that of any active metabolites?

          Additionally, is the half-life of a medication (and its active metabolites) the same regardless of how it is administered (i.e. Half life via IV route vs intranasal route).

          Lastly, in the post above from April it appears ketamine leaves adipose tissues rather quickly and you theorized that very little or no ketamine would be left after an hour. Thereafter, in your post above from August, you suggest waiting 4 hours. Would you be able to tell me which is your best suggestion for ketamine intranasal

          FYI: these questions are all related to intranasal KETAMINE and not esketamine. I know you said you don't have any information about esketamine's transfer, but the intranasal ketamine should mimic the recommendation for IV ketamine, no?

          Thank you!
          Last edited by MNicole; 08-26-2019, 09:11 PM.


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