Safety is one of the most common concerns people have when considering Spravato. That’s reasonable. Spravato works differently from traditional antidepressants, and it’s administered in a clinical setting rather than taken at home.

The short answer is this: Spravato is considered safe when administered in a properly supervised medical environment. The structure around treatment is intentional and required.

Understanding what monitoring should be in place can help you evaluate whether a clinic is providing care at the right level.

Spravato (esketamine) can cause temporary effects such as:

• Increases in blood pressure
• Dissociation (a feeling of detachment)
• Sedation or drowsiness
• Dizziness or impaired coordination

For most patients, these effects are short-lived and resolve during the observation period. But because they can occur, the FDA requires that Spravato be administered under its REMS (Risk Evaluation and Mitigation Strategy) program.

This means it is never taken at home and must be given in a certified healthcare setting.

A clinic offering Spravato should follow structured monitoring protocols. At a minimum, this includes:

Before each session:

• Blood pressure is checked
• Symptoms and recent health changes are reviewed
• Any medication changes are discussed

If blood pressure is too high or something feels medically unstable, treatment may be postponed. That’s not a setback — it’s a safety decision.

Spravato is self-administered under supervision. Staff should:

• Confirm proper dosing
• Observe administration
• Ensure the patient is stable before beginning observation

There should be no rush through this process.

Patients must remain in the clinic for at least two hours after dosing.

During this time:

• Blood pressure is rechecked
• Alertness is assessed
• Side effects are monitored
• Staff remain available throughout

Patients are not discharged until they are medically stable.

Spravato can temporarily raise blood pressure. For most people, this increase is mild and resolves on its own.

However, clinics should:

• Check blood pressure before dosing
• Recheck during the observation period
• Have clear protocols if readings exceed safe thresholds

Patients with uncontrolled hypertension or certain cardiovascular conditions may require stabilization before beginning treatment.

Dissociation is one of the most talked-about effects of Spravato. Patients may feel:

• Detached from their body
• Altered perception of time
• Mentally quiet or slowed

These effects are expected and typically temporary.

Monitoring ensures that:

• The patient remains physically safe
• Orientation returns before discharge
• Any distress is addressed promptly

Most patients describe the experience as manageable when supported in a calm, structured setting.

Spravato should be provided in a setting with trained medical professionals who understand:

• How ketamine-based treatments affect the body
• How to assess cardiovascular risk
• When to pause or adjust treatment
• How to respond if something unexpected occurs

Clear supervision and accountability are key components of safe care.

Long-term safety is an important part of the conversation.

Spravato has been studied in controlled settings and is used according to a structured schedule. Ongoing evaluation during treatment helps ensure:

• The medication continues to provide benefit
• Side effects remain manageable
• Dosing frequency is adjusted appropriately

Safety isn’t just about one session — it’s about consistent oversight over time.

If you’re considering Spravato, it’s reasonable to ask:

• How is blood pressure monitored?
• Who is overseeing treatment during sessions?
• What happens if my blood pressure spikes?
• What safety protocols are in place?

A qualified clinic should be able to answer these clearly and confidently.

Spravato isn’t administered like a typical outpatient medication — and that’s intentional. At Therapeutic Infusions, Spravato is provided in a REMS-certified medical setting, which means safety, monitoring, and patient comfort are built into every step of treatment.

Because Spravato can cause temporary effects — such as changes in blood pressure or dissociation — it is administered on-site under medical supervision and followed by a structured observation period. This isn’t an add-on. It’s a required part of how the treatment is delivered so patients can be cared for consistently and responsibly.

At Therapeutic Infusions, REMS compliance includes:

• On-site dosing in a certified clinic
• Monitoring blood pressure, alertness, and overall stability
• Observation for a minimum period after dosing
• Care provided by trained medical professionals in a controlled setting
• Protocols that meet FDA safety standards

This structured approach helps ensure patients are supported medically and emotionally throughout their treatment visits. Rather than being a hurdle, these safeguards are part of what makes Spravato safer and more predictable compared with unsupervised alternatives.

Learn more about how Spravato is administered and monitored on the Spravato treatment page.