Spravato interactions: Alcohol, medications, and other factors

Spravato interactions with other drugs

Before you start treatment with Spravato, tell your doctor and pharmacist about any prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

To learn whether Spravato interacts with supplements, herbs, or vitamins, see the “Spravato and other interactions” section.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Spravato. Some of these interactions are described in detail in “Drug interactions in depth.” Keep in mind this table is not a comprehensive drug interaction checker for Spravato. Your doctor or pharmacist can provide more information on medications that interact with Spravato.

When to avoid Spravato 

In some cases, factors or conditions could prevent your doctor from prescribing Spravato due to the risk of harm. These are known as contraindications. Below are the contraindications of Spravato.

Note: Before you start treatment with Spravato, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Spravato.

Having blood vessel disease

Doctors will likely not prescribe Spravato for people with certain blood vessel conditions. Examples include abdominal aortic aneurysm and arteriovenous malformation (abnormal connection between your arteries and veins).

This is because Spravato can cause an increase in blood pressure, which can worsen an aneurysm and possibly even cause it to rupture. If you have an arteriovenous malformation, an increase in blood pressure could raise your risk of bleeding or an aneurysm.

Your doctor can recommend a treatment other than Spravato.

Having bleeding in your brain in the past

Doctors typically will not prescribe Spravato for people who have had bleeding in the brain (intracranial hemorrhage) in the past. Spravato treatment can increase your blood pressure, which can increase the pressure in your head. This could cause another incident of bleeding in your brain.

If you have previously had bleeding in your brain, talk with your doctor before taking Spravato. They’ll likely prescribe a treatment other than Spravato for your condition.

Having had an allergic reaction to Spravato or any of its ingredients

If you have had an allergic reaction to Spravato or any of its ingredients, your doctor will likely not prescribe Spravato. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better for you.

Spravato and alcohol

If you drink alcohol, your doctor will likely recommend that you do not drink it on days you receive Spravato. They may also advise you to limit alcohol consumption during your treatment, even on days you don’t receive a dose of Spravato.

Consuming alcohol on days you receive Spravato can raise your risk of sedation* (excessive sleepiness) and respiratory depression* as a side effect of Spravato. Your risk of these side effects is also higher if you consume alcohol, even on days you don’t receive Spravato.

If you have concerns about limiting or avoiding alcohol while you’re taking Spravato, talk with your doctor before starting treatment.

* Spravato has a boxed warning about this risk. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see “Boxed warnings” in the introduction of this article.

Drug interactions in depth  

Here’s a closer look at certain drug interactions of Spravato.

Stimulants

Spravato can interact with stimulants, which boost activity in your central nervous system (CNS). These medications are prescribed to treat certain conditions, including attention deficit hyperactivity disorder (ADHD) and narcolepsy.

Spravato treatment can cause an increase in blood pressure. Stimulants can also increase your blood pressure. Taking Spravato and a stimulant together raises your risk of increased blood pressure as a side effect of either medication.

Here are some stimulants that may interact with Spravato:

• dextroamphetamine/amphetamine (Adderall)
• methylphenidate (Ritalin, others)
• armodafinil (Nuvigil)
• modafinil (Provigil)
• pitolisant (Wakix)

Steps you or your doctor may take

If you need to take a stimulant during Spravato treatment, your doctor will likely closely monitor your blood pressure. They’ll likely want you to check your blood pressure at home and keep a log for them to check during appointments.

In rare cases, blood pressure can become high enough to warrant immediate medical attention. Call 911 (or your local emergency number) or go to the nearest emergency room if you develop symptoms of a hypertensive crisis, such as:

• severe headache
• chest pain
• sudden vision changes

Benzodiazepines

Benzodiazepines are prescribed to treat numerous conditions, including anxiety disorders and insomnia.

Spravato can cause sedation* (severe sleepiness) as a side effect. Benzodiazepines can also cause sedation. Taking a benzodiazepine during Spravato treatment can raise your risk of sedation, including the risk that symptoms are severe. For example, you may suddenly become very sleepy or even fall asleep during the day.

Here are some benzodiazepines that may interact with Spravato:

• clonazepam (Klonopin)
• alprazolam (Xanax)
• triazolam (Halcion)
• lorazepam (Ativan, Loreev XR)
• diazepam (Valium, Valtoco)

Steps you or your doctor may take

Before prescribing Spravato, your doctor may suggest exploring a different treatment besides a benzodiazepine for your condition. If you and your doctor agree the benefits of taking a benzodiazepine with Spravato outweigh the risks, your doctor will closely monitor you for symptoms of sedation throughout treatment. Your doctor may advise you not to take doses of the benzodiazepine on days you receive a dose of Spravato.

Immediately notify your doctor if you experience sedation symptoms while taking Spravato and a benzodiazepine.

Certain antidepressants

Spravato may need to be prescribed with an antidepressant. But the drug has interactions with certain antidepressants.

Both Spravato and certain antidepressants can cause sedation.* Taking antidepressants that cause sedation during Spravato treatment can raise your risk of sedation, including the risk of severe symptoms.

Here are some antidepressants that may interact with Spravato:

• TCAs, such as:
  • amitriptyline
  • nortriptyline
  • doxepin (Silenor)
• mirtazapine (Remeron)
• trazodone

Steps you or your doctor may take

If you’re taking an antidepressant that causes sedation, your doctor might suggest switching antidepressants before starting Spravato treatment. Or, they may monitor you closely for sedation during treatment to see how the combination of drugs affects you.

Let your doctor know right away if you have sedation symptoms, especially during your daily activities, if you take Spravato with a sedating antidepressant. Symptoms may include feelings of relaxation, calmness, and drowsiness.

* Spravato has a boxed warning about the risk of sedation. For details, see “Boxed warnings” in the introduction of the article.

Spravato and other interactions 

Spravato may have other interactions, such as with supplements, foods, vaccines, or lab tests.

Here are some potential interactions with Spravato. Keep in mind that the following information does not include all possible Spravato interactions.

Spravato interactions with supplements

Before you start treatment with Spravato, tell your doctor and pharmacist about any supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

In addition to interactions described below, Spravato also interacts with melatonin supplements. Some people take melatonin supplements to help support sleep.

Taking a melatonin supplement during Spravato treatment raises your risk of sedation* as a side effect of Spravato.

Due to this risk, your doctor may suggest you stop taking the melatonin supplement if you’re prescribed Spravato. Or, they may recommend you don’t use the melatonin supplement on days when you receive a dose of Spravato.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

* Spravato has a boxed warning about the risk of sedation. For details, see “Boxed warnings” at the beginning of the article.

Spravato interactions with herbs

Spravato may interact with an herb called valerian (also called valerian root). Some people use this herbal supplement to help with sleep and treat anxiety symptoms.

If you take valerian during Spravato treatment, it may raise your risk of sedation as a side effect.

Your doctor may be able to suggest a treatment option other than valerian. Spravato treatment could also improve your sleep or anxiety symptoms without needing to take a supplement.

Spravato interactions with vitamins

There are no specific reports of vitamins interacting with Spravato. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Spravato.

Spravato interactions with food

Spravato may interact with caffeine. Consuming too much caffeine while taking Spravato can increase the risk of high blood pressure. Foods and beverages that contain caffeine include:

• coffee
• tea
• chocolate
• energy drinks

Because of this interaction, your doctor will likely recommend limiting how much caffeine you consume during Spravato treatment.

If you’d like to learn more about eating certain foods during treatment with Spravato, talk with your doctor.

Spravato interactions with vaccines

There aren’t any known interactions between Spravato and vaccines. Talk with your doctor or pharmacist to check whether you’re due for any vaccines.

Spravato interactions with lab tests

Spravato isn’t known to interact with lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

SPRAVATO INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Spravato.

Both Spravato and cannabis can cause sedation (severe sleepiness) as a side effect. (Spravato has a boxed warning about the risk of sedation. To learn more about this warning, see the introduction of this article.) Due to this risk, your doctor may suggest you avoid cannabis or cannabis products during Spravato treatment.

A topical cannabis product, such as a CBD cream you apply to the skin, may be fine to use during Spravato treatment. These products may not be absorbed by your whole body, which could avoid the interaction with Spravato. But always check with your doctor or pharmacist first before using any topical cannabis product while you’re receiving Spravato.

Before you start treatment with Spravato, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Spravato and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Spravato. Before you receive this drug, be sure to talk with your doctor about your health history. Spravato may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Spravato include:

• Blood vessel disease: Doctors usually will not prescribe Spravato if you have blood vessel disease such as abdominal aortic aneurysm or arteriovenous malformation. To learn more, see “When to avoid Spravato.”
• History of bleeding in the brain: Doctors typically will not prescribe Spravato if you have had bleeding in the brain in the past. To learn more, see “When to avoid Spravato.”
• Heart condition: Spravato can cause increased blood pressure and increased heart rate as a side effect. These effects could be unsafe if you have high blood pressure, an irregular heart rhythm, or another heart condition. Your doctor can determine whether Spravato is safe for you to take based on your specific heart condition. If they prescribe Spravato, they may want to closely monitor your blood pressure after each dose.
• Liver condition: Having a liver condition affects how well your body metabolizes (breaks down) Spravato after you receive a dose. This can raise your risk and severity of side effects. Depending on your specific liver condition, your doctor may prescribe a treatment other than Spravato. They may want you to stay at the clinic for longer than the standard 2 hours after each dose of Spravato. See our Spravato dosage guide for details about receiving Spravato.
• Psychosis: Spravato carries a risk of dissociation* (feeling disconnected from your surroundings) as a side effect. People with psychosis or who have experienced it in the past may have an increased risk of this side effect. Tell your doctor if you have experienced psychosis. Your doctor will determine whether Spravato is safe for you to receive.
• Substance use disorder: If you have substance use disorder, you may have an increased risk of misuse* of Spravato. For this reason, your doctor may want to prescribe a treatment other than Spravato.
• Allergic reaction: If you’ve had an allergic reaction to Spravato or any of its ingredients, your doctor will likely not prescribe Spravato. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better for you.
• Breastfeeding: Breastfeeding during Spravato treatment is not recommended. The drug passes into breast milk and has the potential to cause side effects in a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before starting Spravato. They can talk with you about treatment options and ways to feed a child other than breastfeeding.
• Pregnancy: Doctors typically will not prescribe Spravato during pregnancy. There haven’t been enough clinical trials to determine whether Spravato is safe to receive while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects) or pregnancy loss. However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Spravato. They can advise you on the right treatment plan for you. If you become pregnant during Spravato treatment, immediately tell your doctor.
• Risk of suicidal thoughts and behaviors: Spravato also has a boxed warning about the risk of suicidal thoughts and behaviors. For details, see the boxed warning at the top of this article.

* Spravato has a boxed warning about this risk. A boxed warning is the most serious warning from the FDA. For details, see “Boxed warnings” in the introduction of this article.

FAQ about Spravato and interactions 

Here are some frequently asked questions about Spravato and possible interactions.

Does Spravato interact with Lamictal?

No interactions between Spravato and lamotrigine (Lamictal) were reported in Spravato studies.

However, somnolence (sleepiness) was a common side effect reported in studies of Lamictal used on its own. Spravato also has a boxed warning about the risk of sedation (severe sleepiness). (For details about this risk, see “Boxed warnings” in the introduction to this article.)

It’s possible that taking Spravato and Lamictal together could increase the risk of drowsiness, according to Spravato’s manufacturer. But the drugmaker also notes there are no studies or reports confirming this interaction to date. If you have questions about this, talk with your doctor or pharmacist.

It’s unlikely your doctor will suggest you avoid taking these medications together. But if you do take Lamictal and Spravato and have sleepiness as a side effect, let your doctor know. They may discuss switching to a different treatment besides Lamictal or Spravato. Your doctor can give you more information.

Is it safe to use a nasal corticosteroid or decongestant during Spravato treatment?

Yes, it’s likely safe. But you should take doses of the nasal corticosteroid or nasal decongestant at least 1 hour before you receive a dose of Spravato.

In studies of Spravato, the nasal decongestant oxymetazoline was given 1 hour before people received Spravato. No interaction between the two drugs was noted. The nasal corticosteroid mometasone (Nasonex) was also tested in the same manner, and no interaction was found.

As long as you use the nasal decongestant or nasal corticosteroid at least 1 hour before your Spravato dose, these medications should be safe together. Be sure to tell your doctor or pharmacist about all medications you take, including any nasal decongestant or nasal corticosteroid. They can determine whether your medications are safe to use during Spravato treatment.

Preventing interactions  

You can take certain steps to help prevent interactions with Spravato. Your doctor and pharmacist are key resources, so reaching out to them before starting treatment is a helpful first step. For example, it’s important that you do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication listTrusted Source, which your doctor and pharmacist can help you fill out.

It’s also important to read the Spravato label and other paperworkTrusted Source that may come with the drug. The label may have colored stickers that mention an interaction. The paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Spravato doesn’t come with paperwork, you can ask your doctor or pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Spravato by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.