Driving and monitoring rules for Spravato and ketamine

The REMS

Spravato can only be given at a clinic enrolled in a federal Risk Evaluation and Mitigation Strategy. The clinic must monitor you for at least two hours after each dose, confirm you are stable before you leave, and record each session in the REMS registry. You enroll once, at your first visit. See the Spravato hub, the coverage hub, the coverage checker, treatment comparisons and condition and treatment pages.

Why no driving

Esketamine and ketamine impair attention, judgment and reaction time for hours after the obvious effects fade. The label prohibits driving or operating machinery until the next day after a restful sleep. Clinics apply the same rule to IV and IM ketamine.

What to arrange

• A ride home from someone who can wait or return; rideshare is acceptable at most clinics if you can walk to the car unassisted.
• No work that requires full alertness the rest of the day.
• Someone to check on you that evening if you live alone, at least for the first few sessions.

Observation length by treatment

• Spravato: minimum 2 hours.
• IV ketamine: infusion (40 minutes) plus 30 to 60 minutes of recovery.
• IM ketamine: 60 to 90 minutes.
• Oral or sublingual ketamine in clinic: 90 minutes to 2 hours.
• TMS: no observation period; you drive yourself.

Telehealth and at-home programs

At-home ketamine programs cannot meet the observation standard because no clinician is present. Some use video check-ins and a designated companion. See at-home ketamine vs in-clinic for the trade-offs.