| Major Depressive Disorder
Spravato vs Zoloft
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Spravato vs Zoloft with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsZoloft has a higher rate of injection site reactions vs Spravato based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Zoloft but not Spravato, including UnitedHealthcare
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Category
Spravato
Zoloft
At A Glance
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Oral
Daily
SSRI
Indications
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
- Major Depressive Disorder
- Obsessive-Compulsive Disorder
- Panic Disorder
- Post-Traumatic Stress Disorder
- Phobia, Social
- Premenstrual Dysphoric Disorder
Dosing
Depressive Disorder, Treatment-Resistant Induction (Weeks 1-4): 56 mg or 84 mg intranasally twice weekly; Maintenance (Weeks 5-8): 56 mg or 84 mg once weekly; Week 9 and after: 56 mg or 84 mg every 2 weeks or once weekly, individualized to the least frequent dosing to maintain remission/response.
Major Depressive Disorder 84 mg intranasally twice weekly for 4 weeks in conjunction with an oral antidepressant; dose may be reduced to 56 mg twice weekly based on tolerability.
Major Depressive Disorder Starting 50 mg/day orally; max 200 mg/day; titrate by 25-50 mg/day increments once weekly if inadequate response.
Obsessive-Compulsive Disorder Starting 25 mg/day (ages 6-12) or 50 mg/day (ages >=13) orally; max 200 mg/day; titrate by 25-50 mg/day increments once weekly if inadequate response.
Panic Disorder, Post-Traumatic Stress Disorder, Phobia, Social Starting 25 mg/day orally; max 200 mg/day; titrate by 25-50 mg/day increments once weekly if inadequate response.
Premenstrual Dysphoric Disorder Continuous dosing: starting 50 mg/day orally, max 150 mg/day; intermittent (luteal phase only): starting 50 mg/day, max 100 mg/day.
Contraindications
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels) or arteriovenous malformation
- History of intracerebral hemorrhage
- Hypersensitivity to esketamine, ketamine, or any excipient
- Concomitant use or use within 14 days of stopping MAOIs, including linezolid and intravenous methylene blue, due to increased risk of serotonin syndrome
- Concomitant use of pimozide
- Known hypersensitivity to sertraline (e.g., anaphylaxis, angioedema)
- Concomitant use of disulfiram with ZOLOFT oral solution (contains alcohol)
Adverse Reactions
Most common (>=5%) dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, blood pressure increased, vomiting, feeling drunk
Serious sedation, dissociation, respiratory depression, blood pressure increase, cognitive impairment, impaired ability to drive and operate machinery, ulcerative or interstitial cystitis, embryo-fetal toxicity
Postmarketing bradycardia, respiratory depression (including respiratory arrest), hypotension
Most common (>=5%) Nausea, diarrhea/loose stools, tremor, dyspepsia, decreased appetite, hyperhidrosis, ejaculation failure, decreased libido
Serious Suicidal thoughts and behaviors, serotonin syndrome, QTc prolongation and ventricular arrhythmias, increased risk of bleeding, activation of mania/hypomania, seizures, angle-closure glaucoma, hyponatremia, sexual dysfunction
Postmarketing Agranulocytosis, aplastic anemia, Stevens-Johnson Syndrome, toxic epidermal necrolysis, severe liver events including hepatitis and liver failure, QTc-interval prolongation, ventricular tachycardia, extrapyramidal symptoms, pulmonary hypertension, cerebrovascular spasm
Pharmacology
Esketamine is the S-enantiomer of racemic ketamine and a non-selective, non-competitive NMDA receptor antagonist; the mechanism by which it exerts its antidepressant effect is unknown.
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that potentiates serotonergic activity in the central nervous system through inhibition of neuronal reuptake of serotonin (5-HT), with only very weak effects on norepinephrine and dopamine reuptake and no significant affinity for adrenergic, cholinergic, GABA, dopaminergic, or histaminergic receptors; it does not inhibit monoamine oxidase.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Zoloft
- Covered on 5 commercial plans
- PA (1/12) · Step Therapy (0/12) · Qty limit (3/12)
UnitedHealthcare
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Zoloft
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
Zoloft
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
$10/fillfill
Spravato with Me Savings ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Zoloft.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.