Sprix (Ketorolac) – Nasal


Sprix (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID). NSAID use increases the risk of serious heart and blood vessel issues like stroke and heart attack. It is best to use the lowest dose and for the shortest term possible.

Sprix can also increase your risk of serious stomach or bowel issues such as ulcers or bleeding of your stomach or intestines. Sprix should not be used if you have had a type of heart surgery called a coronary artery bypass graft surgery.

What Is Sprix?

Sprix (ketorolac) is a nasal spray only available with a valid prescription. It is in the drug class known as nonsteroidal anti-inflammatory drugs, or NSAIDs. You may be prescribed Sprix for short-term (no more than five days) use to manage moderate to moderately severe pain.

Like other NSAIDs, Sprix is thought to target and block cyclooxygenase (COX-1 and COX-2) enzymes. By doing this, Sprix helps reduce pain and inflammation in the body.

Multiple safety warnings are associated with Sprix. This formulation of ketorolac can increase your risk of certain events such as heart attacks, stroke, and bleeding in your stomach or intestines. It should also not be used if you have had a type of surgery known as a coronary artery bypass graft.

Sprix is administered by spraying the medication into your nose.

Drug Facts

Generic Name: Sprix

Brand Name(s): Ketorolac

Drug Availability: Prescription

Administration Route: Intranasal

Therapeutic Classification: NSAID

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Ketorolac tromethamine

Dosage Form(s): Nasal spray

What Is Sprix Used For?

The Food and Drug Administration (FDA) approved Sprix for treating moderate to moderately severe pain for up to five days. You may be prescribed Sprix if you need pain relief at the opioid level while not using an opioid.

This medication is not available for use in children younger than 2.

How to Use Sprix

You should always follow directions from your prescribing healthcare provider on how to use Sprix.

This medication must be used in your nose only. Do not inhale it or take it by mouth. Keep this drug away from your eyes, as it may cause a burning feeling. If you get this drug in your eyes, wash it out immediately with water.

To use this medication:

  • First, blow your nose before use to clear your nostrils.
  • Before using it for the first time, you must prime the bottle by holding it upright and pressing the pump five times. Each nasal spray bottle contains medication for one day of therapy to be used for 24 hours, and you will need to prime each time you use a new bottle.
  • Sit up straight or stand, and tilt your head slightly forward.
  • Hold the bottle upright and insert the tip of the container into the nostril and point the bottle toward the back and away from the center of the nose.
  • Hold your breath and spray once, pressing evenly on both sides of the container.
  • After spraying, start breathing through your mouth to expel the product and pinch your nose to help retain spray if dripping occurs.
  • If your healthcare provider has prescribed two sprays, repeat with your other nostril.
  • Put the cap back on after you are done using your dose.
  • Throw away the bottle within 24 hours of priming, even if more medication remains. Use a new bottle for a new day.

Do not use Sprix more than every six hours.

How to Store Sprix

Store Sprix in a cool, dry place. Unopened bottles should be stored in the refrigerator (35–46 degrees F) . Open bottles should be stored at room temperature (68–77 degrees F).

Generally, you should not keep medications stored in areas where they may be exposed to excessive heat or moisture, like your kitchen or bathroom. These environments can affect how well medications work. It is also important to ensure that this medication is kept away from children and pets to prevent accidental consumption.

This medication is a specialty medication. It is generally not available at a regular pharmacy. You should contact your pharmacist to make sure that this medication will be available when you need it.

Off-Label Uses

Healthcare providers may prescribe Sprix for off-label uses, meaning for conditions outside of pain control.

Sprix is sometimes given off-label to prevent or treat migraines.

How Long Does Sprix Take to Work?

How quickly Sprix takes to work will be different for everyone depending on pain level. Generally, Sprix will take a few hours for its pain relief effects to start.

What Are the Side Effects of Sprix?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Sprix are:

  • Nasal pain and discomfort
  • Runny nose
  • Throat irritation
  • Low urine output
  • Rash
  • Slow heart rate
  • High blood pressure

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Bleeding in your gastrointestinal tract: Cramping and stomach pain, weakness, reduced urine flow, bright red bloody stool or dark bloody stool, black or tarry stool, vomit the appearance of coffee grounds
  • Heart-related events, such as a heart attack or stroke: Chest pain, shortness of breath, pain or stiffness in the upper body, cold sweat, facial drooping, arm and leg weakness, speech difficulties, tingling or numbness
  • A severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis): Red, swollen, or peeling skin (with or without fever) or sores in your mouth, throat, nose, or eyes

Long-Term Side Effects

One of the potential long-term side effects of Sprix is the risk of liver damage. This can persist even if you have stopped taking Sprix.

Report Side Effects

Sprix may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Sprix Should I Use?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For nasal dosage form (spray):
    • For pain:
      • Adults weighing 50 kilograms (kg) or more—31.5 milligrams (mg) or 1 spray in each nostril every 6 to 8 hours. Your doctor may adjust your dose if needed. However, the dose is not more than 126 mg (a total of 8 sprays) per day.
      • Older adults and adults weighing less than 50 kg—15.75 mg or 1 spray in only one nostril every 6 to 8 hours. However, the dose is usually not more than 63 mg (a total of 4 sprays) per day.
      • Children—Use and dose must be determined by your doctor.


Sprix requires special dosing depending on certain characteristics. You may be prescribed a different dosage if you:

  • Are 65 years or older
  • Have poor kidney function
  • Weigh less than 110 pounds

Taking this medication during pregnancy may harm the fetus, especially if taken at 20 weeks of gestation or later. Talk to your healthcare provider if you are pregnant or become pregnant while taking this drug.

Missed Dose

If you miss a dose of Sprix, you should take it as soon as you remember. If you are close to the next dose, then you should skip the dose that was missed and take only the next scheduled dose. You should not take more than one dose at a time. If you miss a dose of Sprix, your symptoms may not improve.

Overdose: What Happens If I Take Too Much Sprix?

Taking too much Sprix may enhance the side effects of the medication. An overdose of Sprix can lead to:

  • Fatigue
  • Drowsiness
  • Nausea or vomiting
  • Gastrointestinal bleeding
  • Acute kidney failure
  • Difficulty breathing

There is no specific amount of medication considered to be an overdose or any specific antidotes should you take too much. In this instance, you may be given charcoal or made to vomit to prevent additional side effects, or you may have to undergo other procedures. To treat an overdose, it is necessary to treat the symptoms that you are experiencing.

What Happens If I Overdose on Sprix?

If you think you or someone else may have overdosed on Sprix, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Sprix, call 911 immediately.


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It is very important that your doctor check your progress while you are using this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it.

Do not use any other form of ketorolac (eg, injection or tablets) or other NSAIDs, unless your doctor says it is okay. Some examples of NSAIDs are aspirin, diclofenac, ibuprofen, or naproxen (Advil®, Aleve®, Celebrex®, Ecotrin®, Motrin®, or Voltaren®). Also, you should not use this medicine together with pentoxifylline (Trental®) or probenecid (Benemid®).

Ketorolac may cause bleeding in your stomach or bowels. This problem can happen without warning signs. This is more likely if you have had a stomach ulcer in the past, you smoke or drink alcohol regularly, are over 60 years of age, are in poor health, or are using certain other medicines (such as steroids or a blood thinner). Call your doctor right away if you have bloody or black, tarry stools, severe stomach pain or heartburn, or vomiting of blood or material that looks like coffee grounds.

Ketorolac may increase your risk of having blood clots, heart attack, or stroke. This is more likely in people who already have heart disease. Call your doctor right away if you have chest pain or discomfort, an irregular or fast heartbeat, severe indigestion or heartburn, nausea, sweating, or troubled breathing with exertion.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Some possible warning signs of serious side effects that can occur during treatment with this medicine may include black, tarry stools, decreased urination, severe stomach pain, skin rash, swelling of the face, fingers, feet, or lower legs, unusual bleeding or bruising, unusual weight gain, vomiting of blood or material that looks like coffee grounds, or yellow skin or eyes. Also, signs of serious heart problems could occur, such as chest pain, fast or irregular heartbeat, tightness in the chest, unusual flushing or warmth of the skin, weakness, or slurring of speech. Check with your doctor right away if you notice any of these warning signs.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). Anaphylaxis can be life-threatening and requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, or fainting. Other signs may include changes in color of the skin of the face, very fast but irregular heartbeat or pulse, hive-like swellings on the skin, and puffiness or swelling of the eyelids or around the eyes. If these effects occur, get emergency help at once.

Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine.

It is important to tell your doctor if you are pregnant or planning to become pregnant before using this medicine. Using this medicine while you are pregnant can harm your unborn baby. Do not use this medicine during the latter part of a pregnancy unless your doctor tells you to.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Sprix?

You should not use Sprix if you:

  • Have a history of asthma or allergic reaction after taking any NSAID
  • Have had coronary artery bypass graft surgery
  • Have poor kidney function
  • Have active stomach ulcers or recent gastrointestinal bleeding
  • Are also taking Probalan (probenecid) or Trentall (pentoxifylline)

What Other Medications Interact With Sprix?

You should not take Sprix with probenecid (a drug used to treat gout) or pentoxifylline (a drug used to improve blood flow). Probenecid can increase the exposure to Sprix, whereas pentoxifylline can increase the risk of bleeding.

Similarly, Sprix can interact with other medications, like:

This is not a list of all drug interactions that may occur. Speak to your healthcare provider if you have any questions or concerns about potential interactions. Let your healthcare provider know about all other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

What Medications Are Similar?

Other nonopioid medications used for pain include:

This is a list of drugs also prescribed to treat pain. It is not a list of drugs recommended to take with Sprix. You should not take some of these drugs together. Talk to your pharmacist or your healthcare provider if you have questions.

Frequently Asked Questions

  • How expensive is Sprix? Is there a way to get help paying for it?

    If you need help paying for your medication, the manufacturer may offer financial assistance. There are also organizations that offer assistance programs. Talk to your healthcare provider about other financial assistance programs or nonprofits to help you pay for your medications. 

  • How can I manage the side effects associated with Sprix?

    One of the risks associated with taking an NSAID is that you may be at a higher risk of getting a stomach ulcer. Your prescriber may want you to take another medication known as a proton pump inhibitor (PPI) to help decrease the risk of bleeding.

  • What else should I do to manage my symptoms?

    If you can tolerate it, physical therapy has been shown to have a long-term improvement in pain relief.

How Can I Stay Healthy While Taking Sprix?

To stay healthy while taking Sprix, it is important to take it as directed by your healthcare provider. Using this medication exactly prescribed is necessary to control your pain effectively.

The following are tips for using Sprix:

  • Do not use Sprix more than directed by your healthcare provider.
  • Drink plenty of water during treatment since Sprix can decrease your urine output.
  • Do not breathe in Sprix while administering it.
  • Watch for severe or unusual side effects, such as bloody or black, tarry stools, stomach pain, vomiting blood, skin rash, nausea, or weakness.

Along with taking this medication as prescribed, it is important to get plenty of rest, stay hydrated, and eat a healthy diet as instructed by your healthcare provider.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

The author would like to recognize and thank Chong Yol Gacasan Kim for contributing to this article.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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