Sprix (Ketorolac) – Nasal

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.

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.

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.

Dosage: How Much Sprix Should I Use?

Modifications

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.

Precautions

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:

• Lanoxin (digoxin)
• Lithobid (lithium)
• Trexall (methotrexate)
• Loop diuretics, such as Lasix (furosemide)
• Cyclosporine
• Anti-seizure drugs, such as Dilantin (phenytoin) and Tegretol (carbamazepine)

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:

• Neurontin (gabapentin)
• Advil or Motrin (ibuprofen) and Tylenol (acetaminophen)
• Naprosyn (naproxen)
• Celebrex (celecoxib)

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.

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.

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