Approved indications: Sprix is FDA-approved in adult patients for short-term (up to 5 days) management of moderate to moderately severe acute pain that is severe enough to require analgesia at the opioid level; it is not indicated for minor or chronic pain or for use in children.

Off-label uses: Clinicians may occasionally consider intranasal ketorolac for acute painful conditions such as postoperative pain in ambulatory settings, emergency-department discharge pain control, or selected musculoskeletal or headache conditions, but evidence for the nasal formulation outside postoperative and acute pain trials is more limited and most data come from ketorolac given by injection or orally.

Efficacy expectations: Pain relief typically begins within about 20–30 minutes, with meaningful improvement over the first hour and effects lasting about 6–8 hours between doses; in clinical studies it has reduced pain scores and opioid requirements compared with placebo or standard regimens, offering opioid-level analgesia without opioid-related effects, though its overall pain relief is similar to other potent NSAIDs and limited by the required 5-day maximum treatment duration.

Typical dosing: For most adults younger than 65 years who weigh at least 50 kg (110 lb) and have normal kidney function, the usual dose is 31.5 mg every 6–8 hours (one 15.75 mg spray in each nostril) up to 4 doses (126 mg) in 24 hours; for adults aged 65 years or older, adults under 50 kg, or those with kidney impairment, the dose is reduced to 15.75 mg every 6–8 hours (one spray in a single nostril) up to 4 doses (63 mg) in 24 hours.

Route and technique: Sprix is for use in the nose only and is not an inhaled product; before the first use of each bottle the pump is primed with 5 sprays into the air, then the patient gently blows the nose, sits or stands with the head slightly tilted forward, inserts the tip into the nostril pointing away from the nasal septum, holds the breath, sprays once, and then breathes in gently through the mouth, repeating in the other nostril only if a two-spray dose was prescribed.

Special instructions: Use the lowest effective dose for the shortest possible time, never use Sprix together with other forms of ketorolac or with other systemic NSAIDs, avoid getting the spray in the eyes, and discard each bottle within 24 hours of the first dose; the total duration of all ketorolac treatment (any route) must not exceed 5 days.

Missed dose: If a dose is missed, it may be used when remembered as long as it is not almost time for the next scheduled dose; if it is close to the next dose, skip the missed dose and resume the regular schedule without doubling doses.

Overdose: Taking more than prescribed or using Sprix longer than 5 days increases the risk of serious stomach bleeding, kidney injury, and other complications; in suspected overdose, stop the drug and seek emergency care or contact a poison control center immediately.

Common side effects: The most frequent effects include nasal discomfort or burning, throat irritation, runny nose, increased tearing, headache, dizziness, nausea, indigestion, and transient increases in blood pressure or liver enzymes; these usually start soon after dosing, are mild to moderate, and often improve as treatment stops after a few days.

Serious or rare adverse effects: Like other systemic NSAIDs, Sprix can cause serious stomach or intestinal bleeding or ulcers, kidney injury, fluid retention and worsening heart failure, heart attack or stroke, severe allergic reactions (including bronchospasm in aspirin-sensitive asthma), life-threatening skin reactions, and bleeding complications due to effects on platelets; chest pain, shortness of breath, weakness on one side, black or bloody stools, vomiting blood, severe abdominal pain, little or no urine, facial or throat swelling, or widespread rash require immediate medical attention.

Warnings and precautions: Sprix is contraindicated in active or recent gastrointestinal bleeding or peptic ulcer disease, advanced kidney disease or significant volume depletion, aspirin- or NSAID-sensitive asthma or prior serious skin reactions to NSAIDs, suspected or confirmed cerebrovascular bleeding or bleeding disorders, use around coronary artery bypass graft (CABG) surgery, labor and delivery, and in nursing mothers; it is not indicated in pediatric patients, and older adults or those with kidney impairment or low body weight require the reduced dosing regimen and close monitoring. Use during pregnancy should generally be avoided, especially in the second half of pregnancy, because NSAIDs can affect the fetal kidneys, amniotic fluid, and ductus arteriosus.

Relative safety profile: Compared with opioids, Sprix does not cause respiratory depression, constipation, or dependence, but its gastrointestinal, kidney, cardiovascular, and bleeding risks are similar to or greater than many other NSAIDs because ketorolac is a potent systemic agent and is therefore restricted to a maximum of 5 days of use.

Reporting and safety updates: Patients should report side effects promptly to their healthcare provider and may report them to the FDA through the MedWatch program or equivalent national safety reporting systems; up-to-date safety information is available in the current prescribing information and from regulatory agency websites.

Prescription and OTC drug interactions: Sprix should not be used with other NSAIDs (including high-dose aspirin) or any other ketorolac products, and it can increase bleeding risk when combined with anticoagulants (such as warfarin or DOACs), antiplatelet drugs (such as aspirin or clopidogrel), and medicines that affect serotonin reuptake (SSRIs and SNRIs); it may also interact with corticosteroids, pentoxifylline, and some chemotherapy or immunosuppressant drugs to raise the risk of gastrointestinal or other bleeding.

Other medication and supplement interactions: Sprix can reduce the blood-pressure–lowering and diuretic effects of ACE inhibitors, ARBs, and diuretics and increase the chance of kidney injury with these drugs; it can raise blood levels and toxicity risk of lithium and methotrexate, and should be used cautiously with cyclosporine, tacrolimus, and other nephrotoxic agents; alcohol use further increases the risk of stomach bleeding and should be minimized or avoided while taking Sprix.

Food, procedures, and lifestyle considerations: Because Sprix is given intranasally, it does not have specific food restrictions, but it should not be used as a prophylactic analgesic before major surgery or around CABG surgery, and caution is needed in any situation where normal blood clotting and kidney function are critical.

Precautions and monitoring: Use Sprix carefully or avoid it in patients with a history of ulcers or gastrointestinal bleeding, cardiovascular disease or high cardiovascular risk, uncontrolled hypertension, kidney or liver disease, bleeding disorders, asthma related to aspirin or NSAIDs, or in older or frail adults; for higher-risk patients or repeated short courses, clinicians may monitor blood pressure, kidney function, and signs of bleeding or anemia.

Q: What is Sprix used for?
A: Sprix is a nasal spray form of the NSAID ketorolac used in adults for short-term (up to 5 days) treatment of moderate to moderately severe acute pain that would otherwise need opioid-level pain relief.

Q: How quickly does Sprix start working and how long does it last?
A: Pain relief usually begins within about 20–30 minutes after a dose, and each dose typically provides benefit for around 6–8 hours.

Q: Can I use Sprix with ibuprofen, naproxen, or other NSAIDs?
A: No, Sprix should not be taken together with other NSAIDs (including ibuprofen, naproxen, or other forms of ketorolac or high-dose aspirin) because this greatly increases the risk of stomach bleeding, kidney problems, and other side effects.

Q: Is Sprix safer than opioids?
A: Sprix does not cause dependence or respiratory depression like opioids and can reduce the need for opioid pain medicines, but it has its own serious risks (especially stomach, kidney, heart, and bleeding problems) and therefore is restricted to a maximum of 5 days of use.

Q: Can I use Sprix if I am pregnant or breastfeeding?
A: Sprix and other NSAIDs are generally avoided during pregnancy, especially after mid-pregnancy, and Sprix is not recommended in breastfeeding because ketorolac passes into breast milk and the product labeling lists nursing mothers as a contraindication.

Q: What should I avoid while using Sprix?
A: Avoid other NSAIDs or ketorolac products, limit or avoid alcohol, do not use it longer than 5 days, and use caution with medicines that affect bleeding or kidney function unless your prescriber has specifically reviewed the combination.

Storage: Store unopened Sprix bottles in a refrigerator at 36°F to 46°F (2°C to 8°C), protect from light and freezing; once a bottle is opened and primed, keep it at room temperature (59°F to 86°F, 15°C to 30°C) out of direct sunlight and out of reach of children and pets.

Use period: Each bottle is for a single day of use only and must be thrown away within 24 hours of the first dose, even if liquid remains.

Disposal: After 24 hours, replace the cap and place the used bottle in household trash in a secure container or bag so children and animals cannot reach it; use a local medicine take-back program if available and avoid flushing down the toilet unless specifically instructed.