ketorolac
Sprix nasal spray (ketorolac) is a non-steroidal anti-inflammatory drug (NSAID) nasal spray. It's used to treat moderate-to-severe pain in adults who need pain control that's similar to treatment with opioids. The medication is sprayed directly into the nostrils every 6 to 8 hours for up to 5 days. Even though the medication is sprayed directly into the nose, it still has a rare risk of severe side effects, such as heart attack and stomach ulcers. Some of the more common side effects of Sprix nasal spray (ketorolac) include discomfort and pain in the nose.
What is Sprix nasal spray (ketorolac)?
What is Sprix nasal spray (ketorolac) used for?
- Short-term (up to 5 days) moderate-to-severe pain in adults
How Sprix nasal spray (ketorolac) works
Sprix nasal spray (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID) nasal spray. It works by blocking a protein (called cyclooxygenase, or COX) in your body that makes chemicals that cause inflammation, pain, and swelling.
Drug facts
Side effects of Sprix nasal spray (ketorolac)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nasal discomfort (15%)
- Nose pain (13%)
- Excessive tears (5%)
Less Common Side Effects
- Throat irritation
- Urinating less
- Rash
- Runny nose
Sprix nasal spray (ketorolac) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Stomach bleeding: feeling faint, vomiting blood, bloody or dark stools, severe stomach pain or discomfort
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: chest pain, trouble breathing, weakness in one part of your body or face, slurred speech
- Heart failure: difficulty breathing, swelling, fast heartbeat
- High blood pressure: headache, shortness of breath, changes in vision, light-headedness, fatigue
- Worsening liver problems or liver failure: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
- Kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- Allergic reactions: hives, rash, blisters, swelling of the lips or tongue, difficulty breathing
- Serious skin reactions: skin reddening, blisters, rash
The following Sprix nasal spray (ketorolac) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Itching, redness, tearing, or other sign of eye irritation not present before use of this medicine or becoming worse during use
redness of the clear part of the eye
sensitivity to light
swelling of the eye
swelling of the eyelids
tearing
throbbing pain
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Stinging or burning of the eye when medicine is applied
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Sprix nasal spray (ketorolac)
Pros
- Can start to relieve pain in 20 minutes after a dose
- Possible option for people who don't want to or can't take opioid medications
- Sprayed into the nostrils; option for people who can't swallow pills
Cons
- Must use 3 to 4 times per day for pain control
- Can cause unpleasant side effects, such as nasal pain or discomfort, irritation in your throat, and rash
- Short-term use only (up to 5 days)
Pharmacist tips for Sprix nasal spray (ketorolac)
- The total length of treatment of ketorolac in any form should only be up to 5 days. Using it for longer than 5 days can raise your risk of life-threatening side effects, like heart problems and stomach bleeds. If your pain doesn't get better or worsens after using Sprix nasal spray (ketorolac) as prescribed for 5 days, discuss alternative options for pain control with your prescriber.
- Space out your Sprix nasal spray (ketorolac) doses so that you're not using the medication more often than every 6 hours.
- Each spray bottle of Sprix nasal spray (ketorolac) contains enough medication for 8 sprays (the maximum dose in a single day). The medication in the bottle expires 24 hours after the first spray (even if it still has medication left). Your prescriber might prescribe up to 5 bottles of Sprix nasal spray (ketorolac) for a 5 day supply.
- Store unopened bottles of Sprix nasal spray (ketorolac) in the refrigerator. Don't freeze them. After a bottle is opened, it can be stored at room temperature away from direct light or sunlight for up to 24 hours.
- Sprix nasal spray (ketorolac) can interact with other medications, such as blood thinners and certain antidepressants. Tell your healthcare professional (HCP) about all of the medications you're taking before starting Sprix nasal spray (ketorolac). Don't start any medications while taking Sprix nasal spray (ketorolac) without talking to your HCP or pharmacist first.
- Ask your HCP whether it's safe to use Sprix nasal spray (ketorolac) if you're allergic to aspirin. There's a chance you could be allergic to Sprix nasal spray (ketorolac) as well.
- If you're pregnant and are prescribed Sprix nasal spray (ketorolac), let your healthcare team know before starting the medication. This medication can raise the risk of kidney and heart problems in unborn babies. If you're pregnant or thinking of becoming pregnant, your HCP might recommend safer options for your pain.
How to use Sprix nasal spray (ketorolac):
- Before using Sprix nasal spray (ketorolac) for the first time, you need to prime the bottle. Remove the plastic cover and hold the bottle upright, at least one arm's length away from you. Press down to release the pump 5 times. Keep in mind that you might not see any spray coming out the first few times you press down.
- Blow low your nose, sit or stand up straight, and tilt your head down towards your toes. Place the tip of the Sprix nasal spray (ketorolac) spray into your nostril. Then, point the tip towards the back of your nose.
- Spray Sprix nasal spray (ketorolac) one time in your nostril(s). Don't inhale or breathe in the medication through your nose while spraying because this can interfere with how the medication works and lead to side effects like irritation or discomfort.
- Don't blow your nose right after your dose of Sprix nasal spray (ketorolac) because you might lose some medication. After using Sprix nasal spray (ketorolac), try pinching your nose to help keep the medication in your nose and breathe in through your mouth.
- Don't let Sprix nasal spray (ketorolac) come into contact with your eyes. If the medication accidentally gets in your eyes, use water or saline to wash it out well. If eye irritation lasts longer than 1 hour, seek medical help right away.
Common questions about Sprix nasal spray (ketorolac)
Sprix nasal spray (ketorolac) starts working to relieve pain in as soon as 20 minutes for some people and lasts for about 6 to 8 hours. Although the medication can work quickly, each person's level of pain is different, so the effects of the medication will differ for each person and each pain-related condition. If you feel like your medication isn't working as it should, let your prescriber know.
No, don't take ibuprofen (Advil, Motrin) while you're taking Sprix nasal spray (ketorolac). Both medications are NSAIDs, so taking them both raises your risk for serious side effects like stomach bleeding, blood clots, and kidney problems. If you're need additional pain relief, ask your healthcare team whether acetaminophen (Tylenol) might be appropriate for you.
No, Sprix nasal spray (ketorolac) isn't a controlled substance because it doesn't have a risk of addiction or dependence. But, your pain specialist will still limit the length of Sprix nasal spray (ketorolac) treatment to a maximum of 5 days because it can cause serious side effects with long-term use. Be sure to discuss these risks with your healthcare team before starting Sprix nasal spray (ketorolac).
Sprix nasal spray (ketorolac) isn't likely to cause low blood pressure. People who take NSAIDs are more likely to experience higher blood pressure. In clinical studies, only 2% of people reported having high blood pressure from Sprix nasal spray (ketorolac). Let your prescriber know if you have a history of heart problems or high blood pressure. They'll talk with you about the benefits and risks of taking this medication. If you decided to take Sprix nasal spray (ketorolac), your healthcare team might ask you to check your blood pressure more often during treatment.
People who took Sprix nasal spray (ketorolac) in clinical studies didn't report drowsiness as a side effect. But people who took other NSAIDs did experience sleepiness. To be safe, you might want to avoid driving or doing activities that require focus until you know how Sprix nasal spray (ketorolac) affects you.
No, Sprix nasal spray (ketorolac) is only available with a prescription from a healthcare professional.
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Risks and warnings for Sprix nasal spray (ketorolac)
Sprix nasal spray (ketorolac) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious bleeds
- Risk factors: Older adults | History of stomach bleeding or bleeding problems | Stomach ulcers | Liver problems | Taking other medications that raise your risk for bleeds | Drinking alcohol | Smoking | Taking Sprix nasal spray (ketorolac) for longer than 5 days
Sprix nasal spray (ketorolac) raises your risk for serious bleeds, including brain bleeds, stomach ulcers (sores), and stomach bleeds. These bleeds can happen at any time, even without warning. If not treated right away, these bleeds can be life-threatening. Your risk is higher if you're taking other medications that can raise your risk for bleeds.
To lower your risk of serious bleeds, make sure to take the lowest dose of Sprix nasal spray (ketorolac) for the shortest amount of time possible. If you're feeling faint, experience headaches, vomiting blood, have bloody or dark stools, or have severe stomach pain or discomfort that doesn't go away while taking Sprix nasal spray (ketorolac), get medical attention right away.
Risk of blood clots, heart attack, and stroke
- Risk factors: History of heart problems | Taking high doses of Sprix nasal spray (ketorolac) | Taking Sprix nasal spray (ketorolac) for longer than 5 days | History of, or planned, heart surgery
Sprix nasal spray (ketorolac) can raise your risk of having blood clots, which can cause a heart attack or stroke. Try to take the lowest dose for the shortest time. If you have heart problems, talk to your healthcare professional (HCP) before starting this medication. Don't take Sprix nasal spray (ketorolac) if you had or will have heart surgery. Call 911 or get help right away if you experience chest pain, shortness of breath, weakness on one side of your body, or trouble speaking or walking.
Kidney damage
- Risk factors: Older adult | History of kidney problems, heart failure, or liver problems | Not enough fluids in the body (dehydration) | Taking medications that can cause kidney problems
Sprix nasal spray (ketorolac) can cause kidney problems. Your risk is higher if you have certain factors like older age, certain medical problems like diabetes, or you're taking medications that can cause kidney problems. Your HCP might order lab tests to monitor your kidney health before and during treatment with Sprix nasal spray (ketorolac). If your kidney health worsens, your HCP might stop your Sprix nasal spray (ketorolac) treatment. Contact your HCP if you develop any signs or symptoms of kidney failure, including changes in your need to urinate, tiredness, dry and itchy skin, low appetite, and muscle cramps.
Don't take with other NSAIDs
You should avoid taking any other NSAIDs with Sprix nasal spray (ketorolac) because doing so will raise your risk of serious side effects, such as bleeding, stroke, and kidney problems. Make sure to check all of your medications, including OTC medications, as NSAIDs are often found in combination medications for cold, flu, or headache.
The total duration of treatment with ketorolac-containing medications (including Sprix nasal spray (ketorolac) and other formulations) should last no longer than 5 days. Don't take Sprix nasal spray (ketorolac) with other ketorolac medications at the same time.
High blood pressure and heart failure
- Risk factors: History of heart problems
Sprix nasal spray (ketorolac) can cause your body to hold onto extra fluid, which can raise your blood pressure or put you at risk for heart failure. Tell your HCP if you have a history of heart problems or are taking blood pressure medications before starting Sprix nasal spray (ketorolac) to make sure it's safe for you. Your HCP will screen you for heart problems before starting you on this medication. Some forms of Sprix nasal spray (ketorolac) contain sodium, so it's important to keep track of how much you're getting from your doses if you're on a low-salt diet. If you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while taking Sprix nasal spray (ketorolac), contact your healthcare team.
Liver damage
- Risk factors: History of liver problems
Though rare, Sprix nasal spray (ketorolac) can cause serious liver problems that can lead to liver failure. Get medical attention right away if you notice swelling of your stomach, stomach pain, yellowing of your skin or the whites of your eyes, clay-colored stools, nausea, vomiting, confusion, or dark or brown urine. You might need to stop using the medication to prevent further liver damage.
Severe allergic reactions
- Risk factors: Aspirin allergy | NSAID allergy | Aspirin-sensitive asthma
Severe allergic reactions to Sprix nasal spray (ketorolac) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). Let your healthcare team know if you have an allergy to aspirin or other NSAIDs before starting Sprix nasal spray (ketorolac). If you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing after using Sprix nasal spray (ketorolac), get medical attention right away.
Although rare, Sprix nasal spray (ketorolac) can cause serious skin reactions, such as rash, blisters, skin reddening, or skin peeling. If you notice changes in your skin, stop using Sprix nasal spray (ketorolac) and get medical attention right away.
Sprix nasal spray (ketorolac) dosage
Package| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5 bottles of 15.75mg/spray | 1 package | $1,778.13 | $1,778.13 |
Typical dosage for Sprix nasal spray (ketorolac)
Each spray of Sprix contains 15.75 mg of ketorolac.
- Adults ages 18 to under 65 years: The typical dose is 31.5 mg (1 spray in each nostril) every 6 to 8 hours. The maximum dose is 126 mg (four doses) per day.
- Adults 65 years and older, adults with kidney problems, and adults who weigh less than 50 kg (110 pounds): The typical dose is 15.75 mg (1 spray in only one nostril) every 6 to 8 hours. The maximum dose is 63 mg (four doses) per day.
More on Sprix nasal spray (ketorolac) dosage
Interactions between Sprix nasal spray (ketorolac) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Aceclofenac
- Acemetacin
- Amtolmetin Guacil
- Aspirin
- Bromfenac
- Bufexamac
- Celecoxib
- Choline Salicylate
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Ketoprofen
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Pentoxifylline
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Proglumetacin
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sulfasalazine
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Valdecoxib
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Acenocoumarol
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Bemiparin
- Betamethasone
- Bivalirudin
- Budesonide
- Cangrelor
- Certoparin
- Cilostazol
- Citalopram
- Clopidogrel
- Cortisone
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Deflazacort
- Desirudin
- Desvenlafaxine
- Dexamethasone
- Dipyridamole
- Duloxetine
- Edoxaban
- Enoxaparin
- Epoprostenol
- Eptifibatide
- Escitalopram
- Feverfew
- Fluocortolone
- Fluoxetine
- Fluvoxamine
- Fondaparinux
- Ginkgo
- Heparin
- Hydrocortisone
- Iloprost
- Lepirudin
- Levomilnacipran
- Meadowsweet
- Methotrexate
- Methylprednisolone
- Milnacipran
- Nadroparin
- Nefazodone
- Paramethasone
- Parnaparin
- Paroxetine
- Phenindione
- Phenprocoumon
- Prasugrel
- Prednisolone
- Prednisone
- Protein C
- Reboxetine
- Reviparin
- Rivaroxaban
- Sertraline
- Sibutramine
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Treprostinil
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
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Sprix nasal spray (ketorolac) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Sprix nasal spray (ketorolac) will not be safe for you to take.
- History of or currently have active peptic ulcer disease or stomach bleeds
- History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
- Use for preventing pain before surgery
- Severe kidney problems or at risk for kidney problems due to dehydration
- Use of Sprix nasal spray (ketorolac) after coronary artery bypass graft surgery (CABG)
- Use of Sprix nasal spray (ketorolac) during labor and delivery
- Confirmed, or at high risk for, bleeding
- Taking other NSAIDs at the same time, including aspirin
- Taking probenecid
- Taking pentoxifylline
What are alternatives to Sprix nasal spray (ketorolac)?
