Your Patients Need Sprix — Here's How to Help Them Get It

You prescribe Sprix (Ketorolac tromethamine nasal spray) because it fills a real clinical need: powerful, non-opioid pain relief that patients can self-administer at home. But increasingly, your patients are calling back to report they can't find it at the pharmacy.

This guide provides actionable strategies to help your patients locate and fill their Sprix prescriptions, reduce failed fills, and maintain effective pain management when supply is limited.

Current Availability Landscape

As of early 2026, Sprix is not in a formal FDA-listed shortage, but retail availability remains spotty. Key factors driving the access gap:

• Low retail stocking rates: Fewer than 10% of retail pharmacies carry Sprix on their shelves at any given time
• High unit cost: At approximately $3,459 (brand) or $2,657 (generic with coupon) per 5-day course, pharmacies are reluctant to stock inventory that may not sell
• Wholesaler availability: The product is generally available from major distributors (McKesson, AmerisourceBergen, Cardinal Health) for special order
• Generic option: Generic Ketorolac tromethamine nasal spray is available but faces similar stocking challenges

Why Patients Can't Find Sprix

Understanding the patient experience helps you intervene more effectively:

1. First stop fails: Patient goes to their usual chain pharmacy, which doesn't stock it
2. Phone runaround: Patient calls multiple pharmacies, often while in post-surgical pain
3. Sticker shock: Even when found, the cash price causes patients to abandon the fill
4. Insurance denial: Prior authorization requirements add days of delay when patients need relief now
5. Giving up: Patient calls your office requesting a different medication, or worse, seeks opioids

By anticipating these barriers, you can address them proactively.

What Providers Can Do: 5 Practical Steps

Step 1: Prescribe Early for Planned Procedures

If Sprix is part of your post-surgical pain management protocol, send the prescription 2-3 days before the procedure. This gives the pharmacy time to order from their wholesaler (typically 1-2 business days for delivery).

Include a "do not fill before" date if needed, and instruct the patient to confirm with the pharmacy that the order has arrived before surgery day.

Step 2: Direct Patients to Availability Tools

Recommend Medfinder to your patients as a way to locate pharmacies with Sprix in stock. This reduces the phone call burden on both the patient and your office staff.

Consider adding Medfinder to your post-procedure instruction sheets or patient handouts for medications with known availability challenges.

Step 3: Allow Generic Substitution

Unless there's a specific clinical reason for brand-name Sprix, permit generic substitution on the prescription. Generic Ketorolac tromethamine nasal spray is bioequivalent and may be more readily available from some distributors.

Writing "substitution permitted" or equivalent language ensures pharmacies can fill with whatever version they can source fastest.

Step 4: Prepare Prior Authorization Documentation

Many payers require prior authorization for Sprix. To expedite approval:

• Document the clinical rationale for intranasal delivery (e.g., patient cannot tolerate oral medications post-surgery, needle phobia, no access to injection services)
• Note the non-opioid benefit — particularly relevant for patients with opioid use disorder history or in opioid-sparing protocols
• Include failed trials of alternative NSAIDs if step therapy is required
• Keep a template letter for Sprix PAs in your EMR for efficiency

Step 5: Discuss Backup Plans Upfront

Before the patient leaves your office, briefly discuss what to do if Sprix can't be found or approved:

• "If the pharmacy can't get Sprix in time, call us and we'll prescribe injectable Ketorolac through a home health service or arrange a clinic visit."
• "As a backup, I can also prescribe oral Ketorolac tablets, which are widely available and very affordable."

This prevents panicked calls and manages patient expectations.

Alternative Medications to Consider

When Sprix is truly inaccessible, these are the strongest alternatives in the same therapeutic space:

• IM/IV Ketorolac (Toradol generic): Same active ingredient, widely available, under $20/dose. Requires clinic/home health administration.
• Oral Ketorolac 10 mg tablets: $10-$30 for a 5-day course. Best used as continuation after initial parenteral dosing.
• Diclofenac potassium (Cambia/generic): Oral NSAID with rapid onset. Good for migraine and acute musculoskeletal pain.
• Celecoxib (Celebrex/generic): COX-2 selective, lower GI risk, suitable for patients with GI concerns. $15-$60/month.
• Multimodal approach: Acetaminophen 1000 mg + Ibuprofen 400 mg alternating schedule, with or without gabapentin/pregabalin for neuropathic component.

For more details, see our provider shortage briefing and the patient-facing alternatives guide.

Workflow Tips for Your Practice

Build Sprix Into Pre-Op Checklists

For surgical practices, add "confirm Sprix pharmacy availability" as a pre-operative checklist item, right alongside pre-op labs and medication reconciliation. This catches fill problems before they become pain management emergencies.

Train Front Office Staff

Ensure your staff knows how to:

• Direct patients to Medfinder for availability checks
• Initiate prior authorization requests promptly
• Offer patients the backup medication discussion talking points

Track Fill Success Rates

If you prescribe Sprix regularly, track how often patients successfully fill it versus require alternatives. This data helps you decide whether to keep Sprix in your default protocol or proactively switch to alternatives.

Final Thoughts

Sprix fills an important role in non-opioid acute pain management, but availability challenges mean that prescribing it requires more planning than most medications. By prescribing early, leveraging availability tools like Medfinder, and preparing backup plans, you can maximize the chances your patients get the right pain relief at the right time.

For the patient perspective on finding Sprix, share our patient tips guide with your patients as a resource they can reference on their own.