Provider Briefing: Sprix Availability in 2026

Sprix (Ketorolac tromethamine nasal spray, 15.75 mg/spray) remains one of the few non-opioid options for self-administered acute pain management at home. But prescribing it in 2026 comes with a recurring challenge: your patients may not be able to find it at the pharmacy.

This briefing covers the current supply landscape, prescribing considerations, cost and access barriers, and practical tools to help your patients fill their prescriptions successfully.

Supply Timeline and Current Status

Sprix has a history of supply variability since its FDA approval in 2010:

• 2010: Sprix launched by Luitpold Pharmaceuticals as the first intranasal Ketorolac formulation
• 2014–2017: Product transferred through Egalet Corporation and subsequently Zyla Life Sciences
• 2019–2020: Assertio Therapeutics acquired Zyla, inheriting the Sprix product line
• 2021–2024: Intermittent supply disruptions reported; generic Ketorolac nasal spray introduced
• 2025–2026: Product not listed on the FDA Drug Shortage Database, but retail pharmacy availability remains inconsistent

The pattern is clear: while Sprix hasn't experienced a true manufacturing shortage in recent years, distribution-level scarcity persists. Most retail pharmacies don't stock it, and patients frequently report difficulty filling prescriptions.

Prescribing Implications

Sprix occupies a unique therapeutic niche as an intranasal NSAID with opioid-level analgesic efficacy for short-term acute pain. When prescribing, consider the following:

Clinical Profile

• Indication: Short-term (≤5 days) management of moderate to moderately severe pain requiring opioid-level analgesia
• Dosing: One spray per nostril (31.5 mg total) every 6-8 hours; maximum 126 mg/day. For patients ≥65 years, renally impaired, or weighing <50 kg: one spray in one nostril (15.75 mg) every 6-8 hours; maximum 63 mg/day
• Administration: Each bottle provides 8 sprays and must be discarded within 24 hours of priming
• Duration limit: 5 days total across all Ketorolac formulations (nasal, oral, injectable combined)

Boxed Warning Reminders

Sprix carries the standard NSAID boxed warnings, with additional emphasis on the 5-day treatment limit:

• Increased risk of serious cardiovascular thrombotic events (MI, stroke)
• Increased risk of serious GI adverse events (bleeding, ulceration, perforation)
• Contraindicated as perioperative analgesia in CABG surgery
• Not indicated for minor or chronic pain conditions

Contraindications Relevant to Prescribing

Key contraindications that may affect your prescribing decision include active or history of peptic ulcer/GI bleeding, advanced renal disease, concurrent aspirin or NSAID use, hemorrhagic diathesis, nasal polyps, and use in labor/delivery or breastfeeding. See our drug interactions guide for a comprehensive list.

The Availability Picture

The practical challenge for providers is that prescribing Sprix doesn't guarantee your patient can fill it. Here's why:

• Low retail stocking: Most chain pharmacies (CVS, Walgreens, Rite Aid) don't maintain Sprix inventory due to low demand and high unit cost
• Specialty distribution: The product is available through major wholesalers but must typically be special-ordered, adding 1-3 business days
• Geographic variability: Urban areas with specialty pharmacies have better access than rural regions
• Generic availability: Generic Ketorolac tromethamine nasal spray exists and may be more readily sourced, though it faces similar stocking challenges

Cost and Access Barriers

Cost remains a significant barrier to patient access:

• Cash price: $3,459 (brand) to $2,657 (generic with coupon) for a 5-day supply
• Insurance coverage: Frequently subject to prior authorization and step therapy requirements. Many plans place Sprix on non-preferred or specialty tiers
• Patient assistance: Limited manufacturer programs; third-party discount cards (SingleCare, GoodRx) can reduce generic costs

For comparison, IM/IV Ketorolac (generic Toradol) costs under $20 per dose, and oral Ketorolac tablets run $10-$30 for a full course. The cost differential is a common reason for payer pushback.

Tools and Resources for Your Practice

Several tools can help streamline the prescribing-to-dispensing process:

Medfinder for Providers

Medfinder's provider tools allow you to check real-time pharmacy availability for Sprix and direct patients to pharmacies that have it in stock. This reduces failed fill attempts and phone calls back to your office.

Proactive Prescribing Strategies

1. Send the prescription 2-3 days before the patient needs it for planned procedures, giving the pharmacy time to order
2. Include "DAW 0" (or equivalent) to allow generic substitution, which may be more readily available
3. Provide patients with a backup plan — discuss alternatives upfront in case Sprix can't be sourced
4. Document medical necessity for prior authorization, emphasizing the non-opioid benefit and patient's inability to receive injections

Alternative Protocols

When Sprix is unavailable, consider these evidence-based alternatives:

• IM/IV Ketorolac (if patient has access to a clinic or home health services)
• Oral Ketorolac (as continuation therapy; less ideal as first-line standalone)
• Diclofenac potassium (Cambia for migraine; oral for acute musculoskeletal pain)
• Celecoxib (lower GI risk, suitable for longer-term use)
• Multimodal protocol: Acetaminophen + oral NSAID + gabapentinoid for post-surgical pain

Looking Ahead

The intranasal NSAID space remains underserved. Sprix's unique delivery mechanism fills a genuine clinical gap for non-opioid acute pain management, but access challenges persist. As opioid-sparing protocols continue to gain emphasis, demand for products like Sprix may increase, potentially improving supply chain economics over time.

In the meantime, proactive prescribing — planning ahead, leveraging availability tools, and maintaining backup protocols — remains the best strategy for ensuring your patients get the pain relief they need.

Final Thoughts

Sprix is a valuable tool in the non-opioid pain management arsenal, but its availability challenges require providers to plan ahead. Use Medfinder's provider tools to check availability, communicate alternatives to patients early, and document medical necessity for insurance approvals. For a patient-facing version of this information, see our Sprix shortage update for patients.