April 13, 2020

Vincent J. Angotti
Chief Executive Officer
AcelRx Pharmaceuticals, Inc.
351 Galveston Drive
Redwood City, CA 94063

       Re: AcelRx Pharmaceuticals, Inc.
           Registration Statement on Form S-4
           Filed April 6, 2020
           File No. 333-237584

Dear Mr. Angotti:

       This is to advise you that we have not reviewed and will not review your
registration
statement.

        Please refer to Rules 460 and 461 regarding requests for acceleration.
We remind you
that the company and its management are responsible for the accuracy and
adequacy of their
disclosures, notwithstanding any review, comments, action or absence of action
by the staff.

       Please contact Irene Paik at 202-551-6553 with any questions.



                                                            Sincerely,

                                                            Division of
Corporation Finance
                                                            Office of Life
Sciences
cc:    Rama Padmanabhan - Cooley LLP