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      <issuerCik>0001427925</issuerCik>
      <issuerName>ACELRX PHARMACEUTICALS INC</issuerName>
      <secFileNumber>001-35068</secFileNumber>
      <issuerAddress>
        <com:street1>1850 GATEWAY DRIVE</com:street1>
        <com:street2>SUITE 175</com:street2>
        <com:city>SAN MATEO</com:city>
        <com:stateOrCountry>CA</com:stateOrCountry>
        <com:zipCode>94404</com:zipCode>
      </issuerAddress>
      <issuerContactPhone>650-216-3500</issuerContactPhone>
      <nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>Palmer Pamela P</nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>
      <relationshipsToIssuer>
        <relationshipToIssuer>Officer</relationshipToIssuer>
        <relationshipToIssuer>Director</relationshipToIssuer>
      </relationshipsToIssuer>
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    <securitiesInformation>
      <securitiesClassTitle>Common</securitiesClassTitle>
      <brokerOrMarketmakerDetails>
        <name>Charles Schwab &amp; Co., Inc.</name>
        <address>
          <com:street1>3000 Schwab Way</com:street1>
          <com:city>Westlake</com:city>
          <com:stateOrCountry>TX</com:stateOrCountry>
          <com:zipCode>76262</com:zipCode>
        </address>
      </brokerOrMarketmakerDetails>
      <noOfUnitsSold>9514</noOfUnitsSold>
      <aggregateMarketValue>11178.00</aggregateMarketValue>
      <noOfUnitsOutstanding>16340118</noOfUnitsOutstanding>
      <approxSaleDate>08/24/2023</approxSaleDate>
      <securitiesExchangeName>NASDAQ</securitiesExchangeName>
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      <securitiesClassTitle>Common</securitiesClassTitle>
      <acquiredDate>08/22/2017</acquiredDate>
      <natureOfAcquisitionTransaction>Restricted Stock Lapse - See Remarks</natureOfAcquisitionTransaction>
      <nameOfPersonfromWhomAcquired>ACELRX PHARMACEUTICALS INC</nameOfPersonfromWhomAcquired>
      <isGiftTransaction>N</isGiftTransaction>
      <amountOfSecuritiesAcquired>9514</amountOfSecuritiesAcquired>
      <paymentDate>08/22/2017</paymentDate>
      <natureOfPayment>Equity Compensation</natureOfPayment>
    </securitiesToBeSold>
    <nothingToReportFlagOnSecuritiesSoldInPast3Months>Y</nothingToReportFlagOnSecuritiesSoldInPast3Months>
    <remarks>Shares acquired and paid for between 08/22/2017 through 03/03/2023.</remarks>
    <noticeSignature>
      <noticeDate>08/24/2023</noticeDate>
      <signature>Pamela P Palmer</signature>
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144
0001511365
XXXXXXXX
LIVE
0001427925
ACELRX PHARMACEUTICALS INC
001-35068
1850 GATEWAY DRIVE
SUITE 175
SAN MATEO
CA
94404
650-216-3500
Palmer Pamela P
Officer
Director
Common
Charles Schwab & Co., Inc.
3000 Schwab Way
Westlake
TX
76262
9514
11178.00
16340118
08/24/2023
NASDAQ
Common
08/22/2017
Restricted Stock Lapse - See Remarks
ACELRX PHARMACEUTICALS INC
N
9514
08/22/2017
Equity Compensation
Y
Shares acquired and paid for between 08/22/2017 through 03/03/2023.
08/24/2023
Pamela P Palmer