<?xml version="1.0"?><ownershipDocument>
    <schemaVersion>X0201</schemaVersion>

    <documentType>4</documentType><periodOfReport>2003-10-15</periodOfReport><notSubjectToSection16>0</notSubjectToSection16>
    <issuer>
        <issuerCik>0001040416</issuerCik>
        <issuerName>INSPIRE PHARMACEUTICALS INC</issuerName>
        <issuerTradingSymbol>ISPH</issuerTradingSymbol></issuer><reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001230708</rptOwnerCik>
            <rptOwnerName>STAAB THOMAS R II</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O INSPIRE PHARMACEUTICALS, INC.</rptOwnerStreet1>
            <rptOwnerStreet2>4222 EMPEROR BLVD. / SUITE 200</rptOwnerStreet2>
            <rptOwnerCity>DURHAM</rptOwnerCity>
            <rptOwnerState>NC</rptOwnerState>
            <rptOwnerZipCode>27703</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
            <reportingOwnerRelationship>
<isDirector>0</isDirector><isOfficer>1</isOfficer><isTenPercentOwner>0</isTenPercentOwner><isOther>0</isOther><officerTitle>Chief Financial Officer</officerTitle></reportingOwnerRelationship></reportingOwner><derivativeTable><derivativeTransaction><securityTitle><value>Non-Statutory Stock Option (right to buy)</value></securityTitle><conversionOrExercisePrice><value>20.30</value></conversionOrExercisePrice><transactionDate><value>2003-10-15</value></transactionDate><transactionCoding><transactionFormType>4</transactionFormType><transactionCode>A</transactionCode><equitySwapInvolved>0</equitySwapInvolved></transactionCoding><transactionAmounts><transactionShares><value>10000</value></transactionShares><transactionPricePerShare><value>0.0</value></transactionPricePerShare><transactionAcquiredDisposedCode><value>A</value></transactionAcquiredDisposedCode></transactionAmounts><exerciseDate><footnoteId id="F1"/></exerciseDate><expirationDate><value>2013-10-15</value></expirationDate><underlyingSecurity><underlyingSecurityTitle><value>Common Stock</value></underlyingSecurityTitle><underlyingSecurityShares><value>10000</value></underlyingSecurityShares></underlyingSecurity><postTransactionAmounts><sharesOwnedFollowingTransaction><value>10000</value></sharesOwnedFollowingTransaction></postTransactionAmounts><ownershipNature><directOrIndirectOwnership><value>D</value></directOrIndirectOwnership></ownershipNature></derivativeTransaction></derivativeTable><footnotes><footnote id="F1">Exercisable as to one quarter of such shares on 10/15/2004 and 2.0833% of such shares per month thereafter until fully vested.</footnote></footnotes><ownerSignature><signatureName>/s/ Thomas R. Staab, II</signatureName><signatureDate>2003-10-17</signatureDate></ownerSignature></ownershipDocument>



