Ziconotide (SNX 1111)

What is Ziconotide

Ziconotide (Prialt, also known as SNX 1111) is an intrathecally infused synthetic conopeptide derived from the venom of the piscivorous marine snail, Conus magus.

Ziconotide is a calcium channel blocker specific to the neuronal calcium channels that regulate synaptic transmission in nociceptive neurons.

The non-opiate analgesic is effective for the treatment of severe, chronic pain due to various conditions, although the onset and amount of analgesia provided appear to be variable.

Ziconotide is also being studied for spasticity associated with spinal cord trauma 

Brand Name

Prialt

Indications & Dosage

  • severe pain
  • spasticity
  • spinal cord injury

For the relief of chronic, severe pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments such as systemic analgesics, adjunctive therapies, or intrathecal morphine

Side Effects

  1. abdominal pain
  2. agitation
  3. amnesia
  4. angioedema
  5. anorexia
  6. anxiety
  7. aphasia
  8. apnea
  9. asthenia
  10. ataxia
  11. atrial fibrillation
  12. blurred vision
  13. bradycardia
  14. bullous rash
  15. coma
  16. confusion
  17. constipation
  18. delirium
  19. depression
  20. diaphoresis
  21. diarrhea
  22. diplopia
  23. dizziness
  24. drowsiness
  25. dysarthria
  26. dysesthesia
  27. dysgeusia
  28. dysuria
  29. exfoliative dermatitis
  30. fatigue
  31. fever
  32. hallucinations
  33. headache
  34. hostility
  35. hypoesthesia
  36. hypotension
  37. impaired cognition
  38. infection
  39. insomnia
  40. irritability
  41. lethargy
  42. mania
  43. meningitis
  44. muscle cramps
  45. myalgia
  46. myasthenia
  47. myoclonia
  48. myopathy
  49. nausea
  50. nystagmus
  51. orthostatic hypotension
  52. paranoia
  53. paresthesias
  54. peripheral edema
  55. pruritus
  56. psychosis
  57. renal failure (unspecified)
  58. restlessness
  59. rhabdomyolysis
  60. seizures
  61. sinus tachycardia
  62. sinusitis
  63. skin ulcer
  64. stroke
  65. suicidal ideation
  66. tremor
  67. urinary retention
  68. vertigo
  69. vomiting
  70. xerostomia

Monitoring Parameters

  • neurologic function

Contraindications

  • behavioral changes
  • bipolar disorder
  • bleeding
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • coagulopathy
  • dementia
  • depression
  • driving or operating machinery
  • epidural administration
  • ethanol intoxication
  • geriatric
  • hematological disease
  • hemophilia
  • immunosuppression
  • infants
  • infection
  • intravenous administration
  • neonates
  • neurologic events
  • pregnancy
  • psychiatric event
  • psychosis
  • schizophrenia
  • seizures
  • spinal cord compression
  • suicidal ideation
  • syncope
  • thrombocytopenia
  • von Willebrand’s disease

Interactions

  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Amoxapine
  • Anxiolytics; Sedatives; and Hypnotics
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Barbiturates
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Buspirone
  • Butorphanol
  • Carisoprodol
  • Clozapine
  • COMT inhibitors
  • Droperidol
  • Ethanol
  • Fluoxetine; Olanzapine
  • Gallium Ga 68 Dotatate
  • Haloperidol
  • Loop diuretics
  • Mannitol
  • Maprotiline
  • Methocarbamol
  • Mirtazapine
  • Molindone
  • Nalbuphine
  • Nefazodone
  • Olanzapine
  • Opiate Agonists
  • Opiate Agonists-Antagonists
  • Pentazocine
  • Pentazocine; Naloxone
  • Phenothiazines
  • Pimozide
  • Potassium-sparing diuretics
  • Pramipexole
  • Quetiapine
  • Risperidone
  • Ropinirole
  • Sedating H1-blockers
  • Thiazide diuretics
  • Tramadol
  • Trazodone
  • Tricyclic antidepressants
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