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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
In short, it is a synthetic form of sea snail toxin. The toxin is known to cause selective blockade of the N-type voltage-gated calcium channel, leading to the inhibition of release of glutamate, calcitonin gene-related peptide, and substance P in the brain and spinal cord. The drug is delivered through an intrathecal infusion pump, and thus is only considered in those who have failed therapy with oral medications. Originally ziconitide was only studied in cancer pain, but there have been some studies and case reports on its utility in neuropathic pain. It has been known to induce psychosis, as well as cause other central side effects such as sedation and mental clouding.
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
- abdominal pain
- agitation
- amnesia
- angioedema
- anorexia
- anxiety
- aphasia
- apnea
- asthenia
- ataxia
- atrial fibrillation
- blurred vision
- bradycardia
- bullous rash
- coma
- confusion
- constipation
- delirium
- depression
- diaphoresis
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysarthria
- dysesthesia
- dysgeusia
- dysuria
- exfoliative dermatitis
- fatigue
- fever
- hallucinations
- headache
- hostility
- hypoesthesia
- hypotension
- impaired cognition
- infection
- insomnia
- irritability
- lethargy
- mania
- meningitis
- muscle cramps
- myalgia
- myasthenia
- myoclonia
- myopathy
- nausea
- nystagmus
- orthostatic hypotension
- paranoia
- paresthesias
- peripheral edema
- pruritus
- psychosis
- renal failure (unspecified)
- restlessness
- rhabdomyolysis
- seizures
- sinus tachycardia
- sinusitis
- skin ulcer
- stroke
- suicidal ideation
- tremor
- urinary retention
- vertigo
- vomiting
- 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