Classifications: nonnarcotic analgesic; n-type calcium channel blocker; Therapeutic: nonnarcotic analgesic
Pregnancy Category: C
25 mcg/mL, 100 mcg/mL injection
Ziconotide binds to N-type calcium channels located on the afferent nerves in the dorsal horn in the spinal cord. It is
thought that these binding blocks of N-type calcium channels lead to a blockade of excitatory neurotransmitter release in
the afferent nerve endings.
Ziconotide is effective in controlling severe chronic pain that is intractable to other analgesics.
Management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted.
Spasticity associated with spinal cord trauma.
Hypersensitivity to ziconotide; epidural or intravenous administration; preexisting history of psychosis; sepsis; depression
with suicidal ideation; cognitive impairment; bipolar disorder; schizophrenia; dementia; presence of infection at the injection
site, uncontrolled bleeding, or spinal canal obstruction that impairs circulation of CSF; coagulopathy; seizures; pregnancy
(category C); lactation. Safety and efficacy in children or infants are not established.
Elderly; renal, hepatic, and cardiac impairment; concurrent use of CNS depressant(s); older adults.
Route & Dosage
|Severe Chronic Pain
Adult: Intrathecal Initial 0.1 mcg/h; may titrate up 0.1 mcg/h q23d to 0.8 mcg/h (19.2 mcg/d)
- May be administered undiluted (25 mcg/mL in 20 mL vial) or diluted using the 100 mcg/mL vials. Diluted ziconotide is prepared
with NS without preservatives.
- Administer using an implanted variable-rate microinfusion device or an external microinfusion device and catheter.
- Note: Due to serious adverse events, 19.2 mcg/d (0.8 mcg/h) is the maximum recommended dose.
- Doses should normally be titrated upward by no more than 2.4 mcg/d (0.1 mcg/h) at intervals of 23 times/wk.
- Refrigerate all ziconotide solutions after preparation and begin infusion within 24 h. Discard any unused portion left in
Adverse Effects (≥1%) Body as a Whole:
Accidental injury, back pain, catheter
complication, catheter-site pain, cellulitis, chest pain, chills, fever,
, neck pain, neck rigidity, pain,
pump-site complication, pump-site mass, pump-site pain, viral infection
Abnormal dreams, abnormal gait,
agitation, anxiety, aphasia, asthenia, ataxia,
CSF abnormal, confusion, depression
, difficulty concentrating, dizziness,
dry mouth, dysesthesia,
emotional lability, headache,
hostility, hyperesthesia, hypertonia,
, memory impairment,
mental slowing, meningitis, nervousness, neuralgia
, paranoid reaction, paresthesia,
reflexes decreased, somnolence, speech disorder,
stupor, abnormal thinking, tremor, twitching, vertigo. CV:
Hypertension, hypotension, postural hypotension, syncope, tachycardia, vasodilation. GI:
Abdominal pain, anorexia, constipation
disorder, nausea, vomiting. GU:
Dysuria, urinary incontinence, urinary retention,
urinary tract infection
, impaired urination. Hematologic: Anemia
, ecchymosis. Metabolic/Nutritional: Creatinine
phosphokinase increased, dehydration, edema, hypokalemia, peripheral edema, weight loss. Musculoskeletal: Arthralgia
, leg cramps, myalgia, myasthenia. Respiratory: Bronchitis
, cough increased, dyspnea
, lung disorder, pharyngitis, pneumonia
, rhinitis, sinusitis
. Skin: Cutaneous
surgical complication, dry skin, pruritus, rash, skin disorder, sweating. Special Senses: Abnormal vision, diplopia
photophobia, taste perversion, tinnitus.
and other cns depressants
may increase drowsiness, dizziness, and confusion.
50% protein bound. Metabolism:
Hydrolyzed by peptidases. Half-Life:
Assessment & Drug Effects
- Monitor for and report S&S of meningitis, cognitive impairment, hallucinations, changes in mood or consciousness, or other
- Lab tests: Serum creatine kinase every other week for first month and monthly thereafter.
Patient & Family Education
- Report any of the following to physician: muscle pain, soreness, or weakness, confusion, unusual behavior, symptoms of depression
or suicidal thoughts, fever, headache, stiff neck, nausea or vomiting, seizures.
- Note: Taking this drug with other depressants (e.g., alcohol, sedatives, tranquilizers) will increase the risk of side effects.