Ziconotide: Drug information

For additional information see "Ziconotide: Patient drug information"

For abbreviations, symbols, and age group definitions show table

ALERT: US Boxed Warning

Neuropsychiatric adverse reactions:

Ziconotide is contraindicated in patients with a preexisting history of psychosis. Severe psychiatric symptoms and neurological impairment may occur during treatment with ziconotide. Monitor all patients frequently for evidence of cognitive impairment, hallucinations, or changes in mood or consciousness. Discontinue ziconotide therapy in the event of serious neurological or psychiatric signs or symptoms.

Brand Names: US

Prialt

Pharmacologic Category

Analgesic, Nonopioid;
Calcium Channel Blocker, N-Type

Dosing: Adult

Chronic pain, severe

Chronic pain, severe (intolerant or refractory to other therapies):

Trial dose (off label):

Bolus: Intrathecal: Initial: 1 to 2 mcg once; if needed, adjust additional trial doses based on response and tolerability. Monitor for ≥8 hours after each bolus (Ref).

Co ntinuous infusion : Intrathecal: Initial: 0.5 to 1.2 mcg/day (0.02 to 0.05 mcg/hour); may increase as needed based on response and tolerability by ≤1.2 mcg/day (0.05 mcg/hour) (Ref). Maximum: 19.2 mcg/day (0.8 mcg/hour) (Ref).

Maintenance dose:

Continuous infusion: Intrathecal: Initial: 0.5 to 1.2 mcg/day (0.02 to 0.05 mcg/hour) (Ref). Some experts recommend initiating with ≤0.5 mcg/day (0.02 mcg/hour) (Ref). May increase as needed by up to 0.5 mcg/day (0.02 mcg/hour) weekly based on response and tolerability (Ref). Maximum: 19.2 mcg/day (0.8 mcg/hour). Note: Dosing in the prescribing information may not reflect current clinical practice; initiation and titration with a lower dose is preferred to improve tolerability (Ref). The manufacturer's labeling recommends dose initiation with ≤2.4 mcg/day (≤0.1 mcg/hour); and titration up to 2 to 3 times weekly by up to 2.4 mcg/day.

Discontinuation of therapy: In the event of severe adverse effects, may discontinue therapy abruptly without risk of withdrawal.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Adjustment for Toxicity: Adult

Cognitive impairment: Reduce dose or discontinue. Effects are generally reversible within 3 to 15 days of discontinuation.

Neurologic or psychiatric adverse effects, severe: Interrupt or permanently discontinue therapy.

Reduced level of consciousness: Discontinue until event resolves.

CK elevation with neuromuscular symptoms, persistent: Consider dose reduction or discontinuation.

Dosing: Older Adult

Refer to adult dosing; use with caution and start at the low end of the dosing range.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults.

>10%:

Gastrointestinal: Diarrhea (18%), nausea (40%), vomiting (16%)

Nervous system: Abnormal gait (14%), aphasia (12%), asthenia (18%), ataxia (14%), confusion (15% to 33%), dizziness (46%), drowsiness (17%), hallucination (12%; including auditory hallucination, visual hallucination), headache (13%), memory impairment (7% to 22%), speech disturbance (14%)

Neuromuscular & skeletal: Increased creatine phosphokinase in blood specimen (40%; >3 × ULN: 11%)

Ophthalmic: Blurred vision (12%)

1% to 10%:

Cardiovascular: Atrial fibrillation (<2%), ECG abnormality (<2%), hypotension (≥2%), orthostatic dizziness (≥2%), orthostatic hypotension (≥2%), peripheral edema (≥2%)

Dermatologic: Diaphoresis (5%), pruritus (7%)

Gastrointestinal: Abdominal pain (≥2%), anorexia (6%), constipation (≥2%), decreased appetite (≥2%), dysgeusia (5%), xerostomia (≥2%)

Genitourinary: Dysuria (≥2%), urinary hesitancy (≥2%), urinary retention (9%)

Infection: Sepsis (<2%)

Nervous system: Absent reflexes (≥2%), agitation (≥2%), amnesia (1% to 8%), anxiety (8%), balance impairment (≥2%), burning sensation (≥2%), cerebrovascular accident (<2%), changes in thinking (8%), cognitive dysfunction (≥2%), decreased mental acuity (≥2%), delirium (2%), depression (≥2%), disorientation (≥2%), disturbance in attention (≥2%), dysarthria (7%), falling (≥2%), fatigue (≥2%), hostility (2%), hypoesthesia (≥2%), insomnia (6%), irritability (≥2%), lethargy (≥2%), loss of consciousness (<2%), meningitis (3%), mood disorder (≥2%), myasthenia (≥2%), nervousness (≥2%), paranoid ideation (3%), paresthesia (≥2%), psychosis (1%), rigors (7%), sedated state (≥2%), stupor (2%), suicidal ideation (<2%), tonic-clonic seizure (<2%), tremor (7%), vertigo (7%)

Neuromuscular & skeletal: Limb pain (5%), muscle cramps (≥2%), muscle spasm (6%), myalgia (≥2%), rhabdomyolysis (<2%)

Ophthalmic Diplopia (≥2%), nystagmus disorder (8%), visual disturbance (≥2%)

Renal: Acute kidney injury (<2%)

Respiratory: Respiratory distress (<2%), sinusitis (5%)

Miscellaneous: Fever (5%)

<1%: Nervous system: Manic reaction, suicidal tendencies

Postmarketing:

Cardiovascular: Cardiovascular toxicity (acute) (Heifets 2013)

Dermatologic: Bullous dermatitis, burning skin sensation of skin, dermal ulcers, exfoliation of skin

Hypersensitivity: Hypersensitivity reaction (including angioedema)

Nervous system: Dysesthesia (Grajny 2020)

Neuromuscular & skeletal: Dyskinesia (oro-lingual) (Grajny 2020)

Contraindications

Hypersensitivity to ziconotide or any component of the formulation; history of psychosis; utilization in patients with any other concomitant treatment or medical condition that would render intrathecal administration hazardous (eg, infection at the injection site, uncontrolled bleeding diathesis, spinal canal obstruction that impairs circulation of cerebrospinal fluid).

Warnings/Precautions

Concerns related to adverse effects:

• CNS toxicity: Severe neurological impairment and psychiatric symptoms have been reported. May cause or worsen depression and/or risk of suicide. Cognitive impairment may appear gradually during treatment and is generally reversible after discontinuation (may take up to 2 weeks for cognitive effects to reverse). May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

• Elevated serum creatine kinase: Elevated serum creatine kinase may occur with use; particularly during the first 2 months of therapy.

• Meningitis: May occur with use of intrathecal pumps; monitor for signs of meningitis; treatment of meningitis may require removal of system and discontinuation of intrathecal therapy.

Disease-related concerns:

• Hepatic impairment: Safety and efficacy have not been established in patients with hepatic impairment.

• Renal impairment: Safety and efficacy have not been established in patients with renal impairment.

Special populations:

• Older adult: Use with caution in older adults; may experience a higher incidence of confusion.

• Pediatric: Safety and efficacy have not been established in children.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intrathecal, as acetate [preservative free]:

Prialt: 500 mcg/20 mL (20 mL); 100 mcg/mL (1 mL); 500 mcg/5 mL (5 mL)

Generic Equivalent Available: US

Pricing: US

Solution (Prialt Intrathecal)

100 mcg/mL (per mL): $1,401.50

500 mcg/20 mL (per mL): $332.53

500 mcg/5 mL (per mL): $1,330.11

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Intrathecal: For intrathecal administration only; do not administer IV.

Continuous infusion: Use approved intrathecal drug delivery systems (eg, Medtronic SynchroMed II Infusion System, CADD-Micro ambulatory infusion pump). Refer to product label and delivery system manufacturer's manual for specific instructions and precautions.

Use: Labeled Indications

Chronic pain, severe (intolerant or refractory to other therapies): Management of severe chronic pain in patients requiring intrathecal therapy and who are intolerant or refractory to other therapies (eg, systemic analgesics, adjunctive therapies, intrathecal morphine).

Medication Safety Issues

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (epidural and intrathecal medications) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Adverse events in the presence of maternal toxicity were observed in animal reproduction studies following continuous IV administration of ziconotide in doses greater than the equivalent maximum recommended human dose.

Breastfeeding Considerations

It is not known if ziconotide is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Infants potentially exposed to ziconotide via breast milk should be monitored for sedation, respiratory depression, and/or feeding problems.

Monitoring Parameters

Serum CPK (baseline, every other week for first month, then monthly); psychiatric or neurological impairment, hallucinations, changes in mood or consciousness; suicidality (PACC [Deer 2017b]; manufacturer's labeling).

Mechanism of Action

Ziconotide selectively binds to N-type voltage-sensitive calcium channels located on the nociceptive afferent nerves of the dorsal horn in the spinal cord. This binding is thought to block N-type calcium channels, leading to a blockade of excitatory neurotransmitter release and reducing sensitivity to painful stimuli.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Intrathecal: V_d: ~140 mL

Protein binding: ~50%

Metabolism: Metabolized via endopeptidases and exopeptidases present on multiple organs including kidney, liver, lung; degraded to peptide fragments and free amino acids

Half-life elimination: IV: 1 to 1.6 hours (plasma); Intrathecal: 2.9 to 6.5 hours (CSF)

Excretion: IV: Urine (<1%)

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AT) Austria: Prialt;
(PT) Portugal: Prialt

Deer TR, Hayek SM, Pope JE, et al. The Polyanalgesic Consensus Conference (PACC): recommendations for trialing of intrathecal drug delivery infusion therapy. Neuromodulation. 2017a;20(2):133-154. doi:10.1111/ner.12543 [PubMed 28042906]
Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation. 2017b;20(2):155-176. doi:10.1111/ner.12579 [PubMed 28042914]
Grajny K, Durphy J, Adam O, Azher S, Gupta M, Molho E. Ziconotide-induced oro-lingual dyskinesia: 3 cases. Tremor Other Hyperkinet Mov (N Y). 2020;10:37. doi:10.5334/tohm.431 [PubMed 33101763]
Heifets BD, Smith SM, Leong MS. Acute cardiovascular toxicity of low-dose intrathecal ziconotide. Pain Med. 2013;14(11):1807-1809. doi:10.1111/pme.12196 [PubMed 23855951]
McDowell GC 2nd, Pope JE. Intrathecal ziconotide: dosing and administration strategies in patients with refractory chronic pain. Neuromodulation. 2016;19(5):522-532. [PubMed 26856969]
Mohammed SI, Eldabe S, Simpson KH, et al. Bolus intrathecal injection of ziconotide (Prialt) to evaluate the option of continuous administration via an implanted intrathecal drug delivery (ITDD) system: a pilot study. Neuromodulation. 2013;16(6):576-581. doi:10.1111/ner.12003 [PubMed 23205907]
Pope JE, Deer TR. Intrathecal pharmacology update: novel dosing strategy for intrathecal monotherapy ziconotide on efficacy and sustainability. Neuromodulation. 2015;18(5):414-420. doi:10.1111/ner.12274 [PubMed 25708382]
Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354-372. [PubMed 24446870]
Prialt (ziconotide) [prescribing information]. Deerfield, IL: TerSera Therapeutics LLC; March 2023.

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Ziconotide: Drug information