Ziconotide: a new option for intrathecal analgesia

Abstract

Ziconotide is the synthetic equivalent of a neuroactive peptide found in the venom of the fish-hunting marine snail Conus magus. Its analgesic effect is mediated by a blockade of the N-type calcium channel in the dorsal horn of the spinal cord. The drug is currently licensed for continuous intrathecal infusion in the treatment of chronic intractable pain, and its analgesic efficacy has been demonstrated in both animal and human studies. Ziconotide-induced analgesia is not associated with the development of tolerance, respiratory depression or endocrine side effects, as is common in opioids. Ziconotide is a potent analgesic with a narrow therapeutic window. A low starting dose with slow upward titration, while monitoring the patient, is the recommended strategy for avoiding the more serious side effects, such as delirium, acute psychotic reactions, suicidal ideation and coma.

Keywords: :

• analgesic
• chronic pain
• intrathecal therapy
• nonopioid
• ziconotide