Ziconotide

Products

Ziconotide is commercially available as an infusion solution (Prialt). It has been approved in many countries since 2006.

Structure and properties

Ziconotide (C102H172N36O32S7, Mr = 2639 g/mol) is a peptide of 25 amino acids with three disulfide bridges. It is a synthetic analog of the ω-conopeptide MVIIA, which occurs in the venom of the marine cone snail. In pharmaceuticals, it is present as ziconotide acetate, a hydrophilic molecule that is highly soluble in water.

Effects

Ziconotide (ATC N02BG08) has analgesic properties. It binds to N-type calcium channels in afferent nerves, inhibiting the influx of calcium. This inhibits the release of neurotransmitters such as substance P and signal conduction of pain in the spinal cord.

Indications

As a second-line agent for the treatment of severe chronic pain.

Dosage

According to the SmPC. The solution is administered as a continuous infusion through an intrathecal catheter using a mechanical infusion pump.

Contraindications

  • Hypersensitivity
  • Combination with intrathecal chemotherapy

For complete precautions, see the drug label.

Interactions

Interactions have been described with chemotherapeutic agents, opioids, and central depressant drugs.

Adverse effects

The most common potential adverse effects include dizziness, nystagmus, memory impairment, headache, drowsiness, gait abnormalities, weakness, blurred vision, confusion, nausea, and vomiting.