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Ziconotide

moderate risk

Also: Prialt · SNX-111 · Conotoxin MVIIA

Strong Evidence FDA Approved

Ziconotide (Prialt) is an FDA-approved omega-conotoxin peptide derived from cone snail venom for severe chronic pain requiring intrathecal delivery. It is the only approved non-opioid intrathecal analgesic. Blocks N-type voltage-gated calcium channels in the spinal cord dorsal horn.

Molecular Weight
2639.1 Da
Formula
C102H172N36O32S7
Common Dosing
Intrathecal infusion: 0.1–0.8 mcg/hr via implanted pump (titrated slowly)
Category
therapeutic
Last Reviewed
2025-01-15

Reported Benefits

Severe chronic pain

Strong Evidence 67 studies

FDA-approved; Phase III trials demonstrate significant pain reduction vs. placebo in refractory pain states.

Mechanism of Action

Selective blocker of N-type (Cav2.2) voltage-gated calcium channels; inhibits nociceptive neurotransmitter release in spinal cord dorsal horn without opioid receptor involvement.

Key Clinical Studies

Staats et al. (2004)

Phase III RCT · n=220

PubMed →

Significant pain reduction vs. placebo in refractory pain; FDA approved 2004

Conotoxin: Cone Snail Venom Origin

Ziconotide is derived from Conus magus, a predatory marine cone snail. Cone snail venoms are a rich source of novel channel-blocking peptides. Ziconotide’s approval validates the cone snail venom class as a drug source.

Narrow Therapeutic Index

The dose-response curve is steep and side effects at higher doses are significant (psychiatric effects, cognitive impairment). Slow titration is mandatory. This limits its clinical use to experienced pain management specialists.

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Nava Health

Regulatory Status

FDA Approved

FDA approved as Prialt (intrathecal use only)

Safety Profile

Side Effects

  • •Dizziness
  • •Nausea
  • •Confusion
  • •Psychiatric effects
  • •Meningitis (catheter-related)
  • •Narrow therapeutic index

Contraindications

  • •Infection at pump site
  • •Psychosis/depression history
  • •Intrathecal opioids (safety uncertain)

Drug Interactions

  • •Opioids (caution)
  • •Antiepileptics

Primary Uses

Severe chronic painIntrathecal analgesiaRefractory pain

Related Peptides

SpadinVasoactive Intestinal Peptide

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Disclaimer: This information is for educational and research purposes only. Not medical advice. Consult a qualified healthcare provider before using any compound.