Ziconotide
moderate riskAlso: Prialt · SNX-111 · Conotoxin MVIIA
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.
Reported Benefits
Severe chronic pain
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
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.
Regulatory Status
FDA ApprovedFDA 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
Weekly Briefing
Regulatory updates + new study breakdowns.
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