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Ziconotide
Snapshot captured 2026-09-27 — Evidence added or removed
Overview
Ziconotide is a conotoxin-derived peptide studied for pain through N-type calcium-channel modulation. Evidence for a defined clinical preparation and route must be separated from broad conotoxin research and animal experiments.
Evidence quality
WPF’s atlas includes clinical discussion of intrathecal ziconotide in persistent pain, alongside animal pharmacology, conotoxin discovery, and analytical methods. These sources have different evidentiary weight; an animal antinociception result does not establish patient benefit.
Safety concerns
Patient selection, administration setting, neuropsychiatric and other adverse outcomes, and formal indications require primary and official source review.
Citations as of this version
- Functional crosstalk between neuropeptide FF system and N-type voltage-gated calcium channels in ziconotide-mediated antinociception in mice.
- A Chemoenzymatic Approach To Produce a Cyclic Analogue of the Analgesic Drug MVIIA (Ziconotide)
- ID:15841 A Case of Prolonged Psychosis With Intrathecal Ziconotide
- Ziconotide ( ω‐conotoxin MVIIA )—Efficient solid‐phase synthesis of a linear precursor peptide and its strategic native folding
- Efficacy and safety of the Ca<sub>v</sub>2.2 blocker Ziconotide in pain: a meta-analysis and systematic review.
- Recurrent Ziconotide-Associated Delirium and Psychosis: A Case Report.
- A Simple Approach to Assign Disulfide Connectivity for Ziconotide via Partial Reduction Without Alkylation.
- Ziconotide as an Opioid Rescue: Economic, Clinical, and Subgroup Considerations [Letter].
- Ziconotide and pain in multiple sclerosis: a case report
- Scalable Ligand-Receptor Binding Affinity Landscape: A Case Study with Ziconotide and Ca<sub>V</sub>2.2
- Determination of related substances in disulfide-rich peptide ziconotide by establishing tandem mass spectrometry methods.
- Intrathecal Ziconotide Long-Term Management in Chronic Postamputation Pain. (2026)
- Real-Life Data on Ziconotide-Based Intrathecal Therapy in Patients With Cancer Pain: Interim Analysis of the Observational Practice in Clinics Registry. (2026)
- Can Ziconotide Be Used to Replace Opioids? Exploratory Clinical Experience in 5 Patients Treated in the Pain Unit. (2025)
- Dilution of Ziconotide for Intrathecal Trial: The Effect of Dilution on the Incidence of Side Effects and Pain Relief: A Single-center Retrospective Case-control Study. (2025)
- Intrathecal Ziconotide Infusion Therapy for Oncologic Refractory Neuropathic Pain: Case Report With High-Dose Intraventricular Ziconotide After 15 Years of Treatment. (2024)
- Physicochemical Stability Study of the Morphine-Bupivacaine-Ziconotide Association. (2024)
- SPIDOL study protocol for the assessment of intrathecal ziconotide antalgic efficacy for severe refractory neuropathic pain due to spinal cord lesions. (2024)
- Intrathecal ziconotide for the treatment of chronic pain: a collection of clinical experiences and literature review. (2024)
- A comprehensive review on ziconotide. (2024)
- Ziconotide and psychosis: from a case report to a scoping review. (2024)
- A Benefit/Risk Assessment of Intrathecal Ziconotide in Chronic Pain: A Narrative Review. (2024)
- A Chemoenzymatic Approach To Produce a Cyclic Analogue of the Analgesic Drug MVIIA (Ziconotide). (2023)
- Ziconotide for the Management of Cancer Pain: A Budget Impact Analysis. (2023)
- Long-Term Follow-Up (>11 Years) on Successful Pregnancies With Ziconotide Monotherapy for Arachnoiditis-Related Chronic Pain. (2023)
- Physicochemical Stability Study of the Morphine-Ropivacaine-Ziconotide Association in Implantable Pumps for Intrathecal Administration. (2023)
- Microneedle-mediated delivery of Ziconotide-loaded liposomes fused with exosomes for analgesia. (2023)
- Intrathecal Administration of Ziconotide as a Potential Treatment for Chronic Migraines. (2022)
- [What became of Prialt®? : Observational study on the use of ziconotide in the treatment of chronic pain]. (2021)
- Short-Term Outcomes of a High-Volume, Low-Concentration Bolus Starting Dose Technique With Ziconotide: A Case Series. (2021)
- Structure of human Ca<sub>v</sub>2.2 channel blocked by the painkiller ziconotide. (2021)
- Effect of First-Line Ziconotide Intrathecal Drug Therapy for Neuropathic Pain on Disability, Emotional Well-Being, and Pain Catastrophizing. (2021)
- Stability Study of Admixtures Combining Ziconotide With Morphine or Sufentanil in Polypropylene Syringes. (2021)
- Intrathecal pain management with ziconotide: Time for consensus? (2021)
- Effectiveness and Safety of Intrathecal Ziconotide: Final Results of the Patient Registry of Intrathecal Ziconotide Management (PRIZM). (2020)
- Ziconotide-Induced Oro-lingual Dyskinesia: 3 Cases. (2020)
- Ziconotide for Management of Cancer Pain Refractory to Pharmacotherapy: An Update. (2020)
- Study of Physicochemical Stability of Ziconotide in Medication Cassette Reservoir. (2020)
- Intracerebroventricular administration of N-type calcium channel blocker ziconotide displays anticonvulsant, anxiolytic, and sedative effects in rats: A preclinical and pilot study. (2020)
- Antidepressant-like and memory-enhancing effects of the N-type calcium channel blocker ziconotide in rats. (2020)
- Low-Dose Intrathecal Ziconotide for Spasticity From Primary Lateral Sclerosis: A Case Report. (2019)
- Ziconotide for spinal cord injury-related pain. (2019)
- Intrathecal Therapy for Chronic Pain: A Review of Morphine and Ziconotide as Firstline Options. (2019)
- Pain therapeutics from cone snail venoms: From Ziconotide to novel non-opioid pathways. (2019)
- Do the potential benefits outweigh the risks? An update on the use of ziconotide in clinical practice. (2018)
- Effectiveness and Safety of Intrathecal Ziconotide: Interim Analysis of the Patient Registry of Intrathecal Ziconotide Management (PRIZM). (2018)
- Ziconotide-induced psychosis: A case report and literature review. (2018)
- Ziconotide Monotherapy: A Systematic Review of Randomised Controlled Trials. (2017)
- The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain. (2017)
- Use of Low Dose Ziconotide as First-Line Intrathecal Monotherapy. (2017)
- Perioperative Management of a Patient With an Intrathecal Drug Delivery Device Infusing Ziconotide: A Case Report. (2017)
- Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia. (2017)
- Intrathecal Ziconotide: Dosing and Administration Strategies in Patients With Refractory Chronic Pain. (2016)
- Ziconotide intrathecal delivery as treatment for secondary therapeutic failure of motor cortex stimulation after 6 years. (2016)
- Does pain relief influence recovery of consciousness? A case report of a patient treated with ziconotide. (2016)
- Delivery of ziconotide to cerebrospinal fluid via intranasal pathway for the treatment of chronic pain. (2016)
- Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain. (2016)
- Acute rhabdomyolysis in a patient with long-term exposure to intrathecal ziconotide: a case report. (2015)
- Ziconotide Combination Intrathecal Therapy for Noncancer Pain Is Limited Secondary to Delayed Adverse Effects: A Case Series With a 24-Month Follow-Up. (2015)
- Ziconotide Trialing by Intrathecal Bolus Injections: An Open-Label Non-Randomized Clinical Trial in Postoperative/Posttraumatic Neuropathic Pain Patients Refractory to Conventional Treatment. (2015)
- Ziconotide-induced psychosis: a case report. (2015)
- Intrathecal Ziconotide and Morphine for Pain Relief: A Case Series of Eight Patients with Refractory Cancer Pain, Including Five Cases of Neuropathic Pain. (2015)
- Dual Effect of Ziconotide in Primary Erythromelalgia. (2015)
- Influence of pH and temperature on ziconotide stability in intrathecal analgesic admixtures in implantable pumps and syringes. (2015)
- Tailored delivery of analgesic ziconotide across a blood brain barrier model using viral nanocontainers. (2015)
- Intrathecal Pharmacology Update: Novel Dosing Strategy for Intrathecal Monotherapy Ziconotide on Efficacy and Sustainability. (2015)
- Rationale for Prospective Assays of Intrathecal Mixtures Including Morphine, Ropivacaine and Ziconotide: Prevention of Adverse Events and Feasibility in Clinical Practice. (2015)
- The Relationship Between the Mechanisms of Action and Safety Profiles of Intrathecal Morphine and Ziconotide: A Review of the Literature. (2015)
- Aseptic arachnoiditis in a patient treated with intrathecal morphine infusion: symptom resolution on switch to ziconotide. (2015)
- Dyskinesia caused by ziconotide-baclofen combination in an adolescent affected by cerebral palsy. (2014)
- In vitro stability of low-concentration ziconotide alone or in admixtures in intrathecal pumps. (2014)
- Spinal morphine but not ziconotide or gabapentin analgesia is affected by alternative splicing of voltage-gated calcium channel CaV2.2 pre-mRNA. (2013)
- Ziconotide: a clinical update and pharmacologic review. (2013)
- Bolus intrathecal injection of ziconotide (Prialt®) to evaluate the option of continuous administration via an implanted intrathecal drug delivery (ITDD) system: a pilot study. (2013)
- Acute cardiovascular toxicity of low-dose intrathecal ziconotide. (2013)
- Intrathecal ziconotide: a review of its use in patients with chronic pain refractory to other systemic or intrathecal analgesics. (2013)
- Administering ziconotide and monitoring patients treated with ziconotide: expert opinions. (2013)
- Intrathecal combination of ziconotide and morphine for refractory cancer pain: a rapidly acting and effective choice. (2012)
- Ziconotide adverse events in patients with cancer pain: a multicenter observational study of a slow titration, multidrug protocol. (2012)
- Pharmacokinetic analysis of ziconotide (SNX-111), an intrathecal N-type calcium channel blocking analgesic, delivered by bolus and infusion in the dog. (2012)
- Trigeminal neuralgia relief with intrathecal ziconotide. (2011)
- Increased risk of suicide under intrathecal ziconotide treatment? - a warning. (2011)
- Italian registry on long-term intrathecal ziconotide treatment. (2011)
- Psychiatric predisposition to autonomic and abnormal perception side-effects of ziconotide: a case series study. (2011)
- [Experience in treatment of patients with neuropathic facial pain using ziconotide]. (2011)
- Can ziconotide as a N-type voltage-sensitive calcium channel blocker open a new mode for treatment of autism? A hypothesis. (2011)
- Ziconotide: A rapid detoxification protocol for the conversion from intrathecal morphine--the Raffaeli Detoxification Model. (2011)
- [Neuropsychiatric side effects of intrathecal ziconotide]. (2011)
- Ziconotide combination intrathecal therapy: rationale and evidence. (2010)
- Ziconotide for treatment of severe chronic pain. (2010)
- CNSB004 (Leconotide) causes antihyperalgesia without side effects when given intravenously: a comparison with ziconotide in a rat model of diabetic neuropathic pain. (2010)
- Considerations and methodology for trialing ziconotide. (2010)
- [Recommendations for the management of chronic pain by intrathecal ziconotide]. (2010)
- Case report: successful treatment of a patient with trigeminal neuropathy using ziconotide. (2010)
- Intrathecal ziconotide and opioid combination therapy for noncancer pain: an observational study. (2009)
- Intrathecal ziconotide for complex regional pain syndrome: seven case reports. (2009)
- Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain. (2009)
- Long-term intrathecal ziconotide for chronic pain: an open-label study. (2009)
- Intrathecal therapy: what has changed with the introduction of ziconotide. (2009)
- Intrathecal ziconotide for neuropathic pain: a review. (2009)
- Cost-effectiveness of ziconotide in intrathecal pain management for severe chronic pain patients in the UK. (2009)
- Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports. (2009)
- Dilution and compounding of ziconotide for intrathecal administration. (2008)
- Intrathecal therapy with ziconotide: clinical experience and considerations on its use. (2008)
- Intrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial. (2008)
- Continuous Intrathecal Infusion of Ziconotide for Treatment of Chronic Malignant and Nonmalignant Pain Over 12 Months: A Prospective, Open-label Study. (2008)
- Using ziconotide for intrathecal infusions. (2008)
- Open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of morphine in patients receiving ziconotide for severe chronic pain. (2008)
- Ziconotide: an update and review. (2008)
- Phase II, open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of ziconotide in patients receiving intrathecal morphine for severe chronic pain. (2008)
- Statistical evaluation of the chemical stability of ziconotide solutions during simulated intrathecal administration. (2008)
- Chemical stability of ziconotide-clonidine hydrochloride admixtures with and without morphine sulfate during simulated intrathecal administration. (2007)
- [Ziconotide: an innovative alternative for intense chronic neuropathic pain]. (2007)
- Nonclinical safety of ziconotide: an intrathecal analgesic of a new pharmaceutical class. (2007)
- Successful reduction of neuropathic pain associated with spinal cord injury via of a combination of intrathecal hydromorphone and ziconotide: a case report. (2007)
- Ziconotide: a review of its pharmacology and use in the treatment of pain. (2007)
- Ziconotide. (2006)
- Treatment challenges and complications with ziconotide monotherapy in established pump patients. (2006)
- [New medications; ziconotide]. (2006)
- Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain. (2006)
- Ziconotide: a new nonopioid intrathecal analgesic for the treatment of chronic pain. (2006)
- Intrathecal ziconotide for refractory chronic pain. (2006)
- Ziconotide--a novel neuron-specific calcium channel blocker for the intrathecal treatment of severe chronic pain--a short review. (2006)
- An effective treatment of severe complex regional pain syndrome type 1 in a child using high doses of intrathecal ziconotide. (2006)
- A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. (2006)
- Intrathecal ziconotide in the treatment of chronic nonmalignant pain: a randomized, double-blind, placebo-controlled clinical trial. (2006)
- Ziconotide: a new option for refractory pain. (2006)
- New drugs: tigecycline, ziconotide, and clofarabine. (2005)
- Ziconotide (Prialt) for chronic pain. (2005)
- Ziconotide, an intrathecally administered N-type calcium channel antagonist for the treatment of chronic pain. (2005)
- Elan: ziconotide review focused on off-label uses. (2005)
- Ziconotide: can we use it in palliative care? (2005)
- Ziconotide: neuronal calcium channel blocker for treating severe chronic pain. (2004)
- Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. (2004)
- Intrathecal ziconotide for refractory pain. (2004)
- Intrathecal ziconotide for chronic pain. (2004)
- Pharmacokinetics and pharmacodynamics of intrathecal ziconotide in chronic pain patients. (2003)
- Intractable delirium associated with ziconotide successfully treated with electroconvulsive therapy. (2002)
- Long-term intrathecal ziconotide therapy: a case study and discussion. (2001)
- Ziconotide (Elan Pharmaceuticals). (2001)
- Bioavailability of Ziconotide in brain: influx from blood, stability, and diffusion. (2000)
- Adverse effects associated with the intrathecal administration of ziconotide. (2000)
- An evaluation of intrathecal ziconotide for the treatment of chronic pain. (2000)
- Improvement in mitochondrial dysfunction as a new surrogate efficiency measure for preclinical trials: dose-response and time-window profiles for administration of the calcium channel blocker Ziconotide in experimental brain injury. (2000)
- Neurobehavioral protection by the neuronal calcium channel blocker ziconotide in a model of traumatic diffuse brain injury in rats. (2000)
- Effects of intrathecal administration of ziconotide, a selective neuronal N-type calcium channel blocker, on mechanical allodynia and heat hyperalgesia in a rat model of postoperative pain. (2000)
- Ziconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain. (2000)
- Interactions of intrathecally administered ziconotide, a selective blocker of neuronal N-type voltage-sensitive calcium channels, with morphine on nociception in rats. (2000)
- Ziconotide for the treatment of severe spasticity after spinal cord injury. (2000)
- Ziconotide. CI 1009, SNX 111. (1999)
- USAN Council. List No.421. New names. Ziconotide. (1999)
- The neuroprotective effects of intrathecal administration of the selective N-type calcium channel blocker ziconotide in a rat model of spinal ischemia. (1999)
- Effects of an N-type calcium channel antagonist (SNX 111; Ziconotide) on calcium-45 accumulation following fluid-percussion injury. (1999)
Regulatory status as of this version
- European Union — EMA: approved — Ziconotide (Prialt) is indicated for the treatment of severe, chronic pain in patients who require intrathecal (IT) analgesia.
- United States — FDA: approved — PRIALT (ziconotide intrathecal infusion) is indicated for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted, and who are intolerant of or refractory to other treatment, such as systemic analgesics, adjunctive therapies, or IT morphine. Labeled pediatric use: safety and effectiveness in pediatric patients have not been established.
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