Dosing & Uses
Dosage Forms & Strengths
intrathecal injection
- 25mcg/mL
- 100mcg/mL
Chronic Pain
2.4 mcg/day intrathecal (IT), (0.1 mcg/hour)
Titrate up by 2.4 mcg/day at intervals 2-3 times per week or less if necessary; no more than 19.2 mcg/day (0.8 mcg/hour) by Day 21
Administration
Use in only the Medtronic SynchroMed® EL or SynchroMed® II Infusion System or Simms Deltec Micro® External Microinfusion Device & Catheter
Medtronic Devices: Only the 25 mcg/mL undiluted solution is used for naive pump priming & initial pump fill
Simms Deltec Device: use 5 mcg/mL Prialt diluted in NS
See manufacturer's package inserts for details
Monitor
Cognitive functions, mood alterations
Safety/efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (5)
- calcium/magnesium/potassium/sodium oxybates
calcium/magnesium/potassium/sodium oxybates, ziconotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- metoclopramide intranasal
ziconotide, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- olopatadine intranasal
ziconotide and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b and ziconotide both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.
- sodium oxybate
sodium oxybate, ziconotide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
Monitor Closely (187)
- acrivastine
acrivastine and ziconotide both increase sedation. Use Caution/Monitor.
- albuterol
ziconotide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and ziconotide both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and ziconotide both increase sedation. Use Caution/Monitor.
- amitriptyline
amitriptyline and ziconotide both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and ziconotide both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and ziconotide both increase sedation. Use Caution/Monitor.
- apomorphine
apomorphine and ziconotide both increase sedation. Use Caution/Monitor.
- arformoterol
ziconotide increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
aripiprazole and ziconotide both increase sedation. Use Caution/Monitor.
- armodafinil
ziconotide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and ziconotide both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and ziconotide both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and ziconotide both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and ziconotide both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and ziconotide both increase sedation. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and ziconotide both increase sedation. Use Caution/Monitor.
- benperidol
benperidol and ziconotide both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and ziconotide both increase sedation. Use Caution/Monitor.
- benzphetamine
ziconotide increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, ziconotide. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and ziconotide both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and ziconotide both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and ziconotide both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and ziconotide both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and ziconotide both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and ziconotide both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
buprenorphine subdermal implant and ziconotide both increase sedation. Use Caution/Monitor.
- buprenorphine transdermal
buprenorphine transdermal and ziconotide both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and ziconotide both increase sedation. Use Caution/Monitor.
- butabarbital
butabarbital and ziconotide both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and ziconotide both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and ziconotide both increase sedation. Use Caution/Monitor.
- caffeine
ziconotide increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and ziconotide both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and ziconotide both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, ziconotide. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and ziconotide both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and ziconotide both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and ziconotide both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and ziconotide both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and ziconotide both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and ziconotide both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and ziconotide both increase sedation. Use Caution/Monitor.
- clobazam
ziconotide, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
clomipramine and ziconotide both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and ziconotide both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and ziconotide both increase sedation. Use Caution/Monitor.
- clozapine
clozapine and ziconotide both increase sedation. Use Caution/Monitor.
- codeine
codeine and ziconotide both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and ziconotide both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and ziconotide both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and ziconotide both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and ziconotide both increase sedation. Use Caution/Monitor.
- daridorexant
ziconotide and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desipramine
desipramine and ziconotide both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and ziconotide both increase sedation. Use Caution/Monitor.
- dexfenfluramine
ziconotide increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and ziconotide both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
ziconotide increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
ziconotide increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
dextromoramide and ziconotide both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and ziconotide both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and ziconotide both increase sedation. Use Caution/Monitor.
- diethylpropion
ziconotide increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and ziconotide both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and ziconotide both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and ziconotide both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and ziconotide both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and ziconotide both increase sedation. Use Caution/Monitor.
- dobutamine
ziconotide increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
ziconotide increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
ziconotide increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
doxepin and ziconotide both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and ziconotide both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and ziconotide both increase sedation. Use Caution/Monitor.
- ephedrine
ziconotide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
ziconotide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
ziconotide increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, ziconotide. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and ziconotide both increase sedation. Use Caution/Monitor.
- ethanol
ethanol and ziconotide both increase sedation. Use Caution/Monitor.
- fenfluramine
ziconotide increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fentanyl
fentanyl and ziconotide both increase sedation. Use Caution/Monitor.
- fentanyl intranasal
fentanyl intranasal and ziconotide both increase sedation. Use Caution/Monitor.
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and ziconotide both increase sedation. Use Caution/Monitor.
- fentanyl transdermal
fentanyl transdermal and ziconotide both increase sedation. Use Caution/Monitor.
- fluphenazine
fluphenazine and ziconotide both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and ziconotide both increase sedation. Use Caution/Monitor.
- formoterol
ziconotide increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ganaxolone
ziconotide and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
haloperidol and ziconotide both increase sedation. Use Caution/Monitor.
- hydromorphone
hydromorphone and ziconotide both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and ziconotide both increase sedation. Use Caution/Monitor.
- iloperidone
iloperidone and ziconotide both increase sedation. Use Caution/Monitor.
- imipramine
imipramine and ziconotide both increase sedation. Use Caution/Monitor.
- isoproterenol
ziconotide increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and ziconotide both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
ketotifen, ophthalmic and ziconotide both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, ziconotide. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant will increase the level or effect of ziconotide by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
ziconotide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
levorphanol and ziconotide both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
ziconotide increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
lofepramine and ziconotide both increase sedation. Use Caution/Monitor.
- lofexidine
lofexidine and ziconotide both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and ziconotide both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and ziconotide both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and ziconotide both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and ziconotide both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and ziconotide both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, ziconotide. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
maprotiline and ziconotide both increase sedation. Use Caution/Monitor.
- marijuana
marijuana and ziconotide both increase sedation. Use Caution/Monitor.
- melatonin
melatonin and ziconotide both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and ziconotide both increase sedation. Use Caution/Monitor.
- meprobamate
meprobamate and ziconotide both increase sedation. Use Caution/Monitor.
- metaproterenol
ziconotide increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and ziconotide both increase sedation. Use Caution/Monitor.
- methadone
methadone and ziconotide both increase sedation. Use Caution/Monitor.
- methamphetamine
ziconotide increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and ziconotide both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
ziconotide increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and ziconotide both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, ziconotide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
ziconotide increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
mirtazapine and ziconotide both increase sedation. Use Caution/Monitor.
- modafinil
ziconotide increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and ziconotide both increase sedation. Use Caution/Monitor.
- motherwort
motherwort and ziconotide both increase sedation. Use Caution/Monitor.
- moxonidine
moxonidine and ziconotide both increase sedation. Use Caution/Monitor.
- nabilone
nabilone and ziconotide both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and ziconotide both increase sedation. Use Caution/Monitor.
- norepinephrine
ziconotide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
nortriptyline and ziconotide both increase sedation. Use Caution/Monitor.
- olanzapine
olanzapine and ziconotide both increase sedation. Use Caution/Monitor.
- opium tincture
opium tincture and ziconotide both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and ziconotide both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and ziconotide both increase sedation. Use Caution/Monitor.
- oxycodone
oxycodone and ziconotide both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and ziconotide both increase sedation. Use Caution/Monitor.
- paliperidone
paliperidone and ziconotide both increase sedation. Use Caution/Monitor.
- papaveretum
papaveretum and ziconotide both increase sedation. Use Caution/Monitor.
- papaverine
papaverine and ziconotide both increase sedation. Use Caution/Monitor.
- pentazocine
pentazocine and ziconotide both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and ziconotide both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and ziconotide both increase sedation. Use Caution/Monitor.
- phendimetrazine
ziconotide increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and ziconotide both increase sedation. Use Caution/Monitor.
- phentermine
ziconotide increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
ziconotide increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
ziconotide increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
pholcodine and ziconotide both increase sedation. Use Caution/Monitor.
- pimozide
pimozide and ziconotide both increase sedation. Use Caution/Monitor.
- pirbuterol
ziconotide increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- primidone
primidone and ziconotide both increase sedation. Use Caution/Monitor.
- prochlorperazine
prochlorperazine and ziconotide both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and ziconotide both increase sedation. Use Caution/Monitor.
- propofol
propofol and ziconotide both increase sedation. Use Caution/Monitor.
- propylhexedrine
ziconotide increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
protriptyline and ziconotide both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and ziconotide both increase sedation. Use Caution/Monitor.
- quetiapine
quetiapine and ziconotide both increase sedation. Use Caution/Monitor.
- ramelteon
ramelteon and ziconotide both increase sedation. Use Caution/Monitor.
- risperidone
risperidone and ziconotide both increase sedation. Use Caution/Monitor.
- salmeterol
ziconotide increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
scullcap and ziconotide both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and ziconotide both increase sedation. Use Caution/Monitor.
- sevoflurane
sevoflurane and ziconotide both increase sedation. Use Caution/Monitor.
- shepherd's purse
shepherd's purse and ziconotide both increase sedation. Use Caution/Monitor.
- sufentanil
sufentanil and ziconotide both increase sedation. Use Caution/Monitor.
- tapentadol
tapentadol and ziconotide both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and ziconotide both increase sedation. Use Caution/Monitor.
- terbutaline
ziconotide increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
thioridazine and ziconotide both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and ziconotide both increase sedation. Use Caution/Monitor.
- topiramate
topiramate and ziconotide both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and ziconotide both increase sedation. Use Caution/Monitor.
- trazodone
trazodone and ziconotide both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and ziconotide both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and ziconotide both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and ziconotide both increase sedation. Use Caution/Monitor.
- trimipramine
trimipramine and ziconotide both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and ziconotide both increase sedation. Use Caution/Monitor.
- xylometazoline
ziconotide increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
ziconotide increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone and ziconotide both increase sedation. Use Caution/Monitor.
Minor (28)
- alfentanil
ziconotide, alfentanil. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- belladonna and opium
ziconotide, belladonna and opium. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- buprenorphine
ziconotide, buprenorphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- buprenorphine buccal
ziconotide, buprenorphine buccal. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- butorphanol
ziconotide, butorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- codeine
ziconotide, codeine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- dextromoramide
ziconotide, dextromoramide. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- diamorphine
ziconotide, diamorphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- difenoxin hcl
ziconotide, difenoxin hcl. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- diphenoxylate hcl
ziconotide, diphenoxylate hcl. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- dipipanone
ziconotide, dipipanone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- eucalyptus
eucalyptus and ziconotide both increase sedation. Minor/Significance Unknown.
- hydrocodone
ziconotide, hydrocodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- hydromorphone
ziconotide, hydromorphone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- levorphanol
ziconotide, levorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- meperidine
ziconotide, meperidine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- methadone
ziconotide, methadone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- morphine
ziconotide, morphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- nalbuphine
ziconotide, nalbuphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- opium tincture
ziconotide, opium tincture. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- oxycodone
ziconotide, oxycodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- oxymorphone
ziconotide, oxymorphone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- papaveretum
ziconotide, papaveretum. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- pentazocine
ziconotide, pentazocine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- sage
sage and ziconotide both increase sedation. Minor/Significance Unknown.
- sufentanil
ziconotide, sufentanil. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- tapentadol
ziconotide, tapentadol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
- tramadol
ziconotide, tramadol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Abnormal gait (14%)
Abnormal vision (12%)
Anorexia (10%)
Asthenia (22%)
Ataxia (14%)
Confusion (15%)
Diarrhea (18%)
Headache (13%)
Hypertonia (11%)
Memory impairment (12%)
Nausea (40%)
Somnolence (17%)
Vomiting (16%)
Frequency Not Defined
Anxiety
Aphasia
Dysesthesia
Fever
Hallucinations
Nervousness
Nystagmus
Paresthesia
Speech disorder
Vertigo
Warnings
Black Box Warnings
Severe psychiatric symptoms and neurologic impairment may occur during treatment with ziconotide. Patients with a preexisting history of psychosis should not be treated with ziconotide.
All patients should be monitored frequently for evidence of cognitive impairment, hallucinations, or changes in mood or consciousness. Ziconotide therapy can be interrupted or discontinued abruptly without evidence of withdrawal effects in the event of serious neurologic or psychiatric signs or symptoms.
Contraindications
Hypersensitivity
History of psychosis
IV administration
IT administration to patients with uncontrolled bleeding, infection at the injection site, spinal obstruction that impairs CSF circulation
Cautions
IT administration only
Possibility of severe psychiatric & neurological complications
- Risk of severe or worsening depression w/ suicide risk in susceptible pts
- Monitor for cognitive impairment, hallucinations & mood swings
- Can be interrupted or discontinued abruptly without withdrawal effects
Possibility of meningitis & other infections
Levels of serum creatinine kinase may increase
Pregnancy, lactation
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Excretion into breast milk unknown; discontinue drug or do not nurse
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Putative calcium channel blocker, synthetic conopeptide; binds to N-type voltage sensitive calcium channels located in nociceptive afferent nerves of the dorsal horn in the spinal cord
Not an opioid and does not bind to opioid receptors
Distribution
Protein Bound: 50%
Vd: 140 mL
Metabolism
Metabolism: by peptidases outside of CSF
Metabolites: small peptides/amino acids
Elimination
Half-life: 1-1.6hr in plasma (IV); 2.9-6.5hr in CSF (IT)
Excretion: Urine (<1%)
Images
Patient Handout
ziconotide intrathecal
ZICONOTIDE - INJECTION
(zye-KON-oh-tide)
COMMON BRAND NAME(S): Prialt
WARNING: Severe mental/mood changes (such as confusion, depression, hallucinations, decreased alertness) may occur in some patients. This medication should not be used if you have a history of certain mental disorders (such as psychosis) because it increases the risk of those side effects.
USES: This medication is a non-opioid pain reliever that is used to treat ongoing pain when other treatments or medications cannot control your pain. Ziconotide works by blocking the nerves in the spinal cord that send pain signals. It decreases ongoing pain caused by cancer, AIDS, failed back surgery, multiple sclerosis, neuropathy, and other causes.
HOW TO USE: Read the instruction manual and directions that come with your infusion pump. If you have any questions, ask your doctor or pharmacist.This medication is given by injection as directed by your doctor, usually continuously into the spinal fluid (intrathecal) using a small pump. To decrease the risk of side effects, treatment is usually started slowly and then gradually increased to the best dose for you. The dosage is based on your medical condition and response to treatment.This medication should not be given into a vein (IV) or under the skin. It can cause fainting due to a dangerous drop in blood pressure if it is accidentally given into a vein.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.To prevent infection, learn how to handle the infusion pump, and learn proper care of the injection site. Call your doctor right away if there is any sign of infection around the injection site (such as swelling, redness, tenderness).Contact your doctor or pharmacist to set up a schedule for refilling your pump.Inform your doctor if your pain lasts or gets worse.
SIDE EFFECTS: See also How to Use section.Dizziness, drowsiness, nausea, headache, and weakness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: decreased alertness (unresponsiveness), memory problems, mental/mood changes (such as agitation, depression, hallucinations, thoughts of suicide), new or worsening muscle pain/soreness, numbness/tingling, trouble speaking/swallowing, difficult/unsteady walking, trouble urinating, dark urine, vision changes.A very serious infection (meningitis) may occur if the site of your infusion or the solution going into your spinal cord becomes contaminated. Get medical help right away if you have any symptoms of meningitis, including confusion, high fever, seizures, severe headache, stiff/painful neck, vomiting.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also Warning section.Before using ziconotide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: mental/mood disorders (such as depression, psychosis, thoughts of suicide).This medication is not an opioid (morphine-like drug). If you have been using an opioid (such as codeine, hydrocodone, morphine) regularly for more than a few weeks, or if it has been used in high doses, you may be dependent on it. In such cases, if you suddenly stop the opioid, withdrawal reactions may occur. This medication will not prevent withdrawal reactions from opioids. When stopping extended, regular treatment with opioids, gradually reducing the dosage as directed will help prevent withdrawal reactions. Consult your doctor or pharmacist for more details.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially confusion.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Tell your doctor or pharmacist if you are using other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as CK levels) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If your dose is interrupted or stopped, contact your doctor right away to establish a new dosing schedule.
STORAGE: Store in the refrigerator away from light. Do not freeze. After being mixed with saline, it may be refrigerated for up to 24 hours. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised June 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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