ziconotide (Rx)

Brand and Other Names:Prialt
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Dosing & Uses

AdultPediatric

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

Next:

Interactions

Interaction Checker

and ziconotide

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     activity indicator 
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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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             activity indicator 

            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 (172)

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

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              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

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              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

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              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.

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              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%)

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              Images

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              Patient Handout

              No Patient Handout Available
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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.