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 (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.
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
Formulary
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.
