Ziconotide (Intrathecal)

As a non-narcotic pain reliever, Ziconotide stops the nerves in the spinal cord from sending pain signals. It effectively reduces discomfort in a number of chronic pain causing conditions including cancer, AIDS, multiple sclerosis and more.


Ziconotide, otherwise known as its brand name Prialt, is a non-narcotic pain reliever that is used to treat severe chronic pain caused by conditions such as AIDS, cancer, and failed back surgery. It is recommended for people who are unable to use standard pain-relieving medications such as morphine, due to a lack of response or an inability to administer them.

Intrathecally administered, it works by stopping the pain signals from the nerves from reaching the brain. Ziconotide tends to be continuously injected into the spinal fluid through the use of a small pump and can be managed at home by the user, but it must be directed and delivered by a doctor.

It is vital that Ziconotide is never injected into a vein or administered in any way other than that of an intrathecal injection through an infusion pump. This is because it will cause a dangerous drop in blood pressure that can result in fainting and other problems that may lead to hospitalization.

Conditions treated

  • Chronic pain with narcotic drug tolerance
  • Severe Pain
  • Chronic pain

Type of medicine

  • Non-narcotic intrathecal therapy

Side effects

Typically, the most common side effects of Ziconotide include dizziness, weakness, nausea, forgetfulness, confusion, and uncontrolled eye movements. As these are common side effects, it is expected for them to lessen once you've had enough time to adjust to the medication. However, if any of the above side effects persist, it's important that you go see a doctor as among other things, your dosage may need adjusting.

Serious side effects are much less common and are unlikely to be experienced by many people when taking this medication. You must tell your doctor immediately if you experience any of the following side effects: unresponsiveness or decreased alertness, confusion and memory problems, mental changes such as anxiety, depression, hallucinations or suicidal thoughts, vision changes and trouble speaking or swallowing.

If you experience new or increased muscle pain or numbness, difficulty in walking or you're finding it hard to urinate and it's dark in color, this could be a sign of uncommon but serious muscle side effects and must be reported to a doctor immediately.

A very serious and rare infection, meningitis, can occur if the area of your infusion or its solution becomes contaminated. Symptoms of this can include extreme drowsiness and confusion, a high fever, severe headache, stiff neck, sickness and seizures.

Symptoms such as a rash, itching and swelling of the face, tongue and throat, severe dizziness, and trouble breathing indicate a severe allergic reaction to Ziconotide. In both, highly rare cases of an allergic reaction or meningitis, it is vital that you seek urgent medical attention immediately and get yourself to a hospital.

This is a comprehensive list of side effects, however, there may be a number of additional side effects to what is listed. If you become concerned for any reason following taking Ziconotide, please contact your doctor or healthcare professional as soon as possible.


Available in the form of a solution, finding the right Ziconotide dosage may take you and your doctor a little while. As it is injected into the spinal fluid using a specially designed pump that is implanted inside your body, your doctor will have full control of your dosage. Factors to change your dosage will include its effectiveness at reducing your pain, as well as how your dose can help to minimize any side effects that you may experience. You may also find that your doctor will slowly increase your dose over time, depending on how you initially respond to Ziconotide.

For adults, the initial Ziconotide dosage is recommended to be no more than 2.4 mcg per day (0.1 mcg per hour). This can be increased to a maximum of 19.2 mcg per day (0.8 mcg per hour) in time. It has been found that by the end of a 21-day clinical study, that the average dose for adults was 6.9 mcg per day (0.29 mcg per hour). It is recommended that doses can be given upward to 2.4 mcg per day (0.1 mcg per hour) two to three times per week, but they should never exceed this.

In regards to elderly patients, the dosage should be a cautious one, to reflect the greater risk of side effects and the decreased hepatic, the renal and cardiac function that is more common with this demographic. There is also a higher chance that they will be taking other drug therapies that may interact with the effectiveness or side effects of Ziconotide.


Before you begin taking Ziconotide, it is important to let your doctor know whether you are taking any other medications. It is best to be as clear and transparent with your doctor as possible, to ensure that your treatment will be the best that is can be and to avoid any unnecessary side effects. Because of this, it's also important to inform your doctor of any vitamins, herbal supplements and anything that could potentially affect the medication.

Ziconotide can cause sleepiness, so if you are taking any other medications that may cause drowsiness, it is important to let your doctor know. This type of medicine can include cold and flu medication, allergy tablets, sleeping pills, sedatives, narcotic pain meds, sleeping pills and muscle relaxers. Medicines for depression, anxiety or seizures can also affect your susceptibility towards drowsiness and tiredness.

Water retention tablets such as furosemide and thiazide diuretics have also been found to interfere with this medicine, so make sure to alert your doctor if you regularly take any.

To make things easier, before starting Ziconotide, keep a list of all the products that you use including non-prescription and herbal products, and share it with your doctor. Check the labels of any cough and cold medications you may need to take too, as many contain drowsiness-inducing ingredients. It is also important to remember never to start, stop or change any dosages of your medication before receiving confirmation from your doctor.


Because Ziconotide can reduce mental awareness, tiredness or unconsciousness, you should avoid any activities that require you to be alert and awake. Driving cars and operating machinery are two examples of activities that should be stopped when taking Ziconotide due to increased risk. Alcohol is not recommended at all when taking this drug, as it will contribute to drowsiness.

It is also important to inform your doctor of any allergies or adverse reactions to medications that you've had in the past before starting Ziconotide to avoid an allergic reaction to the drug. Ziconotide contains inactive ingredients which can give the user allergic reactions to other negative effects.

If you've had any problems such as uncontrolled bleeding, an infection close by to the injection site, or a spinal canal blockage, you should also consult your doctor in case of any negative impact.

For those who suffer from any mental disorders such as depression, anxiety, bipolar or more, please inform your doctor. This drug can cause mental side effects that can exacerbate the above, and it is important to keep track of its effects. Particular caution is advised for the elderly with Ziconotide, as they may be more susceptible to its mental effects, especially confusion.

If you have previously been on any narcotic medication, it is vital to report it to your doctor. This is essential for long-term users. Because Ziconotide is not a narcotic medication, you may experience withdrawal reactions. For those who are on narcotic medication like morphine, your doctor is likely to slowly reduce your dosage before starting you on Ziconotide, to avoid withdrawal symptoms.

As with all medication, it is important to receive approval from your doctor before taking Ziconotide if you are pregnant. Ziconotide has been studied and proved to affect pregnancy, having been assigned to pregnancy category C by the FDA.

In animal studies, embryo lethality was evident, as were large increases in post-implantation loss. Maternal toxicity in these animals has also been reported to lead to reduced fetal weights and temporary, delayed ossification of the pubic bones. Because of this, this medicine should only be given during pregnancy when there are more benefits than risks.

Breastfeeding has also been subject to study, with no available data on the excretion of the drug into human milk. However, due to the potential for severe adverse reactions to Ziconotide in nursing infants, it is recommended that users either discontinue Ziconotide or discontinue nursing, depending on the importance of the drug to the mother's health.


Ziconotide should be kept cold but never frozen. It should be stored in a refrigerator at a temperature of 35°F to 46°F. To protect it from light, it is advised that you keep the vial in the outer carton. If the product is diluted and not transferred to the infusion pump immediately, you should keep it at a temperature of 35°F to 46°F and not keep it for any longer than 24 hours, unless you were able to execute dilution in a controlled and validated aseptic condition.

As with all medication, do not use Ziconotide after the expiry date which is featured on the label, and keep it out of sight and reach of children.

If you notice that your solution has become cloudy or discolored, it is vital that you do not use it and dispose of it immediately.


For long-term, chronic pain sufferers, Ziconotide can offer a reliable and effective solution to pain that is catered to anyone who is unable to take narcotics, oral medication or found that alternate pain-relief methods didn't work. However, due to it being an invasive procedure as compared to oral medication, it poses some greater risks. Common side effects including drowsiness and nausea will make it hard for some people to coordinate normal activities that they may previously have taken part in, and the drug may also have more of an impact on a person's life. However, the benefits can far outweigh the risks in this case. Chronic pain is a debilitating condition that can affect every aspect of a person's life and managing that pain can be incredibly hard. Ziconotide offers a solution that will ease the pain, by blocking pain signals from the patient's spinal nerves to their brain, and the dose can be easily increased or decreased to suit the patient.

The fact that it is mostly controlled by a doctor also reduces any anxiety that many patients have with oral medications or injections. This also means that maintenance of how Ziconotide is administered is higher than with other medications.

With the effective use of Ziconotide, a patient's chronic pain can be alleviated, enabling them to regain control of their life and partake in everyday activities that they may have been completely unable to do before. Some patients may be able to walk and sit upright again, whilst others may find that they are able to focus and concentrate on essential tasks such as reading again.

To achieve the best results from Ziconotide, it is important that your work closely with your doctor and it is to be expected that the most results may take time. Finding the right dosage is likely to be a gradual process, which will need complete transparency and cooperation with your doctor.

Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
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