Ziconotide (Prialt)
Overview
A synthetic 25-amino acid peptide identical to omega-conotoxin MVIIA, a neurotoxin found in the venom of the marine cone snail Conus magus. Ziconotide selectively and reversibly blocks N-type voltage-gated calcium channels (Cav2.2) in the dorsal horn of the spinal cord, inhibiting neurotransmitter release from primary afferent nociceptive neurons. It provides analgesia without opioid receptor activation, tolerance development, or respiratory depression.
Key Research Findings
FDA-approved in 2004 for severe chronic pain in patients refractory to or intolerant of systemic analgesics, adjunctive therapies, or intrathecal morphine. Requires intrathecal administration via implanted infusion pump. Clinical trials demonstrated significant pain reduction in patients with cancer pain and non-malignant pain syndromes. Narrow therapeutic index with dose-limiting neuropsychiatric side effects (cognitive impairment, hallucinations, psychosis) requires careful titration.
Intrathecal infusion
FDA Approved
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