• Ziconotide is not an opioid and cannot prevent or relieve symptoms of opioid withdrawal. Do not discontinue opioids abruptly. For withdrawal from IT opioid, gradually taper opioid IT infusion over several weeks, and replace with an equianalgesic dose of oral opioids. Ziconotide does not potentiate opioid-induced respiratory depression.

» Ziconotide should be administered under the direction of a physician experienced in IT therapy. Do not administer IV.

• IT: IT dose is delivered using a programmable implanted variable-rate microinfusion device or an external microinfusion device and catheter. Ziconotide may be administered undiluted (25 mcg/mL in 20-mL vial) or diluted (100 mg/mL in 1-, 2-, or 5-mL vials). Dilute with 0.9% NaCl (preservative—free) using aseptic technique. 100 mg/mL formulation may be administered undiluted once an appropriate dose is established. Refrigerate, but do not freeze, after preparation; administer within 24 hr. Discard solution if discolored or containing particulate matter or any unused portion in vial. Pump refills should be done every 40 days if diluted solution is used or every 60 days if solution is undiluted. Pump should be rinsed and filled according to manufacturer's directions.

• Rate: Dose should be adjusted according to patient's severity of pain, response to therapy, and occurrence of side effects.