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Intrathecal ziconotide for refractory chronic pain.
Ann Pharmacother. 2006 Jul-Aug; 40(7-8):1293-300.AP

Abstract

OBJECTIVE

To describe the pharmacology, efficacy, and safety of ziconotide for treatment of severe chronic pain in patients who are candidates for intrathecal therapy.

DATA SOURCES

A PubMed/MEDLINE search (1966-June 2006) was conducted using the terms ziconotide, Prialt, and SNX-111. Manufacturer-provided data, the Food and Drug Administration medical review of ziconotide, and abstracts presented at American Pain Society meetings (2001-2006) were also reviewed.

STUDY SELECTION AND DATA EXTRACTION

Human studies evaluating the efficacy and safety of ziconotide for the treatment of chronic pain were considered. Animal data were excluded.

DATA SYNTHESIS

Ziconotide is the first and only neuronal-type (N-type) calcium-channel blocker. Ziconotide must be administered intrathecally via continuous infusion. A programmable implanted variable-rate microinfusion device, or an external microinfusion device and catheter must be utilized. In double-blind, placebo-controlled studies, ziconotide significantly improved patient perception of pain from baseline to the end of the study periods, which ranged from 11 to 21 days. Patients enrolled in clinical trials were intolerant of or refractory to other treatment modalities. There have been no studies that directly compared ziconotide with other intrathecal or systemic analgesics. Key ziconotide-related adverse events are neuropsychiatric, including depression, cognitive impairment, and hallucinations; depressed levels of consciousness; and elevation of creatine kinase levels. Ziconotide is also associated with a risk of meningitis due to possible contamination of the microinfusion device.

CONCLUSIONS

Ziconotide is a therapeutic option for treatment of severe chronic pain in patients who have exhausted all other agents, including intrathecal morphine, and for whom the potential benefit outweighs the risks of serious neuropsychiatric adverse effects and of having an implanted device. Further studies are needed to determine the comparative efficacy of ziconotide and other pain therapies.

Links

Publisher Full Text

Authors+Show Affiliations

Lynch SS
Department of Clinical Pharmacy, University of California, San Francisco, 94143, USA. lynchs@pharmacy.ucsf.edu
Cheng CM
No affiliation info available
Yee JL
No affiliation info available

MeSH

Analgesics, Non-NarcoticCalcium Channel BlockersClinical Trials as TopicDrug InteractionsHumansInjections, SpinalPain, Intractableomega-Conotoxins

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16849624

Citation

Lynch, Shalini S., et al. "Intrathecal Ziconotide for Refractory Chronic Pain." The Annals of Pharmacotherapy, vol. 40, no. 7-8, 2006, pp. 1293-300.
Lynch SS, Cheng CM, Yee JL. Intrathecal ziconotide for refractory chronic pain. Ann Pharmacother. 2006;40(7-8):1293-300.
Lynch, S. S., Cheng, C. M., & Yee, J. L. (2006). Intrathecal ziconotide for refractory chronic pain. The Annals of Pharmacotherapy, 40(7-8), 1293-300.
Lynch SS, Cheng CM, Yee JL. Intrathecal Ziconotide for Refractory Chronic Pain. Ann Pharmacother. 2006 Jul-Aug;40(7-8):1293-300. PubMed PMID: 16849624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal ziconotide for refractory chronic pain. AU - Lynch,Shalini S, AU - Cheng,Christine M, AU - Yee,Jennie L, Y1 - 2006/07/18/ PY - 2006/7/20/pubmed PY - 2007/2/22/medline PY - 2006/7/20/entrez SP - 1293 EP - 300 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 40 IS - 7-8 N2 - OBJECTIVE: To describe the pharmacology, efficacy, and safety of ziconotide for treatment of severe chronic pain in patients who are candidates for intrathecal therapy. DATA SOURCES: A PubMed/MEDLINE search (1966-June 2006) was conducted using the terms ziconotide, Prialt, and SNX-111. Manufacturer-provided data, the Food and Drug Administration medical review of ziconotide, and abstracts presented at American Pain Society meetings (2001-2006) were also reviewed. STUDY SELECTION AND DATA EXTRACTION: Human studies evaluating the efficacy and safety of ziconotide for the treatment of chronic pain were considered. Animal data were excluded. DATA SYNTHESIS: Ziconotide is the first and only neuronal-type (N-type) calcium-channel blocker. Ziconotide must be administered intrathecally via continuous infusion. A programmable implanted variable-rate microinfusion device, or an external microinfusion device and catheter must be utilized. In double-blind, placebo-controlled studies, ziconotide significantly improved patient perception of pain from baseline to the end of the study periods, which ranged from 11 to 21 days. Patients enrolled in clinical trials were intolerant of or refractory to other treatment modalities. There have been no studies that directly compared ziconotide with other intrathecal or systemic analgesics. Key ziconotide-related adverse events are neuropsychiatric, including depression, cognitive impairment, and hallucinations; depressed levels of consciousness; and elevation of creatine kinase levels. Ziconotide is also associated with a risk of meningitis due to possible contamination of the microinfusion device. CONCLUSIONS: Ziconotide is a therapeutic option for treatment of severe chronic pain in patients who have exhausted all other agents, including intrathecal morphine, and for whom the potential benefit outweighs the risks of serious neuropsychiatric adverse effects and of having an implanted device. Further studies are needed to determine the comparative efficacy of ziconotide and other pain therapies. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/16849624/Intrathecal_ziconotide_for_refractory_chronic_pain_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1G584?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -