Ziconotide medication belong to Analgesic class. Ziconotide undetermined; however, animal data indicate that ziconotide blocks N-type calcium channels by binding to them, which leads to blockade of excitatory neurotransmitter release in primary afferent nerve terminals and antinociception.

How to Take Ziconotide

Take Ziconotide exactly as prescribed by health care provider. Ziconotide is generally available in market in the form Blisters of powder for oral inhalation 5 mg. For intrathecal (IT) administration only using programmable implanted variable-rate microinfusion device or an external microinfusion device and catheter. Not for intradermal, subcutaneous, IM, IV, intra-arterial, or oral administration. Saline solutions containing preservatives are not appropriate for IT drug administration and should not be used. Initial dose is 2.4 mcg/day (0.1 mcg/hr). Dose is adjusted upward by up to 2.4 mcg/day (0.1 mcg/hr) at intervals of no more than 2 to 3 times/wk, based on patient's severity of pain, response to therapy, and occurrence of adverse effects. Dose increases in increments of less than 2.4 mcg/day (0.1 mcg/hr) and increases in dose less frequently than 2 to 3 times/wk may be used. Recommended max dose is 19.2 mcg/day (0.8 mcg/hr).

Dosage Instructions for Ziconotide Drug

Management of severe chronic pain in patients for whom intrathecal therapy is warranted, and who are intolerant of or refractory to other treatment. Preexisting history of psychosis; infection at the microinfusion injection site, uncontrolled bleeding diathesis, spinal canal obstruction that impairs circulation of CSF, hypersensitivity to any component of the product.

Interactions of Ziconotide with other drugs

Alcohol, other CNS depressants: Additive or potentiation of CNS depressant effects.

Cimetidine: May elevate Ziconotide plasma levels, increasing the therapeutic and adverse effects.

Rifampin: May reduce Ziconotide plasma levels, reducing the effectiveness.

What are the Side Effects of Ziconotide -

Like other medicines, Ziconotide can cause side effects. Some of the more common side effects of Ziconotide include

* Hypertension, hypotension, postural hypotension, syncope, tachycardia, vasodilation (at least 2%); atrial fibrillation (less than 2%).

* Dizziness (47%); confusion (33%); asthenia, memory impairment, somnolence, (22%); ataxia (16%); abnormal gait, headache (15%); speech disorder (14%); aphasia, hallucinations (12%); hypertonia (11%); anxiety (9%); nystagmus, abnormal thinking (8%); dysesthesia, hallucinations, nervousness, paresthesia, vertigo (7%); paranoid reactions (3%);

* Nausea (41%); diarrhea (19%); vomiting (15%); anorexia (10%); constipation, dry mouth, dyspepsia, GI disorder, taste perversion (at least 2%).

* Dehydration, hypokalemia, increased creatinine phosphokinase, peripheral edema, weight loss (at least 2%).

* Pain (11%); fever (7%); abdominal pain, accidental injury, catheter complication, catheter site pain, cellulitis, chest pain, chills, edema, fever, flu syndrome, infection, pain, pump site complication, mass, or pain, viral infection (at least 2%); sepsis (less than 2%).

Warnings and precautions before taking Ziconotide :

* Severe psychiatric symptoms and neurological impairment may occur with ziconotide treatment. Frequently monitor all patients for evidence of cognitive impairment, hallucinations, or changes in mood or consciousness. If necessary, therapy can be interrupted or discontinued abruptly without evidence of withdrawal.

* To reduce risk of meningitis and other infections, ensure patient or caregiver with external microinfusion device is familiar with handling of the device and care of the catheter skin exit site.

* Advise patient before taking Ziconotide that medication usually is started at a low dose and then gradually increased as tolerated until max benefit is obtained.

* Instruct patient to continue to take other medications for pain as prescribed by health care provider.

* Advise patient before taking Ziconotide to notify health care provider immediately if any of the following occur: change in mental status (eg, confusion, decreased alertness, disorientation, lethargy); change in mood or perceptions; symptoms of depression of suicidal ideation; symptoms of meningitis (eg, fever, headache, nausea, seizures, stiff neck, vomiting); new or worsening muscle pain, soreness, or weakness.

* Caution patient that alcohol and other CNS depressants (eg, sedatives) will have additional sedative effects if taken while on ziconotide therapy.

* Caution patient to avoid engaging in driving or performing other activities requiring complete mental alertness or motor coordination during treatment with ziconotide.

* Advise women to inform health care provider if pregnant, planning to become pregnant, or breastfeeding.

* Advise patient before taking Ziconotide not to take any prescription or OTC medications, dietary supplements, or herbal preparations unless advised by health care provider.

* Advise patient before taking Ziconotide that follow-up visits and lab tests will be required to monitor therapy and to keep appointments.

* Caution patient before taking Ziconotide to inform the health care provider if pregnant, planning to become pregnant, or breastfeeding.

What if Overdose of Ziconotide ?

If you think you or anyone else taken overdose of Ziconotide , immediately telephone your doctor or contact your local or regional Poisons Information Centre Seek medical attention immediately. You may need urgent medical attention. Ataxia, confusion, dizziness, garbled speech, hypotension, nausea, nystagmus, sedation, spinal myoclonus, stupor, unresponsiveness, vomiting, word-finding difficulties are may be the overdose symptoms of Ziconotide .

What if Missed Dose of Ziconotide ?

If you miss a dose of Ziconotide medicine and you remember within an hour or so, take the dose immediately. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not double doses.

Storage Conditions for Ziconotide :

Store Ziconotide in refrigerator (36? to 46'F). Ziconotide diluted with saline may be stored in refrigerator but infusion should begin with 24 hr of preparation. Do not freeze. Protect from light.