• Jason A Williams, Miles Day, and James E Heavner.
• Texas Tech University Health Sciences Center, 3601 Fourth Street, MS 818, Lubbock, TX 79430, USA.
• Expert Opin Pharmacother. 2008 Jun 1;9(9):1575-83.

BackgroundZiconotide is the only N-type calcium channel blocker approved by the US FDA for the treatment of chronic pain. The approved indication is for the management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments such as systemic analgesics, adjunctive therapies or intrathecal morphine.ObjectiveThe purpose of this article was to review the available safety, efficacy and dosing information for ziconotide.MethodsThe sources searched for literature from 1980 to January 2008 included Pub Med, MEDLINE and PREMEDLINE using the words ziconotide, conotoxins and pain.Results/ConclusionZiconotide is administered intrathecally by infusion pump to block nociceptive signal transmission in the spinal cord. It is a synthetic neuroactive peptide equivalent to the omega conotoxin MVIIA, a constituent of the venom of the fish-hunting marine snail Conus magus. It is highly potent, has a steep dose-response curve, a slow onset of action and a narrow margin of safety and responses to dose adjustments are slow. Patients receiving ziconotide should be under the care of physicians experienced in the management of intrathecal infusion therapy for pain control and should have convenient access to medical facilities.

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