As the opioid crisis continues to worsen in the US [
[1]
], adequately treating chronic pain is a problem facing many physicians. In 2016, the
Polyanalgesic Consensus Conference guidelines recommended both ziconotide and morphine
as first line intrathecal (IT) analgesics [
[2]
]. Ziconotide was developed as a novel non-opioid treatment for severe, refractory
chronic pain [
[3]
]. As a synthetic equivalent of a conopeptide found in Conus magnus, ziconotide blocks the neurotransmission from primary nociceptive afferent nerves
by binding to N-type voltage sensitive calcium channels in the spinal cord [
3
,
4
]. While ziconotide has advantages compared to morphine, such as lack of tolerance,
withdrawal symptoms, or respiratory depression, it has significant neuropsychiatric
adverse reactions [
[5]
]. As a result, ziconotide carries a black box warning for severe adverse reactions,
including confusion, memory impairment, amnesia, hallucinations, paranoia, and psychosis,
and is contraindicated in patients with pre-existing history of psychosis [
[6]
].Corporation E. Prialt (ziconotide) [prescribing information] San Diegoc2004 [Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021060s003lbl.pdf.
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References
Abuse National Institute on Drug Abuse. Overdose Death Rates 2021 [Available from: https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates“ \t ”_blank.
- The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines.Neuromodulation. 2017; 20: 96-132
- Ziconotide: neuronal calcium channel blocker for treating severe chronic pain.Curr Med Chem. 2004; 11: 3029-3040
- Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain.Ther Clin Risk Manag. 2009; 5: 521-534
- The relationship between the mechanisms of action and safety profiles of intrathecal morphine and ziconotide: a review of the literature.Pain Med. 2015; 16: 1265-1277
Corporation E. Prialt (ziconotide) [prescribing information] San Diegoc2004 [Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021060s003lbl.pdf.
- Ziconotide-induced psychosis: A case report and literature review.Ment Health Clin. 2018; 8: 242-246
Phan SV, Waldfogel JM. Ziconotide-induced psychosis: a case report. Gen Hosp Psychiatry 2015;37(1):97.e11-2.
- Ziconotide-associated psychosis treated with Invega.Psychiatric Annals. 2015; 45: 64-66
- Prolonged delirium with psychotic features from omega conotoxin toxicity.Pain Med. 2013; 14: 447-448
- Intractable delirium associated with ziconotide successfully treated with electroconvulsive therapy.Psychosomatics. 2002; 43: 63-66
- Ziconotide infusion for severe chronic pain: case series of patients with neuropathic pain.Pharmacotherapy. 2006; 26: 395-402
- Morphine-induced hallucinations - resolution with switching to oxycodone: a case report and review of the literature.Cases J. 2009; 2: 9391
- Opioid-induced hallucinations: a review of the literature, pathophysiology, diagnosis, and treatment.Anesth Analg. 2016; 123: 836-843
Article info
Publication history
Published online: August 29, 2021
Identification
Copyright
Published by Elsevier Inc.
