Ziconotide
Ziconotide is a non-opioid analgesic used to treat severe chronic pain in patients who require intrathecal (spinal) therapy and have not responded to other treatments. It is a synthetic peptide derived from cone snail venom that works by blocking calcium channels on pain-sensing nerves in the spinal cord, reducing the transmission of pain signals.
Ziconotide is an intrathecal non-opioid pain medication that blocks N-type calcium channels to manage severe chronic pain when other treatments have failed.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N02BG08
- RxNorm
- 68503
- Generic
- Ziconotide
- Class
- atc-n02
- Brands
- Prialt
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
9 groupspregnancy
first trimesteravoid if possible
use only if potential benefits justify potential risks to fetus; avoid in pregnancy unless absolutely necessary
regular fetal monitoring and ultrasound assessments
Use with caution and monitor for adverse effects.
pregnancy
second trimesteravoid if possible
use only if potential benefits justify potential risks to fetus
regular fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
third trimesteravoid if possible
use only if potential benefits justify potential risks; consider timing of delivery
regular fetal monitoring and assessment of fetal wellbeing
Use with caution and monitor for adverse effects.
lactation
breastfeedingnot recommended
breastfeeding not recommended during ziconotide therapy; either discontinue drug or discontinue breastfeeding
monitor infant for adverse effects
geriatric
elderly over 65start at lower end of dosing range
use with caution; increased sensitivity to CNS effects; start with lowest effective dose and titrate slowly
closely monitor for cognitive effects, confusion, and sedation
Use with caution and monitor for adverse effects.
pediatric_age
children under 18not recommended
not recommended for use in pediatric patients; safety and efficacy not established in patients under 18 years
not applicable
Use of this medication in this population requires careful consideration of risks and benefits.
renal_impairment
severe renal impairmentno specific dose adjustment required
use with caution; drug is primarily cleared by proteolytic cleavage not renal excretion; however monitor closely for adverse effects
monitor renal function and watch for accumulation of adverse effects
Use with caution and monitor for adverse effects.
hepatic_impairment
moderate hepatic impairmentno specific dose adjustment required
use with caution; limited data in hepatic impairment; monitor closely for adverse effects
monitor liver function tests and for signs of toxicity
Use with caution and monitor for adverse effects.
alcohol_users
active alcohol useavoid concomitant use
avoid alcohol consumption during ziconotide therapy; alcohol may enhance CNS depressant effects
monitor for increased sedation, respiratory depression, and cognitive impairment
Use of this medication in this population requires careful consideration of risks and benefits.
Statistics and clinical data
FDA approval year
FDA approval for chronic severe pain management
Drug class
Pharmacological classification
Route of administration
Method of delivery into cerebrospinal fluid
Mechanism of action
Primary pharmacodynamic action
Severe chronic pain requiring intrathecal therapy, particularly when patients have not responded to or cannot tolerate other analgesics including systemic opioids.
Binds selectively to N-type voltage-sensitive calcium channels located on primary nociceptive (A-δ and C) afferent nerve fibers in the superficial layers (Rexed laminae I and II) of the dorsal horn in the spinal cord, blocking calcium influx and inhibiting neurotransmitter release to reduce pain signal transmission.
Administered via intrathecal injection directly into the cerebrospinal fluid. Requires careful dose titration due to narrow therapeutic window. Common adverse effects include dizziness, confusion, and hallucinations. Not an opioid and does not produce physical dependence, but psychiatric symptoms may occur requiring close monitoring.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy