Ziconotide
Also known as: Prialt, SNX-111, ω-Conotoxin MVIIA analog
Overview
Ziconotide (Prialt) is a 25-amino acid synthetic equivalent of ω-conotoxin MVIIA, a peptide toxin from the cone snail Conus magus. FDA-approved in 2004 for severe chronic pain, it represents a first-in-class N-type calcium channel blocker. Because it cannot cross the blood-brain barrier, ziconotide is administered by intrathecal infusion directly into the cerebrospinal fluid. It is indicated for patients with refractory pain who have failed or cannot tolerate systemic opioids or other analgesics.
Mechanism of Action
Ziconotide selectively blocks N-type voltage-gated calcium channels (Cav2.2) in the spinal cord's dorsal horn laminae I and II. N-type channels are the primary calcium entry route mediating neurotransmitter release from primary afferent C-fibers and Aδ-fibers. Blocking these channels prevents calcium influx, inhibiting substance P, glutamate, and CGRP release from nociceptive afferents and interrupting pain signal transmission without activating opioid receptors. This mechanism means there is no cross-tolerance with opioids and no respiratory depression risk.
Potential Benefits
- Potent analgesia for severe chronic and refractory pain
- Non-opioid mechanism with no addiction potential
- No respiratory depression
- Effective for neuropathic, cancer, and AIDS-related pain
- No tolerance development in long-term use
Dosage Protocols
The following reflects doses used in published research studies. This is not medical advice. Consult a qualified healthcare professional.
| Beginner | 0.1 mcg/hour (2.4 mcg/day) starting dose |
| Intermediate | Titrate upward by 2.4 mcg/day no more than 2-3x weekly |
| Advanced | Maintenance typically 6-12 mcg/day; max 19.2 mcg/day |
| Cycle Duration | Chronic — for refractory pain |
FDA-approved (Prialt) for severe chronic pain. Extremely narrow therapeutic window — neurotoxicity risk. Intrathecal pump only.
Use our Reconstitution Calculator to determine exact syringe units for your protocol.
Routes of Administration
Intrathecal (implanted pump) 100% (direct CSF delivery)
Only approved route. Requires implanted programmable intrathecal pump.
Read our full Routes of Administration Guide for detailed comparison of all delivery methods.
Stacking Protocols
Popular research stacks involving Ziconotide:
Intrathecal Pain Combinations
Clinician-managed intrathecal combinations for refractory pain — very carefully titrated.
Explore our complete Peptide Stacking Guide for more combinations and safety considerations.
Reconstitution
| Storage | Refrigerate 2-8°C, protect from light |
|---|
Specialty pharmacy handling. No reconstitution — dilute per pump protocol.
Need exact syringe measurements?
Amino Acid Sequence
Cys-Lys-Gly-Lys-Gly-Ala-Lys-Cys-Ser-Arg-Leu-Met-Tyr-Asp-Cys-Cys-Thr-Gly-Ser-Cys-Arg-Ser-Gly-Lys-Cys-NH2 (three disulfide bonds)
Side Effects & Safety
- Dizziness, nausea, confusion (dose-limiting CNS effects)
- Psychiatric symptoms at higher doses (hallucinations, agitation)
- Catheter/pump complications (device-related)
- Severe psychiatric events require immediate discontinuation
Safety & Contraindications
This information is for educational purposes only. Consult a qualified healthcare provider before using any peptide.
Pregnancy / Lactation
Bleeding Disorders
Active Skin Infection at Injection Site
Drug Interactions
- CNS Depressants:
FDA Safety Information
FDA Boxed Warning: Severe psychiatric symptoms and neurological impairment. Contraindicated in patients with a preexisting history of psychosis.
Pharmacokinetics
| Half-Life | ~4.6 hours (CSF) |
|---|---|
| Storage | Refrigerate at 2-8°C. Protect from light. Do not freeze. |
Synergistic Compounds
The following compounds have been studied alongside Ziconotide for potential complementary or synergistic effects:
Learn More
References & Further Reading
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