Perioperative Management of a Patient With an Intrathecal Drug Delivery Device Infusing Ziconotide

Patel, Sephalie Y.; Hafez, Osama; Sexton, Wade J.; Edwards, David A.

doi:10.1213/xaa.0000000000000432

Cited by 3 publications

(1 citation statement)

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“…Although case reports and small case series can give valuable information and should therefore be published (recent examples are the papers by de la Calle Gil et al., ; Heifets et al., ; Horazeck et al., ; Lanzillo et al., ; Lux, ; Narain et al., ; Obafemi and Roth, ; Patel et al., ; Phan and Waldfogel, ; Pozzi et al., ; Russo et al., ; Staquet et al., ; Voirin et al., ), ‘real life’ data from larger cohorts such as the Registry of Intrathecal Ziconotide Management (PRIZM) (Deer et al., ) are more valuable. A recent interim analysis of the PRIZM study showed that, after 12 months of treatment, 34.8% of patients on ziconotide experienced ≥30% pain intensity reduction (Deer et al., ).…”

Section: Is Ziconotide Really That Effective In Clinical Practice?mentioning

confidence: 99%

Do the potential benefits outweigh the risks? An update on the use of ziconotide in clinical practice

Bäckryd

2018

European Journal of Pain

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Ziconotide is a selective and potent blocker of N-type voltage-gated calcium channels. It was approved by the Food and Drug Administration in 2004 and by the European Medicines Agency in 2005 for the treatment of severe chronic pain in patients needing intrathecal analgesia (ITA). The aim of this paper is to provide a practitioner-oriented, educational, narrative, up-to-date review on the use of ziconotide in clinical pain medicine. Of special concern regarding safety is the partial incongruity between dosing statements in the Summary of Product Characteristics and novel low-dosage, slow uptitration recommendations. Even though ziconotide has obvious advantages compared to opioids, pain practitioners pondering the use of ziconotide nonetheless have to balance its proved potential analgesic effect against its neurological side effects, with special consideration being given to dosing and neuropsychiatric dangers. Using a seesaw analogy, the paper discusses what factors pain physicians should weigh in when considering ziconotide as ITA drug, the non-opioid advantages of ziconotide being counterbalanced by its potential psychiatric side effects. Ziconotide is an important part of the armamentarium of modern interventional pain medicine. If ITA is deemed necessary, ziconotide is a rational alternative, at least in chronic (neuropathic) non-cancer pain. However, in many European countries, ziconotide treatment is only available in a few (if any) centres. The safety profile of ziconotide is not fundamentally more worrying than that of opioids or cannabinoids; it is just different. This paper provides a concise, up-to-date and clinically-oriented summary of the use of ziconotide in clinical practice, not least concerning safety and dosage issues.

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