Ziconotide: Can we use it in palliative care?

Ziconotide (PRIALT®) is a new nonopioid treatment for chronic pain. It is apeptide that is the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. The therapeutic benefit ofziconotide derives from its potent and selective blockade of neuronal N-type voltage-sensitive calcium channels. Interference with these channels inhibits input from pain-sensing primary nociceptors. A recent clinical trial demonstrated that ziconotide has a significant analgesic effect compared to placebo in patients considered intolerant or refractory to other treatment such as systemic analgesics, adjunctive therapies, or intrathecal (IT) morphine. Thus, ziconotide is the first of a new class of agents - N-type calcium channel blockers, or NCCBs. Ziconotide may represent another option for patients with refractory pain.