Peptide Profile
Ziconotide (Prialt)
FDA-approved intrathecal analgesic derived from cone snail venom for severe chronic pain
Dose Range
2.4 mcg/day-19.2 mcg/daymcg
Frequency
Once daily
Route
Intrathecal infusion
Cycle Length
Ongoing/indefinite
Onset
Moderate (1-2 weeks)
Evidence
Strong
Compound Profile
Scientific & Efficacy Data
C102H172N36O32S7
Molecular Formula
2639.2 Da
Molecular Weight
CSF: 4.6 hours; Plasma: 1.3 hours
Half-Life
100% intrathecal; does not cross blood-brain barrier systemically
Bioavailability
107452-89-1
CAS #
16135415
PubChem ID ↗
Developed By · 2004
Elan Pharmaceuticals
Elan Pharmaceuticals (now TerSera Therapeutics)
Primary Benefits
FDA-approved N-type calcium channel blocker providing potent non-opioid analgesia for severe chronic pain refractory to other treatments
Unique mechanism of action independent of opioid receptors eliminates risks of tolerance, dependence, and respiratory depression
Specifically effective for neuropathic pain syndromes through selective blockade of pain signal transmission at the spinal cord
Amino Acid Sequence
25-amino acid peptide with 3 disulfide bridges (synthetic ω-conotoxin MVIIA)Dosing
How much
do I take?
Timing
Best time to take
Use Ziconotide (Prialt) at the same time each day for optimal results. Consistency in timing helps maintain stable levels and maximize therapeutic benefits. Follow your healthcare provider's specific instructions.
With food?
Ziconotide (Prialt) can generally be used with or without food. If you experience any discomfort, try taking it with a light meal. Follow specific guidance from your healthcare provider.
If stacking
Ziconotide (Prialt) should be used as directed by your healthcare provider. If combining with other medications or supplements, discuss potential interactions with your provider. Avoid combining with compounds that have overlapping mechanisms unless specifically guided by a medical professional.
Adjusting Your Dose
Increase if
- +You've tolerated the current dose for the recommended period without significant side effects
- +Therapeutic goals haven't been met at the current dose level
- +Your healthcare provider recommends dose escalation based on your response
- +Lab work or clinical assessments support a higher dose
Decrease if
- -Side effects are bothersome or impacting daily life despite management strategies
- -You experience any signs of an adverse reaction
- -Lab results indicate the need for dose reduction
- -Your healthcare provider recommends a lower dose based on your response
Signs of right dose
- ✓Therapeutic goals being met with minimal side effects
- ✓Stable and consistent response to treatment
- ✓Lab values or clinical markers trending in the right direction
- ✓Good tolerance with manageable or absent side effects
Dosing Calculator
Calculate Your Exact Dose
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Suitability
Is this
right for me?
Best For
Severe chronic pain management
Ziconotide (Prialt) is particularly well-suited for individuals focused on severe chronic pain management. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.
Opioid-refractory neuropathic pain
Ziconotide (Prialt) is particularly well-suited for individuals focused on opioid-refractory neuropathic pain. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.
Cancer-related intractable pain
Ziconotide (Prialt) is particularly well-suited for individuals focused on cancer-related intractable pain. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.
Reducing systemic opioid dependence
Ziconotide (Prialt) is particularly well-suited for individuals focused on reducing systemic opioid dependence. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.
Consider Alternatives If
Who Should Avoid
Do not use if
- ×Pre-existing history of psychosis
- ×Infection at the microinfusion injection site
- ×Uncontrolled bleeding diathesis
- ×Spinal canal obstruction impairing CSF circulation
Use with caution if
- !You are taking other medications—discuss potential interactions with your healthcare provider
- !You have a history of liver or kidney disease
- !You are elderly or have multiple medical conditions
- !You are planning surgery in the near future—inform your surgeon about Ziconotide (Prialt) use
- !You have any chronic health conditions that require regular monitoring
Administration
How do I
use it?
Reconstitution
What you need
- •Ziconotide (Prialt) vial (lyophilized powder or solution)
- •Bacteriostatic water or sterile sodium chloride for reconstitution
- •Alcohol swabs for cleaning vial tops and injection sites
- •Appropriately sized syringes with fine-gauge needles (27-30 gauge)
- •Sharps disposal container
Injection
Route
Subcutaneous injection (into the fatty tissue just under the skin)—allows for consistent absorption and can be self-administered at home after proper training
Best sites
- •Abdomen (stomach area)—at least 2 inches from the belly button, most popular choice for self-injection
- •Front of thighs—middle to upper portion of the outer leg
- •Back of upper arm—outer area (may need assistance from another person)
Technique
- 1.Wash your hands thoroughly with soap and water before handling supplies
- 2.Clean the injection site with an alcohol swab and let it air dry completely
- 3.Pinch a fold of skin at the chosen injection site
- 4.Insert the needle at a 45-90 degree angle (depending on needle length and body composition)
- 5.Inject the medication slowly and steadily over 5-10 seconds
- 6.Release the skin fold and remove the needle, applying gentle pressure with a clean swab
- 7.Rotate injection sites to prevent tissue irritation or lipodystrophy
- 8.Dispose of the needle safely in a sharps container—never recap or reuse needles
Storage
Signs of degradation
Sample Daily Schedule
Safety
Is it
safe?
Safety Profile
Ziconotide (Prialt, FDA-approved since 2004) demonstrates favorable safety in intrathecal delivery with dose-dependent adverse effects primarily cognitive/psychiatric: dizziness, confusion, memory impairment, and mood changes in 20-50% of patients depending on infusion rate. Serious risks include meningitis-like aseptic meningitis (rare but documented), cognitive decline requiring dose reduction in ~25% of treated patients, and infection at intrathecal catheter insertion site. Hemodynamic effects (hypotension, dizziness) occur in dose-dependent fashion, necessitating slow titration (starting at 2.4 mcg/day, increasing weekly).
FDA approval based on Phase 2/3 trials in chronic pain patients demonstrating superior analgesia compared to placebo with manageable side effect profile when dosed carefully. Intrathecal route bypasses blood-brain barrier, achieving high spinal cord concentrations; safety monitoring must include cognitive/psychiatric assessment and CSF parameters. Over 15 years post-market experience supports acceptable benefit-risk profile in treatment-refractory cancer and non-cancer pain when dosed appropriately and infection risks minimized through proper catheter care.
Common Side Effects
Experienced by some users
Dizziness
Most common adverse effect reported in 46% of patients versus 13% placebo in clinical trials
Management: Usually manageable with dose adjustment; may improve with continued therapy
Nausea
Reported in 40% of patients; gastrointestinal effects also include diarrhea (18%) and vomiting (16%)
Management: Antiemetic medications as needed; often improves during dose stabilization
Less Common
- •Confusion and Memory Impairment
- •Ataxia and Nystagmus
These typically resolve with continued use or dose adjustment.
Stop and Seek Help If
- ×Severe or worsening side effects that don't improve with dose adjustment or supportive care
- ×Signs of an allergic reaction—rash, hives, swelling, or difficulty breathing
- ×Your healthcare provider recommends discontinuation based on your clinical response
- ×Development of any new medical condition that may be contraindicated with Ziconotide (Prialt)
- ×Pregnancy or planning to become pregnant (unless specifically approved for use during pregnancy)
- ×Abnormal lab results or clinical markers that suggest adverse effects
Ziconotide (Prialt) should only be started, adjusted, or discontinued under medical supervision. This information is for educational purposes only and does not replace professional medical advice. Never stop a prescribed treatment without consulting your healthcare provider first, as abrupt discontinuation may have consequences.
Interactions
With other peptides
- ✓Intrathecal baclofen may complement ziconotide for mixed pain and spasticity syndromes
- ✓Oral gabapentin addresses peripheral neuropathic pain through complementary calcium channel mechanisms
- ✓Rehabilitation combined with intrathecal analgesia optimizes functional recovery outcomes
With medications
- !CNS Depressants - May potentiate central nervous system depression including somnolence and confusion
- !Intrathecal Opioids - Concurrent intrathecal opioids increase risk of serious adverse events including respiratory depression
- !Psychotropic Medications - May exacerbate psychiatric adverse effects including hallucinations and psychosis risk
With supplements
- ✓Multivitamins - Generally safe to take alongside Ziconotide (Prialt). Space doses apart if taking oral formulations to ensure optimal absorption.
- ✓Electrolyte supplements - Helpful if experiencing any GI side effects that could lead to dehydration. Safe to combine.
Effectiveness
Does it
work?
Evidence Level
Strong human trials
What to Expect
Acute Response (Hours to Days)
What you might notice
- •Pain relief may begin within hours of intrathecal infusion initiation;
- •CSF half-life is 4.6 hours providing continuous analgesic coverage
What's normal
- •Initial response to Ziconotide (Prialt) is beginning at the cellular level
- •Different individuals experience Ziconotide (Prialt)'s onset at different rates
- •Transient systemic effects from initial Ziconotide (Prialt) exposure are common
What's next
- →Maintain consistent Ziconotide (Prialt) administration as prescribed
- →Document subjective effects and physical markers daily
- →Schedule a check-in with your provider about initial observations
Titration Period (1-3 Weeks)
What you might notice
- •Gradual dose optimization over 21 days with incremental increases;
- •progressive pain improvement as therapeutic dose is reached
What's normal
- •Ziconotide (Prialt) has achieved stable, long-term homeostatic integration
- •Sustained efficacy of Ziconotide (Prialt) remains consistent
- •Chronic Ziconotide (Prialt) effects remain stable and predictable
What's next
- →Maintain your established Ziconotide (Prialt) protocol for sustained benefits
- →Continue periodic monitoring to confirm Ziconotide (Prialt) efficacy
- →Review comprehensive Ziconotide (Prialt) response with your provider
Maintenance Therapy (Months to Years)
What you might notice
- •Sustained pain relief without tolerance development;
- •pump refills every 40-84 days;
- •long-term studies show continued efficacy beyond 1 year
What's normal
- •Full therapeutic effects of Ziconotide (Prialt) are well-characterized at this point
- •Maintenance of Ziconotide (Prialt)'s therapeutic effects is typical
- •Tolerance patterns with Ziconotide (Prialt) are generally stable over months
What's next
- →Comprehensive assessment of Ziconotide (Prialt) efficacy should be conducted
- →Discuss long-term continuation, cycling, or protocol modifications
- →Continue regular monitoring of relevant biomarkers or symptoms
Signs It's Working
Treatment Response
- ✓Improvement in the primary symptoms or condition being treated
- ✓Positive changes in relevant lab values or clinical markers
- ✓Consistent, stable response to Ziconotide (Prialt) over time
- ✓Reduction in symptom frequency or severity
General Well-being
- ✓Improved energy levels and daily functioning
- ✓Better quality of life related to the treated condition
- ✓Manageable or absent side effects indicating good tolerance
- ✓Positive feedback from healthcare provider during check-ups
Not Seeing Results?
Common reasons
- •Not at therapeutic dose yet—initial doses are for building tolerance, not maximum effect
- •Insufficient time at target dose—most compounds need several weeks to show full benefits
- •Inconsistent dosing schedule—regular, consistent use is crucial for optimal results
- •Individual variation in response—genetics, metabolism, and other factors affect outcomes
- •Underlying conditions or medications interfering with absorption or effectiveness
- •Improper storage leading to degraded product—always verify proper storage conditions
Key Research
"Efficacy and safety of Cav2.2 blocker Ziconotide in pain: meta-analysis and systematic review"
Research investigators, 2025
Finding: Meta-analysis of ziconotide showed significant pain reduction (22.54-point improvement) versus placebo with 17.85% serious adverse events. Secondary outcomes suggest potential opioid sparing, though evidence quality was moderate.
View Study"Can Ziconotide Be Used to Replace Opioids? Clinical Experience in 5 Patients"
Research investigators, 2025
Finding: Five patients successfully reduced morphine doses by 50% after 6 weeks of ziconotide titration while achieving pain reduction from 8.0 to 2.5. Neuropathic symptoms improved dramatically with 80% reduction in tingling.
View Study"Selecting Neuromodulation Devices For Chronic Pain Conditions: A Narrative Review"
Research investigators, 2026
Finding: A narrative review established ziconotide as a selective Cav2.2 channel blocker offering precise pain relief through intrathecal delivery for refractory chronic pain. Combined with morphine, it reduced opioid requirements.
View Study"Ziconotide as an Opioid Rescue: Economic, Clinical, and Subgroup Considerations"
Research investigators, 2025
Finding: No abstract available for comprehensive analysis.
View Study"Recurrent Ziconotide-Associated Delirium and Psychosis: A Case Report"
Research investigators, 2025
Finding: No abstract available for comprehensive analysis.
View StudyFrequently Asked Questions