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Dr. Grey AI

Peptide

Ziconotide (Prialt)

Ziconotide is a synthetic 25-amino acid peptide derived from omega-conotoxin MVIIA found in Conus magus marine snail venom. FDA-approved in 2004 for severe chronic pain refractory to other treatments. Administered intrathecally via implanted pump. RCTs showed significant pain reduction (14.7% vs 7.2% placebo). Unique non-opioid mechanism with no tolerance development.

Research notice. This page is for education and research. Peptides may not be FDA-approved for human use and may only be legally available for research. Talk to a qualified clinician before considering any peptide.

Best evidence
Grade A
Conditions studied
1
Outcomes
8
Graded outcomes
3320

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

1 condition, plus general outcomes

Chronic pain

Chronic pain: outcomes studied for Ziconotide (Prialt)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Long-term Pain Control

Stable pain scores over 3 years in 644-patient study. No evidence of tolerance development. 119 patients treated >360 days.

Improves (the measure goes down)Moderate effect23 studies

Studies that measured long-term pain control

and 13 more in the citations list

Pain Intensity Reduction

RCT: 14.7% VASPI improvement vs 7.2% placebo (P=0.036). Significant improvement with slow titration protocol.

Improves (the measure goes down)Moderate effect22 studies

Studies that measured pain intensity reduction

and 12 more in the citations list

Opioid-Refractory Pain

Effective in patients refractory to intrathecal morphine and other opioids. Provides option when tolerance develops to opioids.

Improves (the measure goes down)Moderate effect22 studies

Studies that measured opioid-refractory pain

and 12 more in the citations list

Quality of Life

Improved quality of life reported in patients with treatment-resistant chronic pain in long-term studies.

Improves (the measure goes up)Moderate effect16 studies

Studies that measured quality of life

and 6 more in the citations list

Function and Mobility

Improvements in physical function observed alongside pain reduction in clinical trials.

Improves (the measure goes up)Small effect16 studies

Studies that measured function and mobility

and 6 more in the citations list

General

General: outcomes studied for Ziconotide (Prialt)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Anti-Cancer Activity

9 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Moderate effect14 studies

Studies that measured anti-cancer activity

and 4 more in the citations list

Liver Protection

7 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes up)Small effect12 studies

Studies that measured liver protection

and 2 more in the citations list

Safety/Tolerability

5 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes up)Small effect10 studies

Studies that measured safety/tolerability

Key findings

  • Long-term Pain ControlChronic painImproves (the measure goes down)
  • Pain Intensity ReductionChronic painImproves (the measure goes down)
  • Opioid-Refractory PainChronic painImproves (the measure goes down)

Studies cited

51 studies from PubMed

  1. Efficacy and safety of the Ca(v)2.2 blocker Ziconotide in pain: a meta-analysis and systematic review.Pain reports, 2025 · PMID 41255849
  2. Intrathecal ziconotide for the treatment of chronic pain: a collection of clinical experiences and literature reviewNeuromodulation, 2024 · PMID 39194195
  3. A Benefit/Risk Assessment of Intrathecal Ziconotide in Chronic Pain: A Narrative Review.Journal of clinical medicine, 2024 · PMID 38541869
  4. A comprehensive review on ziconotide.Heliyon, 2024 · PMID 38779019
  5. Ziconotide and psychosis: from a case report to a scoping review.Frontiers in molecular neuroscience, 2024 · PMID 39479264
  6. Controversies in intrathecal drug delivery for cancer pain.Regional anesthesia and pain medicine, 2023 · PMID 35977779
  7. Ziconotide for the Management of Cancer Pain: A Budget Impact Analysis.Neuromodulation : journal of the International Neuromodulation Society, 2023 · PMID 36202713
  8. Microneedle-mediated delivery of Ziconotide-loaded liposomes fused with exosomes for analgesia.Journal of controlled release : official journal of the Controlled Release Society, 2023 · PMID 36898532
  9. Venoms classification and therapeutic uses: a narrative review.European review for medical and pharmacological sciences, 2023 · PMID 36876699
  10. How has ziconotide impacted non-cancer pain management?Expert opinion on pharmacotherapy, 2020 · PMID 31935126
  11. Ziconotide for Management of Cancer Pain Refractory to Pharmacotherapy: An Update.Pain medicine (Malden, Mass.), 2020 · PMID 32940675
  12. Intrathecal Drug Delivery.Methods in molecular biology (Clifton, N.J.), 2020 · PMID 31435916
  13. Effectiveness and Safety of Intrathecal Ziconotide: Final Results of the Patient Registry of Intrathecal Ziconotide Management (PRIZM).Pain medicine (Malden, Mass.), 2020 · PMID 32472137
  14. Intrathecal Therapy for Chronic Pain: A Review of Morphine and Ziconotide as Firstline Options.Pain medicine (Malden, Mass.), 2019 · PMID 30137539
  15. Ziconotide: Indications, Adverse Effects, and Limitations in Managing Refractory Chronic Pain.Indian journal of palliative care, 2018 · PMID 29440821
  16. Ziconotide-induced psychosis: A case report and literature review.The mental health clinician, 2018 · PMID 30206508
  17. The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain.Current neuropharmacology, 2017 · PMID 26861471
  18. Ziconotide Monotherapy: A Systematic Review of Randomised Controlled Trials.Current neuropharmacology, 2017 · PMID 26861472
  19. Intrathecal Therapy for Cancer-Related Pain.Pain medicine (Malden, Mass.), 2016 · PMID 28025375
  20. Delivery of ziconotide to cerebrospinal fluid via intranasal pathway for the treatment of chronic pain.Journal of controlled release : official journal of the Controlled Release Society, 2016 · PMID 26732557
  21. Ziconotide Combination Intrathecal Therapy for Noncancer Pain Is Limited Secondary to Delayed Adverse Effects: A Case Series With a 24-Month Follow-Up.Neuromodulation : journal of the International Neuromodulation Society, 2015 · PMID 25655991
  22. Tailored delivery of analgesic ziconotide across a blood brain barrier model using viral nanocontainers.Scientific reports, 2015 · PMID 26234920
  23. The Relationship Between the Mechanisms of Action and Safety Profiles of Intrathecal Morphine and Ziconotide: A Review of the Literature.Pain medicine (Malden, Mass.), 2015 · PMID 25645109
  24. Intrathecal delivery of analgesics.Methods in molecular biology (Clifton, N.J.), 2014 · PMID 24567144
  25. Bolus intrathecal injection of ziconotide (Prialt®) to evaluate the option of continuous administration via an implanted intrathecal drug delivery (ITDD) system: a pilot study.Neuromodulation : journal of the International Neuromodulation Society, 2013 · PMID 23205907
  26. Ziconotide: a clinical update and pharmacologic review.Expert opinion on pharmacotherapy, 2013 · PMID 23537340
  27. Intrathecal ziconotide: a review of its use in patients with chronic pain refractory to other systemic or intrathecal analgesics.CNS drugs, 2013 · PMID 23999971
  28. Long-term intrathecal ziconotide for chronic pain: an open-label studyJ Pain Symptom Manage, 2009 · PMID 18715748
  29. Intrathecal ziconotide and opioid combination therapy for noncancer pain: an observational study.Pain physician, 2009 · PMID 19668287
  30. Intrathecal ziconotide for neuropathic pain: a review.Pain practice : the official journal of World Institute of Pain, 2009 · PMID 19682321
  31. Intrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trialAnesth Analg, 2008 · PMID 18227325
  32. Ziconotide: an update and reviewCNS Drugs, 2008 · PMID 18518786
  33. Intrathecal therapy with ziconotide: clinical experience and considerations on its useJ Pain Res, 2008 · PMID 19034250
  34. Ziconotide: a review of its pharmacology and use in the treatment of pain.Neuropsychiatric disease and treatment, 2007 · PMID 19300539
  35. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic painJ Pain Symptom Manage, 2006 · PMID 16716870
  36. Safety and efficacy of intrathecal ziconotide in the management of severe chronic painTher Clin Risk Manag, 2006 · PMID 17130684
  37. Ziconotide for the treatment of severe chronic painNeurotherapeutics, 2006 · PMID 16488354
  38. An overview of the clinical effectiveness and side effects of ziconotideAnesthesiology, 2006 · PMID 16616596
  39. Ziconotide: a new option for refractory pain.Drugs of today (Barcelona, Spain : 1998), 2006 · PMID 16845440
  40. Intrathecal ziconotide for refractory chronic pain.The Annals of pharmacotherapy, 2006 · PMID 16849624
  41. Ziconotide--a novel neuron-specific calcium channel blocker for the intrathecal treatment of severe chronic pain--a short review.International journal of clinical pharmacology and therapeutics, 2006 · PMID 17063978
  42. Ziconotide, an intrathecally administered N-type calcium channel antagonist for the treatment of chronic pain.Pharmacotherapy, 2005 · PMID 16207099
  43. Ziconotide (Prialt) for chronic pain.The Medical letter on drugs and therapeutics, 2005 · PMID 16331245
  44. Ziconotide: a new non-opioid analgesic for chronic painDrugs Today (Barc), 2004 · PMID 15483612
  45. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trialJAMA, 2004 · PMID 12557264
  46. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial.JAMA, 2004 · PMID 14709577
  47. Intrathecal ziconotide for refractory pain.Expert opinion on investigational drugs, 2004 · PMID 15212625
  48. Intrathecal ziconotide for chronic pain.JAMA, 2004 · PMID 15479926
  49. Ziconotide: neuronal calcium channel blocker for treating severe chronic pain.Current medicinal chemistry, 2004 · PMID 15578997
  50. An evaluation of intrathecal ziconotide for the treatment of chronic painNeurol Res, 2000 · PMID 11060815
  51. Ziconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain.Regional anesthesia and pain medicine, 2000 · PMID 10834782