Ziconotide – novel analgesic

Several studies showed the potential for the novel analgesic ziconotide in the chronic pain setting. Two studies examined the titration schedule, rapid or slow, as a component that may affect the efficacy and safety of the treatment. In one study by Fisher and colleagues, the investigators followed 27 patients who received ziconotide for 1 year after an initial rapid titration. The median time to stable dosing was 196.5 days, with a median maintenance dose of 0.34 mcg/hour. In the slow titration study, the same investigators followed 119 patients and found that the median time to dosing stability was 279 days, with a median dose of 0.24 mcg/hour. The investigators found that slow titration was feasible and may prevent some of the adverse effects associated with ziconotide, such as dizziness and confusion. Another investigator used the slow titration schedule and found it effective, but explained in an interview that patients need appropriate counseling so that they expect a slow change, with maximum benefits seen after 6 months of treatment. A meta-analysis showed that the treatment is effective in a variety of chronic pain settings and is effective in both cancer and non-cancer-related pain.

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