Ziconotide
Aliases: Prialt · ω-conotoxin MVIIA
Last verified: 2026-09-23
The short version
A cone-snail-venom peptide (25 aa) — an intrathecal analgesic for severe opioid-resistant chronic pain; 1000× more potent than morphine without tolerance.
Identity & type
- Molecular type
- analog
- Origin
- A cone-snail-venom peptide (25 aa) — an intrathecal analgesic for severe opioid-resistant chronic pain; 1000× more potent than morphine without tolerance.
Mechanism of action
N-type Ca2+ channel (Cav2.2) blocker in the spinal dorsal horn → interrupts pain transmission.
Dosing & routes
Official / clinical context
Approved drug — indications, dosing and warnings are defined by the official label. Intrathecal 2.4–19.2 mcg/day (pump), very slow titration.
Regulator-approved labeling and published study designs — never a recommendation.
Community-reported practice
Intrathecal 2.4–19.2 mcg/day (pump), very slow titration. Prialt: intrathecally for the most severe pain — strong analgesia without opioid tolerance, but psychiatric/cognitive side effects in some patients.
Unverified self-reports. Not medical advice. Not endorsement.
Expected effects (community)
Prialt: intrathecally for the most severe pain — strong analgesia without opioid tolerance, but psychiatric/cognitive side effects in some patients.
Protocol — official vs community
Official / label
Prialt, intrathecal only via an implanted pump, for severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of/refractory to other treatments: start 2.4 mcg/day (0.1 mcg/hour), with dose increases of ≤2.4 mcg/day at intervals of several days to weeks, up to a maximum of 19.2 mcg/day.
- 01Start: 2.4 mcg/day intrathecally
- 02Escalate in steps of ≤2.4 mcg/day, no more often than every 2–3 days, against pain response and neuropsychiatric tolerability
- 03Maximum: 19.2 mcg/day
Duration: Chronic while the pump is in place; abrupt interruption is not part of the protocol.
A 25-residue cone-snail ω-conotoxin, N-type calcium-channel blocker. The slow titration exists because the therapeutic window is narrow: dizziness, nystagmus, confusion and psychiatric effects define the ceiling. No tolerance/dependence like opioids — its one decisive advantage.
Community (anecdotal)
Structured protocol data for this entry is coming.
Human evidence
Approved 2004; reserved for the most severe pain.
Preclinical evidence
The preclinical phase was completed and submitted to regulators as part of registration; pharmacology and toxicology details are part of the official label.
Known risks
- Dizziness, confusion, nystagmus, psychiatric effects; narrow therapeutic window.characterized
Teal: characterized in clinical/labeling contexts. Amber: theoretical or reported outside controlled settings.
Unknowns & evidence gaps
- Real-world data outside controlled trials