The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.
Intrathecal Ziconotide: Dosing and Administration Strategies in Patients With Refractory Chronic Pain
Open accessAbstract
INTRODUCTION: Ziconotide is a non-opioid analgesic for intrathecal (IT) administration. The aim of this review is to provide a comprehensive and clinically relevant summary of the literature on dosing and administration with IT ziconotide in the management of refractory chronic pain, and to describe novel dosing strategies intended to improve clinical outcomes. MATERIALS AND METHODS: A Medline search was conducted for "ziconotide," supplemented by manual searching of published bibliographies and abstracts from conferences. RESULTS: Early experience with IT ziconotide in clinical trials combined with improved understanding of drug pharmacokinetics in the cerebrospinal fluid have led to a reappraisal of approaches to trialing and initiation of continuous-infusion therapy in an effort to improve tolerability. The traditional paradigm of trialing by inpatient continuous infusion may be shifting toward outpatient trialing by IT bolus, although definitions of success and specific protocols remain to be agreed upon. Expert consensus on IT continuous infusion with ziconotide suggests a starting dose of 0.5 to 1.2 mcg/day followed by dose titration of ≤0.5 mcg/day on a no more than weekly basis, according to individual patients' pain reductions and regimen tolerability. DISCUSSION: Newer modalities that include patient-controlled analgesia and nocturnal flex dosing have been shown to hold promise of further improvements in ziconotide efficacy and tolerability. CONCLUSIONS: Clinical trials and experience confirm the feasibility and usefulness of IT ziconotide in the management of refractory chronic pain. Emerging evidence suggests that additional IT delivery options may further expand the usefulness and benefits of ziconotide.
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“These include intracerebroventricular administration of Cerliponase for Batten's disease (395), intrathecal administration of antisense oligo Spinraza targeting the survival motor neuron 1 gene (SMN1) for infantile spinal muscular atrophy (150), intrathecal Ziconited peptide for chronic pain (398), and intranasal administration of insulin, leptin, and oxytocin (103).”
From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [398]
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Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61729-2 · Cited by 8,291
Smith, T. J., Staats, P. S., Deer, T., Stearns, L. J., Rauck, R. L., Boortz-Marx, R. L., Buchser, E., Català, E., Bryce, D. A., Coyne, P. J., et al. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.02.118 · Cited by 736
Staats, P. S., Yearwood, T., Charapata, S. G., Presley, R. W., Wallace, M. S., Byas-Smith, M., Fisher, R., Bryce, D. A., Mangieri, E. A., Luther, R. R., et al. (2004) · JAMA · doi:10.1001/jama.291.1.63 · Cited by 654
Ziconotide for treatment of severe chronic pain
Schmidtko, A., Lötsch, J., Freynhagen, R., & Geisslinger, G. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60354-6 · Cited by 356
Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain
Hudcova, J., McNicol, E. D., Quah, C. S., Lau, J., & Carr, D. B. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003348.pub2 · Cited by 348
Deer, T. R., Prager, J., Levy, R., Rathmell, J., Buchser, E., Burton, A., Caraway, D., Cousins, M., De Andrés, J., Diwan, S., et al. (2012) · Neuromodulation: Technology at the Neural Interface · doi:10.1111/j.1525-1403.2012.00476.x · Cited by 327
Self-citationRauck, R. L., Wallace, M. S., Leong, M. S., MineHart, M., Webster, L. R., Charapata, S. G., Abraham, J. E., Buffington, D. E., Ellis, D., Kartzinel, R., et al. (2006) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2005.10.003 · Cited by 306
Wallace, M. S., Charapata, S. G., Fisher, R., Byas‐Smith, M. G., Staats, P. S., Mayo, M. R., McGuire, D., & Ellis, D. (2006) · Neuromodulation Technology at the Neural Interface · doi:10.1111/j.1525-1403.2006.00055.x · Cited by 209
Deer, T. R. (2011) · Pain Physician · doi:10.36076/ppj.2011/14/e283 · Cited by 184
Intrathecal Therapy for Cancer and Non-Cancer Pain
Hayek, S. M. (2011) · Pain Physician · doi:10.36076/ppj.2011/14/219 · Cited by 182
Research works printed but not linked: 6
- Collins, 2005, Effectiveness of intrathecal ziconotide in multiple pain etiologies: a meta-analysis of three controlled trials [abstract], Pain Med, 6, 195
- Rosenblum, 2008, Intrathecal bolus injection of ziconotide for severe chronic pain: evaluation of analgesic response [abstract], Anesthesiology, 109
- Caraway, 2008, Intrathecal therapy trials with ziconotide: a trialing protocol before initiation of long-term ziconotide intrathecal therapy is presented, Pract Pain Manag, 8, 53
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- McDowell GC. Arachnoiditis pain managed with ziconotide monotherapy and a personal therapy manager: a case review. Phoenix, AZ. Presented at the American Society of Regional Anesthesia and Pain Medicine, November 18–21, 2010.
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Cited by
Blood-Brain Barrier: From Physiology to Disease and Back
Sweeney, M. D., Zhao, Z., Montagne, A., Nelson, A. R., & Zlokovic, B. V. (2019) · Physiological Reviews · doi:10.1152/physrev.00050.2017 · Cited by 2,312
Metadata
- Authors
- McDowell II, G. C., & Pope, J. E.
- ORCID
- Pope, Jason E.
- Venue
- Neuromodulation: Technology at the Neural Interface
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 19
- Issue
- 5
- Pages
- 522-532
- ISSN
- 1094-7159 (ISSN-L)
- PMC
- PMC5067570
- OpenAlex
- W2268570740
- Cited by
- 57
- References
- 49
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 6 · 2019: 4 · 2018: 12 · 2017: 3 · 2016: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
- Locations
- Neuromodulation Technology at the Neural Interface (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Jazz Pharmaceuticals
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- ziconotide, intrathecal drug delivery, refractory chronic pain, dosing regimen, continuous infusion, dose titration, patient-controlled analgesia, drug tolerability, non-opioid analgesics, cerebrospinal fluid pharmacokinetics
- MeSH terms
- Dose-Response Relationship, Drug, Humans, Intractable Pain, Pain, Intractable, Databases, Bibliographic, Treatment Outcome, Analgesics, Non-Narcotic, omega-Conotoxins, Chronic Pain, Infusions, Spinal
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- McDowell II, G. C., & Pope, J. E. (2016). Intrathecal Ziconotide: Dosing and Administration Strategies in Patients With Refractory Chronic Pain. Neuromodulation: Technology at the Neural Interface. https://doi.org/10.1111/ner.12392
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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