PEPTIDESTAT
ApprovedClinical / approved drugIntrathecalEvidence 4/5

Ziconotide

Also known as: Prialt, SNX-111, omega-conotoxin MVIIA

Ziconotide binds and blocks N-type voltage-gated calcium channels on primary nociceptive afferents in the spinal dorsal horn, preventing presynaptic calcium influx and the release of pain-signaling neurotransmitters.

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Ziconotide
Drug class
Non-opioid N-type voltage-gated calcium channel blocker
Primary targets
N-type (Cav2.2) voltage-gated calcium channels, Dorsal horn primary nociceptive afferents (Rexed laminae I-II)
Dose reference
Per the Prialt label (reference only, not a recommendation): initiate at no more than 2.4 mcg/day (0.1 mcg/hr) intrathecally, titrate up to 2.4 mcg/day at intervals no more than 2-3 times per week, to a recommended maximum of 19.2 mcg/day (0.8 mcg/hr) by about day 21.
Half-life
Serum half-life approximately 1.3 hours; cleared from CSF with a mean half-life of about 4.6 hours (per Prialt label).
Developer / origin
Discovered from Conus magus venom (Olivera et al., University of Utah); developed as SNX-111 by Neurex Corporation, then Elan Pharmaceuticals; now marketed as Prialt
Reference year
2004
Evidence score
4/5 - Approved with randomized controlled trial support (refractory chronic pain)

Approved uses

  • Management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatment, such as systemic analgesics, adjunctive therapies, or intrathecal morphine
Evidence 4/5

Approved with randomized controlled trial support (refractory chronic pain)

Ziconotide is FDA-approved (December 2004) and EMA-authorized for severe refractory chronic pain via intrathecal infusion, supported by multiple randomized, double-blind, placebo-controlled trials in cancer/AIDS pain and chronic nonmalignant pain, though effect sizes were modest and the program is positioned as later-line due to a narrow safety window.

Investigational compound with human randomized or phase 2/3 evidence.

Evidence basis

  • FDA-approved Prialt label and DailyMed prescribing information establishing indication, intrathecal-only route, dosing, and boxed warning
  • Staats 2004 JAMA randomized controlled trial in refractory cancer/AIDS pain
  • Rauck 2006 and Wallace 2006 randomized double-blind placebo-controlled trials in severe chronic and nonmalignant pain
  • EMA Prialt EPAR product information and StatPearls pharmacology review

How to read this entry

Dose references and half-life values are pulled from trial protocols, labels, reviews, or published summaries where available. They are context for research and comparison, not a personal dosing recommendation.

Status matters: approved drugs have regulated indications; investigational compounds are still being studied; research-only peptides do not have established human dosing, safety, or efficacy for consumer use.

Ziconotide guides

Read the matching guide or adjacent research pages for more context.

Ziconotide Peptide: Prialt, Cone Snail Venom and Intrathecal Pain LimitsZiconotide is an FDA-approved, intrathecal-only N-type calcium channel blocker derived from cone snail venom, with strong refractory-pain evidence and a narrow safety window.Abaloparatide Peptide: Tymlos, PTHrP Analog Uses and Safety LimitsAbaloparatide is an FDA-approved PTHrP(1-34) analog peptide that builds bone in high-risk osteoporosis, backed by the ACTIVE and ATOM trials with clear duration and safety limits.Atosiban Peptide: Tractocile, Oxytocin Antagonist Tocolytic for Preterm LaborAtosiban is an EU-approved oxytocin and vasopressin receptor antagonist peptide used intravenously as a short-term tocolytic to delay preterm labor.Bivalirudin Peptide: Angiomax Direct Thrombin Inhibitor GuideBivalirudin is an FDA-approved, hirudin-derived bivalent direct thrombin inhibitor used as a short-acting intravenous anticoagulant during percutaneous coronary intervention.

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