Ziconotide for Intrathecal Use

  • Corey W. HunterEmail author
  • Dipan Patel


Intrathecal drug delivery systems (IDDS) have been successfully utilized for both chronic, refractory cancer and non-cancer pain. Currently, only three pharmacologic agents are approved for intrathecal (IT) use by the Food and Drug Administration (FDA): morphine, baclofen, and ziconotide. Historically, morphine has been relied upon as a first-line agent for pain with (IT) therapy given its profound analgesic properties. However, even at the small doses typically used with IT therapy, morphine can lead to adverse events, complications with therapy, and even death. Baclofen is a power agent used for spasticity with no application in the treatment or management of chronic pain. Ziconotide is the only non-opioid analgesic agent currently available for IT use in the United States. Its pharmacologic effects are modulated via a selective block of presynaptic neuronal N-type calcium channels in the spinal cord. Given the unique mechanism of action of ziconotide, it holds significant advantages over IT opioids when implemented within IDDS. In this chapter, we will overview the current role of ziconotide for IT use in patients with refractory chronic pain.


Neuromodulation Neuropathic pain Cancer pain Intrathecal drug delivery system Ziconotide Intrathecal pump Refractory chronic pain Nociceptive pain Intrathecal drug delivery system Chronic pain 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Ainsworth Institute of Pain ManagementNew YorkUSA
  3. 3.Garden State Pain Control CenterCliftonUSA
  4. 4.Residents & Fellows SocietyNorth American Neuromodulation Society (NANS)Jersey CityUSA

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