Prialt
Prialt (ziconotide) is used to treat severe, long-term pain in adults. You can only use this medication if you can't take other pain medications or if other pain medications stopped working you. Prialt (ziconotide) is injected into the spinal fluid by a healthcare provider through an infusion pump. You can't use this medication if you have a history of psychosis because this medication can make your condition worse.
What is Prialt (ziconotide)?
What is Prialt (ziconotide) used for?
Severe, chronic (long-term) pain
How Prialt (ziconotide) works
Prialt (ziconotide) works to relieve pain by blocking the nerves from sending pain signals to the brain. All pain signals generally travel to the nerves in the spine before it reaches the brain, and Prialt (ziconotide) works directly at the spine to block these signals.
Drug Facts
What are the side effects of Prialt (ziconotide)?
Common Side Effects
- Dizziness (46%)
- Nausea (40%)
- Diarrhea (18%)
- Weakness (18%)
- Sleepiness (17%)
- Vomiting (16%)
- Confusion (15%)
- Walking problems (14%)
- Loss of coordination (14%)
- Headache (13%)
- Blurry vision (12%)
- Difficulty urinating (9%)
- Nystagmus (involuntary movement of the eyes; 8%)
- Forgetfulness (8%)
- Anxiety (8%)
Other Side Effects
- Fever
- Chills/shivers
- Sinus infection
- Eating disorder
- Muscle spasm
- Pain in arms or legs
- Slurred speech
- Change in taste buds
- Memory problems
- Tremor
- Difficulty sleeping
- Itching
- Sweating
Serious Side Effects
- Meningitis (brain infection): fever, headache, stiff neck, weakness, confusion, nausea, vomiting, or seizures
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
being forgetful
change in walking and balance
changes in patterns and rhythms of speech
clumsiness or unsteadiness
confusion
decrease in the frequency of urination
decrease in urine volume
delusions
difficulty in passing urine (dribbling)
difficulty with speaking
feeling unusually cold
problems with speech or speaking
seeing, hearing, or feeling things that are not there
shakiness and unsteady walk
shakiness in the legs, arms, hands, or feet
shivering
slurred speech
thoughts of killing oneself
trembling or shaking of the hands or feet
uncontrolled eye movements
unsteadiness, trembling, or other problems with muscle control or coordination
Less common
Aggressive or angry
chills
confusion as to time, place, or person
convulsions
dark-colored urine
dizziness
drowsiness
fainting
fast heartbeat
fearfulness, suspiciousness, or other mental changes
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
general feeling of illness
holding false beliefs that cannot be changed by fact
lightheadedness
muscle spasm or jerking of all extremities
muscle stiffness
rapid, shallow breathing
severe mood or mental changes
shortness of breath
stiff neck or back
tightness in the chest
troubled breathing
trouble in concentration
trouble in sleeping
unusual behavior unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
Rare
Actions that are out of control
changes in behavior
irritability
talking, feeling, and acting with excitement
Incidence not known
Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Decreased awareness or responsiveness
severe sleepiness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blurred vision
crawling feelings
dizziness
dizziness or lightheadedness
excessive muscle tone, tension, or tightness
feeling of constant movement of self or surroundings
headache
lack or loss of strength
loss of appetite
loss of memory
pain in the arms or legs
problems with memory
sensation of spinning
sleepiness or unusual drowsiness
vomiting
Less common
Acid or sour stomach
back pain
bad, unusual, or unpleasant (after) taste
belching
bladder pain
bloody or cloudy urine
bruising
change in taste
congestion
continuing ringing or buzzing or other unexplained noise in the ears
crying
dehydration
depersonalization
difficulty seeing at night
difficulty with moving
double vision
dysphoria
euphoria
fainting
frequent urge to urinate
hearing loss
hoarseness
increased sensitivity of the eyes to sunlight
increased sensitivity to pain or touch
indigestion
loss of bladder control
loss of taste
lung disorder
nerve pain
pain in the joints
pain or tenderness around the eyes and cheekbones
pale skin
pounding in the ears
quick to react or overreact emotionally
rapidly changing moods
red, scaly, swollen, or peeling areas of the skin
redness or pain at the catheter site
severe muscle stiffness
shortness of breath or troubled breathing
slow or fast heartbeat
stomach discomfort, upset, or pain
sweating
swelling or redness in the joints
tender, swollen glands in the neck
tightness of the chest or wheezing
trouble with swallowing
unusual bleeding or bruising
unusual tiredness or weakness
voice changes
warmth on the skin
weakness or heaviness in the legs
Incidence not known
Burning sensation on the skin
flaking and falling off of skin
skin blisters
sores on the skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Prialt (ziconotide)
Pros
Infusion pump provides medication continuously
Good for people who can't take multiple pills a day
Medication can be stopped suddenly
Medication works directly on the nerves in the spine to target different types of pain
Cons
Has to be injected into the spinal fluid
Risk of infection with the infusion pump
Risk of muscle damage
Might not be able to drive or participate in activities that require coordination
Pharmacist tips for Prialt (ziconotide)
You might experience a change in mood, behavior, or mental state during your treatment with Prialt (ziconotide). This medication can cause symptoms of paranoia, aggressiveness, extreme excitement, depression, suicidal thoughts, confusion, memory problems, or speech problems. Let your provider know how Prialt (ziconotide) is affecting you.
Prialt (ziconotide) can make you less alert and aware of your surroundings. Don't participate in any activities, such as driving or operating machinery, during your treatment.
Let your provider know before starting Prialt (ziconotide) if you are taking other medications that also affect your level of alertness or your mental state. Taking Prialt (ziconotide) together with certain medications can cause more side effects.
Tell your provider if you experience new or worsening muscle pain, soreness, or weakness with or without dark urine. This might be a sign of muscle damage, which needs to be treated right away.
Prialt (ziconotide) can raise the risk of infections, so let your provider know if you experience nausea, vomiting, seizures, fever, headache, or stiff neck.
Speak to your provider if you are pregnant, planning to become pregnant, or breastfeeding before taking Prialt (ziconotide). It's not known if this medication can cause harm to your baby.
Frequently asked questions about Prialt (ziconotide)
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What are the risks and warnings for Prialt (ziconotide)?
Prialt (ziconotide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Changes in thoughts and behavior
Risk factors: History of psychosis | Elderly | Taking other CNS-depressant medications
Prialt (ziconotide) can't be used in people with a history of psychosis (losing touch with reality). This medication can affect your mental state and nervous system. Let your provider know right away if you have trouble concentrating, hallucinations (hearing or seeing things that aren't there), or changes in mood or mental state.
Since Prialt (ziconotide) can affect your mood, this medication can raise the risk of developing new or worsening current depression. Let your provider know if you have thoughts of wanting to harm yourself during your treatment.
Prialt (ziconotide) can also make you less alert and lead to symptoms of confusion, problems with memory, difficulty speaking or understanding language, abnormal thoughts, and forgetfulness. Your risk of these side effects is greater if you're taking other medications that also make you less alert, such as medications for seizures, psychosis, sleep, or blood pressure. And in rare cases, some people became unresponsive while receiving Prialt (ziconotide). Let your caregive or loved ones know of these possible side effects so they can contact your provider right away if you're not able to.
Possible infection
Risk factors: Infusion pump placed outside of the body
Injecting Prialt (ziconotide) into the spinal fluid can raise the risk of a type of brain and spinal cord infection called meningitis. Meningitis can develop when parts of your infusion pump is contaminated by bacteria. Let your provider know if you have any signs or symptoms of meningitis, such as fever, headache, stiff neck, weakness, confusion, nausea, vomiting, and seizures. If an infection occurs, your provider will remove the pump and catheter, and prescribe the appropriate antibiotics.
Muscle damage
Prialt (ziconotide) can raise the level of a protein in the blood called creatine kinase (CK), which can happen during the first two months of treatment. CK is usually found in skeletal muscles, heart muscles, and brain tissues. A high level of CK in the blood might indicate a health problem or muscle damage. Your provider will monitor your CK levels periodically throughout your treatment. Let your provider know if you experience muscle pain, muscle weakness, muscle cramps, overall weakness, or lack of energy.
Can't help with opioid withdrawals
Risk factors: Stopping opioid medications suddenly
If you've been taking opioid medications before starting Prialt (ziconotide), ask your provider how you can stop taking them safely. If you stop opioid medications too suddenly, you might experience withdrawal symptoms including nausea, vomiting, anxiety, fast heart rate, yawning, sneezing, runny nose, or wide pupils. Prialt (ziconotide) isn't an opioid and it can't help ease any withdrawal symptoms.
Problems with driving or operating machinery
Prialt (ziconotide) can lower your alertness and awareness level, so don't drive or operate any machinery during your treatment. Avoid any activities that require your full attention or coordination.
Prialt (ziconotide) dosage forms
Typical dosing for Prialt (ziconotide)
The dose is determined by your provider and will be given via an intrathecal (into the spinal fluid) device. The typical starting dose is 2.4 mcg/day and the maximum dose is 19.2 mcg/day.
Interactions between Prialt (ziconotide) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Prialt (ziconotide) contraindications
Currently getting other treatment or having a health condition that wouldn't allow for injection into the spinal canal
Current infection at injection site
Uncontrolled bleeding problem
Spinal canal obstruction (block)
History of psychosis (loss touch of reality)
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