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Prialt

ziconotide
Used for Pain
Used for Pain

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.

Last reviewed on May 30, 2022
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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

Common BrandsPrialt
Drug ClassAnalgesic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Prialt (ziconotide)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

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

Contact your healthcare provider immediately if you experience any of the following.
  • Meningitis (brain infection): fever, headache, stiff neck, weakness, confusion, nausea, vomiting, or seizures

Source: 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

Anxiety

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

dementia

difficulty in passing urine (dribbling)

difficulty with speaking

feeling unusually cold

painful urination

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

chest pain

chills

confusion as to time, place, or person

convulsions

cough

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

fever

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

sneezing

sore throat

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

wheezing

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

diarrhea

dizziness

dizziness or lightheadedness

excessive muscle tone, tension, or tightness

feeling of constant movement of self or surroundings

headache

itching

lack or loss of strength

loss of appetite

loss of memory

nausea

pain in the arms or legs

problems with memory

sensation of spinning

sleepiness or unusual drowsiness

vomiting

weight loss

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

constipation

continuing ringing or buzzing or other unexplained noise in the ears

crying

dehydration

depersonalization

depression

difficulty seeing at night

difficulty with moving

double vision

dry mouth

dry skin

dysphoria

euphoria

fainting

frequent urge to urinate

hearing loss

heartburn

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

runny nose

severe muscle stiffness

shortness of breath or troubled breathing

sleeplessness

slow or fast heartbeat

stomach discomfort, upset, or pain

stuffy nose

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

Pros and cons of Prialt (ziconotide)

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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

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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

Pharmacist tips for Prialt (ziconotide)

pharmacist
  • 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.

              faqs

              Frequently asked questions about Prialt (ziconotide)

              How is Prialt (ziconotide) given?
              Prialt (ziconotide) is given by an intrathecal device, also known as an infusion pump. This pump delivers the medication into your spinal fluid slowly throughout the day. The infusion pump can be surgically implanted into your body or worn outside of your body with a catheter (tube) inserted into your spinal area. The pump for Prialt (ziconotide) can only be placed by an experienced healthcare provider.
              Is Prialt (ziconotide) an opioid?
              No, Prialt (ziconotide) isn't an opioid. This medication doesn't have the same risk as opioid pain medications, and can be stopped suddenly without withdrawal effects.
              How will my provider determine my dose of Prialt (ziconotide)?
              Your provider will determine your dose based on your pain level, response to the medication, and side effects. Your provider can adjust your dose up to 2 to 3 times a week. Let your provider know how well the medication is working and if you experience any side effects so they can adjust your dose properly.
              How often will my pump gets refilled?
              Depending on the type of pump you're using and whether or not your Prialt (ziconotide) has been diluted, your provider might refill your pump about every 1 to 3 months. Ask your provider if you're not sure how often your pump needs a refill.
              Will Prialt (ziconotide) affect my thinking or memory?
              Prialt (ziconotide) can affect your thinking or memory. Some people who used this medication experienced confusion, memory loss, trouble speaking or forming words, and strange thoughts. But for most people, these side effects go away in about 2 weeks after they stop Prialt (ziconotide). Talk with your provider if you have questions about the side effects of this medication.
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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.

              risk-warning

              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.

                risk-warning

                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.

                  risk-warning

                  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.

                  risk-warning

                  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.

                    risk-warning

                    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.

                    dosage

                    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

                    Interactions between Prialt (ziconotide) and other drugs

                    Prialt (ziconotide) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Prialt (ziconotide). Please note that only the generic name of each medication is listed below.

                    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.

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                    Prialt (ziconotide) contraindications

                    Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Prialt (ziconotide) will not be safe for you to take.
                    • 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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