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  1. USES: Ziconotide is indicated for the management of severe chronic pain in patients who are intolerant or refractory to other treatment, including systemic analgesics, or adjunctive therapies, and in whom intrathecal therapy is warranted.
  1. PHARMACOLOGY: Ziconotide is bound to N-type voltage-sensitive calcium channels located on the primary nociceptive afferent nerves in the superficial layers of the dorsal horn in the spinal cord. It blocks depolarization-induced increases in presynaptic intracellular calcium, which controls excitatory neurotransmitter release into the synaptic cleft. Ziconotide is derived from the venom of the marine snail Conus magus.
  1. EPIDEMIOLOGY: Overdose is rare.
    1. COMMON: Dizziness, nausea, confusion, somnolence, nystagmus, and asthenia. OTHERS: Nausea, vomiting, anorexia, constipation, diarrhea, taste perversion, cognitive impairment, agitation, stupor, headache, dizziness, asthenia, ataxia, delirium, dysarthria, tremor, hallucinations, urinary retention, hypotension, peripheral edema, atrial fibrillation, abnormal ECG, blurred vision, elevated liver enzymes, muscle spasm, pain in limb, rhabdomyolysis, sinusitis, and fever.
    1. Ziconotide overdose information is limited. Exaggerated pharmacologic effects (ie, ataxia, nystagmus, dizziness, stupor, unresponsiveness, spinal myoclonus, confusion, hypotension, nausea, and vomiting) are expected to occur following ziconotide intrathecal doses greater than the maximum recommended dose of 19.2 mcg/day.
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