Ziconotide

CLINICAL USE

Analgesia for intrathecal use

DOSE IN NORMAL RENAL FUNCTION

2.4–21.6 mcg daily; majority require <9.6 mcg/day

PHARMACOKINETICS

Molecular weight : 2639.1 (2699.2 as acetate)

%Protein binding : 53

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) : 30 litres

half-life – normal/ESRD (hrs) : 1.3/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function. Use with caution

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unknown dialysability. Dose as in GFR <10 mL/min

HD : Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux : Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD : Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Contraindicated with IT chemotherapy

ADMINISTRATION

Reconstition

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Route

Intrathecal

Rate of Administration

Over 24 hours

Comments

Dilute with preservative-free sodium chloride 0.9%; concentration should be no lower than 5 mcg/mL in an external pump and 25 mcg/mL in an internal pump

OTHER INFORMATION

Use with caution in renal impairment due to lack of studies Has rarely caused rhabdomyolysis, myositis, acute renal failure and urinary retention .

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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