WESTON, Mass., Sept. 19 /PRNewswire/ -- The recently approved analgesic ziconotide (Prialt(R), Elan Pharmaceuticals) has been met with enthusiasm by the pain-management community because of its ability to improve analgesia in patients with refractory pain unresponsive to opioids. However, a newly published review reveals that the drug has significant limitations -- including potentially severe adverse effects.
The review appears in the September/October 2005 issue of American Journal of Hospice & Palliative Medicine.
Eric Prommer, MD, Assistant Professor at the UCLA School of Medicine and a physician in the Greater Los Angeles VA Healthcare Center's Palliative Care Program, conducted an exhaustive analysis of the existing research on ziconotide. His results showed that ziconotide does have significant analgesic benefits for patients intolerant of other treatments because it successfully inhibits pain messages to the central nervous system (CNS).
However, he also found significant risks associated with the drug, especially at higher dose and titration rates. "Ziconotide may produce analgesia at the potential cost of severe adverse effects," he writes.
Most reported adverse effects are CNS-related, including dizziness, somnolence, blurred vision, ataxia, involuntary rapid eye movement (nystagmus), prolonged periods of unresponsiveness, and confusion (particularly in older patients). Auditory and visual hallucinations and paranoid ideation have also been reported, occurring most frequently in patients with a prior psychiatric history. Discontinuation of the drug resolved the symptoms in all reported cases.
The drug appears to have a "ceiling" related to dose and infusion rates. Dr. Prommer recommends starting the ziconotide infusion at a low dose (< 0.1 µg/h), with incremental increases no more than once or twice weekly. "[It] should not be used in lieu of more traditional methods of managing opioid- resistant pain. How and when it is to be used is yet to be determined," he concludes.
To order the article, visit the Journal's Web site at http://www.hospicejournal.com. For additional information, contact the publisher at American Journal of Hospice & Palliative Medicine, 470 Boston Post Road, Weston, MA 02493, Tel. 781-899-2702 x142.
Contact: Richard DeVito, Sr., Publisher American Journal of Hospice & Palliative Medicine 470 Boston Post Rd. Weston, MA 02493 Phone: 781-899-2702 x142 http://www.hospicejournal.comradsr@pnpco.com
American Journal of Hospice & Palliative MedicineCONTACT: Richard DeVito, Sr., Publisher of American Journal of Hospice &Palliative Medicine, +1-781-899-2702 x142, radsr@pnpco.com
Web site: http://www.hospicejournal.com//
