Integrated Pain Solutions, Columbus, OH, USA.
Summit Pain Alliance, Santa Rosa, CA, USA.
Neuromodulation. 2016 Jul;19(5):522-32. doi: 10.1111/ner.12392. Epub 2016 Feb 9.
Ziconotide is a non-opioid analgesic for intrathecal (IT) administration. The aim of this review is to provide a comprehensive and clinically relevant summary of the literature on dosing and administration with IT ziconotide in the management of refractory chronic pain, and to describe novel dosing strategies intended to improve clinical outcomes.
A Medline search was conducted for "ziconotide," supplemented by manual searching of published bibliographies and abstracts from conferences.
Early experience with IT ziconotide in clinical trials combined with improved understanding of drug pharmacokinetics in the cerebrospinal fluid have led to a reappraisal of approaches to trialing and initiation of continuous-infusion therapy in an effort to improve tolerability. The traditional paradigm of trialing by inpatient continuous infusion may be shifting toward outpatient trialing by IT bolus, although definitions of success and specific protocols remain to be agreed upon. Expert consensus on IT continuous infusion with ziconotide suggests a starting dose of 0.5 to 1.2 mcg/day followed by dose titration of ≤0.5 mcg/day on a no more than weekly basis, according to individual patients' pain reductions and regimen tolerability.
Newer modalities that include patient-controlled analgesia and nocturnal flex dosing have been shown to hold promise of further improvements in ziconotide efficacy and tolerability.
Clinical trials and experience confirm the feasibility and usefulness of IT ziconotide in the management of refractory chronic pain. Emerging evidence suggests that additional IT delivery options may further expand the usefulness and benefits of ziconotide.
齐考诺肽是一种鞘内（IT）给药的非阿片类镇痛药。本综述的目的是提供一个全面和临床相关的文献综述，总结 IT 齐考诺肽在治疗难治性慢性疼痛中的剂量和给药，描述旨在改善临床结果的新的剂量策略。
对“齐考诺肽”进行了 Medline 搜索，补充了已发表文献的参考文献和会议摘要的手动搜索。
临床试验中早期使用 IT 齐考诺肽的经验，以及对药物在脑脊液中药代动力学的理解的提高，促使人们重新评估试验方法和开始连续输注治疗，以提高耐受性。通过 IT 推注进行门诊试验的传统模式可能正在向通过 IT 推注进行门诊试验转变，尽管成功的定义和具体方案仍有待商定。关于 IT 连续输注齐考诺肽的专家共识建议起始剂量为 0.5 至 1.2 mcg/天，然后根据个体患者的疼痛缓解和方案耐受性，每周最多滴定剂量不超过 0.5 mcg/天。
已证明包括患者自控镇痛和夜间弹性剂量在内的新方法有望进一步提高齐考诺肽的疗效和耐受性。
临床试验和经验证实了 IT 齐考诺肽在治疗难治性慢性疼痛中的可行性和实用性。新出现的证据表明，额外的 IT 给药选择可能会进一步扩大齐考诺肽的用途和益处。
