Ziconotide — Dose Evidence | Peptides Community

Reference only — not a dosing recommendation.

Approved regimen

Approved labeled regimen

Product-, indication-, and jurisdiction-specific — see the monograph

FDA-approved regimen:
Intrathecal only via micro-infusion device (SynchroMed II or equivalent)
Start: No more than 2.4 mcg/day (0.1 mcg/hour)
Titrate: Increase by up to 2.4 mcg/day at intervals no more frequently than 2–3 times per week
Maximum: 19.2 mcg/day (0.8 mcg/hour) by Day 21
Device: Use with the Medtronic SynchroMed II or III infusion system per manufacturer's manual for programming, reservoir rinse, initial fill, and refill procedures
Initial fill with naïve pump: Use undiluted 25 mcg/mL; refill within 14 days
Subsequent refills (undiluted): at least every 84 days; (diluted): at least every 40 days

Studied in trials

Studied in trials — not a recommended dose

Pivotal fast-titration (Staats 2004): 0.2–7.2 mcg/day with high AE rates
Wallace 2006 slow titration: 0.1–0.9 mcg/day starting dose, showed improved tolerability — this is a consensus clinical approach, NOT the FDA label starting dose

Not established

Safety or efficacy by any non-IT route (IV, epidural, intranasal, subcutaneous)
Paediatric safety and efficacy
Long-term safety beyond 12 months in controlled studies
Combination with IT opioids (limited data; possible synergy with morphine but must use separate pumps)