Ziconotide, Intrathecal zi-KOH-noh-tide

What are other names for this medicine?

Type of medicine: analgesic (pain medicine)

Generic and brand names: ziconotide, intrathecal; Prialt Intrathecal

What is this medicine used for?

This medicine is used to manage severe chronic pain.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a stroke or other brain disease
• kidney or liver problems
• mental or emotional problems

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

This medicine is given by a drug pump. The pump is a small, battery operated disk and catheter that is implanted under your skin. Check the label on the medicine for directions about your specific dose. Make sure that you understand how to fill and use the pump, and how much medicine to use. Make sure that you refill the pump so that you do not run out of medicine.

Use this medicine exactly as your healthcare provider prescribes. Your provider may adjust your dosage depending on how the medicine works for you.

What should I watch out for?

Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• more outgoing or aggressive behavior than normal
• confusion
• hallucinations
• worsening depression
• suicidal thoughts.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

This medicine may make you feel dizzy or faint, especially when you get up from sitting or lying down. Getting up slowly may help.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines unless your healthcare provider approves.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are using this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Severe confusion, hallucinations (seeing or hearing things that are not there), fainting, thoughts of suicide, vomiting, seizures, fever, headache, stiff neck, trouble walking, memory problems, speech problems, severe muscle pain, severe weakness, dark urine, trouble urinating.

Other: Constipation, trouble sleeping, drowsiness, dizziness, blurred vision, dry mouth, nausea, vomiting, diarrhea.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• alcohol
• antianxiety medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), flurazepam, lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion)
• antidepressants such as amitriptyline, doxepin, fluoxetine (Prozac), fluvoxamine, imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), and sertraline (Zoloft)
• antihistamines such as brompheniramine (Dimetane), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist, Tavist-1), dexchlorpheniramine (Polaramine), and diphenhydramine (Benadryl)
• antipsychotic medicines such as chlorpromazine, fluphenazine, prochlorperazine, and thioridazine
• antiseizure medicines such as carbamazepine (Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), phenytoin (Dilantin), primidone (Mysoline), tiagabine (Gabitril), topiramate (Topamax), and valproic acid (Depacon, Depakene, Depakote)
• barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, and secobarbital (Seconal)
• diuretics such as furosemide (Lasix) and hydrochlorothiazide (Microzide)
• muscle relaxants such as carisoprodol (Soma), chlorzoxazone (Parafon Forte), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), methocarbamol (Robaxin), orphenadrine (Norflex), and tizanidine (Zanaflex)
• natural remedies such as gotu kola, kava, St. John's wort, and valerian
• pain medicines such as codeine, fentanyl (Duragesic, Actiq), hydrocodone (Vicodin, Lortab), hydromorphone (Dilaudid), meperidine (Demerol), morphine (MS Contin, MSIR, Kadian, Oramorph SR), oxycodone (Roxicodone, OxyContin), oxycodone/acetaminophen (Percocet, Tylox), pentazocine (Talwin), and tramadol (Ultram)
• sleeping pills such as chloral hydrate, eszopiclone (Lunesta), temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien)

Do not drink alcohol while you are taking this medicine.

If you are not sure if your medicines might interact

ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines

nonprescription medicines

supplements

natural remedies

and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine in the refrigerator but do not let it freeze. Protect it from heat and light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.