Ziconotide for the Management of Cancer Pain: A Budget Impact Analysis

A comprehensive review on ziconotide

“…Consequently, there are limited products and information available regarding its marketing. It has not yet been routinely prescribed in some developed countries, such as England and the United States, with one concern raised is whether this allocation of resources represents the most optimal approach [ 6 ]. Moreover, the regular administration of ziconotide, either on its own or in combination with morphine, offers an alternative for a group of individuals who have limited pain management options.…”

“…Moreover, the regular administration of ziconotide, either on its own or in combination with morphine, offers an alternative for a group of individuals who have limited pain management options. However, it's worth noting that the use of intrathecal ziconotide in conjunction with morphine does increase healthcare costs in England and the budget impact analysis does not strongly suggest that the incremental costs are substantial [ 6 ]. All of the information presented above points to the potential effectiveness of ziconotide in treating chronic pain, yet it's crucial to consider why it hasn't gained widespread application.…”

“…Regardless of the chosen dose, it is essential to maintain a continuous and steady infusion rate. Recent recommendations suggest that initiating treatment with a lower dose, using smaller dose increments, and lengthening the intervals between dose adjustments can improve the safety of ziconotide administration, while also potentially providing economic benefits [ 6 ]. In summary, the approach with ziconotide is to "start low and go slow."…”

“…Ziconotide, administered via continuous intrathecal infusion, appears to maintain its analgesic efficacy for several months without causing permanent adverse effects [ 42 , 60 ]. Nevertheless, it's important to note that toxicity has been linked to the dose and rate of infusion, which restricts the application of ziconotide [ 6 ]. An additional analysis of ziconotide's safety and efficacy revealed that achieving a higher CSF concentration 4 h after intrathecal infusion resulted in a greater analgesic effect but also correspondingly increased the risk of side-effects [ 91 ].…”

“…Pain is a common reason for seeking medical attention [ 1 , 2 ]. It profoundly impacts individuals' quality of life and places a considerable social and economic burden on societies worldwide [ [2] , [3] , [4] , [5] , [6] ]. It is categorized based on its duration, with acute pain having a short-term nature and often being linked to known causes, such as exposure to heat, extreme cold, chemical irritants [ 7 ], and chronic pain which persists or recurs for a minimum of three months [ 2 , [8] , [9] , [10] ], affecting approximately 20 % of the global population [ 2 , 11 ].…”