Every peptide, mapped to the body.

153 peptides, from approved drugs to compounds still in trials, sorted by where they act.

FDA-approved
In clinical trials
Wellness and performance
Cosmetic and topical

Loading the body

FDA-approved

Brain & sleep

Ziconotide

EvidenceFDA approved

ClassN-type Ca-channel blocker (conotoxin)

Ziconotide (Prialt) is an FDA-approved non-opioid peptide for severe chronic pain, given by spinal pump. Learn how it works and its boxed warning.

Reviewed by: William Maish, MD MBA MPH, Clinical Product Lead
Published: October 5, 2026
Last updated: October 5, 2026

Key takeaway

Ziconotide (sold as Prialt) is a synthetic copy of a cone snail venom peptide, used as a non-opioid painkiller delivered directly into the spinal fluid for severe, treatment-resistant chronic pain. It blocks a specific calcium channel on pain-signaling nerves in the spinal cord. It has been FDA-approved in the U.S. since 2004, is given only by intrathecal pump, and carries a boxed warning for serious psychiatric and neurological effects.

At a glance

What it is	A synthetic cone snail peptide that blocks N-type calcium channels (a non-opioid analgesic)
Approved for	Severe chronic pain in patients who need intrathecal therapy and cannot use or have not responded to other treatments
Key fact	In a controlled trial it reduced pain scores substantially more than placebo in refractory pain
Route	Intrathecal infusion via an implanted or external pump
Evidence strength	FDA approved

What is ziconotide?

Ziconotide, sold under the brand Prialt, is a synthetic version of a peptide found in the venom of a marine cone snail, Conus magus. It is a potent non-opioid painkiller used for severe chronic pain, delivered directly into the cerebrospinal fluid around the spinal cord. It was developed under the code SNX-111 (its natural counterpart is omega-conotoxin MVIIA) and approved in the United States in 2004.

How does ziconotide work?

Ziconotide selectively blocks N-type voltage-gated calcium channels found on the pain-sensing nerves that terminate in the dorsal horn of the spinal cord. Those channels control the release of neurotransmitters that pass pain signals up to the brain. By blocking them, ziconotide prevents the release of these pain-signaling chemicals, interrupting transmission of the pain message at the level of the spinal cord.

Because it is a peptide that does not cross readily into the brain from the bloodstream, it has to be infused directly into the spinal fluid through a pump, and it must never be given intravenously. Its mechanism is entirely different from opioids, so it does not cause respiratory depression or the same tolerance, which is part of its appeal for intractable pain. In a controlled trial in refractory cancer and AIDS pain, ziconotide reduced pain scores¹ substantially more than placebo. It has a narrow therapeutic window, so dosing is cautious and slow.

Is it FDA-approved?

Yes. Ziconotide (Prialt) was approved² by the FDA in 2004 for the management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments. It carries a boxed warning for severe psychiatric symptoms and neurological impairment and is contraindicated in people with a history of psychosis.

What is ziconotide prescribed for?

Ziconotide is prescribed for severe chronic pain in carefully selected patients who need intrathecal (spinal) drug delivery and have not responded to or cannot tolerate other therapies, including intrathecal morphine. It is managed by pain specialists using an implanted or external microinfusion pump.

What are the side effects?

According to the prescribing information, common side effects include:

Dizziness and nausea
Confusion and memory problems
Abnormal gait, drowsiness, and involuntary eye movements

More serious considerations include:

A boxed warning for severe psychiatric symptoms (including depression and suicidal thoughts, hallucinations) and neurological impairment, so patients are monitored closely
The need to stop the drug if serious neurological or psychiatric signs develop
Meningitis or other infections if the pump or catheter becomes contaminated

More for brain & sleep

Sources: FDA prescribing information for Prialt; a randomized trial of intrathecal ziconotide for refractory pain (Staats et al., JAMA, 2004, DOI: 10.1001/jama.291.1.63¹), indexed on PubMed. This document is educational and does not constitute medical advice.