PMID- 25645109
OWN - NLM
STAT- MEDLINE
DCOM- 20160502
LR  - 20220310
IS  - 1526-4637 (Electronic)
IS  - 1526-2375 (Linking)
VI  - 16
IP  - 7
DP  - 2015 Jul
TI  - The Relationship Between the Mechanisms of Action and Safety Profiles of 
      Intrathecal Morphine and Ziconotide: A Review of the Literature.
PG  - 1265-77
LID - 10.1111/pme.12666 [doi]
AB  - OBJECTIVE: To better characterize safety profiles associated with the intrathecal 
      (IT) administration of morphine and ziconotide and discuss how they relate to 
      mechanisms of action. METHODS: Published data were evaluated to identify 
      potential relationships between safety profiles of IT morphine and IT ziconotide 
      and their mechanisms of action. RESULTS: Potentially severe and clinically 
      relevant adverse events (AEs) associated with IT morphine include respiratory 
      depression, tolerance, and granuloma formulation, whereas IT ziconotide is 
      associated with neuropsychiatric AEs, such as cognitive impairment, 
      hallucinations, and changes in mood or consciousness, particularly with high 
      doses and rapid titration. AEs associated with these IT therapies may result from 
      spread of the medication out of the IT space into areas of the central and 
      peripheral nervous systems and systemic circulation. AEs that occur usually can 
      be managed and, in some cases, prevented. To mitigate risk, patients' histories 
      should be reviewed to identify potential complicating factors (e.g., obesity or 
      other risk factors for respiratory dysfunction in patients receiving IT morphine; 
      a history of psychosis in patients receiving IT ziconotide). Also, treatment 
      should be initiated at a low dose, titrated slowly, and patients should be 
      closely monitored during treatment. CONCLUSIONS: IT morphine and IT ziconotide 
      are approved by the US Food and Drug Administration for patients who do not 
      respond to less invasive treatments, but the safety profiles of each may make 
      them more or less appropriate for certain patient populations.
CI  - Wiley Periodicals, Inc.
FAU - Webster, Lynn R
AU  - Webster LR
AD  - PRA Health Sciences, Salt Lake City, Utah, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20150122
PL  - England
TA  - Pain Med
JT  - Pain medicine (Malden, Mass.)
JID - 100894201
RN  - 0 (Analgesics, Non-Narcotic)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (omega-Conotoxins)
RN  - 76I7G6D29C (Morphine)
RN  - 7I64C51O16 (ziconotide)
SB  - IM
MH  - Affect/drug effects
MH  - Analgesics, Non-Narcotic/*adverse effects
MH  - Analgesics, Opioid/*adverse effects
MH  - Cognition/drug effects
MH  - Consciousness/drug effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Tolerance
MH  - Granuloma/chemically induced
MH  - Hallucinations/chemically induced
MH  - Humans
MH  - Injections, Spinal
MH  - Morphine/administration & dosage/*adverse effects/therapeutic use
MH  - Pain/*drug therapy
MH  - *Practice Guidelines as Topic
MH  - Respiratory Insufficiency/chemically induced
MH  - omega-Conotoxins/administration & dosage/*adverse effects/therapeutic use
OTO - NOTNLM
OT  - Chronic Pain
OT  - Morphine
OT  - Psychosis
OT  - Refractory
OT  - Respiratory Depression
OT  - Ziconotide
EDAT- 2015/02/04 06:00
MHDA- 2016/05/03 06:00
CRDT- 2015/02/04 06:00
PHST- 2015/02/04 06:00 [entrez]
PHST- 2015/02/04 06:00 [pubmed]
PHST- 2016/05/03 06:00 [medline]
AID - 10.1111/pme.12666 [doi]
PST - ppublish
SO  - Pain Med. 2015 Jul;16(7):1265-77. doi: 10.1111/pme.12666. Epub 2015 Jan 22.