Voltagegated calcium channel blockers

Ziconotide is an antagonist at N-type voltage-sensitive calcium channels (VSCCs) found at presynaptic terminals in the dorsal horn of the spinal cord. The blockade produced by ziconotide is more specific for nociceptive than somatosensory transmission. There is increased expression of N-type VSCCs in chronic pain states which may explain its greater specificity for chronic rather than acute pain states.

In contrast to opioids and local anesthetics, ziconotide is not associated with the development of tolerance.

Although experience with ziconotide is more limited, its other advantage is that it does not cause respiratory depression.

Drug admixtures are commonly used such as opioids and local anesthetics, clonidine and morphine, and/or bupivacaine. Those with ziconotide result in significantly reduced concentrations of this drug.

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