Ziconotide Dosing Calculator

Dose

Starting 2.4 mcg/day, titrated more rapidly

Frequency

Continuous infusion

Duration

Ongoing

Route

Intrathecal infusion (via implanted pump)

Used in some clinical trials; associated with higher rates of neuropsychiatric adverse events; not recommended

Dose

Initial: 2.4 mcg/day (0.1 mcg/hour). Maximum: 19.2 mcg/day (0.8 mcg/hour)

Frequency

Continuous intrathecal infusion

Duration

Long-term continuous therapy

Titrate upward by no more than 2.4 mcg/day (0.1 mcg/hour) at intervals of no more than 2-3 times per week. Slow titration improves tolerability. Dose adjustments should be based on pain relief and adverse effects.

How much bacteriostatic water should I add to a 5 mg vial of Ziconotide?

The community standard is 1 mL of bacteriostatic water for a 5 mg Ziconotide vial. That gives a concentration of 2.50 mg/mL, so a 2 mcg dose is 0.1 units on a U-100 insulin syringe. Adding 1 mL instead doubles the concentration to 5.00 mg/mL and halves the draw to 0 units. Less water = smaller injection volume but harder to measure precisely.

How many syringe units is a 2 mcg dose of Ziconotide?

On a standard U-100 insulin syringe, a 2 mcg dose of Ziconotide is 0.1 units when the 5 mg vial is reconstituted with 1 mL of bacteriostatic water (2.50 mg/mL). If you use 1 mL of bac water instead, draw 0 units (5.00 mg/mL).

What is the standard Ziconotide dose?

Community-reported protocols for Ziconotide typically use 2 mcg once daily via Intrathecal infusion (via implanted pump). 2 mcg is a common starting dose. Slow titration minimizes neuropsychiatric side effects; maximum recommended dose 19.2 mcg/day

How long does a vial of Ziconotide last at 2 mcg once daily?

A 5 mg vial of Ziconotide contains roughly 2083 doses at 2 mcg per injection. At once daily dosing, that is approximately 2083 days (about 298 weeks) of supply per vial. Reconstituted Ziconotide should generally be used within 28 days when refrigerated.

Where do you inject Ziconotide?

Ziconotide is typically injected intrathecal infusion (via implanted pump). Common sites reported in the literature and by users include: Intrathecal (lumbar level via implanted pump or external device). Rotate sites with each injection to reduce localized irritation.

Can I use sterile water instead of bacteriostatic water for Ziconotide?

Bacteriostatic water (containing 0.9% benzyl alcohol as a preservative) is strongly preferred for multi-dose vials like Ziconotide because it inhibits microbial growth and lets a single vial be used over multiple weeks. Sterile water has no preservative and should generally be reserved for single-use preparations only.