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Dyskinesia Caused by Ziconotide-Baclofen Combination in an Adolescent Affected by Cerebral Palsy
  1. Marco Pozzi, PhD*,
  2. Luigi Piccinini, MD*,
  3. Flavio Giordano, MD,
  4. Carla Carnovale, PharmD,
  5. Valentina Perrone, PharmD,
  6. Paolo Pellegrino, MD,
  7. Stefania Antoniazzi, PharmD§,
  8. Anna Carla Turconi, MD*,
  9. Sonia Radice, BiolD and
  10. Emilio Clementi, MD*,
  1. *Scientific Institute IRCCS Eugenio Medea, Lecco
  2. AOU Anna Meyer Children’s Hospital, Florence
  3. Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco, “Luigi Sacco” University Hospital, Università di Milano
  4. §IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico
  5. Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
  1. Address correspondence to: Emilio Clementi, MD, Department of Biomedical and Clinical Sciences University of Milano, Via GB Grassi 74, 20157 Milano, Italy (e-mail: emilio.clementi{at}unimi.it).

Abstract

Objective To report on the first case of ziconotide-induced dyskinesia. Ziconotide, a synthetic peptide analogue of the ω-conotoxin MVIIA that blocks selectively N-type voltage-sensitive calcium channels, has been used in intrathecal administration for 30 years. Ziconotide is a drug of choice for chronic pain because of its efficacy and flexibility because it can substitute or complement other intrathecal therapies including morphine or baclofen. Whereas substantial information is available regarding its efficacy, systematic data regarding the safety of ziconotide remain scant. The adverse reactions to ziconotide described so far regard only the coordination and execution of intentional movements.

Case Report A 15-year-old male patient developed dyskinesia affecting the head and upper limbs 2 days after administration of ziconotide as an add-on therapy to an established regimen of treatment with baclofen. The strict temporal relationship between ziconotide administration and dyskinesia, together with the absence of any other clinical alteration, led to the hypothesis of a possible adverse drug reaction. Ziconotide was thus withdrawn, and the symptoms disappeared within 2 days.

Conclusions An analysis of the signaling pathways of baclofen and ziconotide revealed a possible drug interaction that allowed ziconotide to trigger dyskinesia.

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Footnotes

  • The authors declare no conflict of interest.

    This work was supported by the Italian Ministry of Health (Ricerca Corrente 2014, to E.C. and A.C.T.).

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