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Active ingredient ziconotide increases suicidal thoughts?

Researchers at the RUB-Klinikum Bergmannsheil suspect that the analgesic drug ziconotide enhances suicidal thoughts in pre-stressed patients. In two concrete cases a causal connection could be discovered.

11/23/2010

The analgesic ziconotide is suspected in scientists to increase the suicidal thoughts of patients. Ziconotide is manufactured synthetically and resembles the structure of the venom of the sea snail „Conus magus“. The painkiller was launched on the drug market six years ago and should be an effective alternative to morphine. Scientists of the pain ambulance „RUB-Klinikum Bergmannsheil“ in Bochum put forward the assumption that the named active substance not only relieves pain, but can lead to psychological side effects in patients. Thus, it could be observed that in some patients apparently suicidal thoughts are intensified. The Bochum researchers suspect that as unwanted effect the mood of the person affected is worsened and at the same time the emotional feeling „fear“ lowered and the impulse control is reduced. If patients with suicidal thoughts are affected in advance, certain mechanisms may increase triggers for suicide. The Bochum researchers advise in the science magazine „PAIN“ Therefore, when taking the drug to closely monitor the patient's mental state. Doctors should make a careful diagnosis and closely monitor the patient's mental health situation.

Undefeated, the active ingredient offers numerous advantages over other strong analgesics. It does not cause any side effects typical of opioid as with antidepressants and does not lead to the development of tolerance. The product has been distributed since 2004 in Europe and the US pharmaceutical market. It offers an alternative in patients for whom opioid drugs are insufficient or have undesirable side effects. But for some time, the suspicion that the drug ziconotide has side effects that may cause adverse consequences for patients.

Evaluation of studies brought first indications
In some studies, it was observed that patients taking suicide took suicide attempts in several cases. However, the authors of the studies at that time were unable to identify any connection with the substance ziconotide. In the trade magazine „Pain“ However, the scientists presented two new cases, which substantiate the suspicion that the drug enhances suicidal thoughts. This is how Prof. Dr. Christoph Maier opposite the trade magazine „Pain“: „The first case is particularly tragic, because a patient who has been experiencing pain in his feet and numerous unsuccessful attempts at treatment for the first time has seen Ziconotid significantly improve his pain for the first time. "Initially, there were no discernable side effects An initial mild onset of depression even fell at the start of treatment, and after about three weeks of drug intake, the patient made a balanced and unremarkable impression on the physicians, and after eight weeks of therapy, the patient surprisingly committed suicide for all.

Causal relationship discovered
In a second case, a 39-year-old female patient was treated with the drug, which has been suffering from severe back pain for a good 14 years. About 20 years ago, the woman fell ill after a pregnancy in a depressive episode and then undertook a suicide attempt. After two months of ziconotide treatment, the patient reported more suicidal thoughts. In addition, the person concerned reported other psychological side effects such as hallucinations and states of confusion as well as a partially occurring memory loss. These conditions would also have led to two serious car accidents, as the patient further reported. The researchers suspect that the accidents had a suicidal character. Thereafter, the drug was discontinued by the doctors. After only two weeks, the thoughts of suicide were gone. The other psychological side effects were after weaning after. „Both cases support the suspicion that there is a causal link between ziconotide and suicidal tendencies, "said Professor Maier, who, in the wake of the observations, called on drug regulatory agencies and the pharmaceutical manufacturer to review the adverse reactions. „Manufacturers and regulatory authorities should urgently review this again, "the expert said.

At the beginning of treatment, the doctor advises his medical colleague to carefully examine patients for their mental state and to monitor them closely and sustainably during treatment. The follow-up examinations should also be carried out independently of the analgesic effect of the preparation. „These cases also underline that increasing pain therapy is not always the way to go if there is a failure to use common drugs, "said Dr. Maier. „Often it is even a wrong path, which was also pointed out at this year's congress of German pain therapists a few weeks ago. "Patients should not discontinue the medicine on their own, but first talk to the attending physician about the further course of therapy. (Sb)