Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Under suspicion: the painkiller ziconotide could increase suicidal ideation

23.11.2010
Experts recommend more precise diagnosis and closer medical surveillance / RUB pharmacists issue a warning in “PAIN”

The active agent ziconotide, the synthetic toxin of the cone snail (Conus magus), was acclaimed a safe alternative to morphine when it was introduced six years ago. Now it is increasingly suspected of causing patients to commit suicide. Researchers working under the auspices of Prof. Christoph Maier (Director of the Pain Clinic Bergmannsheil at the Ruhr University in Bochum) presume that ziconotide not only suppresses the transmission of pain stimuli, but also deteriorates the frame of mind and could simultaneously reduce anxiety and impulse control.

These mechanisms could promote suicidal tendencies in vulnerable patients. The research scientists thus advise careful diagnosis and monitoring of the psychic condition of patients treated with ziconotide. They have published their findings in the Medical Journal “PAIN.”

Alternative to opioids for severe pain

Ziconotide has numerous advantages, including the fact that it does not have any of the side effects typically associated with opioids, such as respiratory depression (asphyxia). Moreover, it does not lead to tolerance development. It has been on the European and American market since 2004, being administered to patients with intrathecal pumps if opioids do not suffice or if these trigger inacceptable side effects. Recently, the number of reports on the psychic side effects of ziconotide has increased. The researchers in Bochum analysed numerous studies, registering an increasing number of attempted suicides, which the original authors had not attributed to the ziconotide treatment. In PAIN, the physicians from RUB present two new cases, which underscore the suspicion that ziconotide enhances suicidal ideation.

Suicide despite pain relief and normal test results

As Prof. Maier stated, the first case is particularly tragic, the patient concerned, who had had pain is his feet for many years and undergone numerous unsuccessful treatments, having experienced a distinct improvement and pain relief for the first time when treated with ziconotide. There were no side effects. Tests disclosed that his depressiveness, which had also not been particularly marked before the ziconotide treatment commenced, even decreased. After a good three weeks, he appeared to be happy to all concerned. But two months after the ziconotide treatment had commenced he unexpectedly committed suicide. A further patient, a 39-year-old woman, who had undergone pain treatment for backache for 14 years, had had depressive phases 20 years previously and had attempted suicide after a pregnancy. Two months after the ziconotide treatment had commenced – which, according to current recommendations, should never have been administered to her in the first place due to her medical history – she mentioned that she had increased suicidal ideation. Moreover, she complained of other psychic side effects with hallucinations, confusion and partial amnesia, which had resulted in two severe car accidents. It is conceivable that the accidents were also of suicidal character. The physicians stopped the ziconotide treatment. Two weeks later both the suicidal ideation and the hallucinations were history.

Pharmaceutical companies and approval authorities must investigate the situation

Prof. Maier concludes that both cases underscore the assumption that there is a causality between ziconotide and suicidal tendencies. The pain specialist strongly emphasizes that the pharmaceutical companies and approval authorities should urgently investigate this yet again. All patients must be analysed for possible psychic disorders before treatment commences and closely monitored irrespective of pain relief due to the drug. The above-mentioned cases also underscore the fact that an increase in pain treatment when standard drugs fail is not always the correct mode of action. As Prof. Maier so aptly said, it is often even exactly the wrong path. This had already been pointed out a few weeks previously at the Congress of the German Pain Therapists (Kongress der deutschen Schmerztherapeuten)

Title

Christoph Maier, Hans-Helmut Gockel, Kai Gruhn, Elena K. Krumova and Marc-Andreas Edel: Increased risk of suicide under intrathecal ziconotide treatment? – A warning. In: PAIN, online 1.11.2010, doi:10.1016/j.pain.2010.10.007, http://www.painjournalonline.com/article/S0304-3959%2810%2900615-9/abstract

Further Information

Prof. Dr. Christoph Maier, Leiter der Schmerzklinik des RUB-Klinikums Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Tel. +49(0)234/302-6366, E-Mail: christoph.maier@rub.de

Editor: Meike Drießen

Dr. Josef König | idw
Further information:
http://www.ruhr-uni-bochum.de/
http://www.painjournalonline.com/article/S0304-3959%2810%2900615-9/abstract

More articles from Health and Medicine:

nachricht Usher syndrome: Gene therapy restores hearing and balance
25.09.2017 | Institut Pasteur

nachricht MRI contrast agent locates and distinguishes aggressive from slow-growing breast cancer
25.09.2017 | Case Western Reserve University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: LaserTAB: More efficient and precise contacts thanks to human-robot collaboration

At the productronica trade fair in Munich this November, the Fraunhofer Institute for Laser Technology ILT will be presenting Laser-Based Tape-Automated Bonding, LaserTAB for short. The experts from Aachen will be demonstrating how new battery cells and power electronics can be micro-welded more efficiently and precisely than ever before thanks to new optics and robot support.

Fraunhofer ILT from Aachen relies on a clever combination of robotics and a laser scanner with new optics as well as process monitoring, which it has developed...

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Fraunhofer ISE Pushes World Record for Multicrystalline Silicon Solar Cells to 22.3 Percent

25.09.2017 | Power and Electrical Engineering

Usher syndrome: Gene therapy restores hearing and balance

25.09.2017 | Health and Medicine

An international team of physicists a coherent amplification effect in laser excited dielectrics

25.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>