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Intrathecal Pump Use & Drug Delivery

How to Prime the Synchromed® II Naïve Pump

Step 1: Prepare

  • The first time the pump is used with PRIALT, it must be primed with undiluted PRIALT.1
  • Use only undiluted PRIALT 25 mcg/mL (20 mL vial) formulation for naïve pump priming.1
  • Using a 5-mL syringe, remove 2 mL from the vial of undiluted 25 mcg/mL PRIALT.1
  • Set aside the remaining 18 mL in the vial.1

Step 2: Rinse

  • Rinse the internal surfaces of the pump with 2 mL of undiluted PRIALT.1
  • Discard the used 2 mL solution after rinsing.1
  • Repeat the rinse procedure two more times for a total of three rinses.1

Step 3: Fill

  • Fill the naïve pump after priming with the appropriate volume of PRIALT.1
  • Initiate PRIALT dosing at a delivery rate of no higher than 2.4 mcg/day or 0.1 mcg/hour.1

PACC Guidelines recommends a starting dose for continuous intrathecal delivery of 0.5-1.2 mcg/day–consistent with the PRIALT prescribing information.2

How to Refill the Synchromed® II Pump

The Initial Pump Refill1

  • Discard the remaining PRIALT in the pump.
  • The Synchromed® II Pump should be refilled using a new vial of PRIALT within 14 days of the initial pump fill to help ensure appropriate dose administration.*

*In a naïve pump, PRIALT is lost due to two factors that do not occur upon subsequent refills: absorption on internal surfaces such as titanium, and by dilution in the residual space of the device.

All Subsequent Refills1

Fill the pump at least every:

  • 40 days if PRIALT is diluted
  • 84 days if PRIALT is undiluted

Watch a video on how to set up and start a patient on PRIALT

Targeted Drug Delivery

Targeted intrathecal drug delivery can be used to deliver analgesics in close proximity to their site of action—the spinal cord. This could be an approach for patients who develop tolerance or are refractory to systemic analgesics.4

If a patient’s severe chronic pain worsens, the patient may require alternative treatments. PRIALT is a non narcotic treatment that uses targeted drug delivery.1

Illustration of multiple routes of drug delivery vs target drug delivery

Potential benefits of targeted drug delivery:

  • Effective pain relief.2
  • Bypasses systemic circulation.2
  • May help reduce systemic opioid use.4, 5

REFERENCES:

  1. PRIALT® (ziconotide) solution, intrathecal infusion [package insert]. Palo Alto, CA; Jazz Pharmaceuticals.
  2. Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15(5):436-464
  3. Deer TR, Pope JE, Hayek S, et al. The Polyanalgesic Consensus Conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation. 2017;1-36. doi:10.1111/ner.12538
  4. Bolash R, et al. Intrathecal Pain Pumps: Indications, Patient Selection, Techniques, and Outcomes. Neurosurg Clin N Am 25 (2014) 735–742
  5. Pope JE, Deer TR, Bruel BM, Falowski S. Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm. Pain Pract. 2016