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NaltrexonePhase 1NCT03769064

Study for Naltrexone on the Abuse Potential of Methylphenidate

A Phase 1 study testing Methylphenidate 60 mg, Treatment Phase Sequence 4213 and Treatment Phase Sequence 2134 in people with Naltrexone and Methylphenidate Abuse, run by Avekshan LLC at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The current abuse liability study aims to assess the potential for co-administration of naltrexone (NTX) to reduce the abuse potential of methylphenidate (MPH). Read more about this study

Who is it for?
Ages 18 to 45 yearsHealthy volunteers can take part
Conditions the study is for
Naltrexone, Methylphenidate Abuse
What is being tested?
Methylphenidate 60 mg, Treatment Phase Sequence 4213 and Treatment Phase Sequence 2134
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
94 participants
Where
1 siteUnited States
Study dates
27 Mar 2018to 20 Jun 2018
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Recreational stimulant users, defined as ≥10 lifetime non-therapeutic experiences (i.e., for psychoactive effects) with CNS stimulants (e.g., amphetamines, cocaine, MPH) and ≥1 non-therapeutic use of a CNS stimulant within the 12 weeks prior to Screening.
  • A body mass index of ≥18 to ≤34 kg/m2 at Screening.
  • In good health, as determined by medical history, PE, vital signs assessments, 12-lead ECG, and clinical laboratory evaluations.
  • A female study subject must meet one of the following criteria:
  • If of childbearing potential - is abstinent from heterosexual intercourse or uses 2 of the accepted contraceptive regimens from at least 30 days prior to the first administration of the study medication, during the study, and for at least 30 days after the last dose of the study medication. An acceptable method of contraception includes the following:
  • Progestogen-containing hormonal contraceptives (birth control pills, injectable/implantable/insertable hormonal birth control products, transdermal patch) and use of condom with spermicide
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  • Intrauterine device (without hormones)
  • Condom
  • Spermicide
  • If of non-childbearing potential - should be surgically sterile (i.e. has undergone complete hysterectomy, bilateral oophorectomy, or tubal ligation) or in a menopausal state (at least 1 year without menses), as confirmed by follicle-stimulating hormone (FSH) levels (postmenopausal must be confirmed by the subject having a serum FSH greater than 40 mIU/mL at Screening). Females of non-childbearing potential must present a proof of postmenopausal status and/or partial or total hysterectomy; if such proof is not available, the female will be considered to be of childbearing potential.
  • A male study subject must agree to use one of the accepted contraceptive regimens during the study and for at least 90 days after the last dose of the study medication:
  • Abstinence from heterosexual intercourse
  • Female partner use of hormonal contraceptives (birth control pills, injectable/implantable/insertable hormonal birth control products, transdermal patch)
  • Female partner with intrauterine device (with or without hormones)
  • Female partner with condom with spermicide used by male study subject
  • Female partner of non-childbearing potential
  • Male sterilization with absence of sperm in the post-vasectomy ejaculate A male study subject must agree not to donate sperm during the study and for at least 90 days after the last dose of the study medication.
  • Subjects must agree to refrain from use of any prescription or over-the-counter medications (with the exception of stable oral, implanted, or injected contraceptive hormones) or herbal remedies and consumption of any alcohol within the exclusionary periods and throughout the study.
  • Subjects must be able to speak, read, and understand English in order to complete the study assessments.
  • Able to provide written informed consent to participate in the study, and to abide by the study restrictions.
  • Willing and able to comply with all study procedures, including a total of 15 overnight stays at the study site.

Who cannot join

  • Evidence of moderate or severe substance use disorder (excluding nicotine and/or caffeine) within the past 2 years, as defined by the DSM-V, or has a lifetime history of participation in a drug rehabilitation program (excluding past participation in tobacco smoking cessation program or previous court-mandated treatment).
  • History of opioid dependence.
  • Subject has a positive urine drug or alcohol screen upon admission into the clinic at the start of the Qualification or Treatment Phase (Day -1 of Parts 1 and 2), except for cannabinoids (delta-9-tetrahydrocannabinol [THC]), which may be seen because of the long half-life of THC and slow release from adipose tissue. If THC is positive, inclusion will be at the discretion of the Investigator. Tests with positive results may be repeated and/or subjects may be rescheduled at the Investigator's discretion.
  • Abnormal pulse rate, blood pressure, oral body temperature, or respiration rate at Screening and prior to administration of any study drug that, in the opinion of the Investigator, increases the risk to the subject of participation in the study. For these parameters, out-of-range values that are not clinically significant (as determined by the Investigator) may be repeated twice and the subject may be enrolled if at least 1 repeated value is within acceptable range.
  • Abnormal 12-lead ECG at Screening and prior to first dose of any study drug that, in the opinion of the Investigator, increases the risk to the subject of participation in the study.
  • Any clinically significant medical history that, in the opinion of the Investigator, increases the risk to the subject of participation in the study.
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  • A history of a major surgical procedure within 30 days prior to the start of study drug administration (Day 1 of Part 1), or any planned surgery during the study.
  • A history of any clinically significant illness within 30 days of the start of study drug administration (Day 1 of Part 1), as determined by the Investigator.
  • History of liver disease.
  • History of narrow-angle glaucoma, based on medical history and/or subject self-reporting.
  • Presence of galactose intolerance, lactase deficiency, or glucose-galactose malabsorption.
  • Presence or history of any narrowing or blockage of the digestive system.
  • Donation of blood, platelets, or plasma within 3 months prior to Screening.
  • Presence or a history of any clinically significant neurological, gastrointestinal, renal, hepatic, cardiovascular, psychiatric, respiratory, metabolic, endocrine, hematological, or other major disorders (including a history of angioedema), as determined by the Investigator.
  • A family history of sudden death or sudden cardiac arrest, as determined by the Investigator.
  • Presence or history of any medically diagnosed, clinically significant Axis I psychiatric disorder (including bipolar disorder, mood disorder, anxiety disorder, thought disorder, any psychotic disorder).
  • Presence of acute suicidality (within 6 months of Screening), as evidenced by a positive response to Question 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS), indicating active suicidal ideation with any intent to act, at Screening or Check-in for each part.
  • Lifetime history of suicidal behavior such that a determination of "yes" is made on the Suicidal Behavior section of the C-SSRS for "Actual Attempt," "Interrupted Attempt," "Aborted Attempt," or "Preparatory Acts or Behavior".
  • Subject history or family history of motor tics or a diagnosis of Tourette's syndrome.
  • History of seizures and/or epilepsy.
  • Receipt of any investigational medicinal product (IMP) or new chemical entity within 30 days or 5 half-lives (if known) of the first study drug administration (Day 1 of Part 1), whichever is longer.
  • Receipt of any medications known to chronically alter drug absorption or elimination processes (e.g., rifampin, glucocorticoids, St. John's wort) within 30 days of the first study drug administration (Day 1 of Part 1).
  • Previous use of any antidepressants, seizure medications, vasodepressors, or theophylline within 3 months prior to Screening. Use of other prescription medications (with the exception of stable oral, implanted, or injected contraceptive hormones) within 30 days before first dosing (Day 1 of Part 1), unless it is determined by the Investigator that there will be no impact on the study procedures or on subject safety.
  • Use of any over-the-counter systemic or topical medication, or vitamin or mineral supplements, within 14 days of first study drug administration (Day 1 of Part 1) unless, in the opinion of the Investigator, the medication will not interfere with study procedures or compromise safety.
  • Consumption of foods or beverages containing poppy seeds, grapefruit, or Seville oranges within 7 days of first study drug administration (Day 1 of Part 1).
  • History of, or a known allergic reaction to, any study drug excipients, or a history of multiple food/drug allergies, or any clinically significant allergic condition (excluding nonactive hay fever).
  • Any clinically significant abnormal PE finding.
  • In the opinion of the Investigator, any clinically significant abnormal laboratory safety findings at Screening and prior to first study drug administration (one repeat assessment at Screening and Check-in for Part 1 is acceptable).
  • Consumption of caffeine within 24 hours prior to Check-in for either study part.
  • Consumption of alcohol or alcohol-containing products within 24 hours prior to Check-in for either study part.
  • Participation in strenuous physical activity within 72 hours prior to Check-in for either study part (e.g., marathon runners, weight lifters).
  • Known presence of serum hepatitis, or positive serologic test for hepatitis B surface antigen, hepatitis C virus antibody, or human immunodeficiency virus (HIV) antibody.
  • Subjects who, in the opinion of the Investigator, should not participate in the study.
  • Use of any opioids within 14 days prior to the first study drug administration in the Treatment Phase.
  • Physical dependence on opioids based on a naloxone challenge test.
  • Elevated aspartate aminotransferase or alanine aminotransferase ≥1.5 x upper limit of normal.
  • History of additional risk factors for torsades de pointes (e.g., heart failure, hypokalemia, family history of Long QT Syndrome).
  • QTcF >450 msec or any clinically significant abnormality on the 12-lead ECG at Screening or Check-in for each part.
  • Presence or history of hypertension of cardiovascular disease.
  • History of depressive disorder within the last 2 years prior to Screening, or Patient Health Questionnaire (PHQ)-9 score >9 at Screening or Check-in for each part, or history of other severe psychiatric disorders (e.g., anxiety, schizophrenia, or bipolar disorder), as declared by subject or as judged by the Investigator.
  • Females who are pregnant or lactating.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Vince & Associates Clinical Research, Inc.

    Overland Park, Kansas, 66212

Other trials in United States

About this study

Official title: Phase 1, Single-dose, Double-blind, Rand., Placebo- and Active-controlled, 4-period, 4-sequence Crossover, Proof-of-Concept Study to Evaluate Effect of Naltrexone on Abuse Potential of Methylphenidate in Healthy Recreational Stimulant Users

The current abuse liability study aims to assess the potential for co-administration of naltrexone (NTX) to reduce the abuse potential of methylphenidate (MPH).

Read the detailed description

The abuse of MPH, as a Schedule II substance, is a well-documented problem. Studies in animal models, including primates, show that high-dose MPH can produce reinforcement or reward. A number of studies suggest that the rapid elevation of MPH levels in the blood and brain that occurs following intranasal or oral administration of supra-therapeutic doses is a key requirement for development of MPH-associated euphoria, reinforcement, and addiction. The concerns about MPH abuse potential and addiction often play a role in the decision of patients, parents, or physicians who opt against treatment with MPH, despite its effectiveness. This provides an imperative for development of MPH formulations that are therapeutically potent but with lower abuse potential. Methylphenidate acts mainly through the dopaminergic system. At sufficiently high doses, MPH can also activate the mu opioid receptors (MOPR) in the brain. Recent data indicate that blockade of MOPRs by naltrexone (NTX) blocks the rewarding effects of MPH in mice. Clinical studies on the modulatory effect of NTX on dopamine release following chronic amphetamine use also support the involvement of opioid-dopamine interactions in the reinforcing and rewarding effects of amphetamine. These data support the hypothesis that NTX will block the reinforcing effect of MPH in humans.

Being tested
Placebo, Methylphenidate 60 mg, Treatment Phase Sequence 4213, Treatment Phase Sequence 2134, Treatment Phase Sequence 1342
Keywords
ADHD, attention deficit hyperactivity disorder, stimulant
Medical subject headings
Attention Deficit Disorder with Hyperactivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PlaceboDrug

    Also called Qualification Phase (Part A)

    Potential subjects will be screened to determine their eligibility for the study within 28 days of the first dose in the Qualification Phase (i.e., Days -28 to -2). Eligible subjects will be admitted to the clinical site on Day -1 of the Qualification Phase (Part 1) and randomized on Day 1 to receive placebo and MPH (60 mg) in 1 of 2 sequences with a 48-hour washout between dose administrations (i.e., dose administration on Days 1 and 3).

  • Methylphenidate 60 mgDrug

    Also called Qualification Phase (Part A)

    Potential subjects will be screened to determine their eligibility for the study within 28 days of the first dose in the Qualification Phase (i.e., Days -28 to -2). Eligible subjects will be admitted to the clinical site on Day -1 of the Qualification Phase (Part 1) and randomized on Day 1 to receive placebo and MPH (60 mg) in 1 of 2 sequences with a 48-hour washout between dose administrations (i.e., dose administration on Days 1 and 3).

  • Treatment Phase Sequence 4213Drug

    Also called Treatment 1

    Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.

  • Treatment Phase Sequence 2134Drug

    Also called Treatment 2

    Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.

  • Treatment Phase Sequence 1342Drug

    Also called Treatment 3

    Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.

  • Treatment Phase Sequence 3421Drug

    Also called Treatment 4

    Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.

Study groups in NCT03769064
Study groupRoleWhat they receive
Qualification Phase (Part A)ExperimentalPlacebo/Methylphenidate (60 mg) on days 1 and 3
Receives: Drug: Placebo; Drug: Methylphenidate 60 mg
Qualification Phase (Part B)ExperimentalMethylphenidate (60 mg)/Placebo on days 1 and 3
Receives: Drug: Placebo; Drug: Methylphenidate 60 mg
Treatment Phase Sequence 4213ExperimentalMethylphenidate 60 mg/Naltrexone 100 mg Methylphenidate 60 mg/Placebo Placebo/Placebo Methylphenidate 60 mg/Naltrexone 50 mg
Receives: Drug: Treatment Phase Sequence 4213
Treatment Phase Sequence 2134ExperimentalMethylphenidate 60 mg/Placebo Placebo/Placebo Methylphenidate 60 mg/Naltrexone 50 mg Methylphenidate 60 mg/Naltrexone 100 mg
Receives: Drug: Treatment Phase Sequence 2134
Treatment Phase Sequence 1342ExperimentalPlacebo/Placebo Methylphenidate 60 mg/Naltrexone 50 mg Methylphenidate 60 mg/Naltrexone 100 mg Methylphenidate 60 mg/Placebo
Receives: Drug: Treatment Phase Sequence 1342
Treatment Phase Sequence 3421ExperimentalMethylphenidate 60 mg/Naltrexone 50 mg Methylphenidate 60 mg/Naltrexone 100 mg Methylphenidate 60 mg/Placebo Placebo/Placebo
Receives: Drug: Treatment Phase Sequence 3421

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maximum Effect of Naltrexone

    To evaluate the maximum effect of 2 doses (50 and 100 mg) of Naltrexone on the abuse potential of a single dose (60 mg) of Methylphenidate in healthy recreational stimulant users using the bipolar Visual Analogue Scale for Drug Liking.

    Visual Analogue Scale (bipolar) is an administered test where the patient assess the following.:

    • Drug Liking, Overall Drug Liking, Alertness/Drowsiness, Overall Take the Drug Again;

    The response anchors are 0 (strong disliking), 50 (neither like nor dislike), and 100 (strong liking).

    Visual Analogue Scale for Drug Liking will be determined periodically over the 8 hour period following each dose administration to assess for response to test question, "At this moment, my liking for this drug is...".

    Measured: 70 days

Secondary outcomes (16)
  1. Time to Maximum Effect of Naltrexone

    Time to maximum effect.

    Measured: 70 days

  2. Effect of Naltrexone

    To evaluate the safety and tolerability of concomitant administration of Naltrexone (50 or 100 mg) and Methylphenidate (60 mg) in healthy recreational stimulant users using the unipolar Visual Analogue Scale for High.

    Visual Analogue Scale (unipolar) is an administered test where patient assesses the following:

    Good Effects, High, Bad Effects

    The response anchors are 0-100 with 0 being the least effect and 100 being the most effect.

    Visual Analogue Scale for High will be administered prior to each dose administration and periodically over the 8 hour period following each dose administration to assess for response to test question, "I am feeling high," with anchor points of 0 (no effect) and 100 (Extremely) being the most effect.

    Measured: 70 days

  3. Time to Minimum Effect

    Time to minimum effect (bipolar scales only)

    Measured: 70 days

  4. Time-Average Area Under the Effect Curve

    Time-average area under the effect curve.

    Measured: 70 days

  5. Adverse Events

    Incidence and severity of adverse events

    Measured: 70 days

  6. Clinical Laboratory Abnormalities

    Incidence of clinical laboratory abnormalities, based on hematology, clinical chemistry, and urinalysis (UA) test results.

    Measured: 70 days

  7. Heart Rate Assessment via Electrocardiogram

    Heart rate assessment will be performed using a 12-lead Electrocardiogram (ECG). Normal range is QTcF ≤ 450 msec.

    Single 12-lead ECGs will be repeated once if either of the following criteria apply:

    • QT interval corrected for heart rate using Fridericia's method (QTcF) >500 msec
    • QTcF change from the baseline (predose) is >60 msec. 12-lead ECGs evaluations may be repeated at the Investigator's (or designee's) discretion and may be performed at other times if judged to be clinically appropriate or if the ongoing review of the data suggests a more detailed assessment of ECGs is required. The Investigator (or designee) will perform a clinical assessment of each 12-lead ECG.

    Measured: 70 days

  8. Heart Rate Assessment via Cardiac Telemetry

    Patient's heart rate and rhythm will be assessed via continuous cardiac telemetry. Monitoring will be conducted on all dosing days from predose until at least 12 hours postdose.

    Normal range is QTcF ≤ 450 msec.

    Measured: 70 days

  9. Supine Blood Pressure Assessment

    Supine blood pressure (systolic/diastolic in mmHg) - normal range for measurements: systolic blood pressure - 86-140 mmHg and diastolic blood pressure - 50-90 mmHg

    Measured: 70 days

  10. Supine Pulse Rate Assessment

    Supine pulse rate (beats per minute) - normal range is 50-100 beats/minute

    Measured: 70 days

  11. Respiratory Rate Assessment

    Respiratory rate (breaths per minute) - normal range is 10-24 breaths/minute

    Measured: 70 days

  12. Oral Body Temperature Assessment

    Oral body temperature (degrees Celsius) - normal range is 36.1-37.4°C

    Measured: 70 days

  13. Physical Examinations (PEs)

    The following assessments will be performed for Physical Examinations (PEs):

    • General Appearance
    • HEENT (head, eyes, ears, nose and throat))
    • Neck/Thyroid
    • Cardiovascular
    • Respiratory
    • Gastrointestinal
    • Musculoskeletal/Extremities
    • Skin
    • Other (will be specified)

    Measured: 70 days

  14. Maximum Observed Plasma Concentration

    maximum observed plasma concentration

    Measured: 70 days

  15. Time of the Maximum Observed Plasma Concentration

    Time of the maximum observed plasma concentration

    Measured: 70 days

  16. Area Under the Plasma Concentration-time Curve

    Area under the plasma concentration-time curve from hour 0 to 24 hours

    Measured: 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Dec 2018
  2. Study start27 Mar 2018
  3. Primary completion20 Jun 2018
  4. Study completion20 Jun 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Model description
The study will consist of a 2-period crossover Qualification Phase (Part 1) to ensure subject eligibility for the treatment phase of the study, and a 4-period crossover Treatment Phase (Part 2) to determine the effect of concomitant administration of MPH and NTX on subjective pharmacodynamic (PD) measures of abuse, relative to MPH and placebo.
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
94 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03769064
Sponsor's protocol ID
AVK-001
Status last verified
Dec 2018
First submitted
11 Oct 2018
Last updated
7 Dec 2018
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Methylphenidate 60 mg, Treatment Phase Sequence 4213 and Treatment Phase Sequence 2134 in people with Naltrexone and Methylphenidate Abuse, run by Avekshan LLC at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 21 inclusion and 41 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Dec 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Maximum Effect of Naltrexone (time frame: 70 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Dec 2018.

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