The current abuse liability study aims to assess the potential for co-administration of naltrexone (NTX) to reduce the abuse potential of methylphenidate (MPH).
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
94
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).
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).
Vince & Associates Clinical Research, Inc.
Overland Park, Kansas, United States
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...".
Time frame: 70 days
Time to Maximum Effect of Naltrexone
Time to maximum effect.
Time frame: 70 days
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.
Time frame: 70 days
Time to Minimum Effect
Time to minimum effect (bipolar scales only)
Time frame: 70 days
Time-Average Area Under the Effect Curve
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Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.
Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.
Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.
Subjects will be administered single doses on Days 1, 4, 7, and 10 of the Treatment Phase.
Time-average area under the effect curve.
Time frame: 70 days
Adverse Events
Incidence and severity of adverse events
Time frame: 70 days
Clinical Laboratory Abnormalities
Incidence of clinical laboratory abnormalities, based on hematology, clinical chemistry, and urinalysis (UA) test results.
Time frame: 70 days
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.
Time frame: 70 days
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.
Time frame: 70 days
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
Time frame: 70 days
Supine Pulse Rate Assessment
Supine pulse rate (beats per minute) - normal range is 50-100 beats/minute
Time frame: 70 days
Respiratory Rate Assessment
Respiratory rate (breaths per minute) - normal range is 10-24 breaths/minute
Time frame: 70 days
Oral Body Temperature Assessment
Oral body temperature (degrees Celsius) - normal range is 36.1-37.4°C
Time frame: 70 days
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)
Time frame: 70 days
Maximum Observed Plasma Concentration
maximum observed plasma concentration
Time frame: 70 days
Time of the Maximum Observed Plasma Concentration
Time of the maximum observed plasma concentration
Time frame: 70 days
Area Under the Plasma Concentration-time Curve
Area under the plasma concentration-time curve from hour 0 to 24 hours
Time frame: 24 hours