Safety Assessment of Atomoxetine With MA IV Administration



Status:Completed
Conditions:Psychiatric
Therapuetic Areas:Psychiatry / Psychology
Healthy:No
Age Range:Any
Updated:2/4/2013
Start Date:October 2009
End Date:March 2010
Contact:Todd Zorick, MD PhD
Email:tzorick@mednet.ucla.edu
Phone:888-791-9988

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A Study to Assess the Cardiovascular, Cognitive and Subjective Effects of Atomoxetine in Combination With Intravenous Methamphetamine


This is a study of 30 nontreatment seeking individuals who use MA compared to 30 individuals
who do not use MA (control subjects). The study has three goals: 1. it aims to identify the
brain regions and pathways that may contribute to the problems of MA abusers in performing
mental tasks; 2. it will serve as a double-blind, placebo-controlled, within-subjects study
to determine the safety and tolerability, and positive effects of MA in MA- abusing
volunteers treated with atomoxetine or placebo; 3. It aims to compare the brain activity as
measured by structural and functional magnetic resonance imaging (fMRI). These are
noninvasive brain imaging procedures, that will be used to study brain function while
control and MA using participants take atomoxetine or placebo and perform tests of memory
and concentration.

MA abusing participants will undergo a 1-day outpatient screening and if it is safe for the
participants to proceed with the study they will participate in two inpatient phases of the
study that will occur in the UCLA research setting, the General Clinical Research Center.
The first inpatient stay will be 15 days, and the second will be a 9 days stay that includes
drug administration and assessments. There will be at least a two week interval between
inpatient phases. During the inpatient phases participants will receive alternating study
drugs; atomoxetine or placebo and four sessions of IV MA administration or placebo.

The study schedule for control participants will include a 1-day outpatient screening and
two phases of outpatient administration of atomoxetine or placebo with a two week study drug
free interval between the phases. Four to five of the outpatient study visits will involve
cognitive tests and brain imaging studies.

In addition, current research has linked certain genes that are related to neurotransmitters
with drug abuse and memory impairment (e.g., A1 allele for the D2 dopamine receptor and
catechol-O-methyltransferase). Therefore blood samples will be obtained to test for these
genes in order to relate the findings to brain function.


FOR MA ABUSING SUBJECTS ONLY

Inclusion Criteria:

In order to participate in the study, MA-using subjects must:

1. Be fluently English-speaking volunteers who meet DSM-IV criteria for MA abuse or
dependence.

2. Be between 18 and 50 years of age.

3. Be able to verbalize understanding of consent form, able to provide written informed
consent, and verbalize willingness to complete study procedures.

4. Have smoked or injected methamphetamine for more than two years.

5. Produce a methamphetamine-positive urine prior to study entry.

6. Have vital signs as follows: resting pulse between 50 and 90 bpm, blood pressures
between 105-150mm Hg systolic and 45-90mm Hg diastolic. Note that a blood pressure of
150/90 and pulse of 90 is too high for randomization but will allow participants to
be enrolled if an acceptable range is demonstrated on a separate occasion.

7. Have an ECG performed that demonstrates normal sinus rhythm, normal conduction, and
no clinically significant arrhythmias.

8. Agree to abstain from MA during the study, evidenced by a MA-negative urine each
morning of the study.

9. If female, have a negative pregnancy test and agree to use one of the following
methods of birth control, or be postmenopausal, have had a hysterectomy or have been
sterilized.

1. oral contraceptives

2. barrier (diaphragm or condom) with spermicide, or condom only

3. intrauterine progesterone,or non-hormonal contraceptive system

4. levonorgestrel implant

5. medroxyprogesterone acetate contraceptive injection

6. complete abstinence from sexual intercourse

NOTE: Recent intermittent alcohol or other illicit drug use without physical dependence is
allowable (however a benzodiazepine-free urine should be produced to document absence of
recent use).

Exclusion Criteria:

1. A current or past history of seizure disorder, including alcohol- or
stimulant-related seizure, febrile seizure, or significant family history of
idiopathic seizure disorder.

2. A history of head trauma that resulted in neurological sequelae (e.g., with loss of
consciousness [LOC] > 15 minutes, or that required hospitalization. Also,
individuals with 3 or more head injuries with LOC > 5 minutes will be excluded).

3. Do not meet DSM-IV criteria (by SCID) for drug dependence other than meth, with the
exception of nicotine and/or marijuana dependence.

4. Any previous medically serious adverse reaction to MA including loss of
consciousness, chest pain, or epileptic seizure resulting in hospitalization.

5. Meeting diagnostic criteria or receiving psychopharmacological treatment for the
following Axis I disorders within the last 6 months: anorexia nervosa, bulimia,
psychosis, bipolar I disorder, organic brain disease, dementia, major depression,
schizoaffective disorder, or schizophrenia.

6. Evidence of clinically significant heart disease, hypertension or significant medical
illness.

7. Have any history of hypersensitivity to atomoxetine, glaucoma, motor tics or with a
family history or diagnosis of Tourette's syndrome.

8. Have any preexisting severe gastrointestinal narrowing, small bowel inflammatory
disease, intestinal adhesions, past history of peritonitis, or cystic fibrosis.

9. Be pregnant or nursing.

10. Have a significant family history of early cardiovascular morbidity or mortality.

11. Have a diagnosis of adult asthma, including those with a history of acute asthma
within the past two years, and those with current or recent (past 2 years) treatment
with inhaled or oral beta-agonist or steroid therapy (due to potential serious
adverse interactions with methamphetamine).

12. Be actively using albuterol or other beta agonist medications, regardless of formal
diagnosis of asthma. (Inhalers are sometimes used by MA addicts to enhance MA
delivery to the lungs.) If respiratory disease is excluded and the subject will
consent to discontinue agonist use, s/he may be considered for inclusion.

13. For subjects suspect for asthma but without formal diagnosis, 1) have a history of
coughing and/or wheezing, 2) have a history of asthma and/or asthma treatment two or
more years before, 3) have a history of other respiratory illness, e.g.,
complications of pulmonary disease (exclude if on beta agonists), 4) use
over-the-counter agonist or allergy medication for respiratory problems (e.g.,
Primatene Mist): a detailed history and physical exam, pulmonary consult, and
pulmonary function tests should be performed prior to including or excluding from the
study or 5) have an FEV1 <70 %.

14. Have any illness, condition, and/or use of medications that in the opinion of the
site Principal Investigator and the admitting physician would preclude safe and/or
successful completion of the study.

15. Have active syphilis that has not been treated or refuse treatment for syphilis.

16. Be undergoing HIV treatment with antiviral and non-antiviral therapy.

17. Have AIDS according to the current CDC criteria for AIDS - MMWR 1999;48
(#RR-13:29-31).

18. Have neurological disorders including Parkinson's disease.

19. Have evidence of significant liver or kidney dysfunction.

20. Have a history of urinary retention or bladder outlet obstruction.

21. Be UCLA students or staff.

22. Have evidence of active tuberculosis infection.
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