Effect of Galantamine on Short-term Abstinence (GAL-K)

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2014 by University of Pennsylvania
Sponsor:
Collaborators:
Information provided by (Responsible Party):
University of Pennsylvania
ClinicalTrials.gov Identifier:
NCT01669538
First received: August 16, 2012
Last updated: March 13, 2014
Last verified: February 2014
  Purpose

This is a randomized, double-blind, placebo-controlled study to test whether a medication called galantamine (Brand Name: Razadyne) will help smokers quit and whether it reduces cognitive problems that smokers experience during a quit attempt.


Condition Intervention Phase
Tobacco Use Disorder
Drug: Galantamine
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: Repurposing Cholinesterase Inhibitors for Smoking Cessation.

Resource links provided by NLM:


Further study details as provided by University of Pennsylvania:

Primary Outcome Measures:
  • Total number of smoke-free days (biochemically verified) during a 7-day quit attempt. [ Time Frame: Days 17-23 ] [ Designated as safety issue: No ]
    Day 17 will be the beginning of a 7-day quit attempt, during which the total number of days of abstinence will be assessed.


Secondary Outcome Measures:
  • Cognitive performance [ Time Frame: Baseline (Day 0), Day 14 (day before start of 24-hour abstinence period), Day 16 (after 24-hour abstinence period ends) ] [ Designated as safety issue: No ]
    Participants will complete neurocognitive tests designed to test working memory and attention. These tests are similar to computer games, in that participants will push a button in response to the pictures they see.

  • Subjective symptoms [ Time Frame: Baseline (day 0), Days 7, 14, 16, 17, 19, 21, and 23 ] [ Designated as safety issue: No ]
    The subjective symptoms, such as smoking behavior, smoking urges, mood, and nicotine withdrawal symptoms, will be assessed at the following in-person sessions: Baseline session; Day 7 (brief monitoring visit); Day 14 (Day before 24-hour abstinence period), Day 16 (after 24-hour abstinence period), and Days 17-23 (during the 7-day quit attempt).

  • Side effects of galantamine [ Time Frame: Baseline (day 0), Days 7, 14, 16, 17, 19, 21, and 23 ] [ Designated as safety issue: Yes ]
    Side effects of galantamine will be assessed at the following in-person sessions: Baseline session; Day 7 (brief monitoring visit); Day 14 (Day before 24-hour abstinence period), Day 16 (after 24-hour abstinence period), and Days 17-23 (during the 7-day quit attempt).


Estimated Enrollment: 80
Study Start Date: August 2012
Estimated Study Completion Date: August 2015
Estimated Primary Completion Date: July 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Galantamine

Galantamine hydrobromide-ER (extended release) is currently marketed for the treatment of Alzheimer's disease. The dosing regimen follows the FDA-approved guidelines. For the first week of study treatment, participants will take 8mg daily of galantamine-ER, preferably with food. 8mg is the lowest dose and this period is designed to introduce the medication into their system. After the initial week, participants will increase their daily dose to 16mg. They will remain on 16mg daily until the end of the treatment period for a total of 23 days on active study medication.

Galantamine will be purchased, encapsulated, and packaged into blister packs by the Investigational Drug Service at the University of Pennsylvania. Both active medication and placebo will look identical.

Drug: Galantamine
Other Names:
  • Galantamine hydrobromide ER
  • Razadyne ER
Placebo Comparator: Placebo

Participants assigned to the placebo (sugar pill) arm will take one capsule daily, preferably with food, for a total of 23 days. They will follow the same instructions and complete the same procedures as those in the active treatment.

Placebo ingredients (sucrose filler and gel capsules) will be purchased, encapsulated, and packaged into blister packs by the Investigational Drug Service at the University of Pennsylvania. Both active medication and placebo will look identical.

Drug: Placebo
Other Name: Sugar pill

Detailed Description:

Galantamine, an FDA-approved treatment for Alzheimer's disease, is used to treat cognitive impairment by enhancing acetylcholine through inhibition of the enzyme, acetylcholinesterase. We propose randomized double-blind placebo-controlled study of short-term (23 days) treatment with galantamine.

Eighty chronic smokers will complete a validated procedure for screening new medications. An equal number of subjects will be assigned to one of two groups: galantamine-ER or placebo. Participants in both groups will take one capsule each day and follow the same procedures. This is not a cross-over trial.

For participants in the galantamine group, following an initial 1-week drug run-up phase (8mg daily of galantamine-ER), the medication dose will be increased to 16mg daily of galantamine-ER for the remainder of the study (up to Day 23).

On Day 15, smokers will begin a mandatory 24-hour abstinence period, which will be followed by a programmed smoking lapse on Day 16. Smokers will then be instructed to abstain for the following 7 days (observed abstinence). Following completion of the study, participants will be offered standard smoking cessation treatment.

On Days 0 (Baseline), 14, and 16, subjects will perform the following computer tasks: a working memory task (Visual/Spatial N-Back), sustained attention tasks (Penn Continuous Performance Task [PCPT-nl] and XO Reaction Time Task), a recall memory task (Word Recognition), an interference control task (Stroop test), and a response inhibition task (Stop Signal Task).

The primary outcome is to identify changes in behavioral performance and subjective symptoms following two weeks treatment of galantamine and after 24 hours of abstinence, compared to baseline.

This study will provide information about the role of the cholinergic system during brief abstinence and whether enhancing acetylcholine reduces abstinence-induced cognitive symptoms that promote smoking relapse. Information obtained in this study may further establish cognitive performance measures as endophenotypes for nicotine dependence.

  Eligibility

Ages Eligible for Study:   18 Years to 60 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Smokers who are between 18 and 60 years of age who self-report smoking at least 10 cigarettes (menthol and non-menthol) per day for at least the last 6 months.
  2. Interest in quitting smoking in the next 2 to 6 months.
  3. Healthy as determined by the Study Physician, based on a medical evaluation including medical history and physical examination, and psychiatric evaluation.
  4. Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the combined consent and HIPAA form.
  5. Women of childbearing potential must consent to use a medically accepted method of birth control while participating in the study (e.g., condoms and spermicide, oral contraceptive, Depo-provera injection, contraceptive patch, tubal ligation).

Exclusion Criteria:

  1. Smoking behavior

    1. Use of chewing tobacco, snuff, and/or snus.
    2. Current enrollment in a smoking cessation program, or use of other smoking cessation medications in the last month or plans to do either in the next 2 months.
    3. Provide a carbon monoxide (CO) breath sample reading less than 10 parts per million (ppm) at either the Intake or Baseline visits.
  2. Alcohol/Drugs

    1. Lifetime history of substance abuse (other than nicotine) and/or currently receiving treatment for substance abuse (e.g., alcohol, opioids, cocaine, stimulants, PCP, benzodiazepines, or study-prohibited medications/recreational drugs) as determined by self-report during the phone screen and/or through the MINI during the Intake visit.
    2. Current alcohol consumption that exceeds 25 standard drinks/week over the past 6 months.
    3. Providing a breath alcohol concentration (BrAC) reading of greater than or equal to 0.01 at the Intake, Baseline, or Testing Days.
    4. A positive urine drug screen for cocaine, amphetamines, methamphetamines, benzodiazepines, PCP, methadone, barbiturates, and opiates at the Intake visit, Baseline visit, or the Testing days.
  3. Medical

    1. Women who are pregnant, planning a pregnancy in the next 3 months, or lactating; all female subjects shall undergo a urine pregnancy test at the Intake visit and must agree in writing to use an approved method of contraception. Following enrollment, pregnancy tests will be conducted at the Baseline visit and Testing days for all female subjects of child-bearing potential.
    2. Diagnosis of Alzheimer's Disease or dementia.
    3. Current treatment of cancer or diagnosed with cancer (except basal cell carcinoma) in the past 6 months.
    4. Liver/kidney failure, peptic ulcer disease, benign prostate hypertrophy.
    5. Asthma or chronic obstructive pulmonary disease (COPD).
    6. History (last 6 months) of abnormal heart rhythms, tachycardia and/or cardiovascular disease (stroke, angina, heart attack). These conditions will be evaluated on a case by case basis by the Study Physician/Health Care Provider.
    7. Serious or unstable disease within the past 6 months, as determined by the Study Physician/Health Care Provider.
    8. Clinically significant abnormalities within physical examination and vital signs at Medical Screen. Abnormalities will be assessed by the Study Physician/Health Care Provider and eligibility will be determined on a case-by-case basis.
    9. Any impairment (physical and/or neurological) including visual or other impairment preventing cognitive task performance.
    10. Uncontrolled high blood pressure (Systolic BP greater than 160 and/or Diastolic BP greater than 100).
    11. Hearing impairment, significant hearing loss (more than 20% in either ear), cochlear implants, or bi-lateral hearing aids.
    12. History of brain injury.
    13. History of epilepsy or a seizure disorder.
    14. Color Blindness.
    15. Low or borderline intellectual functioning - determined by receiving a score of less than 90 on the Shipley Institute of Living Scale (SILS) which correlates with the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Estimated IQ Test (administered at the Intake visit).
  4. Psychiatric Exclusions (determined by self-report on phone screen and/or through the MINI during the Intake visit)

    1. Current diagnosis of major depression. Persons with a history of major depression, in remission for 6 months or longer, are eligible, provided they are not excluded based on medications (below).
    2. Suicide risk score on MINI greater than 0.
    3. History or current diagnosis of schizophrenia, psychosis, and/or bipolar disorder.
    4. Current or past hypomanic/manic episode.
    5. Current or history of a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD).
  5. Medication

    1. Current use, recent discontinuation (within the last month) of any form of smoking cessation medications (i.e., Zyban, Wellbutrin, Wellbutrin SR, Chantix, nicotine replacement therapy).
    2. Current use or recent discontinuation (within the last 60 days) of any of the following:

      • Anti-anxiety or panic disorder medications.
      • Anti-psychotic medications.
      • Mood-stabilizers (e.g., Lithium, Lamictal/lamotrigine, Neurontin/gabapentin, Topamax/topiramate, valproic acid, Tegretol/carbamazepine).
      • Anti-depressants (e.g., Wellbutrin, MAOIs, SSRIs, tricyclic antidepressants).
      • Prescription stimulants (e.g., Provigil, Ritalin, Adderall).
      • Systemic Steroids (e.g., Prednisone).
      • Alzheimer's disease medications (e.g., Acetylcholinesterase inhibitors (ACIs), Aricept/donepezil, Exelon/rivastigmine, Tacrine, or memantine).
      • Parkinson's disease medications(e.g., Cogentin/benztropine).
      • Irritable bowel syndrome medication (e.g., Dicylomine/Bentyl).
      • Heart medications (e.g., quinidine or Procardia/nifedipine).
      • Peptic ulcer disease medication (e.g, Zantac/ranitidine).
      • Muscle relaxants (e.g., Soma/carisoprodol, Anectine/succinylcholine).
      • Anti-fungal medication (e.g., Nizoral/ketoconazole).
      • Anti-seizure medications (e.g., Ativan, Banzel, Carbatrol, Dilantin, Lamictal, Gabitril, Lyrica, Neurontin, Tegretol, Topamax).
      • COPD medication (e.g., Atrovent/Ipratropium Bromide).
      • Urinary retention medications (e.g., Duvoid/bethanechol, Proscar/finasteride, Avodart/dutasteride, Dibenzyline/phenoxybenzamine, Regitine/phentolamine).
      • Eye medication (e.g., Atropine).
    3. Daily use of any of the following:

      • Opiate-containing medications for chronic pain (Duragesic/fentanyl patches, Percocet, Oxycontin).
      • Medication for asthma (albuterol, Serevent, Combivent, Advair, Flovent, Azmacort, Symbicort).
    4. Known drug allergy to the study medication.

    Subjects will be instructed to refrain from using any study prohibited drugs/medications (both recreational and prescription) throughout their participation in the study. After final eligibility is confirmed, subjects who report taking contraindicated medication(s) over the course of the study period may only remain eligible if the Study Physician and/or Principal Investigator determines that the contraindicated medication(s) do/did not impact the study design, data quality, and/or subject safety/welfare. Subjects are permitted to take necessary prescription medications not included within the exclusion list during the study.

  6. General exclusions

    1. Current, anticipated, or pending enrollment in another research program over the next 2-3 months that could potentially affect subject safety and/or the study data/design as determined by the Principal Investigator and/or Study Physician.
    2. Not planning to live in the area for the next two months.
    3. Any medical condition, illness, disorder, or concomitant medication that could compromise participant safety or treatment, as determined by the Principal Investigator and/or Study Physician.
    4. Inability to provide informed consent or complete any of the study tasks as determined by the Principal Investigator.
    5. Completion of neurocognitive assessments and/or use of study medication(s) at the CIRNA in the past 6-months that could influence performance on study tasks as determined by the Principal Investigator.
    6. Not able to effectively communicate in English (reading, writing, speaking).
    7. Missing 2 or more consecutive sessions, or 3 or more sessions during the medication period.
    8. Missing 2 or more consecutive doses during the medication period.
    9. Missing 3 or more doses throughout the medication period.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01669538

Contacts
Contact: Rebecca Ashare, Ph.D. 215-746-5789 rlashare@mail.med.upenn.edu
Contact: Paul Sanborn, M.S. 215-746-7150 sanborn@mail.med.upenn.edu

Locations
United States, Pennsylvania
Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Sub-Investigator: Caryn Lerman, Ph.D.         
Sub-Investigator: Steven Siegel, M.D., Ph.D.         
Sub-Investigator: Andrew Strasser, Ph.D.         
Sponsors and Collaborators
University of Pennsylvania
Investigators
Principal Investigator: Rebecca Ashare, Ph.D. University of Pennsylvania
  More Information

No publications provided

Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT01669538     History of Changes
Other Study ID Numbers: 815789, UPCC15912, K23DA035295
Study First Received: August 16, 2012
Last Updated: March 13, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pennsylvania:
Galantamine
Nicotine Bitartrate
Nicotine Tartrate
Nicotine dependence
Tobacco Dependence

Additional relevant MeSH terms:
Tobacco Use Disorder
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Galantamine
Cholinesterase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cholinergic Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Parasympathomimetics
Autonomic Agents
Peripheral Nervous System Agents
Nootropic Agents
Central Nervous System Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on October 19, 2014