Behavioral and Physiological Effects of Cocaine in Cocaine-dependent Participants Treated With Levodopa in Combination With Carbidopa and Entacapone (LCE) (COST)

May 17, 2018 updated by: Adam Bisaga, New York State Psychiatric Institute
An inpatient safety study to characterize the cardiovascular and behavioral effects of cocaine administration in the presence of LCE. The proposed study involves an inpatient stay of 12 days during which participants will have two cocaine-administration sessions, each including five doses of smoked cocaine with ascending doses.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Cocaine dependence remains a serious public health problem; however no clearly effective pharmacological treatments have been identified to date. We hypothesize that identification of subgroups of cocaine-dependent patients will help to develop targeted and more effective treatments. We hypothesize that individuals who have difficulties in achieving abstinence have a deficit in dopaminergic functioning and correcting this deficit using dopaminergic medication levodopa in combination with carbidopa and entacapone (LCE) to increase availability and uptake of levodopa to synthesize dopamine in the brain will result in clinical improvement. We were unable to locate any clinical reports that might provide data on the interaction between cocaine and LCE. Therefore, we would like to conduct an inpatient safety study to characterize the cardiovascular and behavioral effects of cocaine administration in the presence of LCE. The proposed study involves an inpatient stay of 12 days during which participants will have two cocaine-administration sessions, each including five doses of smoked cocaine with ascending doses. Participants will be maintained on placebo capsules prior to the first study session and on the LCE prior to the second session. Physiological (HR, BP, ECG) as well as behavioral (subjective effects) effects of cocaine will be monitored during cocaine-administration sessions. Serial blood samples will also follow cocaine administration to assess whether the pharmacokinetics of cocaine is altered during treatment with LCE. All participants will also undergo two cognitive testing sessions, one on placebo and one on LCE, employing a computerized battery (Quarters, Gambling task, Drug Stroop, Threat Responsivity task). There will be an optional functional MRI (fMRI) component that will investigate behavioral and neural indicators of reward responsivity, thought to reflect dopaminergic transmission. Participants choosing to undergo fMRI testing will complete two sessions, on the same days as the cognitive task sessions. Data obtained in the present study will be used to inform the large, controlled trial of LCE in treatment seeking cocaine-dependent individuals.

Study Type

Interventional

Enrollment (Actual)

15

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10032
        • New York State Psychiatric Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years to 50 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult, age 21-50.
  • Smokes cocaine on average at least 1x/week; currently spends at least $30/week on cocaine. Has been using cocaine for at least 6 months Urine toxicology positive for cocaine metabolites
  • Has patterns of smoked cocaine use in terms of frequency and amount that parallels or exceed those administered in the study
  • Able to give informed consent and comply with study procedures

Exclusion Criteria:

  • Current DSM-IV criteria of substance use disorders with the exception of cocaine or nicotine dependence, or a history of alcohol or cannabis dependence.
  • Request for drug treatment
  • Unstable medical disorders, or medical disorders that might interfere with study participation, including current seizure disorder, heart disease or a history of serious adverse effects due to cocaine.
  • Judged to be noncompliant with study protocol
  • Concurrent use of any psychotropic medications
  • Concurrent use of MAO inhibitors or epinephrine (patients must be off MAOIs for a minimum of 2 weeks)
  • Clinical laboratory tests outside normal limits that are clinically unacceptable to the study physician (systolic BP > 140 and < 90, diastolic BP > 90 and < 60, and heart rate > 90; BUN, creatinine, LFTs > ULN; hematocrit < 34 for women, < 36 for men; pseudocholinesterase deficiency)
  • Positive serum pregnancy test, lactation, or unwillingness to use a satisfactory method of birth control
  • History of myocardial infarction or ischemia, clinically significant left ventricular hypertrophy, angina, clinically significant arrhythmia, or mitral valve prolapse
  • History of narrow angle glaucoma or prostate cancer
  • History of melanoma or current suspicious undiagnosed skin lesions
  • Currently meeting DSM-IV criteria for all major psychiatric/psychotic disorders other than transient psychosis due to drug abuse
  • History of allergic reaction or adverse reaction to study medications (levodopa/carbidopa/entacapone).
  • Current parole or probation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Basic Science
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental
L-dopa / carbidopa / entacapone (LCE)
Drug: L-dopa / carbidopa / entacapone (LCE)
For this trial we propose a target dosage of L-dopa / carbidopa / entacapone of 400 mg L-dopa / 100mg carbidopa / 200 mg entacapone, twice daily.
Other Names:
  • L/C/E

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Blood pressure
Time Frame: (baseline) prior to and after each of the 6 cocaine administrations at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose
Maximum SBP, maximum DPB will be obtained at baseline, prior to the first session dose, and after each consecutive dose (0, 6, 12, 25, 50, 50 mg). Changes from baseline in blood pressure in the used by cocaine administration under placebo condition will be compared to those obtained during treatment with LCE using repeated measures ANOVA.
(baseline) prior to and after each of the 6 cocaine administrations at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose
heart rate
Time Frame: (baseline) prior to and after each of the 6 cocaine administrations at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose
Heart rate will be obtained at baseline, prior to the first session dose, and after each consecutive dose (0, 6, 12, 25, 50, 50mg). Changes from baseline in heart rate in the used by cocaine administration under placebo condition will be compared to those obtained during treatment with LCE using repeated measures ANOVA.
(baseline) prior to and after each of the 6 cocaine administrations at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Composite (or Profile) of Pharmacokinetics
Time Frame: 18, 32, 46, 60, 74, 104 minutes post dose
Cmax, Area Under Curve, Tmax
18, 32, 46, 60, 74, 104 minutes post dose
subjective cocaine experience
Time Frame: Done at baseline and at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose
1) An assessment of the subjective cocaine experience with and without study medication using a standard battery of 100 mm visual analog scales (VAS) that will be administered pre-dosing and after each dose. Each VAS item will be summarized using AUC, mean and peak scores collected for all time points and analyzed using ANOVA with corrections for multiple comparisons.
Done at baseline and at 4, 18, 32, 46, 60, 74, 104 and 134 minutes after the first dose

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

New York State Psychiatric Institute

Collaborators

National Institute on Drug Abuse (NIDA)
Columbia University

Investigators

  • Principal Investigator: Adam Bisaga, M.D., Columbia University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2010

Primary Completion (Actual)

April 1, 2012

Study Completion (Actual)

April 1, 2012

Study Registration Dates

First Submitted

November 18, 2010

First Submitted That Met QC Criteria

September 19, 2011

First Posted (Estimate)

September 20, 2011

Study Record Updates

Last Update Posted (Actual)

May 21, 2018

Last Update Submitted That Met QC Criteria

May 17, 2018

Last Verified

May 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • #6141 P50 DA 009236-16
  • P50DA009236 (U.S. NIH Grant/Contract)
  • P50DA009236-16 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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