Alternative Dosing Regimens in the Pharmacotherapy of Insomnia
- Registration Number
- NCT02139098
- Lead Sponsor
- Philipps University Marburg Medical Center
- Brief Summary
The purpose of this study is to evaluate whether drug efficiency of zolpidem and amitriptyline can be conditioned according to learning theory in patients with primary insomnia.
- Detailed Description
Previous research has shown that repeated drug treatments can be regarded as conditioning processes. Sleep disorders are especially of interest to be investigated under the perspective of conditioning with drugs, since sleep quality can be defined both in terms of subjective ratings (self-rated sleep quality parameters) and objective measures (via polysomnographic assessment PSG; e.g., total sleep time, sleep onset, sleep architecture). By using two different drugs (zolpidem, amitriptyline) that modulate sleep differentially, the investigators intend to implement a conditioning paradigm in sleep disorders dissociating conditioning effects on subjective and objective sleep parameters. Both drugs should affect objective and subjective sleep parameters positively, while only amitriptyline should modulate the objectively assessed sleep architecture by REM-suppression (latency of REM-sleep onset, percentage of REM-sleep).Patients with mild to moderate insomnia will undergo a classical conditioning paradigm with one of two study medications: amitriptyline or zolpidem. After an acquisition period and a wash-out period, conditioned sleep changes are assessed in an evocation trial. During a second treatment phase of 7 days, patients receive different doses of amitriptyline (between 0mg and 50mg per night) or zolpidem (between 0mg and 5mg per night) to evaluate alternative dosing regimens in the pharmacotherapy of mild to moderate Insomnia.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 23
- age between 18 years to 69 years
- fluent in German language
- provide written informed consent
- ability to understand the explanations and instructions given by the study physician and the investigator
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Sleep disorders caused by medical factors (e.g. sleep apnea, restless legs syndrome, narcolepsy, substance-induced insomnia)
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Contraindications to study medication intake according to the information sheet for health professionals (Summary of medicinal Product Characteristics, SmPC; Fachinformation in Germany) assessed by physical examination (including ECG) and medical history
- allergies to amitriptyline hydrochloride or any of its ingredients
- allergies to zolpidem or any of its ingredients
- acute intoxication with alcohol, analgetics, hypnotics or any other psychotropic drug
- urinary retention
- delirium
- untreated closed-angle glaucoma
- prostatic hyperplasia
- pyloric stenosis
- paralytic ilius
- suicidal thoughts
- liver/ kidney/ pulmonary insufficiency
- myasthenia gravis
- hypokalemia
- bradycardia
- coronary heart disease, cardiac arrhythmias, long QT syndrome or other clinically relevant cardiac disorders
- increased risk of seizures/ history of seizures
- substance dependence syndrome/ history of substance dependence syndrome
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Allergies to ingredients of placebo or novel-tasting drink (CS)
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currently pregnant (verified by urine pregnancy test) or lactating
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patients scoring ≥12 on the Epworth Sleepiness Scale
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patients scoring below 8 or above 21 on the Insomnia Severity Index
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patients suffering from a mental disorder as verified by the SCID (major depression; psychosis; brain injury; substance abuse or dependency syndrome during the last 6 months before V1)
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nicotine consumption > 10 cigarettes/day
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unwillingness to refrain from alcohol consumption throughout the study
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Concomitant medication interfering with study medication intake due to potential interactions (all psychotropic medication including analgetics and muscle relaxants, hypericum derivatives; antihypertensives; anti-arrhythmic agents; antibiotics; cisaprid; anti-malaria drugs; diuretics; imidazole antifungals; cumarin derivatives; antihistaminics; calcium channel blockers; medications that enlarge the QT interval or may lead to hypokalemia)
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change in concomitant medication regime during the last 2 weeks prior to visit 1 or after randomization
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intake of psychotropic medication during the last 3 months
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participation in any other clinical trial 3 months prior to visit 1
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women of childbearing age not using 2 highly effective contraceptive methods
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employee of the Sponsor or the principal investigator
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Amitriptyline flexible dosing Placebo 50 mg capsule amitriptyline before going to bed on 8 out of 17 nights/placebo Zolpidem flexible dosing Placebo 5 mg capsule zolpidem before going to bed on 8 out of 17 nights/placebo Amitriptyline flexible dosing Amitriptyline 50 mg capsule amitriptyline before going to bed on 8 out of 17 nights/placebo Amitriptyline fixed dosing Amitriptyline 50 mg capsule amitriptyline before going to bed on 8 out of 17 nights Zolpidem flexible dosing Zolpidem 5 mg capsule zolpidem before going to bed on 8 out of 17 nights/placebo Zolpidem fixed dosing Zolpidem 5 mg capsule zolpidem before going to bed on 8 out of 17 nights Amitriptyline continuous dosing Amitriptyline 50 mg capsule amitriptyline before going to bed on 13 out of 17 nights
- Primary Outcome Measures
Name Time Method Objective Total Sleep Time Change from baseline to day 10 after first medication intake assessed by polysomnography
Objective Sleep Onset Latency Change from baseline to day 10 after first medication intake assessed by polysomnography
Self-reported Total Sleep Time Change from baseline to day 10 after first medication intake assessed by sleep diary
Self-Reported Sleep Onset Latency Change from baseline to day 10 after first medication intake assessed by sleep diary
- Secondary Outcome Measures
Name Time Method Percentage of REM sleep Change from baseline to day 10 after first medication intake assessed by polysomnography
REM onset latency Change from baseline to day 10 after first medication intake assessed by polysomnography
Objective Sleep Efficiency Change from baseline to day 17 after first medication intake assessed by actigraphy
Objective Total Sleep Time Change from baseline to day 17 after first medication intake assessed by actigraphy
Self-Reported Total Sleep Time Change from baseline to day 18 after first medication intake assessed by sleep diary
Self-reported Sleep Onset Latency (min) Change from baseline to day 18 after first medication intake assessed by sleep diary
Self-reported Sleep Onset Latency (evaluation) Change from baseline to day 18 after first medication intake assessed by sleep diary
Trial Locations
- Locations (1)
Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg
🇩🇪Marburg, Hessen, Germany