Open-Label Pilot Study of Lisdexamfetamine for Cocaine Dependence

Phase 1

Completed

Conditions: Cocaine Dependence

Interventions: Drug: Lisdexamfetamine
Behavioral: medication management

Registration Number: NCT01486810

Lead Sponsor: New York State Psychiatric Institute

Brief Summary: The proposed protocol is an open-label pilot study of the treatment of cocaine dependence using lisdexamfetamine (LDX), a prodrug of d-amphetamine. The investigators plan to enroll 12 patients in an eight-week open-label trial to obtain preliminary data regarding the safety, tolerability, and potential utility of lisdexamfetamine for treatment of cocaine dependence and to determine an effective dosage range.

Detailed Description: In an eight-week open label outpatient pilot trial, we will evaluate the safety, tolerability, and potential utility of LDX in the treatment of cocaine dependence. Patients will receive a flexible-fixed dosing schedule under open-label conditions. Patients will be titrated to the tolerated dose over a two week period, with a maximum of 140mg daily, and then maintained on the highest tolerated dose for four weeks, followed by a two week run-down period. All participants will receive medication management counseling and individual therapy using a structured compliance enhancement manual designed for pharmacotherapy trials in subjects with substance use disorders.

The primary outcome measures will be 1) the maximum total lisdexamfetamine dose achieved during the study period defined as the highest amount of medication per day maintained for a seven day period 2) lisdexamfetamine tolerability as measured by adverse effects reported on the Systematic Assessment for Treatment and Emergent Events (SAFTEE). Secondary outcome measures will be 1) cocaine use as recorded by the number of days of use on the Timeline Follow-Back method (Sobell \& Sobell, 1992) and confirmed by urine toxicology, 2) cocaine craving as measured by the Cocaine Craving Scale (CCS) and Cocaine Craving Questionnaire (CCQ) and 3) alternate measures of cocaine use, such as the dollar value of cocaine used per day, as measured by the Timeline Follow-Back method, and the proportion of urine toxicology samples negative for cocaine.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 17

Inclusion Criteria

Individuals must be treatment seeking
Men and women between the ages of 18-60 who meet DSM-IV criteria for current cocaine dependence
Used cocaine at least four days in the past month
Individuals must be in good general health
Individuals must be capable of giving informed consent and capable of complying with study procedures
Women of child-bearing age must agree to use a method of contraception with proven efficacy, consisting of one of the following: 1) Any form of hormonal contraception; 2) Intra-uterine device; 3) Sterilization; 4) Double-barrier contraception which is a combination of two of the following: condoms, spermicide, diaphragm. Pregnancy tests will be performed monthly and if a woman becomes pregnant, the study medication will be discontinued.

Exclusion Criteria

Individuals who meet DSM-IV-TR criteria for bipolar disorder, schizophrenia, any psychotic disorder other than transient psychosis due to drug abuse, or current major depressive disorder
Individuals with any other current Axis I psychiatric disorder as defined by DSM-IV-TR that in the investigator's judgment are unstable, or would be disrupted by study medication, or are likely to require pharmacotherapy during the study period
Individuals physiologically dependent on any other drugs (excluding nicotine or cannabis) which require medical intervention
Individuals with current psychostimulant abuse or dependence (other than cocaine dependence)
Individuals with current suicidal risk
Individuals with coronary vascular disease as indicated by history or suspected by abnormal ECG or history of cardiac symptoms
Unstable physical disorders which might make participation hazardous such as uncontrolled hypertension (SBP > 140, DBP> 90, or HR > 100 when sitting quietly), acute hepatitis (patients with chronic mildly elevated transaminases < 1.5x upper limit of normal are acceptable), or uncontrolled diabetes
Individuals with a history of seizures, hyperthyroidism and/or glaucoma
Individuals with a family history of sudden cardiac death
History of allergic reaction to study medication
Women who are pregnant or nursing
Currently being prescribed psychotropic medication by another physician (other than sleep medication)
Individuals who are legally mandated (e.g., to avoid incarceration) to participate in substance abuse treatment program

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Lisdexamfetamine and medication management	medication management	Patients will be titrated to the tolerated dose of Lisdexamfetamine over a two week period, with a maximum of 140mg daily, and then maintained on the highest tolerated dose for four weeks. All participants will receive medication management counseling and individual therapy using a structured compliance enhancement manual designed for pharmacotherapy trials in subjects with substance use disorders.
Lisdexamfetamine and medication management	Lisdexamfetamine	Patients will be titrated to the tolerated dose of Lisdexamfetamine over a two week period, with a maximum of 140mg daily, and then maintained on the highest tolerated dose for four weeks. All participants will receive medication management counseling and individual therapy using a structured compliance enhancement manual designed for pharmacotherapy trials in subjects with substance use disorders.

Primary Outcome Measures

Name	Time	Method
Number of Participants Maintained on the Maximum Lisdexamfetamine Daily Dose.	during 1 week of study participation	Number of participants achieving and maintained for a seven day period during the trial on the maximum daily dose of 140 mg..
Mean Maximum Maintained Dose of Lisdexamfetamine for at Least 1 Week of Trial.	during 8 weeks of trial or length of participation	The mean maximum daily dose of lisdexamfetamine that was maintained for at least 1 week of trial.

Secondary Outcome Measures