Evaluating the Efficacy of Dextromethorphan/Quinidine in Treating Irritability in Huntington's Disease

The University of Texas System (UT)

Status and phase: Completed; Phase 3

Conditions: Irritability; Huntington Disease

Treatments: Drug: Dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg); Drug: Placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT03854019

HSC-MS-18-1049

Details and patient eligibility

About

The purpose of this study is to assess efficacy and safety of dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg) in patients with irritability due to Huntington's disease.

Enrollment: 20 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Verified HD mutation carriers;
• Irritable as diagnosed by the Irritability Scale with a score > 14;
• Stable concomitant medication (no change of medication during last 30 days prior to inclusion);
• Written informed consent by prospective study participant before conduct of any trial-related procedure. Participant must be able to make an informed decision of whether or not to participate in the study.

Exclusion criteria

• Hypersensitivity to dextromethorphan (e.g., rash, hives), quinine, mefloquine, quinidine, or dextromethorphan/quinidine with a history of thrombocytopenia, hepatitis, bone marrow depression or lupus-like syndrome induced by these drugs;
• Pregnant or nursing women;
• Active suicidality based on the answer "yes" in questions 4 and 5 of the Columbia-Suicide Severity Rating Scale (baseline version);
• Woman of childbearing potential, not using highly effective methods of contraception such as oral, topical or injected contraception, IUD, contraceptive vaginal ring, or double barrier method such as diaphragm and condom with spermicide) or not surgically sterile (via hysterectomy, ovarectomy or bilateral tubal ligation) or not at least one year post-menopausal;
• Male not using an acceptable barrier method for contraception;
• Presence of any medically not controllable disease (e.g. uncontrolled arterial hypertension or diabetes mellitus);
• Clinically significant renal (calculated creatinine clearance < 30 ml/min) or hepatic dysfunction;
• Patients with pre-existing hepatic disease;
• Individuals with a history or complete heart block, QTc prolongation or tornadoes de pointes, or at high risk of complete AV block;
• Family history of congenital QT prolongation;
• History of unexplained syncope within the past year;
• Use of drugs containing quinidine, quinine, or mefloquine;
• Individuals currently taking strong CYP3A4 inhibitors or tetrabenazine;
• Use of certain antidepressants--amitriptyline, clomipramine, desipramine, fluoxetine, paroxetine, sertraline, venlafaxine;
• Use of certain heart rhythm medications--amiodarone, flecainide, procainamide, propafenone;
• Use of certain medicines to treat psychiatric disorders--chlorpromazine, haloperidol, perphenazine, pimozide, quetiapine, risperidone, thioridazine.
• Use of tamoxifen;
• Presence or history of seizures or diagnosed epilepsy;
• Severe cognitive disorders defined as a score < 18 on the MOCA;
• Clinically relevant abnormal findings in the ECG, the vitals, in the physical examination or laboratory values at screening that could interfere with the objectives of the study or the safety of the subject as judged by the investigator;
• Participation in another investigative drug trial within 2 months;
• Subjects who are unlikely to be compliant and attend scheduled clinic visits as required as determined by the Investigator.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Quadruple Blind

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20 participants in 2 patient groups, including a placebo group

Dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg), then Placebo

Experimental group

Description:

Dextromethorphan/quinidine (DM/Q) 20mg/10mg one capsule once daily for 1 week, followed by DM/Q 20mg /10 mg twice daily for subsequent 4 weeks, and finally DM/Q 20mg/10mg once daily for 7days.

Treatment:

Drug: Dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg)

Drug: Placebo

Placebo, then Dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg)

Placebo Comparator group

Description:

Placebo one capsule once daily for 1 week, followed by placebo twice daily for subsequent 4 weeks, and finally placebo once daily for 7days.

Treatment:

Drug: Dextromethorphan/quinidine 20mg/10mg (DM/Q 20mg/10mg)

Drug: Placebo