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ADHDPhase 1/2NCT03563573

Single-dose Potassium Supplementation in Patients With ADHD for Whom the Anesthetic Lidocaine is Ineffective

A Phase 1/2 study testing Potassium Gluconate Oral Capsule in people with ADHD, run by AlkaliDx, Inc. at 1 site in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Randomized, controlled, double-blind trial of the effect of a single dose of potassium on ADHD symptoms as measured by changes in measures of symptoms of ADHD correlated with the results of their Lidocaine Effectiveness Test. Read more about this study

Who is it for?
Ages 13 to 49 years
Conditions the study is for
ADHD
What is being tested?
Potassium Gluconate Oral Capsule
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
100 participants
Where
1 siteUnited States
Study dates
1 Jul 2018to 31 Dec 2018
Phase
Phase 1/2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 13 to 49 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Previously documented ADHD diagnosis
  • Untreated or taking existing ADHD drugs, but symptoms poorly controlled (e.g., symptoms not well managed by amphetamines, including ongoing inattention and impulsivity)

Who cannot join

  • Well treated with existing ADHD medication
  • Epilepsy
  • IQ less than 80
  • Severe head trauma that led to loss of consciousness for more than an hour or required surgery
  • Birth weight below 5 pounds or 2270 grams
  • Severe autism (milder conditions described as Asperger syndrome or "high-functioning autism" are not excluded)
Show all 55Show fewer
  • Comorbid psychiatric disorders, such as generalized anxiety disorder, major depressive disorder, schizophrenia and schizoaffective disorder, bipolar disorder, and any co-morbid condition at the discretion of the PI that would interfere with a patient's ability to participate
  • Mouth lesions, known to temporarily interfere with lidocaine effectiveness
  • Renal disease or abnormal kidney function or receiving dialysis
  • An individual has a factor likely to reduce penetrance, including excessive salt loss, such as caked salt on the body after exercise and Cystic fibrosis in a relative suggestive of the individual being a carrier.
  • Heart arrhythmia, known or evident on ECG
  • Known intolerance or allergy to lidocaine
  • Already taking supplemental potassium or renin angiotensin aldosterone inhibitors or other potassium elevating agents (see list below)
  • Angiotensin Converting Enzyme Inhibitors
  • Alacepril (not available in US)
  • Benazepril (Lotensin)
  • Captopril (trade name Capoten)
  • Cilazapril (Inhibace)
  • Delapril (not available in US)
  • Enalapril (Vasotec/Renitec)
  • Fosinopril (Fositen/Monopril)
  • Imidapril (Tanatril)
  • Lisinopril (Listril/Lopril/Novatec/Prinivil/Zestril)
  • Moexipril (Univasc)
  • Perindopril (Coversyl/Aceon/Perindo)
  • Quinapril (Accupril)
  • Ramipril (Altace/Prilace/Ramace/Ramiwin/Triatec/Tritace)
  • Spirapril (Renormax)
  • Temocapril (not available in US)
  • Teprotide (but not active by oral administration and not used in US)
  • Trandolapril (Mavik/Odrik/Gopten)
  • Zofenopril
  • Angiotensin receptor blockers
  • Azilsartan (Edarbi)
  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Fimasartan (Kanarb)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar/Olmetec)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)
  • Aldosterone antagonists
  • Spironolactone (Aldactone)
  • Eplerenone (Inspra)
  • Renin inhibitors
  • Aliskiren (Tekturna, Rasilez)
  • Other potassium elevating agents
  • Antibiotics, including penicillin G and trimethoprim
  • Azole antifungals
  • Beta-blockers
  • Herbal supplements, including milkweed, lily of the valley, Siberian ginseng, Hawthorn berries
  • Heparin
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Oral contraceptives containing drospirenone

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Clinical Research Center of New Jersey (CRCNJ)

    Voorhees Township, New Jersey, 08043

Other trials in United States

About this study

Official title: Single-dose Potassium Supplementation in ADHD Patients With Lidocaine Ineffectiveness

Randomized, controlled, double-blind trial of the effect of a single dose of potassium on ADHD symptoms as measured by changes in measures of symptoms of ADHD correlated with the results of their Lidocaine Effectiveness Test.

Read the detailed description

Subjects with a confirmed diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), who are either untreated or poorly controlled with existing ADHD therapy, will be recruited for a single, four-hour session.

Each subject will be tested for lidocaine effectiveness using the application of lidocaine gel to the tongue and assessment by taste.

The subjects will then be assigned to two arms, (1) lidocaine sensitive (effective) or (2) lidocaine insensitive (ineffective), and then randomized as to an intervention of potassium supplementation or a placebo.

Each subject will:

  • Complete questionnaires about their history of certain symptoms and a food diary.
  • Get an ECG to exclude those with arrhythmias.
  • Have their baseline serum potassium tested
  • Have measures of ADHD symptoms performed.

Then each subject will receive the intervention of a single dose of the potassium or placebo.

After the wait of one hour, a repeat serum potassium and measurement of symptoms will be performed.

Note; The FDA also requires a Columbia Suicide Severity Rating Scale (C-SSRS) for all ADHD trials

Conditions
ADHD
Being tested
Potassium Gluconate Oral Capsule, Placebo oral capsule
Keywords
Conditions in which lidocaine is ineffective
Medical subject headings
Attention Deficit Disorder with Hyperactivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Potassium Gluconate Oral CapsuleDrug

    Each subject will receive a dose of ~8 mg/kg of potassium. We will be giving a maximum of 14 mEq in a single dose.

  • Placebo oral capsuleDrug

    Each subject will receive a dose of ~8 mg/kg of a placebo capsule

Study groups in NCT03563573
Study groupRoleWhat they receive
Lidocaine-effective ADHD: InterventionActive comparatorSingle-dose potassium gluconate oral capsule intervention for ADHD subjects for whom lidocaine is effective
Receives: Drug: Potassium Gluconate Oral Capsule
Lidocaine-effective ADHD: PlaceboPlacebo comparatorSingle-dose placebo oral capsule intervention for ADHD subjects for whom lidocaine is effective
Receives: Drug: Placebo oral capsule
Lidocaine-ineffective ADHD: InterventionActive comparatorSingle-dose potassium gluconate oral capsule intervention for ADHD subjects for whom lidocaine is ineffective
Receives: Drug: Potassium Gluconate Oral Capsule
Lidocaine-ineffective ADHD: placeboPlacebo comparatorSingle-dose placebo oral capsule intervention for ADHD subjects for whom lidocaine is ineffective
Receives: Drug: Placebo oral capsule

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Prevalence of lidocaine ineffectiveness in those with ADHD

    Investigator assesses identification and intensity of tastes (such as sweet) before and after application of oral lidocaine gel to the tongue.

    Measured: Baseline

Secondary outcomes (5)
  1. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

    Investigator documentation of adverse reactions to either lidocaine or potassium

    Measured: 1-2 hours after intervention

  2. Other discomforts

    Investigator documentation of complaints or minor discomforts

    Measured: 1-2 hours after intervention

  3. Change in ADHD-RS questionnaires

    The questionnaire is a standard assessment tool for measuring the level of ADHD symptoms. The ADHD-RS-IV is for adults and the ADHD-RSM-5 is for teenagers. This test has been validated for measuring the impact of drugs in ADHD, typically multi-dose, multi-week changes.

    Since this study is a single-dose, several-hour study, the Investigators will complete only the portions designed to done with the patient and by the clinician; sections designed to be completed by parents and teachers. The results will establish expectations for future multi-dose studies.

    All scores on a range of None, Mild, Moderate, Severe.

    1. Carelessness
    2. Difficulty sustaining attention in activities
    3. No follow through
    4. Can't organize
    5. Avoids/dislikes tasks requiring sustained mental effort
    6. Loses Important items
    7. Easily distractible
    8. Forgetful in daily activities

    Measured: Baseline and ~1-2 hours later, 1 hour after intervention

  4. Change in Clinical Global Impression Physician Completed Questionnaire

    Clinician-assessed improvement in overall symptoms, using CGI S (severity) as baseline and CGI I (improvement) to track any change.

    Investigator assesses "Compared to his or her condition at baseline, how much has he or she changed?"

    Very much improved Much improved Minimally improved No change Minimally worse Much worse Very much worse

    Measured: Baseline and ~1-2 hours later, 1 hour after intervention

  5. Change in scores using Quotient ADHD System

    The Quotient device (http://www.quotient-adhd.com) tracks scores on 6 factors of motion analysis; 6 factors of attention response; and 8 factors of attention state. The subject plays a diagnostic "video game" and the machine tracks movement of the head, and speed and accuracy of the mouse clicks.

    The first assessment will serve as a baseline and the assessment post-intervention will measure any changes. (all scores from 0-100)

    Motion Analysis (including Immobility Duration, Number of movements, displacement, area, spacial complexity, temporal scaling)

    Attention Response Analysis (including adjusted Accuracy, Omission Errors, Commission Errors, Latency, Variability, Coefficient of Variation for response latency)

    Attention State Analysis (including number of shifts, Attentive, Impulsive, Distracted, Disengaged, Random, Minimal, Contrary, Overall Results)

    Measured: Baseline and ~1 hour after intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jun 2018
  2. Study start1 Jul 2018 (estimated)
  3. Primary completion4 Nov 2018 (estimated)
  4. Study completion31 Dec 2018 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The trial will have 2 arms, lidocaine sensitive (effective) and lidocaine insensitive (ineffective). The sample will be enriched to have 50% in each arm. Within each arm, subjects will be randomized on a 1-to-1 allocation to the treatment or control groups. The investigators will adopt an iterative approach of testing of batches of subjects because (1) the frequency of lidocaine-insensitivity is only known approximately, (2) the frequency may be unevenly distributed across ethnic groups, and (3) the exact effect size of the potassium is not known, though reported to be high in off-label use in clinical settings with more chronic administration. At the end of testing 40 patients, the results will be analyzed for statistical significance. (1) If the results are statistically significant with a 95% confidence, the testing may stop with the first batch of 40 subjects. (2) If not, sequential, iterative batches of 20 subjects will be tested, and the results reanalyzed.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03563573
Sponsor's protocol ID
2017-01A
Status last verified
Jun 2018
First submitted
15 May 2018
Last updated
20 Jun 2018
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: We plan to submit for publication descriptions of what was accomplished, and the evaluations as described in the study, including the incidence of lidocaine ineffectiveness in those with ADHD.

Publications

  • Infante MA, Moore EM, Nguyen TT, Fourligas N, Mattson SN, Riley EP. Objective assessment of ADHD core symptoms in children with heavy prenatal alcohol exposure. Physiol Behav. 2015 Sep 1;148:45-50. doi: 10.1016/j.physbeh.2014.10.014. Epub 2014 Oct 23.

    PubMed 25447751
  • Levitt JO. Practical aspects in the management of hypokalemic periodic paralysis. J Transl Med. 2008 Apr 21;6:18. doi: 10.1186/1479-5876-6-18.

    PubMed 18426576
  • Nakai Y, Milgrom P, Mancl L, Coldwell SE, Domoto PK, Ramsay DS. Effectiveness of local anesthesia in pediatric dental practice. J Am Dent Assoc. 2000 Dec;131(12):1699-705. doi: 10.14219/jada.archive.2000.0115.

    PubMed 11143733
  • Segal MM. We cannot say whether attention deficit hyperactivity disorder exists, but we can find its molecular mechanisms. Pediatr Neurol. 2014 Jul;51(1):15-6. doi: 10.1016/j.pediatrneurol.2014.04.014. Epub 2014 Apr 18. No abstract available.

    PubMed 24938135
  • Segal MM, Rogers GF, Needleman HL, Chapman CA. Hypokalemic sensory overstimulation. J Child Neurol. 2007 Dec;22(12):1408-10. doi: 10.1177/0883073807307095.

    PubMed 18174562
  • Segal MM, Douglas AF. Late sodium channel openings underlying epileptiform activity are preferentially diminished by the anticonvulsant phenytoin. J Neurophysiol. 1997 Jun;77(6):3021-34. doi: 10.1152/jn.1997.77.6.3021.

    PubMed 9212254
  • Teicher MH, Polcari A, Fourligas N, Vitaliano G, Navalta CP. Hyperactivity persists in male and female adults with ADHD and remains a highly discriminative feature of the disorder: a case-control study. BMC Psychiatry. 2012 Nov 7;12:190. doi: 10.1186/1471-244X-12-190.

    PubMed 23134619

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Potassium Gluconate Oral Capsule in people with ADHD, run by AlkaliDx, Inc. at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 55 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 20 Jun 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Prevalence of lidocaine ineffectiveness in those with ADHD (time frame: Baseline). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03563573, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jun 2018.

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