Cited by 42Autism Spectrum Disorder ResearchNicotinic Acetylcholine Receptors StudyGenetics and Neurodevelopmental Disorders

Placebo-controlled pilot trial of mecamylamine for treatment of autism spectrum disorders

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Arnold, L. Eugene, Aman, Michael G., Hollway, Jill, Hurt, Elizabeth, Bates, Bethany, Li, Xiaobai, Farmer, Cristan, Anand, Rene +3 more·2012·Journal of Child and Adolescent Psychopharmacology

Abstract

OBJECTIVE: To explore possible benefits of a nicotinic acetylcholine receptor (nAChR) agent for autistic symptoms based on postmortem observation of nAChR abnormalities (deficient α4β2 nAChRs, excess α7 nAChRs) in brains of patients with autism. METHOD: Mecamylamine, because of its safety record in children with other disorders, was chosen for this first exploration. Twenty children with autism spectrum disorder age 4-12 years were randomly assigned for 14 weeks to placebo (n=8) or mecamylamine (n=12) in ascending fixed doses: 0.5 mg/day for 6 weeks, 2.5 mg for 2 weeks, then 5 mg/day for 6 weeks. Improvement was rated by a blinded independent evaluator. Because of small sample, data analysis was descriptive. RESULTS: Eighteen participants (10 mecamylamine, 8 placebo) completed the study. All doses were well tolerated; the only side effect of note was constipation (50% compared with 25% of placebo group). Three children had clinically nonsignificant electrocardiographic QT prolongation. Both groups showed modest to moderate improvement, but differences between groups were negligible. On the primary outcome measure, the Ohio Autism Clinical Impressions Scale, 90% of the active treatment group showed improvement at some point (but only 40% sustained it), compared with 62% on placebo. Of the four in active treatment that sustained improvement, three had a maximum dose of 0.13-0.15 mg/kg/day, while those who regressed had doses ≥0.18 mg/kg/day. Graphed means suggested better outcome with lower mg/kg and longer medication duration. Four parents spontaneously reported reduced hyperactivity and irritability and better verbalization and continued mecamylamine at their own expense. CONCLUSION: Mecamylamine appeared to be safe, but not very effective in autism. The suggestion of better results at lower doses and longer exposure warrants consideration for future trials. The next step would be exploration of a more specific α4β2 nAChR agonist, such as varenicline.

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Crossref · 10.1089/cap.2011.0056

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Authors
Arnold, L. E., Aman, M. G., Hollway, J., Hurt, E., Bates, B., Li, X., Farmer, C., Anand, R., Thompson, S., Ramadan, Y., & Williams, C.
Affiliations
  • The Ohio State University (US)
  • The Ohio State University
Corresponding author
Arnold, L. Eugene
Venue
Journal of Child and Adolescent Psychopharmacology
Published
2012-06
Volume
22
Issue
3
Pages
198-205
ISSN
  • 1044-5463 (ISSN-L)
  • 1557-8992
OpenAlex
W2092192222
Cited by
42
References
43
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 5 · 2015: 9 · 2014: 2 · 2013: 2
FWCI
2.10
Type
journal article
Language
en
Open access
Locations
  • Journal of Child and Adolescent Psychopharmacology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Autism Speaks (AS2368)
  • Ohio State University (UL1RR025755)
  • Johns Hopkins University
  • National Institutes of Health (UL1TR000090)
  • Center for Clinical and Translational Research
  • National Center for Research Resources (UL1RR025755)
  • National Center for Advancing Translational Sciences
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
Keywords
mecamylamine, autism spectrum disorder, nicotinic acetylcholine receptors, alpha4beta2 nAChR, alpha7 nAChR, children, drug safety, constipation, QT prolongation, dose-response relationship, varenicline, hyperactivity, irritability
MeSH terms
Child, Child Development Disorders, Pervasive, Child, Preschool, Constipation, Dose-Response Relationship, Drug, Double-Blind Method, Female, Ganglionic Blockers, Humans, Male, Mecamylamine, Pilot Projects, Treatment Outcome

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