Placebo-controlled pilot trial of mecamylamine for treatment of autism spectrum disorders
Open accessAbstract
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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Evidence supporting a significant but complex role of nicotine and nicotinic receptors in ARBS can be gleaned from clinical studies with different primary outcomes that also report on these data, as well as well-conducted case series.
“evidence supporting a significant but complex role of nicotine and nicotinic receptors in these syndromes can be gleaned from a variety of clinical studies with different primary outcomes that also report on these data (Arnold et al., 2012; Conners et al., 1996; Drusch et al., 2013; Newhouse et al., 1994), as well as well-conducted case series (Mayer et al., 2001; Rosin et al., 2001)”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Arnold et al., 2012
The reports of decreased irritability in those cases were spontaneously reported by parents, and treatment was continued in these cases.
“This was spontaneously reported by parents, and was sufficiently convincing that treatment was continued in these cases.”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Arnold et al., 2012
In a small trial of mecamylamine in autism, there was no clinically or statistically significant benefit.
“This small study reported no clinically or statistically significant benefit”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Arnold et al., 2012
In that trial, there was anecdotal evidence of decreased irritability in four cases.
“but provided anecdotal evidence of decreased irritability in four cases.”
From Mood and anxiety regulation by nicotinic acetylcholine receptors: A potential pathway to modulate aggression and related behavioral states (2015) · cites this paper as Arnold et al., 2012
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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
- Publisher
- SAGE Publications
- Published
- 2012-06
- Volume
- 22
- Issue
- 3
- Pages
- 198-205
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- PMC
- PMC3417385
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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