Mecamylamine treatment for alcohol dependence: a randomized controlled trial

Background and aimsThe nicotinic acetylcholine receptor antagonist, mecamylamine, is a potential novel pharmacotherapy for alcohol use disorder. The aims were to compare alcohol consumption between mecamylamine and placebo and test if smoking status modified treatment effects. DesignOut-patient, randomized, double-blind clinical trial for 12weeks of treatment with mecamylamine (10mg) (n=65) versus placebo (n=63). SettingConnecticut, USA. ParticipantsIndividuals had current alcohol dependence (n=128), had an average age of 48.5 [standard deviation (SD)=9.4], 110 (85.9%) were men, and included 74 smokers (57.8%) and 54 non-smokers (42.2%). Participants were randomized to mecamylamine 10mg per day or placebo. All subjects also received medical management therapy administered by trained research personnel. MeasurementsPrimary outcome was percentage of heavy drinking days during the last month of treatment; other outcomes included drinking days, drinks per drinking days, alcohol craving, smoking, symptoms of nicotine withdrawal and side effects. FindingsThere were no significant differences in the percentage of heavy drinking days at 3months between the mecamylamine (mean=18.4, SD=29.0) and placebo treatment groups (mean=20.4, SD=29.2) [F-1,F- 100=1.3, P=0.25; effect size d=0.07; mean difference=2.06, 95% confidence interval (CI)=-8.96 to 13.08]. There were no significant differences in percentage of drinking days or in drinks per drinking day at month 3 between the mecamylamine and placebo groups; there were no significant interactions. ConclusionsMecamylamine 10mg per day did not reduce alcohol consumption significantly in treatment-seeking smokers and non-smokers with alcohol use disorder.