The foremost challenge to the effective treatment of cocaine addiction is the lack of FDA approved pharmacotherapy for this illicit drug. This DP1 proposal directly addresses this concern by performing clinical Phase I/II medication development and evaluation studies to determine the efficacy and safety of l-tetrahydropalmatine (l-THP) as an anti-addiction medication for cocaine dependence. l-THP, a major active single compound isolated from the Chinese herbal medicine Yanhusuo, has been used in clinical practice as an analgesic (commercial name: Rotundine) in China for more than 40 years. It has been reported that l-THP acts on dopamine (DA) receptors as a DP1 partial agonist/D2 antagonist and also interacts with D3 receptor. In addition, it has low affinity binding to alpha1 and 5HT1A receptors. l-THP attenuates cocaine self-administration and brain-stimulation reward in rats and relieves craving in heroin addicts. The mechanism for this action of l-THP is unknown. It could be related to its DA receptor activity, as the dopaminergic system plays a critical role in the activation of brain reward pathways. More importantly, it could be that l-THP binds to multiple monoamine receptors that provide efficacy as a natural cocktail-like cocaine antagonist. Since, it is well known that cocaine non-selectively inhibits several monoamine transporters. Nevertheless, the unique pharmacological profile makes l-THP an excellent candidate for anti-addiction medication. The extensive animal and preclinical pharmacology and toxicity data resulting from decades of studies on l-THP in China provide a solid safety foundation for our proposed translational study. We plan to obtain IND approval of l-THP from the FDA, after which we will conduct clinical phase I and phase II trials. If this transition from animal studies to human clinical studies is successful, it will provide proof of concept that l-THP is an effective medication for cocaine addiction.

Public Health Relevance

We will carry out a medication development study of l-THP as anti-addiction medication for cocaine dependence. l-THP has been used in clinical practice as an analgesic (commercial name: Rotundine) in China more than 40 years. Because animal and human studies indicate that l-THP is effective in treating drug addiction, we plan to obtain IND approval of l-THP from the FDA, then move the study to the clinical phase I and phase II trials in the US. The proposed studies will be a necessary step toward our long term goal of developing l-THP into an FDA-approved new anti-addiction medication.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
NIH Director’s Pioneer Award (NDPA) (DP1)
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Special Emphasis Panel (ZDA1-SXC-E (16))
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Chiang, Nora
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University of Maryland Baltimore
Schools of Pharmacy
United States
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Hassan, Hazem E; Kelly, Deanna; Honick, Moshe et al. (2017) Pharmacokinetics and Safety Assessment of l-Tetrahydropalmatine in Cocaine Users: A Randomized, Double-Blind, Placebo-Controlled Study. J Clin Pharmacol 57:151-160
Faison, Shamia L; Schindler, Charles W; Goldberg, Steven R et al. (2016) l-tetrahydropalmatine reduces nicotine self-administration and reinstatement in rats. BMC Pharmacol Toxicol 17:49
Sushchyk, Sarah; Xi, Zheng-Xiong; Wang, Jia Bei (2016) Combination of Levo-Tetrahydropalmatine and Low Dose Naltrexone: A Promising Treatment for Prevention of Cocaine Relapse. J Pharmacol Exp Ther 357:248-57
Yu, Mingming; Hassan, Hazem E; Ibrahim, Ahmed et al. (2014) Simultaneous determination of L-tetrahydropalmatine and cocaine in human plasma by simple UPLC-FLD method: application in clinical studies. J Chromatogr B Analyt Technol Biomed Life Sci 965:39-44
Wang, Jia Bei; Mantsch, John R (2012) l-tetrahydropalamatine: a potential new medication for the treatment of cocaine addiction. Future Med Chem 4:177-86