Effects of Mexiletine on Colonic Transit in a Patient With Irritable Bowel Syndrome - Constipation (IBS-C)

NCT01717404 — Phase 1, Completed, 1 participants, Mayo Clinic

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Effects of Mexiletine on Colonic Transit in a Patient With a Known SCN5A A997T Mutation

Registry	NCT01717404
Status	Completed
Phase	Phase 1
Study type	Interventional; na, single group, masking: none, treatment
Enrollment	1 (Actual)
Sponsor	Mayo Clinic (Other)
Conditions	IBS
Interventions	Mexiletine (Drug)
Dates	start 2012-10-01, primary completion 2012-11-01, completion 2012-11-01, first posted 2012-10-30, last updated 2013-10-01

-Summary

To understand if Mexiletine will restores normal colonic motility in a patient with irritable bowel syndrome - constipation (IBS-C) and a genetic mutation in SCN5A.

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+Detailed description

To understand if Mexiletine will restore normal colonic motility in a patient with a missense mutation in SCN5A, which encodes a voltage-sensitive sodium channel NaV1.5 as it is known to rescue certain expression defects of NaV1.5 in vitro.

+Arms and interventions

Arm	Type	Interventions	Description
Mexiletine	Experimental	Drug: Mexiletine	6-day treatment period during which the medication will be taken orally with an initial dose of: 200 mg every 8 hours for 3 doses on day 3, increasing to 300 mg every 8 hours on days 4 and 5 (6 doses), and increasing further to 400 mg every 8 hours on days 6-8 if no telemetry changes and no dose limiting side effects

Mexiletine (Drug): 6-day treatment period during which the medication will be taken orally with an initial dose of: 200 mg every 8 hours for 3 doses on day 3, increasing to 300 mg every 8 hours on days 4 and 5 (6 doses), and increasing further to 400 mg every 8 hours on days 6-8 if no telemetry changes and no dose limiting side effects

+Outcome measures

Primary outcomes

change in the 48 hour Colon Transit [Baseline to 10 days]: Colon transit will be measured using validated scintigraphy methods conducted in our Clinical Research Unit (CRU).\[17, 18\] The participant will ingest a Tc-99m labeled sulfur colloid in egg to be used as a stomach marker and ln-111 chloride bound to activated charcoal enclosed in a methacrylate-coated capsule to measure colonic transit.

+Eligibility

Sex: Female, ages: 60 Years to 70 Years

Inclusion Criteria:

* Established IBS diagnosis with a known A997T mutation in NaV1.5T

Exclusion Criteria:

* Normal 48-hour baseline transit study
* Current use of mexiletine
* Inability to stay in Rochester for 9 days for testing
* Known allergy to mexiletine
* Inability to complete daily diary
* Taking a medication known to affect myotonia, had a coexisting neuromuscular disease, or had another serious medical illness including second- or third-degree heart block, atrial flutter, atrial fibrillation, ventricular arrhythmia, history of cardiac arrhythmia requiring medication, congestive heart failure, symptomatic cardiomyopathy, or symptomatic coronary artery disease
* Inability to withdraw medications known to interact with mexiletine. Patient is currently not on any of these medications

+Publications

Results publication: Beyder A, Mazzone A, Strege PR, Tester DJ, Saito YA, Bernard CE, Enders FT, Ek WE, Schmidt PT, Dlugosz A, Lindberg G, Karling P, Ohlsson B, Gazouli M, Nardone G, Cuomo R, Usai-Satta P, Galeazzi F, Neri M, Portincasa P, Bellini M, Barbara G, Camilleri M, Locke GR, Talley NJ, D'Amato M, Ackerman MJ, Farrugia G. Loss-of-function of the voltage-gated sodium channel NaV1.5 (channelopathies) in patients with irritable bowel syndrome. Gastroenterology. 2014 Jun;146(7):1659-1668. doi: 10.1053/j.gastro.2014.02.054. Epub 2014 Mar 5. PMID 24613995

+Investigators

Yuri A Saito Loftus, MD, MPH, Principal investigator, Mayo Clinic