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Randomized Controlled Trial
. 2018 Aug;48(8):2748-2757.
doi: 10.1007/s10803-018-3536-7.

An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder

Alan S Lewis  1   2 , Gerrit Ian van Schalkwyk  3   4 , Mayra Ortiz Lopez  3 , Fred R Volkmar  3 , Marina R Picciotto  5 , Denis G Sukhodolsky  3
Affiliations
Randomized Controlled Trial

An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder

Alan S Lewis et al. J Autism Dev Disord. 2018 Aug.

Abstract

Nicotinic acetylcholine receptors (nAChRs), particularly the α7 nAChR, are implicated in the pathophysiology of both autism spectrum disorder (ASD) and aggressive behavior. We explored the feasibility, tolerability, and preliminary efficacy of targeting nAChRs using transdermal nicotine to reduce aggressive symptoms in adults with ASD. Eight subjects were randomized in a double-blind crossover trial of 7 mg transdermal nicotine or placebo, each for 1 week. All participants tolerated nicotine treatment well. Five subjects contributed data to the primary outcome, Aberrant Behavior Checklist-Irritability (ABC-I) subscale change from baseline, which was improved by nicotine compared to placebo. Sleep ratings were also improved by nicotine and correlated with ABC-I improvement. These findings support further investigation of nAChR agonists for aggression and sleep in ASD.

Keywords: Adult; Aggression; Autism spectrum disorder; Irritability; Nicotine; Nicotinic acetylcholine receptor; Sleep.

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Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Participant flow through the trial.
Fig. 2
Fig. 2
Comparison of effects of 7 mg transdermal nicotine versus placebo on sleep ratings (A) and ABC-Irritability (ABC-I) subscale (B). Caregivers recorded ratings for nightly sleep quality from 0 (worst) to 10 (best) and these were averaged over the nicotine or placebo week. ABC-I reflects caregiver assessment of behavior integrated over the entire nicotine or placebo week. Change in sleep correlated significantly with change in ABC-I score during the nicotine week versus placebo week (r2 = 0.89, p = 0.016) (C).
See this image and copyright information in PMC

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