CA2097732C

CA2097732C - Composition comprising r-alpha-lipoic acid and vitamin e for treating diabetes mellitus

Info

Publication number: CA2097732C
Application number: CA002097732A
Authority: CA
Inventors: Carl-Heinrich Weischer; Heinz Ulrich; Klaus Wessel
Original assignee: Viatris GmbH and Co KG
Current assignee: Evonik Operations GmbH
Priority date: 1992-06-05
Filing date: 1993-06-04
Publication date: 2002-12-31
Anticipated expiration: 2013-06-04
Also published as: JPH06135832A; EP0572922A1; DE4218572A1; CA2097732A1; JP2004217669A

Abstract

The use of alpha-lipoic acid, dihydrolipoic acid, metabolites of alpha-lipoic acid, inter alia 6,8-bisnortetralipoic acid, tetranorlipoic acid, optical isomers R- and S-form of alpha-lipoic acid in oxidized and reduced form in combination with vitamin A, B1, B2, B6, B12, C and E
and their pharmaceutically acceptable salts for the preparation of medicaments with analgesic, anti-inflammatory, antidiabetic, cytoprotective, anti-ulcer, antinecrotic, neuroprotective, detoxifying, anti-ischemic, liver function regulating, anti-allergic, immune-stimulating and antioncogenic effect, corresponding medicaments and their preparation.

Description

COMPOSITION COMPRISING R-ALPHA-LIPOIC ACID AND
VITAMIN E FOR TREATING DIABETES MELLITUS
Alpha-lipoic acid is 1,2-dithia-cyclopentane-3-valeric acid.
Alpha-lipoic acid is widespread in plants and animals in the form of the R-enantiomer; it acts as a coenzyme in many enzymatic reactions, constitutes a growth factor for certain bacteria and protozoa and is used to treat death-head mushroom poisoning. The alpha-lipoic acid racemate also has anti-inflammatory, antinociceptive (analgesic) and cytoprotectide, neuroprotective, .anti-.allergic and antitumour properties.
Of the purely optical isomers of alpha-lipoic acid (R- and S-form, i.e. R-alpha-lipoic acid and S-alpha-lipoic acid), a.n contradistinction to the racemate, the R-enantionmer has a predominantly anti-inflammatory and the S-enantiomer a predominantly antinociceptive effect, the anti-inflammatory effect of the R-enantiomer being for example 10 times stronger than that of the racemate.
The antinociceptive (analgesic) effect of the S-enant:iomer is for example up to 6 times stronger than that of the racemate.
The enantiomers thus constitute very much more specific and stronger acting active substances as compared to the racemate.
These effects are described in EP-A 901213405.
The combination partner vitamin A is essential for growth, for bone development, normal function of the reproductive organs and the eyes and, above all, for the structure and function of mucous membrane epithelium.

-, 209~'~3~

The combination partner vitamin E essentially maintains the function of all cells, also those of the nervous system. Its main function is to protect lipids from peroxidation. Japanese published patent 3-193778 describes esters of lipoic acid with tocopherols. These tocopherol esters of lipoic acid are used to treat W-erythemas.
The combination partner vitamin B1 is mainly active in thiamine deficiency syndrome, i.e. with severely deficient diet, long-term parenteral feeding, zero-diet, hemodialysis, malabsorption and alcohol abuse.
The combination partnerwitamin B2 mainly acts in deficiency symptoms caused~by alcohol abuse or insufficient intake of m:iik and milk products.
The combination partner vitamin B6 mainly acts in deficiency symptoms caused by alcohol abuse or chronic medicament intake (oral contraceptives, isoniazid).
The combination partner vitamin B12 mainly acts in strict vegetarians, after gastric resection and atrophy of the mucous membrane or intestinal disorders which lead to deficiency symptoms such as anaemias, precipitations of the peripheral and central nervous system and polyneuropathies.
The combination partner vitamin C is part of the biochemical redox system and is involved in numerous electron transport reactions. These include inter alia collagen synthesis, noradrenaline, dopamine.and serotinin synthesis and the degradation of 4-hydroxyphenylpyruvate. It also encourages the absorption of iron and has a stimulating effect on leucocyte phagocytosis activity. Together with carotinoids, vitamin A and E, vitamin C has been shown to have an antitumour effect.

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The invention provides the preparation of improved medicaments with analgesic, anti-inflammatory, antidiabetic, cytoprotective, anti--ulcer, antinecrotic, neuroprotective, detoxifying, heavy metal antidote, anti-ischemio, liver function regulating, anti-allergic, immune-stimulating and antioncogenic effect.
The tocopherols (vitamin E) used in the preparation according to this invention can be alpha-tocopherol, B-tocopherol, gamma-tocopherol or delta-tocopherol. These can 0 be used from natural oils (d-form) as well as from synthetic material (dl-form).
It is also possible to use tocopherol acetate as well as other esters of physiologically acceptable acids.
It has surprisingly been found that in the combination 5 of active substances, such as vitamin E with the pure optical isomers of alpha-lipoic acid (R- and S-form, i.e. R-alpha-lipoic acid and S-alpha-lipoic acid) in contrast to the racemate of alpha-lipoic acid alone, the R-enantiomer has an anti-inflammatory and antidiabetic action, i.e. it reduces 0 blood sugar, and the S-enantiomer has an antinociceptive effect in combination with vitamin E, the anti-inflammatory effect of the R-ena-ntiomer in combination with vitamin E is surprisingly also stronger than that of the racemate of alpha-lipoic acid. The antinociceptive (analgesic) effect of 5 the S-enantiomer in combination with vitamin E is for example stronger than that of the racemate of alpha-lipoic acid. The enantiomers in combination with vitamins A, B1, B2, B6, B12, C and E are therefore very much more specific and stronger acting active substances compared to the racemate of alpha-0 lipoic acid.
There are in particular the following differences compared to alpha-lipoic acid (racemate) in combination with the vitamins: A, B1, B6, B12, C or E.

In aqueous solutions the salts are preferably used with pharmaceutically acceptable salt formers.
The preparation of alpha-lipoic acid, dihydrolipoic acid or of the oxidized or reduced R-alpha-lipoic acid and of S
alpha-lipoic acid or the metabolites of alpha-lipoic acid as well as their salts in combination with the vitamins listed is effected in known manner, or by analogy thereto (DE-OS 41 37 773).
Salt formers for the active substances can for example 0 be conventional bases or cations which are physiologically acceptable in the salt form. Examples hereof are: alkaline or alkaline earth metals, ammonium hydroxide, basic amino acids such as arginine and lysine, amines of formula N R12 R2 R3 where the radicals R1, R2 and R3 are the same or different 5 and represent hydrogen, C1-C4-alkyl or C1-C4-oxyalkyl such as mono and diethanolamine, 1-amino-2-propanol, 3-amino-1-propanol; alkylene diamine with one alkylene chain composed of 2 to 6 carbon atoms such as ethylene diamine or hexamethylene tetramine, saturated cyclic amino compounds 0 with 4 - 6 ring carbon atoms such as piperidine, piperazine, pyrrolidine, morpholine; N-methylglucamine, creatine and tromethamine.
RESULTS OF THE COMBINATIONS IN VARIOUS TEST MODELS:

1 ) Analgesia In the acetic acid writhing pain test in the mouse and the Randall Selitto inflammation pain test in the rat 0 the S-enantiomer (S-alpha-lipoic acid) for example shows an analgesic effect which is superior to that of alpha-lipoic acid alone (i.e. the racemate) or of vitamin E alone (peroral application).

2) Anti-inflammatory action In carragheen-edema in the rat the R-enantiomer (R-alpha-lipoic acid) fox example shows an anti-inflammatory effect which is superior to that of alpha-lipoic acid (alone) or to vitamin E alone (peroral application).
Cytoprotective, antinecrotic and anti-ulcer effect In addition, a cytoprotective effect is for example apparent in animal experiments both for the oxidized or reduced R-and S-foxxa of alpha-lipoic acid in combination with.vitamin E starting from a dose as low as 20 mg/kg R- or S-isomer of alpha-lipoic acid in combination with 50 mg/kg vitamin E per os.
4) Antidiabetic effect Tn the alloxan diabetes model or the streptocytozine diabetes model the R-enantiomer (R-alpha-lipoic.acid) in combination with vitamin E for example displays for example an antidiabetic, i.e. blood sugar-reducing effect, which is superior to that of alpha-lipoic acid (alone) or to vitamin E alone (peroral application).
5j Liver metabolism regulating effecti In the rat, the R-enantiomer (R-alpha-lipoic acid) in combination with vitamin E disglays for example a liver enzyme-regulating effect which is superior to that of alpha-lipoic acid.(alone) or to vitamin E alone (peroral application).

2~~'~'~~2 6D Detoxifying (heavy metal antidote) effect In the heavy metal intoxication model in the rat, reduction in the heavy metal content in the liver, and thus a detoxifying effect, is for example present both for the oxidized or reduced racemates or R- and S-foray of alpha-lipoic acid in combination with vitamin E from as low a dose as 30 mg/kg R- or S-isomer of alpha-lipoic acid in combination with 50 mg/kg vitamin E per os.
~) Immune stimulating effect In cats infected with panleucopenia virus an immune stimulating effect occurs for example in animal experiments both for the oxidized or reduced R- and S-form of alpha-lipoic acid in combination with vitamin E from as low as dose as 35 mg/kg R- or S-isomer of alpha-lipoic acid in combination with 50 mg/kg vitamin E per os. .
8) Growth-inhibiting effect on retroviruses In addition, R- and S-alpha-lipoic acid in combination with vitamin E have a growth inhibiting effect against retroviruses, in particular the human immune deficiency virus HIV (HIV-1, HIV-2) and are therefore also suitable for the treatment of diseases caused by viruses of this type.
They have a good, growth-inhibiting effect on HIV (types 1 and 2) which can for example be shown in vitro in the following virological-cell biological animal procedures:
1. Plague reduction test 2. CPE reduction test 3. Determination of reverse transcriptase in the culture supernatant 4. Determination of p24 antigen in the culture supernatant 2~~7'~32 Thus, for example, with a single administration of 0.035 mg/ml R- or S-isomer in combination with 0.1 mg vitamin E the number of infectious viruses (for example HIV-1) in the cell culture supernatant is reduced from 100% in the positive control to 0~. A virus-inhibiting effect can be shown in this test procedure in very low doses, far example 0.001 mg/ml.
As a general dose range for the effect (experiment as above) it is for example possible to use:
0 0.0035 - 0.091 mg/ml R- or S-isomer in combination with 0.001 - 0.01 mg/ml vitamin E, in particular 0.035 - 0.070 mg/ml R-or S-isomer in combination with 0.01 - 0.1 mg/ml vitamin E.
For the in vitro trials the active substance or the combination of active substances is for example used in 5 benzyl alcohol as solvent.
For the in vitro investigations of the replication performance of retroviruses, in particular HIV, the following substrates can for example be used:
0 1. Virus-containing RPMI 1640 medium, for example 1X liquid 041-01875 (Gibeo synthetic culture medium according to Moose, Gerner and Franklin, H.A. (1967), J.A.M.A. 199;
519) with a concentration of 2 x 103 - 1 x 103 infectious units (PFU)/ml.

2. The cell lines Jurkat Clone E6-1, Sup T1 and HeLa CT4.
The combinations of the active substances with, the vitamins display a good analgesic, anti-inflammatory, anti 0 arthrotic and cytoprotective effect in the following investigatory models:
MgS04 writhing test in the mouse after GYIRES et al. (Arch.
int. pharmacodyn, therap. 267, 131-140, 1984) adjuvans-arthritis in the rat after NEWBOULL7 (Brit. J. Pharmacol. 21., 5 127-136, 1963) Na-monoiodacetate-induced arthrosis in rats - 7 _ and chickens according to KALBHEN in: Arthrosis deformans, Eular-Verlag, Basel/Switzerland, 1982; intestinal ulceration in rats after DEL SOLDATO (Agents and Actions 23, 1/2, 1988).
The combinations of the active substances with the vitamins A, B1, B6, B12 C or G show a cytoprotective, detoxifying effect in the following investigatory models:
Examination of acute cell toxicity in mouse fibroblasts (L 929) or the like after: LINDL et al. in: Zell and Gewebekultur, Gustav Fischer Verlag, Stuttgart, New York, 2nd 0 edition, 1989, pages 164-167.
The combination of the active substances with the above vitamins show a good effect on metabolic activity in the following investigatory.models:
Examination of the influence of a substance on metabolic 5 activity after: LINDL et al. in: Zell and Gewebekultur, Gustav Fischer Verlag, Stuttgart, New York, 2nd edition, 1989, pages 167-168.
The combinations of the active substances with the above vitamins,show a good growth-inhibiting effect in the 0 following investigatory models:
Examination of the growth-inhibiting properties of a substance using mouse fibroblasts (L929) or human fibroblasts (MRC9) after: LINDL et al. in: Zell and Gewebekultur, Gustav Fischer Verlag, Stuttgart, New York, 2nd edition, 5 1989, pages 162-164.
The combinations of the active substances with the above vitamins show a good phagocytosis-inhibiting effect in the following investigatory model in macrophages:
Examination of the phagocytosis activity of macrophages after 0 G. ROSSI, in: Zellkultur-Methoden, Berlin Oct. 7-9, 1987 Publ. H.R. Maurer, Inst. fur Pharmazie der freien universitat Berlin, Sept. 29, 1987, page 163.

_ g _ _ g _ TOXICOLOGY OF THE COMBINATIONS COMPARED TO THE INDIVIDUAL ACTIVE
SUBSTANCES
The acute toxicity of R-alpha-lipoic acid and S-alpha-lipoic acid in the mouse (expressed as the LD50 mg/kg; LITCHFIELD and WILCOXON method, J. Pharmacol. Exp. Ther. 95, 99 (1949) ) is for example in excess of 1000 mg/kg with oral application.
TOXICITY
alpha-lipoic acid (racemate) LD50 p.o.mg/kg Species 502 mouse, male 460 mouse, female 1190 rat, male 1210 rat, female Vitamin H1 LD50 p.o.mg/kg i.v.mg/kg ' Species 8200-13300 85 - 125 mouse 12300 200. - 250 rat Vitamin B6 LD50 p.o.mg/kg i.v.mg/kg Species 8400 1020 . mouse 5500-15900 1450 rat Vitamin B12.
LD50 p.o.mg/kg Species 1600 mouse Vitamin C
LD50 p.o.mg/kg i.v.mg/kg Species 8021 1058 mouse >5000 i000 rat Vitamin E
L050 p.o.mg/kg i.v.mg/kg Species >50,000 >2100 yaouse >5000 >1500 rat Examples: TOXICOLOGY OF THE COMBINATIONS
alpha-lipoic acid (racematej with 30 mg/kg vitamin E
LD50 p.o. . Species >1200 mg for alpha-lipoic acid mouse Vitamin E (30 mg/kg p.o.~ with R-enantiomer of alpha-lipoic acid LD50 ~ p.o. Species >1200 mg for the R-enantiomer of mouse alpha-lipoic acid Vitamin E (30 mg/kg p.o.) with S-enantiomer of alpha-lipoic acid . 0 ~5~ p.o. Species >1200 mg for the S-enantiomer of mouse alpha-lipoic said PHARMACEUTICAL FORMULATIONS

The pharmaceutical formulations of the combination of the active substances of with the vitamins generally contain between 1 mg to 3 g as single dose, preferably 2 mg to 1.2 g R- or.S-alpha-lipoic acid for example in combination with 1 0 to 450 mg vitamin E. The active substance levels/kg body weight achieved should be between 1. 5 and 200- mg for R- and S-alpha-lipoic acid, preferably between 4 and 100 mg, in particular between 8 and 70 mg/kg for the R- or S-form of 20~~'~32 ' ~ - 11 -alpha-lipoic acid and for example for the vitamin E preferably between 0.01 and 20 mg/kg BW, particularly between 0.1 and 8 mg/kg BW.
Administration can for example be in the form of tablets, capsules, pills, coated tablets, aerosols or in liquid form.
Liquid forms of application that may for example be used are:
alcoholic or aqueous solutions as well as suspensions. and emulsions.
Preferred forms of application are for example tablets containing between 10 mg and 2000 mg or solutions containing between 10 ml to 0.2 g/ml liquid of active substances.

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-The single dose of active substance of the combination partner in the combination for example with vitamin E can for example be:
a) in the oral medicinal form between 50 mg - 3 g, preferably 100 mg - 1.2 g.
b) in the parenteral medicinal form (for example intravenous, intramuscular) between 50 mg - 2 g, preferably 100 mg - 3 g.

C) in medicinal forms for inhalation (solutions or aerosols) between 100 micrograms - 2 g, preferably 200 micrograms - 1.2 g. The doses according to a) to c) may for example be given 1 to 6 times, preferably 1 to 4 times daily or also as long-s term infusion, for example with the aid of an infusionate.
The daily dose of R- or S-alpha-lipoic acid in the combination for example with vitamin E in man may for example be 2 - 40 mg per kg weight; the single dose for example 1 -0 10 mg per kg weight, this dose appropriately being given up to 4 times daily.
The daily dose may for example be between 100 - 600 mg: the medicaments therefore preferably contain 100 - 600 mg of R-5 or S-alpha-lipoic acid in a pharmaceutical formulation, a dose of this kind preferably being given up to 4 times.
For treatment it is for example possible to recommend 1 to 4 tablets 3 times daily with a content of 10 mg to 2 g active 0 substance or for example in intravenous injection 1 to 4 times daily one ampoule/infusion vial of 1 to 100 ml content with 200 mg to 6 g active slibstance in combination with 0.001 - 2 g of the vitamins.

_ 14 -~~~'~'~32 In oral administration the minimum daily dose of the active substances in combination with the vitamins is for example 100 mg; the maximum daily dose in oral administraion should not exceed 12 g.
The single doss of active substance of the combination partner vitamins in the combination with the R- or S-isomer of alpha-lipoic acid can for exampe be for vitamin E:
a) in the oral medicinal form between 10 mg - 2 g, 0 preferably 20 mg - 800 mg, in particular 25 mg - 300 mg.
b) in the parenteral medicinal forms (for example intramuscular) between 0.1 - 25 mg/kg body weight, preferably 0.2 - 15 mg/kg body weight, in particular 5 1 - 190 mg/kg body weight.
c) in medicinal forms for inhalation (solwtions or aerosols) between 0.01 - 15 mg/kg body weight, preferably 0.1 mg - to mg/kg body weight, in particular 0 0.5 - 5 mg/kg body weight.
The doses according to a) to c) can for example be given 1 to 6 times, preferably 1 to 4 times daily. The daily oral dose of vitamin E in combination with the oxidized or reduced 5 racemate or R- or S-isomer of alpha-lipoic acid in man can for example be 0.1 - 12 mg/kg body weight; the single dose of vitamin E in the combination for example 0.1 - 25 mg per kg weight, this dose appropriately being given up to 4 times per day. The daily dose of vitamin E is preferably 200 - 800 mg:
0 the medicaments therefore preferably contain 10 - 250 mg of vitamin E in a pharmaceutical formulation, a dose of this kind preferably being given 4 times.
For purposes of treatment it is for example possible to recommend far the vitamin E in the combination 3 times daily 5 1 to 4 tablets containing 0.001 mg to 800 mg vitamins or for ~ 0 ~'~'~ ~ 2 example in intravenous,injection 1 to 4 times daily one ampoule/injection vial of 1 to 100 ml content with 0.10 mg to 200 mg of vitamins In the case of oral administration the minimum daily .
dose for example of vitamin E in the combination is 50 mg;
the maximum daily dose in oral administration should not exceed 1.5 g.
The medicaments can be used in human medicine alone or in a mixture with other pharmacologically active substances.
0 The active substances R- or S-alpha-lipoic acid can also be combined with any other agent active against retroviruses, in particular HIV, for example didexocyinosine, dideoxycytidine, however in particular with alpha-interferon and/or azidothymidine (AZT) or with cytostatics such as for example 5 ifosfamide and endoxan.
The dose amounts cited for the active substances of always relate to the free acids of alpha-lipoic acid, dihydrolipoic acid or of oxidized or reduced R- or S-alpha-lipoic acid. Should these be used in the form of their salts, - 0 the stated dosages/dosage ranges should be correspondingly increased to the higher mol weight.
In combinations with other antiretrovirally-effective substances (component b) only one, but also 2 and more (preferably 2) antiretrovirally active substances may be used 5 as component b, in the latter case the dosages quoted for this purpose always apply to the sum of the antiretrovirally active substances in each case. The expression "dosage unit°' always relates to a single dose which can also be ,. administered several times per day.
0 Should the dose be quoted in the form of enzyme units, this is the dose which applies for an entire day, a dose of this kind being given once, preferably, however, distributed over one day 209'~'~32 _ 17 _ (for example in infusion form). The dose information in enzyme units applies in particular to alpha-interferon.
It is for example possible for the combination of vitamin E with R- or S-alpha-lipoic acid with the component b for example AzT
to mix the two components in each case for example in a ratio of 0.01 to 100 to 100 to 1 equimolar parts of active substance, in particular in a ratio of 1 to 10 to 10 to 1, preferably in a ratio of 0.1 to 3 up to 3 to 1 parts. In the case of a combination of vitamin E with R- or S-alpha=lipoic acid and alpha-interferon the three components may be present fox example in the.following ratios: 15 mg - 50 mg - 6 g R- or S-alpha-lipoic acid (component a) to 8 x 106 enzyme units to 1 x 105 enzyme units alpha-interferon, in particular 0.5 - '3 g component a to 1-4 x i06 enzyme units alpha-interferon.
~In the combination of for example vitamin E with R- or S-alpha-lipoic acid and other c~ponents according to b) both components may be present as a mixture. In general the components are however present separately Pram one another in a pharmaceutical formulation, it being possible to use conventional pharmaceutical formulations in this case: for example one component as a tablet or lacquered tablet, the other component as a powder, both in a capsule and vice versa, one component in the form of pellets, the other as a powder, coated tablet or tablets and vice versa'and where the two forms are for example present in a capsule; or in the form of multi-layer or coated tablets. Reference is made in this connection fox example to the book by Karl Thoma, Arzneimittelstabilitat, Frankfurt 1978, for example page 207 et seq.
The combination of the invention may, however, also be present as a product in which in each case the two individual active substances are_present in formulations totally separate from one another, it being possible in particular for the component b, but also both components (a and b) to be contained in ampoules and/or infusion vials so that they can also be administered separately or also at different times.

.. 209~'~32 - ,$ -Should such~totally separate formulations be present, these are adapted to one another and contain' the appropriate active substances in the dosage unit in the same amounts and corresponding weight ratios in which they can be present~in the combined mixture.
In a product for'separate application it is also possible for both combination partners not to be administered simultaneously.
In such cases it is, for example, possible to give vitamin E
intramuscularly and R- or S-alpha-lipoic acid as long-term infusion (dose for example 2 - 5 g per day) and the third component b simultaneously (dose for example 50 - 800 mg or 1-8 x 106 enzyme units, preferably intramuscular) or also as long-term infusion per day or R- or S-alpha-lipoic acid can for example.be given 4 times daily (single dose for example 0.5 - 2 g) and the other component b simultaneously (dose for example 50 - 200 mg or 0.5-3 x 106 enzyme units). It is then for example possible for 1 to 3 further doses of component b (for example between 50 - 200 mg or 0.5-3 x 106 enzyme units) to follow at intervals of in each case 6 and/or 12 hours.
The formulations/products of the invention can preferably also contain additional vitamins such as pantothenic acid and/or folic acid.
To treat diseases caused by retroviruses, in particular HIV
viruses, appropriate medicaments should also contain such an amount of for example vitamin E in combination with R- or S-alpha-lipoic acid or these should be given in such amounts that single or multiple application results~in an active level of vitamin E in the body of between 0.001 and 12 mg/kg, preferably between 0.1 and l0 mg, in particular between 0.2 and 8 mg/kg body weight. -The general dose range for the combinations with the above mentioned vitamins with R- or S-alpha-lipoic acid for analgesic effect is for example:

~09'~'~32 ' - 19 -0.5 - 20 mg/kg body weight oral vitamin E in combination with 1 - 100 mg/kg body weight R- or S-isomer of alpha-lipoic acid.
The general dose range of combinations with the above mentioned vitamins with R-alpha-lipoic acid for anti-inflammatory and cytoprotective effect is for example:
0.5 - 15 mg/kg body weight oral vitamin E in combination with 1 - 100 mg/kg body weight R- or S-isomer of alpha-lipoic acid for the detoxifying, heavy metal antidote effect one can use far example:
0.5 - 25 mg/kg body weight oral vitamin E in combination with 1 - 100 mg/kg~body weight R- or S-isomer of alpha-lipoic acid for the anti-allergic and immune-stimulating effect one can use for example:
0.5 - 20 mg/kg body weight oral vitamin E in combination with 1 - 100 mg/kg body weight R-'or S-isomer of alpha-lipoic acid fox the anti-tumour effect one can use for example:
0.5 - 25 mg/kg body weight oral vitamin E in combination with 1 - 100 mg/kg body weight R- or S-isomer of alpha-l.ipoic acid for the anti-diabetic effect one can use for example:
0.5 - 20 mg/kg body~weight oral vitamin E in combination with i - 100 mg/kg body weight R- or S-isomer of alpha-lipoic acid The following indications may for example be considered:
inflammatory, degenerative articular and extra-articular -rheumatic disorders, non-rheumatic inflammations and swellings, Arthrosis deformans, chondropathies, periarthritis, inflammatory and non-inflammatory diseases.of the skin,. such as.neurodermitis and psoriasis, inflammatory and non-inflammatory disorders of ~0~'~"~32 the gastrointestinal tract, such as gastritis, tllcus ventriculi, ileitis, duodenitis, infections with Campylobacter pylorici, jejunitis, colitis, diabetes mellitus Types I and II, insulin resistance, polyneuropathy of diabetogenic, alcoholic, hepatic and uremic origin, liver parenchyme degeneration, hepatitis, fatty liver and fatty cirrhosis, heavy metal poisonings such. as copper, xinc, cadmium, nickel, lead and arsenic as well as radioactive isotope intoxication as well as chronic liver diseases, inflammatory respiratory tract diseases, such as Asthma bronchiale, sarcoidosis, ARDS (acute respiratory distress syndrome), degenerative diseases of the CNS, acute ischemic .
states, myocardial infarction, liver parenchyme degeneration.
In accordance with the invention, the.dosage forms of the combinations for the analgesic heavy metal antidote, detoxifying, antidiabetic, immune-stimulating and cytoprotective, antinecrotic and/or anti-inflammatory effect are for example 0.01 to 800 fig vitamin E, preferably 0.1 to.600 mg vitamin E in combination with 0.l to 2000 mg, preferably 15 to 600 mg and in particular 50 to 200 mg R-alpha-lipoic acid or S-alpha-lipoic acid In accordance with the invention, a daily dose of the combinations of the above named vitamins with the optical isomers of alpha-lipoic acid (R- or S-form) can be from 0.1 to 800 mg vitamin E, preferably 1 to 600 mg vitamin E in combination with the optical isomers of alpha-lipoic acid (R- or S-form in each case) 10 - 600 mg, preferably 25 to 400 mg or 10 to 200 mg. The maximum daily dose for the cytoprotective effect and for the treatment of states of pain and inflammation should not exceed 1.2 mg for the racemate or R- or S-form of alpha-lipoic acid and 800 mg for vitamin E. The daily doses may be used in the form of a single administration of the entire amount or in the form of 1 to 6, in particular 7 - 4 partial doses per day.

2D9'~'~32 In general administration of 1 to 4 times, in particular 1 to 3 times daily is preferred.
For example, the preferred daily dose in the combination with vitamin E (0.1 - 800 mg for the oral administration of vitamin E in the combination and 0.1 - 20 mg/kg for the intramuscular administration of vitamin E in the combination) both for R-alpha-lipoic acid and also for S-alpha-lipoic acid is preferably 100 mg for the parenteral form of application and 400 mg for the oral form.
0 For example the daily dose for the parenteral form of application of the R- or S-isomers of alpha-lipoic acid in the combination with vitamins can in particular be 300 mg and 600 mg for the oral form.
The medicaments are preferably given orally. For 5 example the vitamin E in the combination with R-alpha-lipoic acid and S-alpha-lipoic acid can in particular also be applied in the form of a solution, for example peroral, topical, parenteral (intravenous, intra-articular, intramuscular, subcutaneous), inhalative, transdermal. The 0 medicaments containing as active substance for example vitamin E in combination with R-alpha-lipoic acid or S-alpha-lipoic acid can for example be formulated in the form of tablets, capsules, pills or coated tablets, granulates, pellets, plasters, solutions or emulsions, the active 5 . substances in each case optionally being combined with appropriate auxiliary substances and carriers. In the case of solutions in each case of 10 - 600 mg, fox example from 25 to 400 mg or 10 to 200 mg administered. The maximum daily dose for the antidiabetic, immune-stimulating, anti-allergic, 0 cytoprotective effect and for the treatment of pain and inflammatory states should for example for the combination of vitamin E with the R- or S-isomers of alpha-lipoic acid for the vitamin E not exceed 800 mg orally and for the R- and S-isomers of alpha-lipoic.acid 1.2 g.

209'~'~3~

The maximum daily dose for the detoxifying, heavy metal antidote effect should fox example for the combinati~n of vitamin E with the R- or S-isomers of alpha-lipoic acid for the vitamin E not exceed 1200 mg orally and 1200 mg for the R- or S-isomers~of alpha-lipoic acid.
The daily doses can bemused in the form of a single administration of the entire amount or in the form of 1 to 6, in particular 1 - 4 partial doses per day. In general an administration of 1 to 4 times, in particular 1 to 3 times daily is preferred.
The preferred daily dose in the combination both for the vitamin E is for example 800 mg orally, preferably 600 mg oral and parenteral for vitarain E 15 mg/kg body weight intramuscular and for R-alpha-lipoic acid and also.for S-alpha-lipoic acid preferably 80 mg for the parenteral form of application and 200 mg for the oral form.
The R-alpha=lipoic acid and S-alpha-lipoic acid.in the combination witli for example vitamin E can for example also be applied in particular in the form of a solution, for example peroral, topical, parenteral (intravenous, intra-articular, intramuscular, subcutaneous), inhalative, transdermal.
Medicaments containing as active substances for example vitamin E in the combination with R-alpha-lipoic acid or S-alpha-lipoic acid can for example be formulated in the form of tablets, capsules, pills or coated tablets, granulates, pellets, plasters, solutions or emulsions, where the active substance is in each case optionally combined with appropriate auxiliary substances and carriers. In the case of solvents these contain for example 0.5 to 20 weight%, preferably 1 to 10 weight% of one of the optical isomers of alpha-lipoic acid (in each case R-form or S-forms together with 0.001 to 10 weight% of the appropriate vitamin.

..

The dosage unit of medicaments with for example vitamin E in . combination with the optical isomers of alpha-lipoic acid or a therapeutically acceptable salt thereof (R-form or S-form in each case) can for example contain:
a) in the case of oral medicaments:
to 1200 mg, preferably 20 to 600 mg, in particular 50 to 400 mg of the optical isomers of alpha-lipoic acid in combination with for example vitamin E 0.'1 to 800 mg, preferably 1 to 400 mg, in particular 1 - 300 mg.
The doses can for example be given l to 6 times, preferably 1 to 4 times, in particular 1 to 3 times daily. However a total dose of the optical isomers of alpha-lipoic acid of 1200 mg and for example of vitamin E of 800 mg per day should not be exceeded for the cytoprotective effect and for the treatment of states of pain and inflammation. The same also applies to the following medicinal forms listed under b) to e).
In addition a total dose of the optical R- or S-isomers of alpha-lipoic acid of 2000 mg and for example of vitamin E of 1200. mg per day should not be exceeded for the detoxifying and heavy metal antidote effect.
b) in the case of parenteral medicinal forms for example intravenous, intramuscular or intra-articular), 10 to 600 mg, .preferably 15 to 500 mg, in particular 20 to 300 mg of the optical isomers of alpha-~lipoic acid in the combination for example with vitamin E 0.01 - 20 mg/kg body weight intramuscular, preferably 0.1 -- 12 mg/kg body weight in particular 1 - 10 mg/kg body weight intramuscular.
The doses can for example be administered 1 to 6 times, preferably 1 to 4 times, in particular 1 to 3 times daily.

c) in the case of medicinal forms for application to the skin and mucous membranes (for example as solutions, lotions, emulsions, ointments, plasters and the like) in the combination:
10 to 500 mg R-alpha-lipoic acid or S-alpha-lipoic acid, preferably 40 to 250 mg, in particular 50 to 200 mg with for example the combination partner vitamin E 0.1 - 600 mg, preferably 1 - 400 mg, in particular 5 - 200 mg.
These doses can for example be given 1 to 6 times, 0 preferably 1 to 4 times, in particular 1 to 3 times daily.
d) in the case of medicinal forms for inhalation (solutions or aerosols):
5 0.02 to 300 mg, preferably 0.25 to 150 mg, in particular 0.5 to 80 mg R-alpha-lipoic acid or S-alpha-lipoic acid combination with for example vitamin E preferably 0.001 - 20 mg/kg, in particular 0.01 to 10 mg/kg. These doses may for example be administered 1 to 6 times, preferably 0 1 to 4 times, in particular 1 to 3 times daily.
If solutions are used, the optical isomers of alpha-lipoic acid and the vitamins contained in the combination are preferably used in the form of a salt.
5 It is of course also possible to prepare pharmaceutical formulations which contain 2 up to for example 6 times the ., above stated dosage units. In particular tablets or capsules contain 20 to 800 mg of the active substances in combination with a vitamin, for example vitamin E 1 - 1200 mg, pellets, 0 powders or granulates 20 to 400 mg of the active substances of in combination with a vitamin, for example vitamin E 1 -800 mg, suppositories 20 to 300 mg pf the active substances in combination with a vitamin, for example 1 - 600 mg of vitamin E R-alpha-lipoic acid or S-alpha-lipoic acid.

To combat retroviruses (for example AIDS) the daily dose is for example 4 - 6 g R- or S-isomer of alpha-lipoic acid in the combination with for example vitamin E 1 - 1200 mg-Corresponding medicaments consequently preferably contain in the combination with 5 mg - 1 g vitamin E R-alpha-lipoic acid or S-alpha-lipoic acid in the single dose (dosage unit) for example in an amount of 600 mg to 1.5 g.
The above stated dosages always relate to combinations 0 with the cited vitamins with, for example, the free optical isomers of alpha-lipoic acid. If the optical isomers of alpha-lipoic acid are used in the form of a salt, the stated dosages/dosage ranges should be increased accordingly on account of the higher mol weight.

In the event of the combination with the vitamins such as for example vitamin E being used with the optical isomers of alpha-lipoic acid in animals, the following indications may in particular be considered: panleucopenia, distemper, 0 hepatoses, Arthrosis deformans, arthritis and dermatitis.
For the treatment of animals it is for example possible to use the following dosages (vitamin E both in combination -with the R-form and with the S-form of alpha-lipoic acid):

For the treatment of cats the oral single dose is generally between about 2 mg/kg and 50 mg/kg of the active substances in combination for example with vitamin E 0.1 to 100 mg/kg, preferably 1 to 8o mg/kg, in particular 2 - 40 0 mg/kg body weight, the parenteral dose is between 0.5 and .40 mg/kg body weight of the active substances in combination with the vitamins for example vitamin E 0.01 mg/kg to 1 0 mg/kg, pref erably 0. 1 to 8 mg/kg, in particular 1 - 4 mg/kg.

_ 2~~'~'~32 For the treatment of arthroses in horses and cattle the oral single dose in general in the combination for the active substances is between about 2 mg/kg and 100 mg/kg body weight and for the vitamins between about 2 mg/kg and 100 mg/kg body weight, the parenteral dose in the combination for the active substances is about between 0.5 and 50 mg/kg body weight and for the vitamins about between 0.005 and 20 mg/kg body weight.
The vitamins active substances such as the optical 0 isomers of alpha-lipoic acid are suitable for the preparation of pharmaceutical compositions and formulations. The pharmaceutical compositions or medicaments contain for example the optical isomers of alpha-lipoic acid as active substance, optionally in a mixture with the vitamins or other 5 pharmacological or pharmaceutically active substances. The medicaments are prepared in known manner, it also being possible to use known and conventional pharmaceutical auxiliary substances as well as other conventional carriers and diluting agents. Carriers arid auxiliary substances that 0 may for example be considered are those recommonded or quoted in the following literature references as auxiliary substances for use in pharmaceuticals, cosmetics and related fields:
Ullmanns Enzyklopgdie der technischen Chemie, Volume 4 5 (1953), page 1 to 39; 3ournal of Pharmaceutical Sciences, Volume 52 (1963), page 91.8 et seg., H. v. Czetsch-Lindenwald, Hilfsstoffe fUr Pharmazie and angrenzende Gebiete; Pharm.
Ind., Issue 2 (1961j, page 72 at seq., Dr. H.P. Fiedler, Lexikon der Hilfsstoffe f6r Pharmazie, Kosmetik and 0 angrenzende Gebiete, Cantor KG, Aulendorf in Wurttemberg (1989).
The pharmaceutical and galenic handling of the vitamins and of the active substances of such as for example R- or S-alpha-lipoic acid is effected using conventional standard 5 methods.

209~~3~
For example in 1 to 5 ml vitamin E for example 250 mg dihydrolipoic acid or in 10 ml vitamin E for example 250 mg R-alpha or S-alpha-lipoic acid and/or auxiliary or carrier substances are well mixed by stirring or homogenizing (for-example using conventional mixing apparatus) (clear solution), working generally being at temperatures between 20 and 50°C, preferably 20 to 40°C, in particular at room temperature. Reference is also made to the following standard textbook: Sucker, Fuchs, Speiser, Pharmazeutische 0 Technologic, Thieme-Verlag Stuttgart, 1978. Application of the vitamins with the active substances such as for example R- or S-alpha-lipoic acid or of the medicaments can be to the skin or mucous membrane or to the inside of the body, for example oral, enteral, pulmonal, nasal, lingual, intravenous, 5 intra-arterial, intracardial, intramuscular, intraperitoneal, intracutaneous, subcutaneous.
The parenteral formulation forms are in particular sterile or sterilized products.
If, for example, the vitamin E is used in combination with R-0 or S-alpha-lipoic acid in the form of their salts, the salt formers can also be used in excess, that is in a higher amount that equimolar.
Examples fox the carriers and auxiliary substances are gelatin, natural sugars such as cane sugar or lactose, 5 lecithin, pectin, starches (for example corn starch or amyloses), cyclodextrins and cyclodextrin derivatives, dextran, polyvinyl pyrrolidone, polyvinyl acetate, gum arabic; alginic acid, tylose, talcum, lycopodium, silicic acid (for example colloidal), cellulose, cellulose 0 derivatives (for example cellulose ethers in which the cellulose hydroxy groups are partially etherified with lower saturated aliphatic alcohols and/or lower saturated aliphatic oxyalcohols, for, example methyloxypropyl cellulose, methyl cellulose, hydroxypropyl methyl cellulose, hydroxypropyl 5 methyl cellulosephthalate, fatty acids as well as magnesium, 2U9'~'~32 calcium or aluminium salts of fatty acids with 12 to 22 carbon atoms, in particular saturated (for example stearates), emulsifiers, oils and fats, in particular vegetable (for example peanut oil, castor oil, olive oil, .
sesame oil, cotton seed oil, corn oil, wheat germ oil, sunflower seed oil, cod liver oil, in each case also hydrated); glycerol esters and, polyglycerol esters of saturated fatty acids C12H24~2 to C18H36~2 and their mixtures, where the glycerol-hydroxy groups are totally or 0 also only partially esterified (for example.mono, dl and triglycerides), pharmaceutically acceptable mono~or multivalent alcohols and polyglycols such as polyethylene glycols (molecular weight range for example 300 to 1500) as well as derivatives hereof, polyethylene oxide, esters of 5 aliphatic saturated or unsaturated fatty acids (2 to 22 carbon atoms, in particular 10 - 18 carbon atoms) with monovalent aliphatic alcohols (1 to 20 carbon atoms) or multivalent alcohols such as glycolen, glycerol, diethylene glycol, pentaerythritol, sorbitol, mannitol and the like, 0 which may optionally also be etherified, esters of citric acid with primary alcohols, acetic acid, urea, benzyl benzoate, dioxolanes, glyzerol formals, tetrahydrofurfuryl alcohol, polyglycolesters with C1-C12-alcohols, dimethylacetamide, lactamides, lactates, ethylcarbonates, 5 silicons (in particular medium-viscous polydimethylsiloxanes), calcium carbonate, sodium carbonate, calcium phosphate, sodium phosphate, magnesium carbonate and the like. Other auxiliary substances that may be considered are substances which'effect disintegration (so-called 0 disintegrants) such as cross-linked polyvinyl pyrrolidone, sodiumcarboxymethyl starches, sodiumcarboxymethyl cellulose or microcrystalline cellulose. It is also possible to use known covering materials. Agents of this type that may for example be used are:

209~~32 Polymerisates as well as copolymerisates of acrylic acid and/or methacrylic acid and/or their esters, copalymerisates of acrylic and methacrylic acid esters with a lawer ammonium group content (for example Eudragi~ RS), copolymerisates of acrylic and - 28a -- 20~'~°~3~

methacrylic acid esters and trimethylammonium methacrylate (for example Eudragit"" RL); polyvinylacetate; fats, oils, waxes, fatty alcohols;
hydroxypropyl methyl cellulose phthalate or -acetate ruccinate;
cellulose acetate phthalate, starch acetate phthalate as~weli as polyvinylacetate phthalate; carboxymethyl cellulose; methyl cellulose phthalate, methyl cellulose succinate, -phthalate succinate as well as methyl cellulose phthalic acid half esters;
zein; ethyl cellulose as well as ethyl cellulose succinate;
shellack, gluten; ethylcarboxyethyl cellulose; ethacrylate malefic acid anhydride copolymer; malefic acid anhydride vinyLaethylether copolymer; styrol-malefic acid copolymerisates;
2-ethyl-hexyl-acrylate malefic acid anhydride; crotonic acid-vinyl acetate copolymer;
glutaminic acid/glutaminic acid ester-copolymer;
carboxymethylethyl cellulose glycerol mono-octanoate;
celluloseacetate succinate; polyarginine. Plasticizing agents for covering substances that may be used are: .
citric and tartaric acid esters (acetyltriethyl citrate, acetyltributyl-, tributyl-, triethyl citrate); glycerol and glycerol esters (glycerol diacetate, - triacetate, acetylated monoglycerides, castor oil); phthalic acid esters (dibutyl-, diamyl-, diethyl-, dimethyl, dipropyl-phthalate, di-(2-methoxy-or 2-ethoxyethyl)-phthalate, ethylphthalyl-glycolate~
butylphthalyl ethylglycolate and butylglycolate; alcohols (propylene glycol, polyethylene glycol of various'chain lengths), adipates (diethyladipate, di-(2-methoxy- or 2-ethoxyethyl)-adipate); benzophenone; diethyl- and dibutylsebacate, dibutylsuccinate, dibutyltartrate;
diethyleneglycol dipropionate; ethylene glycoldiacetate, -dibutyrate, -dipropionate, trib~itylphosphate, -tributyrin, polyethylene glycol sorbitane monooleate (polysorbates such as polysorbate 80); sorbitane monooleate. For the preparation of solutions or suspensions it is for example possible to use water or physiologically acceptable organic solvents such as alcohols (ethanol, propanol, isopropanol, 1,2-propylene glycol, . 209"l'~3~

polyglycols and their derivatives, fatty alcohols, partial esters of glycerol), oils (for example peanut oil, olive oil, sesame oil, almond oil, sunflower oil, Soya bean oil, castor oil), paraffins, dimethylsulfoxide, txiglycerides and the like.
For injectable solutions or suspensions it is for example possible to use non-toxic parenterally acceptable dissolution agents or solvents, such as:.water, 1,3-butane diol, ethanol, 1,2-propylene glycol, polyglycols mixed with water, glycerol, Ringer's solution, isotonic sodium chloride solution or also solidified ails including synthetic mono- or diglycerides or fatty acids such as oleic acid.
To prepare the formulations it is possible to use known and conventional solubilizers or emulsifiers. Solubilizers and emulsifiers that may for example be used are: polyvinyl pyrrolidone, sorbitane fatty acid esters such as sorbitane trioleate, phosphatides such as lecithin, acacia, tragacanth, polyoxyethylated sorbitane monooleate and other ethoxylated fatty acid esters of sorbitane, polyoxyethylated fats, polyoxyethylated oleotriglycerides, -linolisated oleotriglycerides, polyethylene oxide condensation products of fatty alcohols, alkyl phenols or Fatty acids or also '-methyl-3-(2-hydroxyethyl) imidazolidone-(2).
In this context polyoxyethylated means that the appropriate substances contain polyoxyethylene chains, the degree of polymerization of which generally lies between 2 and ~0 and in .' particular between 10 to 20. Polyoxyethylated substances of this type may for example be, obtained by reacting hydroxyl group-containing compounds (for example mono- or diglycerides or unsaturated compounds such as those containing oleic acid radicals) with ethylene oxide (for example 40.mo1 ethylene oxide r per 1 mol glyceride). Examples of oleotriglycerides are olive . oil, peanut oil, castor oil, sesame oil, cotton seed oil, corn oil.

See also Dr. H.P. Fiedler "Lexikon der Hilfsstoffe fur Pharmazie, Kosmetik and angrenzende Gebiete'° 1971, p. 191-195.
In addition it is also possible to add conserving agents, stabilizers, buffers, flavour correcting agents, sweeteners, colourants, antioxidants, complex formers and the like.
Complex formers that may for example be considered are:
chelate formers such as ethylenediamino tetraacetic acid, 0 nitrilotriacetic acid, diethylene triamine pentaacetic acid as well as their salts. It is also ssible to use as complex formers those containing the vitamins in combination with for example Ror S-alpha-lipoic acid in a cavity.
Hxamples hereof are urea, thiourea, cyclodextrins, amylose.
5 It is optionally necessary to stabilize the active substance molecule with physiologically acceptable bases or buffers to a pH range of approx 6 to 9. In general as neutral to weakly basic (up to pH 8) a pH value as possible is preferred.
Antioxidants that may for example be used are sodium sulfite, 0 sodium hydrogen sulfite, sodium metabisulfite, ascorbic acid, ascorbyl palmitate, -myristate, -stearate, gallic acid, gallic acid alkyl ester, butylhydroxyanisol, nordihydroguaiacic acid, tocopherols as well as synergists (substances which form heavy metals through complex 5 formation, for example lecithin, ascorbic acid, phosphoric acid ethylene diamine tetraacetic acid, citrates, tartrates).
The addition of synergists considerably raises the antioxygenic effect of the antioxidants.
0 Conserving agents that may for example be used are sorbic acid, p-hydroxybenzoic acid ester (for example lower alkyl ester), benzoic acid, sodium benzoate, trichloroisobutyl alcohol, phenoli cresol, benzethonium chloride, chlorohexidine and formalin derivatives.

Example 1 Suppositories with 50 mg dihydrolipoic acid or with R- or S-alpha-lipoic acid and 200 mg alphatocopherol or 200 mg alphatocopherol acetate 5 g ascorbyl palmitate and 5 g Oxynex LM**) (E. Merck, Darmstadt) are suspended in 175 g molten hard fat*,). 20 g alpha tocopherol and 5 g dihydrolipoic acid are then mixed 0 thereto and the mixture is cast into hollow cells of 2.3 ml after homogenization and cooled. Before sealing the hollow cells are gassed with nitrogen.
A suppository weighing 2.1 g contians 50 mg dihydrolipoic 5 acid and 200 mg alphatocopherol.
Suppositories with R- or S-alpha-lipaic acid may be prepared in the same manner by using the same amount of either R- or w S-alpha-lipoic acid instead of dihydrolipoic acid.

*) hard fat is a mixture of mono-, di- and triglycerides of saturated fatty acids of C1pH2002 to CigH3g02 **) Oxynex LM is a trade mark commercial additive for fats 5 and fat-containing foodstuffs. It is a light brown to brown, waxy mass which melts on heating to 55°C to a clear brown liquid and contains tocopherol, ascorbyl palmitate, citric acid and lecithin.
0 Example 2 .,_ Capsules containing 200 mg dihydrolipoic acid or R- or S-alpha-lipoic acid arid 500 mg alphatocopherol or alphatocopherol acetate ~0~~'~32 200 g R-alpha;lipoic acid are mixed with 500 g alphatocopherol. 595 g MiglyolLnJ neutral oil and 100 g sorbitol syrup, 25 g glycerol are then mixed thereto and the mixture filled into size 00 capsules. One capsule weighing 1.42 g contains 200 mg R- or S-alpha-lipoic acid and 500 mg alphatocopherol.
In the same manner it is possible to prepare capsules with dihydrolipoic acid or with S-alpha-lipoic acid by using the 0 same amount of either dihydrolipoic acid or S-alpha-lipoic acid instead of R-alpha-lipoic acid.
Miglyo~ is a commercial mixture of medium-chain triglycerides Example 3 Ampoules containing 250 mg R- or S-alpha-lipoic acid and 250 mg vitamin C (ascorbic acid) in 10 ml 250 g R-alpha-lipoic acid are dissolved with stirring together with 352.3 tromethamine (2-amino-(hydroxymethyl)-1,3-propanediol) in a mixture of 8 litres of water for injection purposes and 200 g 5 1,27propylene glycol with stirring. 250 mg vitamin C are then dissolved into this batch. The solution is made up to litres with water for injection purposes and then filtered through a membrane filter of pore size 0.2 um with glass fibre prefilter. The filtrate is filled under aseptic 0 conditions in 10 m1 portions into sterilized 10 ml ampoules.
One ampoule contains 250 ml R-alpha-lipoic acid as tromethamine,salt and 250 mg vitamin C in 10 ml injection ., solution.

- ~4 -In the same manner it is possible to prepare ampoules with S-alpha-lipoic acid by using the same amount of S-alpha-lipoic acid instead of R-alpha-lipoic acid.
Example 4 Tablets with 50 mg S- or R-alpha-lipoic acid and 50 mg vitamin C
ascorbic acid 250 g S-alpha-lipoic acid and 250 g vitamin C are evenly ground With 550 g micxocrystalline cellulose. After sieving the mixture, 250 g starch (starch 1500/Colorcon), 682.5 g laotose, 15 g magnesium stearate and 2,5 g highly disperse silicon dioxide are added thereto arid the mixture is pressed into tablets weighing 400.O.mg each.
One tablet contains 50 mg S-alpha-lipoie.acid and 50 mg vitamin C.
In the same manner it is possible to prepare tablets with 50 mg R-alpha-lipoic acid by using the same amount of R-alpha-lipoic acid instead of 250 g S-alpha-lipoic acid.
The tablets may optionally be provided,with a gastric juice soluble or gastric juice permeable film coating using ,. conventional methods.
Example 5 Ampoules containing 50 mg dihydrolipoic acid or 50 mg R- or S-alpha-lipoic acid and 200 mg,alphatocopherol acetate in 4 ml injection solution ,.' . ~ ~ - 35 -50 g R-alpha-lipoic acid are dissolved with 750 g alphatocopherol acetate. The solution is filled up with 3200 g neutral oil.
The solution is sterilized using gamma or beta radiation-and filled in 10 ml portions into sterilized 10 ml ampoules under aseptic conditions. One 4 ml ampoule contains 50 mg R-alpha-lipoic acid and 200 mg alphatocopherol acetate.
In the same manner it is possible to prepare ampoules with dihydrolipoic acid or with S-alpha-lipoic acid by using the same amount of either dihydrolipoic acid or S-alpha-lipoic acid instead of R-alpha-lipoic acid.
Example 6 Ointment with 2% dihydrolipoic acid or 2% R- or S-alpha-lipoid acid and with 2% alphatocopherol.
20 g R-alpha-lipoic acid are mixed With 20 g alphatocopherol . with 400 g Vaselinum album and 100 g sorbitol 70% and 100 g Alcohol cetylicus et stearylicus and 360 g wool wax.
This mixture~is filled under sterile conditions into_50 g tubes after homogenization.
The ointment contains 2% R-alpha-lipoic acid and 2%
alphatocopherol acetate.
In the same manner it is possible to prepare an ointment with dihydrolipoic acid or with S-alpha-lipoic acid by using the same amount of either dihydrolipoic acid or S-alpha-lipoic acid instead of R-alpha-lipoic acid.
Example 7 ,, :;;,--:.. ' °_~

Tablets containing 120 mg S- or R-alpha-lipoic acid and 67 mg vitamin C ascorbic acid 825 g S-alpha-lipoic acid and 425 g vitamin C are evenly ground with 550 g microcrystalline cellulose. After the mixture has been sieved 250 g starch (starch 1500/Colorcon), 682.5 g lactose, 15 g magnesium stearate and 2.5 g highly disperse silicon dioxide are mixed thereto and the mixture is pressed into tablets weighing 400.0 mg each.
One tablet contains 120 mg S-alpha-lipoic acid and 61 mg vitamin C.
In the same manner it is possible to prepare tablets with 'e~U rr~g R-alpha-lipoic acid by using the same amount of R-alpha-lipoic acid instead of S-alpha-lipoic acid.
The tablets may optionally be provided with a gastric juice soluble or gastric juice permeable film coating using conventional methods.

2097'~3~
--, A synergistic combination of medicaments containing as active substance alpha-lipoic acid,, dihydrolipoic acid, their metabolites as.well as the oxidized and reduced enantionmers of alpha-lipoic acid such as R-alpha-lipoic acid or S-alpha-lipoic acid as well as metabolites of alpha-lipoic acid with the '. vitamins A, B 1-6, 812, C and E.

Claims

1. Use of a composition comprising pure R-alpha-lipoic acid and vitamin E, or a pharmaceutically acceptable salt thereof, for treating diabetes mellitus Type I or Type II.

2. The use according to claim 1, wherein the composition further comprises a pharmaceutically acceptable carrier, diluent, auxiliary substance or combination thereof.

3. The use according to claim 2, wherein said auxiliary substance comprises a stabilizer, solubilizer or combination thereof.

4. The use according to claim 1, 2 or 3, wherein the ratio of R-alpha-lipoic acid to vitamin E is 1:0.001 to 0.8 parts by weight.

5. The use according to any one of claims 1 to 4, comprising 5 to 6,000 mg of R-alpha-lipoic acid and 0.001 to 3,000 mg or 1 to,150,000 IU of vitamin E.

6. The use according to any one of claims 1 to 4, comprising 10 to 3,000 mg of R-alpha-lipoic acid.

7. The use according to any one of claims 1 to 4, comprising 2 to 3,0.00 mg of R-alpha-lipoic acid and 0.001 to 1,000 mg or 1 to 150,000 IU of vitamin E.

8. The use according to claim 7, comprising 2 to 1,000 mg of R-alpha-lipoic acid.

9. The use according to any one of claims 1 to 4, comprising 2 to 1,000 mg of R-alpha-lipoic acid and 0.005 to 500 mg or 1 to 150,000 IU of vitamin E.

10. The use according to claim 9, comprising 2 to 800 mg of R-alpha-lipoic acid.

11. Use of a composition comprising pure R-alpha-lipoic acid and vitamin E, or a pharmaceutically acceptable salt thereof, in the manufacture of a medicament for treating diabetes mellitus Type I or Type II.

12. The use according to claim 11, wherein the composition further comprises a pharmaceutically acceptable carrier, diluent, auxiliary substance or combination thereof.

13. The use according to claim 12, wherein said auxiliary substance comprises a stabilizer, solubilizer or combination thereof.

14. The use according to claim 11, 12 or 13, wherein the ratio of R-alpha-lipoic acid to vitamin E is 1:0.001 to 0.8 parts by weight.

15. The use according to any one of claims 11 to 14, comprising 5 to 6,000 mg of R-alpha-lipoic acid and 0.001 to 3, 000 mg or 1 to 150, 000 IU of vitamin E.

16. The use according to any one of claims 11 to 14, comprising 10 to 3, 000 mg of R-alpha-lipoic acid.

17. The use according to any one of claims 11 to 14, comprising 2 to 3,000 mg of R-alpha-lipoic acid and 0.001 to 1,000 mg or 1 to 150, 000 IU of vitamin E.

18. The use according to claim 17, comprising 2 to 1,000 mg of R-alpha-lipoic acid.

19. The use according to any one of claims 11 to 14, comprising 2 to 1,000 mg of R-alpha-lipoic acid and 0.005 to 500 mg or 1 to 150,000 IU of vitamin E.

20. The use according to claim 19, comprising 2 to 800 mg of R-alpha-lipoic acid.

21. A composition comprising pure R-alpha-lipoic acid and vitamin E, or a pharmaceutically acceptable salt thereof, for treating diabetes mellitus Type I or Type II.

22. The composition of claim 21, wherein the composition further comprises a pharmaceutically acceptable carrier, diluent, auxiliary substance or combination thereof.

23. The composition according to claim 22, wherein said auxiliary substance comprises a stabilizer, solubilizer or combination thereof.

24. The composition according to claim 21, 22 or 23, wherein the ratio of R-alpha-lipoic acid to vitamin E is 1:0.001 to 0.8 parts by weight.

25. The composition according to any one of claims 21 to 24, comprising 5 to 6,000 mg of R-alpha-lipoic acid and 0.001 to 3,000 mg or 1 to 150,000 IU of vitamin E.

26. The composition according to any one of claims 21 to 24, comprising 10 to 3,000 mg of R-alpha-lipoic acid.

27. The composition according to any one of claims 21 to 24, comprising 2 to 3,000 mg of R-alpha-lipoic acid and 0.001 to 1,000 mg or 1 to 150,000 IU of vitamin E.

28. The composition according to claim 27, comprising 2 to 1,000 mg of R-alpha-lipoic acid.

29. The composition according to any one of claims 21 to 24, comprising 2 to 1,000 mg of R-alpha-lipoic acid and 0.005 to 500 mg or 1 to 150,000 IU of vitamin E.

30. The composition according to claim 29, comprising 2 to 800 mg of R-alpha-lipoic acid.