Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/08—Drugs for disorders of the alimentary tract or the digestive system for nausea, cinetosis or vertigo; Antiemetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/02—Non-specific cardiovascular stimulants, e.g. drugs for syncope, antihypotensives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/04—Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure

Definitions

• the present invention relates to a method for the treatment and/or prophylaxis of nausea and bradycardia associated with myocardial instability .
• EP-A-158532 and EP-A-237281 (A.H. Robins Company, Inc.), EP-A-67770 and EP-A-2666730 (Merrell Toraude et Compagnie), GB 2125398A, GB 2145416A and 2152049A (Sandoz Limited), EP-A-322016, 350129 and 350130 (Duphar international Research B.V.), EP-A-307172 and US 4921982 (Eli Lilly and Company), EP-A-323077, EP-A-306148 and GB 2208385A and EP-A-361629 (John Wyeth and Brother Limited), EP-A-234872 (Adria Laboratories Inc.), EP-A-294292 (Adir et Compagnie), EP-A-339950, US 4924010, 4920219, 4290227 and WO90/6309 (Rorer International (overseas), Inc.), EP-A-309423 and EP- A-
• EP-A-358903 disclose classes of compounds containing a saturated azacyclic or azabicyclic moiety, such as tropanyl, granatyl or quinuclidinyl, and are 5-HT 3 receptor antagonists.
• EP-A-242973 EP-A-276163, EP-A-291172, EP-A-307145,
• EP-A-357414, EP-A-357415, EP-A-357416, EP-A-357417, EP-A-364274 and EP-A-385722 (Glaxo Group Limited), EP-A-315316 (Beecham Group p.l.c), EP-A-361317 (Fujisawa), EP-A-375045 and EP-A-377238 (Duphar), EP-A-376624 and EP-A-381422 (Yamanouchi Pharmaceutical Co. Ltd.), EP-A-392663 (Ono Pharmaceutical Co.
• EP-A-373061 (Adir et Compagnie)
• US 4914207 Pfizer
• GB 2229182A Merck Sharp and Dohme Limited
• EP-A-201165 (Beecham Group p.l.c.) discloses the use of 5-HTo receptor antagonists, in particular MDL 72222 (Example 1), ICS 205-930 (Example 2) and ondansetron (Example 5) as antiemetic agents.
• EP-A-200444 (Example 6) discloses the 5-HT 3 receptor antagonist, granisetron, which is also disclosed as an antiemetic agent. Ondansetron and granisetron are under clinical evaluation as antiemetic agents in cytotoxic drug induced emesis.
• Myocardial instability occurs as a result of myocardial infarction, myocardial reperfusion following thrombolysis, percutaneous transluminal coronary angioplasty (PTCA), coronary bypass grafts and coronary cardiac catheterisation. Nausea, bradycardia (slowing of the heart) and hypotension as a result of myocardial instability is well known (E. Braunwald, Heart Disease' publ. Saunders pp. 1197-8, 1236, 1253, 1264), and there is a need for a suitable treatment to overcome these problems.
• PTCA percutaneous transluminal coronary angioplasty
• 5-HT 3 receptor antagonists such as compounds of the above classes, are of potential use in the treatment or prophylaxis of nausea, bradycardia and/or hypotension associated with myocardial instability.
• the present invention provides a method for the treatment and/or prophylaxis of nausea and bradycardia and/or hypotension associated with myocardial instability in mammals, such as humans, which method comprises administering to the mammal in need of such treatment and/or prophylaxis an effective and/or prophylactic amount of a 5-HT 3 receptor antagonist, such as a compound of formula (I), or a pharmaceutically acceptable salt thereof:
• a 5-HT 3 receptor antagonist such as a compound of formula (I), or a pharmaceutically acceptable salt thereof:
• X is a phenyl group or a monocyclic 5 or 6 membered heteroaryl group, either of which group is optionally fused to a saturated or unsaturated 5-7 membered carbocyclic or heterocyclic ring;
• A is a linking moiety; and
• R is a saturated azabicyclic moiety or an imidazolyl moiety.
• X may be unsubstituted or substituted, usually by one or more substituents selected from halogen, C 1-6 alkoxy, C1-6 alkylthio, C 1-6 alkyl, hydroxy, amino, C 1-6 alkylamino, C 1-7 alkanoylamino, or two substituents on X (when fused), may be linked to form a saturated or unsaturated optionally substituted carbocyclic ring.
• Heteroatoms for heteroaryl and heterocyclic groups are selected from oxygen, nitrogen and sulphur.
• X may be joined to A by an aromatic carbon atom, or (when X is fused), by a carbocyclic ring carbon atom, or by a heterocyclic ring carbon or nitrogen atom.
• A is attached at an aromatic carbon atom, it is preferably attached at the aromatic carbon adjacent a 'fused' carbon atom, which is attached to the heteroatom of a heterocyclic ring in formula (I).
• Suitable examples of X are as described in the aforementioned patent publications relating to 5-HT 3 receptor antagonists containing a saturated azabicyclic moiety, the subject matter of which is incorporated herein by reference.
• Suitable examples of A include CONH (amide), COO (ester), NHCONH (ureide), CONHCONH (extended ureide), or a group of structure (h):
• dotted circle represents two double bonds in any position in the 5 membered ring;
• two of G, H and I are selected from oxygen, sulphur, nitrogen and carbon and the other is oxygen, sulphur or nitrogen;
• E is a bond or C 1-5 alkylene optionally substituted by phenyl or hydroxy.
• A may also be a keto - (methylene or ethylene) linkage, such as -CO-(CH 2 ) 2 -, or another of the linkages as described in the abovementioned patent publications relating to further classes of compounds having 5-HT 3 receptor antagonist activity containing an unsaturated N-heterocycle, in particular those in the name of Glaxo Group Limited.
• the suitable X values in formula (I) which are described in the referenced patent publications, are that part of the structure remaining when the saturated azabicyclic moiety and A (where A is one of the suitable examples listed above), are disregarded.
• Preferred examples of X include a group of sub-formula (a), (b), (c), (d), (e), (f) or (g):
• R a to R e and R g are selected from hydrogen, halogen or hydroxy;
• R 1 is hydrogen and R 2 is hydrogen or C 1- 4 alkyl; or R 1 and R 2 together are a bond;
• R w are independently selected from hydrogen or C 1-6 alkyl;
• R 12 is hydrogen, C 1-6 alkoxy or amino optionally substituted by a C 1-6 alkyl group, or R 12 is alkanoylamino; and
• R 13 is halo, C 1-6 alkyl, C 1-6 alkoxy or C 1-6 alkylthio;
• R 1 4 is hydrogen or C 1-6 alkyl; and L is CH or N.
• moieties in alkyl or alkyl containing groups in R 1 to R 14 include methyl, ethyl, n- and iso-propvl, n-, iso-, sec- and tert-butyl, preferably methyl.
• R 2 and R 4 or R 8 and R 9 when joined include C 2 , C 3 , C 4 , C 5 or C 6 polymethylene, preferably C 2 , C 3 , C 4 or C 5 polymethylene.
• R a to R e and R g are preferably selected from hydrogen, fluoro, chloro and hydroxy, most preferably hydrogen.
• - R b may be 5-, 6- or 7-chloro or fluoro.
• X is of sub-formula (a)
• one of R 1 and R 3 is preferably hydrogen and one or both of R 2 and R 4 (most preferably both) are alkyl groups, such as methyl, or are joined to form C 2-7 polymethylene; or when one of R 2 and R 4 is hydrogen, the other is preferably ethyl or n- or iso- propyl.
• R 5 is preferably hydrogen or a methyl or ethyl group.
• R 7 is preferably methyl.
• R 8 and R 9 are preferably both methyl groups.
• R 12 is preferably amino and R 13 is preferably chloro or bromo, most preferably chloro.
• R 10 is preferably methoxy when C 1- 6 alkoxy.
• R 9 and R 11 are preferably chloro or methyl and R 10 is preferably hydrogen.
• R 14 is preferably hydrogen or methyl.
• X is preferably a group of sub-formula (e).
• R Suitable examples of R are as described in the aforementioned patent publications relating to 5-HT 3 receptor antagonists containing a saturated azabicyclic moiety.
• R then include the groups of sub-formula (i), (j) and (k):
• Z is (CH 2 ) n wherein n is 2 or 3, or Z is CH 2 -O-CH 2 ; p and q are independently 1 to 3; and R 15 or R 16 is methyl or ethyl, preferably methyl.
• R is most preferably endo-9-azabicyclo [3.2.1] non-3-yl, endo-8-azabicyclo [3.2.1] oct-3-yl, 9-aza-3-oxabicyclo- [3.2.1]non-7-yl or 3-quinuclidinyl.
• R may also be an imidazolyl group, in particular, 5-methyl-4-imidazolyl.
• Examples of the compounds of formula (I) include the examples described in the aforementioned Patent Publications/References disclosing compounds containing a saturated azabicyclic moiety. Particular examples include MDL 72222, ICS 205-930 (tropisetron) and PU 46470A, described in Example 5 of EP-A-247266, and granisetron.
• Examples of compounds of formula (I) also include the examples described in the aforementioned Patent Publications/References disclosing compounds containing an imidazolyl moiety, in particular, ondansetron and Examples 1, 2, 3, 4 and 5 in EP-A-315316 (Beecham Group p.l.c.).
• 5-HT 3 receptor antagonists are as described and claimed in the aforementioned patent publications, in particular, those in the name of Glaxo Group Limited.
• references to a5-HT 3 receptor antagonist including compounds of formula (I) and the specific compounds mentioned hereinbefore and salts thereof, include solvates such as hydrates.
• 5-HT 3 receptor antagonists may be identified by standard methods, such as tests involving antagonism of the von Bezold Jarisch reflex, as described by Fozard J.R. et. al., J. Cardiovasc. Pharmacol. 2, 229-245 (1980).
• the compounds of formula (I), including the specific compounds mentioned hereinbefore and salts thereof may be prepared as described in the aforementioned Patent Publications/References.
• the 5-HT 3 receptor antagonist is in substantially pure pharmaceutically acceptable form.
• the administration of the 5-HT 3 receptor antagonist may be by way of oral, sublingual, transdermal or parenteral administration.
• Parenteral administration will generally be preferred, and the 5-HT 3 receptor antagonist administered during or after cardiac treatment (thrombolysis, PTCA, coronary bypass grafts, coronary and cardiac catheterisation).
• cardiac treatment thrombolysis, PTCA, coronary bypass grafts, coronary and cardiac catheterisation.
• the preferred administration may be pretreatment by way of oral, sublingual or transdermal administration.
• a unit dose will normally contain 0.1 to 50 mg for example 0.5 to 10 mg, of the 5-HT 3 receptor antagonist, such as a compound of formula (I) or a pharmaceutically acceptable salt thereof.
• Unit doses will normally be administered once or more than once a day, for example 2, 3, or 4 times a day, more usually 1 to 3 times a day, such that the total daily dose is normally in the range, for a 70 kg adult of 0.1 to 50 mg, for example 0.1 to 5 mg, that is in the range of approximately 0.001 to 1 mg/kg/day, more usually 0.005 to 0.2 mg/kg/day.
• the 5-HT 3 receptor antagonist is administered in the form of a unit-dose composition, such as a unit dose oral or parenteral composition.
• compositions are prepared by admixture and are suitably adapted for oral or parenteral administration, and as such may be in the form of tablets, capsules, oral liquid preparations, powders, granules, lozenges, reconstitutable powders, injectable and infusable solutions or suspensions or suppositories.
• Tablets and capsules for oral administration are usually presented in a unit dose, and contain conventional excipients such as binding agents, fillers, diluents, tabletting agents, lubricants, disintegrants, colourants, flavourings, and wetting agents.
• the tablets may be coated according to well known methods in the art.
• Suitable fillers for use include cellulose, mannitol, lactose and other similar agents.
• Suitable disintegrants include starch, polyvinylpyrrolidone and starch derivatives such as sodium starch glycollate.
• Suitable lubricants include, for example, magnesium stearate.
• Suitable pharmaceutically acceptable wetting agents include sodium lauryl sulphate.
• compositions may be prepared by conventional methods of blending, filling or tabletting. Repeated blending operations may be used to distribute the active agent throughout those compositions employing large quantities of fillers. Such operations are, of course, conventional in the art.
• Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups, or elixirs, or may be presented as a dry product for reconstitution with water or other suitable vehicle before use.
• Such liquid preparations may contain conventional additives such as suspending agents, for example sorbitol, syrup, methyl cellulose, gelatin, hydroxyethylcellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, or acacia; non-aqueous vehicles (which may include edible oils), for example, almond oil, fractionated coconut oil, oily esters such as esters of glycerine, propylene glycol, or ethyl alcohol; preservatives, for example methyl or propyl p-hydroxybenzoate or sorbic acid, and if desired conventional flavouring or colouring agents.
• suspending agents for example sorbitol, syrup, methyl cellulose, gelatin, hydroxyethylcellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate
• Oral formulations also include conventional sustained release formulations, such as tablets or granules having an enteric coating.
• fluid unit dose forms are prepared containing the 5-HT 3 receptor antagonist and a sterile vehicle.
• the compound depending on the vehicle and the concentration, can be either suspended or dissolved.
• Parenteral solutions are normally prepared by dissolving the compound in a vehicle and filter sterilising before filling into a suitable vial or ampoule and sealing.
• adjuvants such as a local anaesthetic, preservatives and buffering agents are also dissolved in the vehicle.
• the composition can be frozen after filling into the vial and the water removed under vacuum.
• Parenteral suspensions are prepared in substantially the same manner except that the compound is suspended in the vehicle instead of being dissolved and sterilised by exposure to ethylene oxide before suspending in the sterile vehicle.
• a surfactant or wetting agent is included in the composition to facilitate uniform distribution of the compound of the invention.
• compositions will usually be accompanied by written or printed directions for use in the treatment concerned.
• the present invention also provides the use of a5-HT 3 receptor antagonist, such as a compound of formula (I) or a pharmaceutically acceptable salt thereof, in the manufacture of a medicament for use in the treatment and/or prophylaxis of nausea, bradycardia and/or hypotension associated with myocardial instability.
• a5-HT 3 receptor antagonist such as a compound of formula (I) or a pharmaceutically acceptable salt thereof
• Such treatment and/or prophylaxis may be carried out as hereinbefore described.
• the present invention further provides a pharmaceutical composition for use in the treatment and/or prophylaxis of nausea, bradycardia and/or hypotension associated with myocardial instability, which comprises a5-HT 3 receptor antagonist, such as a compound of formula (I) or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
• a5-HT 3 receptor antagonist such as a compound of formula (I) or a pharmaceutically acceptable salt thereof
• a pharmaceutically acceptable carrier may be prepared in the manner as hereinbefore described.

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• 1989
  • 1989-12-21 GB GB898928837A patent/GB8928837D0/en active Pending
• 1990
  • 1990-12-19 IE IE460390A patent/IE904603A1/en unknown
  • 1990-12-19 ZA ZA9010219A patent/ZA9010219B/xx unknown
  • 1990-12-20 JP JP3502103A patent/JPH05502872A/ja active Pending
  • 1990-12-20 WO PCT/GB1990/001996 patent/WO1991009593A2/en not_active Application Discontinuation
  • 1990-12-20 AU AU70516/91A patent/AU7051691A/en not_active Abandoned
  • 1990-12-20 KR KR1019920701481A patent/KR920703037A/ko not_active Application Discontinuation
  • 1990-12-20 EP EP91901843A patent/EP0506813A1/de not_active Withdrawn
  • 1990-12-20 CA CA002071994A patent/CA2071994A1/en not_active Abandoned

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