EP0626849A1 - Utilisation de la brofaromine comme agent de traitement du stress post-traumatique - Google Patents

Utilisation de la brofaromine comme agent de traitement du stress post-traumatique

Info

Publication number
EP0626849A1
EP0626849A1 EP93903683A EP93903683A EP0626849A1 EP 0626849 A1 EP0626849 A1 EP 0626849A1 EP 93903683 A EP93903683 A EP 93903683A EP 93903683 A EP93903683 A EP 93903683A EP 0626849 A1 EP0626849 A1 EP 0626849A1
Authority
EP
European Patent Office
Prior art keywords
brofaromine
traumatic stress
pharmaceutically acceptable
treating
salt
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP93903683A
Other languages
German (de)
English (en)
Inventor
Richard Katz
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Novartis AG
Original Assignee
Ciba Geigy AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ciba Geigy AG filed Critical Ciba Geigy AG
Publication of EP0626849A1 publication Critical patent/EP0626849A1/fr
Withdrawn legal-status Critical Current

Links

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
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • 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

Definitions

  • the present invention relates to psychological disorders associated with traumatic stress and its management.
  • the invention further deals with brofaromine, a selective, reversible onoamine oxidase type A inhibitor, with serotonin uptake inhibitory properties..
  • Brofaromine is an Monoamine Oxidase (MAO) inhibitor antidepressant compound, first patented in the US in 1980 by Schenker et al. (US 4,210,655), which patent is incorporated herein by reference.
  • MAO Monoamine Oxidase
  • This patent states that brofaromine, i.e. 4-(5-methoxy-2- benzofuranyl)-piperidine, is a selective MAO type A inhibitor, blocks serotonin reuptake, and that the compound is useful in the treatment of depression.
  • DSM-ID.-R the diagnostic and statistical manual of the American Psychiatric Association, as distinct disorders: panic disorder with agoraphobia, social phobia, bulimia, borderline personality disorder, and post-traumatic stress disorder (PTSD) among others.
  • PTSD is a condition believed to be brought on by the witnessing of traumatic events which so shock ones sensibilities that an indelible mark is left on the individual.
  • Motor vehicle accidents, war injuries, crime (especially violent crime), child and spousal abuse, natural disasters, industrial accidents, etc. are typical types of incidents which carry some of the hallmarks of PTSD in susceptible patients whether or not there is any significant physical injury to the victim of or participant in the event More importantly, there is an even larger population of patients exhibiting the symptoms of the disorder who have merely witnessed the events, especially if the witnessed events are particularly horrifying.
  • the disorder is characterized by: reexperiencing of intrusive thoughts and images in waking and sleep, increased arousal and hypersensitivity to trauma-related stimulation, and persistent avoidance activity.
  • DSM-IH-R criteria PTSD is diagnosed when
  • the patient has experienced an event outside the range of usual human experience and that event would be distressing to almost everyone;
  • the patient has recurrent and intrusive distressing recollections or dreams of the event or feelings of the event recurring or psychological distress at exposure;
  • the patient persistently practices at least three avoidant behaviors such as making efforts to avoid thoughts or feelings, making efforts to avoid activities or situations, has psychogenic amnesia of the trauma, has lessened interest in significant activities, is detached or estranged, has a sense of foreshortened future, and a restricted range of affect;
  • the a patient has increased arousal evidenced by at least two of difficulty in falling or staying asleep, irritability or outbursts of anger, difficulty in concentrating, hypervigilence, and exaggerated startle response;
  • PTSD is a psychological disease state for which various treatments have been reviewed in Arch Gen Psychiatry, Vol 47, March 1990, pp 259-266; J. Clin Psychiatry 51:10 (suppl), pp 33-38, October 1990; and M. Friedman, "Biological Approaches to the Diagnosis and Treatment of Post-Traumatic Stress Disorder, J. Traumatic Stress 4(1), 67-91, 1991.
  • the Journal of Clinical Psychiatry article mentions the use of tricyclic antidepressants and MAO inhibitors generally in the treatment of PTSD. These are discussed at page 34, Column 2 through page 35, Column 2.
  • the only MAO inhibitor discussed is phenelzine and the symptoms showing improvement fall into the intrusive recollections and hyperarousal areas. There is no mention of any effect on the avoidant behavior aspects of the condition.
  • the Friedman article mentions that virtually every type of psychotropic agent appears to alleviate DSM-III-R intrusive recollections and hyperarousal, but does not alleviate the avoidant symptoms of the disorder. Brofaromine is not mentioned. Phenelzine is the only MAO inhibitor discussed and appears to be the only agent of this class tested in PTSD heretofore.
  • the Arch Gen Psychiatry reference appears to be cumulative with the other two articles mentioned here.
  • moclobemide and brofaromine are selective, inhibitors of type A MAO. As such, one would expect reduced efficacy as compared to the classical MAO inhibitors since with moclobemide and brofaromine, type B MAO is still available to act in its normal course. Moclobemide also has a potential safety problem similar to the classical MAO inhibitors since its metabolite is an MAO type B inhibitor. MAO type B is primarily responsible for removing tyramine.
  • Another object of the invention is to provide a PTSD treatment and/or a medicament for the treatment of which will reduce or eliminate the avoidant behavior and hostile symptoms of the disorder.
  • the present invention is a method of treating post-traumatic stress disorder in a warm-blooded animal in need of such treatment comprising administering to said animal a post-traumatic stress disorder treating effective amount of brofaromine or a pharmaceutically acceptable salt thereof.
  • Brofaromine and its pharmaceutically acceptable salts are disclosed in US Patent 4,210,655, which is incorporated herein by reference.
  • the cited patent also discloses the synthesis of brofaromine and its pharmaceutically acceptable salts, their uses in depression, their pharmaceutical compositions, antidepressant dosages, and routes of administration. All of this disclosure is applicable to the instant invention.
  • salts of brofaromine for use in the instant invention include, without limitation, the salts formed from the combination of brofaromine with one of the acids selected from the group consisting of hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, methanesulfonic acid, ethanesulfonic acid, 2-hydroxyethanesulfonic acid, acetic acid, lactic acid, succinic acid, fumaric acid, maleic acid, malic acid, tartaric acid, citric acid, benzoic acid, salicylic acid, phenylacetic acid, mandelic acid, and embonic acid.
  • the salt is the hydrochloride.
  • Particularly advantageous dosage amounts and regimens are selected from about 0.1 to about 5.0 mg kg, more preferably about 0.5 to about 2.0 mg kg, most preferably about 1.0 to about 1.5 mg/kg, given from 1 to 4 times a day in single or divided doses, more preferably from 1 to 3 times a day, and typically given orally or by intravenous injection twice daily.
  • compositions of brofaromine contain 50 or 75 mg of brofaromine per dosage unit intended for mammals of 40 to 70 kg.
  • the compositions typically contain generally acceptable pharmaceutical carriers, such as lactose, saccharose, sorbitol, and mannitol; starches, such as potato starch, corn starch, and amylopectin; cellulose derivatives; or gelatin.
  • the compositions may also contain a lubricant, such as magnesium stearate, calcium stearate, or polyethylene glycol.
  • Other standard agents used in the manufacture of tablets, capsules, or intravenous solutions may also be present as appropriate.
  • Example 1 An adult individual having suffered acute sexual trauma and satisfies the DSM-III-R criteria for PTSD is given brofaromine hydrochloride (in an amount sufficient to administer 50 mg of free brofaromine) twice daily.
  • brofaromine hydrochloride in an amount sufficient to administer 50 mg of free brofaromine twice daily.
  • the normally present psychological sequelae of the trauma, inclusive of images of the traumatic event, social and situational phobic avoidance and increased arousal to associated stimuli are all significantly reduced.
  • Example 3 An individual having witnessed military atrocities and satisfies the DSM-IH-R criteria for PTSD is given brofaromine hydrochloride (in an amount sufficient to administer 75 mg of free brofaromine) twice daily. Recollections of the trauma, social avoidance, social and vocational disability, and increased arousal to associated stimuli are all substantially reduced.
  • Example 3 Tablets, each comprising 50 mg of 4-(7-bromo-5-methoxybenzofuran-2-yl)- piperidine or of a salt, for example the hydrochloride, thereof, can be prepared as follows:
  • composition (10 000 tablets)
  • active ingredient 500.0 g lactose 1000.0 g potato starch 852.0 g gelatin 8.0 g talc 60.0 g magnesium stearate 10.0 g silica (highly disperse) 20.0 g ethanol q.s.
  • the active ingredient is mixed with the lactose and 792 g of potato starch, and the mixture is moistened with an ethanolic solution of the gelatin and granulated through a sieve. After drying, the remaining potato starch, the magnesium stearate, the talc and the silica are mixed in and the mixture is compressed to form tablets which each weigh 295.0 mg and comprise 50.0 mg of active ingredient, and which may, if desired, be provided with dividing notches for finer adjustment of the dose.
  • Example 4 Film-coated tablets, each comprising 50 mg of 4-(7-bromo-5-methoxybenzo- furan-2-yl)piperidine or of a salt, for example the hydrochloride, thereof, can be prepared . as follows:
  • composition for 1000 film-coated tablets
  • active ingredient 50.0 g lactose 200.0 g com starch 120.0 g talc 17.0 g calcium stearate 10.0 g hydroxypropylmethylcellulose 2.36 g shellac 0.64 g water q.s. methylene chloride q.s.
  • the active ingredient, the lactose and 90 g of the com starch are mixed, and the mixture is moistened with a paste, prepared from 30 g of com starch and water (with heating), and granulated.
  • the granules arc dried, and the remaining com starch, the talc and the calcium stearate are added and mixed with the granules.
  • the mixture is compressed to form tablets (weight: 400 mg), which are coated with a solution of the hydroxypropylmethylcellulose and the shellac in methylene chloride; final weight of each film-coated tablet: 583 mg.
  • Example 5 Hard gelatin capsules, each containing 500 mg of 4-(7-bromo-5-methoxy- benzofuran-2-yl)piperidine or of a salt, for example the hydrochloride, thereof, can be prepared, for example, as follows:
  • Composition for 1000 capsules
  • active ingredient 500.0 g lactose 250.0 g microcrystalline cellulose 30.0 g sodium Iauryl sulfate 2.0 g magnesium stearate 8.0 g
  • the sodium Iauryl sulfate is added to the lyophilised active ingredient through a sieve having a mesh size of 0.2 mm.
  • the two components are mixed intimately.
  • the lactose is added through a sieve having a mesh size of 0.6 mm and then the micro- crystalline cellulose through a sieve having a mesh size of 0.9 mm.
  • the mixture is mixed intimately again for 10 minutes.
  • the magnesium stearate is added through a sieve having a mesh size of 0.8 mm.
  • hard gelatin capsules of a suitable size are each filled with 790 mg of the resulting formulation.
  • Example 6 A 5 % injection or infusion solution of 4-(7-bromo-5-methoxybenzofuran-2- yl)piperidine or of a salt, for example the hydrochloride, thereof can be prepared, for example, as follows:
  • composition for 1000 or 400 ampoules
  • the active ingredient and the sodium chloride are dissolved in 1000 ml of water and filtered through a microfilter.
  • the buffer solution is added, and the mixture is made up to 2500 ml with water.
  • To prepare unit dose forms 1.0 or 2.5 ml are introduced into each glass ampoule, which then contains 50 or 125 mg, respectively, of active ingredient.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Medicinal Chemistry (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Epidemiology (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Chemical & Material Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Medicinal Preparation (AREA)

Abstract

L'invention concerne un procédé de traitement de troubles liés au stress post-traumatique chez un animal à sang chaud nécessitant ce traitement, et qui consiste à administrer audit animal une quantité efficace de brofaromine ou d'un sel pharmaceutiquement acceptable de celle-ci afin de traiter les troubles liés au stress post-traumatique.
EP93903683A 1992-02-21 1993-01-27 Utilisation de la brofaromine comme agent de traitement du stress post-traumatique Withdrawn EP0626849A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US83963992A 1992-02-21 1992-02-21
US839639 1992-02-21
PCT/US1993/000728 WO1993016695A1 (fr) 1992-02-21 1993-01-27 Utilisation de la brofaromine comme agent de traitement du stress post-traumatique

Publications (1)

Publication Number Publication Date
EP0626849A1 true EP0626849A1 (fr) 1994-12-07

Family

ID=25280288

Family Applications (1)

Application Number Title Priority Date Filing Date
EP93903683A Withdrawn EP0626849A1 (fr) 1992-02-21 1993-01-27 Utilisation de la brofaromine comme agent de traitement du stress post-traumatique

Country Status (7)

Country Link
EP (1) EP0626849A1 (fr)
JP (1) JPH07503972A (fr)
KR (1) KR950700063A (fr)
AU (1) AU676672B2 (fr)
CA (1) CA2117430A1 (fr)
NZ (1) NZ249041A (fr)
WO (1) WO1993016695A1 (fr)

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6579899B1 (en) 1998-07-16 2003-06-17 Massachusetts Institute Of Technology Composition for treatment of stress
CA2337507A1 (fr) * 1998-07-16 2000-01-27 Massachusetts Institute Of Technology Composition pour le traitement du stress
JP2003511698A (ja) * 1999-10-12 2003-03-25 コンネクス・ゲゼルシャフト・ツーア・オプティミエルング・フォン・フォルシュング・ウント・エントヴィックルング・エムベーハー 便中の酸耐性微生物の改良された検出方法

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CH592656A5 (fr) * 1973-03-02 1977-10-31 Ciba Geigy Ag
AU3595093A (en) * 1992-02-21 1993-09-13 Ciba-Geigy Ag Brofaromine as an agent for treating social phobia

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9316695A1 *

Also Published As

Publication number Publication date
KR950700063A (ko) 1995-01-16
AU3484493A (en) 1993-09-13
AU676672B2 (en) 1997-03-20
NZ249041A (en) 1997-07-27
CA2117430A1 (fr) 1993-09-02
WO1993016695A1 (fr) 1993-09-02
JPH07503972A (ja) 1995-04-27

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