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• • 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
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
• • 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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
• • 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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
• • 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
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
  • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
• • 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
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/196—Carboxylic acids, e.g. valproic acid having an amino group the amino group being directly attached to a ring, e.g. anthranilic acid, mefenamic acid, diclofenac, chlorambucil
• • 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
• • 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
  • A61K31/4453—Non condensed piperidines, e.g. piperocaine only substituted in position 1, e.g. propipocaine, diperodon
• • 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
  • A61K31/4468—Non condensed piperidines, e.g. piperocaine having a nitrogen directly attached in position 4, e.g. clebopride, fentanyl
• • 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
  • A61K31/451—Non condensed piperidines, e.g. piperocaine having a carbocyclic group directly attached to the heterocyclic ring, e.g. glutethimide, meperidine, loperamide, phencyclidine, piminodine
• • 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
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
• • 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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
• • 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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
  • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine

Definitions

• This invention relates to a novel method of treatment and to a novel use of a medicament. 5
• WO 99/18967 describes pharmaceutical compositions for treating chronic and neuropathic pain which comprises an analgesic amount of an opioid and an opioid potentiating amount of a CCK antagonist.
• WO 5 '967 describes the use of both CCK-A (CCK-1) antagonists and CCK-B (CCK 2) antagonists, although it is described that, generally, CCK-B (CCK-2) antagonists are preferred.
• page 2, lines 6 to 8 of WO '967 describes that CCK-A (CCK- 1) antagonists may be suitable, but only at relatively higher dosages.
• CCK-A (CCK-1) antagonist which is mentioned is devazepide, which is 3 s-(-) 1 , 3 dihydro-3 -(2-indolecarbonylamino)- 1 -me thyl-5 -phenyl-2H- 1 ,4- benzodiazepin-2-one.
• WO 99/18967 describes a pharmaceutical 5 formulation comprising a CCK antagonist, such as devazepide (Devacade®), an opioid and a biphasic carrier, comprising a glyceride derivative organic phase.
• a CCK antagonist such as devazepide (Devacade®)
• Devacade® devazepide
• a biphasic carrier comprising a glyceride derivative organic phase.
• the use of the CCK antagonist is intended to block the CCK receptors thereby reversing or preventing the development of opioid tolerance in patients and potentiating the analgesic effect of the opioid.
• patients undergoing opioid therapy will receive a stable dose of an opioid.
• a patient may also use an additional 'breakthrough pain' relieving dose of opioid therapy, as symptoms dictate.
• the opioid dose may be reduced as much as 95% in some cases, in others as much as 75%.
• the administration of a combination of an opioid and devazepide does not just retain the "pain level" experienced by a patient, but actually improves it, i.e. it is not just a case of opioid sparing or opioid potentiation, but the effect of the opioid is superpotentiated.
• the analgesic sparing amount of devazepide will advantageously cause a reduction in the amount of analgesic administered to the patient.
• the reduction may vary but may, for example, be a reduction of from 25% to 95% w/w of the amount of analgesic required in the absence of devazepide, more preferably from 25% to 75% w/w.
• a reduced amount of analgesic of from 25% to 95% w/w may be administered.
• a reduced amount of analgesic of from 25 to 75% w/w may be administered.
• the opioid may be selected from those which are effective analgesics and particularly those which need to be administered at relatively high or increasing doses.
• examples include morphine, or a salt thereof such as the sulphate, chloride or hydrochloride other analgesics such as, meperidine, pentazocine, dextropropoxyphene, pethidine, fentanyl, alfentanil, alphaprodine, dextromoramide, diphenoxylate, dipipanone, meptazinol, methadone, nalbuphine, phenadoxone, phenazocine, remifentanil, tramadol, or the 1,4-hydroxymorphinan opioid analgesics such as butorphanol, morphine-6-glucuronide, codeine, dihydrocodeine, diamorphine, buprenorphine, heroin (diacetylmorphine), hydrocodone (d
• Naloxone is also included within the definition of an opioid.
• analgesics which may be mentioned are hydromorphone, oxycodone, morphine, e.g. morphine sulphate and fentanyl.
• the analgesic is morphine or morphine sulphate, hi a further preferred embodiment the opioid is fentanyl, or a salt thereof.
• a method of treatment of a patient requiring analgesia which comprises the administration of a therapeutically effective amount of an analgesic whilst minimising the amount of the analgesic by the separate, simultaneous or sequential administration of a therapeutically effective amount of devazepide.
• analgesic will be an opioid analgesic.
• devazepide in the manufacture of a medicament for the treatment of analgesia wherein the treatment comprises the administration of a therapeutically effective amount of an analgesic whilst minimising the amount of the analgesic by the separate, simultaneous or sequential administration of a therapeutically effective amount of devazepide.
• the devazepide and/or the opioid may be administered using any methods conventionally known per se.
• such methods would include, but shall not be limited to, administration intravenously, intra-arterially, orally, intrathecally, intranasally, intrarectally, intramuscularly/subcutaneously, by inhalation and by transdermal patch.
• the devazepide and/or opioid When the devazepide and/or opioid is administered intravenously, it may, for example, be as an intravenous bolus or a continuous intravenous infusion.
• the devazepide and/or the opioid is administered subcutaneously, it may, for example, be by subcutaneous infusion.
• the opioid and/or devazepide are administered intravenously or orally.
• Oral administration is especially preferred.
• the opioid and the devazepide will be administered using the same mode of administration.
• the opioid when the opioid is administered intravenously then the devazepide will be administered intravenously also.
• the opioid when the opioid is administered orally then the devazepide will be administered orally also.
• the opioid may be administered by a transdermal patch.
• the preferred opioid is fentanyl.
• the composition may be made up into a capsule formulation, e.g. with a fill weight of 150 mg ⁇ 5% by weight or 300 mg ⁇ 5% by weight.
• the capsule formulation may comprise 1.25mg devazepide, and 148.75 mg of a filler or other excipient, e.g. corn starch, i a further preferred embodiment, the capsule formulation may comprise 2.5mg devazepide, and 297.5 mg of a filler or other excipient, e.g. corn starch.
• fillers may be selected from the group lactose, mannitol, talc, magnesium stearate, sodium chloride, potassium chloride, citric acid, spray-dried lactose, hydrolysed starches, directly compressible starch, macrocrystalline cellulose, cellulosics, sorbitol, sucrose, sucrose-based materials, icodextrin, calcium sulphate, dibasic calcium phosphate and dextrose.
• a preferred filler is starch, e.g. corn starch.
• the size of the devazepide and filler particles may be the same or different. However, in a preferred embodiment the sizes of the devazepide and filler particles will differ. Preferentially, the devazepide and/or the filler may be of reduced particle size, e.g. by milling.
• the daily dosage of devazepide may vary depending upon, inter alia, the weight of the patient, the method of administration, etc. In patients that are suffering serious disorders, such as cancer patients, the weight of the patient may be very low and therefore the dosage of devazepide consequentially may be low.
• the daily dosage of devazepide may be up to 0.7 mg/kg/day.
• the daily dosage of devazepide may be from 25 ⁇ g/kg/day to 0.7 mg/kg/day, more preferably from 50 ⁇ g/kg/day to 0.5 mg/kg/day.
• the daily dosage of devazepide may be from preferably 0.07 mg/kg/day to 0.7 mg/kg/day.
• the daily dosage of devazepide may be from 0.07 mg/kg/day to 0.29 mg/kg/day.
• the dosage of devazepide is preferably 50 ⁇ g/kg/day to 0.5 mg/kg/day.
• the ratio of devazepide to dose of opioid may be varied.
• the ratio devazepide to opioid may be from 2:1 to 1:200 w/w, preferably from 1 :2 to 1:40 w/w.
• the dosage of the opioid analgesic administered may vary depending upon, inter alia, the nature of the opioid analgesic, the weight of the patient, the method of administration, etc.
• the dosage of, e.g. an opioid, such as morphine may be from 5 to 2000mg daily.
• a particular dosage which may be mentioned is from 10 to 240mg daily.
• a daily dosage of morphine may be from 5 to lOOmg or occasionally up to 500mg.
• the devazepide used in the method of the invention is the S enantiomer, preferentially, the S enantiomer wherein the level of R enantiomer, which may be present as an impurity, is not greater than 1.5% w/w.
• Patients completed a pre-treatment period of at least two weeks duration. During pre-treatment the patients continued to take regular doses of strong opioids and breakthrough analgesics when required. All use of strong opioids and analgesics was recorded. Patients completed an assessment of their pain each evening prior to going to bed, using a pain questionnaire. Any adverse events and changes in concomitant medication were also recorded.
• each patient received blinded treatments of devazepide 1.25mg, devazepide 5mg and placebo twice daily for two weeks with washout periods between each treatment, according to the following schedule.
• Breakthrough analgesic product use included (in addition to the above) tramadol, diclofenac, dihydrocodeine, paracetamol, codeine, aspirin, ibuprofen, dextropropoxyphene, buprenorphine, pethidine, carbamazepine, and hydromorphone (and combination products containing the above, for example; AnadinTM (aspirin), AnadinTM extra (aspirin and paracetamol), co-codamol, co- dydramol, co-proxamol, and remedeine).
• a research programme has included a double blind, double dummy, randomised, crossover study of a single dose of either 1.25mg devazepide, 5.0 mg devazepide or placebo. Patients who took part in the study had pain with a neuropathic element, and were taking regular doses of strong opioids. Following completion of the study those patients who, in the opinion of their Clinical Investigator, had gained benefit from participation were given the opportunity to consent to continue receiving devazepide treatment for a period of up to six months. 2.2 Study design
• the primary objective of this study was to compare descriptive and visual analogue scale (NAS) assessments of pain and pain relief in patients with neuropathic pain.
• NAS descriptive and visual analogue scale
• Figure 1 illustrates the trend with a weaker opioid, dihydrocodeine.
• the patient(s) commenced on 120 mg dihydrocodeine per day.

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• 2002
  • 2002-06-10 GB GB0213198A patent/GB0213198D0/en not_active Ceased
• 2003
  • 2003-06-10 AU AU2003246888A patent/AU2003246888A1/en not_active Abandoned
  • 2003-06-10 EP EP03757146A patent/EP1569654A1/de not_active Withdrawn
  • 2003-06-10 JP JP2004510798A patent/JP2005533046A/ja not_active Withdrawn
  • 2003-06-10 WO PCT/GB2003/002480 patent/WO2003103679A1/en active Application Filing

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