EP1682110A1

EP1682110A1 - Pharmaceutical composition consisting of a beta-3 adrenoceptor agonist and an alpha agonist

Info

Publication number: EP1682110A1
Application number: EP04791032A
Authority: EP
Inventors: Martin Michel; Marion Wienrich; Ursula Ebinger
Original assignee: Boehringer Ingelheim International GmbH; Boehringer Ingelheim Pharma GmbH and Co KG
Current assignee: Boehringer Ingelheim International GmbH; Boehringer Ingelheim Pharma GmbH and Co KG
Priority date: 2003-11-04
Filing date: 2004-10-29
Publication date: 2006-07-26
Also published as: US20050154041A1; CA2544503A1; WO2005046664A1; JP2007509897A; DE10352132A1

Abstract

The invention relates to a new combination for treating dysfunction of the bladder, containing alpha agonists and a beta-3 adrenoceptor agonist.

Description

PHARMACEUTICAL COMPOSITION OF A BETA-3 ADRENOCEPTOR AGONIST AND AN ALPHA AGONIST

This invention describes a new combination of active ingredients for the treatment of hamstring dysfunction. According to the invention, a pharmaceutical active ingredient combination comprising at least one beta-3 adrenoceptor agonist and at least one alpha agonist (alpha adrenoceptor agonist) is presented.

State of the art

The incidence of urinary incontinence is increasing due to the shift in the age structure. However, most of those affected are still not being treated or are being treated inadequately. In addition to the medical complications, such as chronic urinary tract infections, urinary incontinence is associated with high psychological suffering for those affected. An estimated 100 million older people are affected by urinary incontinence.

The lower urinary tract consists of the urinary bladder, the urethra, the corresponding muscles and the ligaments of the holding apparatus. The function of the bladder is to store and empty the urine. For the fulfillment of the memory function, not only the relaxation of the urinary bladder muscle (detrusor muscle), but also locking mechanisms through the bladder neck, the smooth muscles of the urethra and the striated muscles of the urethra and the pelvic floor are important. During urinary bladder emptying (micturition), the detrusor muscle contracts while the urethra and pelvic floor relax or the urinary sphincter muscle opens. These processes require complicated control by the parasympathetic, sympathetic and somatic nervous system.

Bladder dysfunction is a heterogeneous group of disorders that differ in terms of their etiology, diagnosis, and therapy.

In the standardization recommendations of the International Continence Society (ICS), urinary incontinence is defined as involuntary urine loss, which is objectively detectable and is a social and hygienic problem. In general, urinary incontinence only occurs if there is an unintentional increase in pressure in the bladder during the storage phase. This can occur as a result of uninhibited contractions of the detrusor muscle (urge incontinence) or incompetence of the urethral occlusion mechanism (stress incontinence).

According to the definition of the ICS, one speaks of an overactive bladder (OAB) in the case of non-suppressable, imperative urge to urinate, associated with or without urge incontinence, usually with increased micturition frequency and urination at night. Pathophysiologically, this disease can be involuntary

Contractions during the filling phase are based, the cause of which may be neurogenic or non-neurogenic (idiopathic) in nature.

Urge incontinence is characterized by irresistible urge to urinate and involuntary loss of urine.

Stress incontinence is characterized by the involuntary loss of urine, which usually occurs when increased intra-abdominal pressure occurs. This can occur, for example, when lifting, coughing, sneezing, running and when there is no detrusor activity. The loss of urine occurs as a result of a variable

Combination of insufficiency of the urinary sphincter muscles and pelvic floor as well as an anatomical defect of the holding device. As a result, the urethra's occlusion pressure becomes too low and incontinence is the result. Pure stress incontinence often occurs in women, especially if they have given birth. In men, this form of urinary incontinence is usually only observed after prostatectomy or other surgical intervention in the small pelvis.

With so-called mixed incontinence, patients suffer from symptoms of stress incontinence and urge incontinence. Again, women are particularly affected. Various treatment approaches are available for the therapy of various forms of urinary bladder dysfunction, in particular stress incontinence, urge incontinence, mixed incontinence or the hyperactive bladder (hyperactive bladder without urge incontinence or with urge incontinence).

To treat urge incontinence, the WHO recommends treatment with anticholinergics (antimuscarinics). However, their use is limited due to their moderate effectiveness and above all the considerable side effects such as dry mouth, accommodation disorders, constipation, central nervous effects (dizziness, tiredness, confusion).

Conservative and surgical measures are available for the treatment of stress incontinence. A generally applicable drug therapy has not yet been established. -Adrenoceptor agonists, such as pseudoephedrine and phenylpropanolamine, have an extremely moderate effect in the treatment of mild stress incontinence. The disadvantage is that these have no selectivity for the urethral muscles and are associated with frequent side effects such as hypertension, tachycardia, arrhythmia, sleep disorders, headaches and tremors.

The treatment of mixed incontinence is discussed controversially and includes combinations of invasive procedures for the treatment of the stress incontinence component and medicinal procedures for the treatment of the urge incontinence component.

It has been reported since the mid-1995s that selective beta-3 adrenoceptor agonists are also promising in the treatment of urinary incontinence (EP 0 958 835). Since the stimulation of beta-3 receptors is of extraordinary importance for the relaxation of the detrusor muscle, the use of selective beta-3 adrenoceptors in patients with urge incontinence should reduce or prevent involuntary detrusor contractions during the urinary storage phase result. Experiments with beta-3 adrenoceptor agonists promise high effectiveness with good tolerability. In addition, their effect should be limited to the storage phase of the bladder and an undisturbed emptying of the bladder without residual urine should be guaranteed.

Since 1995 it has also been reported that alpha agonists, especially alpha 1L agonists, can be used to treat urinary incontinence. Further details can be found, for example, in WO 96/32939. The advantages here include good effectiveness with comparatively few side effects on the cardio-vascular system.

There are also only limited therapeutic options for the therapy of the hyperactive bladder. Medications with antimuscarinics as an active ingredient are also among the few established forms of treatment.

Object of the invention

Despite the promising approaches and advances in the treatment of various forms of urinary incontinence, which are causally complex and heterogeneous, the development of efficient and well-tolerated therapies remains a challenge. The present invention is intended to provide such a contribution to the therapy of urinary incontinence. The invention is preferably suitable for the treatment of stress incontinence, urge incontinence, mixed incontinence or hyperactive bladder (hyperactive bladder without urge incontinence or with urge incontinence).

For this purpose, a pharmaceutical composition is presented that combines both the advantages of the alpha agonists and those of the beta-3 adrenoceptor agonists in a manner that promotes the therapy of the underlying disease. Description of the invention

According to the present invention, there is provided a new pharmaceutical composition comprising (a) at least one alpha agonist in a pharmaceutically effective amount and (b) at least one beta-3 adrenoceptor agonist in a pharmaceutically effective amount as active ingredients.

a) active components

In the description of the preferred embodiment, for the sake of

Clarity some terminology can be used. Such terminology is intended to encompass the stated embodiment as well as all technical equivalents which act in a similar manner for a similar purpose in order to achieve a similar result. To the extent that any pharmaceutically active compound is disclosed or claimed, it is expressly intended that all active metabolites generated in vivo be included, and it is expressly intended that all enantiomers, diastereomers or tautomers be included, when the compound can be in an enantiomeric, diastereomeric or tautomeric form. Of course, the most pharmacologically effective and side effect-free isomer is preferred. Also included are pharmacologically acceptable salts thereof. Examples of pharmaceutically active salts for each of the compounds that are the subject of this description include, but are not limited to, salts made from pharmaceutically acceptable acids or bases, including organic and inorganic acids and bases. If the compound preferred for use is basic, salts can be prepared from pharmaceutically acceptable acids. When choosing the most preferred salt, or to clarify whether a salt or the neutral compound is used, properties such as bioavailability, manufacturability, processability and storability are taken into account. Suitable pharmaceutically acceptable acids include acetic, benzenesulfonic (besylate), benzoic, p-bromophenylsulfonic, camphor sulfonic, carbon, citric, ethanesulfonic, fumaric, gluconic, glutamine, hydrogen bromide, hydrogen chloride, Hydrogen iodide, isethione, milk, maleic, apple, almond, methanesulfone (mesylate), mucin, saltpetre, oxal, pamoa, Pantothenic, phosphoric, amber, sulfuric, wine, p-toluenesulfonic acid and the like. Examples of such pharmaceutically acceptable salts include, but are not limited to, acetate, benzoate, hydroxybutyrate, bisulfate, bisulfite, bromide, butyn-l, 4-dioate, caproate, chloride, chlorobenzoate, citrate, dihydrogen phosphate, dinitrobenzoate, fumarate, glycoate , Heptanoate, hexin-1,6-dioate, hydroxybenzoate, iodide, lactate, maleate, malonate, mandelate, metaphosphate, methanesulfonate, methoxybenzoate, methylbenzoate, monohydrogenphosphate, naphthalene-1-sulfonate, naphthalene-2-sulfonate, oxalate, phenylbutyrion , Phosphate, phthalate, phenylacetate, propanesulfonate, propiolate, propionate, pyrophosphate, pyrosulfate, sebacate, suberate, succinate, sulfate, sulfite, sulfonate, tartrate, xylene sulfonate and the like.

To the extent necessary for completion, the synthesis of the compounds for which prior art is cited and their dosages are expressly included by reference to the prior art cited at the appropriate place.

The following compounds are listed as examples of alpha agonists: aa) Midodrin, ab) N- [3- (1H-imidazol-4-ylmethyl) phenyl] ethanylsulfonamide (ABT-866), ac) Garomefrin hydrochloride (also known as NS 49) , ad) N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide (also known as R 450), ae) N-5- ( 4,5-dihydro-3H-imidazol-4-yl) -2-hydroxy-5,6,7,8-tetrahydronaphth-l-yl] - methanesulfonamide (also known as A 61603), af) N-5- ( 3H-imidazol-4-yl) -5,6,7,8-tetrahydronaphth-l-yl] methanesulfonamide (also known as A 204176), ag) 2-amino-l- (4-hydroxy-2-methanesulphonamidophenyl) ethanol, ah) (5-chloro-2,3-dimethyl-phenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, ai) (5-chloro-2,3-diethyl-phenyl) - (4,5-dihydro-1H-imidazol-2-yl) amine, aj) (3-isopropyl-2-methylphenyl) - (4,5-dihydro-1H-imidazol-2-yl) amine, ak ) (3-tert.butyl-6-methoxy-phenyl) - (4,5-dihydro-1H-imidazol-2-yl) amine, al) (6-chloro-3-isopropyl-2-methylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, am) (4-chlorine - 3-isopropyl-2-methylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, an) (6-bromo-3-isopropyl-2-methylphenyl) - (4, 5-dihydro-lH-imidazol-2-yl) amine, ao) (6-bromo-3- tert-butylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, ap) (4-bromo-3-isopropyl-2-methylphenyl) - (4,5-dihydro-lH -imidazol-2-yl) amine, aq) (5-chloro-3-isopropyl-2-methylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, ar) N- (4th , 5-dihydro-1H-imidazol-2-ylmethyl) -5-fluoro-2- (methylsulfonyl) aniline (for details see WO-00066563), as) N- (4, 5-dihydro-1H-imidazole-2 -ylmethyl) -2- (l-ethyl-lH-pyrazol-5-yl) aniline (for details see WO-00066563), at) 2 - [(4,5-dihydro-lH-imidazol-2-ylmethyl) amino] -N-methylbenzenesulfonamide (for details see WO-00066563), au) N- (4,5-dihydro-lH-imidazol-2-ylmethyl) -2- [1- (2,2,2-trifluoroethyl) -l Hl, 2,4-triazol-5-yl] aniline (for details see WO-00066563), av) N- (4, 5-dihydro-lH-imidazol-2-ylmethyl) -2- (methylsulfonyl) aniline (for details see WO-00066563).

In particularly preferred embodiments, the alpha agonist garomefrin is hydrochloride, N- [6-chloro-3- (4,5-dihydro-1H-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide and / or midodrin ,

The second component comprises one or more beta-3 adrenoreceptor agonists. This is preferably selected from the following group:

with 1) X = Br, Y = H, R = OH

2- [2-bromo-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino] ethyl] phenoxy] acetic acid, 2) X = Cl, Y = H, R = OH

2- [2-chloro-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] amino] ethylj-phenoxyacetic acid,

3) X = Y = Cl, R = OH

2- [2,5-dichloro-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino] ethyl] phenoxy] acetic acid,

4) X = Y = H, R = OH 2- [4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] amino] ethyl] -2, 5-dimethylphenoxy] acetic acid,

5) X = OH; Y = H; R = OH 2- [2-hydroxy-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino] ethyl] phenoxy] acetic acid,

6) X = Cl; Y = H, R = OEt

Ethyl 2- [2-chloro-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino] ethyl] phenoxy] acetate,

7) X = Cl; Y = Cl, R = OEt

Ethyl 2- [2,5-dichloro-4- [2 - [[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino] ethyl] phenoxy] acetate,

8) X = Me; Y = Me, R = OEt (-) - ethyl 2- [4- (2- {[(lS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) - l-methylethyl] amino} ethyl) - 2,5-dimethylphenyloxy] acetate,

9) X = Me; Y = Me, R = OH

(-) - 2- [4- (2 - {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] amino} ethyl) -2,5-dimethylphenyloxyacetic acid, Details on the above-mentioned compounds 1 to 9 can be found in WO 00/02846.

Further information on this substance can be found in J. Med. Chem. 44 (2001) 1456.

11)

Disodium - ([R, R] -5-2 - [[2- (3-chlorophenyl) -2-hydroxyethyl] amino] propyl) -l, 3-benzodioxole-2,2-dicarboxylate

More detailed information on this substance can be found in J. Med. Chem. 44 (2001) 1456 or in the Journal of Urology 165 (2001) 240. 12)

Further information on this substance, which is also known as CGP 12177A, can be found in the Journal of Urology 165 (2001) 240 or in J. Med. Chem. 44 (2001) 1456.

13)

Further information on this substance, which is also known as SB 226552, can be found in J. Med. Chem. 44 (2001) 1456.

14)

Further information on this substance, which is also known as L755507, can be found in J. Med. Chem. 44 (2001) 1456. 15)

More detailed information on this substance, which is also known as L 770664, can be found in J. J. Med. Chem. 44 (2001) 1456.

16)

More detailed information on this substance can be found in J. Med. Chem. 44 (2001) 1456 or in Bioorg. Med. Chem. Lett. 9 (2001) 2045.

17)

with 1) Ar = 4-OHPh-O-, Rl = octyl, R2 = H 2) Ar = 4-OH, 3-methylsulfonylamidophenyl-O-, Rl = 2,5-diFbenzyl, R2 = H 3) Ar = 4 -OH, 3-methylsulfonylamidophenyl, Rl = 2,5-diFbenzyl, R2 = H More information on these substances can be found in the Bioorg. Med. Chem. Lett. 11 (2000) 3123.

18)

More information on this substance can be found in the Bioorg. Med. Chem. Lett. 11 (2001) 981.

2- [2-chloro-4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) phenoxy] acetic acid More information on this substance can be found in Med. Chem. 46 (2003) 105.

20)

n = 0 or 1

Further information on this substance can be found in the Bioor. Med. Chem. Lett. 10 (2000)

1,971th

21)

More information on this substance can be found in the Bioorg. Med. Chem. Lett. 11 (2001)

757th

22)

n = 0 or 1

1,971th

23)

Further information on this substance can be found in the Bioor. Med. Chem. Lett. 10 (2000) 1971. 24)

More information on this substance can be found in the Bioorg. Med. Chem. Lett. 10 (2000) 1531.

25)

FK175

[R- (R *, S *)] - [[8 - [[2- (3-chlorophenyl) -2-hydroxyethyl] amino] -6,7,8,9-tetrahydro-5H-benzocyclohepten-2-yl ] oxy] -acetic acid ethyl ester, hydrochloride,

26)

GS-332 [IS- [lα, 3ß (S *)]] - 3- [3 - [[2- (3-chlorophenyl) -2-hydroxyethyl] amino] cyclohexyl] phenoxy] - acetic acid, monosodium salt,

27)

Further information on this compound, also known as N-5984, can be found in the literature.

28) 2- (3- {[2- (3-Chlorophenyl) -2R-hydroxyl-ethylamino] ethylamino} phenyl) furan-3-carboxylic acid. Further information on this connection can be found in the literature.

29) 2- (3- {[2- (3-Chlorophenyl) -2R-hydroxyl-ethylamino] ethylamino} phenyl) thiophene-3-carboxylic acid. Information about this compound can be found in the literature.

30)

Further information on this compound, also known as SB -418790, can be found in the literature. 31)

More detailed information on this compound, also known as CP-331684, can be found in the literature.

32)

More detailed information on this compound, also known as SB-251023, can be found in the literature.

33)

Further information on this compound, (R) -2- (2-aminothiazol-4-yl) -4 '- [2- [2- (hydroxy-2-phenylethyl) amino] ethyl] acetanilide can be found in the literature WO 03/037881.

34) (S) -4- [2-Hydroxy-3 - [[2- [4- (5-carbamoyl-2-pyridyloxy) phenyl] -1,1-dimethyl-ethyl] amino] propoxy] carbazole (LY 377604 ).

35)

This connection is also known under the name SR 58611.

The most preferred are:

(-) - Ethyl 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) - 2,5-dimethylphenyloxy] acetate .

(-) - Ethyl-2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -

2,5-dimethylphenyloxy] acetate monohydrochloride,

(-) - 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxyacetic acid or others pharmacologically acceptable salts thereof.

Particularly interesting representatives of beta-3-adrenoceptor agonists are (-) - ethyl-2- [4- (2- {[(1 S, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl ] amino} ethyl) -2,5-dimethylphenyloxy] acetate or (-) - 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] -amino} ethyl) -2,5-dimethylphenyloxy] acetic acid, the enantiomers, other diastereoisomers thereof and pharmacologically active salts thereof.

These compounds are disclosed in WO 00/02846 or WO 2003024916.

These two last named compounds are represented by the following formula II, which should prevail in the event of contradictions to the above name:

at R = OEthyl: (-) - ethyl-2- [4- (2 - {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] amino} ethyl) -2, 5-dimethylphenyloxy] acetate, preferably the monohydrate, when R = OH: (-) - 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l -methylethyl ] - amino} ethyl) -2,5-dimethylphenyloxy] acetic acid.

Particularly preferred combinations include a combination of (a) Garomefrin hydrochloride, N- [6-chloro-3- (4,5-dihydro-1H-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide or midodrin and (b) at least one of the following compounds: (-) ethyl-2- [4- (2- {[(1 S, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino } ethyl) - 2,5-dimethylphenyloxy] acetate, (-) - ethyl-2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetate monohydrochloride, (-) - 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l-methylethyl ] amino} ethyl) -2,5-dimethylphenyloxy] acetic acid or any other pharmacologically acceptable salt thereof or any active metabolite thereof.

It is expressly pointed out that the invention comprises each of the following combinations: (aa, 1); (ab, 1); (ac, 1); (ad, 1); (ae, 1); (af, 1); (ag, 1); (ah, 1); (ai, 1); (aj, 1); (Ak, l); (al, 1); (Am, l); (An, l); (Ao, l); (Ap, l); (Aq, l); (Ar, l); (As, l); (At, l); (Au, l); (Av, l); (aa, 2); (starting at 2); (ac, 2); (ad, 2); (ae, 2); (af, 2); (ag, 2); (ah, 2); (ai, 2); (aj, 2); (Ak, 2); (al, 2); (on 2); (In, 2); (Ao, 2); (Ap, 2); (Aq, 2); (Ar, 2); (As, 2); (At 2); (Au, 2); (Av, 2); (aa, 3); (from 3); (ac, 3); (ad, 3); (ae, 3); (af, 3); (ag, 3); (ah, 3); (ai, 3); (aj, 3); (Ak, 3); (al, 3); (at 3); (To, 3); (Ao, 3); (Ap, 3); (Aq, 3); (Ar, 3); (As, 3); (At 3); (Au, 3); (Av, 3); (Aa,

4); (from 4); (ac, 4); (ad, 4); (ae, 4); (af, 4); (ag, 4); (ah, 4); (ai, 4); (aj, 4); (Ak, 4); (al, 4);

(at 4); (To, 4); (Ao, 4); (Ap, 4); (Aq, 4); (Ar, 4); (As, 4); (At, 4); (Au, 4); (Av, 4); (aa, 5); (from 5); (Ac,

5); (ad, 5); (ae, 5); (af, 5); (ag, 5); (ah, 5); (ai, 5); (aj, 5); (Ak, 5); (al, 5); (Am, 5); (An, 5); (Ao, 5); (Ap, 5); (Aq, 5); (Ar, 5); (As, 5); (At 5); (Au, 5); (Av, 5); (aa, 6); (from 6); (ac, 6); (ad, 6); (Ae,

6); (af, 6); (ag, 6); (ah, 6); (ai, 6); (aj, 6); (Ak, 6); (al, 6); (at 6); (At, 6); (Ao, 6); (Ap, 6);

(Aq, 6); (Ar, 6); (As, 6); (At, 6); (Au, 6); (Av, 6); (aa, 7); (ab, 7); (ac, 7); (ad, 7); (ae, 7); (af, 7);

(ag, 7); (ah, 7); (ai, 7); (aj, 7); (Ak, 7); (al, 7); (Am, 7); (An, 7); (Ao, 7); (Ap, 7); (Aq, 7); (Ar, 7);

(AS, 7); (At 7); (Au, 7); (Av, 7); (aa, 8); (ab, 8); (ac, 8); (ad, 8); (ae, 8); (af, 8); (ag, 8); (ah, 8); (ai, 8); (aj, 8); (Ak, 8); (al, 8); (Am, 8); (An, 8); (Ao, 8); (Ap, 8); (Aq, 8); (Ar, 8); (As, 8); (At 8);

(Au, 8); (Av, 8); (aa, 9); (ab, 9); (ac, 9); (ad, 9); (ae, 9); (af, 9); (ag, 9); (ah, 9); (ai, 9); (aj, 9);

(Ak, 9); (al, 9); (Am, 9); (An, 9); (Ao, 9); (Ap, 9); (Aq, 9); (Ar, 9); (As, 9); (At 9); (Au, 9); (Av, 9); (Aa,

10); (from 10); (ac, 10); (ad, 10); (ae, 10); (af, 10); (ag, 10); (ah, 10); (ai, 10); (aj, 10);

(Ak, 10); (al, 10); (Am, 10); (An, 10); (Ao, 10); (Ap, 10); (Aq, 10); (Ar, 10); (AS, 10); (At 10); (Au, 10); (Av, 10); (aa, 11); (from 11); (ac, 11); (ad, 11); (ae, 11); (af, 11); (ag, 11); (ah, 11);

(ai, 11); (aj, 11); (Ak, ll); (al, 11); (Am, ll); (An, ll); (Ao, ll); (ap, l l); (Aq, ll); (Ar, ll);

(As, ll); (At, ll); (Au, ll); (Av, ll); (aa, 12); (from 12); (ac, 12); (ad, 12); (ae, 12); (af, 12); (Ag,

12); (ah, 12); (ai, 12); (aj, 12); (Ak, 12); (al, 12); (on 12); (An, 12); (Ao, 12); (Ap, 12); (Aq, 12);

(Ar, 12); (AS, 12); (At 12); (Au, 12); (Av, 12); (aa, 13); (ab, 13); (ac, 13); (ad, 13); (ae, 13); (af, 13); (ag, 13); (ah, 13); (ai, 13); (aj, 13); (Ak, 13); (al, 13); (at 13th); (An, 13); (Ao, 13); (Ap, 13);

(Aq, 13); (Ar, 13); (AS, 13); (At 13); (Au, 13); (Av, 13); (aa, 14); (ab, 14); (ac, 14); (ad, 14); (Ae,

14); (af, 14); (ag, 14); (ah, 14); (ai, 14); (aj, 14); (Ak, 14); (al, 14); (at the 14th); (An, 14); (Ao, 14);

(Ap, 14); (Aq, 14); (Ar, 14); (AS, 14); (At 14); (Au, 14); (Av, 14); (aa, 15); (from 15); (ac, 15); (Ad,

15); (ae, 15); (af, 15); (ag, 15); (ah, 15); (ai, 15); (aj, 15); (Ak, 15); (al, 15); (Am, 15); (An, 15); (Ao, 15); (Ap, 15); (Aq, 15); (Ar, 15); (AS, 15); (At 15); (Au, 15); (Av, 15); (aa, 16); (from,

16); (ac, 16); (ad, 16); (ae, 16); (af, 16); (ag, 16); (ah, 16); (ai, 16); (aj, 16); (Ak, 16); (Al,

16); (at 16); (An, 16); (Ao, 16); (Aρ, 16); (Aq, 16); (Ar, 16); (AS, 16); (At 16); (Au, 16); (Av, 16);

(aa, 17); (ab, 17); (ac, 17); (ad, 17); (ae, 17); (af, 17); (ag, 17); (ah, 17); (ai, 17); (aj, 17);

(Ak, 17); (al, 17); (Am, 17); (An, 17); (Ao, 17); (Ap, 17); (Aq, 17); (Ar, 17); (AS, 17); (At 17); (Au, 17); (Av, 17); (aa, 18); (ab, 18); (ac, 18); (ad, 18); (ae, 18); (af, 18); (ag, 18); (ah, 18); (ai, 18); (aj, 18); (Ak, 18); (al, 18); (Am, 18); (An, 18); (Ao, 18); (Ap, 18); (Aq, 18); (Ar, 18); (AS, 18); (At 18); (Au, 18); (Av, 18); (aa, 19); (ab, 19); (ac, 19); (ad, 19); (ae, 19); (af, 19); (ag, 19); (ah, 19); (ai, 19); (aj, 19); (Ak, 19); (al, 19); (at 19); (An, 19); (Ao, 19); (Ap, 19); (Aq, 19); (Ar, 19); (AS, 19); (At 19); (Au, 19); (Av, 19); (aa, 20); (from 20); (ac, 20); (ad, 20); (ae, 20); (af, 20); (ag, 20); (ah, 20); (ai, 20); (aj, 20); (Ak, 20); (al, 20); (on 20); (An, 20); (Ao, 20); (Ap, 20); (Aq, 20); (Ar, 20); (AS, 20); (At 20); (Au, 20); (Av, 20); (aa, 21); (ab, 21); (ac, 21); (ad, 21); (ae, 21); (af, 21); (ag, 21); (ah, 21); (ai, 21); (aj, 21); (Ak, 21); (al, 21); (Am, 21); (An, 21); (Ao, 21); (Ap, 21); (Aq, 21); (Ar, 21); (AS, 21); (At 21); (Au, 21); (Av, 21); (aa, 22); (ab, 22); (ac, 22); (ad, 22); (ae, 22); (af, 22); (ag, 22); (ah, 22); (ai, 22); (aj, 22); (Ak, 22); (al, 22); (Am, 22); (An, 22); (Ao, 22); (Ap, 22); (Aq, 22); (Ar, 22); (AS, 22); (At 22); (Au, 22); (Av, 22); (aa, 23); (ab, 23); (ac, 23); (ad, 23); (ae, 23); (af, 23); (ag, 23); (ah, 23); (ai, 23); (aj, 23); (Ak, 23); (al, 23); (Am, 23); (An, 23); (Ao, 23); (Ap, 23); (Aq, 23); (Ar, 23); (AS, 23); (At 23); (Au, 23); (Av, 23); (aa, 24); (ab, 24); (ac, 24); (ad, 24); (ae, 24); (af, 24); (ag, 24); (ah, 24); (ai, 24); (aj, 24); (Ak, 24); (al, 24); (Am, 24); (An, 24); (Ao, 24); (Ap, 24); (Aq, 24); (Ar, 24); (AS, 24); (At 24); (Au, 24); (Av, 24); (aa, 25); (ab, 25); (ac, 25); (ad, 25); (ae, 25); (af, 25); (ag, 25); (ah, 25); (ai, 25); (aj, 25); (Ak, 25); (al, 25); (on the 25th); (An, 25); (Ao, 25); (Ap, 25); (Aq, 25); (Ar, 25); (AS, 25); (At 25); (Au, 25); (Av, 25); (aa, 26); (ab, 26); (ac, 26); (ad, 26); (ae, 26); (af, 26); (ag, 26); (ah, 26); (ai, 26); (aj, 26); (Ak, 26); (al, 26); (on 26); (An, 26); (Ao, 26); (Ap, 26); (Aq, 26); (Ar, 26); (AS, 26); (At 26); (Au, 26); (Av, 26); (aa, 27); (ab, 27); (ac, 27); (ad, 27); (ae, 27); (af, 27); (ag, 27); (ah, 27); (ai, 27); (aj, 27); (Ak, 27); (al, 27); (On the 27th); (An, 27); (Ao, 27); (Ap, 27); (Aq, 27); (Ar, 27); (AS, 27); (At 27); (Au, 27); (Av, 27); (aa, 28); (ab, 28); (ac, 28); (ad, 28); (ae, 28); (af, 28); (ag, 28); (ah, 28); (ai, 28); (aj, 28); (Ak, 28); (al, 28); (on the 28th); (An, 28); (Ao, 28); (Ap, 28); (Aq, 28); (Ar, 28); (AS, 28); (At, 28); (Au, 28); (Av, 28); (aa, 29); (ab, 29); (ac, 29); (ad, 29); (ae, 29); (af, 29); (ag, 29); (ah, 29); (ai, 29); (aj, 29); (Ak, 29); (al, 29); (On the 29th); (An, 29); (Ao, 29); (Ap, 29); (Aq, 29); (Ar, 29); (AS, 29); (At 29); (Au, 29); (Av, 29); (aa, 30); (from 30); (ac, 30); (ad, 30); (ae, 30); (af, 30); (ag, 30); (ah, 30); (ai, 30); (aj, 30); (Ak, 30); (al, 30); (Am, 30); (An, 30); (Ao, 30); (Ap, 30); (Aq, 30); (Ar, 30); (AS, 30); (At 30); (Au, 30); (Av, 30); (aa, 31); (ab, 31); (ac, 31); (ad, 31); (ae, 31); (af, 31); (ag, 31); (ah, 31); (ai, 31); (aj, 31); (Ak, 31); (al, 31); (Am, 31); (An, 31); (Ao, 31); (Ap, 31); (Aq, 31); (Ar, 31); (AS, 31); (At, 31); (Au, 31); (Av, 31); (aa, 32); (ab, 32); (ac, 32); (ad, 32); (ae, 32); (af, 32); (ag, 32); (ah, 32); (ai, 32); (aj, 32); (Ak, 32); (al, 32); (Am, 32); (An, 32); (Ao, 32); (Ap, 32); (Aq, 32); (Ar, 32); (AS, 32); (At 32); (Au, 32); (Av, 32); (aa, 33); (ab, 33); (ac, 33); (ad, 33); (ae, 33); (af, 33); (ag, 33); (ah, 33); (ai, 33); (aj, 33); (Ak, 33); (al, 33); (Am, 33); (An, 33); (Ao, 33); (Ap, 33); (Aq, 33); (Ar, 33); (AS, 33); (At 33); (Au, 33); (Av, 33); (aa, 34); (ab, 34); (ac, 34); (ad, 34); (ae, 34); (af, 34); (ag, 34); (ah, 34); (ai, 34); (aj, 34); (Ak, 34); (al, 34); (Am, 34); (34,); (Ao, 34); (Ap, 34); (Aq, 34); (Ar, 34); (AS, 34); (At, 34); (Au, 34); (Av, 34); (aa, 35); (ab, 35); (ac, 35); (ad, 35); (ae, 35); (af, 35); (ag, 35); (ah, 35); (ai, 35); (aj, 35); (Ak, 35); (al, 35); (Am, 35); (An, 35); (Ao, 35); (Ap, 35); (Aq, 35); (Ar, 35); (AS, 35); (At 35); (Au, 35); (Av, 35).

b) Dosage

In order to determine the optimal dose of the two active ingredients for urinary incontinence, various framework conditions must be taken into account, such as the age and body weight of the patient, the nature and stage of the disease, and the potency of the compound. This is considered to be within the skill of those skilled in the art and one can consult the existing literature on the components to determine the optimal dosage.

The dosages given below expressly include all numerical values, whole or fractional, within the range given. The information relates to adult people. Pediatric doses may be lower.

Administrations more than once a day or twice a day (e.g. 3, 4, 5 or 6 administrations per day) are also expressly contemplated herein.

The preferred dose of the alpha agonist for humans is between 0.001 mg and 5 g per day.

In some cases a smaller amount may be sufficient, while in other cases a larger total amount may be necessary. The daily total dose can be taken in one piece or within several servings, depending on the therapy regimen. The therapy regiment can also prescribe intervals between receipts that are longer than a day.

The selection of the dosage of this first component (a) is the one that can provide relief for the patient.

The dosages and regimen (i.e., one, two, three or more administrations per day) of the second component will depend on the factors already referred to in connection with the dosage choice of the first component.

The average daily dose of the second component (beta-3 agonist) for an adult human is about 1 mg to 1000 mg, preferably 10 mg to about 750 mg per day, preferably 50 to 500 mg, more preferably 80 to 200 mg, administered in one or more cans.

c) Application forms

The compositions of the present invention may conveniently be administered in a pharmaceutical composition containing the active components in combination with a suitable carrier. Such pharmaceutical compositions can be prepared by methods and contain carriers that are well known in the art. Generally recognized frameworks are available to the specialist in this regard.

The compositions of the present invention can be administered parenterally (e.g., by intravenous, intraperitoneal, subcutaneous or intramuscular injection), topically, orally, intranasally, intravaginally, transdermally, rectally, pulmonally by inhalation or nasally by inhalation, with oral administration being particularly preferred. Enteric formulations are preferred among the oral forms of administration. Therefore enteric capsules or enteric tablets are preferred, which can be achieved in both cases, for example, with an enteric coating. The person skilled in the art will find instructions for enteric-coated formulations in the prior art.

Various formulation options are given below. The person skilled in the art can select a suitable formulation from this.

For oral therapeutic administration, the composition of the invention can be combined with one or more carriers and in the form of ingestible ones

Tablets, buccal tablets, sublingual tablets, sugar-coated tablets, powders, powders, lozenges, dragees, granules, capsules, elixirs, suspensions, solutions, syrups, wafers, chewing gums, foods and the like can be used.

For example, a powder can be produced by grinding the particles of the active substance to a suitable size.

Diluted powders can be produced by finely grinding the powdery substance with a non-toxic carrier material, such as lactose, and applying it as a powder. Other suitable carrier materials in this regard are other carbohydrates, such as starch or mannitol. If necessary, these powders

Contain flavoring agents, preservatives, dispersing agents, colorants and other pharmacological auxiliaries.

Capsules can be produced from a powder of the type mentioned above or other powders which are introduced into a capsule, preferably a gelatin capsule, and the capsule is then closed.

It is also possible for lubricants known from the prior art to be introduced into the capsule or for the closure of the two capsule parts. The effectiveness of a capsule when taken orally can be enhanced by the fact that disintegrating or solubilizing substances are added, such as, for example, carboxymethyl cellulose, carboxymethyl cellulose calcium, low-substituted hydroxyprophyl cellulose, calcium carbonate, sodium carbonate and other substances. The active ingredient can be present in the capsule not only as a solid, but also in suspension, for example in vegetable oil, polyethylene glycol, glycerol with the aid of surface-active substances, etc.

Tablets can be made by pressing the powdered mixture and then e.g. is processed into granules. The tablets can contain various excipients, e.g. Starches, milk sugar, cane sugar, glucose (e.g. for vaginal tablets), sodium chloride, urea for solution u. Injection tablets, amylose, various types of cellulose as described above and others. For example, glycerin or starch can be used as a humectant.

For example, starch, alginic acid, calcium alginate, pectic acid, powdered agar agar, formaldehyde gelatin, calcium carbonate, sodium bicarbonate, magnesium peroxide, amylose can be used as disintegrants.

For example, cane sugar, stearin, solid paraffin, (preferably with a melting range of 50-52 ° C) are used as counter-disintegrants or solution retarders; Cocoa fat, hydrogenated fats into consideration.

Other disintegrants can be: corn starch, potato starch, alginic acid and the like.

Quaternary ammonium compounds, sodium lauryl sulfate and saponins are suitable as absorption accelerators.

For example, ether can be used as the binder distributor and cetyl alcohol as the hydrophilizing agent or as the disintegration accelerator, Glycerin monostearate, starch, corn starch, milk sugar, wetting agents (e.g. Aerosol OT, Pluronics, Tweens), tragacanth, gum arabic, gelatin and others.

Sucrose, fructose, lactose or aspartame can be used as sweeteners or peppermint, wintergreen oil, cherry flavor and much more as flavoring agents.

In addition, other auxiliaries are generally considered: Aerosil, Aerosol OT ethyl cellulose, amberlite resin, XE-88, Amijel, Amisterol, Amylose, Avicel microcrystalline cellulose, bentonite, calcium sulfate, Carbowax 4000 u. 6000, carrageenan, castor wax, cellulose, cellulose microcrystalline, crospovidone, dextrans, dextrin,

Dicalcium phosphate, base for pharmaceutical tablets, kaolin, lactose (USP), lactosil, magnesium stearate, mannitol, granular mannitol NF methyl cellulose, Miglyol 812 neutral oil, milk powder, milk sugar, nal-tab, nepol amylose, Pöfizer crystalline sorbitol, plasdone, polyethylene glycolate, poly , Polyvinylpyrrolidone, precirol, cattle claw oil (hydrogenated), orodispersible tablet base, silicone, stabiline, starx 1500, syloid, tablet base Waldhof, Tablettol, Talcum cetylatum u. stearatum, Tego metal soaps, dextrose and. Tylose. Particularly suitable is the tabletting aid K (M25), which otherwise meets the requirements of the following pharmacopoeias: DAB, Ph, Eur, BP and. NF.

Further usable auxiliaries can be found in the examples, but other auxiliaries from the prior art can also be used.

For example, tablets can be manufactured by direct compression.

Other formulations that can be administered orally, such as solutions, syrups, elixirs, etc., can also be prepared. If necessary, the connection can be microencapsulated. Parenteral administration can be achieved by dissolving the compound in a liquid and injecting it subcutaneously, intramuscularly or intravenously. Examples of suitable solvents are water or oily media.

To produce suppositories, the compound can be formulated with low-melting and water-soluble or water-insoluble materials such as polyethylene glycol, cocoa butter, higher esters (for example moerysthyl, palmitate) or mixtures thereof.

The above listing is exemplary only, and one skilled in the art could consider other adjuvants.

Various other materials can be present as coatings or to otherwise modify the physical form of the solid unit dosage form. For example, tablets, pills or capsules can be coated with gelatin, wax, shellac or sugar and the like. As already mentioned, enteric formulations are preferred for the oral dosage forms. Enteric coatings for tablets or capsules are therefore preferred. In the case of a syrup or elixir, sucrose or fructose may be included as a sweetener, methyl and propyl paraben as a preservative, a color and a flavoring such as cherry or orange flavor.

The auxiliary substances mentioned are not limited to the use of the application form in the context in which they were mentioned, but can also be transferred to the other application forms.

Of course, any material used in the manufacture of any unit dosage form should be pharmaceutically acceptable and substantially non-toxic in the amounts used. In addition, the active components can incorporate sustained release preparations and devices which include, but are not limited to, those based on osmotic pressures to achieve a desired release profile. Once-daily formulations for each of the active components are specifically included.

Such compositions and preparations should contain at least 0.001% active compound. The percentage of compositions and preparations can, of course, be varied and may conveniently be between about 0.1 to about 100% by weight of a given unit dosage form. The amount of active compound in such therapeutically useful compositions is such that an effective dosage amount is obtained.

The composition of the invention containing the two active components can be administered in the same physical form or simultaneously in accordance with the dosages described above and in the delivery vehicles described above. The dosages for each active component can be measured separately and can be administered as a single combined dose or administered separately. They can be administered at the same or different times, as long as both active ingredients are effective in the patient at one time over a 24-hour period. It is preferred if the two components come into effect in such a way that an effect is achieved which is improved compared to the respective individual effect. Simultaneous or co-administration means that the patient takes one drug within about 5 minutes after taking the other drug. For reasons of simple handling, formulations are preferred in which the two drugs are administered to the patient close together and typically at the same time.

d) indications

The medicament composition according to the invention can preferably be used individually for the treatment or prophylaxis, inter alia, of each of the diseases mentioned below The clinical picture, as well as in combination with another of the named clinical pictures, can be used without being limited to: urinary incontinence, in particular stress incontinence, urge incontinence, mixed incontinence or hyperactive bladder of neurogenic or non-neurogenic origin and their further subindications.

According to the invention, both those clinical pictures are included, the cause of which is an organ dysfunction or illness, and also those which are attributable to diseases or disorders of the central nervous system. Accordingly, any treatment for bladder dysfunction, particularly any type of urinary incontinence, is contemplated by the present invention.

Thus, a further embodiment of the present invention comprises the use of the composition according to the invention for the manufacture of a medicament for the treatment or prevention of any of the indications for bladder dysfunction mentioned in the previous paragraph.

Treatment of the above diseases or disorders is accomplished by delivering a therapeutically effective amount of the composition of the invention to a mammal. In most cases this is human, but the treatment of food animals (e.g. cattle) and pets (e.g. dogs, cats and horses) is expressly covered here. For veterinary uses, the dosages to be used may be different from the dosages given herein.

The new composition with a minimal level of deleterious side effects is expected to provide rapid relief to those suffering from the above diseases and disorders.

e) Examples are particularly preferred combinations N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide and (-) - ethyl-2- [4- (2- {[( IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetate.

N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methylphenyljmethanesulfonamide and (-) - ethyl-2- [4- (2- {[(lS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetate monohydrochloride.

N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methylphenyljmethanesulfonamide and (-) - 2- [4- (2- {[(lS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetic acid.

N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide and (-) - 2- [4- (2- {[(lS, 2R) -2-Hydroxy-2- (4-hydroxyphenyl) -1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetic acid monohydrochloride.

Claims

claims

1. A composition comprising: (a) a pharmaceutically effective amount of one or more alpha agonists, optionally in the form of a pharmaceutically active salt thereof (b) and (b) a pharmaceutically effective amount of one or more beta-3 adrenoceptor agonists optionally in Form of a pharmaceutically active salt thereof.

2. The composition according to claim 1, in which the at least one component (a) is selected from the group consisting of midodrin, N- [3- (1H-imidazol-4-ylmethyl) phenyl] ethanylsulfonamide, Garomefrin hydrochloride, N- [6 -Chlor-3- (4,5-dihydro-1H-imidazol-2-ylmethoxy) -2-methylphenyl] methanesulfonamide, N-5- (4,5-dihydro-3H-imidazol-4-yl) -2 -hydroxy-5,6,7,8-tetrahydronaphth-l-yl] methanesulfonamide, N-5- (3H-imidazol-4-yl) -5,6,7,8-tetrahydronaphth-l-yl] methanesulfonamide , 2-amino-1 - (4-hydroxy-2-methanesulphonamidophenyl) ethanol, (5-chloro-2,3-dimethylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, ( 5-chloro-2,3-diethylphenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, (3-isopropyl-2-methylphenyl) - (4,5-dihydro-lH -imidazol-2-yl) amine, (3-tert-butyl-6-methoxy-phenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, (6-chloro-3-isopropyl-2 -methyl-phenyl) - (4,5-dihydro-1H-imidazol-2-yl) amine, (4-chloro-3-isopropyl-2-methyl-phenyl) - (4,5-dihydro-1H-imidazole) 2-yl) amine, (6-bromo-3-isopropyl-2-methylphenyl) - (4,5-dihydro- 1H-imidazol-2-yl) amine, (6-bromo-3-tert-butylphenyl) - (4,5-dihydro-1H-imidazol-2-yl) amine, (4-bromo-3-isopropyl- 2-methyl-phenyl) - (4,5-dihydro-lH-imidazol-2-yl) amine, (5-chloro-3-isopropyl-2-methyl-phenyl) - (4,5-dihydro-lH-imidazole) -2-yl) amine, N- (4,5-dihydro-lH-imidazol-2-ylmethyl) -5-fluoro-2- (methylsulfonyl) aniline, N- (4,5-dihydro-lH-imidazol-2 -ylmethyl) -2- (1-ethyl-1H-pyrazol-5-yl) aniline, 2 - [(4,5-dihydro-1H-imidazol-2-ylmethyl) amino] -N-methylbenzenesulfonamide, N- (4th , 5-dihydro-lH-imidazol-2-ylmethyl) -2- [1- (2,2,2-trifluoroethyl) -! Hl, 2,4-triazol-5-yl] aniline, N- (4,5-dihydro-lH-imidazole-2- ylmethyl) -2- (methylsulfonyl) aniline, one of the respective metabolites, one of the respective enantiomers, one of the respective pharmacologically acceptable salts and / or mixtures thereof.

3. Composition according to one of claims 1 or 2, in which the component (b) (-) - ethyl-2- [4- (2 - {[(IS, 2R) -2-hydroxy-2- (4-hydroxyρhenyl ) -l-methylethyl] -amino} - ethyl) -2,5-dimethylphenyloxy] acetate and / or (-) - 2- [4- (2- {[(IS, 2R) -2-hydroxy-2- ( 4-hydroxyphenyl) -l-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetic acid and / or a metabolite thereof and / or an enantiomer thereof and / or a pharmacologically acceptable salt thereof.

4. Composition according to one of claims 1 to 3, in which the component (a) Garomefrin hydrochloride, N- [6-chloro-3- (4,5-dihydro-lH-imidazol-2-ylmethoxy) -2-methyl- phenyl] methanesulfonamide or midodrine and component (b) (-) - ethyl-2- [4- (2- {[(IS, 2R) -2-hydroxy-2- (4-hydroxyphenyl) -l- methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetate and / or (-) - 2- [4- (2- {[(1 S, 2R) -2-hydroxy-2- (4-hydroxyphenyl) - 1-methylethyl] amino} ethyl) -2,5-dimethylphenyloxy] acetic acid and / or a pharmaceutically acceptable salt thereof.

5. The composition of claim 4 containing from about 0.1 mg to about 5 g of component (a) and from about 10 mg to about 750 mg of component (b).

6. A composition according to any one of claims 1 to 5, in which component (a) and component (b) are formulated in the same application form.

7. A composition according to any one of claims 1 to 5, in which component (a) and component (b) are formulated in different application forms.

8. Composition according to one of claims 1 to 7 as a medicament.

9. The composition of claim 8 for rectal, vaginal, topical, oral, sublingual, intranasal, transdermal or parenteral application.

10. The composition of claim 8 or 9 for simultaneous administration of the two components (a) and (b).

11. The composition of claim 8 or 9, wherein at least one of the two components is released at least partially delayed.

12. The composition of claim 8 or 9, wherein at least one of the two components is at least partially released immediately.

13. Use of a composition according to any one of claims 1 to 12 for the manufacture of a medicament for treating bladder dysfunction such as urinary incontinence or hyperactive bladder or a central nervous system disorder or disorder related to bladder dysfunction such as urinary incontinence or hyperactive bladder in a Mammal.

14. Use according to claim 13, characterized in that the bladder dysfunction is selected from the group consisting of urinary incontinence, urge incontinence, stress incontinence, mixed incontinence, other forms of urinary incontinence and / or hyperactive bladder.

15. Use of a first composition containing component (a) according to one of claims 1, 2, 5, 9, 11 or 12, which does not contain component (b) in combination with a second composition containing component (b) according to one of claims 1, 3, 9, 11 or 12, which does not contain component (a) for the manufacture of a medication for the treatment of bladder fiction disorders according to one of claims 13 or 14.

16. A method of treating bladder dysfunction such as urinary incontinence or hyperactive bladder or a central nervous system disorder or disorder related to bladder dysfunction such as urinary incontinence or hyperactive bladder in a mammal, which is the administration of a composition according to any one of claims 1 to 12 to the mammal.

17. The method of claim 16, wherein the bladder dysfunction is selected from the group consisting of urinary incontinence, urge incontinence, stress incontinence, mixed incontinence, other forms of urinary incontinence and / or hyperactive bladder.