IE19970487A1 - Ranolazine and related piperazines for use in the treatment of shock conditions - Google Patents
Ranolazine and related piperazines for use in the treatment of shock conditionsInfo
- Publication number
- IE19970487A1 IE19970487A1 IE1997/0487A IE970487A IE19970487A1 IE 19970487 A1 IE19970487 A1 IE 19970487A1 IE 1997/0487 A IE1997/0487 A IE 1997/0487A IE 970487 A IE970487 A IE 970487A IE 19970487 A1 IE19970487 A1 IE 19970487A1
- Authority
- IE
- Ireland
- Prior art keywords
- lower alkyl
- compound
- ranolazine
- transplants
- treatment
- Prior art date
Links
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- 238000010348 incorporation Methods 0.000 description 1
- 230000002401 inhibitory effect Effects 0.000 description 1
- 238000009588 inulin clearance Methods 0.000 description 1
- 230000002045 lasting Effects 0.000 description 1
- 230000004301 light adaptation Effects 0.000 description 1
- 230000000670 limiting Effects 0.000 description 1
- 239000008297 liquid dosage form Substances 0.000 description 1
- 238000011068 load Methods 0.000 description 1
- 239000006210 lotion Substances 0.000 description 1
- 239000000314 lubricant Substances 0.000 description 1
- 239000008176 lyophilized powder Substances 0.000 description 1
- 239000001095 magnesium carbonate Substances 0.000 description 1
- 239000011776 magnesium carbonate Substances 0.000 description 1
- 229910000021 magnesium carbonate Inorganic materials 0.000 description 1
- 229910052943 magnesium sulfate Inorganic materials 0.000 description 1
- CSNNHWWHGAXBCP-UHFFFAOYSA-L magnesium sulphate Substances [Mg+2].[O-][S+2]([O-])([O-])[O-] CSNNHWWHGAXBCP-UHFFFAOYSA-L 0.000 description 1
- 235000019341 magnesium sulphate Nutrition 0.000 description 1
- 239000000594 mannitol Substances 0.000 description 1
- 235000010355 mannitol Nutrition 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 239000004005 microsphere Substances 0.000 description 1
- 229910000403 monosodium phosphate Inorganic materials 0.000 description 1
- 235000019799 monosodium phosphate Nutrition 0.000 description 1
- 239000002674 ointment Substances 0.000 description 1
- 239000006179 pH buffering agent Substances 0.000 description 1
- 230000002093 peripheral Effects 0.000 description 1
- 230000002572 peristaltic Effects 0.000 description 1
- GLUUGHFHXGJENI-UHFFFAOYSA-N piperazine Chemical compound C1CNCCN1 GLUUGHFHXGJENI-UHFFFAOYSA-N 0.000 description 1
- 229920000573 polyethylene Polymers 0.000 description 1
- 229920002523 polyethylene Glycol 1000 Polymers 0.000 description 1
- 229920001223 polyethylene glycol Polymers 0.000 description 1
- 229920000642 polymer Polymers 0.000 description 1
- 238000002203 pretreatment Methods 0.000 description 1
- 125000001436 propyl group Chemical group [H]C([*])([H])C([H])([H])C([H])([H])[H] 0.000 description 1
- 230000001681 protective Effects 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 102000004169 proteins and genes Human genes 0.000 description 1
- KEAYESYHFKHZAL-UHFFFAOYSA-N sodium Chemical compound [Na] KEAYESYHFKHZAL-UHFFFAOYSA-N 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
- 229910052708 sodium Inorganic materials 0.000 description 1
- VMHLLURERBWHNL-UHFFFAOYSA-M sodium acetate Chemical compound [Na+].CC([O-])=O VMHLLURERBWHNL-UHFFFAOYSA-M 0.000 description 1
- 239000001632 sodium acetate Substances 0.000 description 1
- 235000017281 sodium acetate Nutrition 0.000 description 1
- 229910000030 sodium bicarbonate Inorganic materials 0.000 description 1
- AJPJDKMHJJGVTQ-UHFFFAOYSA-M sodium dihydrogen phosphate Chemical compound [Na+].OP(O)([O-])=O AJPJDKMHJJGVTQ-UHFFFAOYSA-M 0.000 description 1
- 229940035044 sorbitan monolaurate Drugs 0.000 description 1
- 238000002798 spectrophotometry method Methods 0.000 description 1
- 238000003756 stirring Methods 0.000 description 1
- 235000012222 talc Nutrition 0.000 description 1
- 239000000454 talc Substances 0.000 description 1
- 229910052623 talc Inorganic materials 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 238000005550 wet granulation Methods 0.000 description 1
- 239000000080 wetting agent Substances 0.000 description 1
Abstract
ABSTRACT Piperazine derivatives, particularly ranolazine, are useful for treatment of tissues Oifig Na bPaitinni The Patents Office experiencing a physical or chemical insult, and specifically for treating cardioplegia, hypoxic and/or reperfusion injury to cardiac or skeletal muscle or brain tissue, and for use in transplants.
Description
Field of the Invention
The present invention relates to methods of
treatment using ranolazine or another piperazine
derivative compound of Formula I, particularly to methods
of using ranolazine for treatment of tissues experiencing
a physical or chemical insult, and specifically to
methods of treating cardioplegia, hypoxic and/or
reperfusion injury to cardiac or skeletal muscle or brain
tissue, and for use in transplants.
B r n ' n
Ranolazine, i.e., :N—(2,6—dimethylphenyl)—4—
[2—hydroxy—3-(2—methoxyphenoxy)propyl]—l—piperazine
acetamide or l-[3—(2—methoxyphenoxy)hydroxypropyl]—
4-[(2,6—dimethylphenyl)aminocarbony1methyl]piperazine,
and the dihydrochloride salt thereof, and the compounds
of Formula I, are described in U.S. Patent
No. 4,567,264. Ranolazine is disclosed as a calcium
entry blocking compound useful in the treatment of
cardiovascular diseases, such as, myocardial infarction,
congestive heart failure, angina and arrhythmia.
One aspect of the present invention concerns a
method of treating tissues experiencing a physical or
chemical insult, by administering an effective amount of
a compound of Formula I:
(Formula I)
and the pharmaceutically acceptable esters and acid
addition salts thereof, wherein:
R1, R2, R3,
hydrogen, lower alkyl, lower alkoxy, cyano,
trifluoromethyl, halo, lower alkylthio, lower alkyl
sulfinyl, lower alkyl sulfonyl, N—optionally substituted
is methyl, R4
R4 and R5 are each independently
alkylamido, except that when R1 is not
methyl; or
R2 and R3 together form —OCH20—;
R6, R7, R8, R9 and R10
hydrogen, lower acyl, aminocarbonylmethyl,
are each independently
cyano, lower alkyl, lower alkoxy, trifluoromethyl, halo,
lower alkylthio, lower alkyl sulfinyl, lower alkyl
sulfonyl, di-lower alkyl amino;
R6 and R7 together form -CH=CH-CH=CE—; or
R7 and R8 together form -ocazo-;
R11 and R12 are each independently hydrogen or
lower alkyl; and
w is oxygen or sulfur.
In a preferred embodiment, the invention entails a
method of treatment wherein the compound of Formula I is
one in which R1 and R5 are methyl, particularly where
R2, R3 R4 R11 and R12 are hydrogen, and more
particularly where W is oxygen. Most preferred is the
where R6 is
method of treatment with ranolazine,
R9 and R10 are hydrogen.
i.e.,
methoxy and R7, R8,
IE 97 0487
In another aSP€Ct, the present invention entails a
method for Protecting the myocardium against global
ischaemic damage induced by cardioplegia, which method
comprises administering to a subject undergoing cardiac
surgery. and/Or adding to the extra-corporeal circulation
of such subject. an effective amount of a compound of
Formula I, preferably ranolazine.
The invention also entails a method for protecting
skeletal muscle against damage resulting, e.g., from
trauma or subsequent to muscle or systemic diseases,
which method comprises administering to a subject whose
skeletal muscle is or is likely to be damaged an
effective amount of a compound of Formula I, preferably
ranolazine.
A further aspect of this invention entails a method
for treating shock conditions (including cardiogenic
shock). which method comprises administering to a subject
experiencing shock an effective amount of a compound of
Formula I, preferably ranolazine.
Still another aspect of this invention entails a
method of protecting myocardial tissue against ischaemic
damage in subjects with myocardial infarction, especially
in patients who are waiting to receive treatment such as
thrombolytic drugs or PTCA (percutaneous transthoracic
coronary angioplasty), which method comprises
administering to a subject suffefing fmmt orsusceotflfle to
suffer from myocardial infarction or undergoino ?TCA an effective amount
of a compound of Formula I, oreferably ranolazine.
Another aspect of the invention is a method for
protecting neuronal tissue against ischaemia resulting
from cardiac function impairment or from non—cardiac
conditions (including protecting brain tissue against
ischaemia—induced metabolic disorders), which method
comprises administering to a subject suffering from or
susceptible to suffer from neuronal tissue damage an
IE 97 0487
€ffeCtiVe amount Of a compound of Formula I, preferably
ranolazine.
In still another aspect, the present invention
entails a method for preserving donor tissues used in
transplants (protecting them from the deleterious effects
of ischaemia), by administration to the donor, the
recipient and/or by adding to the ez;yixQ perfusion fluid
an effective amount of a compound of Formula I,
preferably ranolazine or a pharmaceutically acceptable
salt thereof, particularly for renal transplants, skin
grafts, cardiac transplants, lung transplants, corneal
transplants, and liver transplants.
In yet another aspect, the invention relates to
pharmaceutical compositions containing a therapeutically
effective amount (up to 5 mg/ml for liquid and semi—solid
formulations) of a compound of Formula I, particularly
ranolazine or a pharmaceutically acceptable salt thereof,
admixed with at least one pharmaceutically acceptable
excipient, such compositions being adapted for use in the
methods of treatment of the present invention.
Another aspect of the invention entails methods of
treatment by coadministration of a compound of Formula I
together with another pharmaceutically active agent, such
as thrombolytic agents [especially TPA (Tissue Plasminogen
Activator) or streptokinase] or anti—anginals (such as
beta blockers, including propranolol and timolol).
DETAILED DESCRIPTION OF THE INVENTIOH
Definitions and General Parameters
The following definitions are set forth to
illustrate and define the meaning and scope of the
various terms used to describe the invention herein.
As used herein, the term "treatment" or "treating"
means any treatment of a disease in a mammal, including:
IE 97 0487
(i) preventing the disease, that is, causing the
clinical symptoms of the disease not to develop;
(ii) inhibiting the disease, that is, arresting the
development of clinical symptoms; and/or
(iii) relieving the disease, that is, causing the
regression of clinical symptoms.
As used herein, the term "q.s.” means adding a
quantity sufficient to achieve a stated function, e.g.,
to bring a solution to the desired volume (i.e., 100%).
As used herein, the term "effective amount" means a
dosage sufficient to provide treatment for the disease
state being treated. This will vary depending on the
patient, the disease and the treatment being effected.
Preparation of ganglazine
Ranolazine and the piperazine compounds of Formula I
can be prepared, for example, as described in U.S. Patent
No. 4,567,264.
Utilitv. Testing and Administration
It has surprisingly been found that ranolazine is
active in methods of treatment unrelated to its initially
identified calcium entry blocking mechanism and
cardioselective indications. Particularly interesting is
the fact that ranolazine has now been found to protect
tissues against ischaemia (improving cellular oxygen
utilization efficiency) at doses that do not produce any
cardiodepressant effects (see, Allely and Alps, supra;
and Ferrangon, et a1., gupgaa)
fieaeral Utility
The piperazine compounds of Formula I, particularly
ranolazine and the pharmaceutically acceptable salts
thereof (preferably the dihydrochloride). are useful for
IE 97 0487
treating tissues experiencing a physical or chemical
insult. For example, such treatment can be for
cardioplegia, or for hypoxic reperfusion injury to
cardiac or skeletal muscles, or brain tissue. The
compounds of Formula I, particularly ranolazine and its
salts, are also useful for preserving (e.g., preventing
deterioration of) donor tissues used in transplants, by
administration to the transplant donor, to the transplant
recipient, or by perfusion of the tissues to be
transplanted, particularly for renal transplants, skin
grafts, cardiac transplants, lung transplants, corneal
transplants, and liver transplants.
Testing
Protection against myocardial ischaemia can also be
assessed via effectiveness to prevent ischaemia—induced
increase in alpha-l adrenoceptor number in the
myocardium. It is known that alpha-l adrenoceptor
E9-270487
A detailed description is set
IE 370487
. 3_3Q, 1612, 1985).
description is set forth in Example 3.
The utility of compounds of Formula I, as
exemplified by ranolazine, in organ transplant is
demonstrated by administering the test compound to pigs
before nephrectomy. and/or by adding the compound to the
fluid used for flushing and storage of the organ and by
A detailed
assessing functionality of transplanted kidneys over a
period of 14 days. Improvement of renal function in
treated animals is assessed by measurement of the
glomerular filtration rate and also by peak serum levels
for creatinine and urea. Glomerular filtration is a well
established indicator of renal function (see, e.g., Mudge
and Weiner in
Goodman and Gilman, 879, 7th Ed, 1985) and it is
generally assessed by measurement of inulin and/or
creatinine clearance (Ieztb9gx_gf_nedicing, 1088-93,
l4th Ed., 1975 — Beeson and Mcbermott Editors). A
detailed description is set forth in Example 4.
followed by an infusion over the period of reperfusion,
IE 970487
as described bY Alps, et a1., (Arzneim. Eorsch Drug Reg.,
11, (1), 5, 868-876, 1983).
Administration
Administration of ranolazine in pure form or in an
appropriate pharmaceutical composition can be carried out
via any of the accepted modes of administration of agents
Thus,
be, for example, orally, nasally, parenterally or
for serving similar utilities. administration can
topically, including by perfusion. Administration can be
achieved in the form of solid, semi—solid, lyophilized
powder, or liquid dosage forms, such as for example,
tablets, suppositories, capsules, powders, solutions,
suspensions, emulsions, creams, lotions, aerosols,
ointments or the like, preferably in unit dosage forms
suitable for simple administration of precise dosages.
The compositions will include a conventional
pharmaceutical carrier or excipient and an effective
amount of ranolazine or a pharmaceutically acceptable
salt thereof, and in addition, may include other
medicinal agents, pharmaceutical agents, carriers,
adjuvants, etc. Sustained release and slow release
formulations for maintaining extended or constant dosage
levels are also useful in the present invention.
Ranolazine can also be co—administered with other active
agents, such as thrombolytic agents [especially TPA
(Tissue Plasminogen Activator) or streptokinase] or
anti—angina1s (such as beta blockers, including
propranolol and timolol).
The preferred method of administration is
parenteral, except for those cases when the subject must
be pre-treated before surgery or when the subject must be
maintained under therapy after acute episodes of
ischaemia (in which instances it may be preferable to
administer the composition orally).
IE 970482‘
_11_
Genera11Y» dePending on the intended mode of
administration, the pharmaceutically acceptable
compositions will contain about 1% to about 99% by weight
of the pharmaceutically active compound of this invention
and 99% to lZ by weight of suitable pharmaceutical
excipients. Preferably, the composition will be about 5
to 75% by weight of a pharmaceutically active compound,
with the rest being suitable pharmaceutical excipients.
For liquid and semi—solid formulations, about 5 mg/ml is
preferred as the maximum concentration for the active
ingredient.
Oral administration entails using a convenient daily
dosage regimen which can be adjusted according to the
degree of affliction. For such oral administration, a
pharmaceutically acceptable, non—toxic composition is
formed by the incorporation of any of the normally
employed excipients, such as, for example, pharmaceutical
grades of mannitol, lactose, starch, magnesium stearate,
sodium saccharine, talcum, cellulose, glucose, gelatin,
Such
compositions take the form of solutions, suspensions,
sucrose, magnesium carbonate, and the like.
tablets, capsules, powders, sustained release or slow
release formulations and the like.
Preferably the oral compositions will take the form
of a capsule or tablet and thus the composition will
contain, along with the active ingredient, a diluent such
as lactose, sucrose, dicalcium phosphate, and the like; a
disintegrant such as starch or derivatives thereof; a
lubricant such as magnesium stearate and the like; and a
binder such as a starch, gum acacia, polyvinylpyrroli—
done, gelatin, cellulose and derivatives thereof, and the
like.
The active compounds may be formulated into a
suppository using, for example, about 0.5% to about 50%
active ingredient disposed in a carrier of polyethylene
aE9Z0487
_l2._
glycols (PEG) [e.g., PEG 1000 (96%) and PEG 4000 (4‘Z,)] or
semi—synthetic glycerides (witepsol“, Suppocire”).
Another preferred mode of administration is
parenterally. Liquid pharmaceutically administerable
compositions can, for example, be prepared by dissolving,
dispersing, etc. an active compound (about 0.5% to about
%), as described above, and optional pharmaceutical
adjuvants in a carrier, such as, for example, water,
saline, aqueous dextrose, glycerol, ethanol and the like,
to thereby form a solution or suspension.
For preservation of tissues awaiting transplantation,
a perfusion solution is preferred. Such solutions
include an active compound in a carrier such as
Eurocollins Solution (Fresenius, A.G., Bad Homburg, vdH,
Germany), University of Wisconsin Fluid (Kalayoglu, M.,
et al., Iha_Lanaat, 1988 i, 617), phosphate buffered
sucrose (see, e.g., Example 7E) and Hyperosmolar Citrate
(Ross, et al., Transplantation, 1976, 498-501).
If desired, the pharmaceutical composition to be
administered may also contain minor amounts of non—toxic
auxiliary substances such as wetting or emulsifying
agents, pH buffering agents and the like, such as for
example, sodium acetate, sorbitan monolaurate,
triethanolamine oleate, etc.
Actual methods of preparing such dosage forms are
known, or will be apparent, to those skilled in this art;
for example, see R m n n' Ph rm
16th Ed., (Mack Publishing Company, Easton, Pennsylvania,
1980). The composition to be administered will, in any
event, contain a quantity of the active compound(s) in a
pharmaceutically effective amount for relief of the
particular condition being treated when administered in
accordance with the teachings of this invention.
Example 7 describes oral and parenteral formulations
containing ranolazine. Such formulations should not be
IE 970487
Construed 33 narrowing the invention. In particular,
parenteral formulations can be given as dilutions with
perfusion fluids, dialysis fluids and/or fluids used to
flush and store organs. It is also intended that the
invention encompasses the possibility to associate
ranolazine with other pharmaceutical agents, as
co—prescription or by concomitant dissolution in fluids.
Dgsagg
Generally, ranolazine is administered in a
therapeutically effective amount, i.e., a dosage
sufficient to effect treatment. The amount of active
compound administered will, of course, be dependent on
the subject treated, the subject's weight, the severity
of the affliction, the route of administration and the
judgement of the prescribing physician. However, absent
sufficient time to weigh the foregoing factors in detail,
e.g., in emergency situations, effective i.v. dosages
range from about 0.05 to about 5 mg/kg for bolus
injection followed by an infusion ranging from about 0.3
to about 30 mg/kg/hour.
dosage ranges from about 0.1 to about 2.5 mg/kg and the
Preferably, the i.v. bolus
infusion dosage from about 1.5 to about 15 mg/kg/hour.
For an average 70 kg human, the i.v. bolus would range
from about 3.5 to about 350 mg, or preferably, from about
to about 105 mg. In other situations, the oral dosage
is in the range of about 10 to about 1400 mg per day, preferably
about 35 to about 1400 mg per day, more preferably about
to about 700 mg/day, for an average
kg human. For administration by perfusion fluid, a
concentration of about 0.001 to about 5 g per litre is
used, preferably about 0.005 to about 2.5 g per litre,
and most preferably about 0.005 to about 0.1 g per litre;
perfusion can continue from tissue removal from the donor
until its use for transplantation.
IE 970487
EXAMPLES
The following preparations and examples are given to
enable those skilled in the art to more clearly understand
and to practice the present invention. They should not be
considered as limiting the scope of the invention, but
merely as being illustrative and representative thereof.
EXAMPLE 1
Protection Against Cardiac Ischaemia
This is an adaptation of the model described by
Alps, et al., (Arzneim. Forsch Drug Res., 13, (l), 6,
868-876, 1983).
Eight male baboons were anaesthetized then randomly
allocated to one of the two following groups:
r A
Four animals were subjected to 30 min. occlusion of
II I I
the left anterior descending coronary artery (LAD)
followed by a reperfusion period of 5.5 hours. Venous
plasma samples taken pre—thoracotomy, pre—LAD ligation
and every hour during the reperfusion period were
analyzed for CPK2 and LDHI iso-enzyme levels.
loading dose of ranolazine (S00 ug/kg) intravenously
min. before LAD ligation followed by a continuous
infusion of 50 ug/kg/min. for a 6-hour period starting at
LAD ligation time.
_15_
RE T
CPK2 iso-enzyme levels in plasma remained below
the detection limits until the first hour
post—infarction. LDHI plasma levels were identical
at pre—surgery and pre—1igation times (pre—infarct
period). Results, as reported in Table l, are expressed
in international units of iso-enzyme per litre of plasma.
T l 1
> Time > Pre— > lhr Post- > 6hr Post— >
> r Pr -in r r r ' n r rf i n)
> > > > >
> Control CPK2 > N.D. > 10.5 > 232.8 >
> group LDH1 > 52.7 > — > 333.8 >
> —————————————— ——> — —— -- > ———————— ——>
> Tested CPK2 > N.D. > 11.0 > 28.5 >
> group LDH1 > 53.0 - > 85.8 >
> > > > >
As shown above, ranolazine strongly inhibited the
release of CPK2 and LDH1, such a result being
indicative of an effective protection of the myocardial
tissue against deleterious effects of ischaemia.
E LE
Skeletal Muscle Protection
Skeletal muscle protection was determined according
to the experimental conditions as per Example 1, except
that plasma samples were assayed for CPK3 and LDH5
iso—enzymes. The results are reported in Table 2.
|E970437
Table 2
> Time > > Post-reperfusion >
> Group > Pre—surzerv > 6hr Post—infarct >
) > ) )
> Control CPK3 > 104.6 > 2016.5 >
> group LDE5 > 30.0 > 212.0 >
> --------------- --> ----------- -—> ————————————————— -—>
> Tested CPK3 > 84.0 > 141.0 >
> group LDH5 > 27.4 > 22.3 >
Iso—enzyme levels are given in International Units per
litre of plasma.
Thus, ranolazine clearly protected the muscle from
surgery—induced damage.
This method has been described by Ferrandon et al.,
Br. J. Pharmacol., 21, 247P, 1988.
Male Sprague—Dawley rats were anaesthetized with
pentobarbitone sodium (50 mg/kg, i p.). After injection
of heparin (200 units i.v.) the thorax was opened, the
heart removed with a length of aorta attached and then
immersed in ice cold Krebs‘ solution (118 mM NaCl, 4.55
mM KC1, 1.2 mM KHZSO4, 1.2 mM MgSO4, 11.0 mM
glucose, 20.0 mM NaHC03, 1.35 mM Caclz, pH 7.4). The
heart was gently palpated to expel the blood. Hearts
were then perfused with the above solution warmed to 37° C
and gassed with 95% 02 and 5% C02 retrogradely via
the aorta (Langendorff model) using a peristaltic pump
set to deliver 14 ml/min. A microelectrode was
introduced into the ventricular muscle wall and a
lE970487
reference electrode placed in contact with the perfusion
fluid 3cm above the heart.
connected to a pH meter.
Hearts were perfused at 14 ml/min for a 15 min
period to obtain a stable baseline ventricular pH. The
aortic flow was then reduced to 1 ml/min for 15 min by
decreasing the pump speed.
the initial rate for 15 min.
The two electrodes were
The flow was then restored to
Values of coronary flow and
ventricular pH were measured at 5 minute intervals.
After restoration of the initial flow rate measurements
were made at 30 seconds, 1 minute and 5 min. Samples of
coronary effluent were collected and stored on ice.
Infusions of ranolazine (1 pM) were started 10 min
prior to reducing the flow rate and were continued for
At the end of the
the hearts dried at
the remainder of the experiment.
experiment the atria were removed and
75°C for 2 days.
Biochemical determination of lactate released into
the coronary effluent was made using a spectrophotometric
method.
was obtained by reference to a standard curve.
The quantity of lactate contained in the samples
Lactate
release from the heart mass was calculated using the
following formula:
£lactate1(microMo1/ml) x coronarv flow (ml/min)
dry weight of the heart (g)
The results are reported in Tables 3 and 4.
lE97o437
pH Modifications
After 10 min
Pre— of Fall in
ischeamia low perfusion pH
CONTROLS 7.36 6.77 0.59
RANOLAZINE 7.38 7.10 0.28
Thus, ranolazine inhibits the ischaemia—induced fall
in pH by approximately 50%.
Lactate release modifications*
> 2 min >> 5 min > 15 min >> 1 min
> before >> after > after >> after
Group > low perf. >> low perf. > low oerf. >> reperf
> >> > >>
CONTROLS > 0.6 >> 3.34 > 5.0 >> 17.4
> >> > >>
1 pM > >> > >>
mmmAmmE> L2 >> 2A5 > 26 >> 80
> >> > >>
*Values are expressed as micromoles of lactate released per
minute in the coronary effluent by 1 g of dried heart.
Thus, the compounds belonging to this invention
clearly reduced the sequelae of low flow perfusion.
'E970437
EXAMPLE 4
Protection For Organ Transplants
Twenty left nephrectomised pigs were autotransplanted
with their kidneys after preservation for 24 hours in
phosphate buffered sucrose (PBS 140) and immediate
contralateral nephrectomy followed the
autotransplantation.
The quality of the preservation and post—transplant
renal function were assessed by measurement of glomerular
filtration rate (GFR) using inulin clearance on day 7.
Qrgup A gn=lQ2 placebo group
The animals received placebo pre-treatment (bolus
and infusion) commencing 5 min prior to left nephrectomy
and lasting until the kidney was removed.
then flushed with PBS 140 containing placebo before
storage in PBS 140.
was auto—transplanted.
The kidney was
After 24 hours storage the kidney
Gr B =10 r
The animals received a bolus dose of ranolazine
intravenously (0.85mg/kg) 5 min prior to nephrectomy
followed by an infusion (0.25mg/kg/h) until the kidney
The kidney was then flushed with PBS 140
solution containing ranolazine 0.5mg/l (made up
immediately before flush) prior to storage. After 24
hours storage the kidney was auto—transplanted.
was removed.
_20_
Table 5
Group A Group B
Glomerular filtration l6.4ml/min 56 6ml/min
rate at day 7
Peak Serum Urea 43.4mm/1 28.SmM/l
Peak Serum Creatinine l063pM/1 750uM/l
The results shown in Table 5 demonstrate that organs
preserved in a fluid containing ranolazine achieved
superior functionality after transplantation as compared
with the control group that did not receive ranolazine.
EXAnBLE_i
Protection Against Brain Ischaemia
Isoenzyme appearance in peripheral venous blood was
determined according to the experimental conditions as
per Example 1, except that plasma samples were assayed
for CPKI. The results are reported in Table 6.
CPKI Levels
.7
19.3
.8
19.9
CONTROL GROUP
RANOLAZINE GROUP
lE9704
IE 97 0487
_21_
Results are expressed in International Units per
litre Of Plasma, and clearly demonstrate the protective
role of ranolazine in cerebral ischaemia.
EXAMPLE 6
Protection Against Myocardial Ischaemia
Male Sprague-Dawley rats were pentobarbitone—
anaethetized and mechanically respired with room air. A
left lateral thoracotomy was then performed and the left
anterior descending coronary artery (LAD) was occluded
for a period of 30 min. Control animals had the ligature
placed in position but not tied.
Compounds (500 ug/kg ranolazine, saline vehicle)
were administered either i.p. or i.v. 15 min prior to LAD
ligation or i.p. for 3 days (twice a day) plus 15 min
prior to occlusion.
At the end of the ischaemic period the ischaemic
zone of the left ventricle was excised and analyzed for
alpha-l—adrenoceptor density according to the method
described by Williams et al. (gardiovascnlar
Pharmacology, 3, 522, 1981). The apparent
alpha—l-adrenoceptor density was calculated at 0.1 nM
[3H]—prazosin and results were expressed as femtomole
of receptors per mg of protein, as shown in Table 7.
These results demonstrate that ranolazine inhibits the
ischaemia-induced increase in a—l adrenoreceptor
density in rats left ventricle and is therefore useful to
prevent tissue damage resulting from myocardial ischaemia.
lE970487
Table 7
gram; mi; No. Animals Alpha-1 densitv
Control 12 8.55
Ischaemia/Treated by
saline vehicle only 12 16.30
Ischaemia/Treated by
ranolazine i.p. 13 11 20
Ischaemia/Treated by
ranolazine i.v. 9 9.71
Ischaemia/Treated by
ranolazine i.p. 3 days 9 8.33
EXAMPLE 7
Formulations
The following example illustrates the preparation of
representative pharmaceutical formulations containing a
compound of Formula I, as exemplified by ranolazine.
A. I.V. FORMULATION (low concentration)
(ranolazine) 5.0 mg 0.5 g
dextrose monohydrate 51.2 mg 5.1 g
sodium hydroxide q.s. to pH 4 pH 4
water for injection to 1.0 ml 100 ml
B. I.V. FORMULATION (high concentration)
(ranolazine) 20.0 mg 2 8
dextrose monohydrate 39.4 mg 4 g
sodium hydroxide q.s. to pH 4 pH 4
water for injection to 1.0 ml 100 ml
IE 97 048 7
_23_
To prepare the I.V. formulations, ranolazine and
dextrose monohydrate are dissolved into water (70 per
cent of the final desired volume) then sodium hydroxide
(l0N solution) is added under stirring until pH 4 and the
volume is completed to 100 ml with water.
filtered through a 0.2 micron membrane filter and
The medium is
packaged in ampoules or vials under sterile conditions.
Alternatively the medium can be filtered under
non-sterile conditions, packed in ampoules then
sterilized by autoclaving.
C. FILM COATED TABLET FORMULATION
In r i n Bart: by weight
ranolazine ECl (A) 80.0
microcrystalline cellulose (B) 16.5
polyvinylpyrrolidone (C) 1.0
crosscarmellose sodium (D) 2.0
magnesium stearate (E) 0.5
(A), (B) and half of (D) are mixed then (C) and
(E) and the
After careful
water are added to allow wet granulation.
remaining part of (D) are finally added.
mix the granulated mixture is dried, formed into tablets
containing up to 250 mg of active compound, and the
tablets are film coated using white Opadry” following
appropriate techniques.
E97068?
_24_
D; CQNTRQLLED RELEASE FQEflULATIQN
. Parts by weight
ranolazine BASE (A) 90
microcrystalline cellulose (B) 10
The two above ingredients are dry mixed then water
is added to form a wet mass adequate for extrusion then
spheronisation (0.5 to 1.4 mm). Microspheres are coated
with appropriate release—control1ing polymers then put
into hard shell capsules containing up to 250 mg of
active ingredient per unit.
E. EEBEDSIQN ILQID
In r i n Parts by weight
Ranolazine 20 mg
Phosphate Buffered Sucrose:
Sucrose 48.0 g
Sodium Dihydrogen Phosphate 4.59 g
Sodium Monohydrogen Phosphate 6.53 g
Water For Injection (U.S P.) q.s. to 1000 ml
The ingredients are dissolved in a portion of the water
For Injection, and once dissolved, the remaining volume
is made up with water For Injection.
while the present invention has been described with
reference to the specific embodiments thereof, it should
be understood by those skilled in the art that various
changes may be made and equivalents may be substituted
lE97o437
._25_
without departing from the true spirit and scope of the
invention. In addition, many modifications may be made
to adapt a particular situation, material, composition of
matter, process. process step or steps, to the objective,
spirit and scope of the present invention. All such
modifications are intended to be within the scope of the
claims appended hereto.
Claims (1)
- WHAT IS QLAIMED IS: 1. A method of treating tissues experiencing a physical or chemical insult, by administering an effective amount of a compound of the formula: R R R R 011 R11 ? R8 w—cH2 -53; CH2-—N N—cH —c—N R3 H 3 0 R7 R6 H R12 R5 R4 or a pharmaceutically acceptable esters or acid addition salts thereof, wherein: R1, R2, R3, R4 and R5 hydrogen, lower alkyl, lower alkoxy, cyano, are each independently trifluoromethyl, halo, lower alkylthio, lower alkyl sulfinyl, lower alkyl sulfonyl, N—optionally substituted alkylamido, except that when R1 is methyl, R4 methyl; or R2 and R3 together form —OCH2O—; R6, R7, R8, R9 and R10 hydrogen, lower acyl, aminocarbonylmethyl, is not are each independently cyano, lower alkyl, lower alkoxy, trifluoromethyl, halo, lower alkylthio, lower alkyl sulfinyl, lower alkyl sulfonyl, di—lower alkyl amino; R6 and R7 together form -CH=CH—CH=CH—; or R7 and R8 together form —OCH2O-; R11 and R12 are each independently hydrogen or lower alkyl; and W is oxygen or sulfur. S 2. The method of Claim 1 wherein R1 and R are methyl. 4 ii The method of Claim 2 wherein R2, R3, R , R and R12 are hydrogen. 4. The method of Claim 3 wherein W is oxygen. :73. 8 The method of Claim 4 wherein R6 is methoxy and R , R , R9 and R10 are hydrogen, i e., ranolazine. 6. The method of Claim 1, comprising a method for protecting the myocardium against global ischaemic damage induced by cardioplegia, preferably wherein said method comprises systemically administering said compound to a subject undergoing cardiac surgery, or adding to the extra—corporeal circulation of such subject, an effective amount of said compound. 7. The method of Claim 1 comprising a method for protecting skeletal muscle against damage resulting from trauma or subsequent to muscle or systemic diseases. 8. The method of Claim l comprising a method for treating shock conditions, including cardiogenic shock. 9. The method of Claim 1 comprising a method for protecting neuronal tissue against ischaemia resulting from cardiac function impairment or from non-cardiac conditions, including protecting brain tissue against ischaemia—induced metabolic disorders. 10. The method of Claim 1 comprising a method for preserving donor tissues used in transplants, by administration to the donor, the recipient and/or by adding to the eg;yiyo perfusion fluid an effective amount of said compound, preferrably wherein the donor tissues are used in renal transplants, skin grafts, cardiac transplants. lung transplants, corneal transplants, or liver transplants. 11. The method of Claim 1 comprising a method of protecting myocardial tissue against ischaemic damage in subjects with myocardial infarction. 12. The method of any one of Claims 6-11 wherein said compound is ranolazine, or a pharmaceutically acceptable salt thereof. 13. The method of Claim 1 comprising coadministration of said compound together with a second pharmaceutically active agent. 14. agent is TPA or streptokinase. The method of Claim 13 wherein said second 15. A pharmaceutical composition containing a therapeutically effective amount, up to 5 mg/ml for liquid and semi-solid formulations, of a compound of the formula: or a pharmaceutically acceptable esters or acid addition salts thereof, wherein: R1, R2, R3, R4 and R5 are each independently hydrogen, lower alkyl, lower alkoxy. cyano. trif1“°r°methY1» halo. lower alkylthio. lower alkyl lOWer alkyl sulfonyl, N—optionally substituted alkylamido. except that when R1 sulfinyl, is methyl, R4 is not methyl; or 2 3 R6 an; R gtoggther form —OCH2O—; R 1 R , R . R and R10 are each independently hydrogen. lower acyl, aminocarbonylmethyl, CYaD0- 10W€f alkyl. lower alkoxy, trifluoromethyl, halo, lower alkylthio. lower alkyl sulfinyl, lower alkyl sulfonyl, di—lower alkyl amino; R; and R7 together form —CH~CH—CH=CH—; or R and R together form —C 420-; ll 12 . R are each independently hydrogen or lower alkyl; and W is oxygen or sulfur, admixed with at least one pharmaceutically acceptable excipient. 16. The pharmaceutical composition of Claim 25 wherein said compound is ranolazine. 17. A pharmaceutical composition substantially as hereinbefore described by way of Example. l8. A compound of the formula stated in any of claims l to 5, for use in the treatment of tissues experiencing a physical or chemical insult. l9. A compound as claimed in claim l8 for use in the treatment of the conditions specified in any of claims 6 to ll. 20. Use of a compound of the formula stated in any of claims 7 to 5 {OF “S9 in the DV€PaVatl0n Of a Dharmaceutical composition for treatment of tissues experiencing a physical or chemical insult. Dated this Zlst day of June, l990. TOMKINS & CO.,
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
USUNITEDSTATESOFAMERICA23/06/19893 |
Publications (2)
Publication Number | Publication Date |
---|---|
IE19970487A1 true IE19970487A1 (en) | 1990-12-23 |
IE83554B1 IE83554B1 (en) | 2004-08-11 |
Family
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