JP5766699B2 - ボツリヌス神経毒素により早漏を処置する方法 - Google Patents
ボツリヌス神経毒素により早漏を処置する方法 Download PDFInfo
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- JP5766699B2 JP5766699B2 JP2012526812A JP2012526812A JP5766699B2 JP 5766699 B2 JP5766699 B2 JP 5766699B2 JP 2012526812 A JP2012526812 A JP 2012526812A JP 2012526812 A JP2012526812 A JP 2012526812A JP 5766699 B2 JP5766699 B2 JP 5766699B2
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Description
本出願は、2009年8月26日出願の米国特許出願第12/548,073号の利益を主張し、その開示全体は、この具体的参照により、本明細書に組み込まれる。
(1)頸部ジストニアを治療するための筋肉内注射(複数の筋肉)当たり約75〜125単位のBOTOX(登録商標)
(2)眉間のしわ(額のしわ)を治療するための筋肉内注射当たり5〜10単位のBOTOX(登録商標)(5単位は鼻根筋に筋肉内注射され、10単位は各皺眉筋に筋肉内注射される)
(3)恥骨直腸筋の括約筋内注射によって便秘を治療するための約30〜80単位のBOTOX(登録商標)
(4)上瞼の外側瞼板前部眼輪筋および下瞼の外側瞼板前部眼輪筋に注射することにより眼瞼痙攣を治療するための、筋肉当たり約1〜5単位の筋肉内注射用BOTOX(登録商標)
(5)斜視を治療するために、外眼筋に約1〜5単位のBOTOX(登録商標)が筋肉内注射されてきた:注射される量は、注射される筋肉の大きさおよび所望の筋肉麻痺の程度(すなわち所望のジオプター矯正量)の両方に基づいて変化する。
(6)以下のような5つの異なる上肢屈筋にBOTOX(登録商標)を筋肉内注射することにより、脳卒中後の上肢痙性を治療する:
(a)深指屈筋:7.5U〜30U
(b)浅指屈筋:7.5U〜30U
(c)尺側手根屈筋:10U〜40U
(d)橈側手根屈筋:15U〜60U
(e)上腕二頭筋:50U〜200U。
各治療セッションで、筋肉内注射により90U〜360Uの上肢屈筋BOTOX(登録商標)が患者に投与されるように、記載した5つの筋肉の各々は同じ治療セッションで注射されてきた。
(7)偏頭痛を治療するために頭蓋周囲に注射される(眉間、前頭および側頭筋に対称的に注射される)25UのBOTOX(登録商標)注射は、25Uの注射後3ヶ月にわたる偏頭痛の頻度、最大重症度、付随する嘔吐および急性薬剤使用の減少によって評価されるように、ビヒクルと比較して偏頭痛の予防的治療として有意な利点を示してきた。
定義
早漏の治療
彼のパートナーの挿入後約2分以内にクライマックスに達すると訴える24歳の男性が受診する(この患者の場合、彼のクライマックスベースライン時間は2分である)。これは、この患者および彼のパートナーにとって大きな驚愕の対象である。医師は、イソプロピルアルコールで注射領域を洗浄し、30ゲージ針を使用して、患者の陰茎に約50単位のA型ボツリヌス毒素(BOTOX(登録商標))を投与することにより患者を治療する。注射は陰茎亀頭および尿道口から約1cmになされ、48時間は性交を行わないよう患者に指示する。経過観察のための来院で、患者は、注射部位に若干の疼痛を経験したものの、それは注射から24時間以内に消失し、それを除けば、勃起不全または感受性の損失はないことを報告する。患者は、彼のクライマックスベースライン時間が2倍に(約2分から約4分に)なり、しばしば4分よりも長く(彼のクライマックスベースライン時間の2倍より長い)性交を楽しむことさえできることを報告する。これらの結果、すなわち、この患者が性交の開始後に射精する時期の延期は、ボツリヌス神経毒素の初回投与後約4ヶ月間観察され、その後、この患者は、同じ位置に同量のボツリヌス毒素を再度注射するために再来院する。
早漏の治療
毎回性交に従事する度に、彼のパートナーの挿入後約10秒以内に患者がクライマックスに達するため(彼のクライマックスベースライン時間は約10秒である)、患者および彼のパートナーの両者がこの状況を非常に煩わしく感じていると訴える32歳の男性が受診する。それに応じて、また患者の詳細な性交歴を聴取した後、医師は、この患者が早漏に罹患していると判定し、該患者にボツリヌス神経毒素を投与することを決定する。したがって、医師は、患者の陰茎小帯から亀頭の前領域にかけてイソプロピルアルコールで洗浄し、次いで、リドカイン麻酔クリームを局所的に塗布してその領域を麻酔し、その後、25ゲージ針を使用して25単位のボツリヌス神経毒素(BOTOX(登録商標))を注射する。処置後、向こう48時間は性交を行わないよう患者に指示する。浮腫および/または炎症が見られた場合の、その領域への適切な氷嚢の適用を推奨する(1回に約15分以上適用しないこと)。
原発性早漏の治療
何十年間も苦しんだ末、42歳の男性が受診し、一旦性的に覚醒すると、性交を開始さえしないうちに早期に射精するため、早漏に罹患していることが彼の性交を行う能力を妨げていると報告する。彼は性的成熟に達して以来この調子であることを医師に伝える。医師は、フルオキセチン20mg(毎日服用)を処方して、これが患者の原発性早漏を緩和するのに役立つかどうか調べることを決定する。フルオキセチン服用から2ヶ月後、患者は性交開始前の早漏に変化がないことを報告する。毎日のフルオキセチンに加えて局所療法を処方し、具体的には、性交の約10分前に5%リドカインクリームを局所的に塗布するよう患者に指示する。3週間後、患者はなおも状態に変化がないことを報告する。
続発性早漏の治療
早漏に罹患すると訴える52歳男性が受診する。患者は、以前はこの状態を患っていなかったが、最も新しいパートナーと性的関係を持って以来、早漏エピソードを回避することができないことを医師に伝える。医師は、患者の小帯に2500単位のB型ボツリヌス毒素(MYOBLOC(登録商標))を投与することによりこの患者を治療することを決定する。注射後、向こう48時間は性交を行わないよう患者に指示する。2.5週間後に患者が再来院し、今度は早期に射精することなく彼のパートナーに挿入し、最長約15分間性交を行うことができると報告し、これらの良好な結果は約4ヶ月観察され、その後、患者はさらなるボツリヌス毒素の投与のために再来院する。今度は、医師は、B型ボツリヌス毒素の経皮用製剤を用いて患者の小帯にボツリヌス毒素を投与する。患者は、射精が発生するまで最低でも約9分耐えることができるという良好な結果が報告される。
1.早漏の効果的な軽減:典型的には、ボツリヌス神経毒素の投与後約48〜約72時間で典型的には最初に認められる、比較的迅速な効果の発現を用いることによって、患者のクライマックスベースライン時間を少なくとも2倍にすることを含む。
2.長期的な早漏の軽減を達成することができ、ボツリヌス神経毒素の投与後約3ヶ月〜約6ヶ月の効果持続期間が観察される。
3.開示される発明の実施による副作用は全くないか、またはごくわずかであり、本方法は局所型であり、これまで早漏の治療において用いられてきた医薬品の摂取および全身性循環を必要としない。
4.以前に用いられていた早漏を治療するための方法とは異なり、本明細書に開示される方法による神経毒の使用は、勃起不全または感受性の損失をもたらさない。
Claims (8)
- 早漏を治療するための医薬組成物であって、A型およびB型ボツリヌス神経毒素からなる群から選択されるボツリヌス神経毒素を有効成分として含み、前記治療を必要とする患者の陰茎に、注射により局所投与される、医薬組成物。
- 注射により、筋肉内、皮下、真皮下または皮内投与される、請求項1に記載の医薬組成物。
- 前記ボツリヌス神経毒素が、1単位〜20,000単位の量で投与される、請求項1または2に記載の医薬組成物。
- 前記ボツリヌス神経毒素が、A型ボツリヌス神経毒素である、請求項1〜3のいずれかに記載の医薬組成物。
- 前記ボツリヌス神経毒素が、A型ボツリヌス神経毒素であり、1単位〜2,500単位の量で投与されるか、またはB型ボツリヌス神経毒素であり、100〜10,000単位の量で投与される、請求項1〜3のいずれかに記載の医薬組成物。
- 前記ボツリヌス神経毒素が、B型ボツリヌス神経毒素であり、1単位〜10,000単位の量で投与される、請求項1〜3のいずれかに記載の医薬組成物。
- 少なくとも2つの陰茎の位置に注射される、請求項1〜6のいずれかに記載の医薬組成物。
- 前記陰茎の小帯に投与される、請求項1〜7のいずれかに記載の医薬組成物。
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PCT/US2010/044959 WO2011028371A1 (en) | 2009-08-26 | 2010-08-10 | Methods of treating chronic neurogenic inflammation using a modified clostridial toxin |
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EP2649983A1 (en) | 2012-04-13 | 2013-10-16 | Lipotec, S.A. | Compounds which inhibit neuronal exocytosis (II) |
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JP6643324B2 (ja) * | 2014-09-02 | 2020-02-12 | アメリカン シルヴァー リミテッド ライアビリティ カンパニー | ボツリヌス毒素及びコロイド状銀粒子 |
RU2565104C1 (ru) * | 2014-10-24 | 2015-10-20 | Государственное бюджетное образовательное учреждение высшего профессионального образования Первый Московский государственный медицинский университет им. И.М. Сеченова Министерства здравоохранения Российской Федерации (ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России) | Способ лечения преждевременной эякуляции |
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