MXPA00011510A - Pharmaceutical composition containinig gaba analogs and an antiviral agent to treat shingles - Google Patents

Abstract

The present invention is a method of using certain analogs of glutamic acid and gamma-aminobutyric acid in combination with an anti-viral agent to treat shingles.

Description

PHARMACEUTICAL COMPOSITION CONTAINING ANALOGS GABA AND AN ANTIVIRAL AGENT TO TREAT THE ZOSTER BACKGROUND OF THE INVENTION FIELD OF THE INVENTION The present invention relates to the use of glutamic acid analogs and gamma-aminobutyric acid (GABA) in combination with an antiviral agent for the treatment of zoster.

PRIOR ART The GABA analogs used in the present invention are known agents useful in anticonvulsant therapy for diseases of the central nervous system such as epilepsy, Huntington's chorea, cerebral ischemia, Parkinson's disease, tardive dyskinesia and spasiness. . It has also been suggested that the compounds can be used as antidepressants, anxiolytics and antipsychotics. See WO 92/09560 (Serial No. 618,692 filed November 27, 1990) and WP 93/23383 (Serial number of the United States 886,080 filed May 20, 1992).

The publication WO 97/33858 teaches that the compounds related to gabapentin are useful or treat epilepsy, mental lacunae, hypokinesia, cranial diseases, neurodegenerative diseases, depression, anxiety, panic, pain and diseases. neuropathological The publication WO 97/33858 does not specify what forms of pain are treated.

Additionally, the GABA analog compounds of the present invention are known for the treatment of neuropathic pain. For example, see Rosner H; Rubin L; Kestenbaum A., Gapapentin adjunctive therapy in neurophatic pain states. Clin J Pain, 1996 Mar, 12: 1, 56-8; Segal AZ; Rordorf G., Gabapentin as a novel treatment for postherpetic neuralgia. Neurology, 1996 Abri, 46: 4, 1175-6; Wetzel CH; Connelly JF., Use of gabapentin in pain management. Ann Pharmacother, 1997 Sep, 31: 9, 1082-3; Zapp JJ., Postpoliomyelitis pain treated with gabapentin [letter]. Am Fam Physician, 1996 Jun, 53.8, 2442, 2445; Cheville A, et al., Neuropathic pain in radiation myelopathy: a case report. Program book, American Pain Society (14th Annual Scientific Meeting). Abstract # 95823, p. A-115; Sist T; Filadora V; Miner M; Lemma M., Gapapentin for idiopathic trigeminal neuralgia: report of two cases. Neurology, 1997 May, 48: 5, 1467; Waldman SD, Tutorial 28: Evaluation and Treatment of Trigeminal Neuralgia. Pain Digest (1997) 7: 21-24; Mellick LB; Mellick GA., Successful treatment of reflex sympathetic dystrophy with gabapentin [letter]. Am J Emerg Med, 1995 Jan, 13: 1, 96; Mellick GA; Seng MI., The use of gabapentin in the treatment of sympathetic reflex dystrophy and a phofíc disorder. Am J Pain Manage 1995; 5: 7-9; Mellick GA; Mellicy LB; Mellick LB., Gabapentin in the management of reflex sympathetic dystrophy [letter]. J. Symptom Manage, 1995 May, 10: 4, 265-6; Mellick GA; Mellick LB., Reflex sympathetic dystrophy treated with gabapentin. Arch Phys Med Rehabil, 1997 Jan, 78: 1, 98-105 and Mackin GA., Medical and pharmacologic management of upper limb neuropathic pain syndromes. J Hand Ther, 1997 Abri-Jun, 10: 2, 96-109.

The Patent of E.U.A. No. 5, 589,180 discloses a plasticizer composition for the treatment of pain caused by herpes zoster or post herpetic neuralgia comprising an adhesive containing 2-10% by weight of lidocaine, at least one of propylene glycol and clicerin as a solvent and a coating.

Antiviral compounds are known to treat herpes. These compounds include acyclovir, famciclovir, valacilovir, peniclovir and mixtures thereof. These antiviral compounds interfere with the enzyme thymidine kinase that is needed for the replication of the herpes virus.

SUMMARY OF THE INVENTION This invention provides a method for the treatment of zoster comprising the administration to a subject suffering from zoster an effective amount of a GABA analog and an antiviral agent. A preferred embodiment uses a cyclic amino acid compound of Formula I wherein Ri is hydrogen or lower alkyl and n is an integer from 4 to 6 and pharmaceutically acceptable salts thereof. An especially preferred embodiment uses a compound of Formula I wherein Ri is hydrogen and n is 4, which compound is 1- (aminomethyl) -cyclohexane acetic acid, known generically as gabapentin.

In another embodiment, the invention includes the treatment of zoster with a compound of Formula II and an antiviral agent. Formula II H2NCH- CH2COOH R * p wherein R2 is a long or branched chain alkyl of 1 to 6 carbon atoms, phenyl or cycloalkyl having from 3 to 6 carbon atoms; R3 is hydrogen or methyl and R4 is hydrogen, methyl or carboxyl or an individual enantiomeric isomer or a pharmaceutically acceptable salt thereof, in unit dosage form, to a mammal in need of such treatment.

Preferred compounds of the invention are those wherein F and R3 are hydrogen and R2 is - (CH2) 0-2-i C4H9 as an (R), (S) or (R, S) isomer.

The most preferred compounds of the Formula II of the invention are (S) -3- (aminomethyl) -5-methylhexanoic acid and 3-aminomethyl-5-methyl-hexanoic acid, known generically as pregabalin.

DETAILED DESCRIPTION OF THE PREFERRED MODALITIES The method of this invention uses any GABA analog. A GABA analog is any compound derived from or based on gamma-aminobutyric acid. The compounds are readily available either commercially or by synthetic methodology well known to those skilled in the art of organic chemistry. The preferred GABA analogs to be used in the method of this invention are cyclic amino acids of Formula I. These are described in the U.S. Pat. No. 4,024,175, which is incorporated herein by reference. Another preferred method uses the GABA analogs of Formula II and these are described in the U.S. Patent. 5,563,175 which is incorporated herein by reference.

All that is required to practice the method of this invention is to administer a GABA analogue in an amount that is effective to treat the zoster. Said amounts will generally be from about 1 to about 300 mg per kg of the subject's coforal weight. Typical doses will be from about 10 to about 5000 mg per day for an adult of normal weight. It is expected that the common doses that should be administered could be from 100 mg three times a day up to 600 mg four times a day. Commercially available capsules of 100 mg, 300 mg and 400 mg of gabapentin can be administered. Alternative forms include liquids and tablets with an enteric layer.

If a compound of Formula II, such as pregabalin is used, the dose level is one sixth of gabapentin. The dose range for gabapentin is from about 0.15 mg to about 50 mg per kg per day of the subject's body weight. Typical doses for gabapentin will be from about 1.6 mg to about 840 mg per day with single doses ranging from about 0.15 mg to about 65 mg per dose.

The compounds of the present invention can form pharmaceutically acceptable salts with both inorganic and organic acids or bases. For example, the acid addition salts of the basic compounds are prepared by dissolving the free base in aqueous alcohol solution or aqueous solution or other suitable solvents containing the appropriate acid and isolating the salt by evaporating the solution . Examples of pharmaceutically acceptable salts are hydrochlorides, hydrobromides, hydrosulphates, etc., as well as sodium, potassium and magnesium salts, etc.

The compounds of Formula II may contain one or more asymmetric carbon atoms. The invention includes the individual enantiomers or diastomers and mixtures thereof. Enantiomers or diastomers can be prepared or isolated by methods well known in the art.

The pharmaceutical compositions of the compound of the present invention or its salts are produced by the formulation of active compound in unit dosage form with a pharmaceutical carrier. Some examples of unit dosage forms are tablets, capsules, pills, powders, aqueous and non-aqueous oral solutions and suspensions and parenteral solutions packaged in containers containing one or more number of dose units and which are capable of being subdivided into individual doses. . Some examples of pharmaceutically suitable carriers, including pharmaceutical diluents are gelatin capsules; sugars such as lactose and sucrose; starches such as corn starch and potato starch, cellulose derivatives such as carboxymethyl cellulose, ethyl cellulose, methyl cellulose and cellulose acetate phthalate; gelatin, talcum, stearic acid, magnesium stearate, vegetable oils such as peanut oil, cottonseed oil, sesame oil, olive oil, corn oil and theobroma oil; propylene glycol, glycerin, sorbitol, polyethylene glycol, water, agar gum, alginic acid, isotonic saline and phosphate stabilizer solutions, as well as other compatible substances normally used in pharmaceutical formulations. The compositions of the invention may also contain other components such as coloring agents, flavoring agents and / or preservatives. These materials, if present, are commonly used in relatively small quantities. The compositions may, if desired, also contain other therapeutic agents.

The percentage of the active ingredient in the preceding compositions can be varied within wide limits, but for practical purposes it is preferably present in a concentration of at least 10% in a solid composition and at least 2% in a primary liquid composition. The most satisfactory compositions are those in which a much higher proportion of the active compound is present.

The routes of administration of the subject compound or its salts are oral or parenteral. For example, a useful intravenous dose is between 5 and 50 mg and a useful oral dose is between 20 and 800 mg. The dose is within the range of doses used in the treatment of pain or according to the needs of the patient as described by the doctor.

A unit dose form of the GABA analogue to be used in this invention may also comprise other compounds useful in the treatment of pain.

The advantages of the use of compounds of Formula I and II, especially gabapentin and pregabalin, in the present invention include the relatively non-toxic nature of the compounds, easy preparation, the fact that the compounds are well tolerated and the ease of IV administration of drugs. Gabapentin has few interactions with the important classes of drugs that are not metabolized in the liver but are excreted unchanged. In addition, drugs are not metabolized in the body. The subjects treated with the method of the present invention are mammals including humans.

The antiviral compositions used in the present invention reduce viral load, thereby reducing the number of days of the condition. GABA analogues have no direct impact on viral load. GABA analogs work to decrease the signs of pain that are transmitted from the peripheral nerves to the brain. The combination of actions improves the control and relief of pain during zoster infection.

Claims (20)

1. A method for the treatment of paranasal sinus pain or pain, comprising administering a pharmaceutically composition comprising: (a) an analgesically effective amount of a GABA analog and (b) an effective amount of an antiviral agent .

2. The method according to claim 1, wherein the GABA analog is the compound according to Formula I: wherein Ri is hydrogen or lower alkyl and n is an integer from 4 to 6 and pharmaceutically acceptable salts thereof.

3. The method according to claim 2, wherein Formula I comprises gabapentin.

4. The method according to claim 1, wherein the antiviral agent is selected from the group consisting of acyclovir, famciclovir, valacilovir, peniclovir and mixtures thereof.

5. The method according to claim 2, comprising from about 10 mg to about 400 mg of Formula I.

6. The method according to claim 3, comprising from about 10 mg to about 400 mg of gabapentin.

7. The method according to claim 3, comprising from about 10 mg to about 400 mg of gabapentin and from about 60 mg to about 200 mg of the antiviral agent.

8. The method according to claim 1, wherein the GABA analog is a compound according to Formula II: lili wherein R2 is a long or branched chain alkyl of 1 to 6 carbon atoms, phenyl or cycloalkyl having from 3 to 6 carbon atoms; R3 is hydrogen or methyl and R is hydrogen, methyl or carboxyl.

9. The method according to claim 8, wherein Formula II comprises pregabalin.

10. The method according to claim 8, comprising from about 0.15 mg to about 65 mg of Formula II.

11. The method according to claim 9, comprising from about 0.15 mg to about 65 mg of pregabalin.

12. A composition for eliciting an improved analgesic response in a mammal comprising: (a) an analgesically effective amount of a GABA analog and (b) an effective amount of an antiviral agent.

13. The composition according to claim 12, wherein the GABA analog compound according to Formula I: wherein R ^ is hydrogen or lower alkyl and n is an integer from 4 to 6 and pharmaceutically acceptable salts thereof.

14. The composition of the method according to claim 13, wherein Formula I comprises gabapentin.

15. The composition according to claim 13, comprising from about 10 mg to about 400 mg of Formula I.

16. The composition according to claim 14, comprising from about 10 mg to about 400 mg of gabapentin.

17. The composition according to claim 12, wherein the GABA analog is a compound according to Formula II: R- II wherein R2 is a long or branched chain alkyl of 1 to 6 carbon atoms, phenyl or cycloalkyl having from 3 to 6 carbon atoms; R3 is hydrogen or methyl and Ri is hydrogen, methyl or carboxyl.

18. The composition according to claim 17, wherein Formula II comprises pregabalin.

19. The composition according to claim 17, comprising from about 0.15 mg to about 65 mg of Formula II.

20. The composition according to claim 19, comprising from about 0.15 mg to about 65 mg of pregabalin.