MXPA98002735A - Compositions of melatonine and analgesic agents and methods of use of the mis - Google Patents

Abstract

Compositions comprising melatonin and one or more analgesic agents are described, as well as methods for administering melatonin and one or more analgesic agents to relieve pain and induce sleep.

Description

COMPOSITIONS OF MELATONINE AND ANALGESIC AGENTS AND METHODS OF USE THEREOF BACKGROUND OF THE INVENTION Analgesic agents, particularly non-narcotic analgesic agents, are administered to people as a treatment for pain. The most commonly used analgesic agents include aspirin and aspirin-like compounds, often called nonsteroidal anti-inflammatory drugs (also referred to as NSAIDs). Although the effectiveness of these analgesic agents in relieving pain is well known, other physiological effects resulting from the administration of analgesics are frequent. For example, the treatment of pain with analgesic agents often results in the loss of sleep. Therefore, people who experience pain at night can find their sleep patterns seriously affected after taking an analgesic, although they no longer experience more pain. Often these people are subjected to hypnotic drugs, such as a benzodiazepine, or antihistamines, such as diphenhydramine hydrochloride, to fall asleep. Benzodiazepines have the disadvantage of being addictive, and in addition, people who take them often experience residual effects of amnesia for a while. While antihistamines can make a person feel numb, they also have the disadvantage of producing non-specific antihistamine effects in a person who does not have the need to have those effects. Therefore, it would be advantageous to have a composition that would provide pain relief and induce sleep without producing those undesirable side effects.

BRIEF DESCRIPTION OF THE INVENTION This invention relates to compositions comprising melatonin and one or more non-narcotic analgesic agents. These compositions provide the person with effective pain relief while reducing, partially or completely, the alteration of normal sleep patterns during the night. The present invention also relates to methods of alleviating pain, fever and inflammation while inducing sleep by administering a composition consisting of melatonin and one or more non-narcotic analgesic agents. Analgesic agents are administered for analgesic relief (suppress pain). The most commonly used non-narcotic analgesic agents include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetabulum and ibuprofen. However, aspirin and NSAIDs, in addition to their already known properties to relieve pain, are also known to alter sleep in mammals. Recent studies have indicated that the administration of a non-narcotic analgesic agent leads to the suppression of normal nighttime relaxation in the synthesis of melatonin, which has sleep-inducing properties that result in the alteration of normal sleep patterns. Murphy, P.J., and others. Phvsiol. & Behavior, 55 (6): 1063-1066 (1994). Therefore, people who take non-narcotic pain medications often experience great difficulty falling asleep. The present invention is based on the discovery, by the applicant, that the administration of an effective dose of a non-narcotic analgesic agent with an effective dose of exogenous melatonin reduces, partially or totally, the sleep disturbance that often accompanies the administration of analgesic agents. The administration of melatonin provides an effective means to induce sleep by restoring endogenous serum melatonin to levels sufficient to induce sleep in the person, even in the presence of the analgesic. Methods for administering compositions comprising melatonin and one or more analgesic agents, as described herein, include administration of the compositions up to four hours, preferably up to two hours, before a person wishes to sleep, or at four-hour intervals if the person wakes up and wishes to regain sleep. In a preferred embodiment of this invention, the compositions are administered orally (ingested) or transdermally. The compositions of the present invention are effective in alleviating or significantly reducing pain in a person who wishes to sleep and seek relief from pain without the consequent lack of sleep that is often associated with the therapeutic dose of the analgesic agents. In addition, the use of melatonin to induce sleep has several advantages unlike conventional hypnotic drugs, such as benzodiazepines. Melatonin is metabolized naturally hours after administration. Thus, sleep-inducing methods that use melatonin do not produce adverse residual effects the day after administration, such as conventional hypnotics. In addition, the compositions of the present invention also lack undesirable antihistamine effects that appear when an antihistamine is the agent used to produce drowsiness in a person.

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to compositions that alleviate pain and induce a person's sleep. The compositions of the present invention comprise an effective dose of melatonin and an effective dose of one, or more, analgesic agents. The effective doses of melatonin and the analgesic can be combined to be administered in a single composition (i.e., a single tablet) or can be administered as individual compositions. In addition, the present invention relates to methods for administering the compositions of the present invention for alleviating pain while partially or totally reducing sleep disturbance. A definition of sleep recognized by the technique is the incited state of unconsciousness. Sleep is also often defined as the resting state, which occurs periodically, characterized by relative physical and nervous inactivity, diminished responses, unconsciousness and typical brainwave patterns in electroencephalography. Melatonin (N-acetyl-5-methoxytryptamine) is a neurohormone secreted by the pineal gland in mammals, including humans. Dawson, D. and others, J. Pineal Res. 15: 112 (1993). It is believed to have hypnotic (sleep-inducing) and significant circadian effects. Normally melatonin is secreted at a circadian rhythm (or 24 hours) with plasma levels of approximately 10 pg / ml during the day, normally increasing around 10 times more during the night. Waldhauser, F. and Steger, H., PROCEEDINGS OF THE FIRST INTERNATIONAL CONGRESS ON MELATONIN IN HUMANS. pp. 179-191, Vienna, Austria, (Nov. 1985). The synthesis and secretion of melatonin begins when the dark begins by the action of norepinephrine in the & -adrenoreceptors (and to a lesser extent, the otarereceptors) of the pinealocitos. Studies indicate that prostaglandins facilitate this process. Surall,? _ O ros, J. Pham, Pharmacol. 39: 840-843 (1987); Murphy, P.J., and_ others, Phvsiol. & Behavior. 55 (6): 1063-1066 (1994). For example, indomethacin, which inhibits prostaglandin synthesis, greatly impairs the nocturnal rise in melatonin content and partially inhibits the release of melatonin. Surall, and others, J. Pharm. Pharmacol. 39: 840-843 (1987). Also, prostaglandin synthesis occurs in areas that are known to influence sleep and wakefulness, especially the preoptic area of the hypothalamus. Murphy, P.J., and others, Physiol. & Behavior. 55 (6): 1063-1066 (1994). Prostaglandins appear to act in physiological concentrations in pre- and post-synaptic events in the neuroeffector sympathetic pineal junction. Surall, and others, J. Pharm. Pharmacol. 39: 840-843 (1987). Exogenous melatonin increases the level of melatonin in blood plasma to cause hypnotic effects in people. Da are, D. and others. J. Pineal Res. 15: 1-12 (1993). Dollins, and others Proc. Nat. Acad. Sci. Non-narcotic analgesic agents, such as aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), are a heterogeneous group of compounds, which are usually not chemically related, which are administered to patients to reduce pain. Non-narcotic analgesic agents encompassing the present invention include, but are not limited to, salicylates, pyrazole derivatives, paraminophenol derivatives, indomethacin, sulindac, tolmetino, propionic acid derivatives, piroxicam, diclofenac, orphenadrine, nabu etona, ketorolac, acid mefanamic, meclofenamate, etodolac, naproxen, ibruprofen, ketoprofen, flurbiprofen, diflunisal and fenoprofen. Other suitable analgesic agents encompassed by this application can be found, for example, in standard pharmacology reference books such as PHYSICIAN'S DESK REFERENCE. 48a. Ed., Medical Economics Data Production Company, Montvale, N.J. (1994); THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 8a. ed. , eds. Gilman, A.G. and others. Pergamon Press, The sford, N.Y. (1990). Analgesic agents can inhibit the production of prostaglandins. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS. 8a. ed., eds. Gilman, A.G. and others. Pergamon Press, Elmsford, N.Y. (1990). Prostaglandins influence pain by sensitizing pain receptors to mechanical and chemical stimulation. Prostaglandins also influence fever, acting within the hypothalamus or to produce the elevation of body temperature. Finally, prostaglandins are associated with inflammation, possibly inducing vasodilation and increasing vascular permeability. Therefore, many analgesic agents show antipyretic and anti-inflammatory qualities. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS. 8a. ed. , eds. Gilman, A.G. and others. Pergamon Press, Elmsford, N.Y. (1990). Recent reports have shown that non-narcotic analgesic agents interrupt sleep in animals and humans. Murphy. P.J., and others. Physiol. & Behavior, 55 (6): 1063-1066 (1994); Horne, J.A., and others. Electroencephalography Clin. Neurophysiol. 49: 409-413 (1980). For example, carefully administered, low doses of ibuprofen and aspirin altered sleep patterns in healthy and young subjects, and increased the percentage of time they remained awake. Murphy, P.J., and others. Physiol. & Behavior. 55 (66): 1063-1066 (1994). This is particularly annoying for people who want to ingest an analgesic agent for the sole purpose of relieving minor pain in order to sleep. A likely reason for this effect of sleep disturbance is that the administration of an analgesic agent leads to the suppression of the normal nocturnal circulation of melatonin synthesis. For example, when a dose of aspirin or ibuprofen is administered at 23:00 hours (11 p.m.), the synthesis of melatonin is suppressed approximately 75k in 75 minutes. Murphy, P.J., and others. Physiol. & Behavior. 55 (6): 1063-1066 (1994). In addition, long-acting analgesic agents, such as indomethacin, show a longer duration of inhibition of plasma melatonin levels than those with less action, such as ibuprofen. Surall, and others. Pharm. Pharmacol. 39: 840-843 (1987). It is thought that this decrease in melatonin is due to the fact that analgesic agents inhibit the synthesis of prostaglandin, since prostaglandins play a role in the production of melatonin. Murphy, P: J :, and others. Physiol. & Behavior. 55 (6): 1063-1066 (1994).

The present invention is based on the applicant's discovery in which the administration of an effective dose of a non-narcotic analgesic agent and an effective dose of melatonin reduces, partially or totally, the sleep disturbance that often accompanies the administration of agents that relieve pain. Compositions consisting of melatonin and an analgesic, or individual compositions of melatonin and an analgesic agent, utilize the properties of melatonin that induce sleep and the analgesic properties of the analgesic agents to provide pain relief and to induce sleep in a person who experiences pain. Pharmaceutical grade melatonin, and melatonin derivatives, are commercially available. As defined herein, an effective dose of melatonin is a sufficient dose to induce sleep in a person in the presence of an analgesic agent. Specifically, an effective dose of melatonin will generally be less than about 100 mg of melatonin. Preferably, an effective dose will be a single dose of about 0.1 to 10 mg of melatonin, i.e., 1 or 5 mg. In a low dose embodiment of the present invention, the dose of melatonin used is less than about 1 mg, preferably in the range of 0.1 to 0.5 mg, preferably 0.1 to 0.3 mg. In other embodiments, it may be appropriate to use doses of between 10 and 100 mg, ie, 25, 50 or 75 mg.

Non-narcotic analgesic agents are also commercially available. Analgesic agents suitable for use in the present invention include, but are not limited to: aspirin, (acetylsalicylic acid), salicylates other than aspirin, paraminophenol derivatives (such as acetaminophen - ie, ANEXSIA, BUFFERIN * iR, EXCEDRIN «, LORTABfR, MIDRINMR, AND TYLEN0LMR), propionic acid derivatives (such as ANAPROX» *, ADVIL ™, IBUMR, LODINE, MECLOMEN ™, MOTRIN ™, NALFON ™, NAPROSYN ™, NUPRIN, PONSTEL ™, RELAFEN1 and TORADOL ™), pyrazolone derivatives, paraminophenol derivatives, indomethacin, sulindac, tolmetin, propionic acid derivatives, piroxicam, diclofenac, orphenadrine , nabumetone, ketorolac, mefanamic acid, meclofenamate, etodolac, naproxen, ibuprofen, ketoprofen, flurbiprofen, diflunisal and fenoprofen. (e.g., ofenadrine citrate). See PHISICIAN'S DESK REFERENCE, 48a. Ed., Medical Economics Data Production Company, Montvale, N.J. (1994); THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 8a. ed., eds. Gilman, a.G. and others. Pergamon Press, Elmsford, N.Y. (1990). The chemical formulas corresponding to the analgesic agents described above can be found in USAN AND THE USP DICTIONARY OF DRUG AMES. eds. Griffiths, M.C. and others. United States Phar acopeial Convention, Inc., Rockville, Md. (1988); THE MERCK INDEX: AN ENCYCLOPEDIA OF CHEMICALS. DRUG ÑAMES. AND BIOLOGICALS. lia Ed., Eds. Budavari, S. and others. Merck & Co., Inc., Rahway, N.J. (1989), and THE PHARMACOLOGICAL BASIS OF THERAPEUTICS. 8th ed. , eds. Gilman, A.G. and others. Pergamon press, Elmsford, N.Y. (1990). As used herein, an effective dose of an analgesic agent is a sufficient dose to alleviate pain, that is, to completely relieve the pain sensation or to partially or totally reduce the pain sensation that affects the person. Effective doses of the analgesic agents are known to those skilled in the art, or can be readily ascertained, for example, in the Physician's Desk Reference. PHISICIAN'S DESK REFERENCE, 48a. Ed., Medical Economics Data Production Company, Montvale, N.J. (1994). For example, as used in the example, an effective dose of aspirin is 650 mg. A single analgesic agent or a combination of analgesic agents can be used in the compositions of the present invention. It will be appreciated that the actual preferred amounts of the active compound in a specific case will vary according to the specific compound being used, the particular compositions formulated and the mode of administration. The dosages for a given person will be determined on an individual basis and will be based at least in part on the consideration of the characteristics of the person receiving them, such as size, weight, age as well as the type and severity of the pain that is going to rat. The compositions of the present invention may optionally include, in addition to melatonin (or melatonin derivatives) and analgesic agent (s), other components. The components included in a particular composition are determined primarily by the manner in which the composition is administered. For example, a composition to be administered orally in the form of a tablet may include, in addition to melatonin and one or more analgesic agents, a filler (ie, lactose), a binder (i.e., carboxymethylcellulose, gelatin), an agent flavoring, an adjuvant, a coloring agent, and a coating material (ie, wax or plasticizer). The compositions of the present invention can be used in combination with conventional excipients, i.e., pharmaceutically acceptable organic or inorganic carrier substances, suitable for the route of administration, which do not react in a detrimental manner with the active derivatives. Suitable pharmaceutically acceptable carriers include, but are not limited to water, saline solutions, alcohols, gum arabic, vegetable oils, benzyl alcohols, polyethylene glycols, gelatin, carbohydrates such as lactose, amylose or starch, magnesium stearate, talc, silicic acid , viscous paraffin, perfume oil, lipid acid esters, hydroxy ethyl cellulose and polyvinyl pyrrolidine. For parenteral application, injectables, sterile solutions, preferably oily or aqueous solutions, as well as suspensions, emulsions, or implants, including suppositories, are particularly suitable. The present invention also includes methods for alleviating pain while reducing, in whole or in part, sleep disturbance (ie, inducing sleep). These methods, as described herein, consist of administering a composition of this invention up to 4 hours before a person wishes to sleep. As described herein, compositions of the present invention include individual compositions consisting of an effective dose of melatonin or an effective dose of an analgesic agent, or a composition consisting of an effective dose of more than one analgesic agent. Compositions of this invention also include compositions that combine an effective dose of melatonin and an effective dose of one, or more, analgesic agents. In a preferred embodiment, the compositions will be administered to the person in a short period of time before the time when the person wishes to fall asleep. For example, in the example, the melatonin compositions and a composition of an analgesic agent were substantially simultaneously administered approximately 15 minutes before the time when sleep was desired. The administration of the composition can be at four-hour intervals during the period in which the person wanted to sleep. For exampleIf the person wakes up during the night and wishes to go back to sleep, the person can take (that is, self-administered or administered by another person) an additional dose of a composition. Subsequently, the doses of the composition can be administered, if necessary, at four-hour intervals. To produce the desired effect of pain relief and sleep induction, the effective doses of melatonin and analgesic agent (s) can be administered simultaneously or substantially in a substantial manner, ie, up to 6 to 8 hours a of the other. This is because at the effective dosing scale of melatonin, for example, 0.1 mg. at 10.0 g., elevated plasma melatonin levels can last up to eight hours. In addition, some analgesic agents have average lifetimes high enough for that type of administration to be effective. In a preferred embodiment of this invention, the method of administration is oral administration (ingestion) or transdermal administration. However, the compositions can be administered in various ways known to those skilled in the art, including, but not limited to: nasal administration, intraocular administration, suppository administration, or injection. The way in which the composition can be administered (for example, tablet, capsule, bolus, powder, nasal spray, eye drops or gel) will depend on the route by which it is administered. The compositions of this invention can also be administered through the use of extended release capsules, a percutaneous patch or a microscopic pump. The compositions of this invention can be administered each time a person experiences pain, for example, after surgery, injury, flu or other disease that causes muscle or joint pain, strenuous physical work or exercise, or when there is tension or headaches. for migraine or menstrual cramps. Thus, as a result of the discovery made by the applicant, the melatonin compositions and one or more analgesic agents, and the methods of their use are now available for the treatment of pain and for the induction of sleep. The use of melatonin which produces sufficient levels of endogenous melatonin in the blood to induce sleep has several advantages over conventional hypnotic chemicals, such as benzodiazepines. Benzodiazepines are generally the drugs that are chosen for the treatment of insomnia. However, they alter the composition of the sleep architecture in electroencephalogram (EEG) and the endogenous circadian rhythm. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS. 8a. ed. , eds. Gilman, A.G. and others. Perga on Press, Elmsford, N.Y. (1990). In normal people, the dream consists of a series of stages that have a precise temporal organization. Benzodiazepines can alter the composition and durations of these stages, and the chronic use of these drugs can cause dangerous cumulative effects, causing nightmares, anxiety , irritability and tachycardia. The use of benzodiazepines in combination with analgesics can be especially problematic, since some analgesics, such as aspirin, have also been shown to have a significant effect that disrupts sleep architecture. Home, J.A., and others. Electroencephalography Clin.

Neurophysiol. 49: 409-413 (1980). Melatonin does not affect the sleep architecture as determined by the EEG in normal and healthy patients. Da are, D. and others. J. Pineal Res. 15: 1-12 (1993). Furthermore, inducing sleep using melatonin does not produce adverse residual effects the day after administration, as conventional drugs do to induce sleep. Melatonin is metabolized naturally hours after administration. Thus, although the sleep inducing effect of low doses of melatonin acts rapidly, its duration is not prolonged (i.e., blood melatonin levels do not remain at night levels that exceed the normal period of desired sleep). Therefore, blood melatonin levels fall to normal levels during the day after approximately seven hours and a person will wake up, for example, the next day with blood levels of melatonin at normal day levels, without feelings of drowsiness . It is also unlikely that the use of melatonin has the dangers of drug abuse and / or overdoses, which occur with conventional chemical hypnotics. In addition, since melatonin is an endogenous substance that is naturally generated, the doses of melatonin described here will reasonably be lacking in the potential effects that induce amnesia of the benzodiazepines. THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 8a. ed. , eds. Gilman, a.G. and others, Pergamon Press, Elmsford, N.Y. (1990). Finally, in fact it has been shown that benzodiazepines suppress the endogenous production of melatonin. Dawson and others, J. Pineal Res. 15: 1-12 (1993). The present invention is illustrated by the following example, which is not intended to be limiting in any way.

EXAMPLE Selection of patient and protocol. A healthy male subject participated in the study.

I was experiencing a mild chronic muscle pain caused by physical exertion. The first night of the experiment, he administered orally only melatonin (0.3 mg) at 22:00 hours. On the second night of the experiment, he administered orally only aspirin (650 mg) at 7:00 p.m. and again at 10:00 p.m. On the third night of the experiment, he administered orally to himself a combination of melatonin (0.3 mg) and aspirin (650 mg) at 22:00 hours. He recorded his subjective impressions concerning the relative ease with which he began to be sleepy after the administration of each substance. The induction of sleep was measured by asking the subject to look at a clock every few minutes and record the time, until he fell asleep. Principles of sleep appeared approximately fifteen or twenty minutes after the administration of melatonin alone or aspirin alone. However, there were sleep principles approximately three minutes after the administration of the combination of melatonin and aspirin. Then, it was found that melatonin alone could not induce sleep due to the continuous perception of pain. Aspirin pain relief, but could not induce sleep either.

However, the combination of melatonin and aspirin used was highly effective in inducing sleep.

Equivalents Those skilled in the art will know, or may investigate using only routine experimentation, many equivalents of the specific embodiments of the invention described herein. These and all other equivalents will be within the scope of this invention.

Claims (15)

NOVELTY OF THE INVENTION CLAIMS

1. A composition for inducing sleep in a person who wishes to sleep and experience pain, comprising an effective non-analgesic dose of melatonin of 0.1 and 10.0 mg and an effective dose of one or more non-narcotic analgesic agents.

2. The composition of claim 1, further characterized in that the dose of melatonin is between 0.1 to 0.3 mg.

3. The composition of claim 1, further characterized in that the dose of melatonin is 0.3 mg.

4. The composition of claim 1, further characterized in that one or more analgesic agents is selected from a group consisting of salicylates, pyrazolone derivatives, paraminophenol derivatives, indomethacin, sulindac, tolmetin, propionic acid derivatives, piroxicam, diclofenac , orphenadrine, nabumetone, ketorolac, mefanamic acid, meclofenamate, etodolac, naproxen, ibuprofen, ketoprofen, flurbiprofen, diflunisal and fenoprofen.

5. A composition that relieves pain and induces sleep when administered to a person, comprising 0.3 mg of melatonin and 650 mg of aspirin.

6. - A method to alleviate pain and induce sleep, which consists of administering to a person who wishes to sleep and experience pain, an effective non-analgesic melatonin dose of 0.1 to 10.0 mg and an effective dose of one or more analgesic agents.

7. The method of claim 6, further characterized in that one or more analgesic agents are selected from the group consisting of salicylates, pyrazolone derivatives, derivatives of inofenol, indomethacin, sulindac, tolmetin, propionic acid derivatives, piroxicam, diclofenac, orphenadrine, nabumetone, ketorolac, mefanamic acid, meclofenamate, etodolac, naproxen, ibuprofen, ketoprofen, flurbiprofen, diflunisal and fenoprofen.

8. The method of claim 6, further characterized in that the effective dose of melatonin and the effective dose of one or more analgesic agents are administered in a single composition.

9. The method of claim 8, further characterized in that the composition is administered orally.

10. The method of claim 6, further characterized in that the effective dose of melatonin and the effective dose of one or more analgesic agents are administered orally.

11. The method of claim 4, further characterized in that the effective dose of melatonin and the effective dose of one or more analgesic agents are administered transdermally.

12. The method of claim 6, further characterized in that the compositions are administered up to 4 hours before the person wishes to sleep.

13. The method of claim 6, further characterized in that the compositions are administered at four hour intervals.

14. The method of claim 6, further characterized in that an additional effective dose of melatonin is administered subsequent to the initial administration of melatonin.

15. The use of the composition according to claims 1 to 3 to prepare a medicament or drug to alleviate pain and induce sleep.