NZ222911A

NZ222911A - Method of relieving nausea and emesis by administering noroxymorphone derivatives; mixture of noroxymorphone derivatives and a narcotic analgesic

Info

Publication number: NZ222911A
Application number: NZ222911A
Authority: NZ
Inventors: Leon I Goldberg
Original assignee: Univ Chicago
Priority date: 1987-09-03
Filing date: 1987-12-14
Publication date: 1990-11-27
Also published as: DK693387D0; JPS6468376A; DK693387A; JP2625457B2; CA1315689C; KR890004704A; DK167340B1; PH22582A

Description

New Zealand Paient Spedficaiion for Paient Number £22911 ■ ■ • • • , . .wf.. ft' -ri* 'j\ M o *»• RO DRAWINGS Priority Date{sy. .. 3-.f)-.S?: ; Complete Soecific«tion Filed: Class: .. Afc> A//*&$.-. 2'r^ovm Publication Date: P.O. Journal, No: . ....E8&: PATENTS FORM NO. 5 PATENTS ACT 1953 /""s sj \ ! COMPLETE SPECIFICATION QUATERNARY DERIVATIVES OF NOROXYMORPHONE WHICH RELIEVE NAUSEA AND EMESIS WE, THE UNIVERSITY OF CHICAGO, an Illinois non-profit corporation, of 947 East 58th Street, Chicago, Illinois 60637, U.S.A., hereby declare the invention, for which we pray that a patent may be granted to us, and the method by which it is to be performed, to be particularly described in and by the following statement: (Followed by la) 14DEC1987- - la - U33:19038/JPG/DAD QUATERNARY DERIVATIVES OF NOROXYMORPHONE WHICH RELIEVE NAUSEA AND EMESIS BACKGROUND OF THE INVENTION The administration of therapeutic doses of morphine and other clinically useful narcotic analgesics is often accompanied by unpleasant side effects on the gastrointestinal system. For instance, morphine and related opiates such as meperidine and methadone may retard intestinal mobility by causing contractions of the small bowel circular smooth muscle.

Morphine and related narcotics may also induce nausea and increased mobility of the gastro-intestinal tract resulting in emesis or vomiting. These side effects are caused by direct stimulation of the chemoreceptor trigger zone for emesis in the area postrema of the medulla. (Goodman and Bilman, The Pharmacological Basis of Therapeutics, p. 502 [6th ed. 1980], incorporated herein by reference.) Studies have shown that morphine and other narcotics cause emesis in dogs. For example, Wang and Glaviano, JPET 111:329-334 (9143), incorporated herein by reference, reported that administration of 0.5 mg/kg of morphine intravenously to 12 dogs resulted in emesis in 9 dogs within an average of 2.4 minutes. (Mg/kg refers to milligrams of morphine per kilograms of body weight.) When 1.0 mg/kg of 222911 r\ morphine was administered intramuscularly to 13 dogs, 12 of them vomited within an average time of 3.5 minutes.

NEW ZEALAND PATENT 0?fiCE i 18SEPI990 RECEIVED SUMMARY OF THE IhTVENTION U. S. Patent No. 4,176,186 to myself and others disclosed treatment of intestinal immobility associated with the use of "narcotic analgesics through the administration of quaternary derivatives of noroxymorphone. It has now been discovered that the ' same compounds are also useful for the treatment, both > prophylactic and therapeutic, of the nausea and vomiting associated with the administration of these drugs.

According to the invention, therefore, nausea and vomiting by warm-blooded non-auman animals receiving morphine and related opiates, meperidine, methadone or the like, may be prevented or relieved by the administration of methylnaltrexone or other quaternary derivatives of noroxvmnmhone represented by the formula: £ —A/& CH3 X0 / VA of wherein ' R is selected from the group consisting chioroallyl, cyclopropyl-methyl and propargyl, and X is the anion of an acid, especially a chloride, bromide, iodide or methylsulfate anion.

^ These compounds are administered to the animal either prior to or simultaneously with the administration of the narcotic analgesic. They may be administered either enterally or parenterally. There has not been observed any interference with the analgesic activity of the opiates." As used herein, unless the sense of the usage indicates otherwise, the term "morphine" refers to any narcotic analgesic.

DETAILED DESCRIPTION This invention relates to the use of quaternary derivatives of noroxymorphone to prevent or relieve nausea and vomiting associated with the administration of morphine to warm-blooded animals. The useful compounds are represented by the formula: R is allyl or a related radical such as chloroallyl, cyclopropyl-methyl or propargyl, and X is the anion of an acid, especially a chloride, bromide, iodide or methylsulfate anion.

The compounds are synthesized as described in United States Patent No. 4,176,186, the disclosure of which is incorporated herein by reference. A particularly preferred noroxymorphone derivative is methylnaltrexone, but other compounds represented by the above formula are also suitable.

Methylnaltrexone or other noroxymorphone derivatives may be administered to the patient either Hu ~ wherein enterally or parenterally. However, a preferred method of administration is by injection. Nausea and emesis may follow after even a single does of morphine, unlike intestinal immobility which is usually the effect of chronic repeated usage of the drug. Consequently, it is contemplated that the patient will be given an injection of methylnaltrexone prior to surgery or other occasion when morphine is used to treat acute pain.

As illustrated by the following Controls and Examples, our studies show that methylnaltrexone inhibits emesis when administered either together with the morphine or before the morphine is administered. It is thought that methylnaltrexone or other quaternary noroxymorphone derivatives may be administered up to two hours before the administration of morphine, but that period may be variable. In our studies, methylnaltrexone was administered intramuscularly by means of a syringe. Methylnaltrexone may also be administered enterally or parenterally by other means. It has been found to be effective in dosages in the range of.about 0.05 mg/kg to about 1.0 mg/kg for each 1 mg/kg of administered morphine. It was found effective when administered "*"in the same syringe as morphine and also when administered up to about one hour before the administration of morphine.

The effect of methylnaltrexone in reversing the emetic effects of morphine is illustrated herein. The unit of mg/kg refers to milligrams of substance administered per kilograms of body weight.

CONTROL 1 AND EXAMPLE 1 One mg/kg of morphine was administered intramuscularly to five dogs. Four dogs vomited. In each instance, vomiting occurred within four minutes. On a different day the same dose of morphine was 1 administered intramuscularly to the same five dogs in the same syringe with 1 mg/kg of methylnaltrexone. None of the dogs vomited.

CONTROL 2 AND EXAMPLE 2 Six dogs were given intramuscular doses of 1 mg/kg of morphine. All six dogs vomited. On an additional day the same dose of morphine was combined with 0.5 mg/kg of methylnaltrexone and administered in the same 10 syringe to the same dogs. None of the dogs vomited.

CONTROL 3 AND EXAMPLE 3 One mg/kg of morphine was administered intramuscularly to three dogs. All three dogs vomited. 15 On an additional day the morphine was combined with 0.25 mg/kg of methylnaltrexone and administered in the same syringe. None of the dogs vomited.

CONTROL 4 AND EXAMPLE 4 20 Methylnaltrexone was administered to two dogs prior to the administration of 1 mg/kg morphine. In one dog, 0.5 mg/kg of methylnaltrexone was administered intramuscularly 15 minutes before the morphine. No vomiting occurred. In the second dog, the same dose of 25 methylnaltrexone was administered 30 minutes before the administration of morphine. No vomiting occurred.

CONTROL 5 AND EXAMPLE 5 0.05 mg/kg methylnaltrexone was administered '30 intravenously to four dogs one minute prior to the administration of 1.0 mg/kg morphine. No vomiting occurred in any of the dogs. On a different day, the same animals were given 1.0 mg/kg morphine without the administration of methylnaltrexone. All four dogs 35 vomited. a 1 The administration of methylnaltrexone alone was found to produce no noticeable effects in the animals. Previous studies with larger doses of methylnaltrexone have demonstrated that unlike the non-quaternary 5 naltrexone, methylnaltrexone does not precipitate withdrawal systems in morphine-tolerant dogs. Russell et al., Eur. J. Pharmacol. 78:255-261 (1982), incorporated herein by reference. Methylnaltrexone has not been found to interfere with the analgesic activity 10 of morphine or narcotics. vwrvsaammaM mjtSmfZovr'w*'*, - v _ i' .vi rw'vw'i."^!.,-..,..,,,,. 222911 o

Claims

WHAT WE CLAIM IS:

1. A method for preventing or relieving nausea and emesis associated with the use of narcotic analgesics in warm-blooded non-human animals, which comprises administering to an animal prone towards nausea or emesis on receiving narcotic analgesics, an effective amount of at least one nausea and emesis relieving compound of the formula: X© —Af&CH3 0 '0 HD wherein ' R is selected from the group consisting of chloroallyl, cyclopropyl-methyl and propargyl, and X is the anion of an acid, especially a chloride, bromide, iodide or methylsulfate anion, prior to or simultaneously wrfch administration of the narcotic analgesic.

2. A method as claimed in claim 1, where the compound is administered to the animal in an amount between 0.05 mg/kg and 1.0 mg/kg. 30 3. A method as claimed in claim 1, where the compound is administered to the animal enterally.

NEW ;3t5,U'\tNlD PATENT OFFICE received

4. A method as claimed in claim 1, where the compound is administered to the animal parenterally. ABSEP1990

5. A method as claimed in claim 4, where the compound is administered to the animal by injection.

6. A method as claimed in claim 1, where the compound is administered to the animal prior to the administration of the narcotic analgesic.

7. A method as claimed in claim 6, where the compound is administered to the animal up to two hours prior to the administration of the narcotic analgesic.

8. A method as claimed in claim 1, where the compound is administered to the animal concurrently with the administration of the narcotic analgesic.

9. A method as claimed in claim 1, where the compound comprises methylnaltrexone.

10. A method for preventing or relieving nausea and emesis associated with the use of narcotic analgesics in warm-blooded non-human animals, which comprises administering to an animal prone to exhibit nausea or emesis on administration of narcotic analgesic, methylnaltrexone, in the amount of between 0.05 mg/kg and 1.0 mg/kg simultaneous with or up to two hours prior to the time of administration of said narcotic analgesic.

11. A method as claimed in claim 10, where the methylnaltrexone is administered to the animal parenterally. NEW ZEALAND PATENT OFFICE 18SEPN90 RECEIVED 222911 9

12. A method for preventing or relieving nausea and emesis in non-human, warm-blooded animals as claimed in any one of claims 1 to 9 or either of claims 10 or 11 substantially as hereinbefore described with reference to any one on Examples 1 to 5.

13. A mixture for preventing or relieving nausea and emesis associated with the use of narcotic analgesics, said mixture comprising: an effective amount of at least one nausea and emesis relieving compound of the formula: wherein R is selected from the group consisting of chloroallyl, cyclopropyl-methyl and propargyl, and X is the anion of an acid, especially a chloride, bromide iodide or methylsulfate anion: and a narcotic analgesic.

14. A mixture as claimed in claim 13 wherein said compound is methylnaltrexone.

15. A mixture for preventing or relieving nausea and emesis associated with the use of narcotic analgesics as claimed in either claim 13 or 14, substantially as hereinbefore described with reference to any one of Examples 1 to 3. y © r—/V&CH3 HMP. BERRY & ASSOCIATES. THE UNIVERSITY OF CHICAGO. by their authorised agents