TW541178B - Pharmaceutical combination for treatment of psychoses - Google Patents
Pharmaceutical combination for treatment of psychoses Download PDFInfo
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- TW541178B TW541178B TW086113280A TW86113280A TW541178B TW 541178 B TW541178 B TW 541178B TW 086113280 A TW086113280 A TW 086113280A TW 86113280 A TW86113280 A TW 86113280A TW 541178 B TW541178 B TW 541178B
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- KCXFHTAICRTXLI-UHFFFAOYSA-N propane-1-sulfonic acid Chemical compound CCCS(O)(=O)=O KCXFHTAICRTXLI-UHFFFAOYSA-N 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 230000001337 psychedelic effect Effects 0.000 description 1
- 239000003196 psychodysleptic agent Substances 0.000 description 1
- 239000008213 purified water Substances 0.000 description 1
- DLOBKMWCBFOUHP-UHFFFAOYSA-M pyrene-1-sulfonate Chemical compound C1=C2C(S(=O)(=O)[O-])=CC=C(C=C3)C2=C2C3=CC=CC2=C1 DLOBKMWCBFOUHP-UHFFFAOYSA-M 0.000 description 1
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- JUJWROOIHBZHMG-UHFFFAOYSA-N pyridine Substances C1=CC=NC=C1 JUJWROOIHBZHMG-UHFFFAOYSA-N 0.000 description 1
- 229960004431 quetiapine Drugs 0.000 description 1
- URKOMYMAXPYINW-UHFFFAOYSA-N quetiapine Chemical compound C1CN(CCOCCO)CCN1C1=NC2=CC=CC=C2SC2=CC=CC=C12 URKOMYMAXPYINW-UHFFFAOYSA-N 0.000 description 1
- 239000012066 reaction slurry Substances 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 239000013557 residual solvent Substances 0.000 description 1
- 239000011342 resin composition Substances 0.000 description 1
- 229960001534 risperidone Drugs 0.000 description 1
- RAPZEAPATHNIPO-UHFFFAOYSA-N risperidone Chemical compound FC1=CC=C2C(C3CCN(CC3)CCC=3C(=O)N4CCCCC4=NC=3C)=NOC2=C1 RAPZEAPATHNIPO-UHFFFAOYSA-N 0.000 description 1
- YGSDEFSMJLZEOE-UHFFFAOYSA-M salicylate Chemical compound OC1=CC=CC=C1C([O-])=O YGSDEFSMJLZEOE-UHFFFAOYSA-M 0.000 description 1
- 238000005070 sampling Methods 0.000 description 1
- 238000007789 sealing Methods 0.000 description 1
- 229940116351 sebacate Drugs 0.000 description 1
- CXMXRPHRNRROMY-UHFFFAOYSA-L sebacate(2-) Chemical compound [O-]C(=O)CCCCCCCCC([O-])=O CXMXRPHRNRROMY-UHFFFAOYSA-L 0.000 description 1
- 229960000652 sertindole Drugs 0.000 description 1
- GZKLJWGUPQBVJQ-UHFFFAOYSA-N sertindole Chemical compound C1=CC(F)=CC=C1N1C2=CC=C(Cl)C=C2C(C2CCN(CCN3C(NCC3)=O)CC2)=C1 GZKLJWGUPQBVJQ-UHFFFAOYSA-N 0.000 description 1
- 229960002073 sertraline Drugs 0.000 description 1
- VGKDLMBJGBXTGI-SJCJKPOMSA-N sertraline Chemical compound C1([C@@H]2CC[C@@H](C3=CC=CC=C32)NC)=CC=C(Cl)C(Cl)=C1 VGKDLMBJGBXTGI-SJCJKPOMSA-N 0.000 description 1
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- 235000012239 silicon dioxide Nutrition 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
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- 235000019812 sodium carboxymethyl cellulose Nutrition 0.000 description 1
- 229920001027 sodium carboxymethylcellulose Polymers 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 235000019333 sodium laurylsulphate Nutrition 0.000 description 1
- HRQDCDQDOPSGBR-UHFFFAOYSA-M sodium;octane-1-sulfonate Chemical compound [Na+].CCCCCCCCS([O-])(=O)=O HRQDCDQDOPSGBR-UHFFFAOYSA-M 0.000 description 1
- 239000007909 solid dosage form Substances 0.000 description 1
- 239000012453 solvate Substances 0.000 description 1
- 229910001220 stainless steel Inorganic materials 0.000 description 1
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- 239000001117 sulphuric acid Substances 0.000 description 1
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- 239000007885 tablet disintegrant Substances 0.000 description 1
- 229940095064 tartrate Drugs 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 238000003828 vacuum filtration Methods 0.000 description 1
- 229920002554 vinyl polymer Polymers 0.000 description 1
- 238000005550 wet granulation Methods 0.000 description 1
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Description
541178 五、發明説明（1 , 本發明係關於藥理學、罂鏟 未主子贾樂及醫樂化學之領域，提供抗 精神病之方法及組合物。 精神病為嚴重之精神疾病，以缺乏或喪失與現實接觸為 特徵。精神病病人亦可能罹患幻覺及妄想，為該疾病之一 κ和神病對於病人、其家庭及社會整體需要極大情咸 及經濟代價。雖然料這些不同疾病狀況之機制不大^ 瞭’但是最近發現之療法對於治療精神病病人提供所希 望。經由引入新賴非典型抗精神病劑，精神病之治療已有 進展。雖然廷些非典型抗精神病劑之副作用情形遠優於傳 ’先藥“仁是増重為以非典型抗精神病劑治療之病人所發 現之副作用。 雖然这些新穎藥劑表明可以無法測量地改進精神病病人 之生活，但疋其不足以治療每一個精神病病人。因為精神 病頭不具有複雜之病原學，故一些在疾病期間顯示抑鬱症 狀足精神分裂症者，或亦具有精神病症狀之抑鬱者，僅使 用非典型抗精神病劑可能無法完全緩解。 本發明提供一種治療罹患或容易罹患精神病、急性躁 狂、溫和焦慮狀態或抑鬱合併精神病症狀之方法，包括對 琢病人施用有效量之第一成分，其為一種非典型抗精神病 劑’合併有效量之第二成份，其為一種5-羥色胺再吸收抑 制劑。 本發明亦提供一種醫藥組合物，其包括第一成份，其為 種非典型抗精神病劑，及第二成份，其為一種5-輕色胺 再吸收抑制劑。 -4- 本紙張尺度適用中國國家標準(CNS) Α4規格(210 X 297公釐) 541178 A7 B7 五、發明説明（2 ) 在本說明書中，所有溫度為攝氏度數，所有量，量之比 例，及濃度係以重量單位表示，除非另外說明。 化合物 在本發明之一般表示中，第一成份為一種用作非典型抗 精神病劑之化合物。非典型抗精神病劑用於治療之必要特 點為較少急性錐體外徵狀，特別是肌緊張不足，與典型抗 精神病劑如鹵p比醇（haloperidol)用於治療比較。克羅西平 (clozapine )為原型非典型抗精神病劑，不同於典型抗精神 病劑，具有下列特徵：（1)在治療對於典型抗精神病劑無反 應之精神分裂症病人之全部精神病理學有較大效果；（2)在 治療精神分裂症之否認（negative)癥候中有較大效果；及（3) 與治療有關之血清激乳素濃度較不常且較小量增加 (Beasley, et al·， Neuropsychopharmacology, 14(2)， 111-123, (1996))。非典型抗精神病劑包括，但不限於： 歐藍西平（olanzapine )，2-甲基-4-( 4-甲基-1-六氫吡畊基）-10H-嘧吩并[2,3-b] [1，5]苯并二氮雜萆，為已知之化合物， 述於美國專利5,229,382，可用於治療精神分裂症，精神分 裂形（schizophreniform)達常，急性躁狂，溫和焦慮狀態，及 精神病。美國專利5,229,382併入本文供參考； 克羅西平（clozapine)，8-氯-11-(4-甲基-1-六氫吡畊基）-5H-二苯并[b,e][l，4]二氮雜箪，述於美國專利3,539,573，其 併入本文供參考。其治療精神分裂症之臨床效果己揭示 (Hanes, et al., Psychopharmacol. Bull·, 24, 62 (1988))； 瑞斯哌酮(risperidone )，3-[2-[4-(6-氟-1，2-苯并異呤唑-3- 本紙張尺度適用中國國家標準(CNS) A4規格(21〇x 297公釐） 541178 A7 B7 五、發明説明（3 ) 基）六氫说咬基]乙基;μ2•甲基-6,7,8,9-四氫吡啶并[H a] P密淀_4_酮及其治療精神病之用途述於美國專利 4,804,663，其併人本文供參考； 斯汀朵（sertindole)，氟小（4-氟苯基）_1H_ 吲 哚-3-基]-1-六氫吡啶基]乙基]咪唑啶_2_酮，述於美國專利 4,710,500。其治療精神分裂症之用途於美國專利5，丨12,838 及 5,238,945。美國專利 4,71〇,5〇〇，5，1 12,838 及 5,238,945 併入 本文供參考； 喹提阿平（quetiapine)，5-[2_ [4-二苯并[b，f] [1，4]噻氮雜萆 (thiazepin)-ll-基-1-六氫吡畊基]乙氧基]乙醇及其在證明治 療精神分裂症利用之分析中之活性述於美國專利 4,879,288 ’其併入本文供參考。4提阿平典型以其⑹-2· 丁 晞二酸（2:1)鹽施用；及 西帕斯酮(ziprasidone)，5- [2- [4- ( 1，2-苯井異，塞唑-3-基）-1-六氫说畊基]乙基]-6-氯-1，3-二氫-2H-吲哚-2-酮，典型以鹽 酉父鹽一水合物施用。此化合物述於美國專利4,831，031及 5,312,925 °其在證明治療精神分裂症利用之分析中之活性 述於美國專利4,831，〇31。美國專利4,831，031及5,312,925併 入本文供參考；。 相似地，當本發明是以最廣泛意義而言時，第二成份化 合物為一種用作5-輕色胺再吸收抑制劑之化合物。化合物 在該利用中活性之測量現在為一種標準藥理分析。Wong，et a1·，Ne_uropsychopharmacol〇gy 也 337-344 (1993)。許多化合 物，包括上述者，具有該活性，而毫無疑問地，未來將有 -6 - 本紙張尺度適用中@ 0家標準(CNS) A4規格(210 X 297公董) '' ~
541178 A7 _ B7 五、發明説明（5 ) 苯基）-1，3-二氫-5-異苯并呋喃腈，於美國專利4，136，193中 揭示為5 -輕色胺再吸收抑制劑。其藥理揭示於Christensen et al·，Eur. J. Pharmacol. 41，153 (1977)，其對於抑鬱之臨床效果 之報告可發現於 Dufour et al.，Int. Clin. Psychopharmacol. 2, 225 (1987)，及 Timmerman 红公·，同書，239 ; 氟克散滿（fluvoxamine )，5-甲氧基- l-[4-(三氟甲基）-苯 基]-1-戊酮0-(2-胺基乙基）肟，美國專利4,085,225所教 導。有關該藥之科學論文已由Claassen红§i.，Brit. L Pharmacol. 60, 505 (1977); De Wilde 红公·，J. Affective Disord. 45 249 (1982);及 Benfield gt al·，Drugs 32· 313 Π986)所發表; 帕羅西汀（paroxetine)，反式-(-)-3-[(1，3-苯并二17号茂 (dioxol)-5-基氧基）甲基]-4- ( 4-氟苯基）六氫ρ比淀，可發現於 美國專利3,912,743及4,007，196。該藥活性之報告揭示於 Lassen，Eur. J. PharmacoL 47, 351 (1978); Hassan et ai., Brit. J. Clin. Pharmacol. 19, 705 (1985); Laursen et al.? Acta Psychiat. Scand. 71, 249 (1985);及 Battegay et al·，Neuropsvchobiology 13, 31(1985);及 斯差來恩（sertraline )，（ IS-順式）-4- ( 3，4-二氯苯基）-1，2,3,4-四氫-N-甲基-1-萘基胺鹽酸鹽，為5-經色胺再吸收 抑制劑，其以抗抑鬱劑上市。其揭示於美國專利 4,536,518。 上述與本發明中所用化合物有關之所有美國專利併入本 文供參考。 應明瞭，雖然較佳使用單一非典型抗精神病劑作為第一 本紙張尺度適用中國國家標準(CNS) A4規格(210X 297公釐) 541178 A7 B7 五、發明説明（7 ) 面間距所 晶型，具有典型X射線粉末繞射圖式，如下列 示： d 10.2689 8.577 7.4721 7.125 6.1459 6.071 5.4849 5.2181 5.1251 4.9874 4.7665 4.7158 4.4787 4.3307 4.2294 4.141 3.9873 3.7206 3.5645 3.5366 3.3828 3.2516 3.134 3.0848 3.0638 3.0111 2.8739 2.8102 2.7217 2.6432 2.6007 -10- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐） 541178 A7 B7 五、發明説明（8 ) 第II型之X射線繞射圖式之典型實例如下，其中d表平面 間距，：^^表典型相對強度： d Ι/Ιι 10.2689 100.00 8.577 7.96 7.4721 1.41 7.125 6.50 6.1459 3.12 6.071 5.12 5.4849 0.52 5.2181 6.86 5.1251 2.47 4.9874 7.41 4.7665 4.03 4.7158 6.80 4.4787 14.72 4.3307 1.48 4.2294 23.19 4.141 11.28 3.9873 9.01 3.7206 14.04 3.5645 2.27 3.5366 4.85 3.3828 3.47 3.2516 1.25 3.134 0.81 3.0848 0.45 3.0638 1.34 3.0111 3.51 2.8739 0.79 2.8102 1.47 2.7217 0.20 2.6432 1.26 2.6007 0.77 -11 - 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) 541178 A7 B7 五、發明説明（9 ) 本文中所示X射線繞射圖式係使用Siemens D5000 X射線粉 末繞射計獲得，其具有一波長，λ= 1.541A之銅Κα輻射源。 歐藍西平第11型多晶型較佳以實質上純歐藍西平第11型 多晶型施用。 本文中所用之「實質上純」表第II型結合少於約5%第I 型，較佳少於約2%第I型，更佳少於約1%第I型。此外， 「實質上純」第II型含有少於約0.5%有關物質，其中「有 關物質」表不欲之化學雜質或殘餘之溶劑或水。特別是， 「實質上純」第II型應含有少於約0.05%乙腈，更佳少於約 0.005%乙腈。此外，本發明之多晶型應含有少於0.5%結合 水0 由’382專利所教導之方法獲得之多晶型稱為第I型，具有 典型X射線繞射圖式，實質上如下，其係使用Siemens D5000 X射線粉末繞射計獲得，其中d表平面間距： -12- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐） 裝 訂
541178 A7 B7 五、發明説明（ 10 ) d 9.9463 8.5579 8.2445 6.8862 6.3787 6.2439 5.5895 5.3055 4.9815 4.8333 4.7255 4.6286 4.533 4.4624 4.2915 4.2346 4.0855 3.8254 3.7489 3.6983 3.5817 3.5064 3.3392 3.2806 3.2138 3.1118 3.0507 2.948 2.8172 2.7589 2.6597 2.6336 2.5956 -13 - 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) 541178 A7 B7 五 發明説明（11 ) 其中d表平面 第I型之X射線繞射圖式之典型實例如下， 間距，1/1丨表典型相對強度·· d Ι/Ιι 9.9463 100.00 8.5579 15.18 8.2445 1.96 6.8862 14.73 6.3787 4.25 6.2439 5.21 5.5895 1.10 5.3055 0.95 4.9815 6.14 4.8333 68.37 4.7255 21.88 4.6286 3.82 4.533 17.83 4.4624 5.02 4.2915 9.19 4.2346 18.88 4.0855 17.29 3.8254 6.49 3.7489 10.64 3.6983 14.65 3.5817 3.04 3.5064 9.23 3.3392 4.67 3.2806 1.96 3.2138 2.52 3.1118 4.81 3.0507 1.96 2.948 2.40 2.8172 2.89 2.7589 2.27 2.6597 1.86 2.6336 1.10 2.5956 1.73 -14- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) 541178 A7 _____ —_B7 五、發明説明（12) ' ~~ 本文中所示之X射線繞射圖式係以波長人=1541八之銅心 獲得。標示”dn之襴中之平面間距係以埃為單位。典型相 對強度係在標示”1/1!”之攔中。 雖然iv監西平弟II型為較佳，但是應明瞭本文中所用之播一 語「歐藍西平」包括所有溶劑化物及多晶型，除非特別么 明0
製備1 技術級歐藍西平
中間物1
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線 在適合之三頸燒瓶中加入下列： 二甲亞颯（分析） ：6體積 中間物1 : 75克 N-曱基六氫吡畊（試劑） ：6當量 例如， 中間物1可使用熟習技藝人士已知之方法製備 中間物1之製備教導於382專利中。 -15 - 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐） 541178 A7 ______ B7 五、發明説明（1 ~) ^ - 加入表面下之氮噴氣官，以移除反應期間所形成之氨。 反應加熱至120 t，在整個反應期間維持在該溫度。反應 以HPLC追蹤，直到剩餘5%中間物丨未反應為止。在反應完 全後，混合物緩慢冷卻至20t (約2小時）。然後反應混合 物移入適合之三頸圓底燒瓶及水浴中。在此溶液中，加入 10體積試劑級甲醇，並攪拌，反應混合物在2〇它攪拌3〇分 鐘。3體積水緩慢加入歷約3〇分鐘。反應漿液冷卻至〇至5 °C，攪拌30分鐘。產物過濾，然後濕餅以冷卻甲醇洗。濕 餅在真空中於45t乾燥過夜。產物確認為技術級歐藍西 平。 產率 76·7°/〇 ;效能：98.1% 製備2 歐藍西平第II型多晶型 270克技術級2-甲基-4-(4_甲基六氫吡畊基卜ι〇η^塞吩 并[2,3-b][l，5]苯并一氮雜箪之樣品懸浮於無水醋酸乙醋（2 7 升）中。混合物加熱至76 °C，在76 t：維持30分鐘。混合物 冷卻至25 °C。生成之產物使用真空過濾分離。產物使用X 射線粉末分析確認為第Π型。 產量·· 197克。 上述製備第II型之方法提供醫藥極佳產物，具有效能 >97%，有關物質總量< 0.5%，分離之產率> 73%。 熟習技藝人士應明瞭，本發明中所用之大部份或所有化 合物可形成鹽，通常使用藥劑之鹽形式，因為其較自由驗 容易結晶及純化。在所有情況，使用上述藥劑之鹽包括在 -16- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) ' ^--- 裝 訂
541178 A7 B7 五、發明説明（I4 ) 本說明中，通常較佳，且所有化合物之醫藥可接受鹽包括 於其名稱中。 本發明中所用之許多化合物為胺，故可與許多無機及有 機酸反應而形成醫藥可接受之酸加成鹽。因為本發明化合 物之一些自由胺在室溫典型為油狀，故自由胺較佳轉化為 其醫藥可接受酸加成鹽以便於處理及施用，因為該鹽在室 溫一般為固體。通常用以形成該鹽之酸為無機酸，如鹽 酸，氫溴酸，氫埃酸，硫酸，磷酸，等；有機酸，如對-甲苯橫酸，甲績酸，草酸，對-潰苯基橫酸，碳酸，號J白 酸，擰檬酸，苯甲酸，醋酸，等。因此，醫藥可接受鹽之 實例為硫酸鹽，焦硫酸鹽，硫酸氫鹽，亞硫酸鹽，亞硫酸 氫鹽，磷酸鹽，磷酸一氫鹽，磷酸二氫鹽，偏磷酸鹽，焦 磷酸鹽，氯化物，溴化物，琪化物，醋酸鹽，丙酸鹽，癸 酸鹽，辛酸鹽，丙烯酸鹽，甲酸鹽，異丁酸鹽，己酸鹽， 庚酸鹽，丙炔酸鹽，草酸鹽，丙二酸鹽，琥珀酸鹽，栓酸 鹽，癸二酸鹽，反式丁晞二酸鹽，順式丁婦二酸鹽，丁炔-1,4-二酸鹽，己炔-1，6-二酸鹽，苯甲酸鹽，氯苯甲酸鹽， 甲基苯甲酸，二硝基苯甲酸，羥基苯甲酸鹽，甲氧基苯甲 酸鹽，酞酸鹽，磺酸鹽，二甲苯磺酸鹽，苯基醋酸鹽，苯 基丙酸鹽，苯基丁酸鹽，檸檬酸鹽，乳酸鹽，β-羥基丁酸 鹽，羥乙酸鹽，酒石酸鹽，甲磺酸鹽，丙磺酸鹽，莕-1-磺 酸鹽，莕-2-磺酸鹽，苯乙醇酸鹽，等。較佳之醫藥可接受 鹽為鹽酸鹽，草酸鹽或反式丁烯二酸鹽。 -17- 本紙張尺度適用中國國家標準(CNS) Α4規格(210 X 297公釐) 裝 、訂
541178 A7 B7 五、發明説明（15 ) 一'------ 施用 本發：中所用藥物之劑量，在最後之分析中，必需由醫 生使用樂物之知識，合併藥物之性質（如臨床試驗決定）， 病人（特點（包括醫生治療外之疾病）決定。劑量之概要及 -些較佳劑量提供於下文。—些藥物之劑量指導分別示於 下文；為產生所欲組合之指導，可選擇各成份藥物之指 導。 歐藍西平：約0.25至50毫克，一次/天；較佳為1至3〇毫 克 ’人/天’取佳為1至25毫克，一次/天； 克羅西平：約12.5至900毫克/天；較佳為約15〇至45〇毫克 /天； 瑞斯旅酮：約〇·25至16毫克/天；較佳為約2-8毫克/天； 斯汁朵：約0.0001至1.0毫克/公斤/天； 峻提阿平：約1.0至40毫克/公斤，每天給予一次，或分成 數劑； 西帕斯酮：約5至500毫克/天；較佳約50至100毫克/天； ll克西汀：約1至約80毫克，一次/天；較佳約1〇至約4〇 毫克，一次/天；貪食及強迫觀念及強迫行為疾病，較佳 為約20至約8〇毫克，一次/天； 杜羅克西汀：約1至約3〇毫克，一次/天；較佳為约5至約 20毫克，一次/天； 务拉發克西汀：約1〇至約15〇毫克，1-3次/天；較佳為約 25至約125毫克，三次/天； 夕那西普恩·約10至約100毫克，1-2次/天’較佳為約25 -18- 本紙張尺度適用㈣g家標準(CNS) Μ規格㈣χ 297公爱） 541178 五 A7 B7 、發明説明（17 ) 佳。該等合併醫藥組合物含有有效量各種化合物，有效量 係關於所施用化合物之每天劑量。各合併劑量單位可含有 所有化合物之每天劑量，或可含有一部份每天劑量，如劑 量之三分之一。或者，各劑量單位可含有一種化合物之完 全劑量，及其他化合物之一部份劑量。在此情況，病人每 天口服一合併劑量單位，及一或多個僅含有其他化合物之 單位。各劑量單位中所含各藥物之量依所選擇用於治療之 藥物及其他因子（如合併治療之適應症）而定。 調配合併醫藥組合物之惰性成份及方式為習知，但本發 明之組合除外。可使用醫藥科學中所用之一般調配方法。 可使用一般類型之組合物，包括錠（tablets)，口嚼錠，膠 囊，溶液，非經腸溶液，經鼻噴液或粉末，錠（troches)， 栓劑，經皮貼片及懸浮液。一般，組合物含有總共約0.5% 至約50%化合物，依所欲劑量及所用組合物之種類而定。 然而，化合物之量最佳定義為有效量，即各化合物提供所 欲劑量於需要該治療病人之量。合併組合之活性並非依據 組合物之本質而定，故組合物僅以方便性及經濟性而選擇 及調配。任何組合可依據所欲形式之組合物而調配。下文 將提供不同組合物之一些討論，然後提供一些典型調配 物。 膠囊係由化合物與適合稀釋劑混合及適當量之混合物裝 入膠囊中而製備。一般稀釋劑包括惰性粉末物質，如許多 不同種類之澱粉，纖維素粉末，特別是結晶及微晶纖維 素，糖，如果糖，甘露糖醇，及蔗糖，麵粉粒，及相似之 -20- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐）
訂
A7 B7
541178 五、發明说明（18 可食用粉末。 錠係由直接壓縮，濕顆粒化，或乾燥 '祀床賴叔化而製備。卞 調配物通常併入稀釋劑，黏合劑，， 潤滑劑，及崩解劑，κ 及化合物。典型稀釋劑包括例如各種搬粉，乳糖，甘， 醇’高嶺i，構_或硬酸轉，無機鹽如氯化制，= 粉。亦可使㈣料衍生物粉末。典型㈣合劑如奸； 明膠，及糖，如乳糖，果糖，葡萄糖，” 八於及合成用 亦方便，包括金合歡膠’海藻酸鹽，甲基纖維素，聚乙海 基吡咯啶’等。聚乙二醇，乙基纖維素及蠟亦可用作黏: 劑。 鍵調配物中需要潤滑劑以防止錠及衝頭（punches)黏於右 中。·潤滑劑係選自滑性固體，如滑石，硬脂酸錢及辟，辱 脂酸，及氫化植物油。 ' 錠崩解劑為在濕化時會膨脹以崩解錠及釋出化合物之物 質。其包括澱粉，黏土，纖維素，藻酸（algins)及膠。更特 別可使用例如玉米及馬鈴薯殿粉，甲基纖維素，瓊脂，賸 土，木纖維素，天然海綿粉末，陽離子交換樹脂，海藻 酸，吉（guar)膠，柑橘漿，及羧甲基纖維素，以及月桂硫 酸鈉。 經腸（enteric)調配物通常用以保護活性成份免於胃之強 酸。該調配物係由固體劑型塗覆一層不溶於酸環境及溶於 驗環境中之聚合物薄膜而產生。薄膜實例為醋酸酞酸纖維 素，聚醋酸酞酸乙晞酯，g太酸羥丙基甲基纖維素，及醋酸 琥珀酸羥丙基甲基纖維素。較佳為調配杜羅克西汀及含有 -21 - 本紙張尺度適用中國國家標準(CNS) A4規格(210X297公釐)
541178 A7 B7
五、發明説明（19 杜羅克西汀之組合物成經腸組合物，承 文佳為調配成經腸小 粒。 較佳之杜羅克西汀經腸調配物么—# ^ 種小粒調配物，包含 a) —杜羅克西汀核心及醫藥可接受之 <軾形劑；b ) —選擇性 分離層；c) 一腸溶層，包含醋酸琥6 〜 塬珀馱羥丙基甲基纖維素 (HPMCAS)及醫藥可接受之賦形劑；d ; 選擇性加工層。此 經腸調配物述於美國專利5,5〇8 276中， ’ τ 诉入本文供參考。 錠通常塗糖作為調味劑及密封劑。化合物亦可調配成口 嚼錠，由使用大量愉快味道之物質如甘露糖醇於調配物 中，現在已充分完成實施。即溶錠類調配物現在亦常使用 以確使病人消耗該劑型，及避免困擾 、兄1¾¾ 些病人呑嚥固體之 困難。 當施用栓劑組合時，可使用一般基質。椰子油為一種傳 統之栓劑基質，其可由加入蠟以稍微提高熔點而修改。特 別包έ各種刀子量聚乙二醇之水可溶混之栓劑基質亦廣泛 使用。 最近經皮貼片已相當普遍。其典型包含一種樹脂組合 物’藥物溶於或部份溶於其中，以一保護組合物之薄膜與 皮膚接觸。最近有許多專利涉及此領域。較複雜之貼片組 合物亦使用，特別是具有一膜穿刺許多孔之貼片，藥物以 滲透作用經孔泵送。 下列典型配方提供作為醫藥科學家之興趣及資料。 -22-
本紙張尺度適用中國國家標準(cj7s) Α4規格(2ι〇χ 297公幻 541178 A7 B7 五、發明説明（) 調配物1 硬明膠膠囊係使用下列成份製備： 量 (毫克/膠嚢） 歐藍西平 25毫克 氟克西汀，消旋，鹽酸鹽 20 乾燥澱粉 150 硬脂酸鎂 1〇_ 總共 210毫克 調配物2 錠係使用下列成份製備： 量 (毫克/錠） 歐藍西平 10 氟克西丁，消旋，鹽酸鹽 10 微晶纖維素 275 二氧化矽，發煙 10 硬脂酸 5 總共 310毫克 各成份換合，壓縮，形成鍵，各重465毫克。 -23 - 本紙張尺度適用中國國家標準(CNS) A4規格(210 x 297公釐) 541178
調配物3 製備含有下列成份之氣溶膠溶液： 重量 5亳克 10 25,75 100.75亳克 瑞斯嗓酉同 (+)-杜羅克西汀，鹽酸鹽 乙醇 推進劑22(氯二氟甲烷） 總共 活性成份與乙醇混合，混合物加入一部份推進劑Μ中， 冷卻至-30 t：，移入一充填裝置中。然後所需量裝入不鏽 鋼容器中，以其餘推進劑稀釋。然後閥單元裝入容器中。 調配物4 含有80毫克活性成份之錠係如下製造： 斯汀朵 60毫克 (+)-杜維克西>丁，鹽酸鹽 20 毫克 澱粉 30毫克 微晶纖維素 20毫克 聚乙晞基外(:哈咬酮（於水中之1 〇%溶液）4 毫克 4.5 毫克 0.5 毫克 1 毫克 140 毫克 羧甲基澱粉鈉 硬脂酸鎂 滑石 總共 -24- 本紙張尺度通用中國國家標準(CNS) A4規格(210 X 297公釐) 541178 A7 B7 五、發明説明 活性成份，澱粉及纖維素通過45號網目美國篩，*也、 亚徹底 混合。含有聚乙烯基说咯啶酮之水溶液與生成之粉末混 合，然後混合物通過14號網目美國篩。所產生之顆粒在 °C乾燥，通過18號網目美國篩。羧甲基澱粉制，硬脂酸 鎂，及滑石先通過60號網目美國篩，然後加 / 浑貝粒中，在 混合後，在製錠機上壓縮成錠，各重1毫克。
調配物5 含有130毫克活性成份之膠囊係如下製造： 峻提阿平 說克西汀，消旋，鹽酸鹽 澱粉 微晶纖維素 硬脂酸鎂 總共 7Q毫克 3Q毫克 39毫克 39毫克 180毫克 裝 訂 網 活性成份，纖維素，澱粉，及硬脂 n . m ^ ^ 故幾捧合，通過45號 目吴國師，裝入硬明膠膠囊中，夂去 T各重2S0亳克。 iS配物6 各含45毫克活性成份之栓劑係如 西帕斯酮 (+)-杜羅克西、;丁，鹽酸鹽 飽和脂肪酸甘油酯 總共 下製造：： 75毫克 5亳克2,080亳克
>25- 541178 五、發明説明 A7 B7
活f生成6通過6〇號網目美國篩，懸浮於先使用所需之最 】熔解《飽和脂肪酸甘油酯中。然後混合物倒入標稱2 克容量之栓劑模中，冷卻。 配物7 每5毫升劑量含有70毫克活性成份之懸浮液係如下製 造： 歐藍西平 2〇 亳克 斯差來恩 100 亳克 羧曱基纖維素鈉 50 毫克 糖漿 1.25亳升 苯甲酸溶液 〇·1〇亳升 調味劑 通ΈΓ 著色劑 Ά 田 通里 純化水至總共 5毫升 活性成份通過4 5號網目美國篩，與幾甲基纖維素鈉及_ 漿混合’形成均勾糊。苯甲酸溶液，調味劑及著色劑以— 部份水稀釋，加入，並攪拌。然後充分水加入，以產生所 需體積。 -26- 本紙張尺度適用中國國家標準(CNS) A4規格(210X297公釐) 541178 A7 B7 五、發明説明（25 )
Manual of Mental Disorders, 4th Edition (由 American Psychiatric Association (DSM)所出版）中分類。為讀者之方便起見，這 些疾病狀態之DSM編碼提供如下： 妄想狂型精神分裂症 295.30 無組織型精神分裂症 295.10 緊張型精神分裂症 295.20 未分化型精神分裂症 295.90 其餘型精神分裂症 295.60 精神分裂症疾病295.40 精感分裂症 295.70 抑鬱型情感分裂症 296.24 具有精神病特點之重大抑鬱症 296.34 精神病通常與其他疾病或症狀有關，或由其他症狀所引 起。例如，其與神經病學症狀，内分泌症狀，代謝症狀， 流體或電解質不平衡，肝或腎疾病，及涉及中樞神經系統 之自體免疫疾病有關。精神病亦可與使用或濫用.某些物質 有關。這些物質包括，但不限於，古柯鹼，哌醋曱酯 (methylphenidate)，地塞米松（dexmethasone)，安非他命及有 關物質，大麻，迷幻藥，吸入劑，搗片（opioids)，苯環己 17瓜症（phencyclidine)，鎮靜劑，安眠藥，及抗焦慮藥。精神 病亦可因斷除某些物質而發生。這些物質包括，但不限 於，鎮靜劑，安眠藥，及抗焦慮藥。本發明之具體實施例 可用於治療與這些症狀有關之精神病。 單胺之微透析分析 -28- 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) 541178 A7 B7 五、發明説明（26 )
Sprague-Dawley 氣（Harlan 或 Charles River)，重 270-300 克， 在氯醛（chloral)合水/戊巴比妥麻醉（170及36毫克/公斤，經 腹膜内，於30%丙二醇，14%乙醇中）下以外科手術植入微 透析探針（Perry and Fuller，Effect of fluoxetine on serotonin and dopamine concentration in rat hypothalamus after administration of fluoxetine plus L-5-hydroxytryptophan? Life Sci·，50, 1683-90 (1992))。使用David Kopf趨異體（stereotaxic)裝置將探針植入 視丘下部一側，於嘴側（rostral)座標-1.5毫米，側面座標-1.3 毫米，腹面座標-9.0 毫米（Paxinos and Watson，1986)。在 48小時恢復期後，鼠放入一個裝有液體迴轉系統（供自由 運動動物之 CMA/120 系統，Bioanalytical Systems, West Lafayette，IN)之大塑膠杯中。過濾之人造腦脊髓液 (CSF)(150 mM NaCl，3·0 mM KC1，1·7 mM CaC12，及 0.9 mM MgC12)以1.0毫升/分鐘速率經探針灌注。透析液輸出管線 以一 20微升迴路裝入十口（tenport) HPLC閥中。在各30分鐘 取樣期間結束後，收集於迴路中之透析液注射於分析管柱 (Spherisorb3pODS2, 2X150毫米，Keystone Scientific)上。 測量單胺所用之方法係如Perry and Fuller (1992)所述。簡 言之’分析收集於20微升迴路之透析液中5-HT，NE及DA。 20微升注射入具有移動相之管柱，其解析NE，DA，及5-HT: 75 mM醋酸鉀，〇·5 mM乙二胺四醋酸，1.4 mM辛烷磺 酸鈉，及8%甲醇，PH 4.9。胺管柱之移動相以流動規畫泵 輸送’初流率0.2毫升/分鐘，於5分鐘增加至0.3毫升/分 鐘，然後於26分鐘減少至0.2毫升/分鐘，總操作時間為30 -29- 本紙張尺度適用中國國家標準(CNS) A4規格(210X297公釐) 541178 A7 B7 五 、發明説明（27 ) 分鐘。使用流動規畫於25分鐘期間内溶離5-HT。胺管柱之 電化學檢測器（EG&G, Model 400)設定於電位400 mV及敏感 度0.2 nA/V。在藥物施用前測量基礎量至少90分鐘。藥物 係於過濾之去離子水（體積0.25-0.3毫升）中製備，以所欲劑 量施用。
.訂
線 -30-本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐)
Claims (1)
- 541178 A Β c D Anr liy η: I 第080113280號專利申請案 中文申請專利範圍替換本(92年2月) ------- 申請專利範圍 • 種用於治療罹患或容易罹患精神病、急性躁狂，溫 和焦慮狀態或抑鬱合併精神病症狀的病人之醫藥組 合’包括有效量之第一成份，其為歐藍西平 (〇lanzapine )，合併有效量之第二成份，其為氟克西汁 (fluoxetine )，其中該組合協乘性增加多巴胺和原腎上 腺素濃度。 2.根據申請專利範圍第丨項之醫藥組合，其中氟克西汀為 鹽酸鹽形式。 3·根據申請專利範圍第1或2項之醫藥組合，其中化合物 之施用為口服。 4.根據申請專利範圍第1項之醫藥組合，其中病人罹患精 神分裂症。 5·根據申請專利範圍第1項之醫藥組合，其中病人罹患情 感分裂（schizoaffective)症。 6·根據申請專利範圍第1項之醫藥組合，其中歐藍西平實 質上為純的型II歐藍西平。 7.根據申請專利範圍第1項之醫藥組合，係用於治療憂费 合併精神病症狀。 8·根據申請專利範圍第1項之醫藥組合，係用於治療妄想 狂型精神分裂症295.30。 9·根據申請專利範圍第1項之醫藥組合，係用於治療無組 織型精神分裂症2 9 5 . 1 0。 10.根據申請專利範圍第i項之醫藥組合，係用於治療緊張 型精神分裂症295.20。 本紙張尺度適财® s家料(CNS) A4規格(210 X 297公楚) 1L根據申請專利範圍第1項之醫藥組合，係用於治療未分 化型精神分裂症。 12·根據申請專利範圍第1項之醫藥組合，係用於治療其餘 型精神分裂症295.60。 13·根據申請專利範圍第1項之醫藥組合，係用於治療精神 分裂症疾病295.40。 14·根據申請專利範圍第1項之醫藥組合’係用於治療情感 分裂症295.70。 15·根據申請專利範圍第1項之醫藥組合，係用於治療抑鬱 型情感分裂症。 16·根據申請專利範圍第1項之醫藥組合’係用於治療具有 精神病特點之重大抑鬱症296.24，296.34。 17·根據申凊專利範圍第1項之醫藥組合’係用於治療狂 躁。 18.根據申請專利範圍第1項之醫藥組合，係用於治療抵抗 單獨以抗精神病劑治療之雙相型情感障礙。 以根據申請專利範圍第1項之醫藥組合，係用於治療特徵 在於疾病期間存有抑鬱型精神病之情感分裂症。 20.根據申請專利範圍第丨項之醫藥組合，係用於治療特徵 在於疾病期間存有抵抗單獨以抗精神病劑治療之抑營 型精神病之情感分裂症。 2L根據申請專利範圍第丨項之醫藥組合，係用於治療侵略 /暴力相關疾病，係選自狂躁、精神分裂症、情感分裂 病、濫用藥物、顱腦損傷及精神發展遲緩所紐之 -2 - 541178 A B c D 、申請專利範圍 群。 22·—種用於協乘性增加腦中多巴胺及原腎上腺素濃度之 醫藥組合物，其包括第一成份，其為歐藍西平，以及 第二成份，其為氟克西汀鹽酸鹽。 23. 根據申請專利範圍第2 2項之醫藥組合物，其中歐藍西 平為型11的歐藍西平多晶型。 24. 根據申請專利範圍第2 2項之醫藥組合物，包含i至2 5 毫克歐藍西平及1至80毫克氟克西汀鹽酸鹽。 25·根據申請專利範圍第2 2項之醫藥組合物，包含1至2 5 毫克歐藍西平及10至40毫克氟克西汀鹽酸鹽。 26·根據申請專利範圍第2 2項之醫藥組合物，包含1至2 5 愛克歐藍西平及20至80毫克氯1克西〉、丁鹽酸鹽。 27. 根據申請專利範圍第2 2項之醫藥組合物，其中該病人 患有雙相型情感障礙。 28. —種用於治療患有雙相型情感障礙之病人的醫藥組 合，包括有效量之第一成份，其為歐藍西平 (olanzapine )，合併有效量之第二成份，其為氟克西汀 (fluoxetine )，其中該組合協乘性增加多巴胺和原腎上 腺素濃度。 29. 根據申請專利範圍第2 8項之醫藥組合，其中氟克西汀 為鹽酸鹽形式。 本紙張尺度適用中國國家標準(CNS) A4規格(210 X 297公釐) 修正 本年月曰 丨補充91U 申請案 中文補充說明書修正本(91年2月） 方法 微透析分析係根據Perry及Fuller，1992及李等人，1998所述之方法。 動物手術 體重 260-300 毫克之雄性 Sprague-Dawley 鼠（Harlan，SpragUe-Dawley， Indianapolis，IN USA)係用於微透析研究。大鼠在手術日以氯醛水合物/ 戊巴比妥麻醉（170毫克/公斤及36毫克/公斤分別於30%丙二醇及14% 乙醇）麻醉，以植入微透析探針。根據先前公開之方法（Perry及Fdler 1992)，在使用前2天，構築環型微透析探針並植入大鼠額前區皮質 内。调整PFC為· A (前端至前窗點）η毫米，L (矢中斷面縫合之側 邊1〇·8毫，V (腦膜表面腹側）4毫米。在實驗終了時，探針位置以組 織學上確認。具不適當探針位置或單胺基線值之大鼠不包於統計分析 中。 微透析 在實驗日’人工腦脊髓液（ρΗ:7·4,由15〇nM NaC1, 3mM κα，i姻 CaCU 〇.9mM MgCl2組成）以2.0 Vmin之低流速遞送至探針。每15 分鐘收集騎物樣品直到4小時。根據先前公開之方法（Li等人， 簡），使用具電化學檢測之HpLC、線上分_色胺，多巴胺及原腎上 腺素。檢測之敏感度為約每通樣品3 fm〇1。達成穩定的基線後，測定 藥物之效果至少3個樣品。 藥物處理 在實驗期間，所有藥物以！毫升知之體積，經由植入的皮下（sc)管 U:\TYPEVLAN\B\2 DOCLANM9 541178 投藥以避免碰觸老鼠。歐藍西平溶解於〇·〇1Ν Ηα，必要時進一步酸化 =超音波處理。溶液之_值調整至4·7。減时溶解於絲水。在結 合研死中’在氟克西;了注射前30分鐘投藥歐藍西平喊㈣在藥物動 力交互作用。 數據分折 所有微透析數據係計算自透析物基線濃度之百分比變化（最終3個藥物 預〉王射值之平均值定義為·%)。與基線值比較，每—時間點之百分 比又化之頭著差芳係藉成對樣品之t_test測定。統計顯著性之 最小濃度係設定在PC0.05。 參考資料 Li XM5 Perry KW3 Wong DT? Bymaster FP(1998) : Olanzapine increases in vivo dopamine and norepinephrine release in rat prefrontal cortex, nucleus accumbens and striatum. Psychopharmac〇l〇gy l36 : 153-61 Perry KW5 Fuller Rw (1992) . Effect of fluoxetine on serotonin and dopamine concentration in microdialysis fluid from rat striatum，Life Sci 50 : 1683-90.歐藍西平（3 毫 克/公斤）及氟克西汀（10毫克/公斤）單獨及結合得自老鼠額前區皮質 透析液之銳胺，原腎上腺纽多巴胺之作·如上所述。此等試驗之 數據係摘錄於下表： 羥色胺 時間(小時） 歐藍西平 3 mg/kg (%基線） 氟克西汀 1 〇 mg/kg (%基線） 歐藍西平+ 氟克西汀 (%基線） 1 101·7±13·7 367.6*±56.5 283.5*±28.3 2 123·0 士 14·4 331·6*±50·4 259.5*±20.5 3 118·6±56.9 373.1*±52.6 291·0*±20·6 4 102.8±13.0 _1^2*±65.6 338.3*±32·8 *=ρ <0.05相對於基線濃度 U：\TYPE\LAN^\2 DOCLANX19 2- 541178 此轉魏明歐藍西平單獨對羥色胺濃度财很少或沒有作用。氣克西 / 丁在70正#個小時期間顯著提綠色胺濃度，提升濃度至超過基線之 35〇〇/〇歐風西平及氟克的結合不會料麟列於氟克西;了單獨之作 用0 多巴胺濃;I之 氟克西ί丁 歐監西平+ 10 mg/kg 氟克西汀 (%基線） (%基線） ϊτΐτΤί^τ- 361.4*±28.3# 143.Γ±7.7 324·3*±36·3# 143·5*±12·7 348.8*±36.3# 134.0* + 4.4 315·0*±30·5# 時間(小時) T 2 3 4 歐藍西平 3 mg/kg j%基線） 229L0*±27.7 165.2*±17·7 1〇2·0±6·7 1〇7·5±15·8 *=ρ <0.05相對於基線濃度 # = ρ<0·05結合相對於單一藥物達成之濃度 此等數據綱歐藍西平顯著影響投藥後第卜2小時之多巴胺濃度，俾 作用迅速降低。氟克西汀在實驗期間提高多巴胺濃度至基線之约 15〇%。在4小時後，作用趨近於基線。驚娜，麟西平及氟克西碎 結合在整個4小時期間，提升並維持多巴胺之濃度至超過基線之 300% 0 星賢上毯盘 時間(小時） 歐藍西平 3 mg/kg (%基線） 氟克西汀 10 mg/kg (%基線） 歐藍西平+ 氟克西汁 (%基線） ^ ^1 164.Γ±11.8 209.0*±26.1 272·3*±15.7 2 137.7*±12.9 178.2*土17.7 253.5*±16.9# 3 102·2±8·2 188·5*±14·3 268.7* ±24.3# 4 106·0±7·8 179·7*±27·0 241·6*±27·6 *二P <0.05相對於基線濃度 # = ρ<0·05結合相對於單一藥物達成之濃度 uaTYPE\LAN\B\2D〇CLANM9 此等數據說明歐藍西平顯著影響投藥後第丨，2小時之原腎上腺素濃 度’但其作用迅速降低。氟克西;;了在實驗期間持續提高原腎上腺素濃度 至基線之約18G%。麟地，歐藍西平及氟克西;丁之結合在投藥後i至3 小時提高並維持原腎上腺素濃度至超過基線之25〇%。在第4小時，原 腎上腺素之作用減少至約基線之240。/。。基於此等實驗結果，歐藍西平 及氟克西汀之結合提升原腎上腺素及多巴胺的濃度高於單一化合物所造 成之增加。 U:\TYPE\LAN\B\2 DOCLANM9 -4-
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| JP6869988B2 (ja) | 2015-12-23 | 2021-05-12 | ニューロクライン バイオサイエンシーズ，インコーポレイテッド | （Ｓ）−（２Ｒ，３Ｒ，１１ｂＲ）−３−イソブチル−９，１０−ジメトキシ−２，３，４，６，７，１１ｂ−ヘキサヒドロ−１Ｈ−ピリド［２，１−ａ］イソキノリン−２−イル２−アミノ−３−メチルブタノエートジ（４−メチルベンゼンスルホネート）の調製のための合成方法 |
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| TW201919622A (zh) | 2017-09-21 | 2019-06-01 | 美商紐羅克里生物科學有限公司 | 高劑量戊苯那嗪（valbenazine）調配物及組合物、方法以及相關套組 |
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| AU2017435893B2 (en) | 2017-10-10 | 2023-06-29 | Neurocrine Biosciences, Inc | Methods for the administration of certain VMAT2 inhibitors |
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| CN108938645A (zh) * | 2018-08-24 | 2018-12-07 | 山西医科大学第医院 | 一种抗精神病药物组合物 |
| CN108938635A (zh) * | 2018-08-24 | 2018-12-07 | 山西医科大学第医院 | 一种低剂量非典型抗精神病药物组合物 |
| CN108926569A (zh) * | 2018-08-24 | 2018-12-04 | 山西医科大学第医院 | 一种非典型抗精神病药物组合物 |
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| CN111084778B (zh) * | 2019-12-31 | 2022-06-24 | 北京鑫开元医药科技有限公司 | 一种奥氮平盐酸氟西汀胶囊及其制备方法 |
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