WO1991016896A1 - Composition pharmaceutique utilisee dans le traitement de douleurs - Google Patents

Composition pharmaceutique utilisee dans le traitement de douleurs Download PDF

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Publication number
WO1991016896A1
WO1991016896A1 PCT/US1991/002985 US9102985W WO9116896A1 WO 1991016896 A1 WO1991016896 A1 WO 1991016896A1 US 9102985 W US9102985 W US 9102985W WO 9116896 A1 WO9116896 A1 WO 9116896A1
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analgesic
misoprostol
dosage
agent
recited
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PCT/US1991/002985
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English (en)
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Michael F. Rafferty
Awilda Stapelfeld
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G.D. Searle & Co.
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Publication of WO1991016896A1 publication Critical patent/WO1991016896A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins

Definitions

  • the invention herein is directed to a new pharmaceutical composition useful in the treatment of pain which comprises two active ingredients, namely a nonsteroidal anti-inflammatory agent and a prostaglandin, which prostaglandin exhibits analgesic activity.
  • the nonsteroidal anti-inflammatory agent can be selected from diclofenac, ibuprofen and piroxicam.
  • the prostaglandin is misoprostol, (+) methyl 11a, 16-dihydroxy-16-methyl-9-oxoprost-l3E-en-l-oate.
  • the invention herein is also directed to a new method for treating mild to moderate pain by administering one of the above-mentioned nonsteroidal anti-inflammatory agents in an amount which by itself would provide less than a therapeutic analgesic effect and misoprostol in an amount sufficient to potentiate the analgesic effect of the nonsteroidal anti-inflammatory agent to the desired therapeutic analgesic effect.
  • Nonsteroidal anti-inflammatory drugs comprise a class of drugs which have long been recognized as having high therapeutic value especially for the treatment of inflammatory conditions such as experienced in inflammatory diseases like osteoarthritis (OA) and rheumatoid arthritis (RA) .
  • NSAIDs are also widely regarded as having high therapeutic value in the treatment of mild to moderate pain. While the NSAIDs present a beneficial therapeutic value they also have been known to exhibit undesirable side effects. An especially undesirable side effect of the administration of NSAIDs is the ulcerogenic effects generally associated with chronic use. In chronic use of NSAIDs, use of high dosages of NSAIDs and especially the use of NSAIDs by the elderly can lead to NSAID induced ulcers. NSAID induced ulcers in the stomach can be dangerous. Such ulcers generally exhibit little or few symptoms and can cause dangerous
  • prostaglandins have been shown to prevent NSAID induced ulcers.
  • the prostaglandin compound commercially available under the USAN (United States Adopted Name) name misoprostol is a pharmaceutically acceptable prostaglandin which has been accepted for use in the prevention of NSAID induced ulcers in many countries, including the United States. Misoprostol is commercially available by prescription in such countries.
  • E-type prostaglandins are recognized as modulators of pain sensitivity. However, the extent and nature of the modulation is not well understood nor predictable. A review of the scientific literature reveals that the nature and direction of this modulatory effect can differ depending upon experimental design and investigator. Both PGE j ⁇ and PGE 2 have been reported to potentiate the behavioral response (writhing) to intraperitoneal phenylbenzoguinone injection in mice
  • HEET NSAID administration and which composition would exhibit enhanced analgesic activity Such a composition could thereby provide the same or greater analgesic therapeutic benefit using less NSAID and thereby further decrease the likelihood of the undesirable NSAID ulcerogenic side effect due to the decreased amount of NSAID and the cytoprotective activity of the prostaglandin. Such a combination would provide an improved NSAID with respect to both efficacy and safety.
  • the present invention is directed to a method for imparting analgesia, relief from mild to moderate pain, to a patient in need thereof by administering, concomitantly or simultaneously, a nonsteroidal anti-inflammatory agent and the prostaglandin, misoprostol in an effective dose to potentiate the analgesic effect of the NSAID.
  • the present invention is directed to a method for treating mild to moderate pain in a subject in need of such therapy, which method provides a desired therapeutic analgesic effect sufficient to relieve the mild to moderate pain.
  • the method is performed by administering an analgesic agent, selected from the nonsteroidal anti-inflammatory agents (NSAIDs) diclofenac, ibuprofen and piroxicam, or their pharmaceutically acceptable salts, in a dosage which by itself would provide less than the desired therapeutic analgesic effect and administering misoprostol in an effective dosage which is sufficient to potentiate the analgesic effect of the selected dosage of the analgesic agent to the desired therapeutic analgesic effect.
  • an analgesic agent selected from the nonsteroidal anti-inflammatory agents (NSAIDs) diclofenac, ibuprofen and piroxicam, or their pharmaceutically acceptable salts
  • NSAIDs nonsteroidal anti-inflammatory agents
  • ibuprofen and piroxicam or their pharmaceutically acceptable salts
  • the composition includes an analgesic agent selected from diclofenac, ibuprofen, piroxicam and their pharmaceutically acceptable salts in an amount of the analgesic agent which by itself would provide less than the desired therapeutic analgesic effect.
  • the composition also includes the prostaglandin, misoprostol, in an amount which is sufficient to potentiate the analgesic effect of the analgesic agent to the desired therapeutic analgesic effect.
  • Figure 1 is an isobolographic analysis of coadministered misoprostol and diclofenac calculated ED 50 values
  • Figure 2 is an isobolographic analysis of coadministered misoprostol and ibuprofen calculated ED 50 values
  • Figure 3 is an isobolographic analysis of coadministered misoprostol and piroxicam calculated ED 50 values
  • Figure 4 is a graphic analysis of coadministered misoprostol and diclofenac showing a comparison of actual versus predicted responses
  • Figure 5 is a graphic analysis of coadministered misoprostol and ibuprofen showing a comparison of actual versus predicted responses
  • Figure 6 is a graphic analysis of coadministered misoprostol and piroxicam showing a comparison of actual versus predicted responses
  • Figure 7 is a graphic representation illustrating the possible dose ranges for misoprostol and an analgesic agent.
  • the invention herein is directed to a composition and a method for treating mild to moderate pain in a subject (either human or animal, i.e., mammal) in need of such treatment by administering, concomitantly or simultaneously, misoprostol and a nonsteroidal anti-inflammatory agent selected from diclofenac, ibuprofen, piroxicam and their pharmaceutically acceptable salts.
  • misoprostol selected from diclofenac, ibuprofen, piroxicam and their pharmaceutically acceptable salts.
  • a nonsteroidal anti-inflammatory agent selected from diclofenac, ibuprofen, piroxicam and their pharmaceutically acceptable salts.
  • analgesic agents One benefit derived from the method herein is that the
  • administration of the misoprostol potentiates the analgesic activity of the analgesic agent such that the analgesic agent can be used in a dosage less than the dosage which would be used if the analgesic agent were used by itself.
  • the administration of the misoprostol enhances the analgesic activity of the analgesic agent by potentiation such that the amount of analgesic agent administered to obtain a desired therapeutic analgesic effect can be reduced but the desired therapeutic analgesic effect can be achieved.
  • the opportunity to use less NSAID especially in combination with a cytoprotective prostaglandin reduces the likelihood of occurrence of the undesirable side effect of the NSAID inducing an ulcer.
  • the practice of the method and use of the composition herein can diminish the likelihood and/or occurrence of such a deleterious side effect.
  • other benefits can be derived from the composition and method herein.
  • prostaglandins including misoprostol, have shown anti- inflammatory activity. Therefore, the combination of the prostglandin with the NSAID can beneficiate or increase the anti-inflammatory activity of the combination or coadministration regimen. That is, the composition or coadministration regimen can exhibit a greater anti-inflammatory activity than the administration of the NSAID alone.
  • misoprostol exhibits a potentiating effect on the analgesic activity exhibited by the above-described analgesic agents.
  • Misoprostol is shown by the following formula: With regard to the illustrated structure, the dashed line indicates the group extends behind the plane of the paper and the solid, blackened triangular shape indicates that the group projects from the plane of the paper.
  • the prostaglandin, misoprostol can be prepared by known reaction schemes such as by the methods taught in U. S. Patents 3,965,143, 4,452,994, 4,529,811 and 4,777,275.
  • the individual isomers can be obtained by chromatographic separation such as taught in U.S. Patent 4,060,691.
  • the dosage regimen for the method of this invention is selected in accordance with a variety of factors including the type, age, weight, sex, and medical condition of the patient, the route of administration, the extent of the mild to moderate pain of the patient and the particular nonsteroidal anti-inflammatory agent employed.
  • Dosages of misoprostol useful in the method herein are in the range up to 1600 ⁇ g per day. A preferred range is up to 800 ⁇ g per day. Greater or lesser dosages can be used, depending upon the above-noted factors. It is preferred to use as low a dose of misoprostol as possible to obtain the desired potentiation of the therapeutic analgesic benefit of the analgesic agent.
  • misoprostol The lowest dose of misoprostol is dependent upon the analgesic agent with which it is to be administered and is balanced against the desire to use a low dosage of the selected analgesic agent. Based upon the studies described hereinafter, misoprostol can be used in an amount from about 5 ⁇ g to about 200 ⁇ g per tablet and in a dosage from about 25 ⁇ g to about 1600 ⁇ g per day.
  • nonsteroidal anti-inflammatory agent and "analgesic agent” as used herein, include diclofenac,
  • the term "desired therapeutic analgesic effective dosage” as used herein means, with respect to the nonsteroidal anti-inflammatory agent, the dose sufficient for imparting the requisite suppression/alleviation of mild to moderate pain in a patient in need of such therapy.
  • the specific dose is dependent upon the same factors noted above with respect to the dosage of prostaglandin. The determination of the specific dosage for a subject is well within the skill of the prescribing physician.
  • the Physician's Desk Reference, 44th Edition (1990) lists the daily single dosages for various nonsteroidal anti-inflammatory agents.
  • mild to moderate pain is a term accepted and understood by those skilled in the medicinal arts and especially, trained medical doctors.
  • a mild pain means a pain which does not cause the subject to modify a behavior
  • a moderate pain means a pain which would cause a subject to modify a behavior.
  • mild to moderate pain refers to a pain for which a physician would prescribe the general class of NSAID's as an analgesic agent for relieving the pain.
  • pain is a subjective condition, physicians are trained to evaluate a patient's overall condition, history and description of the level of discomfort so as to assess and thereby diagnose the extent of pain. Following such observation and evaluation the physician can prescribe the desired therapeutic analgesic dosage and dosing regimen.
  • the analgesic agent can be present in any dosage which would be below the therapeutically acceptable amount if such analgesic agent at such dosage were administered alone.
  • SHEET diclofenac for treating osteoarthritis is 100 to 150 mg per day in divided doses.
  • the recommended dosage is 150 to 200 mg per day in divided doses.
  • the recommended dosage is 100 to 125 mg per day in divided doses.
  • Diclofenac is currently, commercially available by prescription in tablets containing 25, 50 and 75 mg and is administered in prescribed dosing ranges utilizing these 25 mg, 50 mg and 75 mg tablets.
  • the pharmaceutical composition herein can include an amount up to about 75 mg of diclofenac. Such an amount as up to 75 mg can provide an analgesic effect up to or greater than the current largest commercially available amount of 75 mg.
  • the composition can contain up to but less than 25 mg of diclofenac and exhibit the same or better therapeutic analgesic effect as the 25 mg current commercially available tablet.
  • the composition can contain up to but less than 50 mg, or greater than 25 mg but less than 50 mg, of diclofenac and exhibit the same or better therapeutic analgesic effect as the 50 mg current commercially available tablet.
  • the composition can contain up to but less than 75 mg, or greater than 50 mg but less than 75 mg, of diclofenac and exhibit the same or better therapeutic analgesic effect as the 75 mg current commercially available tablet.
  • the pharmaceutical composition includes a dosage of up to about 25mg.
  • An amount up to 25 mg is desirable as it is less than the current commercially available lowest dosage but is an amount which can provide the same or better analgesic therapeutic effect than the commercially available 25 mg tablet.
  • Such a dosage provides an advantage in that it can provide a therapeutic benefit using a relatively low dosage of the NSAID.
  • Various excipients can be combined with the diclofenac as is well known in the
  • the diclofenac can be administered in an amount up to about 200 mg per day and preferably in an amount up to about 100 mg per day in divided doses or in a single dose.
  • the current commercially available diclofenac tablets can be administered.
  • the NSAID can be piroxicam.
  • piroxicam capsules contain either 10 mg or 20 mg of piroxicam.
  • the PDR, 44th Edition recommends that piroxicam be administered in a single daily dose of 20 mg for rheumatoid arthritis and osteoarthritis.
  • the pharmaceutical composition herein can contain up to 20 mg and preferably contains less than 10 mg of piroxicam.
  • the use of an amount up to 20 mg can provide an analgesic therapeutic benefit equivalent or greater than a 20 mg dosage of piroxicam by itself.
  • the use of an amount up to 10 mg can provide a therapeutic analgesic benefit equivalent or greater than the use of 10 mg of piroxicam by itself, which 10 mg is the lowest dosage now currently available.
  • the composition can contain up to but less than 10 mg of piroxicam and exhibit the same or better therapeutic analgesic effect as the 10 mg current commercially available tablet.
  • the composition can contain up to but less than 20 mg, or greater than 10 mg but less than 20 mg, of piroxicam and exhibit the same or better therapeutic analgesic effect as the 20 mg current commercially available tablet.
  • Various excipients can be present, provided such excipients do not exhibit a destabilizing effect on either the piroxicam or the prostaglandin.
  • the piroxicam can be administered in an amount up to about 20 mg per day and preferably in an amount up to about 10 mg per day in either divided doses or in a single dose.
  • the current commercially available piroxicam tablets can be administered.
  • the NSAID can be ibuprofen.
  • Ibuprofen is available as an over-the-counter analgesic agent in tablets containing 200 mg.
  • Ibuprofen is available by prescription in tablets containing 300, 400, 600 and 800 mg of ibuprofen.
  • the PDR, 44th Edition recommends that ibuprofen be administered in dosages of 1200 mg to 3200 mg daily for rheumatoid and osteoarthritis; in dosages of 400 mg every 4 to 6 hours as necessary for relief of mild to moderate pain; and in dosages of 400 mg every 4 hours for dysmenorrhea.
  • the pharmaceutical composition herein can include up to about 800 mg of ibuprofen and preferably up to about 200 mg of ibuprofen.
  • An amount up to 800 mg can provide the equivalent or greater analgesic therapeutic benefit than the use of 800 mg of ibuprofen by itself.
  • the use of up to 200 mg can provide an analgesic therapeutic benefit equivalent or greater than the current commercially available lowest dosage tablet of 200 mg.
  • the composition can contain up to but less than 200 mg of ibuprofen and exhibit the same or better therapeutic analgesic effect as the 200 mg current commercially available tablet.
  • the composition can contain up to but less than 300 mg, or greater than 200 mg but less than 300 mg, of ibuprofen and exhibit the same or better therapeutic analgesic effect as the 300 mg current commercially available tablet.
  • the composition can contain up to but less than 400 mg, or greater than 300 mg but less than 400 mg, of ibuprofen and exhibit the same or better therapeutic analgesic effect as the 400 mg current commercially available
  • the composition can contain up to but less than 600 mg, or greater than 400 mg but less than 600 mg, of ibuprofen and exhibit the same or better therapeutic analgesic effect as the 600 mg current commercially available tablet.
  • the composition can contain up to but less than 800 mg, or greater than 600 mg but less than 800 mg, of ibuprofen and exhibit the same or better therapeutic analgesic effect as the 800 mg current commercially available tablet.
  • Various excipients can be present, provided such excipients do not exhibit a destabilizing effect on either the ibuprofen or the prostaglandin.
  • the ibuprofen can be administered in an amount up to about 3200 mg per day and preferably in an amount up to about 1200 mg per day in either divided doses or in a single dose.
  • the current commercially available ibuprofen tablets can be administered.
  • misoprostol, NSAID or composition herein can be formulated into pharmaceutically acceptable dosage forms by conventional methods known to the pharmaceutical art.
  • the commercially available forms, formulations and compositions of the NSAIDs and misoprostol can be used. Similar formulations but with lower amounts of the NSAIDs can be used in the practice of the invention herein.
  • a particularly preferred formulation for misoprostol is taught in U.S. Patent 4,301,146.
  • misoprostol, NSAID or composition herein can be administered in such oral unit dosage forms as tablets, capsules, pills, powders, or granules. They can be administered intraperitoneally, subcutaneously, or intramuscularly, using forms known in the pharmaceutical art. In general, the preferred form of administration is oral.
  • E SHEET method and composition is that the misoprostol is an orally available prostaglandin and can be formulated into orally available dosage forms.
  • An advantage of oral availability is that the methodology of administration is easy to follow and does not require an attending, skilled medical professional. Oral availability is also an accepted and expected method of treatment for mild to moderate pain relief.
  • the method herein is performed by administering the nonsteroidal anti-inflammatory agent and misoprostol to the patient in need of such therapy in the dosage forms and the dosages set forth herein.
  • the two components can be administered simultaneously or concomitantly.
  • the order of administration of the two active ingredients is not critical, although it can be beneficial to administer the misoprostol first to benefit from the cytoprotective properties in preventing NSAID induced ulcers.
  • a particularly preferred manner of treatment is the co-administering of the two active ingredients in a single dosage form such as a tablet or capsule.
  • the sequencing and timing of the performance of the steps of the method herein are well within the skill of a physician prescribing an analgesic regimen.
  • Figure 7 illustrates a plot of the dosage of NSAID versus the dosage of misoprostol.
  • the dosage for the NSAID is represented along the y axis and the dosage for misoprostol is represented along the x axis.
  • the point represented by A along the x axis is the minimum effective amount of misoprostol which potentiates the analgesic activity of an NSAID, which amount is about 25 micrograms (meg or ⁇ g) per day or about 5 meg per tablet.
  • the point represented by B along the x axis is the maximum tolerable daily dosage for misoprostol, which has been found to be as high as
  • SUBSTITUTE SHEET about 1600 meg per day.
  • the PDR, 44th Edition states that cumulative daily doses of 1600 meg have been tolerated by humans with only symptoms of gastrointestinal discomfort being reported. Therefore, it is preferable to use an amount of misoprostol up to about 1600 meg per day and preferably as low a dosage as possible when balanced against the dosage of NSAID administered.
  • the PDR also states that the recommended adult oral dose for Cytotec (G.D.Searle and Co's brand of misoprostol) for the prevention of NSAID induced gastric ulcers is 200 meg four times daily with food, thereby providing a recommended daily dosage of 800 meg.
  • the points along the y axis will be described in general terms as the specifics of the locations of such points depend upon the NSAID selected.
  • the point represented by C along the y axis is the minimum dosage of an NSAID which would provide a therapeutic benefit in alleviating mild to moderate pain.
  • the point represented as D on the graph is the maximum daily dosage for an NSAID.
  • the point represented by E is the combined dosage for the NSAID and misoprostol and represents the activity for the minimum dosage of NSAID and minimum dosage of misoprostol.
  • the point identified as F is the intersection of the lines extended from the maximum dosages for both the misoprostol and NSAID.
  • the line EF represents the line which would be formed interconnecting the minimum dosages for the misoprostol and NSAID in combination for the ED values, e.g., ED 10 , ED 20 , ED 30 , etc.
  • the area bounded by the lines A B F D C A represent acceptable pharmaceutical dosages for the combination of misoprostol with an NSAID.
  • the area bounded by the lines E F D C E represents the preferred dosages for the combination of NSAID and misoprostol as such an area represents the greatest analgesic activity with the minimum acceptable dose of misoprostol. For each of the NSAIDs herein, such an area is reflected in a range of NSAID to misoprostol of 3:1 for diclofenac, 5:1 for ibuprofen and 1:1 for piroxicam.
  • the efficacy of the composition herein for use in treating mild to moderate pain was shown in the phenyl-benzoquinone-induced writhing test in the mouse.
  • This model is widely used as a primary in vivo efficacy screen for the detection of a wide variety of analgesic agents.
  • Diclofenac sodium-[o-[2,6-dichlorophenyl]- amino]phenyl]-acetate
  • NSAID sodium-[o-[2,6-dichlorophenyl]- amino]phenyl]-acetate
  • the following example illustrates the effect of misoprostol and the NSAIDs herein in pain relief in the mouse writhing assay.
  • Example 1 Method for Mouse Writhing Assay. This experiment is recognized for the screening of compounds for use as analgesic agents. Diclofenac has been reported in the literature to be active in this assay following oral administration, with an ED 50 value of 4.3 mg/kg i.g., Menasse et al, "Pharmacological Properties of Diclofenac Sodium and its Metabolites," Scand. J. Rheumatology 22(suppl.): 5-16; 1978. In this experiment the ability of misoprostol, certain NSAIDs and combinations of misoprostol with such NSAIDs to suppress the chemically induced writhing response in mice was determined.
  • mice Male albino mice (Charles River Laboratory; CD-I, 20-30 grams were randomly divided into groups of ten and weighed. Twenty-five minutes after intragastric (i.g.) administration of the test compound, 0.025% w/v phenylbenzoquinone (PBQ) was injected intraperitoneally (i.p.; 0.1 ml/10 grams of body weight). Five minutes after i.p. injection of PBQ, each animal was placed into a large glass beaker and the number of writhes that occurred in the subsequent ten minutes was counted. A writhe consisted of a dorsoflexion of the back, extension of the hindlimbs, and strong contraction of the abdominal musculature.
  • PBQ phenylbenzoquinone
  • Test compounds were considered to have significantly inhibited the writhing response if the number of writhes observed was less than or equal to one half of the median number of writhes recorded for the control group of mice on the same day (Taber, R.I., "Predictive Value of Analgesic Assays in Mice and Rats," Advances in Biochemical Psychopharmacology, vol. 8, p 191, (1974)).
  • the number of writhes for each animal was converted to the square root function.
  • the effective dose (ED 50 ) that inhibited writhing 50% compared to control values was determined by a regression analysis of the least squared means.
  • this procedure of analysis is performed by first determining the ED 50 values for the two agents separately and plotting these values on separate axes. A line is drawn between the two values which line represents the theoretical dose-additivity line. If the pharmacological effects of the two drugs when coadministered add together, then any dose combination represented by a point on the line will produce an ED 50 efficacy. The next step in the analysis was the evaluation of a series of dose combinations and identification of combinations which would generate an ED 50 response. These values are plotted on the graph. If the values fall on the line, then the drugs are additive.
  • SHEET isobolographs for the combination of misoprostol with diclofenac, piroxicam and ibuprofen all show the empirically determined values to be inside the line of additivity and, therefore, synergistic.
  • Figure 1 there is shown the isobolographic analysis of coadministered misoprostol and diclofenac.
  • the ED 50 for diclofenac alone was 1.8 mg/kg.
  • the ED 50 for misoprostol alone was 0.6 mg/kg.
  • the isobolographic analysis shows that an ED 50 for the coadministered misoprostol and diclofenac could be obtained using 0.05 mg/kg of diclofenac with a 0.02 mg/kg of misoprostol. This represents a 36 fold decrease in the ED 50 value.
  • an isobolographic analysis is illustrated for the coadministered misoprostol with ibuprofen.
  • the graph is based upon results from the mouse writhing assay.
  • the ED 50 for misoprostol 0.6 mg/kg and for ibuprofen is 3 mg/kg.
  • misoprostol was present in amount of 0.01 mg/kg.
  • the ibuprofen was present in amount of about 0.08 mg/kg.
  • the ibuprofen exhibited about a 38 fold decrease in dose. That is 1/38 the amount of ibuprofen can be used when coadministered with misoprostol to thereby obtain the same analgesic activity as would be predicted for a dose 38 times as great.
  • Figure 3 represents the isobolographic analysis of coadministered misoprostol and piroxicam.
  • the misoprostol is plotted along the x axis and piroxicam is plotted along the y axis.
  • Figure 3 and the results of the mouse writhing assay performed using coadministered misoprostol and piroxicam there was about a 67 fold decrease in the amount of piroxicam required when combined with 0.009 mg/kg of misoprostol.
  • the use of the method herein can enhance the analgesic effect of a mild to moderate pain relief therapeutic regimen which includes the administration of a nonsteroidal anti-inflammatory agent.
  • the method can thus provide the desired extent of pain relief by using a lower dose of the nonsteroidal anti-inflammatory
  • the method can, therefore, reduce the incidence of gastrointestinal side effects of the nonsteroidal anti-inflammatory agent.
  • the use of an amount of NSAID which is less than the normal amount which would be prescribed, i.e., the normal therapeutic amount, is a significant improvement over the current NSAID therapeutic regimen.
  • prostaglandins have been disclosed as being useful in adjunctive therapy with normal therapeutic dosages of NSAIDs in order to diminish the ulcerogenic side effects of the NSAID administration.
  • the improved method and composition herein is beneficial in that it provides the opportunity to use less NSAID (lower dosage) than heretofore was believed to be therapeutic.
  • the combination of an NSAID with misoprostol creates an attractive therapy for mild to moderate pain relief.
  • the invention herein of employing a prostaglandin which potentiates the analgesic effect of a particular NSAID (one which is capable of interacting with a potentiating prostaglandin to produce an analgesic- potentiated effect) in an effective amount to potentiate such effect is especially beneficial in that it reduces the amount of NSAID administered, it reduces the liklihood of ulcer formation, it aids in the healing of ulcers (if formed) , and it alleviates the mild to moderate pain for which it was administered.
  • the formulation can be formed in an admixture as disclosed in copending patent application ser. no. , titled “Stabilized Pharmaceutical Admixture Composition,” of Franz et. al. (docket no. 2609) or in a tablet such as disclosed in copending patent application ser. no. , titled "Pharmaceutical Composition

Abstract

Composition pharmaceutique et procédé de traitement de douleurs bénignes à modérées chez un sujet nécessitant un tel traitement, consistant à administrer un agent analgésique choisi parmi le diclofénac, l'ibuprofène, le piroxycam ainsi que leurs sels pharmaceutiquement acceptables en une posologie qui par elle-même a un effet inférieur à l'effet thérapeutique, et à administrer du misoprostol en une posologie suffisante pour potentialiser l'effet analgésique de l'agent analgésique jusqu'à obtention de l'effet thérapeutique.
PCT/US1991/002985 1990-05-03 1991-05-01 Composition pharmaceutique utilisee dans le traitement de douleurs WO1991016896A1 (fr)

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US5474985A (en) * 1993-12-22 1995-12-12 The Regents Of The University Of California Preventing and treating elevated intraocular pressure associated with administered or endogenous steroids using non-steroidal cyclooxygenase inhibitors
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US5674888A (en) * 1995-06-07 1997-10-07 University Of California Method for the treatment of a trabecular meshwork whose cells are subject to inhibition of cell division
US8852636B2 (en) 2001-06-01 2014-10-07 Pozen Inc. Pharmaceutical compositions for the coordinated delivery of NSAIDs
US8945621B2 (en) 2009-06-25 2015-02-03 Pozen Inc. Method for treating a patient at risk for developing an NSAID-associated ulcer
US9220698B2 (en) 2008-09-09 2015-12-29 Pozen Inc. Method for delivering a pharmaceutical composition to patient in need thereof
US9539214B2 (en) 2011-12-28 2017-01-10 Pozen Inc. Compositions and methods for delivery of omeprazole plus acetylsalicylic acid

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EP0682521A1 (fr) * 1993-02-12 1995-11-22 McKEE, Rex N. Procede de traitement au misoprostol de muqueuses et de tissus epitheliaux presentant des lesions
EP0682521A4 (fr) * 1993-02-12 1997-07-30 Rex N Mckee Procede de traitement au misoprostol de muqueuses et de tissus epitheliaux presentant des lesions.
US5474985A (en) * 1993-12-22 1995-12-12 The Regents Of The University Of California Preventing and treating elevated intraocular pressure associated with administered or endogenous steroids using non-steroidal cyclooxygenase inhibitors
US5599535A (en) * 1995-06-07 1997-02-04 Regents Of The University Of California Methods for the cyto-protection of the trabecular meshwork
US5674888A (en) * 1995-06-07 1997-10-07 University Of California Method for the treatment of a trabecular meshwork whose cells are subject to inhibition of cell division
WO1997011701A1 (fr) * 1995-09-27 1997-04-03 Merck-Frosst Canada Inc. Compositions de traitement d'inflammations contenant certaines prostaglandines et un inhibiteur de cyclo-oxygenase-2 selectif
US9161920B2 (en) 2001-06-01 2015-10-20 Pozen Inc. Pharmaceutical compositions for the coordinated delivery of NSAIDs
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US9707181B2 (en) 2001-06-01 2017-07-18 Pozen Inc. Pharmaceutical compositions for the coordinated delivery of NSAIDs
US8852636B2 (en) 2001-06-01 2014-10-07 Pozen Inc. Pharmaceutical compositions for the coordinated delivery of NSAIDs
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US9364439B2 (en) 2001-06-01 2016-06-14 Pozen Inc. Pharmaceutical compositions for the coordinated delivery of NSAIDs
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US9220698B2 (en) 2008-09-09 2015-12-29 Pozen Inc. Method for delivering a pharmaceutical composition to patient in need thereof
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US9801824B2 (en) 2008-09-09 2017-10-31 Pozen Inc. Method for delivering a pharmaceutical composition to patient in need thereof
US8945621B2 (en) 2009-06-25 2015-02-03 Pozen Inc. Method for treating a patient at risk for developing an NSAID-associated ulcer
US9539214B2 (en) 2011-12-28 2017-01-10 Pozen Inc. Compositions and methods for delivery of omeprazole plus acetylsalicylic acid
US9987231B2 (en) 2011-12-28 2018-06-05 Pozen Inc. Compositions and methods for delivery of omeprazole plus acetylsalicylic acid
US10603283B2 (en) 2011-12-28 2020-03-31 Genus Lifesciences, Inc. Compositions and methods for delivery of omeprazole plus acetylsalicylic acid

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PT97563A (pt) 1992-01-31
AU7793791A (en) 1991-11-27
IE911487A1 (en) 1991-11-06

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