Classifications

• • 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
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/06—Antigout agents, e.g. antihyperuricemic or uricosuric agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention involves a drug combination comprising an inhibitor of cyclooxygenase-2 in combination with a neurokinin-1 (NK-1) receptor antagonist.
• NK-1 neurokinin-1
• Inhibitors of cyclooxygenase-2 are a sub-class of the class of drugs known as non-steroidal antiinflammatory drugs (NSAIDs).
• NSAIDs non-steroidal antiinflammatory drugs
• the NSAIDs are active in reducing the prostaglandin-induced pain and swelling associated with the inflammation process but are also active in affecting other prostaglandin-regulated processes such as maintenance of the gastric lining.
• use of high doses of most common NSAIDs can produce severe side effects, including life threatenting ulcers, that limit their therapeutic potential.
• An alternative to NSAIDs is the use of corticosteroids, which have even more serious side effects, especially when long term therapy is involved.
• Previous NSAIDs have been found to prevent the production of prostaglandin by inhibiting enzymes in the human arachidonic acid/prostaglandin pathway including the enzyme cyclooxygenase (COX).
• COX cyclooxygenase
• COX-1 is constitutively expressed and is involved with physiological functions
• COX-2 is induced locally in inflamed tissue.
• conventional NSAIDs block both forms of the enzyme
• the inducible COX-2 enzyme associated inflammation has provided a more focussed drug target which should enable effective antiinflammatory analgesia with reduced gastrointestinal side effects.
• Many compounds which have activity as COX-2 inhibitors have been identified, and clinical trials are reported to be in progress.
• Neurokinin 1 (NK-1; substance P) receptor antagonists are being developed for the treatment of a number of physiological disorders associated with an excess or imbalance of tachykinins, and in particular substance P.
• Substance P has been implicated in the pathology of a number of inflammatory conditions (see, for instance, International (PCT) patent specification Nos. WO 95/16679, WO 95/18124 and WO 95/23798).
• Improved therapies for treating and preventing inflammatory disorders are currently being sought for the large number of individuals who are at risk from these disorders.
• the present invention addresses this problem by providing a combination therapy comprised of a COX-2 inhibitor with a NK-1 receptor antagonist.
• the COX-2 inhibitor together with the NK-1 receptor antagonist provide enhanced treatment options as compared with administration of either the COX-2 inhibitor or the NK-1 receptor antagonist alone.
• the present invention provides a novel drug combination comprised of a COX-2 inhibitor in combination with a NK-1 receptor antagonist, which is useful for treating, preventing, reducing the progression, and/or reducing the risk of developing inflammatory disorders.
• the present invention accordingly provides the use of a COX-2 inhibitor in combination with a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of inflammatory disorders.
• the present invention also provides a method for the treatment or prevention of inflammatory disorders, which method comprises administration to a patient in need of such treatment an amount of a COX-2 inhibitor and an amount of a NK-1 receptor antagonist, such that together they give effective relief.
• a pharmaceutical composition for the treatment or prevention of inflammatory disorders comprising a COX-2 inhibitor and a NK-1 receptor antagonist, together with at least one pharmaceutically acceptable carrier or excipient.
• COX-2 inhibitor and the NK-1 receptor antagonist may be present as a combined preparation for simultaneous, separate or sequential use for the treatment or prevention of inflammatory disorders.
• Such combined preparations may be, for example, in the form of a twin pack.
• a product comprising a COX-2 inhibitor and a NK-1 receptor antagonist as a combined preparation for simultaneous, separate or sequential use in the treatment or prevention of inflammatory disorders.
• both the COX-2 inhibitor and the NK-1 receptor antagonist will be administered to a patient, within a reasonable period of time.
• the compounds may be in the same pharmaceutically acceptable carrier and therefore administered simultaneously. They may be in separate pharmaceutical carriers such as conventional oral dosage forms which are taken simultaneously.
• the term “combination” also refers to the case where the compounds are provided in separate dosage forms and are administered sequentially. Therefore, by way of example, the COX-2 inhibitor may be administered as a tablet and then, within a reasonable period of time, the NK-1 receptor antagonist may be administered either as an oral dosage form such as a tablet or a fast-dissolving oral dosage form.
• a fast dissolving oral formulation is meant, an oral delivery form which when placed on the tongue of a patient, dissolves within about 10 seconds.
• COX-2 mediated diseases and disorders includes inflammatory diseases susceptible to treatment with a non-steroidal anti-inflammatory agent.
• Such "inflammatory disorders” include rheumatoid arthritis, degenerative joint diseases (osteoarthritis), bursitis, tendinitis, ankylosing spondylitis, gout and synovitis.
• inhibitor of cyclooxygenase-2 means compounds which selectively inhibit cyclooxygenase-2 over cyclooxygenase-1.
• the compounds have a cyclooxygenase-2 IC50 of less than about 2 ⁇ M in the human whole blood COX-2 assay, yet have a cyclooxygenase-1 IC50 of greater than about 5 ⁇ M in the human whole blood COX-1 assay.
• the compounds have a selectivity ratio of cyclooxygenase-2 inhibition over cyclooxygenase-1 inhibition of at least 10, and more preferably of at least 40. The resulting selectivity may indicate an ability to reduce the incidence of common NSAID-induced side effects.
• NS-398, flosulide, nimesulide and L-745,337 are example members.
• a second class is the tricyclic inhibitor class, which can be further divided into the sub-classes of tricyclic inhibitors with a central carbocyclic ring (examples include SC-57666, 1, and 2); those with a central monocyclic heterocyclic ring (examples include DuP 697, SC-58125, SC-58635, and 3, 4 and 5); and those with a central bicyclic heterocyclic ring (examples include 6, 7, 8, 9 and 10).
• Compounds 3, 4 and 5 are described in U.S. Patent No. 5,474,995.
• the third identified class can be referred to as those which are structurally modified NSAIDS, and includes L-761,066 and structure 11 as example members.
• COX-2 inhibitor compounds which are included in the scope of this invention include:
• Patent No. 5,474,995. See Examples herein for compounds 13 and 25; compound 26, U.S. Patent No. 5,633,272. Also incorporated herein by reference are those compounds described in WO 96/41645 as having structural Formula I, shown below, and the definition and preferred definitions and species described therein:
• Particularly preferred compounds of formula (I) include:
• NK-1 receptor antagonists of use in the present invention are described in published European Patent Specification Nos. 0 360 390,
• NK-1 receptor antagonists are those described in European Patent Specification No. 0 577 394, especially compounds of formula (I):
• R 1 is selected from the group consisting of:
• Ci-ealkyl substituted with one or more of the substituents selected from:
• heterocycle wherein the heterocycle is selected from the group consisting of:
• Ci- ⁇ alkyl unsubstituted or substituted with halo, -CF 3 , -OCH3, or phenyl
• R 2 and R 3 are independently selected from the group consisting of:
• R 5 is phenyl, unsubstituted or substituted with halo
• R 6 , R 7 and R 8 are independently selected from the group consisting of:
• Z is hydrogen or C ⁇ - 4 alkyl; and pharmaceutically acceptable salts thereof.
• Particularly preferred compounds of formula (I) are: 4-(3-(l,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S)- phenyl-morpholine;
• NK-1 receptor antagonists are those described in International (PCT) Patent Specification No. WO 95/18124, especially compounds of formula (II) and pharmaceutically acceptable salts thereof:
• a 1 is fluorine or CF3;
• a 2 is fluorine or CF3;
• a 3 is fluorine or hydrogen;
• R 8 is hydrogen, C ⁇ -4 alkyl, C3-7cycloalkyl or C3-7cycloalkylC ⁇ - alkyl, or C2- 4 alkyl substituted by one or two substituents selected from Ci- 4 alkoxy, hydroxyl or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, O and S; or R 7 , R 8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may optionally contain an oxygen or sulphur ring atom, a group S(O) or S(O) 2 or a second nitrogen atom which will be part of a NH or NR C moiety where
• R c is C ⁇ -4 alkyl optionally substituted by hydroxy or Ci- 4 alkoxy; or R 7 , R 8 and the nitrogen atom to which they are attached form a non-aromatic azabicyclic ring system of 6 to 12 ring atoms; or Z, R 7 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms which may optionally contain an oxygen ring atom;
• X is an alkylene chain of 1 to 4 carbon atoms optionally substituted by oxo
• Y is a Ci- 4 alkyl group optionally substituted by a hydroxyl group; with the proviso that if Y is Ci- 4 alkyl, R 6 is susbstituted at least by a group of formula ZNR 7 R 8 as defined above.
• Particularly preferred compounds of formula (II) include: 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl- 1, 2, 3-triazol-4-yl)methyl-3-(S)-phenylmorpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl- 1, 2, 3-triazol-4-yl)methyl-3-(S)-(4-fluorophenyl)morpholine; 2-(R)-(l-(S)-(3,5-bis(trifluoromethyl)phenyl)-2-hydroxyethoxy)-3-(S)-(4- fluorophenyl)-4-(l,2,4-triazol-3-yl)methylmorpholine; and pharmaceutically acceptable salts thereof.
• NK-1 receptor antagonists are those described in European Patent Specification No. WO 95/23798, especially compounds of formula (III):
• R 2 and R 3 are independently selected from the group consisting of:
• R 6 , R 7 and R 8 are independently selected from the group consisting of: (1) hydrogen, (2) Ci-ealkyl,
• R n , R 12 and R 13 are independently selected from the group consisting of:
• A is unsubstituted l- ⁇ alkyl
• B is selected from the group consisting of:
• p is 0 or 1;
• X is selected from:
• Y is -O-
• Z is hydrogen or Ci- ⁇ alkyl; and pharmaceutically acceptable salts thereof.
• Particularly preferred compounds of formula (III) include: (1) 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(5-oxo- lH,4H-l,2,4-triazolo)methyl)morpholine N-oxide; (2) 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(4- (ethoxycarbonyloxy-l-ethyl)-5-oxo-lH-l,2,4- triazolo)methyl)morpholine;
• NK-1 receptor antagonists are those described in
• R 1 represents hydrogen, hydroxy, Ci- ⁇ alkyl, C2-6alkenyl, C3 7cycloalkyl, C3-7cycloalkylCi- alkyl, Ci- ⁇ alkoxy, fluoroCi-6alkoxy, Ci-6alkoxyCi- alkyl, Ci-6alkoxyCi- 4 alkoxy, fluoroCi-6alkoxyC ⁇ .
• R a and R b each independently represent hydrogen, C ⁇ - 4 alkyl or fluoroC ⁇ - 4 alkyl;
• R 3 represents hydrogen, halogen, Ci- ⁇ alkyl, fluorod- ⁇ alkyl, Ci- ⁇ alkoxy, fluoroCi-ealkoxy, C3-7cycloalkyl, C3-7cycloalkylC ⁇ - alkyl, cyano, SR a , SOR a , SO 2 R a , NR a R b , NR a COR 14 , COR a , CO 2 R a , CONR a R b or C ⁇ -4 alkyl substituted by cyano, CO 2 R a or CONR a R b where R a and R b are as previously defined;
• R 4 represents hydrogen, halogen, Ci- ⁇ alkyl, Ci- ⁇ alkoxy, CF3, OCF3, NO 2 , CN, SR a , SOR a , SO 2 R a , C0 2 R a , CONR a R , C -6alkenyl, d-ealkynyl or C ⁇ - alkyl substituted by Ci- 4 alkoxy, where R a and R b are as previously defined; and the broken line represents an optional double bond; and pharmaceutically acceptable salts thereof.
• Particularly preferred compounds of formula (IN) include: (3R,5R,6S)-3-(2-methoxy-5-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7- aza-spiro[4.5]decane;
• NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No.
• Y is (CH 2 ) n wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH 2 ) n may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH 2 ) n may optionally be substituted with R 4 , and wherein any one of the carbon atoms of said (CH 2 ) n may optionally be substituted with R 7 ;
• Z is (CH 2 ) m wherein m is an integer from 0 to 6, and wherein any one of the carbon-carbon single bonds of (CH 2 ) m may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH 2 ) m may optionally be substituted with R 8 ;
• R 1 is hydrogen or Ci- ⁇ alkyl optionally substituted with hydroxy, Ci- alkoxy or fluoro;
• R 2 is a radical selected from hydrogen, Ci-6 straight or branched alkyl, C3-7cycloalkyl wherein one of the CH 2 groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C 2 -6alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl - C 2 -6alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, Ci-6 alkyl, Ci- ⁇ alk
• R 5 is hydrogen, phenyl or Ci- ⁇ alkyl; or R 2 and R 5 together with the carbon to which they are attached, form a saturated ring having from 3 to 7 carbon atoms wherein one of the
• CH 2 groups in said ring may optionally be replaced by oxygen, NH or sulfur;
• R 3 is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of the (CH2) groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, Ci- ⁇ alkyl, Ci- ⁇ alkoxy, trifluoromethyl, amino, Ci- ⁇ alkylamino, -CO-NH- Ci- ⁇ alkyl, Ci-eal
• R 4 and R 7 are each independently selected from hydroxy, halogen, halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl,
• R 6 is -NHCOR 9 , -NHCH 2 R 9 , SO2R 8 or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ;
• R 9 is C ⁇ -6alkyl, hydrogen, phenyl or phenylCi-ealkyl; with the proviso that (a) when m is 0, R 8 is absent, (b) when R 4 , R 6 , R 7 or
• R 8 is as defined in R 2 , it cannot form together with the carbon to which it is attached ,a ring with R 5 , and (c) when R 4 and R 7 are attached to the same carbon atom, then either each of R 4 and R 7 is independently selected from hydrogen, fluoro and Ci- ⁇ alkyl, or R 4 and R 7 , together with the carbon to which they are attached, for a C3-6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached.
• a particularly preferred compound of formula (V) is (2S,3S)-cis-3-(2- methoxybenzylamino)-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof.
• Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 93/21155, i.e. compounds of formula (VI):
• radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical;
• R 1 is optionally substituted phenyl, cyclohexadienyl, naphthyl, indenyl or optionally substituted heterocycle;
• R 2 is H, halogen, OH, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino;
• R 3 is optionally 2-substituted phenyl; R 4 is OH or fluorine when R 5 is H; or R 4 and R 5 are OH ; or R 4 and R 5 together form a bond.
• a particularly preferred compound of formula (VI) is (3aS, 4S, 7aS)- 7,7-diphenyl-4-(2-methoxyphenyl)-2-[(2S)-(2-methoxyphenyl)propionyl] perhydroisoindol-4-ol; or a pharmaceutically acceptable salt thereof.
• NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 591 040, i.e. compounds of formula (VII):
• Ar represents an optionally substituted mono-, di- or tricyclic aromatic or heteroaromatic group
• T represents a bond, a hydroxymethylene group, a Ci- alkoxymethylene group or a Ci-salkylene group
• Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or fluorine, trifluoromethyl, Ci- alkoxy, Ci- alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group
• R represents hydrogen, Ci- alkyl, ⁇ -Ci- alkoxyCi- alkyl, or ⁇ -C2- 4 alkanoyloxyC2-4alkyl;
• Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4- butylene group;
• Am + represents the radical
• Xi, X2 and X3 together with the nitrogen atom to which they are attached, form an azabicyclic or azatricyclic ring system optionally substituted by a phenyl or benzyl group; and A" represents a pharmaceutically acceptable anion.
• a particularly preferred compound of formula (VII) is (+) l-[2-[3-
• NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No.
• R 1 represents an optionally substituted aralkyl, aryloxyalkyl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an ⁇ -amino acid optionally N-substituted by a lower alkanoyl or carbamoyl-lower alkanoyl group;
• R 2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group
• R 3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy
• R 4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group
• Xi represents methylene, ethylene, a bond, an optionally ketalised carbonyl group or an optionally etherified hydroxymethylene group;
• X 2 represents alkylene, carbonyl or a bond
• X3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an alkyl group optionally substituted by phenyl, hydroxy methyl, optionally esterified or amidated carboxy, or (in other than the ⁇ -position) hydroxy.
• a particularly preferred compound of formula (VIII) is (2R * , 4S * )-2- benzyl-l-(3,5-dimethylbenzoyl)-N-(4-quinolinylmethyl)-4-piperidineamine; or a pharmaceutically acceptable salt thereof.
• NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 443 132, i.e. compounds of formula (IX)
• R 1 is aryl, or a group of the formula:
• Z is O or N-R 5 , in which R 5 is hydrogen or lower alkyl; R 2 is hydroxy or lower alkoxy;
• R 3 is hydrogen or optionally substituted lower alkyl
• R 4 is optionally substituted ar(lower)alkyl
• A is carbonyl or sulfonyl
• Y is a bond or lower alkenylene.
• a particularly preferred compound of formula (IX) is the compound of formula (IXa)
• NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 92/17449, i.e. compounds of the formula (X)
• R 1 is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, Ci-ioalkyl optionally substituted with from one to three fluoro groups, Ci-ioalkoxy optionally substituted with from one to three fluoro groups, amino, C ⁇ - ⁇ oalkyl-S-, C ⁇ - ⁇ oalkyl-S(O)-,
• a particularly preferred compound of formula (X) is (2S ,3S)-3-(2- methoxy-5-trifluoromethoxybenzyl)-amino-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof
• Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 95/08549, i.e. compounds of formula (XI)
• R 1 is a Ci- 4 alkoxy group
• R 2 ⁇ s
• R 3 is a hydrogen or halogen atom
• R 4 and R 5 may each independently represent a hydrogen or halogen atom, or a Ci- 4 alkyl, C ⁇ - 4 alkoxy or trifluoromethyl group
• R 6 is a hydrogen atom, a Ci- 4 alkyl, (CH 2 ) m cyclopropyl, -S(O) n C ⁇ - 4 alkyl, phenyl, NR R 8 , CH 2 C(O)CF 3 or trifluoromethyl group;
• R 7 and R 8 may each independently represent a hydrogen atom, or a Ci- 4 alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and m represents zero or 1.
• Particularly preferred compounds of formula (XI) are (2-methoxy-5- tetrazol-l-yl-benzyl)-([2S,3S]-2-phenyl-piperidin-3-yl)-amine; and [2- methoxy-5-(5-trifluoromethyl-tetrazol-l-yl)-benzyl]-([2S,3S]-2-phenyl- piperidin-3-yl)-amine; or a pharmaceutically acceptable salt thereof.
• Another class of tachykinin antagonists of use in the present invention is that described in International Patent Specification No. WO 95/14017, i.e. compounds of formula (XII)
• R 1 or a pharmaceutically acceptable salt thereof, wherein m is zero, 1, 2 or 3; n is zero or 1; o is zero, 1 or 2; p is zero or 1;
• R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, Ci-3alkoxy, trifluoromethyl, Ci- alkyl, phenyl-C ⁇ -3alkoxy, or Ci- alkanoyl groups;
• R 1 is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quinolinyl, isoquinolinyl, reduced quinolinyl, reduced isoquinolinyl, phenyl-(C ⁇ - 4 alkyl)-, phenyl-(C ⁇ - alkoxy)-, quinolinyl-(C ⁇ - alkyl)-, isoquinolinyl-(Ci- 4 alkyl)-, reduced quniolinyl-(Ci- 4 alkyl)-, reduced isoquinolinyl-(C ⁇ - 4 alkyl)-, benzoyl-(Ci-3alkyl)-,
• R 2 is hydrogen, C ⁇ - alkyl, C ⁇ -4 alkylsulfonyl, carboxy-(Ci-3alkyl)-, C ⁇ -3alkoxycarbonyl-(C ⁇ -3alkyl)-, or -CO-R 6 ;
• R 6 is hydrogen, C ⁇ -4 alkyl, Ci-3haloalkyl, phenyl, C ⁇ -3alkoxy, C ⁇ -3hydroxyalkyl, amino, Ci- 4 alkylamino, di(Ci-4alkyl)amino, or -(CH 2 ) q -R 7 ; q is zero to 3;
• R 7 is carboxy, C ⁇ -4 alkoxycarbonyl, C ⁇ -4 alkylcarbonyloxy, amino, Ci-4alkylamino, di(C ⁇ - 4 alkyl)amino, Ci-ealkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(C ⁇ - alkyl)-, quinolinyl-(C ⁇ - alkyl)-, isoquinolinyl-(C ⁇ - 4 alkyl)-, reduced quinolinyl-
• R 8 is hydrogen or Ci- ⁇ alkyl
• R 3 is phenyl, phenyl-(Ci-6alkyl)-, Cs-scycloalkyl, Cs-scycloalkenyl, Ci- ⁇ alkyl, naphthyl, d-salkenyl, or hydrogen; any one or which groups except hydrogen may be substituted with one or two halo, Ci-3alkoxy, Ci-3alkylthio, nitro, trifluoromethyl, or Ci-3alkyl groups; and
• R 4 is hydrogen or Ci-3alkyl; with the proviso that if R 1 is hydrogen or halo, R 3 is phenyl, phenyl-(C ⁇ -6alkyl)-, d-scycloalkyl, d-scycloalkenyl, or naphthyl.
• a particularly preferred compound of formula (XII) is [N-(2- methoxybenzyl)acetylamino]-3-(lH-indol-3-yl)-2-[N-(2-(4-piperidin-l- yl)piperidin-l-yl)acetylamino]propane; or a pharmaceutically acceptable salt thereof.
• the preferred stereochemistry of the ⁇ -carbon is either (R) when the substituent is an alkyl (e.g. methyl) group or (S) when the substituent is a hydroxyalkyl (e.g. hydroxy methyl) group.
• the preferred compounds of formula (IV) will have the stereochemistry of the 5- and 6-positions as shown below (5-(R), 6-(S)).
• suitable alkyl groups include straight-chained and branched alkyl groups containing from 1 to 6 carbon atoms. Typical examples include methyl and ethyl groups, and straight- chained or branched propyl and butyl groups. Particular alkyl groups are methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl and tert-butyl.
• suitable alkenyl groups include straight-chained and branched alkenyl groups containing from 2 to 6 carbon atoms. Typical examples include vinyl and allyl groups.
• suitable alkynyl groups include straight-chained and branched alkynyl groups containing from 2 to 6 carbon atoms. Typical examples include ethynyl and propargyl groups.
• suitable cycloalkyl groups include groups containing from 3 to 7 carbon atoms. Particular cycloalkyl groups are cyclopropyl and cyclohexyl. Unless otherwise defined herein, suitable aryl groups include phenyl and naphthyl groups.
• a particular aryl-C j 6 alkyl, e.g. phenyl-Ci- ⁇ alkyl, group is benzyl.
• suitable heteroaryl groups include pyridyl, quinolyl, isoquinolyl, pyridazinyl, pyrimidinyl, pyrazinyl, pyranyl, furyl, benzofuryl, thienyl, benzthienyl, imidazolyl, oxadiazolyl and thiadiazolyl groups.
• halogen as used herein includes fluorine, chlorine, bromine and iodine.
• Suitable pharmaceutically acceptable salts of the NK-1 receptor antagonists of use in the present invention include acid addition salts which may, for example, be formed by mixing a solution of the compound with a solution of a pharmaceutically acceptable non-toxic acid such as hydrochloric acid, fumaric acid, maleic acid, succinic acid, acetic acid, citric acid, tartaric acid, carbonic acid, phosphoric acid or sulphuric acid.
• Salts of amine groups may also comprise the quaternary ammonium salts in which the amino nitrogen atom carries an alkyl, alkenyl, alkynyl or aralkyl group.
• the present invention also contemplates salts thereof, preferably non-toxic pharmaceutically acceptable salts thereof, such as the sodium, potassium and calcium salts thereof.
• the compounds of use in this invention may have one or more chiral centers and the present compounds may occur as racemates, racemic mixtures and as individual diasteriomers or enantiomers with all such isomeric forms and mixtures thereof being included within the scope of this invention.
• some of the crystalline forms for compounds of the present invention may exist as polymorphs and as such are intended to be included in the present invention.
• some of the compounds of the instant invention may form solvates with water or common organic solvents.
• COX-2 inhibitors that may be used with this invention encompass all pharmaceutically acceptable salt forms of the compounds.
• Examples of such salt forms of COX-2 inhibitors include but are not limited to salts derived from inorganic bases including aluminum, ammonium, calcium, copper, ferric, ferrous, lithium, magnesium, manganic salts, manganous, potassium, sodium, zinc, and the like. Particularly preferred are the ammonium, calcium, magnesium, potassium, and sodium salts.
• Salts derived from pharmaceutically acceptable organic non-toxic bases include salts of primary, secondary, and tertiary amines, substituted amines including naturally occurring substituted amines, cyclic amines, and basic ion exchange resins, such as arginine, betaine, caffeine, choline, N,N-dibenzylethylenediamine, diethylamine, 2-diethylaminoethanol, 2-dimethylaminoethanol, ethanolamine, ethylenediamine, N-ethylmorpholine, N-ethylpiperidine, glucamine, glucosamine, histidine, hydrabamine, isopropylamine, lysine, methylglucamine, morpholine, piperazine, piperidine, polyamine resins, procaine, purines, theobromine, triethylamine, trimethylamine, tripropylamine, tromethamine, and the like.
• basic ion exchange resins such as arg
• the instant pharmaceutical combination comprising a COX-2 inhibitor in combination with a NK-1 receptor antagonist includes administration of a single pharmaceutical dosage formulation which contains both the COX-2 inhibitor and the NK-1 receptor antagonist, as well as administration of each active agent in its own separate pharmaceutical dosage formulation.
• the COX-2 inhibitor and the NK-1 receptor antagonist can be administered at essentially the same time, i.e., concurrently, or at separately staggered times, i.e, sequentially.
• the instant pharmaceutical combination is understood to include all these regimens. Administration in these various ways are suitable for the present invention as long as the beneficial pharmaceutical effect of the COX-2 inhibitor and the NK-1 receptor antagonist are realized by the patient at substantially the same time.
• Such beneficial effect is preferably achieved when the target blood level concentrations of each active drug are maintained at substantially the same time.
• the COX-2 inhibitor and the NK-1 receptor antagonist be co-administered concurrently on a once-a-day dosing schedule; however, varying dosing schedules, such as the COX-2 inhibitor once, twice or more times per day and the NK-1 receptor antagonist once per day, is also encompassed herein.
• a single oral dosage formulation comprised of both the COX-2 inhibitor and the NK-1 receptor antagonist is preferred.
• a single dosage formulation will provide convenience for the patient, which is an important consideration especially for patients who already have an inflammatory disorder such as rheumatoid arthritis and may be in need of multiple medications.
• terapéuticaally effective amount is intended to mean that amount of a drug or pharmaceutical agent that will elicit the biological or medical response of a tissue, a system, animal or human that is being sought by a researcher, veterinarian, medical doctor or other clinician.
• prophylactically effective amount is intended to mean that amount of a pharmaceutical drug that will prevent or reduce the risk of occurrence of the biological or medical event that is sought to be prevented in a tissue, a system, animal or human by a researcher, veterinarian, medical doctor or other clinician.
• the dosage regimen utilizing a COX-2 inhibitor in combination with a NK-1 receptor antagonist is selected in accordance with a variety of factors including type, species, age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound or salt or ester thereof employed. Since two different active agents are being used together in a combination therapy, the potency of each of the agents and the interactive effects achieved by combining them together must also be taken into account. A consideration of these factors is well within the purview of the ordinarily skilled clinician for the purpose of determining the therapeutically effective or prophylactically effective dosage amounts needed to prevent, counter, or arrest the progress of the condition.
• patient includes mammals, especially humans, who take a COX-2 inhibitor in combination with a NK-1 receptor antagonist for any of the uses described herein. Administering of the drug combination to the patient includes both self-administration and administration to the patient by another person.
• the inhibitor of cyclooxygenase-2 may be administered at a dosage level up to conventional dosage levels for NSAIDs. Suitable dosage levels will depend upon the antiinflammatory effect of the chosen inhibitor of cyclooxygenase-2, but typically suitable levels will be about 0.001 to 50 mg/kg per day, preferably 0.005 to 30mg/kg per day, and especially 0.05 to lOmg/kg per day.
• the compound may be administered on a regimen of up to 6 times per day, preferably 1 to 4 times per day, and especially once per day.
• a suitable dosage level for the NK-1 receptor antagonist is about 0.05 to 1500mg per day, preferably about 0.25 to 1500mg per day, and especially about 0.25 to 500mg/kg per day.
• the compounds may be administered on a regimen of up to 6 times per day, preferably 1 to 4 times per day, especially 1 or 2 times daily.
• the active agents employed in the instant combination therapy can be administered in such oral forms as tablets, capsules (each of which includes sustained release or timed release formulations), pills, powders, granules, elixirs, tinctures, suspensions, syrups, and emulsions.
• the instant invention includes the use of both oral rapid-release and time-controlled release pharmaceutical formulations.
• a particular example of an oral time-controlled release pharmaceutical formulation is described in U.S Patent No. 5,366,738.
• Oral formulations are preferred.
• Such pharmaceutical compositions are known to those of ordinary skill in the pharmaceutical arts; for example, see Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA.
• the active agents are typically administered in admixture with suitable pharmaceutical diluents, excipients or carriers (collectively referred to herein as "carrier” materials) suitably selected with respect to the intended form of administration, that is, oral tablets, capsules, elixirs, syrups and the like, and consistent with conventional pharmaceutical practices.
• carrier suitable pharmaceutical diluents, excipients or carriers
• the active drug component can be combined with a non-toxic, pharmaceutically acceptable, inert carrier such as lactose, starch, sucrose, glucose, modified sugars, modified starches, methyl cellulose and its derivatives, dicalcium phosphate, calcium sulfate, mannitol, sorbitol and other reducing and non-reducing sugars, magnesium stearate, steric acid, sodium stearyl fumarate, glyceryl behenate, calcium stearate and the like.
• a non-toxic, pharmaceutically acceptable, inert carrier such as lactose, starch, sucrose, glucose, modified sugars, modified starches, methyl cellulose and its derivatives, dicalcium phosphate, calcium sulfate, mannitol, sorbitol and other reducing and non-reducing sugars, magnesium stearate, steric acid, sodium stearyl fumarate, glyceryl behenate, calcium stearate and the like.
• suitable binders, lubricants, disintegrating agents and coloring and flavoring agents can also be incorporated into the mixture.
• Stabilizing agents such as antioxidants (BHA, BHT, propyl gallate, sodium ascorbate, citric acid) can also be added to stabilize the dosage forms.
• suitable components include gelatin, sweeteners, natural and synthetic gums such as acacia, tragacanth or alginates, carboxymethylcellulose, polyethylene glycol, waxes and the like.
• the active drugs can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamellar vesicles and multilamellar vesicles.
• Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine or phosphatidylcholines. Active drug may also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled. Active drug may also be coupled with soluble polymers as targetable drug carriers. Such polymers can include polyvinyl- pyrrolidone, pyran copolymer, polyhydroxy-propyl-methacrylamide-phenol, polyhydroxy-ethyl-aspartamide-phenol, or polyethyleneoxide-polylysine substituted with palmitoyl residues.
• active drug may be coupled to a class of biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polyglycolic acid, copolymers of polylactic and polyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, polycyanoacrylates and cross linked or amphipathic block copolymers of hydrogels.
• biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polyglycolic acid, copolymers of polylactic and polyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, polycyanoacrylates and cross linked or amphipathic block copolymers of hydrogels.
• the active agents of the present method may be administered in divided doses, for example two or three times daily, a single daily dose of each of the COX-2 inhibitor and the NK-1 receptor antagonist is preferred, with a single daily dose of both agents in a single pharmaceutical composition being most preferred.
• the instant invention also encompasses a process for preparing a pharmaceutical composition comprising combining the COX-2 inhibitor and the NK-1 receptor antagonist with a pharmaceutically acceptable carrier, as well as the pharmaceutical composition which is made by combining the COX-2 inhibitor and the NK-1 receptor antagonist with a pharmaceutically acceptable carrier.
• a therapeutically effective amount of a COX-2 inhibitor and a NK-1 receptor antagonist can be used together for the preparation of a medicament useful for preventing or reducing the risk of developing an inflammatory disorder such as rheumatoid arthritis, halting or slowing the progression of an inflammatory disorder such as rheumatoid arthritis, once it has become clinically manifest, and preventing or reducing the risk of a first or subsequent occurrence of an inflammatory disorder such as rheumatoid arthritis.
• the medicament may be comprised of a COX-2 inhibitor in combination with about 1 mg to 300 mg of a NK-1 receptor antagonist, or more particularly about 3 mg to 100 mg of the NK-1 receptor antagonist.
• NK-1 receptor antagonist which may be used in the medicament preparation include 1 mg, 3 mg, 5 mg, 10 mg, 20 mg, 30 mg, 50 mg, 100 mg and 300 mg, as well as sub-milligram amounts of NK-1 receptor antagonists which have sufficient potency at such levels.
• the medicament may be comprised of a NK-1 receptor antagonist, for example, at the above dosages, in combination with about 0.1 to 20 mg of a COX-2 inhibitor.
• the instant invention also encompasses the use of a NK-1 receptor antagonist for the manufacture of a medicament for the combined use with a cyclooxygenase-2 inhibitor for preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder; and the use of a cyclooxygenase-2 inhibitor for the preparation of a medicament for the combined use with a NK-1 receptor antagonist for preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder.
• (IX), (X), (XI) and (XII) may be prepared by the methods described in EP-A-0 577 394 (or WO 95/16679), WO 95/18124, WO 95/23798, WO 97/49710, EP-A-0 436 334, WO 93/21155, EP-A-0 591 040, EP-A-0 532 456, EP-A-0 443 132, WO 92/17449, WO 95/08549 and WO 95/14017, respectively.
• NK-1 receptor antagonists of the formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (IC50) of less than lOOnM. Most preferred are compounds of formulae (I), (II), (III) and
• NK-1 receptor antagonists of use in the present invention are compounds which are potent NK-1 receptor antagonists with an NK-1 receptor affinity (IC50) of less than lOnM, favourably less than 2nM and preferably less than InM.
• NK-1 receptor antagonists of use in the present invention are orally active, long acting, CNS-penetrant NK-1 receptor antagonists, identified using a combination of the following assays:
• ASSAY 1 NK-1 Receptor binding
• NK-1 receptor binding assays are performed in intact Chinese hamster ovary (CHO) cells expressing the human NK-1 receptor using a modification of the assay conditions described by Cascieri et al, J. Pharmacol. Exp. Ther. , 1992, 42, 458. Typically, the receptor is expressed at a level of 3xl0 5 receptors per cell. Cells are grown in monolayer culture, detached from the plate with enzyme-free dissociation solution (Speciality Media Inc.), and washed prior to use in the assay.
• enzyme-free dissociation solution Specification Media Inc.
• 125 I-Tyr 8 - substance P (O.lnM, 2000Ci/mmol; New England Nuclear) is incubated in the presence or absence of test compounds (dissolved in 5 ⁇ l dimethylsulphoxide, DMSO) with 5xl0 4 CHO cells.
• Ligand binding is performed in 0.25ml of 50mM Tris-HCl, pH7.5, containing 5mM MnCl 2 , 150mM NaCI, 0.02% bovine serum albumin (Sigma), 50 ⁇ g/ml chymostatin (Peninsula), O.lnM phenylmethylsulphonyl fluoride, 2 ⁇ g/ml pepstatin, 2 ⁇ g/ml leupeptin and 2.8 ⁇ g/ml furoyl saccharine.
• the incubation proceeds at room temperature until equilibrium is achieved (>40 minutes) and the receptor-ligand complex is harvested by filtration over GF/C filters pre- soaked in 0.1% polyethylenimine using a Tomtek 96-well harvester. Nonspecific binding is determined using excess substance P (l ⁇ M) and represents ⁇ 10% of total binding.
• CNS-penetrant NK-1 receptor antagonists for use in the present invention can be identified by their ability to inhibit foot tapping in gerbils induced by central infusion of NK-1 receptor agonists such as GR73632, based on the method of Rupniak & Williams, Eur. J. Pharmacol, 1994, 265, 179.
• Male or female Mongolian gerbils (35-70g) are anaesthetised by inhalation of an isoflurane/oxygen mixture to permit exposure of the jugular vein in order to permit administration of test compounds or vehicle in an injection volume of approximately 5ml kg i.v.
• test compounds may be administered orally or by subcutaneous or intraperitoneal routes. A skin incision is then made in the midline of the scalp to expose the skull.
• the selective NK-1 receptor agonist e.g. GR73632 (d Ala[L-Pro 9 ,Me-Leu 10 ] -substance P-(7-ll)
• GR73632 d Ala[L-Pro 9 ,Me-Leu 10 ] -substance P-(7-ll)
• ASSAY 3 Ferret Emesis Individually housed male ferrets (1.0 -2.5 kg) are dosed orally by gavage with test compound. Ten minutes later they are fed with approximately lOOg of tinned cat food. At 60 minutes following oral dosing, cisplatin (lOmg/kg) is given i.v. via a jugular vein catheter inserted under a brief period of halothane anaesthesia. The catheter is then removed, the jugular vein ligated and the skin incision closed. The ferrets recover rapidly from the anaesthetic and are mobile within 10-20 minutes.
• FCA Freunds Complete Adjuvant
• the diameter of the hind footpads is measured with vernier calipers at a consistent mid plantar site.
• thermal hyperalgesia is determined by the Hargreaves Method on unrestrained animals. The method determines the withdrawal latency to an infra-red source (Ugo Basile). Hyperalgesia is assessed 4 hours after dosing.
• a suitable selection cascade for NKj antagonists of use according to the present invention is as follows:
• IC50 ⁇ 2nM especially IC50 ⁇ InM.
• ii Determine ability of compounds to penetrate CNS by their ability to inhibit foot tapping in gerbils induced by central injection of an NKi agonist (Assay 2); select compounds that inhibit foot tapping with ID50 ⁇ 3mg/kg i.v., and preferably ID50 ⁇ lmg/kg i.v. when administered immediately prior to central NKi agonist challenge, or ID50 ⁇ 30mg/kg p.o., and preferably ID50 ⁇ lOmg/kg p.o. 1 hour prior to challenge.
• Particularly preferred compounds of use in the present invention are identified using steps (i) to (iv) followed by step (v): (v) Determine activity of compounds in assays for inhibition of pharmacologically evoked foot tapping in gerbils and/or inhibition of adjuvant arthritis in guinea-pigs (Assay 4). Select compounds with ID50 ⁇ 20mg/kg, and preferably ID50 ⁇ lOmg/kg.
• Yet further preferred compounds of use in the present invention may be selected from those compounds which satisfy the NK-1 receptor binding criteria of step (i) which, in addition, have ⁇ 5-fold shift in affinity when incubated in the presence of human serum albumin (HSA) to show non-specific protein binding.
• HSA human serum albumin
• a NK-1 receptor antagonist of use in the present invention is the compound 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)- ethoxy)-3-(S)-(4-fluorophenyl)-4-(3-(5-oxo-lH,4H-l,2,4-triazolo)methyl)- morpholine, the preparation of which is described in International Patent Specification No. WO 95/16679. In the aforementioned assays, this compound has the following activity:
• a NK-1 receptor antagonist of use in the present invention is the compound 2-(R)-(l-(R)-(3,5- bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(N,N-dimethylamino)methyl-l,2,3- triazol-4-yl)methyl-3-(S)-phenylmorpholine, the preparation of which is described in International Patent Specification No. WO 95/18124. In the aforementioned assays, this compound has the following activity:
• COX-2 inhibitors of use in the present invention are identified using the following one or more of the following selection criteria:
• formulations may be prepared with separate active ingredients or with a combination of active ingredients in one composition.
• the ratio of the COX-2 inhibitor and the NK-1 receptor antagonist will depend upon the choice of active ingredients.
• the active ingredient, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste.
• the resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate.
• the resulting granulation is then compressed into tablets containing ⁇ Omg, lOOmg and 300mg of the NK-1 receptor antagonist per tablet.
• NK-1 receptor antagonist ⁇ .0 100.0 300.0
• the active ingredients, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste.
• the resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate.
• the resulting granulation is then compressed into tablets containing 20mg of the COX-2 inhibitor and
• NK-1 receptor antagonist 50mg, lOOmg and 300mg of the NK-1 receptor antagonist per tablet.
• Magnesium stearate 1 1 1 1 Tablet dose strengths of between 5 and 25 mg can be accomodated by varying total tablet weight, and the ratio of the first three ingredients. Generally it is preferable to maintain a 1:1 ratio for microcrystalline cellulose actose monohydrate.
• Tablet dose strengths of between 5 and 25 mg can be accomodated by varying total tablet weight, and the ratio of the first three ingredients.
• Capsule dose strengths of between 1 and 50 mg can be accomodated by varying total fill weight, and the ratio of the first three ingredients. Generally it is preferable to maintain a 1:1 ratio for microcrystalline cellulose : lactose monohydrate.
• Solution dose strengths of between 1 and 50 mg/5ml can be accomodated by varying the ratio of the two ingredients.
• Suspension dose strengths of between 1 and 50 mg/5ml can be accomodated by varying the ratio of the first two ingredients. l ⁇

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• 1998
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