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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/10—Drugs for disorders of the urinary system of the bladder

Definitions

• (+) - tramadol Q-demethyltramadol or (+) - O-demethyltramadol.
• the invention relates to the use of (+) - tramadol or O-demethyltramadol, in particular (+) - O-demethyltramadol, O-desmethyl-N-mono-desmethyl-tramadol, in particular (+) - O-desmethyl -N-mono-desmethyl-tramadol, as free bases and / or in the form of physiologically tolerable salts for the manufacture of a medicament for the treatment of increased urge to urinate or urinary incontinence as well as corresponding medicaments and methods for the treatment of increased urge to urinate or urinary incontinence.
• Urinary incontinence is the involuntary loss of urine. This occurs in an uncontrolled manner when the pressure inside the bladder exceeds the pressure necessary to close the ureter.
• the causes can be, on the one hand, an increased internal bladder pressure (e.g. due to detruson's instability) with the consequence of urge incontinence and, on the other hand, a reduced sphincter pressure (e.g. after birth or surgery) with the result of stress incontinence.
• the detrusor is the roughly bundled, multi-layered bladder wall muscles, the contraction of which leads to emptying of the urine, the sphincter the sphincter of the urethra. Mixed forms of these types of incontinence as well as so-called excess incontinence (e.g.
• Urge to urinate is the state of increased bladder muscle tension aimed at emptying urine (micturition) when the bladder capacity is approached (or exceeded). This tension acts as a micturition.
• Increased urge to urinate means in particular the occurrence of premature or sometimes sometimes even painful urge to urinate up to the so-called urge to urinate. This leads to a significantly more frequent micturition.
• causes can include bladder infections and neurogenic bladder disorders as well as bladder tuberculosis. However, not all causes have yet been clarified.
• WO 98/46216 showed for the first time that tramadol can also be used in the indications of increased urge to urinate and urinary incontinence.
• Tramadol - (1 RS, 2RS) -2-dimethylaminomethyl-1- (3-methoxyphenyl) - cyclohexanol - is a racemate and a known centrally acting analgesic, which causes a strong pain relief without the side effects known for opioids (J. Pharmacol. Exptl. Ther. 267, 331 (1993)).
• tramadol even if tramadol shows significantly fewer side effects than opioids, is associated with some, sometimes unpleasant, side effects depending on the dose.
• analgesic effects are largely undesirable with permanent urinary incontinence treatment.
• the use of the racemate tramadol in this indication has disadvantages, because even if the racemate already has an effect on the bladder function at lower doses than is required for analgesic effects, therapeutic doses - especially in certain patient groups - can already show undesirable side effects.
• (+) - tramadol has an excellent effect on bladder function and is therefore good for Treatment of appropriate diseases is suitable and this in considerably lower doses than the racemate.
• the subject of the invention is the use of (+) - tramadol as a free base and / or in the form of physiologically tolerable salts for the manufacture of a medicament for the treatment of increased urge to urinate or urinary incontinence.
• Tramadol is a racemate and consists of equal amounts of (+) - and (-) - enantiomers. It is known from analgesia that the enantiomers of tramadol have a pharmacological profile which differs from that of the racemate.
• the (+) - enantiomer is characterized by an opiate-like analgesic effect, which is enhanced compared to tramadol, while a clear inhibition of noradrenaline reuptake is observed in the (-) - enantiomer. It was demonstrated for (+) - and (-) - tramadol that, depending on the model, their effects are mutually reinforcing (Raffa, R. et. Al., 1993, J. Pharmacol. Exptl. Ther. 267: 331 ). It is reasonable to assume that the potent analgesic effect of tramadol is based on this conditional enhancement.
• (+) - Tramadol was not only significantly more effective than the racemate but was also considerably more effective than the double dose of the racemate mixture of (+) - and (-) - tramadol used. However, it can be concluded from this that (+) - tramadol is not only the actually active substance, but that (-) - tramadol is not only ineffective, but in contrast to analgesia in racemate the effect on the bladder function of (+) - Tramadol even seems to inhibit.
• (+) - tramadol has clear advantages over the prior art, the use of tramadol as a racemate (WO 98/46216), since the dosage can be considerably lower, significantly less than 50% of the dosage required for tramadol. The side effects are correspondingly lower, since (-) - Tramadol also contributes to these, especially the analgesic effects. Possibilities for the production of (+) - tramadol are described in Arzneisch./Drug Res. 28 (I), 114 (1978) and particularly preferably in DE 196 01 745 C1.
• (+) - tramadol When using (+) - tramadol it is not necessary, but preferred to use only the (+) - tramadol enantiomer. However, a lower proportion of (-) - tramadol compared to the (+) - tramadol is acceptable and may be contained in the use according to the invention.
• Suitable salts in the sense of this invention and in each of the claimed uses are salts of the respective active ingredient with inorganic or organic acids and / or a sugar substitute such as saccharin, cyclamate or acesulfame.
• the hydrochloride is particularly preferred.
• Another object of the present invention is the use of O-demethyltramadol and / or its enantiomers, diastereomers, bases or salts of physiologically compatible acids for the production of a medicament for the treatment of increased urge to urinate or urinary incontinence.
• the use of (+) - O-demethyltramadol as the free base and / or in the form of physiologically acceptable salts is particularly preferred.
• Tramadol forms the metabolite O-demethyltramadol in vivo, which is also present as a mixture of enantiomers.
• (+) - O-demethyltramadol it is not necessary, but preferred to use only the (+) - O-demethyltramadol enantiomer. However, a smaller proportion of (-) - O-demethyltramadol than the (+) - O-demethyltramadol is acceptable and may be contained in the use according to the invention.
• Another object of the present invention is the use of O-desmethyl-N-mono-desmethyl-tramadol and / or its enantiomers; in particular mixtures of its enantiomers or a single enantiomer; Diastereomers, bases or salts of physiologically compatible acids for the manufacture of a medicament for the treatment of increased urge to urinate or urinary incontinence.
• the use of (+) - O-desmethyl-N-mono-desmethyl-tramadol is preferred as the free base and / or in the form of physiologically tolerable salts.
• O-desmethyl-N-mono-desmethyl-tramadol (referred to in some places in the following text and in the literature as M5) is one of the in vivo metabolites of tramadol (1 RS, 2RS) -2 [(dimethylamino) methyl ] -1- (3-methoxyphenyl) cyclohexanol known (Lintz et al., Arzneiffen.Forsch./Drug Res. 31 (11), 1932-1943, 1981). M5 shows only a low penetration of the blood-brain barrier, since central nervous effects - eg analgesic - are markedly weaker when administered iv than in contrast to icv.
• (+) - O-desmethyl-N-mono-desmethyl-tramadol it is not necessary, but preferred to use only the (+) - O-desmethyl-N-mono-desmethyl-tramadol enantiomer. However, a smaller proportion of (-) - O-desmethyl-N-mono-desmethyl-tramadol than the (+) - O-desmethyl-N-mono-desmethyl-tramadol is acceptable and may be present in the use according to the invention.
• the invention further relates to medicaments for the treatment of increased urge to urinate or urinary incontinence which contain at least (+) - tramadol as the free base and / or in the form of physiologically compatible salts as well as optionally additives and / or auxiliary substances.
• at least (+) - tramadol as the free base and / or in the form of physiologically compatible salts as well as optionally additives and / or auxiliary substances.
• it is not necessary, but preferred to use only the (+) - tramadol enantiomer.
• the (+) - tramadol lower proportion of (-) - tramadol is acceptable and may be contained in medicinal products according to the invention.
• the invention also includes medicaments for the treatment of increased urge to urinate or urinary incontinence, the O-demethyltramadol and / or its enantiomers, diasteroisomers, bases or salts of physiologically compatible acids, in particular (+) - O-demethyltramadol as the free base and / or contain in the form of physiologically compatible salts, and optionally additives and / or auxiliaries.
• the O-demethyltramadol and / or its enantiomers, diasteroisomers, bases or salts of physiologically compatible acids in particular (+) - O-demethyltramadol as the free base and / or contain in the form of physiologically compatible salts, and optionally additives and / or auxiliaries.
• the corresponding drugs with (+) - O-demethyltramadol it is not necessary, but preferred to use only the (+) - O-demethyltramadol enantiomer.
• the invention also encompasses medicaments for the treatment of increased urge to urinate or urinary incontinence, the active substance being at least O-desmethyl-N-mono-desmethyl-tramadol and / or its enantiomers; in particular mixtures of its enantiomers or a single enantiomer; Diastereomers, bases or salts of physiologically compatible acids, in particular (+) - O-desmethyl-N-mono-desmethyl-tramadol as free base and / or in the form of physiologically compatible salts, and optionally additives and / or auxiliaries.
• the active substance being at least O-desmethyl-N-mono-desmethyl-tramadol and / or its enantiomers; in particular mixtures of its enantiomers or a single enantiomer; Diastereomers, bases or salts of physiologically compatible acids, in particular (+) - O-desmethyl-N-mono-desmethyl-tramadol as free base and / or in
• Suitable salts in the sense of this invention and in each of the claimed uses are salts of the respective active ingredient with inorganic or organic acids and / or a sugar substitute such as saccharin, cyclamate or acesulfame.
• the hydrochloride is particularly preferred.
• auxiliaries for the purposes of this invention are all substances known to the person skilled in the art from the prior art for achieving galenical formulations.
• the selection of these auxiliaries and the amounts to be used depend on whether the medicament is to be administered orally, intravenously, intraperitoneally, intradermally, intramuscularly, intranasally, buccally or locally.
• Preparations in the form of tablets, chewable tablets, dragées, capsules, granules, drops, juices or syrups are suitable for oral administration, and solutions, suspensions, easily reconstitutable dry preparations and sprays for parenteral, topical and inhalation administration. Another possibility is suppositories for use in the rectum.
• auxiliaries and additives for oral administration forms are disintegrants, lubricants, binders, fillers, mold release agents, if appropriate
• Solvents, flavors, sugar, in particular carriers, diluents, colors, antioxidants etc. Waxes or fatty acid esters can be used for suppositories and carriers, preservatives, suspension aids etc. for parenteral application agents.
• the amounts of active ingredient to be administered to patients vary depending on the weight of the patient, the type of application and the severity of the disease.
• the compounds according to the invention can be released in a delayed manner from preparation forms which can be used orally, rectally or percutaneously.
• corresponding slow-release formulations in particular in the form of a “once-daily” preparation, which only has to be taken once a day, are particularly preferred.
• drugs that contain at least 0.05 to 90.0% of the active ingredient, in particular low effective doses, in order to avoid side effects or analgesic effects.
• the invention further relates to a method for the treatment of increased urge to urinate or urinary incontinence, in which (+) - tramadol is used as the free base and / or in the form of physiologically tolerable salts, or corresponding methods in which O-demethyltramadol and / or its enantiomers, diasteroisomers, bases or salts of physiologically compatible acids, in particular (+) - O-demethyltramadol as / or in the form of physiologically compatible salts, are used.
• the invention also encompasses a corresponding process in which O-desmethyl-N-mono-desmethyl-tramadol and / or its enantiomers, diasteroisomers, bases or salts of physiologically tolerated acids, in particular (+) - O-desmethyl-N- mono-desmethyl-tramadol can be used as the free base and / or in the form of physiologically acceptable salts.
• Example 1 Test system cystometry on the awake naive rat Cystometric studies were carried out on naive, female Sprague-Dawley rats using the method of Ishizuka et. al. ((1997), Naunyn-Schmiedeberg's Arch. Pharmacol. 355: 787-793). Three days after the implantation of bladder and venous catheters, the animals were examined while awake, free to move. The urinary catheter was connected to a pressure transducer and an injection pump. The animals were placed in metabolic cages, which made it possible to measure urine volume. Physiological saline was infused into the emptied bladder (10 ml / hour) and bladder pressure and micturition volume were recorded continuously. After a stabilization phase, a 20-minute phase was recorded, which was characterized by normal, reproducible micturition cycles. The following parameters were determined in detail:
• miceturition pressure MP maximum pressure during micturition, basal pressure BP, lowest pressure during the filling phase, threshold pressure TP, bladder capacity BC, residual volume after previous micturition plus volume of the infused solution during the filling phase), micturition volume MV, volume of urine discontinued and residual volume (residual volume RV, bladder capacity minus the micturition volume).
• threshold pressure TP
• the mean of 3 micturition cycles was determined at the effective maximum and presented as a percentage change compared to the previous value (Table 1).
• Table 1 Influence of the cystometric parameters by tramadol and its enantiomers. Average values with standard deviation before (v) and after application (h) of the test substance as well as the difference (Diff), the change compared to the previous value [%]; n corresponds to the number of attempts; Significance (Student T-Test): * p ⁇ 0.05; ** p ⁇ 0.01; *** p ⁇ 0.001.
• (+) - tramadol has a significantly better effect on bladder function than racemic tramadol.
• Example 3 Comparison of racemic tramadol, (+) - tramadol and (+) - O-desmethyltramadol
• Example 2 In an analogous experiment according to Example 1, after recording three reproducible micturition cycles as a pre-value, racemic tramadol ((r) -Tram) (1, 0 and 5.0 mg / kg), (+) - tramadol ((+) - Tram) (0.1, 0.3, and 0.5 mg / kg) and (+) - O-desmethyltramadol ((+) - M1) (0.1 and 0.5 mg / kg) in vehicle 0 , 9% NaCI iv applied and the effect on the cystometric parameters recorded 90 to 120 minutes.
• the mean of 3 micturition cycles was determined at the effective maximum and shown as a percentage change compared to the previous value (Table 2). For comparison, data from Table 1 are listed again.
• the "inter-contraction interval” the time interval between micturition, was measured in minutes.
• the “inter-contraction interval” is also an important parameter for Measurement of the physiological effectiveness of a substance in the treatment of urinary incontinence.
• (+) -Tram was only effective in much higher doses than (+) - Tram and showed a clear reduction in ICI at the most effective dose (10 mg / kg). However, the latter in particular is an extremely unfavorable side effect in the treatment of urinary incontinence.
• (+) - Tram is overall clearly superior to the racemic Tramadol. For example, (+) - Tram also a significant increase in bladder capacity. However, the (+) - O-desmethyl-tramadol appears even better both at 0.1 and in particular at 0.5 mg / kg i. v ..
• the mean of 3 micturition cycles was determined at the effective maximum and shown as a percentage change compared to the previous value (Table 3).
• 10 ⁇ g / kg were administered intrathecally (it) applied (Table 3).
• the "inter-contraction interval" the time interval between micturition, was measured in minutes.
• (+) - O-desmethyl-N-mono-desmethyl-tramadol is also effective and at 10.0 mg / kg i.v. comparable to tramadol.
• threshold pressure There was a clear increase in threshold pressure, with (+) - M5 the interval between micturition did not shorten.
• (+) - M5 is also effective and, in addition to increasing the threshold pressure, causes significant increases in bladder capacity and the interval between micturition.
• a positive effect of O-desmethyl-N-mono-desmethyl-tramadol, in particular of (+) - O-desmethyl-N-mono-desmethyl-tramadol, on the bladder function has thus been demonstrated.

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