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Definitions

• GHB Gamma-hydroxybutyric acid or "gamma-hydroxybutyrate”
• GHB is an endogenous compound with hypnotic properties that is found in many human body tissues.
• GHB is present, for example, in the mammalian brain, the human nervous system and other tissues.
• the extraordinary range of the pharmacological effects of GHB or its salts has attracted scientific attention for more than three decades.
• GHB has been found to have tissue- protective effects in animals and man in many different organs including brain, liver, lung, heart, kidney, gut and pancreatic B cells.
• brain the highest GHB concentration is found in the hypothalamus and basal ganglia and GHB is postulated to function as a neurotransmitter (Snead and Morley, 1981).
• GHB neuropharmacologic effects include increases in brain dopamine, depression of glucose utilization but not oxygen consumption in the brain, and hypothermia. GHB is converted to succinate and then metabolized via the Krebs cycle. Clinical trials have shown that GHB increases delta sleep and improves the continuity of sleep (Ladinsky et al, 1983; Stock et al., 1973; Laborit, 1973; Lapierre et al., 1990; Yamada et al., 1967; Grove-White and Kelman, 1971; Scharf, 1985).
• GHB monosodium salt sodium oxybate
• GHB monosodium salt sodium oxybate
• These low doses also can induce REM and slow wave sleep and, in contrast to the hypnotics in common use, without the development of tolerance to these sleep-inducing effects in time.
• GHB increases total sleep time and REM sleep, and it decreases REM latency (Mamelak et al, 1973; Yamada et al, 1967; Bedard et al, 1989), reduces sleep apnea (Series et al., 1992; Scrima et al., 1987), and improves general anesthesia (Hasenbos and Gielen, 1985).
• GHB has several clinical applications other than the treatment of sleep disorders. GHB has been reported to reduce alcohol craving, the number of daily drinks consumed, and the symptoms of alcohol withdrawal in patients (Gallimberti et al, 1989; Gallimberti et al, 1992; Gessa et al., 1992). GHB has been used to decrease the symptoms of opiate withdrawal, including both heroin and methadone withdrawal (Gallimberti et al., 1994; Gallimberti et al., 1993). It has analgesic effects that make it suitable as a pain reliever (U.S. Patent No. 4,393,236). Intravenous administration of GHB has been reported to reduce intracranial pressure in patients (Strong, A. 1984).
• GHB is also an effective therapeutic agent for the treatment of chronic fatigue syndrome and fibromyalgia (Scharf, U.S. Patent No. 5,990,162).
• GHB glycogen deacetylase
• Y is H or a hydroxyl-protecting group
• X is the residue of a carbohydrate
• n has a value of 1 to the number of available hydroxyl groups in said carbohydrate, or a pharmaceutically acceptable salt thereof.
• X is a saccharide.
• Y is H, a (C 4 -C 6 ) acetal, (C,-C 5 ) acyl or (C r C 5 ) alkyl.
• Preferred carbohydrates are water-soluble or water-dispersible.
• X is the residue of a monosaccharide, the residue of a disaccharide or the residue of a polysaccharide.
• Examples of compounds of formula (I) include l,2,3,4,6-pentakis(4- hydroxy-butyroyl)hexanose; 6-(4-hydroxy-butyroyl)hexanose and 1,2,3,4,6- pentakis(4-acetoxybutyroyl)hexanose.
• X is the residue of a chemically-modified cellulose.
• chemically-modified cellulose compositions include water-soluble or water-dispersible celluloses such as hydroxypropyl-methylcellulose, hydroxypropylcellulose or hydroxyethylcellulose.
• R' is H or a hydroxyl protecting group
• R' is H, ( -C ⁇ alkyl or benzyl
• X and Z are each residues of a hydroxy group-containing amino acid or a bis(carboxy)amino acid
• Y is a moiety covalently linking X and Z
• n is 0-1
• m and k are 0 to the number of available OH groups in X and Z
• q and p are 0 to the number of available CO 2 groups on X and Z, with the proviso that m and q are not both zero and p and k are not both zero, or a pharmaceutically acceptable salt thereof.
• An embodiment of the compound of formula II is a compound of formula (III):
• R 1 is H or a hydroxyl-protecting group
• R is H, (C,-C 4 ) alkyl or benzyl
• X is a residue of a hydroxy group-containing amino acids
• Z is a residue of a hydroxy group-containing amino acid or a bis(carboxy)amino acid
• Y is a moiety covalently linking X and Z
• n is O-l
• m is 1 to the number of hydroxy groups on amino acid X
• p is 1 to the number of CO 2 H groups on the amino acid X or Z, or a pharmaceutically acceptable salt thereof.
• m, p, q and k are individually 0-5, more preferably 0-3, and most preferably 0-2.
• the present invention also provides a compound of formula (IV):
• L and L' are individually H, (C,-C 6 )alkyl or a hydroxyl protecting group or an organic moiety comprising at least one fatty alcohol, ester or analog thereof. At least one of L and L' is said moiety (the FA moiety).
• the FA moiety is (A)(Y)(Z) n , and wherein A is (C 2 -C 6 )alkyl, Y is H, OH, N(R !
• R 1 , R 2 and R 3 are each ( -C ⁇ alkyl or R 1 and R 2 together with N are a (C 5 -C 7 )heterocyclic ring, optionally substituted with 1 or 2 N(R 3 ), S, non-peroxide O or a combination thereof; n is 1-2 and Z is YR, wherein Y is O, S, NH, N(CH 3 ), NHC(O) or OC(O) and R is (C 8 -C 22 )alkyl, optionally substituted with 1-2 double bonds.
• L' is a 2-substituted lecithin moiety, i.e., the C 2 OC(O)R 2 moiety of lecithin is replaced by C 2 OC(O)(CH 2 ) 3 OL and Y is hexadecanoyl; L is not H.
• n 1 and (A)(Y)(Z) n is -CH[CH 2 Y] [CH 2 Z], e.g., is derived by replacement of the 2'-acyloxyl moiety of lecithin with L-O(CH 2 ) 3 C(O)-.
• L or L' is l,3-dihexdecanoylprop-2-yl, the other is not H.
• L and L' are derived from organic polyols, such as glycerol, ethylene glycol, propylene glycol, 2,2'-hydroxyethyl ether and the like.
• the organic moieties L and L ' can also be simple fatty acid esters of C 4 -OH or fatty alcohol esters of CO 2 H.
• the present invention also provides compounds of formula (V):
• L is defined above, n is 2-6, preferably 2-5, most preferably 2-3, and L" is (C 2 -C 12 ) alkyl, preferably (C 3 -C 10 )alkyl, most preferably (C 3 -C 6 )alkyl, wherein the alkyl chain is optionally interrupted by about 1-3-O- moieties, i.e., is the residue of an alkylene polyol, preferably a l, ⁇ -alkylene diol such as 1,3-propane diol, or a polyoxyalkylene glycol.
• Examples of compounds of formula (V) include l,2,3-tris(4-hydroxy-butyroyl)propane and l,3-bis(4- acetoxybutyroyl)propane .
• the present invention also provides a pharmaceutical composition comprising an effective amount of the compound of formula (I), (II), (III) or (V), or mixtures thereof in combination with a pharmaceutically acceptable carrier.
• the pharmaceutical composition of the present invention may be adapted for parenteral, oral, topical or local administration.
• the present invention also provides a therapeutic method comprising administering to a mammal afflicted with a pathology or condition ameliorated by GHB, an amount of a compound of formula I, II, III, IV and/or V effective to treat said pathology or condition.
• the term "effective amount” means that the composition can deliver an amount of GHB to a target cell, tissue or organ effective to accomplish a therapeutic objective, i.e., to alter cellular metabolism or energetics or to ameliorate at least one symptom of one of the pathologies discussed herein.
• FIG. 1A shows a compound comprising esters of GHB and a fully charged hexopyranose.
• FIG. IB shows a GHB and a partially charged hexopyranose ester.
• FIG. 2 shows a GHB-sucrose ester.
• FIG. 3 shows GHB linked to representative amino acids.
• FIG.4 shows GHB linked to amino acid conjugates.
• amino acid comprises the residues of the natural amino acids (e.g. Ala, Arg, Asn, Asp, Cys, Glu, Gin, Gly, His, Hyl, Hyp, He, Leu, Lys, Met, P e, Pro, Ser, Thr, Trp, Tyr, and Val) in D or L form, as well as unnatural amino acids (e.g.
• the term also comprises natural and unnatural amino acids bearing a conventional amino protecting group (e.g.
• acetyl or benzyloxycarbonyl as well as natural and unnatural amino acids protected at the carboxy terminus (e.g. as a (C r C 6 )alkyl, phenyl or benzyl ester or amide; or as an -methylbenzyl amide).
• suitable amino and carboxy protecting groups are known to those skilled in the art (See for example, T. W. Greene, Protecting Groups In Organic Synthesis: Wiley: New York, 1981, and references cited therein).
• An amino acid can be linked to the remainder of a compound of formula I through the carboxy terminus, the amino terminus, or through any other convenient point of attachment, such as, for example, through the sulfur of cysteine.
• hydroxy amino acid includes naturally occurring, synthetic and semi-synthetic amino acids, such as serine, threonine, tyrosine and hydroxyproline.
• amino acids are -amino acids, most preferably with ⁇ -hydroxyl groups.
• carbohydrate as used herein is defined to include polyhydroxy aldehydes, or polyhydroxy ketones or substances that yield such compounds on hydrolysis.
• carbohydrate includes monosaccharides, oligosaccharides, disaccharides, trisaccharides, tetrasaccharides, pentasaccharides, hexasaccharides, polysaccharides, homopolysaccharides, and heteropolysaccharides.
• the term includes any of the aldoses, as well as glucose, dextrose, mannose, galactose arabinose, xylose, ribose, fructose, sucrose, altrose, allose, idose, gulose, talose, lyxose, threose, erythrose, apiose, and any of the same in acid form.
• the term also includes deoxy sugars and deoxy-aldoses, including rhamnose and fucose.
• the term further includes glyceraldehyde, cellulose, starch, glycogen, and amylose.
• carbohydrate derivatives such as acetals, ketals, acyl esters and the like.
• saccharide includes monosaccharides, disaccharides, trisaccharides and polysaccharides.
• the term includes glucose, sucrose, fructose and ribose, as well as deoxy sugars such as deoxyribose and the like. Saccharide derivatives can conveniently be prepared as described in International Patent Applications Publication Numbers WO 96/34005 and 97/03995.
• oligopeptide describes a sequence of 2 to 25 amino acids (e.g. as defined hereinabove) or peptidyl residues. The sequence may be linear, branched or cyclic.
• a cyclic peptide can be prepared or may result from the formation of disulfide bridges between two cysteine residues in a sequence.
• An oligopeptide can be linked to the remainder of a compound of formula I through the carboxy terminus, the amino terminus, or through any other convenient point of attachment, such as, for example, through the sulfur of a cysteine.
• a peptide comprises 3 to 25, or 5 to 21 amino acids.
• Peptide derivatives can be prepared as disclosed in U.S. Patent Numbers 4,612,302; 4,853,371; and 4,684,620.
• linking moiety refers to an at least divalent organic molecule that can join two amino acids or oligopeptidyl residues by reaction with functional groups therein. Such moieties include alkane and alkene dicarboxylic acids and diamines.
• alkyl includes branched, straight-chain and cyclic alkyl groups, including (cycloalkyl)alkyl.
• a fatty alcohol is a (C 8 -C 22 )alkanol, preferably a (C 10 -C 20 )alkanol, optionally comprising 1-3 double bonds;
• a fatty acid is a (C 8 -C 22 )alkanoic acid (i.e., (C,-C ⁇ )C(O)OH), optionally comprising 1-3 double bonds.
• hydroxyl protecting group includes removable hydroxy moiety protecting groups known to the art, such as acid- or base-labile groups such as acetals (THP, (l-ethoxy)ethyl), tris(alkyl)silyl groups (Me 3 , Si, (t- Bu(Me 2 )Si)), (C 2 -C 7 )acyl groups (acetyl), as well as groups that can be removed by hydrogenolysis, such as benzyl. See, also, part (C)(a), hereinbelow, which references additional OH protecting groups.
• acid- or base-labile groups such as acetals (THP, (l-ethoxy)ethyl), tris(alkyl)silyl groups (Me 3 , Si, (t- Bu(Me 2 )Si)), (C 2 -C 7 )acyl groups (acetyl), as well as groups that can be removed by hydrogenolysis, such as benzyl. See, also, part (
• GHB has been shown to be effective in treating narcolepsy and sleep disorders (Lee, 1977; Mamelak, 1977; Hoes, 1980; Scharf, 1985; Scrima, 1990; Gallimberti, 1992; Series, 1992; Lammers, 1993), reducing alcohol craving and alcohol withdrawal symptoms (Gallimberti et al., 1989; Gallimberti et al, 1992; Gessa et al, 1992), reducing opiate withdrawal symptoms (Gallimberti et al., 1994; Gallimberti et al., 1993), reducing pain (U.S. Patent No.
• GHB has been used with other analgesics, neuroleptics, or with a subliminal barbiturate dose for use as an anesthesia.
• GHB has been used in closed cranio-cerebral trauma and as soporifics (U.S. 5,380,937). Therefore, the compounds of the present invention can also be used in combination with analgesics, neuroleptics or barbiturates for use as an anesthesia.
• the inventors contemplate the use of the GHB compositions of the present invention as a narcotic, hypnotic, or as a soporific.
• the present invention provides compounds and pharmaceutical compositions that can be used in the treatments of hypnosis; narcolepsy (particularly cataplexy); drug abuse; anxiety; cerebrovascular diseases; central nervous system disorders, neurological disorders, including Parkinson's Disease and Alzheimer Disease; Multiple Sclerosis; autism; depression; inflammatory disorders, including those of the bowel, such as irritable bowel disorder, regional illitis, and ulcerative collitis; autoimmune inflammatory disorders; certain endocrine disturbances and diabetes.
• the present compounds can also be administered for the purpose of tissue protection, including protection following hypoxia/anoxia such as in stroke, organ transplantation, organ preservation, myocardial infarction or ischemia/reperfusion injury; protection following radiation, progeria, or an increased level of intracranial pressure, e.g., due to head trauma.
• tissue protection including protection following hypoxia/anoxia such as in stroke, organ transplantation, organ preservation, myocardial infarction or ischemia/reperfusion injury; protection following radiation, progeria, or an increased level of intracranial pressure, e.g., due to head trauma.
• the present compounds can be used to treat other pathologies believed to be caused or exacerbated by lipid peroxidation and/or free radicals, such as pathologies associated with oxidative stress, including normal aging.
• GHB is available from the Aldrich Chemical Co., Milwaukee, WI, and can be employed to prepare the compounds within the scope of formula (I) or (II).
• the GHB compositions of the present invention can be prepared by and administered by any of the means described herein, particularly those described in the section and the examples, or by any means as would be known to those of skill in the art.
• a compound of the present invention can be employed as the free acid or alcohol, or as a phaniiaceutically acceptable salt or ester thereof.
• Such salts can be formed from acids or amino groups described herein, by methods available to one or ordinary skill in the art. In cases where compounds are sufficiently basic or acidic to form stable salts with nontoxic organic acids or metal salts, administration of the compounds as salts may be appropriate.
• pharmaceutically acceptable salts are organic acid addition salts formed with acids which can form a physiological acceptable anion, for example, tosylate, methanesulfonate, acetate, citrate, malonate, tartarate, succinate, benzoate, ascorbate, -ketoglutarate, and -glycerophosphate.
• Suitable inorganic salts may also be formed, including hydrochloride, sulfate, nitrate, bicarbonate, and carbonate salts.
• Pharmaceutically acceptable salts may be obtained using standard procedures well known in the art, for example by reacting a sufficiently basic compound such as an amine with a suitable acid affording a physiologically acceptable anion.
• Alkali metal (for example, sodium, potassium or lithium) or alkaline earth metal (for example calcium) salts of carboxylic acids can also be made.
• the cations can also be readily exchanged with other metal or organic cations, such as Ca + , K + , Li + , or (R) N + wherein each R is H, phenyl, (C,-C 6 )alkyl or hydroxy(C r C 6 )alkyl, i.e., ammonium or hydroxyethyl amine salts.
• other metal or organic cations such as Ca + , K + , Li + , or (R) N + wherein each R is H, phenyl, (C,-C 6 )alkyl or hydroxy(C r C 6 )alkyl, i.e., ammonium or hydroxyethyl amine salts.
• Hydroxy protecting groups such as esters, ethers, acetals and ketals may be utilized in the present compounds.
• Useful hydroxy protecting groups are descried in Greene, T. W.; Wutz, P. G. M., "Protecting Groups in Organic Synthesis", 2nd ed., John Wiley & Sons, Inc (1991).
• GHB can be esterified with ( -C ⁇ alkanols or the benzyl ester prepared.
• the ester can be removed and the acid can be activated if necessary, i.e., by formation of an acid chloride or anhydride.
• an acid chloride or anhydride for preparation methods for 4- hydroxy-butanoic acid and its derivatives, see, Marvel et al., J. Am. Chem. Soc. 51, 260 (1929); Japanese patent 63174947, German Pat. Nos. 237310, 237308 and 237309.
• the activated carboxyl group of GHB can be reacted with the target hydroxyl groups in various sugars via ester bonds, as described, for example, in P. Pouillart et al, Eur. J. Pharm. ScL. 7, 93 (1998), P. R. Pouillart, Life Sciences. 63, 1739 (1998); P. Pouillart et al, J. Pharm. Sc 81, 241 (1992), and references cited therein.
• Most types of sugars including triose (or glycerol) tetroses, pentoses and hexoses can be used to make the compounds of the present invention. In the latter two cases, the open chain and ring (pyranoses and furanoses) forms may be used as scaffolds.
• An example of hexopyranose is depicted in Figure la, where a maximum of 5 GHB molecules can be anchored to each sugar monomer.
• GHB compounds can be synthesized from sucrose (containing a furanose and a pyranose ring), glucose and one from any open chain hexose. These compounds may be synthesized by a single step from free GHB or from its lactone.
• hydrocarbon chains may provide adequate protection from enzymes present in the digestive tract.
• These compositions may be susceptible to acid catalyzed hydrolysis, which depends on the steric environments around each ester bond. For example, the 6- OH ester bond will be readily hydrolyzed.
• These molecules may be viewed as miniature micelles and can be transported into the circulatory system via the fat absorption mechanism.
• Linking GHB to partially charged sugars may provide for better uptake and delivery of the drug.
• the depicted compound has only 3- GHBs attached to the sugar.
• the choice of hydroxyl groups for esterification can be based on the rates of hydrolysis of the corresponding esters so that desired levels of free GHB can be maintained within the cells of the target organ.
• Free hydroxyl groups can be used to anchor various groups.
• Steric shielding of GHB-ester linkages enhances the stability of the compounds in acidic medium. For example, one or more pairs of adjacent OH group groups on the sugar ring can be protected as acetals or as ketals, as taught by Pouillart et al., cited above, using acetals.
• the ketone can be varied in bulk, in order to shield the ester linkages to a greater or lesser extent.
• the attachment of lipophilic groups, such as steroids or fatty acids, to GHB via e.g., ketal or acetal linkages, can enhance the transfer across the blood-brain barrier.
• the use of a ketosteriod or benzaldehyde to form a ketal or acetal is shown in Fig. 1(b).
• a lipophilic composition may also be useful for delivery of GHB via salves or dermal patches. Free hydroxyl groups of the sugar may also be used to attach a second complementary therapeutic agent to the GHB composition.
• Amino acids (AA), serine, threonine, tyrosine, aspartic acid and glutamic acid contain side chains containing OH groups and/or second CO 2 H groups that can be coupled to GHB by ester linkages, following N-protection (See Fig. 3). Each of these compounds could be linked to two GHB molecules. Alternatively, the carboxylic acid of GHB can be reacted with an acid-protected amino acid to form the amide from the amine of the amino acid. Because the ester linkages of these compounds have different steric environments, the hydrolysis rates of these compounds in vivo will vary. A significantly slow rate of hydrolysis will be seen with serine and threonine, due to the ester linkages associated with their side chains.
• the ester linkage associated with the phenoxy side chain can be very rapidly hydrolyzed.
• Single amino acid compounds, i.e., AA-(GHB) 2 can only deliver 2 GHB molecules, and due to the lack of steric shielding, these compounds may have limited stability in the stomach pH.
• tailored small peptides having 3 to 5 amino acids can significantly improve the quantity of GHB delivered and have enhanced stability.
• the compounds of the present invention may comprise two or more amino acids.
• Such compounds can be constructed by using covalent linking moieties such as succinic acid to couple the amino acids tyrosine and threonine, or using maleic acid to couple aspartic and glutamic acids.
• Each of these conjugates comprises 4 GHB per molecule, where each ester linkage is in a significantly different steric shielding. (See Fig. 4).
• the succinic and maleic acid linkers have significantly different degrees of flexibility.
• Succinic acid has full rotational freedom, whereas using maleic acid, GHB molecules will be held in a cis orientation.
• Each compound, having two amide and four ester linkages, can give rise to distinct structural organizations with different stability and cellular uptake.
• the invention provides a pharmaceutical formulation comprising a compound of formula (I), (II), or (III), together with one or more pharmaceutically acceptable carriers therefor and, optionally, other therapeutic and/or prophylactic ingredients.
• the cations and carrier(s) must be "acceptable” in the sense of being compatible with the other ingredients of the formulation and not deleterious to the recipient thereof, i.e., they do not produce an adverse, allergic, or other untoward reaction when administered to an animal, or a human, at appropriate levels.
• Pharmaceutical formulations include those suitable for oral or parenteral
• compositions suitable for parenteral administration also include forms suitable for administration by inhalation or insufflation or for nasal, or topical (including buccal, rectal, vaginal, transdermal or sublingual) administration.
• the formulations may, where appropriate, be conveniently presented in discrete unit dosage forms, by bringing the active compound into association with liquid carriers, solid matrices, semi-solid carriers, finely divided solid carriers or combinations thereof, and then, if necessary, shaping the product into the desired delivery system.
• the active compounds of the invention may be formulated for parenteral administration, e.g., formulated for injection via intravenous, intraarterial, intramuscular, subcutaneous, intralesional, intraperitoneal or other parenteral routes.
• parenteral administration e.g., formulated for injection via intravenous, intraarterial, intramuscular, subcutaneous, intralesional, intraperitoneal or other parenteral routes.
• the preparation of an aqueous composition that contains a GHB agent as an active component or ingredient will be known to those of skill in the art in light of the present disclosure.
• the pharmaceutical dosage forms suitable for injection or infusion can include sterile aqueous solutions or dispersions or sterile powders comprising the active ingredient which are adapted for the extemporaneous preparation of sterile injectable or infusible solutions or dispersions.
• the compounds of the invention may be lyophilized for more ready formulation into a desired vehicle where appropriate.
• the active agent can optionally be encapsulated in liposomes. In all cases, the ultimate dosage form should be sterile, fluid and stable under the conditions of manufacture and storage.
• the liquid carrier or vehicle can be a solvent or liquid dispersion medium comprising, for example, water, ethanol, glycerol, a polyol (for example, glycerol, propylene glycol, liquid polyethylene glycols, and the like), vegetable oils, nontoxic glyceryl esters, and suitable mixtures thereof.
• the proper fluidity can be maintained, for example, by the formation of liposomes, by the maintenance of the required particle size in the case of dispersions, by the use of surfactants, or by the use of a substance, such as lecithin (e.g., a coating).
• Solutions of the active compounds as free acid or pharmacologically acceptable salts can be prepared in water suitably mixed with hydroxypropylcellulose and/or a pharmaceutically acceptable surfactant.
• the prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like.
• isotonic agents for example, sugars, buffers or sodium chloride.
• Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin.
• Sterile injectable solutions are prepared by incorporating the active compounds in the required amount in the appropriate solvent with various of the other ingredients as required, followed by filtered sterilization.
• dispersions are prepared by incorporating the various sterilized active ingredients into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above.
• the preferred methods of preparation are vacuum-drying and freeze-drying techniques which yield a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered, pyrogen-free solution thereof.
• the compounds according to the invention may be presented in unit dose form in ampules, pre-f ⁇ lled syringes, small volume infusion containers, multi- dose containers with an added preservative, or indwelling pumps or dispensers, or in devices which allow for sustained release of the compounds.
• the active GHB agent may be included within a therapeutic composition to comprise about 0.1 to about 100 grams GHB per unit dosage form, and multiple doses can also be administered.
• one dosage could be dissolved in 1 ml of isotonic NaCl solution and either added to 1000 ml of fluid or injected at the proposed site of infusion (see, for example, "Remington's Pharmaceutical Sciences” 15th Edition, pages 1035-1038 and 1570-1580).
• Some variation in dosage will necessarily occur depending on the condition of the subject being treated. The person responsible for administration will, in any event, determine the appropriate dose for the individual subject.
• compositions formulated for parenteral administration include, e.g., tablets or other solids; liposomal formulations; time release capsules; and any other form currently used, including creams or lotions, which then may be admixed with an aqueous medium for oral administration.
• compositions suitable for oral administration may be presented as discrete unit dosage forms such as hard or soft gelatin capsules, cachets or tablets each containing a predetermined amount of the active ingredient; as a powder or as granules; as a solution, a suspension or as an emulsion; or in a chewable base such as a synthetic resin or chicle for ingestion of the active ingredient from a chewing gum.
• the active ingredient may also be presented as a bolus, syrup, electuary or paste.
• Tablets and capsules for oral administration may contain conventional excipients such as binding agents, fillers, lubricants, disintegrants, or wetting agents.
• the tablets may be coated according to methods well known in the art, i.e., with enteric coatings.
• the tablets, troches, pills, capsules and the like may also contain the following: a binder, natural as gum tragacanth, acacia, cornstarch, or gelatin or synthetic as polyvinyl acetate; excipients, such as dicalcium phosphate; a disintegrating agent, such as corn starch, potato starch, alginic acid and the like; a lubricant, such as magnesium stearate; and a sweetening agent, such as sucrose, lactose, aspartame or saccharin may be added or a natural or synthetic flavoring agent.
• a binder natural as gum tragacanth, acacia, cornstarch, or gelatin or synthetic as polyvinyl acetate
• excipients such as dicalcium phosphate
• a disintegrating agent such as corn starch, potato starch, alginic acid and the like
• a lubricant such as magnesium stearate
• a sweetening agent such as sucrose, lac
• the dosage unit form When the dosage unit form is a capsule for admixing with a specific volume of an aqueous medium, it may contain, in addition to materials of the above type, a liquid carrier, such as vegetable oil or a polyethylene glycol. Various other materials may be present as coatings or to otherwise modify the physical form of the dosage unit. For instance, tablets, pills, or capsules may be coated with gelatin, wax, shellac, sugar, natural or synthetic polymers, or both. A syrup or elixir may contain the active compounds, sucrose or fructose as a sweetening agent, a preservative, a dye and/or a flavoring. Of course, any material used in preparing any unit dosage form should be pharmaceutically acceptable and substantially non-toxic in the amounts employed.
• compositions and preparations should contain at least 0.1% of the active compound.
• the percentage of the compositions and preparations may, of course, be varied and may conveniently be between about 2 to about 75%) of the weight of the unit, or preferably between 25-60%.
• the amount of active compounds in such therapeutically useful compositions is such that a suitable dosage will be obtained.
• the GHB-containing agent may be packaged separately from or in combination with the excipients, salts, flavorings or any other components described herein, to be admixed with an aqueous medium in the case of oral or injectable formulations, or they may be incorporated directly with the food (i.e., a beverage, candy bar or cake) of the diet.
• the present compounds may be applied in pure form, i.e., when they are liquids. However, it will generally be desirable to administer them to the skin as compositions or formulations, in combination with a dermatologically acceptable carrier, which may be a solid or a liquid.
• a dermatologically acceptable carrier which may be a solid or a liquid.
• useful dermatological compositions which can be used to deliver the compounds of formula I, II, or III to the skin are known to the art; for example, see Jacquet et al. (U.S. Pat. No. 4,608,392), Geria (U.S. Pat. No. 4,992,478), Smith et al. (U.S. Pat. No. 4,559,157) and Wortzman (U.S. Pat. No. 4,820,508).
• Useful solid carriers for dermatological compositions include finely divided solids such as talc, clay, microcrystalline cellulose, silica, alumina and the like.
• Useful liquid carriers include water, alcohols or glycols or water- alcohol/glycol blends, in which the present compounds can be dissolved or dispersed at effective levels, optionally with the aid of non-toxic surfactants.
• Adjuvants such as fragrances and additional antimicrobial agents can be added to optimize the properties for a given use.
• the resultant liquid compositions can be applied from absorbent pads, used to impregnate bandages and other dressings, or sprayed onto the affected area using pump-type or aerosol sprayers.
• Ointments, pastes, gels, lotions, soaps and creams may, for example, be formulated with an aqueous or oily base with the addition of suitable thickening and/or gelling agents.
• Lotions may be formulated with an aqueous or oily base and will in general also contain one or more emulsifying agents, stabilizing agents, dispersing agents, suspending agents, thickening agents, or coloring agents.
• Thickeners such as synthetic polymers, fatty acids, fatty acid salts and esters, fatty alcohols, modified celluloses or modified mineral materials can be employed.
• compound(s) of formula (I), formula (II), or formula (III) may be formulated as the active ingredient of a transdermal patch.
• Suitable transdermal delivery systems are disclosed, for example, in A. Fisher et al. (U.S. Pat. No. 4,788,603), Chien et al. (U.S. Pat. No. 5,145,682) or R. Bawa et al. (U.S. Pat. Nos. 4,931,279, 4,668,506 and 4,713,224).
• the active ingredient can also be delivered via iontophoresis, e.g., as disclosed in U.S. Pat. Nos. 4,140,122, 4,383,529, or 4,051,842.
• Formulations suitable for topical administration in the mouth include unit dosage forms such as lozenges comprising active ingredient in a flavored base, usually sucrose and acadia or tragacanth; pastilles comprising the active ingredient in an inert base such as gelatin and glycerin or sucrose and acacia; mucoadherent gels, and mouthwashes comprising the active ingredient in a suitable liquid carrier.
• unit dosage forms such as lozenges comprising active ingredient in a flavored base, usually sucrose and acadia or tragacanth; pastilles comprising the active ingredient in an inert base such as gelatin and glycerin or sucrose and acacia; mucoadherent gels, and mouthwashes comprising the active ingredient in a suitable liquid carrier.
• the above-described formulations can be adapted to provide sustained release of the active ingredient employed, e.g., by combination with certain hydrophilic polymer matrices, e.g., comprising natural gels, synthetic poly
• compositions suitable for rectal administration wherein the carrier is a solid are most preferably presented as unit dose suppositories.
• Suitable carriers include cocoa butter and other materials commonly used in the art, and the suppositories may be conveniently formed by admixture of the active compound with the softened or melted carrier(s) followed by chilling and shaping in molds.
• Formulations suitable for vaginal administration may be presented as pessaries, tampons, creams, gels, pastes, foams or sprays containing, in addition to the active ingredient, such carriers as are known in the art to be appropriate.
• the compounds according to the invention are conveniently delivered form an insufflator, nebulizer or a pressurized pack or other convenient means of delivering an aerosol spray.
• Pressurized packs may comprise a suitable propellant such as dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• the dosage unit may be determined by providing a valve to deliver a metered amount.
• the compounds according to the invention may take the form of a dry powder composition, for example, a powder mix of the compound and a suitable powder base such as lactose or starch.
• the powder composition may be presented in unit dosage form in, for example, capsules or cartridges or, e.g., gelatin or blister packs from which the powder may be administered with the aid of an inhalator or insufflator.
• the compounds of the invention may be administered via a liquid spray, such as via a plastic bottle atomizer. Typical of these are the Mistometer ® (Wintrop) and the Medihaler ® (Riker).
• Nasal solutions are usually aqueous solutions designed to be administered to the nasal passages in drops or sprays. Nasal solutions are prepared so that they are similar in many respects to nasal secretions, so that normal ciliary action is maintained. Thus, the aqueous nasal solutions usually are isotonic and lightly buffered to maintain a pH of 5.5 to 6.5, though other pH ranges disclosed herein the specific example, such as pH 3 to about pH 9, or pH 6 to about 7.5, are contemplated. In addition, preservatives, similar to those used in ophthalmic preparations, and appropriate drug stabilizers, if required, may be included in the formulation. Various commercial nasal preparations are known and include, for example, antibiotics and antihistamines and are used for asthma prophylaxis.
• GHB has typically been administered in clinical trials as an oral solution
• Useful dosages of the compounds of formula (I), (II), (III), (IV) or (V) can be determined by comparing their in vitro activity, and in vivo activity in animal models. Methods for the extrapolation of effective dosages in mice, and other animals, to humans are known to the art; for example, see U.S. Pat. No. 4,938,949.
• the concentration of the compound(s) of formula (I), (II), (III), (IN) or (V) in a liquid composition, such as a lotion will be from about 0.01-25 wt-%, preferably from about 0.5-10 wt-%.
• concentration in a semi-solid or solid composition such as a gel or a powder will be about 0.01-15 wt-%, preferably about 0.5-2.5 wt-% .
• a suitable dose will be in the range of from about 0.05 to 50 gm per day; or preferably from about 0.05 to about 500 mg per kilogram body weight of the recipient per day, preferably in the range of 0.1 to 200 mg/kg/day.
• the compound is conveniently administered in unit dosage form; for example, containing 0.1-20 g, conveniently 1-7.5 g, or more conveniently, 2-5 g of active ingredient per unit dosage form.
• the total daily dose i.e., of about 0.05-50 g, may be administered for about 1-4 months, or longer, as needed.
• the active ingredient should be administered to achieve peak plasma concentrations of the active compound of from about 0.5 to about 75 ⁇ M, preferably, about 1 to 50 ⁇ M, most preferably, about 2 to about 30 ⁇ M. This may be achieved, for example, by the intravenous injection of a 0.05 to 5% solution of the active ingredient, optionally in saline, or orally administered as a bolus containing about 1-100 mg of the active ingredient. Desirable blood levels may be maintained by continuous infusion to provide about 0.01-5.0 mg/kg/hr or by intermittent infusions containing about 0.4-15 mg/kg of the active ingredient(s).
• the desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as two, three, four or more sub-doses per day.
• the sub-dose itself may be further divided, e.g., into a number of discrete loosely spaced administrations; such as multiple inhalations from an insufflator or by application of a plurality of drops into the eye.

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