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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
• • 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
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/216—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acids having aromatic rings, e.g. benactizyne, clofibrate
• • 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
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
  • A61K31/222—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin with compounds having aromatic groups, e.g. dipivefrine, ibopamine
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
• • 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
  • A61P13/02—Drugs for disorders of the urinary system of urine or of the urinary tract, e.g. urine acidifiers
• • 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

• the invention relates to the use of weak opioids and mixed opioid agonists / antagonists 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 detrusor instability) with the consequence of urge incontinence and on the other hand a reduced sphincter pressure (e.g. after birth or surgical interventions) with the result of stress incontinence.
• the detrusor is the roughly bundled, multilayered bladder wall muscles, the contraction of which leads to emptying of the urine, the sphincter the sphincter of the urethra. There are 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. That leads to the follow to a much 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.
• drugs which increase the resistance of the urethra or bladder neck in particular, show affinities for a-adrenoreceptors like ephedrine, for ß-o adrenoreceptors like clenbutarol or are hormones like estradiol.
• diarylmethylpiperazines and piperidines are also described for this indication in WO 93/15062. Tramadol was also found to have a positive effect on bladder function in a rat model with 5 rhythmic bladder contractions (Nippon-Shinyaku, WO 98/46216). Furthermore, there are studies in the literature to characterize the opioid side effect hamretention, from which there is some evidence of the influence of bladder functions by weak opioids such as diphenoxylate (Fowler et al., 1987 J.
• 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. However, this is particularly preferred
• Codeine ((5 a, 6 a) - 7, 8- di dehydro- 4, 5-epoxy- 3-methoxy-17-methyl morphinan- 6-ol) is an active ingredient with antitussive, narcotic and analgesic effects. It is in the German Reichspatent (DRP) 247 180 by C. H. Boehringer v. Described in 1912.
• Dihydrocodeine ((5 a, 6 a) - 4, 5-epoxy-3-methoxy-17-methylmorphinan-6-ol) is used as an analgesic and antitussive and is used by Stein, A .: Pharmacy (PHARAT) 10, 180 (1955).
• Dextropropoxyphene [S- (R *, S *)] - a- [2- (dimethyl amino) - 1-methyl ethyl] - a-phenyl benzene ethanol propanoate (ester)
• PHARAT Pharmacy
• Meptazinol (3-ethyl hexa hydro-1-methyl-1 H-azepin-3-yl) phenol
• a nakotic and analgesic is described in DE-OS 1 941 534 or GB 1 285 025.
• Tilidine (trans-2- (dimethylamino) -1-phenyl-3-cyclohexene-1-carboxylic acid ethyl ester) is described in DE 1 518 959 or US 3,557,126 and is a known analgesic and narcotic.
• dextropropoxyophene codeine, meptazinol or Tilidine, preferably codeine, meptazinol or Tilidine for the preparation of the medicament.
• codeine is used, preferably in the form of the free base, the HBr or HI salt or as codeine phosphate.
• tilidine is used, preferably in the form of the free base or the HCl salt, also in the form of its racemates; Enantiomers, diastereomers, in particular mixtures of the enantiomers or diastereomers or a single enantiomer or diastereomer.
• meptazinol is used, preferably in the form of the free base or the HCl salt, also in the form of its racemate; Enantiomers, diastereomers, in particular mixtures of the enantiomers or diastereomers or a single enantiomer or diastereomer.
• dihydrocodeine is used, preferably in the form of the free base or as a dihydrocodeine tartrate.
• Dextropropoxyphen used, preferably in the form of the free base, the HCl salt or the napsylate, also in the form of its racemates; Enantiomers, diastereomers, in particular mixtures of the enantiomers or diastereomers or a single enantiomer or diastereomer.
• Naltrexone and / or levallorphan A preferred example would be tilidine and naloxone.
• the invention also encompasses medicaments for the treatment of increased urge to urinate or urinary incontinence, the active substance selected from at least one of the compounds
• 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, flavorings, sugar, in particular carriers, diluents, colorants, antioxidants, etc.
• suppositories i.a. Waxes or fatty acid esters and carriers, preservatives, suspension aids etc. are used for parenteral application agents.
• the amounts of active ingredient to be administered to patients vary in
• the compounds according to the invention can be released in a delayed manner from preparation forms which can be used orally, rectally or percutaneously.
• preparation forms which can be used orally, rectally or percutaneously.
• corresponding slow-release formulations in particular in the form of a
• “Once-daily” preparations which only have to be taken once a day, are particularly preferred. Further preferred are 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.
• a dose is preferably used in the medicinal product which is lower than the doses below the analgesic effect necessary for an analgesic effect. Dosages between the lower limit of the dose used in pain therapy and 10% of this dose, preferably between 80% and 20% of this dose, in particular between 50 and 30%, are customary.
• Excipients can be, for example: water, ethanol, 2-propanol, glycerol, ethylene glycol, propylene glycol, polyethylene glycol, polypropylene glycol, glucose, fructose, lactose, sucrose, dextrose, molasses, starch, modified starch, gelatin, sorbitol, inositol, mannitol, microcrystalline cellulose , Methyl cellulose, carboxymethyl cellulose, cellulose acetate, shellac, cetyl alcohol, polyvinyl pyrrolidone, paraffins, waxes, natural and synthetic rubbers, acacia gum, alginates, dextran, saturated and unsaturated fatty acids, stearic acid,
• compositions according to the invention are produced with the aid of the prior art the pharmaceutical formulation of well-known agents, devices, methods and processes, as described, for example, in "Remington 's Pharmaceutical Sciences", ed. AR Gennaro, 17th Ed., Mack Publishing Company, Easton, Pa. (1985), in particular in Part 8, Chapters 76 to 93.
• a solid formulation such as a tablet
• the active ingredient of the drug i.e. a compound of general structure I or one of its pharmaceutically acceptable salts
• a pharmaceutical carrier e.g. conventional tablet ingredients such as corn starch, lactose, sucrose, sorbitol, talc, magnesium stearate, dicalcium phosphate or pharmaceutically acceptable gums
• pharmaceutical diluents such as e.g. Water, granulated to form a solid composition containing a compound of the invention or a pharmaceutically acceptable salt thereof in homogeneous distribution.
• a homogeneous distribution is understood here to mean that the active ingredient is uniformly distributed over the entire composition, so that it can be easily divided into equally effective unit dose forms, such as tablets, pills or capsules.
• the solid composition is then
• Suitable coating agents include polymeric acids and mixtures of polymeric acids with materials such as e.g. Shellac, cetyl alcohol and / or cellulose acetate.
• Drugs containing dextropropoxyophene, codeine, meptazinol or tilidine, preferably codeine, meptazinol or tilidine, are particularly preferred. Even if the medicaments according to the invention only show minor side effects, it may be advantageous, for example to avoid certain forms of dependency, to use morphine antagonists, in particular naloxone, naitrexone and / or levallorphan, in addition to the compounds of the general formula I. A preferred example would be tilidine and naloxone.
• the invention also relates to a method for the treatment of increased urge to urinate or urinary incontinence, in which codeine or dihydrocodeine, dextropropoxyphene, meptazinol, pethidine or tilidine in the form of their bases and / or salts of physiologically compatible acids, optionally also in the form of their racemates; Enantiomers, diastereomers, in particular mixtures of their enantiomers or diastereomers or a single enantiomer or diastereomer, can be used.
• Example 1 Test system cystometry on the anesthetized naive rat
• the cystometric examination in naive female rats was carried out according to the method of Kimura et al. (Kimura et al., 1996, Int. J. Urol. 3: 218-227).
• Kimura et al. 1996, Int. J. Urol. 3: 218-227).
• ventilated rats the abdomen is opened and the ureters are tied off.
• the urine is drained from the kidneys.
• a catheter is inserted into the bladder and fixed. Saline is infused into the bladder by means of an infusion pump until this shows rhythmic spontaneous activity in the form of contractions, which over a connected pressure sensor can be recorded.
• the test substance is administered iv in a cumulative manner after stable initial values have been reached. Influencing the bladder function manifests itself by suppressing the spontaneous contractions. The absence of contractions over a period of 10 minutes is considered a parameter for the suppression.
• the investigated substances show a positive effect on bladder regulation and are therefore suitable for the treatment of urinary incontinence.
• 38.5 g of meptazinol-HCl is dissolved in 1 liter of water for injections at room temperature and then adjusted to isotonic conditions by adding anhydrous glucose for injections.
• 0.5 ml for example, 19.25 mg or »300 ⁇ g / kg are applied.
• the dose can be given about 3 times a day.
• Example 3 Liquid oral application form in combination with naloxone
• Dextropropoxyphen-HCI, microcrystalline cellulose and lactose are mixed homogeneously in a mixer and then with
• the moist granules are extruded in a screw extruder with a 0.8 mm (hole diameter) perforated disk and then rounded off to pellets in a spheronizer.
• the pellets are dried in a drying cabinet at 45 ° C. overnight.
• the classified pellets of grain size 800 - 1200 ⁇ m are mixed with an aqueous dispersion of Eudragit RS 30D + Eudragit RL 30D, containing tiethyl citrate as a plasticizer and talc as an anti-adhesive, (solid content of the ready-to-use dispersion:
• Example for one dose 1 capsule, ie with a body weight of 65kg «770 ⁇ g / kg. Usually 2 capsules are taken a day.
• Example 5 Solid oral slow-release form of application (slow-release tablets)
• the excipients and the active ingredient are mixed homogeneously in a mixer and then pressed on a tablet press to give tablets with a diameter of 9 mm.
• Example of a dose 1 tablet, ie for a body weight of 65kg »262 ⁇ g / kg. Usually 2 tablets are taken a day.

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• Engineering & Computer Science (AREA)
• General Chemical & Material Sciences (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Organic Chemistry (AREA)
• Urology & Nephrology (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Other In-Based Heterocyclic Compounds (AREA)
• Medicines Containing Material From Animals Or Micro-Organisms (AREA)

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• 2000
  • 2000-11-30 DE DE10059415A patent/DE10059415A1/de not_active Withdrawn
• 2001
  • 2001-11-28 CA CA002430281A patent/CA2430281C/en not_active Expired - Fee Related
  • 2001-11-28 AT AT01998335T patent/ATE287265T1/de active
  • 2001-11-28 HU HU0303285A patent/HUP0303285A3/hu unknown
  • 2001-11-28 DE DE50105150T patent/DE50105150D1/de not_active Expired - Lifetime
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  • 2001-11-28 AU AU2002220736A patent/AU2002220736B2/en not_active Ceased
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  • 2001-11-28 JP JP2002545684A patent/JP2004527465A/ja active Pending
  • 2001-11-28 WO PCT/EP2001/013911 patent/WO2002043713A2/de not_active Ceased
  • 2001-11-28 PL PL363677A patent/PL204246B1/pl unknown
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