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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
  • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches
• • 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
  • A61K31/136—Amines having aromatic rings, e.g. ketamine, nortriptyline having the amino group directly attached to the aromatic ring, e.g. benzeneamine
• • 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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/02—Suppositories; Bougies; Bases therefor; Ovules
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
  • A61K9/2059—Starch, including chemically or physically modified derivatives; Amylose; Amylopectin; Dextrin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
  • A61K9/2806—Coating materials
  • A61K9/282—Organic compounds, e.g. fats
  • A61K9/2826—Sugars or sugar alcohols, e.g. sucrose; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4866—Organic macromolecular compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/04—Centrally acting analgesics, e.g. opioids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/06—Antimigraine agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/08—Antiepileptics; Anticonvulsants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/20—Hypnotics; Sedatives
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/06—Antiarrhythmics

Definitions

• the invention relates to the use of ambroxol and its pharmacologically acceptable salts for the manufacture of a medicament for the treatment of diseases which are based on a strong activation of voltage-dependent sodium channels, in particular for the treatment of chronic pain.
• ambroxol trans-4- (2-amino-3,5-dibromobenzylamino) -cyclohexanol
• ambroxol is a known antitussive and expectorant.
• ambroxol is described in the literature (Society for Neuroscience Abstracts, 2000, Vol.26, No. 1-2).
• sodium channel blockers as analgesics.
• known sodium channel blockers are not fundamentally suitable for the treatment of chronic pain and treatment of diseases caused by excessive activation of voltage-dependent sodium channels, as they preferentially inhibit those sodium channels which play a minor role in the generation and transmission of noxious signals in sensory neurons ie those that can be inhibited by tetrodotoxin, as opposed to tetrodotoxin-resistant sodium neuronal channels.
• Diseases associated with chronic or chronic recurrent pain include, but are not limited to: Migraines, neuralgia, muscle aches and inflammatory pains. They share common mechanisms with chronic recurrent pain [Dray, A. Urban L. and Dickenson, A. Trends in Pharmacological Sciences 1994; 15: 190-197].
• Chronic neuronal pain includes postoperative pain, shingles, phantom pain, diabetic neuropathy, chronic nerve compression pain, and AIDS and terminal cancer. It is the object of the present invention to provide an active ingredient for the treatment of diseases caused by excessive activation of voltage-dependent sodium channels. In particular, the object of the present invention is to provide an active ingredient for the treatment of chronic pain, especially chronic neuronal or neuropathic pain, with good bioavailability and strong antinociceptive action.
• ambroxol has a very good effect in the treatment of chronic pain and neurological disorders, which relies on a blockade of excessively activated voltage-gated sodium channels, particularly over-potentiated voltage-dependent neuronal sodium channels.
• the invention therefore relates to the use of ambroxol or one of its pharmacologically acceptable salts for the manufacture of a medicament for the treatment of diseases which are based on a strong activation of voltage-dependent sodium channels.
• ambroxol or one of its pharmacologically acceptable salts for the preparation of a medicament for the treatment of chronic and / or neuropathic pain, preferably in diabetic neuropathy, postherpetic neuralgia, chronic back pain, migraine, trigeminal neuralgia or tumor pain, particularly preferred in diabetic neuropathy, postherpetic neuralgia, chronic back pain or migraine, especially preferred in diabetic neuropathy or postherpetic neuralgia.
• ambroxol or one of its pharmacologically acceptable salts for the manufacture of a medicament for the treatment of cerebral excitotoxicity-related disorders, preferably status epileptic, brain trauma or brain stroke, more preferably status epileptic or brain trauma, most preferably status epileptic.
• ambroxol or one of its pharmacologically acceptable salts for the manufacture of a medicament for the treatment of cardiac arrhythmias.
• a further subject of the invention is a pharmaceutical composition containing ambroxol and one or more active substances selected from the group consisting of anticonvulsants, for example barbiturates, preferably phenobarbital, hydantoins, succinimides, oxazolidines, benzodiazepines, neuroprotective substances, for example NMDA receptor antagonists, and antiarrhythmics, preferably lidocaine, verapamil or gallopamil.
• anticonvulsants for example barbiturates, preferably phenobarbital, hydantoins, succinimides, oxazolidines, benzodiazepines, neuroprotective substances, for example NMDA receptor antagonists, and antiarrhythmics, preferably lidocaine, verapamil or gallopamil.
• ambroxol or one of its pharmacologically acceptable salts in combination with one or more further active compounds selected from the group consisting of anticonvulsants, for example barbiturates, hydantoins, succinimides, oxazolidines, benzodiazepines, preferably phenobarbital, neuroprotective substances, for example NMDA.
• Receptor antagonists, or antiarrhythmics preferably lidocaine, verapamil or gallopamil.
• a further subject of the invention is a pharmaceutical composition containing ambroxol and one or more active substances selected from the group consisting of opioids, preferably morphine, buprenorphine, levomethadone, codeine, tramadol or tilidine, non-steroidal analgesics, for example acetylsalicylic acid, paracetamol, diciofenac, meloxicam , Ibuprofen, ibuprofen lysinate, ibuprofen in extruded form (as described in WO 99/06038), gabapentin and antidepressants, preferably imipramine, maprotiline, mianserin, fluoxetine, viloxazine, tranylcypromine or moclobemide, and alpha adrenergic agonists such as clonidine.
• opioids preferably morphine, buprenorphine, levomethadone, codeine, tramadol or t
• ambroxol or one of its pharmacologically tolerable salts in combination with one or more further analgesics selected from the group consisting of opioids, preferably morphine, buprenorphine, levomethadone, codeine, tramadol or tilidine, non-steroidal analgesics, for example, acetylsalicylic acid, paracetamol, diciofenac, meloxicam, ibuprofen, ibuprofenlysinate, ibuprofen in extruded form (as described in WO 99/06038), gabapentin or antidepressants, preferably imipramine, maprotiline, mianserin, fluoxetine, viloxazine, tranylcypromine or moclobemide ,
• opioids preferably morphine, buprenorphine, levomethadone, codeine, tramadol or tilidine
• ambroxol for the treatment of pain patients or patients with tumor diseases.
• Suitable acids for salt formation of ambroxol are, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid, oxalic acid, malonic acid, fumaric acid, maleic acid, tartaric acid, citric acid, ascorbic acid and methanesulfonic acid, preferably hydrochloric acid.
• ambroxol The effect of ambroxol according to the invention will be illustrated by the following examples. These serve only to illustrate the invention and are not to be regarded as limiting.
• Ambroxol has an antinociceptive effect based on a blockade of voltage-dependent sodium channels. In contrast to described clinically used sodium channel blockers, ambroxol preferentially inhibits tetrodotoxin-resistant sodium channels in nociceptive C-fiber neurons. Their particular relevance to inflammatory and chronic pain conditions has been demonstrated in vivo (Waxman et al., (1999) Proceedings of the National Academy of Science 96, 7635-7639; Khasar et al. (1998) Neuroscience Letters 256, 17-20).
• mice Male rats (Chbb: THOM) weighing 250-300 grams are used. 20 ⁇ l of a 2% formaldehyde solution is injected into the plantar region of the right hindpaw. Immediately thereafter, the number of flinches (twitching of the affected hindpaw) and the duration of licking of the affected paw are registered for one hour. After every 5 minutes, the values are summarized in epochs. From the epoch values, time-effect curves for flinches and leaks are created. Typically, two phases of formalin activity (flinches, licking) are observed. A first phase of 0-10 minutes and a second phase of 10-60 minutes.
• the number of flinches and duration of the leak drops to 0 (Snterphase). From the time-effect curves, the areas under the curve for the first phase and for the second phase are determined. Per control, placebo and substance dose usually 5 animals are used. The results of the substance doses are compared with those of the control and ED 50 values are calculated. ED 5 o is the dose at which the control values are inhibited by 50%.
• the ED 50 value for ambroxol hydrochloride is 70 mg / kg po
• Ambroxol reduced tactile allodynia as well as thermal hyperalgesia in other rat neuropathic pain test models (1 ,, (2) .
• Bennett GJ and Xie YK A peripheral mononeuropathy in rat in Pain., 33, 87-107, 19883.
• Seltzer, Z., Dubner R. and Shir, Y. A novel behavioral model of neuropathic pain disorder, Pain 43, 205-218, 1990.
• Ambroxol may be used alone or in combination with other pharmacologically active substances.
• Suitable application forms are, for example, tablets, capsules, suppositories, solutions, juices, emulsions or dispersible powders.
• Corresponding tablets can be prepared, for example, by mixing the active substance (s) with known excipients, for example inert Diluents such as calcium carbonate, calcium phosphate or milk sugar, disintegrants such as corn starch or alginic acid, binders such as starch or gelatin, lubricants such as magnesium stearate or talc, and / or depot effecting agents such as carboxymethyl cellulose, cellulose acetate phthalate, or polyvinyl acetate.
• the tablets can also consist of several layers.
• Coated tablets can accordingly be produced by coating cores produced analogously to the tablets with agents customarily used in tablet coatings, for example collidone or shellac, gum arabic, talc, titanium dioxide or sugar.
• the core can also consist of several layers.
• the dragee sheath to achieve a depot effect of several layers may consist of the above mentioned in the tablets excipients can be used.
• Juices of the active compounds or active compound combinations according to the invention may additionally contain a sweetener, such as saccharin, cyclamate, glycerol or sugar, as well as a taste-improving agent, e.g. Flavorings such as vanillin or orange extract. They may also contain suspending aids or thickening agents, such as sodium carboxymethylcellulose, wetting agents, for example condensation products of fatty alcohols with ethylene oxide, or protective agents, such as p-hydroxybenzoates.
• a sweetener such as saccharin, cyclamate, glycerol or sugar
• a taste-improving agent e.g. Flavorings such as vanillin or orange extract.
• suspending aids or thickening agents such as sodium carboxymethylcellulose, wetting agents, for example condensation products of fatty alcohols with ethylene oxide, or protective agents, such as p-hydroxybenzoates.
• Injection solutions are prepared in a conventional manner, e.g. with the addition of
• Preservatives such as p-hydroxybenzoates, or stabilizers, such as alkali salts of ethylenediaminetetraacetic acid prepared and filled into injection bottles or ampoules.
• the capsules containing one or more active ingredients or combinations of active substances can be prepared, for example, by mixing the active ingredients with inert carriers, such as lactose or sorbitol, and encapsulating them in gelatine capsules.
• suitable suppositories can be prepared, for example, by mixing with suitable carriers, such as neutral fats or polyethylene glycol or its derivatives.
• a therapeutically effective daily dose is 30 and 4000 mg, preferably 100 to 2000 mg per adult.
• Ambroxol, lactose and some of the corn starch are mixed together.
• the mixture is screened, then moistened with a solution of polyvinylpyrrolidone in water, kneaded, wet granulated and dried.
• the granules, the remainder of the corn starch and the magnesium stearate are sieved and mixed together.
• the mixture is compressed into tablets of suitable shape and size.
• Ambroxol, corn starch, lactose and polyvinylpyrrolidone are mixed well and moistened with water.
• the moist mass is forced through a sieve with 1 mm mesh size, dried at about 45 ° C and then strikes the granules through the same sieve.
• curved tablet cores having a diameter of 11 mm are pressed on a tableting machine.
• the coated dragee cores are coated in a known manner with a layer which consists essentially of sugar and talc.
• the finished dragees are polished with wax.
• Ambroxol and cornstarch are mixed and moistened with water. The moist mass is sieved and dried. The dry granules are sieved and mixed with magnesium stearate. The final mixture is filled into hard gelatine capsules size 1.
• Citric Acid Monohydrate 100 mg Sodium Hydroxide 35 mg
• Ambroxol is dissolved in water at intrinsic pH or optionally at pH 4.5 to 5.5 and admixed with mannitol as isotonan. The resulting solution is filtered pyrogen-free and the filtrate filled under aseptic conditions in injection bottles, which are then closed with rubber stoppers and autoclaved.
• the hard fat is melted.
• Ambroxol is homogeneously dispersed at 40 ° C. It is cooled to 38 ° C and poured into slightly pre-cooled suppository molds.
• Distilled water is heated to 70 ° C. Herein is stirring Hydroxyethyl cellulose dissolved. After addition of sorbitol solution and glycerol is cooled to room temperature. At room temperature, sorbic acid, flavor and ambroxol are added. To vent the suspension is evacuated with stirring.
• the ingredients are processed in the usual way to an ointment.

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Cited By (7)

Citations (4)

• 2002
  • 2002-01-25 DE DE10203104A patent/DE10203104A1/de not_active Withdrawn
• 2003
  • 2003-01-21 WO PCT/EP2003/000531 patent/WO2003061642A1/de not_active Ceased
  • 2003-01-21 ES ES03731681T patent/ES2295588T3/es not_active Expired - Lifetime
  • 2003-01-21 EP EP03731681A patent/EP1471899B1/de not_active Expired - Lifetime
  • 2003-01-21 JP JP2003561587A patent/JP2005526713A/ja active Pending
  • 2003-01-21 DE DE50308460T patent/DE50308460D1/de not_active Expired - Lifetime
  • 2003-01-21 AT AT03731681T patent/ATE376416T1/de active
  • 2003-01-21 CA CA2473885A patent/CA2473885C/en not_active Expired - Fee Related
  • 2003-01-23 TW TW092101479A patent/TW200307534A/zh unknown
  • 2003-01-23 UY UY27620A patent/UY27620A1/es not_active Application Discontinuation
  • 2003-01-24 PE PE2003000077A patent/PE20040176A1/es not_active Application Discontinuation
  • 2003-01-24 AR ARP030100207A patent/AR038316A1/es not_active Application Discontinuation

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