WO2004043429A1 - Therapie combinee pour traiter les dysfonctionnements d'ordre sexuel chez la femme apres la menopause, comprenant un agent androgene, un oestrogene et une agent antimuscarinique - Google Patents

Therapie combinee pour traiter les dysfonctionnements d'ordre sexuel chez la femme apres la menopause, comprenant un agent androgene, un oestrogene et une agent antimuscarinique Download PDF

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WO2004043429A1
WO2004043429A1 PCT/US2003/034418 US0334418W WO2004043429A1 WO 2004043429 A1 WO2004043429 A1 WO 2004043429A1 US 0334418 W US0334418 W US 0334418W WO 2004043429 A1 WO2004043429 A1 WO 2004043429A1
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dosage form
androgen
freatment
vaginal
dosage
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PCT/US2003/034418
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English (en)
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Chris R. Bilkey
Greg J. Slatter
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Pharmacia & Upjohn Company
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Priority to AU2003287248A priority Critical patent/AU2003287248A1/en
Publication of WO2004043429A1 publication Critical patent/WO2004043429A1/fr

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    • 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
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/13—Amines
    • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
    • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
    • 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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
    • 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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
    • A61K31/568—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/02—Drugs for genital or sexual disorders; Contraceptives for disorders of the vagina
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/12—Drugs for genital or sexual disorders; Contraceptives for climacteric disorders

Definitions

  • the present invention relates to pharmaceutical compositions in the form of vaginal dosage forms useful for treatment of symptoms related to female sexual dysfunction, and to therapeutic methods of use of such dosage forms.
  • Female sexual dysfunction (FSD) in postmenopausal women is a complex psychosexual disorder that can be treated hormonally with combinations of androgens and estrogens. See for example Berrnan et al. (1999), "Female sexual dysfunction: anatomy, physiology, evaluation and treatment options", Curr. Opin. Urol. 9(6), 563-568; Berrnan et al. (2000), "Anatomy and physiology of female sexual function and dysfunction. Classification, evaluation and treatment options", European Urology 38(1), 20-29; Berrnan et al.
  • An oral dosage form comprising esterified estrogens and the androgen methyltestosterone is commercially available, for example as Estratest® of Solvay Pharmaceuticals, and is disclosed by Berrnan et al. (1999), op. cit, to be useful in treatment of FSD.
  • Estratest® of Solvay Pharmaceuticals
  • Berrnan et al. (1999), op. cit to be useful in treatment of FSD.
  • a topical testosterone cream, currently used in treating vulvar lichen planus is indicated by Berrnan et al. (2000), op. cit, to have potential benefits including increased vaginal lubrication, increased libido and heightened arousal.
  • FSD FSD as defined above is further compounded by atrophic vaginitis, a disorder characterized by vaginal dryness, soreness and/or irritation. Atrophic vaginitis makes sexual activity uncomfortable or painful, and is treatable with locally administered estrogen.
  • Nagifem® is a vaginal tablet containing 25 ⁇ g estradiol in a modified release matrix, indicated for postmenopausal atrophic vaginitis, and currently marketed by Pharmacia Corp. in North America.
  • the Nagifem® tablet comprises a core having estradiol, in the form of estradiol hemihydrate, in a matrix comprising hydroxypropylmethylcellulose (HPMC), lactose monohydrate, corn starch and magnesium stearate, and a film coating comprising HPMC and polyethylene glycol (PEG).
  • HPMC hydroxypropylmethylcellulose
  • PEG polyethylene glycol
  • urinary incontinence can be associated with FSD in postmenopausal women. See Greendale et al. (2001), "Factors related to sexual function in postmenopausal women with a history of breast cancer", Menopause 8(2), 111-119; and Lalos et al. (2001), "Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome", J. Adv. Nurs. 33(3), 316-327.
  • Topical or intravaginal application of an estrogen such as estradiol is known to have a therapeutic effect in some cases of urinary incontinence, as disclosed or suggested by Batra & Iosif (1983), "Female urethra: a target for estrogen action", J. Urol. 129(2), 418-420; Karram et al. (1989), “Management of coexistent stress and urge urinary incontinence", Obstetrics & Gynecology 73(1); Goode et al. (1997), “Pharmacologic treatment of lower urinary tract dysfunction in geriatric patients", Am. J. Med. Sci.
  • Postmenopausal FSD is therefore an under-recognized and under-treated disorder.
  • therapies exist for individual disorders such as atrophic vaginitis (for example intravaginal estrogen, e.g., estradiol, administration), decreased sexual desire or arousal (for example androgen, e.g., testosterone, therapy) and urinary incontinence (for example oral administration of an antimuscarinic drug such as tolterodine) that can contribute to FSD
  • a significant unmet medical need remains for a treatment regimen that addresses a combination of two or more of such individual disorders, and for pharmaceutical compositions tailored to such a regimen.
  • a pharmaceutical dosage form comprising at least two agents selected from (a) an estrogen, (b) an androgen, and (c) an antimuscarinic, in total and relative dosage amounts that are therapeutically effective in treatment of FSD or disorders contributing thereto, said dosage form being adapted for intravaginal administration.
  • a vaginal dosage form of the invention comprises an estrogen and an androgen in total and relative dosage amounts that are therapeutically effective in treatment of FSD characterized at least by atrophic vaginitis and low libido.
  • a vaginal dosage form of the invention comprises an estrogen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment of FSD characterized at least by atrophic vaginitis and anxiety arising from urinary incontinence.
  • a vaginal dosage form of the invention comprises an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment of FSD characterized at least by low libido and anxiety arising from urinary incontinence.
  • a vaginal dosage form of the invention comprises an estrogen, an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment of FSD characterized by atrophic vaginitis, low libido and anxiety arising from urinary incontinence.
  • a method of treatment of FSD comprising administering intravaginally, in a treatment regimen extending over a period of at least 7 days, one to a plurality of dosage forms independently comprising one or more agents selected from (a) an estrogen, (b) an androgen, and (c) an antimuscarinic, wherein no more than one dosage form is administered on any day, wherein at least one such dosage form comprises at least two of said agents, and wherein said agents are administered in total and relative dosage amounts that are therapeutically effective in treatment of FSD or disorders contributing thereto.
  • kits comprising a package having contained therein a plurality of vaginal dosage forms independently comprising one or more agents selected from (a) an estrogen, (b) an androgen and (c) an antimuscarinic, wherein at least one such dosage form comprises at least two of said agents, said package and/or said dosage forms bearing indicia identifying a day on which each dosage form is to be intravaginally administered, said indicia corresponding to a treatment regimen extending over a period of at least 7 days wherein no more than one dosage form is administered on any day, said treatment regimen providing administration of said agents in total and relative dosage amounts that are therapeutically effective in treatment of FSD or disorders contributing thereto.
  • PMSA postmenopausal sexual avoidance
  • anxiety arising from urinary incontinence such anxiety (a) being of a degree sufficient to cause the sufferer to refrain repeatedly, though not necessarily to totally abstain, from sexual intercourse, and (b) ranging from mere embarrassment to severe neurosis.
  • a pharmaceutical dosage form comprising at least two agents selected from (a) an estrogen, (b) an androgen, and (c) an antimuscarinic, in total and relative dosage amounts that are therapeutically effective in treatment of PMSA, said dosage form being adapted for intravaginal administration; a vaginal dosage form comprising an estrogen and an androgen in total and relative dosage amounts that are therapeutically effective in treatment of PMSA; a vaginal dosage form comprising an estrogen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment ofPMSA; a vaginal dosage form comprising an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in freatment of PMSA; a vaginal dosage form comprising an estrogen, an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in freatment of PMSA; a vaginal dosage form comprising an estrogen, an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in freat
  • FIG. 1 is a diagram showing a PMSA freatment paradigm within which the present invention can be practiced.
  • Fig. 2 is a diagrammatic representation of a first kit of the invention, being a pack of vaginal tablets corresponding to a "cyclic" freatment regimen as described hereinbelow.
  • Fig. 3 is a diagrammatic representation of a second kit of the invention, being a pack of vaginal tablets corresponding to a "weekend” freatment regimen as described hereinbelow.
  • Fig. 4 is a diagrammatic representation of a third kit of the invention, being a pack of disposable vaginal applicators corresponding to a "weekend" freatment regimen as described hereinbelow.
  • postmenopausal herein relates to all stages of a woman's life from the onset of menopause onward, whether menopause occurs normally, prematurely or artificially, for example as a result of surgery. It is contemplated that certain benefits of the present invention will be afforded to perimenopausal or even to premenopausal women and the scope of the invention therefore extends to therapy for FSD or disorders contributory thereto at any stage of a woman's adult life. However, in preferred embodiments the invention is directed to postmenopausal FSD and in particular to PMSA as defined above.
  • the invention provides a novel and unique integrated approach, and pharmaceutical products useful therein, to freatment of PMSA.
  • a paradigm for this approach is shown in Fig. 1, wherein the three contributory factors listed above are represented as interlocking circles.
  • "Atrophic vaginitis” will be understood in Fig. 1 as an abbreviation for vaginal dryness, soreness or irritation of a severity sufficient to cause pain or discomfort during sexual intercourse, whether or not such vaginal dryness, soreness or irritation falls within a clinical definition of atrophic vaginitis, and whether or not such pain or discomfort falls within a clinical definition of dyspareunia.
  • “Low libido” will be understood in Fig.
  • Fig. 1 as an abbreviation for low libido, including decreased sexual desire and/or arousal, associated with low testosterone level.
  • "Incontinence” will be understood in Fig. 1 as an abbreviation for anxiety arising from urinary incontinence, such anxiety (a) being of a degree sufficient to cause the sufferer to refrain repeatedly, though not necessarily to totally abstain, from sexual intercourse, and (b) ranging from mere embarrassment to severe neurosis.
  • PMSA is a syndrome characterized by at least two of these three factors; thus the areas of Fig. 1 where two or three circles overlap represent situations where the present invention has particular utility.
  • Area "EA" represents PMSA characterized by atrophic vaginitis and low libido, for which a vaginal dosage form of the invention comprising an estrogen and an androgen will be the freatment of choice.
  • Area "TE” represents PMSA characterized by incontinence and atrophic vaginitis, for which a vaginal dosage form of the invention comprising an antimuscarinic ⁇ e.g., tolterodine) and an estrogen will be the freatment of choice.
  • Area "TA” represents PMSA characterized by incontinence and low libido, for which a vaginal dosage form of the invention comprising an antimuscarinic ⁇ e.g., tolterodine) and an androgen will be the freatment of choice. This can also be the freatment of choice for women having all three contributory factors to PMSA, but who are already on an oral estrogen regimen, for example as hormone replacement therapy, or for whom estrogens are contraindicated for any reason.
  • area "TEA” represents PMSA characterized by all three contributory factors, for which a vaginal dosage form of the invention comprising an antimuscarinic ⁇ e.g., tolterodine), an estrogen and an androgen will be the freatment of choice, except as indicated immediately above.
  • an antimuscarinic ⁇ e.g., tolterodine e.g., tolterodine
  • an estrogen and an androgen will be the freatment of choice, except as indicated immediately above.
  • Any dosage form adapted for intravaginal administration can be used according to the invention, including without limitation tablets, ovules, pessaries, creams, ointments, gels, foams, sponges and implants, preferably discrete unit dosage forms such as tablets, ovules and pessaries.
  • Presently preferred dosage forms are vaginal tablets adapted for mucosal delivery of the therapeutic agents.
  • Especially preferred are tablets that produce a gel layer on contact with the vaginal mucosa and that erode gradually to release the therapeutic agents for diffusion through the gel layer into the mucosa.
  • Such tablets can illustratively be formulated similarly to Vagifem® vaginal tablets of Pharmacia Corp., but having at least two therapeutic agents as required herein as opposed to estradiol alone.
  • Applicators for example disposable applicators similar to those in which Vagifem® tablets are commercially supplied, can optionally be provided to facilitate intravaginal administration of tablets of the invention.
  • a vaginal tablet comprising at least two agents selected from (a) an estrogen, (b) an androgen, and (c) an antimuscarinic, in total and relative dosage amounts that are therapeutically effective in freatment of FSD, disorders contributing thereto, or PMSA; a vaginal tablet comprising an esfrogen and an androgen in total and relative dosage amounts that are therapeutically effective in treatment of FSD, disorders contributing thereto, or PMSA; a vaginal tablet comprising an esfrogen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment of
  • vaginal tablet comprising an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in freatment of
  • vaginal tablet comprising an esfrogen, an androgen and an antimuscarinic in total and relative dosage amounts that are therapeutically effective in treatment of FSD, disorders contributing thereto, or PMSA; a vaginal tablet comprising an androgen in a dosage amount that, as part of a freatment regimen comprising co-therapy of the androgen with an esfrogen and/or an antimuscarinic, is therapeutically effective in freatment of FSD, disorders contributing thereto, or PMSA; a vaginal tablet comprising an antimuscarinic in a dosage amount that, as part of a treatment regimen comprising co-therapy of the antimuscarinic with an esfrogen and or an androgen, is therapeutically effective in treatment of FSD, disorders contributing thereto, or PMSA; a method of freatment of FSD, disorders contributing thereto, or PMSA, the method comprising administering infravaginally, in a freatment regimen extending
  • An embodiment of the invention is a vaginal dosage form, for example a vaginal tablet, comprising an androgen and at least one agent selected from an estrogen and an antimuscarinic, in total and relative dosage amounts that are therapeutically effective in freatment of FSD, disorders contributing thereto, or PMSA.
  • Therapeutic agents suitable as an esfrogen component of a vaginal dosage form of the invention include nonsteroidal and steroidal types.
  • Illustrative nonsteroidal estrogens include broparoestrol, chlorotrianisine, dienesfrol, diethylstilbesfrol, fosfesfrol, hexesfrol, methesfrol and salts and esters thereof. Steroidal estrogens are presently preferred.
  • Illustrative steroidal estrogens include colpormon, conjugated esfrogenic hormones, equilenin, equilin, esfradiol, estriol, esfrone, ethinyl esfradiol, mesfranol, moxestrol, quinesfradiol, quinesfrol and salts and esters thereof.
  • Esfradiol is an especially preferred esfrogen.
  • Therapeutic agents suitable as an androgen component of a vaginal dosage form of the invention illustratively include boldenone, cloxotestosterone, fluoxymesterone, mesterolone, methandrostenolone, methyltestosterone, norethandrolone, normethandrolone, oxandrolone, oxymesterone, oxymetholone, prasterone, stanolone, stanozolol, testosterone and salts and esters thereof. Methyltestosterone and testosterone are presently preferred.
  • Therapeutic agents suitable as an antimuscarinic component of a vaginal dosage form of the invention can be selected from antimuscarinics known to be effective for treating urinary incontinence or overactive bladder.
  • antimuscarinics include oxybutynin, tolterodine and salts and esters thereof, more especially tolterodine and its pharmaceutically acceptable salts, for example tolterodine tarfrate.
  • Either the racemate or the S-enantiomer of tolterodine can be used.
  • the 5-hydroxymethyl metabolite of tolterodine disclosed in International Patent Publication No. WO 94/11337, incorporated herein by reference, or its salts or esters can be used.
  • An appropriate dosage amount for each therapeutic agent can be selected based on readily available literature showing therapeutically effective doses of individual esfrogens, androgens and antimuscarinics.
  • suitable dosage amounts it will be recognized that the objective of intravaginal estrogen administration is primarily local delivery, but that for the androgen and the antimuscarinic systemic delivery will generally be desired. It will further be recognized that delivery via the vaginal mucosa circumvents first-pass metabolism, thus dosage amounts lower than those typically administered orally may be effective.
  • estradiol can be administered infravaginally in a dosage amount of about 10 to about 50 ⁇ g, preferably about 15 to about 40 ⁇ g, for example about 25 ⁇ g, no more than once daily.
  • Other esfrogens can be administered in dosage amounts therapeutically equivalent to these dosage amounts of esfradiol.
  • a suitable dosage amount of methyltestosterone is likely to be found in the range of about 0.5 to about 2.5 mg, no more than once daily, but greater or lesser amounts can be safe and effective in particular cases.
  • Other androgens can be administered in dosage amounts therapeutically equivalent to these dosage amounts of methyltestosterone. It will be found desirable to minimize the dosage amount of androgen and/or to minimize the number of days on which it is administered, to reduce risk of undesirable hepatic side- effects and masculinization.
  • a suitable amount of tolterodine is likely to be found in the range of about 0.1 to about 12 mg, preferably about 0.2 to about 6 mg, more preferably about 0.5 to about 5 mg, for example about 1 to about 2 mg, no more than once daily.
  • Other antimuscarinics can be administered in dosage amounts therapeutically equivalent to these dosage amounts of tolterodine.
  • Dosage forms of the invention comprising tolterodine are preferably formulated to exhibit release characteristics providing a tolterodine pharmacokinetic profile by intravaginal administration appropriate for once-a-day or less frequent treatment. Release characteristics with respect to esfrogen and/or androgen can also be consistent with once-a-day or less frequent adminisfration.
  • a freatment regimen of the invention is implemented over a period described herein as a freatment cycle. Any convenient freatment cycle period of 7 days or longer can be used. A freatment cycle period of 28 days is often particularly convenient.
  • a dosage form of the invention is administered infravaginally not less than once per freatment cycle, and not more than once per day during the freatment cycle.
  • vaginal dosage form comprising two or three therapeutic agents, i.e., a combination dosage form, is administered intermittently.
  • options include:
  • a monotherapeutic dosage form for example an esfradiol tablet or a tolterodine tablet;
  • a placebo dosage form i.e. , a dosage form containing no therapeutic agent
  • An advantage of the present invention is that the freatment regimen can be tailored precisely to the particular symptoms exhibited by the patient.
  • a further advantage is that the freatment regimen can be designed to provide maximum relief of symptoms, and thereby stimulate interest in sexual activity, at convenient or predictable times, such on a 28-day cycle or at weekends.
  • a "cyclic" freatment regimen lasting 28 days, for a woman receiving esfrogen and androgen combination therapy could be as shown below:
  • an illustrative "cyclic" freatment regimen could be: where T represents tolterodine monotherapy, TE represents adminisfration of a tolterodine
  • TA represents adminisfration of a tolterodine + androgen dosage form
  • TEA represents adminisfration of a tolterodine + estrogen + androgen dosage form in accordance with the invention.
  • a "weekend" freatment regimen lasting 28 days, for a woman receiving tolterodine, esfrogen and androgen combination therapy could be as shown below:
  • x, T, TE and TA are as defined above.
  • an embodiment of the present invention is a kit comprising a package having contained therein a plurality of vaginal tablets, at least a portion of which comprise two or more of estrogen, androgen and tolterodine, said package and/or said tablets bearing indicia identifying a day on which each dosage form is to be administered.
  • the indicia can be on the applicators.
  • the indicia can be numerical, e.g., 1, 2, 3, etc.; representative of days of the week, e.g., M, T, W, etc.; or otherwise indicative of a particular day in the freatment cycle.
  • the tablets and/or disposable vaginal applicators therefor can in addition be color coded or otherwise visually differentiated.
  • Any suitable package configuration can be employed, for example a rectangular matrix as illustrated in Figs. 2 and 3, or a "dial-a-dose" package as is sometimes used for oral contraceptives.
  • Fig. 2 shows an illustrative kit in the form of a rectangular blister package of tablets suitable for a "cyclic" freatment regimen involving tolterodine, esfrogen and androgen.
  • a blister pack 21 is marked with day indicia 22, in this case representative of days of the week Monday through Sunday, and week indicia 23, in this case numerical.
  • the blister pack holds twenty-eight vaginal tablets, some of which 24 contain tolterodine as sole therapeutic agent, others 25 contain tolterodine + esfrogen, still others 26 contain tolterodine + androgen, and yet others 27 contain tolterodine + esfrogen + androgen.
  • Fig. 3 shows a kit in the form of a rectangular blister package of tablets suitable for a "weekend" freatment regimen involving tolterodine, esfrogen and androgen.
  • a blister pack 31 is marked with day indicia 32, in this case representative of days of the week Monday through Sunday, and week indicia 33, in this case numerical.
  • the blister pack holds twenty-eight vaginal tablets, some of which 34 contain tolterodine as sole therapeutic agent, others 35 contain tolterodine + esfrogen, and still others 36 contain tolterodine + androgen. Also provided as part of the kit (not shown) is a product label insert providing directions for use and other necessary information, and optionally one or more vaginal applicators.
  • FIG. 4 shows a seven-day kit suitable for a "weekend" freatment regimen.
  • a package 41 comprises seven independently sealed but openable compartments 42 each containing a disposable vaginal applicator 43 having a vaginal tablet 44 dischargeably disposed therein.
  • the compartments 42 and/or applicators 43 are marked with day indicia 45, in this case representative of days of the week Monday through Sunday, and/or indicia 46 representative of the therapeutic agent or agents present in the tablet disposed in each applicator, in this case T for tolterodine, TA for tolterodine + androgen, and TE for tolterodine + estrogen.
  • the package 41 has a transparent wall 47 and the day indicia 45 and/or therapeutic agent indicia 46 are on the applicators 43 and are legible through the wall 47.
  • the package 41 has lines of weakness, for example, perforations 48, between compartments 42 to facilitate tearing of the package into single- compartment pieces without unsealing the compartments.
  • the packages illustrated in Figs. 2, 3 and 4 are preferably enclosed within an outer package (not shown).
  • a vaginal tablet containing 25 ⁇ g esfradiol and 1 mg methyltestosterone is formulated similarly to Vagifem® tablets except for the addition of the methyltestosterone.
  • the tablet is useful as part of a freatment regimen for PMSA.
  • the esfradiol is delivered primarily locally for relief of vaginal dryness, soreness and/or irritation.
  • the methyltestosterone is delivered systemically to increase libido.
  • a vaginal tablet containing 25 ⁇ g esfradiol and 2 mg tolterodine tarfrate is formulated similarly to Vagifem® tablets except for the addition of the tolterodine tarfrate.
  • the tablet is useful as part of a treatment regimen for PMSA.
  • the esfradiol is delivered primarily locally for relief of vaginal dryness, soreness and/or irritation.
  • the tolterodine is delivered systemically to confrol urinary incontinence and thereby remove a source of anxiety contributing to PMSA.
  • a vaginal tablet containing 1 mg methyltestosterone and 2 mg tolterodine tarfrate is formulated similarly to Vagifem® tablets except for replacement of esfradiol by methyltestosterone and tolterodine tarfrate.
  • the tablet is useful as part of a freatment regimen for PMSA.
  • the methyltestosterone is delivered systemically to increase libido.
  • the tolterodine is delivered systemically to confrol urinary incontinence and thereby remove a source of anxiety contributing to PMSA.
  • a vaginal tablet containing 25 ⁇ g esfradiol, 1 mg methyltestosterone and 2 mg tolterodine tarfrate is formulated similarly to Vagifem® tablets except for the addition of the methyltestosterone and the tolterodine tarfrate.
  • the tablet is useful as part of a freatment regimen for PMSA.
  • the esfradiol is delivered primarily locally for relief of vaginal dryness, soreness and/or irritation.
  • the methyltestosterone is delivered systemically to increase libido.
  • the tolterodine is delivered systemically to control urinary incontinence and thereby remove a source of anxiety contributing to PMSA.
  • a vaginal tablet containing 1 mg methyltestosterone is formulated similarly to
  • Vagifem® tablets except for replacement of esfradiol by methyltestosterone.
  • the tablet is useful as part of a freatment regimen for PMSA.
  • the methyltestosterone is delivered systemically to increase libido.
  • vaginal tablet containing 2 mg tolterodine tarfrate is formulated similarly to
  • Vagifem® tablets except for replacement of esfradiol by tolterodine tarfrate.
  • the tablet is useful as part of a freatment regimen for PMSA.
  • the tolterodine is delivered systemically to confrol urinary incontinence and thereby remove a source of anxiety contributing to PMSA.

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  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

Abstract

La présente invention concerne un ensemble de formes pharmaceutiques comprenant chacune un agent androgène et au moins un agent sélectionné dans le groupe comprenant un oestrogène et une agent antimuscarinique, en des quantités de dosage totales et relatives qui sont actives d'un point de vue thérapeutique pour traiter les dysfonctionnements d'ordre sexuel chez la femme (FSD) ou les troubles d'ordre sexuels après la ménopause (PMSA), lesdites formes pharmaceutiques étant conçues pour être administrées par voie intravaginale. Un procédé de traitement des FSD ou des PMSA comprend l'administration par voie intravaginale, pendant une période de traitement d'au moins 7 jours, de formes pharmaceutiques dont au moins une partie comprend un agent androgène et au moins un agent choisi dans le groupe qui comprend un oestrogène et un agent antimuscarinique, en des quantités de dosage totales et relatives qui sont actives d'un point de vue thérapeutique pour traiter les FSD ou les PMSA, une seule forme pharmaceutique étant administrée par jour. L'invention a également pour objet un kit utile pour la mise en place d'un traitement de ce type.
PCT/US2003/034418 2002-11-12 2003-10-29 Therapie combinee pour traiter les dysfonctionnements d'ordre sexuel chez la femme apres la menopause, comprenant un agent androgene, un oestrogene et une agent antimuscarinique WO2004043429A1 (fr)

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AU2003287248A AU2003287248A1 (en) 2002-11-12 2003-10-29 Combination therapy for postmenopausal female sexual dysfunction comprising an androgen, an estrogen and an antimuscarinic

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US42553702P 2002-11-12 2002-11-12
US60/425,537 2002-11-12

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WO2004043429A1 true WO2004043429A1 (fr) 2004-05-27

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EP1526855A2 (fr) * 2002-08-07 2005-05-04 R & D Pharma - SAM Compositions pharmaceutiques destinees au traitement de l'incontinence urinaire

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