WO2005097120A1 - Compositions with reduced hepatotoxicity - Google Patents

Compositions with reduced hepatotoxicity Download PDF

Info

Publication number
WO2005097120A1
WO2005097120A1 PCT/US2005/009795 US2005009795W WO2005097120A1 WO 2005097120 A1 WO2005097120 A1 WO 2005097120A1 US 2005009795 W US2005009795 W US 2005009795W WO 2005097120 A1 WO2005097120 A1 WO 2005097120A1
Authority
WO
WIPO (PCT)
Prior art keywords
composition
amount
standard dose
per standard
present
Prior art date
Application number
PCT/US2005/009795
Other languages
French (fr)
Inventor
Joel E. Bernstein
Original Assignee
Winston Laboratories, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Winston Laboratories, Inc. filed Critical Winston Laboratories, Inc.
Priority to JP2007506267A priority Critical patent/JP2007530688A/en
Priority to EP05731289A priority patent/EP1729769A4/en
Priority to CA002561619A priority patent/CA2561619A1/en
Publication of WO2005097120A1 publication Critical patent/WO2005097120A1/en

Links

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
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • 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
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • 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
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
    • 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
    • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
    • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
    • 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
    • A61K47/20—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing sulfur, e.g. dimethyl sulfoxide [DMSO], docusate, sodium lauryl sulfate or aminosulfonic acids
    • 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
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
    • 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
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/10—Antimycotics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/06—Antianaemics
    • 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
    • A61K9/2013—Organic compounds, e.g. phospholipids, fats

Definitions

  • compositions of pharmaceutical compounds having hepatotoxicity in which compositions the hepatotoxicity is mitigated. More particularly, this invention relates to compositions of hepatotoxic compounds such as acetaminophen, methotrexate, statin drugs, niacin, divalproex sodium, valproic acid or fluconazole, each of which is known to have hepatotoxic properties, in which compositions the hepatotoxicity of the compound is mitigated.
  • hepatotoxic compounds such as acetaminophen, methotrexate, statin drugs, niacin, divalproex sodium, valproic acid or fluconazole, each of which is known to have hepatotoxic properties, in which compositions the hepatotoxicity of the compound is mitigated.
  • Acetaminophen is the active metabolite of phenacetin, a drug whose use extends back to the 1880's. Although acetaminophen was first used as an analgesic and antipyretic in 1893, it did not achieve widespread use until after 1949. For many years, acetaminophen was used as a second-line choice to aspirin as an analgesic/antipyretic; but the elucidation of the relationship between aspirin use and Reye's Syndrome and the recognition of aspirin's propensity to produce gastrointestinal bleeding vaulted acetaminophen into its current day position as the analgesic/antipyretic of first choice in both children and adults.
  • acetaminophen While acetaminophen is usually well tolerated, its use can be accompanied by a very serious adverse effect - potentially fatal hepatic necrosis. Hepatic necrosis with acetaminophen is largely confined to two groups of patients: 1. Patients who ingest acute overdoses or who chronically utilize high dosage regimens of acetaminophen. 2. Ingestion of acetaminophen by alcoholics or in combination with alcohol ingestion. It has been reported that more than 26,000 patients per year are hospitalized in the U.S. for acetaminophen induced hepatic necroses, and of these, more than 400 die each year.
  • Atorvastatin, simvastatin and other cholesterol reducing agents of the "statin" family are the most widely used pharmaceuticals in the world.
  • liver toxicity is a significant problem, and patients with a history of old or active hepatitis must avoid these drugs even if they could benefit from their cholesterol lowering actions.
  • Niacin also known as nicotinic acid or vitamin B 3
  • Fluconazole, a potent antifungal agent, and divalproex sodium and valproic acid, widely used antiepileptics are three other agents whose clinical use is limited by their hepatotoxicity.
  • nicotinamide also known as niacinamide
  • methionine an essential amino acid which is a DL racemic mixture of D & L methionine
  • nicotinamide and methionine can be administered in combination with hepatotoxic phiarmaceutical compounds such as acetaminophen, methotrexate, a "statin" cholesterol lowering agent, fluconazole, divalproex sodium or valproic acid, in substantially lower doses than disclosed in the prior art, and when administered as such, can. provide a substantive protective effect against the hepatotoxicity of these agents without negatively affecting their beneficial therapeutic activity.
  • hepatotoxic phiarmaceutical compounds such as acetaminophen, methotrexate, a "statin" cholesterol lowering agent, fluconazole, divalproex sodium or valproic acid
  • hepatotoxic pharmaceutical compounds such as acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium, valproic acid, and related drugs
  • compositions of hepatotoxic therapeutic drugs sixch as acetaminophen, methotrexate, the "statins,” niacin, fluconazole, divalproex sodium, valproic acid, and related drugs, which compositions provide ttie therapeutic benefits of the active drug with markedly reduced potential for serious hepatotoxicity.
  • compositions in wTiich the hepatotoxic properties are mitigated.
  • the compositions can include a standard dose of the hepatotoxic compound, together with relatively low dosages of nicotinamide and methionine. Low dosages of folic acid also can be added to ttie compositions to further mitigate the hepatotoxic properties.
  • Specific embodiments of the invention can be in the form of formulations of acetaminophen together with mixtures of low do sages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid; or formulations of methotrexate together with mixtures of low dosages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid.
  • These formulations are incorporated into pharmaceutically acceptable vehicles for use in humans and animals.
  • formulations of atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium or valproic acid each can be formulated into pharmaceutically acceptable vehicles for use in humans and animals together with mixtures of low dosages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid.
  • Such formulations include those suitable for oral administration such as capsules, tablets, caplets, or liquid solutions or suspensions, as well as sterile solutions or suspensions suitable for intradermal, subcutaneous, intramuscular, intravenous or intrathecal injection.
  • acetaminophen 80 mg - 1000 mg per single dose form, e.g. single capsule, single tablet, etc.
  • methotrexate 2.5 mg - 250 mg per single dose form
  • atorvastatin or simvastatin 5 mg - 100 mg per single dose form
  • niacin 250 mg - 1000 mg per single dose form
  • fluconazole 10 mg - 250 mg per single dose form
  • divalproex sodium 100 mg - 750 mg per single dose form
  • valproic acid 25 mg - 500 mg per single dose form
  • methionine may be present in the amount of about 5 mg to about 500 mg per single dose form, and preferably about 10 mg to 100 mg per single dose form
  • nicotinamide may be present in the amount of about 10 mg to 500 mg per single dose form, and preferably about 25 mg to about 200 mg per single dose form.
  • Suitable pharmaceutical vehicles for the combinations of hepatotoxic compounds such as acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium or valproic acid, with hepatotoxicity mitigators methionine, nicotinamide and folic acid, and methods of preparing such formulations as are within the scope of the invention, will be readily apparent to and understood by those skilled in the art.
  • the compositions of the instant invention will be more readily comprehended from the following examples:
  • Two tablets comprised of 500 mg acetaminophen, 50 mg methionine, and 25 mg nicotinamide, are administered to patients with painful osteoarthritis four times daily for 12 weeks producing substantial relief of joint pain without evidence of any hepatotoxicity.
  • Capsules are prepared each containing by weight 325 mg acetaminophen, 50 mg methionine, 50 mg nicotinamide, and 500 meg folic acid.
  • One to two of such capsules are administered to patients with osteoarthritis or fibromyalgia pain four to six times daily for 6 months for relief of joint or soft tissue pain without evidence of damage to the patients' livers.
  • Example 3
  • Tablets are prepared each containing 2.5 mg methotrexate, 100 mg methionine, 100 mg nicotinamide and 100 meg folic acid. Two of such tablets are administered to patients with psoriasis of the skin twice daily for 6 months. Such patients demonstrate improvement in their psoriatic lesions without evidence of serious methotrexate-induced liver damage.
  • Example 5
  • Tablets containing 250 mg divalproex sodium, 250 mg methionine and 100 mg nicotinamide by weight are administered twice daily to patients with migraine headaches to prevent or diminish the severity of migraine headaches without evidence of serious liver damage.
  • Capsules are prepared each containing by weight 10 mg atorvastatin, 500 mg methionine, 100 mg nicotinamide, and 1.0 mg folic acid and administered to patients once daily. Such patients have lower serum cholesterol and triglycerides without vidence of significant alteration in their liver functions.
  • An oral suspension containing 10 mg/ml fluconazole, 25 mg/ml methionine and 20 mg/ml nicotinamide is administered to children for treatment of oropharyngeal candidiasis at a dosage of 2 - 12 mg/kg per day for 3 weeks with a substantially lessened risk of liver toxicity than with standard fluconazole suspensions.

Landscapes

  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Medicinal Chemistry (AREA)
  • Epidemiology (AREA)
  • General Chemical & Material Sciences (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Organic Chemistry (AREA)
  • Pain & Pain Management (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Oil, Petroleum & Natural Gas (AREA)
  • Dermatology (AREA)
  • Diabetes (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Neurosurgery (AREA)
  • Hematology (AREA)
  • Proteomics, Peptides & Aminoacids (AREA)
  • Oncology (AREA)
  • Rheumatology (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Communicable Diseases (AREA)
  • Obesity (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

Abstract

Pharmaceutical compositions of hepatotoxic compounds are provided in which the hepatotoxicity of the compounds is mitigated by including quantities of nicotinamide and methionine in the composition. Folic acid also can be included to further mitigate the hepatotoxic effects. The hepatotoxic compounds can include acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, flucanozole, divalproex sodium, and valproic acid.

Description

COMPOSITIONS WITH REDUCED HEPATOTOXICITY
BACKGROUND OF THE INVENTION
This invention relates to compositions of pharmaceutical compounds having hepatotoxicity, in which compositions the hepatotoxicity is mitigated. More particularly, this invention relates to compositions of hepatotoxic compounds such as acetaminophen, methotrexate, statin drugs, niacin, divalproex sodium, valproic acid or fluconazole, each of which is known to have hepatotoxic properties, in which compositions the hepatotoxicity of the compound is mitigated.
Acetaminophen is the active metabolite of phenacetin, a drug whose use extends back to the 1880's. Although acetaminophen was first used as an analgesic and antipyretic in 1893, it did not achieve widespread use until after 1949. For many years, acetaminophen was used as a second-line choice to aspirin as an analgesic/antipyretic; but the elucidation of the relationship between aspirin use and Reye's Syndrome and the recognition of aspirin's propensity to produce gastrointestinal bleeding vaulted acetaminophen into its current day position as the analgesic/antipyretic of first choice in both children and adults. While acetaminophen is usually well tolerated, its use can be accompanied by a very serious adverse effect - potentially fatal hepatic necrosis. Hepatic necrosis with acetaminophen is largely confined to two groups of patients: 1. Patients who ingest acute overdoses or who chronically utilize high dosage regimens of acetaminophen. 2. Ingestion of acetaminophen by alcoholics or in combination with alcohol ingestion. It has been reported that more than 26,000 patients per year are hospitalized in the U.S. for acetaminophen induced hepatic necroses, and of these, more than 400 die each year. Many of these overdoses are the result of suicide attempts, but reports indicate that more than 2,000 hospitalizations and 100 deaths a year were attributable to non-intentional acetaminophen overdoses. In fact, an Advisory Panel of the U.S. Food and Drug Administration has recommended that new warning language be added to the label of acetaminophen containing products concerning the danger of hepatic necroses. Methotrexate, an inhibitor of cell metabolism, has been utilized for several decades as a therapeutic agent widely used in several different diseases including rheumatoid arthritis and psoriasis. While methotrexate administration is associated with various other side effects, severe and sometimes fatal liver toxicity is a significant limiting factor in its therapeutic usefulness. Atorvastatin, simvastatin and other cholesterol reducing agents of the "statin" family are the most widely used pharmaceuticals in the world. In spite of their widespread use, liver toxicity is a significant problem, and patients with a history of old or active hepatitis must avoid these drugs even if they could benefit from their cholesterol lowering actions. Niacin (also known as nicotinic acid or vitamin B3), another agent frequently employed as a cholesterol lowering agent, is also associated with a high incidence of liver toxicity. Fluconazole, a potent antifungal agent, and divalproex sodium and valproic acid, widely used antiepileptics are three other agents whose clinical use is limited by their hepatotoxicity.
The concerns about the hepatic toxicity of acetaminophen, methotrexate, the
"statin" cholesterol lowering agents, niacin, fluconazole, divalproex sodium and valproic acid, prompted me to search for a substitute or a mixture of substances that in combination with any of these drugs would substantially reduce the risk of hepatic toxicity without adversely affecting the therapeutic benefits conferred by these drugs. In reviewing the scientific literature, I learned that nicotinamide (also known as niacinamide), which is the amide of vitamin B3 (niacin), and methionine, an essential amino acid which is a DL racemic mixture of D & L methionine, have been used in very high dosages to prevent liver damage from acetaminophen or methotrexate. These drugs have been administered as single large doses or multiple large doses over a short (usually 24 hr) period. Published dosages of methionine for such usage range from about 2.5 gm to over 21 gm administered as a single dose for over 24 hours. Wright, B., Crowe, M., British Medical Journal (England), vol. 317, Dec. 12, 1998, p. 1656; Vale, J.A., Proudfoot, A.T., The Lancet, 1995, vol. 346, pp. 547-52. Similarly, doses of nicotinamide utilized for a similar purpose have ranged from about 2 gm to 7 gm per 24 hours. Kroger, H., et al., General Pharmacology 33 (1999) 203-206. I have discovered, surprisingly, that nicotinamide and methionine can be administered in combination with hepatotoxic phiarmaceutical compounds such as acetaminophen, methotrexate, a "statin" cholesterol lowering agent, fluconazole, divalproex sodium or valproic acid, in substantially lower doses than disclosed in the prior art, and when administered as such, can. provide a substantive protective effect against the hepatotoxicity of these agents without negatively affecting their beneficial therapeutic activity. I have furthermoxe discovered that by adding a modest amount of folic acid to the nicotinamide and methionine mixture, in combination with hepatotoxic pharmaceutical compounds such as acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium, valproic acid, and related drugs, I can achieve a therapeutic product which provides the therapeutic benefits of each of these agents with almost no potential for liver toxicity.
It is thus the object of the invention to provide pharmaceutically acceptable compositions of hepatotoxic therapeutic drugs sixch as acetaminophen, methotrexate, the "statins," niacin, fluconazole, divalproex sodium, valproic acid, and related drugs, which compositions provide ttie therapeutic benefits of the active drug with markedly reduced potential for serious hepatotoxicity.
Detailed Description of the Preferred Embodiments
In accordance with the invention, compounds having known hepatotoxic properties are formulated into compositions in wTiich the hepatotoxic properties are mitigated. The compositions can include a standard dose of the hepatotoxic compound, together with relatively low dosages of nicotinamide and methionine. Low dosages of folic acid also can be added to ttie compositions to further mitigate the hepatotoxic properties.
Specific embodiments of the invention can be in the form of formulations of acetaminophen together with mixtures of low do sages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid; or formulations of methotrexate together with mixtures of low dosages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid. These formulations are incorporated into pharmaceutically acceptable vehicles for use in humans and animals. Similarly, formulations of atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium or valproic acid each can be formulated into pharmaceutically acceptable vehicles for use in humans and animals together with mixtures of low dosages of nicotinamide and methionine, or together with low dosages of nicotinamide, methionine and folic acid. Such formulations include those suitable for oral administration such as capsules, tablets, caplets, or liquid solutions or suspensions, as well as sterile solutions or suspensions suitable for intradermal, subcutaneous, intramuscular, intravenous or intrathecal injection.
In each of the foregoing formulations, whether for oral ingestion or for injection, when combined with standard dosages of either acetaminophen (80 mg - 1000 mg per single dose form, e.g. single capsule, single tablet, etc.), methotrexate (2.5 mg - 250 mg per single dose form), atorvastatin or simvastatin (5 mg - 100 mg per single dose form), niacin (250 mg - 1000 mg per single dose form), fluconazole (10 mg - 250 mg per single dose form), divalproex sodium (100 mg - 750 mg per single dose form), and valproic acid (25 mg - 500 mg per single dose form), methionine may be present in the amount of about 5 mg to about 500 mg per single dose form, and preferably about 10 mg to 100 mg per single dose form, and nicotinamide may be present in the amount of about 10 mg to 500 mg per single dose form, and preferably about 25 mg to about 200 mg per single dose form. When folic acid is included in the standard dose fomiulation, folic acid may be present in the amount of about 50 meg to about 5 mg, and preferably about 500 meg to 1 mg, per single dose form.
Suitable pharmaceutical vehicles for the combinations of hepatotoxic compounds such as acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, fluconazole, divalproex sodium or valproic acid, with hepatotoxicity mitigators methionine, nicotinamide and folic acid, and methods of preparing such formulations as are within the scope of the invention, will be readily apparent to and understood by those skilled in the art. The compositions of the instant invention will be more readily comprehended from the following examples:
Examples
Example 1
Two tablets, comprised of 500 mg acetaminophen, 50 mg methionine, and 25 mg nicotinamide, are administered to patients with painful osteoarthritis four times daily for 12 weeks producing substantial relief of joint pain without evidence of any hepatotoxicity.
Example 2
Capsules are prepared each containing by weight 325 mg acetaminophen, 50 mg methionine, 50 mg nicotinamide, and 500 meg folic acid. One to two of such capsules are administered to patients with osteoarthritis or fibromyalgia pain four to six times daily for 6 months for relief of joint or soft tissue pain without evidence of damage to the patients' livers. Example 3
Two caplets each containing 500 mg acetaminophen, 200 mg methionine, and 100 mg nicotinamide are administered four times daily for twelve (12) weeks to patients with osteoarthritis for relief of osteoarthritis pain without evidence of liver damage. Example 4
Tablets are prepared each containing 2.5 mg methotrexate, 100 mg methionine, 100 mg nicotinamide and 100 meg folic acid. Two of such tablets are administered to patients with psoriasis of the skin twice daily for 6 months. Such patients demonstrate improvement in their psoriatic lesions without evidence of serious methotrexate-induced liver damage. Example 5
Tablets containing 250 mg divalproex sodium, 250 mg methionine and 100 mg nicotinamide by weight are administered twice daily to patients with migraine headaches to prevent or diminish the severity of migraine headaches without evidence of serious liver damage.
Example f>
Capsules are prepared each containing by weight 10 mg atorvastatin, 500 mg methionine, 100 mg nicotinamide, and 1.0 mg folic acid and administered to patients once daily. Such patients have lower serum cholesterol and triglycerides without vidence of significant alteration in their liver functions.
Example 7
An oral suspension containing 10 mg/ml fluconazole, 25 mg/ml methionine and 20 mg/ml nicotinamide is administered to children for treatment of oropharyngeal candidiasis at a dosage of 2 - 12 mg/kg per day for 3 weeks with a substantially lessened risk of liver toxicity than with standard fluconazole suspensions.

Claims

What is claimed is:
1. A composition comprising one or more standard doses of a hepatotoxic compound in a pharmaceutically acceptable carrier, the composition further comprising about 5 mg to about 500 mg methionine per standard dose and about 10 mg to about 500 mg nicotinamide per standard dose.
2. The composition of claim 1 wherein said composition is suitable for oral ingestion.
3. The composition of claim 2 wherein said composition is selected from the group consisting of solutions, suspensions, tablets, capsules and caplets.
4. The composition of claim 1 wherein said composition is suitable for injection.
5. The composition of claim 4 wherein said composition is selected from the group consisting of sterile solutions or suspensions.
6. The composition of claim 5 wherein said composition is suitable for intradermal, subcutaneous, intramuscular, intravenous or intrathecal injection.
7. The composition of claim 1 wherein said composition also contains folic acid in an amount of about 50 meg to about 5 mg per standard dose.
8. The composition of claim 7 wherein said composition is suitable for oral ingestion.
9. The composition of claim 8 wherein said composition is selected from the group consisting of solutions, suspensions, tablets, capsules and caplets.
10. The composition of claim 7 wherein said composition is suitable for injection.
11. The composition of claim 10 wherein said composition is selected from the group consisting of" sterile solutions or suspensions.
12. The composition of claim 11 wherein said composition is suitable for intradermal, subcutaneous, intramuscular, intravenous, or intrathecal injection.
13. The composition of claim 1 wherein said hepatotoxic compound is selected from the group consisting of acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, flucanozole, divalproex sodium, and valproic acid.
14. The composition of claim 13 wherein said hepatotoxic compound is acetaminophen.
15. The composition of claim 14 wherein said acetaminophen is present in the amount of about 80-1000 mg per standard dose.
16. The composition of claim 13 wherein said hepatotoxic compound is methotrexate.
17. The composition of claim 1 wherein said methotrexate is present in the amount of about 25-250 mg per standard dose.
18. The composition of claim 13 wherein said hepatotoxic compound is atorvastatin.
19. The composition of claim 18 wherein said atorvastatin is present in the amount of about 5-100 mg per standard dose per standard dose.
20. The composition of claim 13 wherein said hepatotoxic compound is simvastatin.
21. The composition of claim 20 wherein said simvastatin is present in the amount of about 5-100 mg per standard dose.
22. The composition of claim 13 wherein said hepatotoxic compound is niacin.
23. The composition of claim 22 wherein said niacin is present in the amount of about 250-1000 mg per standard dose.
24. The composition of claim 13 wherein said hepatotoxic compound is flucanozole.
25. The composition of claim 24 wherein said flucanozole is present in the amount of about 10-250 mg per standard dose.
26. The composition of claim 13 wherein said hepatotoxic compound is divalproex sodium.
27. The composition of claim 26 wherein said divalproex sodium is present in the amount of 100-750 mg per standard dose.
28. The composition of claim 13 wherein said hepatotoxic compound is valproic acid.
29. The composition of claim 28 wherein said valproic acid is present in the amount of 25-500 mg per standard dose.
30. A method of mitigating the hepatotoxicity of a hepatotoxic compound comprising formulating a composition comprising a quantity of the hepatotoxic compound, said composition comprising a quantity of nicotinamide, and a quantity of methionine.
31. The method of claim 30 wherein said composition is formulated such that for each standard dose of the hepatotoxic compound in the composition, the nicotinamide is present in the amount of about 5-500 mg, and the methionine is present in the amount of about 25-500 mg.
32. The method of claim 31 wherein said nicotinamide is present in the amount of about 25-200 mg per standard dose of the hepatotoxic compound.
33. The method of claim 31 wherein said methionine is present in the amount of about 10-100 mg per standard dose of the hepatotoxic compound.
34. The method of claim 30 wherein said composition further comprises a quantity of folic acid.
35. The method of claim 34 wherein said folic acid is present in the amount of about 50 meg - 5 mg per standard dose of the hepatotoxic compound.
36. The method of claim 35 wherein said folic acid is present in the amount of about 500 mg - 1 mg per standard dose of the hepatotoxic compound.
37. The method of claim 30 wherein said hepatotoxic compound is selected from the group consisting of acetaminophen, methotrexate, atorvastatin, simvastatin, niacin, flucanozole, divalproex sodium, and valproic acid.
PCT/US2005/009795 2004-03-31 2005-03-23 Compositions with reduced hepatotoxicity WO2005097120A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP2007506267A JP2007530688A (en) 2004-03-31 2005-03-23 Composition with reduced hepatotoxicity
EP05731289A EP1729769A4 (en) 2004-03-31 2005-03-23 Compositions with reduced hepatotoxicity
CA002561619A CA2561619A1 (en) 2004-03-31 2005-03-23 Compositions with reduced hepatotoxicity

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/813,760 2004-03-31
US10/813,760 US20050220862A1 (en) 2004-03-31 2004-03-31 Compositions with reduced hepatotoxicity

Publications (1)

Publication Number Publication Date
WO2005097120A1 true WO2005097120A1 (en) 2005-10-20

Family

ID=35054591

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2005/009795 WO2005097120A1 (en) 2004-03-31 2005-03-23 Compositions with reduced hepatotoxicity

Country Status (6)

Country Link
US (2) US20050220862A1 (en)
EP (1) EP1729769A4 (en)
JP (1) JP2007530688A (en)
KR (1) KR20070003995A (en)
CA (1) CA2561619A1 (en)
WO (1) WO2005097120A1 (en)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009097874A1 (en) * 2008-02-07 2009-08-13 Velleja Research S.R.L. Amino acid formulations comprising cysteine, methionine and/or serine for the prevention of paracetamol-induced liver damage
WO2009073630A3 (en) * 2007-11-29 2010-02-04 Alltranz Inc. Methods and compositons for enhancing the viability of microneedle pores
WO2012090218A1 (en) * 2010-12-30 2012-07-05 Zota Health Care Ltd Synergistic effects of the combination of the specific compounds with paracetamol and their effects on various diseases

Families Citing this family (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8700430B2 (en) * 2006-07-17 2014-04-15 Walgreen Co. Optimization of a medication therapy regimen
US8478605B2 (en) * 2006-07-17 2013-07-02 Walgreen Co. Appropriateness of a medication therapy regimen
US20080126130A1 (en) * 2006-07-17 2008-05-29 Walgreen Co. Compliance With A Medication Therapy Regimen
US20080015893A1 (en) * 2006-07-17 2008-01-17 Walgreen Co. Identification of Inappropriate Medications In A Medication Therapy Regimen
CN106390130B (en) * 2016-09-18 2018-06-01 中国人民解放军第二军医大学 Purposes of the niacinamide as antifungal medicine synergist
WO2023144118A1 (en) * 2022-01-25 2023-08-03 INSERM (Institut National de la Santé et de la Recherche Médicale) Methods of therapy comprising simultaneous administration of methotrexate and folic acid

Family Cites Families (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3983250A (en) * 1974-10-02 1976-09-28 The Dow Chemical Company Halophenyl acetamidines as anxiolytic antidepressants
GB1583602A (en) * 1977-05-26 1981-01-28 Sterwin Ag N-acetyl-para-aminophenyl-n'-acetyl-amino-thioalkanoic acid ester derivatives
US4314989A (en) * 1980-05-07 1982-02-09 Rosen Gerald M Methionine sulfoxide amflioration of acetaminophen toxicity
JPS57110176A (en) * 1980-12-27 1982-07-08 Snow Brand Milk Prod Co Ltd Nutrious food composition for tube feeding
US4526788A (en) * 1983-03-18 1985-07-02 American Cyanamid Company Polymeric[[(oxazolidinyl)alkyl]amino]anthraquinones
HU190597B (en) * 1983-07-11 1986-09-29 Chinoin Gyogyszer Es Vegyeszeti Termekek Gyara Rt,Hu Process for preparing synrtgetic pharmaceutical compositions
US4656159A (en) * 1984-10-31 1987-04-07 Georgetown University Galactose-C-6 nitrogen mustard compounds and their uses
US4837239A (en) * 1985-08-23 1989-06-06 Syntex (U.S.A.) Inc. Cardiotonic phosphodiesterase inhibitors complexed with water soluble vitamins
EP0285343B1 (en) * 1987-03-26 1994-06-29 University College London Preventing adp-ribosylation of g-proteins
GB8717955D0 (en) * 1987-07-29 1987-09-03 Fujisawa Pharmaceutical Co Prevention & treatment of aids
IN172468B (en) * 1990-07-14 1993-08-14 Asta Medica Ag
US5474757A (en) * 1992-10-16 1995-12-12 Rutgers University Prevention of acetaminophen overdose toxicity with organosulfur compounds
GB9309387D0 (en) * 1993-05-06 1993-06-16 Wellcome Found Nitric oxide scavengers
TW254852B (en) * 1993-12-02 1995-08-21 Senju Pharma Co
US5648523A (en) * 1995-10-26 1997-07-15 Chiang Long Y Fullerene derivatives as free-radical scavengers
US5597585A (en) * 1995-12-26 1997-01-28 Williams; Andrew H. Vitamin/mineral composition
US6673831B1 (en) * 1996-04-17 2004-01-06 Merck & Co., Inc. Combination therapy for reducing the risks associated with cardiovascular disease
US5804567A (en) * 1996-07-18 1998-09-08 Cancer Institute (Hospital), Chinese Academy Of Medical Sciences Method of increasing the effectiveness of anti-metabolites
US7071230B2 (en) * 1997-10-02 2006-07-04 Board Of Trustees Of Southern Illinois University Therapeutic use of D-methionine to reduce the toxicity of noise
US6812327B1 (en) * 1996-10-25 2004-11-02 Human Genome Sciences, Inc. Neutrokine-alpha polypeptides
US6048846A (en) * 1998-02-26 2000-04-11 Cochran; Timothy M. Compositions used in human treatment
HU230656B1 (en) * 1998-09-25 2017-06-28 Cubist Pharmaceuticals Llc Use of daptomycin
US7371388B1 (en) * 2000-05-04 2008-05-13 Human Genome Sciences, Inc. Treatment of Sjogren's syndrome by administration of TR18 polypeptides
US6733797B1 (en) * 2000-11-15 2004-05-11 William K. Summers Neuroceutical for improving memory and cognitive abilities
HU227813B1 (en) * 2005-07-14 2012-03-28 Egis Gyogyszergyar Nyilvanosan Muekoedoe Reszvenytarsasag Pharmaceutical composition for the treatment of psychosis

Non-Patent Citations (3)

* Cited by examiner, † Cited by third party
Title
KROEGER H. ET AL: "Protection from acetaminophen-induced liver damage by the synergistic action of low doses of the poly(ADP-ribose)polymerase-inhibitor nicotinamide and the antioxidant N-acetylcysteine or the amino acid L-methionine", GENERAL PHARMACOLOGY, vol. 28, no. 2, 1997, pages 257 - 263, XP000981810 *
KRÖGER H. ET AL: "Nicotinamide and methionine reduce the liver toxic effect of methotrexate", GENERAL PHARMACOLOGY, vol. 33, no. 2, 1999, pages 203 - 206, XP002983723 *
See also references of EP1729769A4 *

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009073630A3 (en) * 2007-11-29 2010-02-04 Alltranz Inc. Methods and compositons for enhancing the viability of microneedle pores
WO2009097874A1 (en) * 2008-02-07 2009-08-13 Velleja Research S.R.L. Amino acid formulations comprising cysteine, methionine and/or serine for the prevention of paracetamol-induced liver damage
WO2012090218A1 (en) * 2010-12-30 2012-07-05 Zota Health Care Ltd Synergistic effects of the combination of the specific compounds with paracetamol and their effects on various diseases

Also Published As

Publication number Publication date
EP1729769A4 (en) 2008-11-05
KR20070003995A (en) 2007-01-05
EP1729769A1 (en) 2006-12-13
JP2007530688A (en) 2007-11-01
US20110288099A1 (en) 2011-11-24
US20050220862A1 (en) 2005-10-06
CA2561619A1 (en) 2005-10-20
US9238017B2 (en) 2016-01-19

Similar Documents

Publication Publication Date Title
US9238017B2 (en) Compositions with reduced hepatotoxicity
US5331000A (en) Antipyretic and analgesic methods and compositions containing optically pure R(-) ketoprofen
JP2015078185A (en) N-acetylcysteine composition and method for treatment and prevention of drug toxicity
CA2892902C (en) Entacapone for prevention and treatment of obesity and related metabolic diseases
EP2141155B1 (en) Prophylactic and/or therapeutic agent for hyperlipidemia
CA1217428A (en) Analgesic and anti-inflammatory compositions comprising ibuprofen and methods of using same
EP0710108A1 (en) Liquid pharmaceutical composition for oral use containing 2-(4-isobutylphenyl)propionic acid
CN101265178A (en) Amino acid salt of (S)-ibuprofen and medicinal composition thereof
AU3806393A (en) Antipyretic and analgesic methods and compositions containing optically pure r-etodolac
JP3797764B2 (en) Light stabilizing composition
US6048540A (en) Acetamenophen composition with reduced liver toxicity
IE913184A1 (en) Method for treating respiratory disorders
TW200300341A (en) Pharmaceutical composition comprising a combination of metformin and a 4-oxobutanoic acid, and the use thereof for treating diabetes
JP2012176899A (en) Aqueous solution for injection, containing 2-(1-piperazinyl)-5-methylbenzene sulfonic acid derivative
JP5376786B2 (en) Nerve cell activation composition
KR102427941B1 (en) Injectable formulation with enhanced stability containing ibuprofen and afginine
CN113116899B (en) Pharmaceutical composition for treating influenza and preparation containing pharmaceutical composition
EP1547614B1 (en) Medicinal composition for inhibiting the expression of atp-citrate lyase and use thereof
CN113461528B (en) Phenoxy acid derivative and application thereof
IE913185A1 (en) Method for providing improved analgesic effect
JP5669111B2 (en) Antimalarial drugs containing araremycin or its derivatives as active ingredients
JPH06102624B2 (en) Anti-arrhythmic drugs of non-heart origin
JP2009084208A (en) Composition for nerve cell activation and nerve stretch promotion
JPH072661A (en) Agent for inhibiting secretion myeloperoxidase
CA2148768A1 (en) Analgesic method and composition

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NA NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SM SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GM KE LS MW MZ NA SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LT LU MC NL PL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
WWE Wipo information: entry into national phase

Ref document number: 2007506267

Country of ref document: JP

WWE Wipo information: entry into national phase

Ref document number: 2005731289

Country of ref document: EP

WWE Wipo information: entry into national phase

Ref document number: 2561619

Country of ref document: CA

WWE Wipo information: entry into national phase

Ref document number: 1020067020315

Country of ref document: KR

NENP Non-entry into the national phase

Ref country code: DE

WWW Wipo information: withdrawn in national office

Country of ref document: DE

WWP Wipo information: published in national office

Ref document number: 2005731289

Country of ref document: EP

WWP Wipo information: published in national office

Ref document number: 1020067020315

Country of ref document: KR