WO2008042773A2

WO2008042773A2 - Unitary pharmaceutical composition, method, and kit for the treatment or prevention of metabolic or endocrine disorders

Info

Publication number: WO2008042773A2
Application number: PCT/US2007/079889
Authority: WO
Inventors: Michael Schwartz; George Mitchell Grass Iv
Original assignee: Pdxrx, Inc.
Priority date: 2006-09-29
Filing date: 2007-09-28
Publication date: 2008-04-10
Also published as: WO2008042773A3

Abstract

Unitary dosage form pharmaceutical composition(s), pharmaceutical kit(s), and method(s) of treatment comprising sufficient amounts of at least one biguanide, at least one first pharmaceutical agent, and optionally at least one HmG-CoA reductase inhibitor, or at least one fibrate, or at least one angiotensin converting enzyme inhibitor, or at least one angiotensin II receptor blocker, or at least one second pharmaceutical agent, or combinations thereof, for the treatment or prevention of diabetic, cardiac, or endocrine outcomes associated with obesity as well as various metabolic or endocrine disorders or combinations thereof. In a preferred embodiment, the biguanide is metformin, stereoisomers thereof, derivatives thereof, or metabolites thereof, and the first pharmaceutical agent is sibutramine, rimonabant, derivatives thereof, stereoisomers thereof, or metabolites thereof. Magnesium may also optionally be included.

Description

UNITARY PHARMACEUTICAL COMPOSITION, METHOD,

AND KIT FOR THE TREATMENT OR PREVENTION OF

METABOLIC OR ENDOCRINE DISORDERS

Related Applications

[0001] This application claims the benefit of United States Provisional Application Serial No. 60/848,150, filed on September 29, 2006, the disclosure of which is hereby incorporated by reference.

Field of the Invention

[0002] The present technology relates to the treatment and prevention of endocrine and metabolic disorders. More specifically, the presently described technology relates to unitary pharmaceutical compositions, methods, and kits for the treatment or prevention of diabetic, cardiac, or endocrine outcomes associated with obesity as well as various metabolic or endocrine disorders in humans or animals.

Background of Invention

[0003] Endocrine and/or metabolic disorders can be complex and difficult disease states to diagnose and/or treat. In addition, many patients suffering from endocrine and metabolic disorders are obese. Some of the diseases related to obesity include, for example, diabetes mellitus (Type 1 and/or Type 2), insulin resistance, metabolic syndrome, hypertension, cardiac insufficiency, diabetic nephropathy, hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitosterolemia, nonalcoholic steatohepatitis (NASH), polycystic ovary syndrome (PCOS), impaired glucose tolerance (IGT), and congestive heart failure (CHF). These diseases can be interrelated, and a patient often suffers from more than one of these disorders.

[0004] Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (high blood sugar levels) resulting from the defective secretion or action of the hormone insulin. There are two predominant forms of diabetes.

[0005] Type 1 diabetes, previously called juvenile onset diabetes, is characterized by decreased or absent production of insulin due to immune mediated destruction of insulin secreting pancreatic cells. Type 1 diabetes is an autoimmune disorder, in which the immune system mounts an attack on the insulin-producing cells in the pancreas. The exact triggers are unknown. Type 1 diabetes was once called juvenile diabetes because it is generally diagnosed in childhood or early adulthood. Patients with Type 1 diabetes supply insulin to their bodies by injection, pumps, inhalation, or through use of other methods. [0006] Type 2 diabetes, previously called adult onset diabetes, is characterized by body tissue resistance to insulin, although decreased secretion of insulin can also occur.

[0007] Type 1 diabetes typically requires insulin injection or inhalation. Type 2 diabetes can be managed by dietary monitoring, weight reduction, exercise, and oral medication. Insulin is used in Type 2 diabetes if oral medication proves ineffective or has intolerable side effects. However, typical cases of Type 2 diabetes, in general, are treated with medication.

[0008] There is an increasing incidence of patients with both Type 1 and Type 2 diabetes. The exact causes for the increasing incidence of Type 1 diabetes have not been elucidated, whereas it is believed that the rise in the incidence of Type 2 diabetes is attributable to the increase in obesity starting in children and adolescents.

[0009] For most diabetic patients, the main risks of the disease are from long-term complications such as cardiovascular disease, chronic renal failure, retinal damage which can lead to blindness, nerve damage, and infections, most commonly gangrene, with risk of amputation of toes, feet, and extremities. Serious complications are much less common in people who control their blood sugars well with their lifestyle and medications. Therefore, patient understanding and participation in treatment is vital, as blood glucose levels change continuously and require monitoring. [0010] In patients whose only problem is lack of insulin, the term "insulin resistance" is used to describe the presence of various forms of antibodies against insulin that lead to inactivation and/or altered insulin pharmacokinetics with lower-than-expected decreases in glucose levels after any given dose of insulin.

[0011] Insulin resistance in other and sometimes overlapping forms of diabetes and the "pre-diabetic stage" denotes decreased response to insulin of cells with cell receptors to insulin. It is one of the metabolic causes of the very common "metabolic syndrome," which is the clustering of diabetes mellitus (Type 2), hypertension, combined hyperlipidemia and central obesity in patients. It also underlies most processes behind the metabolic complications of polycystic ovarian syndrome (PCOS) and non-alcoholic steatohepatitis (NASH).

[0012] Insulin is secreted by pancreatic cells in response to the increasing levels of glucose (sugar) in the bloodstream that occur after ingesting food. Insulin binds to specific receptors that signal cells to absorb and metabolize glucose. In an "insulin resistant" person the complex interplay between insulin, receptors and the transmission of the message is blunted. More glucose remains in the bloodstream for longer periods of time to damage and "age" cell proteins and cell structures through glycosylation.

[0013] Further, insulin resistance and atherosclerosis often appear together. Insulin resistance in these patients can be detected by elevating fasting glucose levels. Insulin resistance is associated with hypertension and dyslipidemia involving small dense low-density lipoprotein (sdLDL) particles. It includes decreased high-density lipoprotein (HDL) levels, impaired fibrinolysis, a hypercoagulable state and increased inflammatory cytokine levels.

[0014] The root genetic and environmental causes of metabolic syndrome are complex and have only been partially elucidated. Most patients are older, obese, and have a degree of insulin resistance. There is debate regarding whether obesity or insulin resistance is the cause of the metabolic syndrome or a by-product of an underlying, more far-reaching metabolic derangement. The metabolic syndrome is also found increasingly in children and adolescents.

[0015] Hypertension or high blood pressure is a medical condition wherein the blood pressure is chronically elevated. While it was formally called arterial hypertension, the word "hypertension" without a qualifier generally refers to arterial hypertension. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure.

[0016] In patients with diabetes mellitus or kidney disease, studies have shown that blood pressure over 130/80 rnmHg should be considered a risk factor and can warrant treatment. Thus, treatments addressing diabetes mellitus and hypertension are frequently given to the same patient.

[0017] Combined hyperlipidemia is a commonly occurring form of hypercholesterolemia (elevated cholesterol levels) characterized by increased LDL and triglyceride concentrations, often accompanied by decreased HDL. The elevated triglyceride levels are generally due to an increase in VLDL (very low density lipoprotein), a class of lipoprotein that is prone to cause atherosclerosis.

[0018] Hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertriglyceridemia and sitosterolemia are most commonly treated with fibrate drugs and HmG-CoA reductase inhibitors (sometimes known as statins). Fibrates (including, among many others, clofibrate) act on the peroxisome proliferator-activated receptors (PPARs), specifically PP ARa, to decrease free fatty acid production. HmG-CoA reductase inhibitor drugs (including, among many others, atorvastatin, simvastatin, and rosuvastatin) competitively inhibit the conversion of HmG-CoA to mevalonate. This reduces cholesterol biosynthesis in hepatic cells. In response to this reduction, cells react with an enhanced synthesis of LDL-C receptors, which increases the uptake of LDL-C particles and enhances cholesterol clearance from the plasma. HmG-CoA reductase inhibitors also have antiinflammatory properties, which may enhance their anti- arteriosclerotic effects beyond the lowering of chloesterin levels. Hyperlipidemia is frequently associated with other endocrine or metabolic disorders such as diabetes mellitus and/or hypertension, requiring combined treatments.

[0019] Central obesity (or "apple-shaped" or "masculine" obesity) occurs when the main deposits of body fat are localized around the abdomen and the upper body. Central obesity is common in polycystic ovary syndrome (PCOS) and metabolic syndrome, and it is associated with a statistically higher risk of heart disease, hypertension, insulin resistance and diabetes mellitus Type 2.

[0020] Further, polycystic ovary syndrome (PCOS), is an endocrine disorder that affects about 5% to about 10% of women. It occurs among all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS. Women with PCOS are at risk for endometrial hyperplasia and endometrial cancer (cancer of the uterine lining), insulin resistance, Type 2 diabetes, high blood pressure, dyslipidemia (disorders of lipid metabolism), and cardiovascular disease.

[0021] Other diseases related to those discussed above include nonalcoholic steatohepatitis (NASH) and congestive heart failure (CHF). Non-alcoholic steatohepatitis (NASH) resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged, scarred, and no longer able to work properly.

[0022] Although NASH has become more common, its underlying cause is not clear. It most often occurs in persons who are middle- aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or a pre-diabetic condition. NASH also occurs in children. While the underlying reason for the liver injury that causes NASH is not known, several factors are possible candidates, including insulin resistance and hyperlipidemia.

[0023] Congestive heart failure (CHF) is an inability of the heart to pump blood at a rate sufficient to meet the metabolic demands of the body tissues. Common causes of heart failure include systemic hypertension, atherosclerotic heart disease, and valvular disease. When the heart pumps blood at an insufficient rate, salt and water are retained by the kidneys and fluid accumulates in the interstitial spaces. Heart failure may develop acutely or chronically, and may range from mild to severe.

[0024] In light of the above, patients often suffer from multiple endocrine and metabolic disorders concurrently, and any treatment plan preferably addresses the multiple existing disorders. Since these disorders can be complex and interrelated, there is a need in the art to effectively treat a number of these disorders in a manner that allows for improved patient compliance while minimizing or preventing adverse events. In addition, these disorders are increasingly affecting human children and adolescents. Treatments should be effective in treating human children and adolescents as well as human adults. Finally, such treatment modalities should also be considered for potential use in animals as well.

[0025] There are a number of medications available to treat diabetes. For example, biguanides are a class of compounds often used to treat diabetes mellitus, including both Type 1 and Type 2 diabetes. Biguanides may also be used to treat pre-diabetic conditions. Specific biguanides include, for example, metformin, phenphormin, and buformin. Of these compounds, metformin, commercially available under the brand name Glucophage®, is currently the most common biguanide utilized in treating diabetic conditions.

[0026] Biguanides generally lower blood sugar levels. In hyperinsulinemia, biguanides can lower fasting levels of insulin in plasma. Biguanides reduce gluconeogenesis in the liver, enhance absorption of glucose into cells, reduce the level of glucose in the blood, and lower insulin requirements. [0027] The most important and serious side effect of biguanides is lactic acidosis. Phenformin and buformin are more prone to cause acidosis than metformin.

[0028] There are also medications available to treat obesity. For example, selective neurotransmitter reuptake inhibitors can be used to treat obesity. Sibutramine is sold under the trade name Meridia® (by Knoll Pharmaceutical Co.) in the United States. Sibutramine is an orally administered agent for the treatment of obesity. It is a centrally-acting stimulant chemically related to amphetamine, methamphetamine, and phentermine (one of the drugs previously commercialized in the Fen-Phen® combination).

[0029] Sibutramine is a neurotransmitter reuptake inhibitor that helps control appetite and treat obesity by selectively inhibiting the reuptake of serotonin, norepinephrine, and to a lesser extent dopamine (i.e., neurotransmitters); as such it is an appetite suppressant, although it also has antidepressant properties due to its actions upon the aforementioned neurotransmitters. Sibutramine is also believed to increase serotonin and noradrenaline levels in the brain. The serotonergic action, in particular, is thought to influence appetite.

[0030] Metformin and sibutramine administered separately to patients with Type 2 diabetes mellitus can improve metabolic control in patients, in particular those who lose weight. See, e.g., McNulty et al, "A Randomized Trial of Sibutramine in the Management of Obese Type 2 Diabetic Patients Treated With Metformin," Diabetes Care, Vol. 26, No. 1, pp. 125-131 (January 2003).

[0031] Another medication that can be used to treat obesity is rimonabant. Rimonabant is a cannabinoid receptor blocker and blocks the CBl receptor of the endocannabinoid system. Rimonabant blocks a protein in brain cells that allows cannabis, the active ingredient in marijuana, to work. It is believed that obese people have more endocannabinoid receptors than non-obese people, and rimonabant blocks some of these receptors, thus suppressing appetite. Rimonabant may also be effective against other metabolic disorders, such as lipid metabolism, glucose metabolism, insulin resistance, and central obesity.

[0032] Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARB 's) are available in the United States, for example, to treat hypertension and congestive heart failure. Angiotensin converting enzyme inhibitors inhibit the synthesis of angiotensin II, an enzyme in the body that binds to the ATI receptor and causes blood vessels to tighten. As a result of inhibiting the synthesis of angiotensin II, blood vessels are relaxed. This lowers blood pressure and increases the supplye of blood and oxygen to the heart. Angiotensin II, however, can also be produced though alternative pathways that are not blocked by ACE inhibitors. Angiotensin II receptor blockers (ARBs) lower blood pressure by blocking the ATI receptor. [0033] In addition, magnesium has been identified as an important cofactor in carbohydrate metabolism, and a strong relationship between magnesium and insulin action has been reported. A magnesium deficiency has been associated with insulin resistance in obese human children. See, e.g., Huerta et al., "Magnesium Deficiency Is Associated With Insulin Resistance in Obese Human children," Diabetes Care, Vol. 28, No. 5, pp. 1175-1181 (May 2005). In addition, magnesium intake and development of Type 2 diabetes is inversely related. Lopez-Ridaura et al., "Magnesium Intake And Risk For Type 2 Diabetes In Men And Women," Diabetes Care, Vol. 27, No. 1, pp. 134-140 (Jan. 2004).

[0034] As discussed above, treating these metabolic and/or endocrine diseases depends heavily on patient understanding and participation in treatment. Therefore, while medications are currently available to treat single endocrine or metabolic disorders, there is a need in the prior art for a composition, pharmaceutical kit, and a method of treatment regimen for treating one or more endocrine and metabolic disorders of humans or animals in a concurrent manner that comprises a pharmaceutical composition, namely provided in a unitary pharmaceutical dosage form that is effective to treat multiple disorders.

Summary of the Invention [0035] The presently described technology involves pharmaceutical compositions, pharmaceutical kits, and methods of treatment utilizing a unitary dosage form comprising effective amounts of at least one biguanide and at least one first pharmaceutical agent for the treatment or prevention of diabetic, cardiac, or endocrine outcomes associated with obesity as well as various metabolic or endocrine disorders in humans or animals.

[0036] In at least one preferred embodiment, there is provided at least one biguanide and a first pharmaceutical agent comprising a selective reuptake inhibitor, which can be a selective neurotransmitter reuptake inhibitor, or selective blocker. As discussed above, biguanides are typically utilized in treating insulin resistance and Type 2 diabetes. In such a preferred embodiment, the selective neurotransmitter reuptake inhibitor selectively inhibits the reuptake of epinephrine, norepinephrine, serotonin, dopamine, pre-cursors thereof, metabolites thereof, or derivatives thereof. Alternatively, the first pharmaceutical agent can be a selective blocker that blocks, for example, the CBl receptor of the endocannabinoid system. These pharmaceutical agents are typically utilized in treating depression and/or assisting in treating obesity.

[0037] In at least one other alternative of this preferred embodiment, the biguanide is metformin, derivatives thereof, stereoisomers thereof, or metabolites thereof, and the first pharmaceutical agent is sibutramine, rimonabant, derivatives thereof, stereoisomers thereof, or metabolites thereof. In a still further alternative embodiment, the sibutramine is a substantially optically pure metabolite of sibutramine.

[0038] In other embodiments, the first pharmaceutical agent can be, for example, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, bupropion, nefazodone, trazodone, duloxetine, venlafaxine, mirtazapine, maprotiline, isocarboxazid, phenelzine, tranylcypromine, combinations thereof, steroisomers thereof, alternatives thereof, equivalents thereof, or derivatives thereof.

[0039] In another aspect of the presently disclosed technology, the unitary dosage form pharmaceutical composition further comprises one or more second pharmaceutical agent(s). The second pharmaceutical agent can be a selective reuptake inhibitor such as, for example, a selective serotonin reuptake inhibitor, combinations thereof, steroisomers thereof, alternatives thereof, equivalents thereof, or derivatives thereof. Selective serotonin reuptake inhibitors include, for example, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof.

[0040] However, it should be understood that other (non-SSRI's or agents with other modes of action) pharmaceutical components such as known psychiatric compounds can be included within the spirit and scope of the present technology as the one or more second pharmaceutical agent(s). Such components include, but are not limited to, bupropion, nefazodone, trazodone, duloxetine, venlafaxine, mirtazapine, maprotiline, isocarboxazid, phenelzine, tranylcypromine, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof.

[0041] In another aspect of the present technology, the pharmaceutical composition administered to a human or animal in a unitary dosage form can comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one HmG-CoA reductase inhibitor. As an alternative to this aspect of the presently described technology, one or more embodiments may comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one fibrate. HmG-CoA reductase inhibitors and fibrates are typically utilized in treating hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitsoterolemia, and ateriosclerotic vascular disease. Magnesium or a salt thereof may be optionally included in one or more of the above- described pharmaceutical compositions as well.

[0042] In a further aspect of the present technology, there is provided a pharmaceutical composition administered to a human or animal in a unitary dosage form, comprising effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin converting enzyme ("ACE") inhibitor. As an alternative to this aspect of the presently described technology, one or more embodiments may comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin II receptor blocker ("ARB"). In still further embodiments, this aspect of the unitary dosage form pharmaceutical composition can comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, at least one angiotensin converting enzyme inhibitor, and at least one angiotensin II receptor blocker.

[0043] Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers are typically utilized in treating hypertension and cardiac insufficiency and in preventing diabetic nephropathy. Magnesium or a salt thereof may be optionally included in one or more of the above-described unitary dosage form pharmaceutical composition aspects. It should also be understood that the second pharmaceutical agent(s) noted herein can be incorporated into this or other aspects of the present technology described above and hereafter.

[0044] The unitary dosage form pharmaceutical compositions of the present technology can be prepared for administration to a human or animal as an immediate release dosage form, a controlled release dosage form, a sustained release dosage form, or as an extended release dosage form. Thus, the unitary dosage form can be, for example, a tablet, a capsule, a troche, a pill, a pellet, a nanoparticle, a liposome, a micelle, a spray, an aerosol, a suppository, a solution, an emulsion, a suspension, a topical delivery device, a cream, an ointment, a lotion, a dispersion, a sachet, a cachet, a powder, an inhalant, an injectible, a chewable dosage form, a dissolvable film, combinations thereof, or admixtures with organic or inorganic excipients suitable for nasal, enteral, rectal, or parenteral applications. Preferably, the present technology is a unitary tablet or sachet dosage form suitable for administration to a human or animal.

[0045] In yet another aspect, the present technology provides a method of treating or preventing one or more metabolic or endocrine diseases comprising the step of administering to a patient (human or animal) a unitary dosage form of a pharmaceutical composition comprising a sufficient quantity of at least one biguanide and a sufficient quantity of at least one first pharmaceutical agent. In one preferred embodiment, the sufficient quantity of the biguanide comprises a sufficient quantity of metformin, metabolites thereof, stereoisomers thereof, or derivatives thereof to treat a metabolic or endocrine disorder such as diabetes mellitus. For example, the sufficient quantity of metformin, metabolites thereof, stereoisomers thereof, or derivatives thereof can be between about 100 mg to about 3000 mg per dose of the unitary dosage form administered to a human or animal. In a more preferred embodiment, the sufficient quantity of the metformin, metabolites thereof, stereoisomers thereof, or derivatives thereof, is less than about 1000 mg per dose of the unitary dosage form administered to the human or animal patient.

[0046] With respect to the same preferred embodiment(s) and method aspect of the present technology, the sufficient quantity of the first pharmaceutical agent comprises a sufficient quantity of sibutramine, rimonabant, or derivatives thereof. More preferably, the sibutramine derivative is a substantially optically pure metabolite of sibutramine. In one or more of the preferred embodiments, the sufficient quantity of sibutramine, rimonabant, or a derivative thereof can be between about 1 mg to about 30 mg per dose of the unitary dosage form administered to a patient (human or animal). In a more preferred embodiment, the sufficient quantity of sibutramine, rimonabant, or a derivative thereof is less than about 10 mg per dose of the unitary dosage form administered to the patient.

[0047] Moreover, in one or more of the embodiments noted above, the pharmaceutical composition can further comprise a sufficient quantity of magnesium or a salt thereof. For example, the sufficient quantity of elemental magnesium equivalents can be between about 10 mg to about 1500 mg per dose of the pharmaceutical composition administered as a unitary dosage form administered to a patient (human or animal) being treated. More preferably, the sufficient quantity of magnesium or a salt thereof is less than about 500 per dose of the pharmaceutical composition administered to the patient.

[0048] In one or more alternative embodiments of this method of treatment aspect of the present technology, the pharmaceutical compositions may further comprise a sufficient quantity of at least one second pharmaceutical agent. For example, the sufficient quantity of the second pharmaceutical agent can be a sufficient quantity of at least one selective reuptake inhibitor or selective blocker. An example of a selective reuptake inhibitor includes, for example, a selective serotonin reuptake inhibitor, derivatives thereof, stereoisomers thereof, alternatives thereof, equivalents thereof, or combinations thereof. Selective serotonin reuptake inhibitors include, for example, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, combinations thereof, equivalents thereof, stereoisomers thereof, derivatives thereof, or alternatives thereof. However, it should be understood that other pharmaceutical components (non- SSRJ' s or agents with other modes of action) such as known psychiatric compounds can be included within the spirit and scope of the present technology. Such components include, but are not limited to, bupropion, nefazodone, trazodone, duloxetine, venlafaxine, mirtazapine, maprotiline, isocarboxazid, phenelzine, tranylcypromine, combinations thereof, equivalents thereof, derivatives thereof, or alternatives thereof. Dosing for such second pharmaceutical agents will be those dosing parameters known to those skilled in the art for such components in human (infant to adult) or animal (infant to adult) capacities. Further dosing for such components can be found, for example, in Lacy et al., Drug Information Handbook, 14^th ed., 2006 (Lexi-Comp.) and Hodding et al., Pediatric Dosage Handbook, 12^th ed., 2005 (Lexi-Comp.).

[0049] In one or more embodiments of this method aspect of the present technology, metabolic or endocrine diseases to be treated or prevented include, for example, obesity, insulin resistance, hypertension, cardiac insufficienicy, diabetic nephropathy, hyperinsulinemia, hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitosterolemia, hypertension, arteriosclerotic vascular diseases, non-alcoholic steatohepatitis, polycystic ovary syndrome, impaired glucose tolerance, insulin dependent Type 1 diabetes, non-insulin dependent Type 2 diabetes, congestive heart failure, and combinations thereof.

[0050] As noted before, patients to be treated for such disorders can be infant to adult humans or animals. Preferably, the patient to be treated is a human and may range from an infant to an adult.

[0051] In an alternative embodiment, at least one of the methods of the present technology can further comprise the step of measuring one or more biomarkers of a patient to determine their need or suitability for treatment with the unitary dosage form pharmaceutical compositions of the present technology described herein. Such biomarker measurements may include, for example, genetic determinations or predispositions, proteomic measurements, phenotypic observations or measurements and combinations of such genetic, proteomic, or phenotypic biomarker indicators.

[0052] In another alternative embodiment, at least one of the methods of the present technology can further comprise the step of measuring one or more biomarkers of a patient (human or animal) to determine or adjust the sufficient quantity of the biguanide or the selective reuptake inhibitor or selective blocker of the pharmaceutical composition administered to the patient as a unitary dosage form.

[0053] For a still further aspect, the present technology provides a pharmaceutical kit for the treatment or prevention of one or more metabolic or endocrine diseases comprising a unitary dosage form containing a pharmaceutical composition further comprising at least one biguanide and at least one first pharmaceutical agent. In at least one preferred embodiment, the biguanide comprises metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof, while the first pharmaceutical agent comprises sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof. In an alternative embodiment, the unitary dosage form can further comprise magnesium or a salt thereof, a second pharmaceutical agent, an HmG-CoA reductase inhibitor, a fibrate, an angiotensin converting enzyme inhibitor, an angiotensin II receptor blocker, or combinations thereof.

Detailed Description of one or More Preferred Embodiment(s)

[0054] The presently described technology provides one or more pharmaceutical compositions, pharmaceutical kits, and methods of treatment utilizing a unitary dosage form comprising effective amounts of at least one biguanide and at least one first pharmaceutical agent for the treatment or prevention of at least one endocrine disorder and/or at least one metabolic disorder. Optionally, a sufficient quantity of one or more of magnesium or a salt(s) thereof, a second pharmaceutical agent, an HmG-CoA reductase inhibitor, a fibrate, an ACE inhibitor, or an ARB may be utilized in the practice of the present technology.

[0055] Biguanides, typically utilized in treating insulin resistance and/or Type 2 diabetes, for use in the presently described technology include, but are not limited to, metformin, phenphormin, and buformin, derivatives thereof, stereoisomers thereof, metabolites thereof, equivalents thereof, alternatives thereof, and/or combinations thereof. Metformin (GLUCOPHAGE®, commercially available from Bristol-Myers Squibb, Princeton, NJ), for example, is the preferred biguanide of the present technology used for treating endocrine and metabolic disorders.

[0056] Metformin is currently commercially available in 500 mg, 850 mg, and 1000 mg doses for human patients. Metformin may be administered to human patients in amounts ranging from about 70 mg to about 5000 mg per any given 24 hour dosing period. Preferably, metformin may be administered to human patients in amounts ranging from about 850 mg to about 2000 mg per any given 24 hour dosing period.

[0057] Alternatively, the dosing range for metformin, as well as the other pharmaceutical compounds described herein, can be derived from the minimal and maximal given doses per day as known in the art. The minimal dose for use in the presently described technology can be derived by dividing the minimal dose for adults known in the art by seven. The maximal dose for use in the presently described technology can be derived by multiplying the maximal dose for adults known in the art by two. This range covers doses for children and adolescents as well as adults, and also allows for dose reductions of any single component(s) that are synergistic in action and/or toxicity, for pharmacologic interaction between compounds, pharmacologic interaction(s) with other medication(s) that a patient may be taking, and/or to adjust for hepatic and renal dysfunction.

[0058] The amount of biguanide should be optimized to take into account the pharmacokinetic and dynamic properties of the components of the pharmaceutical composition in the unitary dosage form(s), as well as drug/drug interaction(s) encountered under steady state conditions.

[0059] The first pharmaceutical agent of the present technology can be a selective reuptake inhibitor or a selective blocker, generally utilized in treating depression and in assisting in treating obesity. An example of a selective reuptake inhibitor can be, for example, a selective neurotransmitter reuptake inhibitor. A selective neurotransmitter reuptake inhibitor can selectively inhibit the reuptake of epinephrine, norepinephrine, serotonin, dopamine, derivatives thereof, stereoisomers thereof, pre-cursors thereof, metabolites thereof, or combinations thereof.

[0060] A selective blocker of the present technology can selectively block neurotransmitters or other compounds, or receptors for such neurotransmitters or compounds. An example of a selective neurotransmitter reuptake inhibitor of the present technology can be sibutramine, derivatives thereof, stereoisomers thereof, or metabolites thereof, while an example of a selective blocker can be rimonabant, derivatives thereof, stereoisomers thereof, or metabolites thereof.

[0061] Sibutramine, as an example, may be administered to human patients in amounts ranging from about 1 mg to about 30 mg per any given 24 hour dosing period. Preferably, sibutramine may be administered to human patients in amounts ranging from about 10 mg to about 15 mg per any given 24 hour dosing period. It should be understood by those skilled in the art, however, that the dosing of sibutramine can be varied on a per patient and per disease state basis in the practice of the present technology.

[0062] Rimonabant, as an example, may be administered to human patients in amounts ranging from about 0.7 mg to about 40 mg per any given 24 hour dosing period. Preferably, rimonabant may be administered to human patients in amounts ranging from about 5 mg to about 20 mg per any given 24 hour dosing period. It should be understood by those skilled in the art, however, that the dosing of rimonabant can be varied on a per patient and per disease state basis in the practice of the present technology.

[0063] The amount of the selective reuptake inhibitor can be optimized to take into account the pharmacokinetic and dynamic properties of the combined components of the pharmaceutical composition in the unitary dosage form(s) of the present technology, as well as drug/drug interaction(s) encountered under steady state conditions. These same considerations can be considered and taken into account regarding the additional components noted herein, including the secondary pharmaceutical agent(s), magnesium, HmG- CoA reductase inhibitor(s), fibrate(s), ACE inhibitor(s) and ARB(s) used in the practice of the present technology.

[0064] Additional neurotransmitter reuptake inhibitors that can be used as a first pharmaceutical agent for treating depression and assisting in treating obesity in accordance with the presently described technology include, but are not limited to, selective serotonin reuptake inhibitors such as citalopram (CELEXA®, available from Forest Pharmaceuticals, Inc., St. Louis, MO); escitalopram (LEXAPRO®, available from Forest Pharmaceuticals, Inc., St. Louis, MO); fluoxetine (PROZAC®, available from Eli Lilly & Co., Indianapolis, IN); fluvoxamine (LUVOX®, available from the joint cooperation of Solvay Pharmaceuticals, Marietta, GA and the Upjohn Company, New York, NY); paroxetine (PAXIL®, available from SmithKline Beecham, Inc., Parsippany, NJ); sertraline (ZOLOFT®, available from Pfizer, New York, NY); and optically pure stereoisomers, active metabolites, and pharmaceutically acceptable salts, solvates, clathrates, and various stereoisomers thereof.

[0065] Citalopram may be administered to human patients in amounts ranging from about 2.8 mg to about 120 mg per any given 24 hour dosing period. Preferably, citalopram may be administered to human patients in amounts ranging from about 10 mg to about 60 mg per any given 24 hour dosing period.

[0066] Escitalopram may be administered to human adults and children in amounts ranging from about 1.4 mg to about 40 mg per any given 24 hour dosing period. Preferably, escitalopram may be administered to human patients in amounts ranging from about 10 mg to about 20 mg per any given 24 hour dosing period.

[0067] Fluoxetine may be administered to human patients in amounts ranging from about 0.7 mg to about 160 mg per any given 24 hour dosing period. Preferably, fluoxetine may be administered to human patients in amounts ranging from about 10 mg to about 80 mg per any given 24 hour dosing period.

[0068] Fluvoxamine may be administered to human patients in amounts ranging from about 7 mg to about 600 mg per any given 24 hour dosing period. Preferably, fluvoxamine may be administered to human patients in amounts ranging from about 50 to about 300 mg per any given 24 hour dosing period.

[0069] Paroxetine may be administered to human patients in amounts ranging from about 1.5 mg to about 140 mg per any given 24 hour dosing period. Preferably, paroxetine may be administered to human patients in amounts ranging from about 10 mg and about 60 mg per any given 24 hour dosing period.

[0070] Sertraline may be administered to human patients in amounts ranging from about 3.6 mg per any given 24 hour dosing period, with a maximum dose of about 400 mg per any given 24 hour dosing period. Preferably, sertraline may be administered to human patients in amounts ranging from about 25 mg to about 200 mg per any given 24 hour dosing period.

[0071] Again, it should be understood by those skilled in the art that the dosing of the additional reuptake inhibitors noted above can be varied based upon the particular patient and/or disease state being treated. Further, the amount of such additional components can be optimized in consideration of the pharmacokinetic and dynamic properties of each in a unitary dosage form(s) of the present technology, as well as the drug/drug interaction(s) encountered under steady state conditions. [0072] Further selective reuptake inhibitors for use in the practice of the present technology include milnacipran and duloxetine. {Medicine and Drug Journal, Vol. 36, No. 2, pp. 151-157 (2000).) Milnacipran may be administered to human patients in amounts ranging from about 50 mg to about 100 mg per any given 24 hour dosing period. Preferably, milnacipran may be administered to human patients in amounts ranging from about 70 mg to about 80 mg per any given 24 hour dosing period.

[0073] In addition, it should be understood by those skilled in the art that fluoxetine {Am. J. Clin. Nutr. 64, pp. 267-273 (1996)), sertraline (/. Endocrinol. Invest. 19, pp. 727-733 (1996)), paroxetine {Drugs 55, pp. 85-120 (1998)), and fluvoxamine {J. CHn. Psychiatry 57, pp. 346- 348 (1996)) are considered useful as anti-obesity agents.

[0074] In other embodiments, the selective reuptake inhibitor (non- SSRJ' s or agents with other modes of action) or selective blocker, generally utilized in treating depression and obesity, can be, for example, bupropion (WELLBUTRIN®, available from GlaxoSmithKline, Philadelphia, PA), nefazodone (available from Teva Pharmaceuticals USA, Philadelphia, PA), trazodone (DEXYREL®, available from Apothecon, Inc., Princeton, NJ), duloxetine (CYMBALTA®, available from Eli Lilly & Co., Indianapolis, IN), venlafaxine (EFFEXOR®, available from Wyeth Pharmaceuticals, Inc.), mirtazapine (REMERON®, available from Organon, Inc., West Orange, NJ), maprotiline (available from Mylan Pharmaceuticals, Inc., Pittsburgh, PA), isocarboxazid (MARPLAN®, available from Oxford Pharmaceutical Services, Inc., Totowa, NJ), phenelzine (NARDIL®, available from Park-Davis, New York, NY), tranylcypromine (PARNATE®, available from SmithKline Beecham, Parsippany, NJ), combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof.

[0075] Bupropion, for example, may be administered to human patients in amounts ranging from about 30 mg to about 900 mg per any given 24 hour dosing period. Preferably, bupropion may be administered to human patients in amounts ranging from about 50 mg to about 450 mg per any given 24 hour dosing period.

[0076] Nefazodone may be administered to human patients in amounts ranging from about 300 mg to about 600 mg per any given 24 hour dosing period. Preferably, nefazodone may be administered to human patients in amounts ranging from about 400 mg to about 500 mg per any given 24 hour dosing period.

[0077] Additionally, trazodone may be administered to human patients in amounts ranging from about 150 mg to about 600 mg per any given 24 hour dosing period. Preferably, trazodone may be administered to human patients in amounts ranging from about 300 mg to about 400 mg per any given 24 hour dosing period. [0078] Duloxetine may be administered to human patients in amounts ranging from about 40 mg (given as two 20 mg doses) to about 60 mg per any given 24 hour dosing period. Preferably, duloxetine may be administered to human patients in amounts ranging from about 45 mg to about 55 mg per any given 24 hour dosing period.

[0079] Venlafaxine may be administered to human patients in amounts ranging from about 12.5 mg to about 225 mg per any given 24 hour dosing period. Preferably, venlafaxine may be administered to human patients in amounts ranging from about 100 mg to about 200 mg per any given 24 hour dosing period.

[0080] Mirtazapine may be administered to human patients in amounts ranging from about 15 mg to about 45 mg per any given 24 hour dosing period. Preferably, mirtazapine may be administered to human patients in amounts ranging from about 25 mg to about 35 mg per any given 24 hour dosing period.

[0081] Maprotiline may be administered to human patients in amounts ranging from about 75 mg to about 225 mg per any given 24 hour dosing period. Preferably, maprotiline may be administered to human patients in amounts ranging from about 125 mg to about 200 mg per any given 24 hour dosing period. [0082] Isocarboxazid may be administered to human patients in amounts ranging from about 20 mg to about 60 mg per any given 24 hour dosing period. Preferably, isocarboxazid may be administered to human patients in amounts ranging from about 30 mg to about 50 mg per any given 24 hour dosing period.

[0083] Phenelzine may be administered to human patients in amounts ranging from about 30 mg to about 90 mg per any given 24 hour dosing period. Preferably, phenelzine may be administered to human patients in amounts ranging from about 40 mg to about 60 mg per any given 24 hour dosing period.

[0084] Tranylcypromine may be administered to human patients in amounts ranging from about 20 mg to about 60 mg per any given 24 hour dosing period. Preferably, tranylcypromine may be administered to human patients in amounts ranging from about 30 mg to about 50 mg per any given 24 hour dosing period.

[0085] The dose of a selective reuptake inhibitor (non-SSRI or agents with other modes of action) or selective blocker such as those disclosed should be optimized to take into account the pharmacokinetic and dynamic properties of the combined components of the pharmaceutical composition in the unitary dosage form(s), as well as drug/drug interaction(s) encountered under steady state conditions. [0086] In at least one preferred embodiment, the first pharmaceutical agent comprises a racemic or optically pure sibutramine metabolite or a pharmaceutically acceptable salt, solvate, or clathrate thereof. Preferred racemic and optically pure sibutramine metabolites include, but are not limited to, (+)- desmethylsibutramine, (-)- desmethylsibutramine, (:t)- desmethylsibutramine, (+ )- didesmethylsibutramine, (-). didesmethylsibutramine, and (:!:)- didesmelhylsibutramine. Optically pure metabolites of sibutramine are most preferred.

[0087] As used herein, the term "optically pure" means that a composition contains greater than about 90% of the desired stereoisomer by weight, preferably greater than about 95% of the desired stereoisomer by weight, and more preferably greater than about 99% of the desired stereoisomer by weight, based upon the total weight of the active ingredient. For example, optically pure (+)- desmethylsibutramine is substantially free of (-)- desmethylsibutramine. As used herein, the term "substantially free" means that a composition contains less than about 10% by weight, preferably less than about 5% by weight, and more preferably less than about 1% by weight of a particular compound.

[0088] It should be further understood that pharmaceutically acceptable salts, solvates, and clathrates of racemic and optically pure sibutramine metabolites can be utilized in the methods, pharmaceutical compositions, and pharmaceutical kits of the present technology. As used herein, the term "pharmaceutically acceptable salt" refers to a salt prepared from a pharmaceutically acceptable nontoxic inorganic or organic acid. Inorganic acids include, but are not limited to, hydrochloric, hydrobromic, hydroiodic, nitric, sulfuric, and phosphoric. Organic acids include, but are not limited to, aliphatic, aromatic, carboxylic, and sulfonic organic acids including, but not limited to, formic, acetic, propionic, succinic, benzoic 60 camphorsulfonic, citric, fumaric, gluconic, iselhionic, lactic, malic, mucic, tartaric, para-toluenesulfonic, glycolic, glucuronic, maleic, furoic, glutamic, benzoic, anthranilic, salicylic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, panlolhenic, benzenesulfonic, stearic, sulfanilic, alginic, and galacturonic acid. Particularly preferred acids are hydrobromic, hydrochloric, phosphoric, and sulfuric acids, and most particularly preferred is hydrochloric acid.

[0089] The unitary dosage form can also include magnesium, a salt thereof, magnesium equivalent, or a derivative thereof. Magnesium is . a necessary intercellular co-factor for many enzymes utilized by a human or animal body, and plays an essential role in protein synthesis. The magnesium ion (Mg²⁺) also plays a fundamental role in carbohydrate metabolism, and in the action of insulin in particular.

[0090] Moreover, although not wanting to be bound to any particular theory, it is believed that there is a link between magnesium depletion and ischemic heart disease. See, e.g., Acta Med Hung, Vol. 1-2, pp. 55-64 (1994). It is also believed that magnesium supplementation also reduces platelet reactivity in non-insulin dependent diabetes mellitus patients, reduces the incidence of congestive heart failure and death in those with acute myocardial infarction, improves glucose metabolism, improves insulin sensitivity, and reduces lipid abnormalities. Further, it is believed that magnesium supplementation also reduces systolic and diastolic blood pressure.

[0091] A bioavailable source of magnesium is magnesium chloride. Magnesium may also be optionally complexed with a suitable complex such as citrate, fumarate, malate, glutarate, and succinate, as well as other bioavailable forms of magnesium, particularly forms of magnesium that are chelated to an organic anion thus forming a membrane permeable complex that is more permeable than magnesium alone. It should be understood by those skilled in the art that any of the above forms of magnesium are suitable for use in the practice of the present technology.

[0092] In one or more preferred embodiments of the present technology, the dose of elemental magnesium equivalent is about 45% in the range of about 10 mg up to about 3 g per any given 24 hour dosing period. As used herein, "elemental magnesium equivalent" refers to the amount of bioavailable magnesium present in the particular complex (e.g., magnesium chloride) chosen for any given unitary dosage form formulation of the present technology. [0093] In at least one preferred embodiment, elemental magnesium equivalent is present in the range of about 10 mg up to about 1500 mg per any given 24 hour dosing period. In another preferred embodiment, elemental magnesium equivalent is present in the range of about 60 mg up to about 1500 mg per any given 24 hour dosing period.

[0094] In yet another preferred embodiment, magnesium chloride is present as the magnesium component of the present technology in the range of about 100 mg up to about 200 mg per any given 24 hour dosing period. Alternatively, magnesium chloride can be present in the range of about 200 mg up to about 500 mg per any given 24 hour dosing period, more preferably, magnesium chloride is present at about 384 mg per any given 24 hour dosing period.

[0095] In one or more embodiments of the present technology, the unitary dosage form can also comprise a second pharmaceutical agent, such as a selective reuptake inhibitor, for example, selective serotonin reuptake inhibitors, or a selective blocker, for example, a selective receptor blocker such as a CBl receptor blocker in the endocannabinoid system. These agents are generally utilized in treating depression and obesity or assisting in treating obesity. Selective serotonin reuptake inhibitors include, for example, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof. However, it should be understood that other selective reuptake inhibitors or selective blockers (non-SSRI's or agents with other modes of action) such as known psychiatric compounds can be included within the spirit and scope of the present technology. Such components include, but are not limited to, bupropion, nefazodone, trazodone, duloxetine, venlafaxine, mirtazapine, maprotiline, isocarboxazid, phenelzine, tranylcypromine, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof, or those other selective reuptake inhibitors or selective blockers discussed herein.

[0096] In still further embodiments, the pharmaceutical composition of the one or more unitary dosage forms of the present technology can comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one HmG-CoA reductase inhibitor.

[0097] In other embodiments, the pharmaceutical composition can comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one fibrate. In other embodiments, the pharmaceutical composition comprises effective amounts of at least one biguanide, at least one pharmaceutical agent, and ezetimibe. HmG-CoA reductase inhibitors, fibrates, and ezetimibe are generally utilized in treating hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitosterolemia and/or vascular disease. [0098] Magnesium or a salt thereof may be optionally included in any of the above pharmaceutical compositions in unitary dosage forms of the present technology.

[0099] Further, selective reductase inhibitors, such as atorvastatin (Am. J. Cardiol. 79, pp. 1248-1252 (1997)), and cerivastatin (Atherosclerosis 135, pp. 119-130 (1997)) are used clinically, and nisvastatin (also known as pitavastatin) (Life Sci. 65, pp. 1493-1502 (1999)) and S-4522 (Bioorg. Med. Chem. 5, pp., 437-444 (1997)) are in clinical testing. Such components can also be utilized in accordance with the presently described technology to treat a variety of endocrine or metabolic disorders such as hyperlipidemia.

[00100] As an example, nisvastatin (also known as pitavastatin) may be administered to human patients in amounts ranging from about 0.12 mg to about 8 mg per any given 24 hour dosing period.

[00101] HmG-CoA reductase inhibitors (statins) also for use in the present technology include, but are not limited to atorvastatin (LIPITOR®, available from Pfizer, New York, NY), fluvastatin (LESCOL®, available from Novartis Pharmaceuticals Corp., East Hanover, NJ), lovastatin (MEVACOR®, available from Merck & Co., Inc., White House Station, NJ), pravastatin (PRAVACHOL®, available from Bristol-Myers Squibb, Princeton, NJ), rosuvastatin (CRESTOR®, available from AstraZeneca LP, Wilmington, DE), simvastatin (ZOCOR®, available from Merck & Co., Inc., White House Station, NJ), derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

[00102] Atorvastatin may be administered to human patients in amounts ranging from about 1.4 mg to about 160 mg per any given 24 hour dosing period. Preferably, atorvastatin may be administered to human patients in amounts ranging from about 10 mg to about 80 mg per any given 24 hour dosing period.

[00103] Fluvastatin may be administered to human patients in amounts ranging from about 2.8 mg to about 320 mg per any given 24 hour dosing period. Preferably, fluvastatin may be administered to human patients in amounts ranging from about 20 mg to about 80 mg per any given 24 hour dosing period.

[00104] Lovastatin may be administered to human patients in amounts ranging from about 1.4 to about 160 mg per any given 24 hour dosing period. Preferably, lovastatin may be administered to human patients in amounts ranging from about 10 mg to about 80 mg per any given 24 hour dosing period.

[00105] Pravastatin may be administered to human patients in amounts ranging from about 2.8 to about 160 mg per any given 24 hour dosing period. Preferably, pravastatin may be administered to human patients in amounts ranging from about 20 mg to about 80 mg per any given 24 hour dosing period. [00106] Rosuvastatin may be administered to human patients in amounts ranging from about 0.7 mg to about 80 mg per any given 24 hour dosing period. Preferably, rosuvastatin may be administered to human patients in amounts ranging from about 5 mg to about 40 mg per any given 24 hour dosing period.

[00107] Simvastatin may be administered to human patients in amounts ranging from about 0.7 to about 160 mg per any given 24 hour dosing period. Preferably, simvastatin may be administered to human patients in amounts ranging from about 5 mg to about 80 mg per any given 24 hour dosing period.

[00108] Fibrates for use in the present technology include, but are not limited to fenofibrate (TRICOR®, available from Abbott Laboratories, Abbott Park, IL), gemfibrozil (available from Mylan Pharmaceuticals, Inc., Pittsburgh, PA), derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

[00109] Fenofibrate may be administered to human patients in amounts ranging from about 40 mg to about 160 mg per any given 24 hour dosing period. Preferably, fenofibrate may be administered to human patients in amounts ranging from about 60 mg to about 120 mg per any given 24 hour dosing period.

[00110] Gemfibrozil may be administered to human patients in amounts of about 1200 mg per any given 24 hour dosing period. [00111] Ezetimibe (ZETIA®, available from Merck/Schering- Plough), derivatives thereof, stereoisomers thereof, or metabolites thereof, is also available for use in the present technology. Ezetimibe may be administered to human patients in amounts ranging from about 1.4 mg to about 20 mg per any given 24 hour dosing period. Preferably, ezetimibe may be administered to human patients in amounts of about 10 mg per any given 24 hour dosing period.

[00112] In additional embodiments, the pharmaceutical composition of the one or more unitary dosage forms of the present technology can comprise effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin converting enzyme inhibitor. In other embodiments, the pharmaceutical composition comprises effective amounts of at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin II receptor blocker. In still further embodiments, the unitary dosage form comprises effective amounts of at least one biguanide, at least one first pharmaceutical agent, at least one angiotensin converting enzyme inhibitor, and at least one angiotensin II receptor blocker. Angiotensin converting enzymes and angiotensin II receptor blockers are generally utilized in treating hypertension, cardiac insufficiency and diabetic nephropathy. One or more HmG-CoA reductase inhibitors, one or more fibrates, or magnesium or a salt thereof may be optionally included in any of the above pharmaceutical compositions in unitary dosage forms of the present technology. [00113] Angiotensin converting enzyme inhibitors for use in the presently described technology include, but are not limited to, enalapril (VASOTEC®, from BioVail Pharmaceuticals, Inc., Bridgewater, NJ), enalapril and hydrochlorothiazide (VASERETIC®, from BioVail Pharmaceuticals, Inc., Bridgewater, NJ), lisinopril (PRINIVIL®, from Merck & Co., Inc., White House Station, NJ), benazepril (LOTENSIN®, available from Novartis Pharamaceuticals Corp., East Hanover, NJ), captopril (CAPOTEN®, available from Par Pharmaceuticals, Inc., Woodcliff Lake, NJ), cilazapril, fosinopril (MONOPRIL®, available from Bristol-Myers Squibb Co., Princeton, NJ), moexipril (UNIVASC®, available from Schwartz Pharma, Milwaukee, WI), perindopril (ACEON®, available from Solvay Pharmaceuticals, Marietta, GA), quinapril (ACCUPREL®, available from Pfizer, New York, NY), ramipril (ALTACE®, available from Monarch Pharmaceuticals, Bristol, TN), trandolapril (MA VIK®, available from Abbott Laboratories, Abbott Park, IL), imidapril (available from Tanabe Pharmaceutical Co, Tokyo, Japan), derivatives thereof, stereoisomers thereof, metabolites thereof, or equivalents thereof. In a preferred embodiment, the angiotensin converting enzyme inhibitor is imidapril, derivatives thereof, stereoisomers thereof, metabolites thereof, or equivalents thereof

[00114] Enalapril may be administered to human patients in amounts ranging from about 0.4 mg to about 80 mg per any given 24 hour dosing period. Preferably, enalapril may be administered to human patients in amounts ranging from about 2.5 mg to about 40 mg per any given 24 hour dosing period.

[00115] Lisinopril may be administered to human patients in amounts ranging from about 0.7 mg to about 80 mg per any given 24 hour dosing period. Preferably, lisinopril may be administered to human patients in amounts ranging from about 5 mg to about 40 mg per any given 24 hour dosing period.

[00116] Benazepril may be administered to human patients in amounts ranging from about 0.7 mg to about 80 mg per any given 24 hour dosing period. Preferably, benazepril may be administered to human patients in amounts ranging from about 20 mg to about 40 mg per any given 24 hour dosing period.

[00117] Captopril may be administered to human patients in amounts ranging from about 0.8 mg to about 300 mg per any given 24 hour dosing period. Preferably, captopril may be administered to human patients in amounts ranging from about 6 mg to about 250 mg per any given 24 hour dosing period.

[00118] Cilazapril may be administered to human patients in amounts ranging from about 2.5 mg to about 10 mg per any given 24 hour dosing period. Preferably, cilazapril may be administered to human patients in amounts ranging from about 4 mg to about 8 mg per any given 24 hour dosing period. [00119] Fosinopril may be administered to human patients in amounts ranging from about 0.4 mg to about 160 mg per any given 24 hour dosing period. Preferably, fosinopril may be administered to human patients in amounts ranging from about 5 mg and about 40 mg per any given 24 hour dosing period.

[00120] Moexipril may be administered to human patients in amounts ranging from about 7.5 mg to about 33 mg per any given 24 hour dosing period. Preferably, moexipril may be administered to human patients in amounts ranging from about 10 mg to about 20 mg per any given 24 hour dosing period.

[00121] Perindopril may be administered to human patients in amounts ranging from about 0.6 mg to about 16 mg per any given 24 hour dosing period. Preferably, perindopril may be administered to human patients in amounts ranging from about 4 mg to about 12 mg per any given 24 hour dosing period.

[00122] Quinapril may be administered to human patients in amounts ranging from about 0.7 mg to about 160 mg per any given 24 hour dosing period. Preferably, quinapril may be administered to human patients in amounts ranging from about 10 mg to about 40 mg per any given 24 hour dosing period.

[00123] Ramipril may be administered to human patients in amounts ranging from about 0.4 mg to about 20 mg per any given 24 hour dosing period. Preferably, ramipril may be administered to human patients in amounts ranging from about 2.5 mg to about 15 mg per any given 24 hour dosing period.

[00124] Trandolapril may be administered to human patients in amounts ranging from about 1 mg to about 4 mg per any given 24 hour dosing period. Preferably, trandolapril may be administered to human patients in amounts ranging from about 2 mg to about 3 mg per any given 24 hour dosing period.

[00125] Imidapril may be administered to human patients in amounts ranging from about 5 mg to about 20 mg per any given 24 hour dosing period. Preferably, trandolapril may be administered to human patients in amounts ranging from about 5 mg to about 10 mg per any given 24 hour dosing period.

[00126] Angiotensin II receptor blockers for use in the presently described technology include, but are not limited to, irbesartan (AVAPRO®, available from Bristol-Myers Squibb Co., Princeton, NJ), irbesartan and hydrochlorothiazide (AVALDDE®, available from Bristol-Myers Squibb Co., Princeton, NJ), losartan (COZAAR®, available from Merck & Co., Inc., White House Station, NJ), losartan and hydrochlorothiazide (HYZAAR®, available from Merck & Co., Inc., White House Station, NJ), valsartan (DIO VAN®, available from Novartis Pharmaceuticals Corp., East Hanover, NJ), candesartan (ATACAND®, available from AstraZeneca LP, Wilmington, DE), eprosartan (TEVETEN®, available from Bio Vail Pharmaceuticals, Inc., Bridgewater, NJ), olmesartan (BENICAR®, available from Sankyo Pharma, Parsippany, NJ), and telmisartan (MYCAJΛDIS®, available from Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT), derivatives thereof, stereoisomers thereof, metabolites thereof, or equivalents thereof.

[00127] Irbesartan may be administered to human patients in amounts ranging from about 10 mg to about 600 mg per any given 24 hour dosing period. Preferably, irbesartan may be administered to human patients in amounts ranging from about 75 to about 300 mg per any given 24 hour dosing period.

[00128] Losartan may be administered to human patients in amounts ranging from about 1.8 mg to about 200 mg per any given 24 hour dosing period. Preferably, losartan may be administered to human patients in amounts ranging from about 50 mg to about 100 mg per any given 24 hour dosing period.

[00129] Valsartan may be administered to human patients in amounts ranging from about 5.7 mg to about 640 mg per any given 24 hour dosing period. Preferably, valsartan may be administered to human patients in amounts ranging from about 80 mg to about 320 mg per any given 24 hour dosing period. [00130] Candesartan may be administered to human patients in amounts ranging from about 0.6 mg to about 64 mg per any given 24 hour dosing period. Preferably, candesartan may be administered to human patients in amounts ranging from about 4 mg to about 32 mg per any given 24 hour dosing period.

[00131] Eprosartan may be administered to human patients in amounts ranging from about 50 mg to about 1600 mg per any given 24 hour dosing period. Preferably, eprosartan may be administered to human patients in amounts ranging from about 400 mg to about 800 mg per any given 24 hour dosing period.

[00132] Olmesartan may be administered to human patients in amounts ranging from about 2.8 to about 80 mg per any given 24 hour dosing period. Preferably, olmesartan may be administered to human patients in amounts ranging from about 20 to about 40 per any given 24 hour dosing period.

[00133] Telmisartan may be administered to human patients in amounts ranging from about 2.8 mg to about 160 mg per any given 24 hour dosing period. Preferably, telmisartan may be administered to human patients in amounts ranging from about 20 to about 80 per any given 24 hour dosing period.

[00134] In further embodiments of the presently described technology, the pharmaceutical composition of the unitary dosage form(s) can comprise, in addition to the components discussed above, one or more components from the following categories: (i) insulin or insulin mimetics (insulin analogs with prolonged action, inhaled insulin preparations and organic vanadium compounds); (ii) agents which effect the secretion of insulin (sulfonylureas, BTS-67582 (Knoll AG), KAD-1229 (Kissei), A-4166 (Ajinomoto), glucagon-like pepetide-1, phosphodiesterase inhibitors and the imidazolin derivative (PMS-812; Universite Paris VII)); (iii) inhibitors of hepatic glucose production (biguanides, glucagon receptor antagonists, glycogen phosphorylase, pyruvate dehydrogenase kinase inhibitors, FBPase inhibitors and G-6-Pase inhibitors); (iv) insulin sensitizers (peroxisome proliferator activated receptor (PPAR)-gamma activators, thiazolidinediones, rexinoids and beta 3 adrenergic receptor agonists); and, (v) agents that inhibit glucose absorption.

[00135] Agents that inhibit glucose absorption can also be utilized and include, for example, acarbose (an alpha-glucosidase inhibitor) and cholecystokinin octapeptide (CCK-8). In addition, inhibitors of the Na⁺-glucose cotransporter (T- 1095; Tanabe), found in the intestines and kidneys and which actively transport glucose, reduce blood glucose levels by blocking glucose reabsorption and increasing its excretion in urine can also be utilized in the practice of the present technology. Amylin and its synthetic analog, pramlintide, which are known to delay the process of gastric emptying, and exendin-4 (Amylin Pharmaceuticals), can be used in the practice of the present technology as well. Combination therapy with one or more of these agents is a possible option to improve the control of blood glucose levels and should be considered within the scope of the presently described technology. Although not wanting to be bound by any particular theory, it is believed that the complementary mechanisms of action of different classes of these agents can demonstrate synergistic effects when used in accordance with the practice of the present technology.

[00136] The unitary dosage form described herein can be prepared as an immediate release dosage form, a controlled release dosage form, a sustained release dosage form, and an extended release dosage form. The dosage form may also allow each included component of the pharmaceutical composition to be released at different rates. Thus, one of ordinary skill in the art will recognize that the unitary dosage form can be varied based upon the particular patient or disease state to be treated or prevented, or formulation desired.

[00137] Examples of suitable unitary dosage forms of the present technology include, for example, a tablet, a capsule, a troche, a pill, a pellet, a nanoparticle, a liposome, a micelle, a spray, an aerosol, a suppository, a solution, an emulsion, a suspension, a topical delivery device, a cream, an ointment, a lotion, a dispersion, a sachet, a cachet, a powder, an inhalant, an injectible, a chewable dosage form, a dissolvable film, combinations thereof, or admixtures with organic or inorganic excipients suitable for nasal, enteral, rectal, or parenteral applications. Preferably, the unitary dosage form of the presently described technology is a tablet, a capsule, or a pill, more preferably a sachet.

[00138] Additionally, it should be understood by those skilled in the art that the components of the pharmaceutical composition of the unitary dosage form(s) of the present technology may be compounded, for example, with non-toxic, pharmaceutically and physiologically acceptable carriers for tablets, pellets, capsules, troches, lozenges, aqueous or oily suspensions, dispersible powders or granules, suppositories, solutions, emulsions, suspensions, hard or soft capsules, caplets or syrups or elixirs and any other form suitable for such use(s).

[00139] The carriers that can be used include, for example, glucose, lactose, gum acacia, gelatin, mannitol, starch paste, magnesium trisilicate, talc, corn starch, keratin, colloidal silica, potato starch, urea, medium chain length triglycerides, dextrans, and other carriers suitable for use in manufacturing preparations, in solid, semisolid, or liquid form.

[00140] In addition auxiliary, stabilizing, thickening and coloring agents may be used. The components contemplated for use in the pharmaceutical compositions of the unitary dosage forms of the present technology as described herein can be included, combined, or incorporated in amount(s) sufficient to produce the desired effect upon the targeted process, condition or disease state.

[00141] The compounds may also be taste masked to better allow them to be administered as solutions or dissolving dosage forms, especially when used in pediatric populations, or others who have difficulty swallowing solid dosage forms. The pharmaceutical compositions of the present technology may contain one or more agents, for example, flavoring agents (such as peppermint, oil of wintergreen or cherry), coloring agents, preserving agents, and the like, in order to provide pharmaceutically elegant and palatable preparations.

[00142] Tableted unitary dosage forms of the present technology containing the pharmaceutical composition (e.g., the biguanide component and the first pharmaceutical agent, alone or in combination with other components) in admixture with non-toxic pharmaceutically acceptable excipients may also be manufactured by known methods. The excipients used may be, for example, (1) inert diluents, such as calcium carbonate, lactose, calcium phosphate, sodium phosphate, and the like; (2) granulating and disintegrating agents, such as corn starch, potato starch, alginic acid, and the like; (3) binding agents, such as gum tragacanth, corn starch, gelatin, acacia, and the like; and (4) lubricating agents, such as magnesium stearate, stearic acid, and the like. The tableted unitary dosage forms of the present technology can also be uncoated or they may be coated by known techniques to delay disintegration and absorption in the gastrointestinal tract of a human or animal. One exemplary embodiment of the present technology includes metformin manufactured in a controlled (delayed, sustained, pulsated, etc.) release matrix core with an immediate release sibutramine (or other first pharmaceutical agent) coated on the outside.

[00143] Another exemplary embodiment includes metformin manufactured as a multiparticulate bead. The beads may release metformin in an immediate or controlled release manner, or populations of beads with differing release characteristics may be combined. Sibutramine (or other first pharmaceutical agent) can be added to this bead population as a powder or can be manufactured as a multiparticulate bead with an immediate release or controlled (delayed, sustained, pulsated, etc.) release. This particular unitary dosage form embodiment of the present technology has the advantage of separating the two active ingredients to provide better stability. The dosage form may be a tablet, placed in capsules, packaged as a sachet for reconstitution as a suspension or sprinkled on food, or delivered as a liquid suspension. Another exemplary embodiment includes a metformin bead (either extruded drug or coated on nonpareil (sugar) beads). The metformin bead is then coated with a first coating to separate the metformin and the sibutramine, and then the sibutramine is coated around the first coating. This approach does not require mixing different bead populations. [00144] In yet another aspect of the present technology, there is provided a method of treating or preventing one or more metabolic or endocrine diseases comprising the step of administering to a patient (a human or animal) a unitary dosage form containing a pharmaceutical composition comprising a sufficient quantity of at least one biguanide and a sufficient quantity of at least one first pharmaceutical agent. Optional additional components such as magnesium or inclusion of a second pharmaceutical agent(s), HmG-CoA reductase inhibitors, fibrates, ACE inhibitors, ARB 's, or other additional components, are also envisaged.

[00145] Suitable biguanides and first pharmaceutical agents for use in a preferred method include, for example, the biguanides and first pharmaceutical agents, such as selective reuptake inhibitors and selective blockers (SSRTs, non-SSRI's, and agents with other modes of action) described herein.

[00146] More specifically, in at least one preferred embodiment, the sufficient quantity of the biguanide utilized in the method of the present technology comprises a sufficient quantity of metformin, metabolites thereof, stereoisomers thereof, or derivatives thereof. More preferably, the sufficient quantity of metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof is between about 200 mg to about 3000 mg per dose of the unitary dosage form administered. In a more preferred embodiment, the sufficient quantity of the metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof is less than about 2000 mg per dose of the unitary dosage form administered.

[00147] The sufficient quantity of the first pharmaceutical agent comprises a sufficient quantity of sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof. Preferably, the sibutramine derivative is a substantially optically pure metabolite of sibutramine. It is also preferable that the sufficient quantity of sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof is between about 1 mg to about 5 mg to about 10 mg to about 20 mg per dose of the unitary dosage form administered. More preferably, in alternative embodiments, the sufficient quantity of sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof is less than about 1 mg per dose of the unitary dosage form administered.

[00148] In at least one embodiment of the method of the present technology, the pharmaceutical composition further comprises a sufficient quantity of magnesium, derivative thereof, or a salt thereof. In at least one preferred embodiment, the sufficient quantity of magnesium, derivative thereof, or salt thereof is between about 200 mg to about 3000 mg per dose of the unitary dosage form administered. In a more preferred embodiment, the sufficient quantity of magnesium or salt thereof is less than about 500 mg per dose of the unitary dosage form administered. [00149] In other preferred embodiments, the unitary dosage form further comprises a sufficient quantity of a second pharmaceutical agent, such as a selective reuptake inhibitor or selective blocker. In at least one preferred embodiment, the sufficient quantity of the second reuptake inhibitor or selective blocker comprises a sufficient quantity of at least one selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors include, for example, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof. However, it should be understood that other selective reuptake inhibitor or selective blockers (non-SSRI's or agents with other modes of action) such as known psychiatric compounds can be included within the spirit and scope of the present technology. Such components include, but are not limited to, bupropion, nefazodone, trazodone, duloxetine, venlafaxine, mirtazapine, maprotiline, isocarboxazid, phenelzine, tranylcypromine, combinations thereof, stereoisomers thereof, equivalents thereof, derivatives thereof, or alternatives thereof. The inclusion of one or more HmG-CoA reductase inhibitors, fibrates, ACE inhibitors, ARB 's or other additional components disclosed herein are also envisaged.

[00150] In one or more preferred embodiments of the present technology, the metabolic or endocrine diseases to be treated or prevented include, for example, obesity, insulin resistance, hyperinsulinemia, hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitosterolemia, hypertension, cardiac insufficiency, arteriosclerotic vascular disease, diabetic nephropathy, non-alcoholic steatohepatitis, polycystic ovary syndrome, impaired glucose tolerance, insulin dependent Type 1 diabetes, non-insulin dependent Type 2 diabetes, congestive heart failure, and combinations thereof.

[00151] The patient to be treated with the method(s) of the presently described technology may be a human adult, adolescent, or child. Animals (infant to adult) are also envisaged. The dosages of different compounds in the unitary dosage form can be adjusted to account for the different patient (human or animal) classes. Additionally, due to drug-drug interactions or other kinetic effects for such patient classes, an initially effective dosage form may not be suitable for long-term use. This can be overcome by administration of an initial "starter" dose combination that may change over time until an optimal equilibrium is reached in any given patient.

[00152] Moreover, it is believed that the reduction of the dose of one or more of the combined components of the present technology may be possible due to the synergistic effects of the combined dosage in a unitary dosage form or to avoid additive toxicities of the combined dosage. Such a reduction may provide the benefit of avoiding, reducing, minimizing, or preventing drug-drug interactions or side effects of the individual compounds/agents of the unitary dosage form(s) of the present technology because of the lower dosage of each.

[00153] In at least one preferred embodiment, the method of the present technology can further comprise the step of measuring one or more biomarkers of the patient (human or animal) to determine or adjust the sufficient quantity of the biguanide or the selective reuptake inhibitor (or other added components) of the unitary dosage form. For example, the patient's glycated hemoglobin (HbAIc) levels, insulin levels, levels of other hormones involved in glucose homeostatis, blood glucose levels, or other common and or novel indicators (such as leptin, grehlin, oxyntomodulin, incretin, or glucagons) may be measured in order to determine the sufficient quantity of biguanide or first pharmaceutical agent such as a selective reuptake inhibitor or blocker (SSRI' s, non-SSRI's, and other modes of action) in the unitary dosage form.

[00154] In a still further aspect, the present technology provides a pharmaceutical kit for the treatment or prevention of one or more metabolic or endocrine diseases comprising a unitary dosage form further comprising a pharmaceutical composition comprising at least one biguanide and at least one first pharmaceutical agent, such as, for example, a selective reuptake inhibitor or selective blocker. Suitable biguanides and first pharmaceutical agents for use in a preferred embodiment of this aspect of the present technology can include, for example, the biguanides and first pharmaceutical agents, such as selective reuptake inhibitors and selective blockers (SSRI' s, non- S SRI' s, and agents with other modes of action) disclosed herein. In at least one preferred embodiment, the biguanide comprises metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof, while the first pharmaceutical agent comprises sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof. Optionally, such unitary dosage form(s) can further comprise magnesium, a derivative thereof, or a salt thereof, one or more HmG- CoA reductase inhibitors, one or more fibrates, one or more ACE inhibitors, one or more ARB 's, one or more secondary selective reuptake inhibitors or selective blockers, or one or more of the additional components described herein.

[00155] Obesity, diabetes, insulin resistance, hyperlipidemia, metabolic syndrome, PCOS, cardiac outcomes, and NASH are often associated in a single patient. Although not wanting to be bound by any particular theory, it is believed that the use of the unitary dosage form pharmaceutical compositions, methods, and kits of the present technology will enhance the effectiveness of each component, and may allow reduction in the amount of each component utilized due to synergistic effects of the agents in combination. In addition, it is also believed the presently described technology will provide convenience to the patient and/or healthcare provider since the dosing schedule is simplified and the number of dosage forms administered is reduced. This enhances patient compliance, minimizes reduced therapeutic outcomes, reduces negative side effects, and increases healthcare efficiencies, effectiveness, and savings.

[00156] Combination therapy in a unitary dosage form may also allow for lower doses of some compounds, with diminished adverse event profiles, combined efficacy, and increased compliance. The unitary dosage forms can be adapted in advance to accommodate drug/drug interactions and diminish risks from partial compliance and withdrawal from some of the treatments. Further, the advantage of such unitary dosage form compositions, methods, and kits being available for patients in potential steady state conditions or capacities is also believed to lead to an increased ease of administration resulting in better compliance and more effective treatment. Fostering compliance is especially important in the human pediatric and elderly patient populations. Another potential advantage of a unitary dosage form is the ability to better predict the timing of the administration of each drug. For example, a combination of sustained, delayed, pulsatile, or immediate release dosage forms provides an advantage if one pharmaceutical compound should be administered at a time relative to a second pharmaceutical compound, rather than depending upon the patient to take the two drugs at specific time intervals. Finally, unitary combinational products also have economic advantages over the purchase of separate products.

[00157] While particular elements, embodiments and applications of the present invention have been shown and described, it will be understood, of course, that the invention is not limited thereto since modifications can be made by those skilled in the art without departing from the scope of the present disclosure, particularly in light of the foregoing teachings and appended claims. Further, all references cited herein are incorporated in their entirety.

Claims

What is claimed is:

1. A unitary dosage form for the treatment or prevention of one or more metabolic or endocrine disorders comprising a pharmaceutical composition further comprising at least one biguanide and at least one first pharmaceutical agent.

2. The unitary dosage form of claim 1, wherein the biguanide is metformin, stereoisomers thereof, derivatives thereof, or metabolites thereof.

3. The unitary dosage form of claim 1, wherein the first pharmaceutical agent is a selective reuptake inhibitor or selective blocker.

4. The unitary dosage form of claim 3, wherein the selective reuptake inhibitor or selective blocker is a selective neurotransmitter reuptake inhibitor.

5. The unitary dosage form of claim 4, wherein the selective neurotransmitter reuptake inhibitor selectively inhibits the reuptake of epinephrine, norepinephrine, serotonin, dopamine, or derivatives thereof, pre-cursors thereof, or metabolites thereof.

6. The unitary dosage form of claim 1, wherein the first pharmaceutical agent is sibutramine, rimonabant, derivatives thereof, stereoisomers thereof, or metabolites thereof.

7. The unitary dosage form of claim 6, wherein the sibutramine is a substantially optically pure metabolite of sibutramine.

8. The unitary dosage form of claim 1, wherein the pharmaceutical composition further comprises magnesium, a salt thereof, or a derivative thereof.

9. The unitary dosage form of claim 1, wherein the pharmaceutical composition further comprises a second pharmaceutical agent.

10. The unitary dosage form of claim 9, wherein the second pharmaceutical agent is a selective serotonin reuptake inhibitor, an atypical antidepressant, a monoamine oxidase reuptake inhibitor, a tetracyclic compound, derivatives thereof, stereoisomers thereof, or metabolites thereof.

11. The unitary dosage form of claim 10, wherein the selective serotonin reuptake inhibitor is citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

12. The unitary dosage form of claim 10, wherein the atypical antidepressant is bupropion, nefazodone, trazodone, derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

13. The unitary dosage form of claim 10, wherein the monamine oxidase reuptake inhibitor is isocarboxazid, phenelzine, tranylcypromine, derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

14. The unitary dosage form of claim 10, wherein the tetracyclic compound is maprotiline, mirtazapine, derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

15. The unitary dosage form of claim 1, wherein the pharmaceutical composition further comprises an anti-hyperlipidemia component selected from the group consisting of HmG-CoA reductase inhibitors, fibrates, and ezetimibe.

16. The unitary dosage form of claim 15, wherein the HmG- CoA reductase inhibitor is atorvastatin, simvastatin, derivatives thereof, stereoisomers thereof, metabolites thereof, or combinations thereof.

17. The unitary dosage form of claim 15, wherein the fibrate is fenofibrate, derivatives thereof, steroisomers thereof, or metabolites thereof.

18. The unitary dosage form of claim 1, wherein the pharmaceutical composition further comprises at least one angiotensin converting enzyme inhibitor.

19. The unitary dosage form of claim 1, wherein the pharmaceutical composition further comprises at least one angiotensin II receptor blocker.

20. The unitary dosage form of claim 1, wherein the unitary dosage form is a member selected from the group consisting of an immediate release dosage form, a controlled release dosage form, a sustained release dosage form, an extended release dosage form, derivatives thereof, and combinations thereof.

21. The unitary dosage form of claim 1, wherein the unitary dosage form is a member selected from the group consisting of a tablet, a capsule, a troche, a pill, a pellet, a nanoparticle, a liposome, a micelle, a spray, an aerosol, a suppository, a solution, an emulsion, a suspension, a topical delivery device, a cream, an ointment, a lotion, a dispersion, a sachet, a cachet, a powder, an inhalant, an injectible, a chewable dosage form, a dissolvable film, combinations thereof, or admixtures with organic or inorganic excipients suitable for nasal, enteral, rectal, or parenteral applications.

22. The unitary dosage form of claim 21, wherein the unitary dosage form is a sachet.

23. The unitary dosage form of claim 21 , wherein the unitary dosage form is a tablet.

24. The unitary dosage form of claim 21, wherein the unitary dosage form is a capsule.

25. The unitary dosage form of claim 21, wherein the unitary dosage form is a multiparticulate fomulation.

26. The unitary dosage form of claim 21 , wherein the unitary dosage form incorporates technology to mask the taste of one or more of the therapeutic agents.

27. A unitary dosage form for the treatment or prevention of one or more metabolic or endocrine disorders comprising a pharmaceutical composition including at least one biguanide and at least one selective reuptake inhibitor or selective blocker.

28. The unitary dosage form of claim 27, wherein the biguanide is metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof.

29. The unitary dosage form of claim 27, wherein the selective reuptake inhibitor or selective blocker selectively inhibits the reuptake of epinephrine, norepinephrine, serotonin, dopamine, or derivatives thereof.

30. The unitary dosage form of claim 27, wherein the selective reuptake inhibitor or selective blocker is sibutramine, rimonabant, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, bupropion, duloxetine, venlafaxine, nefazodone, trazodone, mirtazapine, isocarboxazid, phenelzine, tranylcypromine, sertraline, combinations thereof, stereoisomers thereof, metabolites thereof, or derivatives thereof.

31. The unitary dosage form of claim 30, wherein the sibutramine is a substantially optically pure metabolite of sibutramine.

32. The unitary dosage form of claim 27, wherein the pharmaceutical composition further comprises magnesium, derivatives thereof, or a salt thereof.

33. The unitary dosage form of claim 27, wherein the pharmaceutical composition further comprises at least one angiotensin converting enzyme inhibitor.

34. The unitary dosage form of claim 27, wherein the pharmaceutical composition further comprises at least one angiotensin II receptor blocker.

35. The unitary dosage form of claim 27, wherein the unitary dosage form is an immediate release, a controlled release, a sustained release, or an extended release dosage form.

36. The unitary dosage form of claim 35, wherein the unitary dosage form is a solid or liquid admixture with organic or inorganic excipients suitable for nasal, enteral, transdermal, rectal, or parenteral applications.

37. The unitary dosage form of claim 35, wherein the unitary dosage form is a tablet, a capsule, a sachet, or a pill.

38. A unitary dosage form for the treatment or prevention of at least one disease related to obesity comprising a pharmaceutical composition further comprising at least one biguanide, at least one first pharmaceutical agent, and at least one magnesium or a salt thereof.

39. The unitary dosage form of claim 38, wherein the biguanide is metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof.

40. The unitary dosage form of claim 38, wherein the first pharmaceutical agent comprises a selective reuptake inhibitor or selective blocker.

41. The unitary dosage form of claim 40, wherein the selective reuptake inhibitor or selective blocker selectively inhibits the reuptake of epinephrine, norepinephrine, serotonin, dopamine, combinations thereof, precursors thereof, or derivatives thereof.

42. The unitary dosage form of claim 40, wherein the selective reuptake inhibitor or selective blocker is sibutramine, rimonabant, metabolites thereof, stereoisomers thereof, or derivatives thereof.

43. The unitary dosage form of claim 38, wherein the pharmaceutical composition further comprises at least one angiotensin converting enzyme inhibitor.

44. The unitary dosage form of claim 38, wherein the pharmaceutical composition further comprises at least one angiotensin II receptor blocker.

45. The unitary dosage form of claim 38, wherein the unitary dosage form is an immediate release, a controlled release, a sustained release, or an extended release tablet, capsule, pill, sachet, powder, or inhalant.

46. The unitary dosage form of claim 38, wherein the unitary dosage form includes the biguanide in a controlled release matrix core and the first pharmaceutical agent in an immediate release coating on the outside of the controlled release matrix core.

47. A method of treating or preventing one or more metabolic or endocrine diseases comprising the step of administering to a patient a unitary dosage form pharmaceutical composition comprising a sufficient quantity of at least one biguanide and a sufficient quantity of at least one first pharmaceutical agent.

48. The method according to claim 47, wherein the sufficient quantity of the biguanide comprises a sufficient quantity of metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof.

49. The method according to 48, wherein the sufficient quantity of metformin, stereoiosmers thereof, metabolites thereof, or derivatives thereof is between about 70 mg to about 5000 mg per dose of the unitary dosage form administered.

50. The method according to claim 48, wherein the sufficient quantity of the metformin, metabolites thereof, stereoisomers thereof, or derivatives thereof is less than about 500 mg per dose of the unitary dosage form administered.

51. The method according to claim 47, wherein the sufficient quantity of the first pharmaceutical agent comprises a sufficient quantity of sibutramine, rimonabant, stereoisomers thereof, or derivatives thereof.

52. The method according to claim 51, wherein the sibutramine derivative is a substantially optically pure metabolite of sibutramine.

53. The method according to claim 51 , wherein the sufficient quantity of sibutramine, rimonabant, stereoisomers thereof, or derivatives thereof is between about 1 mg to about 30 mg per dose of the unitary dosage form administered.

54. The method according to claim 51, wherein the sufficient quantity of sibutramine, rimonabant, stereoisomers thereof, or derivatives thereof is less than about 5 mg per dose of the unitary dosage form administered.

55. The method according to claim 47, wherein the pharmaceutical composition further comprises a sufficient quantity of magnesium or a salt thereof.

56. The method according to claim 55, wherein the sufficient quantity of magnesium or salt thereof is between about 10 mg to about 1500 mg per dose of the unitary dosage form administered.

57. The method according to claim 55, wherein the sufficient quantity of magnesium or salt thereof is less than about 280 per dose of the unitary dosage form administered.

58. The method according to claim 47, wherein the pharmaceutical composition further comprises a sufficient quantity of a second pharmaceutical agent.

59. The method according to claim 58, wherein the sufficient quantity of the second pharmaceutical agent comprises a sufficient quantity of at least one selective serotonin reuptake inhibitor, derivatives thereof, stereoisomers thereof, or combinations thereof.

60. The method according to claim 59, wherein the selective serotonin reuptake inhibitor is citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, combinations thereof, stereoisomers thereof, metabolites thereof, or derivatives thereof.

61. The method according to claim 47, wherein the pharmaceutical composition further comprises at least one angiotensin converting enzyme inhibitor.

62. The method according to claim 47, wherein the pharmaceutical composition further comprises at least one angiotensin II receptor blocker.

63. The method according to claim 47, wherein the unitary dosage form is an immediate release, a controlled release, a sustained release, or an extended release dosage form.

64. The method according to claim 47, wherein the one or more metabolic or endocrine diseases to be treated or prevented is a member selected from the group consisting of obesity, insulin resistance, hyperinsulinemia, hyperlipidemia, hyperlipoproteinemia, hypercholesteremia, hypertrigliceridemia, sitosterolemia, hypertension, cardiac insufficiency, arteriosclerotic vascular disease, diabetic nephropathy, non-alcoholic steatohepatitis, polycystic ovary syndrome, impaired glucose tolerance, insulin dependent Type 1 diabetes, non-insulin dependent Type 2 diabetes, congestive heart failure, and combinations thereof.

65. The method according to claim 64, wherein the metabolic or endocrine disease is insulin dependent type 1 diabetes.

66. The method according to claim 64, wherein the metabolic or endocrine disease is insulin resistance.

67. The method according to claim 64, wherein the endocrine disease is metabolic syndrome.

68. The method according to claim 64, wherein the metabolic or endocrine disease is impaired glucose tolerance.

69. The method according to claim 64, wherein the metabolic or endocrine disease is obesity.

70. The method according to claim 47, wherein the patient is a human or an animal.

71. The method according to claim 47, wherein the patient is a child.

72. The method according to claim 47, wherein the patient is an adult.

73. The method according to claim 47, wherein the patient is an adolescent.

74. The method according to claim 47, wherein the method further comprises the step of measuring one or more biomarkers of the patient to determine the potential for successful treatment of the patient with the biguanide or the first pharmaceutical agent of the pharmaceutical composition.

75. The method according to claim 47, wherein the method further comprises the step of measuring one or more biomarkers of the patient to determine or adjust the sufficient quantity of the biguanide or the first pharmaceutical agent of the pharmaceutical composition.

76. A pharmaceutical kit for the treatment or prevention of one or more metabolic diseases comprising a unitary dosage form pharmaceutical composition comprising at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin converting enzyme inhibitor or angiotensin II receptor blocker.

77. The pharmaceutical kit of claim 76, wherein the biguanide comprises metformin, stereoisomers thereof, metabolites thereof, or derivatives thereof.

78. The pharmaceutical kit of claim 76, wherein the first pharmaceutical agent comprises sibutramine, rimonabant, combinations thereof, metabolites thereof, stereoisomers thereof, or derivatives thereof.

79. The pharmaceutical kit of claim 76, wherein the pharmaceutical composition further comprises at least one HmG-CoA reductase inhibitor.

80. The pharmaceutical kit of claim 76, wherein the pharmaceutical composition further comprises at least one fibrate.

81. The pharmaceutical kit of claim 76, wherein the pharmaceutical composition further comprises at least one angiotensin converting enzyme inhibitor.

82. The pharmaceutical kit of claim 76, wherein the pharmaceutical composition further comprises at least one angiotensin II receptor blocker.

83. The pharmaceutical kit of claim 76, wherein the pharmaceutical composition further comprises magnesium or a salt thereof.

84. The pharmaceutical kit of claim 76, wherein the unitary dosage form is an immediate release, a controlled release, a sustained release, or an extended release dosage form.

85. A pharmaceutical composition in a unitary dosage form for the treatment or prevention of one or more metabolic or endocrine disorders comprising a unitary dosage form including at least one biguanide, at least one first pharmaceutical agent, and at least one angiotensin converting enzyme inhibitor.

86. The pharmaceutical composition of claim 85, further comprising magnesium or a salt thereof.

87. The pharmaceutical composition of claim 85, further comprising at least one second pharmaceutical agent.

88. A pharmaceutical composition in a unitary dosage form for the treatment or prevention of one or more metabolic or endocrine disorders comprising a unitary dosage form including at least one biguanide, at least one. first pharmaceutical agent, and at least one angiotensin II receptor blocker.

89. The pharmaceutical composition of claim 88, further comprising magnesium or a salt thereof.

90. The pharmaceutical composition of claim 88, further comprising at least one second pharmaceutical agent.

91. A pharmaceutical composition in a unitary dosage form for the treatment or prevention of one or more metabolic or endocrine disorders including at least one biguanide, at least one first pharmaceutical agent, at least one angiotensin converting enzyme inhibitor, and at least one angiotensin II receptor blocker.

92. The pharmaceutical composition of claim 91, further comprising magnesium or a salt thereof.