WO2008143490A1 - Pharmaceutical composition combining an anticonvulsant agent and an antiviral agent - Google Patents

Pharmaceutical composition combining an anticonvulsant agent and an antiviral agent Download PDF

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WO2008143490A1
WO2008143490A1 PCT/MX2008/000061 MX2008000061W WO2008143490A1 WO 2008143490 A1 WO2008143490 A1 WO 2008143490A1 MX 2008000061 W MX2008000061 W MX 2008000061W WO 2008143490 A1 WO2008143490 A1 WO 2008143490A1
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gabapentin
pharmaceutical composition
pain
agent
acyclovir
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PCT/MX2008/000061
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Spanish (es)
French (fr)
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María Elena GARCÍA ARMENTA
Josefina Santos Murillo
Victor Guillermo Alvarez Ochoa
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ESPINOSA ABDALA, Leopoldo de Jesús
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Application filed by ESPINOSA ABDALA, Leopoldo de Jesús filed Critical ESPINOSA ABDALA, Leopoldo de Jesús
Priority to ARP080102159A priority Critical patent/AR066668A1/en
Publication of WO2008143490A1 publication Critical patent/WO2008143490A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A61K31/52—Purines, e.g. adenine
    • A61K31/522—Purines, e.g. adenine having oxo groups directly attached to the heterocyclic ring, e.g. hypoxanthine, guanine, acyclovir
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/20—Antivirals for DNA viruses
    • A61P31/22—Antivirals for DNA viruses for herpes viruses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents

Definitions

  • the present invention is applied in the pharmaceutical industry and describes a pharmaceutical composition composed of the synergistic combination of an anticonvulsant agent, such as: Gabapentin and an antiviral agent, known as: Acyclovir, which are formulated in a single dosage unit, It is indicated for the prevention and / or treatment of post-herpetic neuralgia.
  • an anticonvulsant agent such as: Gabapentin
  • an antiviral agent known as: Acyclovir
  • the combination of the aforementioned active ingredients produces a greater synergistic effect when they are administered together in a single dose unit unlike when they are administered independently, generating benefits such as: lower dosages, faster action and lower side effects.
  • Herpes zoster is a viral disease, characterized by the manifestation of a rash Vesicular dermal distributed in the region of a skin dermatome, associated or not associated with neuropathic pain called "rash".
  • Herpes zoster is produced by the reactivation of the Varicella Zoster Virus (WZ), which remains dormant in the sensory ganglia after suffering from Chickenpox (primary infection).
  • WZ Varicella Zoster Virus
  • Herpes zoster is presented as a rash of 2 to 3 weeks duration in immunocompromised patients and is accompanied by moderate to severe pain.
  • the pain does not resolve when the rash is relieved, it remains continuous for weeks, sometimes for months or years; This persistent pain is known as "post-herpetic neuralgia" (NPH).
  • NPH post-herpetic neuralgia
  • the dermatome most frequently affected by the Herpes zoster virus is usually the thoracic (62%), the lumbar (14%), the cervical (11%), the ophthalmic (8%) and others (5%
  • Herpes zoster is presented by the reactivation of the "sleeping" or cantonized varicella zoster virus (for years), which is hidden in the dorsal sensory ganglia of the cranial or spinal nerves during early infection of the primary chickenpox. The virus then reappears in neurons and satellite cells associated with nerves and subsequently spreads to the skin through peripheral nerves. In periods of immunodeficiency it can be reactivated producing dermal lesions and acute neuralgia.
  • Post-Herpetic Neuralgia is the most common complication of Herpes zoster disease.
  • Post-herpetic neuralgia is defined as a localized pain that persists at least three months after the acute inflammatory phase manifested by the presence of Herpes zoster disease in the skin, it being possible that the duration of pain after rash healing remains longer, ranging from one month to six months after it.
  • Post-herpetic neuralgia Patients suffering from post-herpetic neuralgia manifest different types of pain, which can be deep pain, burning, stabbing pain, lacerating, altered touch sensitivity (paraesthesia), painful sensation caused by trivial stimuli or mechanical stimulation by innocuous light ( allodynia), exaggerated responses to stimuli (hyperesthesia), electroshock-type pain, increased pain in response to repeated stimulation and unbearable itching.
  • Post-herpetic neuralgia can affect 9 to 13% of patients suffering from Herpes zoster and can be maintained for 3 to 5 years on average. The risk of post-herpetic neuralgia increases with age and intratability of pain.
  • the pain associated with acute Herpes zoster and post-herpetic neuralgia is neuropathic. It is the result of a peripheral nerve injury, which alters the process of central nervous system signals. After the reactivation of the varicella zoster virus, which causes inflammation of the dorsal root ganglia, there is a significant alteration of the molecular, cellular and connective properties of the nociceptive pathways of the central nervous system, after anatomical differentiation. These changes can cause an abnormal increase in activity in the central nervous system pain transmission neurons.
  • NPH pain is described as burning and continuous, it can be a lancinating pain and with dysesthesias.
  • the pain spreads. characteristically along a single dermatome of the central dorsal line in a ventral direction. Often the pain remains confined to a single dermatome even though there is a cutaneous extension beyond the originally affected dermatome.
  • Dysesthesia is the intermittent occurrence of abnormal sensations that are not pleasant and are often described as pain. The discreet touch or rubbing may be intolerable for patients, who present changes in the skin in the form of pigmentation and scar even after the rash has healed.
  • Post-herpetic neuralgia occurs when there is necrosis and scarring of neurons in the dorsal root ganglion, causing degeneration and destruction of motor and sensory projections.
  • the inflammatory process can involve the anterior and posterior horn of the spinal cord.
  • Mononeuritis extends peripherally ' from the dorsal root ganglion and is characterized by axonal damage and myelin disruption, the number of nerves terminals in the skin helped by the decrease of neurons.
  • the risk factors for suffering an NPH, after suffering from Herpes zoster are: a) age, where the incidence increases in patients older than 50 years; b) immunosuppression or diseases that alter the immune system, such as cancer, chemotherapies, transplants, HIV; c) severity of dermatological lesions; d) severity of pain during the acute phase of HZ.
  • NPH Post-Herpetic Neuralgia
  • Pharmacological therapies have shown some benefits in terms of pain reduction and improvement of quality of life. These treatments have included tricyclic antidepressants, anticonvulsants, topical agents and opioid analgesics, which are administered independently, thereby causing the manifestation of greater side effects, especially in elderly patients who suffer most frequently.
  • NPH Post-Herpetic Neuralgia
  • the pharmaceutical composition object of the present invention is composed of the synergistic combination of an anticonvulsant agent and an antiviral agent; which produce a satisfactory therapeutic effect when administered together in a single oral dosage unit as opposed to When these are administered independently once the NPH is installed, generating benefits such as: lower concentrations of the active ingredients formulated, lower doses administered, faster action, greater efficacy of the therapeutic effect, lower adverse effects and a significant reduction of the risk of presenting NPH.
  • Gabapentin is a derivative of the GABA neurotransmitter (gamma-aminobutyric acid) and was developed as a structural analogue for the GABA system, but does not act on GABA-ergic receptors, nor is it converted or metabolized into GABA or a GABA antagonist, nor is it a GABA reuptake inhibitor.
  • Gabapentin shows no affinity for other common receptors, such as: benzodiazepine, glutamate, NMDA (N-methyl-D-aspartate), ⁇ l and ⁇ 2 or ⁇ -adrenergic, cholinergic, muscarinic, nicotinic, dopaminergic, histamine, serotonergic, opiates, cannabinoids, voltage-dependent calcium or sodium channels. It also does not alter the uptake of dopamine, norepinephrine or serotonin.
  • ⁇ 2 ⁇ is an auxiliary subunit of the calcium channels activated by the voltage present in the post-synaptic dorsal horn neurons, which they play a very important role in the modulation of GABA-ergic, glutaminergic and monoaminergic function, in addition to interrupting most of the processes involved in the development of neuropathic pain.
  • Gabapentin is a cyclic amino acid that is structurally related to gamma-aminobutyric acid (GABA), and unlike the latter, Gabapentin is able to cross the blood-brain barrier, distributed in the central nervous system in concentrations similar to those in plasma.
  • GABA gamma-aminobutyric acid
  • Gabapentin does not interfere with the metabolism of other antiepileptic drugs, for this reason, there is no need to monitor or adjust doses during use. Although it is structurally related to GABA, the mechanism of action of Gabapentin is different from other drugs involved in neuronal synapses mediated by GABA Gabapentin does not attach to the sites of antiepileptic drug receptors or to common neurotransmission receptors. It has not been found that Gabapentin is metabolically linked to GABA or a GABA agonist and neither has the reuptake or degradation of GABA been demonstrated.
  • Gabapentin is particularly effective in preventing neuropathic pain (spinal nerve ligation, streptozotocin-induced diabetes, Herpes zoster infection), although it also prevents pain associated with inflammatory processes ;
  • Gabapentin does not act on immediate pain.
  • the pharmacokinetic properties of Gabapentin predict a good safety profile and good bioavailability in a wide spectrum of populations. About 50 to 60% of Gabapentin is rapidly absorbed in the gastrointestinal tract after oral administration.
  • Acyclovir is a nucleoside analogue of guanine. Its structure differs from other nucleoside analogs in that it contains only a part of it (the glycidic ring is replaced by an open chain). Chemically it resembles deoxiguanosine, a precursor to purine DNA.
  • Deoxiguanosine is normally converted to its 5'-triphosphate nucleotide, which serves as one of the four substrates for polymerase synthesis in DNA construction.
  • Acyclovir in its original state has no antiviral activity, but its metabolites are active antiviral substances. In its absorbable form, Acyclovir is very little related to the enzymes of uninfected cells. Acyclovir is selectively converted into a monophosphate form through the enzyme thymidine kinase specific for the Herpes simplex virus.
  • the monophosphate is phosphorylated to convert it, first to acyclo-GDP diphosphate through the action of guanylate kinase enzymes and then to acyclo-GTP active triphosphate by the intervention of cellular kinase enzymes.
  • Acyclo-GTP active triphosphate inhibits the synthesis of viral DNA through 2 mechanisms: the first is a competitive mechanism with viral polymerase, and the second is a mechanism that by incorporating acyclo-GTP active triphosphate into the DNA chain in synthesis, stops its replication.
  • Acyclo-GTP active triphosphate is relatively unrelated to normal cell polymerases, which added to the fact that phosphorylation occurs only in infected cells, its effect on normal cells is much less toxic.
  • DNA polymerase specific for the Herpes simplex virus is inhibited 10 to 30 times more effectively than its cellular counterpart.
  • Acyclovir 5'-triphosphate forms an irreversible complex with DNA polymerase specific for Herpes simplex virus 1, which makes the agent a "suicide inactivator" of this enzyme. It is also a weak inhibitor of normal human cellular ⁇ polymerase DNA.
  • Acyclovir 5'-triphosphate is inserted as if it were deoxyguanosine, into the elongated DNA chain. Since this compound does not have a 3'-hydroxyl group in its deoxyribose analog side chain, it is incapable of enter the elongated DNA chain through the usual 3 'and 5' junction. This ends the chain and blocks viral DNA replication.
  • Acyclovir is mainly administered orally in the form of capsules and suspension. It is also administered topically, as a cream and intravenously in patients with severe infections caused by the Herpes virus.
  • Acyclovir Due to its low solubility, the absorption of Acyclovir is very slow, variable and incomplete (much of the administered dose is expelled without variation by feces). The skin absorption is minimal.
  • Acyclovir is widely distributed throughout the body, including cerebrospinal fluid and placenta. The volume of distribution equals that of total body water. The concentration of Acyclovir in the cerebrospinal fluid and in the aqueous humor are between one third to one half of the plasma concentration.
  • Acyclovir is metabolized in the liver. Acyclovir is mainly eliminated in the urine, by glomerular filtration and tubular secretion. The only Acyclovir metabolite identified by high pressure liquid-liquid chromatography that is eliminated in the urine is 9-
  • Acyclovir (8.6% to 19.8%) of the dose of Acyclovir that is administered orally is eliminated without being modified.
  • the plasma half-life of Acyclovir in patients with normal renal function is 2.5 to 3.3 hours.
  • Acyclovir is the first synthetic purine nucleoside with a very selective in vitro and in vivo inhibitory activity for Herpes viruses, including Herpes simplex virus types 1
  • HSV-I varicella-zoster virus
  • VZV varicella-zoster virus
  • the anticonvulsant agent used in the pharmaceutical composition object of the present invention is the active substance Gabapentin, which is present in the formulation in a concentration range from 300.0 mg. up to 3.6 gr., a concentration of 300.0 mg being preferably used. at 900.0 mg per dose unit.
  • the antiviral agent that is formulated in the pharmaceutical composition object of the present The invention is the active substance Aciclovir, which is present in the formulation in a concentration range from 200.0 mg. up to 1.0 gr. , preferably a concentration of approximately 200.0 mg being used. at 800.0 mg per dose unit.
  • the pharmaceutical composition protected by the present invention is formulated to be administered orally in a single dosage unit in the form of capsules and tablets, in which the synergistic combination of the active ingredients is contained: Gabapentin and Aciclovir, as well as pharmaceutically acceptable excipients.
  • Said pharmaceutical composition has been developed with the purpose of providing a pharmaceutical alternative for the prevention and / or treatment of post-herpetic neuralgia (NPH), which offers significant advantages such as: lower concentrations of the active principles contained in the formulation , reduction of the risk of presenting NPH, effective control of pain suffered by patients infected with the Herpes zoster virus in acute phase, as well as minor side effects.
  • NPH post-herpetic neuralgia

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Abstract

The invention relates to a pharmaceutical composition comprising a synergic combination of an anticonvulsant agent such as the active principle gabapentin and an antiviral agent such as the active principle aciclovir, which are formulated in a single dosage unit for oral administration, said composition being intended for the prevention and/or treatment of postherpetic neuralgia.

Description

COMPOSICIÓN FARMACÉUTICA QUE COMPRENDE LA COMBINACIÓN DE UN AGENTE ANTICONVULSIVO Y UN AGENTE ANTIVIRAL. PHARMACEUTICAL COMPOSITION THAT INCLUDES THE COMBINATION OF AN ANTI-CONVULSIVE AGENT AND AN ANTI-VIRAL AGENT.
CAMPO DE LA INVENCIÓN. La presente invención es aplicada en la industria farmacéutica y describe una composición farmacéutica compuesta por la combinación sinérgica de un agente anticonvulsivo, tal como: Gabapentina y un agente antiviral, conocido como: Aciclovir, los cuales se encuentran formulados en una sola unidad de dosificación, misma que está indicada para la prevención y/o tratamiento de la neuralgia post- herpética .FIELD OF THE INVENTION The present invention is applied in the pharmaceutical industry and describes a pharmaceutical composition composed of the synergistic combination of an anticonvulsant agent, such as: Gabapentin and an antiviral agent, known as: Acyclovir, which are formulated in a single dosage unit, It is indicated for the prevention and / or treatment of post-herpetic neuralgia.
La combinación de los principios activos antes mencionados produce un mayor efecto sinérgico cuando son administrados en conjunto en una sola unidad de dosis a diferencia de cuando estos se administran de forma independiente, generando beneficios como lo son: menores dosificaciones, mayor rapidez de acción y menores efectos secundarios.The combination of the aforementioned active ingredients produces a greater synergistic effect when they are administered together in a single dose unit unlike when they are administered independently, generating benefits such as: lower dosages, faster action and lower side effects.
ANTECEDENTES DE LA INVENCIÓN.BACKGROUND OF THE INVENTION
El Herpes zoster es una enfermedad viral, caracterizada por la manifestación de una erupción dérmica vesicular distribuida en la región de un dermatoma cutáneo, asociado o no a dolor neuropático denominada "rash" . El Herpes zoster es producido por la reactivación del Virus Varicela Zoster (WZ) , que permanece latente en los ganglios sensitivos tras haber padecido la Varicela (infección primaria) . El Herpes zoster se presenta como un rash de 2 a 3 semanas de duración en pacientes inmunocomprometidos y es acompañado por dolor de intensidad moderada a severa. En algunos pacientes, el dolor no se resuelve cuando el rash es aliviado, éste se mantiene continuo por semanas, algunas veces, por meses o años; a este dolor persistente se le conoce con el nombre de "neuralgia post-herpética" (NPH) . Los resultados de estudios recientes sugieren que el dolor asociado con Herpes zoster tiene 3 fases: neuralgia herpética aguda, caracterizada por la manifestación de rash, que compromete uno o varios dermatomas unilateralmente (entre el T3 y L3 , son los más frecuentemente comprometidos) , asociado con dolor intenso presente durante los 30 días después del inicio del rash; la neuralgia herpética subaguda, misma que se presenta durante los 30 hasta los 120 días después del inicio del rash, y la neuralgia post-herpética (NPH) , la cual es definida como el dolor que persiste por más de 120 días después del inicio del rash. El dermatoma más frecuentemente afectado por el virus del Herpes zoster suele ser el torácico (62%), el lumbar (14%), el cervical (11%) , el oftálmico (8%) y otros (5%) .Herpes zoster is a viral disease, characterized by the manifestation of a rash Vesicular dermal distributed in the region of a skin dermatome, associated or not associated with neuropathic pain called "rash". Herpes zoster is produced by the reactivation of the Varicella Zoster Virus (WZ), which remains dormant in the sensory ganglia after suffering from Chickenpox (primary infection). Herpes zoster is presented as a rash of 2 to 3 weeks duration in immunocompromised patients and is accompanied by moderate to severe pain. In some patients, the pain does not resolve when the rash is relieved, it remains continuous for weeks, sometimes for months or years; This persistent pain is known as "post-herpetic neuralgia" (NPH). The results of recent studies suggest that the pain associated with Herpes zoster has 3 phases: acute herpetic neuralgia, characterized by the manifestation of rash, which involves one or more dermatomes unilaterally (between T3 and L3, are the most frequently compromised), associated with severe pain present during the 30 days after the onset of rash; subacute herpetic neuralgia, which occurs during the 30 to 120 days after onset of rash, and post-herpetic neuralgia (NPH), which is defined as pain that persists for more than 120 days after the onset of rash. The dermatome most frequently affected by the Herpes zoster virus is usually the thoracic (62%), the lumbar (14%), the cervical (11%), the ophthalmic (8%) and others (5%).
El Herpes zoster se presenta por la reactivación del virus de la Varicela zoster "durmiente" o acantonado (durante años) , el cual se esconde en los ganglios sensoriales dorsales de los nervios craneales o espinales durante la infección precoz de la varicela primaria. Después, el virus reaparece en las neuronas y en las células satélite asociadas con los nervios y posteriormente se disemina a la piel a través de los nervios periféricos. En períodos de inmunodeficiencia se puede reactivar produciendo lesiones dérmicas y una neuralgia aguda.Herpes zoster is presented by the reactivation of the "sleeping" or cantonized varicella zoster virus (for years), which is hidden in the dorsal sensory ganglia of the cranial or spinal nerves during early infection of the primary chickenpox. The virus then reappears in neurons and satellite cells associated with nerves and subsequently spreads to the skin through peripheral nerves. In periods of immunodeficiency it can be reactivated producing dermal lesions and acute neuralgia.
La Neuralgia Post-Herpética (NPH) es la complicación más frecuente de la enfermedad del Herpes zoster. La neuralgia post-herpética se define como un dolor localizado que persiste al menos tres meses después de la fase inflamatoria aguda manifestada por la presencia de la enfermedad del Herpes zoster en la piel, siendo posible que la duración del dolor después de la cicatrización del rash permanezca por más tiempo, oscilando entre un mes hasta seis meses después de ésta . Los pacientes que padecen de neuralgia post- herpética manifiestan diferentes tipos de dolor, pudiendo ser dolor profundo, quemazón, dolor punzante, lacerante, alteración de la sensibilidad al toque (parestesia) , sensación dolorosa provocada por estímulos triviales o estimulación mecánica por luz inocua (alodinia) , respuestas exageradas a los estímulos (hiperestesia) , dolores de tipo electroshock, aumento del dolor en respuesta a la estimulación repetida y prurito insoportable. La neuralgia post-herpética puede afectar del 9 al 13% de los pacientes que padecen de Herpes zoster y puede mantenerse durante 3 a 5 años en promedio. El riesgo de neuralgia post-herpética aumenta con la edad y la intratabilidad del dolor. En un estudio se publicó que el 62% de los pacientes con Herpes zoster mayores de 50 años sufrían de neuralgia post-herpética y que en el 20% de éstos la neuralgia puede persistir durante más de seis meses. La incidencia de neuralgia post- herpética aumenta en pacientes con Herpes zoster oftálmico y es mayor en mujeres.Post-Herpetic Neuralgia (NPH) is the most common complication of Herpes zoster disease. Post-herpetic neuralgia is defined as a localized pain that persists at least three months after the acute inflammatory phase manifested by the presence of Herpes zoster disease in the skin, it being possible that the duration of pain after rash healing remains longer, ranging from one month to six months after it. Patients suffering from post-herpetic neuralgia manifest different types of pain, which can be deep pain, burning, stabbing pain, lacerating, altered touch sensitivity (paraesthesia), painful sensation caused by trivial stimuli or mechanical stimulation by innocuous light ( allodynia), exaggerated responses to stimuli (hyperesthesia), electroshock-type pain, increased pain in response to repeated stimulation and unbearable itching. Post-herpetic neuralgia can affect 9 to 13% of patients suffering from Herpes zoster and can be maintained for 3 to 5 years on average. The risk of post-herpetic neuralgia increases with age and intratability of pain. In one study it was published that 62% of patients with Herpes zoster older than 50 years suffered from post-herpetic neuralgia and that in 20% of these neuralgia may persist for more than six months. The incidence of post-neuralgia Herpetic increases in patients with ophthalmic Herpes zoster and is greater in women.
El dolor asociado con el Herpes zoster agudo y la neuralgia post-herpética es neuropático. Es el resultado de una lesión de los nervios periféricos, que altera el proceso de señales del sistema nervioso central. Después de la reactivación del virus varicela zoster, que origina la inflamación de los ganglios de la raíz dorsal, se produce una alteración significativa de las propiedades moleculares, celulares y conectivas de las vías nociceptivas del sistema nervioso central, después de la diferenciación anatómica. Estos cambios pueden originar un aumento anormal de actividad en las neuronas de transmisión del dolor del sistema nervioso central.The pain associated with acute Herpes zoster and post-herpetic neuralgia is neuropathic. It is the result of a peripheral nerve injury, which alters the process of central nervous system signals. After the reactivation of the varicella zoster virus, which causes inflammation of the dorsal root ganglia, there is a significant alteration of the molecular, cellular and connective properties of the nociceptive pathways of the central nervous system, after anatomical differentiation. These changes can cause an abnormal increase in activity in the central nervous system pain transmission neurons.
Se ha demostrado en animales, después de una lesión aferente primaria, que los aferentes primarios de diámetro grande supervivientes forman nuevas conexiones con posibles neuronas espinales de transmisión del dolor. Estas nuevas conexiones y la hiperactividad de las neuronas de proyección del cuerno dorsal podrían ser responsables de algunos casos de dolor y alodinia . En la región periférica, después de la lesión vírica, las neuronas periféricas se descargan espontáneamente, tienen umbrales más bajos de activación y muestran respuestas exageradas a los estímulos. El crecimiento excesivo de los axones después de la lesión también produce brotes nerviosos que son proclives a realizar descargas no provocadas.It has been shown in animals, after a primary afferent lesion, that surviving large-diameter primary afferents form new connections with possible spinal pain transmission neurons. These new connections and the hyperactivity of the projection neurons of the dorsal horn could be responsible for some cases of pain and allodynia. In the peripheral region, after viral injury, peripheral neurons discharge spontaneously, have lower activation thresholds and show exaggerated responses to stimuli. Axon overgrowth after injury also produces nerve breakouts that are prone to unprovoked discharges.
Se han realizado estudios que han demostrado la reducción anatómica de la densidad de inervación cutánea en la dermis superior y epidermis de la piel dolorida provocada por una NPH. Esto se correlacionó significativamente con la pérdida de función sensorial térmica e inversamente con la gravedad de la alodinia. Los resultados de dichos estudios confirman la hipótesis de que los nervios aferentes cutáneos contribuyen a la manifestación de dolor presente en una NPH. El dolor inicial puede estar extendido, y ocasionalmente parece afectar a más área de piel que la inervada por un solo ganglio dorsal. Después, el dolor se localiza en una zona limitada de piel.Studies have been carried out that have demonstrated the anatomical reduction of the skin innervation density in the upper dermis and epidermis of the painful skin caused by an NPH. This was significantly correlated with the loss of thermal sensory function and inversely with the severity of allodynia. The results of these studies confirm the hypothesis that cutaneous afferent nerves contribute to the manifestation of pain present in an NPH. The initial pain may be widespread, and occasionally seems to affect more area of skin than that innervated by a single dorsal ganglion. Afterwards, the pain is located in a limited area of skin.
El dolor por NPH se describe como quemante y continuo, puede ser un dolor lancinante y con disestesias. Típicamente el dolor se extiende característicamente a lo largo de un solo dermatoma de la línea dorsal central en una dirección ventral. Con frecuencia el dolor permanece confinado a un solo dermatoma a pesar de que exista una extensión cutánea mas allá del dermatoma afectado originalmente. La disestesia es la ocurrencia intermitente de las sensaciones anormales que no son placenteras y son descritas frecuentemente como dolor. El toque o roce discreto puede ser intolerable para los pacientes, los cuales presentan cambios en la piel en forma de pigmentación y cicatriz aún después de que el rash ha sanado .NPH pain is described as burning and continuous, it can be a lancinating pain and with dysesthesias. Typically the pain spreads. characteristically along a single dermatome of the central dorsal line in a ventral direction. Often the pain remains confined to a single dermatome even though there is a cutaneous extension beyond the originally affected dermatome. Dysesthesia is the intermittent occurrence of abnormal sensations that are not pleasant and are often described as pain. The discreet touch or rubbing may be intolerable for patients, who present changes in the skin in the form of pigmentation and scar even after the rash has healed.
La neuralgia post-herpética se produce cuando existe necrosis y cicatrización de las neuronas en el ganglio de la raíz dorsal, produciendo una degeneración y destrucción de las proyecciones motoras y sensoriales .Post-herpetic neuralgia occurs when there is necrosis and scarring of neurons in the dorsal root ganglion, causing degeneration and destruction of motor and sensory projections.
El proceso inflamatorio puede envolver el cuerno anterior y posterior del cordón espinal. La mononeuritis se extiende periféricamente ' desde el ganglio de la raíz dorsal y está caracterizada por daño axonal y disrupción de la mielina, el número de nervios terminales en la piel ayudados por la disminución de neuronas .The inflammatory process can involve the anterior and posterior horn of the spinal cord. Mononeuritis extends peripherally ' from the dorsal root ganglion and is characterized by axonal damage and myelin disruption, the number of nerves terminals in the skin helped by the decrease of neurons.
Los cambios patológicos en el ganglio de la raíz dorsal en las neuronas de los pacientes con NPH incluyen la presencia de "células fantasma" . La destrucción de largas fibras mielinizadas también se ha reportado. Las autopsias de pacientes con NPH revelaron atrofia característica del cuerno dorsal.Pathological changes in the dorsal root ganglion in neurons of patients with PHN include the presence of "phantom cells." The destruction of long myelinated fibers has also been reported. Autopsies of patients with PHN revealed characteristic atrophy of the dorsal horn.
Los factores de riesgo para padecer una NPH, tras haber sufrido de Herpes zoster son: a) la edad, en donde la incidencia aumenta en pacientes con edad mayor a los 50 años; b) inmunosupresión o enfermedades que alteran el sistema inmunológico, tales como cáncer, quimioterapias, transplantes, VIH; c) severidad de las lesiones dermatológicas; d) severidad del dolor durante la fase aguda del HZ.The risk factors for suffering an NPH, after suffering from Herpes zoster are: a) age, where the incidence increases in patients older than 50 years; b) immunosuppression or diseases that alter the immune system, such as cancer, chemotherapies, transplants, HIV; c) severity of dermatological lesions; d) severity of pain during the acute phase of HZ.
El significado clínico del Herpes zoster y de la NPH es soportado por datos que demuestran que la NPH tiene un impacto negativo en la calidad de vida de los pacientes .The clinical significance of Herpes zoster and NPH is supported by data demonstrating that NPH has a negative impact on the quality of life of patients.
Hoy en día, el tratamiento para la Neuralgia Post- Herpética (NPH) se ha centrado en el uso de psicotrópicos y medicamentos anticonvulsivantes . Las terapias farmacológicas han mostrado algunos beneficios en términos de reducción del dolor y mejoría de la calidad de vida. Estos tratamientos han incluido los antidepresivos tricíclicos, anticonvulsivantes , agentes tópicos y analgésicos opioides, los cuales son administrados de forma independiente, provocando con esto la manifestación de mayores efectos secundarios, especialmente en los pacientes ancianos que la sufren con mayor frecuencia. SUMARIO DE LA INVENCIÓNToday, treatment for Post-Herpetic Neuralgia (NPH) has focused on the use of psychotropic and anticonvulsant medications. The Pharmacological therapies have shown some benefits in terms of pain reduction and improvement of quality of life. These treatments have included tricyclic antidepressants, anticonvulsants, topical agents and opioid analgesics, which are administered independently, thereby causing the manifestation of greater side effects, especially in elderly patients who suffer most frequently. SUMMARY OF THE INVENTION
Con el objeto de ofrecer una alternativa farmacéutica que logre prevenir o reducir los riesgos de aparición de una Neuralgia Post-Herpética (NPH) , nuestras investigaciones se han enfocado en el desarrollo de una composición farmacéutica caracterizada por manifestar actividad terapéutica al ser administrada desde el inicio de la fase aguda asociada con la presencia de Herpes zoster, misma que esta compuesta por la combinación de un agente anticonvulsivo y un agente antiviral que actúan de forma smérgica, los cuales están formulados en una sola unidad de dosificación, brindando beneficios como lo son- menores concentraciones de los principios activos utilizados, menor frecuencia de administración y, por consecuencia, menores efectos secundarios. El desarrollo de la composición farmacéutica se describe a continuación. DESCRIPCIÓN DETALLADA DE LA INVENCIÓN.In order to offer a pharmaceutical alternative that manages to prevent or reduce the risks of the appearance of a Post-Herpetic Neuralgia (NPH), our research has focused on the development of a pharmaceutical composition characterized by manifesting therapeutic activity when administered from the beginning. of the acute phase associated with the presence of Herpes zoster, which is composed of the combination of an anticonvulsant agent and an antiviral agent that act synergistically, which are formulated in a single dosage unit, providing benefits such as lower concentrations of the principles assets used, lower frequency of administration and, consequently, lower side effects. The development of the pharmaceutical composition is described below. DETAILED DESCRIPTION OF THE INVENTION.
En la actualidad, la mayoría de los medicamentos encontrados en el mercado para el tratamiento de la NPH, están compuestos por principios activos que se encuentran formulados de forma independiente, mismos que cumplen con una actividad terapéutica específica; sin embargo, estos medicamentos solo contemplan el tratamiento de la Neuralgia Post-Herpética (NPH) , no así su prevención.At present, most of the medicines found in the market for the treatment of NPH are composed of active ingredients that are formulated independently, which comply with a specific therapeutic activity; However, these medications only contemplate the treatment of Post-Herpetic Neuralgia (NPH), but not its prevention.
Por tal motivo y con el fin de suprimir todos los inconvenientes que se presentan cuando se administran los principios activos de forma independiente una vez instalada la NPH, es que se llevo a cabo el desarrollo de la composición farmacéutica objeto de la presente invención, la cual está compuesta por la combinación sinérgica de un agente anticonvulsivo y un agente antiviral; los cuáles producen un efecto terapéutico satisfactorio al ser administrados en conjunto en una sola unidad de dosificación por vía oral a diferencia de cuando éstos son administrados de forma independiente una vez instalada la NPH, generando beneficios como lo son: menores concentraciones de los principios activos formulados, menores dosis administradas, mayor rapidez de acción, mayor eficacia del efecto terapéutico, menores efectos adversos y una reducción significativa del riesgo de presentar NPH.For this reason and in order to eliminate all the inconveniences that arise when the active substances are administered independently once the NPH is installed, it is that the development of the pharmaceutical composition object of the present invention was carried out, which it is composed of the synergistic combination of an anticonvulsant agent and an antiviral agent; which produce a satisfactory therapeutic effect when administered together in a single oral dosage unit as opposed to When these are administered independently once the NPH is installed, generating benefits such as: lower concentrations of the active ingredients formulated, lower doses administered, faster action, greater efficacy of the therapeutic effect, lower adverse effects and a significant reduction of the risk of presenting NPH.
La Gabapentina es un derivado del neurotransmisor GABA (ácido gamma-aminobutírico) y fue desarrollada como un análogo estructural para el sistema GABA, pero no actúa sobre los receptores GABA-érgicos , ni se convierte o metaboliza en GABA o en un antagonista del GABA, ni es un inhibidor de la recaptación del GABA. La Gabapentina no muestra ninguna afinidad hacia otros receptores comunes, como los: benzodiazepínicos, de glutamato, NMDA (N-metil-D-aspartato) , αl y α2 o β- adrenérgicos, colinérgicos , muscarínicos , nicotínicos, dopaminérgicos , histaminicos , serotoninérgicos, opiáceos, canabinoides , calcicos voltaje-dependientes o canales de sodio. Tampoco altera la captación de dopamina, norepinefriña o serotonina.Gabapentin is a derivative of the GABA neurotransmitter (gamma-aminobutyric acid) and was developed as a structural analogue for the GABA system, but does not act on GABA-ergic receptors, nor is it converted or metabolized into GABA or a GABA antagonist, nor is it a GABA reuptake inhibitor. Gabapentin shows no affinity for other common receptors, such as: benzodiazepine, glutamate, NMDA (N-methyl-D-aspartate), αl and α2 or β-adrenergic, cholinergic, muscarinic, nicotinic, dopaminergic, histamine, serotonergic, opiates, cannabinoids, voltage-dependent calcium or sodium channels. It also does not alter the uptake of dopamine, norepinephrine or serotonin.
Estudios subsecuentes no han dilucidado el mecanismo exacto por el cual la Gabapentina ejerce su acción; sin embargo, se sabe que ésta muestra una gran afinidad y se une a una proteína denominada α2δ, la cual es una subunidad auxiliar de los canales de calcio activados por el voltaje presente en las neuronas post- sinápticas del cuerno dorsal, mismas que juegan un papel muy importante en la modulación de la función GABA-érgica, glutaminérgica y monoaminérgica, además de interrumpir a la mayoría de los procesos involucrados en el desarrollo del dolor neuropático. La Gabapentina es un aminoácido cíclico que esta estructuralmente relacionado con el ácido gamma- aminobutírico (GABA) , y a diferencia de éste último, la Gabapentina es capaz de atravesar la barrera hematoencefálica, distribuyéndose en el sistema nervioso central en concentraciones similares a las del plasma .Subsequent studies have not elucidated the exact mechanism by which Gabapentin exerts its action; However, it is known that this shows great affinity and binds to a protein called α 2 δ, which is an auxiliary subunit of the calcium channels activated by the voltage present in the post-synaptic dorsal horn neurons, which they play a very important role in the modulation of GABA-ergic, glutaminergic and monoaminergic function, in addition to interrupting most of the processes involved in the development of neuropathic pain. Gabapentin is a cyclic amino acid that is structurally related to gamma-aminobutyric acid (GABA), and unlike the latter, Gabapentin is able to cross the blood-brain barrier, distributed in the central nervous system in concentrations similar to those in plasma.
La Gabapentina no interfiere con el metabolismo de otros fármacos antiepilépticos, por tal razón, no hay necesidad de monitorear ni de ajustar las dosis durante su empleo. Aunque se encuentra estructuralmente relacionado con GABA, el mecanismo de acción de la Gabapentina es diferente al de otros fármacos que intervienen en las sinapsis neuronales mediadas por GABA. La Gabapentina no se acopla a los sitios de los receptores de fármacos antiepilépticos o a los receptores de neurotransmisión comunes. No se ha encontrado que la Gabapentina se una metabólicamente al GABA o a un agonista del GABA y tampoco se ha demostrado la recaptación o la degradación del GABA. Los estudios realizados en animales que cursan con dolor han revelado que la Gabapentina es particularmente eficaz en la prevención del dolor neuropático (ligadura de los nervios espinales, diabetes inducida por estreptozotocina, infección por Herpes zoster) , aunque también previene el dolor asociado con procesos inflamatorios; sin embargo, la Gabapentina no actúa sobre el dolor inmediato. Las propiedades farmacocinéticas de la Gabapentina predicen un buen perfil de seguridad y buena biodisponibilidad en un amplio espectro de poblaciones. Alrededor del 50 al 60% de la Gabapentina es rápidamente absorbida en el tracto gastrointestinal después de la administración oral. Las concentraciones plasmáticas máximas de Gabapentina son alcanzadas dentro de las 3 primeras horas después de su administración, con variabilidad interindividual y dependiente de la dosis, ya que la biodisponibilidad de la Gabapentina no es proporcional a la dosis : a medida que las dosis aumentan, la biodisponibilidad disminuye. Los alimentos no afectan ni la velocidad, ni la cantidad de Gabapentina absorbida. La Gabapentina no se une o se une muy poco a las proteínas plasmáticas (3%) ; es eliminada completamente por vía renal en forma no metabolizada y no induce o inhibe a las enzimas hepáticas. La vida media de eliminación de la Gabapentina es de 5 a 7 horas y no se ve afectada por la administración de dosis múltiples. No se han identificado efectos específicos sobre el sistema cardiovascular o respiratorio. Aunque la insuficiencia renal reduce el aclaramiento de la Gabapentina en adultos, la edad no tiene un efecto directo sobre la eliminación. No se han encontrado interacciones significativas entre la Gabapentina y otros agentes antiepilépticos convencionales o anticonceptivos orales. La Gabapentina es ampliamente distribuida en el cuerpo. Las concentraciones plasmáticas máximas se alcanzan dentro de las 3 primeras horas después de su administración. El Aciclovir es un nucleósido análogo de la guanina. Su estructura difiere de otros análogos de nucleósidos en que contiene sólo una parte de éste (el anillo glucídico esta reemplazado por una cadena abierta) . Químicamente se parece a la deoxiguanosina, un precursor del ADN purina. La deoxiguanosina, es convertida normalmente a su nucleótido 5 ' -trifosfato, el cual sirve como uno de los cuatro sustratos para la síntesis de polimerasa en la construcción del ADN. El Aciclovir en su estado original no tiene actividad antiviral, pero sus metabolitos son las sustancias antivirales activas. En su forma absorbible, el Aciclovir es muy poco afín a las enzimas de células no infectadas. El Aciclovir es convertido selectivamente en una forma monofosfatada a través de la enzima timidina quinasa especifica del virus del Herpes simple. Posteriormente, el monofosfato es fosforilado para convertirlo, primero en difosfato acíclo-GDP por medio de la acción de las enzimas guanilato quinasas y luego en trifosfato activo aciclo- GTP por intervención de las enzimas quinasas celulares. El trifosfato activo aciclo-GTP inhibe la síntesis de ADN viral a través de 2 mecanismos: el primero es un mecanismo competitivo con la polimerasa viral, y el segundo es un mecanismo que al incorporar el trifosfato activo aciclo-GTP en la cadena del ADN en síntesis, detiene su replicación. El trifosfato activo aciclo-GTP es relativamente poco afín a las polimerasas celulares normales, lo que sumado al hecho de que la fosforilación ocurre sólo en células infectadas, resulta mucho menos tóxico su efecto en células normales . En el primer mecanismo, la ADN polimerasa específica para el virus del Herpes simple es inhibida 10 a 30 veces más efectivamente que su contraparte celular. De hecho, el Aciclovir 5 ' -trifosfato forma un complejo irreversible con la ADN polimerasa especifica para el virus del Herpes simple 1, el cual hace que el agente sea un "inactivador suicida" de esta enzima. También es un inhibidor débil del ADN α polimerasa celular humano normal.Gabapentin does not interfere with the metabolism of other antiepileptic drugs, for this reason, there is no need to monitor or adjust doses during use. Although it is structurally related to GABA, the mechanism of action of Gabapentin is different from other drugs involved in neuronal synapses mediated by GABA Gabapentin does not attach to the sites of antiepileptic drug receptors or to common neurotransmission receptors. It has not been found that Gabapentin is metabolically linked to GABA or a GABA agonist and neither has the reuptake or degradation of GABA been demonstrated. Studies in animals that are in pain have revealed that Gabapentin is particularly effective in preventing neuropathic pain (spinal nerve ligation, streptozotocin-induced diabetes, Herpes zoster infection), although it also prevents pain associated with inflammatory processes ; However, Gabapentin does not act on immediate pain. The pharmacokinetic properties of Gabapentin predict a good safety profile and good bioavailability in a wide spectrum of populations. About 50 to 60% of Gabapentin is rapidly absorbed in the gastrointestinal tract after oral administration. Maximum plasma concentrations of Gabapentin are reached within the first 3 hours after administration, with interindividual variability and dose-dependent, since the bioavailability of Gabapentin is not proportional to the dose: as the doses increase, the bioavailability decreases. Food does not affect the speed or the amount of Gabapentin absorbed. Gabapentin does not bind or binds very little to plasma proteins (3%); It is completely eliminated by the kidneys in an un-metabolized way and does not induce or inhibit liver enzymes. The elimination half-life of Gabapentin is 5 to 7 hours and is not affected by the administration of multiple doses. No specific effects on the cardiovascular or respiratory system have been identified. Although renal failure reduces the clearance of Gabapentin in adults, age does not have a direct effect on elimination. No significant interactions have been found between Gabapentin and other conventional antiepileptic agents or oral contraceptives. Gabapentin is widely distributed in the body. Maximum plasma concentrations are reached within the first 3 hours after administration. Acyclovir is a nucleoside analogue of guanine. Its structure differs from other nucleoside analogs in that it contains only a part of it (the glycidic ring is replaced by an open chain). Chemically it resembles deoxiguanosine, a precursor to purine DNA. Deoxiguanosine is normally converted to its 5'-triphosphate nucleotide, which serves as one of the four substrates for polymerase synthesis in DNA construction. Acyclovir in its original state has no antiviral activity, but its metabolites are active antiviral substances. In its absorbable form, Acyclovir is very little related to the enzymes of uninfected cells. Acyclovir is selectively converted into a monophosphate form through the enzyme thymidine kinase specific for the Herpes simplex virus. Subsequently, the monophosphate is phosphorylated to convert it, first to acyclo-GDP diphosphate through the action of guanylate kinase enzymes and then to acyclo-GTP active triphosphate by the intervention of cellular kinase enzymes. Acyclo-GTP active triphosphate inhibits the synthesis of viral DNA through 2 mechanisms: the first is a competitive mechanism with viral polymerase, and the second is a mechanism that by incorporating acyclo-GTP active triphosphate into the DNA chain in synthesis, stops its replication. Acyclo-GTP active triphosphate is relatively unrelated to normal cell polymerases, which added to the fact that phosphorylation occurs only in infected cells, its effect on normal cells is much less toxic. In the first mechanism, DNA polymerase specific for the Herpes simplex virus is inhibited 10 to 30 times more effectively than its cellular counterpart. In fact, Acyclovir 5'-triphosphate forms an irreversible complex with DNA polymerase specific for Herpes simplex virus 1, which makes the agent a "suicide inactivator" of this enzyme. It is also a weak inhibitor of normal human cellular α polymerase DNA.
En el segundo mecanismo, el Aciclovir 5'- trifosfato es insertado como si fuera deoxiguanosina, dentro de la cadena de ADN elongada. Dado que este compuesto no tiene un grupo 3'-hidroxil en su cadena lateral análoga desoxirribosa, este es incapaz de entrar a la cadena de ADN elongada a través de la unión usual 3' y 5' . Esto termina la cadena y bloquea la replicación del ADN viral.In the second mechanism, Acyclovir 5'-triphosphate is inserted as if it were deoxyguanosine, into the elongated DNA chain. Since this compound does not have a 3'-hydroxyl group in its deoxyribose analog side chain, it is incapable of enter the elongated DNA chain through the usual 3 'and 5' junction. This ends the chain and blocks viral DNA replication.
El Aciclovir es administrado principalmente por vía oral en forma de cápsulas y suspensión. También es administrado por vía tópica, en forma de crema y por vía intravenosa en pacientes con infecciones graves provocadas por el Herpes virus.Acyclovir is mainly administered orally in the form of capsules and suspension. It is also administered topically, as a cream and intravenously in patients with severe infections caused by the Herpes virus.
Debido a su baja solubilidad, la absorción del Aciclovir es muy lenta, variable e incompleta (gran parte de la dosis administrada es expulsada sin variación por las heces) . La absorción cutánea es mínima. El Aciclovir se distribuye ampliamente por el organismo, incluyendo líquido cefalorraquídeo y placenta. El volumen de distribución equivale al del agua corporal total. La concentración del Aciclovir en el líquido cefalorraquídeo y en el humor acuoso son entre un tercio a un medio de la concentración plasmática. El Aciclovir es metabolizado en el hígado. El Aciclovir se elimina principalmente por la orina, mediante filtración glomerular y secreción tubular. El único metabolito del Aciclovir identificado por cromatografía liquido- liquido de alta presión que es eliminado por la orina es el 9-Due to its low solubility, the absorption of Acyclovir is very slow, variable and incomplete (much of the administered dose is expelled without variation by feces). The skin absorption is minimal. Acyclovir is widely distributed throughout the body, including cerebrospinal fluid and placenta. The volume of distribution equals that of total body water. The concentration of Acyclovir in the cerebrospinal fluid and in the aqueous humor are between one third to one half of the plasma concentration. Acyclovir is metabolized in the liver. Acyclovir is mainly eliminated in the urine, by glomerular filtration and tubular secretion. The only Acyclovir metabolite identified by high pressure liquid-liquid chromatography that is eliminated in the urine is 9-
[ (carboximetoxi) metil] guanina . Aproximadamente un 14.4%[(carboxymethoxy) methyl] guanine. Approximately 14.4%
(8.6% a 19.8%) de la dosis de Aciclovir que es administrada por vía oral es eliminada sin ser modificada. La vida media plasmática del Aciclovir en pacientes con función renal normal es de 2.5 a 3.3 horas .(8.6% to 19.8%) of the dose of Acyclovir that is administered orally is eliminated without being modified. The plasma half-life of Acyclovir in patients with normal renal function is 2.5 to 3.3 hours.
El Aciclovir es el primer nucleósido purínico sintético con una actividad inhibitoria in vitro e in vivo muy selectiva para los virus del Herpes, entre los cuales se incluyen el virus del Herpes simple tipos 1Acyclovir is the first synthetic purine nucleoside with a very selective in vitro and in vivo inhibitory activity for Herpes viruses, including Herpes simplex virus types 1
(HSV-I) y 2 (HSV-2) , en menor medida el virus de la varicela-zoster (VZV), y en forma limitada, el virus de(HSV-I) and 2 (HSV-2), to a lesser extent varicella-zoster virus (VZV), and to a limited extent, the virus
Epstein-Barr (EBV) y Citomegalovirus (CMV) . El agente anticonvulsivo utilizado en la composición farmacéutica objeto de la presente invención es el principio activo Gabapentina, el cual esta presente en la formulación en un rango de concentración desde 300.0 mg . hasta 3.6 gr., siendo preferentemente utilizada una concentración de 300.0 mg . a 900.0 mg . por unidad de dosis.Epstein-Barr (EBV) and Cytomegalovirus (CMV). The anticonvulsant agent used in the pharmaceutical composition object of the present invention is the active substance Gabapentin, which is present in the formulation in a concentration range from 300.0 mg. up to 3.6 gr., a concentration of 300.0 mg being preferably used. at 900.0 mg per dose unit.
El agente antiviral que se encuentra formulado en la composición farmacéutica objeto de la presente invención es el principio activo Aciclovir, mismo que esta presente en la formulación en un rango de concentración desde 200.0 mg . hasta 1.0 gr . , siendo preferentemente utilizada una concentración de aproximadamente 200.0 mg. a 800.0 mg. por unidad de dosis .The antiviral agent that is formulated in the pharmaceutical composition object of the present The invention is the active substance Aciclovir, which is present in the formulation in a concentration range from 200.0 mg. up to 1.0 gr. , preferably a concentration of approximately 200.0 mg being used. at 800.0 mg per dose unit.
La composición farmacéutica protegida mediante la presente invención, está formulada para ser administrada por vía oral en una sola unidad de dosificación en forma de cápsulas y tabletas, en las cuales se encuentra contenida la combinación sinérgica de los principios activos: Gabapentina y Aciclovir, así como excipientes farmacéuticamente aceptables .The pharmaceutical composition protected by the present invention is formulated to be administered orally in a single dosage unit in the form of capsules and tablets, in which the synergistic combination of the active ingredients is contained: Gabapentin and Aciclovir, as well as pharmaceutically acceptable excipients.
Para evaluar la eficiencia y tolerancia de la composición farmacéutica motivo de la presente invención, así como el efecto sinérgico de los principios activos Gabapentina y Aciclovir combinados en una sola unidad de dosificación, se realizó un estudio clínico comparativo en el cual se administraron por separado los principios activos antes mencionados, así como la combinación de éstos. Material y Método: Se realizó un estudio clínico controlado, randomizado, doble ciego que incluyó a 150 pacientes con edades entre los 18 - 75 años con un promedio de 62 años de edad. El estudio evaluó la eficacia, tolerabilidad y los eventos adversos producidos al administrar los principios activos Aciclovir y Gabapentina de forma independiente a las dosis comúnmente utilizadas y la combinación Aciclovir / Gabapentina en una sola unidad de dosis. Todos los pacientes entraron al estudio con un diagnóstico de infección por el virus del Herpes zoster en fase aguda, presentando un rash cutáneo en tórax, cara y muslos, con manifestaciones de dolor tipo quemante y lancinante, astenia, adinamia y alteraciones del sueño ocasionadas por el dolor. Desde el inicio, los pacientes fueron divididos en 3 grupos de tratamiento. El grupo 1 recibió Aciclovir 800 mg . 3 veces al día,- el grupo 2 recibió Gabapentina 300 mg . 3 veces al día, si era necesario, estas dosis podían incrementarse. El grupo 3 recibió la combinación de Aciclovir 200 mg . / Gabapentina 300 mg . tres veces al día.To evaluate the efficiency and tolerance of the pharmaceutical composition that is the subject of the present invention, as well as the synergistic effect of the active ingredients Gabapentin and Aciclovir combined in a single dosage unit, a comparative clinical study was conducted in which the drugs were administered separately. active ingredients mentioned above, as well as the combination of these. Material and method: A randomized, double-blind, controlled clinical study involving 150 patients aged 18-75 years with an average age of 62 years was performed. The study evaluated the efficacy, tolerability and adverse events produced by administering the active substances Acyclovir and Gabapentin independently of the commonly used doses and the combination Aciclovir / Gabapentin in a single dose unit. All patients entered the study with a diagnosis of acute Herpes zoster virus infection, presenting a rash on the chest, face and thighs, with manifestations of burning and lancinating pain, asthenia, adinamia and sleep disturbances caused by the pain. From the beginning, the patients were divided into 3 treatment groups. Group 1 received Aciclovir 800 mg. 3 times a day, - group 2 received Gabapentin 300 mg. 3 times a day, if necessary, these doses could be increased. Group 3 received the combination of Aciclovir 200 mg. / Gabapentin 300 mg. three times a day.
Con evaluaciones cada semana durante el primer mes y la estabilización de la fase aguda con manifestación de curación de las lesiones, se hizo un seguimiento de 12 meses con visitas semestrales para evaluar el dolor post-herpético . El tratamiento fue suspendido, posteriormente a la estabilización de la fase aguda. Resultados :With evaluations every week during the first month and the stabilization of the acute phase with manifestation After healing the lesions, a 12-month follow-up was carried out with semi-annual visits to assess post-herpetic pain. The treatment was suspended, after the stabilization of the acute phase. Results:
Los 150 pacientes terminaron el estudio, sin embargo, se reportaron efectos adversos en todos los grupos con un mayor número en el grupo 2 que recibió la Gabapentina, en estos pacientes el 50% del grupo manifestó mareos y el 10% de ellos manifestó visión borrosa. El grupo 1 que recibió el Aciclovir reportó en 25% de los casos, malestar gastrointestinal. En el grupo 3 que recibió la combinación Aciclovir / Gabapentina el 2% de los pacientes manifestó mareos; sin embargo en ninguno de los grupos fue necesario suspender el tratamiento.The 150 patients finished the study, however, adverse effects were reported in all groups with a greater number in group 2 who received Gabapentin, in these patients 50% of the group manifested dizziness and 10% of them manifested blurred vision . Group 1 that received Acyclovir reported in 25% of cases, gastrointestinal distress. In group 3 who received the Acyclovir / Gabapentin combination, 2% of the patients manifested dizziness; however, in none of the groups was it necessary to suspend treatment.
En la evaluación realizada a los 6 meses, el 60% de los pacientes del grupo 1 que recibieron Aciclovir, continuaron con dolor en la zona lesionada, con intensidades que variaron de leve en un 15% a moderado e intenso en un 95%.In the 6-month evaluation, 60% of the patients in group 1 who received Aciclovir continued with pain in the injured area, with intensities ranging from mild in 15% to moderate and intense in 95%.
En los pacientes del grupo 2 que recibieron Gabapentina, el 40% de los pacientes continuaron con dolor en la zona lesionada, con intensidades que variaron de leve en un 60% a moderado e intenso en un 40%.In group 2 patients who received Gabapentin, 40% of patients continued with pain in the injured area, with intensities that varied from mild in 60% to moderate and intense in 40%.
En los pacientes del grupo 3 que recibieron la combinación Aciclovir / Gabapentma, solo el 2% continuaron con dolor en la zona lesionada con una intensidad leve.In patients of group 3 who received the Aciclovir / Gabapentma combination, only 2% continued with pain in the injured area with a mild intensity.
Conclusiones :Conclusions:
Se ha demostrado que la combinación de Aciclovir / Gabapentma administrados en una sola unidad de dosis durante el inicio de la fase aguda del Herpes zoster, beneficia al paciente reduciendo el riesgo de la aparición de dolor neuropático post-herpético, además de reducir las concentraciones de los principios activos y disminuir la manifestación de eventos adversos. En la actualidad, se administran tratamientos antivirales como monoterapias , siendo también necesario el uso de medicamentos analgésicos dentro de los cuales existe una basta variedad, pero éstos no previenen la aparición de la neuralgia post-herpética La presente combinación demuestra una actividad smérgica a diferencia de la administración de dichos principios activos de forma independiente para el tratamiento y/o prevención de la neuralgia post-herpética, especialmente en pacientes ancianos.It has been shown that the combination of Acyclovir / Gabapentma administered in a single dose unit during the onset of the acute phase of Herpes zoster, benefits the patient by reducing the risk of the occurrence of post-herpetic neuropathic pain, in addition to reducing the concentrations of the active ingredients and decrease the manifestation of adverse events. Currently, antiviral treatments such as monotherapies are administered, the use of analgesic drugs also being necessary within which there is a wide variety, but these do not prevent the onset of post-herpetic neuralgia. This combination demonstrates a synergistic activity unlike the administration of said active principles independently for the treatment and / or prevention of post-herpetic neuralgia, especially in elderly patients.
Dicha composición farmacéutica ha sido desarrollada con la finalidad de brindar una alternativa farmacéutica para la prevención y/o tratamiento de la neuralgia post-herpética (NPH) , la cual ofrece significativas ventajas como lo son: menores concentraciones de los principios activos contenidos en la formulación, reducción del riesgo de presentar NPH, control eficaz del dolor padecido por los pacientes contagiados por el virus del Herpes zoster en fase aguda, asi como menores efectos secundarios . Said pharmaceutical composition has been developed with the purpose of providing a pharmaceutical alternative for the prevention and / or treatment of post-herpetic neuralgia (NPH), which offers significant advantages such as: lower concentrations of the active principles contained in the formulation , reduction of the risk of presenting NPH, effective control of pain suffered by patients infected with the Herpes zoster virus in acute phase, as well as minor side effects.

Claims

NOVEDAD DE LA INVENCIÓN.Habiendo descrito la presente invención, se considera como novedad y, por lo tanto, se reclama como propiedad lo contenido en las siguientesREIVINDICACIONES NOVELTY OF THE INVENTION. Having described the present invention, it is considered as a novelty and, therefore, what is contained in the following claims is claimed as property.
1. Composición farmacéutica caracterizada por estar compuesta por la combinación sinérgica de un agente anticonvulsivo, tal como lo es el principio activo: Gabapentina y un agente antiviral, tal como lo es el principio activo Aciclovir, los cuales se encuentran presentes en la formulación en un rango de concentración de 300.0 mg . a 900.0 mg . para la Gabapentina y de 200.0 mg . a 800.0 mg . para el Aciclovir, además de excipientes farmacéuticamente aceptables; mismos que se encuentran formulados en una sola unidad de dosificación para ser administrada por vía oral, la cual está indicada para la prevención y/o tratamiento de la Neuralgia Post-herpética . 1. Pharmaceutical composition characterized by being composed of the synergistic combination of an anticonvulsant agent, such as the active substance: Gabapentin and an antiviral agent, such as the active substance Aciclovir, which are present in the formulation in a concentration range of 300.0 mg. at 900.0 mg for Gabapentin and 200.0 mg. at 800.0 mg for Acyclovir, in addition to pharmaceutically acceptable excipients; same that are formulated in a single dosage unit to be administered orally, which is indicated for the prevention and / or treatment of Post-herpetic Neuralgia.
2. Composición farmacéutica de conformidad con la reivindicación 1, caracterizada porque el agente anticonvulsivo, como lo es el principio activo: Gabapentina se encuentra presente en la formulación en un rango de concentración desde 300.0 mg . hasta 900.0 mg . , siendo preferentemente utilizada en la formulación una concentración de 300.0 mg . por unidad de dosis.2. Pharmaceutical composition according to claim 1, characterized in that the anticonvulsant agent, as is the active ingredient: Gabapentin is present in the formulation in a concentration range from 300.0 mg. up to 900.0 mg , a concentration of 300.0 mg being preferably used in the formulation. per dose unit.
3. Composición farmacéutica de conformidad con las reivindicaciones 1 y 2, caracterizada porque el agente antiviral, como lo es el principio activo: Aciclovir se encuentra presente en la formulación en un rango de concentración desde 200.0 mg . hasta 800.0 mg., siendo preferentemente utilizada en la formulación una concentración de 200.0 mg . por unidad de dosis.3. Pharmaceutical composition according to claims 1 and 2, characterized in that the antiviral agent, as is the active ingredient: Acyclovir is present in the formulation in a concentration range from 200.0 mg. up to 800.0 mg., a concentration of 200.0 mg is preferably used in the formulation. per dose unit.
4. Composición farmacéutica de conformidad con las reivindicaciones 1 a 3, caracterizada porque esta formulada en una sola unidad de dosificación para su administración por vía oral en forma de cápsulas y tabletas.4. Pharmaceutical composition according to claims 1 to 3, characterized in that it is formulated in a single dosage unit for oral administration in the form of capsules and tablets.
5. El uso de la composición farmacéutica de conformidad con las reivindicaciones 1 a 4, caracterizada porque está indicada para la prevención y/o el tratamiento de la Neuralgia Post-herpética . 5. The use of the pharmaceutical composition according to claims 1 to 4, characterized in that it is indicated for the prevention and / or treatment of Post-herpetic Neuralgia.
PCT/MX2008/000061 2007-05-21 2008-05-19 Pharmaceutical composition combining an anticonvulsant agent and an antiviral agent WO2008143490A1 (en)

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ES2230863T3 (en) * 1998-07-09 2005-05-01 Warner-Lambert Company Llc PHARMACEUTICAL COMPOSITION CONTAINING GABA ANALOGS AND AN ANTIVIRICAL AGENT FOR THE TREATMENT OF HERPRES ZOSTER.

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Publication number Priority date Publication date Assignee Title
ES2230863T3 (en) * 1998-07-09 2005-05-01 Warner-Lambert Company Llc PHARMACEUTICAL COMPOSITION CONTAINING GABA ANALOGS AND AN ANTIVIRICAL AGENT FOR THE TREATMENT OF HERPRES ZOSTER.

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Title
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TAKASAKI I. ET AL.: "Effects of analgesic on delayed postherpetic pain in mice", ANESTHESIOLOGY, vol. 96, no. 5, 2002, pages 1168 - 1174 *

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