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  • C07C217/74—Compounds containing amino and etherified hydroxy groups bound to the same carbon skeleton having etherified hydroxy groups bound to carbon atoms of at least one six-membered aromatic ring and amino groups bound to acyclic carbon atoms or to carbon atoms of rings other than six-membered aromatic rings of the same carbon skeleton with rings other than six-membered aromatic rings being part of the carbon skeleton
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  • C07D489/02—Heterocyclic compounds containing 4aH-8, 9 c- Iminoethano-phenanthro [4, 5-b, c, d] furan ring systems, e.g. derivatives of [4, 5-epoxy]-morphinan of the formula: with oxygen atoms attached in positions 3 and 6, e.g. morphine, morphinone
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Definitions

• Buprenorphine (Formula 1) is a semisynthetic opioid derivative of thebaine. It is a mixed agonist-antagonist opioid receptor modulator that is used to treat opioid addiction in higher dosages, to control moderate acute pain in non-opioid-tolerant individuals in lower dosages and to control moderate chronic pain in even smaller doses. Buprenorphine is absorbed in the gastrointestinal tract and acts systemically.
• Naloxone (Formula 2) is a pure opioid antagonist. Naloxone is a medication used to reverse opioid-induced depression of the central nervous system, respiratory system, and hypotension. Naloxone may be combined with opioids that are taken by mouth to decrease the risk of their misuse. Naloxone is absorbed in the gastrointestinal tract and may act systemically, leading to opioid withdrawal symptoms.
• Naltrexone (Formula 3) is an opioid antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its
• naltrexone hydrochloride hydrochloride salt, naltrexone hydrochloride. It is also absorbed in the gastrointestinal tract and acts systemically. Like naloxone, naltrexone may induce opioid withdrawal symptoms.
• Des-venlafaxine also known as O-desmethylvenlafaxine, is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. It has been considered for use in the treatment of chronic idiopathic constipation and gastroparesis, but because it acts systemically and its CNS effects can include sexual dysfunction its use for those purposes in persons not suffering from depression is contra-indicated.
• Acetaminophen (Formula 5), chemically named N-acetyl-p-aminophenol, is one of the most widely used medications in the United States. It is over-the-counter analgesic and antipyretic, commonly sold under the trade name Tylenol®. Acetaminophen is classified as a mild analgesic. It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies. In combination with opioid analgesics, acetaminophen can also be used in the management of more severe pain such as post-surgical pain and providing palliative care in advanced cancer patients. The quinone metabolite of acetaminophen is hepatotoxic. While usual dosing of acetaminophen is considered harmless, both acute and chronic overdoses can be fatal.
• Albuterol (Formula 6) is a short-acting p 2 -adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It relaxes muscles in the airways and increases air flow to the lungs. Albuterol is also used to prevent exercise-induced bronchospasm. It is usually given by inhalation to sidestep high first pass metabolism in the liver. Its highly variable bioavailability has been attributed to its phenolic hydroxyl group.
• IBS-D Diarrhea-predominant irritable bowel syndrome
• IBS-D is a highly prevalent gastrointestinal disorder that is often accompanied, in addition to diarrhea, by both visceral hyperalgesia (enhanced pain from colorectal stimuli), discomfort, bloating, and gas.
• Eluxadoline® (Forest Laboratories, Inc.) is a ⁇ opioid receptor agonist and ⁇ opioid receptor antagonist that has met primary endpoints of improvement in stool consistency and reduction of abdominal pain in Phase III testing, albeit without a demonstrable effect on reducing colonic hypersensitivity that results in hyperalgesia.
• pancreatitis a potentially life threatening disease, were reported in Phase II trials.
• ⁇ agonists have a constricting effect on the Sphincter of Oddi, a muscular valve that regulates the flow of bile and pancreatic juice from the bile duct into the duodenum. It is very important that a drug with ⁇ -receptor agonist activity and that is prescribed for long-term use, not lead to constriction of the Sphincter of Oddi.
• the corresponding dimers are resistant to tampering, e.g., kitchen chemistry conversion to drugs of abuse; and are substantially non-absorbed in the GI tract, permitting their peripheral use without entering the central nervous system with consequent adverse effects such as addiction or opioid withdrawal.
• the dimerization of des-venlafaxine prevents passage of the active agent across the blood brain barrier, and although the dimer is no longer effective in the treatment of depression, that requires CNS penetration, its functional ligands remain active and act locally in the intestinal tract, thus avoiding all centrally mediated adverse events, including sexual dysfunction.
• the dimerization therefore, permits the agent to be safely utilized in the treatment of gastroparesis and chronic idiopathic constipation.
• the des-venlafaxine dimer is expected to function as a peripheral serotonin norepinephrine reuptake inhibitor. Unlike des- venlafaxine, the dimer is expected to act only peripherally in the gastrointestinal tract.
• Serotonin inherently has propulsive effect on the gastrointestinal tract and the dimer, therefore, could be used for treatment of intestinal conditions such as gastroparesis, chronic idiopathic constipation and pseudointestinal obstruction (ileus).
• the effect of dimerizing acetaminophen is to prevent formation of the quinone metabolite of the parent compound, which is hepatotoxic in acute and chronic use.
• dimerization reduces the ionic nature of the active agent, potentially enhancing transport through the blood-brain barrier and hence, analgesia.
• Figure 1 provides a synthetic route to buprenorphine dimer HC1 salt.
• Figure 2 provides a synthetic route to naloxone dimer HC1 salt.
• Figure 3 provides a synthetic route to the naltrexone dimer HC1 salt
• Figure 4 provides a synthetic route to des-venlafaxine dimer HC1 salt.
• Figure 5 provides a synthetic route to the acetaminophen dimer.
• Figure 6 provides a synthetic route to the albuterol dimer.
• DHP is DHP is dihydropyran
• t-BuNH 2 is tert-butyl amine
• TBSCI is tert-butyldimethylsilyl chloride
• LAH is Lithium aluminium hydride
• (Boc) 2 0 is tert-butyl dicarbonate
• AcOH is acetic acid.
• Figure 7 provides a bar chart illustrating the stability of the buprenorphme dimer when exposed to CYP enzymes in the presence and absence of a co-factor.
• Figure 8 provides a bar graph showing the stability of the buprenorphme dimer to aqueous conditions, as well as acidic and basic condition, each at room temperature and at 140°F for the indicated period of time.
• Figure 9 provides the results of buprenorphme dimer receptor binding experiments
• Figure 10 provides the results of buprenorphme dimer receptor binding experiments
• Figure 11 provides ⁇ agonist functional assay results for the buprenorphme dimer.
• Figure 12 provides ⁇ antagonist functional assay results for the buprenorphme dimer.
• Figure 13 provides the results of oral and IV bioavailability of the buprenorphme dimer
• Figure 14 provides the graphs for stress-induced fecal output of male CD-I mice according to the evaluation of Example 7.
• Figure 15 shows the buprenorphme dimer decreases fecal output in a dose-dependent manner.
• Figure 16 shows the effect of the buprenorphme dimer on gastrointestinal motility in post inflammatory models according to Example 7.
• Figure 17 provides a bar chart illustrating the stability of the naloxone dimer salt when exposed to CYP enzymes in the presence and absence of a co-factor.
• Figure 18 provides a bar graph showing the stability of the naloxone dimer salt to aqueous conditions, as well as acidic and basic condition, each at room temperature and at 140°F for the indicated period of time.
• Figure 19 provides the results of the human ⁇ opioid receptor binding assay of the naloxone dimer and naloxone.
• Figure 20 provides a bar graph showing the effect of the naloxone dimer salt in alleviating loperamide -induced constipation in mice.
• compositions comprising the dimers.
• a pharmaceutical composition can further comprise a
• pharmaceutically acceptable carrier Illustrative pharmaceutically acceptable carriers and formulations are described below.
• a pharmaceutically acceptable salt of a dimer may be used instead of or in addition to a dimer in any or all of the compositions and methods of treating discussed herein.
• a pharmaceutically acceptable salt of the dimer i.e., any pharmaceutically acceptable salt of any of the dimers
• These salts can be prepared, for example, in situ during the final isolation and purification of the compound or by separately reacting the purified compound in its free base form with a suitable organic or inorganic acid and isolating the salt thus formed.
• the pharmaceutically acceptable salt of the dimer is prepared using acetic, alginic, anthranilic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethenesulfonic, formic, fumaric, furoic, galacturonic, gluconic, glucuronic, glutamic, glycolic, hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic, methanesulfonic, mucic, nitric, pamoic, pantothenic, phenylacetic, phosphoric, propionic, salicylic, stearic, succinic, sulfanilic, sulfuric, tartaric acid, or /?-toluenesulfonic acid.
• the dimers of the invention can exist in unsolvated as well as solvated forms with pharmaceutically acceptable solvents such as water, ethanol, and the like.
• the solvated forms are considered equivalent to the unsolvated forms for the purposes of the present invention.
• the solvated form of the dimer is a hydrate.
• salt formation may improve shelf life of the resultant therapeutic agent.
• Appropriate salt synthesis can afford products that are crystalline, less prone to oxidation and easy to handle.
• Various salts can be prepared that would afford stable and crystalline compounds.
• a few examples are hydrochloric, sulfuric, /?-toluenesulfonic, methanesulfonic, malonic, fumaric, and ascorbic acid salts.
• such a pharmaceutical composition is formulated as oral tablet or capsule, extended release oral tablet or capsule (hard gelatin capsule, soft gelatin capsule), sublingual tablet or film, or extended release sublingual tablet or film.
• the dimers provided herein can be administered to a subject orally in the
• Suitable formulations can be prepared by methods commonly employed using conventional, organic or inorganic additives, such as an excipient (e.g., sucrose, starch, mannitol, sorbitol, lactose, glucose, cellulose, talc, calcium phosphate or calcium carbonate), a binder (e.g., cellulose, methylcellulose, hydroxymethylcellulose, polypropylpyrrolidone, polyvinylpyrrolidone, gelatin, gum arabic, polyethyleneglycol, sucrose or starch), a disintegrator (e.g., starch, carboxymethylcellulose, hydroxypropylstarch, low substituted hydroxypropylcellulose, sodium bicarbonate, calcium phosphate or calcium citrate), a lubricant (e.g., sucrose, starch, mannitol, sorbitol, lactose, glucose, cellulose, talc, calcium phosphate or calcium carbonate), a binder (e.g., cellulose,
• citric acid sodium citrate or acetic acid
• a suspending agent e.g., methylcellulose, polyvinyl pyrroliclone or aluminum stearate
• a dispersing agent e.g., hydroxypropylmethylcellulose
• a diluent e.g., water
• base wax e.g., cocoa butter, white petrolatum or polyethylene glycol
• Incubations of the dimer (e.g., 1 ⁇ ) with human liver microsomes (e.g., 1 mg protein/mL) were carried out using a Tecan Liquid Handling System (Tecan), or equivalent, at 37 ⁇ 1°C in 0.2-mL incubation mixtures (final volume) containing potassium phosphate buffer (50 mM, pH 7.4), MgCl 2 (3 mM) and EDTA (1 mM, pH 7.4) with and without a cofactor, NADPH-generating system, at the final concentrations indicated in a 96-well plate format.
• Tecan Tecan Liquid Handling System
• the NADPH-generating system consisted of NADP (1 mM, pH 7.4), glucose-6- phosphate (5 mM, pH 7.4) and glucose-6-phosphate dehydrogenase (1 Unit/mL).
• the buprenorphine dimer was dissolved in aqueous methanolic solution (methanol 0.5% v/v, or less). Reactions were started typically by addition of the cofactor, and stopped at four designated time points (e.g., up to 120 min) by the addition of an equal volume of stop reagent (e.g., acetonitrile, 0.2 mL containing an internal standard). Zero-time incubations served as 100% value to determine percent loss of substrate.
• stop reagent e.g., acetonitrile, 0.2 mL containing an internal standard.
• Incubations were carried out in triplicate with an exception for zero-time samples (which were incubated in quadruplicate).
• Zero-cofactor (no NADPH) incubations were performed at zero-time and the longest time point.
• the samples were subjected to centrifugation (e.g., 920 x g for 10 min at 10°C) and the supernatant fractions analyzed by LC-MS/MS.
• Additional incubations were carried out with microsomes and a marker substrate (e.g., dextromethorphan to monitor substrate loss) as a positive control to determine if the test system was metabolically competent.
• the above samples were analyzed by an LC-MS/MS method. Analysis was performed for the samples at each incubation solution. Results were determined by a comparison of peak ratios over the time course of the experiment (typically reported as "% Parent Remaining").
• Results are shown in Figure 7 and indicate that the buprenorphine dimer was relatively stable in presence of microsomal enzymes for the duration of the assay.
• the microsomal enzymes are typically responsible for metabolism of drugs such as
• the dimer was stable in presence of the microsomes, with or without the co-factor.
• the assay was terminated at 2 hours because enzymes are typically not stable beyond 2 hours at incubation temperatures of 37°C.
• This example illustrates the binding of the buprenorphine dimer provided herein to the following receptors: ⁇ -opioid receptor; ⁇ -opioid receptor; and ⁇ -opioid receptor.
• Membranes from Chinese Hamster Ovary cells expressing the human ⁇ opioid receptor were homogenized in assay buffer (50 mM Tris, pH 7.5 with 5 mM MgC12) using glass tissue grinder, Teflon pestle and Steadfast Stirrer (Fisher Scientific). The concentrates of the membranes were adjusted to 300 ⁇ g/mL in assay plate, a 96 well round bottom polypropylene plate. Compounds to be tested were solubilized in DMSO (Pierce), 10 mM, then diluted in assay buffer to 3.6 nM.
• assay buffer 50 mM Tris, pH 7.5 with 5 mM MgC12
• a second 96 well round bottom polypropylene plate known as the premix plate
• 60 ⁇ of 6X compound was combined with 60 ⁇ ⁇ of 3.6 nM 3 H-Naloxone.
• 50 ⁇ ⁇ was transferred to the assay plate containing the membranes, in duplicate.
• the assay plate was incubated for 2 h at room temperature.
• a GF/C 96 well filter plate (Perkin Elmer #6005174) was pretreated with 0.3% polyethylenimine for 30 min.
• the contents of the assay plate were filtered through the filter plate using a Packard Filtermate Harvester, and washed 3 times with 0.9% saline at 4°C.
• the filter plate was dried, underside sealed, and 30 ⁇ , Microscint 20 (Packard #6013621) was added to each well.
• a Topcount-NXT Microplate Scintillation Counter (Packard) was used to measure emitted energies in the range of 2.9 to 35 KeV. Results were compared to maximum binding, wells receiving no inhibitions. Nonspecific binding was determined in presence of 50 ⁇ unlabeled naloxone.
• the biological activity of the buprenorphine dimer is shown in Figure 9.
• Results The graph in Figure 9 shows that the dimer has significant affinity for the opioid ⁇ receptor
• the opioid ⁇ receptor affinity of the buprenorphine dimer at 10 "8 M ( ⁇ 10 ng) was similar to that of buprenorphine .
• Membranes from cloned HEK-293 cells expressing the human ⁇ opioid receptor were homogenized in assay buffer (50 mM Tris, pH 7.5 with 5 mM MgC12) using glass tissue grinder, Teflon pestle and Steadfast Stirrer (Fisher Scientific). The concentrates of the membranes were adjusted to 300 ⁇ g/mL in the assay plate, a 96 well round bottom polypropylene plate. Compounds to be tested were solubilized in DMSO (Pierce), 10 mM, then diluted in assay buffer to 3.6 nM.
• assay buffer 50 mM Tris, pH 7.5 with 5 mM MgC12
• a second 96 well round bottom polypropylene plate known as the premix plate
• 60 of 6X compound was combined with 60 ⁇ ⁇ of 3.6 nM 3 H-Diprenorphine (DPN).
• DPN H-Diprenorphine
• the assay plate was incubated for 18 h at room temperature.
• a GF/C 96 well filter plate (Perkin Elmer #6005174) was pretreated with 0.3% polyethylenimine for 30 min.
• the contents of the assay plate were filtered through the filter plate using a Packard Filtermate Harvester, and washed 3 times with 0.9% saline at 4 °C.
• the filter plate was dried, underside sealed, and 30
• Microscint 20 (Packard #6013621) was added to each well.
• a Topcount-NXT Microplate Scintillation Counter (Packard) was used to measure emitted energies in the range of 2.9 to 35 KeV. Results were compared to maximum binding, wells receiving no inhibitions.
• Nonspecific binding was determined in the presence of 50 ⁇ unlabelled naloxone.
• the biological activity of the buprenorphine dimer is shown in Figure 10.
• Figure 10 describes the opioid ⁇ receptor agonist profile of the buprenorphine dimer. Neither the monomer nor the dimer of buprenorphine lost its affinity for the K receptor. Qualitatively, as with buprenorphine, the binding of the buprenorphine dimer to opioid ⁇ receptor increases with concentration. It is estimated that at about 1 ⁇ g, the opioid K receptor affinity of the dimer was similar to that of buprenorphine.
• the assay was designed to test the ability of a compound to interfere with the binding of tritiated naltrindole to the human ⁇ subtype 2 opioid receptor.
• Membranes from Chinese Hamster Ovary cells expressing the human ⁇ subtype 2 opioid receptor (Perkin Elmer #RBHODM400UA) were homogenized in assay buffer (50 mM Tris, pH 7.5 with 5 mM MgCl 2 ) using a glass tissue grinder, Teflon pestle and Steadfast Stirrer (Fisher
• CHO-hMOR cell membranes were purchased from Receptor Biology Inc. (Baltimore Md). About 10 mg/ml of membrane protein was suspended in 10 mM TRIS-HCl pH 7.2 , 2 mM EDTA, 10%> sucrose, and the suspension kept on ice. One mL of membranes was added to 15 mL cold binding assay buffer containing 50 mM HEPES, pH 7.6, 5 mM MgCl 2 , 100 mM NaCl, 1 mM DTT and 1 mM EDTA.
• the membrane suspension was homogenized with a polytron and centrifuged at 3000 rpm for 10 min. The supernatant was then centrifuged at 18,000 rpm for 20 min. The pellet was resuspended in 10 mL assay buffer with a polytron.
• the membranes were pre incubated with wheat germ agglutinin coated SPA beads (Amersham) at 25°C, for 45 min in the assay buffer.
• the SPA bead (5 mg/ml) coupled with membranes (10 ⁇ g/ml) was then incubated with 0.5 nM [ 35 S]GTPyS in the assay buffer.
• the basal binding is that taking place in absence of added test compound; this unmodulated binding was considered as 100%, with agonist stimulated binding rising to levels
• a range of concentrations of receptor agonist SNC80 was used to stimulate[ S]GTPyS binding. Both basal and non-specific binding were tested in the absence of agonist; non-specific binding determination included 10 ⁇ unlabeled GTPyS.
• the buprenorphine dimer was tested for function as an antagonist by evaluating its potential to inhibit agonist-stimulated GTPyS binding using D-Phe-Cys-Tyr-D-Trp-Orn-Thr- Pen-Thr-NH2 (CTOP) as the standard. Radioactivity was quantified on a Packard Top Count. The following parameters are calculated:
• % Stimulation [(test compound cpm- non-specific cpm)/(basal cpm - non-specific cpm)]* 100
• % Inhibition (% stimulation by 1 ⁇ SNC80 -% stimulation by 1 ⁇ SNC80 in presence of test compound)* 100/(%stimulation by 1 ⁇ SNC80-100).
• EC 50 was calculated using GraphPad Prism. Graphs for the compounds tested are shown in Figures 11 and 12.
• Results Data shown in Figure 11 indicates that the buprenorphine dimer is a potent ⁇ agonist. The results also indicate that the opioid ⁇ receptor activity of the dimer at 10 "6 M ( ⁇ 1 ⁇ g) is similar to that of buprenorphine. Data in Figure 12 shows that the buprenorphine dimer does not function as a ⁇ -antagonist.
• Standard curve was prepared in mouse plasma spiked with either the test drugs (10- 25000 nM).
• Plasma samples 50 ⁇ were extracted in 300 ⁇ ⁇ acetonitrile containing losartan or buprenorphine-d4 as internal standard. Extracts were centrifuged at 16000 x g at 4°C for 5 minutes. Supematants (250 ⁇ ) were transferred to a new tube and dried under N 2 at 45°C for 1 hour. Samples were reconstituted with 100 ⁇ _, of 30% acetonitrile, vortexed and centrifuged. Supematants (90 ⁇ ) were transferred to LC vials and 10 ⁇ is injected on LC/MS.
• Figures 13 depicts the plasma concentration profiles of the dimer after 10 mg oral and IV dose.
• the graph indicates that the absolute bioavailability, measured as a ratio of the area under the concentration curve after oral and IV dose, of the dimer is 1% or less, whereas that of the monomer is about 30%.
• mice Male CD-I mice, average weight about 30 to 35 g, with an average of 5 mice per dose group.
• the mice were generally housed in colony housing where they are housed 3 per cage in polycarbonate cages with access to food and water ad lib.
• mice On the day of the experiment the mice were transported to the procedure room where they were individually housed in 20 cm wide x 20 cm deep x 15 cm tall cages, equipped with a wire mesh bottom after intragastric administration of test compounds.
• Figures 14 shows that oral dose of the dimer significantly reduced the fecal output in mice versus placebo (vehicle).
• the doses investigated were 25 and 50 mg per kg of mice. The results do not change even when the animals with zero fecal output, suggesting extreme sensitivity, were removed from the analysis.
• Figure 15 shows that fecal output in mice decreases with dose, which indicates a true pharmacological effect.
• This test was designed to measure the effect of test substance on gastrointestinal hypersensitivity following inflammation.
• Post-inflammatory altered GI transit was induced in male CD-I mice by injecting freshly opened oil of mustard (95% pure allyl isothiocyanate, 0.5% in ethanol).
• mustard 95% pure allyl isothiocyanate, 0.5% in ethanol.
• the effect of stress on the post-inflammatory GI tract was tested 3-4 weeks after dosing. At this point, the GI tract was in a hypersensitive state, i.e., having a
• test substance significantly greater response to stimuli (hyperalgesia).
• the effect of the test substance was measured after oral administration (intragastric gavage) and subjecting animals to
• results As shown in Figure 16, the buprenorphine dimer at 25 mg per kg significantly decreases gastrointestinal motility in this model as measured by fecal output.
• the graph also shows the fecal pellet output in the mice not treated with mustard oil is transient and does not last beyond 1 hour. The increase in pellet excretion in mustard oil treated animals persists even at 2 hours. The dimer continues to inhibit gastrointestinal motility with statistically significant results even at 2 hours.
• Naloxone (5.0 g, 15.27 mmol, 1 equiv) and potassium carbonate (6.32 g, 45.8 mmol, 3 equiv) were charged to a 500-mL, 3 -neck round bottom flask followed by anhydrous DMF (50 ml, 10 vol).
• the mixture was heated to 60°C and 1 ,2-dibromoethane (6.57 mL, 76.35 mmol, 5 equiv) was added to the reaction mixture via syringe.
• the reaction mixture was stirred at 110°C for 16 h. TLC analysis shows mostly intermediate 3.
• naltrexone dimer HC1 salt is similarly synthesized, substituting for naloxone a molar equivalent of naltrexone, as shown in Figure 3.
• naloxone dimer Metabolic stability of the naloxone dimer was investigated using a protocol similar to the buprenorphine dimer experiment discussed in Example 3. Approximately 1 ⁇ of the dimer was incubated with human liver microsomes (1 mg protein/ml) for up to 1 hour. The incubation medium was assayed by LC/MS/MS for the formation of naloxone over time. As shown in Figure 17, there was no evidence of formation naloxone over time.
• Naloxone dimer stability was assessed at room temperature in untreated tap water and in the presence of acid (IN HC1) or base (5% aqueous sodium bicarbonate).
• the protocol was similar to the buprenorphine dimer stress stability experiment described in Example 3. The dimer was relatively stable under those conditions and under the described conditions does not appreciably degrade to naloxone, as shown in Figure 18.
• DAMGO is a peptide with a high affinity for human ⁇ opioid receptor. As the concentration of naloxone or the naloxone dimer was increased it gradually replaced the DAMGO bound to the receptor and thus the downward slope of the curves as shown in Figure 19.
• the binding affinities of naloxone, the naloxone dimer, and other similar antagonists are provided in Table 1.
• Antagonist Ki ( nM)
• mice were subjected to mild stress, which normally induces diarrhea and gastrointestinal motility measured by number of fecal pellets excreted per hour.
• the number of pellets expelled by the group treated with loperamide is significantly less than the pellets excreted per hour by control (vehicle) animals. This observation confirms the constipating effects of loperamide.
• the naloxone dimer offers significant benefit over naloxone, naltrexone, pegylated naloxone and methyl naltrexone as it is expected to act on the gastrointestinal tract receptors without being absorbed to treat opioid bowel disorder in general and opioid induced constipation in particular.
• the naloxone dimer can also find other therapeutic uses such as treatment of bloating, decreased gastric motility, abdominal cramping, and GERD
• Raney Nickel (30 wt%) was added to a mixture of compound 3 (1 equiv) in acetic acid (6 vol). The mixture was flushed with hydrogen (30 psi) then stirred under 140-150 psi of hydrogen at 55 °C for 3 hours, then cooled to room temperature. The mixture was filtered through a pad of celite and the filtrate was
• composition in Table 2 can be used for oral tablets of the dimers of the invention.
• the dose of the dimers provided herein to be administered to a patient is rather widely variable and can be subject to the judgment of a health-care practitioner. Dosage may be properly varied depending on the age, body weight and medical condition of the subject and the type of administration. In one embodiment, one dose is given per day. In any given case, the amount of the dimer provided herein administered will depend on such factors as the solubility of the active component, the formulation used and the route of administration.
• therapeutically effective dose we mean a dose that yields an appreciable and beneficial effect in a statistically significant number of patients.
• the patient is a mammal. In more specific embodiments, the patient is a human. In certain specific embodiments, the patient may be a domesticated mammal such as a dog, a cat, or a horse.
• Preferred dosages for IBS-D Patients are about 0.15 mg/kg of an IBS- D patient's body weight to about 7.2 mg/kg of a patient's body weight, more preferably from about 0.7 mg/kg of an IBS-D patient's body weight to about 3.0 mg/kg of a patient's body weight, and still more preferably about 1.5 mg/kg of a patient's body weight in unit dosage for oral administration.
• from about 10 to about 500 mg preferably from about 50 to about 200 mg, more preferably about 100 mg, will be administered to an IBS-D patient.
• Table 3 we provide putative dosages of dimers according to the invention for preferred indications, compared to those of the monomers for their own indications. The
• Desvenlafaxine Anti-depressant 50 mg PO Gastroparesis, 50-200 mg PO constipation, ileus

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