EP1624867A1 - Weitere therapeutische verwendung von zolpidem - Google Patents
Weitere therapeutische verwendung von zolpidemInfo
- Publication number
- EP1624867A1 EP1624867A1 EP04733850A EP04733850A EP1624867A1 EP 1624867 A1 EP1624867 A1 EP 1624867A1 EP 04733850 A EP04733850 A EP 04733850A EP 04733850 A EP04733850 A EP 04733850A EP 1624867 A1 EP1624867 A1 EP 1624867A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- zolpidem
- brain
- treatment
- use according
- subject
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
- A61K31/437—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a five-membered ring having nitrogen as a ring hetero atom, e.g. indolizine, beta-carboline
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
-
- 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
- A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
- A61P25/16—Anti-Parkinson drugs
-
- 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
- A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
-
- 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
- A61P25/20—Hypnotics; Sedatives
-
- 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
- A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
- A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
Definitions
- This invention relates to a new therapeutic use of zolpidem.
- Background of the Invention WO96/31210 discloses the use of imidazo[1 ,2-a]pyridine-3-acetamide derivatives, and in particular the anti-insomnia drug zolpidem, for the treatment of neuropsychiatric syndromes associated with dysfunction of the neural circuits of the basal ganglia. This use is based on the observation of the efficacy of zolpidem in the treatment of Parkinson's disease. It is reported that both the symptoms of PD (akinesia and rigidity) and obsessive-compulsive symptoms (cessation of verbal iterations) were improved.
- diaschisis The concept of diaschisis was first described by Von Monakow in the early 20th century. It offers an explanation for the phenomenon of acute phase central nervous system disorder symptoms that are more extensive and of a different nature to those of the chronic phase.
- CCD crossed cerebellar diaschisis
- diaschisis can be instantaneous or it can occur within hours and can reverse spontaneously within days or years.
- the underlying pathogenesis of diaschisis is not clear. Implicated is a trigger resulting in a neurophysiological shutdown and decreased cerebral blood flow of uninjured brain distant from the actual site of brain damage.
- Diaschisis has been reported in brain injury and in various central nervous system diseases. The incidence of diaschisis in stroke has been reported to be around 45%. Diaschisis may play a role in coma. It has been shown that traumatic brain injury is followed by a metabolic diaschisis which is related to the degree and extent of behavioural deficits. It appears that CCD is seen more often with focal cortical injuries and is more pronounced with severe brain lesions. Diaschisis can give rise to impaired consciousness and its reversal is associated with recovery of impaired function. Some authors have suggested that spontaneous reversal of diaschisis may play a role in recovery from stroke. Summary of the Invention
- the present invention is based on the surprising discovery that zolpidem and related compounds, such as those described in WO96/31210, have utility in treating conditions of the brain which exhibit diaschisis.
- brain injury triggers a set of events that can result in a state of dormancy of normal neuronal tissue at a site, close to or (as in classical diaschisis) removed from the brain injury site.
- the symptomatology that is then observed in brain-injured patients is a combined symptomatology of dormant viable brain tissue and dead, non-viable brain tissue.
- the reversal of dormancy or diaschisis, or of non-functionality induced by ischaemia or post-ischaemia, in viable neuronal tissue after administration of zolpidem can result in reversal of brain injury effects.
- Brain dormancy is most likely concurrent with a structural change or folding of the complex GABA receptor molecule. This state can be at least partially reversed by zolpidem's selective GABAergic stimulation of, in particular, the omega 1 receptors.
- zolpidem in brain-injured patients is transient and it occurs for the duration of drug action only. However, after first application and proof of efficacy in an controlled environment, it could be used daily for many years in brain-injured patients, without adverse effects. Effects of the drug may remain potent even after many years of constant treatment.
- Patients who may benefit from treatment according to the invention include those having a trauma-induced injury, but who do not necessarily exhibit akinesia or tremor, as in Parkinsonism.
- the patient may have lost cognition, e.g. have had a cerebellar or cerebral infarct such as in stroke.
- the patient may exhibit ataxia, e.g. spinocerebellar ataxia, or other symptoms related to cerebral ischemic injury. Other conditions are ruptured brain aneurism and intracerebral bleed.
- the patient may exhibit one or more of strabismus, salivation and muscle spasm, or impaired swallowing, smell or taste, or require long-term rehabilitation, e.g. over a period of one month, one year or more.
- Ramsay-Hunt syndrome is a complication of Herpes Zoster infection of the geniculate (facial) ganglion with a typical vesicular zoster eruption in the external auditory meatus.
- Ramsay-Hunt syndrome many cases previously described as the Ramsay-Hunt syndrome, as well as other hitherto unclassified system degenerations associated with myoclonus epilepsy, are examples of myoclonus, epilepsy and ragged red fibres (MERRF).
- Vascular and multi-infarct dementia, and Bell's palsy e.g. of cerebral origin, may also be treated by this invention. Such conditions are characterised by areas of diaschisis/dormancy in the brain.
- Such conditions can be treated according to the invention, so that the patient has increased mobility and functionality.
- the patient may exhibit some evidence of regeneration.
- the present invention may provide the first effective treatment.
- Areas of diaschisis or dormancy may be identified, e.g. by brain SPECT (single photon emission computed tomography).
- SPECT single photon emission computed tomography
- zolpidem which is used herein for the purposes of illustration
- Two examples are a small but relatively more frequent dose by the sublingual route for rapid absorption or a depot providing sustained release that avoids a peak of absorption that usually follows the use of tablets or capsules.
- the dosage of zolpidem may be, for example, 1 to 100 mg of the drug per day.
- Suitable formulations, routes of administration and dosages will be evident to one of ordinary skill in the art, and will be chosen according to the usual factors, such as the potency of the drug, the route of administration, the severity of the condition, the state of the patient etc.
- the present invention is based on the following illustrative Examples.
- a male patient was prescribed 10 mg zolpidem for treatment of his insomnia. He had suffered a stroke several years before and presented with left-sided paraplegia since the onset of his stroke. His cognition was still normal but he had some aphasia and decreased proprioseption that was evident from his inability to use scissors with his right hand. The clinical and neurological features of the patient were unremarkable apart from the above.
- the patient was investigated by 99m Tc HMPAO Brain Spect before and after zolpidem application. Two brain SPECT studies were completed on different days. The first study was completed in the normal baseline state and the second study was performed 1 hour after application of 10 mg zolpidem on the following day.
- the imaging was started 30 minutes after intravenous injection of 900 MBq 99m Tc HMPAO, using a dual head SOPHY DST XLi gamma camera. Acquisition parameters were 64 angular views over 360° at 45 seconds per view. Ultra high resolution fanbeam collimation without zoom was used and a 20% symmetrical window over 140 KeV. The images were reconstructed using a Metz prefilter. Transaxial, sagital and coronal slices were constructed without attenuation or scatter correction. The images before and after application of zolpidem were assessed in comparative transaxial slices and in different segments of the brain.
- P1 49 year male with titubation, dizziness and loss of balance from age 34. Deteriorating speech and handwriting. Cerebellar signs included moderate gait ataxia, intention tremor, dysdiadochokinesis and titubation. Deep tendon reflexes were all brisk. After zolpidem, ataxia, intention tremor and titubation improved moderately.
- P2 37 year male with loss of balance and deterioration of handwriting since age 25. He had bilaterally brisk tendon reflexes, ataxia, intention tremor, dysdiadochokinesis and titubation. After zolpidem ataxia, intention tremor and titubation improved.
- P3 5 year male with speech incoordination since age 30. Current explosive speech and severe dysarthria. His handwriting and speech continue to deteriorate. Tendon reflexes were bilaterally brisk. He had titubation, intention tremor, disdiachokinesis and gait ataxia. After zolpidem, ataxia, intention tremor and titubation improved moderately.
- P4 22 year female who developed loss of balance at age 18 with subsequent speech deterioration. Occasional titubation. She was clinically depressed and dull in emotion, only responding to instructions. She had gait ataxia and intention tremor. There was no improvement after zolpidem.
- P5 24 year female with leg weakness and loss of balance. Speech deteriorated from age 22. Cerebellar signs included ataxia, intention tremor and dysdiachokinesis with intermittent titubation. Zolpidem slightly improved ataxia, intention tremor and titubation.
- Zolpidem was used for the therapy of Ramsay-Hunt syndrome in a 60- year old patient who had suffered from the condition for two months before zolpidem treatment. On treatment, the following features improved. He was able to drink fluids directly from a cup, rather than through a straw and the tonus of his facial nerves improved. Also, as part of the syndrome he could not close his left eye. After zolpidem he could.
- test dose of zolpidem 10 mg test dose of zolpidem was given. The patient was then examined for any changes in hearing. Results were compared to the baseline state with no zolpidem. The patient was also evaluated by the speech therapist before and after zolpidem.
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Life Sciences & Earth Sciences (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Chemical & Material Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Pharmacology & Pharmacy (AREA)
- Medicinal Chemistry (AREA)
- Biomedical Technology (AREA)
- Organic Chemistry (AREA)
- General Chemical & Material Sciences (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Neurosurgery (AREA)
- Neurology (AREA)
- Epidemiology (AREA)
- Psychiatry (AREA)
- Cardiology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Urology & Nephrology (AREA)
- Anesthesiology (AREA)
- Psychology (AREA)
- Hospice & Palliative Care (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Nitrogen Condensed Heterocyclic Rings (AREA)
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GBGB0311457.6A GB0311457D0 (en) | 2003-05-19 | 2003-05-19 | New therapeutic use |
| US47382103P | 2003-05-27 | 2003-05-27 | |
| PCT/GB2004/002172 WO2004100948A1 (en) | 2003-05-19 | 2004-05-19 | Further therapeutic use of zolpidem |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| EP1624867A1 true EP1624867A1 (de) | 2006-02-15 |
Family
ID=33454596
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| EP04733850A Withdrawn EP1624867A1 (de) | 2003-05-19 | 2004-05-19 | Weitere therapeutische verwendung von zolpidem |
Country Status (7)
| Country | Link |
|---|---|
| EP (1) | EP1624867A1 (de) |
| JP (1) | JP2008506630A (de) |
| KR (1) | KR20060023129A (de) |
| AU (1) | AU2004237943A1 (de) |
| CA (1) | CA2526458A1 (de) |
| IL (1) | IL172061A0 (de) |
| WO (1) | WO2004100948A1 (de) |
Families Citing this family (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| GB2443928A (en) * | 2006-11-08 | 2008-05-21 | Regen Therapeutics Plc | Transdermal pharmaceutical composition comprising Zolpidem |
| GB0809936D0 (en) * | 2008-05-30 | 2008-07-09 | Regen Therapeutics Plc | Therapeutic use of zolpidem |
| RU2424802C2 (ru) * | 2009-05-18 | 2011-07-27 | Государственное образовательное учреждение Высшего профессионального образования Читинская государственная медицинская академия | Средство, оказывающее антиишемическое, антигипоксическое и антиамнестическое действие в остром периоде черепно-мозговой травмы |
Family Cites Families (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| IT1276522B1 (it) * | 1995-04-07 | 1997-10-31 | Elena Benincasa | Uso dello zolpidem per il trattamento terapeudico di sindromi neuropsichiatriche associate a disfunsione e di circuiti neurali dei |
| DE69910795T2 (de) * | 1998-06-09 | 2004-06-17 | Takeda Chemical Industries, Ltd. | Pharmazeutische kombination mit einer trizyclischen verbindung und mindestens einer von zolpidem, zopiclone und brotizolam, zur behandlung oder verhinderung von schlafstörungen |
| JP3509637B2 (ja) * | 1998-06-09 | 2004-03-22 | 武田薬品工業株式会社 | 睡眠障害予防治療剤 |
| US6333345B1 (en) * | 1999-05-14 | 2001-12-25 | Sepracor, Inc. | Methods of using and compositions comprising N-desmethylzolpidem |
| IT1318624B1 (it) * | 2000-07-14 | 2003-08-27 | Dinamite Dipharma S P A In For | Processo per la preparazione di 2-fenil-imidazo (1,2-a)piridin-3-acetammidi. |
-
2004
- 2004-05-19 KR KR1020057022142A patent/KR20060023129A/ko not_active Withdrawn
- 2004-05-19 CA CA002526458A patent/CA2526458A1/en not_active Abandoned
- 2004-05-19 WO PCT/GB2004/002172 patent/WO2004100948A1/en not_active Ceased
- 2004-05-19 JP JP2006530520A patent/JP2008506630A/ja active Pending
- 2004-05-19 AU AU2004237943A patent/AU2004237943A1/en not_active Abandoned
- 2004-05-19 EP EP04733850A patent/EP1624867A1/de not_active Withdrawn
-
2005
- 2005-11-20 IL IL172061A patent/IL172061A0/en unknown
Non-Patent Citations (1)
| Title |
|---|
| See references of WO2004100948A1 * |
Also Published As
| Publication number | Publication date |
|---|---|
| CA2526458A1 (en) | 2004-11-25 |
| AU2004237943A1 (en) | 2004-11-25 |
| JP2008506630A (ja) | 2008-03-06 |
| IL172061A0 (en) | 2011-07-31 |
| WO2004100948A1 (en) | 2004-11-25 |
| KR20060023129A (ko) | 2006-03-13 |
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