ES2284888T3 - Administracion oral de 6-hidroxi-oximorfona utilizada como analgesico. - Google Patents

Administracion oral de 6-hidroxi-oximorfona utilizada como analgesico. Download PDF

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ES2284888T3
ES2284888T3 ES02746895T ES02746895T ES2284888T3 ES 2284888 T3 ES2284888 T3 ES 2284888T3 ES 02746895 T ES02746895 T ES 02746895T ES 02746895 T ES02746895 T ES 02746895T ES 2284888 T3 ES2284888 T3 ES 2284888T3
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oxymorphone
hydroxy
pharmaceutical composition
use according
oral administration
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Huai-Hung Kao
Richard Smith-Carliss
Troy Mccall
David Lee
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Endo Pharmaceuticals Inc
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    • 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
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/02—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
    • A61K47/38—Cellulose; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2009—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2013—Organic compounds, e.g. phospholipids, fats
    • A61K9/2018—Sugars, or sugar alcohols, e.g. lactose, mannitol; Derivatives thereof, e.g. polysorbates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2022—Organic macromolecular compounds
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2022—Organic macromolecular compounds
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A61K9/2054—Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2072—Pills, tablets, discs, rods characterised by shape, structure or size; Tablets with holes, special break lines or identification marks; Partially coated tablets; Disintegrating flat shaped forms
    • A61K9/2086—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat
    • A61K9/209—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat containing drug in at least two layers or in the core and in at least one outer layer
    • 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
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]

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  • Pain & Pain Management (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Rheumatology (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Neurosurgery (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Medicinal Preparation (AREA)
  • Heterocyclic Carbon Compounds Containing A Hetero Ring Having Oxygen Or Sulfur (AREA)
  • Nitrogen Condensed Heterocyclic Rings (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Dental Preparations (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

Abstract

Utilización de 6-hidroxi oximorfona para la fabricación de una composición farmacéutica para el tratamiento del dolor, donde dicha composición farmacéutica debe suministrarse mediante administración oral.

Description

Administración oral de 6-hidroxi-oximorfona utilizada como analgésico.
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Campo de la invención
La invención hace referencia a una utilización de 6-hidroxi oximorfona para la fabricación de una composición para el tratamiento del dolor donde dicha composición farmacéutica se suministrará mediante administración oral.
Cone, Edward J; "General procedure for the isolation and identification of 6-alpha and 6-beta hydroxyl metabolites of narcotic agonists and antagonists with a hydromorphone structure", J. Chromatography, (1976), 129, 355-61 da a conocer el aislamiento y la identificación de ciertos metabolitos hidroxilos 6-alfa y 6-beta de agonistas y antagonistas narcóticos utilizando cromatografía en capa fina y cromatografía de gas. Se ha revelado que algunos de los compuestos dados a conocer presentan actividad narcótica.
La patente US-A-6.529.011 da a conocer una composición para administración nasal de metabolitos polares de analgésicos opioides que comprenden un metabolito polar de un analgésico opioide y un agente estimulador de la absorción. La morfina-6-glucuronida y la morfina-6-sulfato se revelan como metabolitos preferentes.
John L. Plummer, et al., Pain, 40 (1990) 339-347; Elsevier, "Influence of polarity on dose-response relationships of intrathecal opioids in rats"; especula que, en los humanos, los opioides mas polares que la morfina, tales como la 6-hidroxioximorfona, pueden resultar útiles en situaciones en las que se desea un alivio del dolor prolongado a continuación de una administración intratecal.
Sumario de la invención
La presente invención es tal como se describe en las reivindicaciones adjuntas. La presente invención proporciona una utilización de la 6-hidroxi oximorfona para la fabricación de una composición farmacéutica para el tratamiento del dolor donde dicha composición farmacéutica debe suministrarse mediante administración oral. Para conseguir el efecto analgésico deseado, los niveles en plasma sanguíneo de 6-hidroxi oximorfona deben elevarse hasta aproximadamente 0,2 ng/ml, más preferentemente hasta aproximadamente 0,3 ng/ml durante el tratamiento. También se proporciona una utilización de la 6-hidroxi oximorfona para la fabricación de composiciones farmacéuticas que comprenden uno o más portadores, diluyentes y excipientes para el tratamiento del dolor, donde dicha composición farmacéutica debe suministrarse mediante administración oral.
Breve descripción de las figuras
La Figura 1 es un perfil farmacocinético de la 6-hidroxi oximorfona con puntuaciones PID.
La Figura de referencia 2 es un perfil farmacocinético de la oximorfona con puntuaciones PID.
La Figura 3 es un perfil farmacocinético de la 6-hidroxi oximorfona con puntuaciones de dolor categórico.
La Figura de referencia 4 es un perfil farmacocinético de la oximorfona con puntuaciones de dolor categórico.
Las utilizaciones descritas en la presente memoria prevén la administración de una composición farmacéutica que contiene 6-hidroxi oximorfona como un ingrediente activo. En una forma de realización preferente la composición preferente comprende sólo 6-hidroxi oximorfona (excepto, por supuesto, los portadores, los diluyentes y otros excipientes). En otras formas de realización preferentes, la 6-hidroxi oximorfona puede combinarse con otros opioides u otros agentes farmacéuticos. Por ejemplo, otra forma de realización proporciona composiciones que comprenden 6-hidroxi oximorfona y su original, la oximorfona.
En dos estudios separados, se registraron los niveles en plasma sanguíneo y las indicaciones de alivio de dolor sobre un periodo posterior de 12 horas. Las Figuras 1-4 muestran una representación gráfica de los datos que combinan ambos estudios de manera que resulta posible evaluar el efecto de los niveles en plasma sanguíneo de la oximorfona y su metabolito 6-hidroxi oximorfona sobre el dolor.
La administración de oximorfona produce los niveles en plasma sanguíneo de oximorfona y de todos sus metabolitos, 6-hidroxi oximorfona. Los niveles de oximorfona alcanzan un máximo en el intervalo de 2 horas, caen ligeramente y se mantienen en un valor meseta. De manera interesante, el nivel se incrementa de nuevo a las 4-6 horas de la administración. Después de este tiempo, los niveles de oximorfona caen nuevamente y eventualmente caen a niveles cercanos a la meseta anterior.
Como con la oximorfona, los niveles en plasma sanguíneo de la 6-hidroxi oximorfona alcanzan un pico en las 2 horas después de la administración. Sin embargo, después del pico inicial, se observa una reducción más o menos constante en los niveles en plasma de la 6-hidroxi oximorfona.
Comparando estos niveles con los perfiles de dolor, resulta posible observar una correlación entre los niveles de 6-hidroxi oximorfona y el alivio del dolor. Los niveles de dolor prácticamente reflejan exactamente los niveles de 6-hidroxi oximorfona, con aumentos considerables en el alivio del dolor cerca de los picos asociados con los niveles sanguíneos de 6-hidroxi oximorfona. Por lo tanto, el alivio del dolor puede conseguirse mediante la administración exclusiva de 6-hidroxi oximorfona.
Además de los estudios farmacocinéticos, se han realizado estudios de fijación a receptores para comparar la afinidad de fijación de la 6-hidroxi oximorfona con la de la oximorfona. Los resultados se muestran en la Tabla 1. Estos resultados indican claramente que la 6-hidroxi oximorfona presenta una gran afinidad por los sitios receptores \delta, \kappa y \mu, comparable a la afinidad de fijación de su original. Los presentes inventores creen que en virtud de esta afinidad de fijación, la 6-hidroxi oximorfona presenta efectos analgésicos similares a su original, la oximorfona.
TABLA 1 Informe de ensayo
1
Por lo tanto, se han desarrollado directamente utilizaciones de la 6-hidroxi oximorfona. Se cree que el isómero \beta presenta una mayor eficacia en el tratamiento del dolor.
Las composiciones farmacéuticas que contienen 6-\alpha-hidroxi oximorfona, 6-\beta-hidroxi oximorfona o mezclas de las mismas pueden ser utilizadas en la invención.
La formulación puede ser utilizada como una suspensión, un jarabe u otro líquido, una tableta, una cápsula, una cápsula de gelatina rellena de líquido y otro medio sólido o semisólido. De manera alternativa, la composición puede presentar la forma de una formulación de liberación temporizada, incluyendo las formulaciones de liberación controlada, suspendida o prolongada. Independientemente de la formulación, se proporcionará al paciente una cantidad de 6-hidroxi oximorfona para inducir analgesia. Los niveles en plasma sanguíneo de 6-hidroxi oximorfona deben incrementarse a niveles suficientes para inducir el nivel deseado de analgesia.
La cantidad administrada dependerá de los criterios normales tales como el peso del paciente, la intensidad del dolor y otros factores. En base a los estudios farmacocinéticos, unos niveles en plasma sanguíneo de por lo menos 0,2 ng/ml proporcionarán cierta analgesia. El límite superior del nivel de plasma será establecido en última instancia por razones de seguridad. La sobredosis de cualquier opioide, incluyendo 6-hidroxi oximorfona, puede conllevar un fallo respiratorio y otros efectos secundarios no deseados y puede incluso derivar en la muerte. El nivel en plasma sanguíneo de 6-hidroxi oximorfona debe incrementarse hasta por lo menos 0,3 ng/ml. Pueden requerirse dosis subsecuentes para mantener estos niveles sanguíneos.
La administración preferente es de 6-hidroxi oximorfona con portadores y excipientes adecuados, como resultará evidente para los expertos en la materia. Por lo tanto, el plasma sanguíneo resultante en estas administraciones preferentes se encontrará considerablemente libre de oximorfona.
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Claims (6)

1. Utilización de 6-hidroxi oximorfona para la fabricación de una composición farmacéutica para el tratamiento del dolor, donde dicha composición farmacéutica debe suministrarse mediante administración oral.
2. Utilización según la reivindicación 1 en la que dicha composición farmacéutica es una forma de administración oral seleccionada de entre el grupo formado por una formulación líquida, un jarabe, una suspensión, una formulación sólida, una tableta, una cápsula, una cápsula de gelatina rellena de líquido y una formulación semisólida.
3. Utilización según cualquiera de las reivindicaciones anteriores en la que dicha composición farmacéutica comprende, además de dicha 6-hidroxi oximorfona, uno o más portadores, diluyentes y excipientes.
4. Utilización según cualquiera de las reivindicaciones anteriores en la que dicha composición farmacéutica comprende, además de dicha 6-hidroxi oximorforna, otro agente farmacéutico.
5. Utilización según la reivindicación 4 en la que dicho agente farmacéutico es un opioide.
6. Utilización según la reivindicación 5 en la que dicha composición farmacéutica comprende 6-hidroxi oximorfona y oximorfona.
ES02746895T 2001-07-06 2002-07-03 Administracion oral de 6-hidroxi-oximorfona utilizada como analgesico. Expired - Lifetime ES2284888T3 (es)

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Application Number Priority Date Filing Date Title
US30335701P 2001-07-06 2001-07-06
US303357P 2001-07-06
US32943201P 2001-10-15 2001-10-15
US32944401P 2001-10-15 2001-10-15
US32944501P 2001-10-15 2001-10-15
US329432P 2001-10-15
US329444P 2001-10-15
US329445P 2001-10-15

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US (13) US20040214849A1 (es)
EP (4) EP2311460A1 (es)
JP (4) JP2005515966A (es)
KR (1) KR20030034171A (es)
CN (3) CN1268338C (es)
AT (1) ATE359077T1 (es)
AU (3) AU2002318211B2 (es)
BR (1) BR0205721A (es)
CA (3) CA2452871C (es)
DE (1) DE60219478T2 (es)
ES (1) ES2284888T3 (es)
NO (1) NO20031018L (es)
WO (3) WO2003004032A1 (es)

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US20070098793A1 (en) 2007-05-03
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US20160136152A1 (en) 2016-05-19
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US20090192183A1 (en) 2009-07-30
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