US3781429A - Method of inhibiting ulcerogenesis induced by non-steroidal anti-inflammatory agents - Google Patents
Method of inhibiting ulcerogenesis induced by non-steroidal anti-inflammatory agents Download PDFInfo
- Publication number
- US3781429A US3781429A US00293710A US3781429DA US3781429A US 3781429 A US3781429 A US 3781429A US 00293710 A US00293710 A US 00293710A US 3781429D A US3781429D A US 3781429DA US 3781429 A US3781429 A US 3781429A
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- United States
- Prior art keywords
- inhibiting
- inflammatory agents
- moiety
- steroidal anti
- induced
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- Expired - Lifetime
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- 238000000034 method Methods 0.000 title abstract description 14
- 239000000041 non-steroidal anti-inflammatory agent Substances 0.000 title abstract description 8
- 229940021182 non-steroidal anti-inflammatory drug Drugs 0.000 title abstract description 8
- 230000002401 inhibitory effect Effects 0.000 title abstract description 7
- 241000124008 Mammalia Species 0.000 abstract description 12
- 229940094443 oxytocics prostaglandins Drugs 0.000 abstract description 6
- 150000003180 prostaglandins Chemical class 0.000 abstract description 6
- 230000000694 effects Effects 0.000 abstract description 2
- 150000001875 compounds Chemical class 0.000 description 19
- CGIGDMFJXJATDK-UHFFFAOYSA-N indomethacin Chemical compound CC1=C(CC(O)=O)C2=CC(OC)=CC=C2N1C(=O)C1=CC=C(Cl)C=C1 CGIGDMFJXJATDK-UHFFFAOYSA-N 0.000 description 18
- VGGSQFUCUMXWEO-UHFFFAOYSA-N Ethene Chemical compound C=C VGGSQFUCUMXWEO-UHFFFAOYSA-N 0.000 description 16
- 239000005977 Ethylene Substances 0.000 description 16
- 239000001257 hydrogen Substances 0.000 description 15
- 229910052739 hydrogen Inorganic materials 0.000 description 15
- 125000004435 hydrogen atom Chemical group [H]* 0.000 description 15
- HQKMJHAJHXVSDF-UHFFFAOYSA-L magnesium stearate Chemical compound [Mg+2].CCCCCCCCCCCCCCCCCC([O-])=O.CCCCCCCCCCCCCCCCCC([O-])=O HQKMJHAJHXVSDF-UHFFFAOYSA-L 0.000 description 14
- 239000000203 mixture Substances 0.000 description 12
- 208000025865 Ulcer Diseases 0.000 description 10
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 10
- 229920002261 Corn starch Polymers 0.000 description 9
- 239000008120 corn starch Substances 0.000 description 9
- 229940099112 cornstarch Drugs 0.000 description 9
- 231100000397 ulcer Toxicity 0.000 description 9
- 239000004480 active ingredient Substances 0.000 description 8
- 239000002775 capsule Substances 0.000 description 7
- 230000002496 gastric effect Effects 0.000 description 7
- 229960000905 indomethacin Drugs 0.000 description 7
- 235000019359 magnesium stearate Nutrition 0.000 description 7
- 231100000252 nontoxic Toxicity 0.000 description 7
- 230000003000 nontoxic effect Effects 0.000 description 7
- 230000001562 ulcerogenic effect Effects 0.000 description 7
- 230000037396 body weight Effects 0.000 description 6
- 239000008187 granular material Substances 0.000 description 6
- 238000002360 preparation method Methods 0.000 description 6
- 125000002091 cationic group Chemical group 0.000 description 5
- 239000003795 chemical substances by application Substances 0.000 description 5
- 239000012153 distilled water Substances 0.000 description 5
- 210000002784 stomach Anatomy 0.000 description 5
- BGKHCLZFGPIKKU-UHFFFAOYSA-N (13E,15S)-15-hydroxy-9-oxo-prosta-10,13-dienoic acid Natural products CCCCCC(O)C=CC1C=CC(=O)C1CCCCCCC(O)=O BGKHCLZFGPIKKU-UHFFFAOYSA-N 0.000 description 4
- GUBGYTABKSRVRQ-QKKXKWKRSA-N Lactose Natural products OC[C@H]1O[C@@H](O[C@H]2[C@H](O)[C@@H](O)C(O)O[C@@H]2CO)[C@H](O)[C@@H](O)[C@H]1O GUBGYTABKSRVRQ-QKKXKWKRSA-N 0.000 description 4
- 241001465754 Metazoa Species 0.000 description 4
- 125000000217 alkyl group Chemical group 0.000 description 4
- 229940089536 indocin Drugs 0.000 description 4
- 239000008101 lactose Substances 0.000 description 4
- 229920002472 Starch Polymers 0.000 description 3
- -1 amine cations Chemical class 0.000 description 3
- 125000004432 carbon atom Chemical group C* 0.000 description 3
- 238000006243 chemical reaction Methods 0.000 description 3
- 239000003937 drug carrier Substances 0.000 description 3
- 239000000975 dye Substances 0.000 description 3
- 239000000796 flavoring agent Substances 0.000 description 3
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- 239000000463 material Substances 0.000 description 3
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- 239000008107 starch Substances 0.000 description 3
- 235000019698 starch Nutrition 0.000 description 3
- BSYNRYMUTXBXSQ-UHFFFAOYSA-N Aspirin Chemical compound CC(=O)OC1=CC=CC=C1C(O)=O BSYNRYMUTXBXSQ-UHFFFAOYSA-N 0.000 description 2
- 241000416162 Astragalus gummifer Species 0.000 description 2
- 241000167854 Bourreria succulenta Species 0.000 description 2
- 206010009900 Colitis ulcerative Diseases 0.000 description 2
- FBPFZTCFMRRESA-FSIIMWSLSA-N D-Glucitol Natural products OC[C@H](O)[C@H](O)[C@@H](O)[C@H](O)CO FBPFZTCFMRRESA-FSIIMWSLSA-N 0.000 description 2
- 208000032843 Hemorrhage Diseases 0.000 description 2
- WINXNKPZLFISPD-UHFFFAOYSA-M Saccharin sodium Chemical group [Na+].C1=CC=C2C(=O)[N-]S(=O)(=O)C2=C1 WINXNKPZLFISPD-UHFFFAOYSA-M 0.000 description 2
- CZMRCDWAGMRECN-UGDNZRGBSA-N Sucrose Chemical compound O[C@H]1[C@H](O)[C@@H](CO)O[C@@]1(CO)O[C@@H]1[C@H](O)[C@@H](O)[C@H](O)[C@@H](CO)O1 CZMRCDWAGMRECN-UGDNZRGBSA-N 0.000 description 2
- 229930006000 Sucrose Natural products 0.000 description 2
- 229920001615 Tragacanth Polymers 0.000 description 2
- 201000006704 Ulcerative Colitis Diseases 0.000 description 2
- 229960001138 acetylsalicylic acid Drugs 0.000 description 2
- 238000003556 assay Methods 0.000 description 2
- 150000001768 cations Chemical class 0.000 description 2
- 235000019693 cherries Nutrition 0.000 description 2
- 229940079593 drug Drugs 0.000 description 2
- 239000003814 drug Substances 0.000 description 2
- 235000019634 flavors Nutrition 0.000 description 2
- 235000013305 food Nutrition 0.000 description 2
- 235000003599 food sweetener Nutrition 0.000 description 2
- 238000003304 gavage Methods 0.000 description 2
- 239000011812 mixed powder Substances 0.000 description 2
- 239000000546 pharmaceutical excipient Substances 0.000 description 2
- VYMDGNCVAMGZFE-UHFFFAOYSA-N phenylbutazonum Chemical compound O=C1C(CCCC)C(=O)N(C=2C=CC=CC=2)N1C1=CC=CC=C1 VYMDGNCVAMGZFE-UHFFFAOYSA-N 0.000 description 2
- 239000006187 pill Substances 0.000 description 2
- 239000003755 preservative agent Substances 0.000 description 2
- 239000003223 protective agent Substances 0.000 description 2
- 239000000600 sorbitol Substances 0.000 description 2
- 238000003756 stirring Methods 0.000 description 2
- 239000005720 sucrose Substances 0.000 description 2
- 239000003765 sweetening agent Substances 0.000 description 2
- 208000024891 symptom Diseases 0.000 description 2
- 239000006188 syrup Substances 0.000 description 2
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- 239000007916 tablet composition Substances 0.000 description 2
- GETQZCLCWQTVFV-UHFFFAOYSA-N trimethylamine Chemical compound CN(C)C GETQZCLCWQTVFV-UHFFFAOYSA-N 0.000 description 2
- HBAQYPYDRFILMT-UHFFFAOYSA-N 8-[3-(1-cyclopropylpyrazol-4-yl)-1H-pyrazolo[4,3-d]pyrimidin-5-yl]-3-methyl-3,8-diazabicyclo[3.2.1]octan-2-one Chemical class C1(CC1)N1N=CC(=C1)C1=NNC2=C1N=C(N=C2)N1C2C(N(CC1CC2)C)=O HBAQYPYDRFILMT-UHFFFAOYSA-N 0.000 description 1
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- 206010067484 Adverse reaction Diseases 0.000 description 1
- KHOITXIGCFIULA-UHFFFAOYSA-N Alophen Chemical compound C1=CC(OC(=O)C)=CC=C1C(C=1N=CC=CC=1)C1=CC=C(OC(C)=O)C=C1 KHOITXIGCFIULA-UHFFFAOYSA-N 0.000 description 1
- GUBGYTABKSRVRQ-XLOQQCSPSA-N Alpha-Lactose Chemical compound O[C@@H]1[C@@H](O)[C@@H](O)[C@@H](CO)O[C@H]1O[C@@H]1[C@@H](CO)O[C@H](O)[C@H](O)[C@H]1O GUBGYTABKSRVRQ-XLOQQCSPSA-N 0.000 description 1
- BHPQYMZQTOCNFJ-UHFFFAOYSA-N Calcium cation Chemical compound [Ca+2] BHPQYMZQTOCNFJ-UHFFFAOYSA-N 0.000 description 1
- 229920002134 Carboxymethyl cellulose Polymers 0.000 description 1
- 201000009030 Carcinoma Diseases 0.000 description 1
- 208000011231 Crohn disease Diseases 0.000 description 1
- XZMCDFZZKTWFGF-UHFFFAOYSA-N Cyanamide Chemical compound NC#N XZMCDFZZKTWFGF-UHFFFAOYSA-N 0.000 description 1
- 206010012735 Diarrhoea Diseases 0.000 description 1
- 235000019739 Dicalciumphosphate Nutrition 0.000 description 1
- 206010013554 Diverticulum Diseases 0.000 description 1
- 208000007882 Gastritis Diseases 0.000 description 1
- 208000012671 Gastrointestinal haemorrhages Diseases 0.000 description 1
- 108010010803 Gelatin Proteins 0.000 description 1
- 235000010643 Leucaena leucocephala Nutrition 0.000 description 1
- 240000007472 Leucaena leucocephala Species 0.000 description 1
- JLVVSXFLKOJNIY-UHFFFAOYSA-N Magnesium ion Chemical compound [Mg+2] JLVVSXFLKOJNIY-UHFFFAOYSA-N 0.000 description 1
- 244000246386 Mentha pulegium Species 0.000 description 1
- 235000016257 Mentha pulegium Nutrition 0.000 description 1
- 235000004357 Mentha x piperita Nutrition 0.000 description 1
- 241000238367 Mya arenaria Species 0.000 description 1
- 206010028813 Nausea Diseases 0.000 description 1
- 229910019142 PO4 Inorganic materials 0.000 description 1
- NPYPAHLBTDXSSS-UHFFFAOYSA-N Potassium ion Chemical compound [K+] NPYPAHLBTDXSSS-UHFFFAOYSA-N 0.000 description 1
- 241000700159 Rattus Species 0.000 description 1
- 229920001800 Shellac Polymers 0.000 description 1
- FKNQFGJONOIPTF-UHFFFAOYSA-N Sodium cation Chemical compound [Na+] FKNQFGJONOIPTF-UHFFFAOYSA-N 0.000 description 1
- 206010047700 Vomiting Diseases 0.000 description 1
- 239000013543 active substance Substances 0.000 description 1
- 230000006838 adverse reaction Effects 0.000 description 1
- 230000032683 aging Effects 0.000 description 1
- 239000000783 alginic acid Substances 0.000 description 1
- 235000010443 alginic acid Nutrition 0.000 description 1
- 229920000615 alginic acid Polymers 0.000 description 1
- 229960001126 alginic acid Drugs 0.000 description 1
- 150000004781 alginic acids Chemical class 0.000 description 1
- 208000022531 anorexia Diseases 0.000 description 1
- 229940069428 antacid Drugs 0.000 description 1
- 239000003159 antacid agent Substances 0.000 description 1
- 239000002260 anti-inflammatory agent Substances 0.000 description 1
- 229940121363 anti-inflammatory agent Drugs 0.000 description 1
- 239000011230 binding agent Substances 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 229910001424 calcium ion Inorganic materials 0.000 description 1
- 239000001506 calcium phosphate Substances 0.000 description 1
- 239000007963 capsule composition Substances 0.000 description 1
- 239000001768 carboxy methyl cellulose Substances 0.000 description 1
- 235000010948 carboxy methyl cellulose Nutrition 0.000 description 1
- 239000008112 carboxymethyl-cellulose Substances 0.000 description 1
- 238000002512 chemotherapy Methods 0.000 description 1
- 239000007958 cherry flavor Substances 0.000 description 1
- 150000001860 citric acid derivatives Chemical class 0.000 description 1
- 238000000576 coating method Methods 0.000 description 1
- 239000007799 cork Substances 0.000 description 1
- 206010061428 decreased appetite Diseases 0.000 description 1
- 230000018109 developmental process Effects 0.000 description 1
- GUJOJGAPFQRJSV-UHFFFAOYSA-N dialuminum;dioxosilane;oxygen(2-);hydrate Chemical compound O.[O-2].[O-2].[O-2].[Al+3].[Al+3].O=[Si]=O.O=[Si]=O.O=[Si]=O.O=[Si]=O GUJOJGAPFQRJSV-UHFFFAOYSA-N 0.000 description 1
- NEFBYIFKOOEVPA-UHFFFAOYSA-K dicalcium phosphate Chemical compound [Ca+2].[Ca+2].[O-]P([O-])([O-])=O NEFBYIFKOOEVPA-UHFFFAOYSA-K 0.000 description 1
- 229940038472 dicalcium phosphate Drugs 0.000 description 1
- 229910000390 dicalcium phosphate Inorganic materials 0.000 description 1
- 235000005911 diet Nutrition 0.000 description 1
- 230000037213 diet Effects 0.000 description 1
- XEYBRNLFEZDVAW-ARSRFYASSA-N dinoprostone Chemical compound CCCCC[C@H](O)\C=C\[C@H]1[C@H](O)CC(=O)[C@@H]1C\C=C/CCCC(O)=O XEYBRNLFEZDVAW-ARSRFYASSA-N 0.000 description 1
- 229960002986 dinoprostone Drugs 0.000 description 1
- 210000001198 duodenum Anatomy 0.000 description 1
- 201000006549 dyspepsia Diseases 0.000 description 1
- 208000023062 epigastric abdominal pain Diseases 0.000 description 1
- 210000003238 esophagus Anatomy 0.000 description 1
- BEFDCLMNVWHSGT-UHFFFAOYSA-N ethenylcyclopentane Chemical compound C=CC1CCCC1 BEFDCLMNVWHSGT-UHFFFAOYSA-N 0.000 description 1
- 239000010685 fatty oil Substances 0.000 description 1
- 235000013355 food flavoring agent Nutrition 0.000 description 1
- 238000009472 formulation Methods 0.000 description 1
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- 229920000159 gelatin Polymers 0.000 description 1
- 239000008273 gelatin Substances 0.000 description 1
- 239000007903 gelatin capsule Substances 0.000 description 1
- 235000019322 gelatine Nutrition 0.000 description 1
- 235000011852 gelatine desserts Nutrition 0.000 description 1
- 239000011521 glass Substances 0.000 description 1
- 239000007887 hard shell capsule Substances 0.000 description 1
- 235000001050 hortel pimenta Nutrition 0.000 description 1
- 239000003701 inert diluent Substances 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- XMGQYMWWDOXHJM-UHFFFAOYSA-N limonene Chemical compound CC(=C)C1CCC(C)=CC1 XMGQYMWWDOXHJM-UHFFFAOYSA-N 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 239000000314 lubricant Substances 0.000 description 1
- 229910001425 magnesium ion Inorganic materials 0.000 description 1
- 235000012054 meals Nutrition 0.000 description 1
- 229910052751 metal Inorganic materials 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 229920000609 methyl cellulose Polymers 0.000 description 1
- 125000002496 methyl group Chemical group [H]C([H])([H])* 0.000 description 1
- 235000010270 methyl p-hydroxybenzoate Nutrition 0.000 description 1
- OSWPMRLSEDHDFF-UHFFFAOYSA-N methyl salicylate Chemical compound COC(=O)C1=CC=CC=C1O OSWPMRLSEDHDFF-UHFFFAOYSA-N 0.000 description 1
- 239000001923 methylcellulose Substances 0.000 description 1
- 235000010981 methylcellulose Nutrition 0.000 description 1
- 230000008693 nausea Effects 0.000 description 1
- 239000007968 orange flavor Substances 0.000 description 1
- 239000008177 pharmaceutical agent Substances 0.000 description 1
- 125000001997 phenyl group Chemical group [H]C1=C([H])C([H])=C(*)C([H])=C1[H] 0.000 description 1
- 229960002895 phenylbutazone Drugs 0.000 description 1
- 235000021317 phosphate Nutrition 0.000 description 1
- 150000003013 phosphoric acid derivatives Chemical class 0.000 description 1
- 229910001414 potassium ion Inorganic materials 0.000 description 1
- 229920001592 potato starch Polymers 0.000 description 1
- 229940116317 potato starch Drugs 0.000 description 1
- MFDFERRIHVXMIY-UHFFFAOYSA-N procaine Chemical compound CCN(CC)CCOC(=O)C1=CC=C(N)C=C1 MFDFERRIHVXMIY-UHFFFAOYSA-N 0.000 description 1
- 229960004919 procaine Drugs 0.000 description 1
- 235000010232 propyl p-hydroxybenzoate Nutrition 0.000 description 1
- WGJJROVFWIXTPA-OALUTQOASA-N prostanoic acid Chemical class CCCCCCCC[C@H]1CCC[C@@H]1CCCCCCC(O)=O WGJJROVFWIXTPA-OALUTQOASA-N 0.000 description 1
- 230000002829 reductive effect Effects 0.000 description 1
- 238000012552 review Methods 0.000 description 1
- CVHZOJJKTDOEJC-UHFFFAOYSA-N saccharin Chemical compound C1=CC=C2C(=O)NS(=O)(=O)C2=C1 CVHZOJJKTDOEJC-UHFFFAOYSA-N 0.000 description 1
- 229940081974 saccharin Drugs 0.000 description 1
- 235000019204 saccharin Nutrition 0.000 description 1
- 239000000901 saccharin and its Na,K and Ca salt Substances 0.000 description 1
- 150000003839 salts Chemical class 0.000 description 1
- 239000004208 shellac Substances 0.000 description 1
- ZLGIYFNHBLSMPS-ATJNOEHPSA-N shellac Chemical compound OCCCCCC(O)C(O)CCCCCCCC(O)=O.C1C23[C@H](C(O)=O)CCC2[C@](C)(CO)[C@@H]1C(C(O)=O)=C[C@@H]3O ZLGIYFNHBLSMPS-ATJNOEHPSA-N 0.000 description 1
- 229940113147 shellac Drugs 0.000 description 1
- 235000013874 shellac Nutrition 0.000 description 1
- 230000011664 signaling Effects 0.000 description 1
- 210000000813 small intestine Anatomy 0.000 description 1
- 235000010234 sodium benzoate Nutrition 0.000 description 1
- 239000004299 sodium benzoate Substances 0.000 description 1
- 229910001415 sodium ion Inorganic materials 0.000 description 1
- 235000010199 sorbic acid Nutrition 0.000 description 1
- 239000004334 sorbic acid Substances 0.000 description 1
- 229940075582 sorbic acid Drugs 0.000 description 1
- 238000007920 subcutaneous administration Methods 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 239000000375 suspending agent Substances 0.000 description 1
- 239000000725 suspension Substances 0.000 description 1
- 239000003826 tablet Substances 0.000 description 1
- 150000003892 tartrate salts Chemical class 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 239000000196 tragacanth Substances 0.000 description 1
- 235000010487 tragacanth Nutrition 0.000 description 1
- 229940116362 tragacanth Drugs 0.000 description 1
- 230000036269 ulceration Effects 0.000 description 1
- 230000008673 vomiting Effects 0.000 description 1
- 235000012431 wafers Nutrition 0.000 description 1
- 239000009637 wintergreen oil Substances 0.000 description 1
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
- A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
Definitions
- non-toxic pharmaceutically acceptable cationic salts of the prostanoic acid derivatives of the above general formulae when R is hydrogen.
- the cations comprised in these salts include, for example, the non-toxic metal cations such as the sodium ion, potassium ion, calcium ion, and magnesium ion as well as the organic amine cations such as the tr i(lower alkyl)amine cations (e.g., trimethylamine), procaine, and the like.
- the risks of continuing Indocin therapy in the face of such symptoms must be weighed against the possible benefits to the individual patient.
- the gastrointestinal effects may be reduced by giving the drug immediately after meals, with food, or with antacids. As advancing years appear to increase the possibility of adverse reactions, Indocin should be used with concomitantly greater care in the aging.
- prostaglandins in general are not effective when administered by the oral route.
- the subject prostaglandins are indeed effective orally and at relatively low doses.
- the assay to determine the protective effect of these compounds is carried out in the following manner.
- Rats were starved for 48 hours (water was given ad libitum).
- Indomethacin (20 mg./kg. of body weight) was administered by the subcutaneous route and one-half the dose of the test compound was administered by gavage at the same time. After three hours, the second half of the test compound was administered, also by gavage.
- Five hours after the administration of indomethacin the animals were decapitated and the stomachs removed.
- the stomachs were washed with distilled water, blotted on gauze, cut along the larger curvature, and the contents rinsed with distilled Water.
- the stomachs were spread out, pinned on a cork and visualized under magnifying glass for ulcers. The criteria for scoring of ulcers was as previ ously reported. [Abdel-Galil et al., Brit. J. Pharmac. Chemotherapy 33:1-14 (1968).]
- the active compounds of the present invention may be orally administered, for example, with an inert diluent or with an assimilable edible carrier, or they may be enclosed in hard or soft shell gelatin capsules, or they may be compressed into tablets, or they may be incorporated directly with the food of the diet.
- the compounds may be incorporated with excipients and used in the form of tablets, troches, capsules, elixirs, suspensions, syrups, wafers, and the like.
- Such compositions and preparations should contain at least 0.1% of active compound.
- the percentage in the compositions and preparations may, of course, be varied and may conveniently be between about 5% to about 75% or more of the weight of the unit.
- compositions or preparations according to the present invention are prepared so that an oral dosage unit form contains between about 0.05 and 20 milligrams of active compound. It may also be desirable to combine a protective compound of the present invention with indomethacin, aspirin, phenyl'butazone, or the like in one capsule or tablet for convenience of administration.
- the tablets, troches, pills, capsules and the like may also contain the following: a binder such as gum tragacanth, acacia, cornstarch, or gelatin; an excipient such as dicalcium phosphate; a disintegrating agent such as cornstarch, potato starch, alginic acid, and the like; a lubricant such as magnesium stearate; and a sweetening agent such as sucrose, lactose, or saccharin may he added or a. flavoring agent such as peppermint, oil of wintergreen, or cherry flavoring.
- a binder such as gum tragacanth, acacia, cornstarch, or gelatin
- an excipient such as dicalcium phosphate
- a disintegrating agent such as cornstarch, potato starch, alginic acid, and the like
- a lubricant such as magnesium stearate
- a sweetening agent such as sucrose, lactose, or saccharin may he added or
- any material may be present as coatings or to otherwise modify the physical form of the dosage unit.
- tablets, pills or capsules may be coated with shellac, sugar, or both.
- a syrup or elixir may contain the active compounds, sucrose as a sweetening agent, methyl and propyl parabens as preservatives, a dye and flavoring such as cherry or orange flavor.
- any material used in preparing any dosage unit form should be pharmaceutically pure and substantially non-toxic in the amounts employed.
- racemic active agents of the novel compositions of this invention can be resolved at appropriate stages into their optically active components by a number of methods of resolution well known in the art. It is to be understood that the above pictorial representation of the active compounds of the present invention is to be construed as inclusive of other forms including enantiomers and racemates, and not to be construed as limited to the particular form shown.
- EXAMPLE 1 Preparation of capsule formulation Ingredient: Milligrams per capsule Prostaglandin A 5 Starch Magnesium stearate 5 The active ingredient, starch and magnesium stearate are blended together. The mixture is used to fill hard shell capsules of a suitable size at a fill weight of milligrams per capsule.
- EXAMPLE 2 Preparation of tablet formulation
- the active ingredient, lactose and corn starch (for mix) are blended together.
- the sorn starch (for paste) is suspended in water at a ratio of 10 grams of corn starch per 80 milliliters of water and heated with stirring to form a paste.
- This paste is then used to granulate the mixed powders.
- the Wet granules are passed through a No. 8 screen and dried at 120 F.
- the dry granules are passed through a No. 16 screen.
- the mixture is lubricated with magnesium stearate and compressed into tablets in a suitable tableting machine. Each tablet contains 2 milligrams of active ingredient.
- the sorbitol solution is added to 40 milliliters of distilled water and the active ingredient is suspended therein.
- the sucaryl, saccharin, sodium benzoate, flavor and dye are added and dissolved in the above solution.
- the volume is adjusted to 100 milliliters with distilled water.
- a suspending agent such as bentonite magma, tragacanth, carboxymethylcellulose, or methylcellulose may be used. Phosphates, citrates or tartrates may be added as buifers. Preservatives may include the parabens, sorbic acid and the like and other flavors and dyes may be used in place of those listed above.
- EXAMPLE 4 Magnesium stearate 5 Preparation of tablet formulation Ingredient: Milligrams per tablet ll-deoxy-prostaglandin E 2 Lactose 200 Corn starch (for mix) 50 Corn starch (for paste) 50 Magnesium stearate 6
- the active ingredient, lactose and corn starch (for mix) are blended together.
- the corn starch (for paste) is suspended in water at a ratio of 10 grams of corn starch per 80 milliliters of water and heated with stirring to form a paste. This paste is then used to granulate the mixed powders.
- the wet granules are passed through a No. 8 screen and dried at 120 F.
- the dry granules are passed through a No. 16 screen.
- the mixture is lubricated with magnesium stearate and compressed into tablets in a suitable tableting machine. Each tablet contains 2 milligrams of active ingredient.
- R is hydrogen or alkyl having up to 12 carbon atoms, R is hydrogen or hydroxy, the moiety C C is ethylene or cis-vinylene, and the moiety -C -C is ethylene or cis-vinylene with the proviso that when the moiety -C -C is ethylene then the moiety C -C must be ethylene, and the non-toxic pharmaceutically acceptable cationic salts thereof when R is hydrogen; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body Weight of said mammal.
- the method of inhibiting the ulcerogenic effect induced by non-steroidal anti-inflammatory agents in a mammal which comprises administering concomitantly with said agents and orally to said mammal an effective amount of a compound selected from the group consisting of those of the formula:
- R is hydrogen or alkyl having up to 12 carbon atoms, the moiety -C C is ethylene or ci s-vinylene, and the moiety -C C is ethylene or cis-vinylene, with the proviso that when the moiety C C is ethylene then the moiety --C -C must be ethylene, and the non-toxic pharmaceutically acceptable cationic salts thereof when R is hydrogen; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body Weight of said mammal.
- the method of inhibiting the ulcerogenic effect induced by non-steroidal anti-inflammatory agents in a mammal which comprises administering concomitantly with said agents and orally to said mammal an effective amount of a compound selected from the group consisting of 13,14-dihydro-prostaglandin E and the non-toxic pharmaceutically acceptable cationic salts thereof; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body weight of said mammal.
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Abstract
THIS DISCLOSURE DESCRIBES THE METHOD OF INHIBITING THE ULCEROPGENIC EFFECT INDUCED BY NON-STEROIDAL ANTI-INFLAMMATORY AGENTS IN MAMMALS BY ADMINISTERING ORALLY THE PROSTAGLANDINS OF THE E SERIES AND CERTAIN 11-DEOXY DERIVATIVES THEREOF AND THE PROSTAGLANDINS OF THE A SERIES.
Description
United StatesPatent O 3,781,429 METHOD OF INHIBITlNG ULCEROGENESIS IN- DUCED BY NON-STEROIDAL ANTl-INFLAM- MATORY AGENTS Ruth Partridge, Pearl River, N.Y., and Martin Joseph Weiss, Oradell, NJ., assignors to American Cyanamid Company, Stamford, Conn. No Drawing. Filed Sept. 29, 1972, Ser. No. 293,710 Int. Cl. A61k 27/00 US. Cl. 424-234 9 Claims ABSTRACT OF THE DISCLOSURE This disclosure describes the method of inhibiting the ulcerogenic effect induced by non-steroidal anti-inflammatory agents in mammals by administering orally the prostaglandins of the E series and certain ll-deoxy derivatives thereof and the prostaglandins of the A series.
BRIEF SUMMARY OF THE INVENTION H OH wherein R is hydrogen or alkyl having up to 12 carbon atoms, R is hydrogen or hydroxy, the moiety C -C is ethylene or cis-vinylene, and the moiety C C is ethylene or cis-vinylene with the proviso that when the moiety --C C is ethylene then the moiety C1'7 C18 must be ethylene.
Also embraced within the scope of the present invention are the non-toxic pharmaceutically acceptable cationic salts of the prostanoic acid derivatives of the above general formulae, when R is hydrogen. The cations comprised in these salts include, for example, the non-toxic metal cations such as the sodium ion, potassium ion, calcium ion, and magnesium ion as well as the organic amine cations such as the tr i(lower alkyl)amine cations (e.g., trimethylamine), procaine, and the like.
DETAJLED DESCRIPTION OF THE INVENTION We have found that the substances of the above general formulae are useful when administered by the oral route as protective agents against the ulcerogenic and gastrointestinal effects induced by certain otherwise valuable pharmaceutical agents, particularly non-steroidal anti-inflammatory agents such as indomethacin, phenylbutazone, and aspirin. Thus, with the concomitant use of the protective agents of this invention, it should be possible to administer larger and potentially more eflicacious doses of these anti-inflammatory agents without increasing the danger of increased ulcerogenic or gastrointestinal side effects. Indicative of the serious nature of this problem are the following statements concerning indomethacin (Indocin) taken from Physicians Desk Reference, 1972 (Medical Economics Inc., Oradell, NJ p. 964.
Gastrointestinal effects-Because of the occurrence and, at times, severity of gastrointestinal reactions to indocin, the prescribing physician must be continuously alert for any sign or symptom signalling a possible gastrointestinal reaction. The risks of continuing Indocin therapy in the face of such symptoms must be weighed against the possible benefits to the individual patient. The gastrointestinal effects may be reduced by giving the drug immediately after meals, with food, or with antacids. As advancing years appear to increase the possibility of adverse reactions, Indocin should be used with concomitantly greater care in the aging.
Gastrointestinal reactions.%ingle or multiple ulcerations, including perforation and hemorrhage of the esophagus, stomach, duodenum or small intestines. Fatalities have been reported to occur in some instances. Gastrointestinal bleeding without obvious ulcer formation. Perforation of pre-existing sigmoid lesions (diverticulum, carcinoma, etc.). Increased abdominal pain in ulcerative colitis patients or the development of ulcerative colitis and regional ileitis have been reported to occur rarely. Gastritis may persist after the cessation of the drug. Nausea, vomiting, anorexia, epigastric distress, abdominal pain and diarrhea.
It is further to be noted that prostaglandins in general are not effective when administered by the oral route. Thus, it is most unexpected that for the novel use of this invention the subject prostaglandins are indeed effective orally and at relatively low doses. The assay to determine the protective effect of these compounds is carried out in the following manner.
Rats were starved for 48 hours (water was given ad libitum). Indomethacin (20 mg./kg. of body weight) was administered by the subcutaneous route and one-half the dose of the test compound was administered by gavage at the same time. After three hours, the second half of the test compound was administered, also by gavage. Five hours after the administration of indomethacin the animals were decapitated and the stomachs removed. The stomachs were washed with distilled water, blotted on gauze, cut along the larger curvature, and the contents rinsed with distilled Water. The stomachs were spread out, pinned on a cork and visualized under magnifying glass for ulcers. The criteria for scoring of ulcers was as previ ously reported. [Abdel-Galil et al., Brit. J. Pharmac. Chemotherapy 33:1-14 (1968).]
Score:
0-Norm'al stomach 1Petechial hemorrhage or pin point ulcer 2-1 or 2 small ulcers 3Many ulcers, a few large 4--Many ulcers, mainly large Control animals treated with indomethacin but not test compound usually give scores of about 2.5-3.7. Compounds which reduce the ulcer score by 0.7 unit are considered active. Control animals treated with neither indomethacin nor test compound give scores of about 0.5-
0.8. The results obtained in this assay with typical protective compounds of the present invention are set forth in the Table I below.
TABLE I Total oral dose (mg./ kg. of bed weight Ulcer score Treated animals Compound Controls l-Prostaglandin El--...'..'.-'.'-'-'------ l-Prostaglandln E 5 rs PP The active compounds of the present invention and the non-toxic pharmaceutically acceptable cationic salts thereof when R is hydrogen have thus been found to be highly useful for inhibiting the ulcerogenic effect induced by relatively high doses of non-steroidal anti-inflammatory agents in mammals when administered orally. A preferred dosage regimen for optimum results would be from about 0.003 mg. to about 0.7 mg. per kilogram of body weight per day and such dosage units are employed that a total of from about 0.20 mg. to about 50.0 mg. of active ingredient for a subject of about 70 kg. body weight are administered in a 24-hour period.
The active compounds of the present invention may be orally administered, for example, with an inert diluent or with an assimilable edible carrier, or they may be enclosed in hard or soft shell gelatin capsules, or they may be compressed into tablets, or they may be incorporated directly with the food of the diet. For oral therapeutic administration, the compounds may be incorporated with excipients and used in the form of tablets, troches, capsules, elixirs, suspensions, syrups, wafers, and the like. Such compositions and preparations should contain at least 0.1% of active compound. The percentage in the compositions and preparations may, of course, be varied and may conveniently be between about 5% to about 75% or more of the weight of the unit. The amount of active ingredient in such therapeutically useful compositions is such that a suitable dosage will be obtained. Preferred compositions or preparations according to the present invention are prepared so that an oral dosage unit form contains between about 0.05 and 20 milligrams of active compound. It may also be desirable to combine a protective compound of the present invention with indomethacin, aspirin, phenyl'butazone, or the like in one capsule or tablet for convenience of administration.
The tablets, troches, pills, capsules and the like may also contain the following: a binder such as gum tragacanth, acacia, cornstarch, or gelatin; an excipient such as dicalcium phosphate; a disintegrating agent such as cornstarch, potato starch, alginic acid, and the like; a lubricant such as magnesium stearate; and a sweetening agent such as sucrose, lactose, or saccharin may he added or a. flavoring agent such as peppermint, oil of wintergreen, or cherry flavoring. When the dosage unit form is a capsule, it may contain, in addition to materials of the above type, a liquid carrier such as a fatty oil. Various other materials may be present as coatings or to otherwise modify the physical form of the dosage unit. For instance, tablets, pills or capsules may be coated with shellac, sugar, or both. A syrup or elixir may contain the active compounds, sucrose as a sweetening agent, methyl and propyl parabens as preservatives, a dye and flavoring such as cherry or orange flavor. Of course, any material used in preparing any dosage unit form should be pharmaceutically pure and substantially non-toxic in the amounts employed.
The racemic active agents of the novel compositions of this invention can be resolved at appropriate stages into their optically active components by a number of methods of resolution well known in the art. It is to be understood that the above pictorial representation of the active compounds of the present invention is to be construed as inclusive of other forms including enantiomers and racemates, and not to be construed as limited to the particular form shown.
The invention will be described in greater detail in conjunction with the following specific examples.
EXAMPLE 1 Preparation of capsule formulation Ingredient: Milligrams per capsule Prostaglandin A 5 Starch Magnesium stearate 5 The active ingredient, starch and magnesium stearate are blended together. The mixture is used to fill hard shell capsules of a suitable size at a fill weight of milligrams per capsule.
EXAMPLE 2 Preparation of tablet formulation The active ingredient, lactose and corn starch (for mix) are blended together. The sorn starch (for paste) is suspended in water at a ratio of 10 grams of corn starch per 80 milliliters of water and heated with stirring to form a paste. This paste is then used to granulate the mixed powders. The Wet granules are passed through a No. 8 screen and dried at 120 F. The dry granules are passed through a No. 16 screen. The mixture is lubricated with magnesium stearate and compressed into tablets in a suitable tableting machine. Each tablet contains 2 milligrams of active ingredient.
Sorbitol solution (70% NE): 40 ml. Distilled water: q.s. to ml.
The sorbitol solution is added to 40 milliliters of distilled water and the active ingredient is suspended therein. The sucaryl, saccharin, sodium benzoate, flavor and dye are added and dissolved in the above solution. The volume is adjusted to 100 milliliters with distilled water.
Other ingredients may replace those listed in the above formulation. For example, a suspending agent such as bentonite magma, tragacanth, carboxymethylcellulose, or methylcellulose may be used. Phosphates, citrates or tartrates may be added as buifers. Preservatives may include the parabens, sorbic acid and the like and other flavors and dyes may be used in place of those listed above.
EXAMPLE 4 Magnesium stearate 5 Preparation of tablet formulation Ingredient: Milligrams per tablet ll-deoxy-prostaglandin E 2 Lactose 200 Corn starch (for mix) 50 Corn starch (for paste) 50 Magnesium stearate 6 The active ingredient, lactose and corn starch (for mix) are blended together. The corn starch (for paste) is suspended in water at a ratio of 10 grams of corn starch per 80 milliliters of water and heated with stirring to form a paste. This paste is then used to granulate the mixed powders. The wet granules are passed through a No. 8 screen and dried at 120 F. The dry granules are passed through a No. 16 screen. The mixture is lubricated with magnesium stearate and compressed into tablets in a suitable tableting machine. Each tablet contains 2 milligrams of active ingredient.
What is claimed is:
1. The method of inhibiting the ulcerogenic eliect induced by non-steroidal anti-inflammatory agents in a mammal which comprises administering concomitantly with said agents and orally to said mammal and effective amount of a compound selected from the group consisting of those of the formula:
wherein R is hydrogen or alkyl having up to 12 carbon atoms, R is hydrogen or hydroxy, the moiety C C is ethylene or cis-vinylene, and the moiety -C -C is ethylene or cis-vinylene with the proviso that when the moiety -C -C is ethylene then the moiety C -C must be ethylene, and the non-toxic pharmaceutically acceptable cationic salts thereof when R is hydrogen; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body Weight of said mammal.
2. The method according to claim 1 wherein R and R are 'both hydrogen, the moiety -C C is cis-vinylene, and the moiety C C is ethylene; ll-deoxyprostaglandin E 3. The method according to claim 1 wherein R and R are both hydrogen, and the moieties C -C and --C C are both cis-vinylene; ll-deoxy-prostaglandin 4. The method according to claim 1 wherein R is hydrogen, R is hydroxy, the moiety C C is ethylene, and the moiety C -C is cis-vinylene; prostaglandin E 5. The method of inhibiting the ulcerogenic effect induced by non-steroidal anti-inflammatory agents in a mammal which comprises administering concomitantly with said agents and orally to said mammal an effective amount of a compound selected from the group consisting of those of the formula:
wherein R is hydrogen or alkyl having up to 12 carbon atoms, the moiety -C C is ethylene or ci s-vinylene, and the moiety -C C is ethylene or cis-vinylene, with the proviso that when the moiety C C is ethylene then the moiety --C -C must be ethylene, and the non-toxic pharmaceutically acceptable cationic salts thereof when R is hydrogen; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body Weight of said mammal.
6. The method according to claim 5 wherein R is hydrogen, and the moieties C -C and -C -C are both ethylene; prostaglandin A 7. The method according to claim 5 wherein R is hydrogen, the moiety -C C is cis-vinylene, and the moiety C -C is ethylene; prostaglandin A 8. The method according to claim 5 wherein R is hydrogen, and the moieties C -C and -C -C are both cis-vinylene; prostaglandin A 9. The method of inhibiting the ulcerogenic effect induced by non-steroidal anti-inflammatory agents in a mammal which comprises administering concomitantly with said agents and orally to said mammal an effective amount of a compound selected from the group consisting of 13,14-dihydro-prostaglandin E and the non-toxic pharmaceutically acceptable cationic salts thereof; in association with a pharmaceutical carrier to provide a daily dosage of from about 0.003 mg. to about 0.7 mg. per kilogram of body weight of said mammal.
References Cited Horton: Physiological Reviews, vol. 49 (1969), pp. 127, 131 and 143.
SAM ROSEN, Primary Examiner US. Cl. X.R.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US29371072A | 1972-09-29 | 1972-09-29 |
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|---|---|
| US3781429A true US3781429A (en) | 1973-12-25 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| US00293710A Expired - Lifetime US3781429A (en) | 1972-09-29 | 1972-09-29 | Method of inhibiting ulcerogenesis induced by non-steroidal anti-inflammatory agents |
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Cited By (16)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3911124A (en) * | 1974-01-28 | 1975-10-07 | Upjohn Co | Method of reducing the undesirable gastrointestinal effects of prostaglandin synthetase inhibitors |
| US3917828A (en) * | 1974-01-28 | 1975-11-04 | Upjohn Co | Method of reducing the undesirable gastraintestinal effects of prostaglandin synthetase inhibitors |
| US3927213A (en) * | 1973-07-10 | 1975-12-16 | American Home Prod | Prostaglandin E{HD 2 {B and derivatives for reducing the side effects of anti-inflammatory agents |
| US3928588A (en) * | 1974-02-22 | 1975-12-23 | Upjohn Co | Method of reducing the undesirable gastrointestinal effects of prostaglandin synthetase inhibitors |
| US4089951A (en) * | 1976-04-14 | 1978-05-16 | Imperial Chemical Industries Limited | Oestrus or menstrual regulation |
| US4359465A (en) * | 1980-07-28 | 1982-11-16 | The Upjohn Company | Methods for treating gastrointestinal inflammation |
| EP0029247B1 (en) * | 1979-11-20 | 1983-04-13 | A. Nattermann & Cie. GmbH | Alkenyl thienyl alkane carboxylic acids and their derivatives, process for their preparation and medicaments containing them |
| EP0108452A1 (en) * | 1982-11-05 | 1984-05-16 | The Procter & Gamble Company | Treatment of gastric inflammatory disease with cytoprotective prostaglandins and histamine-2 blocking anti-secretory agents |
| EP0159784A1 (en) | 1984-03-08 | 1985-10-30 | The Upjohn Company | Carbacyclin analogues |
| WO1992006684A1 (en) * | 1990-10-18 | 1992-04-30 | Syntex (Usa) Inc. | A new use of enprostil |
| US6183779B1 (en) | 1999-03-22 | 2001-02-06 | Pharmascience Inc. | Stabilized pharmaceutical composition of a nonsteroidal anti-inflammatory agent and a prostaglandin |
| US6410595B1 (en) | 1997-07-09 | 2002-06-25 | Androsolutions, Inc. | Methods and compositions for treating male erectile dysfunction |
| US6414027B1 (en) | 1997-07-09 | 2002-07-02 | Androsolutions, Inc. | Methods and compositions for treating male erectile dysfunction |
| WO2004004738A1 (en) * | 2002-07-02 | 2004-01-15 | Wakamoto Pharmaceutical Co.,Ltd. | Remedy or preventive for keratoconjunctival epithelial cell injury |
| US20050124699A1 (en) * | 2002-07-02 | 2005-06-09 | Wakamoto Pharmaceutical Co., Ltd. | Drugs for treating or preventing disorders of corneal and/or conjunctival epithelial cells |
| WO2009005172A1 (en) * | 2007-07-03 | 2009-01-08 | Sucampo Ag | Pharmaceutical combination of nsaid and prostaglandin compound |
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1972
- 1972-09-29 US US00293710A patent/US3781429A/en not_active Expired - Lifetime
Cited By (19)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3927213A (en) * | 1973-07-10 | 1975-12-16 | American Home Prod | Prostaglandin E{HD 2 {B and derivatives for reducing the side effects of anti-inflammatory agents |
| US3911124A (en) * | 1974-01-28 | 1975-10-07 | Upjohn Co | Method of reducing the undesirable gastrointestinal effects of prostaglandin synthetase inhibitors |
| US3917828A (en) * | 1974-01-28 | 1975-11-04 | Upjohn Co | Method of reducing the undesirable gastraintestinal effects of prostaglandin synthetase inhibitors |
| US3928588A (en) * | 1974-02-22 | 1975-12-23 | Upjohn Co | Method of reducing the undesirable gastrointestinal effects of prostaglandin synthetase inhibitors |
| US4089951A (en) * | 1976-04-14 | 1978-05-16 | Imperial Chemical Industries Limited | Oestrus or menstrual regulation |
| EP0029247B1 (en) * | 1979-11-20 | 1983-04-13 | A. Nattermann & Cie. GmbH | Alkenyl thienyl alkane carboxylic acids and their derivatives, process for their preparation and medicaments containing them |
| US4359465A (en) * | 1980-07-28 | 1982-11-16 | The Upjohn Company | Methods for treating gastrointestinal inflammation |
| EP0108452A1 (en) * | 1982-11-05 | 1984-05-16 | The Procter & Gamble Company | Treatment of gastric inflammatory disease with cytoprotective prostaglandins and histamine-2 blocking anti-secretory agents |
| EP0159784A1 (en) | 1984-03-08 | 1985-10-30 | The Upjohn Company | Carbacyclin analogues |
| WO1992006684A1 (en) * | 1990-10-18 | 1992-04-30 | Syntex (Usa) Inc. | A new use of enprostil |
| US6410595B1 (en) | 1997-07-09 | 2002-06-25 | Androsolutions, Inc. | Methods and compositions for treating male erectile dysfunction |
| US6414027B1 (en) | 1997-07-09 | 2002-07-02 | Androsolutions, Inc. | Methods and compositions for treating male erectile dysfunction |
| US6559184B2 (en) | 1997-07-09 | 2003-05-06 | Androsolutions, Inc. | Methods and compositions for treating male erectile dysfunction |
| US6183779B1 (en) | 1999-03-22 | 2001-02-06 | Pharmascience Inc. | Stabilized pharmaceutical composition of a nonsteroidal anti-inflammatory agent and a prostaglandin |
| US6287600B1 (en) | 1999-03-22 | 2001-09-11 | Pharmascience Inc. | Stabilized pharmaceutical composition of a nonsteroidal anti-inflammatory agent and a prostaglandin |
| WO2004004738A1 (en) * | 2002-07-02 | 2004-01-15 | Wakamoto Pharmaceutical Co.,Ltd. | Remedy or preventive for keratoconjunctival epithelial cell injury |
| US20050124699A1 (en) * | 2002-07-02 | 2005-06-09 | Wakamoto Pharmaceutical Co., Ltd. | Drugs for treating or preventing disorders of corneal and/or conjunctival epithelial cells |
| WO2009005172A1 (en) * | 2007-07-03 | 2009-01-08 | Sucampo Ag | Pharmaceutical combination of nsaid and prostaglandin compound |
| US20090012165A1 (en) * | 2007-07-03 | 2009-01-08 | Sucampo Ag | Pharmaceutical combination of nsaid and prostaglandin compound |
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