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WO2018152554A1 - Compositions antitussives et méthodes - Google Patents

Compositions antitussives et méthodes Download PDF

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Publication number
WO2018152554A1
WO2018152554A1 PCT/US2018/033909 US2018033909W WO2018152554A1 WO 2018152554 A1 WO2018152554 A1 WO 2018152554A1 US 2018033909 W US2018033909 W US 2018033909W WO 2018152554 A1 WO2018152554 A1 WO 2018152554A1
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Prior art keywords
hydrochloride
cough
methyl
chosen
nicotinic receptor
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English (en)
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Jing Liang
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Attenua Inc
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Attenua Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • 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
    • A61K31/4375—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 six-membered ring having nitrogen as a ring heteroatom, e.g. quinolizines, naphthyridines, berberine, vincamine
    • 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
    • A61K31/465—Nicotine; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/14—Antitussive agents

Definitions

  • compositions incorporating antitussive compounds capable of affecting nicotinic acetylcholinergic receptors (nAChRs), for example, as agonists and/or partial agonists of specific nicotinic receptor subtypes.
  • nAChRs nicotinic acetylcholinergic receptors
  • Methods of agonistic and/or partial agonist nicotinic acetylcholinergic receptor (nAChR) activity in a human are also provided for treating a wide variety of conditions and disorders, particularly those associated with suppressing cough.
  • Cough is the most common symptom for which patients seek medical advice from primary health care providers.
  • Current antitussive therapies are minimally effective and have side effects that limit their utility.
  • In the United States alone over 2 billion dollars are spent annually on over the counter cough remedies with questionable efficacy, potential toxicity, and abuse potential, with billions more spent annually in sick days and doctor's visits.
  • Cough is the primary mechanism of transmission of airborne infections, including all forms of influenza, tuberculosis, and Bordetella pertussis, the gram negative bacterium causing whooping cough. As such, cough represents a major public health issue that is poorly treated with currently existing therapies.
  • the present disclosure relates to pharmaceutical compositions incorporating antitussive compounds capable of affecting nicotinic acetylcholinergic receptors (nAChRs), for example, as agonists and/or partial agonists of specific nicotinic receptor subtypes.
  • nAChRs nicotinic acetylcholinergic receptors
  • the present disclosure relates to pharmaceutical compositions incorporating antitussive compounds capable of affecting nicotinic acetylcholinergic receptors (nAChRs), for example, as agonists and/or partial agonists of specific nicotinic receptor subtypes, specifically, the ⁇ 4 ⁇ 2 nAChR subtype.
  • nAChRs nicotinic acetylcholinergic receptors
  • the present disclosure relates to pharmaceutical compositions incorporating antitussive compounds capable of affecting nicotinic acetylcholinergic receptors (nAChRs), for example, as agonists and/or partial agonists of specific nicotinic receptor subtypes, specifically, the a 7 nAChR subtype.
  • nAChRs nicotinic acetylcholinergic receptors
  • antitussive compounds disclosed herein are of the azabicycloalkane category, and generally are azabicyclooctanes.
  • the aryl group in the arylalkyl moiety is a 6-membered ring heteroaromatic, preferably 3-pyridinyl moieties, and the alkyl group is typically a Ci-4 alkyl.
  • the substituent at the 3-position of the 1 -azabicycloalkane is a carbonyl-containing functional group, preferably an amide, or similar functionality.
  • compositions incorporating antitussive compounds comprising a nicotinic receptor agonist and/or partial agonist of a specific nicotinic receptor subtype, specifically of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes.
  • a method of treating cough in a subject in need thereof comprising the step of administering to the subject a therapeutically effective amount of a nicotinic receptor agonist and/or partial agonist of a specific nicotinic receptor subtype, optionally of the ⁇ 4 ⁇ 2 or nAChR subtypes.
  • Treatment of cough may be effected by suppressing cough in the subject.
  • the nicotinic receptor agonist and/or partial agonist may be formulated as a pharmaceutical composition.
  • antitussive compounds for use in human therapy.
  • the antitussive compounds are selected from nicotinic receptor agonists and/or partial agonists of a specific nicotinic receptor subtype, optionally of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes.
  • the antitussive compounds may be formulated as a pharmaceutical composition.
  • antitussive compounds for use in treating cough.
  • the antitussive compounds are selected from nicotinic receptor agonists and/or partial agonists of a specific nicotinic receptor subtype, optionally of the ⁇ 4 ⁇ 2 or a 7 nAChR subtypes.
  • Treatment of cough may be effected by suppressing cough.
  • antitussive compounds for the manufacture of medicaments to treat cough.
  • the antitussive compounds are selected from nicotinic receptor agonists and/or partial agonists of a specific nicotinic receptor subtype, optionally of the ⁇ 4 ⁇ 2 or a 7 nAChR subtypes.
  • Disclosed herein is a method of suppressing cough in a subject comprising administering to the subject in need thereof a therapeutically effective amount of a nicotinic receptor agonist.
  • said nicotinic receptor agonist is a a7 nicotinic receptor agonist.
  • said a7 nicotinic receptor agonist is chosen from N-[(3R)-1- Azabicyclo[2.2.2]oct-3-yl]-7-chloro-l-benzothiophene-2-carboxamide (encenicline, EVP- 6124), N-[(3R)-l-Azabicyclo[2.2.2]oct-3-yl]-7-chloro-l-benzothiophene-2-carboxamide (CP-810123), (3R)-3- ⁇ [6-(4-methylphenyl)pyridin-3-yl]oxy ⁇ -l-azabicyclo[2.2.2]octane (AQW-051), 2-(((3i?,4i?,55',75 -l-azaadamantan-4-yl)oxy)-5-phenyl-l,3,4-thiadiazole (Nelonicline, ABT-126), (4aS,6R,8aS)-5,6,9
  • said method further comprises administering to said subject one or more additional pharmaceutically active ingredients chosen from antitussives other than nicotine or a derivative thereof, antipyretics, expectorants, mucolytics, nasal decongestants, antihistamines, opioid analgesics, or non-opiate analgesics.
  • additional pharmaceutically active ingredients chosen from antitussives other than nicotine or a derivative thereof, antipyretics, expectorants, mucolytics, nasal decongestants, antihistamines, opioid analgesics, or non-opiate analgesics.
  • said antitussive is chosen from ambroxol, apomorphine hydrochloride, beechwood creosote, benzonatate, camphor ethanedisulfonate, caramiphen edisylate, carbetapentane citrate, chlophendianol hydrochloride, codeine, codeine phosphate, codeine sulfate, dextromethorphan, dextromethorphan hydrobromide, diphenhydramine, diphenhydramine hydrochloride, fentanyl, fentanyl citrate, hydrocodone, hydromorphone hydrochloride, levorphanol tartrate, menthol, methadone hydrochloride, morphine, morphine sulfate, noscapine, noscapine hydrochloride, oxycodone hydrochloride, oxymorphone hydrochloride or zinc gluconate.
  • said expectorant is chosen from acetylcysteine, ammonium carbonate, ammonium chloride, antimony potassium tartrate, glycerin, guaifenesin, potassium iodide, sodium citrate, terpin hydrate, or tolu balsam.
  • said mucolytic is chosen from acetylcysteine, ambroxol, bromhexine, carbocisteine, domiodol, domase alfa, eprazinone, erdosteine, letosteine, mesna, neltenexine, sobrerol, stepronin, or tiopronin.
  • said nasal decongestant is chosen from ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine bitartrate, hydroxy amphetamine hydrobromide, mephentermine sulfate, methoxamine hydrochloride, naphazoline hydrochloride, oxymetalozine hydrochloride, phenylpropanolamine hydrochloride, propylhexedrine, psuedoephedrine hydrochloride, tetrahydrozoline hydrochloride, or xylometazoline hydrochloride.
  • said antihistamine is chosen from antazoline, azatadine, brompheniramine, brompheniramine mepyramine, carbinoxamine, chlorcyclizine, chlorpheniramine, chlorpheniramine, clemastine, cyclizine, cyproheptadine,
  • said opioid analgesic is chosen from codeine, diphenoxylate, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, oxycodone, oxymorphone, or propoxyphene.
  • said non-opioid analgesic is chosen from memantine, acetaminophen, aspirin, ibuprofen, or naproxen.
  • said nicotinic receptor agonist is administered in the form of a capsule, elixir, fast-melt strip, gum, lozenge, liquid, lotion, nasal-inhaled spray, oral-inhaled spray, orally disintegrating tablet, syrup, tablet, or transdermal patch.
  • said subject is a human.
  • said nicotinic receptor agonist is administered once a day.
  • said nicotinic receptor agonist is administered twice a day.
  • said nicotinic receptor agonist is administered at least three times a day.
  • said cough is a symptom of one or more conditions chosen from sneezing, rhinorrhea, nasal obstruction, nasal congestion, nasal pruritus, rhinorrhea, allergies, allergic vasomotor rhinitis (hay fever), seasonal allergic vasomotor rhinitis, perennial allergic vasomotor rhinitis, a respiratory disease, a cold, acute bronchitis, chronic bronchitis, asthmatic bronchitis, bronchiectasis, pneumonia, lung tuberculosis, silicosis, silicotuberculosis, pulmonary cancer, upper respiratory inflammation, pharyngitis, laryngitis, nasal catarrh, asthma, bronchial asthma, infantile asthma, pulmonary emphysema, pneumoconiosis, pulmonary fibrosis, pulmonary silicosis, pulmonary suppuration, pleuritis, tonsillitis, cough hives,
  • said cough is acute.
  • said cough is subacute.
  • said cough is chronic.
  • said nicotinic receptor agonist is administered orally or by intramuscular injection, subcutaneous injection, intraperitoneal injection, intrathecal, sublingual.
  • said method of suppressing or reducing cough comprises orally consuming a cough suppressing or reducing amount of a nicotinic receptor agonist.
  • the term "and/or" when used in a list of two or more items, means that any one of the listed items can be employed by itself or in combination with any one or more of the listed items.
  • the expression “A and/or B” is intended to mean either or both of A and B, i.e. A alone, B alone or A and B in combination.
  • the expression “A, B and/or C” is intended to mean A alone, B alone, C alone, A and B in combination, A and C in combination, B and C in combination or A, B, and C in combination.
  • ni and m are the numbers, then unless otherwise specified, this notation is intended to include the numbers themselves and the range between them. This range may be integral or continuous between and including the end values.
  • the range “from 2 to 6 carbons” is intended to include two, three, four, five, and six carbons, since carbons come in integer units. Compare, by way of example, the range “from 1 to 3 ⁇ (micromolar),” which is intended to include 1 ⁇ , 3 ⁇ , and everything in between to any number of significant figures (e.g., 1.255 ⁇ , 2.1 ⁇ , 2.9999 ⁇ , etc.).
  • combination therapy means the administration of two or more therapeutic agents to treat a therapeutic condition or disorder described in the present disclosure. Such administration encompasses co-administration of these therapeutic agents in a substantially simultaneous manner, such as in a single capsule having a fixed ratio of active ingredients or in multiple, separate capsules for each active ingredient. In addition, such administration also encompasses use of each type of therapeutic agent in a sequential manner. In either case, the treatment regimen will provide beneficial effects of the drug combination in treating the conditions or disorders described herein.
  • terapéuticaally effective is intended to qualify the amount of active ingredients used in the treatment of a disease or disorder or on the effecting of a clinical endpoint.
  • therapeutically acceptable refers to those compounds (or salts, prodrugs, tautomers, zwitterionic forms, etc.) which are suitable for use in contact with the tissues of patients without undue toxicity, irritation, and allergic response, are commensurate with a reasonable benefit/risk ratio, and are effective for their intended use.
  • treatment of a patient is intended to include prophylaxis.
  • Treatment may also be preemptive in nature, i.e., it may include prevention of a disease or condition.
  • Prevention of a disease or condition may involve complete protection from the disease or condition, for example as in the case of prevention of infection with a pathogen, or may involve prevention disease progression or worsening of the condition.
  • prevention of a disease or condition may not mean complete foreclosure of any effect related to the diseases or conditions at any level, but instead may mean prevention of the symptoms of a disease or condition to a clinically significant or detectable level.
  • Prevention of diseases may also mean prevention of progression of a disease to a later stage of the disease.
  • an "agonist” is a substance that stimulates its binding partner, typically a receptor. Stimulation is defined in the context of the particular assay, or may be apparent in the literature from a discussion herein that makes a comparison to a factor or substance that is accepted as an "agonist” or an “antagonist” of the particular binding partner under substantially similar circumstances as appreciated by those of skill in the art. Stimulation may be defined with respect to an increase in a particular effect or function that is induced by interaction of the agonist or partial agonist with a binding partner and can include allosteric effects.
  • an "antagonist” is a substance that inhibits its binding partner, typically a receptor. Inhibition is defined in the context of the particular assay, or may be apparent in the literature from a discussion herein that makes a comparison toa factor or substance that is accepted as an "agonist” or an “antagonist” of the particular binding partner under substantially similar circumstances as appreciated by those of skill in the art. Inhibition may be defined with respect to a decrease in a particular effect or function that is induced by interaction of the antagonist with a binding partner, and can include allosteric effects.
  • a "partial agonist” is a substance that provides a level of stimulation to its binding partner binds to and activates a given receptor, but have only partial efficacy at the receptor relative to a full agonist.
  • ⁇ 4 ⁇ 2 nicotinic acetylcholinergic receptors contain two oc4 subunits and three ⁇ 2 subunits, therefore it as two binding sites for ACh and other agonists.
  • ⁇ 4 ⁇ 2 nAChRs account for approximately 90% of the nAChRs in the human brain and when chronically exposed to nicotine or other nicotine agonists leads to increase in density of ⁇ 4 ⁇ 2 receptors which is the opposite of what usually happens when other receptors are chronically exposed to their agonists.
  • a7 nicotinic acetylcholinergic receptors are homomeric neuronal acetylcholine receptors consisting of five a7 subunits and has five ACh binding sites. Abnormality in the a7 receptors expression have been reported to influence progression of diseases such as Alzheimer's disease and schizophrenia.
  • N-Methyl-D-Aspartate (NMD A) Receptor Antagonists are are a class of anesthetics that work to antagonize, or inhibit the action of, the N-Methyl-D- aspartatereceptor (NMDAR). They are used as anesthetics for animals and for humans; the state of anesthesia they induce is referred to as dissociative anesthesia. Memantine is an example of an NMDA receptor antagonist that can be used in combination with the antitussive compounds described herein, for treating or suppressing cough.
  • the compounds disclosed herein can exist as therapeutically acceptable salts.
  • the present disclosure includes compounds listed above in the form of salts, including acid addition salts. Suitable salts include those formed with both organic and inorganic acids. Such acid addition salts will normally be pharmaceutically acceptable. However, salts of non- pharmaceutically acceptable salts may be of utility in the preparation and purification of the compound in question. Basic addition salts may also be formed and be pharmaceutically acceptable.
  • Pharmaceutical Salts Properties. Selection, and Use. (Stahl, P. Heinrich. Wiley-VCHA, Zurich, Switzerland, 2002).
  • terapéuticaally acceptable salt represents salts or zwitterionic forms of the compounds disclosed herein which are water or oil-soluble or dispersible and therapeutically acceptable as defined herein.
  • the salts can be prepared during the final isolation and purification of the compounds or separately by reacting the appropriate compound in the form of the free base with a suitable acid.
  • Representative acid addition salts include acetate, adipate, alginate, L-ascorbate, aspartate, benzoate, benzenesulfonate (besylate), bisulfate, butyrate, camphorate, camphorsulfonate, citrate, digluconate, formate, fumarate, gentisate, glutarate, glycerophosphate, glycolate, hemisulfate, heptanoate, hexanoate, hippurate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethansulfonate (isethionate), lactate, maleate, malonate, DL-mandelate, mesitylenesulfonate, methanesulfonate, naphthylenesulfonate, nicotinate, 2-naphthalenesulfonate, oxalate, pamoate, pectinate, persulfate, 3-phenyl
  • basic groups in the compounds disclosed herein can be quaternized with methyl, ethyl, propyl, and butyl chlorides, bromides, and iodides; dimethyl, diethyl, dibutyl, and diamyl sulfates; decyl, lauryl, myristyl, and steryl chlorides, bromides, and iodides; and benzyl and phenethyl bromides.
  • acids which can be employed to form therapeutically acceptable addition salts include inorganic acids such as hydrochloric, hydrobromic, sulfuric, and phosphoric, and organic acids such as oxalic, maleic, succinic, and citric.
  • Salts can also be formed by coordination of the compounds with an alkali metal or alkaline earth ion.
  • the present disclosure contemplates sodium, potassium, magnesium, and calcium salts of the compounds disclosed herein, and the like.
  • Basic addition salts can be prepared during the final isolation and purification of the compounds by reacting a carboxy group with a suitable base such as the hydroxide, carbonate, or bicarbonate of a metal cation or with ammonia or an organic primary, secondary, or tertiary amine.
  • the cations of therapeutically acceptable salts include lithium, sodium, potassium, calcium, magnesium, and aluminum, as well as nontoxic quaternary amine cations such as ammonium, tetramethylammonium, tetraethylammonium, methylamine, dimethylamine, trimethylamine, triethylamine, diethylamine, ethylamine, tributylamine, pyridine, N,N-dimethylaniline, N-methylpiperidine, N-methylmorpholine, dicyclohexylamine, procaine, dibenzylamine, ⁇ , ⁇ -dibenzylphenethylamine, 1 -ephenamine, and ⁇ , ⁇ '-dibenzylethylenediamine.
  • nontoxic quaternary amine cations such as ammonium, tetramethylammonium, tetraethylammonium, methylamine, dimethylamine, trimethylamine, triethylamine, diethy
  • a salt of a compound can be made by reacting the appropriate compound in the form of the free base with the appropriate acid.
  • antitussive compounds for treating or suppressing cough, wherein the antitussive compounds are nicotinic receptor agonists.
  • Nicotinic receptor agonists are ligands that mimic the action of acetylcholine at nicotinic acetylcholine receptors.
  • nicotinic receptor agonists specifically, the ⁇ 4 ⁇ 2 nAChR subtype: trans-meta-nicotine, varenicline, 5-iodo-3-(2(5 -azetidinylmethoxy)pyridine (5-iodo-A-85380), Tebanicline (Ebanicline, ABT-594), 3-(5,6-dichloro-pyridin-3-yl)-l(S),5 (S)-3,6-diazabicyclo[3.2.0]heptane (ABT-894), acetylcholine, cytisine, imidacloprid, lobeline, ispronicline (TC-1734, AZD-3480), metanicotine, (E)-N-Methyl-4-(3-pyridinyl)-3- buten-l-amine oxalate (RJR-2403, Metanicotine, TC-2403
  • the ⁇ 4 ⁇ 2 nicotinic receptor agonists may be present in the form of their pharmaceutically acceptable salts, such as, but not limited to, an acid salt such as acetates, tartrates, chloride, phosphate, sulfates, sulfites, carbonates, bicarbonate and citrates.
  • an acid salt such as acetates, tartrates, chloride, phosphate, sulfates, sulfites, carbonates, bicarbonate and citrates.
  • nicotinic receptor agonists specifically, the a 7 nAChR subtype: N-[(3R)-l-Azabicyclo[2.2.2]oct-3-yl]-7-chloro-l-benzothiophene-2-carboxamide (encenicline, EVP-6124), N-[(3R)-l-Azabicyclo[2.2.2]oct-3-yl]-7-chloro-l-benzothiophene- 2-carboxamide (CP-810123), (3R)-3 - ⁇ [6-(4-methy lpheny l)py ridin-3 -y 1] oxy ⁇ - 1 - azabicyclo[2.2.2]octane (AQW-051), 2-(((3i?,4i?,55',75 -l-azaadamantan-4-yl)oxy)-5-phenyl- 1,3,4-thiadiazol
  • the a7 nicotinic receptor agonists may be present in the form of their pharmaceutically acceptable salts, such as, but not limited to, an acid salt such as acetates, tartrates, chloride, phosphate, sulfates, sulfites, carbonates, bicarbonate and citrates.
  • an acid salt such as acetates, tartrates, chloride, phosphate, sulfates, sulfites, carbonates, bicarbonate and citrates.
  • the pharmaceutical compositions described herein is the (2R,3R;
  • Another embodiment as described herein is the pure enantiomer, (2S,3R)-N-(2-((3- pyridinyl)methyl)-l-azabicyclo[2.2.2]oct-3-yl)benzofuran-2-carboxamide and/or pharmaceutically acceptable salts thereof.
  • the pharmaceutically acceptable salt of the pure enantiomer, (2S,3R)-N-(2-((3-pyridinyl)methyl)-l-azabicyclo[2.2.2]oct-3- yl)benzofuran-2-carboxamide is the hydrochloride salt.
  • the antitussive compound is administered in combination with an additional antitussive chosen from ambroxol, apomorphine hydrochloride, beechwood creosote, benzonatate, camphor ethanedisulfonate, caramiphen edisylate, carbetapentane citrate, chlophendianol hydrochloride, codeine, codeine phosphate, codeine sulfate, dextromethorphan, dextromethorphan hydrobromide, diphenhydramine, diphenhydramine hydrochloride, fentanyl, fentanyl citrate, hydrocodone, hydromorphone hydrochloride, levorphanol tartrate, menthol, methadone hydrochloride, morphine, morphine sulfate, noscapine, noscapine hydrochloride, oxycodone hydrochloride, and oxymorphone hydrochloride, zinc gluconate.
  • an additional antitussive chosen from am
  • the antitussive compound is administered in combination with an expectorant chosen from acetylcysteine, ammonium carbonate, ammonium chloride, antimony potassium tartrate, glycerin, guaifenesin, potassium iodide, sodium citrate, terpin hydrate, tolu balsam.
  • an expectorant chosen from acetylcysteine, ammonium carbonate, ammonium chloride, antimony potassium tartrate, glycerin, guaifenesin, potassium iodide, sodium citrate, terpin hydrate, tolu balsam.
  • the antitussive compound is administered in combination with a mucolytic chosen from acetylcysteine, ambroxol, bromhexine, carbocisteine, domiodol, dornase alfa, eprazinone, erdosteine, letosteine, mesna, neltenexine, sobrerol, stepronin, and tiopronin.
  • a mucolytic chosen from acetylcysteine, ambroxol, bromhexine, carbocisteine, domiodol, dornase alfa, eprazinone, erdosteine, letosteine, mesna, neltenexine, sobrerol, stepronin, and tiopronin.
  • the antitussive compound is administered in combination with a nasal decongestant chosen from ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine bitartrate, hydroxy amphetamine hydrobromide, mephentermine sulfate, methoxamine hydrochloride, naphazoline hydrochloride, oxymetalozine hydrochloride, phenylpropanolamine hydrochloride, propylhexedrine, psuedoephedrine hydrochloride, tetrahydrozoline hydrochloride, and xylometazoline hydrochloride.
  • a nasal decongestant chosen from ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine bitartrate, hydroxy amphetamine hydrobromide, mephentermine sulfate, metho
  • the antitussive composition comprises an antihistamine chosen from antazoline, azatadine, brompheniramine, brompheniramine mepyramine, carbinoxamine, chlorcyclizine, chlorpheniramine, chlorpheniramine, clemastine, cyclizine, cyproheptadine, dexchlorpheniramine, dimenhydrinate, dimetindene, diphenhydramine, diphenhydramine, doxylamine, doxylamine, hydroxyzine, ketotifen, meclizine, pheniramine, promethazine, trimeprazine, and triprolidine.
  • an antihistamine chosen from antazoline, azatadine, brompheniramine, brompheniramine mepyramine, carbinoxamine, chlorcyclizine, chlorpheniramine, chlorpheniramine, clemastine, cyclizine, cyproheptadine, dexchlorpheni
  • the antitussive compound is administered in combination with an opioid analgesic chosen from codeine, diphenoxylate, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, oxycodone, oxymorphone, and propoxyphene.
  • opioid analgesic chosen from codeine, diphenoxylate, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, oxycodone, oxymorphone, and propoxyphene.
  • the antitussive compound is administered in combination with a non-opioid analgesic chosen from memantine, acetaminophen, aspirin, ibuprofen and naproxen.
  • a non-opioid analgesic chosen from memantine, acetaminophen, aspirin, ibuprofen and naproxen.
  • the compounds described herein can be incorporated into pharmaceutical compositions and used to prevent a condition or disorder in a subject susceptible to such a condition or disorder, and/or to treat a subject suffering from the condition or disorder.
  • such condition or disorder is cough, optionally wherein prevention or treatment is effected by suppressing cough.
  • compositions described herein include nicotinic receptor agonists, specifically, of the ⁇ 4 ⁇ 2 or a 7 nAChR subtypes.
  • the pharmaceutical compositions described herein include one or more additional ingredients selected from antitussives other than nicotine or a derivative thereof, antipyretics, expectorants, mucolytics, nasal decongestants, antihistamines, opioid analgesics, or non-opiate analgesics. Such ingredients may be selected from any of the options set forth above.
  • compositions are preferably administered orally (e.g., in liquid form within a solvent such as an aqueous or non-aqueous liquid, or within a solid carrier).
  • Preferred compositions for oral administration include pills, tablets, capsules, caplets, syrups, and solutions, including hard gelatin capsules and time-release capsules.
  • Compositions can be formulated in unit dose form, or in multiple or subunit doses.
  • Preferred compositions are in liquid or semisolid form.
  • Compositions including a liquid pharmaceutically inert carrier such as water or other pharmaceutically compatible liquids or semisolids can be used. The use of such liquids and semisolids is well known to those of skill in the art.
  • compositions can also be administered via injection, i.e., intravenously, intramuscularly, subcutaneously, intraperitoneally, intraarterially, intrathecally; and intracerebroventricularly.
  • Intravenous administration is the preferred method of injection.
  • Suitable carriers for injection are well known to those of skill in the art and include 5% dextrose solutions, saline, and phosphate-buffered saline.
  • the compounds can also be administered as an infusion or inj ection (e.g., as a suspension or as anemulsion in a pharmaceutically acceptable liquid or mixture of liquids).
  • the formulations can also be administered using other means, for example, rectal administration.
  • Formulations useful for rectal administration are well known to those of skill in the art.
  • the compounds can also be administered by inhalation (e.g., in the form of an aerosol either nasally or using delivery articles of the type set forth in U. S. Patent No. 4,922,901 to Brooks et al., the disclosure of which is incorporated herein in its entirety); topically (e.g., in lotionform); or transdermally (e.g., using a transdermal patch, using technology that is commercially available from Novartis and Alza Corporation).
  • inhalation e.g., in the form of an aerosol either nasally or using delivery articles of the type set forth in U. S. Patent No. 4,922,901 to Brooks et al., the disclosure of which is incorporated herein in its entirety
  • topically e.g., in lotionform
  • transdermally e.g., using a transdermal patch, using technology that is commercially available from Novartis and Alza Corporation.
  • compositions used and the particular subject receiving the treatment can contain a liquid carrier that can be oily, aqueous, emulsified or contain certain solvents suitable to the mode of administration.
  • compositions can be administered intermittently or at a gradual, continuous, constant or controlled rate to a warm-blooded animal (e.g., a mammal such as a mouse, rat, cat, rabbit, dog, pig, cow, or monkey), but advantageously are administered to a human being.
  • a warm-blooded animal e.g., a mammal such as a mouse, rat, cat, rabbit, dog, pig, cow, or monkey
  • time of day and the number of times per day that the pharmaceutical formulation is administered can vary.
  • the active ingredients interact with receptor sites within the body of the subject that affect suppressing cough. More specifically, in suppressing cough, preferable administration is designed to optimize the effect upon those relevant nicotinic acethylcholine receptor (nAChR) subtypes, e.g., specifically, of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes, that have an effect upon suppressing cough, while minimizing the effects upon muscle-type receptor subtypes.
  • nAChR nicotinic acethylcholine receptor
  • Other suitable methods for administering the compounds of the present disclosure are described in U.S. Patent No. 5,604,231 to Smith et al, the contents of which are hereby incorporated by reference.
  • the compounds described herein can be employed as part of a pharmaceutical composition with other compounds intended to prevent or treat a particular disorder.
  • the pharmaceutical compositions can also include various other components as additives or adjuncts.
  • Exemplary pharmaceutically acceptable components or adjuncts which are employed in relevant circumstances include antioxidants, free-radical scavenging agents, peptides, growth factors, antibiotics, bacteriostatic agents, immunosuppressives, anticoagulants, buffering agents, antiinflammatoryagents, anti-pyretics, time-release binders, anesthetics, steroids, vitamins, minerals and corticosteroids.
  • Such components can provide additional therapeutic benefit, act to affect the therapeutic action of the pharmaceutical composition, or act towards preventing any potential side effects that can be imposed as a result of administration of the pharmaceutical composition.
  • an effective amount of the compound is that amount effective to prevent occurrence of the symptoms of the disorder or to treat some symptoms of the disorder from which the patient suffers.
  • an effective amount of compound is an amount sufficient to pass across the blood-brain barrier of the subject, to bind to relevant receptor sites in the brain of the subject and to modulate the activity of relevant nAChR subtypes (e.g., specifically, of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes, that have an effect upon suppressing cough).
  • Prevention of the disorder is manifested by delaying the onset of the symptoms of the disorder.
  • Treatment of the disorder is manifested by a decrease in the symptoms associated with the disorder or an amelioration of the recurrence of the symptoms of the disorder.
  • the effective amount is sufficient to obtain the desired result, but insufficient to cause appreciable side effects.
  • the effective dose can vary, depending upon factors such as the condition of the patient, the severity of the symptoms of the disorder, and the manner in which the pharmaceutical composition is administered.
  • the effective dose of typical compounds generally requires administering the compound in an amount sufficient to modulate the activity of relevant nAChRs subtypes (e.g., specifically, of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes, that have an effect upon suppressing cough), but the amount should be insufficient to induce effects on skeletal muscles and ganglia to any significant degree.
  • the effective dose of compounds will of course differ from patient to patient, but in general includes amounts starting where desired therapeutic effects occur but below the amount where muscular effects are observed.
  • the compounds when employed in effective amounts in accordance with the method described herein, are selective to certain relevant nAChRs subtypes (e.g., specifically, of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes, that have an effect upon suppressing cough), but do not significantly activate receptors associated with undesirable side effects at concentrations at least greater than those required for eliciting the release of dopamine or other neurotransmitters.
  • nAChRs subtypes e.g., specifically, of the ⁇ 4 ⁇ 2 or a7 nAChR subtypes, that have an effect upon suppressing cough
  • a particular dose of compound effective in preventing and/or treating a cough is essentially ineffective in eliciting activation of certain ganglionic-type nAChRs at concentration higher than 5 times (5x), preferably higher than 100 times (lOOx), and more preferably higher than 1,000 times (lOOOx) than those required for modulation of neurotransmitter release.
  • the compounds described herein when employed in effective amounts in accordance with the methods described herein, can be used to treat cough by providing some degree of prevention and/or suppression of cough, by inhibiting the progression of cough, ameliorate symptoms of cough, and ameliorate to some degree of the recurrence of cough.
  • the effective amounts of those compounds are typically below the threshold concentration required to elicit any appreciable side effects, for example those effects relating to skeletal muscle.
  • the compounds can be administered in a therapeutic window in which certain cough disorders are treated and certain side effects are avoided.
  • the effective dose ofthe compounds described herein is sufficient to provide the desired effects upon the cough but is insufficient (i.e., is not at a high enough level) to provide undesirable side effects.
  • the compounds are administered at a dosage effective for treating a cough disorder but less than 1/5, and often less than 1/10, the amount required to elicit certain side effects to any significant degree.
  • Compounds may be administered orally at a dose of from 0.1 mg to 1 g/kg per day.
  • the dose range for adult humans is generally from 5 mg to 2 g/day.
  • Tablets or other forms of presentation provided in discrete units may conveniently contain an amount of one or more compounds which is effective at such dosage or as a multiple of the same, for instance, units containing 5 mg to 500 mg, usually around 10 mg to 200 mg.
  • the method comprises administering to said subject one or more additional pharmaceutically active ingredients chosen from antitussives other than nicotine or derivatives thereof, antihistamines, antipyretics, expectorants, mucolytics, nasal decongestants, non-opiate analgesics oropioid analgesics.
  • additional pharmaceutically active ingredients chosen from antitussives other than nicotine or derivatives thereof, antihistamines, antipyretics, expectorants, mucolytics, nasal decongestants, non-opiate analgesics oropioid analgesics.
  • the antitussive is chosen from ambroxol, apomorphine hydrochloride, beechwood creosote, benzonatate, camphor ethanedisulfonate, caramiphen edisylate, carbetapentane citrate, chlophendianol hydrochloride, codeine, codeine phosphate, codeine sulfate, dextromethorphan, dextromethorphan hydrobromide, diphenhydramine, diphenhydramine hydrochloride, fentanyl, fentanyl citrate, hydrocodone, hydromorphone hydrochloride, levorphanol tartrate, menthol, methadone hydrochloride, morphine, morphine sulfate, noscapine, noscapine hydrochloride, oxycodone hydrochloride or oxymorphone hydrochloride.
  • the expectorant is chosen from acetylcysteine, ammonium carbonate, ammonium chloride, antimony potassium tartrate, glycerin, guaifenesin, potassium iodide, sodium citrate, terpin hydrate, tolu balsam.
  • the mucolytic is chosen from acetylcysteine, ambroxol, bromhexine, carbocisteine, domiodol, dornase alfa, eprazinone, erdosteine, letosteine, mesna, neltenexine, sobrerol, stepronin or tiopronin.
  • the nasal decongestant is chosen from ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine bitartrate, hydroxy amphetamine hydrobromide, mephentermine sulfate, methoxamine hydrochloride, naphazoline hydrochloride, oxymetalozine hydrochloride, phenylpropanolamine hydrochloride, propylhexedrine, psuedoephedrine hydrochloride, tetrahydrozoline hydrochloride, or xylometazoline hydrochloride.
  • the antihistamine is chosen from antazoline, azatadine, brompheniramine, brompheniramine mepyramine, carbinoxamine, chlorcyclizine, chlorpheniramine, chlorpheniramine, clemastine, cyclizine, cyproheptadine, dexchlorpheniramine, dimenhydrinate, dimetindene, diphenhydramine, diphenhydramine, doxylamine, doxylamine, hydroxyzine, ketotifen, meclizine, pheniramine, promethazine, trimeprazine or triprolidine.
  • opioid analgesic is chosen from codeine, diphenoxylate, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine, oxycodone, oxymorphone or propoxyphene.
  • non-opioid analgesic is chosen from memantine, acetaminophen, aspirin, ibuprofen or naproxen.
  • said nicotinic receptor agonist is administered in the form of a capsule, elixir, fast-melt strip, gum, lozenge, liquid, lotion, nasal-inhaled spray, oral-inhaled spray, orally disintegrating tablet, syrup, tablet, or transdermal patch.
  • the subject is a human.
  • the cough is a symptom of one or more conditions chosen from sneezing, rhinorrhea, nasal obstruction, nasal congestion, nasal pruritus, rhinorrhea, allergies, allergic vasomotor rhinitis (hay fever), seasonal allergic vasomotor rhinitis, perennial allergic vasomotor rhinitis, a respiratory disease, a cold, acute bronchitis, chronic bronchitis, asthmatic bronchitis, bronchiectasis, pneumonia, lung tuberculosis, silicosis, silicotuberculosis, pulmonary cancer, upper respiratory inflammation, pharyngitis, laryngitis, nasal catarrh, asthma, bronchial asthma, infantile asthma, pulmonary emphysema, pneumoconiosis, pulmonary fibrosis, pulmonary silicosis, pulmonary suppuration, pleuritis, tonsillitis, cough hives,
  • nicotinic receptor agonist is administered orally or by intramuscular injection, subcutaneous injection, intraperitoneal injection, intrathecal, sublingualmal.
  • Capsaicin the pungent extract of red peppers, has been shown in over three decades of clinical experience to experimentally induce cough in a safe, dose-dependent and reproducible manner.
  • capsaicin cough challenge testing has become an important tool in clinical research, allowing for the accurate measurement of the effect of a pharmacological or other intervention on the sensitivity of the cough reflex.
  • the standard endpoint measured in capsaicin cough challenge testing is the concentration of capsaicin inducing 5 or more coughs (C5). In healthy volunteers, this endpoint has been demonstrated to be highly reproducible, in the short-term (20 minutes to 14 days) and long term (months to years).
  • Standard capsaicin challenge methodology is used in this study to assess the effect of e-cig vapor exposure on cough reflex sensitivity.
  • Electronic cigarettes are electronic nicotine delivery devices.
  • a cartridge within the e-cig contains nicotine in a vehicle of distilled water, as well as either vegetable glycerin or propylene glycol.
  • a lithium battery within the e-cig generates heat, thus vaporizing the nicotine solution. No combustion is involved in the creation of the nicotine- containing vapor that is inhaled by the user and promptly absorbed from the respiratory tract into the bloodstream.
  • Subjects will inhale single, vital-capacity breaths of ascending, doubling concentrations (range 0.49 ⁇ to 1 ,000 ⁇ ) of aerosolized capsaicin solution, administered via a compressed air-driven nebulizer controlled by a dosimeter, with 1 -minute intervals between inhalations, until 5 or more coughs resulted in the 15 seconds following an inhalation.
  • Placebo saline breaths are randomly interspersed between capsaicin doses to increase challenge blindness.
  • the end point of capsaicin challenge testing is the concentration of capsaicin inducing 5 or more coughs (C5).
  • the estimated nicotine intake from a tobacco cigarette is in the range of 1.07-2.6 mg, depending on the brand.
  • Fifteen minutes after the conclusion of the e-cigarette session subjects undergo capsaicin cough challenge.
  • the number of coughs induced by each of the 30 puffs of the e-cig is tabulated. A cough number of 5 is assigned for >5 coughs.

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  • General Health & Medical Sciences (AREA)
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  • Organic Chemistry (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

La présente invention concerne des compositions qui incluent des agonistes des récepteurs nicotiniques, spécifiquement des sous-types α7 nAChR, ainsi que des méthodes permettant de traiter ou de supprimer la toux.
PCT/US2018/033909 2017-05-22 2018-05-22 Compositions antitussives et méthodes Ceased WO2018152554A1 (fr)

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040072854A1 (en) * 2002-03-13 2004-04-15 Schering Corporation NK1 antagonists
US20170027918A1 (en) * 2015-07-31 2017-02-02 Attenua, Inc. Antitussive compositions and methods

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040072854A1 (en) * 2002-03-13 2004-04-15 Schering Corporation NK1 antagonists
US20170027918A1 (en) * 2015-07-31 2017-02-02 Attenua, Inc. Antitussive compositions and methods

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