U.S. patent application number 10/849240 was filed with the patent office on 2004-10-28 for analgesic composition and method.
This patent application is currently assigned to Wex Medical Instrumentation Co., Ltd.. Invention is credited to Ku, Baoshan, Shum, Frank Hay Kong.
Application Number | 20040214842 10/849240 |
Document ID | / |
Family ID | 4662967 |
Filed Date | 2004-10-28 |
United States Patent
Application |
20040214842 |
Kind Code |
A1 |
Ku, Baoshan ; et
al. |
October 28, 2004 |
Analgesic composition and method
Abstract
A pharmaceutical analgesic composition comprising an opioid
analgesic agent and a compound that binds to the SS1 or SS2 subunit
of a sodium channel, such as tetrodotoxin and saxitoxin, and
analogs thereof. Administration of an opioid analgesic agent and a
compound that binds to the SS1 or SS2 subunit of a sodium channel,
such as tetrodotoxin and saxitoxin, and analogs thereof, produces
analgesia in the treatment of pain in mammals.
Inventors: |
Ku, Baoshan; (Beijing,
CN) ; Shum, Frank Hay Kong; (North Point,
HK) |
Correspondence
Address: |
BIRCH STEWART KOLASCH & BIRCH
PO BOX 747
FALLS CHURCH
VA
22040-0747
US
|
Assignee: |
Wex Medical Instrumentation Co.,
Ltd.
|
Family ID: |
4662967 |
Appl. No.: |
10/849240 |
Filed: |
May 20, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10849240 |
May 20, 2004 |
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10062483 |
Feb 5, 2002 |
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6780866 |
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Current U.S.
Class: |
514/267 ;
514/282; 514/452 |
Current CPC
Class: |
A61K 31/485 20130101;
A61P 25/04 20180101; A61K 2300/00 20130101; A61K 2300/00 20130101;
A61K 2300/00 20130101; A61K 31/517 20130101; A61K 31/52 20130101;
A61K 31/52 20130101; A61K 2300/00 20130101; A61K 31/517 20130101;
A61K 31/519 20130101; A61K 31/485 20130101; A61K 45/06 20130101;
A61P 25/06 20180101; A61P 43/00 20180101; A61K 31/519 20130101 |
Class at
Publication: |
514/267 ;
514/282; 514/452 |
International
Class: |
A61K 031/519; A61K
031/485; A61K 031/335 |
Foreign Application Data
Date |
Code |
Application Number |
May 18, 2001 |
CN |
01118098.6 |
Claims
We claim:
1. A pharmaceutical composition comprising an opioid and a sodium
channel blocker that specifically binds to the SS1 or SS2 subunit
of a sodium channel and a pharmaceutically acceptable carrier.
2. The pharmaceutical composition of claim 1, wherein the sodium
channel blocker is tetrodotoxin represented by the formula I below:
3
3. The pharmaceutical composition of claim 1, wherein the sodium
channel blocker is saxitoxin represented by the formula II below:
4
4. The pharmaceutical composition of claim 1, wherein the opioid is
selected from the group consisting of morphine, codeine, methadone
and fentanyl.
5. The pharmaceutical composition of claim 2, wherein the opioid is
selected from the group consisting of morphine, codeine, methadone
and fentanyl.
6. The pharmaceutical composition of claim 1, wherein the sodium
channel blocker and the opioid are present in a ratio by weight of
from 1:100 to 1:30,000.
Description
[0001] This application is a Divisional of co-pending Application
No. 10/062,483, filed on Feb. 5, 2002, and for which priority is
claimed under 35 U.S.C. .sctn. 120; and this application claims
priority of Application No. 01118098.6 filed in China on May 8,
2001 under35 U.S.C. .sctn.119; the entire contents of all are
hereby incorporated by reference.
FIELD OF INVENTION
[0002] The present invention relates to a method of producing
analgesia in a mammal experiencing pain, comprising administering
to the mammal a composition comprising a synergistically effective
analgesic combination of an opioid analgesic agent and a compound
that binds to the SS1 or SS2 subunit of a sodium channel in a
pharmaceutically suitable vehicle.
BACKGROUND OF THE INVENTION
[0003] According to U.S. Pat. No. 6,150,524, opioid analgesics such
as morphine are the most powerful analgesics for treating severe
chronic and acute pain. An example of chronic pain is the pain
experienced by cancer patients. An example of acute pain is the
pain experienced after operations. The pain relieving activity of
opioid analgesics includes a depressive effect on the central
nervous system. The analgesic activity of opioid analgesics such as
morphine and deltorphin II can be mediated via different opioid
receptors, for example, via.mu.-opioid and .delta.-opioid
receptors. Opioid analgesics are invaluable for the treatment of
severe acute or chronic pain as, for example, may occur in bone
degenerative diseases and cancer conditions. They are easy to
administer and they provide effective pain relief in most patients.
Due to the excellent overall tolerability of opioids, the doses of
morphine and other strong opioids can be increased to relatively
high levels.
[0004] The opioids used for treating such pain are indeed highly
effective but have a number of unpleasant and/or undesirable side
effects (e.g. a short duration of activity, respiratory depression,
nausea, constipation, diuresis and euphoria and they are also
addictive). In some patients, particularly in the chronically ill,
the opioid side effects make it impossible to continuously
administer sufficiently high dosages to adequately control pain
over the needed period of time. There are also some pain conditions
that do not sufficiently respond to opioid pain treatment alone.
Therefore, there is a constant need for improved opioid containing
analgesic combinations with increased analgesic activity which
comprise opioid and non-opioid analgesically active agents and
which offer the possibility of reducing the opioid dose needed for
efficient pain relief and thereby also reducing the opioid side
effects that might result from the otherwise required higher
dosages.
[0005] Recently, Hartmann (U.S. Pat. No. 6,150,524) and Nagase
(U.S. Pat. No. 6,177,438) have discovered morphine derivatives
through modifying the structure of morphine so as to reduce the
adverse effects associated with the use of morphine. The results
based upon animal studies, however, are still insufficient to
support pharmaceutical use in humans with acceptable safety and
efficacy.
[0006] On the other hand, sodium channel blocking compounds that
bind to the SS1 or SS2 subunit of a sodium channel, particularly
tetrodotoxin and saxitoxin, are found to possess a potent analgesic
property (U.S. pat. application Ser. No. 09/695,053). Tetrodotoxin
is effective on all severe chronic pains. Tetrodotoxin is capable
of providing analgesia in a mammal experiencing acute or chronic
pain.
[0007] In one embodiment, tetrodotoxin (TTX) was found to be about
3,000 times more analgesically potent than morphine. Moreover, TTX
does not produce addiction. Furthermore, trials in humans indicate
that TTX also provides a duration of action much longer than
morphine. TTX provides significant analgesia for pain from chemical
stimulation. However, a larger dose appears to be necessary for
suppressing pain induced by heat. In studies of use of TTX to treat
addiction, experiments suggest a steep dose-toxicity curve for TTX.
Therefore, there is a need to improve safety by reducing the TTX
dose needed for efficient pain relief.
[0008] Fairbanks (U.S. Pat. No. 6,204,271) introduced
co-administration of an opioid analgesic agent and moxonidine as a
non-opioid agent for producing synergistic analgesia in mammals,
hoping to provide a reduced propensity for causing undesirable side
effects. Moxonidine is known to be an
imidazoline/.alpha.2-adrenergic (I1/.alpha.2-AR) receptor agonist
and is clinically used in antihypertensive medications. Monoxidine
is reported to have analgesic activity, but is not comparable to
TTX, which is potent and provides long duration of relief in cancer
patients. TTX is also non-addictive as shown through studies in a
variety of animals.
SUMMARY OF THE INVENTION
[0009] The present invention is related to producing analgesia in
mammals, in particular in humans, by co-administering
synergistically effective amounts of (1) a sodium channel blocking
compound that specifically binds to the SS1 or SS2 subunit of a
sodium channel, such as tetrodotoxin or saxitoxin or analogs
thereof; and (2) an opioid analgesic agent. The present invention
further pertains to analgesic pharmaceutical compositions
comprising synergistically effective amounts of a sodium
channel-blocking compound that specifically binds to the SS1 or SS2
subunit of a sodium channel and an opioid analgesic agent.
[0010] An object of this invention is to provide a potent analgesic
composition containing a long-acting analgesic sodium
channel-blocking compound that binds to the SS1 or SS2 subunit of a
sodium channel, and an opioid analgesic agent, with a reduced
propensity for causing undesirable adverse effects.
[0011] It is also an object of the invention to provide a
non-addictive sodium channel blocker with analgesic activity
showing synergy with the analgesic activity of the opioid, and to
provide analgesic compositions comprising an opioid analgesic
agent, such as morphine and its derivatives, and such a
synergistically effective non-addictive sodium channel blocker
which allows reducing the amount of the opioid necessary to achieve
effective pain treatment.
[0012] It is further an object of the invention to present a method
for producing analgesia induced by opioids or sodium channel
blockers that binds to the SS1 or SS2 subunit in larger mammals,
particularly in humans, whereby undesirable side effects of acute
and chronic administration of strong opioids and said sodium
channel blockers are reduced.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 shows the analgesia effect of co-administered TTX and
morphine observed in the formalin-induced inflammatory pain test in
rats.
[0014] FIG. 2 shows the actual and the theoretical predictive
analgesia effect of TTX at 0.19 .mu.g/kg co-administered with
morphine observed in the formalin-induced inflammatorypain test in
rats.
[0015] FIG. 3 shows the actual and the theoretical predictive
analgesia effect of TTX at 0.39 .mu.g/kg co-administered with
morphine observed in the formalin test in rats.
[0016] FIG. 4 shows the actual and the theoretical predictive
analgesia effect of TTX at 0.39 .mu.g/kg co-administered with
morphine observed in the tail-flick test in mice.
[0017] FIG. 5 shows the actual and the theoretical predictive
analgesia effect of TTX at 0.79 .mu.g/kg co-administered with
morphine observed in the tail-flick test in mice.
DETAILED DESCRIPTION OF THE INVENTION
[0018] The present invention is related to producing analgesia in
mammals, in particular in humans, by co-administering
synergistically effective amounts of (1) a sodium channel blocking
compound that specifically binds to the SS1 or SS2 subunit of a
sodium channel; and (2) an opioid analgesic agent. In such a
combination, the opioid agent or a pharmaceutically acceptable
derivative or salt thereof, can be administered in a low-analgesic
dose, or even in a per se sub-analgesic dose. The composition may
contain both, a sodium channel blocking compound that specifically
binds to the SS1 or SS2 subunit of a sodium channel and the opioid
agent, together in one dosage form or each in a separate dosage
form. Tetrodotoxin and saxitoxin are known to be sodium
channel-blocking compounds that specifically bind to the SS1 or SS2
subunit of a sodium channel.
[0019] Tetrodotoxin and its pharmacologically acceptable salts are
species of octahydro-12-(hydroxymethyl)-2-imino-5,9:7, 10a
-dimethano-10aH -[1,3]dioxocino[6,5d]-d-pyrimidine-4, 7, 10, 11,
12-pentol derivatives that may be used in accordance with the
invention. The chemical name of tetrodotoxin and other related data
are shown below:
[0020] Chemical octahydro-12-(hydroxymethyl)-2-imino-5, 9: 7,
10a-dimethano-10aH-[1,3]dioxocino[6,5-d]pyrimidine-4, 7, 10, 11,
12-pentol
[0021] Molecular formula: C.sub.11H.sub.17N.sub.3O.sub.8
[0022] Molecular weight: 319.27
[0023] Structure: 1
[0024] TTX compounds can be manufactured in a known manner
essentially in accordance with the processes described in U.S.
patent applications Ser. Nos. 09/695,711, 09/818,775, and
09/818,863 or in a manner similar to these processes.
[0025] Saxitoxin (STX) and its pharmacologically acceptable salts
are species of 2,6-diamino-4-((aminocarbonyl)oxy)
methyl-3a,4,8,9-tetrahydro-- 1H, 10H-pyrrolo(1,2-c)purine-10,
10-diol(3aS-(3a-a-a-4-a,10aR*)) derivatives which may be used in
accordance with the invention.
[0026] The chemical name of saxitoxin and other related data are
shown below:
[0027] Chemical name: 2,6-diamino-4-((aminocarbonyl)oxy)
methyl-3a,4,8,9-tetrahydro-1H, 10OH-pyrrolo(1,2-c)purine-10,
10-diol(3aS-(3a-a-a-4-a,10aR*))
[0028] Molecular formula: C.sub.10H.sub.17N.sub.7O.sub.4
[0029] Molecular weight: 299.3
[0030] Structure: 2
[0031] One of the findings in this invention is that tetrodotoxin
synergizes with the analgesic activity of opioids, in particular
opioids such as morphine, when tetrodotoxin and such an opioid
analgesic are co-administered for the treatment of pain. This
co-administration results in a greater-than-additive effect.
[0032] According to U.S. patent application Ser. No. 09/695,053,
TTX and STX possess similar modes of action and toxicity.
Therefore, the inventors suggest that STX is also synergistic with
the analgesic activity of opioids at similar dosage ranges.
[0033] Opioid or opiate is a general term for natural or synthetic
substances that bind to specific receptors ("opioid receptors") in
the central nervous system, producing an agonist action. At present
two types of opioid receptors, .mu.- and .delta. are known. Also
two subtypes of .mu. receptors, .mu.1 and .mu.2 are known. Opioid
analgesics are extremely useful in managing severe acute pain,
postoperative pain and chronic pain including cancer pain. Typical
opioid analgesics are morphine, codeine, methadone and fentanyl.
These analgesics can be used in the invention. Opioid agonists with
opioid receptor activity, like morphine and compounds structurally
related to morphine, or compounds functionally related to morphine
such as deltorphin II, or pharmaceutically acceptable derivatives
or salts thereof, can be used in the invention. Fentanyl,
remifentanil, etc., are further examples of opioid analgesics used
in clinical treatment that can be employed. Morphine is most
preferably used as the opioid. Suitable pharmaceutically acceptable
salts of opioids include hydrochlorides, hydrobromides,
hydroiodides, sulphates, bisulphates, phosphates, acetates,
nitrates, citrates, tartrates, bitartrates, terephthalates,
succinates, malates, maleates, fumarates, pectinates and pamoates.
Preferably, the pharmaceutically acceptable salt of morphine is a
hydrochloride, a sulphate or a tartrate.
[0034] Nociception is a processing reaction by the central nervous
system to the transmission of stimulation of nociceptors. Noxious
stimuli can cause depolarization in the primary perceptive nerve
endings so as to excite the nociceptor receptors. The nociceptors
indeed are the nerve endings of neurons that have their cell bodies
outside the spinal column in the dorsal root ganglion. The true
nociception neurons are the myelinated fibers (Ad) and unmyelinated
fibers (C-fibers). Nociception acts also like an alarm to induce
escape or defense reactions against noxious stimuli.
[0035] Tetrodotoxin has long been considered interesting for its
action of altering the pain caused by nociception. According to
Catterall, in animal models of neuropathic pain in rats,
tetrodotoxin inhibits the ectopic discharges originating at related
dorsal root ganglia (DRG) and dorsal horn (DH) of the spinal cord
and hyperexcitability of neurons, and increases the reaction
threshold of pain receptors. As Kostyun et al. pointed out that at
least two types of voltage-dependent sodium channels exist in the
dorsal root ganglion neurons of a mammal, i.e., the TTX-S sodium
channel that is sensitive to tetrodotoxin and manifests rapid
inward ionic currents, and the TTX-R channel that is resistant to
tetrodotoxin and manifests slower inward ionic currents.
[0036] Peripheral application of TTX blocked the fast excitatory
postsynaptic potentials (EPSP) evoked by electrical stimulation but
failed to block the electrically evoked slow EPSPs (Srdija
Jeftinija). This finding provides an explanation of the result that
TTX produced only 71.7% inhibition even at a dose of 2.5 .mu.g/kg
in the formalin test model in rats.
[0037] Morphine as a classic analgesic produces pain inhibition
primarily via p receptors (Besse, D. et al.). A recent study shows
that morphine can block the excitatory amino acid mediated membrane
current in ambignal motoneurons of the rat, produce
hyperpolarization in the membrane potential, and cause EPSPs to
disappear (Zhang, M. et al.).
[0038] North concluded that morphine can increase a potassium
conductance and produce hyperpolarization by exciting .mu.
receptors. In addition, the disappearance of EPSPs may result from
the inhibition of the entry of calcium and sodium ions. Further
study by Hung et al. shows that the inhibition by morphine of
sodium channels is not caused by direct stimulation to opioid
receptors, but rather is related to delay in the recovery rate of
inactivated sodium channels.
[0039] Without being bound by any theory of the invention, in view
of the blocking action of TTX and morphine on sodium channels, the
inventors believe the synergistic analgesic effect of
co-administering a trace amount of TTX and a small morphine dose,
occurs by tetrodotoxin inhibiting the transmission of noxious
stimulation to the spinal column, while morphine produces a central
blockade of sodium currents.
[0040] The inventors studied the synergistic analgesic action in
two animal pain models. According to the invention, by
co-administering an opioid with a trace amount of tetrodotoxin,
equal pain relieving effects may be achieved with dosages that are
substantially reduced as-compared to the dosages needed when the
opioid is administered alone. In the model of formaldehyde
(formalin) induced inflammatory pain in rats, the ID50 dose of
morphine was reduced 16-fold. Clear synergistic action was observed
when TTX at the dose of 0.19 .mu.g/kg (1/100 LD50) was given in
combination with morphine, respectively at doses of 0.08, 0.15,
0.20, 0.60, 1.25, 2.5 mg/kg, as shown in FIG. 2. TTX at the dose of
0.39 .mu.g/kg co-administered with morphine at 0.15 mg/kg also
produced a synergistic effect (FIG. 3).
[0041] In the other nociceptive pain model, heat-induced tail-flick
in mice, the ED50 of morphine was reduced 2 to 5 fold, and the
duration of action was prolonged significantly.
[0042] Therefore, the combination of tetrodotoxin and morphine will
either produce positive synergistic analgesic action, or at least
produce equal analgesic effect at lower dose levels for both,
establishing the feasibility of the present invention.
[0043] Tetrodotoxin produces pharmacological effects on the
cardiovascular system, analgesia and local anesthesia. In
particular, it provides significant alleviation of various dull
pains and stinging pains without causing addiction. Based upon the
findings of the present invention, the safety and efficacy of TTX
can be improved by lowering the dose necessary for treating pain
through synergistic action. Opioid analgesic agents, such as
morphine, are of limited use because they readily induce tolerance,
dependence-and addiction. By co-administration of small morphine
doses and trace amounts of TTX, this invention provides a novel
solution that markedly improves anesthesia effect and substantially
reduces undesirable adverse effects. In terms of weight, the
proportions of sodium channel blocker and opiate for
co-administration will be preferably from 1:100 to 1:30,000, more
preferably from 1:200 to 1:5,000, still more preferably from 1:500
to 1:2000.
[0044] As compounds, preferred combinations of the sodium channel
blocker and opiate are TTX or STX combined with morphine or codeine
or fentanyl.
EXAMPLES
[0045] The following examples illustrate the methods and
compositions of the invention, but are in no way intended to limit
the invention.
Example 1
[0046] Formalin Induced Inflammatory Pain Test in Rats
[0047] In this example, the synergistic analgesia effect produced
by co-administering tetrodotoxin and morphine was observed in a
formalin test in rats.
[0048] 1. Materials and Methods
[0049] 1.1 Animal
[0050] Wistar male rats having a body weight between 180-300 grams,
first class, QA No. 013056, supplied by the Experimental Animal
Center of Medical Branch, Beijing University.
[0051] 1.2 Test article and reagents
[0052] Tetrodotoxin powder, purity 95%, Nanning Maple Leaf
Pharmaceutical Co., LTD., batch no. 0324C. Before use, the powder
was dissolved into an acetic acid solution at the required
concentrations and stored at 4.degree. C. in a refrigerator.
[0053] Morphine hydrochloride powder, batch no. 960802, Qinghai
Pharmaceutical Plant.
[0054] Formaldehyde (formalin), batch no. 9401002, Beijing No. 3
Chemical Plant. Prepared to the required concentrations before
use.
[0055] 1.3 Method
[0056] The method described by Vogel et al. was followed. Having a
body weight between 180.about.220 grams, 228 male Wistar rats were
randomly divided into 24 groups. They were not given food, only
water ad-libitum during the 12 hours prior to dosing. The rats were
dosed intramuscularly with a normal saline solution (control),
morphine hydrochloride (0.08-10.00 mg/kg) or TTX at 0.39 .mu.g/kg
or 0.19 .mu.g/kg; or by co-administering intramuscularly TTX at
0.39 .mu.g/kg+morphine (0.08-2.50 mg/kg), or TTX at 0.19
.mu.g/kg+morphine (0.08-5.0 mg) on either side of a rat. The
injection volume was 0.1 mL/100 gram body weight. At 40 minutes
after dosing, each rat was given subcutaneously 0.06 mL of 2.5%
formalin in the plantar surface of the right paw. Then the animal
was put into a 12 cm.times.12 cm.times.12 cm polymethyl
methacrylate box to observe. Its reactions to pain were monitored
in the following 5 minutes. The analgesia effect would be
manifested if the animal put all its paws on the floor and
indicated no preference to the treated paw. Parameter signs
included twitching, lifting, licking or gnawing the treated hind
paw. The painful response scores were calculated as per the
following formula: licking/gnawing time (sec).times.3+twitching
occurrences.times.2/3+lifting time (sec).
[0057] The pain response scores of the TTX groups were compared
with those of the control groups, and the following formula was
used to calculate the inhibition rate of TTX on pain responses:
[0058] Inhibition rate (%)=(the average of the pain response scores
of the control group-that of the TTX group)/the average of the pain
response scores of the control group.times.100%
[0059] The medium inhibition dose, ID50, was calculated by the
Logit method.
[0060] 1.4 Results
[0061] During preliminary tests, no significant differences were
observed among the results of normal saline, buffer solution and
normal saline plus buffer solution. Therefore, only normal saline
was used as a control in the formal tests. Neither administering on
both sides of an animal nor variance in injection volumes were
taken into consideration for co-administering groups.
[0062] As shown in Table 1 and FIG. 1, the half inhibition dose
(ID50) of morphine in the model of formalin-induced pain in rats
was 2.30 mg/kg body weight. A trace amount of TTX, 0.19 .mu.g/kg or
{fraction (1/100)} of LD50, produced an inhibition rate of 11.6%
when used alone, but effected significant analgesia when
co-administered with a small dose of morphine, e.g., increasing the
inhibition rate to 63.7% in combination with 0.30 mg/kg of
morphine. Morphine used alone at 0.30 mg/kg only produced 10.2%
inhibition. Combination of TTX at 0.19 .mu.g/kg with morphine at
2.50 mg/kg increased the inhibition rate to 86.7% from 34.9% where
the latter was used alone. TTX at a dose of 0.39 .mu.g/kg
({fraction (1/50)} of LD50) produced an inhibition rate of 32.9%
when used alone and 66.2% in combination of 0.15 mg/kg of morphine,
whereas the latter only produced an inhibition rate of 7.2% when
used alone. Analgesia effect increased with the morphine doses in
other groups but not significantly.
Example 2
[0063] Heat Induced Tail Flick Latency Test in Mice
[0064] In this example, the synergistic analgesia effect produced
by co-administering tetrodotoxin and morphine was observed through
heat-induced tail-flick test in mice.
[0065] 1. Materials and Methods
[0066] 1.1 Animal
[0067] Kunming mice having a body weight between 12-22 grams, first
class, QA No. 013056, supplied by the Experimental Animal Center of
Medical Branch, Beijing University.
[0068] 1.2 Test Article and Reagents
[0069] Tetrodotoxin powder, purity 95%, Nanning Maple Leaf
Pharmaceutical Co., LTD., batchno. 0324C. Before use, the powder
was dissolved into an acetic acid solution to the required
concentrations and stored at 4.degree. C. in a refrigerator.
[0070] Morphine hydrochloride powder, batch no. 960802, Qinghai
Pharmaceutical Plant.
[0071] Formaldehyde, batch no. 9401002, Beijing No. 3 Chemical
Plant. Prepared to the required concentrations before use.
[0072] 1.3 Method
[0073] The method of heat stimulation-induced tail-flick in mice
was used to assess the analgesia effect of co-administering TTX and
morphine. A one fold increase in pain threshold/latency was adopted
as the criterion for determining the doses of morphine, either used
alone or in combination with TTX at 0.79 .mu.g/kg ({fraction
(1/25)} LD50) and 0.39 .mu.g/kg (1/50 LD50), and ED50 was
calculated by the probit method. For co-administeration, TTX and
morphine were given intramuscularly on either side of an
animal.
[0074] Dosage Determination:
[0075] Where morphine was given alone, the upper and lower limits
of dosage and a progression ratio were determined through
preliminary tests so as to calculate the doses for four animal
groups. Likewise, the morphine doses were determined for
co-administeration with TTX at doses of 0.79 .mu.g/kg ({fraction
(1/25)} LD.sub.50) and 0.39 .mu.g/kg ({fraction (1/50)} LD.sub.50),
respectively.
[0076] Animal Grouping:
[0077] 320 screened mice, half male and half female, were randomly
divided into 16 groups. They were not given food, only water 12
hours prior to dosing. Rats were dosed with a saline solution as a
control, morphine hydrochloride (0.01-1.80 mg/kg), TTX X2 at 0.79
.mu.g/kg ({fraction (1/25)} LD.sub.50) and 0.39 .mu.g/kg ({fraction
(1/50)} LD50), and 12 co-administering groups of TTX at 0.79
.mu.g/kg in combination of morphine (0.004-0.33 mg/kg) and TTX at
0.39 .mu.g/kg in combination with morphine (0.01-1.50 mg/kg),
respectively.
[0078] The heat tail flick analgesia meter includes a heat source
consisting of a 12 V, 50 watt, 8.75 mm projector lamp. The light
beam from the heat source was focused and directed to a point on
the tail of a mouse being tested, having a distance of 1-2 mm plus
1/3 of the tail length to the tail end.
[0079] The test drugs were given intramuscularly. TTX, morphine or
a mixture of the two was injected into the gluteal muscle on either
side of the animal in a volume of 0.1 mL/10 g body weight. The
tail-flick latencies, which were assessed in response to a noxious
heat stimulus, i.e., the response time from applying radiant heat
on the dorsal surface of the tail to the occurrence of tail flick,
were measured and recorded at 15, 30, 45, 60, 90, 120, 150, 180
min. after dosing. For each measurement, three readings were made
consecutively one minute apart, and their average was recorded as
the latency. The testing on one animal would be terminated when
tail-flick was not observed within 20 seconds, and the latency
would be recorded as 20 seconds. The pain inhibition rate was
calculated according to the following formula for the purpose of
assessing the analgesia potency:
[0080] Inhibition rate (%)=[(observed latency-latency of
control)/light-deactivation time].times.100
[0081] 1.4 Statistics
[0082] The results were processed with SPSS, a statistical software
provided by SPSS, Inc. of Chicago, Ill., USA. Half effective dose
(ED50) and half inhibition dose (ID50) were calculated with the
probit method. The synergistic action of TTX and morphine was
evaluated by an isobologram.
[0083] 2. Results
[0084] As shown in Tables 2 and 3, ED50 for morphine used alone was
0.41 mg/kg at 45 min after dosing, providing the criterion of one
fold increase in latency for the heat-induced tail flick test in
mice. Co-administered with TTX at a dose of {fraction (1/25)} LD50
(0.79 .mu.g/kg), the ED50 of morphine decreased to 0.07 mg/kg. When
co-administered with TTX at a dose of {fraction (1/50)} LD50 (0.39
.mu.g/kg), the ED50 of morphine decreased to 0.21 mg/kg.
[0085] Providing the basic latency as a criterion, ID50 for
morphine used alone was 0.33 mg/kg at 45 min after dosing.
Co-administered with TTX at small doses of 0.79 .mu.g/kg and 0.39
.mu.g/kg, the ID50 of morphine decreased respectively to 0.08 mg/kg
and 0.15 mg/kg, or only 1/4 and 1/2 of the ID50 for morphine used
alone.
[0086] For practical use of the synergistic interaction between an
opioid analgesic agent and a compound that binds to the SS1 or SS2
subunit of a sodium channel, it is helpful to characterize the
toxicity resulting from co-administration thereof, and subsequently
to elicit the optimal analgesic proportions in the combination or
composition thereof. Therefore, test protocols are designed for
this purpose as shown in Example 3-6.
Example 3
[0087] Toxicity of TTX and Morphine Co-administered by
Intramuscular Injection in Rats
[0088] This test is intended to measure the toxicity interaction of
TTX and morphine through determining and comparing the half death
doses (LD50) of morphine, and co-administered TTX and morphine. The
LD50 of TTX is known from U.S. patent application Ser. No.
09/695,053. The method will follow the test for determining acute
toxicity. Toxicity of the combination of TTX and morphine will be
examined in two proportions to obtain the LD50 values,
respectively.
[0089] Wistar rats, having a body weight between 200-220 grams
each, will be randomly divided into 12.about.15 groups of 10, half
male and half female; and each test drug or combination will use
4.about.5 groups of animals. They will be allowed no food, only
water ad-libitum during the 12 hours before dosing. For determining
LD50 of TTX or morphine individually, each animal will receive one
administration of the test drug. For co-administration of TTX and
morphine, each animal will be given TTX and morphine on either side
(in separate dosage forms) or one administration of TTX and
morphine in a singular dosage form. After dosing, the animals will
be monitored with respect to toxic reactions and death for seven
consecutive days. Autopsy will be conducted on any dead animals
immediately, with general examination for toxic reactions in major
organs.
[0090] Consequently, the LD50 values will be determined by the
Bliss method. If the LD50 increases significantly by comparison
with the theoretical additive, the toxicity of co-administeration
is lower than that of TTX or morphine individually used, indicating
improved safety in light of the synergistic analgesic action
between TTX and morphine. Even if the LD50 remains unchanged, the
combined use of TTX and morphine can still be desirable.
Example 4
[0091] Isobolographic Profile for the Interaction Between TTX and
Morphine by the Pain Model of Formalin-induced Inflammation in
Rats
[0092] The isobologram is a commonly used technique to establish
superadditive, subadditive, or merely additive effects resulting
from the administration of two compounds. The design of this test
follows Tallarida's method, which was also adopted in U.S. Pat. No.
5,468,744. As mentioned above, the purpose is to elicit the optimal
analgesic proportions in the combination or composition of TTX and
morphine, in light of the findings of toxicity interactions in
Example 3. The pain model of formalin test in rats will be used to
assess the analgesic effects of the test drug or combinations,
particularly, to determine the half inhibition doses (ID50). For
determining ID50 of TTX or morphine individually, each animal will
receive one administration of the test drug. For co-administration
of TTX and morphine, each animal will be given TTX and morphine on
either side (in separate dosage forms) or one administration of TTX
and morphine in a single dosage form. The proportions of TTX and
morphine in terms of weight for co-administration will be between
1:200 to 1:5,000. The number of particular proportions/animal
groups will be determined based upon these proportion ranges so
that sound and sufficient data can be made available for one person
in the art with ordinary skills to draw and interpret isobolograms
thereupon.
Example 5
[0093] Toxicity of Saxitoxin (STX) and Morphine Co-administered by
Intramuscular Injection in Rats
[0094] As in Example 3, this test is intended to conclude the
toxicity interaction of STX and morphine through determining and
comparing the half death doses (LD50) of STX, morphine, and
co-administered STX and morphine. Toxicity of the combination of
STX and morphine will be examined in two proportions to obtain the
LD50 values, respectively.
[0095] Wistar rats, half male and half female, having a body weight
between 200-220 grams each, will be randomly divided into
16.about.20 groups of 10, and each test drug or combination will
use 4.about.5 groups of animals. The test method and procedure will
follow Example 3, as will the analysis of the toxicity interaction
between STX and morphine and the feasibility of their combination
use.
Example 6
[0096] Isobologram Profile for the Interaction Between STX and
Morphine by the Pain Model of Formalin-induced Inflammation in
Mice
[0097] The method will follow Example 4, replacing TTX with
STX.
[0098] In terms of weight, the proportions of STX and morphine for
co-administration will be preferably between 1:200 to 1:5,000.
[0099] References:
[0100] Various articles of the scientific and patent literature are
cited herein. Each such article is hereby incorporated in its
entirety and for all purposes by such citation.
[0101] 1. Hartmann, et al., Morphine derivatives with analgesic
activity, U.S. Pat. No. 6,150,524, 2000.
[0102] 2. Nagase, et al., Morphine derivatives and pharmaceutical
use thereof, U.S. Pat. No. 6,177,438, 2001.
[0103] 3. Dong, Q. B. et al., A Method of Analgesia, U.S. patent
application Ser. No. 09/695,053, 2000.
[0104] 4. Adams, et al. Synergistic local anesthetic compositions,
U.S. Pat. No. 4,022,899, 1977.
[0105] 5. Catterall WA. Cellular and molecular biology of voltage
gated sodium channels. Physiol Rev. 1992;72; s15-s18.
[0106] 6. Kostyun, P. G., Veselovsky, N. S and Tsyndrenko, A. Y.,
Ionic currents in the somatic membrane of rat dorsal root ganglion
neurons. I. Sodium current, Neuroscience, 6(1981) 2423-2430.
[0107] 7. Srdija Jeftinija, The role of tetrodotoxin-resistant
Sodium channels of small primary afferent fibers. Brain Research
639 (1994) 125-134.
[0108] 8. U.S. patent application Ser. No. 09/695,053, 2000.
[0109] 9. Besse, D., Lombard, M-C. And Besson, J-M (1991)
Autoradiographic distribution of mu, delta and kappa opioid binging
sites in the superficial dorsal horn, over the rostrocaudal axis of
the rat spinal cord. Brain Res., 548:287-291.
[0110] 10. Zhang M, Nie L, Liu L, Wang Y T, Neuman R S, Bieger D.
Morphine blocked the exitatory amino acid mediated membrane current
in ambignal motoneurons of the rat. Acta Physiologica Sinica,
1995,47(3),253-258.
[0111] 11. North, R. A. and Willianms, J. T. (1985). On the
potassium conductance increased by opiates in rat brains coeruleus
neurones. J. Physiol., 364,265-280.
[0112] 12. C.-F. Hung, C.-H. Tsai and M-J. Su, Opioid receptor
independent effects of morphine on membrane currents in single
cardiac myocytes, British Journal of Anesthesia
1998;81:925-931.
[0113] 13. H. Gerhard Vogel, Wolfgang H. Vogel, Guide to
pharmacological tests-new drug discovery and pharmacological
evaluation, translated by Guanhua Du et al., Sciences Publishing of
China, 2001, 499-500.
[0114] 14. Duanzheng Xu, Application of bio-statistics in
pharmacology, Sciences Publishing of China, 1986, 357-366.
[0115] 15. Tallarida, R. J. et al., Statistical analysis of
drug-drug and site-site interactions with isobolograms, Life Sci.
1989; 45: 947-961.
[0116] 16. Zhang, W. et al., Statistics and Programs of
Pharmacology, Beijing People's Health Publishing Service. 1988;
108-116.
1TABLE 1 Analgesia effect of co-administered TTX and morphine:
formalin test in rats Inhi- bition ID.sub.50 of Animal Pain
reaction rate morphine Test drug Dose(mg/kg) number score (%)
(mg/kg) Normal 8 252.3 .+-. 105.4 saline TTX 0.19 .times. 10.sup.-3
10 223.0 .+-. 58.3 11.6 0.39 .times. 10.sup.-3 10 169.1 .+-. 47.2
32.9 Morphine 0.08 8 243.8 .+-. 36.4 3.4 0.15 8 234.0 .+-. 26.9 7.2
0.30 8 226.5 .+-. 73.5 10.2 0.60 8 274.3 .+-. 119.5 11.0 2.30 1.25
8 190.3 .+-. 129.9 24.6 (1.38.about. 2.50 8 164.3 .+-. 82.0 34.9
4.26) 5.00 8 49.8 .+-. 34.1 80.2 10.00 8 5.6 .+-. 6.5 97.7 TTX 0.08
8 162.9 .+-. 55.4 35.4 (0.39 .times. 0.15 20 85.3 .+-. 54.2 66.2
10.sup.-3 0.30 14 138.0 .+-. 50.7 45.3 mg/kg) + 0.60 14 119.5 .+-.
38.3 52.6 morphine 1.25 14 109.3 .+-. 64.4 56.7 2.50 8 71.6 .+-.
44.2 71.6 TTX 0.08 8 132.0 .+-. 39.3 47.7 (0.19 .times. 0.15 10
94.1 .+-. 43.9 62.7 10.sup.-3 0.30 8 91.6 .+-. 51.3 63.7 mg/kg) +
0.60 8 146.8 .+-. 66.6 41.8 morphine 1.25 8 139.4 .+-. 68.9 44.7
2.50 8 36.6 .+-. 16.3 86.7 5.00 8 24.4 .+-. 12.1 90.3
[0117]
2TABLE 2 Analgesia effect of co-administered TTX and morphine -
ID.sub.50 (heat induced tail flick test in mice, latency Mean .+-.
SD, n = 20), compared with the ID.sub.50 for morphine used alone.
Latency Dose before Latency after Inhibition ID.sub.50 & 95%
Confidence Group (mg/kg) dosing dosing rate(%) Limits Control 5.36
.+-. 0.96 5.43 .+-. 0.89 1.29 (normal saline) TTX 0.79 .times.
10.sup.-3 5.25 .+-. 0.59 6.04 .+-. 0.76 12.06 0.39 .times.
10.sup.-3 5.56 .+-. 0.81 5.88 .+-. 1.00 5.44 Morphine 0.01 5.48
.+-. 1.44 6.35 .+-. 1.87 13.70 hydrochloride 0.06 5.83 .+-. 1.49
8.67 .+-. 2.54 32.76 0.33 0.33 5.21 .+-. 1.39 10.04 .+-. 2.49 48.11
(0.21.about.0.55) 1.80 5.63 .+-. 1.31 18.94 .+-. 1.02 70.27 TTX
0.004 5.83 .+-. 1.26 7.22 .+-. 1.14 19.25 (0.79 ug/kg) + 0.016 6.37
.+-. 1.08 9.96 .+-. 2.40 36.04 0.08 morphine 0.073 5.78 .+-. 1.29
11.82 .+-. 2.65 51.09 (0.05.about.0.14) hydrochloride 0.330 6.31
.+-. 1.10 17.21 .+-. 2.23 63.33 TTX 0.01 5.76 .+-. 0.89 8.17 .+-.
1.94 29.50 (0.39 ug/kg) + 0.05 5.84 .+-. 0.73 10.16 .+-. 1.85 42.52
0.15 morphine 0.28 5.55 .+-. 0.88 12.50 .+-. 3.46 55.60
(0.08.about.0.33) hydrochloride 1.50 5.61 .+-. 0.86 16.28 .+-. 2.53
65.54
[0118]
3TABLE 3 Analgesia effect of co-administered TTX and morphine -
ED.sub.50 (heat induced tail flick test in mice, n = 20); ED.sub.50
of morphine by comparison with the latencies at 45 min after
dosing. Percentage of positive Dose Positive occurrences ED.sub.50
& 95% Confidence ED.sub.95 & 95% Confidence Group (mg/kg)
occurrences (%) Limits Limits Control (N.S) TTX 0.79 .times.
10.sup.-3 0.39 .times. 10.sup.-3 Morphine 0.01 0 0 Hydrochloride
0.06 2 10 0.41 0.77 0.33 7 35 (0.30.about.0.84) (0.54.about.1.91)
1.80 20 100 TTX 0.004 0 0 (0.79 ug/kg) + 0.016 2 10 0.07 0.13
Morphine 0.073 10 50 (0.06.about.0.10) (0.10.about.0.22)
Hydrochloride 0.330 20 100 TTX 0.01 1 5 (0.39 ug/kg) + 0.05 2 10
0.21 0.42 Morphine 0.28 14 70 (0.16.about.0.29) (0.33.about.0.62)
Hydrochloride 1.50 20 100
* * * * *