Combination Therapies Employing Nicotinic Acid Derivatives or Fibric Acid Derivatives

1 . A pharmaceutical composition comprising: (a) a nicotinic acid derivative or a fibric acid derivative; (b) pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound; and (c) a pharmaceutically acceptable carrier.

2 . The pharmaceutical composition according to claim 1 wherein the fibric acid derivative is selected from the group consisting of:

bezafibrate, clofibrate, ciprofibrate, fenofibrate, and gemfibrozil, and a mixture thereof.

3 . The pharmaceutical composition according to claim 1 wherein the nicotinic acid derivative is selected from the group consisting of niacin, niceritrol, acipimox, and acifran.

4 . The pharmaceutical composition according to claim 1 wherein the pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is selected from the group consisting: pyridoxal, pyridoxal-5′-phosphate, pyridoxamine, a 3-acylated analogue of pyridoxal, a 3-acylated analogue of pyridoxal-4,5-aminal, a pyridoxine phosphate analogue, and a mixture thereof.

5 . The pharmaceutical composition according to claim 1 wherein the pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is pyridoxal-5-phosphate.

6 . The pharmaceutical composition according to claim 1 wherein the nicotinic acid derivative is niacin.

7 . The pharmaceutical composition according to claim 1 wherein the fibric acid derivative is fenofibrate.

8 . The pharmaceutical composition according to claim 4 wherein the 3-acylated analogue of pyridoxal is:

wherein,

R 1 is alkyl,

alkenyl,

in which alkyl or alkenyl

can be interrupted by nitrogen, oxygen, or sulfur, and

can be substituted at the terminal carbon by hydroxy, alkoxy, alkanoyloxy, alkanoyloxyaryl, alkoxyalkanoyl, alkoxycarbonyl, or dialkylcarbamoyloxy;

alkoxy;

dialkylamino;

alkanoyloxy;

alkanoyloxyaryl;

alkoxyalkanoyl;

alkoxycarbonyl;

dialkylcarbamoyloxy; or

aryl, in which aryl can be substituted by alkyl, alkoxy, amino, hydroxy, halo, nitro, or alkanoyloxy

aryloxy,

arylthio, or

aralkyl, or a pharmaceutically acceptable acid addition salt thereof.

9 . The pharmaceutical composition according to claim 4 wherein the 3-acylated analogue of pyridoxal-4,5-animal is

wherein,

R 1 is alkyl,

alkenyl,

in which alkyl or alkenyl

can be interrupted by nitrogen, oxygen, or sulfur, and can be substituted at the terminal carbon by hydroxy, alkoxy, alkanoyloxy, alkanoyloxyaryl, alkoxyalkanoyl, alkoxycarbonyl, or dialkylcarbamoyloxy;

alkoxy;

dialkylamino;

alkanoyloxy;

alkanoyloxyaryl;

alkoxyalkanoyl;

alkoxycarbonyl;

dialkylcarbamoyloxy; or

aryl, in which aryl can be substituted by alkyl, alkoxy, amino, hydroxy, halo, nitro, or alkanoyloxy

aryloxy,

arylthio, or

aralkyl; and

R 2 is a secondary amino group, or a pharmaceutically acceptable acid addition salt thereof.

10 . The pharmaceutical composition according to claim 4 wherein the pyridoxine phosphate analogue is selected from the group consisting of:

(a)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CH 2 OH, CH 3 , —CO 2 R 6 in which R 6 is hydrogen, alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 is hydrogen and R 4 is hydroxy, halo, alkoxy, alkylcarbonyloxy, alkylamino or arylamino; or

R 3 and R 4 are halo; and

R 5 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 7 in which R 7 is hydrogen, alkyl, aryl, or aralkyl;

or a pharmaceutically acceptable acid addition salt thereof;

(b)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CHO, —CH 2 OH, —CH 3 , —CO 2 R 5 in which R 5 is hydrogen, alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 is hydrogen, alkyl, aryl, or aralkyl;

R 4 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 6 in which R 6 is hydrogen, alkyl, aryl, or aralkyl; and

n is 1 to 6;

or a pharmaceutically acceptable acid addition salt thereof; and

(c)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CHO, —CH 2 OH, —CH 3 , or —CO 2 R 8 in which R 8 is hydrogen, alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 is hydrogen and R 4 is hydroxy, halo, alkoxy or alkylcarbonyloxy; or

R 3 and R 4 can be taken together to form ═O;

R 5 and R 6 are hydrogen; or

R 5 and R 6 are halo; and

R 7 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 8 in which R 8 is hydrogen, alkyl, aryl, or aralkyl;

or a pharmaceutically acceptable acid addition salt thereof.

11 . A method for treating cardiovascular disease in a patient comprising administering a therapeutically effective dose of the pharmaceutical composition according to claim 1 .

12 . The method according to claim 11 , wherein the patient is susceptible to hepatotoxicity.

13 . The method according to claim 11 wherein the cardiovascular disease is selected from the group consisting: congestive heart failure, myocardial ischemia, arrhythmia, myocardial infarction, ischemic stroke, hemorrhagic stroke, coronary artery disease, hypertension (high blood pressure), atherosclerosis (clogging of the arteries), aneurysm, peripheral artery disease (PAD), thrombophlebitis (vein inflammation), diseases of the heart lining, diseases of the heart muscle, carditis, congestive heart failure, endocarditis, ischemic heart disease, valvular heart disease (malfunction of a valve or valves in the blood vessels of the heart), arteriosclerosis (hardening of the arteries), acute coronary syndrome (ACS), deep vein thrombosis (DVT), Kawazaki disease, high cholesterol, and heart transplant.

14 . The method according to claim 11 wherein the dose of the nicotinic acid derivative is between 0.1 and 5000 mg per day.

15 . The method according to claim 11 wherein the dose of the nicotinic acid derivative is between 100 and 3000 mg per day.

16 . The method according to claim 11 wherein the dose of the nicotinic acid derivative is selected from the group consisting of 100, 250, 500, 1000 and 3000 mg per day.

17 . The method according to claim 11 wherein the dose of the fibric acid derivative is between 0.1 and 1000 mg per day.

18 . The method according to claim 11 wherein the dose of the fibric acid derivative is selected from the group consisting of 100, 200, 400 and 600 mg per day.

19 . The method according to claim 11 wherein the fibric acid derivative is bezafibrate and the dose is between 400 and 600 mg per day.

20 . The method according to claim 11 wherein the fibric acid derivative is ciprofibrate and the dose is 200 mg per day.

21 . The method according to claim 11 wherein the fibric acid derivative is gemfibrozil and the dose is between 400 and 600 mg per day.

22 . The method according to claim 11 wherein the fibric acid derivative is fenofibrate and the dose is between 40 and 200 mg per day.

23 . The method according to claim 11 wherein the dose of the pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is between 0.1 to 50 mg/kg per day.

24 . The method according to claim 11 wherein the dose of pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is between 1 to 15 mg/kg per day.

25 . A method of treating diabetes comprising administering a therapeutically effective dose of the pharmaceutical composition according to claim 1 .

26 . A method of treating hypercholesterolemia in a patient, comprising administering a therapeutically effective dose of: (a) a nicotinic acid derivative or a fibric acid derivative and (b) a compound selected from the group consisting: pyridoxal-5′-phosphate, a 3-acylated analogue of pyridoxal, a 3-acylated analogue of pyridoxal-4,5-aminal, a pyridoxine phosphate analogue, and a mixture thereof.

27 . The method according to claim 26 wherein the pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is pyridoxal-5-phosphate.

28 . The method according to claim 26 wherein the 3-acylated analogue of pyridoxal is:

wherein,

R 1 is alkyl,

alkenyl,

in which alkyl or alkenyl

can be interrupted by nitrogen, oxygen, or sulfur, and

can be substituted at the terminal carbon by hydroxy, alkoxy, alkanoyloxy, alkanoyloxyaryl, alkoxyalkanoyl, alkoxycarbonyl, or dialkylcarbamoyloxy;

alkoxy;

dialkylamino;

alkanoyloxy;

alkanoyloxyaryl;

alkoxyalkanoyl;

alkoxycarbonyl;

dialkylcarbamoyloxy; or

aryl, in which aryl can be substituted by alkyl, alkoxy, amino, hydroxy, halo, nitro, or alkanoyloxy

aryloxy,

arylthio, or

aralkyl, or a pharmaceutically acceptable acid addition salt thereof.

29 . The method according to claim 26 wherein the 3-acylated analogue of pyridoxal-4,5-aminal is

wherein,

R 1 is alkyl,

alkenyl,

in which alkyl or alkenyl

can be interrupted by nitrogen, oxygen, or sulfur, and can be substituted at the terminal carbon by hydroxy, alkoxy, alkanoyloxy, alkanoyloxyaryl, alkoxyalkanoyl, alkoxycarbonyl, or dialkylcarbamoyloxy;

alkoxy;

dialkylamino;

alkanoyloxy;

alkanoyloxyaryl;

alkoxyalkanoyl;

alkoxycarbonyl;

dialkylcarbamoyloxy; or

aryl, in which aryl can be substituted by alkyl, alkoxy, amino, hydroxy, halo, nitro, or alkanoyloxy

aryloxy,

arylthio, or

aralkyl; and

R 2 is a secondary amino group, or a pharmaceutically acceptable acid addition salt thereof.

30 . The pharmaceutical composition according to claim 26 wherein the pyridoxine phosphate analogue is selected from the group consisting of:

(a)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CH 2 OH, CH 3 , —CO 2 R 6 in which R 6 is hydrogen, alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 hydrogen and R 4 is hydroxy, halo, alkoxy, alkylcarbonyloxy, alkylamino or arylamino; or

R 3 and R 4 are halo; and

R 5 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 7 in which R 7 is hydrogen, alkyl, aryl, or aralkyl;

or a pharmaceutically acceptable acid addition salt thereof;

(b)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CHO, —CH 2 OH, —CH 3 , —CO 2 R 5 in which R 5 is hydrogen, alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 is hydrogen, alkyl, aryl, or aralkyl;

R 4 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 6 in which R 6 is hydrogen, alkyl, aryl, or aralkyl; and

n is 1 to 6;

or a pharmaceutically acceptable acid addition salt thereof; and

(c)

wherein,

R 1 is hydrogen or alkyl;

R 2 is —CHO, —CH 2 OH, —CH 3 , —CO 2 R 8 in which R 8 is hydrogen alkyl, or aryl, or —CH 2 —O-alkyl- in which alkyl is covalently bonded to the oxygen at the 3-position instead of R 1 ;

R 3 is hydrogen and R 4 is hydroxy, halo, alkoxy or alkylcarbonyloxy; or

R 3 and R 4 can be taken together to form ═O;

R 5 and R 6 are hydrogen; or

R 5 and R 6 are halo; and

R 7 is hydrogen, alkyl, aryl, aralkyl, or —CO 2 R 8 in which R 8 is hydrogen, alkyl, aryl or aralkyl;

or a pharmaceutically acceptable acid addition salt thereof.

31 . A method of decreasing the side effects of nicotinic acid derivative administration comprising administering pyridoxal-5′-phosphate or a pyridoxal-5′-phosphate related compound, wherein the side effects of nicotinic acid derivative administration are decreased.

32 . The method of claim 31 , wherein the nicotinic acid derivative is niacin.

33 . The method of claim 31 wherein the side effect is selected from a group consisting of an elevated homocysteine level and an elevated thromboxane A2 level.

34 . The method of claim 31 wherein the pyridoxal-5′-phosphate or pyridoxal-5′-phosphate related compound is pyridoxal-5′-phosphate.