Compositions comprising enzyme-cleavable opioid prodrugs and inhibitors thereof

1. A composition comprising:

an opioid prodrug comprising a ketone-containing opioid covalently bound to a promoiety comprising a GI enzyme-cleavable moiety wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to the GI enzyme-cleavable moiety, and wherein cleavage of the GI enzyme-cleavable moiety by a GI enzyme mediates release of the opioid; and

a GI enzyme inhibitor that interacts with the GI enzyme that mediates enzymatically-controlled release of the opioid from the opioid prodrug following ingestion of the composition.

2. A composition comprising:

a container suitable for containing a composition for administration to a patient; and

a dose unit comprising the composition of claim 1 disposed within the container.

3. The composition of claim 1 , wherein the composition is a dose unit having a total weight of from 1 microgram to 2 grams.

4. The composition of claim 1 , wherein the composition has a combined weight of opioid prodrug and GI enzyme inhibitor of from 0.1% to 99% per gram of the composition.

5. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(Ia):

wherein:

R a is hydrogen or hydroxyl;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group;

n is an integer from 2 to 4;

R 3 is hydrogen or (1-4C)alkyl;

R 4 is

each R 6 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, and substituted heteroarylalkyl, or optionally, R 6 and R 7 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each W is independently —NR 8 —, —O— or —S—;

each R 8 is independently selected from hydrogen, alkyl, substituted alkyl, aryl and substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

p is an integer from one to 100; and

R 7 is selected from hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

6. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(Ib):

wherein:

R a is hydrogen or hydroxyl;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl or substituted cycloalkyl group;

n is an integer from 2 to 4;

R 3 is hydrogen or (1-4C)alkyl;

R 4 is

each R 6 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, and substituted heteroarylalkyl, or optionally, R 6 and R 7 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each W is independently —NR 8 —, —O— or —S—;

each R 8 is independently selected from hydrogen, alkyl, substituted alkyl, aryl and substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

p is an integer from one to 100; and

R 7 is selected from hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

7. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(II):

wherein:

R a is hydrogen or hydroxyl;

R 5 is selected from (1-6C)alkyl, (1-6C) substituted alkyl, —(CH 2 ) q (C 6 H 4 )—COOH, —(CH 2 ) q (C 6 H 4 )—COOCH 3 , and —(CH 2 ) q (C 6 H 4 )—COOCH 2 CH 3 , where q is an integer from one to 10;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl or substituted cycloalkyl group;

n is 2 or 3;

R 3 is hydrogen;

R 4 is a residue of an L-amino acid selected from alanine, arginine, asparagine, aspartic acid, cysteine, glycine, glutamine, glutamic acid, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine, or a residue of an N-acyl derivative of any of said amino acids; or a residue of a peptide composed of at least two L-amino acid residues selected independently from alanine, arginine, asparagine, aspartic acid, cysteine, glycine, glutamine, glutamic acid, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine or a residue of an N-acyl derivative thereof.

8. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(IIIa):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—NR 5 —(C(R 1 )(R 2 )) n —NR 3 R 4 ;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group, or two R 2 or R 3 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group;

n is an integer from 2 to 4;

R 3 is hydrogen or (1-4C) alkyl;

R 4 is

each R 6 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, and substituted heteroarylalkyl, or optionally, R 6 and R 7 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each W is independently —NR 8 —, —O— or —S—;

each R 8 is independently selected from hydrogen, alkyl, substituted alkyl, aryl and substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

p is an integer from one to 100; and

R 7 is selected from hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

9. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(IIIb):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—NR 5 —(C(R 1 )(R 2 )) n —NR 3 R 4 ;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl or substituted cycloalkyl group;

n is an integer from 2 to 4;

R 3 is hydrogen or (1-4C) alkyl;

R 4 is

each R 6 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, and substituted heteroarylalkyl, or optionally, R 6 and R 7 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each W is independently —NR 8 —, —O— or —S—;

each R 8 is independently selected from hydrogen, alkyl, substituted alkyl, aryl and substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

p is an integer from one to 100; and

R 7 is selected from hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substituted arylalkyl;

or a salt, hydrate or solvate thereof.

10. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(IV):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—NR 5 —(C(R 1 )(R 2 )) n —NR 3 R 4 ;

R 5 is selected from (1-6C)alkyl, (1-6C) substituted alkyl, —(CH 2 ) q (C 6 H 4 )—COOH, —(CH 2 ) q (C 6 H 4 )—COOCH 3 , and —(CH 2 ) q (C 6 H 4 )—COOCH 2 CH 3 , where q is an integer from one to 10;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl or substituted cycloalkyl group;

n is 2 or 3;

R 3 is hydrogen;

R 4 is a residue of an L-amino acid selected from alanine, arginine, asparagine, aspartic acid, cysteine, glycine, glutamine, glutamic acid, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine, or a residue of an N-acyl derivative of any of said amino acids; or a residue of a peptide composed of at least two L-amino acid residues selected independently from alanine, arginine, asparagine, aspartic acid, cysteine, glycine, glutamine, glutamic acid, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine or a residue of an N-acyl derivative thereof;

or a salt, hydrate or solvate thereof.

11. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(Va):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—NR 5 —(C(R 1 )(R 2 )) n —NR 3 R 4 ;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group;

n is an integer from 2 to 4;

R 3 is hydrogen;

R 4 is a trypsin-cleavable moiety;

or a salt, hydrate or solvate thereof.

12. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(Vb):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—NR 5 —(C(R 1 )(R 2 )) n —NR 3 R 4 ;

R 5 is selected from alkyl, substituted alkyl, arylalkyl, substituted arylalkyl, aryl and substituted aryl;

each R 1 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

each R 2 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, acyl, and aminoacyl;

or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group, or two R 1 or R 2 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl group;

n is an integer from 2 to 4;

R 3 is hydrogen;

R 4 is a GI enzyme-cleavable moiety;

or a salt, hydrate or solvate thereof.

13. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(VI):

wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —C(O)—Y—(C(R 1 )(R 2 )) n —NR 3 R 4 ;

Y is —NR 5 —, —O— or —S—;

n is an integer from 1 to 4;

each R 1 , R 2 , R 3 and R 5 is independently hydrogen, alkyl, substituted alkyl, aryl or substituted aryl, or R 1 and R 2 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group;

R 4 is

each R 6 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, substituted heteroarylalkyl, or optionally, R 6 and R 7 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

R 7 is hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl or substituted arylalkyl;

p is an integer from 1 to 10;

each W is independently —NR 8 —, —O— or —S—; and

each R 8 is independently hydrogen, alkyl, substituted alkyl, aryl or substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring.

14. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(VII):

or salts, solvates or hydrates thereof wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond —(CR 12 R 13 )—Y—Z—R 11 ;

R 12 and R 13 are independently hydrogen, alkyl, substituted alkyl, alkoxy, substituted alkoxy, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl;

Y is aryl, heteroaryl or arylaryl optionally substituted with one or more —F, —Cl, —Br, —I, —R 14 , —O − , —OR 14 , —SR 14 , —S − , —NR 14 R 15 , —CF 3 , —CN, —OCN, —SCN, —NO, —NO 2 , —N 3 , —S(O) 2 O − , —S(O) 2 OH, —S(O) 2 R 14 , —OS(O 2 )O − , —OS(O) 2 R 14 , —P(O)(O − ) 2 , —P(O)(OR 14 )(O − ), —OP(O)(OR 14 )(OR 15 ), —C(O)R 14 , —C(S)R 14 , —C(O)OR 14 , —C(O)NR 14 R 15 , —C(O)O − , —C(S)OR 14 , —NR 16 C(O)NR 14 R 15 , —NR 16 C(S)NR 14 R 15 , —NR 17 C(NR 16 )NR 15 R 14 or —C(NR 16 )NR 15 R 14 ;

R 14 , R 15 , R 16 and R 17 are independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, cycloheteroalkyl, substituted cycloheteroalkyl, aryl, substituted aryl, heteroaryl or substituted heteroaryl, or optionally R 14 and R 15 together with the nitrogen atom to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

Z is N(R 18 )—, —O— or —S—;

R 18 is hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl or

each W is independently —NR 20 —, —O— or —S—;

each R 19 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, substituted heteroarylalkyl, or optionally, R 19 and R 20 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each R 20 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl or optionally, R 20 and R 21 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

R 21 is hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl or substituted arylalkyl;

n is an integer from 0 to 5;

R 11 is

each U is independently —NR 23 —, —O— or —S—;

each R 22 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, substituted heteroarylalkyl, or optionally, R 22 and R 23 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

each R 23 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, or optionally, R 23 and R 24 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

R 24 is hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl or substituted arylalkyl; and

o is an integer from 1 to 100;

provided that Z is oriented para or ortho to X—(CR 12 R 13 )— and that both R 18 and R 11 are not hydrogen.

15. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(VIII):

or salts, solvates or hydrates thereof wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —(CR 12 R 13 )—Y—Z—R 11 ;

R 12 and R 13 are independently hydrogen, alkyl, substituted alkyl, alkoxy, substituted alkoxy, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl;

R k 26 are each independently selected from the group consisting of one or more of —F, —Cl, —Br, —I, —R 14 , —O − , —OR 14 , —SR 14 , —S − , —NR 14 R 15 , —CF 3 , —CN, —OCN, —SCN, —NO, —NO 2 , —N 3 , —S(O) 2 O − , —S(O) 2 OH, —S(O) 2 R 14 , —OS(O) 2 R 14 , —P(O)(O − ) 2 , —P(O)(OR 14 )(O − ), —OP(O)(OR 14 )(OR 15 ), —C(O)R 14 , —C(S)R 14 , —C(O)OR 14 , —C(O)NR 14 R 15 , —C(O)O − , —C(S)OR 14 , —NR 16 C(O)N R 14 R 15 , —NR 16 C(S)NR 14 R 15 , —NR 17 C(NR 16 )NR 15 R 14 and —C(NR 16 )NR 15 R 14 , and k is 0, 1, 2, 3, or 4;

R 14 , R 15 , R 16 and R 17 are independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, cycloheteroalkyl, substituted cycloheteroalkyl, aryl, substituted aryl, heteroaryl or substituted heteroaryl, or optionally R 4 and R 5 together with the nitrogen atom to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

R 18 is hydrogen or methyl;

R 22 is a side chain of an amino acid or a derivative of a side chain of an amino acid;

each U is independently —NR 23 —, —O— or —S—;

each R 23 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl or optionally, R 23 and R 24 together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring; and

R 24 is hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl or substituted arylalkyl; and

o is an integer from 1 to 100.

16. The composition of claim 1 , wherein the opioid prodrug is a compound of formula KC-(IX):

X—C(R 31a )(R 32a ))—Ar—Z—C(O)—Y—(C(R 31 )(R 32 )) n —N—(R 33 )(R 34 )A-  (KC-(IX))

or a salt, hydrate or solvate thereof wherein:

X represents a residue of a ketone-containing opioid, wherein the hydrogen atom of the corresponding enolic group of the ketone is replaced by a covalent bond to —(C(R 31a )(R 32a )—Ar—Z—C(O)—Y—(C(R 31 )(R 32 )) n —N—(R 33 )(R 34 );

R 31 a and R 32 a are independently hydrogen, alkyl, substituted alkyl, alkoxy, substituted alkoxy, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl or substituted heteroarylalkyl;

Ar is aryl, heteroaryl or arylaryl optionally substituted with one or more —F, —Cl, —Br, —I, —R 34a , —O − , —OR 34a , —SR 34a , —S—, —NR 34a R 35a , —CF 3 , —CN, —OCN, —SCN, —NO, —NO 2 , —N 3 , —S(O) 2 O′, —S(O) 2 OH, —S(O) 2 R 34a , —OS(O 2 )O″, —OS(O) 2 R 34a , —P(0)(0″) 2 , —P(O)(OR 34a )(O″), —OP(O)(OR 34a )(OR 35a ), —C(0)R 34a , —C(S)R 34a , —C(O)OR 34a , —C(O)NR 34a R 35a , —C(O)O; —C(S)OR 34a , —NR 36a C(O)NR 34a R 35a , —NR 36a C(S)NR 34a R 35a , —NR 37a C(NR 36a )NR 35a R 34a or —C(NR 36a )NR 35a R 34a , or tethered to a polymer;

R 34a , R 35a , R 36a and R 37a are independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, cycloheteroalkyl, substituted cycloheteroalkyl, aryl, substituted aryl, heteroaryl or substituted heteroaryl, or optionally R 34 and R 35 together with the nitrogen atom to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

Z is O, S or NH;

Y is —NR 35 —, —O— or —S—;

n is an integer from 1 to 10;

each R 31 , R 32 , R 33 and R 35 is independently hydrogen, alkyl, substituted alkyl, aryl or substituted aryl, or R 31 and R 32 together with the carbon to which they are attached form a cycloalkyl or substituted cycloalkyl group, or two R 31 or R 32 groups on adjacent carbon atoms, together with the carbon atoms to which they are attached, form a cycloalkyl or substituted cycloalkyl group;

each R 36 is independently hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, substituted heteroarylalkyl, or optionally, R 36 and R 37 together with

the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring;

R 37 is hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl or substituted arylalkyl;

p is an integer from 1 to 5;

each W is independently —NR 38 —, —O— or —S—;

each R 38 is independently hydrogen, alkyl, substituted alkyl, aryl or substituted aryl, or optionally, each R 36 and R 38 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring; and

A′ represents an anion.

17. A method to treat a patient comprising administering a pharmaceutical composition or dose unit comprising the composition of claim 1 to a patient in need thereof.

18. The composition of claim 5 , wherein R 3 is hydrogen.

19. The composition of claim 6 , wherein R 3 is hydrogen.

20. The composition of claim 8 , wherein R 3 is hydrogen.

21. The composition of claim 9 , wherein R 3 is hydrogen.

22. The composition of claim 11 , wherein X is hydrocodone or oxycodone.

23. The composition of claim 11 , wherein R 5 is alkyl or substituted alkyl.

24. The composition of claim 23 , wherein R 5 is ethyl or methyl.

25. The composition of claim 23 , wherein R 5 is methyl.

26. The composition of claim 11 , wherein each R 1 and R 2 is independently selected from hydrogen, alkyl, substituted alkyl and aminoacyl.

27. The composition of claim 26 , wherein R 1 and R 2 are hydrogen.

28. The composition of claim 26 , wherein R 1 and R 2 which are on the same carbon are alkyl.

29. The composition of claim 26 , wherein R 1 and R 2 which are on the same carbon are methyl.

30. The composition of claim 26 , wherein the alkyl is methyl.

31. The composition of claim 26 , wherein the aminoacyl is —C(O)NR 10a R 10b , wherein each R 10a and R 10b is independently selected from hydrogen, alkyl, substituted alkyl, and acyl.

32. The composition of claim 31 , wherein R 10a and R 10b are methyl.

33. The composition of claim 11 , wherein each R 4 is

p is 1 or 2;

each R 6 is independently selected from hydrogen, alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted arylalkyl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heteroarylalkyl, and substituted heteroarylalkyl;

each W is —NR 8 —;

each R 8 is independently selected from hydrogen, alkyl, substituted alkyl, aryl and substituted aryl, or optionally, each R 6 and R 8 independently together with the atoms to which they are bonded form a cycloheteroalkyl or substituted cycloheteroalkyl ring; and

R 7 is selected from hydrogen, alkyl, substituted alkyl, acyl, substituted acyl, alkoxycarbonyl, substituted alkoxycarbonyl, aryl, substituted aryl, arylalkyl, and substituted arylalkyl.

34. The composition of claim 33 , wherein p is 1 and wherein R 6 is a side chain of an amino acid residue selected from lysine, arginine, homolysine, homoarginine, ornithine, arginine mimics, arginine homologues, arginine truncates, arginine with varying oxidation, lysine mimics, lysine homologues, lysine truncates, and lysine with varying oxidation states.

35. The composition of claim 33 , wherein p is 1 and wherein R 6 is a side chain of an amino acid residue selected from L-lysine and L-arginine.

36. The composition of claim 33 , wherein p is 2, and wherein a first R 6 is a side chain of an amino acid residue selected from lysine, arginine, homolysine, homoarginine, ornithine, arginine mimics, arginine homologues, arginine truncates, arginine with varying oxidation, lysine mimics, lysine homologues, lysine truncates, and lysine with varying oxidation states and a second R 6 is a side chain of an amino acid residue selected from alanine, arginine, asparagine, aspartic acid, cysteine, glycine, glutamine, glutamic acid, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine and valine, or a residue of an N-acyl derivative thereof.

37. The composition of claim 33 , wherein each R 6 is independently a side chain of an amino acid residue selected from glycine, L-lysine or L-arginine.

38. The composition of claim 33 , wherein a first R 6 is a side chain of an amino acid residue selected from L-lysine or L-arginine and a second R 6 is a side chain of glycine.

39. The composition of claim 33 , wherein each R 8 is hydrogen.

40. The composition of claim 33 , wherein R 7 is selected from hydrogen and acyl.

41. The composition of claim 40 , wherein R 7 is selected from hydrogen, acetyl, benzoyl, malonyl, piperonyl and succinyl.

42. The composition of claim 41 , wherein R 7 is acetyl or malonyl.

43. The composition of claim 11 , wherein the opioid prodrug is a compound selected from the group consisting of:

44. The composition of claim 11 , wherein:

X is hydrocodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and —C(O)NR 10a R 10b ), wherein R 10a and R 10b are methyl;

each R 2 is hydrogen;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is malonyl or acetyl;

or a salt, hydrate or solvate thereof.

45. The composition of claim 11 , wherein:

X is hydrocodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and methyl;

each R 2 is independently selected from hydrogen and methyl;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is acetyl;

or a salt, hydrate or solvate thereof.

46. The composition of claim 11 , wherein:

X is oxycodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and —C(O)NR 10a R 10b , wherein R 10a and R 10b are —CH 2 C(O)OH;

each R 2 is hydrogen;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is acetyl;

or a salt, hydrate or solvate thereof.

47. The composition of claim 11 , wherein:

X is oxycodone;

R 5 is methyl;

n is 3;

each R 1 is independently selected from hydrogen and dimethyl;

each R 2 is independently selected from hydrogen and dimethyl;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is malonyl;

or a salt, hydrate or solvate thereof.

48. The composition of claim 11 , wherein:

X is oxycodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and —C(O)NR 10a R 10b , wherein R 10a and R 10b are methyl;

each R 2 is hydrogen;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is malonyl or acetyl;

or a salt, hydrate or solvate thereof.

49. The composition of claim 39 , wherein:

X is oxycodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and methyl;

each R 2 is independently selected from hydrogen and methyl;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is acetyl;

or a salt, hydrate or solvate thereof.

50. The composition of claim 11 , wherein:

X is hydrocodone;

R 5 is methyl;

n is 2;

each R 1 is independently selected from hydrogen and —C(O)NR 10a R 10b , wherein R 10a and R 10b are —CH 2 C(O)OH;

each R 2 is hydrogen;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is acetyl;

or a salt, hydrate or solvate thereof.

51. The composition of claim 11 , wherein:

X is hydrocodone;

R 5 is methyl;

n is 3;

each R 1 is independently selected from hydrogen and dimethyl;

each R 2 is independently selected from hydrogen and dimethyl;

R 3 is hydrogen;

R 4 is

wherein p is 2;

each R 6 is independently hydrogen or —CH 2 CH 2 CH 2 NH(C═NH)NH 2 ;

each W is —NR 8 —;

each R 8 is hydrogen; and

R 7 is malonyl;

or a salt, hydrate or solvate thereof.