Compositions of buprenorphine and μ antagonists

1. A method of treating a depressive disorder, wherein said depressive disorder is selected from major depressive disorder, chronic depression, severe unipolar recurrent major depressive episodes, dysthymic disorder, depressive neurosis and neurotic depression, melancholic depression, atypical depression, reactive depression, treatment resistant depression, seasonal affective disorder and pediatric depression; premenstrual syndrome, premenstrual dysphoric disorder, hot flashes, bipolar disorders or manic depression, bipolar I disorder, bipolar II disorder and cyclothymic disorder, comprising administering a composition comprising buprenorphine and a μ opioid receptor antagonist, wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 0.7 and about 2.2; wherein;

AAnAI

=

[

C

max

⁡

(

BUP

)

/

EC

50

]

[

C

max

⁡

(

ANTAGONIST

)

/

IC

50

]

wherein, EC 50 represents the half maximal effective serum concentration of buprenorphine, expressed as nM;

IC 50 represents the half maximal inhibitory concentration of the μ opioid antagonist in humans, expressed as nM;

C max(BUP) represents the peak serum or plasma concentration of buprenorphine and/or a μ opioid receptor agonist metabolite of buprenorphine, expressed as nM; and

C max(ANTAGONIST) represents the peak serum concentration of the μ opioid antagonist and/or a μ opioid receptor antagonist metabolite of said μ opioid antagonist, expressed as nM to a subject in need thereof; and

wherein said antagonist is a compound of Formula I:

or a pharmaceutically acceptable salt, ester or prodrug thereof wherein;

s is 0, 1 or 2;

t is 0, 1, 2, 3, 4, 5, 6, or 7;

X is S or O;

R 1 is selected from aliphatic, substituted aliphatic, aryl, substituted aryl, heterocyclyl or substituted heterocyclyl;

each R 2 , R 3 , R 4 , R 5 , R 6 , R 7 and R 8 is independently selected from hydrogen, halogen, —OR 20 , —SR 20 , —NR 20 R 21 , —C(O)R 20 , —C(O)OR 20 , —C(O)NR 20 R 21 , —N(R 20 )C(O)R 21 , —CF 3 , —CN, —NO 2 , —N 3 , acyl, alkoxy, substituted alkoxy, alkylamino, substituted alkylamino, dialkylamino, substituted dialkylamino, substituted or unsubstituted alkylthio, substituted or unsubstituted alkylsulfonyl, optionally substituted aliphatic, optionally substituted aryl, heterocyclyl or substituted heterocyclyl;

each R 9 and R 10 is selected from hydrogen, aliphatic, substituted aliphatic, aryl, substituted aryl, heterocyclyl or substituted heterocyclyl;

alternatively, two of R 2 , R 3 , R 4 , R 5 , R 6 , R 7 and R 8 together with the atoms they are attached to form an optionally substituted ring; alternatively R 2 and R 3 together with the carbon they are attached to form a C═X group; wherein each R 20 and R 21 is independently selected from absent, hydrogen, halogen, —OH, —SH, —NH 2 , —CF 3 , —CN, —NO 2 , —N 3 , —C(O)OH, —C(O)NH 2 , acyl, alkoxy, substituted alkoxy, alkylamino, substituted alkylamino, dialkylamino, substituted dialkylamino, substituted or unsubstituted alkylthio, substituted or unsubstituted alkylsulfonyl, aliphatic, substituted aliphatic, aryl or substituted aryl; and

alternatively, R 9 and R 10 together with the atom they are attached to form an optionally substituted ring; alternatively two R 5 groups, or an R 5 and an R 6 group, together with the carbon they are attached to form a C═X group.

2. The method according to claim 1 , wherein said depressive disorder is major depressive disorder.

3. The method according to claim 2 , wherein said major depressive disorder is resistant to two or more antidepressants.

4. The method according to claim 3 , wherein said antidepressants are selected from the group consisting of selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Monoamine oxidase inhibitors (MAOIs) and Tricyclic antidepressants.

5. The method according to claim 1 , wherein said depressive disorder is treatment resistant depression.

6. The method according to claim 1 , wherein said composition is administered orally or -sublingually.

7. The method according to claim 1 , wherein said subject exhibits one or more depressive symptoms selected from irritability, feelings of hopelessness and helplessness, inability to concentrate, sadness, insomnia, appetite loss, lack of interest in life's activities, thoughts of suicide, dizziness, nausea, vomiting, hyperhidrosis, menorrhagia, pain in extremity, constipation, sedation, fatigue, feeling abnormal, flushing and somnolence.

8. The method according to claim 1 , wherein said antagonist is a compound of Formula II:

or a pharmaceutically acceptable salt, ester or prodrug thereof wherein;

R 1 is —(CH 2 ) n -c-C 3 H 5 , —(CH 2 ) n -c-C 4 H 7 , —(CH 2 ) n -c-C 5 H 9 , —(CH 2 ) n —CH═CH 2 or —(CH 2 ) n —CH═C(CH 3 ) 2 wherein n and m are independently 0, 1, 2 or 3;

R 6 and R 7 are independently H, —OH or together R 6 and R 7 form an —O— or —S— group;

X is S or O; and

R 5 and R 11 are independently H, —OH, OCH 3 or together R 5 and R 1 form a ═O or ═CH 2 group.

9. The method according to claim 1 , wherein said antagonist is selected from:

10. The method according to claim 8 , wherein said μ opioid antagonist is:

or a salt, ester or prodrug thereof.

11. The method according to claim 1 , wherein said composition comprises about 1 mg to about 100 mg of buprenorphine and about 0.25 to about 100 mg of a compound of Formula I.

12. The method according to claim 11 , wherein said composition comprises about 2 mg to about 50 mg of buprenorphine.

13. The method according to claim 11 , wherein said composition comprises about 3 to about 25 mg of buprenorphine.

14. The method according to claim 11 , wherein said composition comprises about 3 to about 10 mg of buprenorphine.

15. The method according to claim 11 , wherein said composition comprises about 0.25 to about 50 mg of a compound of Formula I.

16. The method according to claim 11 , wherein said composition comprises about 0.5 to about 25 mg of a compound of Formula I.

17. The method according to claim 11 , wherein said composition comprises about 1.0 to about 20 mg of a compound of Formula I.

18. The method according to claim 11 , wherein said composition comprises about 2.0 to about 10 mg of a compound of Formula I.

19. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 0.8 and about 2.1.

20. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 0.9 and about 2.0.

21. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 1.0 and about 1.8.

22. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 1.1 and about 1.6.

23. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of between about 1.2 and about 1.4.

24. The method according to claim 1 , wherein the composition is characterized by an Agonist Antagonist Activity Index (AAnAI) of about 1.3.

25. The method according to claim 1 , wherein said composition is administered sublingually.