Organic compounds
The invention relates to particular substituted heterocycle fused gamma-carbolines, their prodrugs, in free, solid, pharmaceutically acceptable salt and/or substantially pure form as described herein, pharmaceutical compositions thereof, and methods of use in the treatment of diseases involving the 5-HT 2A receptor, the serotonin transporter (SERT), pathways involving the dopamine D 1 and D 2 receptor signaling system, and/or the μ-opioid receptor.
1. A method for the treatment of a central nervous system disorder in a patient in need of such treatment, comprising administering to the patient a compound of a Formula I:
wherein:
X is —NH—;
L is O;
Z is —O— or —C(O)—;
in free or pharmaceutically acceptable salt form;
optionally in an isolated or purified free or salt form;
wherein the central nervous system disorder is a pain disorder selected from neuropathic pain, idiopathic pain, chronic pain, or fibromyalgia, or wherein the central nervous system disorder is a drug dependency selected from opiate dependency, cocaine dependency, amphetamine dependency, alcohol dependency, substance addiction, substance-use disorder, or substance-induced disorder, or wherein the patient has any combination of such disorders.
2. The method according to claim 1 , wherein the compound is:
3. The method according to claim 1 , wherein the compound is:
4. The method according to claim 1 , wherein the compound is in the form of a pharmaceutically acceptable salt.
5. The method according to claim 4 , wherein the pharmaceutically acceptable salt is an acid addition salt selected from the group consisting of hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, nitric, acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, palmoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, and isethionic acid salts.
6. The method of claim 5 , wherein the pharmaceutically acceptable salt is an acid addition salt selected from the group consisting of fumaric, phosphoric and toluenesulfonic acid salts.
7. The method according to claim 1 , wherein the compound is administered in the form of a pharmaceutical composition comprising the compound according to claim 1 , in free or pharmaceutically acceptable salt form, in admixture with a pharmaceutically acceptable diluent or carrier.
8. The method according to claim 1 , wherein the patient is not responsive to or cannot tolerate the side effects of non-narcotic analgesics and/or opiate and opioid drugs, or wherein the use of opiate drugs are contraindicated in said patient, due to prior substance abuse or a high potential for substance abuse.
9. The method according to claim 8 , wherein said drugs are selected from the group consisting of morphine, codeine, thebaine, oripavine, morphine dipropionate, morphine dinicotinate, dihydrocodeine, buprenorphine, etorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl, alpha-methylfentantyl, alfentanyl, trefantinil, brifentanil, remifentanil, octfentanil, sufentanil, carfentanyl, meperidine, prodine, promedol, propoxyphene, dextropropoxyphene, methadone, diphenoxylate, dezocine, pentazocine, phenazocine, butorphanol, nalbuphine, levorphanol, levomethorphan, tramadol, tapentadol, and anileridine, or any combinations thereof.
10. The method according to claim 1 , wherein the disorder is neuropathic pain, idiopathic pain, chronic pain, or fibromyalgia.
11. The method according to claim 1 , wherein the disorder is neuropathic pain.
12. The method according to claim 1 , wherein the disorder is opiate dependency, cocaine dependency, amphetamine dependency, or alcohol dependency.
13. The method according to claim 1 , wherein the disorder is a substance addiction, a substance-use disorder, or a substance-induced disorder.
14. The method according to claim 13 , wherein the central nervous system disorder is selected from intoxication, withdrawal, substance-induced psychosis, substance-induced bipolar disorder, substance-induced depressive disorder, substance-induced anxiety disorder, substance-induced obsessive-compulsive disorder, substance-induced sleep disorder, substance-induced sexual dysfunction, substance-induced delirium, or substance-induced neurocognitive disorder.