Combination analgesic employing opioid agonist and neutral antagonist
In some embodiments, the invention provides a non-addictive analgesic co-formulation comprising an opioid agonist in an amount sufficient to confer analgesia in a mammalian subject (such as a human) and a neutral opioid antagonist in an amount sufficient to inhibit peripheral effects of the opioid agonist, and insufficient to block substantial central effects of the opioid agonist in the subject. The formulation may be formulated for oral administration to the subject. Such formulations, and methods of using the same, may also deter diversion, inhibit peripheral effects of the opioid agonist, and reduce addiction liability.
1. A unit dosage of an analgesic composition, formulated for oral administration to a subject, comprising:
(a) an opioid agonist in an amount sufficient to confer analgesia in the subject;
(b) a non-aversive neutral opioid antagonist in an amount sufficient to substantially inhibit peripheral effects and insufficient to block substantial central effects of the agonist in the subject, wherein the amounts of the neutral opioid antagonist and the opioid agonist are selected so that a weight/weight (w/w) ratio of (1) an amount of 6β-naltrexol equivalent to the amount of neutral opioid antagonist divided by (2) an amount of morphine equivalent to the opioid agonist is at least 1.0, and the opioid antagonist is selected to have a blood half-life that is substantially longer than the blood half-life of the opioid agonist, so as to deter abuse resulting from overly frequent administration of the unit dosage; and
(c) a pharmaceutically acceptable carrier.
2. The unit dosage of claim 1 , wherein the subject is a human.
3. The unit dosage of claim 1 , wherein the w/w ratio of the amount of 6β-naltrexol divided by the amount of morphine is at least 2.0.
4. The unit dosage of claim 1 , wherein the agonist is morphine.
5. The unit dosage of claim 1 , wherein the agonist is not morphine.
6. The unit dosage of claim 1 , wherein the antagonist is 6β-naltrexol.
7. The unit dosage of claim 1 , wherein the antagonist is not 6β-naltrexol.
8. The unit dosage of claim 1 , wherein the blood half-life of the antagonist is at least 2-fold longer than the blood half-life of the agonist.
9. The unit dosage of claim 1 , wherein the agonist is selected from the group consisting of alfentanil, allylprodine, alphaprodine, anileridine, benzylmorphine, bezitramide, buprenorphine, butorphanol, clonitazene, codeine, desomorphine, dextromoramide, dezocine, diampromide, diamorphone, dihydrocodeine, dihydromorphine, dimenoxadol, dimepheptanol, dimethylthiambutene, dioxaphetyl butyrate, dipipanone, eptazocine, ethoheptazine, ethylmethylthiambutene, ethylmorphine, etonitazene, fentanyl, heroin, hydrocodone, hydromorphone, hydroxypethidine, isomethadone, ketobemidone, levorphanol, levophenacylmorphan, lofentanil, meperidine, meptazinol, metazocine, methadone, metopon, morphine, myrophine, narceine, nicomorphine, norlevorphanol, normethadone, noroxycodone, nalorphine, nalbuphene, normorphine, norpipanone, opium, oxycodone, oxymorphone, papavereturn, pentazocine, phenadoxone, phenomorphan, phenazocine, phenoperidine, piminodine, piritramide, propheptazine, promedol, properidine, propoxyphene, sufentanil, tilidine, and tramadol.
10. The unit dosage of claim 1 , wherein the antagonist is a naltrexone analog represented by formula Iα or Iβ:
wherein:
R 1 is C 3 -C 6 (cycloalkyl)(alkyl) or C 5 -C 7 (cycloalkenyl)alkyl;
R 2 is H, OH or esters thereof;
R 3 is H, alkyl or C 1 -C 6 alkyl-C═O;
R 4 and R 5 are independently H, halogen, C 1 -C 6 alkyl, C 1 -C 4 alkoxy, nitro, amino, cyano, carboxyl or acyl which may be substituted for one or more hydrogens on the ring;
X 1 and X 2 are the same or different, and may be H, alkyl, —OR 6 , —NR 7 R 8 R 9 , —NCOR 10 , —NO 2 , or —SR 11 ;
R 6 and R 11 are independently H, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, substituted aryl, acyl, aroyl, polyethyleneglycyl (PEGyl) or a polyether group;
R 7 , R 8 and R 10 are independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl;
R 9 can be present or absent and is independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl;
R 12 is hydrogen;
or pharmaceutically acceptable salts thereof.
11. The unit dosage of claim 1 , wherein the antagonist is a naloxone analog represented by formula Iα or Iβ:
wherein:
R 1 is C 3 -C 6 alkenyl;
R 2 is H, OH or esters thereof;
R 3 is H, alkyl or C 1 -C 6 alkyl-C═O;
R 4 and R 5 are independently H, halogen, C 1 -C 6 alkyl, C 1 -C 4 alkoxy, nitro, amino, cyano, carboxyl or acyl which may be substituted for one or more hydrogens on the ring;
X 1 and X 2 are the same or different, and may be H, alkyl, —OR 6 , —NR 7 R 8 R 9 , —NCOR 10 , —NO 2 , or —SR 11 ;
R 6 and R 11 are independently H, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, substituted aryl, acyl, aroyl, polyethyleneglycyl (PEGyl) or a polyether group;
R 7 , R 8 and R 10 are independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl;
R 9 can be present or absent and is independently hydrogen, alkyl, substituted alkyl, cycloalkyl, substituted cycloalkyl, aryl, or substituted aryl;
R 12 is hydrogen;
or pharmaceutically acceptable salts thereof.
12. The unit dosage of claim 1 , wherein the opioid antagonist is selected from the group consisting of 6β-naltrexol, 6β-naltrexamide, 6β-naloxol, 6α-naltrexol, 6α-naloxol, 6α-naltrexamine, 6β-naltrexamine, 6-deoxynaltrexone, and 6α-naltrexamide, pharmaceutically acceptable physical isomorphs thereof, and pharmaceutically acceptable salts thereof.
13. The unit dosage of claim 1 , wherein the unit dosage is in a slow-release formulation.