Medicaments for the treatment or prevention of the withdrawal syndrome

Abstract: The invention relates to the use of compounds which act as antagonists of 5-hydroxytryptamine (5-HT) at 5-HT₃ receptors for the relief or prevention of a withdrawal syndrome resulting from addiction to a drug or substance of abuse and/or for the suppression of dependence on drugs or substances of abuse.

Description: This invention relates to a new medical use for certain chemical compounds and pharmaceutical compositions containing them. In particular it relates to the use in the treatment of subjects addicted, recovering from addiction, or liable to become addicted, to drugs or substances of abuse of compounds which act as antagonists of 5-hydroxytryptamine (5-HT) at receptors known in the art as 5-HT₃, 5-HT'M' or 5-HT 'M'-like' receptors. Such receptors have been described for example by Fozard et al ., Eur. J. Pharmacol., 1979, 59 , 195-210; Ireland, Straughan and Tyers, Br. J. Pharmacol., 1962, 75 , 16P; Humphrey, Neuropharm., 1984 23 , 1503-1570; Richardson et al ., Nature, 1985, 316 , 126-131; and Bradley et al ., Neuropharm., 1986, 25 , 563-576. Receptors of this type are now designated as 5-HT₃ receptors. 5-HT receptors of this type are located, for example, on the terminals of afferent, sensory neurones, in the isolated guinea-pig ileum preparation and are also present in the central nervous system. Compounds which act as antagonists of 5-HT at 5-HT₃ receptors may be identified using standard tests, for example, in vitro by measuring their inhibition of the depolarising effect of 5-HT on the rat or rabbit isolated vagus nerve, or the tachycardia produced by 5-HT in the rabbit isolated heart of the contraction produced by 5-HT in the guinea-pig isolated ileum, or in vivo by measuring their effect on the Von Bezold-Jarisch reflex (induced by 5-HT) as described, for example, in the above-mentioned references. A variety of compounds which act as antagonists of 5-HT at 5-HT₃ receptors have been described in the art. The known compounds are generally azabicyclo derivatives and/or benzoic acid derivatives, or imidazole derivatives. Azabicyclo derivatives include compounds containing a bridged piperidyl group, such as a tropyl, pseudotropyl, homotropyl or quinuclidinyl group. An azabicyclo derivative preferably contains a carbocyclic or heterocyclic aromatic group linked, for example as an ester or amide, to the azabicyclic ring. The aromatic group may be for example an optionally substituted phenyl, indolyl, benzofuranyl, benzothienyl, benzisoxazolyl, indazolyl or pyrimidinyl group. Berzoic acid derivatives which act as antagonists of 5-HT at 5-HT₃ receptors include benzoates and benzamides. A benzoic acid derivative may for example be an ester or an amide formed with an azabicyclic group as defined above, or formed with a piperidyl group. Such compounds have been disclosed inter alia in published UK Patent Applications Nos. 2100259, 2125398, 2131420, 2132189, 2145416, 2152049, 2153821 and 2169292, published European Patent Applications Nos. 111608, 116255, 158265, 191562, 200444, 210840, 214772, 219193, 221702, 226267, 227215, 230718, 235878 and 242973, and published Australian Patent Application No. 87/67121. The compounds disclosed in published Eurpoean Patent Application Nos. 13138, 67615, and 94742 are described in published European Patent Applications Nos. 215545 and 220011 as antagonists of 5-HT at 5-HT₃ receptors. The compounds disclosed in these specifications have been described as being of use in a variety of conditions, including migraine. However there is no disclosure in these specifications of compounds which are antagonists of 5-HT at 5-HT₃ receptors being of use in the treatment of drug abuse. We have now found that compounds which act as 5-HT antagonists at 5-HT₃ receptors may be used in the treatment of subjects addicted, recovering from addiction, or liable to become addicted, to drugs or substances of abuse. 1,2,3,9-Tetrahydro-9-methyl-3-[(2-methylimidazol-1-yl)methyl]-4H-carbazol-4-one and its salts and solvates, which are disclosed in published UK Patent Application No 2153821A, cocaine and morphine are however excluded from the present invention. It will be appreciated that general references hereinafter to "compounds which act as antagonists of 5-HT at 5-HT₃ receptors" and to those compounds "disclosed in published UK Patent Application No. 2153821A" exclude 1,2,3,9-tetrahydro-9-methyl-3-[(2-methylimidazol-1-yl)methyl]-4 H -carbazol-4-one and its salts and solvates. Repeated administration to a subject of certain drugs such as opiates (e.g. morphine), cocaine or benzodiazepines (e.g. diazepam, chlorodiazepoxide or lorazepam), or substances of abuse such as alcohol or nicotine (e.g. smoking) can lead to physical and/or psychological dependence upon that drug or substance. When the drug or substance of abuse is withdrawn from a dependent subject, the subject develops certain symptoms, such as aggressive behaviour, agitation and intense craving for the drug or substance of abuse. These symptoms may be collectively described as a withdrawal or abstinence syndrome. It has not been shown that administration of a compound which acts as a 5-HT antagonist at 5-HT₃ receptors can prevent, alleviate or reverse this withdrawal syndrome. The compounds are therefore of use for the prevention or relief of a withdrawal syndrome resulting from addiction to drugs or substances of abuse. It has also been shown that compounds which act as 5-HT antagonists at 5-HT₃ receptors suppress dependence on drugs or substances of abuse. The compounds are therefore also of use in reducing the craving for a drug or substance of abuse after addiction to that drug or substance, and can therefore be used for maintainence therapy during remission from addition to drugs or substances of abuse. The compounds may also be used for prophylactic treatment of subjects liable to become dependent on drugs or substances of abuse. The effectiveness of compounds for use according to the present invention in the treatment of a withdrawal syndrome resulting from addiction to a drug or substance of abuse, and for the suppression of dependence on a drug or substance of abuse may be demonstrated in animals using standard tests, for example, the light/dark exploration test in mice, the rat social interaction test, a marmoset behavioural test and the 'drinkometer' alcohol consumption test in rats. Accordingly the invention provides a method of treatment for the relief or prevention of a withdrawal syndrome resulting from addiction to a drug or substance of abuse and/or for the suppression of dependence on drugs or substances of abuse, which comprises administering to a human or animal subject an effective amount of a compound which acts as an antagonist of 5-HT at 5-HT₃ receptors, or a physiologically acceptable salt or solvate thereof. Preferred compounds for use in the present invention are azabicyclo derivatives (e.g. containing a bridged piperidyl group such as a tropyl, pseudotropyl, homotropyl or quinuclidinyl group) and benzoic acid derivatives (e.g. benzoates and benzamides) which act as antagonists of 5-HT at 5-HT₃ receptors. Further preferred 5-HT₃ receptor antagonists for use in the present invention are 3-(imidazol-1-yl)-methyltetrahydrocarbazolones and 3-(imidazol-4-yl)-(indol-3-yl)-1-propanones. Particular mention may be made of the compounds which act as antagonists of 5-HT at 5-HT₃ receptors disclosed in published UK Patent Applications Nos. 2100259, 2125398, 2131420, 2132189, 2145416, 2152049, 2153821 and 2169292, published European Patent Applications Nos. 13138, 67615, 94742, 111608, 116255, 158265, 191562, 200444, 210840, 214772, 219193, 221702, 226267, 227215, 230718, 235878 and 242973, and published Australian Patent Application No. 87/67121. Preferred compounds for use according to the invention are those described in published UK Patent Application Nos. 2100259, 2131794, 2132189, 2125398, 2152049 and 2153821, published European Patent Applications Nos. 13138, 94742, 200444, 221702, 226267, 235878 and 242973 and published Australian Patent Application No. 87/67121. Particularly preferred compounds for use according to the present invention are those described in published UK Patent Application Nos. 2100259 and 2125398 and published European Patent Application Nos. 94742, 200444 and 242973. A group of compounds described in UK Specification No. 2125398 may be represented by the general formula (I): wherein R₁ and R₂ independently represent hydrogen, halogen, C₁₋₄alkyl, C₁₋₄ alkoxy, hydroxy, amino, C₁₋₄ alkylamino, di(C₁₋₄)alkylamino, mercapto or C₁₋₄ alkylthio; R₃ represents hydrogen, C₁₋₄ alkyl, C₃₋₅ alkenyl, aryl or aralkyl; R₄ represents hydrogen, C₁₋₇ alkyl, C₃₋₅ alkenyl or aralkyl; n is 2 or 3; the free valence is attached to either fused ring, and the azabicyclic ring is in either the exo or endo configuration; and acid addition salts and quaternary ammonium salts thereof. In the compounds of formula (I) R, and R₂ may, for example, independently represent hydrogen, halogen or C₁₋₄ alkyl, R₃ may be, for example, hydrogen or C₁₋₄ alkyl and R₄ may be, for example, hydrogen, C₁₋₇ alkyl or aralkyl. The carbonyl group is preferably attached to the 3-position of the indole ring. The azabicyclic ring is preferably in the endo configuration. Compounds described in UK Specification No. 2100259 may be represented by the general formula (II): wherein R₅ represents C₁₋₄ alkyl, C₁₋₄ alkoxy, or halogen; and R₆ and R₇ independently represent hydrogen, C₁₋₄ alkyl, C₁₋₄ alkoxy or halogen provided that R₆ is hydrogen when R₇ is hydrogen; and pharmaceutically acceptable salts thereof. A preferred class of compounds of formula (II) are those in which R₅ and R₇ are the same and each represents methyl, methoxy or chlorine, and R₆ represents hydrogen. A group of compounds described in European Specification No. 94742 may be represented by the general formula (III): wherein R₈ represents a C₁₋₆ alkoxy or amino N -substituted by one or two groups selected from C₁₋₆ alkyl or C₃₋₈ cycloalkyl or optionally N -substituted by C₄₋₅ polymethylene; one of R₉, R₁₀ and R₁₁ is hydrogen and the other two are independently selected from hydrogen, chloro, bromo, trifluoromethyl, hydroxy, C₁₋₆ alkoxy, C₁₋₆ alkylthio, C₁₋₆ alkyl and amino; one of R₁₄ and R₁₅ represents hydrogen, C₁₋₆ alkyl, phenyl or phenylC₁₋₃alkyl, which phenyl moieties may be substituted by C₁₋₆ alkyl, C₁₋₆ alkoxy, CF₃ or halogen, and the other of R₁₂ and R₁₃ is hydrogen or C₁₋₆ alkyl; q is zero or an integer from 1 to 4; r is zero, or an integer from 1 to 3; and s is zero, 1 or 2. Preferred compounds of formula (IV) are those wherein R₈ is methoxy, R₉ is hydrogen, R₁₀ is 4-amino, R₁₁ is 5-chloro (relative to the benzamide group), R₁₂ and R₁₃ independently represent hydrogen or C₁₋₆ alkyl; q is zero, r is 1 or 2 and s is zero, 1 or 2. A group of compounds described in European Specification No. 200444 may be represented by the general formula (IV) : wherein X is CO and Y is NH or O; and p is 2 or 3; and pharmaceutically acceptable salts thereof. Compounds described in our UK Patent Specification No. 2153821 and European Specifications Nos. 191562, 210840 and 219193 may be represented by the general formula (V): wherein R¹⁴ represents a hydrogen atom or a group selected from C₁₋₁₀alkyl, C₃₋₆ alkenyl, C₃₋₁₀ alkynyl, C₃₋₇cycloalkyl, C₃₋₇cycloalkylC₁₋₄alkyl, phenyl or phenylC₁₋₃alkyl, and in the case where Q represents a hydrogen atom, R¹⁴ may also represent -CO₂R¹⁸, -COR¹⁸, -CONR¹⁸R¹⁹ or -SO₂R¹⁸ (wherein R¹⁸ and R¹⁹, which may be the same or different, each represents a hydrogen atom, a C₁₋₆ alkyl or C₃₋₇cycloalkyl group, or a phenyl or phenylC₁₋₄alkyl group, in which the phenyl group is optionally substituted by one or more C₁₋₄alkyl, C₁₋₄alkoxy or hydroxy groups or halogen atoms, with the proviso that R¹⁸ does not represent a hydrogen atom when R¹⁴ represents a group -CO₂R¹⁸ or -SO₂R¹⁸); one of the groups represented by R¹⁵, R¹⁶ and R¹⁷ is a hydrogen atom or a C₁₋₆ alkyl, C₃₋₇ cycloalkyl, C₂₋₆ alkenyl, or phenylC₁₋₃alkyl group, and each of the other two groups, which may be the same or different, represents a hydrogen atom or a C₁₋₆ alkyl group; Q represents a hydrogen atom or a halogen atom or a hydroxy, C₁₋₄alkoxy, phenylC₁₋₃alkoxy or C₁₋₆ alkyl group or a group -NR²⁰R²¹ or -CONR²⁰R²¹(wherein R²⁰ and R²¹, which may be the same or different, each represents a hydrogen atom or a C₁₋₄ alkyl or C₃₋₄ alkenyl group, or together with the nitrogen atom to which they are attached form a saturated 5 to 7 membered ring); and physiologically acceptable salts and solvates thereof. A preferred class of compounds represented by the formula (V) for use according to the present invention is that wherein R¹⁴ represents a hydrogen atom or a methyl, ethyl, propyl, prop-2-yl, prop-2-enyl or cyclopentyl group; R¹⁶ represents a hydrogen atom; and either R¹⁵ represents a methyl, ethyl, propyl or prop-2-yl group and R¹⁷ represents a hydrogen atom or R¹⁵ represents a hydrogen atom and R¹⁷ represents a methyl or ethyl group; and Q represents a hydrogen atom. A group of compounds described in European Patent Specification No. 242972 may be represented by the general formula (VI): wherein Im represents an imidazolyl group of formula : R²² represents a hydrogen atom or a C₁₋₆ alkyl, C₃₋₆ alkenyl, C₃₋₁₀alkynyl, C₃₋₇ cycloalkyl, C₃₋₇ cycloalkylC₁₋₄alkyl, phenyl or phenylC₁₋₃alkyl group; R²³ represents a hydrogen atom or a C₁₋₆ alkyl, C₃₋₆ alkenyl, C₃₋₇cycloalkyl, phenyl or phenylC₁₋₃alkyl group; R²⁴ and R²⁵, which may be the same or different, each represents a hydrogen atom or a C₁₋₆ alkyl group; one of the groups represented by R²⁶,R²⁷ and R²⁸, is a hydrogen atom or a C₁₋₆ alkyl, C₃₋₇ cycloalkyl, C₃₋₆ alkenyl, phenyl or phenylC₁₋₃alkyl group, and each of the other two groups, which may be the same or different, represents a hydrogen atom or a C₁₋₆ alkyl group; and physiologically acceptable salts and solvates thereof. A preferred class of compounds represented by the formula (VI) for use according to the present invention are those wherein R²² represents a hydrogen atom or a methyl, prop-2-enyl or cyclopentyl group; R²³ represents a hydrogen atom or a methyl group; R²⁴ and R²⁵ each independently represent a hydrogen atom or a methyl group; R²⁶ and R²⁷ each represent a hydrogen atom; and R²⁸ represents a hydrogen atom or a C₁₋₃ alkyl group, most preferably methyl. Compounds described in European Specification No. 235878 and Australian Specification No. 87/67121 may be represented by the general formulae (VII) and (VIII) respectively : wherein L is NH or O; R²⁹ and R³⁰ are independently selected from hydrogen, halogen, CF₃, C₁₋₆alkyl, C₁₋₆ alkoxy, C₁₋₆alkylthio, C₁₋₇acyl, C₁₋₇acylamino, C₁₋₆alkylsulphonylamino N -(C₁₋₆ alkylsulfonyl)- N -C₁₋₄alkylamino, C₁₋₆alkylsulphinyl, hydroxy, nitro or amino, aminocarbonyl, aminosuphonyl, aminosulphonylamino or N -(aminosulphonyl)-C₁₋₄ alkylamino optionally N -substituted by one or two groups selected from C₁₋₆alkyl, C₃₋₈ cycloalkyl, C₃₋₈ cycloalkylC₁₋₄ alkyl, phenyl or phenylC₁₋₄ alkyl groups or optionally N -disubstituted by C₄₋₅polymethylene; Z is a moiety capable of hydrogen bonding to the NH group depicted in formula (VII); D and E are independently selected from hydrogen or C₁₋₄alkyl, or together are a bond; R³¹ and R³² are independently selected from hydrogen, C₁₋₆ alkyl, C₂₋₆alkenylC₁₋₄alkyl, or together are C₂₋₄polymethylene; M is a group of formula (a), (b) or (c) : wherein t is 2 or 3; u is 1 or 2; v is 1 to 3; w is 1 to 3; and R³³ or R³⁴ is C₁₋₇alkyl, C₃₋₈cycloalkyl, C₃₋₈cycloalkylC₁₋₂alkyl or C₂₋₇alkenylC₁₋₄alkenyl; and pharmaceutically acceptable salts thereof. Preferably L is NH; R²⁹ is often hydrogen and R³⁰ is hydrogen or a 4-substituent such as halo or methoxy; Z is preferably C-OCH₃, C-OC₂H₅, C-OC₃H₇, C-CO₂CH₃, C-CO₂C₂H₅ or SO₂N(CH₃)₂; often D and E are both hydrogen; often R³¹ and R³² are both hydrogen; preferably t is 2 or 3 and u, v and w are 1 or 2; and R³³/R³⁴ is preferably methyl or ethyl, most preferably methyl. A group of compounds described in UK Specification No. 2152049 may be represented by the general formula (IX): wherein R¹, R² and R³ are as defined for general formula (I) and G is a group of formula (d) or (e): wherein R³⁵ is C₁₋₄ alkyl and R³⁶ is methoxy; and pharmaceutically acceptable salts thereof. Particularly preferred compounds for use according to the present invention are (3α-tropanyl)-1 H -indole-3-carboxylic acid ester and endo- N -(9-methyl-9-azabicyclo[3,3,1]non-3-yl)-1-methyl-indazole-3-carboxamide. Other preferred compounds for use according to the present invention are: 3-(5-methyl-1 H -imidazol-4-yl)-1-(1-methyl-1 H -indol-3-yl)-1-propanone; 1αH, 3α,5αH-tropan-3-yl-3,5-dimethylbenzoate; and (±)-endo-4-amino-5-chloro-2-methoxy- N -(1-azabicyclo)-[3.3.1]-non-4-yl) benzamide, particularly in the form of its hydrochloride hydrate. Further preferred compounds for use according to the present invention are : 1αH,3α,5αH-tropan-3-yl-3,5-dichlorobenzoate; indole-[5-(2-methyl-2-azabicyclo(2.2.2)octyl]-3-carboxylate; 1 H -indol-3-yl-carboxylic acid (3R*,4S*)-1-azabicyclo-[2.2.1]hept-3-yl ester; 1 H -indolyl-3-carboxylic acid 2S-(1-methyl-2-pyrrolidinylmethyl) ester; 4-amino-5-chloro-2-methoxy- N -(3-quinuclidinylmethyl)benzamide; 1-methyl-3-indazolecarboxylic acid (endo-8-methyl-8-azabicyclo [3,2,1] oct-3-yl)ester; (±)4-amino-5-chloro-2-methoxy- N -(6'α-[4'-thia-1'-azabicyclo[3,3,1] nonyl])benzamide; (±)4-amino-5-chloro-2-methoxy- N -(6'α-[4'-oxa-1'-azabicyclo[3,3,1] nonyl])benzamide; and physiologically acceptable salts and solvates thereof. The invention also provides a pharmaceutical composition which comprises an effective amount of at least one compound (e.g. an azabicyclo derivative or a benzoic acid derivative) which acts as an antagonist of 5-HT at 5-HT₃ receptors, for use in human or veterinary medicine, for the relief or prevention of a withdrawal syndrome resulting from addiction to a drug or substance of abuse and/or for the suppression of dependence on drugs or substances of abuse. In a further aspect the invention provides for the use of a compound (e.g. an azabicyclo derivative or a benzoic acid derivative) which acts as an antagonist of 5-HT at 5-HT₃ receptors for the manufacture of a medicament for the relief or prevention of a withdrawal syndrome resulting from addiction to a drug or substance of abuse and/or for the suppression of dependence on drugs or substances of abuse. Pharmaceutical compositions for use according to the present invention may be formulated in conventional manner, optionally with one or more physiologically acceptable carriers and/or excipients. For example, the compounds described in the aforementioned patent specifications may be formulated in the manner described therein. Compounds for use according to the present invention may be formulated for oral, buccal, parenteral, rectal or transdermal administration or in a form suitable for administration by inhalation or insufflation (either through the mouth or the nose). For oral administration, the pharmaceutical compositions may take the form of, for example, tablets or capsules prepared by conventional means with pharmaceutically acceptable excipients such as binding agents (e.g. pregelatinised maize starch, polyvinylpyrrolidone or hydroxypropyl methylcellulose); fillers (e.g. lactose, microcrystalline cellulose or calcium hydrogen phosphate); lubricants (e.g. magnesium stearate, talc or silica); disintegrants (e.g. potato starch or sodium starch glycollate); or wetting agents (e.g. sodium lauryl sulphate). The tablets may be coated by methods well known in the art. Liquid preparations of oral administration may take the form of, for example, solutions, syrups or suspensions, or they may be presented as a dry product for constitution with water or other suitable vehicle before use. Such liquid preparations may be prepared by conventional means with pharmaceutically acceptable additives such as suspending agents (e.g. sorbitol syrup, cellulose derivatives or hydrogenated edible fats); emulsifying agents (e.g. lecithin or acacia); non-aqueous vehicles (e.g. almond oil, oily esters, ethyl alcohol or fractionated vegetable oils); and preservatives (e.g. methyl or propyl- p -hydroxybenzoates or sorbic acid). The preparations may also contain buffer salts, flavouring, colouring and sweetening agents as appropriate. Preparations for oral administration may be suitably formulated to give controlled release of the active compound. For buccal administration the compositions may take the form of tablets or lozenges formulated in conventional manner. Compounds for use according to the present invention may be formulated for parenteral administration by injection e.g. by bolus injection or continuous infusion. Formulations for injection may be presented in unit dosage form e.g. in ampoules or in multi-dose containers, with an added preservative. The compositions may take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilising and/or dispersing agents. Alternatively, the active ingredient may be in powder form for constitution with a suitable vehicle, e.g. sterile pyrogen-free water, before use. The compounds for use according to the present invention may also be formulated in rectal compositions such as suppositories or retention enemas, e.g. containing conventional suppository bases such as cocoa butter or other glycerides. In addition to the formulations described previously, the compounds may also be formulated as a depot preparation. Such long acting formulations may be administered by implantation (for example subcutaneously, transcutaneously or intramuscularly) or by intramuscular injection. Thus, for example, the compounds for use according to the present invention may be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly soluble salt. The dose at which the compounds may be administered to man will depend upon the route of administration, the body weight of the patient, the severity of the condition to be treated and the potency of the compounds. For example, the compounds disclosed in the aforementioned patent specifications may be administered at doses in the ranges specified therein for the compounds, or at lower doses for example 0.5µg to 20mg e.g. 0.005 - 20mg, preferably 0.05 - 10mg per unit dose which may be administered, for example, 1 to 4 times per day. Thus a unit dose of a compound of formula (I) as herein defined may contain from 0.2 to 250mg of the active ingredient, and may be administered for example up to four times per day, such that the overall daily dose is in the range 0.5 to 500mg. A unit dose of a compound of formula (II) as herein defined may contain from about 0.5 to 100mg of the active ingredient, usually 1 to 50mg and preferably 3 to 30mg, and may be administered, for example, from 1 to 4 times per day. A unit dose of a compound of formula (III) as herein defined may contain 0.1 to 20mg of the active ingredient, for example 0.5 to 10mg, and may be administered, for example, up to six times per day, such that the total daily dose is normally in the range 0.01 to 10 mg/kg. A unit dose of a compound of formula (IV) as herein defined may contain 0.5 to 1000mg of the active ingredient, for example 1 to 500mg, and may be administered, for example, 1 to 4 times per day, such that the total daily dose is in the range 0.001 to 50mg/kg, more usually 0.002 to 25mg/kg. A unit dose of a compound of formula (V) as herein defined may contain 0.05 to 20mg of the active ingredient, preferably 0.1 to 10mg, and may be administered 1 to 4 times per day. A unit dose of a compound of formula (VI) as herein defined may contain 0.001 to 100mg of the active ingredient, preferably 0.01 to 50mg, and may be administered 1 to 4 times per day. A unit dose of a compound of formula (VII) as herein defined may contain 0.05 to 1000mg of the active ingredient, for example 0.1 to 500mg, and may be administered, for example, 1 to 4 times per day, such that the total daily dose is in the range 0.0001 to 50mg/kg, more usually 0.0002 to 25mg/kg. A unit dose of a compound of formula (VIII) as herein defined may contain 0.05 to 1000mg of the active ingredient, for example 0.5 to 500mg, and may be administered, for example, 1 to 4 times per day, such that the total daily dose is in the range 0.0001 to 50mg/kg, more usually 0.0002 to 25mg/kg. A unit dose of a compound of formula (IX) as herein defined may contain from 0.1 to 250mg of the active ingredient, and may be administered up to four times per day, such that the overall daily dose is in the range 0.5 to 500mg. The following examples illustrate pharmaceutical formulations for use according to the invention, containing either (3α-tropanyl)-1 H -indole-3-carboxylic acid ester or a compound of formula (VI) as the active ingredient. Other compounds which are antagonists of 5-HT at 5-HT₃ receptors may be formulated in a similar manner. TABLETS FOR ORAL ADMINISTRATION Tablets may be prepared by the normal methods such as direct compression or wet granulation. The tablets may be film coated with suitable rim forming materials, such as hyroxypropyl methylcellulose, using standard techniques. Alternatively the tablets may be sugar coated. Direct Compression Tablet mg/tablet Active Ingredient 0.50 Calcium Hydrogen Phosphate BP 87.25 Croscarmellose Sodium NF 1.8 Magnesium Stearate BP 0.45 Compression weight 90.0 The active ingredient is passed through a 60 mesh sieve, blended with the calcium hydrogen phosphate, croscarmellose sodium and magnesium stearate. The resultant mix is compressed into tablets using a Manesty F3 tablet machine fitted with 5.5mm, flat bevelled edge punches. Tablets of other strengths may be prepared by altering the ratio of active ingredient to excipients or the compression weight and using punches to suit. CAPSULES mg/capsule Active Ingredient 0.5 Starch 1500 98.5 Magnesium Stearate BP 1.0 Fill Weight 100.0 The active ingredient is sieved and blended with the excipients. The mix is filled into size No. 2 hard gelatin capsules using suitable machinery. Other doses may be prepared by altering the fill weight and if necessary changing the capsule size to suit. SYRUP This may be either a sucrose or sucrose free presentation. The hydroxypropylmethylcellulose is dispersed in hot water, cooled and then mixed with an aqueous solution containing the active ingredient and the other components of the formulation. The resultant solution is adjusted to volume and mixed. The syrup is clarified by filtration. Injection for Intravenous Administration Sodium chloride may be added to adjust the tonicity of the solution and the pH may be adjusted, using acid or alkali, to that of optimum stability and/or facilitate solution of the active ingredient. Alternatively suitable buffer salts may be used. The solution is prepared, clarified and filled into appropriate size ampoules sealed by fusion of the glass. The injection is sterilised by heating in an autoclave using one of the acceptable cycles. Alternatively the solution may be sterilised by filtration and filled into sterile ampoules under aseptic conditions. The solution may be packed under an inert atmosphere of nitrogen or other suitable gas. SUPPOSITORY Active Ingredient 0.5mg Witepsol H15 to 1.0g A suspension of the active ingredient is prepared in the molten Witepsol and filled, using suitable machinery, into 1q size suppository moulds. The efficacy of the compounds for use according to the present invention in the treatment of a withdrawal syndrome after addiction to a drug or substance of abuse has been demonstrated in animals using, for example, the light/dark exploration test in mice. Test Compound Y : 3-(5-methyl-1 H -imidazol-4-yl)-1-(1-methyl-1 H -indol-3-yl)-1-propanone. Test Compound Z : (3α-tropanyl)-1 H -indole-3-carboxylic acid ester. Light/Dark Exploration Test in Mice Animals Male albino BKW mice, 25-30g, were housed 10 to a cage and allowed free access to food and water. They were kept on a reversed light cycle with the lights on between 22.00h and 10.00h. Procedure and Results The method was based on that described by J. Crawley and F. K. Goodwin, Pharmacol. Biochem. and Behaviours, 1980, 13 , 167-170. The apparatus was an open-topped box, 45cm long, 27cm wide and 27cm high, divided into a small (2/5) area and a large (3/5) area by a partition that extended 20cm above the walls. There was a 7.5 x 7.5cm opening in the partition at floor level. The small compartment was painted black and the large compartment white. The floor of each compartment was marked into 9cm squares. The white compartment was illuminated by a 100W tungsten bulb 17cm above the box and the black compartment by a similarly placed 60W red bulb. The laboratory was illuminated with red light. All tests were performed between 13.00h and 18.00h. Each mouse was tested by placing it in the centre of the white area and allowing it to explore the novel environment for 5 minutes. Its behaviour was recorded on videotape and the behavioural analysis was performed subsequently from the recording. Five parameters were measured : the latency to entry into the dark compartments, the time spent in each area, the number of transitions between compartment, the number of lines crossed in each compartment and the number of times the mice stood up on their hind legs only (i.e. the number of rears) in each compartment. Drugs were administered intraperitoneally except where otherwise stated. Thus, in Experiments 1 and 2 groups of mice (5 per group) were treated with alcohol (8% v/v in drinking water) for 14 days, and then either : (A): the alcohol dosing was abruptly ceased and the mice were tested 2½ days after the last dose; or (B): as (A) with administration of the test compound Y, 10ng/kg (Experiment 1) or the test compound Z, 0.01 mg/kg (Experiment 2), on 5 separate occasions over the 2½ day alcohol withdrawal period. Treatment Rears/5min (light) Rears/5min (dark) Experiment 1 Vehicle 26.0 39.0 (A) Alcohol withdrawal 9.0 62.0 (B) Alcohol withdrawal + Test compound Y (10ng/kg) 44.0 32.0 Experiment 2 Vehicle 16.7 29.3 (A) Alcohol withdrawal 8.7 44.7 (B) Alcohol withdrawal + Test Compound Z (0.01mg/kg) 14.7 44.0¹ Results are means, standard error of the mean less than 11.7%. Conclusions In test (A) of both Experiments 1 and 2, the mice displayed an abstinence syndrome manifest as an increased tendency to stay in the dark area. Administration of either test compound resulted in the prevention or reversal of this abstinence syndrome.

Claims: Use of compounds which act as antagonists of 5-hydroxytryptamine (5-HT) at 5-HT₃ receptors for the manufacture of a medicament for the relief or prevention of a withdrawal syndrome resulting from addiction to a drug or substance of abuse and/or for the suppression of dependence on drugs or `substances of abuse, excluding the use of 1,2,3,9-tetrahydro-9-methyl-3-[(2-methyl-1 H -imidazol-1-yl)-methyl]-4 H -carbazol-4-one and physiologically acceptable salts and solvates thereof, cocaine and morphine. Use according to Claim 1 wherein the compound which acts as an antagonist of 5-HT at 5-HT₃ receptors is an azabicyclo derivative and/or a benzoic acid derivative. Use according Claim 1 wherein the compound which acts as an antagonist of 5-HT at 5-HT₃ receptors is a compound of formula (I) wherein R₁ and R₂ independently represent hydrogen, halogen C₁₋₄alkyl, C₁₋₄ alkoxy, hydroxy, amino, C₁₋₄ alkylamino, di(C₁₋₄)alkylamino, mercapto or C₁₋₄ alkylthio; R₃ represents hydrogen, C₁₋₄ alkyl, C₃₋₅ alkenyl, aryl or aralkyl; R₄ represents hydrogen, C₁₋₇ alkyl, C₃₋₅ alkenyl or aralkyl; n is 2 or 3; the free valence is attached to either fused ring, and the azabicyclic ring is in either the exo or endo configuration; or an acid addition salt or quaternary ammonium salt thereof. Use according to Claim 1 wherein the compound which acts as an antagonist of 5-HT at 5-HT₃ receptors is a compound of formula (IV) wherein X is CO and Y is NH or O; and p is 2 or 3; or a pharmaceutically acceptable salt thereof. Use according to Claim 3 wherein the compound which acts as an antagonist of 5-HT at 5-HT₃ receptors is (3α-tropanyl)-1 H -indole-3-carboxylic acid ester. Use according to Claim 4 wherein the compound which acts as an antagonist of 5-HT at 5-HT₃ receptors is endo- N -(9-methyl-9-azabicyclo[3,3,1]non-3-yl)-1-methyl-indazole-3-carboxamide.

Inventors: TYERS MICHAEL BRIAN, TYERS, MICHAEL BRIAN
Applicants: GLAXO GROUP LTD, GLAXO GROUP LIMITED
Application year: 1987
Main classification: A61K31
IPC codes: C07D403, A61K31, C07D451, C07D455, A61K45, A61P43