ANAESTHETIC COMPOSITION

Abstract: An injectable anaesthetic pharmaceutical composition which does not exhibit muscle rigidity to any substantial degree includes an effective to induce anaesthesia of at least one substituted N-(4-piperidinyl)-N-amide and an amount effective to inhibit muscle rigidity of at least one alpha-2 adrenergic agonist as principle ingredients. Typically, the composition comprises a solution of fentanyl and clonidine. The clonidine reduces the amount of fentanyl that is required to induce anaesthesia.

Description: The present invention is directed to an injectable pharmaceutical composition for inducing and maintaining anesthesia without the side-effect of muscle rigidity and methods of using the same. Fentanyl, also known as N-phenyl-N-[1-(2-phenyl-ethyl)-4-piperidinyl] propanamide, and other substituted N-(4-piperidinyl)-N-amides are known in the art as potent analgesics and anesthetics (see, for example, U.S. Patent Nos. 3,141,823; 3,164,600; 3,998,834; 4,167,574; 4,196,210 and 4,584,303). Such compounds tend to exhibit muscle rigidity in virtually all muscle groups especially chest and abdominal muscles which can interfere with positive pressure ventillation. (See, " Postoperative Rigidity Following Sufentanil Administration" , Marc Goldberg, M.D. et al . , Anesthesiology , Vol. 63 No. 2 August, 1985, pp. 199-200; and "Physiology of Alfentanil-Induced Rigidity" , James L. Benthuysen, M.D. et al . , Anesthesiology, Vol. 64, 1986, pp. 440-446 and publications cited therein). Alpha-2 adrenergic agonists are known to decrease the stimulation-induced release of norepinephrine from the central and peripheral adrenergic neurons leading to a decrease of sympathetic outflow (e.g., " Inhibitory Effects of Clonidine on Responses to Sympathetic Nerve Stimulation in the Pithed Rat" , J.D. Doxey et al., Br.J.Pharmacol, 61,559 (1977); "Effects of Clonidine on Central Sympathetic Tone ", H. Klupp et al., Eur.J.Pharmacol. 10, 225 (1970); and "Centrally Mediated Decrease in Sympathetic Tone Induced by 2(2,6-dichlorophenylamino)-2 imidazoline" , H. Schmitt et al., Eur.J.Pharmacol. 1, 147 (1967). Such compounds are also known to have vasopressor and antihypertensive activity and include clonidine and derivatives thereof (U.S. Patent Nos. 3,202,660 and 3,454,701) guanfacine and derivatives thereof (U.S. Patent No. 3,632,645), guanabenz (U.K. Patent No. 1,019,120) and alpha-methyl DOPA (U.S. Patent No. 3,230,143). Chem. Abstr., 1983, 98:191500u reports that administration after fentanyl of 20 microgrammes per kilogramme of clonidine by slow infusion reduced sympathetic activity and greatly attenuated naloxone response. Chem. Abstr., 1979, 91:49486f reports that central noradrenergic receptor stimulators including clonidine did not enhance the analgesic activity of antinociceptive drugs studied in rats, but they did enhance catalepsy induced by fentanyl. Applicants have discovered that the administration of an injectable pharmaceutical composition containing the above-mentioned substituted N-(4-piperidinyl)-N-amides (e.g., fentanyl) and alpha-2-adrenergic agonists (e.g., clonidine) induces anaesthesia but inhibits or substantially eliminates the muscle rigidity associated with the administration of compositions containing the substituted amides alone. Furthermore, our experiments have shown that pharmaceutical compositions according to the invention reduce the amount of anaesthetic needed to induce anaesthesia by up to seven times. Other advantageous effects that have been observed using rats are a reduction in the amount of inhalation anaesthetic often used to maintain anaesthesia and a stabilisation of cardiovascular parameters during anaesthesia. It is an object of the present invention to provide an injectable pharmaceutical anaesthetic composition that inhibits or substantially eliminates the side-effects of muscle rigidity. The present invention provides an injectable pharmaceutical composition for inducing anaesthesia while inhibiting muscle rigidity comprising: (a) an amount effective to induce anaesthesia of at least one substituted N-(4-piperidinyl)-N-amide or a pharmaceutically acceptable acid addition salt thereof; (b) an amount effective to inhibit rigidity of at least one alpha-2 adrenergic agonist or a pharmaceutically acceptable acid addition salt thereof; (c) a pharmaceutically acceptable carrier. wherein the N-(4-piperidinyl)-N-amide is a compound of the formula: and wherein the alpha-2-adrenergic agonist is guanabenz; alpha-methyl DOPA; a compound of the formula wherein R₁ is chlorine or methyl; and substituted 2-(phenylamino)-1,3-diazacyclopentenes-(2) having the formula: wherein R₁ and R₂ are each independently selected from hydrogen, methyl and ethyl and R₃ is selected from trifluoromethylphenyl; 2,6-dichloro-phenyl; 2-chloro-6-methyl-phenyl; 2-methyl-4-chloro-phenyl; 2-chloro-4-methyl-phenyl; 2-chloro-4-ethyl-phenyl; 2-chloro-6-ethyl-phenyl; 2-chloro-4-tert. butyl-phenyl; 2,6-dichloro-4-methyl-phenyl; 2,4-dichloro-6-methyl-phenyl; 2,4-dimethyl-6-chloro-phenyl; and 2,6-dimethyl- 4-chloro-phenyl, and their pharmaceutically acceptable acid addition salts. The substituted N-(4-piperidinyl)-N-amides employed in the present invention include fentanyl, i.e., N-phenyl-N[1(2phenylethyl)-4-piperidinyl] propanamide and derivatives thereof which have potent analgesic properties making them useful as anesthetics. Fentanyl and methods of preparing the same are disclosed in U.S. Patent Nos. 3,141,823 and 3,164,600. Other N-(4-piperindyl)-N-amides for use in the invention are disclosed in US Patents Nos 3 998 834; 4 167 574; 4 196 210 and 4 584 303 which also disclose methods of making such compounds. All the alpha-2 adrenergic agonists for use in the composition according to the invention, and methods of making the same, except guanabenz, are disclosed in U.S. Patent Nos. 3,632,645; 3,230,143; 3,202,660; and 3,454,701 respectively. Guanabenz may be prepared by reacting a compound of the formula with a compound of the formula in the presence of a suitable solvent such as, for example, ethylalcohol/benzene at a temperature of between 50 and 100°C with or in the absence of a catalyst such as p-toluenesulfonic acid (about 1% by weight based on the weight of the latter compound mentioned above). If desired, the reactants may be refluxed with the continuous removal of water. The desired compound may be isolated from the reaction mixture in a conventional manner, for example, by distilling off the solvent and purifying the residue by distillation, crystallization or chromatography, as disclosed in U.S. Patent Nos. 3,982,020. Alternatively, guanabenz may be prepared from 2,6-dichlorobenzaldehyde and aminoguanidine bicarbonate and HC1 in butanol as disclosed in U.S. Patent No. 3,975,533. The free base compounds employed in the composition of the present invention may be transformed into pharmaceutically acceptable acid addition salts by customary methods described in the aforementioned patents as, for example, by acidifying a solution of the free base in a suitable organic solvent with the desired acid. Such acids may be inorganic and organic and include by way of example sulfuric, phosphoric, hydrochloric, hydrobromic, hydroiodic, sulfonic, citric, lactic, maleic, malic, succinic, tartaric, cinnamic, acetic, benzoic, gluconic, ascorbic and related acids. The compounds may also form quaternary ammonium salts with a variety of organic esters of sulfuric, hydrohalic and aromatic sulfonic acids. Among such esters are methyl chloride and bromide, ethyl chloride, propyl chloride, butyl chloride, isobutyl chloride, benzyl chloride and bromide, phenethyl bromide, naphthylmethyl chloride, dimethylsulfate, diethylsulfate, methyl benzenesulfonate, ethyl toluenesulfonate, ethylene chlorohydrin, propylene chlorohydrin, allyl bromide, methallyl bromide and crotyl bromide. Compositions of the present invention may be made, for example, by preparing separate stock solutions containing the respective active ingredients and a pharmaceutically acceptable carrier such as distilled water to provide a concentration of the active ingredient in each of the stock solutions of about 1.0 mg/ml. The stock solutions are then combined to form an injectable solution in a manner such that the concentration of the active ingredients in the injectable composition is in the range of from 0.001 to 1.0 mg/kg, preferably from 0.01 to 0.20 mg/kg for the substituted amide and from 0.001 to 1.0 mg/kg, preferably from .0001 to 0.020 mg/kg for the alpha-2-adrenergic agonist. The compositions of the present invention may be administered to warm blooded animals including humans in any manner by injection, preferably intravenously. Pharmaceutically acceptable carriers which may be employed to make the composition include, in addition to distilled water, saline and other customarily employed aqueous carriers. The invention is illustrated in the following examples which are for illustrative purposes only. EXAMPLES 1-3 The following are definitions of terms used in this example and those that follow: "Loss of Righting" (LOR) - is a general measure of the onset of anesthesia and specifically "righting" is lost when the test animal remains supine for at least 30 seconds. "Analgesia" - is achieved when a supramaximal paw pinch is delivered to the test animal with a pair of Kelly forceps and there is no vocalization or overt movements in response thereto. "Muscle Rigidity" - is indicated by extreme extensor muscle tone and the absence of hind limb flexion while standing the stiff test animal in a supported vertical position. The degree of rigidity is visually determined on a scale on 0 (no rigidity) to 3 (extreme rigidity). Three samples of a composition comprising fentanyl and clonidine (Samples 1-3) were prepared by combining 1 mg/ml solutions of fentanyl and clonidine in distilled water, respectively so that the respective combined solutions had the concentrations shown in Table 1. Each of the combined solutions were injected as a bolus into a tail vein of a restrained Male Sprague-Dawley rat. After injection, the rat was removed from the restrainer and observed for twenty minutes. Measurements were taken during the observation period to determine the percent loss of righting, the percent of analgesia and the degree of muscle rigidity. The results are shown in Table 1. The results were compared with control compositions containing the amounts of clonidine or fentanyl alone as shown in Table 1 which were administered to comparable rats in the same manner as Samples 1-3. The results are shown in Table 1. As shown by the control samples in Table 1, muscle rigidity becomes extreme as the dose of fentanyl increases to an effective anesthesia level (100% LOR) in the absence of clonidine. In contradistinction, the combination of clonidine and fentanyl at the 100% LOR level results in no muscle rigidity. Furthermore, the amount of fentanyl necessary to achieve a 100% LRO level employing the composition of the present invention is one-seventh the amount (0,005 mg/kg vs. 0.035 mg/kg) needed to obtain the same anesthesia induced state when fentanyl is administered alone. EXAMPLES 4-6 Three further samples of a composition comprising clonidine and fentanyl (Samples 4-6) having the amounts of fentanyl and clonidine shown in Table 2 were prepared by the method described in Example 1. The results are shown in Table 2. As can be seen from the results in Table 2 an effective state of anesthesia was obtained by administering the composition of the present invention containing only 0.010 mg/kg of fentanyl (Sample 6) as compared to 0.035 mg/kg of fentanyl (see Table 1) when used alone. In addition, only mild, transient muscle rigidity was observed at the effective dose for the combination of fentanyl and clonidine while muscle rigidity experienced by the administration of fentanyl alone was extreme and prolonged as shown in Table 1. EXAMPLES 7-12 Six samples of the composition comprising clonidine and fentanyl (Samples 7-12) having the dosages amounts listed in Table 3 were prepared and administered in the same manner as described in Example 1. The results are shown in Table 3. As shown in Table 3, equal doses of clonidine and fentanyl in a composition of the present invention achieved the desired anesthetic effect with as little as 0.010 mg/kg of fentanyl as compared with 0.035 mg/kg using fentanyl alone (see Table 1). Furthermore, consistent with the results obtained from samples 4-6 as shown in Table 2, the addition of clonidine to fentanyl resulted in only mild, transient muscle rigidity as compared with extreme and prolonged muscle rigidity evidenced in the test animals receiving fentanyl alone.

Claims: Claims for the following Contracting States : BE, CH, DE, FR, GB, IT, LI, LU, NL, SE An injectable pharmaceutical composition for inducing anaesthesia while inhibiting muscle rigidity comprising: (a) an amount effective to induce anaesthesia of at least one substituted N-(4-piperidinyl)-N-amide or a pharmaceutically acceptable acid addition salt thereof; (b) an amount effective to inhibit muscle rigidity of at least one alpha-2 adrenergic agonist or a pharmaceutically acceptable acid addition salt thereof; and (c) a pharmaceutically acceptable carrier; wherein the alpha-2 adrenergic agonist is selected from guanabenz; alpha-methyl DOPA; compounds of the formula wherein R₁ is chlorine or methyl; and substituted 2-(phenylamino)-1,3-diazacyclopentenes-(2) having the formula wherein R₁ an R₂ are each independently selected from hydrogen, methyl and ethyl and R₃ is selected from trifluoro-methyl- phenyl; 2,6-dichloro-phenyl; 2-chloro-6-methyl-phenyl; 2-methyl-4-chloro-phenyl; 2-chloro-4-methyl-phenyl; 2-chloro-4-ethyl-phenyl; 2-chloro-6-ethyl-phenyl; 2-chloro-4-tert.butyl-phenyl; 2,6-dichloro-4-methyl-phenyl; 2,4-di-chloro-6-methyl-phenyl; 2,4-dimethyl-6-chloro-phenyl; 2,6-dimethyl-4-chloro-phenyl; and their pharmaceutically acceptable acid addition salts; and the substituted N-(4-piperidinyl)-N-amide is selected from compounds having the formula: and pharmaceutically acceptable salts thereof. A composition according to claim 1, wherein R₁ and R₂ are each hydrogen and R₃ is 2,6-dichlorophenyl. A composition according to claim 1 or claim 2, wherein the substituted N-(4-piperidinyl)-N-amide is a compound of the formula: or a pharmaceutically acceptable salt thereof. A composition according to any one of the preceding claims, wherein the anaesthetic effective amount of the substituted N-(4-piperi-dinyl)-N-amide is in the range of from 0.01 to 0.20 mg/kg. A composition according to any one of the preceding claims, wherein the muscle rigidity inhibiting amount of alpha-2 adrenergic agonist is in the range of from 0.001 - 0.020 mg/kg. An injectable pharmaceutical composition for inducing anaesthesia while inhibiting muscle rigidity consisting essentially of : (a) an amount effective to induce anaesthesia of a compound of the formula: or a pharmaceutically acceptable salt thereof; (b) An amount effective to inhibit muscle rigidity of a compound of the formula : or a pharmaceutically acceptable acid addition salt thereof; and (c) a pharmaceutically acceptable carrier. A process for the preparation of a pharmaceutical composition according to any one of the preceding claims, which comprises dissolving the compounds (a) and (b) in the carrier (c). The use of compounds (a) and (b) in the amounts defined in any one of claims 1 to 6, in the manufacture of an anaesthetic composition able to be administered to induce anaesthesia while inhibiting the muscle rigidity associated with compound (a). Claim for the following Contracting State : ES A process for the preparation of an injectable pharmaceutical composition for inducing anaesthesia while inhibiting muscle rigidity which comprises dissolving (a) an amount effective to induce anaesthesia of at least one substituted N-(4-piperidinyl)-N-amide or a pharmaceutically acceptable acid addition salt thereof and (b) an amount effective to inhibit muscle rigidity of at least one alpha-2 adrenergic agonist or a pharmaceutically acceptable acid addition salt thereof in a pharmaceutically acceptable carrier (c), or dissolving (a) an amount effective to induce anaesthesia of at least one substituted N-(4-piperidinyl)-N-amide or a pharmaceutically acceptable acid addition salt thereof in a pharmaceutically acceptable carrier (c) to form a first solution, (b) an amount effective to inhibit muscle rigitity of at least one alpha-2 adrenergic agonist or a pharmaceutically acceptable acid addition salt thereof in a pharmaceutically acceptable carrier (c) to form a second solution, and combining the first and the second solution, wherein the alpha-2 adrenergic agonist is selected from guanabenz; alpha-methyl DOPA; compounds of the formula wherein R₁ is chlorine or methyl; and substituted 2-(Phenylamino)-1,3-diazacyclopentenes-(2) having the formula wherein R₁ and R₂ are each independently selected from hydrogen, methyl and ethyl and R₃ is selected from trifluoro-methyl- phenyl; 2,6-dichloro-phenyl; 2-chloro-6-methyl-phenyl; 2-methyl-4-chloro-phenyl; 2-chloro-4-methyl-phenyl; 2-chloro-4-ethyl-phenyl; 2-chloro-6-ethyl-phenyl; 2-chloro-4-tert.butyl-phenyl; 2,6-dichloro-4-methyl-phenyl; 2,4-di-chloro-6-methyl-phenyl; 2,4-dimethyl-6-chloro-phenyl; 2,6-dimethyl-4-chloro-phenyl; and their pharmaceutically acceptable acid addition salts; and the substituted N-(4-piperidinyl)-N-amide is selected from compounds having the formula: and pharmaceutically acceptable salts thereof. A process according to claim 1, wherein R₁ and R₂ are each hydrogen and R₃ is 2,6-dichlorophenyl. A process according to claim 1 or claim 2, wherein the substituted N-(4 -piperidinyl)-N-amide is a compound of the formula or a pharmaceutically acceptable salt thereof. A process according to any one of the preceding claims, wherein the anaesthetic effective amount of the substituted N-(4-piperi-dinyl)-N-amide is in the range of from 0.01 to 0.20 mg/kg. A process according to any one of the preceding claims, wherein the muscle rigidity inhibiting amount of alpha-2 adrenergic agonist is in the range of from 0.001 - 0.020 mg/kg. A process according to claim 1 wherein the substituted N-(4-piperidinyl)-N-amide is a compound of the formula or a pharmaceutically acceptable salt thereof; and the alpha-2 adrenergic agonist is a compound of the formula or a pharmaceutically acceptable acid addition salt thereof.

Inventors: CAPACCHIONE, JOHN F., JERUSSI, THOMAS P.
Applicants: ANAQUEST, INC.
Application year: 1987
Main classification: A61K31
IPC codes: A61K45, A61K31, A61P21, A61P23