The use of ranitidine bismuth citrate and in combination with claritromycin or claritromycin and tetracyclin in the manufacture of a medicament for treating gastrointestinal disorders

Abstract: The use is described of both (i) ranitidine bismuth citrate and (ii) one or more Helicobacter pylori -inhibiting antibiotics in treating or preventing gastrointestinal disorders. Pharmaceutical compositions containing both (i) and (ii) and methods for the preparation of pharmaceutical compositions containing (i) and (ii) are also described.

Description: The present invention relates to improvements in the treatment of gastrointestinal disorders. More particularly it relates to the co-administration of a salt formed between ranitidine and a complex of bismuth with a carboxylic acid, with antibiotics. In our published UK Patent Specification No. 2220937A we describe and claim salts formed between ranitidine and a complex of bismuth with a carboxylic acid, particularly tartaric acid and, more especially, citric acid. One such salt is N-[2-[[[5-[(dimethylamino)methyl]-2-furanyl]methyl]thio]ethyl]-N'-methyl-2-nitro-1,1-ethenediamine 2-hydroxy-1,2,3-propanetricarboxylate bismuth (3 + ) complex, also known as ranitidine bismuth citrate. The salts disclosed in UK Patent Specification No. 2220937A possess the H 2 -antagonist antisecretory properties associated with ranitidine, together with antibacterial activity against Helicobacter pylori (formerly Campylobacter pylori ). In addition, such salts possess cytoprotective properties, and display activity against the human gastric pepsins, with preferential inhibition of pepsin 1, a pepsin isozyme associated with peptic ulcer. The salts disclosed in UK Patent Specification No. 2220937A thus possess a particularly advantageous combination of properties for the treatment of gastrointestinal disorders, especially peptic ulcer disease and other gastroduodenal conditions, for example gastritis and non-ulcer dyspepsia. George et al. (Med. J. Australia, Vol. 153, p.145-149, 1990) discloses the use of ranitidine, followed by a "triple therapy" of colloidal bismuth subcitrate, tetracyclin and metronidazole or colloidal bismuth subcitrate, amoxycillin and metronidazole for the treatment of duodenal ulcers. Graham et al . (Ann. Int. Med., Vol. 115, p.266-269, 1991) discloses the use of ranitidine plus a "triple therapy" of bismuth subsalicylate, tetracyclin and metronidazole for the treatment of duodenal ulcers. We have now shown that the antibacterial activity of ranitidine bismuth citrate against Helicobacter organisms may be significantly enhanced by co-administering the compound with one or more antibiotics. The present invention thus provides, in one aspect, the use of (i) ranitidine bismuth citrate in combination with (ii) clarithromycin or clarithromycin and tetracyclin in the manufacture of medicaments for simultaneous, separate or sequential use in treating or preventing gastrointestinal disorders. The term "gastrointestinal disorder" as used herein encompasses a disease or other disorder of the gastrointestinal tract, including for example a disorder not manifested by the presence of ulcerations in the gastric mucosa (eg gastritis, non-ulcer dyspepsia, esophagal reflux disease and gastric motility disorders), and peptic ulcer disease (eg gastric and duodenal ulcer disease). The ranitidine bismuth citrate and clarithromycin or clarithromycin and tetracyclin are preferably co-administered in the form of separate pharmaceutical compositions for simultaneous and/or sequential use. Alternatively the ranitidine bismuth citrate and the antibiotic(s) may be administered as a single pharmaceutical composition for oral use comprising effective amounts of the active ingredients. Thus, according to a further aspect, the invention provides a product containing (i) ranitidine bismuth citrate in combination with (ii) clarithromycin or clarithromycin and tetracyclin as a combined preparation for simultaneous, separate or sequential use in treating or preventing gastrointestinal disorders. When the ranitidine bismuth citrate and the one or more antibiotics are administered as separate preparations, each of the antibiotics may conveniently be provided in the manner known in the art and/or commercially for the compounds concerned. Administration of both the ranitidine bismuth citrate and the antibiotic(s) by the oral route is preferred, although the antibiotic(s), where appropriate, may also be given by another route, for example parenterally (e.g. intravenously, intramuscularly or subcutaneously). The ranitidine bismuth citrate may conveniently be formulated as tablets (including chewable tablets), capsules (of either the hard or soft type), or as a liquid preparation, as described for example in UK Patent Specification Nos. 2220937A and 2248185A. Tablets are generally preferred. As stated hereinabove, ranitidine bismuth citrate and the antibiotic(s) may be administered as a single pharmaceutical composition for oral use. Thus according to a further aspect the invention provides a pharmaceutical composition, for oral use in human or veterinary medicine, comprising ranitidine bismuth citrate in combination with clarithromycin or clarithromycin and tetracyclin. Such compositions may be formulated in a conventional manner using additional pharmaceutically acceptable carriers or excipients as appropriate. Thus, the composition may be prepared by conventional means with additional carriers or 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); disintegrates (e.g. starch or sodium starch glycollate); or wetting agents (e.g. sodium lauryl sulphate). An alkaline salt of the type described in UK Patent Specification No. 2248185A may be added to improve the rate of disintegration and/or dissolution of the composition. Tablets may be coated by methods well known in the art. The preparations may also contain flavouring, colouring and/or sweetening agents as appropriate. The compositions may be prepared according to conventional techniques well known in the pharmaceutical industry. Thus, for example, the ranitidine bismuth citrate and the antibiotic(s) may be admixed together, if desired, with suitable excipients. Tablets may be prepared, for example, by direct compression of such a mixture. Capsules may be prepared by filling the blend along with suitable excipients into gelatin capsules, using a suitable filling machine. When ranitidine bismuth citrate and the antibiotic(s) are administered as a single pharmaceutical composition for oral use the composition is preferably in the form of a capsule or, more particularly, a tablet. The compositions for use according to the invention may, if desired, be presented in a pack or dispenser device which may contain one or more unit dosage forms containing the active ingredients. The pack may for example comprise metal or plastic foil, such as a blister pack. Where the ranitidine bismuth citrate and the one or more antibiotics are intended for administration as separate compositions these may be presented in the form of, for example, a multiple (e.g. twin) pack. The doses at which the ranitidine bismuth citrate and the one or more antibiotics may be administered to man (of approximately 70kg body weight) will depend on the route of administration of the antibiotic and on the nature and severity of the condition being treated. It will also be appreciated that it may be necessary to make routine variations to the dosage depending on the age and weight of the patient. A proposed dosage of ranitidine bismuth citrate for use according to the invention is 150mg to 1.5g, preferably 200 - 800mg per unit dose. The unit dose may be administered, for example, I to 4 times per day. The one or more antibiotics may conveniently be administered at doses within the normal dosage range at which the compound(s) are therapeutically effective, or at higher doses if required. The antibiotic(s) may be taken one or more times daily as appropriate. The uses of the present invention comprise administering the Helicobacter pylori -inhibiting antibiotic(s) and ranitidine bismuth citrate either concurrently or non-concurrently. As used herein, concurrent administration means that the agents are given within 24 hours of each other, whereas non-concurrent administration means that the agents are given more than 24 hours apart. When the agents are administered concurrently, it may be preferable to administer the agents within about 1 hour of each other or, more preferably, within about 5 minutes of each other. For the uses of the present invention, the duration of administration of the agents during either concurrent or non-concurrent dosing will vary according to the specific gastrointestinal disorder being treated. However, a typical regime would be to administer ranitidine bismuth citrate for 4 to 8 weeks and during this period to administer the one or more antibiotics for 1 to 2 weeks.

Claims: The use of (i) ranitidine bismuth citrate in combination with (ii) clarithromycin in the manufacture of a medicament for simultaneous, separate or sequential use in treating or preventing gastrointestinal disorders. The use of (i) ranitidine bismuth citrate in combination with (ii) clarithromycin and tetracyclin in the manufacture of a medicament for simultaneous, separate or sequential use in treating or preventing gastrointestinal disorders. The use according to Claim 1 or Claim 2 in which components (i) and (ii) are presented as separate compositions for said use. The use according to any one of Claims 1 to 3 in which components (i) and (ii) are in forms suitable for oral administration. The use according to any one of Claims 1 to 4 in which component (i) is formulated as a tablet. A product containing components (i) and (ii) as defined in Claim 1 or Claim 2 as a combined preparation for simultaneous, separate, or sequential use in treating or preventing gastrointestinal disorders. A pharmaceutical composition, for oral use, which comprises components (i) and (ii) as defined in Claim 1 or Claim 2 together with a pharmaceutical carrier or excipient. A product as claimed in Claim 6 or Claim 7 in which components (i) and (ii) are in forms suitable for oral administration. A product as claimed in any one of Claims 6 to 8 in which component (i) is formulated as a tablet.

Inventors: MCCOLM ANDREW ALEXANDER, MCCOLM, ANDREW ALEXANDER
Applicants: GLAXO GROUP LTD, GLAXO GROUP LIMITED
Application year: 1992
Main classification: A61K31
IPC codes: A61K31, A61P1, A61P31, A61K9, A61P33, A61J1