Patent Publication Number: US-4925672-A

Title: Products containing a calcium antagonist and a lipid-lowering agent

Description:
It is known that calcium antagonists are effective drugs for the treatment of coronary heart disease (H. Eichstadt, Calcium-Antagonisten, Chapter 33 in Handbuch der inneren Medizin, Volume IX/3: Koronarerkrankungen, Editor H. Roskamm, Springer-Verlag, Berlin, 1984; U. Borchard, Spektrum Koronartherapeutika, Aesopus Verlag, Zug, 1985). 
     Furthermore, a number of lipid-lowering agents which can be used for the treatment of hyperlipidemia have been described (W. Kruse et al., Spektrum Lipidsenker, Aesopus Verlag, Zug, 1985). It is also known that fibrates improve the flow properties of the blood (eg. Ernst/Matrai, Therapiewoche 38 (1988), 136-139; Lecture by Leschke at the experts&#39; discussion Aktueller Stand der Therapie von Fettstoffwechselstorungen, Wiesbaden, Oct. 10 1987; Arzte-Zeitung 6 (1987), 29). 
     We have found that the action of calcium antagonists can be improved by adding lipid-lowering agents. 
     The present invention relates to products containing a calcium antagonist and a lipid-lowering agent. 
     The products may be in the form of combination preparations for simultaneous use in a fixed combination or as separate components for use simultaneously or sequentially. 
     Particular examples of calcium antagonists are diltiazem, etafenone, fendiline, gallopamil, nifedipine, prenylamine, perhexiline and verapamil. Among these, verapamil and gallopamil are preferred. 
     Examples of suitable lipid-lowering agents are bezafibrate, clofibrate and aluminum clofibrate and etofylline clofibrate, colestipol, colestyramine, dextrothyroxine, etiroxate, etofibrate, fenofibrate, gemfibrozil, inositol nicotinate, magnesium pyridoxal 5&#39;-phosphate glutamate, probucol, 3-pyridylmethanol, β-sitosterol and xantinol nicotinate. Among these substances, the fibrates (benzafibrate, clofibrate, etofibrate and fenofibrate) are preferred. 
     If the substances contain basic groups, they can also be used for the combination preparation in the form of their salts with physiologically tolerated acids. Suitable and preferred physiologically tolerated acids are hydrochloric acid, sulfuric acid, phosphoric acid, acetic acid, citric acid, malonic acid, salicylic acid, maleic acid, fumaric acid, succinic acid, ascorbic acid, malic acid, methanesulfonic acid, lactic acid, gluconic acid, glucuronic acid, amidosulfonic acid, benzoic acid and tartaric acid. 
     The calcium antagonist and lipid-lowering agent are present in the mixture in amounts which are at the lower limit of the doses usually recommended for these substances, or somewhat below this limit. As a rule, the ratio of the amounts of lipid-lowering agent to calcium antagonist is from 10:1 to 1:10. For a combination of verapamil and fenofibrate, this ratio is preferably from 1:2 to 2:1. 
     The novel combination improves the flow properties of the blood in an unexpected synergistic manner compared with the individual components of the combination. It is therefore suitable for the therapy and prevention of symptoms due to disturbances of myocardial blood flow in coronary heat disease, ie. all angina pectoris forms, for the aftertreatment of myocardial infarction and for use before and after balloon angioplasty and bypass operations. 
     The novel products can be administered parenterally but are preferably administered orally. Tablets, coated tablets and capsules are particularly suitable for oral administration. Sustained-release forms are especially suitable. The known processes, as described in, for example, H. Sucker et al., Pharmazeutische Technologie, Thieme-Verlag, Stuttgart 1978, are suitable for the preparation of the stated forms. It is also possible possible to convert the individual components of the mixture into administration forms and to pack these together, for example in a blister pack. 
    
    
     EXAMPLE 1 
     20 Isoptin®RR sustained-release tablets and 20 Normalip® sustained-release capsules were introduced in pairs into each blister pack. 
     EXAMPLE 2 
     Pellets having the following composition were prepared: 
     
         ______________________________________                                    
(a)       fenofibrate     100.00    mg                                    
          sucrose         17.92     mg                                    
          corn starch     5.96      mg                                    
          polyvidone      0.74      mg                                    
          talc            1.49      mg                                    
          polymethacrylic acid L*                                         
                          1.44      mg                                    
          polymethacrylic acid E*                                         
                          0.40      mg                                    
          stearic acid    0.05      mg                                    
                          128.00    mg                                    
(b)       verapamil hydrochloride                                         
                          100.00    mg                                    
          colloidal silica                                                
                          1.00      mg                                    
          corn starch     6.96      mg                                    
          sugar pellets   22.65     mg                                    
          ethylcellulose  3.40      mg                                    
          glycerol mono-/dioleate                                         
                          2.27      mg                                    
          ® Eudragit RS**                                             
                          1.45      mg                                    
          ® Eudragit S***                                             
                          2.90      mg                                    
          dibutyl phthalate                                               
                          0.29      mg                                    
          talc            9.38      mg                                    
                          150.30    mg                                    
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 *Manufacturer: Rohm, Darmstadt                                           
 **Polymer of acrylates and methacrylates having a low content of         
 quaternary ammonium groups (manufacturer: Rohm, Darmstadt)               
 ***Anionic polymer of methacrylic acid and methacrylates (manufacturer:  
 Rohm, Darmstadt) 128.0 mg of pellets (a) and 150.3 mg of pellets (b) were
 introduced into each hard gelatine capsules.                             
 
    
     EXAMPLE 3 
     Example 2 was repeated, except that 192.0 mg of pellets (a) and 150.3 mg of pellets (b) were introduced per hard gelatine capsule. 
     EXAMPLE 4 
     Example 2 was repeated, except that 128.0 mg of pellets (a) and 300.6 mg of pellets (b) were introduced per hard gelatine capsule. 
     EXAMPLE 5 
     Tablets having the following composition were compressed: 
     
         ______________________________________                                    
(a)        fenofibrate     80.00                                          
           sucrose         14.35                                          
           corn starch     4.77                                           
           polyvidone      0.59                                           
           talc            1.19                                           
(b)        verapamil hydrochloride                                        
                           80.00                                          
           colloidal silica                                               
                           0.80                                           
           corn starch     5.60                                           
           sugar pellets   18.17                                          
           ethylcellulose  2.72                                           
           glycerol mono-/dioleate                                        
                           1.81                                           
           talc            7.50                                           
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 The tablets were introduced into capsules in the ratio of 1:1.