A ring-annulated dihydropyrrolo[2,1-a]isoquinoline derivative according to formula I or a pharmaceutically acceptable salt thereof wherein R1 is phenyl, heteroaryl, cycloalkyl, alkyl, heterocycloalkyl or heterocycloalkenyl, each optionally substituted with one or more alkyl or halogen; or R1 is halogen; R2 is H or alkyl; R3 is hydroxyl, alkoxy; alkylthio or alkyl; R4 is heteroaryl, heterocycloalkyl or heterocycloalkenyl, each optionally substituted with one or more hydroxy, cyano, halogen, alkoxy or alkyl, the alkyl group optionally substituted with one or more hydroxy or fluorine; or R4 is halogen, nitro, cyano, amino, carboxylic acid or N-hydroxy-imidamide; or R4 is alkyl, alkenyl, alkynyl, cycloalkyl, alkoxy, alkylthio, alkylOC alkyl, each optionally substituted with one or more hydroxy, oxo, cyano or fluorine; or R4 is -NH R6, -NHSO2R6, -NHR6, -C N R8, -C OR6, -S R6 or -SO2R6; R5 is H or halogen; R6 is alkyl, alkenyl or heteroaryl, each optionally substituted with one or more alkyl, alkoxy, hydroxy or halogen; or R6 is (di)[ alkyl]amino alkyl, (di)[ alkyl]aminoC alkyl or heterocycloalkyl alkyl, the heterocycloalkyl group optionally substituted with one or more alkyl, oxo, hydroxy, fluorine or (di)[ alkyl]amino alkyl; Y is a bond, Y is (CH 2) n or Y is X(CH 2) m, wherein one or more of the hydrogen atoms in the (CH 2) n or (CH 2) m groups in Y may optionally be substituted with alkyl, fluorine or hydroxy; X is O, S or NR9; R7 is H or alkyl, optionally substituted with one or more hydroxyl groups; R8 is H, or alkyl, alkenlyl or heteroaryl, each optionally substituted with one or more alkyl, alkoxy, hydroxy or halogen; or R8 is heterocycloalkyl alkyl, the heterocycloalkyl group optionally substituted with alkyl or (di)[ alkyl]amino alkyl; or R7 and R8 can form, together with the interconnecting nitrogen, a heterocycloalkyl group, optionally susbstituted with hydroxy, alkoxycarbonyl or alkyl, the alkyl group optionally substituted with one or more hydroxy or fluorine; R9 is hydrogen or R10-carbonyl; R10 is alkyl, optionally substituted with halogen; n is 0-4; m is 2 or 3. R1 is phenyl, heteroaryl, cycloalkyl, alkyl, heterocycloalkyl or heterocycloalkenyl, each optionally substituted with one or more alkyl or halogen; or R1 is halogen; R2 is H or alkyl; R3 is hydroxyl, alkoxy; alkylthio or alkyl; R4 is heteroaryl, heterocycloalkyl or heterocycloalkenyl, each optionally substituted with one or more hydroxy, cyano, halogen, alkoxy or alkyl, the alkyl group optionally substituted with one or more hydroxy or fluorine; or R4 is halogen, nitro, cyano, amino, carboxylic acid or N-hydroxy-imidamide; or R4 is alkyl, alkenyl, alkynyl, cycloalkyl, alkoxy, alkylthio, alkylOC alkyl, each optionally substituted with one or more hydroxy, oxo, cyano or fluorine; or R4 is -NH R6, -NHSO2R6, -NHR6, -C N R8, -C OR6, -S R6 or -SO2R6; R5 is H or halogen; R6 is alkyl, alkenyl or heteroaryl, each optionally substituted with one or more alkyl, alkoxy, hydroxy or halogen; or R6 is (di)[ alkyl]amino alkyl, (di)[ alkyl]aminoC alkyl or heterocycloalkyl alkyl, the heterocycloalkyl group optionally substituted with one or more alkyl, oxo, hydroxy, fluorine or (di)[ alkyl]amino alkyl; Y is a bond, Y is (CH 2) n or Y is X(CH 2) m, wherein one or more of the hydrogen atoms in the (CH 2) n or (CH 2) m groups in Y may optionally be substituted with alkyl, fluorine or hydroxy; X is O, S or NR9; R7 is H or alkyl, optionally substituted with one or more hydroxyl groups; R8 is H, or alkyl, alkenlyl or heteroaryl, each optionally substituted with one or more alkyl, alkoxy, hydroxy or halogen; or R8 is heterocycloalkyl alkyl, the heterocycloalkyl group optionally substituted with alkyl or (di)[ alkyl]amino alkyl; or R7 and R8 can form, together with the interconnecting nitrogen, a heterocycloalkyl group, optionally susbstituted with hydroxy, alkoxycarbonyl or alkyl, the alkyl group optionally substituted with one or more hydroxy or fluorine; R9 is hydrogen or R10-carbonyl; R10 is alkyl, optionally substituted with halogen; n is 0-4; m is 2 or 3.