(12) United States Patent (10) Patent No.: US 6,528,521 B2 Ruff Et Al
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US006528521B2 (12) United States Patent (10) Patent No.: US 6,528,521 B2 Ruff et al. (45) Date of Patent: Mar. 4, 2003 (54) TREATMENT OF ANTI-DEPRESSION DRUG- 5,756.483. A 5/1998 Merkus ....................... 514/58 INDUCED SEXUAL DYSFUNCTION WITH 5,770,606 A 6/1998 El-Rashidy et al. ........ 514/284 APOMORPHINE 5,866,164 A 2/1999 Kuczynski et al. ......... 424/472 5,897.864. A 4/1999 Cohen ..................... 424/195.1 5,939,094. A 8/1999 Durif et al. ................. 424/448 (75) Inventors: 3. P slot, NSS). 5,945,117 A 8/1999 El-Rashidy et al. ........ 424/430 (73) Assignee: Tap Pharmaceutical Products, Inc., OTHER PUBLICATIONS Lake Forest, IL (US) Marketletter of Jul. 17, 1995 (abstract).* (*) Notice: Subject to any disclaimer, the term of this patent is extended or adjusted under 35 Wilson, E.K., Chemical & Engineering News, 76(26), pp. 29 U.S.C. 154(b) by 0 days. (Jun. 29, 1998). (21) Appl. No.: 09/993,782 * cited by examiner (22) Filed: Nov. 14, 2001 O O Primary Examiner Phyllis G. Spivack (65) Prior Publication Data (74) Attorney, Agent, or Firm- Wood, Phillips, Katz, Clark US 2002/0115683 A1 Aug. 22, 2002 & Mortimer Related U.S. Application Data (57) ABSTRACT (60) Provisional application No. 60/249,031, filed on Nov. 15, A method for treating Sexual dysfunction that is caused by 2000. anti-depressant medication in a patient in need of Such (51) Int. Cl. .............................................. A61K 31/473 treatment, comprising administering a therapeutically effec (52) U.S. Cl. ....................................................... 5141284 tive amount of apomorphine, or a pharmaceutically accept (58) Field of Search .......................................... 514,284 able salt thereof to said patient, is disclosed. The method may be utilized for patients taking anti-depressants Such as (56) References Cited tricyclic anti-depressants, monamine oxidase inhibitors or Serotonin Selective reuptake inhibitors. U.S. PATENT DOCUMENTS 4,521,421. A 6/1985 Foreman ..................... 514/267 9 Claims, No Drawings US 6,528,521 B2 1 2 TREATMENT OF ANTI-DEPRESSION DRUG SUMMARY OF THE INVENTION INDUCED SEXUAL DYSFUNCTION WITH The present invention is directed to a method of treating APOMORPHINE Sexual dysfunction in a patient taking anti-depressant medi cation in need of Such treatment comprising administering a This application claims the benefit of Provisional appli therapeutically effective amount of apomorphine or a phar cation Ser. No. 60/249,031, filed Nov. 15, 2000. maceutically acceptable Salt thereof to Said patient. The FIELD OF THE INVENTION anti-depressant medication may be a tricyclic anti depressant, a monamine oxidase inhibitor or a Serotonin The present invention is directed to a method for treating selective reuptake inhibitor. Preferably, the therapeutically Sexual dysfunction in a patient taking anti-depressant medi 1O effective amount of apomorphine is an amount wherein a cation in need of Such treatment comprising administering a concentration of apomorphine is attained within Said therapeutically effective amount of apomorphine or a phar patient's plasma of up to 10 nanograms per milliliter. maceutically acceptable Salt thereof to Said patient. The method may be utilized for patients taking anti-depressants If the patient is male, the therapeutically effective amount 15 may be an amount Sufficient to induce an erection adequate Such as tricyclic anti-depressants, monamine oxidase inhibi for vaginal penetration. Alternatively, if the patient is female tors or Serotonin Selective reuptake inhibitors. the therapeutically effective amount may be an amount BACKGROUND OF THE INVENTION Sufficient to induce clitoral erectogenesis and vaginal engorgement. Preferably, the therapeutically effective Depression is a chronic illness that affects people of all amount is insufficient to produce emesis. However, if larger ageS. Tricyclic antidepressants, monamine oxidase (potentially emesis-inducing) doses are required, the apo inhibitors, and Selective Serotonin reuptake inhibitors are classes of drugs which are prescribed for the treatment of morphine may be co-administered with an emesis-inhibiting depression. Tricyclic anti-depressants include imipramine amount of an anti-emetic agent. hydrochloride, imipramine pamoate, amitriptyline The anti-emetic agent may be nicotine, lobeline Sulfate, hydrochloride, desipramine hydrochloride and protriptyline 25 metoclopramide, chlorpromazine, prochlorperazine, hydrochloride. Monamine oxidase inhibitors include pipamazine, thiethylperazine, oxypendyl hydrochloride, isocarboxazid, phenelZine Sulfate and tranylcypromine Sul domperidone, ondansetron, buclizine hydrochloride, cycliz fate. Of the various classes of anti-depressants currently ine hydrochloride, dimenhydrinate, Scopolamine, available, the Selective Serotonin reuptake inhibitors metopimazine, trimethobenzamide, benzauinamine hydro (SSRIs) are among the most successful. chloride or diphenidol hydrochloride. SSRIs include fluoxetine, fluvoxamine, citalopram, In the method, apomorphine may administered cericlamine, femoxetine, ifoxetine, cyanodothiepin, intranasally, orally ingested, Sublingually or administered by seritraline, paroxetine and litoxetine. Anti-depressants have inhalation to the lungs. Moreover, the apomorphine may be many undesirable Side effects, Such as disturbance of Sexual administered as a pharmaceutically acceptable Salt, prefer function. Since Sexual dysfunction is common in depression 35 ably the hydrochloride salt. as part of the underlying disease, the use of a drug to treat depression which may further cause Sexual dysfunction is DETAILED DESCRIPTION OF THE particularly objectionable. INVENTION A variety of Strategies have been reported in the manage In males, the form of Sexual dysfunction is erectile ment of SSRI-induced Sexual dysfunction, including waiting 40 dysfunction. A normal erection occurs as a result of a for tolerance to develop, dosage reduction, drug holidayS, coordinated vascular event in the penis. This is usually Substitution of another anti-depressant drug, and various triggered neurally and consists of vasodilation and Smooth augmentation Strategies (addition of another drug) with muscle relaxation in the penis and its Supplying arterial 5-HT, 5-HT, and C adrenergic receptor antagonists, vessels. Arterial inflow causes enlargement of the Substance 5-HT1A and dopamine receptor agonists and phosphodi 45 of the corpora cavemosa. Venous outflow is trapped by this esterase enzyme inhibitors, as disclosed by Rosen et al. in J. enlargement, permitting Sustained high blood preSSures in Clin. Psychopharmacol. Vol. 19, No 1, pp.67-84. the penis Sufficient to cause rigidity. Muscles in the Augmentation Strategies may include co-treatment with perineum also assist in creating and maintaining penile cy proheptadine, bethanecol, yohimbine, amantadine, 50 rigidity. Erection may be induced centrally in the nervous alprazolam, chlordiazepoxide, clonazepam, diazepam or System by Sexual thoughts or fantasy, and is usually rein lorazepam according to Forman et al., “Drug-induced infer forced locally by reflex mechanisms. Erectile mechanics are tility and Sexual Dysfunction” in Textbook of Erectile substantially similar in the female for the clitoris. Dysfunction, Oxford: Isis Medical Media Ltd, 1999, pp. Impotence or male erectile dysfunction is defined as the 40–43; co-treatment with Ginkgo Biloba as disclosed in U.S. 55 inability to achieve and Sustain an erection Sufficient for Pat. No. 5,897,864; or co-treatment with sidenafil, according intercourse. Impotence in any given case can result from to Fava et al., “An Open Trial of Oral Sildenafil in psychological disturbances (psychogenic), from physiologi Antidepressant-Induced Sexual Dysfunction”, Psychother. cal abnormalities in general (organic), from neurological Psychosom., 1998, 328-331. disturbances (neurogenic), hormonal deficiencies Nevertheless, there is still a need for effective medications 60 (endocrine) or from a combination of the foregoing. Impo which can be used to treat Sexual dysfunction in patients tence may be hormonal, congenital, Vascular or partial taking anti-depressants. ability, among others. It is therefore an object of the present invention to provide These descriptions are not exact, however. There is cur a method for the treatment of Sexual dysfunction in patients rently no Standardized method of diagnosis or treatment. AS taking anti-depressants, to treat the condition potentially 65 used herein, psychogenic impotence is defined as functional caused by the depression and exacerbated by the anti impotence with no apparent overwhelming organic basis. It depressant. may be characterized by an inability to have an erection in US 6,528,521 B2 3 4 response to Some Stimuli (e.g., masturbation, spontaneous diamyl Sulfates, long chain halides Such as decyl, lauryl, nocturnal, spontaneous early morning, video erotica, etc.) myristyl and Stearyl chlorides, bromides and iodides, aryla but not others (e.g., partner or spousal attention). lkyl halides like benzyl and phenethyl bromides and others. Females also can have Sexual dysfunction that increases Water or oil-soluble or dispersible products are thereby with age and is associated with the presence of vascular risk obtained. Examples of acids which can be employed to form factors and onset of menopause. Some of the vascular and pharmaceutically acceptable acid addition Salts include Such muscular mechanisms that contribute to penile erection in inorganic acids