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US Patent 6207674 - Dextromethorphan and oxidase inhibitor for weaning patients from narcotics and anti-depressants

US Patent Issued on March 27, 2001
Estimated Patent Expiration Date: Icon_subject December 22, 2019Estimated Expiration Date is calculated based on simple USPTO term provisions. It does not account for terminal disclaimers, term adjustments, failure to pay maintenance fees, or other factors which might affect the term of a patent.
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Abstract

Patients can be helped to break free of addictive or habit-forming narcotics and anti-depressants, by treatment using two drugs. One drug is dextromethorphan (DM), which has been used for decades as an anti-tussive (cough-suppressing) drug in cough syrups. The other drug is an oxidase inhibitor which suppresses activity of a liver enzyme called cytochrome P450-2D6 (also called debrisoquin hydroxylase, sparteine monooxygenase, cytochrome P450-DB, and CYP2D6). In most patients, this oxidase enzyme rapidly degrades DM and converts it into a metabolite called dextrorphan. An oxidase inhibitor (such as quinidine) which suppresses cytochrome P450-2D6 activity increases the half-life and concentration of DM in the circulating blood. When this combined treatment was administered orally to patients who had become dependent on morphine and anti-depressant drugs because of chronic intractable pain, it initially helped the patients reduce their dosages of morphine and other drugs, including anti-depressants. When additional testing was done, the combined treatment allowed patients to entirely terminate all use of morphine and anti-depressants, with minimal withdrawal or other adverse effects. Importantly, these same patients received no substantial benefit from taking dm by itself, without an oxidase inhibitor. Accordingly, the combination of dextromethorphan plus an anti-oxidase drug can allow at least some patients to break entirely free of narcotics and/or anti-depressants, even after years of use for chronic pain and other medical problems, even when they are not substantially helped by dextromethorphan alone.

Other References

  • Bisaga, A., et al, "Opiate withdrawal with dextromethorphan [letter]," Amer. J. Psychiatry 154: 584 (1997)
  • Grass, S., et al, "NMDA receptor antagonists potentiate morphine's antinociceptive effect in the rat," Acta Physiol. Scand. 158: 269-73 (1996)
  • Hoffmann, O., et al, "Dextromethorphan potentiates morphine antinociception, but does not reverse tolerance in rats," Neuroreport 7: 838-40 (1996)
  • Kauppila,T., et al, "Dextromethorpan potentiates the effect of morphine in rats with peripheral neuropathy," Neuroreport 9: 1071-4 (1998)
  • Koyuncuoglu, H., et al, "The treatment of heroin addicts with dextromethorphan: a double-blind comparison of dextromethorphan with chlorpromazine," Int. J. Clin. Pharmacol. Ther. Toxicol. 28: 147-52 (1990)
  • Manning, B.H., et al, "Continuous coadministration of dextromethorphan or MK-801 with morphine: attenuation of morphine dependence and naloxone-reversible attenuation of morphine tolerance," Pain 67: 79-88 (1996)
  • Mao, J., et al, "Oral administration of dextromethorphan prevents the development of morphine tolerance and dependence in rats," Pain 67: 361-8 (1996)
  • Plesan, A., et al, "Comparison of ketamine and dextromethorphan in potentiating the antinociceptive effect of morphine in rats," Anesth. Analg. 86: 825-9 (1998)
  • Zhang,Y., et al, "Dextromethorphan: Enhancing its systemic availability by way of low-dose quinidine-mediated inhibition of cytochrome P4502D6," Clin. Pharmacol. Ther. 51: 647-655 (1992)
  • Bisaga et al., Opiate Withdrawal With Dextromethorphan, Am J. Psychiatry, 154:4, p. 584, Apr. 1997.
  • Zhang et al., Dextromethorphan: Enhancing its systemic availability by way of low-dose quinidine-mediated inhibition of cytochrome P4502D6, Clin Pharmacol & Therapeutics, 51:6 pp. 647-655, Jun. 199

Inventor

Application

No. 471060 filed on 12/22/1999

US Classes:

514/289, Two of the cyclos share at least three ring members (i.e., bridged) (e.g., morphinans, etc.)514/305, Quinuclidines (including unsaturation)514/491, With an additional active ingredient514/649, Amino nitrogen attached to aryl ring or aryl ring system by an acyclic carbon or acyclic chain514/651, Ether oxygen is part of the chain514/652, Alkanol group only between the amino nitrogen and an ether oxygen which is bonded directly to the aryl ring or aryl ring system (i.e., aryloxy alkanol amines)514/654The chain consists of two or more carbons which are unsubtituted or have acyclic hydrocarbyl substituents only

Field of Search

514/289, Two of the cyclos share at least three ring members (i.e., bridged) (e.g., morphinans, etc.)514/305, Quinuclidines (including unsaturation)514/491, With an additional active ingredient514/649, Amino nitrogen attached to aryl ring or aryl ring system by an acyclic carbon or acyclic chain514/651, Ether oxygen is part of the chain514/652, Alkanol group only between the amino nitrogen and an ether oxygen which is bonded directly to the aryl ring or aryl ring system (i.e., aryloxy alkanol amines)514/654The chain consists of two or more carbons which are unsubtituted or have acyclic hydrocarbyl substituents only

Examiners

Primary: Krass, Frederick
Assistant: Jagoe, Donna

Attorney, Agent or Firm

US Patent References

4316888, Method and composition of reducing pain
Issued on: 02/23/1982
Inventor: Nelson
5166207, Method for enhancing the systemic delivery of dextromethorphan for the treatment of neurological disorders
Issued on: 11/24/1992
Inventor: Smith
5206248, Method for reducing emotional lability
Issued on: 04/27/1993
Inventor: Smith
5321012, Inhibiting the development of tolerance to and/or dependence on a narcotic addictive substance
Issued on: 06/14/1994
Inventor: Mayer, et al.
5350756, Use of a cytochrome oxidase inhibitor to increase the cough-suppressing activity of dextromorphan
Issued on: 09/27/1994
Inventor: Smith
5352683, Method for the treatment of chronic pain
Issued on: 10/04/1994
Inventor: Mayer, et al.
5366980, Use of dextromethorphan and an oxidase inhibitor to treat dermatitis
Issued on: 11/22/1994
Inventor: Smith
5502058, Method for the treatment of pain
Issued on: 03/26/1996
Inventor: Mayer, et al.
5556838, Inhibiting the development of tolerance to and/or dependence on an addictive substance
Issued on: 09/17/1996
Inventor: Mayer, et al.
5863927Dextromethorphan and an oxidase inhibitor for treating intractable conditions
Issued on: 01/26/1999
Inventor: Smith, et al.

International Classes

A61K 31//44
.31/27
31/135

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