Combinations of opioid/tlr4 antagonist and a cyclooxygenase (cox) inhibitor for use in the treatment of pain

Abstract

Disclosed are compositions for treatment of pain comprising a first compound and a second compound, the first compound is an opioid antagonist that treats pain by blocking Toll-like receptor 4 (TLR4) and the second compound is a cyclooxygenase (COX) inhibitor that enhances the pain treatment effect of the first compound. Examples of opioid antagonist include naltrexone and naloxone. Examples of cyclooxygenase inhibitors include ibuprofen, naproxen, meloxicam, diclofenac and meclofenamic acid, synergistic pharmaceutical compositions thereof, and their use in the treatment, prevention, and reversal of neuropathic pain and nociceptive pain with an allodynic component.

That which is claimed is: 
     
         1 . A composition for treatment of pain in a mammal comprising a synergistic ratio of an opioid/TLR4 antagonist, or pharmaceutically acceptable salts or solvates thereof and a cyclooxygenase (COX) inhibitor, or pharmaceutically acceptable salts or solvates thereof. 
     
     
         2 . A composition comprising the formulation of  claim 1 , wherein the opioid/TLR4 antagonist is selected from a group consisting of naltrexone, norbinaltorphimine, nalmefene, naloxone, nalorphine, methylnaltrexone, samidorphan, cyprodime, naltrindole, amentoflavone, naltriben, norbinaltorphimine, 6-β-naltrexol, metabolites and pro drugs thereof, including all enantiomeric and epimeric forms as well as the appropriate mixtures thereof, or pharmaceutically acceptable salts or solvates of any thereof. 
     
     
         3 . A composition comprising the formulation of  claim 1 , wherein, the opioid/TLR4 antagonist is naltrexone as well as pro drugs thereof or any enantiomeric and epimeric forms thereof, as well as the appropriate mixtures thereof, or pharmaceutically acceptable salts or solvates of any thereof. 
     
     
         4 . A composition comprising the formulation of  claim 3 , wherein, the opioid/TLR4 antagonist is naltrexone in a sustained release formulation, as well as pro drugs thereof or any enantiomeric and epimeric forms thereof, as well as the appropriate mixtures thereof, or pharmaceutically acceptable salts or solvates of any thereof. 
     
     
         5 . A composition comprising the formulation of  claim 3 , wherein, the opioid/TLR4 antagonist is (+)-naltrexone (dextro-naltrexone),as well as appropriate mixtures thereof, as well as pro drugs thereof, or pharmaceutically acceptable salts or solvates thereof. 
     
     
         6 . A composition comprising the formulation of  claim 1 , wherein the cyclooxygenase (COX) inhibitor is selected from a group consisting of Aspirin Diflunisal, Salsalate. Ibuprofen, Dexibuprofen, Naproxen, Fenoprofen, Ketoprofen, Dexketoprofen, Flurbiprofen, Oxaprozin, Loxoprofen. Indomethacin, Tolmetin, Sulindac, Etodolac, Ketorolac, iclofenac, Nabumetone. Piroxicam, Meloxicam, Tenoxicam, Droxicam, Lornoxicam, Isoxicam. Mefenamic acid, Meclofenamic acid, Flufenamic acid, Tolfenamic acid. Celecoxib, Rofecoxib, Valdecoxib, Parecoxib, Lumiracoxib, Etoricoxib, Firocoxib, Sulphonanilides, Nimesulide, Licofelone, Lysine, clonixinate, Hyperforin, Figwort, Calcitriol or pharmaceutically acceptable salts or solvates of any thereof. 
     
     
         7 . A composition comprising the formulation of  claim 1 , wherein the cyclooxygenase (COX) inhibitor is ibuprofen, or pharmaceutically acceptable salts or solvates thereof. 
     
     
         8 . A composition according to  claim 1 , wherein, the opioid/TLR4 antagonist is naltrexone, or pharmaceutically acceptable salts or solvates thereof, in a therapeutically effective amount and the cyclooxygenase (COX) inhibitor is ibuprofen, or pharmaceutically acceptable salts or solvates thereof, in a therapeutically effective amount. 
     
     
         9 . A composition according to  claim 9 , wherein naltrexone and ibuprofen, or pharmaceutically acceptable salts or solvates of any thereof, are in a weight to weight combination range which corresponds to a synergistic combination of 1:90 parts by weight. 
     
     
         10 . A composition according to  claim 9 , wherein the dose range of naltrexone, or pharmaceutically acceptable salts or solvates thereof, is about 0.004 mg/kg-0.71 mg/kg. And wherein, the dose range of ibuprofen, or pharmaceutically acceptable salts or solvates thereof, is about 3 mg/kg-35 mg/kg per day. 
     
     
         11 . A composition according to  claim 9 , wherein the human dose range of naltrexone is 0.25 mg-50 mg per day. And wherein, the human the dose range of ibuprofen is 200 mg-2400 mg, wherein said composition is formulated into a single fixed combination dosage form. 
     
     
         12 . A composition according to  claim 9 , wherein the human dose range of naltrexone is 0.25 mg-15 mg per day. And wherein, the human the dose range of ibuprofen is 200 mg-2400 mg, wherein said composition is formulated into a single fixed combination dosage form. 
     
     
         13 . A composition according to  claim 9 , wherein the composition is administered once, twice, three or four times through the day. 
     
     
         14 . A composition of  claim 9 , wherein the therapeutically effective dose of the pharmaceutical composition is administered systemically, including but are not limited to mucosal, nasal, oral, parenteral, gastrointestinal, topical or sublingual routes. 
     
     
         15 . A composition, according to  claim 9 , wherein said combination is in a single dosage form, and wherein, said single dosage form is in the form of tablets, lozenges, troches, hard candies, liquid, powders, sprays, creams, salves and suppositories. 
     
     
         16 . A composition, according to  claim 1  for treating, preventing and reversing pain. 
     
     
         17 . A method of treating neuropathic pain, nociceptive pain, nociceptive pain with an allodynic component, migraine, trigeminal neuralgia, vulvodynia, irritable bowel syndrome, post herpetic neuralgia, or diabetic neuropathy in a mammal in need thereof, comprising administering to the mammal in a therapeutically effective amount of a combination according to  claims 9 .