RU2177786C2 - Composition to modulate human sexual response - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: the method deals with a preparation for peroral intake of a quick-acting composition to modulate human sexual response and/or treat impotence. Decomposition rate of a quick-acting composition is about 20 min or less. Composition has got an opportunity to deliver a vasodilator into human circulation system. Composition refers to a fast-soluble powder, a press cake, a pellet, suspension and/or solution. Vasodilator is selected out of the group consisted of phentolamine, phenoxybenzamine, nitroglycerin thymoxamine, nicotinylic alcohol, imipramine, verapamyl, isoxuprine, naphthidrofuryl, tolasoline and papaverine or their derivatives. EFFECT: easy-to-use atraumatic preparation with no constant application scheme and multiple doses to meet desired results. 27 cl, 11 tbl, 5 ex

Description

 The invention relates to improved formulations for introducing vasodilating agents into the human circulatory system to modulate the sexual response as needed.

 The sexual reaction in both men and women results from a complex interaction of psychological, hormonal and other physiological factors. An important aspect of the sexual reaction common to men and women is the erectile reaction, which occurs as a result of the interaction between the autonomic nervous system, the endocrine system and the circulatory system.

 The absence of an erectile reaction is most characteristic of men and is called impotence. Impotence is a man’s inability to achieve or maintain a penis erection sufficient for penetration into the vagina and sexual intercourse. In an attempt to cure impotence, various methods have been tried. These methods include the use of an external or internal implantable prosthesis (See, for example, US patent 5.065.744, Zumanowsky (Zumanovsky)). In attempts to cure impotence, various medicinal formulations and methods of their administration were tried. For example, US Pat. No. 3,943,246, Stumer, describes the treatment of male impotence with buccal and oral daily doses of 300-1500 international units of oxytocin, or daily divided doses of 150-250 international units of desamine-oxytocin. The patent states that buccal administration of 100 international units three times a day for 14 days improves potency in 12 out of 16 treated patients.

 U.S. Patent 4,530,920, Nestor et. at. (Nestor et al.), Offers the possibility of introducing nonapeptide and decapeptide analogs of the luteinizing hormone, which secrete hormonal agonists, which may be useful for stimulating or improving the sexual response or treatment of impotence and frigidity. Nestor et al. Offers various methods of administration of analogues, including buccal, sublingual, oral, parenteral (including subcutaneous, intramuscular and intravenous administration), rectal, vaginal and others.

 U.S. Patent 4,139,617, Grunwell et al. (Grunwell et al.), Offers buccal and other methods of administering 19-oxygenated-andrest-5-enes to enhance libido in human beings through endocrine treatment.

 U.S. Patent 4.863.911, Anderson et al. (Anderson et al.), Considers methods for treating sexual dysfunction in mammals using a bio-oxidative derivative of an estrogen compound that crosses the blood-brain barrier. One of the implied objectives of the invention of Anderson et al. Is the treatment of "psychological impotence" in men. The test results showed that the medicinal compositions used in this study stimulated the stage of excitation of the input of the genitals and the latent state of sexual intercourse in castrated rats.

 A number of publications suggest the use of various vasodilators to treat impotence in men. Attempts to use vasodilators to treat impotence were prompted by the fact that a significant percentage of cases of impotence were of a vascular nature, i.e., arose as a result of insufficient vascular function.

 Voss et al. (Bocc et al.), US Pat. No. 4,801,587, issued January 31, 1989, proposes the use of an ointment containing a vasodilating agent and a carrier agent for topical application to the penis in men suffering from impotence. The patent of Voss et al. Also describes the application of such an ointment to the urethra of the penis using a catheter, as well as a multi-stage scheme for applying a vasodilator to the skin of the penis. In addition, Voss et al. Propose surgical removal of a portion of the fibrous membrane surrounding the cavernous body, which facilitates the penetration of an ointment containing a vasodilating agent into the cavernous body. Vasodilators for use by Boss et al. Include papaverine, hydralazine, sodium nitroprusside, phenoxybenzamine, and phentolamine. The Voss et al. Patent, however, does not provide information regarding the actual effectiveness of the proposed treatment or the nature of the reaction to such treatment.

 US Pat. No. 4,127,118, Latorre, describes the treatment of male impotence by directly injecting vasodilators into the cavernous body and the spongy body of the penis using a syringe and one or more hypodermic needles. In particular, the Latorra patent offers an intracavernous and intratubular injection of sympathomimetic amines, such as nilidrin hydrochloride, adrenergic blocking agents, such as tolazoline hydrochloride, and directly acting vasodilators, such as isoxuprin hydrochloride and nicotinyl alcohol.

 Brindley GS (Brindley G.S.) (Br. J. Pharmac. 87: 495-500, 1986) showed that when directly injected into the cavernous body with a hypodermic needle, certain smooth muscle relaxants such as phenoxybenzamine, phentolamine, thymoxamine, imipramine, verapamil, papaverine and naphthydrofuril caused an erection. The study indicated that an injection of “an appropriate dose of phenoxybenzamine or papaverine followed by an erection that continued for several hours.” Injection of other studied drugs caused an erection lasting from about 11 minutes to about 6.5 hours.

 Zorgniotti et al. (Zorgniotti et al.), J. Urol. 133: 39-41 (1985), showed that an intracavernous injection of a combination of papaverine and phentolamine could cause an erection in men who are constantly suffering from impotence. Similarly, Althof et al. (Altof et al.), J. Sex Marital Ther. 17 (2): 101-112 (1991), described that an intracavernous injection of papaverine hydrochloride and phentolamine mesylate caused improved erectile ability in 84% of the injected patients. However, in this study, the incidence of failed sexual intercourse was 57%, fibrotic nodules developed in 26% of patients, 30% of patients developed abnormal liver function values, and hematomas were observed in 19% of patients.

 Other studies describing the intracavernous injection of drugs using hypodermic needles for the treatment of impotence include: Brindley (Brindley), J. Physiol. 342: 24P (1983); Brindley (Brindley), Br. J. Psychiatr. 143: 312-337 (1983); Virag (Virag), Lancet ii: 978 (1982) and Virag et al. (Virog et al.), Angiology 35: 79-87 (1984).

 Although intracavernous injection has certain advantages for obtaining an erection in men suffering from impotence, the technique of such treatment itself has numerous disadvantages. Obvious flaws include pain, risk of infection, inconvenience, and obstruction during intercourse. Priapism (prolonged and painful erection) can also be a potential problem when using injection methods (Brindley (1986)). Another problem encountered in some cases of intracavernous injection involves the formation of fibrous lesions of the penis (Corriere et al. (Corrier et al.) J. Urol. 140: 615-617 (1988) and Larsen et al. (Larsen et al.) J Urol. 137: 292-293 (1987)).

 Phentolamine, which has been shown to have the potential to create an erection with intracavernous subcutaneous injection, has also been orally administered to test its effect on men with nonspecific erectile insufficiency (Gwinup, Gvinar, Ann. Int. Med. July 15 1988, pp. 162-163). In this study, 16 patients were given either an oral or placebo or 50 mg oral dose of phentolamine. Eleven of 16 patients (including three placebo-treated patients) showed an increase in penis size. They became more responsive to sexual stimulation and were able to provide an erection sufficient to penetrate the vagina after waiting for 1.5 hours before sexual intercourse.

 Sonda et al. (Sonda et al.), Sex & Marital Ther. 16 (1): 15-21 (year), it was reported that ingestion of yohimbine gave a subjective improvement in erectile ability in 38% of treated impotent men, but only 5% of treated patients reported complete satisfaction.

 Zorgniotti et al. (Zorgniotti et al.), PCT / US94 / 09048, describes the administration through the mucous membranes of a number of vasodilating agents, including phentolamine mesylate, to modulate the sexual response in humans. Of particular interest from the point of view of the justification of the present invention is the discovery of Stanley et al. (Stanley et al.), US Pat. No. 4,885,173, which relates to methods of administering drugs having a cardiovascular or renal effect, in the form of a lollipop, which significantly improves absorbed products through the mucous tissues of the mouth, pharynx and esophagus. The Stanley et al. Patent suggests that a large number of drugs administered in the form of lozenges can improve the function of the cardiovascular system, including drugs that have a direct vasodilating effect, including calcium channel blockers, β-adrenergic blockers, serotonin receptor blocking agents , angina blocking agents, other antihypertensive agents, cardiac stimulants and agents that improve vascular function of the kidneys.

 US patent 5.059.603, Rubin (Rubin), describes the local application to the penis of isoxuprin and caffeine, as well as nitroglycerin and caffeine in combination with the corresponding carrier compounds for the treatment of impotence.

 In this area, there continues to be a need for effective means of modulating a person’s sexual response and, in particular, increasing erectile ability in males suffering from impotence. Ideally, such drugs should be convenient and easy to use, should not require a constant regimen of the drug or even multiple doses to obtain the desired results, should be atraumatic and provide a quick and predictable ability to stimulate erectile function on demand and in response to normal sexual stimulation.

 All references cited in this description are used in their entirety.

 The present invention provides improved formulations for modulating a human sexual response by introducing a vasodilating agent into the circulatory system in an amount that allows an increase in blood flow to the genitals. In accordance with the invention, modulation of the sexual response in men and women is provided as needed by oral administration of an effective amount of a vasodilator. The vasodilating agents used in the present invention include the group consisting of phentolamine mesylate, phentolamine hydrochloride, phenoxybenzamine, yohimbine, organic nitrates (e.g. nitroglycerin), thymoxamine, imipramine, verapamil, isoxuprin, naphthidrofinoperolepin neapolinaperinolone papolamine . A preferred embodiment of a vasodilator in this case is phentolamine mesylate. A composition for oral administration preferred by the present invention contains a vasodilating agent in the composition of an instant tablet. Preferred instant tablets have a disintegration time of from 1 minute to about 10 minutes. The most preference is given to instant tablets having disintegration times of less than one minute. Preferred oral doses of phentolamine mesylate in the compositions of the present invention are from about 5 mg to about 80 mg.

 The present invention is also directed to the creation of a vasodilator composition comprising in combination a vasodilator and a chewable tablet.

 The present invention is particularly directed to improved methods of treating male impotence by administering a vasodilator in an amount that allows for increased blood flow to the penis, erectile capacity being provided on demand by oral administration of the vasodilator.

 Preferably, the amount of vasodilating agent used in the practice of the invention to treat male impotence effectively improves erectile ability from about 1 minute to about 60 minutes following administration of the agent.

 The invention is also specifically directed to methods of modulating the phase of excitation and the platophase of the female sexual response as needed by oral administration of an effective amount of a vasodilator.

 The methods of the present invention are also applicable in the preparation of sexual intercourse due to the ability to modulate the sexual response in both men and women.

 The present invention is also directed to the use of a drug having a vasodilating effect for the manufacture of a medicament for oral administration to improve the sexual response of a person, and in particular to improve erectile ability in response to sexual stimulation. Vasodilator drugs used to make the drug include, but are not limited to, phentolamine mesylate, phentolamine hydrochloride, phenoxybenzamine, yohimbine, organic nitrates, thymoxamine, imipramine, verapamil, isoxuprin, naftidrofuril, tolazoline and papaver.

 Other numerous advantages of the present invention will be apparent from the following detailed description of the invention, including the accompanying examples and the accompanying claims.

 The sexual reaction in both men and women includes a complex interaction between the endocrine, neurological and psychological components, which as a result forms certain psychological and analytical reactions in both men and women.

 If there are obvious differences in the sexual reaction between men and women, there is one general aspect of the sexual reaction - this is an erectile reaction. An erectile reaction in both men and women is the result of blood filling the cavernous tissues of the genitals in response to sexual stimulation (physical, psychological, or both).

 The vascular network of the cavernous tissue of both men and women is the same. In particular, in both men and women, arterial circulation to the erectile tissues of the genitals comes from the common iliac artery, which branches from the abdominal aorta. The common iliac artery branches into the internal and external iliac arteries. The internal artery of the external genitalia originates from the smaller of the two terminal branches of the internal iliac artery.

 In women, the internal artery of the external genitalia branches into the superficial perineal artery, which supplies the external labia. The internal artery of the external genitalia also branches into the artery of the bulb, which supplies the vestibular bulb and erectile tissue of the vagina. The artery of the cavernous body, another branch of the internal artery of the genital organs, supplies the cavernous body of the clitoris. Another branch of the internal artery of the genital organs is the dorsal artery of the clitoris, which supplies the dorsal surface of the clitoris and ends in the glands and membrane folds surrounding the clitoris, which corresponds to the foreskin of a man.

 In a man, the internal artery of the genital organs branches into the back artery of the penis (which itself branches into the left and right branches) and the artery of the cavernous body, all these arteries supplying blood to the cavernous body. The dorsal artery of the penis is similar to the dorsal artery of the clitoris in a woman, while the artery of the cavernous body in a man is similar to the artery of the same name in a woman.

 The man’s erectile reaction is regulated by the autonomic nervous system, which controls the blood flow to the penis through the interaction of peripheral nerves associated with arterial vessels in and around the cavernous body. In an unexcited or non-erectile state, the arteries supplying the cavernous body are maintained in a relatively reduced state, which reduces the flow of blood to the cavernous body. However, in an excited state, the smooth muscles associated with the arteries relax under the influence of catecholamines and the blood flow to the cavernous body increases significantly, causing an increase in size and hardening of the penis. The aforementioned Brindley (1986) hypothesizes that smooth muscle contraction opens valves through which blood can flow from the cavernous body to extracavernous veins. According to Brindley (1986), when the corresponding smooth muscles relax, the valves close, reducing the venous outflow from the corpora cavernosa. When this is accompanied by an increased arterial blood flow into the cavernous body, as a result, the cavernous body is filled with blood and an erection occurs.

 The pre-orgasm sexual reaction in women can be broken down into distinct phases. Both the excitation phase and the plateau phase involve the expansion of blood vessels and the filling of arterial blood (vascular hyperemia) of the genitals in a manner analogous to the erectile reaction of men.

 The phase of excitation of the sexual reaction of women is characterized by vascular hyperemia of the walls of the vagina, which leads to the transduction of the vaginal discharge and vaginal lubrication. Further, the inner third of the vaginal cavity expands, and the cervix and uterine body rise. This is accompanied by flattening and raising of the labia majora and an increase in clitoris size [Kolodny et al. (Kolodny et al.), Textbook of Sexual Medicine, Little and Brown, Boston, MA (1979)].

 In the female sexual reaction, after the excitation phase, a plateau phase follows, which is characterized by noticeable vascular hyperemia of the external third of the vagina, causing a narrowing of the vaginal opening and body and clitoris glands against the pubic symphysis. These reactions are also accompanied by marked vascular hyperemia of the labia (the aforementioned Kolodny (1979)).

 The phenomena of vascular hyperemia characteristic of female sexual response are not limited to genitalia. In the perigastric space, blood is also filled sometimes sometimes to such an extent that it masks the previous erection of the nipples, which usually accompanies the phase of excitation.

 The absence of an erectile reaction in men to such an extent that penetration into the vagina and sexual intercourse become impossible is called impotence. Impotence has many possible causes, which can be divided into several general classifications. Impotence associated with the processes of the endocrine system can occur as a result of primary gonad failure, progressive diabetic disorders, hypothyroidism, as one of the secondary consequences of pituitary adenoma, hypogonadism of acquired or unclear origin, hyperprolacturemia and other endocrine disorders.

 Chronic systemic diseases, such as cirrhosis, chronic renal failure, malignant tumors and other systemic diseases, can also cause impotence. Neurogenic impotence arising from the central nervous system can be caused by temporary disorders in the temporal lobe due to trauma, epilepsy, neoplasms and strokes, intramedullary vertebral injuries, paraplegia and demyelination disorders. Neurogenic causes of impotence arising in the peripheral nervous system include somatic and autonomic neuropathies, pelvic neoplasms, granulomas, injuries, etc. Urological causes of impotence include complete prostate ectomy, local injuries, neoplasms, Peyronie’s disease, etc. In addition, as discussed above , a significant percentage of cases of impotence are vascular in nature.

 At least half of the cases of male impotence can be psychogenic in the absence of a clearly obvious reason for the violation. Even when identifying the organic cause of impotence, psychological factors can play a role in the disorder.

 The present invention is intended to improve circulatory factors of erectile characteristics as needed using vasodilating agents introduced into the circulatory system using a rapidly soluble oral composition.

 In the practice of the present invention can be used a large number of vasodilators, which have demonstrated systematic efficacy as vasodilators. Suitable vasodilators include agents generally classified as α-adrenergic antagonists, sympathomimetic amines, and those agents that provide direct relaxation of vascular smooth muscles. Exemplary α-adrenergic antagonists include phentolamine hydrochloride, phentolamine mesylate, phenoxybenzamine, tolazoline, yohimbine and others. Preference is given in the practice of the present invention to phentolamine mesylate as a vasodilator based on the α-adrenergic agent. An exemplary sympathomimetic amine contemplated for use by the method of the present invention is nilidrin, but other sympathomimetic amines having a vasodilating effect are also contemplated.

 Nicotinic acid (or nicotinyl alcohol) has a direct vasodilating effect, suitable for use in the practice of the present invention. Also considered is the use of papaverine, a non-specific smooth muscle relaxant that has a vasodilating effect and which can be used to treat male impotence by direct injection into the cavernous body either in pure form or in combination with other agents such as phentolamine. Organic nitrates, such as nitroglycerin and amyl nitrate, have significant vasodilating effects due to their ability to provide vascular relaxation of smooth muscles and are thus considered for use in accordance with the present invention. Other vasodilators useful in the practice of the present invention include, but are not limited to, thymoxamine, imipramine, verapamil, naftidrofuril and isoxuprine.

 The formulations also eliminate the need for long-term treatment through the use of a single dose, providing rapidly improving erectile ability on demand.

 In accordance with the present invention, the vasodilating agent is orally administered in the form of a composition in the form of an instant tablet, an instant chewable tablet, solutions, carbonated compositions and other orally administrable compositions that allow for the rapid administration of a vasodilator to the circulatory system in order to improve erectile ability within a short time (as needed) after administration of a single dose of the agent.

 The compositions and methods of the present invention, therefore, are more convenient and help to reduce any side effects that may occur as a result of constant or daily administration of drugs. In addition, the methods of the present invention give greater spontaneity in sexual activity than is permitted by other methods, such as intracavernous injection of vasodilators.

 The following examples are intended to illustrate the present invention, but not to limit the essence of the present invention, which will be set forth in the accompanying claims.

 Example 1 describes instant formulations for oral administration of vasodilating agents. Example 2 describes the bioavailability of phentolamine mesylate with the administration of a rapidly dissolving oral composition. Example 3 describes the effect of oral administration of the instant composition of phentolamine mesylate on the erectile ability of men. Example 4 describes other vasodilating agents suitable for modulating a human sexual response. Example 5 addresses the modulation of an erectile response in women.

Example 1
Instant formulations for oral administration of vasodilating agents
The present invention is directed to the creation of rapidly dissolving oral administration formulations for the rapid delivery of vasodilating agents to the vascular system, thereby providing accelerated (as needed) stimulation of improved erectile ability in response to sexual stimulation, as well as to the creation of other oral administration formulations to improve "on demand" erectile ability in response to sexual stimulation, including chewable tablets, carbonated formulations, solutions, lozenges, lozenges, powders, solutions, suspensions, emulsions or powders in the form of gelatin capsules or other types.

 An exemplary composition of an instant tablet that includes phentolamine mesylate is shown in table 1.

 The components shown in Table 1 (and the tablet formulations below) were finely ground and thoroughly mixed before they were molded into tablets having a total weight of about 400 mg. Other methods of mixing and molding tablets will be understood by those who are experienced in the art. The physical characteristics of the tablets prepared by this method include an average hardness of 10.7 Kp (Knopp hardness), an average thickness of about 0.20 inches, and an average disintegration time of about 0.71 minutes.

As shown in Table 1, the disintegrant - Croscarmellose Sodium NF (supplied as the Ac-Di-Sol ^®, from FMC Corporation) was used to accelerate the dissolution of the tablet although to obtain the same effect can be used by other disintegrants such as those described below.

Tablets suitable for use in the practice of the present invention may contain other pharmaceutical excipients, pharmaceutically acceptable salts, carriers and other substances well known in the art. Buffing agents, flavoring agents and inert fillers such as lactose, sucrose, corn starch, as well as binders such as gum arabic, corn starch or gelatin, may also be used. Potato starch and analgesic acid, as well as other commercially available disintegrants, including Explotab ^® sodium starch glycolate, Polyplasdone XL, crospovidone NF, pregelatinized starch NF Starch 1500 ^o, can be used as disintegrants. Known (Gissinger et al. "A Comparative Evaluation of the Properties of Some Tablet Disintegrants" (Jissinger et al., "Comparative Evaluation of the Properties of Some Tablet Disintegrants"), Drug Development and Industrial Pharmacy 6 (5): 511-536 (1980) ) other disintegrants and methods for measuring the disintegration time of tablets, and this is used in this patent as a reference. A method for measuring tablet disintegration times is also discussed in European Pharmacopeia 1980, which is incorporated by reference. In the practice of the present invention, disintegration times of less than 20 minutes are preferred. Disintegration times of the order of two minutes or less are more preferred. Most preferably, the dissolution time is less than one minute. Preferred periods of dissolution may vary depending on the pharmacokinetic properties of the vasodilator itself.

 The compositions used in the practical application of the present invention may vary as long as the composition retains the fast solubility properties and improved bioavailability of the active component or components.

 Another example of a rapidly disintegrating tablet formulation is described in US Pat. No. 5,298,261 by Rebley et al. (Pebbles et al.) (Patent 261), which is used here for reference. Patent 261 describes a quick-dissolving tablet containing a drug and a matrix network that was dried in vacuum below the freezing temperature of the matrix, but above its decomposition temperature. The matrix network described in patent 261 preferably contains gum, hydrocarbons and a drug. As gum arabic, preference is given to Arabian gum, guayar, xanthine, carrageenan or tragacanth. Preferred hydrocarbons described in patent 261 include mannitol, dextrose, sucrose, lactose, maltose, maltodextrin or corn syrup crystals.

 Another instant composition is described in US patent 5.079.018, Ecanow (Ekanou) (patent 018), which is used here as a reference. Patent 018 describes a readily soluble carrier that contains a drug, an internal frame structure of a water-soluble hydratable gel, or a foaming agent, preferably of protein origin.

 The above formulations are given as an example, and other instant formulations will be apparent to those skilled in the art.

Example 2
Bioavailability of phentolamine mesylate as an instant oral composition
Preliminary studies have been conducted to compare the bioavailability of a single dose of 40 mg of phentolamine mesylate, administered orally in the form of an instant tablet, with the bioactivity of phentolamine mesylate, administered orally in the form of a solid release tablet.

 Instant tablets containing 40 mg of phentolamine mesylate were prepared as described in Table 1. Solid release tablets containing 40 mg of phentolamine mesylate were prepared as follows.

 The molding of the tablets was carried out by direct compression. The physical characteristics of the tablets prepared according to Table 2 include a hardness of 11.5 Kp, an average tablet thickness of 0.16 inches and an average disintegration time of about 26.33 minutes.

 In preliminary studies, a single dose of 40 mg of phentolamine, either as a fast-dissolving tablet or as a solid release tablet, was administered to a group of volunteers.

 Each of the participants in the experiment took 5 ml of blood for analysis before administration of the dose and 0.25, 0.50, 0.75, 1.00, 1.5 and 2 hours after administration of the composition and the level of phentolamine in the plasma was determined using gas chromatograph with electronic capture detectors as follows.

 Phentolamine (CIBA GEIGY AG) and internal standard BA 11038 (CIBA GEIGY AG) were extracted from alkalized heparinized human plasma using 5% isopropyl alcohol in toluene. The desired compositions were re-extracted from the organic layer with an acid solution (for example, 0.05 M sulfonic acid), again made alkaline and extracted with 5% isopropyl alcohol in toluene. The organic solvent was then evaporated and the dried extracts were reduced with hexane and treated with heptafluorobutyrylimidazole. Hoods were then washed and restored with hexane. Hoods were then analyzed by injection into a gas chromatograph equipped with a DB-5 capillary column with a wide channel and an electronic capture detector. The linear range of phentolamine concentration by this method was 5-400 ng / ml, and the lower limit of the exact amount was 5 ng / ml. Phentolamine levels were determined by comparison with a standard curve obtained using a known concentration of phentolamine in the treated solution using the method described above.

 Table 3 shows the concentration of phentolamine in the plasma of the examined group of volunteers who received a dose of 40 mg of phentolamine mesylate in the composition of a standard solid tablet usual release, shown in table 2, at different periods after administration.

 As can be seen from table 3, countable quantities of phentolamine were detected only in one of the three tested volunteers and only 2 hours after the administration of the tablet.

 However, as can be seen from Table 4 below, when the same volunteers were given 40 mg of phentolamine mesylate in the form of the instant tablet composition shown in Table 1, in plasma after 0.25 hours after administration, quantifiable levels of phentolamine were found at the maximum level of plasma, which takes place between 0.5 hours and after 0.75 hours after drug administration, while a decrease in the above levels was observed between 1.5 hours and 2.0 hours after administration.

 In view of the above data, which show that the rapidly dissolving oral composition of phentolamine mesylate phentolamine provides faster absorption of phentolamine mesylate than the oral administration formulations of conventional release, more extensive studies have been conducted on the bioavailability of several dosage levels of phentolamine mesylate orally administered rapidly in oral form the above composition (40 mg of phentolamine mesylate). The compositions were prepared as follows.

 After mixing all the components, the tablets were prepared by direct compression. The physical characteristics of the tablets prepared in accordance with tables 5 and 6 were substantially similar to the physical characteristics of the tablets prepared in accordance with table 1.

 In this study, several males were selected based on their medical history and physical examination. All patients suffered from impotence of organic etiology for less than 3-4 years.

 In this study, male subjects received one of the above phentolamine mesylate formulations at the indicated doses. Blood samples were taken from each patient five milliliters before dosing and after 0.083, 0.125, 0.167, 0.250, 0.50, 0.750, 1.0, 1.5, 2.0, 4.0, 6.0 and 8 hours after dose, and the level of phentolamine in the plasma was measured as described above.

 Tables 7, 8 and 9 show the results of these studies.

 Table 7 shows the plasma levels of phentolamine mesylate after administration of a 20 mg drug dose as a composition of an instant oral tablet, as shown in table 5.

 As shown in table 7, the average peak levels of phentolamine in plasma occurs at 5.4 ng / ml with a maximum value in the range between 0.25 h and 0.50 h with the next decrease in the level of phentolamine starting in the interval between 0.50 h and 0.75 hours

 Table 8 shows the average plasma levels of phentolamine after administration of a dose of 40 mg in the form of an instant oral composition shown in table 1.

 These data show that a maximum of average plasma levels of phentolamine at 16.7 ng / ml occurred approximately 0.5 hours after administration, while quantifiable drug levels persisted for approximately 2 hours after administration. Moreover, in two patients, such levels were detected even 4 hours after administration.

 Table 9 shows the individual and average values of the concentration of phentolamine in plasma after a dose of 60 mg of phentolamine mesylate in the form of a rapidly dissolving oral administration of the composition shown in table 6.

 The results in table 9 show that changes in the plasma levels of patients receiving 60 mg of phentolamine as an instant oral composition were observed at approximately 2.27 ng / ml with a maximum occurring approximately 0.75 hours after administration, while as quantifiable drug levels were maintained in plasma for at least 4 hours after administration.

 Although the studies described above were carried out using a quick-dissolving composition, the present invention also encompasses other formulations that provide rapid absorption of an active vasodilator and a corresponding improvement in erectile ability. For example, the present invention also includes a chewable tablet formulation shown in Table 10.

Example 3
The effect of the administration of the instant oral composition of phentolamine mesylate on the erectile capacity of men
In order to test the effect of the rapidly soluble orally administered composition of phentolamine mesylate on erectile ability, one control blind test was performed.

 All patients suffered from impotence of organic etiology. Patients selected for examination based on medical history and physical examination suffered from impotence for at least 3-4 years. Two tablets were given to each patient: an instant tablet containing 40 mg of phentolamine mesylate (see table 1), and a placebo tablet without phentolamine mesylate.

 Patients were asked to take one tablet 20-30 minutes before attempting sexual intercourse. One or more days after taking the first tablet, patients repeated the process with the second tablet.

 Patients were advised not to drink alcohol before taking the pills and not expect an erection without sexual stimulation. Patients were told that any of the pills could have the desired effect and they were asked to record the results in terms of an erection and penetration into the vagina or the inability to achieve an erection sufficient to penetrate the vagina. Patients were also asked to record side effects. The results of this study are shown in table 11.

 As can be seen from table 11, 50% of patients in group A who took a rapidly dissolving oral administration were able to achieve an erection sufficient to penetrate the vagina within 30 minutes after drug administration, while in group B this was only possible 33% of patients. Also, as shown in table 10, there were no patients responding to placebo.

 Although significant success has been achieved precisely with a dose of 40 mg phentolamine mesylate, it is contemplated that doses of 5 mg to about 100 mg will be applicable to the practice of the present invention.

Example 4
Vasodilating agents useful for modulating human sexual response
A number of other vasodilating agents can be used in the practice of the present invention based on their demonstrated effectiveness as vasodilator agents. Suitable vasodilators include those that are generally classified as α-adrenergic antagonists, sympathomimetic amines, and those agents that directly inhibit relaxation of vascular smooth muscles.

 Exemplary α-adrenergic antagonists include phentolamine hydrochloride, phentolamine mesylate, phenoxybenzamine, tolazoline, dibenamine, yohimbine and others. In the practice of the present invention, phentolamine mesylate is preferred. An exemplary sympathomimetic amine contemplated for use by the method of the present invention is nilidrin, although the invention also contemplates the use of other sympathomimetic amines having a suitable vasodilating effect.

 Nicotinic acid (or nicotinyl alcohol) has a direct vasodilating effect, which is applicable in the practice of the present invention. Papaverine is also a nonspecific smooth muscle relaxant with a vasodilating effect, and it has been used to treat male impotence by direct injection into the cavernous body, either on its own or in combination with other drugs, such as phentolamine.

 Organic nitrates, such as nitroglycerin and amyl nitrate, also have sufficient vasodilating effects due to their ability to relax smooth muscles. Other vasodilators for use in the practice of the present invention include, but are not limited to, thymoxamine, imipramine, verapamil, naftidrofuril, isoxuprin, etc.

 In the practical use of the present invention, these vasodilating agents are administered in the form of a rapidly soluble, orally administrable composition or in the form of other formulations, such as lozenges, lozenges, chewable tablets, aerated formulations, powders, solutions and other formulations that provide for the rapid delivery of the vasodilator to the circulatory system and realize on demand the advantages of the present invention.

 The appropriate doses of each vasodilator for each administration regimen are easily determined by those who have the usual skills in this field. In order to determine the appropriate dose of each of the vasodilating agents of the present invention, those who have the usual skill in this field can use, as a starting point, the usual published dosage of the vasodilator. The usual oral doses for commercially available vasodilators can be found in the Physitian's Desk Reference, published annually by Medical Economic Data, Montvale New Jersey, and in the available medical literature.

As an example, Pavabid ^®, oral administration of papaverine hydrochloride, is delivered Marion Merrel Dow and is generally administered at 150 mg every 12 hours to allow its vasodilating action.

The oral dose of Calon ^® (verapamil hydrochloride), supplied by Searle, is determined by the appointment of an individual patient from 120 mg to about 240 mg of the drug every 12 hours, and the specific dose depends on the individual patient's response to the drug.

Yohimbine hydrochloride, available as Daytohimbin ^® (Dayton Pharmaceuticals), Yocon ^® (Palisades Pharmaceuticals), and Yohimex ^o (Kramer), is administered orally at 5.4 mg three times a day.

Imipramine hydrochloride, available as the Tofranil ^® by Geigy, is administered orally 4 times a day, the total dose is from about 50 mg to about 150 mg per day.

 Imipramine Pamoate, also available from Geigy, is administered orally in doses of 150 mg / day.

 Using the established dosage of oral administration as starting points, it is possible to determine the optimal dosage for a special administration regimen by measuring the blood flow in the main artery of the patient’s genital circulatory system before administering the drug using a Doppler ultrasonic speed sensor, as described in Zorgniotti et al. (Zorgniotti et al.), PCT / US94 / 09048. Other methods can be used to measure blood flow in the genitals, such as thermography, plethysmography, radiometric or scanning methods, and other methods well known in the art. After measuring the blood flow in the main artery, various dosages of the corresponding vasodilating agents can be prescribed using the formulations included in the present invention, and their effect on the blood flow can be measured. The magnitude of the increase in blood flow necessary to modulate or improve a person’s sexual response may vary individually, but it is easily determined as described by Zorgniotti et al. (Zorgniotti et al.) In PCT / US94 / 09048. In addition, individual patients may receive different dosages of the appropriate vasodilators until the optimal dosage is determined.

 Blood flow studies can also be combined with estimates of sexual sensitivity, which is determined by the improvement in erectile ability in response to sexual stimulation.

Example 5
Modulation of the sexual response in women
As discussed above, the anatomy of the vessels of the genitals of men and women, as well as the erectile reaction formulated by this vasculature, are remarkably similar. In both men and women, an erectile reaction occurs when, under the influence of physical and psychological stimulation, the blood flow to the genitals increases due to the relaxation of smooth muscles in the arteries serving the genitals.

 The methods and compositions of the present invention can be used to improve or enhance the erectile response in women with impaired sexual response, as evidenced by the reduced ability to form enough vaginal lubricant to facilitate convenient penetration of the penis, and other symptoms of impaired sexual responsiveness that may be correlated with erectile reaction.

 As with the sexual response of men, in the absence of any clinically diagnosed dysfunction in the erectile response of women, the methods of the present invention can be used to enhance the normal sexual response in women. An “on-demand” aspect of the present invention will provide a faster response to sexual stimulation along with improved sensations during the arousal phase and plateau phase of the female sexual response due to the increased blood flow to the tissues.

 In practice, enhancing female sexual response using the methods of the present invention is performed in much the same way as the above description for males.

 An effective dose of a vasodilator is administered to the woman in accordance with the compositions of the present invention. The required doses of the desired vasodilating agent can be easily determined using the methods described in Example 4. Measurement of female sexual response can be carried out using the methods described in Masters, W. H. and Johnson, V. E., Human Sexual Response, Little, Brown and Co. , Boston (1966), used in this patent for reference. Along with other methods well known in this field, Doppler ultrasonic velocity measurement, thermography using an isothermal blood flow transducer, radio scanning methods, and photoplethysmography can be used to measure blood flow. In addition, compression measurements of the external 1/3 of the vagina, which is characteristic of the plateau phase of the female sexual characteristics, can be performed using methods and equipment well known in this field, including, but not limited to, tension sensors or other devices for measuring muscle contraction or stretching.

 In addition, enhanced sexual response can be measured in a more subjective way, by the usual questioning of a female subject to describe any changes in sensations caused by the administration of a vasodilating agent according to the method of the present invention. An appropriate placebo control should also be carried out in order to determine the possibility of a direct correlation of the result with the administration of a vasodilator.

 Preferred embodiments of the present invention include administering from about 5 mg to about 80 mg of phentolamine mesylate as an instant oral composition of the present invention from about 1 minute to about 1 hour before and during preparation for sexual intercourse. However, any vasodilating agent may be used within the spirit of the present invention.

 Although this invention is described by way of preferred options, the presented examples are not intended to limit the essence of the present invention, which involves the use of any pharmacological vasodilator, capable of being absorbed by the circulatory system when taking the drug in the form of an orally administered composition capable of improving erectile ability on demand.

Claims (27)

 1. A dosage form for oral administration, which is a fast-acting composition for modulating the human sexual reaction, containing a vasodilator and a pharmaceutically acceptable carrier, capable of delivering a vasodilator to the human circulatory system in an amount effective to modulate and / or improve the sexual response as needed, and having a disintegration time of 20 minutes or less.  2. The dosage form according to claim 1, characterized in that the fast-acting composition is an instant powder, tablet, chewable tablet, effervescent tablet, effervescent powder, encapsulated powder, cake, lozenge, suspension and / or solution.  3. The dosage form according to claim 1 or 2, characterized in that the vasodilator is selected from the group consisting of phentolamine, phenoxybenzamine, nitroglycerin, thymoxamine, nicotinyl alcohol, imipramine, verapamil, isoxuprin, naphthidrofuril, tolazoline and papaverine thereof.  4. The dosage form according to any one of paragraphs. 1-3, characterized in that the composition has a disintegration time of less than 20 minutes  5. The dosage form according to claim 4, characterized in that the composition has a disintegration time of 1-10 minutes.  6. The dosage form according to claim 4, characterized in that the composition has a disintegration time of less than 1 minute.  7. The dosage form according to any one of paragraphs. 1-6, characterized in that the vasodilator is a phentolamine mesylate.  8. The dosage form according to claim 7, characterized in that the composition contains from about 5 mg to about 80 mg of phentolamine mesylate.  9. The dosage form according to claim 7, characterized in that the composition contains 40 mg of phentolamine mesylate.  10. The dosage form according to claim 7, characterized in that the composition contains 80 mg of phentolamine mesylate.  11. The dosage form according to any one of paragraphs. 1-6, characterized in that the vasodilator is a phentolamine hydrochloride.  12. The dosage form according to claim 11, characterized in that the composition contains from about 5 mg to about 80 mg of phentolamine hydrochloride.  13. The dosage form according to claim 11, characterized in that the composition contains 40 mg of phentolamine hydrochloride.  14. The dosage form according to claim 11, characterized in that the composition contains 80 mg of phentolamine hydrochloride.  15. A dosage form for oral administration, which is a fast-acting composition for treating impotence, containing a vasodilator and a pharmaceutically acceptable carrier, having a disintegration time of not more than 20 minutes and having the ability to deliver a vasodilator to the male circulatory system in an amount effective to modulate and / or improving sexual response as needed.  16. The dosage form according to p. 15, characterized in that the fast-acting composition is an instant powder, tablet, chewing gum, effervescent tablet, effervescent powder, encapsulated powder, cake, lozenge, suspension and / or solution.  17. A dosage form according to claim 15 or 16, characterized in that the vasodilator is selected from the group consisting of phentolamine, phenoxybenzamine, nitroglycerin, thymoxamine, nicotinyl alcohol, imipramine, verapamil, isoxuprin, naftidrofuril, tolazoline and their papaverine.  18. The dosage form according to any one of paragraphs. 15-17, characterized in that the composition has a disintegration time of 1 to 10 minutes  19. The dosage form according to claim 18, characterized in that the composition has a disintegration time of less than 1 min.  20. The dosage form according to any one of paragraphs. 15-19, characterized in that the vasodilator is a phentolamine mesylate.  21. The dosage form according to claim 20, characterized in that the composition contains from about 5 mg to about 80 mg of phentolamine mesylate.  22. The dosage form according to p. 20, characterized in that the composition contains 40 mg of phentolamine mesylate.  23. The dosage form according to claim 20, characterized in that the composition contains 80 mg of phentolamine mesylate.  24. The dosage form according to any one of paragraphs. 15-19, characterized in that the vasodilator is a phentolamine hydrochloride.  25. The dosage form according to p. 24, characterized in that the composition contains from about 5 mg to about 80 mg of phentolamine hydrochloride.  26. The dosage form according to p. 24, characterized in that the composition contains 40 mg of phentolamine hydrochloride.  27. The dosage form according to p. 24, characterized in that the composition contains 80 mg of phentolamine hydrochloride.

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