JP2001316264A - New drug for treating neuropathy syndrome accompanied with cerebrovascular disorder - Google Patents
New drug for treating neuropathy syndrome accompanied with cerebrovascular disorderInfo
- Publication number
- JP2001316264A JP2001316264A JP2001135136A JP2001135136A JP2001316264A JP 2001316264 A JP2001316264 A JP 2001316264A JP 2001135136 A JP2001135136 A JP 2001135136A JP 2001135136 A JP2001135136 A JP 2001135136A JP 2001316264 A JP2001316264 A JP 2001316264A
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- cerebrovascular
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Abstract
Description
【０００１】本発明は、脳血管障害に伴う精神症候の新
規治療剤に関する。脳梗塞（脳血栓、脳塞栓）および脳
出血などの脳血管疾患では、局所的な脳の虚血状態が惹
起され、神経細胞の脱落、脳室の拡大など、脳の器質性
障害や機能性障害が起こる。従って、脳血管疾患を有す
る患者では、知的機能の低下（記憶力・記銘力の低下な
ど）や種々の精神障害（情緒障害、自発性低下、問題行
動など）が発現する。[0001] The present invention relates to a novel therapeutic agent for mental symptoms associated with cerebrovascular disorders. In cerebrovascular diseases such as cerebral infarction (cerebral thrombosis, cerebral embolism) and cerebral hemorrhage, localized cerebral ischemia is caused, and organic or functional disorders of the brain such as loss of nerve cells and enlargement of the ventricle are caused. Occur. Therefore, in a patient having a cerebrovascular disease, a decrease in intellectual function (such as a decrease in memory and memorization) and various mental disorders (an emotional disorder, a decrease in spontaneity, problem behavior, and the like) occur.
【０００２】これら脳血管疾患に基づく精神障害の発現
メカニズムについては明らかではないが、脳虚血時の動
物およびヒトで、脳内セロトニンおよびドーパミン神経
機能に異常が生ずるためではないかと考えられている。
即ち、虚血に伴いセロトニンやドーパミンなどの遊離が
亢進したり、その脳内含量が低下すること（Chang eta
l.,J.Neurochem.,60,1483,1993;Luthman et al.,Pharma
col.Biochem.Behav.,41,231,1991)、また、これら神経
伝達物質を受容し、神経伝達を司る蛋白（受容体）の含
量が変動すること（Robinson & Starkstein,J.Geriatr.
Psychiatry,22,1,1989;Bracha et al.,Biol.Psychiatr
y,25,265,1989;Nagasawa et al.,J.Neurosci.Res.,33,4
85,1992）などが知られている。これら中枢セロトニン
およびドーパミン神経系は情動および精神機能の発現に
重要な役割を担っていることが一般的に知られており、
従って、脳血管疾患に伴う精神障害の発現には、これら
中枢セロトニンおよびドーパミン神経系の機能異常が関
与している可能性があると考えられる。[0002] The mechanism of the manifestation of these psychiatric disorders based on cerebrovascular disease is not clear, but it is thought that abnormalities may occur in brain serotonin and dopamine nerve function in animals and humans during cerebral ischemia. .
That is, the release of serotonin and dopamine and the like is increased with ischemia, and the brain content is decreased (Chang eta
l., J. Neurochem., 60, 1483, 1993; Luthman et al., Pharma
Col. Biochem. Behav., 41, 231, 1991), and the contents of proteins (receptors) that receive these neurotransmitters and control neurotransmission fluctuate (Robinson & Starkstein, J. Geriatr.
Psychiatry, 22, 1, 1989; Bracha et al., Biol. Psychiatr
y, 25, 265, 1989; Nagasawa et al., J. Neurosci. Res., 33, 4
85,1992). It is generally known that these central serotonin and dopamine nervous systems play important roles in the development of emotional and mental functions,
Therefore, it is considered that the dysfunction of these central serotonin and dopamine nervous systems may be involved in the development of mental disorders associated with cerebrovascular disease.
【０００３】脳血管疾患に伴う精神障害に対する臨床応
用に関しては、これまでにドーパミンＤ２遮断薬（典型
的抗精神病薬）の適用が検討されて来たが、その効果と
しては問題行動に関してある程度の効果が認められるも
のの、逆に情緒障害や自発性低下などを悪化させる場合
もあり、満足すべき治療剤とはいい難い。[0003] With respect to clinical application for psychiatric disorders associated with cerebrovascular disease, the application of dopamine D2 blockers (typical antipsychotics) has been studied so far. However, conversely, emotional disorders and spontaneous deterioration may be worsened, and it is not a satisfactory therapeutic agent.
【０００４】本発明者らは、各種精神症候の改善または
治療法を検討する内、セロトニン２受容体とドーパミン
Ｄ２受容体の両者を遮断し得る化合物が、脳血管障害に
伴う精神症候の治療に極めて顕著な改善、治療効果を発
揮することを見い出し、本発明を完成するに至った。[0004] The present inventors have studied various amelioration or treatment methods for psychiatric symptoms, and found that a compound capable of blocking both serotonin 2 receptor and dopamine D2 receptor is useful for treating psychiatric symptoms associated with cerebrovascular disorders. It has been found that the present invention exhibits extremely remarkable improvement and therapeutic effects, and has completed the present invention.
【０００５】即ち、本発明は、セロトニン２受容体とド
ーパミンＤ２受容体の両者を遮断し得る化合物を必須成
分とする、脳血管障害に伴う精神症候治療剤を提供する
ものである。That is, the present invention provides a therapeutic agent for psychiatric symptoms associated with cerebrovascular disorders, which comprises a compound capable of blocking both serotonin 2 receptor and dopamine D2 receptor as an essential component.
【０００６】本発明に係る治療剤により、改善または治
癒が期待できる精神症候としては、脳梗塞（脳血栓、脳
塞栓）および脳出血の患者に現れる問題行動（攻撃行
為、精神興奮、徘徊、せん妄、幻覚、妄想など）、情緒
障害（不安、緊張、抑うつ、感情失禁、焦燥感、表情の
欠乏、不機嫌など）および自発性低下（積極性の低下、
欲求表現の低下、意欲低下、家事・娯楽・趣味等への関
心の低下など）などが挙げられる。[0006] Psychotic symptoms that can be expected to be improved or cured by the therapeutic agent of the present invention include problematic behaviors (aggression, mental excitement, wandering, delirium, hallucinations) that appear in patients with cerebral infarction (cerebral thrombosis, cerebral embolism) and cerebral hemorrhage. , Delusions, etc.), emotional disorders (such as anxiety, nervousness, depression, incontinence, frustration, lack of facial expression, sullen mood) and decreased spontaneity (eg,
Decrease in desire expression, decrease in motivation, decrease in interest in housework, entertainment, hobbies, and the like).
【０００７】セロトニン２受容体とドーパミンＤ２受容
体の両者を遮断し得る化合物は、特定のものに限定され
る訳ではないが、代表的なものとして、以下の化合物を
挙げることができる。The compounds capable of blocking both the serotonin 2 receptor and the dopamine D2 receptor are not limited to specific ones, but the following compounds may be mentioned as typical ones.
【０００８】ＳＭ−９０１８ 〔Ｎ−［４−［４−
（１，２−ベンゾイソチアゾール−３−イル）−１−ピ
ペラジニル］ブチル］−１，２−シス−シクロヘキサン
ジカルボキシイミド塩酸塩〕[0008] SM-9018 [N- [4- [4-
(1,2-Benzoisothiazol-3-yl) -1-piperazinyl] butyl] -1,2-cis-cyclohexanedicarboximide hydrochloride]
【化１】 Japan. J. Pharmacol. 53 pp321-329 (1990)、特開昭６
２−１２３１７９号公報Embedded image Japan. J. Pharmacol. 53 pp321-329 (1990), JP-A-6
2-123179 gazette
【０００９】リスペリドン 〔３−〔２−〔４−（６−
フルオロ−１，２−ベンゾイソオキサゾール−３−イ
ル）ピペリジノ〕エチル〕−６，７，８，９−テトラヒ
ドロ−２−メチル−４Ｈ−ピリド〔１，２−ａ〕ピリミ
ジン−４−オン〕 Risperidone [3- [2- [4- (6-
Fluoro-1,2-benzisoxazol-3-yl) piperidino] ethyl] -6,7,8,9-tetrahydro-2-methyl-4H-pyrido [1,2-a] pyrimidin-4-one]
【化２】 Drug Data Report 1987, 9 (11), p916、特開昭６１−
２２１１８６号公報Embedded image Drug Data Report 1987, 9 (11), p916, JP-A-61-
No. 221186
【００１０】ジプラシドン・塩酸塩 （ＣＰ−８８０５
９−０１）〔５−〔２−〔４−（１，２−ベンズイソチ
アゾール−３−イル）ピペラジン−１−イル〕エチル〕
−６−クロロインドリン−２−オン・塩酸塩〕 Ziprasidone hydrochloride (CP-8805)
9-01) [5- [2- [4- (1,2-benzisothiazol-3-yl) piperazin-1-yl] ethyl]
-6-chloroindoline-2-one hydrochloride]
【化３】 Drug Data Report 1993, 15 (11), p1000、特開昭６３
−３０１８６１号公報Embedded image Drug Data Report 1993, 15 (11), p1000, JP 63
-301861
【００１１】オカペリドン （Ｒ−７９５９８）〔３−
〔２−〔４−（６−フルオロ−１，２−ベンズイソオキ
サゾール−３−イル）−１−ピペリジニル〕エチル〕−
２，９−ジメチル−４Ｈ−ピリド〔１，２−ａ〕ピリミ
ジン−４−オン〕[0011] ocaperidone (R-79598) [3-
[2- [4- (6-Fluoro-1,2-benzisoxazol-3-yl) -1-piperidinyl] ethyl]-
2,9-dimethyl-4H-pyrido [1,2-a] pyrimidin-4-one]
【化４】 Drug Data Report 1990, 12 (8), p605、特開平４−２
３４８８２号公報Embedded image Drug Data Report 1990, 12 (8), p605, JP-A-4-2
No. 34882
【００１２】Ｏrg−５２２２ 〔トランス−５−クロロ
−２−メチル−２，３，３ａ，１２ｂ−テトラヒドロ−
１Ｈ−ジベンズ〔２，３：６，７〕オキセピノ〔４，５
−ｃ〕ピロール・マレイン酸塩（１：１）〕 Org-5222 [trans-5-chloro-2-methyl-2,3,3a, 12b-tetrahydro-
1H-dibenz [2,3: 6,7] oxepino [4,5
-C] pyrrole maleate (1: 1)]
【化５】 Drug Data Report 1991, 13 (8), p641、特開昭５３−
２４６５号公報Embedded image Drug Data Report 1991, 13 (8), p641, JP-A-53-
No. 2465
【００１３】ＡＤ−５４２３ 〔２−（４−エチル−１
−ピペラジニル）−４−（４−フルオロフェニル）−
５，６，７，８，９，１０−ヘキサヒドロシクロオクタ
〔ｂ〕ピリジン〕 AD-5423 [2- (4-ethyl-1)
-Piperazinyl) -4- (4-fluorophenyl)-
5,6,7,8,9,10-hexahydrocycloocta [b] pyridine]
【化６】 Drug Data Report 1990, 12 (10), p766、特開平３−７
２５７号公報Embedded image Drug Data Report 1990, 12 (10), p766, JP-A-3-7
No. 257
【００１４】セルチンドール 〔５−クロロ−１−（４
−フルオロフェニル）−３−〔１−（２−オキソイミダ
ゾリジン−１−イルエチル）−４−ピペリジル〕−１Ｈ
−インドール〕[0014] Sertindole [5-chloro-1- (4
-Fluorophenyl) -3- [1- (2-oxoimidazolidin-1-ylethyl) -4-piperidyl] -1H
-Indole)
【化７】 Drug Data Report 1990, 12 (11), p859、特開昭６１−
２３６７６４号公報Embedded image Drug Data Report 1990, 12 (11), p859, JP-A-61-
No. 236764
【００１５】アンペロジド 〔４−〔４，４−ビス（４
−フルオロフェニル）ブチル〕−Ｎ−エチル−１−ピペ
ラジンカルボキサミド〕 Amperodide [4- [4,4-bis (4
-Fluorophenyl) butyl] -N-ethyl-1-piperazinecarboxamide]
【化８】 Drugs of Future 1982, 7 (5), p305、特開昭５５−５
７５７２号公報Embedded image Drugs of Future 1982, 7 (5), p305, JP-A-55-5
No. 7572
【００１６】ＨＰ−８７３ 〔１−〔４−〔３−〔４−
（６−フルオロ−１，２−ベンズイソオキサゾール−３
−イル）−１−ピペリジニル〕プロポキシ〕−３−メト
キシフェニル〕エタノン〕 HP-873 [1- [4- [3- [4-
(6-fluoro-1,2-benzisoxazole-3
-Yl) -1-piperidinyl] propoxy] -3-methoxyphenyl] ethanone]
【化９】 Drug Data Report 1991, 13 (1), p8、特開平３−６３
２６３号公報Embedded image Drug Data Report 1991, 13 (1), p8, JP-A-3-63
No. 263
【００１７】カルボトロリン （ＷＹ−４７７９１）
〔８−フルオロ−２−〔２−（４−ピリジル）エチル〕
−２，３，４，５−テトラヒドロ−１Ｈ−ピリド〔４，
３−ｂ〕インドール・塩酸塩〕 Carbotroline (WY-47991)
[8-fluoro-2- [2- (4-pyridyl) ethyl]
-2,3,4,5-tetrahydro-1H-pyrido [4,
3-b] Indole / hydrochloride]
【化１０】 Drug Data Report 1991, 13 (9), p737、特開昭６２−
６７０８３号公報Embedded image Drug Data Report 1991, 13 (9), p737, JP-A-62-2
No. 67083
【００１８】以上の化合物の他、Ｏrg−１０，４９０
（Clin. Neuropharmacol. 1992, 15 (Suppl.1, Part
B）: 23B; Drug News Perspect 1992, 5 (10), p604;
特開平２−１４３５０号公報）、クロザピン（Pharmaco
logical Review 43 587 (1991);特開昭４９−１３１８
９号公報）、セロクエル（ICI204636）（Pharmacologic
alReview 43 587 (1991); 特開昭６３−８３７８号公
報）、オランザピン（DrugData Report 1992, 14 (11),
954; EP-A-454436）などもセロトニン受容体およびド
ーパミン受容体の両者を遮断する化合物として知られて
おり、これらも本発明に使用することができる。In addition to the above compounds, Org-10,490
(Clin. Neuropharmacol. 1992, 15 (Suppl. 1, Part
B): 23B; Drug News Perspect 1992, 5 (10), p604;
JP-A-2-14350), clozapine (Pharmaco)
logical Review 43 587 (1991); JP-A-49-1318
No. 9), Seroquel (ICI204636) (Pharmacologic)
alReview 43 587 (1991); JP-A-63-8378), olanzapine (DrugData Report 1992, 14 (11),
954; EP-A-454436) are also known as compounds that block both serotonin receptors and dopamine receptors, and these can also be used in the present invention.
【００１９】上に列挙した化合物、またはその他の、セ
ロトニン受容体およびドーパミン受容体の両者を遮断し
得る化合物は、当業者に知られている手順に従って、医
薬製剤に調製することができる。例えば、上記化合物
は、通常の賦形剤、希釈剤または担体と配合して、錠
剤、カプセル剤、懸濁剤、粉末剤等に成形することがで
きる。そのような製剤に適当な賦形剤、希釈剤および担
体の例には、以下のものが包含される。デンプン、糖、
マンニトール、およびケイ素誘導体といったような充填
剤および増量剤、カルボキシメチルセルロースおよび他
のセルロース誘導体、アルギン酸塩、ゼラチン、および
ポリビニルピロリドンといったような結合剤、グリセロ
ールといったような湿潤剤、寒天、炭酸カルシウム、お
よび重炭酸ナトリウムといったような崩壊剤、パラフィ
ンといったような溶解遅延剤、第四級アンモニウム化合
物といったような吸収促進剤、セチルアルコール、グリ
セロールモノステアレートといったような界面活性剤、
カオリンおよびベントナイトといったような吸着担体、
並びにタルク、ステアリン酸カルシウムおよびマグネシ
ウム、および固形ポリエチルグリコールといったような
滑沢剤。The compounds listed above, or other compounds that can block both serotonin and dopamine receptors, can be prepared into pharmaceutical preparations according to procedures known to those skilled in the art. For example, the above compounds can be formulated into tablets, capsules, suspensions, powders, etc., by mixing with conventional excipients, diluents or carriers. Examples of suitable excipients, diluents and carriers for such formulations include the following. Starch, sugar,
Fillers and fillers such as mannitol, and silicon derivatives, carboxymethylcellulose and other cellulose derivatives, binders such as alginate, gelatin, and polyvinylpyrrolidone, wetting agents such as glycerol, agar, calcium carbonate, and heavy metals. Disintegrants such as sodium carbonate, dissolution retarders such as paraffin, absorption enhancers such as quaternary ammonium compounds, cetyl alcohol, surfactants such as glycerol monostearate,
Adsorption carriers such as kaolin and bentonite,
And lubricants such as talc, calcium and magnesium stearate, and solid polyethyl glycol.
【００２０】上記化合物はまた、経口投与に便利なエリ
キシル剤または溶液剤として、あるいは非経口（例え
ば、筋肉内、皮下または静脈内経路）投与に適当な溶液
剤として製剤化することもできる。さらに、上記化合物
は、徐放性投与形態等に製剤化してもよい。場合によっ
ては一定時間の間、好ましくは腸管の特定部位において
のみ活性成分を放出するような製剤に設計することもで
きる。例えば、高分子物質またはワックスにより、コー
ティング、エンベロープおよび保護マトリックスを施す
ことができる。The compounds can also be formulated as elixirs or solutions for convenient oral administration or as solutions suitable for parenteral (eg, intramuscular, subcutaneous or intravenous route) administration. Further, the above compounds may be formulated into sustained release dosage forms and the like. In some cases, the formulation may be designed to release the active ingredient over a period of time, preferably only at specific sites in the intestinal tract. For example, coatings, envelopes and protective matrices can be applied with polymeric substances or waxes.
【００２１】本発明に係るセロトニン２受容体とドーパ
ミンＤ２受容体の両者を遮断し得る化合物のヒトへの投
与量は、容体の重篤度、投与経路、および関連要因によ
って異なり、これらは担当医師により決定されるべきで
ある。通例、成人一人当たり一日の許容有効量は約０.
０５〜約５００mg／日、さらに一般的には約０.２〜約
５０mg／日である。その疾患または障害を抑制するのに
十分な期間にわたり、そのような用量を毎日１〜約３
回、要すればそれ以上の回数で、処置を必要とする対象
患者に投与する。例えばＳＭ−９０１８を経口投与する
場合には、成人一人当たり０.５〜１０mg／日の範囲で
投与するのが適切である。より具体的には、ＳＭ−９０
１８を経口投与する場合、１mgを一日１回〜３回、約８
週間投与し、その間、改善が見られない場合は２mgに増
量してもよい。The dose of a compound capable of blocking both the serotonin 2 receptor and the dopamine D2 receptor according to the present invention to humans depends on the severity of the condition, the route of administration and related factors, and will be determined by the attending physician. Should be determined by As a rule, the effective daily dose per adult is about 0.5.
From about 0.5 to about 500 mg / day, more usually from about 0.2 to about 50 mg / day. Such doses should be administered daily for a period sufficient to control the disease or disorder, from 1 to about 3
The dose is administered to the subject in need of treatment, and more often if necessary. For example, when SM-9018 is orally administered, it is appropriate to administer it in the range of 0.5 to 10 mg / day per adult. More specifically, SM-90
18 orally, 1 mg once to three times a day, about 8
Weekly administration, during which time the dose may be increased to 2 mg if no improvement is observed.
【００２２】本発明において使用し得る化合物であっ
て、先に記載したものは、いずれも既に医薬として使用
されているか、または臨床試験が行われている化合物で
ある。The compounds which can be used in the present invention and which have been described above are all compounds which have already been used as medicaments or have undergone clinical trials.
【００２３】本発明に係る化合物は、通常、記述した医
薬製剤の形で、脳血管障害に伴う精神症候を有する患者
に投与される。具体的には、脳梗塞（脳血栓症、脳塞栓
症など）および脳出血の患者であって、発症後１カ月以
上を経過して症状の安定したもののうち、問題行動（攻
撃的行為、精神興奮、徘徊、せん妄など）、情緒障害
（不安、緊張、抑うつ気分、感情失禁、焦燥感など）、
自発性低下、幻覚・妄想、睡眠障害、身体的愁訴（頭痛
・頭重、心気的訴え、食欲不振など）のいずれかを持続
してもつ患者が挙げられる。投与方法は、経口投与が好
ましいが、これに限られるものではない。The compounds according to the invention are usually administered in the form of the described pharmaceutical preparations to patients with psychiatric symptoms associated with cerebrovascular disorders. Specifically, patients with cerebral infarction (cerebral thrombosis, cerebral embolism, etc.) and cerebral hemorrhage, who have stable symptoms after more than one month from the onset, have problematic behaviors (aggressive behavior, Wandering, delirium, etc.), emotional disorders (anxiety, tension, depressed mood, emotional incontinence, frustration, etc.),
Patients who have sustained any of decreased spontaneity, hallucinations / delusions, sleep disorders, and physical complaints (headache / heavy weight, emotional complaints, anorexia, etc.). The administration method is preferably oral administration, but is not limited thereto.
【００２４】記述した、本発明に係る化合物は、記述し
た文献記載の方法により製造することができる。例えば
ＳＭ−９０１８は、特開昭６２−１２３１７９号公報、
２１頁に化合物番号８として記載されており、公報記載
の実施例に従って製造することができる。以下に製造
例、製剤例、試験例を挙げて本発明をより詳細に説明す
るが、本発明はこれらに限定されるものではない。The compounds according to the invention described can be prepared by the methods described in the described literature. For example, SM-9018 is disclosed in Japanese Patent Application Laid-Open No. 62-123179,
It is described as Compound No. 8 on page 21, and can be produced according to Examples described in the gazette. Hereinafter, the present invention will be described in more detail with reference to Production Examples, Formulation Examples, and Test Examples, but the present invention is not limited thereto.
【００２５】製造例１ ＳＭ−９０１８の合成 Ｎ−（４−ブロモブチル）−１，２−シス−シクロヘキ
サンジカルボキシイミド２.３７g（８.２２mmol）、１
−（１，２−ベンゾイソチアゾール−３−イル）ピペラ
ジン１.５g（６.８４mmol）、炭酸カリウム１.１３g
（８.２１mmol）、よう化カリウム０.１１３g（０.６８
mmol）および乾燥ＤＭＦ１５mlの混合物を撹拌しなが
ら、９０〜１００℃の温浴で７時間加熱した。濾過して
固形物を除き、濾液を減圧濃縮して得られた油状残渣
４.１gをシリカゲルカラムクロマトグラフ精製すること
により、Ｎ−［４−［４−（１，２−ベンゾイソチアゾ
ール−３−イル）−１−ピペラジニル］ブチル］−１，
２−シス−シクロヘキサンジカルボキシイミド２.４８g
（５.８１mmol、８４.９％）を得た。常法により塩酸塩
とし、イソプロピルアルコールで再結晶することによ
り、ＳＭ−９０１８（Ｎ−［４−［４−（１，２−ベン
ゾイソチアゾール−３−イル）−１−ピペラジニル］ブ
チル］−１，２−シス−シクロヘキサンジカルボキシイ
ミド塩酸塩）を得た。mp．１８４〜１８５℃ Production Example 1 Synthesis of SM-9018 2.37 g (8.22 mmol) of N- (4-bromobutyl) -1,2-cis-cyclohexanedicarboximide
1.5 g (6.84 mmol) of-(1,2-benzoisothiazol-3-yl) piperazine, 1.13 g of potassium carbonate
(8.21 mmol), 0.113 g (0.68) of potassium iodide.
(mmol) and dried DMF (15 ml) was heated with stirring in a warm bath at 90-100 ° C for 7 hours. The solid was removed by filtration, and the filtrate was concentrated under reduced pressure to obtain 4.1 g of an oily residue, which was purified by silica gel column chromatography to give N- [4- [4- (1,2-benzoisothiazole-3). -Yl) -1-piperazinyl] butyl] -1,
2.48 g of 2-cis-cyclohexanedicarboximide
(5.81 mmol, 84.9%). The resulting compound was converted into a hydrochloride by a conventional method, and recrystallized from isopropyl alcohol to give SM-9018 (N- [4- [4- (1,2-benzoisothiazol-3-yl) -1-piperazinyl] butyl] -1. , 2-cis-cyclohexanedicarboximide hydrochloride). mp. 184-185 ° C
【００２６】製剤例１ ゼラチンカプセル剤 以下の成分を用いて、ゼラチン硬カプセル剤を製造す
る。 成 分 量（mg／カプセル） ＳＭ−９０１８ １ デンプン，ＮＦ ０ 〜 ４００ 乳糖 ０ 〜 ４００ ステアリン酸マグネシウム ０ 〜 １０ 各成分を均一に混合し、篩にかけてゼラチン硬カプセル
に充填する。 Formulation Example 1 Gelatin Capsule A gelatin hard capsule is produced using the following ingredients. Ingredient Quantity (mg / capsule) SM-9018 1 Starch, NF 0-400 Lactose 0-400 mixed Magnesium stearate 0-10 The components uniformly, and filled into hard gelatin capsules sieved.
【００２７】 製剤例２ 錠剤 成 分 量（mg／錠剤） ＳＭ−９０１８ １ 微結晶セルロース ０ 〜 ２００ 二酸化ケイ素 ０ 〜 ２００ ステアリン酸塩 ０ 〜 ５ 各成分を均一に混合し、圧縮して錠剤を成形する。[0027] Formulation Example 2 Tablets Ingredient Quantity (mg / tablet) to SM-9018 1 Microcrystalline cellulose 0-200 Silicon dioxide 0-200 Stearate 0-5 The components were uniformly mixed and compressed to form tablets I do.
【００２８】試験例１ ＳＭ−９０１８の脳血管障害に
伴う精神症候に対する臨床試験 脳梗塞または脳出血の患者であって、前記した種々の精
神症候を示す患者にＳＭ−９０１８を投与し、その精神
症候に改善がみられるか否かを試験した。 Test Example 1 Clinical Test of SM-9018 for Mental Symptoms Associated with Cerebrovascular Disease SM-9018 was administered to patients with cerebral infarction or cerebral hemorrhage who exhibited the various psychiatric symptoms described above. Was tested for improvement.
【００２９】（１）投与方法 投与開始２週間後まで、１回当たり１mgのＳＭ−９０１
８を１回／日（StepＩ）、２回／日（StepII）又は３回
／日（StepIII）経口投与し、適切な効果があれば継続
した。適切な効果がなく、安全性に問題がない場合は、
各々、１mg×２回／日、２mg×２回／日、２mg×３回／
日に増量した。 （２）投与期間： ８週間 （３）試験結果 症候の改善度を、著明改善、中等度改善、軽度改
善、不変その他で評価した。このうち、「＋／症
例数」は下記（ｉ）〜（iii）のとおりであった。(1) Administration method 1 mg SM-901 at a time until 2 weeks after the start of administration
8 was orally administered once / day (Step I), twice / day (Step II) or three times / day (Step III) and continued if appropriate effects were obtained. If it's not working properly and there are no safety issues,
1 mg x 2 times / day, 2 mg x 2 times / day, 2 mg x 3 times / day, respectively
Increased the day. (2) Administration period: 8 weeks (3) Test results The degree of improvement in symptoms was evaluated as marked improvement, moderate improvement, mild improvement, unchanged, and others. Among them, “+ / number of cases” was as shown in the following (i) to (iii).
【００３０】（ｉ）問題行動(I) Problematic behavior
【表１】 StepＩ StepII StepIII 攻撃的行為 ２／７ ３／４ ２／５ 精神興奮 ２／１４ ４／１０ ３／８ 徘徊 １／６ １／３ ０／３ せん妄 １／４ ２／５ １／４ 問題行動全般 ２／１８ ５／１０ ３／１０ [Table 1] Step I Step II Step III Aggressive action 2/7 3/4 2/5 Mental arousal 2/14 4/10 3/8 Wandering 1/6 1/3 0/3 Delirium 1/4 2/5 1/4 Overall problem behavior 2/18 5/10 3/10
【００３１】（ii）情緒障害(Ii) Emotional disorders
【表２】 StepＩ StepII StepIII 不安 ３／２２ ４／２３ ６／１９ 緊張 ２／１８ ３／１８ ５／１５ 抑うつ気分 ４／２５ ８／２３ ６／１８ 感情失禁 ２／１３ ３／１３ ２／１０ 焦燥感 ４／２５ ５／１９ ５／１６ 不機嫌 ４／１８ ９／２１ ６／１６ 情緒障害全般 ８／３３ １１／２８ １０／２０ [Table 2] Step I Step II Step III Anxiety 3/22 4/23 6/19 Tension 2/18 3/18 5/15 Depressive mood 4/25 8/23 6/18 Emotional incontinence 2/13 3/13 2/10 Frustration Feeling 4/25 5/19 5/16 Grumpy 4/18 9/21 6/16 General emotional disorders 8/33 11/28 10/20
【００３２】（iii）自発性低下(Iii) Decrease in spontaneity
【表３】 StepＩ StepII StepIII 働きかけに対する積極性の低下 ５／３０ ６／２３ ３／１７ 欲求表現の低下 ３／２９ ５／２３ ３／１６ 日常生活動作への意欲低下 ３／３０ ５／２６ ６／１７ 家事娯楽趣味等への関心低下 ４／３１ ６／２７ ８／１６ 自発性低下全般 ４／３２ ８／２７ ９／１８ [Table 3] Step I Step II Step III Decrease in aggressiveness to work 5/30 6/23 3/17 Decrease in desire expression 3/29 5/23 3/16 Decrease in motivation for daily activities 3/30 5/26 6/17 Decrease in interest in housework, recreational hobbies, etc. 4/31 6/27 8/16 Decline in spontaneity 4/32 8/27 9/18
【００３３】（iv）最終全般改善度（総合評価）(Iv) Final overall improvement (comprehensive evaluation)
【表４】 症例数 著明改善 中等度改善 軽度改善 StepＩ ３５ ２ ５ ２０ StepII ２８ ３ １０ ８ StepIII ２０ ６ ７ ３ [Table 4] Number of cases Remarkable improvement Moderate improvement Mild improvement Step I 35 25 20 Step II 28 3 10 8 Step III 20 6 7 3
【００３４】上記の総合評価によると、各種精神症候の
軽度改善を含めると、StepＩでは全患者の約７７％、St
epIIでは約７５％、StepIIIでは約８０％に、何らかの
精神症候の改善がみられたことがわかる。According to the above comprehensive evaluation, including slight improvement of various psychiatric symptoms, in Step I, about 77% of all patients
It can be seen that about 75% of epII and about 80% of StepIII showed some improvement in mental symptoms.
───────────────────────────────────────────────────── フロントページの続き (51)Int.Cl.7 識別記号 ＦＩ テーマコート゛(参考） Ａ６１Ｋ 31/496 Ａ６１Ｋ 31/496 ４Ｃ０８６ 31/519 31/519 45/00 45/00 Ａ６１Ｐ 9/10 Ａ６１Ｐ 9/10 25/00 25/00 25/18 25/18 25/22 25/22 25/24 25/24 // Ｃ０７Ｄ 221/04 Ｃ０７Ｄ 221/04 295/14 295/14 Ａ 401/14 401/14 413/04 413/04 413/14 413/14 417/12 417/12 471/04 １０３ 471/04 １０３Ｓ 491/044 491/044 Ｆターム(参考） 4C034 CB01 4C050 AA01 BB04 CC19 EE01 FF02 GG01 HH01 4C063 AA01 AA03 BB02 BB03 BB09 CC07 CC22 CC51 CC61 DD06 DD07 DD29 DD61 EE01 4C065 AA03 BB11 CC01 DD02 EE02 HH10 KK05 LL04 PP13 4C084 AA17 NA14 ZA112 ZA122 ZA182 ZA362 4C086 AA01 AA02 BC11 BC13 BC17 BC21 BC38 BC50 BC68 BC80 CB05 CB09 CB22 GA07 GA10 GA12 MA03 MA04 NA14 ZA11 ZA12 ZA18 ZA36 ──────────────────────────────────────────────────続 き Continued on the front page (51) Int.Cl. 7 Identification symbol FI theme coat ゛ (Reference) A61K 31/496 A61K 31/496 4C086 31/519 31/519 45/00 45/00 A61P 9/10 A61P 9 / 10 25/00 25/00 25/18 25/18 25/22 25/22 25/24 25/24 // C07D 221/04 C07D 221/04 295/14 295/14 A 401/14 401/14 413 / 04 413/04 413/14 413/14 417/12 417/12 471/04 103 471/04 103S 491/044 491/044 F term (reference) 4C034 CB01 4C050 AA01 BB04 CC19 EE01 FF02 GG01 HH01 4C063 AA01 AA03 BB02 BB03 BB09 CC07 CC22 CC51 CC61 DD06 DD07 DD29 DD61 EE01 4C065 AA03 BB11 CC01 DD02 EE02 HH10 KK05 LL04 PP13 4C084 AA17 NA14 ZA112 ZA122 ZA182 ZA362 4C086 AA01 AA02 BC11 BC13 BC17 GA07 BC08 BC05 BC05 BC05 BC03 ZA18 ZA36
Claims (8)
容体の両者を遮断し得る化合物（ただし、リスペリドン
を除く）を必須成分として含有する脳血管障害に伴う精
神症候治療剤。1. A therapeutic agent for psychiatric symptoms associated with cerebrovascular disorder, comprising as an essential component a compound capable of blocking both serotonin 2 receptor and dopamine D2 receptor (excluding risperidone).
ン、オカペリドン、アンペロジド、カルボトロリン、Ｈ
Ｐ−８７３、ＡＤ−５４２３、Ｏｒｇ−５２２２、セル
チンドール、オランザピンまたはセロクエルである請求
項１記載の脳血管障害に伴う精神症候治療剤。2. The method according to claim 1, wherein the compound is SM-9018, ziprasidone, ocaperidone, amperide, carbotroline, H
The therapeutic agent for psychiatric symptoms associated with cerebrovascular disorders according to claim 1, which is P-873, AD-5423, Org-5222, sertindole, olanzapine or Seroquel.
ン、オランザピンまたはセロクエルである請求項１記載
の脳血管障害に伴う精神症候治療剤。3. The method according to claim 1, wherein the compound is SM-9018, ziprasidone, olanzapine or Seroquel.
化合物を含有する請求項１〜３のいずれかに記載の精神
症候治療剤。4. The therapeutic agent for psychiatric symptoms according to any one of claims 1 to 3, comprising a compound of 0.2 to 50 mg / day for each adult.
請求項１〜４のいずれかに記載の精神症候治療剤。5. The therapeutic agent for a psychiatric disorder according to claim 1, wherein the cerebrovascular disorder is cerebral infarction or cerebral hemorrhage.
自発性低下、問題行動、幻覚または妄想である請求項１
〜５のいずれかに記載の精神症候治療剤。6. A psychiatric symptom associated with a cerebrovascular disorder is an emotional disorder,
Claim 1 is decreased spontaneity, problem behavior, hallucinations or delusions.
6. The therapeutic agent for psychiatric symptoms according to any one of claims to 5.
たは自発性低下である請求項１〜５のいずれかに記載の
精神症候治療剤。7. The therapeutic agent for a psychiatric disorder according to claim 1, wherein the psychiatric disorder associated with a cerebrovascular disorder is an emotional disorder or spontaneous decline.
である請求項１〜５のいずれかに記載の精神症候治療
剤。8. The therapeutic agent for a psychiatric disorder according to claim 1, wherein the psychiatric disorder associated with cerebrovascular disorder is spontaneous decline.
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