TREATMENT OF SUBSTANCE ABUSE
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] 'The present application claims priority to United States provisional patent
application serial number 60/759,148, filed, January 13, 2006, the entirety of which is hereby
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention relates to the use of compounds in the treatment of
substance abuse and/or its symptoms.
BACKGROUND OF THE INVENTION
[0003] According to the National Survey on Drug Use and Health authored by the
Substance Abuse and Mental Health Services Administration of the United States
Department of Health and Human Services, an estimated 21.6 million Americans (9.1 percent
of the total population aged 12 or older) were classified with substance dependence or abuse
in 2003. Of these, 3.1 million were classified with dependence on or abuse of both alcohol
and illicit drugs, 3.8 million were dependent on or abused illicit drugs but not alcohol, and
14.8 million were dependent on or abused alcohol but not illicit drugs.
[0004] Agents that are abused include those used recreationally to alter mood, thought, or
feeling (e.g., cigarettes, alcohol, etc.), those that are prescribed or otherwise administered for
therapeutic benefit but upon which dependency develops (e.g., pain relievers, such asfor
example, Vicodin®, Lortab®, Lorcet®, Percocet®, Percodan®, Tylox®, Hydrocodone,
OxyContin®, methadone, Tramadol, etc, tranquilizers, stimulants, or sedatives), and those
that are obtained illegally for the purpose of achieving a particular physiological effect or
"high" (e.g., marijuana, heroine, cocaine, ecstasy, LSD, PCP, methamphetamine, etc.).
[0005] Many people who would like to quit use of such abused agents cannot because
they are addicted to one or more dependence-inducing components (e.g., opioids, nicotine,
etc.). Moreover, treatment for substance abuse often involves transfer of dependence to an
alternative, but also dependence-inducing agent. Even successful treatment often involves
significant and unpleasant withdrawal symptoms.

[0006] There remains a need for improved therapies for the treatment of substance abuse.
SUMMARY OF THE INVENTION
[0007] The present invention provides methods and. compositions for the treatment of
substance abuse and/or its symptoms, including withdrawal. In particular, the invention
encompasses the finding that compounds of formula I are useful in the treatment of substance
abuse and/or its symptoms:

or a pharmaceutically acceptable salt thereof, wherein:
=== designates a single or double bond;
n is 1 or 2;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, -OC1-6
perfluoroalkyl, or phenyl optionally substituted with one to five groups independently
selected from halogen, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6 perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered carbocyclic ring, wherein said ring is optionally
substituted with 1-3 groups independently selected from halogen, -R, or -OR; and
R5 and R6 are each independently -R.
[0008] For example, the invention provides methods that involve administering to an
individual in need thereof a therapeutically effective amount of a compound of formula I, or a
pharmaceutically acceptable salt, prodrug, or metabolite thereof. The present invention also
provides compositions comprising a compound of formula I or a pharmaceutically acceptable
salt thereof, and one or more pharmaceutically acceptable carriers, excipients, or diluents,
formulated for the treatment of substance abuse.

DESCRIPTION OF THE DRAWING
[0009] Figure 1 shows inhibition by a compound of formula I of hyperactivity produced
by cocaine.
DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS OF THE INVENTION
1. Compounds and Definitions:
[0010] As noted above, the present invention provides methods and compositions for the
treatment of substance abuse and/or its symptoms, including withdrawal.
[0011] In general, compounds that are useful in accordance with the present invention
have the structure presented in formula I:

or a pharmaceutically acceptable salt thereof, wherein:
=== designates a single or double bond;
n is 1 or 2;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, -OC1-6
perfluoroalkyl, or phenyl optionally substituted with one to five groups independently
selected from halogen, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6 perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered carbocyclic ring, wherein said ring is optionally
substituted with 1-3 groups independently selected from halogen, -R, or -OR; and
R5 and R6 are each independently -R.
[0012] As used herein, the term "alkyl", includes, but is not limited to, straight and
branched chains such as methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, or t-
butyl. In certain embodiments, the term "alkyl".refers to straight and branched chains having
from 1 to 3 carbon atoms.

[0013] The terms "halogen" or "halo," as used herein, refer to chlorine, bromine, fluorine
or iodine.
[0014] The term "perfluoroalkyl," as used herein refers to an alkyl group, as defined
herein, wherein every hydrogen atom on said alkyl group is replaced by a fluorine atom.
Such perfluoroalkyl groups include -CF3.
[0015] The terms "effective amount" and "therapeutically effective amount," as used
herein, refer to the amount of a composition of the present invention that, when administered
to a patient, is effective to at least partially treat a condition from which the patient is
suffering from.
[0016] The term "pharmaceutically acceptable salts" or "pharmaceutically acceptable
salt" refers to salts derived from treating a compound of formula I with an organic or
inorganic acid such as, for example, acetic, lactic, citric, cinnamic, tartaric, succinic, fumaric,
maleic, malonic, mandelic, malic, oxalic, propionic, hydrochloric, hydrobromic, phosphoric,
nitric, sulfuric, glycolic, pyruvic, methanesulfonic, ethanesuifonic, toluenesulfonic, salicylic,
benzoic, or similarly known acceptable acids. In certain embodiments, the present invention
provides the hydrochloride salt of a compound of formula I.
[0017] The term "patient," as used herein, refers to a mammal. In certain embodiments,
the term "patient" refers to a human.
[0018] The terms "administer," "administering," or "administration," as used herein, refer
to either directly administering a compound or composition to a patient, or administering a
prodrug derivative or analog of the compound to the patient, which will form an equivalent
amount of the active compound or substance within the patient's body.
[0019] The terms "treat" or "treating," as used herein, refers to partially or completely
alleviating, inhibiting, preventing, ameliorating and/or relieving the condition, or one or more
symptoms thereof. Those of ordinary skill in the art will appreciate that substance abuse
often involves symptoms of physical and/or psychological dependence. Also, when the
substance of abuse is withdrawn from a dependent individual, the individual often develops
certain symptoms including sleep and mood disturbance and intense craving of the substance
of abuse, known as "withdrawal". The present invention encompasses treatment of substance
abuse itself, dependence, and also of withdrawal.
[0020] "Withdrawal" refers to a collection of symptoms that arise when administration of
a relevant substance is reduced, delayed, or stopped. The substance-specific symptoms of

withdrawal can cause clinically significant distress or impairment in social, occupational or
other important areas of functioning. These symptoms are not due to a general medical
condition and are not better accounted for by another mental disorder. Withdrawal usually,
but not necessarily, is associated with substance dependence.
[0021] Withdrawal symptoms can arise upon reduction of any of a variety of substances.
For example, the discontinued use of tobacco products, all of which contain nicotine,
typically results in the onset of nicotine withdrawal conditions. Individuals often suffer the
symptoms of nicotine withdrawal as a consequence of the discontinued use of tobacco in any
form, including, but not limited to smoking of cigarette, cigar, or pipe tobacco, or the oral or
intranasal ingestion of tobacco or chewing tobacco. Such oral or intranasal tobacco includes,
but is not limited to snuff and chewing tobacco. The cessation of nicotine use or reduction in
the amount of nicotine use., is often followed within 24 hours by symptoms including
dysphoric, depressed mood; light-headedness; insomnia; irritability, frustration or anger;
anxiety; nervous tremor; difficulty concentrating; restlessness; decreased heart rate; increased
appetite or weight gain; and the craving for tobacco or nicotine. These symptoms often cause
clinically significant distress or impairment in social, occupational, or other important areas
of functioning. The present invention is most preferably used to alleviate one or more
symptoms attributed to nicotine withdrawal when such symptoms are not due to a general
medical condition and are not better accounted for by another medical disorder. The present
method is also helpful to those who have replaced, or partially replaced, their use of tobacco
with the use of nicotine replacement therapy. Thus, such patients can be assisted to reduce
and even eliminate entirely their dependence on nicotine in all forms.
[0022] The discontinuation or reduction in administration of an opioid, typically self-
administration, through injection or orally, through smoking or intranasal ingestion, often
results in the presence of a characteristic opioid withdrawal condition. This withdrawal
condition can also be precipitated by administration of an opioid antagonist such as naloxone
or naltrexone after opioid use. Opioid withdrawal is characterized by symptoms that are
generally opposite to the opioid agonist effects. These withdrawal symptoms may include
anxiety; restlessness; muscle aches, often in the back and legs; craving for opioids; irritability
and increased sensitivity to pain; dysphoric mood; nausea or vomiting; lacrimation;
rhinorrhoea; papillary dilation; piloerection; sweating; diarrhea; yawning; fever; and
insomnia. When dependence is on short-acting opioids, such as heroin, withdrawal symptoms

usually occur within 6-24 hours after the last dose, while with longer-acting opioids, such as
methadone, symptoms may take 2-4 days to emerge. These symptoms often cause clinically
significant distress or impairment in social, occupational or other important areas of
functioning. The present invention is most preferably used to alleviate one or more symptoms
attributed to opioid withdrawal when such symptoms are not due to a general medical
condition and are not better accounted for by another medical disorder.
[0023] The discontinued or reduction in use of ethanol (ethanol containing beverages)
results in the onset of ethanol withdrawal conditions. Ethanol withdrawal conditions are
characterized by symptoms that begin when blood concentrations of ethanol decline sharply,
within 4 to 12 hours after ethanol use has been stopped or reduced. These ethanol withdrawal
symptoms include craving for ethanol; autonomic hyperactivity (such as sweating or pulse
rate greater than 100); hand tremor; insomnia; nausea; vomiting; transient visual, tactile, or
auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures.
These symptoms often cause clinically significant distress or impairment in social,
occupationaJ, or other important areas of functioning. The present invention is most
preferably used to alleviate one or more symptoms attributed to ethanol withdrawal when
such symptoms are not due to a general medical condition and are not better accounted for by
another medical disorder.
[0024] The terms "suffer" or "suffering" as used herein refers to one or more conditions
that a patient has been diagnosed with, or is suspected to have.
[0025] The term "substance abuse", as used herein, may be defined with reference to
criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (1994)
("DSM-TV"), which was prepared by the Task Force on Nomenclature and Statistics of the
American Psychiatric Association. A feature of substance abuse is a maladaptive pattern of
substance use manifested by recurrent and significant adverse consequences related to the
repeated use of substances. As recited in the DSM-IV, substance abuse is defined as
maladaptive pattern of substance abuse leading to clinically significant impairment or
distress, as manifested by one (or more) of the following, occurring within a 12-month
period: (1) recurrent substance use resulting in a failure to fulfill major role obligations at
work, school, or home; (2) recurrent substance use in situations in which it is physically
hazardous; (3) recurrent substance-related legal problems; and (4) continued substance use
despite having persistent or recurrent social or interpersonal problems caused or exacerbated

by the effects of the substance. In addition, the DMS-IV requires that the symptoms of
substance abuse do not meet the criteria for substance dependence.
[0026] The term "substance dependence", as used herein, may be defined with reference
to criteria set form in the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed.
(1994) ("DSM-IV"), which was prepared by the Task Force on Nomenclature and Statistics
of the American Psychiatric Association. The criteria for substance dependence set forth in
DSM-IV is a pattern of substance use, leading to clinically significant impairment or distress
as manifested by at least three selected from the following group, occurring at any time
within the same twelve month period: (1) tolerance as defined by either (a) a need for
substantially increased amounts of the substance to achieve the desired effect; or (b)
substantially diminished effect with continued use of the same amount of the substance; (2)
withdrawal, as demonstrated by either (a) the characteristic withdrawal syndrome for the
specific substance; or (b) the same, or a closely related substance is taken to relieve or avoid
withdrawal symptoms; (3) the substance is often taken in larger amounts or over a longer
period then was intended; (4) there is a persistent desire or unsuccessful efforts to cut down
or control substance use; (5) a great deal of time is spent in activities to obtain the substance,
use the substance, or recover from its effects; (6) important social, occupational or
recreational activities are given up or reduced because of substance use; and (7) the substance
use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the substance.
Substance dependence can be with physiological dependence; that is evidence of tolerance or
withdrawal is present, or without physiological dependence, where no evidence of tolerance
or withdrawal is present. Four of the conditions set forth in DSM-IV include remission.
These types of remission are based on the interval of time that has elapsed since the cessation
of dependencies and whether there is continued presence of one or more of the symptoms
included in the criteria for dependencies.
[0027] The qualifier "early full remission" is used when for at least one month, but for
less than twelve months, no symptom of dependence has been met.
[0028] The qualifier "early partial remission" is used when for at least one month but less
than 12 months, one or more symptoms for dependence has been met, but the full criteria for
dependence has not been met.

[0029] The term "sustained full remission" is used when none of the symptoms of
dependence have been met at any time during a period of twelve months or longer.
[0030] The term "sustained partial remission" is used if the symptoms for dependence
have not been met for a period of twelve months or longer, however, one or more symptom
for dependence has been met.
[0031] The qualifier "on agonist therapy" is used if title subject is on a prescribed agonist
medication and no symptom for dependence has been met for that class of medication for at
least the past month. It also applies to those being treated for dependence using a partial
agonist.
[0032] The term "in a controlled environment" is used if the subject is in an environment
where access to substances of abuse are restricted and no symptom for dependence has been
met for at least the past month.
[0033] The term "cessation and withdrawal" shall include, but is not limited to, the
following conditions characterized in the DSM-IV: Nicotine Withdrawal; Nicotine-Related
Disorder Not otherwise Specified; Nicotine Dependence, with physiological dependence;
Nicotine Dependence, without physiological dependence; Nicotine Dependence, Early Full
Remission; Nicotine Dependence, Early Partial Remission; Nicotine Dependence, Sustained
Full Remission; Nicotine Dependence, Sustained Partial Remission; Nicotine Dependence,
On Agonist Therapy; Opioid Withdrawal; Opioid-R.elated Disorder Not Otherwise Specified;
Opioid Dependence, with physiological dependence; Opioid Dependence, without
physiological dependence; Opioid Dependence, Early Full Remission; Opioid Dependence,
Early Partial Remission; Opioid Dependence, Sustained Full Remission; Opioid Dependence,
Sustained Partial Remission; Opioid Dependence On Agonist Therapy; and Opioid
Dependence in a controlled environment; Ethanol Withdrawal; Ethanol Dependence with
Physiological Dependence; Ethanol Withdrawal, without Physiological Dependence; Ethanol
Withdrawal, Early Full Remission; Ethanol Withdrawal, Early Partial Remission; Ethanol
Withdrawal, Sustained Full Remission; Ethanol Withdrawal, Sustained Partial Remission;
Ethanol Withdrawal, on Agonist Therapy; and Ethanol Withdrawal, In a Controlled
Environment.
2. Description of Exemplary Compounds:
[0034] In certain embodiments, the present invention provides a compound of formula I:


or a pharmaceutically acceptable salt thereof for use in. treating one or more symptoms of
substance abuse and/or its symptoms, wherein:
== designates a single or double bond;
n is 1 or 2;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, -OC1-6
perfluoroalkyl, or phenyl optionally substituted with one to five groups independently
selected from halogen, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6 perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R3 and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsaturated 4-8 membered carbocyclic ring, wherein said ring is optionally
substituted with 1-3 groups independently selected from halogen, -R, or -OR; and
Rs and R6 are each independently -R.
[0035] The compounds of formula I, as defined above or in classes and subclasses as
described herein, have affinity for and agonist or partial agonist activity at the 2C subtype of
brain serotonin receptors.
[0036] In certain embodiments, === designates a single bond. In other embodiments,
== designates a double bond.
[0037] In certain embodiments, the R1 group of formula I is R, OR, halogen, cyano, or -
C1-3 perfluoroalkyl. In other embodiments, the R1 group of formula I is hydrogen, halogen,
cyano, -OR wherein R is C1-3 alkyl, or trifluoromethyl. According to another embodiment,
the R1 group of formula I is hydrogen.
[0038] In certain embodiments, the R2 group of formula I is R, OR, halogen, cyano, or -
C1-3 perfluoroalkyl. In other embodiments, the R2 group of formula I is hydrogen, halogen,
cyano, -OR wherein R is hydrogen, C1-3 alkyl, or trifluoromethyl. According to another
embodiment, the R2 group of formula I is hydrogen.

[0039] According to one aspect of the present invention, at least one of R1 and R2 groups
of formula I is -OH. According to another aspect of the present invention, both of the R1 and
R2 groups of formula I are -OH.
[0040] According to another embodiment, each of the R1 and R2 groups of formula I is
hydrogen. According to yet another embodiment, each of the R5 and R6 groups of formula I
is hydrogen.
[0041] As defined generally above, the R3 and R4 groups of formula I are taken together
to form a saturated or unsaturated 4-8 membered carbocyclic ring, wherein said ring is
optionally substituted with 1-3 groups independently selected from halogen, -R, or OR.
According to one embodiment, the R3 and R4 groups of formula I are taken together to form a
saturated or unsaturated 5-8 membered carbocyclic ring, wherein said ring is optionally
substituted with 1-3 groups independently selected from halogen, -R, or OR. In certain
embodiments, the R3 and R4 groups of formula I are taken together to form a saturated or
unsaturated 5-6 membered carbocyclic ring, wherein said ring is optionally substituted with
1-3 groups independently selected from halogen, -R, or OR.
[0042] As defined generally above, n is 1 or 2. Accordingly, the present invention
provides methods and compositions using a compound of formulae I-a and I-b:

or a pharmaceutically acceptable salt thereof, wherein each of R1, R2, R3, R4, R5, and R5 is as
defined above for compounds of formula I and described in classes and subclasses above and
herein.
[0043] In other embodiments, n is 1 and the R3 and R4 groups of formula I are taken
together to form a saturated 5-membered carbocyclic ring and said compound is of formula
II:


or a pharmaceutically acceptable salt thereof, wherein each of R1, R2, R5, and R6 is as defined
above for compounds of formula I and described in classes and subclasses above and herein.
[0044] Compounds of the present invention contain asymmetric carbon atoms and thus
give rise to stereoisomers, including enantiomers and diastereomers. Accordingly, it is
contemplated that the present invention relates to all of these stereoisomers, as well as to
mixtures of the stereoisomers. Throughout this application, the name of the product of this
invention, v/here the absolute configuration of an asymmetric center is not indicated, is
intended to embrace the individual stereoisomers as well as mixtures of stereoisomers.
[0045] According to another aspect, the present invention provides methods and
compositions using a compound of either of formulae I-c or I-d:

or a pharmaceutically acceptable salt thereof, wherein each of n, R1, R2, R3, R4, R5, and R6 is
as defined above for compounds of formula I and described in classes and subclasses above
and herein.
[0046] In certain embodiments, the present invention provides methods and compositions
using a compound of formula III:


or a pharmaceutically acceptable salt thereof, wherein each R1, R2, R5, and R6 are as defined
above for compounds of formula I and in classes and subclasses as described above and
herein.
[0047] Where an enantiomer is preferred, it may, in some embodiments be provided
substantially free of the corresponding enantiomer. Thus, an enantiomer substantially free of
the corresponding enantiomer refers to a compound which is isolated or separated via
separation techniques or prepared free of the corresponding enantiomer. "Substantially free,"
as used herein, means that the compound is made up of a significantly greater proportion of
one enantiomer. In certain embodiments the compound is made up of at least about 90% by
weight of a preferred enantiomer. In other embodiments of the invention, the compound is
made up of at least about 99% by weight of a preferred enantiomer. Preferred enantiomers
may be isolated from racemic mixtures by any method known to those skilled in the art,
including chiral high pressure liquid chromatography (HPLC) and the formation and
crystallization of chiral salts or prepared by methods described herein. See, for example,
Jacques, et al., Enantiomers, Racemates and Resolutions (Wiley Interscience, New York,
1981); Wilen, S.H., et al., Tetrahedron 33:2725 (1977); Eliel, E.L. Stereochemistry of
Carbon Compounds (McGraw-Hill, NY, 1962); Wilen, S.H. Tables of Resolving Agents and
Optical Resolutions p. 268 (E.L. Eliel, Ed., Univ. of Notre Dame Press, Notre Dame, IN
1972).
[0048] Exemplary compounds useful for the methods of the present invention are set
forth in Table 1, below.
Table 1. Exemplary Compounds of Formula I
4,5,6,7,9a, 10,11,12,13,13a-decahydro-9H- [ 1,4]diazepino[6,7,1 -de]phenanthridine;
2-bromo-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c][ 1,4]diazepino [6,7,1 -ij]quinoline;

2-bromo-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyelohepta[c][l ,4]diazepino[6,7,l-
ij]quinoline;
2-chIoro-4,5,6,7,9}9a,10,ll,12,12a-decahydrocyclopenta[c][l,4]diazepino [6,7,l-ij]quinoline;
2-chloro-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c] [ 1,4] diazepino[6,7,1 -
ij]quinoline;
2-phenyl-4,556,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino[6,7,1-ij]quinoline;
2-methoxy-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino[6,7,1 -
ij]quinolme;
1 -fluoro-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c][1,4]diazepino [6,7,1 -ij]quinoline;
1 -fluoro-4,5,637,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c] [ 1,4]diazepino [6,7,1 -
ij]quinoli.ne;
1 -(trifluoromethyl)-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino[6,7,1 -
ij]quinoline;
1 -fluoro-2-methoxy-4,5,6]7,9,9aJ 10,11,12,12a-decahydrocyclopenta[c] [1,4]diazepino[6,7,1 -
ij]quinoline;
l-fluoro-2-methoxy-4)5,6,7,9,9a,l 0,11,12,13,14,14a-dodecahydrocyclo-
hepta[c][l,4]diazepino[6,7,l-ij]quinoline;
4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c][ 1,4]diazepino[6,7,1 -ij] quinoline;
4,5,6,7,9,9a,10,ll,12,13,14,14a-dodecahydrocyclohepta[c][l,4]diazepino [6,7,l-ij]quinoline;
4,5,6,7,9,9al0,ll,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,l-ij] quinoline;
(9aR, 12aS)-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino[6,7,1 -
ij]quinoline;
(9aS,l 2aR)-4.,5,6,7,9,9a, 10,11,12,l2a-decahydrocyclopenta[c] [l,4]diazepino[6,7,l -
ij]quinoline;
(9aR, 14aS)-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c] [ 1,4]diazepino[6,7,1 -
ij]quinoline; or
(9aS,14aR)-4,.5,6,7,9,9a,10,l 1,12,13,14,14a-dodecahydrocyc]ohepta[c][l,4]diazepino[6,7,l-
ij]quinoline;
or a pharmaceutically acceptable salt thereof, including the: hydrochloride salt of each of the
above compounds.

3. General Methods of Providing the Present Compounds:
[0049] Compounds of formula I for use in accordance with the present invention may be
obtained or produced according to any available means including methods described in detail
in United States patent application serial numbers 10/422,524, filed April 24, 2003 and
11/267,448 filed November 4, 2005, and in United States provisional patent application serial
numbers 60/702,509, filed July 26, 2005 and 60/727,606 filed October 17, 2005, the entirety
of each of which is hereby incorporated herein by reference.
4. Uses, Formulation and Administration
[0050] According to the present invention, compounds of formula I may be used to treat,
prevent, or alleviate dependence, withdrawal, or symptoms thereof for any of a variety of
substances including, for example, recreational substances (e.g., alcohol, tobacco),
pharmacologic agents (e.g., pain relievers [for example, Vicodin®, Lortab®, Lorcet®,
Percocet®, Percodan®, Tylox®, Hydrocodone, OxyContin®, methadone, Tramadol, etc],
tranquilizers, stimulants, or sedatives), and illicit drugs (e.g., marijuana, heroine, cocaine,
ecstasy, LSD, PCP, methamphetamine, etc.).
[0051] In evaluating substance abuse in accordance with the present invention, reference
may be made, for example, to the National Survey on Drug Use and Health (NSDUH), which
obtains information on nine different categories of illicit drug use: marijuana, cocaine, heroin,
hallucinogens, inhalants, and nonmedical use of prescription-type pain relievers,
tranquilizers, stimulants, and sedatives. In these categories, hashish is included with
marijuana, and crack, is considered a form of cocaine. Several drugs are grouped under the
hallucinogens category, including LSD, PCP, peyote, mescaline, mushrooms, and "Ecstasy"
(MDMA). Inhalants include a variety of substances, such as amyl nitrite, cleaning fluids,
gasoline, paint, and glue. The four categories of prescription-type drugs (pain relievers,
tranquilizers, stimulants, and sedatives) cover numerous drugs available through prescriptions
and sometimes illegally "on the street." Methamphetamine is considered a type of stimulant.
Respondents are asked to report only uses of drugs that were not prescribed for them or drugs
they took only for the experience or feeling they caused. Over-the-counter drugs and
legitimate uses of prescription drugs are not included. NSDUH reports combine the four
prescription-type drug groups into a category referred to as "any psychotherapeutics."

[0052] The NSDUH categorizes alcohol abuse through use of questions about the
frequency of the consumption of alcoholic beverages, such as beer, wine, whiskey, brandy,
and mixed drinks. An extensive list of examples of the kinds of beverages covered is given to
respondents prior to the question administration. A "drink" is defined as a can or bottle of
beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it.
Times when the respondent only had a sip or two from a drink are not considered as
consumption. For this report, estimates for the prevalence of alcohol use are reported
primarily at three levels defined for both males and females and for all ages as follows:
Current use - At least one drink in the past 30 days (includes binge and heavy use).
Binge use - Five or more drinks on the same occasion at least once in the past 30 days
(includes heavy use).
Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past
30 days
[0053] The NSDUH also characterizes the use of tobacco products, including cigarettes,
chewing tobacco, snuff, cigars, and pipe tobacco. For analytic purposes, data for chewing
tobacco and snuff are combined as "smokeless tobacco." Cigarette use is defined as smoking
"part or all of a cigarette." Questions to determine nicotine dependence among current
cigarette smokers also are included in NSDUH. Nicotine dependence is based on criteria
from the Nicotine Dependence Syndrome Scale (NDSS) or the Fagerstrom Test of Nicotine
Dependence (FTND).
[0054] The present invention provides methods of treating, each of the conditions listed
above in a patient, preferably in a human, the methods including administering a
therapeutically effective amount of at least one compound of formula I or a phannaceutically
acceptable salt thereof to an individual engaged in or susceptible to substance dependence or
abuse, and/or to an individual suffering from substance withdrawal.
[0055] In certain embodiments, compounds of the present invention are useful for
treating alcoholism (e.g., alcohol abuse, addiction and/or dependence including treatment for
abstinence, craving reduction and relapse prevention of alcohol intake) and/or tobacco abuse
(e.g., smoking addiction, cessation and/or dependence including treatment for craving
reduction and relapse prevention of tobacco smoking).
5. Pharmaceutical Compositions

[0056] The present invention also relates to compositions comprising at least one
compound of formula I, or a pharmaceutically acceptable salt thereof, and one or more
pharmaceutically acceptable carriers, excipients, or diluents, formulated for administration to
treat, prevent, or alleviate substance dependence or abuse, and/or their symptoms. Such
pharmaceutical formulations may be prepared in accordance with acceptable pharmaceutical
procedures, such as, for example, those described in Remingtons Pharmaceutical Sciences,
17th edition., ed. Alfonoso R. Gennaro, Mack Publishing Company, Easton, PA (1985),
which is incorporated herein by reference in its entirety. Pharmaceutically acceptable carriers
are those carriers that are compatible with the other ingredients in the formulation and are
biologically acceptable.
[0057] In certain embodiments, compounds of formula I are the only pharmacologically
active ingredients in the composition; in other embodiments one or more other agents is
included, for example to treat the same or different symptoms of substance dependence or
abuse.
[0058] In some embodiments of the invention, therapy utilizing compounds of formula I
is administered concomitantly with, in connection with,, and/or subsequent to an educational
and/or behavioral modification program to enhance continued abstinence from substance
dependence or abuse. The method of the present invention may be particularly useful in
treating symptoms of withdrawal often observed in rehabilitation or other treatment
programs. Therefore, the programs can be more effective by focusing on educational and
behavioral modification goals, further reducing the incidence of program non-completion.
[0059] The compounds of formula I can be administered orally or parenterally, neat, or in
combination with conventional pharmaceutical carriers. Applicable solid carriers can include
one or more substances that can. also act as flavoring agents, lubricants, solubilizers,
suspending agents, fillers, glidants, compression aids, binders, tablet-disintegrating agents, or
encapsulating materials. In powders, the carrier is a finely divided solid that is in admixture
with the finely divided active ingredient. In tablets, the active ingredient is mixed with a
carrier having the necessary compression properties in suitable proportions and compacted in
the shape and size desired. The powders and tablets preferably contain up to 99% of the
active ingredient. Suitable solid carriers include, for example, calcium phosphate,
magnesium stearate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, methyl cellulose,

sodium carboxymethyl cellulose, polyvinylpyrrolidine, low melting waxes and ion exchange
resins.
[0060] Liquid carriers can be used in preparing solutions, suspensions, emulsions, syrups
and elixirs. The active ingredient can be dissolved or suspended in a pharmaceutically
acceptable liquid carrier such as water, an organic solvent, a mixture of both, or a
pharmaceutically acceptable oil or fat. The liquid carrier can contain other suitable
pharmaceutical additives such as, for example, solubilizers, emulsifiers, buffers,
preservatives, sweeteners, flavoring agents, suspending agents, thickening agents, colors,
viscosity regulators, stabilizers or osmo-regulators. Suitable examples of liquid carriers for
oral and parenteral administration include water (particularly containing additives as above,
e.g. cellulose derivatives, preferably sodium carboxymethyl cellulose solution), alcohols
(including monohydric alcohols and polyhydric alcohols e.g. glycols) and their derivatives,
and oils (e.g. fractionated coconut oil and arachis oil). For parenteral administration, the
carrier can also be an oily ester such as ethyl oleate and isopropyl myristate. Sterile liquid
carriers are used in sterile liquid form compositions for parenteral administration. The liquid
carrier for pressurized compositions can be halogenated hydrocarbon or other
pharmaceutically acceptable propellant.
[0061] Liquid pharmaceutical compositions that are sterile solutions or suspensions can
be administered by, for example, intramuscular, intraperitoneal or subcutaneous injection.
Sterile solutions can also be administered Intravenously. Compositions for oral
administration can be in either liquid or solid form.
[0062] The compounds of formula I can be administered rectally or vaginally in the form
of a conventional suppository. For administration by intranasal or intrabronchial inhalation or
insufflation, the compounds of formula I can be formulated into an aqueous or partially
aqueous solution, which can then be utilized in the form of an aerosol. The compounds of
formula I can also be administered transdermally through the use of a transdermal patch
containing the: active compound and a carrier that is inert to the active compound, is non-
toxic to the skin, and allows delivery of the agent for systemic absorption into the blood
stream via the skin. The carrier can take any number of forms such as creams and ointments,
pastes, gels, and occlusive devices. The creams and ointments can be viscous liquid or
semisolid emulsions of either the oil-in-water or water-in-oil type. Pastes comprised of
absorptive powders dispersed in petroleum or hydrophilic petroleum containing the active

ingredient can also be suitable. A variety of occlusive devices can be used to release the
active ingredient into the blood stream such as a semipermeable membrane covering a
reservoir containing the active ingredient with or without a carrier, or a matrix containing the
active ingredient. Other occlusive devices are known in the literature.
[0063] Preferably the pharmaceutical composition is in unit dosage form, e.g. as tablets,
capsules, powders, solutions, suspensions, emulsions, granules, or suppositories. In such
form, the composition is sub-divided in unit dose containing appropriate quantities of the
active ingredient; the unit dosage forms can be packaged compositions, for example,
packeted powders, vials, ampoules, prefilled syringes or sachets containing liquids. The unit
dosage form can be, for example, a capsule or tablet itself, or it can be the appropriate
number of any such compositions in package form.
[0064] The amount of compound of formula I provided to a patient will vary depending
upon what is being administered, the purpose of the administration, such as prophylaxis or
therapy, the state of the patient, the manner of administration, and the like. In therapeutic
applications, compounds of Formula I are provided to a patient suffering from a condition in
an amount sufficient to treat or at least partially treat the symptoms of the condition and its
complications. An amount adequate to accomplish this is a "therapeutically effective
amount" as described previously herein. The dosage to be used in the treatment of a specific
case must be subjectively determined by the attending physician. The variables involved
include the specific condition and the size, age, and response pattern of the patient. The
treatment of substance dependence or abuse follows the same method of subjective drug
administration under the guidance of the attending physician. Generally, a starting dose may
about 0.5 mg per day with gradual increase in the daily dose to about 500 mg per day, to
provide the desired dosage level in the patient. A suitable dose of a compound of formula I
for use in the practice of the present invention is expected to be within the range of about 0.5
to about 500 mg, or about 1 mg to 500 mg.
[0065] In certain embodiments, the present invention relates to use of prodrugs of
compounds of formula I. The term "prodrug," as used herein, means a compound that is
convertible in vivo by metabolic means (e.g. by hydrolysis) to a compound of formula I.
Various forms of prodrugs are known in the art such as those discussed in, for example,
Bundgaard, (ed.), Design of Prodrugs, Elsevier (1985); Widder, et al. (ed.), Methods in
Enzymology, vol. 4, Academic Press (1985); Krogsgaard-Larsen, et al., (ed). "Design and

Application of Prodrugs, Textbook of Drug Design and Development, Chapter 5, 113-191
(1991), Bundgaard, et al., Journal of Drug Delivery Reviews, 8:1-38(1992), Bundgaard, J. of
Pharmaceutical Sciences, 77:285 et seq. (1988); and Higuchi and Stella (eds.) Prodrugs as
Novel Drug Delivery Systems, American Chemical Society (1975), each of which is hereby
incorporated by reference in its entirety.
[0066] According to another embodiment, a compound of the present invention is
administered in combination with one or more agents useful for treating substance abuse. In
certain embodiments, a compound of the present invention is administered in combination
with one or more agents to treat tobacco abuse. Such agents include nicotine receptor partial
agonists bupropion hypochloride (Zyban™) and nicotine replacement therapies.
[0067] According to yet another embodiment, a compound of the present invention is
administered in combination with one or more agents to treat alcoholism, such as opioid
antagonists (e.g., naltrexone, N-methyl:naltrexone, ReVia™), nalmefene, disulfiram
(Antabuse™), and acamprosate (CampralTM).
[0068] In certain embodiments, a compound is administered in combination with one or
more agents for reducing alcohol withdrawal symptoms such as benzodiazepines, beta-
blockers, clonidine, carbamazepine, pregabalin, and gabapentin (Neurontin™). In other
embodiments of the invention, therapy utilizing compounds of the present invention is
administered concomitantly with, in connection with, and/or subsequent to an educational
and/or behavioral modification program to enhance continued abstinence from substance
dependence or abuse. The method of the present invention may be particularly useful in
treating symptoms of withdrawal often observed in rehabilitation or other treatment
programs. Therefore, the programs can be more effective by focusing on educational and
behavioral modification goals, further reducing the incidence of program non-completion.
EXAMPLES
1. Example 1: Administration of a Benzodiazepine Compound Inhibits Cocaine Effects
[0069] Using (9aR, 12aS)-4,5,6,7,9,9a,10,ll,12,12a-
decahydrocyclopenta[c][l,4]diazepino[6,7,l-ij]quinoline hydrochloride (Compound 1) as an
example, the Rats were dosed either with vehicle or with cocaine in the presence or absence
of Compound 1 (1.7 mg/kg. sc). One hour after dosing (i.p. & s.c), rats were put in a open
field, where distance moved and zones crossed were recorded by the ethovision program.

Animal groups Treatment Number of animals (n)
1 Vehicle + Vehicle 6
2 Vehicle + cocaine (3 mg/kg) 6
3 Compound 1 (1.7 mg/kg) + vehicle 6
4 . Compound 1 (1.7 mg/kg) + cocaine (3 mg/kg) 6
[0070] Animals were brought to the lab room 1 hour before the start of the experiment.
Rats were injected with compound(s) 1 hour before being placed in the open field. Rats were
then placed in open field, and the test lasted for five minutes. Results (Figure 1) showed that
cocaine (3 mg/kg, ip) produced an increase in both distance moved and the number of zones
crossed. Compound 1 (1.7 mg/kg, sc) had no effect on locomotor activity alone and
completely reversed the hyperactivity produced by cocaine.
2. Example 2: Effect of Compounds of Formula I on Alcohol Intake
[0071] To further illustrate the useful pharmacological properties of compounds of
formula I, the effect of compound administered systematically may be determined in alcohol
preferring (P) rats. Because of its pattern of drinking, the P animal seems to represent a valid
genetically based model to approximate the human condition of alcoholism (McBride et al.,
Alcohol 7:199-205, 1990; Lankford et al., Pharmacol Biochem. Behav. 8:293-299,1991).
After maximally preferred alcohol concentrations have stabilised for four days, test
compounds are administered, for example in a dose of 2.5 and 10 mg/kg twice a day over
four consecutive days. Control injections of saline are without effect on alcohol consumption
in this model, whereas compounds of Formula I may reduce alcohol intake, both in terms of
absolute g/kg and in proportion of alcohol to total fluid intake. Compounds of formula I may,
for example, reduce intake of alcohol.
3. Example 3: Additional Assays
[0072] One of ordinary skill in the art would recognize that additional assays are useful
for testing the effectivenes of compounds of the present invention in methods of the present
invention. Another such method is described by Pastor R. Couceyro, et al, "CART Peptides
Modulate the Locomotor and Motivational Properties of Psycho stimulants" JPET Fast
Forward. Published on August 11, 2005 as DOI:10.1124/jpet.l05.091678, the entirety of
which is hereby incorporated herein by reference.

[0073] The entire disclosure of each patent, patent application, and publication cited or
described in this document is hereby incorporated by reference.

CLAIMS
We claim:
1. A method for treating a patient suffering from, or susceptible to, one or more
symptoms of substance abuse, dependence, or withdrawal comprising administering to said
patient a compound of formula I:

or a pharmaceutically acceptable salt thereof, wherein:
=== designates a single or double bond;
n is 1 or 2;
R1 and R2 are each independently halogen, -CN, -R, -OR, -C1-6 perfluoroalkyl, -OC1-6
perfluoroalkyl, or phenyl optionally substituted with one to five groups independently
selected from halogen, -R, -OR, -C1-6 perfluoroalkyl, or -OC1-6 perfluoroalkyl;
each R is independently hydrogen or a C1-6 alkyl group;
R and R4 are taken together, with the carbon atoms to which they are bound, to form a
saturated or unsarurated 4-8 membered carbocyclic ring, wherein said ring is optionally
substituted with 1-3 groups independently selected from halogen, -R, or -OR; and
R5 and R6 are each independently -R.
2. The method according to claim 1, wherein R1 and R2 are each independently
R, OR, halogen, cyano, or -C1-3 perfluoroalkyl.
3. The method according to claim 2, wherein R1 and R2 are each independently
hydrogen, halogen, cyano, -OR wherein R is hydrogen, C1-3 alkyl, or trifluoromethyl.
4. The method according to claim 3, wherein each of R1 and R2 is hydrogen.

5. The method according to any one of claims 1 to 4, wherein R3 and R4 ar<
taken together to form a saturated or unsarurated 5-8 rnembered carbocyclic ring, whereii
said ring is optionally substituted with 1-3 groups independently selected from halogen, -R
or OR.
6. The method according to claim 5, wherein R3 and R4 are taken together tc
form a saturated or unsaturated 5-6 membered carbocyclic ring, wherein said ring i:
optionally substituted with 1-3 groups independently selected from halogen, -R, or OR,
7. The method according to claim 6, wherein said compound is of formula II:

or a pharmaceutically acceptable salt thereof.
8. The method according to any one of claims 1 to 6, wherein said compound is
of I-b:

or a pharmaceutically acceptable salt thereof.
9. The method according to any one of claims 1 to 6, wherein said compound is
of formula I-c or I-d:


or a pharmaceutically acceptable salt thereof.
10. The method according to any one of claims 1 to 4, wherein said compound is
of formula III:

or a pharmaceutically acceptable salt thereof.
11. The method according to any one of claims 1 to 10 wherein each of R5 and R6
is hydrogen.
12. The method according to claim 1, wherein said compound is selected from:
4,5,6,7,9a, 10,11,12,13,13a-decahydro-9i/-[ 1,4]diazepino[6,7,1 -de]phenanthridine;
2-bromo-4,5,6,7,9,9a,10,11,12,12a-decahydrocyclopenta[c][1,4Jdiazepino [6,7,1 -ij]quinoline;
2-bromo-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c] [1,4]diazepino[6,7,1 -
ij]quinoline ;
2-chloro-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c]|[1,4]diazepino [6,7, l-ij]quinoline;
2-chloro-4,5,6,7,9,9a, 10,11,12,3 3,14,14a-dodecahydrocyc lohepta[c] [ 1,4]diazepino [6,7,1 -
ij]quinoline hydrochloride;
2-phenyl-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino[6,7,1-ij]quinoline;

2-methoxy-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c] [ 1,4]diazepino [6,7,1 -
ij]quinoline;
l-fluoro-4,5,6,7,9,9a,10,ll,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,l-ij]quinoline;
l-fluoro-4,5,6,7,9,9a,10,ll,12,13,14,14a-dodecahydrocyclohepta[c][l,4]diazepino[6,7,1-
ij]quinoline;
l-(trifluoromethyl)-4.5,6,7,9,9a,10,ll,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,l-
ij]quinoline;
1 -fluoro-2-methoxy-4,5,6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c][l ,4]diazepino[6,7,1 -
ij]quinoline;
l-fluoro-2-methoxy-4,5,6,7,9,9a,10,ll,12,13,14,14a-dodecahydrocyclo-
hepta[c][ 1,4]diazepino[6,7,1 -ij]quinoline;
4,5,6,7,9,9a 10,11,12,12a-decahydrocyclopenta[c][l ,4]diazepino[6,7,1 -ij] quinoline;
4,5,6,7,9,9a,10,ll,12,13,14,14a-dodecahydrocyclohepta[c][l,4]dia2epino[6,7,l-ij]quinoline;
4,5,6,7,9,9a,10,ll,12,12a-decahydrocyclopenta[c][l,4]dia:zepino[6,7,l-ij] quinoline;
(9aR, 12aS)-4,5,6,7,9,9a, 10,11,12,12a-decahydrocy clopenta[c] [1,4]diazepino[6,7,1-
ij]quinoline;
(9aS, 12aR)-4,5}6,7,9,9a, 10,11,12,12a-decahydrocyclopenta[c][l,4]diazepino[6,7,l-
ij]quinolixie;
(9aR,14aS)-4,5,6,7,9,9a,10,11,12,13,14,14a-dodecahydrocyclohepta[c][l,4]diazepino[6,7,l-
ij]quinoline; or
(9aS, 14aR)-4,5,6,7,9,9a, 10,11,12,13,14,14a-dodecahydrocyclohepta[c][ 1,4]diazepino[6,7,1 -
ij]quinoline;
or a pharmaceutically acceptable salt thereof.
13. A method for treating a patient suffering from, or susceptible to, one or more
symptoms of substance abuse, dependence, or withdrawal comprising administering to the
patient a composition comprising a compound according to any one of claims 1 to 12, and
one or more pharmaceutically acceptable carriers.
14. The method according to any one of claims 1 to 13, wherein said substance is
a recreational substance, a pharmacologic agent, or an illicit drug.

15. The method according to claim 14, wherein said substance is a pain reliever, a
tranquilizer, a stimulant, a tobacco product, or a sedative.
16. The method according to claim 14, wherein said substance is Vicodin®,
Lortab®, Lorcet®, Percocet®, Percodan®, Tylox®, Hydrocodone, OxyContin®, methadone,
Tramadol, marijuana, heroine, cocaine, ecstasy, LSD, PCP, or methamphetamine.
17. The use of a compound or composition as defined in any one of claims 1 to 13
in the manufacture of a medicament for the treatment of one or more symptoms of substance
abuse, dependence, or withdrawal.

The present invention provides methods and compositions for use in the treatment, prevention, and/or alleviation of
drug abuse and/or its symptoms. In particular, the invention demonstrates that compositions comprising compounds of formula (I)
are useful in such treatment revention and/or alleviation: formula (I) or a pharmaceutically acceptable salt thereof, wherein each of
n, R1, R2, R3, R4, R5, and R6 are as defined herein.