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Title:
DRUGS FOR INCONTINENCE
Document Type and Number:
WIPO Patent Application WO/2002/011707
Kind Code:
A2
Abstract:
Use in the incontinence of one or more of the following classes of drugs selected from the following: B) salified and non salified nitric oxide-donor drugs, of formula: A - X¿1? - N(O)¿z?, B') nitrate salts of drugs used for the incontinence, and which do not contain in the molecule a nitric oxide donor group; C) organic or inorganic salts of compounds inhibiting phosphodiesterases.

Inventors:
DEL SOLDATO PIERO (IT)
BENEDINI FRANCESCA (IT)
Application Number:
PCT/EP2001/008734
Publication Date:
February 14, 2002
Filing Date:
July 27, 2001
Export Citation:
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Assignee:
NICOX SA (FR)
DEL SOLDATO PIERO (IT)
BENEDINI FRANCESCA (IT)
International Classes:
A61K31/00; C07D231/56; A61K31/04; A61K31/133; A61K31/137; A61K31/14; A61K31/165; A61K31/215; A61K31/216; A61K31/27; A61K31/352; A61K31/381; A61K31/4025; A61K31/404; A61K31/416; A61K31/4184; A61K31/44; A61K31/4402; A61K31/4409; A61K31/4422; A61K31/4453; A61K31/4465; A61K31/4525; A61K31/453; A61K31/454; A61K31/46; A61K31/472; A61K31/4745; A61K31/495; A61K31/4985; A61K31/502; A61K31/506; A61K31/517; A61K31/519; A61K31/522; A61K31/5415; A61K31/55; A61K31/5513; A61K31/554; A61P13/00; A61P13/02; C07D213/74; C07D217/20; C07D311/30; C07D311/84; (IPC1-7): A61K31/00
Domestic Patent References:
WO1998009948A21998-03-12
WO1996037202A11996-11-28
WO2001089473A12001-11-29
WO1999067231A11999-12-29
WO1996028448A11996-09-19
WO2000051988A12000-09-08
Foreign References:
US6203817B12001-03-20
GB2330579A1999-04-28
EP1092719A22001-04-18
DE19540642A11997-05-07
EP1020190A22000-07-19
US5525604A1996-06-11
US5436233A1995-07-25
EP0943613A11999-09-22
Other References:
LINDSTROM, LEIF H.: "Effect of pilocarpine and oxotremorine on hormone-activated copulatory behavior in the ovariectomized hamster" NAUNYN-SCHMIEDEBERG'S ARCH. PHARMACOL. (1972), 275(3), 233-41 , XP001055429
SULLIVAN J ET AL: "Pharmacological management of incontinence." EUROPEAN UROLOGY, vol. 36, no. SUPPL. 1, June 1999 (1999-06), pages 89-95, XP001094443 Pre-Congress Satellite Symposium on a1-Adrenoceptors as Targets for Therapeutic Agents in Urology in connection with the XIIIth Congress of Pharmacology;Paris, France; Munich, Germany; July 23-24, 1998; July 26, 1998 ISSN: 0302-2838
See also references of EP 1307184A2
Attorney, Agent or Firm:
Sama, Daniele (Via G.B. Morgagni 2, Milano, IT)
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Claims:
CLAIMS
1. Use in the incontinence of one or more of the following classes of drugs selected from the following: A) nitric oxide donor drugs, salifie and non salifie of formula AX,N (O) z wherein A, Xl, Z have the meaning defined below; B') nitrate salts of drugs used for the incontinence and which do not contain in the molecule a nitric oxide donor group; C) organic or inorganic salts of compounds inhibiting phosphodiesterases; in the compounds of general formula: AXiN (0) z z is an integer and is 1 or 2, preferably 2; A = R (COXu)t and wherein t is an integer 0 or 1; u is 0 or 1; X = 0, NH, NRlc wherein Rlc is a linear or branched ClCl alkyl ; X1 is the following bivalent linking group: wherein: nIx is an integer in the range 03; nIIX is an integer in the range 13; RTIX, RTIX., RTIIX, RTIIX., equal to or different from each other are H or a linear or branched ClC4 alkyl ; Y is a heterocyclic ring containing one or two nitrogen atoms, optionally one oxygen or sulphur atom, said saturated, unsaturated or aromatic ring having 5 or 6 atoms; R of the radical A of formula AXlN (O)z is selected from the following groups: Group I) wherein t = 1 and u = 1 Ia) wherein: Rl is the OCOR3 group; wherein R, is methyl, ethyl or a linear or branched C3C5 alkyl, or the residue of a heterocycle having only one ring having 5 or 6 atoms which can be aromatic, partially or totally hydrogenated, containing one or more heteroatoms independently selected from O, N and S; R, is hydrogen, hydroxy, halogen, linear or branched C1C4 alkyl, linear or branched ClC4 alkoxy; a linear or branched ClC4 perfluoroalkyl, for example trifluorome thyl; nitro, amino, monoor di(Cl4) alkylamino; nI is an integer 0 or 1; group II) wherein t = 1, u = 1 IIa) wherein: RIIS is H, linear or branched when possible ClC, alkyl ; RII6 has the same meaning as RII5, or when RIIS is H it can be benzyl; RII1, RII2 and RII3 can independently be hydrogen, linear or branched when possible ClC6 alkyl, or linear or branched when possible C1C6 alkoxy, or Cl, F, Br; RII4 is RII1 or bromine; IIb) is the residue of the 2 [ (2methyl3 (trifluorome thyl) phenyl] amino]3pyridincarboxylic] acid and when the COOH group is present the compound is known as flunixin ; group III) wherein t = 1, u = 1 and R is wherein: R2a and 3a are H, linear or branched when possible, substituted or not, C1Cl2 alkyl or allyl, with the proviso that if one of the two is allyl the other is H; preferably R2a is H, C1C4 alkyl, R3a is H; Rla is selected from IIID) R1a corresponds to the following formulas: (XXXVII) (XII) wherein the meanings are the following: when R1a is as defined in formula (IV), Ketoprofen residue: RIII1 is H, SURI113 wherein RIII3 contains from 1 to 4 carbon atoms, linear or branched when possible ; RIII2 is H, hydroxy; when R1a is as defined in formula (XXI), carprofen residue: Rxxio is H, linear or branched when possible alkyl from 1 to 6 carbon atoms, C1C6 alkoxycarbonyl linked to a ClC6 alkyl, C1C6 carboxyalkyl, Cl C6 alkanoyl, optionally substituted with halogens, benzyl or halobenzyl, benzoyl or halobenzoyl; R,, i i s H, halogen, hydroxy, CN, C1C6 alkyl optionally containing OH groups, C1C6 alkoxy, acetyl, benzyloxy, SRxxi2 wherein Rxxi2 is C1C6 alkyl ; C,C, perfluoroalkyl ; C,C, carboxyalkyl optionally containing OH groups, NO2, amino; sulphamoyl, dial kyl sulphamoyl with ClC6 alkyl, or difluoroalkyl sulphonyl with ClC3 alkyl ; il is halogen, CN, C1C6 alkyl containing one or more OH groups, C1C6 alkoxy, acetyl, acetamid, benzyloxy, SRIII3 being RIII3 as above defined, ClC3 perfluoroalkyl, hydroxy, C1C6 carboxyalkyl, NO2, amino, monoor dialkylamino C1C6 ; sulphamoyl, di alkyl sulphamoyl ClC6, or difluoroalkylsulphamoyl as above defined; or Rxxi together with Rxxi1 is a C1C6 alkylen dioxy; when R1a is as defined in formula (XXXV) tiaprofenic acid residue: Ar is phenyl, hydroxyphenyl optionally mono or polysubstituted with halogen, alkanoyl and alkoxy C1C6, C1C6, preferably C1C3, trialkyl, cyclo pentyl, cyclohexyl, cycloheptyl, heteroaryl, prefe rably thienyl, furyl optionally containing OH, pyridyl; when R1a is as defined in formula (II), suprofen residue, wherein R3a is H, R2a is methyl and X = O ; when R1a is as defined in formula (VI), R is the residue of indoprofen when R2a = H and R3a = CH3; of indobufen when R2a is equal to H and R3a = C2H5 ; X = O ; when Rla is as defined in formula (VIII), R is the e todolac residue when R2a = R3a = H and X = O ; when Rla is as defined in formula (VII), R is the fenoprofen residue when R3a = H, Ka = CH3 and X = O ; when R1a is as defined in formula (III), R is the fenbufen residue when R2a = R3a = H and X = O ; when R1a is as defined in formula (IX), R is the flurbiprofen residue when R3a = H, R2a = CH3, X = O; when Rla is as defined in formula (X) R is the tolmetin residue when R2a = R3a = H, X = O ; in group IIID) Rla corresponds to the following formulas: IIIa), when Ka = H and R3a = CH3 the pranoprofen residue is obtained: αmethyl5H[1]benzopyran[2, 3 b] pyridin7acetic acid; the preferred compond has R2a = H, R3a = CH3, u = 1 and X = 0 ; (XXX), when R2a = H and R3a = CH3 the bermoprofen residue is obtained: dibenz [b, f] oxepin2acetic acid; (XXXI), when R. = H and R3a = CH3, R is the radical of the CS670 compound: 2[4(2oxo1cyclo hexyliden methyl) phenyl]propionic acid; (XXXII), when R2a = R3a = H the Pemedolac residue is obtained; (XXXIII), when R2a = R3a = H the pyrazolac residue is obtained: 4(4chlorophenyl)1(4fluro phenyl)3 pyrazolic acid; (XXXVI), when R2a = H, R3a = CH3 the zaltoprofen residue is obtained; when the residue is saturated with an hydroxyl or amino group, or with the carboxylic function the compounds are known as dibenzothiepine derivatives ; (XXXVII), when R2a = R3a = H the mofezolac residue is obtained: 3,4di (pmethoxyphenyl) isoxazol5acetic acid; (XII), when R2a = R3a = H the bromfenac residue is obtained: 2amino3 (4bromobenzoyl) benzeneacetic acid; in group IV) wherein t = 1, u = 1, R is wherein: RIVd and RIVd1 are at least one H and the other a linear or branched ClC6, preferably Cl and C2 alkyl, or difluo roalkyl with the alkyl from 1 to 6 carbon atoms, C1 is preferred, or RIVd and RIVd1 form together a methylene group; Rlv has the following meaning: (III) wherein the compounds of group IV) have the following meanings: in formula (II): Rivii is C1C6 alkyl, C3C7 cycloalkyl, C1C7 alkoxymethyl, C1C3 trifluoroalkyl, vinyl, ethynyl, halogen, C1C6 alkoxy, dif luoroalkoxy, with the C1C7 alkyl, C1C7 alkoxymethyloxy, alkylthio methyloxy with the ClC., alkyl, alkyl methylthio with the C1C7 alkyl, cyan, difluoromethylthio, phenylor phe nylalkyl substituted with CiCe alkyl.
2. formula (X) loxoprofen residue; in. formula (III): Riviii is a C2Cs alkyl, optionally branched when possible, C.
3. and C, alkyloxy, allyloxy, phenoxy, phenylthio, cycloalkyl from 5 to 7 carbon atoms, optionally substituted in position 1 by a C1C.
4. alkyl ; Group V) (LX) Group VE) (XXXXI) In group V) : when R is formula (II), R,, ii is H or a linear or branched ClC4 alkyl ; RVii1 is RVii, or a linear or branched C,C, alkoxy; Cl, F, Br ; the position of RVii1 being ortho, or metha, or para ; when R is formula (V), of which the residue of the known tenidap has been indicated; when R is formula (V) A = R and t = 0, when R is formula (VII), A is RCO, t = 1 u = 0 or A is R and t = 0; when R is formula (IX), A = R and t = 0, or A = RCO with t = 1 and u = 0; when R is formula (III) A = RCOO, t = 1 and u = 0 or 1; or t = 0 and A = R; when R is formula (IV) A = RCOO, t = 1 and u = 1 ; when R is formula (LX) and in (COXu)t u = t = 1 and X is oxygen, the precursor compound is sulindac ; when R is formula (X) it is the meloxicam residue; when R is formula (XI) the residue is known as ampiroxicam when the termination isCH (CH3) OCOC2Hs ; when R is formula (XIII) and the valence is saturated with H, the residue derives from lornoxicam; when R is formula (XXXX) and the valence is saturated with H the compound is known as paracetamol; when R is formula (XXXXI) and the valence is saturated with H the compound is known as tramadol.
5. 2 Use according to claim 1, wherein Y is selected from the following: (Y12) (Y13) (Y14) (Y15).
6. Use according to claim 2, wherein Y is Y12 (pyridyl) substituted in position 2 and 6.
7. Use according to claims 13, wherein in the compounds A) of formula AXiN (O)z z is 2 and. nIX and nIIX in formula (B) of X1 are integers equal to 1 and RTIX, RTIX., RTIIX, RTIIX. are equal to H.
8. Use according to claims 14, wherein in the compounds of formula A) AX1N (O)z R, X, u and t of formula A = R (COXu)t, and Y in formula (B) of Xi, have the following meanings: when R is selected from group I), in the compounds of formula Ia) X is equal to O or NH, R1 is acetoxy, preferably in ortho position with respect toCO, R2 is hydrogen; in X1 RTIX = RTIX, = RTIIX = RTIIX, = H, nIX = nIIX = 1 and Y is an aromatic ring having 6 atoms, containing one nitrogen atom, said aromatic ring having the two free valences in position 2 and 6; in the compounds of formula Ib) R3 = CH3, nI = 0, X is equal to O, X1 is as above defined for Ia) ; in this case Ib) is the residue of the acetylsalicylsa licylic acid; when R is selected in group II) in formula IIa Rill, RII4 are hydrogen and RII2 and RII3 are chlorine in ortho position with respect to NH; RII5 and RII6 are H, X is equal to O, and X1 is as above defined for the compounds of formula Ia) ; when R is selected in group III), when R1a is as defined in formula (IV) RIII1 and RIII2 are H, R3a is H, and R2a is methyl, X = 0 ; when R1a is as defined in formula (XXI) Rio is H, the linking group is in position 2, Rxxi is H, Rxxi1 is chlorine and it is in para position with respect to nitrogen; when R1a is as defined in formula (XXXV) Ar is phenyl, R3a is H, R2. is methyl and X is 0 ; R3a is H, R2a is methyl and X is O ; . when Rla is as defined in formula IIIa), R2a = H, Ft., a = CH3, u = 1 and X = O ; when Ela is as defined in formula (XXX) R2a = H, R3a = CH3, u = 1 and X = O ; when Rla is as defined in formula (XXXI), R2a = H, R3a = CH3, u = 1 and X = O ; when R1a is as defined in formula (XXXII), R2a = R3a = H, u = 1 and X = O ; when R1a is as defined in formula (XXXIII), R2a = R3a = H, u = 1 and X = O ; when R1a is as defined in formula (XXXVI), Pa = H, R3a = CH3, u = 1 and X = O ; when R1a is as defined in formula (XXXVII), R2a = R3a = H, t = 1 and X = O ; when R1a is as defined in formula (XII), R2a = R3a = H, u = 1, t = 1, X = 0, R2, = R3a = H; or t = 0 ; when R is selected in group IV), when RI is the formula (II), Rivii = CH3O, RIVd = H and Rival = CH3, X = O and X1 is as above defined for Ia) ; when RIV is formula (X), RIVd = H, RIVd1 = CH3, X = O and Xi is as above defined for Ia) ; when RI is formula (III), Riviii is and RIVd = H, RIVd1 is CH3, X = O and X1 is as above defined for Ia) ; when R is selected in group V, when R is formula (II), Rvii and Rvii1 are H, and A = R; when R is formula (X), A = RCO, t = 1 and u = 0; when R is formula (XI), A = RCO, t = 1 and u = 0 ; when R is formula (XIII), A = RCO., t = 1 and u = 0; when R corresponds to formula (XXXX) or (XXXXI), A = RCO, t = 1 and u = 0.
9. Use according to claims 15, wherein the drugs of the nitrate salts compounds B') are selected from B'1) anticholinergic drugs, B'2) calcium antagonist drugs, B'3) drugs which facilitate the opening of the potassium channels, B'4) alphaadrenergic agonist drugs, B'5) alphaadrenergic antagonist drugs, B'6) betaadrenergic agonist drugs, B'7) antidepressant drugs, B'8) GABA agonist drugs, B'9) agonist drugs of the muscarinic receptor and B'10) other drugs selected from inaperizone (B'10b), moxonidine (B'lOc), papaverine (B'10e), benzydamine (B'lOg) (B'lOg) B11) antagonist serotoninergic drugs of the 5HT4 receptor.
10. Use according to claim 6, wherein the compounds B') are selected from the following: B1) propantheline (B'1a, emepronium (B'1b), trospium (B'lc), tolterodine (B'1d), dariphenacine (B'1e), vamicamide (B'1f), zamiphenacine (B'1g), atropine (B'lh), cyclodrine (B'li), oxybutynin (B'll), N desethyloxybutynin (B'1lI), dicyclomine (B'1m), propiverine (B'1n), flavoxate (B'1o), terodiline (B'1p) ; B'2) nifedipine (B'2a), flunarizine (B'2b), diltiazem (B'2c) ; B'3) pinacidil; B'4) ephedrine (B'4a), pseudoephedrine, phenylpropa nolamine (B'4c), midodrine (B'4d), deglymidodrine (B'4e) ; B'5) alfuzosin (B'5a), doxazosin (B5'b), prazozin (B'5c) Bw6) clenbuterol (B'6a), terbutaline (B'6b), formoterol (B'6c) ; B'7) imipramine (B'7a), clozapine (B'7b), milnacipran (B'7c), fluphenazine (B'7d), nortriptyline (B'7e), duloxetine (B'7f) ; B'8) baclofen ; B'9) bethanechol; (B'8) (B'9) bill) 3(piperidin1yl) propyl 4 amino5chloro2me thoxy benzoate (B'lla), 1[4amino5chloro2(3, 5 dimethoxy phenyl) methyl oxy]3 [1 [2methylsulpho nylamino] ethyl piperidin4yl]1propanone (B'llb) 1piperidinylethyllHindol3carboxylate (B'11c), (S)2chloro5methoxy4 [5 (2piperidylmethyl) 1, 2, 4oxadiazol3yl] aniline (B'lld).
11. Use according to claims 17, wherein the compounds inhibiting the phosphodiesterase C) salifiable with organic or inorganic acids are selected from the following: (Cl) 1 [4ethoxy3 (6, 7dihydro1methyl7 oxo3propyllHpyrazol [4,3d]pyrimidin5yl)phenyl] sulphoyl]4methylpiperazine (Sildenafil), (C2) 2 (2 propyloxyphenyl)8azapurin6one (Zaprinast), (C3) 2,6 bis(diethanolamino)4,8dipiperidino pyrimido [5, 4d] pyrimidine (dipyridamol), (C4) 6chloro4(1, 3dioxain dan5yl) methylamino2 (4carboxy1piperidinyl)quinazo line, (C5) N(phenylmethyl)1ethyl1Hpyrazol[3,4b] quinolin4amine, (C6) 1 (2chlorobenzyl)3isobutyryl2 propyl6aminocarbonylindol, (C7) 1benzyl6chloro2 [1 [3 (imidazol1yl) propyl] indol5ylamino carbo nyl] benzimidazol, (C8) 2 (1imidazolyl)5 (phenyl)4 (1, 3dioxaindan5yl) methyl aminopyrimidine, (C9) 6 ethynyl4 (2methoxyethyl) amino2 (1imidazolyl) quinazo line, (C10) 1cyclopentyl3ethyl6 (2propoxyphenyl) py razol [3,4d] pyrimidin4one, (Cll) lcyclopentyl3 ethyl6 (4methoxybenzyl)pyrazol [3, 4d]pyrimidin4 one, (C12) 1, 3dimethyl6 (2propoxy5methansulphonami dophenyl)1, 5dihydro pyrazol [3,4d]pyrimidin4one, (C13) (6R, 12aR)2, 3,6,7,12,12ahexahydro2methyl6 (1, 3dioxan5yl) pyrazino [2',1': 6,1] pyrido [3,4 b] indol1, 4dione, (C14) 1propyl3methyl6 [2propoxy 5[(4lmethyllpyrazinyl) sulphonamido] phenyl]1,5 dihydropyrazol [3,4d] pyrimidin4one, (C15) 3 (4amino carbonyllpiperidinyl)6cyan8 (3chloro4m. ethoxy phthalazine, (C16) 2(1imidazolyl)4(1, 3dioxaindan5 yl) methylamino7,8dihydro5Hthiopyran [3,2d] pyrimidine (C17) 1Cyclo pentyl3ethyl6 (3ethoxypyrid4yl)1H pyrazolo [3,4d] pyrimidin4one, (C18) 1 [3 [1 [ (4 Fluorophenyl) methyl7, 8dihydro8oxolHimidazo [4, 3 g] quinazolin6yl]4propoxyphenyl] carboxamide.
12. Use according to claim 8, wherein the organic salts of C) are selected from oxalate, tartrate, maleate, succinate, citrate, glycinate, lysinate; and the inorganic anions are selected from nitrate, chloride, sulphate, phosphate.
13. Use according to claims 89, wherein the preferred anion is nitrate.
14. Use according to claims 110, obtained with formulations by oral, parenteral use containing one or more salts of the drugs of classes A)C).
15. Nitrate salts of drugs compounds B') of claims 1,6 and 7, excluding the nitrate salts respectively of nifedipine, flunarizine, diltiazem.
16. Nitrate salts of drugs compounds C) of claims 1,8 and 9 excluding sildenafil nitrate, zaprinast nitrate and dipyridamol nitrate.
17. Formulations according to claim 11.
18. Nitrate salts according to claims 1213 for use as a medicament.
Description:
DRUGS FOR INCONTINENCE * * * * * The present invention relates to the use of classes of drugs, optionally mixtures thereof, for the urinary incontinence therapy.

More specifically, the invention relates to the use in the urinary incontinence therapy of one or more of the following compounds as defined hereunder, characterized in that they have a good efficacy in the urinary incontinence treatment combined with. low side effects.

It is well known that the urinary incontinence can be considered a micturition control trouble consequent on a lesion or a dysfunction of the low urinary ducts. In particular the smooth musculature of the urinary bladder, called detrusor muscle, and the internal urethral sphincters (smooth musculature) and external (striated musculature) are involved. See for example Ferguson D. and Christopher N., Urinary Bladder Function and Drug Development, Trends in Pharmacological Sciences, 1996,17,161-165. In this publication it is mentioned that various kinds of incontinence exist characterized by different causes and symptoms. In particular it can be mentioned : incontinence from efforts which consists in the loss of small amounts of urine as a consequence of an intrabdominal pressure increase, due to, for example, a cough or an effort. It is due to the change of the vesico-urethral angle and to the musculature relaxation of the urethral sphincters. It is frequent above all in multipara women; incontinence from urgency which consists in the inability to control the bladder and it appears with a sudden and impelling stimolus to urinate. It is due to intermittent contractions of the bladder musculature without evident causes (detrusor instability) or consequent on interstitial cystitis or other inflammatory phenomena which cause bladder hyperexci- tability. It seems that in all these cases alterations of the bladder innervation are present ; incontinence from bladder overrelaxation which appears in the cases of chronic urinary retention due to obstructive causes. The bladder never empties itself completely with consequent continuous loss of small amounts of urine; total incontinence which consists in the complete lack of control on the bladder due to inability to control the sphincters. It is a consequence of serious neurological damages.

In the prior art the available therapies are based on three different approaches-see for example the above article and Anderson K. E., Pharmacology of Lower Urinary Tract Smooth Muscles and Penile Erectile Tissues, Pharmacolo- gical Reviews, 1993,45,253-308: -reduction of the detrusor activity, -modification of the sensory nervous transmission, -modification of the urethral resistances.

According to the first approach, the detrusor contraction is stimulated by the parasympathetic system and acetylcholine is the main mediator. Therefore to reduce the bladder hyperactivity anticholinergic drugs are used which are effective but of limited use owing to the anticholinergic activity at systemic level. Indeed they cause side effects such as for example fauces dryness, constipation and tachycardia. If one considers that the bladder irritability is often associated to obstructive bladder pathologies, the administration of anticholinergic drugs can potentially cause crises of acute urinary retention.

For example anticholinergic drugs such as oxybutynin or tolterodine are quite effective. Their use is however limited by the side effects typical of anticholinergic agents (fauces dryness, dimmed sight, etc.) Occasionally patients under treatment with said products can also have cardiac rhythm troubles. In patients affected by glaucoma, a worsening of the pathology can happen, furthermore in old patients with prostatic hypertrophy a worsening of the urinary retention can take place.

Another pharmacological approach for reducing the detrusor activity considers the use of drugs which facilitate the opening of the channels of potassium, of calcium- antagonists and of relaxing drugs of the smooth musculature.

Also in this case there are side effects, such as for example the arising of a marked hypotensive action due to the aspecific effect of vasodilation induced by these drugs.

The administration of S-agonist drugs induces an increase of the bladder capacity, but their use is limited by the serious side effects affecting the cardiovascular system.

A further pharmacological approach for reducing the bladder hyperactivity is the use of antidepressant drugs, but also with these therapeutic aids there are serious side effects affecting the cardiovascular system (orthostatic hypotension, arrhythmia).

Another pharmacological method for reducing the detrusor activity consists in the use of the prostglandin synthesis inhibitors which have been experimented in some cases of detrusor hyperactivity and enuresis with promising results.

Also in this case the side effects which have been noticed have been significant. The use of these drugs is based on the fact that several prostglandines are synthesized at bladder level as a consequence of nervous stimulation and some of them would have the function of mediators of the detrusor muscle contractions. Some prostglandines would be furthermore involved in phenomena of incontinence from urgency and bladder hyperactivity noticed during some inflammatory pathologies of the urinary tract.

The non steroidal antiinflammatory drugs are potentially useful for reducing the limit of excitability of the urinary bladder, and are therefore effective in the cases of detrusor instability. Unfortunately they show the drawback that at active doses they are poorly tolerated especially at the gastrointestinal apparatus level.

The NO enzyme synthetase inhibitors could prevent the bladder hyperexcitability and hyperalgesia consequent on inflammatory phenomena such as interstitial cistitis; see Rice A. S. C., Topical Spinal Administration of a Nitric Oxide Synthase Inibitor Prevents the Hyper-Reflexia Associated with a Rat Model of Persistent Visceral Pain, Neuroscience Letters, 1995,187,111-114. However, at present, therapeutically usable drugs of this kind do not exist because of the corresponding aspecificity of their pharmacological profile.

The second approach which consists in the modification of the sensory nervous transmission (in the cases when the urinary incontinence derives from lesions of the nervous system) implies the use of active drugs on the neurotransmission, for example of gamma-aminobutyric acid (GABA), or peptides, or purines, which are important neurotransmitters at the urinary ducts level.

Also clinical studies which use capsaicin by intravescical instillation with sometimes positive results are known. However this treatment has limited clinical applications due to its transitory effect and besides obtainable only by local administration.

The third approach is based on the fact that at the urethra level the musculature tone is mediated by different neurotransmission systems, for example the adrenergic one by stimulation of the a receptors. To modify the urethral resistances a-agonist drugs are used with sometimes satisfactory results; they increase the pressure bearable by the urethra. However the use of these compounds is contraindicated in the case of obstructive pathologies of the bladder, in which even alpha-antagonist drugs are used. In these cases it is indeed frequent that an hyperactivity of the sphincters takes place, which hinders the regular bladder emptying, causing incontinence from urgency. Also in this case, as well as in the first above described approach, serious side effects of hypotensive type bound to the a- antagonist activity affecting the cardiocirculatory apparatus level are to be pointed out.

Up to now the commercially available drugs solve the problem only in a limited number of cases but generally inducing side effects also of a certain seriousness.

Good results have been obtained with products described in patent application WO 98/09948 in the name of the Applicant wherein nitroxyderivatives of particular classes of non steroidal antinflammatory drugs are used. These products are very good drugs for the incontinence treatment with low side effects, however they have the drawback to have to be mainly administered by os. When a parenteral administration is necessary (cases of bad absorption, seriously ill hospitalized patients where the administration by os cannot be carried out), it has been found that the products mentioned in said application are not administrable by parenteral route.

The Applicant has unexpectedly and surprisingly found compounds effective in the incontinence treatment and giving lower side effects, and are administrable also parenterally, therefore overcoming the drawbacks of the prior art.

An object of the present invention is the use in the incontinence of one or more of the following classes of drugs selected from the following: A) nitric oxide donor drugs, optionally salified, of formula: A-X1-N (O) z wherein A, Xi, Z have the meaning defined below; B') nitrate salts of drugs used for the incontinence and which do not contain in the molecule a nitric oxide donor group; C) organic or inorganic salts of compounds inhibiting phosphodiesterases; in the compounds of general formula: A-X1-N (O) z z is an integer and is 1 or 2, preferably 2; A =@ R(COXu)t and wherein t is an integer 0 or 1; u is 0 or # X = 0, NH, NRIC wherein Rl, is a linear or branched Cl-calo alkyl ; X1 is the following bivalent linking group: wherein: nIx is an integer in the range 0-3, preferably 1; nIIX is an integer in the range 1-3, preferably 1; RTIX, RTIX., RTIIX, RTIIX., equal to or different from each other are H or linear or branched C1-C4 alkyl ; preferably RTIX RTIX t , RTIIX, are H; Y is a heterocyclic ring containing one or two nitrogen atoms, optionally one oxygen or sulphur atom, said saturated, unsaturated or aromatic ring, having 5 or 6 atoms; R is selected from the following groups: Group I) wherein t = 1 and u = 1 Ia) wherein: R1 is the OCOR3 group; wherein R3 is methyl, ethyl or linear or branched C3-C5 alkyl, or the residue of a heterocycle with only one ring having 5 or 6 atoms which can be aromatic, partially or totally hydrogenated, containing one or more heteroatoms independently selected from O, N and S; R2 is hydrogen, hydroxy, halogen, linear or branched when possible C1-C4 alkyl ; a linear or branched when possible C,-C, alkoxyl; a linear or branched when possible C1-C4 perfluoroalkyl, for example trifluoromethyl ; nitro, amino, mono-or di-(C14) alkylamlno ; nI is an integer 0 or 1; preferably in the compounds of formula Ia) X is equal to O or NH, R1 is acetoxy, preferably in ortho position with respect to-CO-, R2 is hydrogen; preferably Xi is the linking group (B) wherein RrIX = RTIX.= RTIIX = RTIIX, = H, nIX = nIIX = 1; Preferably in the compounds of formula Ib) R3 = CH3, nI = 0, X is equal to O, X1 is as above defined for Ia) ; in this case Ib) is the residue of the acetylsalicylsalicylic acid ; Group II, wherein t = it u = 1 wherein: RII5 is H, linear or branched when possible C1-C3 alkyl ; R... has the same meaning as RII5, or when RII5 is H it can be benzyl; RII1, RII2 and RII3 can independently be hydrogen, linear or branched when possible Ci-Cg alkyl, or linear or branched when possible C1-C6 alkoxy, or Cl, F, Br ; RII4 is RII1 or bromine; the compounds wherein RII1, RII4 are hydrogen and RIIEZ and RII3 are chlorine in ortho position with respect to NH are preferred ; Rj,, and RII6 are H, X is equal to O, and X1 is as above defined for the compounds of formula Ia) ; IIb) is the residue of the 2- [ (2-methyl-3- (trifluoromethyl) phenyl] amino]-3-pyridincarboxylic] acid and when the-COOH group is present the compound is known as flunixin; Group III) wherein t = 1, u = 1 and R is wherein: R2a and R3a are H, linear or branched when possible, substituted or not, C1-C12 alkyl or allyl, with the proviso that if one of the two is allyl, the other is H; preferably R2a is H, C1-C4 alkyl, R3a is H; Rla is selected from IIID) R1a corresponds to the following formulas: (XXXVII) (XII) wherein the meanings are the following: when R1a is as defined in formula (IV), Ketoprofen residue: Run is H, SRIII3 wherein RIII3 contains from 1 to 4 carbon atoms, linear or branched when possible; RIIEZ is H, hydroxy; the compounds wherein RIII1 and RIII2 are H, R3a is H, and R2a is methyl, X = O, are preferred; when R1a is as adefined in formula (XXI), carprofen residue: Rxxio is H, linear or branched when possible alkyl from 1 to 6 carbon atoms, C1-C6 alkoxycarbonyl linked to a Ci-Cg alkyl, Cl-C6 carboxyalkyl, C1-C6 alkanoyl, optionally substituted with halogens, benzyl or halobenzyl, benzoyl or halobenzoyl ; R=i is H, halogen, hydroxy, CN, C1-C6@ alkyl optionally containing OH groups, C1-C6 alkoxy, acetyl, benzyloxy, SRxxi2 wherein R=i2 is Cl-C6 alkyl ; Cl-C3 perfluoroalkyl ; C1-C6 carboxyalkyl optionally containing OH groups, NO2, amino; sulphamoyl, di-alkyl sulphamoyl with C1-C6 alkyl, or difluoroalkylsulphonyl with C1-C3 alkyl ; Rxxi1 is halogen, CN, C1-C6 alkyl containing one or more OH groups, C1-C6 alkoxy, acetyl, acetamido, benzyloxy, SRIII3 being RIII3 as above defined, C1-C3 perfluoroalkyl, hydroxy, C1-C6 carboxyalkyl, NO2, amino, mono-or di-al- kyl-amino Ci-Cg ; sulphamoyl, di-alkyl sulphamoyl C1-C6, or di-fluoroalkylsulphamoyl as above defined ; together with Rxxi1 is a Cl-C6 alkylen dioxy; the compounds are preferred wherein Ri. is H, the linking group is in position 2, R,,. i is H, R,, i, is chlorine and is in para position with respect to nitrogen ; R3a is H, R2a is methyl and X is O ; when R1a is as defined in formula (XXXV), tiaprofenic acid residue: Ar is phenyl, hydroxyphenyl optionally mono-or polysubstituted with halogen, alkanoyl and alkoxy C1-C6, C1-C6, preferably C1C3, trialkyl, cyclopentyl, cyclohexyl, cycloheptyl, heteroaryl, preferably thienyl, furyl optionally containing OH, pyridyl; the preferred compounds of (XXXV) are those wherein Ar is phenyl, R3a is H, R2a is methyl and X is O ; when R1a is as defined in formula (II), suprofen residue, of which the preferred one has been indicated, wherein R3a is H, R2a is methyl and X = O, as described and obtained in USP 4, 035, 376 herein incorporated by reference ; when R1a is as defined in formula (VI), R is the residue of indoprofen when R2a = H and R3a= CH3 ; of indobuf en when R2 « is equal to H and R3a = C2Hs ; X = O, as described and obtained according to USP 3, 997, 669 herein incorported by reference ; when R1a is as defined in formula (VIII), R is the etodolac residue when R2a = R3a = H and x = O, as described and obtained according to USP 3, 843, 681 herein incorporated by reference ; when Rla is as defined in formula (VII), R is the feno- profen residue when R3a = H, R2a = CH3 and X = O, as described and obtained according to USP 3, 600, 437 herein incorporated by reference; when R1a is as defined in formula (III), R is the fen- bufen residue when R. 2a = R3a = H and X = O, as described and obtained according to USP 3, 784, 701 herein incorporated by reference ; when R1a is as defined in formula (IX), R is the flurbiprofen residue when R3a = H, xa = CH3, X = O ; when R1a is as defined in formula (X) R is the tolmetin residue when R2a = R3a = H, X = O, as described and obtained according to FR 1,574,570 herein incorporated by reference; In group IIID) Rla corresponds to the following formulas: $- IIIa), when R2a = H and R3a = CH3 the pranoprofen residue is obtained: α-methyl-5H-[1]benzopyran-[2,3-b]pyridin- 7-acetic acid; the preferred compound has R2a = H, R3a = CH3, u = 1 and X = O : (XXX), when R2a = H and R3a = CH3 the bermoprofen residue is obtained: dibenz [b, f] oxepin-2-acetic acid; the preferred compound has. R,. = H, R3a = CH3, u = 1 and X = O.

(XXXI), when R2a = H and R3a = CH3, R is the radical of the compound CS-670: 2- [4- (2-oxo-l-cyclohexyliden me- thyl) phenyl]propionic acid; the preferred compound has R2a = H, R3a = CH3, u = 1 and X = O ; (XXXII), when R2a = R3a = H, the Pemedolac residue is obtained; the preferred compound has R2a = R, a = H, u = 1 and X = O ; (XXXIII), when R2a = R3a = H, the pirazolac residue is obtained: 4-(4-chlorophenyl)-1-(-fluorophenyl)-3-pyra- zolic acid derivatives; The preferred compounds have R2a = R3a = H, u = 1 and X = O ; (XXXVI), when R2a = H, R3a = CH3, the zaltoprofen residue is obtained; when the residue is saturated with a hydroxyl or amino group, or with the carboxylic function the compounds are known as dibenzothiepine derivatives; the preferred compounds have R2a = H, R3a = CH3, u = 1 and X = O ; (XXXVII), when R2a = R3a = H the mofezolac residue is obtained: 3,4-di (p-methoxyphenyl) isoxazol-5-acetic acid when the residue is CH2-COOH ; the preferred compounds have R2a = R3a = H, t = 1 and X = O ; (XII), when R2a = R3a = H the bromfenac residue is obtained: 2-amino-3- (4-bromobenzoyl) benzeneacetic acid; the preferred compounds have u = 1, t = 1, X = O, R2a = in group IV) wherein t = 1, u = 1, R is wherein: RIVd and RIVd1 are at least one H and the other a linear or branched when possible Cl-C6, preferably Cl and C2 alkyl, or difluoroalkyl with the alkyl from 1 to 6 carbon atoms, Cl is preferred, or RIVd and RIVd1 form together a methylene group; RI has the following meaning: (III) wherein the compounds of group IV) have the following meanings : -in formula (II) Riv-ii is C1-C6 alkyl, C3-C7 cycloalkyl, C1-C7 alkoxymethyl, C1-C3 trifluoroalkyl, vinyl, ethynyl, halogen, C1-C6 alkoxy, difluoroalkoxy, with Cl-C, alkyl, C1-C7 alkoxy- methyloxy, alkylthiomethyloxy with C1-C7 alkyl, alkyl methylthio with C1-C7 alkyl, cyan, difluoromethylthio, phenyl-or phenylalkyl substituted with Cl-Ca alkyl ; preferably RiV-ii is CH30-, RIVd is H and RIVdl is CH3, and it is known as naproxen residue; X = O and Xl is as above defined for Ia) ; -in formula (X), of which the loxoprofen residue, de- scribed in USP 4,161,538 herein incorporated by reference, has been indicated, the compounds wherein RIVd is H and RIVd1 is CH3, X = O and X1 is as above defined for Ia) are preferred; in formula (III) : RiV-iii is a C2-Cs alkyl, optionally branched when possible, C2 and C3 alkyloxy, allyloxy, phenoxy, phenylthio, cycloalkyl from 5 to 7 carbon atoms, optionally substituted in position 1 by a C1-C2 alkyl ; it is preferred the compound wherein Riz-in is and Rlvc, = H, RIVd1 is CH3, compound known as ibuprofen residue; X = O and X1 is as above defined for Ia) ; Group V) Group VE) (XXXXI) in group V), the compounds have the following meanings: when R is formula (II), RVii is H or a linear or branched when possible C,-C, alkyl ; RViil is RVii, or a linear or branched when possible Cl-C4 alkoxy; Cl, F, Br; the position of RVii-1 being ortho, or metha, or para; the residue of the known Ketorolac is preferred, wherein RVii and Rvii-1 are H, and A = R (A being the group of the formula A-Xl-NO2) and t = 0; when R is formula (V), of which the residue of the known tenidap has been indicated, as described and obtained in USP 4,556,672 herein incorporated by reference; in these compounds of formula (V) A = R and t = 0, when R is formula (VII), of which the residue of the known tenoxicam has been indicated, A is RCO, t = 1 u = 0 or A is R and t = 0, as described and obtained in DE 2,537,070 herein incorporated by reference; when R is formula (IX), wherein A = R and t = 0, or A = RCO with t = 1 and u = 0, the residue of the known piroxicam has been indicated, as described and obtained in USP 3,591,584 herein incorporated by reference; when R is formula (III) wherein A = RCOO, t = 1 and u = 0 or 1 ; or t = 0 and A = R, of which the residue of the known nabumetone has been indicated, as described and obtained in USP 4,061,779 herein incorporated by reference ; when R is formula (IV) wherein A = RCOO, t = 1 and u = 1, of which the indomethacin residue has been indicated, as described and obtained in USP 3,161,654, herein incorporated by reference; when R = formula (LX) and in (COXu) t u = t = 1 and X is oxygen, the precursor compound is known as sulindac; when R is formula (X), the X residue is known as meloxi- cam; the preferred compounds are those wherein A = RCO, t = 1 and u = 0; when R is formula (XI) the residue is known as ampiroxicam when the termination is-CH (CH3) OCOC. ; Hg ; the preferred compounds have A = RCO, t = 1 and u = 0 ; when R is formula (XIII) and the valence is saturated with H, the residue derives from lornoxicam; the preferred compounds have A = RCO, t = 1 and u = 0 ; when R is formula (XXXX) and the valence is saturated with H the compound known as paracetamol is obtained, as described and obtained in USP 2,998,450 herein incorporated by reference; when R is formula (XXXXI) and the valence is saturated with H, the compound known as Tramadol is obtained, as described and obtained in USP 3,652,589; the preferred compounds according to the present invention obtainable with the radicals corresponding to the formulas (XXXX) and (XXXXI) have A= RCO, t = 1 and u = 0.

Preferably Y is selected from the following : (Y12) (Y13) (Y14) (Y15) Preferably Y is an aromatic ring having 6 atoms, containing one nitrogen atom, said aromatic ring having the two free valences in position 2 and 6.

The preferred of Y is Y12 (pyridyl) substituted in position 2 and 6. The bonds can be also in a non symmetric position, for example Y12 (pyridyl) can be substituted also in position 2 and 3; Y1 (pyrazol) can be 3,5-disubstituted.

The X1 precursors as defined by formula (B), wherein the free valence of the oxygen is saturated with H and the free valence of the end carbon is saturated with either a carboxylic or hydroxyl group, are commercially available compounds or they can be obtained by known methods of the prior art.

The compounds containing R of group I of the type Ia) are described in patent application WO 92/01668 wherein also the preparation methods are mentioned. This patent is herein incorporated by reference. The compounds of type Ib) are for example prepared by using the method indicated in The Merck Index, XI ed., 1989, pag. 16, No. 95 for the acetylsali- cylsalicylic.'acid residue. The modifications of the compounds of formula Ib) can be obtained by using the processes mentioned in patent application WO 92/01668.

The compounds wherein R is of group II) are described in patent application WO 94/04484 and USP 3,558,690 wherein also the preparation methods are indicated. These patents are herein incorporated by reference.

The starting compound of IIb), when the valence is saturated with-COOH (flunixin), is obtained according to USP 3,337,570 and USP 3,689,653, both herein incorporated by reference. The compounds containing the substituents mentioned in the previous patents are equivalent to flunixin.

The compounds wherein R is of group III) are described and obtained by the processes mentioned in the following patents: patent application PCT/EP/93 03193 ; for the compounds of formula (IV) see also USP 3,641,127; for the compounds of formula (XXI) see also USP 3,896,145; for the compounds of formula (IX) flurbiprofen residue see also USP 3,755,427; for the compounds of formula (II) see also USP 4,035,376; for the compounds of formula (VI) see also USP 3,997,669; for the compounds of formula (VIII) see also USP 3,843,681; for the compound of formula (VII) see also USP 3,600,437; for the compounds of formula (III) see also USP 3,784,701. All these mentioned patents are herein incorporated by reference.

The procedures for the preparation of the compounds of class IIID) are the following: The residue IIIa) is obtained by preparing the acid compound according to USP 3,931,205, the valence is saturated with-CH (CH3)-COOH. The compounds containing the substituents mentioned in the previous patent are equivalent to pranoprofen. The residue (XXX) is prepared through the compound with the group-CH (CH3)-COOH (bermoprofen) according to USP 4,238,620 herein incorporated by reference.

Other equivalent products are described in the above mentioned patent.

The residue (XXXI) is prepared by starting from the corresponding acid-CH (CH,)-COOH according to USP 4,254,274.

Equivalent compounds are described in the same patent.

The residue (XXXII) is prepared according to EP 238,226 herein incorporated by reference, when the valence is saturated with-CH2-COOH. Equivalent products are reported in said patents as 1,3,4,9 tetrahydropyran [3,4-b] indol-1-ace- tic substituted acids.

The residue (XXXIII) is prepared from pirazolac and the valence is saturated with-CH2-COOH, as indicated in EP 54,812 herein incorporated by reference. Equivalent products are described in said patent.

The residue (XXXVI) is prepared according to UK 2,035,311 herein incorporated by reference, by starting from zaltoprofen and having the-CH (CH3)-COOH termination.

Equivalent products are described in said patent.

The process for preparing the residue (XXXVII) is obtained starting from mofezolac and it is prepared according to EP 26,928. Equivalent products are reported in the same patent.

The compounds wherein R is of group IV) are described in GB patent application 2,283,238, wherein also the preparation methods are indicated; this patent is herein incorporated by reference.

In group IV) the compounds can also be obtained: for the compounds of formula (II) using USP 3,904,682; the compounds of formula (X) according to USP 4,161, 538; the compounds of formula (III) according to USP 3,228,831. The herein mentioned patents are incorporated in the present application by reference.

In group V) the compounds can also be obtained: for the compounds of formula (II) using USP 4,089,969 herein incorporated by reference; the compounds of formula (V) can be obtained according to USP 4,556,672 herein incorporated by reference.

The residue (X) is prepared according to the German patent 2,756,113. Equivalent products are described in said patent.

The residue (XI) is prepared according to EP 147,177, herein incorporated by reference, starting from ampiro- xicam having the termination-CH (CH3) OCOOC2H5. Equivalent products are described in said patent.

The residue (XII) is prepared according to J. Med.

Chem., vol. 27 No. 11, Nov. 1984, Walsh et Al.

"Antiinflammatory Agents. 3. Synthesis and Pharmacological Evaluation of 2-amino-3-benzoylphenylacetic Acid and Analogues", herein incorporated by reference. Equivalent products are described in said publication.

The residue (XIII) is prepared starting from lornoxicam, wherein the valence is saturated with H. It is prepared according to GB 2,003,877. Equivalent products are described in said patent.

The residue (LX) in group V is prepared from Sulindac, obtained according to US 3,654,349.

In general the connection between A and Xi is, as seen, of ester or amidic type (NH or NR, as defined in X) when R is of groups I, II, III, IV and V. For the formation of such connection all the synthesis routes well known for the formation of such bonds are usable.

The preparation of the compounds of formula A-Xi-N (O) z with the linking group Xi of formula (B) is described in published PCT application WO 00/51988 in the name of the Applicant, herein incorporated by reference.

The compounds of group A), as said, are effective in the incontinence treatment, they give lower side effects and are also parenterally administrable, therefore overcoming the drawbacks of the prior art mentioned in patent application WO 98/09948.

The drugs of the nitrate salts compounds B') are selected from B'1) anticholinergic drugs, B'2) calcium-antagonist drugs, Buzz drugs which facilitate the opening of the potassium channels, B'4) alpha-adrenergic agonistic drugs, B'5) alpha-adrenergic antagonist drugs, B'6) beta-adrenergic agonist drugs, B'7) antidepressant drugs, B'8) GABA agonist drugs, B'9) agonist drugs of the muscarinic receptor, and B'10) other drugs selected from inaperizone (B'10b), moxonidine (Bs10c), papaverine (B'l0e), benzydamine (B§10g) : B11) serotoninergic antagonist drugs of the 5-HT4 receptor.

In particular, compounds B') are selected from the following: B'1) propantheline (B'la), emepronium (B'1b), trospium (B'lc), tolterodine (B'1d), dariphenacine (B'le), vamicamide (B'1f), zamiphenacine (B'lg), atropine (B'lh), cyclodrine (B'1i), oxybutynin (B'1l), N- desethyl-oxybutynin (B'1l-I), dicyclomine (B'1m), propiverine (B'1n), flavoxate (Bwlo), terodiline (B'lp) ; B'2) nifedipine (B'2a), flunarizine (B'2b), diltiazem (B'2c) ; B'3) pinacidil; B'4) ephedrine (B'4a), pseudoephedrine, phenylpropanolamine (B'4c), midodrine (B'4d), de-glymidodrine (B'4e) ; B'5) alfuzosin (B'5a), doxazosin (B5'b), prazozin (B'5c) Buzz clenbuterol (B'6a), terbutaline (B'6b), formoterol (B'6c) ; B'7) imipramine (B'7a), clozapine (B'7b), milnacipran (B'7c), fluphenazine (B'7d), nortriptyline (B'7e), duloxetine B'8) baclofen ; B'9) bethanechol; (B'9) Bw11) 3-(piperidin-1-yl) propyl 4 amino-5-chloro-2-methoxy benzoate (B'11a), 1-[4-amino-5-chloro-2-(3, 5-dimethoxy phenyl) methyl oxy]-3- [l- [2-methylsulphonylamino] ethyl piperidin-4-yl]-1-propanone (B'llb), 2 (1-piperidinyl) ethyl-lH-indol-3-carboxylate (B'11c), (S)-2-chloro-5- methoxy-4- [5- (2-piperidylmethyl)-1, 2,4-oxadiazol-3-yl] aniline (B'lld).

The synthesis of the compounds belonging to the classes B'1)-B'9) are described in the volume The Merck Index 12a Ed.; the synthesis of compound B'le) is described in EP 388,054; of compound B'lg) is described in EP 350,309, of compound B'ld) is described in EP 325,571. The synthesis of compound Bila) is carried out as described in EP 501,322, of compound B'llb) as described in Br. J. Pharmacol. 1995,115.

1087-1095, of compound Btllc) as described in EP 429,984.

The compounds inhibiting the phosphodiesteras$ C) salifiable with organic or inorganic acids are selected from the following: (Cl) 1- [4-ethoxy-3- (6, 7-dihydro-1-methyl-7- oxo-3-propyl-lH-pyra-zol [4,3-d]-pyrimidin-5-yl)-phenyl] sul- phoyl]-4-methyl-piperazine (Sildenafil), (C2) 2- (2-propyloxy- phenyl)-8-azapurin-6-one (Zaprinast), (C3) 2,6-bis- (diethano- lamino)-4,8-dipiperidine pyrimido [5,4-d]-pyrimidine (dipy- ridamol), (C4) 6-chloro-4- (1, 3-dioxaindan-5-yl) methylamino- 2 (4-carboxy-1-piperidinyl)-quinazoline, (C5) N- (phenylme- thyl)-1-ethyl-1H-pyrazol-[3,4-b]-quinolin-4-amine, (C6) 1-(2- chlorobenzyl)-3-isobutyryl-2-propyl-6-aminocarbonyl-indol, (C7) 1-benzyl-6-chloro-2-[1-[3-(imidazol-1-il)propyl]indol-5- yl-amino carbonyl] benzimidazol, (C8) 2- (l-imidazolyl)-5- (phe- nyl)-4- (1, 3-dioxaindan-5-yl) methyl aminopyrimidine, (C9) 6- ethynyl-4- (2-methoxyethyl) amino-2- (1-imidazolyl) quinazoline, (C10) 1-cyclopentyl-3-ethyl-6- (2-propoxyphenyl) pyrazol [3,4- <BR> <BR> <BR> d] pyrimidin-4-one, (Cll) 1-cyclopentyl-3-ethyl-6- (4-methoxy- benzyl)-pyrazol- [3, 4-d]-pyrimidin-4-one, (C12) 1,3-dimethyl- 6- (2-propoxy-5-methansulphonamidophenyl)-1, 5-dihydro pyra- zol [3,4-d]-pyrimidin-4-one, (C13) (6R, 12aR)-2, 3,6,7,12, 12a-hexahydro-2-methyl-6- (1, 3-dioxan-5-yl) pyrazin [2', 1': 6,1] pyrido [3,4-b] indol-1, 4-dione, (C14) 1-propyl-3-methyl-6- [2- propoxy-5- [ (4-methyl-1-pyrazinyl) sulphonamido] phenyl]-1, 5- dihydropyrazol [3,4-d] pyrimidin-4-one, (CI5) 3- (4-amino carbo- <BR> <BR> <BR> nyl-1-piperidinyl)-6-cyan-8- (3-chloro-4-methoxy-phthalazine, (C16) 2- (1-imidazolyl)-4- (1, 3-dioxaindan-5-yl) methylamino- 7,8-dihydro-5H-thiopyran [3,2-d] pyrimidine, (C17) 1-Cyclo pen- tyl-3-ethyl-6- (3-ethoxypyrid-4-yl)-lH-pyrazolo [3,4-d] pyrimi- din-4-one, (C18) 1- [3- [1- [ (4-Fluorophenyl) methyl]-7, 8-dihy- dro-8-oxo-lH-imidazo [4,5-g] quinazolin-6-yl]-4-propoxyphenyl] carboxamide.

Examples of organic salts of C) are oxalate, tartrate, maleate, succinate, citrate, glycinate, lysinate ; examples of inorganic anions are nitrate, chloride, sulphate, phosphate.

Nitrate salts are preferred.

The above compounds inhibiting the phosphodiesterases are sinthesized as described in the following references: (Cl) : G. B. 92,480; (C2): DE 2,162,096; (C3): The Merck Index 12th Ed.; (C4): WO 9422855; (C5) : WO 9628159; (C6): WO 9632379; (C7): WO 9703070; (C8): USP 5,525,604; (C9): USP 5,436,233; (C10) : WO 9628448; (C11) : WO 9628429; (C12) : EP 636,626 ; (C13) : WO 9519978; (C14): EP 636,626; (C15) : WO 9605176; (C16): EP 728,759; (C17) : US 5,294,612; (C18) : J. Med. Chem 2000 43 1257-1263.

The nitrate salts of compounds B) and of compounds C) can be prepared as for example described in patent application WO 99/45004 in the name of the Applicant; the other salts of compounds C) with anions different from nitrate are prepared by methods known in the prior art, such as for example described in patent application WO 96/28448.

For the use according to the present invention one or more salts of the drugs of classes A)-C) are formulated in the corresponding pharmaceutical formulations according to well known techniques in the art, together with the usual excipients. The formulations can be for oral, parenteral use and are prepared as known in the prior art. See for example the volume"Remington's Pharmaceutical Sciences luth Ed." The dosages of the salts of the invention in their pharmaceutical compositions are the same, and generally lower than those of their precursors of the above mentioned classes, said salts generally being more effective and better tolerated.

The following Examples illustrate but do not limit the scope of the invention.

EXAMPLE1 Preparation of oxybutynin nitrate salt (B11) To a solution of oxybutynin chloride (1.1 g, 2.82 mmoles) (B'11) in acetonitrile (25 ml) silver nitrate (0.48 g, 2.82 mmoles) dissolved in acetonitrile (10 ml) is added.

The mixture is maintained under stirring for 30 minutes sheltered from light and at room temperature. The precipitate (AgCl) is filtered and the solution is concentrated under reduced pressure up to half of the initial volume. Ethyl ether (50 ml) is added. By cooling with ice a precipitate is separated which is filtered and washed with ethyl ether (3 X 5 ml). After drying 0.8 g of oxybutynin nitrate salt are obtained as an amorphous solid. Yield 68%.

Melting point 86-87°C.

Elementary analysis Calculated % : C 62.84 H 7.67 N 6.66 Found % : C 62.67 H 7.66 N 6.70 EXAMPLE 2 Preparation of benzidamine nitrate salt (B'10g) 1) Preparation of benzidamine base Benzidamine hydrochloride (3 g, 8.7 mmoles) (B'lOg) is dissolved in an aqueous solution of sodium hydroxide (10% w/w, 45 ml) and the solution is extracted with ethyl acetate (3 X 50 ml). The joined organic phases are washed with water, anhydrified with sodium sulphate and the solvent evaporated under reduced pressure. An yellow oil formed by benzidamine free base is obtained.

'I-I NMR (DMSO): 7.65-7.6 (2H, m); 7.45-7.2 (6H, m) ; 7.15 (1H, t); 5.45 (2H, s) ; 4.4 (2h, t); 2.4 (2H, t); 2.2 (6H, s) ; 2.0 (2H, m).

2) Preparation of benzidamine nitrate salt To a solution of benzidamine (2.5 g, 8.1 mmoles) in acetonitrile (15 ml), cooled at 0 °C, nitric acid 65% (0.560 ml, 8.1 mmoles) is added. The mixture is maintained under stirring at 0°C for 30 minutes, the temperature is let reach the room temperature and the mixture is maintained under stirring for 1 hour. After addition of ethyl ether (10 ml) a white solid is separated which is filtered and washed with ethyl ether. After drying 2.6 g of benzidamine nitrate salt are obtained. Melting point 143-144°C.

Elementary analysis Calculated % : C 61.29 H 6.49 N 15.04 Found % : C 60.93 H 6.45 N 14.97 EXAMPLE 3 Preparation of papaverine nitrate salt (B'10e) 1) Preparation papaverine base Papaverine hydrochloride (3 g, 8 mmoles) (Br10e) is dissolved in an aqueous solution of sodium hydroxide (1096 w/w, 50 ml) and the solution is extracted with chloroform (3 X 50 ml). The joined organic phases are washed with water, anhydrified with sodium sulphate and the organic solvent evaporated under reduced pressure. Papaverine base (2.7 g) is obtained as an amorphous solid.

'-H NMR (DMSO): 8.4 (1H, d); 7.6 (2H, d); 7.4 (1H, s) ; 6.8 (2H, m); 4.5 (2H, s) ; 3.9 (6H, d); 3.7 (6H, d).

2) Preparation of papaverine nitrate salt To a solution of papaverine (2.6 g, 7.6 mmoles) in acetonitrile (100 ml), cooled at 0 °C, nitric acid 65% (0.560 ml, 8. 1 mmoles) is added. The mixture is maintained under stirring at 0°C for 30 minutes, it is let reach the'room temperature and the mixture is maintained under stirring for 2 hours. The formed precipitate is filtered and washed with acetonitrile. After drying 2.3 g of papaverine nitrate salt are obtained.

Elementary analysis Calculated % : C 59.69 H 5.51 N 6.96 Found % : C 58.68 H 5.38 N 6.86 EXAMPLE 4 Preparation of phenylpropanolamine nitrate salt (B'4c) To a solution of phenylpropanolamine hydrochloride (2 g, 10.75 mmoles) (B'4c) in acetonitrile (50 ml) silver nitrate (1.83 g, 10.77 mmoles) is added. The salt preparation is carried out following the procedure described in Example 1.

The phenylpropanolamine nitrate salt is obtained as an amorphous solid.

Elementary analysis Calculated C 50.46 H 6.59 N 13.08 Found %: C 50.60 H 6.62 N 13.12 EXAMPLE5 Preparation of pinacidil nitrate salt (B'3) To a solution of pinacidil (3 g, 12.23 mmoles) (B'3) in acetonitrile (100 ml), cooled at 0°C, nitric acid 65% (0. 850 ml, 12.27 mmoles) is added. The mixture is maintained under stirring at 0°C for 30 minutes. At the end it is let reach the room temperature and the mixture is maintained under stirring for 2 hours. After addition of ethyl ether a precipitate forms which is filtered and washed with ethyl ether (3 X 20 ml). After drying 2.3 g of pinacidil nitrate salt are obtained. Yield 60%.

Elementary analysis Calculated % : C 50.64 H 6.54 N 27.26 Found % : C 50.73 H 6.62 N 27.19 EXAMPLE 6 Preparation of terodiline nitrate salt (B'lp) Terodiline hydrochloride (2 g, 6.3 mmoles) (B'lp) is dissolved in an aqueous solution of sodium hydroxide (10% w/w, 35 ml) and the solution extracted with ethyl acetate (3 X 50 ml). The joined organic phases are washed with water, anhydrified with sodium sulphate and the organic solvent evaporated under reduced pressure. The residue is dissolved in acetonitrile (15 ml) and the solution is cooled at 0°C.

Nitric acid 65% (0.440 ml, 6.35 mmoles) is added. The mixture is maintained under stirring at 0°C for 30 minutes, then it is let reach the room temperature and the mixture is maintained under stirring for 1 hour. By adding ethyl ether (10 ml) a white solid is separated which is filtered and washed with ethyl ether. After drying 1.2 g of terodiline nitrate salt are obtained. Yield 55%.

Elementary analysis Calculated % : C 69.74 H 8.19 N 8.13 Found % : C 69.80 H 8.25 N 8.09 EXAMPLE 7 Preparation of propantheline nitrate salt (B'la) The compound is prepared starting from a solution of propantheline bromide (3 g, 6.7 mmoles) (B'la) in acetoni- trile (80 ml), adding silver nitrate (1.3 g, 7.06 mmoles) dissolved in acetonitrile (10 ml), and following the procedure described in Example 1. After drying, propantheli- ne nitrate salt is obtained as an amorphous solid (1.4 g).

Yield 48W.

Elementary analysis Calculated W : C 64.02 H 7.24 N 6.49 Found % : C 64.11 H 7.27 N 6.45 EXAMPLE 8 Preparation of flavoxate nitrate salt (B'lo) The compound is prepared starting from a solution of flavoxate hydrochloride (2 g, 4.7 mmoles) (B'lo) in acetonitrile (50 ml) adding a silver nitrate solution (0.800 g, 4.76 mmoles) in acetonitrile (10 ml) and following the procedure described in Example 1. After drying flavoxate nitrate salt is obtained as an amorphous solid (1.1 g). Yield 50%.

Elementary analysis Calculated W : C 63.42 H 5.77 N 6.16 Found % : C 63.52 H 5.98 N 6.20 EXAMPLE 9 Preparation of dicyclomine nitrate salt (B'lm) The compound is prepared starting from a solution of dicyclomine hydrochloride (2 g, 5.78 mmoles) (Bs lm) in acetonitrile (50 ml) adding silver nitrate (0.990 g, 4.76 mmoles) dissolved in acetonitrile (10 ml) and following the procedure described in Example 1. After drying dicyclomine nitrate salt is obtained as an amorphous solid (1.3 g). Yield 60%.

Elementary analysis Calculated % : C 61.26 H 9.74 N 7.52 Found %: C 61.19 H 9.69 N 7.58 PHARMACOLOGICALEXAMPLES The activity in the urinary incontinence of the compounds according to the present invention has been evaluated in an experimental model of inhibition of the bladder contraction.

The degree of the relaxation induced in the urinary bladder is a measure of the inhibitory action of the urinary incontinence of the drugs described in the present application.

Guinea-pigs of male sex having an average weight equal to 300-500 g were sacrificed and bled. The urinary bladder was removed and prepared for determining the myorelaxing activity in vitro, according to the method described by L. Nilvenbrant, Eur. J. Pharmacol. 327,195-207,1997.

The obtained tissue strips were contracted with carbacol 10-6 M in phisiological solution and the relaxation was determined in the presence of the compounds indicated in Table 1 at the concentrations mentioned therein. The 2- (acetyloxy) benzoic acid 6- (nitroxymethyl)-2-methylpyridyl ester hydrochloride was prepared according to Example 1 of patent application PCT/EP 00/01454 (NCX 4050).

The sildenafil nitrate salt was prepared as described in patent application WO 99/67231 (Ex. 3).

In Table 1 the results are expressed as a percentage of the maximum inhibition of the contractions induced by carbacol 10-6 M and they show that the compounds of the present invention are active in the urinary incontinence since they are able to exert a significant relaxing effect on the urinary guinea-pig bladder, which in the case of the nitrate salts of the drugs used in the incontinence is higher than that of the precursors.

Table 1 Activity in the urinary incontinence of the compounds NCX 4050, sildenafil nitrate, sildenafil citrate, oxybutynin nitrate and oxybutynin hydrochloride in an experimental model in vitro of strips of urinary guinea-pig bladder contracted with carbacol Treatment Concentration Urinary bladder (M) contraction % Placebo--------100 NCX 4050 3x10-5 71 Sildenafil 3x10-5 31 Nitrate Sildenafil 3x10-5 52 Citrate Oxybutynin Hydrochloride 10-6 30 (Comp) Oxybutynin Nitrate 10-6 0