US 5,643,874 AGrant

Pharmaceutical Composition Comprising a Glucosidase and/or Amylase Inhibitor, and a Lipase Inhibitor

Issue Date:1997-07-01

•21 Claims

Abstract

A pharmaceutical composition containing a glucosidase and/or amylase inhibitor and a lipase inhibitor as active substances and usual pharmaceutical carriers.

Metadata

Assignee

Hoffmann-La Roche Inc.

Inventors

Klaus-Dieter Bremer
Pavel Sawlewicz

Application Information

Application Number:US 2791277

Filing Date:1994-07-22

Priority Date:1993-08-05

Art Unit:121

Classifications

IPC:

A61K 3800

Field of Search:

51412;13;54;909

Patent Drawings

This patent does not have any drawings.

Description

Brief Summary of the Invention

The invention relates to pharmaceutical compositions containing an effective amount of at least one but no more than two glucosidase and/or amylase inhibitors and a lipase inhibitor as active substances; and the usual pharmaceutical carriers.

In another aspect, the invention relates to the use of at least one but no more than two glucosidase and/or amylase inhibitors for the combined simultaneous, separate or chronologically spaced use with a lipase inhibitor in the treatment of obesity.

Detailed Description of the Invention

It has been found that such preparations can be used for the treatment of obesity.

Accordingly, the invention is also concerned with the use of at least one but no more than two glucosidase and/or amylase inhibitors for the combined simultaneous, separate or chronologically spaced use with a lipase inhibitor in the treatment of obesity.

Further, the invention is concerned with the use of at least one but no more than two glucosidase and/or amylase inhibitors in the manufacture of pharmaceutical compositions for the combined use with a lipase inhibitor in the treatment of obesity.

Examples of known glucosidase and/or amylase inhibitors which can be used, in accordance with the invention are:

O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydrox y-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4)O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose, also known as acarbose;

2(S),3(R) ,4(S),5(S)-tetrahydroxy-N-[2-hydroxy-1-(hydroxymethyl)-ethyl]-5-(hydroxyme thyl)-1(S)-cyclohexamine, also known as voglibose;

1,5-dideoxy-1,5-[(2-hydroxyethyl)imino]-D-glucitol, also known as miglitol;

1,5-dideoxy-1,5-[2-(4-ethoxycarbonylphenoxy)ethylimino]-D-glucitol, also known as emiglitate;

2,6-dideoxy-2,6-imino-7-(.beta.-D-glucopyranosyl)-D-glycero-L-guloheptitol, also known as MDL-25637;

1,5-dideoxy-1,5-(6-deoxy-1-O-methyl-.alpha.-D-glucopyranos-6-ylimino)-D-glu citol, also known as camiglibose;

1,5,9,11,14-pentahydroxy-3-methyl-8,13-dioxo-5,6,8,13-tetrahydrobenzo[a]nap hthacene-2-carboxylic acid, also known pradimicin Q; ##STR1## wherein m is an integer of 0 to 8, n is an integer of 1 to 8 and m+n is an integer of 1 to 8, also known as adiposine; and

1,2-dideoxy-2-[2(S),3(S),4(R)-trihydroxy-5-(hydroxymethyl)-5-cyclohexen-1(S )-ylamino]-L-glucopyranose, also known as salbostatin.

Examples of known lipase inhibitors are:

(2S,3S ,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexadecanoi c 1,3 acid lactone, also known as tetrahydrolipstatin (previously also known as Orlistat);

(2S ,3S,5S,7Z, 10Z)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-7,10-hexade cadienoic 1,3 acid lactone, also known as lipstatin;

1-(trans-4-isobutylcyclohexyl)-2-(phenylsulfonyloxy)ethanone, also known as FL-386;

4-methylpiperidine-1-carboxylic acid 4-phenoxyphenyl ester, also known as WAY-121898;

N-[3-chloro-4-(trifluoromethyl)phenyl-]N'-[3-(trifluoromethyl)-phenyl]urea, also known as BAY-N-3176;

N-formyl-L-valine-(S)-1 -[[(2S, 3S)-3-hexyl-4-oxo-2-oxetanyl]methyl]hexyl ester, also known as valilactone;

(2S,3S,5S,7Z,10Z)-5-[(S)-2-acetamido-3-carbamoylpropionyloxy]-2-hexyl-3-hyd roxy-7,10-hexadecadienoic lactone, also known as esterastin;

(3S,4S)-4-[(1S,5R,7S,8R,9R,E)-8-hydroxy 1,3,5,7,9-pentamethyl-6-oxo-3-undecenyl]-3-methyl-2-oxetanone, also known as ebelactone A;

(3S,4S)-3-ethyl-4-[(1S,5R,7S,8R,9R,E)-8-hydroxy-1,3,5,7,9-pentamethyl-6-oxo -3-undecenyl]-2-oxetanone, also known as ebelactone B; and

1,6-di(O-(carbamoyl)cyclohexanone oxime)hexane, also known as RHC 80267.

Biomasses or fermentation cakes which result in the fermentative manufacture of lipase inhibitors, such as, (2S,3S,5S, 7Z,10Z)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-7,10-hex adecadienoic 1,3 acid lactone also known as lipstatin or (2S,3S,5S,7Z,10Z)-5-[(S)-2-acetamido-3-carbamoyl-propionyloxy]-2-hexyl-3-h ydroxy-7,10-hexadecadienoic lactone also known as esterastin, can also be used as the lipase inhibitor. The latter are described, for example, in EP-A 129 748 and U.S. Pat. No. 4,189,438.

It is known that either glucosidase inhibitors or amylase inhibitors or both, such as, O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4)O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose also known as acarbose, retard the digestion of carbohydrates.

It is also known that lipase inhibitors, such as, (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone also known as tetrahydrolipstatin, give rise to a partial inhibition of lipase in the intestine.

However, in monotherapy lipase inhibitors themselves in combination with a reduction diet generally bring about only a moderate weight loss and glucosidase and/or amylase inhibitors bring about practically no weight loss. It has now been surprisingly found that a combined use of a glucosidase and/or amylase inhibitor and a lipase inhibitor leads to a substantially greater weight loss than in the case of monotherapy. This has been demonstrated in the following test:

The test was carried out in two trial periods on two volunteers (A and B). The average daily calorie amounts of 2560 Kcal for A and 1850 Kcal for B were determined in a 7 day preliminary trial in which the volunteers took no medication. The volunteers were given 120 mg of (2S,3S,5S)-5-[(S)-2-formamido 4-methyl-is valeryloxy]-2-hexyl-3-hydroxy-hexadecanoic 1,3 acid lactone also known as tetrahydrolipstatin and 100 mg of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose also known as acarbose at each meal time in the subsequent 14 day main trial. A special diet was not adhered to and physical activities were reduced to a minimum. Here, as in the preliminary trial, the average daily calorie amounts of 2185 Kcal for A and 2050 Kcal for B were also ascertained. The weight loss of both volunteers will be evident from the following Table.

In comparison to the above result, the weight loss of patients in the case of monotherapy with tetrahydrolipstatin (3.times.120 mg/day) in a placebo-controlled 12 weeks trial was on average 1.8 kg (i.e. 0.3 kg/14 days) (Int. J. Obesity 1992; 16 (Suppl. 1): 16, Abstr. 063).

In accordance with the invention, at least one but no more than two inhibitors of the glucosidase and/or amylase can be used in the form of pharmaceutical compositions in combination with a lipase inhibitor for the simultaneous, separate or chronologically spaced use in the treatment of obesity.

The use of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha., )]-4,5,6-trihydroxy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-g lucopyranosyl-(1.fwdarw.4)O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose also known as acarbose and (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone also known as tetrahydrolipstatin is preferred.

The active ingredients are administered orally for the treatment of obesity.

They can be administered daily in dosages of about 0.003 mg to about 20 mg, preferably 0.015 mg to 10 mg, of glucosidase and/or amylase inhibitor and of about 0.15 mg to 20 mg, preferably 0.5 mg to 10 mg, of lipase inhibitor per kg body weight.

The compositions, in accordance with the invention, can be incorporated into standard pharmaceutical dosage forms, for example, they are useful for oral application with the usual pharmaceutical adjuvant material, for example, organic or inorganic inert carrier materials, such as, water, gelatin, lactose, starch, magnesium stearate, talc, gums, polyalkyleneglycols and the like. The pharmaceutical preparations can be employed in a solid form, for example, as tablets, capsules, or in liquid form, for example, as solutions, or emulsions. Pharmaceutical adjuvant materials can be added and include preservatives, stabilizers, wetting or emulsifying agents, salts to change the osmotic pressure or to act as buffers. The pharmaceutical preparations can also contain other therapeutically active substances.

Solid dosage forms such as tablets and capsules conveniently contain per dosage unit about 0.2 mg to about 100 mg of glucosidase and/or amylase inhibitor and 10 mg to 200 mg of lipase inhibitor.

In addition to the treatment of obesity, the compositions or active substance combination, in accordance with the invention, can be used for the treatment and prevention of illnesses which frequently occur in association with overweight, such as diabetes, hypertension, hyperlipidemia and insulin-resistance syndrome.

In the case of all of these indications, the active substances can be used in the dosage ranges given above, with the individual dosage depending on the nature of the illness to be treated as well as on the age and condition of the patient and can be determined within the purview of the medical specialist.

The invention is illustrated in more detail by the following Examples.

Pharmaceutical compositions of the following composition are produced in a known manner:

Example A

Example B

Example D

Example E

The formulation of Examples A-E can be prepared by known methods.

Claims

We claim:

1. A pharmaceutical composition which comprises an effective amount of a lipase inhibitor and (a) a glucosidase inhibitor, (b) an amylase inhibitor or, (c) a glucosidase and amylase inhibitor, together with an inert carrier.

2. A pharmaceutical composition according to claim 1, wherein the daily dosage of a lipase inhibitor is 0.15 to 20 mg per Kg body weight and the daily dosage of said glucosidase inhibitor, amylase inhibitor or glucosidase and amylase inhibitor is 0.003 to 20 mg per Kg body weight.

3. A pharmaceutical composition according to claim 1, in the form of a solid dosage unit comprising per dosage unit 10 to 200 mg of a lipase inhibitor and 0.2 to 100 mg of said glucosidase inhibitor, amylase inhibitor or glucosidase and amylase inhibitor.

4. A pharmaceutical composition according to claim 2, wherein the lipase inhibitor is selected from the group consisting of (2S ,3S ,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexadecanoi c 1,3 acid lactone, (2S,3S,5S,7Z,10Z)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydrox y-7,10-hexadecadienoic 1,3 acid lactone, 1-(trans-4-isobutylcyclohexyl)-2-(phenylsulfonyloxy) ethanone, 4-methylpiperidine-1-carboxylic acid 4-phenoxyphenyl ester, N-[3-chloro-4-(trifluoromethyl)phenyl-N'-[3-(trifluoromethyl)phenyl]urea; N-formyl-L-valine-(S)-1-[[(2S,3S)-3-hexyl-4-oxo-2-oxetanyl]methyl]hexyl ester, (2S ,3S, 5S,7Z,10Z)-5-[(S)-2-acetamido-3-carbamoylpropionyloxy]-2-hexyl-3-hydroxy-7 ,10-hexadecadienoic lactone, (3S,4S)-4-[(1S,5R,7S,8R,9R,E)-8-hydroxy-1,3,5,7,9-pentamethyl-6-oxo-3-unde cenyl]-3-methyl-2-oxetanone, (3S,4S)-3-ethyl-4-[(1S,5R, 7S,8R,9R,E)-8-hydroxy-1,3,5,7,9-pentamethyl-6-oxo-3-undecenyl]-2-oxetanone , and 1,6-di(O-(carbamoyl)cyclohexanone oxime)hexane.

5. A pharmaceutical composition according to claim 2, wherein the lipase inhibitor is (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone.

6. A method for treating obesity which comprises administering to a host in need of such treatment an effective amount of a lipase inhibitor and (a) glucosidase inhibitor, (b) amylase inhibitor, (c) or a glucosidase and amylase inhibitor.

7. A method for treating obesity which comprises administering a lipase inhibitor and (a) a glucosidase inhibitor, (b) amylase inhibitor, or (c) a glucosidase and amylase inhibitor in a simultaneous, separate, or chronologically spaced manner.

8. A method according to claim 6, wherein the daily dosage of lipase inhibitor is 0.15 to 20 mg per Kg body weight and the daily dosage of said glucosidase inhibitor, amylase inhibitor or glucosidase and amylase inhibitor is 0.003 to 20 mg per Kg body weight.

9. A method according to claim 6, wherein the lipase inhibitor and (a) glucosidase inhibitor, (b) amylase inhibitor, or (c) glucosidase and amylase inhibitor are administered in a solid dosage unit comprising per dosage unit 10 to 200 mg of lipase inhibitor and 0.2 to 100 mg of the (a) glucosidase inhibitor, (b) amylase inhibitor, or (c) glucosidase and amylase inhibitor.

10. A method according to claim 7, wherein the lipase is inhibitor is selected from the group consisting of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone, (2S,3S,5S, 7Z,10Z)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-7,10-hex adecadienoic 1,3 acid lactone, 1-(trans-4-isobutylcyclohexyl)-2-(phenyl-sulfonyloxy)ethanone, 4-methyl-piperidine-1-carboxylic acid 4-phenoxyphenyl ester, N-[3-chloro-4-(trifluoromethyl)phenyl-N'-[3-(trifluoromethyl)phenyl]urea, N-formyl-L-valine-(S)-1-[[(2S,3S)-3-hexyl-4-oxo-2-oxetanyl]methyl]hexyl ester, (2S ,3S,5S ,7Z, 10Z)-5-[(S)-2-acetamido-3-carbamoyl-propionyloxy]-2-hexyl-3-hydroxy-7,10-h exadecadienoic lactone, (3S,4S)-4-[(1S,5R,7S,8R,9R,E)-8-hydroxy-1,3,5,7,9-pentamethyl-6-oxo-3-unde cenyl]-3-methyl-2-oxetanone, (3S,4S)-3-ethyl-4-[(1S,5R,7S, 8R,9R,E)-8-hydroxy-1,3,5,7,9-pentamethyl-6-oxo-3-undecenyl]-2-oxetanone, and 1,6-di(O-(carbamoyl)cyclohexanone oxime)hexane.

11. A pharmaceutical composition according to claim 2, wherein the (a) glucosidase inhibitor, (b) amylase inhibitor or (c) glucosidase and amylase inhibitor is selected from the group consisting of O-4,6-Dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose, 2(S),3(R),4(S),5(S)-tetrahydroxy-N-[2-hydroxy-1-(hydroxymethyl)-ethyl]-5-( hydroxymethyl)-1(S)-cyclohexamine, 1,5-dideoxy-1,5-[(2-hydroxyethyl)imino]-D-glucitol,1,5-dideoxy-1,5-[2-(4-e thoxy-carbonylphenoxy)ethylimino]-D-glucitol, 2,6-dideoxy-2,6-imino-7-(.beta.-D-glucopyranosyl)-D-glycero-L-gulo-heptito l, 1,5-dideoxy-1,5-(6-deoxy-1-O-methyl-.alpha.-D-glucopyranos-6-ylimino)-D-gl ucitol, ##STR2## wherein m is an integer of 0 to 8, n is an integer of 1 to 8 and m+n is an integer of 1 to 8, 1. 5,9,11,14-pentahydroxy-3-methyl-8,13-dioxo-5,6,8,13-tetrahydrobenzo[a]na phthacene-2-carboxylic acid, and 1,2-dideoxy-2-[2(S),3(S),4(R)-trihydroxy-5-(hydroxymethyl)-5-cyclohexen-1( S)-ylamino]-L-glucopyranose.

12. A pharmaceutical composition according to claim 2, wherein the (a) glucosidase inhibitor, (b) amylase inhibitor, or (c) glucosidase and amylase inhibitor is O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose.

13. A method according to claim 7, wherein the (a) glucosidase inhibitor, (b) amylase inhibitor, or (c) glucosidase and amylase inhibitor is selected from the group consisting of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose, 2(S),3(R),4(S),5(S)-tetrahydroxy-N-[2-hydroxy-1-(hydroxymethyl)ethyl]-5-(h ydroxymethyl)-1(S)-cyclohexamine, 1,5-dideoxy-1,5-[(2-hydroxyethyl)imino]-D-glucitol,1,5-dideoxy-,1,5-[2-(4- ethoxy-carbonylphenoxy)ethylimino]-D-glucitol, 2,6-dideoxy-2,6-imino-7-(.beta.-D-glucopyranosyl)-D-glycero-L-gulo-heptito l, 1,5-dideoxy-,1,5-(6-deoxy-1-O-methyl-.alpha.-D-glucopyranos-6-ylimino)-D-g lucitol, ##STR3## wherein m is an integer of 0 to 8, n is an integer of 1 to 8 and m+n is an integer of 1 to 8, 1,5,9,11,14-pentahydroxy-3-methyl-8,13-dioxo-5,6,8,13-tetrahydrobenzo[a]na phthacene-2-carboxylic acid, and 1,2-dideoxy-2-[2(S),3(S),4(R)-trihydroxy-5-(hydroxymethyl)-5-cyclohexen-1( S)-ylamino]-L-glucopyranose.

14. A method according to claim 7, wherein the (a) glucosidase inhibitor, (b) amylase inhibitor, or (c) glucosidase and amylase inhibitor is O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl)-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.f wdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose.

15. A pharmaceutical composition which comprises an effective amount of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 and lactone; O-4,6-dideoxy -4-[[[1S-(1.alpha.4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydroxy-3-(hydroxym ethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fwdarw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose and an inert carrier.

16. A pharmaceutical composition according to claim 15, wherein the daily dosage of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone is 0.15 to 20 mg per kg body weight and the daily dosage of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose is 0.003 to 20 mg per kg body weight.

17. A pharmaceutical composition according to claim 15, in the form of a solid dosage unit comprising per dosage unit 10 to 200 mg of (2S,3 S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexadecano ic 1,3 acid lactone and 0.2 to 100 mg of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose.

18. A method for treating obesity which comprises administering to a host in need of such treatment an effective amount of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone and O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose.

19. A method for treating obesity which comprises administering to a host in need of such treatment (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone and O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose in a simultaneous, separate, or chronologically spaced manner.

20. A method according to claim 18, wherein the daily dosage of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone is 0.15 to 20 mg per kg body weight and the daily dosage of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose is 0.003 to 20 mg per kg body weight.

21. A method according to claim 18, wherein (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone and O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose are administered in a solid dosage unit comprising per dosage unit 10 to 200 mg of (2S,3S,5S)-5-[(S)-2-formamido-4-methyl-valeryloxy]-2-hexyl-3-hydroxy-hexad ecanoic 1,3 acid lactone and 0.2 to 100 mg of O-4,6-dideoxy-4-[[[1S-(1.alpha.,4.alpha.,5.beta.,6.alpha.)]-4,5,6-trihydro xy-3-(hydroxymethyl-2-cyclohexen-1-yl]amino]-.alpha.-D-glucopyranosyl-(1.fw darw.4) O-.alpha.-D-glucopyranosyl-(1.fwdarw.4)-D-glucose.

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