AU7976698A - Alpha 1a adrenergic receptor antagonists - Google Patents

Description

WO 98/57642 PCT/US98/12678 TITLE OF THE INVENTION ALPHA la ADRENERGIC RECEPTOR ANTAGONISTS This application claims the benefit of U.S. Provisional 5 Application No. 60/050,126, filed June 18, 1997. FIELD OF THE INVENTION: This invention relates to certain novel compounds and derivatives thereof, their synthesis, and their use as alpha la 10 adrenoceptor antagonists. More particularly, the compounds of the present invention are useful for treating benign prostatic hyperplasia (BPH). BACKGROUND OF THE INVENTION 15 Human adrenergic receptors are integral membrane proteins which have been classified into two broad classes, the alpha and the beta adrenergic receptors. Both types mediate the action of the peripheral sympathetic nervous system upon binding of catecholamines, norepinephrine and epinephrine. 20 Norepinephrine is produced by adrenergic nerve endings, while epinephrine is produced by the adrenal medulla. The binding affinity of adrenergic receptors for these compounds forms one basis of the classification: alpha receptors bind norepinephrine more strongly than epinephrine and much more strongly than the synthetic compound 25 isoproterenol. The binding affinity of these hormones is reversed for the beta receptors. In many tissues, the functional responses, such as smooth muscle contraction, induced by alpha receptor activation are opposed to responses induced by beta receptor binding. Subsequently, the functional distinction between alpha and 30 beta receptors was further highlighted and refined by the pharmacological characterization of these receptors from various animal and tissue sources. As a result, alpha and beta adrenergic receptors were further subdivided into alpha 1, alpha 2, 131, and B2 subtypes. Functional differences between alpha 1 and alpha 2 receptors -1- WO 98/57642 PCT/US98/12678 have been recognized, and compounds which exhibit selective binding between these two subtypes have been developed. For a general background on the alpha adrenergic receptors, the reader's attention is directed to Robert R. Ruffolo, Jr., a 5 Adrenoreceptors: Molecular Biology,. Biochemistry and PharmacoloFY, (Progress in Basic and Clinical Pharmacology series, Karger, 1991), wherein the basis of alpha 1/alpha 2 subclassification, the molecular biology, signal transduction (G-protein interaction and location of the significant site for this and ligand binding activity away from the 3' 10 terminus of alpha adrenergic receptors), agonist structure-activity relationships, receptor functions, and therapeutic applications for compounds exhibiting alpha-adrenergic receptor affinity was explored. The cloning, sequencing and expression of alpha receptor subtypes from animal tissues has led to the subclassification of the 15 alpha 1 receptors into alpha ld (formerly known as alpha la or la/ld), alpha lb and alpha la (formerly known as alpha 1c) subtypes. Each alpha 1 receptor subtype exhibits its own pharmacologic and tissue specificities. The designation "alpha la" is the appellation recently approved by the IULTPHAR Nomenclature Committee for the previously 20 designated "alpha 1c" cloned subtype as outlined in the 1995 Receptor and Ion Channel Nomenclature Supplement (Watson and Girdlestone, 1995). The designation alpha la is used throughout this application to refer to this subtype. At the same time, the receptor formerly designated alpha la was renamed alpha ld. The new nomenclature is used 25 throughout this application. Stable cell lines expressing these alpha 1 receptor subtypes are referred to herein; however, these cell lines were deposited with the American Type Culture Collection (ATCC) under the old nomenclature. For a review of the classification of alpha 1 adrenoceptor subtypes, see, Martin C. Michel, et al., Naunyn 30 Schmiedeberg's Arch. Pharmacol. (1995) 352:1-10. The differences in the alpha adrenergic receptor subtypes have relevance in pathophysiologic conditions. Benign prostatic hyperplasia, also known as benign prostatic hypertrophy or BPH, is an illness typically affecting men over fifty years of age, increasing in 35 severity with increasing age. The symptoms of the condition include, -2- WO 98/57642 PCT/US98/12678 but are not limited to, increased difficulty in urination and sexual dysfunction. These symptoms are induced by enlargement, or hyperplasia, of the prostate gland. As the prostate increases in size, it impinges on free-flow of fluids through the male urethra. 5 Concommitantly, the increased noradrenergic innervation of the enlarged prostate leads to an increased adrenergic tone of the bladder neck and urethra, further restricting the flow of urine through the urethra. In benign prostatic hyperplasia, the male hormone 5alpha 10 dihydrotestosterone has been identified as the principal culprit. The continual production of 5a-dihydrotestosterone by the male testes induces incremental growth of the prostate gland throughout the life of the male. Beyond the age of about fifty years, in many men, this enlarged gland begins to obstruct the urethra with the pathologic 15 symptoms noted above. The elucidation of the mechanism summarized above has resulted in the recent development of effective agents to control, and in many cases reverse, the pernicious advance of BPH. In the forefront of these agents is Merck & Co., Inc's product PROSCAR@ (finasteride). 20 The effect of this compound is to inhibit the enzyme testosterone 5-a reductase, which converts testosterone into 5a-dihydrotesterone, resulting in a reduced rate of prostatic enlargement, and often reduction in prostatic mass. The development of such agents as PROSCAR® bodes well 25 for the long-term control of BPH. However, as may be appreciated from the lengthy development of the syndrome, its reversal also is not immediate. In the interim, those males suffering with BPH continue to suffer, and may in fact lose hope that the agents are working sufficiently rapidly. 30 In response to this problem, one solution is to identify pharmaceutically active compounds which complement slower-acting therapeutics by providing acute relief. Agents which induce relaxation of the lower urinary tract tissue, by binding to alpha 1 adrenergic receptors, thus reducing the increased adrenergic tone due to the 35 disease, would be good candidates for this activity. Thus, one such agent -3- WO 98/57642 PCT/US98/12678 is alfuzosin, which is reported in EP 0 204597 to induce urination in cases of prostatic hyperplasia. Likewise, in WO 92/0073, the selective ability of the R(+) enantiomer of terazosin to bind to adrenergic receptors of the alphal subtype was reported. In addition, in WO 92/161213, 5 combinations of 5a-reductase inhibitory compounds and alphal adrenergic receptor blockers (terazosin, doxazosin, prazosin, bunazosin, indoramin, alfuzosin) were disclosed. However, no information as to the alpha ld, alpha lb, or alpha la subtype specificity of these compounds was provided as this data and its relevancy to the treatment 10 of BPH was not known. Current therapy for BPH uses existing non selective alpha 1 antagonists such as prazosin (Minipress, Pfizer), Terazosin (Hytrin, Abbott) or doxazosin mesylate (Cardura, Pfizer). These non-selective antagonists suffer from side effects related to antagonism of the alpha ld and alpha lb receptors in the peripheral 15 vasculature, e.g., hypotension and syncope. The recent cloning of the human alpha la adrenergic receptor (ATCC CRL 11140) and the use of a screening assay utilizing the cloned human alpha la receptor enables identification of compounds which specifically interact with the human alpha la adrenergic 20 receptor. [PCT International Application Publication Nos. WO94/08040, published 14 April 1994 and WO94/10989, published 26 May 1994] As disclosed in the instant patent disclosure, a cloned human alpha la adrenergic receptor and a method for identifying compounds which bind the human alpha la receptor has now made possible the identification of 25 selective human alpha la adrenergic receptor antagonists useful for treating BPH. The instant patent disclosure discloses novel compounds which selectively bind to the human alpha la receptor. These compounds are further tested for binding to other human alpha 1 receptor subtypes, as well as counterscreened against other types of 30 receptors (e.g., alpha 2), thus defining the specificity of the compounds of the present invention for the human alpha la adrenergic receptor. It is an object of the present invention to identify compounds which bind to the alpha la adrenergic receptor. It is a further object of the invention to identify compounds which act as antagonists of the 35 alpha la adrenergic receptor. It is another object of the invention to -4- WO 98/57642 PCT/US98/12678 identify alpha la adrenergic receptor antagonist compounds which are useful agents for treating BPH in animals, preferably mammals, especially humans. Still another object of the invention is to identify alpha la adrenergic receptor antagonists which are useful for relaxing 5 lower urinary tract tissue in animals, preferably mammals, especially humans. It has now been found that the compounds of the present invention are alpha la adrenergic receptor antagonists. Thus, the compounds of the present invention are useful for treating BPH in 10 mammals. Additionally, it has been found that the alpha la adrenergic receptor antagonists of the present invention are also useful for relaxing lower urinary tract tissue in mammals. SUMMARY OF THE INVENTION 15 The present invention provides compounds for the treatment of urinary obstruction caused by benign prostatic hyperplasia (BPH). The compounds antagonize the human alpha la adrenergic receptor at nanomolar and subnanomolar concentrations while exhibiting at least ten fold lower affinity for the alpha ld and alpha lb 20 human adrenergic receptors and many other G-protein coupled receptors. This invention has the advantage over non-selective alpha 1 adrenoceptor antagonists of reduced side effects related to peripheral adrenergic blockade. Such side effects include hypotension, syncope, lethargy, etc. The compounds of the present invention have the 25 structure:

R

1 6 M 2 R1s mO (nf ER q R2 R.N -N "C L jG R13 R'14 L wherein Q is selected from -5- WO 98/57642 PCT/US98/12678 (X)S (X)s (X)s N'R4 R8 R' R8 'N I 'N R9 N O0 N R 5 O O R 10 0 R H RioR (X)s (X)s O R1R12 N 'N 0 N R 11 O N H R12 H O (X)s

R

20 R18 -X) S NR' or R 5 N 'O H

R

1 is selected from unsubstituted, mono- or poly-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, NR 7

COR

1 9 , NR 7

CON(R

1 9 )2, 5 NR 7 SO2R 1 9 , NR 7 SO2N(R 1 9 )2, OR 6 , (CH2) 0

-

4 CO2R 7 , (CH2)o.- 4

CON(R

7 )2, or C1-4 alkyl; or unsubstituted, mono- or poly substituted pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl are independently selected 10 from CF3, cyano, nitro, amino, (CH2)o.- 4 CO2R 7 , (CH2)o0- 4

CON(R

7 )2, (CH2)o 4 SO2N(R 7 )2, (CH2)o- 4 SO2R 6 , phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; -6- WO 98/57642 PCT/US98/12678 E, G, L and M are each independently selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)o0- 4 0R 6 , (CH2)o- 4

N(R

7 )2, (CH2)o-4CN, (CH2)o0-4CF3, (CH2)0- 4 CO2R 7 , (CH2)o-4CON(R 7 )2, (CH2)0- 4 SO2R 7 , or (CH2)0- 4 SO2N(R 7 )2; 5 J is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1- 4 0R 6 , (CH2)1A-4N(R 7 )2, (CH2)1- 4 CN, (CH2)0-4CF3, (CH2)0-4CO2R 7 , (CH2)o- 4

CON(R

7 )2, (CH2)o0- 4 SO2R 7 , or (CH2)o- 4 SO2N(R 7 )2; 10 R 2 is independently selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl, (CH2)o0-4CO2R 7 , (CH2)0- 4

CON(R

7 )2, (CH2)0-.

4

COR

7 , (CH2) 2

-.

4 0R 6 , (CH2)1-4CF3, (CH2)o- 4 SO2R 7 , (CH2)0- 4 SO2N(R 7 )2 or (CH2)1 4CN; 15 R 3 , R 8 , R 9 , R 1 0 , R 1 4 , R 1 5 and R 1 6 are each independently selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2) 2

-.

4 0R 6 or (CH2)o0-4CF3;

R

4 is selected from hydrogen, (CH2)o.0-4COR 6 , (CH2)o-4CN, (CH2)0- 4 CF3, (CH2)o0-4CO2R 7 , (CH2)o.0-4CON(R 7 )2, (CH2)o0- 4 SO2R 6 , or 20 (CH2)0- 4 SO2N(R 7 )2;

R

5 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1- 4 0R 6 or (CH2)o- 4 CF3; 25 R 6 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl or (CH2)o0-4CF3;

R

7 and R 1 9 are each independently selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl or (CH2).1- 4 CF3; 30

R

1 1 and R 1 2 are each independently selected from hydrogen, C1-8 alkyl or C3-8 cycloalkyl;

R

1 3 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, 35 (CH2)2-40R 6 , OR 6 or (CH2)0-4CF3; -7- WO 98/57642 PCT/US98/12678

R

1 8 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1-40R 6 , (CH2)0-4CF3, unsubstituted, mono- or poly-substituted phenyl wherein the substituents on the phenyl are independently 5 selected from halogen, CF3, cyano, nitro, CO2R 7 , OR 6 , (CH2)0-4CON(R 7 )2, (CH2)0-4CO2R 7 or C1-4 alkyl; or unsubstituted, mono- or poly-substituted: pyridyl, pyrazinyl, thienyl, furanyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, furanyl or naphthyl are independently selected from CF3, phenyl, OR 6 , 10 halogen, C1-4 alkyl or C3-8 cycloalkyl;

R

2 0 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)o0- 4 0R 6 or (CH2)o- 4 CF3; 15 W is 0 or NR 1 1 ;

R

2 6 is selected from hydrogen or OR 2 8 ;

R

2 8 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2) 2

-

4 0R 6 20 or (CH2)0- 4 CF3; X is selected from halogen, cyano, nitro, C1-8 alkyl, C3-8 cycloalkyl, (CH2)o_40R 6 or (CH2)o04CF3 25 m, p and q are each independently an integer of from zero to three, provided that when q is zero, R 2 6 is hydrogen; n, o, s and t are each independently an integer of from zero to four; and the pharmaceutically acceptable salts thereof. 30 In a first embodiment of the invention are compounds having the structure -8- WO 98/57642 PCT/US98/12678 M 2 R15 1mO R'- n E R CR Rl- -i RN Q L G R wherein R 4 is selected from (CH2)o- 4 C0OR 6 , (CH2)o.- 4 CN, (CH2)o.- 4 CF3, (CH2)o- 4 CO2R 7 , (CH2)o.- 4

CON(R

7 )2, (CH2)o.0- 4 SO2R 6 , or (CH2)o 4 SO2N(R 7 )2; 5

R

1 3 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)2-40R 6 or (CH2)0-4CF3; and all other variables are as previously defined; and the 10 pharmaceutically acceptable salts thereof. In a second embodiment of the instant invention is the compound of the formula: R16 M 2 R15 m 0 n E q2

R

1 -N J G

R

1 3

R

14 L wherein Q is selected from -9- WO 98/57642 PCT/US98/12678 (Xs (Xs (Xs g 4 R8 R8 9 "N RN R N O N Rs O 0O R 10 H ' 0 R

R

2 18 or t

R

1 is selected from unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, NR 7

COR

19 , NR 7

CON(R

19 )2, 5 NR 7 SO2R 19 , NR 7 SO2N(R 19 )2, OR 6 , (CH2)0-4CO2R 7 , (CH2)0-4CON(R 7 )2, or C14 alkyl; or unsubstituted, mono-, di- or tri substituted pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl are independently selected 10 from CF3, cyano, nitro, amino, (CH2).0-4CO2R 7 , (CH2).0-4CON(R 7 )2, (CH2).0-4SO2N(R 7 )2, (CH2)0-4SO2R 6 , phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; E, G, L, M and J are each independently selected from hydrogen, 15 C1-8 alkyl, C3-8 cycloalkyl, or (CH2)0-4CF3;

R

2 is selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl or (CH2)1-4CF3; 20 R 3 , R 8 , R 9 , R 10 , R 14 , R 15 and R 16 are each independently selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2) 2

-.

4 0R 6 or (CH2)o.- 4 CF3; - 10- WO 98/57642 PCT/US98/12678

R

13 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)2-40R 6 , OR 6 or (CH2)0-4CF3; 5 R 18 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1-4OR 6 , (CH2)0-4CF3, unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, CO2R 7 , OR 6 , (CH2)0 4CON(R 7 )2, (CH2)0-4CO2R 7 or C1-4 alkyl; or unsubstituted, mono-, di- or 10 tri-substituted: pyridyl, pyrazinyl, thienyl, furanyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, furanyl or naphthyl are independently selected from CF3, phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; and 15 R 2 0 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)o.0- 4 0R 6 or (CH2)0- 4 CF3;

R

2 8 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)2-40R 6 or (CH2)0-4CF3; 20 m, n and p are each independently an integer from zero to two, provided that when q is zero, R 28 is hydrogen; and all other variables are as originally defined; 25 and the pharmaceutically acceptable salts thereof. In a third embodiment of the instant invention is the compound of the formula: M 2 R mO ,(- ..g wherein Q is selected from -N R11 JI P G R1 R 14 wherein Q is selected from WO 98/57642 PCT/US98/12678 (X)s (X)s (X)s 's_ I I -I _ NR1 9 dNYI N N R N R O N Rs O O R 10 , O H ' R9 RN18 or -" (X)s or t

R

1 is selected from unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, NR 7

COR

19 , NR 7

CON(R

19 )2, 5 NR 7 SO2R 19 , NR 7 SO2N(R1 9 )2, OR 6 , (CH2)0-4CO2R 7 , (CH2)0-4CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono-, di- or tri substituted pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl are independently selected 10 from CF3, cyano, nitro, amino, (CH2)0-4CO2R 7 , (CH2)0-4CON(R 7 )2, (CH2)0-4SO2N(R 7 )2, (CH2)0-4SO2R 6 , phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; E, G, L, M and J are each independently selected from hydrogen, 15 C1-8 alkyl, C3-8 cycloalkyl, or (CH2)0-4CF3;

R

2 is selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl or (CH2)1-4CF3; 20 R 3 , R 8 , R 9 , R 10 , R 13 , R 14 , R 15 and R 16 are each independently selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2) 2 4 0R 6 or (CH2)o0-4CF3;

R

18 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, - 12- WO 98/57642 PCT/US98/12678 (CH2)1-40R 6 , (CH2)0-4CF3, unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, CO2R 7 , OR 6 , (CH2)0 4CON(R 7 )2, (CH2)0-4CO2R 7 or C1-4 alkyl; or unsubstituted, mono-, di- or 5 tri-substituted: pyridyl, pyrazinyl, thienyl, furanyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, furanyl or naphthyl are independently selected from CF3, phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; and 10 R 2 0 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)o.0-40R 6 or (CH2)0- 4 CF3; m, n and p are each independently an integer from zero to two; and all other variables are as defined previously in the first embodiment; 15 and the pharmaceutically acceptable salts thereof. In a first class of the invention is the compound of the formula R 2 26 mO

R

1

-

N -(C H 2 N R 13 p wherein Q is selected from (X)s (X)s N R4 _N (XR8 S O N R O O 0 or H R 20 H

R

1 is selected from unsubstituted, mono-, di or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, OR 6 , (CH2)0-2CO2R 7 , - 13 - WO 98/57642 PCT/US98/12678 (CH2)0-.2CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono- or di substituted pyridyl wherein the substituents are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; 5

R

2 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-4CF3;

R

4 is selected from hydrogen, COR 6 , (CH2)0-2CO2R 7 , SO2R 6 or 10 (CH2)0-2CON(R 7 )2;

R

5 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)1-30R 6 or (CH2)0-3CF3; and 15 R 6 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl or (CH2)0-2CF3;

R

7 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-2CF3; 20

R

1 3 is selected from hydrogen or OR 6 ;

R

1 8 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)2-40R 6 , (CH2)0-2CF3 or unsubstituted, mono- or di-substituted 25 phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 ,

CON(R

7 )2 or 01-4 alkyl;

R

2 6 is selected from hydrogen or OR 2 8 , wherein R 2 8 is selected from 30 hydrogen or C1-6 alkyl; m, n and p are each independently an integer from zero to one; and t is an integer from one to two; -14- WO 98/57642 PCT/US98/12678 and all other variables are as defined previously in the second embodiment; and the pharmaceutically acceptable salts thereof. In a second class of the invention is the compound of the 5 formula R2 mO 0 N Q Rl-N CH2/ N wherein Q is selected from (X)s (X) N N4--H R 18 (Xs O N R O O or t\ H

R

1 is selected from unsubstituted, mono-, di or tri-substituted phenyl 10 wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, OR 6 , (CH2)0-2CO2R 7 , (CH2)0-2CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono- or di substituted pyridyl wherein the substituents are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 15 alkyl;

R

2 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-4CF3; 20 R 4 is selected from COR 6 , (CH2)0-2CO2R 7 , SO2R 6 or (CH2)0-2CON(R 7 )2;

R

5 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)1-30R 6 or (CH2)0-3CF3; and - 15 - WO 98/57642 PCT/US98/12678

R

6 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl or (CH2)0-2CF3; 5 R 7 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-2CF3;

R

1 8 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)2-40R 6 , (CH2)0-2CF3 or unsubstituted, mono- or di-substituted 10 phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 ,

CON(R

7 )2 or C1-4 alkyl; m, n and p are each independently an integer from zero to one; 15 t is an integer from one to two; and all other variables are as defined previously in the third embodiment; and the pharmaceutically acceptable salts thereof. In a first subclass of the invention is the compound of the 20 formula

R

1 7 ) r N2 NN A 2Q 0 wherein A is C-R 1 7 or N;

R

2 is selected from hydrogen or CH2CF3; 25

R

1 3 is selected from hydrogen or hydroxy; each R 1 7 is independently selected from hydrogen, halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; - 16- WO 98/57642 PCT/US98/12678

R

2 6 is selected from hydrogen or hydroxy; each X is halogen; 5 q and r are each independently an integer from zero to two, provided that when q is zero, R 2 6 is hydrogen; and s is an integer from zero to three; and all other variables are as previously defined in the first class; 10 and the pharmaceutically acceptable salts thereof. In a second subclass of the invention is the compound of the formula

(

1 7 r q 26 NN A R 2 Q 0 wherein A is C-R 1 7 or N; 15

R

2 is selected from hydrogen or CH2CF3; each R 1 7 is independently selected from hydrogen, halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; 20 each X is halogen; q and r are each independently an integer from zero to two; and s is an integer from zero to three; 25 and all other variables are as previously defined in the second class; and the pharmaceutically acceptable salts thereof. Illustrative of the invention is the compound selected from - 17- WO 98/57642 PCT/US98/12678 CN H N N O N a H N N

O

O 0 or F F CN 0 F F and the pharmaceutically acceptable salts thereof. An illustration of the invention is a pharmaceutical 5 composition comprising a therapeutically effective amount of any of the compounds described above and a pharmaceutically acceptable carrier. An example of the invention is a pharmaceutical composition made by combining any of the compounds described above and a pharmaceutically acceptable carrier. Another illustration of the 10 invention is a process for making a pharmaceutical composition comprising combining any of the compounds described above and a pharmaceutically acceptable carrier. Another example of the invention is the composition further comprising a therapeutically effective amount of a testosterone 5-alpha 15 reductase inhibitor. Preferably, the testosterone 5-alpha reductase inhibitor is a type 1, a type 2, both a type 1 and a type 2 (i.e., a three - 18- WO 98/57642 PCT/US98/12678 component combination comprising any of the compounds described above combined with both a type 1 testosterone 5-alpha reductase inhibitor and a type 2 testosterone 5-alpha reductase inhibitor) or a dual type 1 and type 2 testosterone 5-alpha reductase inhibitor. More 5 preferably, the testosterone 5-alpha reductase inhibitor is a type 2 testosterone 5-alpha reductase inhibitor. Most preferably, the testosterone 5-alpha reductase inhibitor is finasteride. More specifically illustrating the invention is a method of treating benign prostatic hyperplasia in a subject in need thereof which 10 comprises administering to the subject a therapeutically effective amount of any of the compounds (or any of the compositions) described above. Further exemplifying the invention is the method of treating BPH wherein the compound (or composition) additionally does 15 not cause a fall in blood pressure at dosages effective to alleviate BPH. Another illustration of the invention is the method of treating benign prostatic hyperplasia wherein the compound is administered in combination with a testosterone 5-alpha reductase inhibitor. Preferably, the testosterone 5-alpha reductase inhibitor is 20 finasteride. Further illustrating the invention is a method of inhibiting contraction of prostate tissue or relaxing lower urinary tract tissue in a subject in need thereof which comprises administering to the subject a therapeutically effective amount of any of the compounds (or any of the 25 compositions) described above. More specifically exemplifying the invention is the method of inhibiting contraction of prostate tissue or relaxing lower urinary tract tissue wherein the compound (or composition) additionally does not cause a fall in blood pressures at dosages effective to inhibit contraction 30 of prostate tissue. More particularly illustrating the invention is the method of inhibiting contraction of prostate tissue or relaxing lower urinary tract tissue wherein the compound (or composition) is administered in combination with a testosterone 5-alpha reductase inhibitor; preferably, 35 the testosterone 5-alpha reductase inhibitor is finasteride. - 19- WO 98/57642 PCT/US98/12678 More particularly exemplifying the invention is a method of treating a disease which is susceptible to treatment by antagonism of the alpha la receptor which comprises administering to a subject in need thereof an amount of any of the compounds described above effective to 5 treat the disease. Diseases which are susceptible to treatment by antagonism of the alpha la receptor include, but are not limited to, BPH, high intraocular pressure, high cholesterol, impotency, sympathetically mediated pain, migraine (see, K.A. Vatz, Headache 1997:37: 107-108) and cardiac arrhythmia. 10 An additional illustration of the invention is the use of any of the compounds described above in the preparation of a medicament for: a) the treatment of benign prostatic hyperplasia; b) relaxing lower urinary tract tissue; or c) inhibiting contraction of prostate tissue; in a subject in need thereof. 15 An additional example of the invention is the use of any of the alpha la antagonist compounds described above and a 5-alpha reductase inhibitor for the manufacture of a medicament for: a) treating benign prostatic hyperplasia; b) relaxing lower urinary tract tissue; or c) inhibiting contraction of prostate tissue which comprises an effective 20 amount of the alpha la antagonist compound and an effective amount of 5-alpha reductase inhibitor, together or separately. DETAILED DESCRIPTION OF THE INVENTION Representative compounds of the present invention exhibit 25 high selectivity for the human alpha la adrenergic receptor. One implication of this selectivity is that these compounds display selectivity for lowering intraurethral pressure without substantially affecting diastolic blood pressure. Representative compounds of this invention display 30 submicromolar affinity for the human alpha la adrenergic receptor subtype while displaying at least ten-fold lower affinity for the human alphald and alphalb adrenergic receptor subtypes, and many other G protein coupled human receptors. Particular representative compounds of this invention exhibit nanomolar and subnanomolar affinity for the 35 human alpha la adrenergic receptor subtype while displaying at least 30 -20- WO 98/57642 PCT/US98/12678 fold lower affinity for the human alphald and alphalb adrenergic receptor subtypes, and many other G-protein coupled human receptors (e.g., serotonin, dopamine, alpha 2 adrenergic, beta adrenergic or muscarinic receptors). 5 These compounds are administered in dosages effective to antagonize the alpha la receptor where such treatment is needed, as in BPH. For use in medicine, the salts of the compounds of this invention refer to non-toxic "pharmaceutically acceptable salts." Other salts may, however, be useful in the preparation of the compounds according to the 10 invention or of their pharmaceutically acceptable salts. Suitable pharmaceutically acceptable salts of the compounds of this invention include acid addition salts which may, for example, be formed by mixing a solution of the compound according to the invention with a solution of a pharmaceutically acceptable acid such as hydrochloric 15 acid, sulphuric acid, fumaric acid, maleic acid, succinic acid, acetic acid, benzoic acid, citric acid, tartaric acid, carbonic acid or phosphoric acid. Furthermore, where the compounds of the invention carry an acidic moiety, suitable pharmaceutically acceptable salts thereof may include alkali metal salts, e.g. sodium or potassium salts; alkaline 20 earth metal salts, e.g. calcium or magnesium salts; and salts formed with suitable organic ligands, e.g. quaternary ammonium salts. Thus, representative pharmaceutically acceptable salts include the following: Acetate, Benzenesulfonate, Benzoate, Bicarbonate, Bisulfate, Bitartrate, Borate, Bromide, Calcium, Camsylate, Carbonate, 25 Chloride, Clavulanate, Citrate, Dihydrochloride, Edetate, Edisylate, Estolate, Esylate, Fumarate, Gluceptate, Gluconate, Glutamate, Glycollylarsanilate, Hexylresorcinate, Hydrabamine, Hydrobromide, Hydrochloride, Hydroxynaphthoate, Iodide, Isothionate, Lactate, Lactobionate, Laurate, Malate, Maleate, Mandelate, Mesylate, 30 Methylbromide, Methylnitrate, Methylsulfate, Mucate, Napsylate, Nitrate, N-methylglucamine ammonium salt, Oleate, Pamoate (Embonate), Palmitate, Pantothenate, Phosphate/diphosphate, Polygalacturonate, Salicylate, Stearate, Sulfate, Subacetate, Succinate, Tannate, Tartrate, Teoclate, Tosylate, Triethiodide and Valerate. -21- WO 98/57642 PCT/US98/12678 Compounds of this invention are used to reduce the acute symptoms of BPH. Thus, compounds of this invention may be used alone or in conjunction with a more long-term anti-BPH therapeutics, such as testosterone 5-a reductase inhibitors, including PROSCAR® 5 (finasteride). Aside from their utility as anti-BPH agents, these compounds may be used to induce highly tissue-specific, localized alpha la adrenergic receptor blockade whenever this is desired. Effects of this blockade include reduction of intra-ocular pressure, control of cardiac arrhythmias, and possibly a host of alpha la receptor mediated central 10 nervous system events. The present invention includes within its scope prodrugs of the compounds of this invention. In general, such prodrugs will be functional derivatives of the compounds of this invention which are readily convertible in vivo into the required compound. Thus, in the 15 methods of treatment of the present invention, the term "administering" shall encompass the treatment of the various conditions described with the compound specifically disclosed or with a compound which may not be specifically disclosed, but which converts to the specified compound in vivo after administration to the patient. Conventional procedures for the 20 selection and preparation of suitable prodrug derivatives are described, for example, in "Design of Prodrugs," ed. H. Bundgaard, Elsevier, 1985. Metabolites of these compounds include active species produced upon introduction of compounds of this invention into the biological milieu. Where the compounds according to the invention have at 25 least one chiral center, they may accordingly exist as enantiomers. Where the compounds according to the invention possess two or more chiral centers, they may additionally exist as diastereoisomers. It is to be understood that all such isomers and mixtures thereof are encompassed within the scope of the present invention. Furthermore, 30 some of the crystalline forms for compounds of the present invention may exist as polymorphs and as such are intended to be included in the present invention. In addition, some of the compounds of the present invention may form solvates with water (i.e., hydrates) or common organic solvents. Such solvates are also encompassed within the scope 35 of this invention. -22- WO 98/57642 PCT/US98/12678 The term "alkyl" shall mean straight or branched chain alkanes of one to ten total carbon atoms, or any number within this range (i.e., methyl, ethyl, 1-propyl, 2-propyl, n-butyl, s-butyl, t-butyl, etc.). 5 The term "alkenyl" shall mean straight or branched chain alkenes of two to ten total carbon atoms, or any number within this range. The term "aryl" as used herein, except where otherwise specifically defined, refers to unsubstituted, mono- or poly-substituted 10 aromatic groups such as phenyl or naphthyl. The term "cycloalkyl" shall mean cyclic rings of alkanes of three to eight total carbon atoms (i.e., cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl or cyclooctyl). Whenever the term "alkyl" or "aryl" or either of their prefix 15 roots appear in a name of a substituent (e.g., aralkoxyaryloxy) it shall be interpreted as including those limitations given above for "alkyl" and "aryl." Designated numbers of carbon atoms (e.g., C1-10) shall refer independently to the number of carbon atoms in an alkyl or cyclic alkyl moiety or to the alkyl portion of a larger substituent in which alkyl 20 appears as its prefix root. The term "halogen" shall include iodine, bromine, chlorine and fluorine. The term "substituted" shall be deemed to include multiple degrees of substitution by a named substituent. The term "poly 25 substituted" as used herein shall include di-, tri-, tetra- and penta substitution by a named substituent. Preferably, a poly-substituted moiety is di-, tri- or tetra-substituted by the named substituents, most preferably, di- or tri-substituted. It is intended that the definition of any substituent or 30 variable (e.g., X, R 6 , R 7 , R 19 ) at a particular location in a molecule be independent of its definitions elsewhere in that molecule. Thus, N(R 19 )2 represents -NH2, -NHCH3, -NHC2H5, -N(CH3)C2H5, etc. It is understood that substituents and substitution patterns on the compounds of the instant invention can be selected by one of ordinary 35 skill in the art to provide compounds that are chemically stable and that -23- WO 98/57642 PCT/US98/12678 can be readily synthesized by techniques known in the art as well as those methods set forth below. Where multiple substituent moieties are disclosed or claimed, the substituted compound can be independently substituted by 5 one or more of the disclosed or claimed substituent moieties, singly or plurally. The term heterocycle or heterocyclic ring, as used herein, represents an unsubstituted or substituted stable 5- to 7-membered monocyclic ring system which may be saturated or unsaturated, and 10 which consists of carbon atoms and from one to three heteroatoms selected from N, O or S, and wherein the nitrogen and sulfur heteroatoms may optionally be oxidized, and the nitrogen heteroatom may optionally be quaternized. The heterocyclic ring may be attached at any heteroatom or carbon atom which results in the creation of a stable 15 structure. Examples of such heterocyclic groups include, but is not limited to, piperidinyl, piperazinyl, oxopiperazinyl, oxopiperidinyl, oxopyrrolidinyl, oxoazepinyl, azepinyl, pyrrolyl, pyrrolidinyl, furanyl, thienyl, pyrazolyl, pyrazolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyridyl, pyrazinyl, pyrimidinyl, pyridazinyl, oxazolyl, 20 oxazolidinyl, isooxazolyl, isoxazolidinyl, morpholinyl, thiazolyl, thiazolidinyl, isothiazolyl, thiadiazolyl, tetrahydropyranyl, thiamorpholinyl, thiamorpholinyl sulfoxide, thiamorpholinyl sulfone, and oxadiazolyl. Morpholino is the same as morpholinyl. The terms "(+)-DHP" and "DHP" as used herein, refers to a 25 dihydropyrimidinone group of the formula (X)q 07 O N Rs H for example: -24- WO 98/57642 PCT/US98/12678 F F O O N O oil , H The term "activated (+)-DHP," as used herein, refers to a N 3-(activated)carbamate of the desired dihydropyrimidinone where the activated group is, for example, a p-nitrophenyl group. A specific 5 example of an activated (+)-DHP is the compound 6 (see, e.g., Scheme 3). The term "(S)-oxa" as used herein, refers to an oxazolidinone group of the formula (X)q 0 R 9 R1 o 0 No 0 for example, F F 0 N 10 O The term "activated (S)-oxa" as used herein, refers to an N (activated)carbamate of the desired oxazolidinone where the activated -25- WO 98/57642 PCT/US98/12678 group is, for example, a p-nitrophenyl group. A specific example of an activated (S)-oxa group is the compound 13 (see, e.g., Scheme 4). The term "thienyl," as used herein, refers to the group S 5 The term "selective alpha la adrenergic receptor antagonist," as used herein, refers to an alpha la antagonist compound which is at least ten fold selective for the human alpha la adrenergic receptor as compared to the human alpha lb, alpha ld, alpha 2a, alpha 2b and alpha 2c adrenergic receptors. 10 The term "lower urinary tract tissue," as used herein, refers to and includes, but is not limited to, prostatic smooth muscle, the prostatic capsule, the urethra and the bladder neck. The term "subject," as used herein refers to an animal, preferably a mammal, most preferably a human, who has been the 15 object of treatment, observation or experiment. The term "therapeutically effective amount" as used herein means that amount of active compound or pharmaceutical agent that elicits the biological or medicinal response in a tissue, system, animal or human that is being sought by a researcher, 20 veterinarian, medical doctor or other clinician, which includes alleviation of the symptoms of the disease being treated. The present invention also provides pharmaceutical compositions comprising one or more compounds of this invention in association with a pharmaceutically acceptable carrier. Preferably 25 these compositions are in unit dosage forms such as tablets, pills, capsules, powders, granules, sterile parenteral solutions or suspensions, metered aerosol or liquid sprays, drops, ampoules, auto injector devices or suppositories; for oral, parenteral, intranasal, sublingual or rectal administration, or for administration by inhalation 30 or insufflation. Alternatively, the compositions may be presented in a form suitable for once-weekly or once-monthly administration; for example, an insoluble salt of the active compound, such as the -26- WO 98/57642 PCT/US98/12678 decanoate salt, may be adapted to provide a depot preparation for intramuscular injection. For preparing solid compositions such as tablets, the principal active ingredient is mixed with a pharmaceutical carrier, e.g. conventional tableting ingredients such as corn starch, 5 lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium phosphate or gums, and other pharmaceutical diluents, e.g. water, to form a solid preformulation composition containing a homogeneous mixture of a compound of the present invention, or a pharmaceutically acceptable salt thereof. When referring to these 10 preformulation compositions as homogeneous, it is meant that the active ingredient is dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms such as tablets, pills and capsules. This solid preformulation composition is then subdivided into unit dosage forms of 15 the type described above containing from 0.1 to about 500 mg of the active ingredient of the present invention. The tablets or pills of the novel composition can be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action. For example, the tablet or pill can comprise an inner dosage and an outer dosage 20 component, the latter being in the form of an envelope over the former. The two components can be separated by an enteric layer which serves to resist disintegration in the stomach and permits the inner component to pass intact into the duodenum or to be delayed in release. A variety of materials can be used for such enteric layers or coatings, such 25 materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol and cellulose acetate. As used herein, the term "composition" is intended to encompass a product comprising the specified ingredients in the 30 specified amounts, as well as any product which results, directly or indirectly, from combination of the specified ingredients in the specified amounts. The liquid forms in which the novel compositions of the present invention may be incorporated for administration orally or by 35 injection include aqueous solutions, suitably flavoured syrups, aqueous -27- WO 98/57642 PCT/US98/12678 or oil suspensions, and flavoured emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil or peanut oil, as well as elixirs and similar pharmaceutical vehicles. Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums 5 such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin. Where the processes for the preparation of the compounds according to the invention give rise to mixtures of stereoisomers, these 10 isomers may be separated by conventional techniques such as preparative chromatography. The compounds may be prepared in racemic form, or individual enantiomers may be prepared either by enantiospecific synthesis or by resolution. The compounds may, for example, be resolved into their component enantiomers by standard 15 techniques, such as the formation of diastereomeric pairs by salt formation with an optically active acid, such as (-)-di-p-toluoyl-d-tartaric acid and/or (+)-di-p-toluoyl-l-tartaric acid followed by fractional crystallization and regeneration of the free base. The compounds may also be resolved by formation of diastereomeric esters or amides, 20 followed by chromatographic separation and removal of the chiral auxiliary. Alternatively, the compounds may be resolved using a chiral HPLC column. During any of the processes for preparation of the compounds of the present invention, it may be necessary and/or 25 desirable to protect sensitive or reactive groups on any of the molecules concerned. This may be achieved by means of conventional protecting groups, such as those described in Protective Groups in Organic Chemistry, ed. J.F.W. McOmie, Plenum Press, 1973; and T.W. Greene & P.G.M. Wuts, Protective Grous in Organic Synthesis, John Wiley & 30 Sons, 1991. The protecting groups may be removed at a convenient subsequent stage using methods known from the art. The specificity of binding of compounds showing affinity for the alpha la receptor is shown by comparing affinity to membranes obtained from tranfected cell lines that express the alpha la receptor 35 and membranes from cell lines or tissues known to express other types -28 - WO 98/57642 PCT/US98/12678 of alpha (e.g., alpha Id, alpha lb) or beta adrenergic receptors. Expression of the cloned human alpha ld, alpha lb, and alpha la receptors and comparison of their binding properties with known selective antagonists provides a rational way for selection of compounds 5 and discovery of new compounds with predictable pharmacological activities. Antagonism by these compounds of the human alpha la adrenergic receptor subtype may be functionally demonstrated in anesthetized animals. These compounds may be used to increase urine flow without exhibiting hypotensive effects. 10 The ability of compounds of the present invention to specifically bind to the alpha la receptor makes them useful for the treatment of BPH. The specificity of binding of compounds showing affinity for the alpha la receptor is compared against the binding affinities to other types of alpha or beta adrenergic receptors. The 15 human alpha adrenergic receptor of the la subtype was recently identified, cloned and expressed as described in PCT International Application Publication Nos. WO94/08040, published 14 April 1994 and WO 94/21660, published 29 September 1994. The cloned human alpha la receptor, when expressed in mammalian cell lines, is used to discover 20 ligands that bind to the receptor and alter its function. Expression of the cloned human alpha ld, alpha lb, and alpha la receptors and comparison of their binding properties with known selective antagonists provides a rational way for selection of compounds and discovery of new compounds with predictable pharmacological activities. 25 Compounds of this invention exhibiting human alpha la adrenergic receptor antagonism may further be defined by counterscreening. This is accomplished according to methods known in the art using other receptors responsible for mediating diverse biological functions. See ex. PCT International Application Publication No. 30 WO94/10989, published 26 May 1994; U.S. Patent No. 5,403,847, issued April 4, 1995]. Compounds which are both selective amongst the various human alphal adrenergic receptor subtypes and which have low affinity for other receptors, such as the alpha2 adrenergic receptors, the B adrenergic receptors, the muscarinic receptors, the serotonin receptors, 35 and others are particularly preferred. The absence of these non-specific -29- WO 98/57642 PCT/US98/12678 activities may be confirmed by using cloned and expressed receptors in an analogous fashion to the method disclosed herein for identifying compounds which have high affinity for the various human alphal adrenergic receptors. Furthermore, functional biological tests are used 5 to confirm the effects of identified compounds as alpha la adrenergic receptor antagonists. The present invention also has the objective of providing suitable topical, oral, systemic and parenteral pharmaceutical formulations for use in the novel methods of treatment of the present 10 invention. The compositions containing compounds of this invention as the active ingredient for use in the specific antagonism of human alpha la adrenergic receptors can be administered in a wide variety of therapeutic dosage forms in conventional vehicles for systemic administration. For example, the compounds can be administered 15 in such oral dosage forms as tablets, capsules (each including timed release and sustained release formulations), pills, powders, granules, elixirs, tinctures, solutions, suspensions, syrups and emulsions, or by injection. Likewise, they may also be administered in intravenous (both bolus and infusion), intraperitoneal, 20 subcutaneous, topical with or without occlusion, or intramuscular form, all using forms well known to those of ordinary skill in the pharmaceutical arts. An effective but non-toxic amount of the compound desired can be employed as an alpha la antagonistic agent. 25 Advantageously, compounds of the present invention may be administered in a single daily dose, or the total daily dosage may be administered in divided doses of two, three or four times daily. Furthermore, compounds for the present invention can be administered in intranasal form via topical use of suitable intranasal 30 vehicles, or via transdermal routes, using those forms of transdermal skin patches well known to those of ordinary skill in that art. To be administered in the form of a transdermal delivery system, the dosage administration will, of course, be continuous rather than intermittent throughout the dosage regimen. -30- WO 98/57642 PCT/US98/12678 The dosage regimen utilizing the compounds of the present invention is selected in accordance with a variety of factors including type, species, age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of 5 administration; the renal and hepatic function of the patient; and the particular compound thereof employed. A physician or veterinarian of ordinary skill can readily determine and prescribe the effective amount of the drug required to prevent, counter or arrest the progress of the condition. Optimal precision in achieving 10 concentration of drug within the range that yields efficacy without toxicity requires a regimen based on the kinetics of the drug's availability to target sites. This involves a consideration of the distribution, equilibrium, and elimination of a drug. In the methods of the present invention, the compounds 15 herein described in detail can form the active ingredient, and are typically administered in admixture with suitable pharmaceutical diluents, excipients or carriers (collectively referred to herein as "carrier" materials) suitably selected with respect to the intended form of administration, that is, oral tablets, capsules, elixirs, syrups 20 and the like, and consistent with conventional pharmaceutical practices. For instance, for oral administration in the form of a tablet or capsule, the active drug component can be combined with an oral, non-toxic pharmaceutically acceptable inert carrier such as 25 ethanol, glycerol, water and the like. Moreover, when desired or necessary, suitable binders, lubricants, disintegrating agents and coloring agents can also be incorporated into the mixture. Suitable binders include, without limitation, starch, gelatin, natural sugars such as glucose or beta-lactose, corn sweeteners, natural and 30 synthetic gums such as acacia, tragacanth or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes and the like. Lubricants used in these dosage forms include, without limitation, sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride and the like. -31- WO 98/57642 PCT/US98/12678 Disintegrators include, without limitation, starch, methyl cellulose, agar, bentonite, xanthan gum and the like. The liquid forms in suitably flavored suspending or dispersing agents such as the synthetic and natural gums, for example, 5 tragacanth, acacia, methyl-cellulose and the like. Other dispersing agents which may be employed include glycerin and the like. For parenteral administration, sterile suspensions and solutions are desired. Isotonic preparations which generally contain suitable preservatives are employed when intravenous administration is desired. 10 The compounds of the present invention can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamellar vesicles and multilamellar vesicles. Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine or phosphatidylcholines. 15 Compounds of the present invention may also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled. The compounds of the present invention may also be coupled with soluble polymers as targetable drug carriers. Such polymers can include polyvinyl 20 pyrrolidone, pyran copolymer, polyhydroxypropylmethacryl amidephenol, polyhydroxy-ethylaspartamidephenol, or polyethyl eneoxidepolylysine substituted with palmitoyl residues. Furthermore, the compounds of the present invention may be coupled to a class of biodegradable polymers useful in achieving 25 controlled release of a drug, for example, polylactic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydro-pyrans, polycyanoacrylates and cross-linked or amphipathic block copolymers of hydrogels. Compounds of this invention may be administered in 30 any of the foregoing compositions and according to dosage regimens established in the art whenever specific blockade of the human alpha la adrenergic receptor is required. The daily dosage of the products may be varied over a wide range from 0.01 to 1,000 mg per adult human per day. For oral 35 administration, the compositions are preferably provided in the form of -32- WO 98/57642 PCT/US98/12678 tablets containing 0.01, 0.05, 0.1, 0.5, 1.0, 2.5, 5.0, 10.0, 15.0, 25.0, 50.0 and 100 milligrams of the active ingredient for the symptomatic adjustment of the dosage to the patient to be treated. A medicament typically contains from about 0.01 mg to about 500 mg of the active ingredient, 5 preferably, from about 1 mg to about 100 mg of active ingredient. An effective amount of the drug is ordinarily supplied at a dosage level of from about 0.0002 mg/kg to about 25 mg/kg of body weight per day. Preferably, the range is from about 0.001 to 10 mg/kg of body weight per day, and especially from about 0.001 mg/kg to 7 mg/kg of body weight per 10 day. The compounds may be administered on a regimen of 1 to 4 times per day. Compounds of this patent disclosure may be used alone at appropriate dosages defined by routine testing in order to obtain optimal antagonism of the human alpha la adrenergic receptor while 15 minimizing any potential toxicity. In addition, co-administration or sequential administration of other agents which alleviate the effects of BPH is desirable. Thus, in one embodiment, this includes administration of compounds of this invention and a human testosterone 5-a reductase inhibitor. Included with this embodiment are 20 inhibitors of 5-alpha reductase isoenzyme 2. Many such compounds are now well known in the art and include such compounds as PROSCAR@, (also known as finasteride, a 4-Aza-steroid; see US Patents 4,377,584 and 4,760,071, for example). In addition to PROSCAR@, which is principally active in prostatic tissue due to its selectivity for human 5 25 a reductase isozyme 2, combinations of compounds which are specifically active in inhibiting testosterone 5-alpha reductase isozyme 1 and compounds which act as dual inhibitors of both isozymes 1 and 2, are useful in combination with compounds of this invention. Compounds that are active as 5a-reductase inhibitors have been 30 described in WO93/23420, EP 0572166; WO 93/23050; WO93/23038,; WO93/23048; WO93/23041; WO93/23040; W093/23039; WO93/23376; WO93/23419, EP 0572165; WO93/23051. The dosages of the alpha la adrenergic receptor and testosterone 5-alpha reductase inhibitors are adjusted when 35 combined to achieve desired effects. As those skilled in the art will -33 - WO 98/57642 PCT/US98/12678 appreciate, dosages of the 5-alpha reductase inhibitor and the alpha la adrenergic receptor antagonist may be independently optimized and combined to achieve a synergistic result wherein the pathology is reduced more than it would be if either agent were used alone. In 5 accordance with the method of the present invention, the individual components of the combination can be administered separately at different times during the course of therapy or concurrently in divided or single combination forms. The instant invention is therefore to be understood as embracing all such regimes of 10 simultaneous or alternating treatment and the term "administering" is to be interpreted accordingly. Thus, in one preferred embodiment of the present invention, a method of treating BPH is provided which comprises administering to a subject in need of treatment any of the compounds 15 of the present invention in combination with finasteride effective to treat BPH. The dosage of finasteride administered to the subject is about 0.01 mg per subject per day to about 50 mg per subject per day in combination with an alpha la antagonist. Preferably, the dosage of finasteride in the combination is about 0.2 mg per subject per day to 20 about 10 mg per subject per day, more preferably, about 1 to about 7 mg per subject to day, most preferably, about 5 mg per subject per day. For the treatment of benign prostatic hyperplasia, compounds of this invention exhibiting alpha la adrenergic receptor 25 blockade can be combined with a therapeutically effective amount of a 5a-reductase 2 inhibitor, such as finasteride, in addition to a 5a reductase 1 inhibitor, such as 4,78-dimethyl-4-aza-5a-cholestan-3 one, in a single oral, systemic, or parenteral pharmaceutical dosage formulation. Alternatively, a combined therapy can be employed 30 wherein the alpha la adrenergic receptor antagonist and the 5a reductase 1 or 2 inhibitor are administered in separate oral, systemic, or parenteral dosage formulations. See, e.g., U.S. Patent No.'s 4,377,584 and 4,760,071 which describe dosages and formulations for 5a-reductase inhibitors. -34- WO 98/57642 PCT/US98/12678 Abbreviations used in the instant specification, particularly the Schemes and Examples, are as follows: AcOH or HOAc = acetic acid 5 BCE = bromochloroethane BINAP = 2,2'-bis(diphenylphosphino)-1,1'-binaphthyl Bn = benzyl Boc or BOC = t-butyloxycarbonyl BOPC1 = bis(2-oxo-3-oxazolidinyl)phosphinic chloride 10 Cbz-C1 = benzyloxycarbonyl chloride dba = dibenzylideneacetone DEAD = diethylazodicarboxylate DIBAL = diisobutylaluminum hydride DMF = N,N-dimethylformamide 15 DMSO = dimethylsulfoxide EDCI = 1-(3-dimethylaminopropyl)-3-ethylcarbodimide hydrochloride Et = ethyl Et3N = triethylamine 20 EtOAc = ethyl acetate EtOH = ethanol FABLRMS = fast atom bombardment low resolution mass spectroscopy HPLC = high performance liquid chromatography 25 HOAc = acetic acid HOBt = 1-hydroxy benzotriazole hydrate i-PrOH = 2-propanol i-Pr2NEt = diisopropylethylamine LAH = lithium aluminum hydride 30 mCPBA = meta-chloroperbenzoic acid Me = methyl MeOH = methanol NMR = nuclear magnetic resonance PCTLC = preparative centrifugal thin layer 35 chromatography -35 - WO 98/57642 PCT/US98/12678 PEI = polyethylenimine Ph = phenyl RT = retention time tBu = tertiary butyl 5 TEBAC = benzyltriethylammonium chloride TFA = trifluoroacetic acid THF = tetrahydrofuran TLC = thin layer chromatography TMS = trimethylsilyl 10 The compounds of the present invention can be prepared readily according to the following reaction schemes and examples, or modifications thereof, using readily available starting materials, reagents and conventional synthesis procedures. In these reactions, it 15 is also possible to make use of variants which are themselves known to those of ordinary skill in this art, but are not mentioned in greater detail. Unless otherwise indicated, all variables are as defined above. The preparation of key intermediates for the compounds of the present invention was accomplished via either Pd mediated coupling 20 reactions or direct nucleophilic displacement as outlined in Schemes 1 and 2. The products, for instance, 4-(ketalized) oxo or 4-hydroxy piperidines were converted to their corresponding piperidone derivatives either by acid catalyzed deketalization or Swern oxidation, respectively. The resulting ketones are further elaborated, for instance, via enolate 25 alkylation. Once the desired ketones were in hand, reductive amination with the desired mono-blocked (protected) diamine was carried out by reaction with acetic acid in methanol followed by slow addition of a THF solution of sodium cyanoborohydride. On occasion, the newly generated secondary amine was protected or alkylated, the terminal amine 30 deprotected and then coupled to the desired Q group via alkylation, acylation, reductive amination, etc. The activated termini species comprising the "Q" groups are readily prepared by one of ordinary skill in the art. For example, oxazolidinones are prepared and activated in general by published and 35 well developed chemistry, in particular, of Evans. [Evans, D.A.; Nelson, -36- WO 98/57642 PCT/US98/12678 J.V.; Taber, R.R. Top. Stereochem. 13, 1 (1982)] The starting materials, in general, are natural and unnatural amino acids. For instance, some of the preferred compounds are prepared from substituted phenylglycine derivatives, which after reduction of the carboxylate and a phosgene 5 equivalent mediated cyclization provides the substituted oxazolidinone ring system. Deprotonation with n-butyl lithium and addition to a THF solution of p-nitrophenylchloroformate produces the stable, isolable "activated"oxazolidinone (oxa). Dihydropyrimidinones are prepared by condensation 10 reaction of the aldehyde, urea and 1,3-acetoacetate type derivative catalyzed by a Lewis Acid, a copper (I) species and acetic acid. Activation was accomplished by treatment with a strong base, for instance, LiN(TMS)2, followed by addition to a THF solution of p nitrophenylchloroformate. 15 Hydantoins and cycloimide were prepared in two chemical steps from ketones as outlined in the literature. More specifically, hydantoins were prepared according to known methodology, e.g., J.J. Edmunds et al., J. Med. Chem. 1995, 38, pp. 3759-3771; J.H. Poupart et al., J. Chem. Res. 1979, pp. 174-175. Saccharins were prepared 20 according to known methods, e.g., page 40 and Examples 21 and 22 of PCT International Application Publication No. WO96/25934, published August 29, 1996. The dihydropyrimidinones and oxazolidinones were synthesized independently in racemic form, and then separated 25 utilizing preparative chiral HPLC. Their optical rotations were recorded. Then they were activated and reacted with prerequisite amines. From the receptor binding studies, a preferred isomer was identified, the (+) rotational isomer in each case. The absolute configurations were determined to be (S) for both the 30 dihydropyrimidinones and oxazolidinones by correlating their optical rotations with x-ray crystal structures obtained of fragments involved in the production of the antagonists. Examples of the preparation of some desired compounds are outlined in Schemes 3-5. Selective Boc protection of 4-amino 35 methylpiperidine (1) followed by reductive amination with ketone (3) -37 - WO 98/57642 PCT/US98/12678 provided the terminally protected amino derivative (4). Acid mediated deprotection of (4) followed by acylation with (6) and (22) provided (7) and (23), Scheme 3 and 4. Other derivatives were prepared via the routes outlined in 5 Schemes 5-7. For example, N-protected 3-hydroxy azetidine (8) was tosylated providing (9). Displacement with sodium azide produced (10) which after reduction with PPH3/H20 resulted in N-protected-3 aminoazetidine (11). Reductive amination with ketone (3) produced (12) which after Boc protection of the secondary amine, hydrogenolysis of the 10 N-protecting group, acylation and HC1/EtOAc mediated concomitant deprotection and salt formation yields the desired products. Still other derivatives were prepared via the routes outlined in Schemes 8 and 9. The synthesis of the 3-aminomethylpyrrolidine intermediate was accomplished from the commercially available lactam 15 as outlined Scheme 8. The ester was converted to the amide by a simple two step process. Subsequent DIBAL reduction yielded the monoprotected diamino intermediate. Reductive aminations with cyclohexanones, followed by deprotection of the N-benzyl group, and acyclation with preferred activated "Q"-groups furnished the final 20 targets. The synthesis of the 4-amino-3-hydroxypyrrolidine intermediate began with 3,4-pyrroline, Scheme 9. BOC protection of the amine followed by mCPBA oxidation provided the epoxidation. Subsequent sodium azide opening of the epoxide and 25 triphenylphosphine/water mediated reduction produced 4-amino-N-1 (1,1-dimethylethoxycarbonyl)-3-hydroxypyrrolidine. The key amino intermediate was alkylated by reductive amination reactions with cyclohexanones. Following the cleavage of the BOC protecting group acyclation with preferred activated "Q"-groups furnished the final 30 targets. -38 - WO 98/57642 PCT/US98/12678 SCHEME 1 HN r Br Pd 2 (dba) 3 KOtBu/P(o-tolyl) 3 or BINAP n HN _ _ R_ n RF H N o Aq HCI A O 0 AcOH neat, THF, or DMF

R

2

R

15

R

1 6 H -(C R32)q

R

1 n R13l Nn .n R 2 R R15 R 1 6 'R14 p R1-N N -(C R 2) q ) O AcOH/MeOH o RR- N-P A NaCNBH 3 R1 p P = BOC HCI EtOAc P= H*HCI -39 - WO 98/57642 PCT/US98/12678 SCHEME 1 (Cont'd) n R2 R l 6 R15 R 1 R'-N N-(CR 2 )q m 13 N-H 140 I

R

1 4 p Q'CI, p-NO 2 PhO, OH] Acylating Agent n R 2 ~ 15

R

16 R-N N(CR:32) qy$ SR13 N Q R 14 pY 0 SCHEME 2 HN R1 O H Br o OH Pd 2 (dba) 3 KOtBu/P(o-tolyl) 3 or BINAP R!HNJ 1 n' "F 0 OH RN5 H 0 OH neat, THF, or DMF Swern Oxidation RO O A -40- WO 98/57642 PCT/US98/12678 SCHEME 3 NH BOCO IN0 1H N H 2 B O 2 0O N H 2 2 CN CNN NN 3 0 O 4H NO 2 4 0 NaCNBH 3 TFA N H a N 02N 0 N 0 5 H NH O 0 6 F [C N F F H N ON H NN0 NN O 0 7 F F -41- WO 98/57642 PCT/US98/12678 SCHEME 4 c c.CN 5 HNH 0 0 0 2 N 13 F F SCN H NID~ O 0 14 QF F - 42 - WO 98/57642 PCT/US98/12678 SCHEME 5

TOS

2 0 N NaN 3 LN -O HO IO 8 9 Ph 3 P N H 2 0 H2

N

3

H

2 11 10 CN CN 11 CN NaCNBH3 N O AcOH ( N N 3 H 12 -43- WO 98/57642 PCT/US98/12678 SCHEME 6 CHPh 2 LAH ,CHPh 2 3 N

AICI

3 HNaCNBH 3 15 2 N 6 cjCN cICN ( N BOC20Oa NCH NBOC 17 N NCHPh 2 NCHPh 2 17 18 H2 S10% Pd-C CN CN Activated Carbamates N NBOC Na Activated Acids 19 NBOC 0 -ZNCOQ 20 -44- WO 98/57642 PCT/US98/12678 SCHEME7 O OH SOMe DIBAL 1.) Tos 2 0 N 2.) NaN 3 O N CH 2

CI

2 90% 3.) Ph 3

P/H

2 0 24 25 RN 3 N NBn 29 AcOH 26 R = OTos NaBH 3 CN 27 R = N 3 MeOH 28 R = NH 2 2HN

H

2 N

BOC

2 0 N 10% Pd-C CN N

CH

2

C

2 CN ONO ' N 31OC Q NH 30 B Bn 31 activated( CN N carbamates and NO NCOQ acids 32 -45 - WO 98/57642 PCT/US98/12678 SCHEME 8 :O 1) NaOH 0 DIBAL Me20C NBn 2) EDCI 2HNOC NBn NH3 2HN\., NaCNBH3 NBn N * AcOH, MeOH CN 0 ONO N 1) H2/Pd-C Final CN

N

2) Activated Products H NBn (+)-DHP or (S)-OXA 5 -46- WO 98/57642 PCT/US98/12678 SCHEME 9 BOC20 mCPBA NH NBOC NaHCO3 HO O NaN3 N PPh3 NBOC DMF 3N - NBOC H20 HO HO + NaCNBH3 2HN NBOC ON AcOH, MeOH CN 0 HO, 1) HCI IN" "l 1 I . Final CN N N l7 NBOC 2) Activated Products H (+)-DHP or (S)-OXA 5 The following examples are provided to further define the invention without, however, limiting the invention to the particulars of these examples. EXAMPLE 1 10 4-Aminomethyl-piperidine-1-carboxylic acid tert-butyl ester (2) A solution of C-piperidin-4-yl-methylamine (1) (5.0 g, 44 mmol) and triethylamine (12 ml 88 mmol) in 150 ml of chloroform was cooled to 00 C. To this solution was added dropwise 15 ditertbutyldicarbonate (8.6 g, 40 mmol) in 100 ml of chloroform. After stirring at room temperature for 24 hours the solution was washed with -47 - WO 98/57642 PCT/US98/12678 water, dried over MgSO 4 , filtered and the solvents removed in vacuo to give the title compound 1H NMR (CDC13) 4.20-4.00 (br m, 2H), 2.75-2.62 (br t, 2H), 2.60 (d, 2H), 1.75-1.65 (br m, 2H), 1.50-1.30 (m, 3H), 1.63 (s, 9H), 1.20-1.00 5 (m, 2H). EXAMPLE 2 NU CN N0 10 N-(2-cyanophenvl)-4-piperidone (3) A solution of 2-fluorobenzonitrile (2.75 g, 22.7 mmol) and 4 piperidone ethylene ketal (4.25 g, 29.7 mmol) in DMF (40 mL) was heated to 120 0 C for 4h. The resulting mixture was cooled to room temperature overnight. The solvent was removed in vacuo and the residue dissolved 15 in ether and sodium bicarbonate solution. The aqueous layer was extracted with two additional portions of ether and the combined organic extracts were washed with brine, dried over Na2SO4, and concentrated under reduced pressure to afford the 4-piperidone ethylene ketal. The crude product was used directly. 20 A solution of 4-piperidone ethylene ketal (533 mg, 2.18 mmol) in ether (10 mL) was treated with 5% aqueous HC1 (20 mL). The mixture was stirred at room temperature (11d). The reaction was diluted with ether and neutralized with sodium bicarbonate solution. The aqueous layer was extracted with two additional portions of ether 25 and the combined organic extracts were washed with brine, dried over Na2SO4, and concentrated under reduced pressure. PCTLC (SiO 2 , 4mm, 20% EtOAc; 80% hexane) afforded the title compound (3). 1H NMR (CDC1 3 , 400 MHz) consistant with assigned structure. -48- WO 98/57642 PCT/US98/12678 FABLRMS m/e 201 g/mole (M++H, C 12

H

12

N

2 0 = 201 g/mole.) HPLC (Vydac; C18; diameter = 4.6 mm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95% - 5%, 5% - 95%, over 16 5 minutes, 2 ml/min flow rate) RT = 7.32 min; focus = 215 nm; 97.5% pure. EXAMPLE 3 4-{[ 1-(2-Cyano-phenyl)-piperidin-4-ylamino]-methyl} 10 cyclohexanecarboxylic acid tert-butv1 ester (4) To a solution of 2-(4-oxo-piperidin-1-yl)-benzonitrile (3) (750 mg, 3.75 mmol) and 2 in 40 ml of methanol was added 4 g of powdered 4A molecular sieves. The resulting suspension was stirred at room temperature for 24 hours. The suspension was subsequently acidified to 15 pH 5 with acetic acid and a 1M solution of NaCNBH3 in THF (6.0 ml 5.6 mmol) was added slowly with a syringe pump over 24 hours. When the addition was complete, the solvent was removed in vacuo and the residue taken up in chloroform and filtered. The solution was then washed with 10% Na 2

CO

3 , dried over MgSO 4 , and the solvent removed in 20 vacuo to give the crude amine. The crude product was purified by chromatography on silica gel (5% MeOH/CHCla) to give the title compound. 1H NMR (CDCl 3 ) 7.54 (dd, 1H, J=7.56 Hz,1.46 Hz), 7.45, (t, 1H, J=7.94 Hz), 7.01-6.94 (m, 2H), 4.18-4.05, (m, 2H), 3.61-3.52 (m, 2H), 25 2.81-2.95 (m, 2H), 2.78-2.57 (m, 3H), 2.55 (d, 2H, J=6.59 Hz), 2.09-1.95 (m, 2H), 1.72 (br d, 2H, J=12.7 Hz), 1.70-1.50 (m, 3H), 1.45 (s, 9H), 1.45-1.30, (m, 1H), 1.20-1.00 (m, 2H). EXAMPLE 4 30 2-{4-r(Piperidin-4-vlmethvl)-aminol]-piperidin- 1-vl-benzonitrile (5) To a solution of 4 (1.5 g, 3.76 mmol) in 30 ml of methylene chloride was added 15 ml of TFA. After stirring at room temperature for 24 hours, the solvents were removed in vacuo and the residue -49 - WO 98/57642 PCT/US98/12678 partitioned between chloroform and 10% Na 2 C0 3 . The organics were dried over MgSO 4 , filtered, and the solvent removed in vacuo to give the title compound. 1H NMR (CDC13) 7.54 (dd, 1H, J=7.57 Hz, J=1.47 Hz), 7.50 5 7.40 (m, 1H), 7.03-6.95, (m, 2H), 3.61-3.55 (m, 2H), 3.30-3.20 (m, 2H), 2.87 (d oft, 2H, J=12.45 Hz, J=2.44 Hz), 2.74 (d oft, 2H, J=12.45Hz, J=2.68 Hz), 2.63-2.55 (m, 1H), 2.57 (d, 2H, J=6.83), 2.08-1.97 (m, 2H), 1.95-1.83 (m, 2H), 1.67-1.50 (m, 3H), 1.42-1.25 (m, 2H). 10 EXAMPLE 5 3-(4- {[1-(2-Cyano-phenyl)-piperidin-4-ylamino]-methyl}-piperidine- 1 carbonyl)-4-(3,4-difluoro-phenyl)-6-methoxymethyl-2-oxo-1,2,3,4 tetrahvdro-pyvrimidine-5-carboxvlic acid methyl ester (7) 15 To a solution of 5 (280 mg, 0.94 mmol) in 30 ml of chloroform was added dropwise 6 in 10 ml of chloroform. The resulting solution was stirred for 20 minutes and the crude material purified by chromatography on silica gel (5% MeOH/CHC13) 1H NMR (DMSO-d6 750C) 7.63 (d, 1H, J=7.57 Hz), 7.55 (t, 1H, 20 J=7.57 Hz), 7.42-7.25 (m, 2H), 7.13 (d, 2H, J=8.31 Hz), 7.03 (t, 1H, J=7.57 Hz), 5.67 (s, 1H), 4.51 (AB q, 2H Ja=48.1 Hz, Jb=13.43Hz, 3.90-3.50 (m, 2H), 3.60 (s, 3H), 3.45 (d, 2H J=11.96Hz), 3.31 (s, 3H), 2.90-2.65 (m, 4H), 2.60-2.45 (m, 1H), 2.39 (d, 2H J=5.86Hz), 1.90 (d, 2H, J=10.74Hz)1.75-1.35 (m, 8H), 1.05-0.90 (m, 1H). 25 MS (FAB) 637 (M+1) Analysis calculated for C33 H 38

N

6 05 F 2 0.50 CHCl 3 , 0.25

H

2 0: C, 57.40; H, 5.61; N, 11.99. Found: C, 57.40; H, 5.56; N, 12.18. EXAMPLE 6 30 Toluene-4-sulfonic acid 1-benzhvdryl-azetidin-3-vl ester (9) To a cooled (0oC) solution of 8 (7 g, 29 mmol) in 100 ml of chloroform was added paratoluene sulfonic anhydride (11.5 g, 35.2mmol), and triethylamine (12 ml, 88mmol). The resulting solution -50- WO 98/57642 PCT/US98/12678 was stirred at room temperature for 24 hours. The solution was subsequently washed with water, dried over MgSO 4 , filtered, and the solvent removed in vacuo. The crude material was purified by chromatography on silica gel to give the desired product as an oil. 5 'H NMR (CDC13) 7.75 (d, 2H, J=8.3Hz), 7.35-7.15 (m, 12H), 4.95-4.82 (m, 1H), 4.32 (s, 1H), 3.50-3.40 (m, 2H), 3.10-3.00 (m, 2H), 2.43 (s, 3H). EXAMPLE 7 10 3-Azido-1-benzhydrv1-azetidine (10) A solution of 9 (11.5 g, 31.8 mmol) and sodium azide (4.12 g, 64 mmol) in 250 ml of DMF was heated to 70'C for 24 hours. After cooling to room temperature the solvent was removed in vacuo and the 15 residue partitioned between chloroform and water. The organics were dried over MgSO 4 , filtered and the solvent removed in vacuo. The crude product was purified by chromatography on silica gel (8:1 hexane: ethyl acetate) afforded the title compound. 1H NMR (CDC1 3 ) 7.41-7.15 (m, 10H), 4.33 (s, 1H), 4.02-3.95 20 (m, 1H) 3.50-3.41 (m, 2H), 3.07-3.00 (m, 2H). EXAMPLE 8 1-Benzhvdrvl-azetidin-3-1vamine (11) 25 A solution of 10 (5.7 g, 21.6 mmol), triphenylphosphine (11.3 g, 43 mmol) and water (5 ml) was heated to reflux for 24 hours. After cooling to room temperature the solvent was removed in vacuo and the residue purified by chromatography on silica gel (90:9:1 CHC13:MeOH:NH 4 OH). 30 1H NMR (CDC1 3 ) 7.41-7.15 (m, 10H), 4.27 (s, 1H), 3.65-3.55 (m, 1H), 3.55-3.50 (m, 2H), 2.65-2.60 (m, 2H) 1.44 (br s, 2H). EXAMPLE 9 -51- WO 98/57642 PCT/US98/12678 2-[4-(1-Benzhydryl-azetidin-3-ylamino)-piperidin-1-yl]-benzonitrile trifluoroacetic acid salt (12) The title compound was prepared from 3 (1.0 g, 3.9 mmol) and 11 using the procedure described for 4. 5 1H NMR (CDC1) 7.56-6.90 (m, 14H), 4.32 (s, 1H), 3.62-3.45 (m, 5H), 2.90-2.87 (m, 2H), 2.75-7.65 (m, 2H), 2.64-2.58 (m, 1H), 1.91 (d, 2H, J=11.36Hz), 1.62-1.53 (m, 2H), 1.50-1.20 (br s, 1H). MS (FAB) 423 (M+1). Analysis calculated for C 28

H

3 o N 4 0.05 H 2 0, 2.30 TFA: 10 C, 57.10; H, 4.76; N, 8.17. Found: C, 57.10; H, 4.75; N, 8.25. EXAMPLE 10 15 2-[4-({ 1-[4-(3,4-Difluoro-phenyl)-2-oxo-oxazolidine-3-carbonyl]-piperidin-4 ylmethyl) -amino)-piperidin- 1-yl]-benzonitrile trifluoroacetic acid salt (14) The title compound was prepared from 5 (200 mg, 0.67 mmol) and 13 (121 mg, 0.67 mmol) using the procedure described for 7. 20 'H NMR (CD 3 OD) 7.70-7.55 (m, 2H), 7.50-7.40 (m, 1H), 7.35 7.25 (m, 2H) 7.20-7.03 (m, 2H), 5.50 (t, 1H, J=9.03Hz), 4.75 (t, 1H, J=8.54Hz), 4.30-4.13 (m, 3H), 3.65 (d, 2H, J=12.21Hz), 3.15-2.85 (m, 6H), 2.25 (d, 2H, J=10.26Hz), 2.10-1.75 (m, 6H), 1.50-1.10 (m, 2H). MS (FAB) 524 (M+1). 25 Analysis calculated for C 28

H

31

N

5 O0 F 2 1.30 TFA, 0.20 H 2 0: C, 54.41; H, 4.88; N, 10.37. Found: C, 54.37; H, 4.88; N, 10.46. -52 - WO 98/57642 PCT/US98/12678 EXAMPLE 11 H2N\_ N 3-Aminomethyl N-diphenvlmethvl azetidine. (16) To a cooled solution of aluminum chloride (0.33 g, 2.41 5 mmol) in ether (50 mL) at -780 C was added lithium aluminum hydride (2.41 ml, 2.41 mmol). After stirring 15 minutes at -780 C the slurry was added a solution of 15 (0.50 g, 2.01 mmol) in ether (10 mL) dropwise. The resulting mixture was stirred at room temperature for 2 hours. The solution was cooled to 0 0 C and quenched with water (10 mL) dropwise 10 followed by 25% NaOH solution (10 mL). The aqueous layer was extracted with EtOAc. The organics were dried over Na2SO4, filtered, and removed in vacuo. The crude product was not purified. 1 H NMR (CDC1 3 , 300 MHz) 7.41-7.13 (m, 10 H), 4.32 (s, 1 H), 3.28 (t, 2 H), 2.88-2.79 (m, 4 H), 2.52-2.42(m, 1 H), 1.28 (s, 1 H). 15 -53- WO 98/57642 PCT/US98/12678 EXAMPLE 12 CN Compound (17) The title compound was prepared from 16 and 3 using the 5 procedure described for the preparation of 4. 1H NMR (CDC1 3 , 400 MHz) 7.54-7.51 (dd, 1 H), 7.46-7.38 (m, 5 H), 7.28-7.24 (m, 4 H), 7.18-7.15 (m, 2 H), 6.99-6.93 (m, 2 H), 4.33 (s, 1 H), 3.57-3.45 (m, 2 H), 3.35-3.31 (t, 2 H), 2.89-2.79 (m, 7 H), 2.64-2.56 (m, 2 H), 2.01-1.98 (m, 2 H), 1.62-1.53 (m, 2 H). 10 MS (FAB) 437 (M+1). EXAMPLE 13 N

H

2 N 0 Ok N-(2-benzamido)-4-piperidone ethylene ketal (21) 15 A mixture of 2-fluorobenzamide (7.0 g, 50.0 mmol) and 4 piperidone ethylene ketal (7.16 g, 50.0 mmol) was heated at 100 C (7 d). The solvent was removed in vacuo and triturated with ether affording the title compound (21). 1 H NMR (DMSO-d6, 300 MHz) consistant with assigned 20 structure. -54- WO 98/57642 PCT/US98/12678 HPLC (Vydac; C18; diameter = 4.6 mm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95% - 5%, 5% - 95%, over 16 minutes, 2 ml/min flow rate) RT = 4.49 min; focus = 215 nm; 100% pure. 5 EXAMPLE 14 N

H

2 N 0 O N-(2-benzamido)-4-piperidone (22) A solution of the ketal 21 (13.2 mg, 46.753 mmol) in acetic acid (50 mL) and 6N aqueous HC1 (50 mL) was heated at 60' C (12 h), 80% 10 conversion. The solvent was removed in vacuo, neutralized with 25% aqueous NaOH, extracted with CHC13 (3 x 250 mL), the combined organic extracts were washed with brine, dried over Na2SO4, and concentrated under reduced pressure to give (22) which was used without further purification. 15 1 H NMR (CDC1 3 , 400 MHz) consistant with assigned structure. EXAMPLE 15 0

NH

2 20 Compound (23) The title compound was prepared from 16 and 22 using the procedure described for the preparation of 4. -55 - WO 98/57642 PCT/US98/12678 1 H NMR (CDC1 3 , 400 MHz) 9.53 (s, 1 H), 8.16-8.13 (m, 1 H), 7.45-7.38 (m, 6 H), 7.29-7.21 (m, 2 H), 7.19-7.15 (m, 4 H), 5.76 (s, 1 H), 5.29 (s, 1 H), 4.33 (s, 1 H), 3.36-3.32 (t, 2 H), 3.20-3.17 (d, 2 H), 2.87-2.75 (m, 7 H), 2.64-2.55 (m, 2 H), 2.03-2.00 (d, 2 H), 1.55-1.45 (m, 2 H). 5 Anal. Calcd for C 2 9

H

34

N

4 0 1 * 0.05 CHC1 3 + 0.60 H 2 0 : C = 74.01, H = 7.54, N = 11.89. Found: C = 74.06, H = 7.51, N = 11.57. MS (FAB) 455 (M+1) EXAMPLE 16 OH 10 N-1-Benzvl-3- hydroxvmethyl pyrrolidine (25) A solution of Methyl 1-benzyl-5-oxo-3-pyrrolidinecarboxylate (24) (10.0 g, 42.8 mmol) in 175 ml of dichloromethane was added dropwise to a cooled solution of 1.5 M DIBAL-H (143 mL, 214 mmol) at 15 780 C. After stirring at room temperature for 48 hours the solution was cooled to 00 C and added 25 mL methanol dropwise. The solution was added 250 mL saturated aqueous Rochelle salts and extracted with chloroform. The combined organics were dried over MgSO 4 , filtered and the solvents removed in vacuo to give the crude alcohol. The crude 20 product was purified by chromatography on silica gel (7% MeOH/CHCl 3 ) to afford the title compound. 'H NMR (CDC13, 400 MHz) 7.33-7.24 (m, 5 H), 3.70-3.66 (m, 1 H), 3.59-3.48 (m, 4 H), 2.86-2.80 (m, 1 H), 2.66-2.63 (d, 1 H), 2.51-2.47 (t, 1 H), 2.34-2.28 (m, 2H), 2.05-1.96 (m, 1 H), 1.75-1.67 (m, 1 H). 25 -56 - WO 98/57642 PCT/US98/12678 EXAMPLE 17 0 _ II

O

N Toluene-4-sulfonic acid 1-benzy1-pyrrolidin-3-methyl ester (26) To a cooled (0OC) solution of 25 (1.0 g, 5.2 rmmol) in 100 ml of 5 chloroform was added para-toluenesulfonic anhydride (2.5 g, 7.8 mmol), and triethylamine (2.1 ml, 15 mmol). The resulting solution was stirred at room temperature for 24 hours. The solution was subsequently washed with water, dried over MgSO 4 , filtered, and the solvent removed in vacuo. The crude material was purified by chromatography on silica 10 gel to afford the desired product. 1 H NMR (CDCl, 400 MHz) 7.78-7.76 (d, 2 H), 7.33-7.23 (m, 7 H), 3.94-3.92 (m, 2 H), 3.53 (s, 2 H), 2.58-2.43 (m, 6 H), 2.27-2.24 (m, 1 H), 1.97-1.88 (m, 1 H), 1.44-1.36 (m, 1 H). 15 EXAMPLE 18 N N-1-Benzvl-3-azidomethyl pvrrolidine (27) A solution of 26 (1.26 g, 3.64 mmol) and sodium azide (0.474 g, 7.29 mmol) in 100 ml of DMF was heated to 70 0 C for 24 hours. After 20 cooling to room temperature the solvent was removed in vacuo and the residue partitioned between chloroform and water. The organics were -57 - WO 98/57642 PCT/US98/12678 dried over MgSO 4 , filtered and the solvent removed in vacuo to afford the azide. 1H NMR (CDCl 3 , 400 MHz) 7.34-7.22 (m, 5 H), 3.60-3.59 (d, 2 H), 3.28-3.26 (m, 2 H), 2.70-2.66 (m, 1 H), 2.57-2.54 (t, 1 H), 2.44-2.38 (m, 2 5 H), 2.31-2.27 (m, 1 H), 2.04-1.98 (m, 1 H), 1.51-1.45 (m, 1 H). EXAMPLE 19 0$- NH 2 N N-1-Benzy1-3-aminomethyl pyrrolidine (28) 10 A solution of 27 (0.71 g, 3.2 mmol), triphenylphosphine (1.7 g, 6.5 mmol), THF (50 mL), and water (5 mL) was heated to reflux for 24 hours. After cooling to room temperature the solvent was removed in vacuo and the residue purified by chromatography on silica gel (90:9:1 CHC13:MeOH:NH 4 OH) to afford the amine. 15 'H NMR (CDC1 3 , 400 MHz) 7.33-7.22 (m, 5 H), 3.60-3.58 (d, 2 H), 2.76-2.72 (m, 1 H), 2.60-2.58 (m, 3 H), 2.52-2.47 (m, 1 H), 2.24-2.17 (m, 2 H), 2.00-1.95 (m, 1 H), 1.48-1.42 (m, 1 H), 1.12 (br s, 2 H). EXAMPLE 20 CN 20 Compound (29) -58- WO 98/57642 PCT/US98/12678 The title compound was prepared from 28 and 3 using the procedure described for the preparation of 4. 1 H NMR (CDC13, 400 MHz) 7.54-7.52 (d, 1 H), 7.46-7.42 (t, 1 H), 7.33-7.22 (m, 5 H), 6.99-6.93 (m, 2 H), 3.65-3.48 (m, 5 H), 3.89-2.83 (t, 2 5 H), 2.79-2.74 (t, 1 H), 2.66-2.59 (m, 4 H), 2.55-2.49 (q, 1 H), 2.34-2.28 (m, 1 H), 2.23-2.19 (t, 1 H), 2.01-1.98 (m, 3 H), 1.63-1.52 (m, 2 H), 1.50-1.45(m, 1 H). Anal. Calcd for C 2 4

H

3 2

N

4 C1 2 * 0.25 Hel + 0.35 ETOAc: C = 62.59, H = 7.25, N = 11.50. Found: C = 62.60, H = 7.10, N = 11.46. 10 MS (FAB) 375 (M+1) EXAMPLE 21 Mixture of 4S-4-(3,4-difluorophenyl)-6-methoxymethyl-2-oxo-1,2,3,4 tetrahydropyrimidine and 4S-4-(3,4-difluorophenyl)-6-methoxymethyl-2 15 oxo-2,3,4,5-tetrahydropyrimidine F F F F HN HN O N O N H To a solution of (+)-4-(3,4-difluorophenyl)-6-methoxymethyl 20 2-oxo-1,2,3,4-tetrahydropyrimidine-5-carboxylic acid methyl ester (4.63 g, 14.7 mmol) in a methanol (100 ml) was added sodium hydroxide (2.94 g, 73.6 mmol). The resulting mixture was refluxed at 90 OC for 16 hours. After cooling to room temperature the solvent was removed in vacuo. The solid was dissolved in CH 2 C1 2 and H 2 0 then neutralized with 10% 25 aqueous HC1 solution. The organic layer was dried over Na 2

SO

4 , concentrated, and purified by PCTLC (7% MeOH in CHC1 3 with 2% NH4OH) to afford a 2.65 g mixture of the title compounds (71% yield). The 1H NMR was consistent with the assigned structure. MS (FAB) 255 (M+1) -59- WO 98/57642 PCT/US98/12678 EXAMPLE 22 Mixture of 4S-4-(3,4-difluorophenyl)-6-methoxymethyl-2-oxo-1,2,3,4 tetrahydropyrimidine and 4S-4-(3,4-difluorophenyl)-6-methoxymethyl-2 5 oxo-2,3,4,5-tetrahydropyrimidine F F F F F NHN O N O- O0NO H To a solution of (+)-4-(3,4-difluorophenyl)-6-methoxymethyl 10 2-oxo-1,2,3,4-tetrahydropyrimidine-5-carboxylic acid methyl ester (5.36 g, 17.0 mmol) in a methanol (150 ml) was added 1N NaOH (10 ml). The resulting mixture was refluxed at 90 OC for 16 hours. After cooling to room temperature the solvent was removed in vacuo. The solid was dissolved in CH 2 C1 2 and H20 then neutralized with 10% aqueous HC1 15 solution. The organic layer was dried over Na 2

SO

4 , concentrated, and purified by PCTLC (7% MeOH in CHC1 with 2% NH 4 0H) to afford a 2.35 g mixture of the title compounds (54% yield). The 1 H NMR was consistent with the assigned structure. MS (FAB) 255 (M+1) 20 EXAMPLE 23 4S-4-(3,4-Difluorophenyl)-6-methoxymethyl-3-(4-nitrophenoxycarbonyl) 2-oxo-1,2,3,4-tetrahydropyrimidine-5-carboxylic acid methyl ester -60 - WO 98/57642 PCT/US98/12678 F F 0 2 N F O N ONq H The title compound was prepared by treating the mixture obtained from Example 21 or Example 22 (1.93 g, 7.59 mmol) with 5 lithium diisopropylamide (2.0M THF solution, 1.1 equivalents) in THF at -78 *C for 20 minutes followed by the rapid addition of 4-nitrophenyl chloroformate (1.5 equivalents) in THF. 0.488 g of the title compound was obtained in a 15% yield. The 'H NMR was consistent with the assigned structure. 10 EXAMPLE 24 Mixture of 4R-4-(3,4-difluorophenyl)-6-methoxymethyl-2-oxo-1,2,3,4 tetrahydropyrimidine and 4R-4-(3,4-difluorophenyl)-6-methoxymethyl-2 oxo-2,3,4,5-tetrahydropyrimidine 15 F F F F SI I 07'N " 0 N C H The title compounds were prepared from 4R-4-(3,4 difluorophenyl)-6-methoxymethyl-2-oxo-1,2,3,4-tetrahydropyrimidine-5 20 carboxylic acid methyl ester (5.0 g, 17.7 mmol) using the procedure described in Example 7. A mixture of 2.0 g of the title compounds was obtained in 50% yield. The 1H NMR was consistent with the assigned structure. -61- WO 98/57642 PCT/US98/12678 MS (FAB) 255 (M+1) Compounds of the invention can be prepared by reacting the products obtained in Example 23 in accordance with procedures and 5 schemes described above. The compound of Example 23 can, for example, be acylated with an arylpiperidinyl aminoalkylpiperidine in accordance with Scheme 3 to obtain the desired compounds. Compounds of the invention can also be prepared by preparing a nitrophenoxy derivative of the compound of Example 24 in accordance 10 with the procedure set forth in Example 23 and then reacting the derivative with an arylpiperidinyl aminoalkylpiperidine as set forth in Scheme 3 to obtain compounds of the invention. 15 Examples 25 and 26 were prepared as outlined in Scheme 8. EXAMPLE 25 (4S)-2-[4-({1-[4-(3,4-Difluorophenyl)-2-oxo-oxazolidine-3-carbonyl] pyrrolidin-3-ylmethyl}-amino)-piperidin-1-yl]-benzonitrile N CN O NN F 20 F 1H NMR (CDC1 3 , 400 MHz) consistent with assigned structure. FABLRMS m/e 510 g/mole (M++H, C 2 7

H

2 9

F

2

N

5 0 3 = 509.55 g/mole.) -62- WO 98/57642 PCT/US98/12678 HPLC (Vydac; C18; diameter = 4.6 mm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95% - 5%, 5% - 95%, over 16 minutes, 2 ml/min flow rate) focus = 215 nm; 100% pure. Anal. Calcd for C 2 7

H

2 9

F

2

N

5 0 3 : C = 57.16, H = 5.84, N = 5 11.11. Found: C = 57.24, H = 5.78, N = 11.12. EXAMPLE 26 (4S)-3-(3-{[1-(2-Cyanophenyl)-piperidin-4-ylamino]-methyl}-pyrrolidine- 1 carbonyl)-4-(3,4-difluorophenyl)-6-methoxymethyl-2-oxo-1,2,3,4 10 tetrahydro-pyrimidine-5-carboxylic acid methyl ester -I CN N 00 N F O F

CO

2 Me 1 H NIMR (CDC1 3 , 400 MHz) consistent with assigned structure. FABLRMS m/e 623 g/mole (M++H, C 3 2

H

3 6

F

2

N

6 0 5 = 622.67 15 g/mole.) HPLC (Vydac; C18; diameter = 4.6 mm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95% - 5%, 5% - 95%, over 16 minutes, 2 ml/min flow rate) focus = 215 rnm; 95.3% pure. Anal. Calcd for C 32

H

3 6

F

2

N

6 0 5 * 1.3 HC1 and 0.55 H 2 0: C = 20 56.62, H = 5.69, N = 12.36. Found: C = 56.53, H = 5.69, N = 12.32. Examples 27 and 28 were prepared as outlined in Scheme 9. -63- WO 98/57642 PCT/US98/12678 EXAMPLE 27 (racemic) (4S)-2-[4-({ 1-[4-(3,4-Difluorophenyl)-2-oxo-oxazolidine-3 carbonyl]-3-hydroxy-pyrrolidin-4-ylmethyl}-amino)-piperidin-1-yl] benzonitrile \NNHq CN a NHOIN N' O F 5 F 1 H NMR (CDC13, 400 MHz) consistent with assigned structure. FABLRMS m/e 501.2 g/mole (M++H, C 2 6

H

3 0

F

2

N

4 0 4 = 500.54 g/mole.) 10 HPLC (Vydac; C18; diameter = 4.6 mm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95%-- 5%, 5% - 95%, over 16 minutes, 2 ml/min flow rate) focus = 215 nm; 87% pure. EXAMPLE 28 15 (racemic) (4S)-3-(4-{[ 1-(2-Cyanophenyl)-piperidin-4-ylamino]-methyl}-3 hydroxy-pyrrolidine- 1-carbonyl)-4-(3,4-difluorophenyl)-6-methoxymethyl 2-oxo-1,2,3,4-tetrahydro-pyrimidine-5-carboxylic acid methyl ester H 0 CN ONH NNH F I Oq F 0 C0 2 Me -64- WO 98/57642 PCT/US98/12678 1H NMR (CDC1 3 , 400 MHz) consistent with assigned structure. FABLRMS m/e 625.88 g/mole (M++H, C 3 1

H

3 4

F

2

N

6 0 6 = 624.65 g/mole.) 5 HPLC (Vydac; C18; diameter = 4.6 rmm; length = 150 mm; gradient = H 2 0 [0.1% H 3

PO

4 ] - CH 3 CN, 95% - 5%, 5% - 95%, over 16 minutes, 2 ml/min flow rate) focus = 215 rnm; 98% pure. EXAMPLE 29 10 As a specific embodiment of an oral composition, 100 mg of the compound of Example 9 (i.e., Compound 14) is formulated with sufficient finely divided lactose to provide a total amount of 580 to 590 mg to fill a size O hard gel capsule. 15 EXAMPLE 30 Screening assay: Alpha la Adrenergic Receptor Binding Membranes prepared from the stably transfected human 20 alpha la cell line (ATCC CRL 11140) were used to identify compounds that bind to the human alpha la adrenergic receptor. These competition binding reactions (total volume = 200 pl) contained 50 mM Tris-HC1 pH. 7.4, 5 mM EDTA, 150 mM NaC1, 100 pM [125 I]-HEAT, membranes prepared from the alpha la cell line and increasing amounts of 25 unlabeled ligand. Reactions were incubated at room temperature for one hour with shaking. Reactions were filtered onto Whatman GF/C glass fiber filters with a Inotec 96 well cell harvester. Filters were washed three times with ice cold buffer and bound radioactivity was determined (Ki). Representative compounds of the present invention 30 were found to have Ki values < 50 nM. EXAMPLE 31 Selective Binding assays -65- WO 98/57642 PCT/US98/12678 Membranes prepared from stably transfected human alpha ld and alpha lb cell lines (ATCC CRL 11138 and CRL 11139, respectively) were used to identify compounds that selectively bind to the human alpha la adrenergic receptor. These competition binding reactions (total 5 volume = 200 p) contained 50 mM Tris-HC1 pH. 7.4, 5 mM EDTA, 150 mM NaC1, 100 pM [125 I]-HEAT, membranes prepared from cell lines transfected with the respective alpha 1 subtype expression plasmid and increasing amounts of unlabeled ligand. Reactions were incubated at room temperature for one hour with shaking. Reactions were filtered 10 onto Whatman GF/C glass fiber filters with a Inotec 96 well cell harvester. Filters were washed three times with ice cold buffer and bound radioactivity was determined (Ki). EXAMPLE 32 15 EXEMPLARY COUNTERSCREENS 1. Assay Title: Dopamine D2, D3, D4 in vitro screen 20 Objective of the Assay: The objective of this assay is to eliminate agents which specifically affect binding of [3H] spiperone to cells expressing human dopamine receptors D2, D3 or D4. 25 Method: Modified from VanTol et al (1991); Nature (Vol 350) Pg 610 613. Frozen pellets containing specific dopamine receptor subtypes stably expressed in clonal cell lines are lysed in 2 ml lysing 30 buffer (10mM Tris-HC1/5mM Mg, pH 7.4). Pellets obtained after centrifuging these membranes (15' at 24,450 rpm) are resuspended in 50mM Tris-HC1 pH 7.4 containing EDTA, MgCI[2], KC1, NaC1, CaCI[2] and ascorbate to give a 1 Mg/mL suspension. The assay is initiated by adding 50-75 pg membranes in a total volume of 500 pl containing 0.2 35 nM [3H]-spiperone. Non-specific binding is defined using 10 p.M -66- WO 98/57642 PCT/US98/12678 apomorphine. The assay is terminated after a 2 hour incubation at room temperature by rapid filtration over GF/B filters presoaked in 0.3% PEI, using 50mM Tris-HCl pH 7.4. 5 2. Assay Title: Serotonin 5HT1a Objective of the Assay The objective of this assay is to eliminate agents which specifically affect binding to cloned human 5HT1a receptor 10 Method: Modified from Schelegel and Peroutka Biochemical Pharmacology 35: 1943-1949 (1986). Mammalian cells expressing cloned human 5HT1a 15 receptors are lysed in ice-cold 5 mM Tris-HC1 , 2 mM EDTA (pH 7.4) and homogenized with a polytron homogenizer. The homogenate is centrifuged at 1000Xg for 30', and then the supernatant is centrifuged again at 38,000Xg for 30'. The binding assay contains 0.25 nM [3H]8-OH DPAT (8-hydroxy-2-dipropylamino-1,2,3,4-tetrahydronaphthalene) in 50 20 mM Tris-HC1, 4 mM CaC12 and 1mg/ml ascorbate. Non-specific binding is defined using 10 RM propranolol. The assay is terminated after a 1 hour incubation at room temperature by rapid filtration over GF/Cfilters EXAMPLE 33 25 EXEMPLARY FUNCTIONAL ASSAYS In order to confirm the specificity of compounds for the human alpha la adrenergic receptor and to define the biological activity of the compounds, the following functional tests may be performed: 30 1. In vitro Rat, Dog and Human Prostate and Dog Urethra Taconic Farms Sprague-Dawley male rats, weighing 250 400 grams are sacrificed by cervical dislocation under anesthesia (methohexital; 50 mg/kg, i.p.). An incision is made into the lower 35 abdomen to remove the ventral lobes of the prostate. Each prostate -67- WO 98/57642 PCT/US98/12678 removed from a mongrel dog is cut into 6-8 pieces longitudinally along the urethra opening and stored in ice-cold oxygenated Krebs solution overnight before use if necessary. Dog urethra proximal to prostate is cut into approximately 5 mm rings, the rings are then cut open for 5 contractile measurement of circular muscles. Human prostate chips from transurethral surgery of benign prostate hyperplasia are also stored overnight in ice-cold Krebs solution if needed. The tissue is placed in a Petri dish containing oxygenated Krebs solution [NaC1, 118 mM; KC1, 4.7 mM; CaC12, 2.5 mM; KH2PO4, 10 1.2 mM; MgSO4, 1.2 mM; NaHCO3, 2.0 mM; dextrose, 11 mM] warmed to 37 0 C. Excess lipid material and connective tissue are carefully removed. Tissue segments are attached to glass tissue holders with 4-0 surgical silk and placed in a 5 ml jacketed tissue bath containing Krebs buffer at 37 0 C, bubbled with 5% CO2/95% 02. The tissues are connected 15 to a Statham-Gould force transducer; 1 gram (rat, human) or 1.5 gram (dog) of tension is applied and the tissues are allowed to equilibrate for one hour. Contractions are recorded on a Hewlett-Packard 7700 series strip chart recorder. After a single priming dose of 3 RM (for rat), 10 p.M (for dog) 20 and 20 gM (for human) of phenylephrine, a cumulative concentration response curve to an agonist is generated; the tissues are washed every 10 minutes for one hour. Vehicle or antagonist is added to the bath and allowed to incubate for one hour, then another cumulative concentration response curve to the agonist is generated. 25 EC50 values are calculated for each group using GraphPad Inplot software. pA2 (-log Kb) values were obtained from Schild plot when three or more concentrations were tested. When less than three concentrations of antagonist are tested, Kb values are calculated according to the following formula Kb =.. , 30 x-1 where x is the ratio of EC50 of agonist in the presence and absence of antagonist and [B] is the antagonist concentration. 2. Measurement of Intra-Urethral Pressure in Anesthetized Dogs 35 -68- WO 98/57642 PCT/US98/12678 PURPOSE: Benign prostatic hyperplasia causes a decreased urine flow rate that may be produced by both passive physical obstruction of the prostatic urethra from increased prostate mass as well as active obstruction due to prostatic contraction. Alpha adrenergic receptor 5 antagonists such as prazosin and terazosin prevent active prostatic contraction, thus improve urine flow rate and provide symptomatic relief in man. However, these are non-selective alpha 1 receptor antagonists which also have pronounced vascular effects. Because we have identified the alpha la receptor subtype as the predominent subtype 10 in the human prostate, it is now possible to specifically target this receptor to inhibit prostatic contraction without concomitant changes in the vasculature. The following model is used to measure adrenergically mediated changes in intra-urethral pressure and arterial pressure in anesthetized dogs in order to evaluate the efficacy and potency of 15 selective alpha adrenergic receptor antagonists. The goals are to: 1) identify the alpha 1 receptor subtypes responsible for prostatic/urethral contraction and vascular responses, and 2) use this model to evaluate novel selective alpha adrenergic antagonists. Novel and standard alpha adrenergic antagonists may be evaluated in this manner. 20 METHODS: Male mongrel dogs (7-12 kg) are used in this study. The dogs are anesthetized with pentobarbital sodium (35 mg/kg, i.v. plus 4 mg/kg/hr iv infusion). An endotracheal tube is inserted and the animal ventilated with room air using a Harvard instruments positive 25 displacement large animal ventilator. Catheters (PE 240 or 260) are placed in the aorta via the femoral artery and vena cava via the femoral veins (2 catheters, one in each vein) for the measurement of arterial pressure and the administration of drugs, respectively. A supra-pubic incision -1/2 inch lateral to the penis is made to expose the urethers, 30 bladder and urethra. The urethers are ligated and cannulated so that urine flows freely into beakers. The dome of the bladder is retracted to facilitate dissection of the proximal and distal urethra. Umbilical tape is passed beneath the urethra at the bladder neck and another piece of umbilical tape is placed under the distal urethra approximately 1-2 cm 35 distal to the prostate. The bladder is incised and a Millar micro-tip -69- WO 98/57642 PCT/US98/12678 pressure transducer is advanced into the urethra. The bladder incision is sutured with 2-0 or 3-0 silk (purse-string suture) to hold the transducer. The tip of the transducer is placed in the prostatic urethra and the position of the Millar catheter is verified by gently squeezing the 5 prostate and noting the large change in urethral pressure. Phenylephrine, an alpha 1 adrenergic agonist, is administered (0.1-100 ug/kg, iv; 0.05 ml/kg volume) in order to construct dose response curves for changes in intra-urethral and arterial pressure. Following administration of increasing doses of an alpha 10 adrenergic antagonist (or vehicle), the effects of phenylephrine on arterial pressure and intra-urethral pressure are re-evaluated. Four or five phenylephrine dose-response curves are generated in each animal (one control, three or four doses of antagonist or vehicle). The relative antagonist potency on phenylephrine induced changes in arterial and 15 intra-urethral pressure are determined by Schild analysis. The family of averaged curves are fit simultaneously (using ALLFIT software package) with a four paramenter logistic equation constraining the slope, minimum response, and maximum response to be constant among curves. The dose ratios for the antagonist doses (rightward shift 20 in the dose-response curves from control) are calculated as the ratio of the ED50's for the respective curves. These dose-ratios are then used to construct a Schild plot and the Kb (expressed as ug/kg, iv) determined. The Kb (dose of antagonist causing a 2-fold rightward shift of the phenylephrine dose-response curve) is used to compare the relative 25 potency of the antagonists on inhibiting phenylephrine responses for intra-urethral and arterial pressure. The relative selectivity is calculated as the ratio of arterial pressure and intra-urethral pressure Kb's. Effects of the alpha 1 antagonists on baseline arterial pressure are also monitored. Comparison of the relative antagonist potency on 30 changes in arterial pressure and intra-urethral pressure provide insight as to whether the alpha receptor subtype responsible for increasing intra-urethral pressure is also present in the systemic vasculature. According to this method, one is able to confirm the selectivity of alpha la adrenergic receptor antagonists that prevent the - 70- WO 98/57642 PCT/US98/12678 increase in intra-urethral pressure to phenylephrine without any activity at the vasculature. While the foregoing specification teaches the principles of 5 the present invention, with examples provided for the purpose of illustration, it will be understood that the practice of the invention encompasses all of the usual variations, adaptations and/or modifications as come within the scope of the following claims and their equivalents. 10 -71-

Claims (25)

1. A compound of the formula: R 1 6 M

2 R15 mO N E R 2 R2 R-N N CR3 N L G R 4 5 wherein Q is selected from (X)s (Xs (Xs IIX 4 R8 R8 SN R 9 N N Rs 0 O R10 ,O ' H ' R o9 (X)s (X)s SR11R12 Ns or R 5 N HO (X)s H -72- WO 98/57642 PCT/US98/12678 R 1 is selected from unsubstituted, mono- or poly-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, NR 7 COR 1 9 , NR 7 CON(R 1 9 )2, NR 7 SO2R 1 9 , NR 7 SO2N(R 1 9 )2, OR 6 , (CH2)o 0 4 CO2R 7 , 5 (CH2)o0- 4 CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono- or poly substituted pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl are independently selected from CF3, cyano, nitro, amino, (CH2)o0- 4 CO2R 7 , (CH2)o.0- 4 CON(R 7 )2, 10 (CH2)o 4 SO2N(R 7 )2, (CH2)o.0- 4 SO2R 6 , phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; E, G, L and M are each independently selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)o0- 4 0R 6 , (CH2)o0- 4 N(R 7 )2, 15 (CH2)o0-4CN, (CH2)0- 4 CF3, (CH2) 0 - 4 CO2R 7 , (CH2)o0- 4 CON(R 7 )2, (CH2) 0 o 4 SO2R 7 , or (CH2)0-4SO2N(R 7 )2; J is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1- 4 0R 6 , (CH2)l- 4 N(R 7 )2, (CH2)1- 4 CN, (CH2)o0- 4 CF3, (CH2)0- 4 CO2R 7 , 20 (CH2)o.0- 4 CON(R 7 )2, (CH2)o0- 4 SO2R 7 , or (CH2)0- 4 SO2N(R 7 )2; R 2 is independently selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl, (CH2)o0- 4 CO2R 7 , (CH2)o.- 4 CON(R 7 )2, (CH2)o0- 4 COR 7 , (CH2) 2 -40R 6 , (CH2)1- 4 CF3, (CH2)o. 4 SO2R 7 , (CH2)o.- 4 SO2N(R7)2 or (CH2)1 25 4 CN; R 3 , R 8 , R 9 , R 1 0 , R 1 4 , R 15 and R 1 6 are each independently selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)2- 4 0R 6 or (CH2)0- 4 CF3; 30 R 4 is selected from hydrogen, (CH2)o- 4 COR 6 , (CH2)0- 4 CN, (CH2)0- 4 CF3, (CH2) 0 - 4 CO2R 7 , (CH2)o4CON(R 7 )2, (CH2)0- 4 SO2R 6 , or (CH2)o4SO2N(R 7 )2; R 5 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, - 73- WO 98/57642 PCT/US98/12678 (CH2)1-4OR 6 or (CH2)o0-4CF3; R 6 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl or (CH2)o- 4 CF3; 5 R 7 and R 1 9 are each independently selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl or (CH2)1-4CF3; R 1 1 and R 1 2 are each independently selected from hydrogen, 10 C1-8 alkyl or C3-8 cycloalkyl; R 1 3 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)2-40R 6 , OR 6 or (CH2)0-4CF3; 15 R 18 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)1-40R 6 , (CH2)0-4CF3, unsubstituted, mono- or poly-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, CO2R 7 , OR 6 , (CH2)0-4CON(R 7 )2, (CH2)0-4CO2R 7 or C1-4 alkyl; or unsubstituted, 20 mono- or poly-substituted: pyridyl, pyrazinyl, thienyl, furanyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, furanyl or naphthyl are independently selected from CF3, phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; 25 R 2 0 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)0-. 4 0R 6 or (CH2)o- 4 CF3; W is O or NR 1 1 ; 30 R 2 6 is selected from hydrogen or OR 2 8 ; R 2 8 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)2-4OR 6 or (CH2)o- 4 CF3; -74- WO 98/57642 PCT/US98/12678 X is selected from halogen, cyano, nitro, C1-8 alkyl, C3-8 cycloalkyl, (CH2)o0_40OR 6 or (CH2)o-4CF3 m, p and q are each independently an integer of from zero to three, 5 provided that when q is zero, R 2 6 is hydrogen; n, o, s and t are each independently an integer of from zero to four; or a pharmaceutically acceptable salt thereof. 10 2. The compound of Claim 1 of the formula: Ri6 M 2 R15 mO R1 N CR N Q R1-N i L G R"R wherein R 4 is selected from (CH2)o- 4 COR 6 , (CH2)0- 4 CN, (CH2)0- 4 CF3, (CH2) 0 - 4 CO2R 7 , (CH2)o.0- 4 CON(R 7 )2, (CH2)o~ 4 SO2R 6 , or (CH2)o 4 S02N(R 7 )2; 15 R 1 3 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, (CH2)2-40R 6 or (CH2)0-4CF3; or a pharmaceutically acceptable salt thereof. 20

3. The compound of Claim 1 of the formula: M 2 R 's mO n E R2 q ') L (N CR3 Q J P G R 3 R 14 L wherein Q is selected from -75- WO 98/57642 PCT/US98/12678 (Xs (Xs (Xs X R R8 N N R9 O N Rs O 0 R1o , O R H '1 R9 R 2 18 or t X s R 1 is selected from unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, NR 7 COR 19 , NR 7 CON(R 19 )2, 5 NR 7 SO2R 19 , NR 7 SO2N(R 19 )2, OR 6 , (CH2)0-4CO2R 7 , (CH2)0-4CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono-, di- or tri substituted pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl wherein the substituents on the pyridyl, pyrazinyl, thienyl, thiazolyl, furanyl, quinazolinyl or naphthyl are independently selected 10 from CF3, cyano, nitro, amino, (CH2)0-4CO2R 7 , (CH2)0-4CON(R 7 )2, (CH2)0-4SO2N(R 7 )2, (CH2)0-4SO2R 6 , phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; E, G, L, M and J are each independently selected from hydrogen, 15 C1-8 alkyl, C3-8 cycloalkyl, or (CH2)0-4CF3; R 2 is selected from hydrogen, C1-8 alkyl, C4-8 cycloalkyl or (CH2)1-4CF3; 20 R 3 , R 8 , R 9 , R 10 , R 14 , R 15 and R 16 are each independently selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2) 2 - 4 0R 6 or (CH2)0- 4 CF3; -76- WO 98/57642 PCT/US98/12678 R 13 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2) 2 .- 4 0R 6 , OR 6 or (CH2)o0-4CF3; R 18 is selected from hydrogen, C1-8 alkyl, C3-8 cycloalkyl, 5 (CH2)1-40OR 6 , (CH2)0-4CF3, unsubstituted, mono-, di- or tri-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, CO2R 7 , OR 6 , (CH2)0 4CON(R 7 )2, (CH2)0-4CO2R 7 or C1-4 alkyl; or unsubstituted, mono-, di- or tri-substituted: pyridyl, pyrazinyl, thienyl, furanyl or naphthyl wherein 10 the substituents on the pyridyl, pyrazinyl, thienyl, furanyl or naphthyl are independently selected from CF3, phenyl, OR 6 , halogen, C1-4 alkyl or C3-8 cycloalkyl; and R 2 0 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, 15 (CH2)o.0- 4 0R 6 or (CH2)o0-4CF3; R 2 8 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2) 2 .- 4 OR 6 , or (CH2)0- 4 CF3; 20 m, n and p are each independently an integer from zero to two, provided that when q is zero, R 2 8 is hydrogen; or a pharmaceutically acceptable salt thereof.

4. The compound of Claim 3, of the formula ( ,. , \qr ,-T)mO R-N N H2 N Q 25 R NR19 ( wherein Q is selected from - 77 - WO 98/57642 PCT/US98/12678 (X)s (X)s H R 18 N R4 "N ~..-X1 ON NRN oL N RsO O0 or t x H R 1 is selected from unsubstituted, mono-, di or tr-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, N(R 7 )2, OR 6 , (CH2)0-2CO2R 7 , 5 (CH2)0-2CON(R 7 )2, or C1-4 alkyl; or unsubstituted, mono- or di substituted pyridyl wherein the substituents are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; 10 R 2 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-4CF3; R 4 is selected from hydrogen, COR 6 , (CH2)0-2CO2R 7 , SO2R 6 or (CH2)0-2CON(R 7 )2; 15 R 5 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, (CH2)1-3OR 6 or (CH2)0-3CF3; and R 6 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl or 20 (CH2)0-2CF3; R 7 is selected from hydrogen, C1-6 alkyl, C4-6 cycloalkyl or (CH2)1-2CF3; 25 R 13 is selected from hydrogen or OR 6 ; R 18 is selected from hydrogen, C1-6 alkyl, C3-6 cycloalkyl, -78 - WO 98/57642 PCT/US98/12678 (CH2)2-40R 6 , (CH2)0-2CF3 or unsubstituted, mono- or di-substituted phenyl wherein the substituents on the phenyl are independently selected from halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; 5 R 2 6 is selected from hydrogen or OR 2 8 , wherein R 2 8 is selected from hydrogen or C1-6 alkyl; m, n and p are each independently an integer from zero to one; and 10 t is an integer from one to two; or a pharmaceutically acceptable salt thereof.

5. The compound of Claim 4, of the formula ( 1 7 )r 26 N N qR2 m A R2 N 15 O wherein A is C-R 1 7 or N; R 2 is selected from hydrogen or CH2CF3; 20 R 1 3 is selected from hydrogen or hydroxy; each R 1 7 is independently selected from hydrogen, halogen, CF3, cyano, nitro, amino, OR 6 , CO2R 7 , CON(R 7 )2 or C1-4 alkyl; 25 R 2 6 is selected from hydrogen or hydroxy; each X is halogen; -79- WO 98/57642 PCT/US98/12678 q and r are each independently an integer from zero to two, provided that when q is zero, R 2 6 is hydrogen; and s is an integer from zero to three; or a pharmaceutically acceptable salt thereof. 5

6. The compound of Claim 5, selected from the group consisting of CN F F N 0 N N Y 0 0 F F ~CN N F 10 and pharmaceutically acceptable salts thereof.

7. A pharmaceutical composition comprising the compound of Claim 1 and a pharmaceutically acceptable carrier. 15

8. The composition of Claim 7 further comprising a testosterone 5-alpha reductase inhibitor. -80 - WO 98/57642 PCT/US98/12678

9. The composition of Claim 8, wherein the testosterone 5 alpha reductase inhibitor is a type 1, a type 2, both a type 1 and a type 2 or a dual type 1 and type 2 testosterone 5-alpha reductase inhibitor. 5

10. The composition of Claim 9, wherein the testosterone 5-alpha reductase inhibitor is a type 2 testosterone 5-alpha reductase inhibitor. 10

11. The composition of Claim 10, wherein the testosterone 5-alpha reductase inhibitor is finasteride.

12. A method of treating benign prostatic hyperplasia in a subject in need thereof which comprises administering to the subject a 15 therapeutically effective amount of the compound of Claim 1.

13. The method of Claim 12, wherein the compound additionally does not cause a fall in blood pressure at dosages effective to alleviate benign prostatic hyperplasia. 20

14. The method of Claim 12, wherein the compound is administered in combination with a testosterone 5-alpha reductase inhibitor. 25

15. The method of Claim 14, wherein the testosterone 5 alpha reductase inhibitor is finasteride.

16. A method of treating benign prostatic hyperplasia in a subject in need thereof which comprises administering a 30 therapeutically effective amount of the composition of Claim 7.

17. The method of Claim 16, wherein the composition further comprises a therapeutically effective amount of a testosterone 5 alpha reductase inhibitor. 35 -81- WO 98/57642 PCT/US98/12678

18. A method of relaxing lower urinary tract tissue in a subject in need thereof which comprises administering to the subject a therapeutically effective amount of the compound of Claim 1. 5

19. The method of Claim 18, wherein the compound additionally does not cause a fall in blood pressure at dosages effective to relax lower urinary tract tissue.

20. The method of Claim 19, wherein the compound is 10 administered in combination with a testosterone 5-alpha reductase inhibitor.

21. The method of Claim 20, wherein the testosterone 5 alpha reductase inhibitor is finasteride. 15

22. A method of treating a condition which is susceptible to treatment by antagonism of the alpha la receptor which comprises administering to a subject in need thereof an amount of the compound of Claim 1 effective to treat the condition. 20

23. A pharmaceutical composition made by combining a compound of Claim 1 and a pharmaceutically acceptable carrier.

24. A process for making a pharmacuetical composition 25 comprising combining a compound of Claim 1 and a pharmaceutically acceptable carrier.

25. A method of eliciting an alpha la antagonizing effect in a mammal in need thereof, comprising administering to the 30 mammal a therapeutically effective amount of the compound of Claim 1. -82-