This invention relates to the compositions and dosage forms for delivery of gabapentin or pregabalin. More particularly, the invention relates to a complex of gabapentin or pregabalin and a transport moiety where the complex provides an enhanced absorption of the drug in the gastrointestinal tract, and more particularly, in the lower gastrointestinal tract.
Scientific understanding about the pathogenesis of neuropathic pain has grown over the last decades as basic research with animal models of neuropathic pain and human clinical trials have revealed the pathophysiological and biochemical changes in the nervous system due to an insult or disease (Backonja, M. M., Clin. J. Pain, 16(2):S67-72 (2000)). Neuropathic pain is a chronic pain, often experienced by cancer patients, stroke victims, elderly persons, diabetics, as painful diabetic neuropathy, persons with herpes zoster (shingles), as postherpetic neuralgia, and in persons with neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS). Clinical characteristics of neuropathic pain include burning, spontaneous pain, shooting pain, and evoked pains. Distinct pathophysiological mechanisms lead to specific sensory symptoms, such as dynamic mechanical allodynia and cold hyperalgesia.
Therapies for treatment of neuropathic pain include use of traditional pain agents such as nonsteroidal anti-inflammatory drugs, analgesics, opoids, or tricyclic antidepressants (Max, M. B., Ann. Neurol., 35(Suppl):S50-S53 (1994); Raja, S. N. et al., Neurology, 59:1015 (2002); Galer, B. S. et al., Pain, 80:533 (1999)). Many patients are refractory to these and other treatments because of inadequate pain relief or intolerable side effects.
The anticonvulsant gabapentin has a clearly demonstrated analgesic effect for the treatment of neuropathic pain, and specifically for the treatment of painful diabetic neuropathy and postherpetic neuralgia (Wheeler, G., Curr. Opin. Invest. Drugs, 3(3):470 (2002)). Gabapentin is also an effective medication for controlling some types of seizures, particularly seizures resulting from epilepsy (Johannessen, S. I. et al., Ther. Drug Monitoring, 25:347 (2003)). Similarly, pregabalin has been shows to be effective for treatment of postherpetic neuralgia and painful diabetic neuropathy (Dworkin, R. H. et al., Neurology, 60:1274 (2003)).
Gabapentin is absorbed from the proximal small bowel into the blood stream by the L-amino acid transport system (Johannessen, supra at 350). Bioavailability of the drug is dose dependent, apparently because the L-amino acid transport system saturates, limiting the amount of drug absorbed (Stewart, B. H. et al., Pharm. Res., 10:276 (1993)). For example, serum gabapentin concentrations increase linearly with doses up to about 1800 mg/d, and then continue to increase at higher doses but less than expected, possibly because the absorption mechanism from the upper G.I. tract becomes saturated (Stewart, supra.).
The L-amino transport system responsible for absorption of gabapentin is present primarily in the epithelial cells of the small intestine (Kanai, Y. et al., J. Toxicol. Sci., 28(1):1 (2003)), thus limiting the absorption of the drug. Pregabalin also appears to be absorbed by the L-amino transport system, along with other amino acid transport systems ((Dworkin, supra, p. 1282).
Differences in the cellular characteristics of the upper and lower G.I. tracts also contribute to the poor absorption of molecules in the lower G.I tract.
Since the typical residence time of a drug in the upper G.I. tract is from approximately four to six hours, drugs having poor colonic absorption are absorbed by the body through a period of only four to six hours after oral ingestion. Frequently it is medically desirable that the administered drug be presented in the patient's blood stream at a relatively constant concentration throughout the day. To achieve this with traditional drug formulations that exhibit minimal colonic absorption, patients would need to ingest the drugs three to four times a day. Practical experience with this inconvenience to patients suggests that this is not an optimum treatment protocol. Accordingly, it is desired that a once daily administration of such drugs, with long-term absorption throughout the day, be achieved.
To provide constant dosing treatments, conventional pharmaceutical development has suggested various controlled release drug systems. Such systems function by releasing their payload of drugs over an extended period of time following administration. However, these conventional forms of controlled release systems are not effective in the case of drugs exhibiting minimal colonic absorption. Since the drugs are only absorbed in the upper G.I. tract and since the residence time of the drug in the upper G.I. tract is only four to six hours, the fact that a proposed controlled release dosage form may release its payload after the residence period of the dosage form in the upper G.I. does not mean the that body will continue to absorb the controlled release drug past the four to six hours of upper G.I. residence. Instead, the drug released by the controlled release dosage form after the dosage form has entered the lower G.I. tract is generally not absorbed and, instead, is expelled from the body with other matter from the lower G.I.
The use of gabapentin to control seizures or neuropathic pain would be greatly improved if an effective concentration of the drug were present in the patient's blood stream throughout the day. To achieve this with traditional gabapentin formulations, patients would need to ingest gabapentin dosages three to four times a day. Practical experience with this inconvenience to patients suggests that this is not an optimum treatment protocol. Additionally, a true once-daily gabapentin treatment would provide advantages beyond convenience. Numerous other advantages are provided by a relatively constant dosage of gabapentin in the bloodstream of the patient. Accordingly, it is desired that a once daily administration of gabapentin, with long-term absorption throughout the day, be achieved.
Accordingly, in one aspect the invention includes a substance comprised of gabapentin or pregabalin and a transport moiety, the gabapentin or pregabalin and the transport moiety forming a complex.
In one embodiment, the transport moiety is an alkyl sulfate salt having between 6-12 carbon atoms. A preferred alkyl sulfate salt is a lauryl sulfate salt.
In another aspect, the invention includes a composition, comprising, a complex comprised of gabapentin or pregabalin and a transport moiety, and a pharmaceutically acceptable vehicle, wherein the composition has an absorption in the lower gastrointestinal tract at least 5-fold higher than gabapentin or pregabalin.
In another aspect, the invention includes a one embodiment, dosage form comprising the composition described above or the substance described above.
In one embodiment, the dosage form is an osmotic dosage form. Exemplary dosage forms, in one embodiment, have (i) a push layer; (ii) drug layer comprising a gabapentin-transport moiety complex or a pregabalin-transport moiety complex; (iii) a semipermeable wall provided around the push layer and the drug layer; and (iv) an exit. Another exemplary dosage form has (i) a semipermeable wall provided around an osmotic formulation a gabapentin-transport moiety complex or a pregabalin-transport moiety complex, an osmagent, and an osmopolymer; and (ii) an exit.
In one embodiment, the dosage form provides a total daily dose of between 200-3600 mg.
In another aspect, the invention provides an improvement in a dosage form comprising gabapentin or pregabalin. The improvement includes a dosage form comprising a complex of gabapentin or pregabalin and a transport moiety associated by a tight-ion pair bond.
In another aspect, the invention includes a method for administering gabapentin or pregabalin, comprising, administering the substance described above to a patient in need thereof.
In one embodiment, the substance is orally administered.
In another aspect, the invention includes a method of preparing a complex of gabapentin or pregabalin and a transport moiety, comprising providing gabapentin or pregabalin; providing a transport moiety; combining the gabapentin or pregabalin and the transport moiety in the presence of a solvent having a dielectric constant less than that of water; whereby the combining results in formation of a complex of gabapentin or pregabalin and the transport moiety.
In one embodiment, combining includes (i) combining the gabapentin or pregabalin and the transport moiety in an aqueous solvent, (ii) adding a solvent having a dielectric constant less than that of water to the aqueous solvent, and (iii) recovering the complex from the solvent.
In another embodiment, combining comprises contacting in a solvent having a dielectric constant at least two fold lower than the dielectric constant of water. Exemplary solvents include methanol, ethanol, acetone, benzene, methylene chloride, and carbon tetrachloride.
In another aspect, the invention includes a method of improving gastrointestinal tract absorption of gabapentin or pregabalin, comprising, providing a complex comprised of gabapentin or pregabalin and a transport moiety, the complex characterized by a tight-ion pair bond; and administering the complex to a patient.
In one embodiment, the improved absorption comprises improved lower gastrointestinal absorption.
In another embodiment, the improved absorption comprises improved absorption in the upper gastrointestinal tract.
These aspects, as well as other aspects, features, and advantages of the invention will become more apparent from the following detailed disclosure of the invention and the accompanying claims.
The following figures are not drawn to scale, and are set forth to illustrate various embodiments of the invention.
The present invention is best understood by reference to the following definitions, the drawings and exemplary disclosure provided herein.
By “composition” is meant one or more of the gapapein-transport moiety or pregabalin-transport moiety complexes, optionally in combination with additional active pharmaceutical ingredients, and/or optionally in combination with inactive ingredients, such as pharmaceutically-acceptable carriers, excipients, suspension agents, surfactants, disintegrants, binders, diluents, lubricants, stabilizers, antioxidants, osmotic agents, colorants, plasticizers, and the like.
By “complex” is meant a substance comprising a drug moiety and a transport moiety associated by a tight-ion pair bond. A drug-moiety-transport moiety complex can be distinguished from a loose ion pair of the drug moiety and the transport moiety by a difference in octanol/water partitioning behavior, characterized by the following relationship:
Δ Log D=Log D(complex)−Log D(loose-ion pair)≧0.15 (Equation 1)
wherein, D, the distribution coefficient (apparent partition coefficient), is the ratio of the equilibrium concentrations of all species of the drug moiety and the transport moiety in octanol to the same species in water (deionized water) at a set pH (typically about pH=5.0 to about pH=7.0) and at 25 degrees Celsius. Log D (complex) is determined for a complex of the drug moiety and transport moiety prepared according to the teachings herein. Log D (loose-ion pair) is determined for a physical mixture of the drug moiety and the transport moiety in deionized water. For instance, the octanoli/water apparent partition coefficient (D=Coctanol/Cwater) of a putative complex (in deionized water at 25 degree Celsuis) can be determined and compared to a 1:1 (mol/mol) physical mixture of the transport moiety and the drug moiety in deionized water at 25 degree Celsuis. If the difference between the Log D for the putative complex (D+T−) and the Log D for the 1:1 (mol/mol) physical mixture, D+∥T− is determined is greater than or equal to 0.15, the putative complex is confirmed as being a complex according to the invention. In preferable embodiments, Δ Log D≧0.20, and more preferably Δ Log D≧0.25, more preferably still Δ Log D≧0.35.
By “dosage form” is meant a pharmaceutical composition in a medium, carrier, vehicle, or device suitable for administration to a patient in need thereof.
By “drug” or “drug moiety” is meant a drug, compound, or agent, or a residue of such a drug, compound, or agent that provides some pharmacological effect when administered to a subject. For use in forming a complex, the drug comprises a(n) acidic, basic, or zwitterionic structural element, or a(n) acidic, basic, or zwitterionic residual structural element.
By “fatty acid” is meant any of the group of organic acids of the general formula CH3(CnHx)COOH where the hydrocarbon chain is either saturated (x=2n, e.g. palmitic acid, C15H31COOH) or unsaturated (x=2n-2, e.g. oleic acid, CH3C16H30COOH).
“Gabapentin” refers to 1-(aminomethyl)cyclohexaneacetic acid with a molecular formula of C9H17NO2 and a molecular weight of 171.24. It is commercially available under the tradename Neurontin®. Its structure is shown in
By “intestine” or “gastrointestinal (G.I.) tract” is meant the portion of the digestive tract that extends from the lower opening of the stomach to the anus, composed of the small intestine (duodenum, jejunum, and ileum) and the large intestine (ascending colon, transverse colon, descending colon, sigmoid colon, and rectum).
By “loose ion-pair” is meant a pair of ions that are, at physiologic pH and in an aqueous environment, are readily interchangeable with other loosely paired or free ions that may be present in the environment of the loose ion pair. Loose ion-pairs can be found experimentally by noting interchange of a member of a loose ion-pair with another ion, at physiologic pH and in an aqueous environment, using isotopic labeling and NMR or mass spectroscopy. Loose ion-pairs also can be found experimentally by noting separation of the ion-pair, at physiologic pH and in an aqueous environment, using reverse phase HPLC. Loose ion-pairs may also be referred to as “physical mixtures,” and are formed by physically mixing the ion-pair together in a medium.
By “lower gastrointestinal tract” or “lower G.I. tract” is meant the large intestine.
By “patient” is meant an animal, preferably a mammal, more preferably a human, in need of therapeutic intervention.
By “tight-ion pair” is meant a pair of ions that are, at physiologic pH and in an aqueous environment are not readily interchangeable with other loosely paired or free ions that may be present in the environment of the tight-ion pair. A tight-ion pair can be experimentally detected by noting the absence of interchange of a member of a tight ion-pair with another ion, at physiologic pH and in an aqueous environment, using isotopic labeling and NMR or mass spectroscopy. Tight ion pairs also can be found experimentally by noting the lack of separation of the ion-pair, at physiologic pH and in an aqueous environment, using reverse phase HPLC.
By “transport moiety” is meant a compound that is capable of forming, or a residue of that compound that has formed, a complex with a drug, wherein the transport moiety serves to improve transport of the drug across epithelial tissue, compared to that of the uncomplexed drug. The transport moiety comprises a hydrophobic portion and a(n) acidic, basic, or zwitterionic structural element, or a(n) acidic, basic, or zwitterionic residual structural element. In a preferred embodiment, the hydrophobic portion comprises a hydrocarbon chain. In an embodiment, the pKa of a basic structural element or basic residual structural element is greater than about 7.0, preferably greater than about 8.0.
By “pharmaceutical composition” is meant a composition suitable for administration to a patient in need thereof.
Pregabalin refers to (S)-(+)-3-(aminomethyl)-5-methylhexanoic acid). Pregabalin is also referred to in the literature as (S)-3-isobutyl GABA or Cl-1008. The structure of pregabalin is shown in
By “structural element” is meant a chemical group that (i) is part of a larger molecule, and (ii) possesses distinguishable chemical functionality. For example, an acidic group or a basic group on a compound is a structural element.
By “substance” is meant a chemical entity having specific characteristics.
By “residual structural element” is meant a structural element that is modified by interaction or reaction with another compound, chemical group, ion, atom, or the like. For example, a carboxyl structural element (COOH) interacts with sodium to form a sodium-carboxylate salt, the COO— being a residual structural element.
By “upper gastrointestinal tract” or “upper G.I. tract” is meant that portion of the gastrointestinal tract including the stomach and the small intestine.
As noted above, gabapentin is effective both as an anti-convulsant and in reducing neuropathic pain. Gabapentin, shown in
Accordingly, in one aspect, the invention provides a compound comprising gabapentin or pregabalin that has significantly improved lower G.I. tract absorption. The compound is a complex of gabapentin and a transport moiety, or a complex of pregabalin and a transport moiety. The compound can be prepared from a salt of the drug, such as gabapentin hydrochloride or pregabalin hydrochloride, according to the generalized synthetic reaction scheme shown in
A specific example of a procedure for preparing a gabapentin-transport moiety complex, where the transport moiety is an alkyl sulfate and more specifically an alkyl sulfate salt, is provided in Example 1A, and illustrated in
In Example 1A, a complex was formed using an alkyl sulfate, lauryl sulfate, as an exemplary transport moiety. It will be understood that lauryl sulfate is merely exemplary and that the preparation procedure is equally applicable to other species suitable as a transport moiety, and to alky sulfates and fatty acids of any carbon chain length. For example, complex formation of gabapentin (or pregabalin) with various alkyl sulfates or fatty acids or salts of the same, where the alkyl chain in the alkyl sulfate or the fatty acid has from 6 to 18 carbon atoms, more preferably 8 to 16 carbon atoms and even more preferably 10 to 14 carbon atoms. The alkyl chain can be saturated or unsaturated. Exemplary saturated alkyl chains in fatty acids contemplated for use in preparation of the complex include butanoic (butyric, 4C); pentanoic (valeric, 5C); hexanoic (caproic, 6C); octanoic (caprylic, 8C); nonanoic (pelargonic, 9C); decanoic (capric, 10C); dodecanoic (lauric, 12C); tetradecanoic (myristic, 14C); hexadecanoic (palmitic, 16C); heptadecanoic (margaric, 17C); and octadecanoic (stearic, 18C); where the systematic name is followed in parenthesis by the fatty acid trivial name and the number of carbon atoms in the fatty acid. Unsaturated fatty acids include oleic acid, linoleic acid, and linolenic acid, all having 18 carbon atoms. Linoleic acid and linolenic acid are polyunsaturated. Exemplary complexes with gabapentin include gabapentin palmitate, gabapentin oleate, gabapentin caprate, gabapentin laurate, gabapentin-lauryl sulfate, gabapentin-decyl sulfate, and gabapentin-tetradecyl sulfate.
Exemplary alkyl sulfates and salts of alkyl sulfates (e.g., sodium, potassium, magnesium, etc), have from 6 to 18 carbon atoms, more preferably 8 to 16 and even more preferably 10 to 14 carbon atoms. Preferred alkyl sulfates include capryl sulfate, lauryl sulfate, and myristyl sulfate. Complex formation of gabapentin or pregabalin with the benzenesulfonic acid, benzoic acid, fumaric acid, and salicylic acid, or the salts of these acids, is also contemplated.
Gabapentin and pregabalin are zwitterionic compounds, permitting the possibility of interaction with positively and negatively charged group. In one embodiment, a transport moiety capable of interaction the positively charged NH3+ moiety of gabapentin and pregabalin is selected, as was discussed with respect to
In an alternative embodiment, a transport moiety capable of interaction with the negatively charged COO− group of gabapentin or pregabalin is selected. For example, primary aliphatic amines (both saturated and unsaturated), diethanolamine, ethylenediamine, procaine, choline, tromethamine, meglumine, magnesium, aluminum, calcium, zinc, alkyltrimethylammonium hydroxides, alkyltrimethylammonium bromides, benzalkonium chloride and benzethonium chloride can be used to complex with the negatively charged group of gabapentin and pregabalin.
With continuing reference to Example 1A, the complex comprised of gabapentin-lauryl sulfate was prepared from methylene chloride (chloforom). Methylene chloride is merely an exemplary solvent, and other solvents in which the transport moiety and the drug are soluble are suitable. For example, fatty acids are soluble in chloroform, benzene, cyclohexane, ethanol (95%), acetic acid, and methanol. The solubility (in g/L) of capric acid, lauric acid, myristic acid, palmitic acid, and stearic acid in these solvents is indicated in Table 1.
In one embodiment, the solvent used for formation of the complex is a solvent having a dielectric constant less than water, and preferably at least two fold lower than the dielectric constant of water, more preferably at least three-fold lower than that of water. The dielectric constant is a measure of the polarity of a solvent and dielectric constants for exemplary solvents are shown in Table 2.
The solvents water, methanol, ethanol, 1-propanol, 1-butanol, and acetic acid are polar protic solvents having a hydrogen atom attached to an electronegative atom, typically oxygen. The solvents acetone, ethyl acetate, methyl ethyl ketone, and acetonitrile are dipolar aprotic solvents, and are in one embodiment, preferred for use in forming the gabapentin (or pregabalin)-transport moiety complex. Dipolar aprotic solvents do not contain an OH bond but typically have a large bond dipole by virtue of a multiple bond between carbon and either oxygen or nitrogen. Most dipolar aprotic solvents contain a C—O double bond. The dipolar aprotic solvents noted in Table 2 have a dielectric constant at least two-fold lower than water.
Fourier Transform Infrared Spectroscopy (FTIR) was use to analyze the gabapentin-lauryl sulfate complex formed as described in Example 1A. The FTIR/ATR methodology is described in the methods section below. For comparison, FTIR/ATR spectra of gabapentin, sodium lauryl sulfate, and of a 1:1 molar ratio physical mixture of gabapentin and sodium lauryl sulfate (two components were dissolved in methanol and dried in air as a solid film) were also generated, and the results are shown in
While not wishing to be bound by specific understanding of mechanisms, the inventors reason as follows. When loose ion-pairs are placed in a polar solvent environment, it is assumed that polar solvent molecules will insert themselves in the space occupied by the ionic bond, thus driving apart the bound ions. A salvation shell, comprising polar solvent molecules electrostatically bonded to a free ion, may be formed around the free ion. This solvation shell then prevents the free ion from forming anything but a loose ion-pairing ionic bond with another free ion. In a situation wherein there are multiple types of counter ions present in the polar solvent, any given loose ion-pairing may be relatively susceptible to counter-ion competition.
This effect is more pronounced as the polarity, expressed as the dielectric constant of the solvent, increases. Based on Coulomb's law, the force between two ions with charges (q1) and (q2) and separated by a distance (r) in a medium of dielectric constant (e) is:
where ε0 is the constant of permittivity of space. The equation shows the importance of dielctric constant (ε) on the stability of a loose ion-pair in solution. In aqueous solution that has a high dielectric constant (ε=80), the electrostatic attraction force is significantly reduced if water molecules attack the ionic bonding and separate the opposite charged ions.
Therefore, high dielectric constant solvent molecules, once present in the vicinity of the ionic bond, will attack the bond and eventually break it. The unbound ions then are free to move around in the solvent. These properties define a loose ion-pair.
Tight ion-pairs are formed differently from loose-ion pairs, and consequently poses different properties from a loose ion-pair. Tight ion-pairs are formed by reducing the number of polar solvent molecules in the bond space between two ions. This allows the ions to move tightly together, and results in a bond that is significantly stronger than a loose ion-pair bond, but is still considered an ionic bond. As disclosed more fully herein, tight ion-pairs are obtained using less polar solvents than water so as to reduce entrapment of polar solvents between the ions.
For additional discussion of loose and tight ion-pairs, D. Quintanar-Guerrero et al., Pharm. Res., 14(2):119-127 (1997).
The difference between loose and tight ion-pairing also can be observed using chromatographic methods. Using reverse phase chromatography, loose ion-pairs can be readily separated under conditions that will not separate tight ion-pairs.
Bonds according to this invention may also be made stronger by selecting the strength of the cation and anion relative to one another. For instance, in the case where the solvent is water, the cation (base) and anion (acid) can be selected to attract one another more strongly. If a weaker bond is desired, then weaker attraction may be selected.
Portions of biological membranes can be modeled to a first order approximation as lipid bilayers for purposes of understanding molecular transport across such membranes. Transport across the lipid bilayer portions (as opposed to active transporters, etc.) is unfavorable for ions because of unfavorable portioning. Various researchers have proposed that charge neutralization of such ions can enhance cross-membrane transport.
In the “ion-pair” theory, ionic drug moieties are paired with transport moiety counter ions to “bury” the charge and render the resulting ion-pair more liable to move through a lipid bilayer. This approach has generated a fair amount of attention and research, especially with regards to enhancing absorption of orally administered drugs across the intestinal epithelium.
While ion-pairing has generated a lot of attention and research, it has not always generated a lot of success. For instance, ion-pairs of two antiviral compounds were found not to result in increased absorption due to the effects of the ion-pair on trans-cellular transport, but rather to an effect on monolayer integrity (J. Van Gelder et al., Int. J. of Pharmaceutics, 186:127-136 (1999). The authors concluded that the formation of ion pairs may not be very efficient as a strategy to enhance trans-epithelial transport of charged hydrophilic compounds as competition by other ions found in in vivo systems may abolish the beneficial effect of counter-ions. Other authors have noted that absorption experiments with ion-pairs have not always pointed at clear-cut mechanisms (D. Quintanar-Guerrero et al., Pharm. Res., 14(2):119-127 (1997)).
The inventors have unexpectedly discovered that a problem with these ion-pair absorption experiments is that they were performed using loose-ion pairs, rather than tight ion-pairs. Indeed, many ion-pair absorption experiments disclosed in the art do not even expressly differentiate between loose ion-pairs and tight ion-pairs. One of skill has to distinguish that loose ion-pairs are disclosed by actually reviewing the disclosed methods of making the ion-pairs and noting that such disclosed methods of making are directed to loose ion-pairs not tight ion-pairs. Loose ion-pairs are relatively susceptible to counter-ion competition, and to solvent-mediated (e.g. water-mediated) cleavage of the ionic bonds that bind loose ion-pairs. Accordingly, when the drug moiety of the ion-pair arrives at an intestinal epithelial cell membrane wall, it may or may not be associated in a loose ion-pair with a transport moiety. The chances of the ion-pair existing near the membrane wall may depend more on the local concentration of the two individual ions than on the ion bond keeping the ions together. Absent the two moieties being bound when they approached an intestinal epithelial cell membrane wall, the rate of absorption of the non-complexed drug moiety might be unaffected by the non-complexed transport moiety. Therefore, loose ion-pairs might have only a limited impact on absorption compared to administration of the drug moiety alone.
In contrast, the inventive complexes possess bonds that are more stable in the presence of polar solvents such as water. Accordingly, the inventors reasoned that, by forming a complex, the drug moiety and the transport moiety would be more likely to be associated as ion-pairs at the time that the moieties would be near the membrane wall. This association would increase the chances that the charges of the moieties would be buried and render the resulting ion-pair more liable to move through the cell membrane.
In an embodiment, the complex comprises a tight ion-pair bond between the drug moiety and the transport moiety. As discussed herein, tight ion-pair bonds are more stable than loose ion-pair bonds, thus increasing the likelihood that the drug moiety and the transport moiety would be associated as ion-pairs at the time that the moieties would be near the membrane wall. This association would increase the chances that the charges of the moieties would be buried and render the tight ion-pair bound complex more liable to move through the cell membrane.
It should be noted that the inventive complexes may improve absorption relative to the non-complexed drug moiety throughout the G.I. tract, not just the lower G.I. tract, as the complex is intended to improve transcellular transport generally, not just in the lower G.I. tract. For instance, if the drug moiety is a substrate for an active transporter found primarily in the upper G.I., the complex formed from the drug moiety may still be a substrate for that transporter. Accordingly, the total transport may be a sum of the transport flux effected by the transporter plus the improved transcellular transport provided by the present invention. In an embodiment, the inventive complex provides improved absorption in the upper G.I. tract, the lower G.I. tract, and both the upper G.I. tract and the lower G.I. tract.
In a study conducted in support of the invention, the lower G.I. absorption of the gabapentin-lauryl sulfate complex was characterized in vivo using a flush ligated colonic model in rats. As described in Example 2, a 10 mg/rat dose of gabapentin in the form of gabapentin-lauryl sulfate complex or as neat gabapentin was intubated into the ligated colon of test rats (n=3 in each group). A third group of rats (n=3) was given 1 mg of gabapentin intravenously. Blood samples were withdrawn periodically for analysis of gabapentin concentration. The data is shown in
With reference to
Pharmacokinetic parameters from this study are shown in Table 3. The area under the curve (AUC) is determined from time zero to time infinity based on 1 mg of gabapentin/rat for each of the gabapentin dosages, where time infinity was estimated by assuming a log-linear decline. Gabapentin bioavailability is expressed as a percent of the gabapentin concentration resulting from intravenous administration of the drug.
The enhanced colonic absorption provided by the complex of gabapentin and lauryl sulfate is apparent from the markedly improved bioavailability of the drug when administered to the lower G.I. tract in the form of the complex relative to the neat drug. The gabapentin-lauryl sulfate complex provided a 13-fold improvement in bioavailability relative to that of the neat drug. Accordingly, the invention contemplates a compound comprised of a complex formed of gabapentin (or pregabalin) and a transport moiety, wherein the complex provides at least a 5-fold increase, more preferably at least a 10-fold increase, and more preferably at least a 12-fold increase in colonic absorption relative to colonic absorption of gabapentin (or pregabalin), as evidenced by gabapentin (or pregabalin) bioavailability determined from gabapentin (or pregabalin) plasma concentration. Thus, gabapentin (or pregabalin) when administered in the form of a gabapentin (or pregabalin)-transport moiety complex provides a significantly enhanced colonic absorption of gabapentin (or pregabalin) into the blood.
Another study was conducted where gabapentin or gabapentin-lauryl sulfate complex were placed in the duodenum of rats, as described in Example 3. Doses of 5 mg/rat, 10 mg/rat, 20 mg/rat were administered and blood samples taken as a function of time for determination of gabapentin concentration. Another group of test animals received gabapentin or gabapentin-lauryl sulfate complex intravenously. The results are shown in
Table 4 shows the pharmacokinetic analysis from the study, where the area under curve from 0 to 4 hours was determined, and normalized to a 1 mg does of gabapentin/kg rat. The data relating to the hour 4 point for gabapentin (iv) assumes a log-linear decline from the data measured for the first three hours. Percent bioavailability is relative to the bioavailability of intravenously administered gabapentin.
*Normalized to dose of 1 mg gabapentin/kg.
The AUC and bioavailability data show that as the dose increases, colonic absorption of gabapentin is improved when the drug is provided in the form of a gapapentin-transport moiety complex.
While the experimental data is based on gabapentin, it will be understood that the findings extend to pregabalin, an analog of gabapentin. Examples 4 and 5 describe methods for determining the in vivo absorption of a pregabalin-lauryl sulfate complex.
The complex described above provides an enhanced absorption rate in the G.I. tract, and in particular in the lower G.I. tract. Dosage forms and methods of treatment using the complex and its increased colonic absorption will now be described. It will be appreciated that the dosage forms described below are merely exemplary. It will also be appreciated that the dosage forms are equally applicable to gabapentin, pregabalin, or a mixture thereof. In the discussion below, reference is made to gabapentin; yet it will be understood that the discussion also applies to pregabalin.
A variety of dosage forms are suitable for use with the gabapentin-transport moiety complex. As discussed above, a dosage form that provides once daily dosing to achieve a therapeutic efficacy for at least about 12 hours, more preferably for at least 15 hours, and still more preferably for at least about 20 hours. The dosage form may be configured and formulated according to any design that delivers a desired dose of gabapentin. Typically, the dosage form is orally administrable and is sized and shaped as a conventional tablet or capsule. Orally administrable dosage forms may be manufactured according to one of various different approaches. For example, the dosage form may be manufactured as a diffusion system, such as a reservoir device or matrix device, a dissolution system, such as encapsulated dissolution systems (including, for example, “tiny time pills”, and beads) and matrix dissolution systems, and combination diffusion/dissolution systems and ion-exchange resin systems, as described in Remington's Pharmaceutical Sciences, 18th Ed., pp. 1682-1685 (1990).
A specific example of a dosage form suitable for use with the gabapentin-transport moiety complex is an osmotic dosage form. Osmotic dosage forms, in general, utilize osmotic pressure to generate a driving force for imbibing fluid into a compartment formed, at least in part, by a semipermeable wall that permits free diffusion of fluid but not drug or osmotic agent(s), if present. An advantage to osmotic systems is that their operation is pH-independent and, thus, continues at the osmotically determined rate throughout an extended time period even as the dosage form transits the gastrointestinal tract and encounters differing microenvironments having significantly different pH values. A review of such dosage forms is found in Santus and Baker, “Osmotic drug delivery: a review of the patent literature,” Journal of Controlled Release, 35:1-21 (1995). Osmotic dosage forms are also described in detail in the following U.S. patents, each incorporated in their entirety herein: U.S. Pat. Nos. 3,845,770; 3,916,899; 3,995,631; 4,008,719; 4,111,202; 4,160,020; 4,327,725; 4,519,801; 4,578,075; 4,681,583; 5,019,397; and 5,156,850.
An exemplary dosage form, referred to in the art as an elementary osmotic pump dosage form, is shown in
Semi-permeable wall 22 of the osmotic dosage form is permeable to the passage of an external fluid, such as water and biological fluids, but is substantially impermeable to the passage of components in the internal compartment. Materials useful for forming the wall are essentially nonerodible and are substantially insoluble in biological fluids during the life of the dosage form. Representative polymers for forming the semi-permeable wall include homopolymers and copolymers, such as, cellulose esters, cellulose ethers, and cellulose ester-ethers. Flux-regulating agents can be admixed with the wall-forming material to modulate the fluid permeability of the wall. For example, agents that produce a marked increase in permeability to fluid such as water are often essentially hydrophilic, while those that produce a marked permeability decrease to water are essentially hydrophobic. Exemplary flux regulating agents include polyhydric alcohols, polyalkylene glycols, polyalkylenediols, polyesters of alkylene glycols, and the like.
In operation, the osmotic gradient across wall 22 due to the presence of osmotically-active agents causes gastric fluid to be imbibed through the wall, swelling of the drug layer, and formation of a deliverable gabapentin-transport moiety complex-containing formulation (e.g., a solution, suspension, slurry or other flowable composition) within the internal compartment. The deliverable gabapentin-transport moiety complex formulation is released through an exit 38 as fluid continues to enter the internal compartment. Even as the complex-containing formulation is released from the dosage form, fluid continues to be drawn into the internal compartment, thereby driving continued release. In this manner, gabapentin-transport moiety complex is released in a sustained and continuous manner over an extended time period.
Preparation of a dosage form like that shown in
Drug layer 46 comprises a gabapentin-transport moiety complex in an admixture with selected excipients, such as those discussed above with reference to
Push layer 48 comprises osmotically active component(s), such as one or more polymers that imbibes an aqueous or biological fluid and swells, referred to in the art as an osmopolymer. Osmopolymers are swellable, hydrophilic polymers that interact with water and aqueous biological fluids and swell or expand to a high degree, typically exhibiting a 2-50 fold volume increase. The osmopolymer can be non-crosslinked or crosslinked, and in a preferred embodiment the osmopolymer is at least lightly crosslinked to create a polymer network that is too large and entangled to easily exit the dosage form during use. Examples of polymers that may be used as osmopolymers are provided in the references noted above that describe osmotic dosage forms in detail. A typical osmopolymer is a poly(alkylene oxide), such as poly(ethylene oxide), and a poly(alkali carboxymethylcellulose), where the alkali is sodium, potassium, or lithium. Additional excipients such as a binder, a lubricant, an antioxidant, and a colorant may also be included in the push layer. In use, as fluid is imbibed across the semi-permeable wall, the osmopolymer(s) swell and push against the drug layer to cause release of the drug from the dosage form via the exit port(s).
The push layer can also include a component referred to as a binder, which is typically a cellulose or vinyl polymer, such as poly-n-vinylamide, poly-n-vinylacetamide, poly(vinyl pyrrolidone), poly-n-vinylcaprolactone, poly-n-vinyl-5-methyl-2-pyrrolidone, and the like. The push layer can also include a lubricant, such as sodium stearate or magnesium stearate, and an antioxidant to inhibit the oxidation of ingredients. Representative antioxidants include, but are not limited to, ascorbic acid, ascorbyl palmitate, butylated hydroxyanisole, a mixture of 2 and 3 tertiary-butyl-4-hydroxyanisole, and butylated hydroxytoluene.
An osmagent may also be incorporated into the drug layer and/or the push layer of the osmotic dosage form. Presence of the osmagent establishes an osmotic activity gradient across the semi-permeable wall. Exemplary osmagents include salts, such as sodium chloride, potassium chloride, lithium chloride, etc. and sugars, such as raffinose, sucrose, glucose, lactose, and carbohydrates.
With continuing reference to
In use, water flows across the wall and into the push layer and the drug layer. The push layer imbibes fluid and begins to swell and, consequently, pushes on drug layer 44 causing the material in the layer to be expelled through the exit orifice and into the gastrointestinal tract. Push layer 48 is designed to imbibe fluid and continue swelling, thus continually expelling drug from the drug layer throughout the period during which the dosage form is in the gastrointestinal tract. In this way, the dosage form provides a continuous supply of gabapentin-transport moiety complex to the gastrointestinal tract for a period of 15 to 20 hours, or through substantially the entire period of the dosage form's passage through the G.I. tract. Since the gabapentin-transport moiety complex is absorbed in both the upper and lower G.I. tracts, administration of the dosage form provides delivery of gabapentin into the blood stream over period time the dosage form is in transit in the G.I. tract.
Another exemplary dosage form is shown in
The push layer consists of 63.67 wt % of polyethylene oxide, 30.00 wt % sodium chloride, 1.00 wt % ferric oxide, 5.00 wt % hydroxypropylmethylcellulose, 0.08 wt % butylated hydroxytoluene and 0.25 wt % magnesium stearate. The semi-permeable wall is comprised of 80.0 wt % cellulose acetate having a 39.8 % acetyl content and 20.0% polyoxyethylene-polyoxypropylene copolymer.
Dissolution rates of dosage forms, such as those shown in
After ingestion of dosage form 80, regions of matrix 82 between bands 88, 90, 92 begin to erode, as illustrated in
It will be appreciated the dosage forms described in
In another aspect, the invention provides a method for administering gabapentin to a patient by administering a composition or a dosage form that contains a complex of gabapentin and a transport moiety, the complex characterized by a tight-ion pair bond between the gabapentin (or pregabalin) and the transport moiety. A composition comprising the complex and a pharmaceutically-acceptable vehicle are administered to the patient, typically via oral administration.
The dose administered is generally adjusted in accord with the age, weight, and condition of the patient, taking into consideration the dosage form and the desired result. In general, the dosage forms and compositions of the gabapentin-transport moiety complex are administered in amounts recommended for gabapentin (Neurontin®) therapy, as set forth in the Physician's Desk Reference. A typical dose for controlling seizures in epiletic patients is 900-1800 mg per day. Typical doses for use in alleviating neuropathic pain are 600-3600 mg per day (Backonja, M., Clinical Therapies, 23(1) (2003)). It will be appreciated that these dose ranges represent approximate ranges and that the increased absorption provided by the complex will alter the required dose.
With respect to pregabalin, the dose administered will also be adjusted in accord with the age, weight, and condition of the patient, taking into consideration the dosage form and the desired result. In general, a dose of at least about 300 mg day is provided and is increased as needed to provide a reduction in perceived pain relief. Reductions in pain can be measured using numerical pain rating scales, such as the Short-Form McGill Pain Questionnaire (Dworkin, R. H. et al., Neurology, 60:1274 (2003)).
From the foregoing, it can be seen how various objects and features of the invention are met. A complex consisting of gabapentin or pregabalin and a transport moiety, the gabapentin (or pregabalin) and transport moiety associated by a non-covalent, tight-ion pair bond, provides an enhanced G.I. absorption of the drug. The complex is prepared from a novel process, where gabapentin or pregabalin is contacted with a transport moiety, such as an alkyl sulfate or a fatty acid, solubilized in a solvent that is less polar than water, the lower polarity evidenced, for example, by a lower dielectric constant. Contact of the drug with the transport moiety-solvent mixture results in formation of a complex between the drug (gabapentin or pregabalin) and the transport moiety, where the two species are associated by a tight-ion pair bond.
The following examples further illustrate the invention described herein and are in no way intended to limit the scope of the invention.
Methods
1. FTIR: Fouier Transform Infrared Spectroscopy was performed on a Perkin-Elmer Spectrum 2000 spectrometer system equipped with an Attenuated Total Reflectance (ATR) accessory and liquid N2 cooled MCT (mercury cadmium telluride) detector.
Gabapentin-Transport Moiety Complex
Pregabalin-Transport Moiety Complex
An animal model commonly known as the “flush ligated colonic model” or “intracolonic ligated model” was used. Fasted, 0.3-0.5 kg Sprague-Dawley male rats were anesthetized and a segment of proximal colon was isolated. The colon was flushed of fecal materials. The segment was ligated at both ends while a catheter was placed in the lumen and exteriorized above the skin for delivery of test formulation. The colonic contents were flushed out and the colon was returned to the abdomen of the animal. Depending on the experimental set up, the test formulation was added after the segment was filled with 1 mL/kg of 20 mM sodium phosphate buffer, pH 7.4, to more accurately simulate the actual colon environment in a clinical situation.
Rats (n=3) were allowed to equilibrate for approximately 1 hour after surgical preparation and prior to exposure to each test formulation. Gabapentin-lauryl sulfate complex or gabapentin was administered as an intracolonic bolus and delivered at 10 mg gabapentin-lauryl sulfate complex/rat or 10 mg gabapentin/rat. Blood samples obtained from the jugular catheter were taken at 0, 15, 30, 60, 90, 120, 180 and 240 minutes and analyzed for gabapentin concentration. At the end of the 4 hour test period, the rats were euthanized with an overdose of pentobarbital. Colonic segments from each rat were excised and opened longitudinally along the anti-mesenteric border. Each segment was pbserved macroscopically for irritation and any abnormality noted. The excised colons were placed on graph paper and measured to approximate colonic surface area. There was no histopathological change visible to the naked eye in the mucosal of any of the test rats.
A control group of rats (n=3) were treated with gabapentin intravenously, at a dose of 1 mg/rat. Blood samples were withdrawn at the same times indicated above for analysis of gabapentin concentration.
The gabapentin plasma concentration for each test animal, and the average plasma concentration for animals in each test group, are shown in Tables A-C.
Twenty-eight rats were randomized into seven test groups (n=4). Gagapentin or gabapentin-lauryl sulfate complex, prepared as described in Example 1A, was intubated via catheter into the beginning of the duodenum of rats at dosages of 5 mg/rat, 10 mg/rat, and 20 mg/rat. The remaining test group was given 1 mg/kg gabapentin intravenously.
Blood samples were taken from each animal over a four hour period and analyzed for gabapentin content. The results are shown in Tables D-H and in
An animal model commonly known as the “intracolonic ligated model” is employed. Fasted, 0.3-0.5 kg Sprague-Dawley male rats are anesthetized and a segment of proximal colon is isolated. The colon is flushed of fecal materials. The segment is ligated at both ends while a catheter is placed in the lumen and exteriorized above the skin for delivery of test formulation. The colonic contents are flushed out and the colon is returned to the abdomen of the animal. Depending on the experimental set up, the test formulation is added after the segment is filled with 1 mL/kg of 20 mM sodium phosphate buffer, pH 7.4, to more accurately simulate the actual colon environment in a clinical situation.
Rats (n=3) are allowed to equilibrate for approximately 1 hour after surgical preparation and prior to exposure to each test formulation. Pregabalin-lauryl sulfate complex or pregabalin are administered as an intracolonic bolus and delivered at 10 mg pregabalin/rat. Blood samples obtained from the jugular catheter are taken at 0, 15, 30, 60, 90, 120, 180 and 240 minutes for analysis of pregabalin concentration. At the end of the 4 hour test period, the rats are euthanized with an overdose of pentobarbital. Colonic segments from each rat are excised and opened longitudinally along the anti-mesenteric border. Each segment is observed macroscopically for irritation and any abnormality noted. The excised colons are placed on graph paper and measured to approximate colonic surface area.
A control group of rats (n=3) is treated with pregabalin intravenously, at a dose of 1 mg/rat. Blood samples are withdrawn at the same times indicated above.
Twenty-eight rats are randomized into seven test groups (n=4). Pregabalin or pregabalin-lauryl sulfate complex, prepared as described in Example 1B, in water is intubated via catheter into the beginning of the duodenum of rats at dosages of 5 mg/rat, 10 mg/rat, and 20 mg/rat. The remaining test group is given 1 mg/kg pregabalin intravenously.
Blood samples are taken from each animal over a four hour period and analyzed for pregabalin content. The dose, AUC, and bioavailability are determined using similar calculations as used for gabapentin in Example 3.
A. Gabapentin-Transport Moiety Complex
A device as shown in
B. Pregabalin-Transport Moiety Complex
A device as shown in
A dosage form, as illustrated in
10 grams of gabapentin, 1.18 g of polyethylene oxide of 100,000 molecular weight, and 0.53 g of polyvinylpyrrolidone having molecular weight of about 38,000 are dry blended in a conventional blender for 20 minutes to yield a homogenous blend. Next, 4 mL denatured anhydrous alcohol is added slowly, with the mixer continuously blending, to the three component dry blend. The mixing is continued for another 5 to 8 minutes. The blended wet composition is passed through a 16 mesh screen and dried overnight at room temperature. Then, the dry granules are passed through a 16 mesh screen and 0.06 g of magnesium stearate are added and all the ingredients are dry blended for 5 minutes. The fresh granules are ready for formulation as the initial dosage layer in the dosage form.
The layer containing gabapentin-lauryl sulfate complex in the dosage form is prepared as follows. First, 9.30 grams of gabapentin-lauryl sulfate complex, prepared as described in Example 1A, 0.50 g polyethylene oxide of 5,000,000 molecular weight, 0.10 g of polyvinylpyrrolidone having molecular weight of about 38,000 are dry blended in a conventional blender for 20 minutes to yield a homogenous blend. Next, denatured anhydrous ethanol is added slowly to the blend with continuous mixing for 5 minutes. The blended wet composition is passed through a 16 mesh screen and dried overnight at room temperature. Then, the dry granules are passed through a 16 mesh screen and 0.10 g magnesium stearate are added and all the dry ingredients were dry blended for 5 minutes.
A push layer comprised of an osmopolymer hydrogel composition is prepared as follows. First, 58.67 g of pharmaceutically acceptable polyethylene oxide comprising a 7,000,000 molecular weight, 5 g Carbopol® 974P, 30 g sodium chloride and 1 g ferric oxide were separately screened through a 40 mesh screen. The screened ingredients were mixed with 5 g of hydroxypropylmethylcellulose of 9,200 molecular weight to produce a homogenous blend. Next, 50 mL of denatured anhydrous alcohol was added slowly to the blend with continuous mixing for 5 minutes. Then, 0.080 g of butylated hydroxytoluene was added followed by more blending. The freshly prepared granulation was passed through a 20 mesh screen and allowed to dry for 20 hours at room temperature (ambient). The dried ingredients were passed through a 20 mesh screen and 0.25 g of magnesium stearate was added and all the ingredients were blended for 5 minutes.
The tri-layer dosage form is prepared as follows. First, 118 mg of the gabapentin composition is added to a punch and die set and tamped, then 511 mg of the gabapentin-lauryl sulfate composition is added to the die set as the second layer and again tamped. Then, 315 mg of the hydrogel composition is added and the three layers are compressed under a compression force of 1.0 ton (1000 kg) into a {fraction (9/32)} inch (0.714 cm) diameter punch die set, forming an intimate tri-layered core (tablet).
A semipermeable wall-forming composition is prepared comprising 80.0 wt % cellulose acetate having a 39.8 % acetyl content and 20.0 % polyoxyethylene-polyoxypropylene copolymer having a molecular weight of 7680-9510 by dissolving the ingredients in acetone in a 80:20 wt/wt composition to make a 5.0% solids solution. The wall-forming composition is sprayed onto and around the tri-layerd core to provide a 60 to 80 mg thickness semi-permeable wall.
Next, a 40 mil (1.02 mm) exit orifice is laser drilled in the semipermeable walled tri-layered tablet to provide contact of the gabapentin layer with the exterior of the delivery device. The dosage form is dried to remove any residual solvent and water.
The in vitro dissolution rates of dosage forms prepared as described in Examples 4 and 5 are determined by placing a dosage form in metal coil sample holders attached to a USP Type VII bath indexer in a constant temperature water bath at 37° C. Aliquots of the release media are injected into a chromatographic system to quantify the amounts of gabapentin (or pregabalin) released into a medium simulating artificial gastric fluid (AGF) during each testing interval.
A dosage form as illustrated in
733 mg portions of the final granulation are placed in die cavities having inside diameters of 0.281 inch. The portions are compressed with deep concave punches under a pressure head of 1 ton, forming longitudinal capsule-shaped tablets.
The capsules are fed into a Tait Capsealer Machine (Tait Design and Machine Co., Manheim, Pa.) where three bands are printed onto each capsule. The material forming the bands is a mixture of 50 wt % ethylcellulose dispersion (Surelease®, Colorcon, West Point, Pa.) and 50 wt % ethyl acrylate methylmethacrylate (Eudragit® NE 30D, RohmPharma, Weiterstadt, Germany). The bands are applied as an aqueous dispersion and the excess water is driven off in a current of warm air. The diameter of the bands is 2 millimeters.
While there has been described and pointed out features and advantages of the invention, as applied to present embodiments, those skilled in the medical art will appreciate that various modifications, changes, additions, and omissions in the method described in the specification can be made without departing from the spirit of the invention.
This application claims the benefit of U.S. provisional patent application No. 60/516,259, filed Oct. 31, 2003, and of U.S. provisional patent application No. 60/519,509, filed Nov. 12, 2003, both applications are incorporated herein by reference in their entirety.
Number | Date | Country | |
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60516259 | Oct 2003 | US | |
60519509 | Nov 2003 | US |