Patent Application
20240238225
The present invention relates to the field of anesthetics. Especially, the present invention refers to an injectable anesthetic solution having a reduced bitterness, comprising a local anesthetic, optionally a vasoconstrictor, a pharmaceutically acceptable solvent and a bitterness suppressant including a sweetener selected from saccharin and/or sorbitol; and/or an amino acid selected from serin and/or threonine. The present invention also relates to the method for manufacturing the injectable anesthetic solution and its uses in dentistry, oral surgery and/or maxillofacial surgery.
In recent years, the number of dental procedures such as fillings, root canals, crowns, and extractions, increased significantly. Most treatments require injecting local anesthetics such as lidocaine-based anesthetics, in order to guarantee high patient comfort.
During the administration of the anesthetics, part of the injected volume may reflux back onto the oral cavity and tongue due to resistance from patients and improper injection techniques, resulting in patients experiencing the bitter and unpalatable taste of the local oral anesthetics. This experience is not well-received by patients, in particular by children. Furthermore, the bitter taste in the mouth of the patient may last up to two hours after the dissipation of the anesthetic.
Thus, eliminating the bitter taste of dental products would partially enhance patient tolerance, change the patient's perspective towards the dental procedures, and render oral care visits more pleasant.
Limited attempts have been made to mask the taste of dental products. The main reported techniques to reduce the bitterness of oral anesthetics deal with providing a coating with insoluble polymers, adding sweeteners or flavors, using ion exchange resins, complexing with cyclodextrins and/or using prodrugs. In these techniques, the aim is to limit or avoid contacting the anesthetics with the taste buds.
However, the main drawback of these techniques is that they cannot be implemented in an injectable formulation due to the stringent requirements and policies of the Food and Drug Administration (FDA). Indeed, the compounds of the injectable formulation have to comply with the injection requirements such as for example a suitable osmolarity. However, until now, the addition of taste masking agents in an injectable formulation causes a modification of its osmolarity, in particular an over osmolarity, rendering them incompatible for injection.
For example, US2020/206351 discloses local anesthetic solutions with diminished bitter taste thanks to the presence of dextrose as bitterness suppressant and comprising a lactated Ringer's solution as buffering agent of this bitterness suppressant. However, as evidenced hereafter in the examples, the solutions of US2020/206351 display an osmolarity of more than 700 mOsm/L. This is much higher than the normal physiological range (about 280 to 310 mOsm/L) and even higher than the highest level tolerated for intra-tissular injection which is of about 600 mOsm/L.
There is thus a need for providing injectable anesthetic solution having a reduced bitter taste, while having an osmolarity suitable for injection, especially intra-tissular injection.
Furthermore, the addition of compounds in the injectable solution should not alter the chemical stability of the active agents. In particular, the anesthetic agent and/or the optionally present vasoconstrictor may be pH sensible active agents. It is thus crucial to control the pH of the solution at a suitable level.
Consequently, reducing or eliminating the bitter taste of oral injectable anesthetics is still challenging. Thus, there is still a need for providing injectable anesthetics overcoming these drawbacks.
The present invention refers to an injectable anesthetic solution comprising:
According to one embodiment, the injectable anesthetic solution comprises a vasoconstrictor which is an epinephrin, preferably the vasoconstrictor is epinephrin bitartrate.
According to one embodiment, the anesthetic agent is a lidocaine or a derivate thereof; preferably is lidocaine hydrochloride.
According to one embodiment, the pharmaceutically acceptable solvent is water, preferably selected from sterilized water, purified water and osmosed water.
According to one embodiment, the bitterness suppressant consists of sodium saccharin and serine.
According to one embodiment, the amount of amino acid ranges from 1% to 6% wt., preferably ranges from 2% to 3% wt., relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the amount of sodium saccharin and/or sorbitol, preferably sodium saccharin, ranges from 0.01% to 5% wt., preferably from 0.01% to 1% wt., more preferably is 0.09% relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the injectable anesthetic solution of the invention further comprises one or more additives selected from the group consisting of: pH adjusting agents; preservative compounds; stabilizers; contrast media agents; and their mixtures thereof.
According to one embodiment, the preservative compound is selected from: sodium bisulfites, potassium bisulfites or metabisulfites, ascorbic acid, citric acid, ethylene diamine tetra acetic acid (EDTA) and their salts (“edetate salts”) such as disodium edetate, sodium hydroxide, benzyl alcohol, phenylethyl alcohol, phenol, meta-cresol, chlorobutanol, thimerosal, phenylmercuric salts, and any combinations thereof; preferably is selected from potassium metabisulfite, disodium edetate, and any combination thereof preferably is sodium metabisulfite or potassium metabisulfite; more preferably the injectable anesthetic solution comprises a preservative compound which is selected from disodium edetate, sodium hydroxide and any mixture thereof. According to one embodiment, the injectable anesthetic solution does not comprise ethylene diamine tetra acetic acid (EDTA).
According to one embodiment, the injectable anesthetic solution comprises:
The present invention also refers to a method for manufacturing the injectable anesthetic solution of the invention, comprising mixing:
According to one embodiment, the injectable anesthetic solution according of the invention is for use in anesthesia during dentistry, oral surgery and/or maxillofacial surgery.
According to one embodiment, dentistry, oral surgery and/or maxillofacial surgery is filling dental root canals.
According to one embodiment, dentistry, oral surgery and/or maxillofacial surgery is dental crowns positioning and/or root extractions.
The present invention also refers to a pre-filled syringe filled with the injectable anesthetic solution of the invention.
In the present invention, the following terms have the following meanings:
“About”: preceding a figure means plus or less 10%, preferably plus or less 5%, more preferably plus or less 1%, of the value of said figure.
“Amino acid”: refers to any chemical compound having a basic amino group (—NH2), an acidic carboxyl group (—COOH) and an organic group (or side chain) that is unique to each amino acid. According to one embodiment, the amino acid is selected from nonpolar amino acids such as glycine, alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine and tryptophan; polar and uncharged amino acids such as serine, cysteine, threonine, tyrosine, asparagine and glutamine; acidic amino acids such as aspartic acid and glutamic acid; and basic amino acids such as arginine, histidine and lysine.
“Anesthetic” or “anaesthetic” refers to any drug inducing anesthesia when administered to a patient. According to one embodiment, the terms “Anesthetic” and “anaesthetic” refer to any drug inducing a temporary loss of sensation and/or awareness in a patient. According to one embodiment, the anesthetic is a local anesthetic, i.e. a drug causing a reversible loss of sensation in a limited area of the body of the patient. According to one embodiment, the local anesthetic in the present invention is a drug causing a reversible loss of sensation of one or more teeth, of the lower and/or upper jaws, and/or of the tongue of the patient.
“Bisulfite” or “hydrogen sulfite”: refers to any chemical compound comprising the anion HSO3−. “Metabisulfite”: refers to any chemical compound comprising the anion S2O52−.
“Bitterness suppressant”: refers to any compound or association of compounds that, when added into a composition, lowers or avoids the bitterness of said composition compared to its taste without said bitterness suppressant.
“Buffering agent”: refers to a compound, or a mixture of compounds, used in a composition to adjust and maintain the pH at a targeted value. The pH of a composition comprising a buffering agent can only vary within a narrow range, especially when a small amount of strong acid or strong base is added to it. Preferably, the buffering agent is a mixture of a weak base and its conjugate acid, or vice versa. Examples of buffering agents include alkaline, neutral or acid substances of sodium bicarbonate; Hartmann's solution; Ringer's solution; lactated Ringer's solution; acetated Ringer's solution; bicarbonated Ringer's solution; and colloids-based agents. In one embodiment, a buffering agent is not a pH adjusting agent.
“Contrast media agent”: refers to any chemical agents that help in the characterization of a pathology by improving the contrast resolution of an imaging modality.
“Effective amount”: refers to the amount of an anesthetic necessary and sufficient for providing an anesthetic effect.
“Injectable”: refers to any compound or composition suitable to be administered to a patient with a device having a needle or a catheter. According to one embodiment, “injectable” refers to a solution suitable to be administered with a syringe to a patient. Herein, an injectable composition, i.e. a composition suitable to be injected, should be such that it does not produce an adverse, allergic or other untoward reaction when administered to a subject in need thereof. Especially, an injectable composition should have a pH and osmolarity adapted to the tissues in which it will be injected. Moreover, for human administration, an injectable composition should meet sterility, pyrogenicity, general safety and purity standards as required by regulatory offices, such as, for example, FDA Office or EMA.
“Lidocaine” or “2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide”: refers to a local anesthetic belonging to the group of amino-amides and having the following formula (I):
According to one embodiment, the terms “lidocaine derivates” refer to any compounds having the backbone of the lidocaine formula as described above or a similar backbone, and optionally substituted by one or more chemical groups identical or different from the substituents of lidocaine. According to one embodiment, the terms “lidocaine derivates” include the formula of the lidocaine. According to one embodiment, the terms “lidocaine derivates” refer to any compounds having the following formula (II):
When m equals 1, the nitrogen atom is under the form of a quaternary ammonium (and thus has a positive charge). According to one embodiment, when m equals 1, the compound of formula (II) is in presence of a counter-ion. According to one embodiment, when m equals 0, there is no R6 group in formula (II). According to one embodiment, m is 0, n is 1, R1 and R5 are methyl, and R2, R3 and R4 are H. According to one embodiment, m is 1, n is 1, R1 and R5 are methyl, and R2, R3 and R4 are H; and R6 is selected from an ethyl group which is not substituted, a dodecyl group or an ethyl group substituted by a phenyl. The term “derivates” applies similarly to other anesthetic agents such as tetracaine; xylocaine; mepivacaine; prilocaine; bupivacaine; etidocaine; ropivacaine; or articaine.
“Parabens” or “paraben derivatives” refers to a family of compounds having as backbone, the chemical structure of para-hydroxybenzoate; said chemical structure may be substituted or not by one or more alkyl groups. According to one embodiment, the paraben derivatives may be methylparaben, ethylparaben, propylparaben or butylparaben.
“pH adjusting agent”: refers to a compound, or a mixture of compounds, used in a composition to adjust the pH at a targeted value. Herein, a pH adjusting agent is not a buffering agent, i.e. the pH of a composition comprising a pH adjusting agent but no buffering agent can vary upon addition of a small amount of strong acid or strong base. Examples of pH adjusting agents include sodium hydroxide and hydrochloric acid.
“Pharmaceutically acceptable salt” refers to any salts which are non-toxic and have no significant impurities or degradation products formed as a result of chemical breakdown of the salt, alone or in combination with excipients and which are suitable for making a dosage form that is administrable to a patient. According to one embodiment, the pharmaceutically acceptable salt may be hydrochloride or tartrate, preferably bitartrate.
“Preservative compound” or “stabilizer”: refers to any chemical compound added in a composition for protecting it against degradation.
“Saccharin”: refers to a compound having as backbone: 1,1-dioxo-1,2-benzothiazol-3-one, and salts thereof. According to one embodiment, the saccharin is sodium saccharin.
“Serin”: refers to 2-amino-3-hydroxypropanoic acid.
“Sweetener”: refers to natural and artificial substances that provide a sweet taste. Examples of sweetener include saccharin (including sodium saccharin) and sorbitol.
“Threonine”: refers to 2-amino-3-hydroxybutanoic acid.
“Vasoconstrictor”: refers to any drug inducing vasoconstriction.
This invention relates to an anesthetic composition, preferably an anesthetic liquid composition, more preferably an anesthetic solution. According to one embodiment, the anesthetic solution is an injectable anesthetic solution. According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
The injectable anesthetic solution of the invention has a pH and osmolarity adapted to the tissues in which it will be injected.
According to one embodiment, the anesthetic agent is a local anesthetic. According to one embodiment, the anesthetic agent is an injectable anesthetic. According to one embodiment, the anesthetic agent is an injectable local anesthetic.
According to one embodiment, the anesthetic agent is selected from: lidocaine derivates; tetracaine derivates; xylocaine derivates; mepivacaine derivates; prilocaine derivates; bupivacaine derivates; etidocaine derivates; ropivacaine derivates; articaine derivates; and any combinations thereof. According to one embodiment, the anesthetic agent is lidocaine or its derivates. According to one embodiment, the anesthetic agent is lidocaine hydrochloride. In the present invention, the term “X derivates” where X is the name of an anesthetic agent, includes the anesthetic agent X itself and any chemical substitutions made on the backbone of said anesthetic agent X or any pharmaceutically acceptable salts of said anesthetic agent X.
According to one embodiment, the anesthetic agent is in an amount ranging from 0.01% wt. to 10% wt., preferably from 1% wt. to 5% wt., more preferably from 1% to 3% wt., even more preferably is 2% wt. or 2.1% wt., relative to the total weight of the injectable anesthetic solution. According to one embodiment, the anesthetic agent is in an amount of 0.01%; 0.02%; 0.03%; 0.04%; 0.05%; 0.06%; 0.07%; 0.08%; 0.09%; 0.1%; 0.2%; 0.3%; 0.4%; 0.5%; 0.6%; 0.7%; 0.8%; 0.9%; 1%; 1.1%; 1.2%; 1.3%; 1.4%; 1.5%; 1.6%; 1.7%; 1.8%; 1.9%; 2%; 2.1%; 2.2%; 2.3%; 2.4%; 2.5%; 2.6%; 2.7%; 2.8%; 2.9%; 3%; 3.1%; 3.2%; 3.3%; 3.4%; 3.5%; 3.6%; 3.7%; 3.8%; 3.9%; 4%; 4.1%; 4.2%; 4.3%; 4.4%; 4.5%; 4.6%; 4.7%; 4.8%; 4.9% or 5% wt., relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the vasoconstrictor is selected from: adrenaline; epinephrin; norepinephrin; phenylephrine; felypressin; levonordefrin or any pharmaceutically acceptable salt thereof; and any combinations thereof. According to one embodiment, the vasoconstrictor is a catecholamine; preferably adrenalin, epinephrin or norepinephrin; more preferably epinephrin; even more preferably epinephrin bitartrate.
According to one embodiment, the vasoconstrictor is in an amount ranging from 0.0001% wt. to 5% wt., preferably from 0.0001% to 1% wt., more preferably in an amount of 0.002% wt., relative to the total weight of the injectable anesthetic solution. According to one embodiment, the anesthetic agent is in an amount of 0.001%; 0.002%; 0.003%; 0.004%; 0.005%; 0.006%; 0.007%; 0.008%; 0.009%; 0.01%; 0.02%; 0.03%; 0.04%; 0.05%; 0.06%; 0.07%; 0.08%; 0.09%; 0.1%; 0.2%; 0.3%; 0.4%; 0.5%; 0.6%; 0.7%; 0.8%; 0.9%; or 1% wt., relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the pharmaceutically acceptable solvent is water, preferably the pharmaceutically acceptable solvent is sterilized water, purified water or osmosed water.
According to one embodiment, the amount of pharmaceutically acceptable solvent in the injectable anesthetic solution ranges from 50% wt. to 98% wt.; preferably from 70% wt. to 97% wt.; more preferably from 80% wt. to 96% wt.; even more preferably is 95.6% wt. relative to the total weight of said injectable anesthetic solution. According to one embodiment, the amount of the pharmaceutically acceptable solvent in the injectable anesthetic solution is 95%, 95.1%, 95.2%, 95.3%, 95.4%, 95.5%, 95.6%, 95.7%, 95.8%, 95.9%, 96%, 96.1%, 96.2%, 96.3%, 96.4%, 96.5%, 96.6%, 96.7%, 96.8%, 96.9%, 97%, 97.1%, 97.2%, 97.3%, 97.4%, 97.5%, 97.6%, 97.7%, 97.8%, 97.9% or 98% wt., relative to the total weight of said injectable anesthetic solution.
According to one embodiment, the bitterness suppressant comprises or consists of at least one sweetener and/or at least one amino acid. According to one embodiment, the bitterness suppressant consists of a sweetener and an amino acid. According to one embodiment, the bitterness suppressant consists of a mixture of sweeteners.
According to one embodiment, the sweetener is an artificial sweetener, preferably is a saccharin; more preferably is sodium saccharin. According to one embodiment, the sweetener is a natural sweetener, preferably is sorbitol (CAS 50-70-4).
According to one embodiment, the sweetener is selected from saccharin (including sodium saccharin), sorbitol and their mixtures. According to one embodiment, the sweetener is not dextrose.
According to one embodiment, the amino acid is selected from nonpolar amino acids such as glycine, alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine and tryptophan; polar and uncharged amino acids such as serine, cysteine, threonine, tyrosine, asparagine and glutamine; acidic amino acids such as aspartic acid and glutamic acid; and basic amino acids such as arginine, histidine and lysine. According to one embodiment, the amino acid is serine and/or threonine. According to one embodiment, the amino acid is serine. According to one embodiment, the amino acid is threonine.
According to one embodiment, the bitterness suppressant comprises or consists of sodium saccharin and an amino acid selected from glycine, alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine and tryptophan, serine, cysteine, threonine, tyrosine, asparagine and glutamine, aspartic acid, glutamic acid, arginine, histidine and lysine. According to one embodiment, the bitterness suppressant comprises or consists of sodium saccharin and serine. According to one embodiment, the bitterness suppressant comprises or consists of sodium saccharin and threonine. According to one embodiment, the bitterness suppressant consists of sodium saccharin, serin and threonine. According to one embodiment, the bitterness suppressant consists of sodium saccharin and sorbitol. According to one embodiment, the bitterness suppressant consists of sodium saccharin, sorbitol and serin. According to one embodiment, the bitterness suppressant consists of sodium saccharin, sorbitol and threonine. According to one embodiment, the bitterness suppressant consists of sorbitol and threonine. According to one embodiment, the bitterness suppressant consists of sorbitol and serine. According to one embodiment, the bitterness suppressant consists of sorbitol, serin and threonine.
According to one embodiment, the amount of bitterness suppressant in the injectable anesthetic solution ranges from 1% wt. to 6% wt., preferably from 1.5% wt. to 3% wt., more preferably is 2.09% wt., relative to the total weight of said injectable anesthetic solution. According to one embodiment, the amount of the bitterness suppressant in the injectable anesthetic solution is 1%, 2%, 3%, 4%, 5% or 6% wt., relative to the total weight of said injectable anesthetic solution.
According to one embodiment, the amount of sweetener (e.g. sodium saccharin and/or sorbitol) in the injectable anesthetic solution ranges from 0.01% to 5% wt., preferably from 0.01% wt. to 1% wt., more preferably from 0.01% to 0.1%, even more preferably is 0.09% wt., relative to the total weight of said injectable anesthetic solution. According to one embodiment, the amount of sweetener in the injectable anesthetic solution is 0.01%; 0.02%; 0.03%; 0.04%; 0.05%; 0.06%; 0.07%; 0.08%; 0.09%; 0.1%; 0.2%; 0.3%; 0.4%; 0.5%; 0.6%; 0.7%; 0.8%; 0.9%; or 1% wt., relative to the total weight of the injectable anesthetic solution. According to one embodiment, the amount of sweetener in the injectable anesthetic solution is 1%; 2%; 3%; 4% or 5% wt., relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the injectable anesthetic solution comprises from 0.01% to 1% wt., preferably 0.09% wt., of sodium saccharin.
According to one embodiment, the injectable anesthetic solution comprises from 0.1% to 4% wt., preferably 1%, 2% or 3% wt., of sorbitol.
According to one embodiment, the injectable anesthetic solution comprises:
According to one embodiment, the amount of amino acid (e.g. serine and/or threonine) in the injectable anesthetic solution ranges from 0.1% wt. to 5.5% wt., preferably from 0.1% wt. to 5% wt., preferably from 1% to 4%, more preferably is 2% wt. or 3%. wt., relative to the total weight of said injectable anesthetic solution. According to one embodiment, the amount of the amino acid in the injectable anesthetic solution is 0.1%; 0.2%; 0.3%; 0.4%; 0.5%; 0.6%; 0.7%; 0.8%; 0.9%; or 1% wt., relative to the total weight of the injectable anesthetic solution. According to one embodiment, the amount of the amino acid in the injectable anesthetic solution is 1%; 2%; 3%; 4%; or 5% wt., relative to the total weight of the injectable anesthetic solution.
According to one embodiment, the injectable anesthetic solution comprises from 0.1% to 5% wt., preferably 2% wt., of serin.
According to one embodiment, the injectable anesthetic solution comprises from 0.1% to 5% wt., preferably 2% wt., of threonine.
According to one embodiment, the injectable anesthetic solution comprises from 0.1% to 5% wt., preferably 2% wt., of serine and threonine. Preferably, when serine and threonine are both present, they are in a weight ratio of 1:1.
According to one embodiment, the injectable anesthetic solution comprises:
According to one embodiment, the injectable anesthetic solution further comprises one or more additives.
According to one embodiment, the additive is selected from the group consisting of: pH adjusting agents; buffering agents; preservative compounds or stabilizers; contrast media agents; chelating agents such as ethylenediaminetetraacetic acid (EDTA) and their salts (“edetate salts”), citric acid, ascorbic acid; osmotic agents; and any mixture thereof. According to one embodiment, the additive is selected from the group consisting of: buffering agents; preservative compounds or stabilizers; contrast media agents; chelating agents such as ethylenediaminetetraacetic acid (EDTA) and their salts (“edetate salts”), citric acid, ascorbic acid; osmotic agents; and any mixture thereof. According to one embodiment, the additive is selected from the group consisting of: pH adjusting agents; preservative compounds or stabilizers; contrast media agents; chelating agents such as ethylenediaminetetraacetic acid (EDTA) and their salts (“edetate salts”), citric acid, ascorbic acid; osmotic agents; and any mixture thereof.
According to one embodiment, the injectable anesthetic solution of the invention comprises a pH adjusting agent. Examples of pH adjusting agents include sodium hydroxide and hydrochloric acid.
According to one embodiment, the injectable anesthetic solution of the invention has a pH ranging from 2.5 to 5.5, preferably from 2.8 to 5.5, more preferably from 2.8 to 5. In one embodiment, the injectable anesthetic solution of the invention has a pH ranging from 3.5 to 5.5, preferably from 3.5 to 5. In one embodiment, the injectable anesthetic solution of the invention has a pH ranging from 4.5 to 5.5, preferably from 4.5 to 5. In one embodiment, the injectable anesthetic solution of the invention has a pH of about 5. Such an acid pH is advantageous to limit the degradation overtime of the active agents present in the solution, especially in case of the presence of a vasoconstrictor such as epinephrine. During the shelf-life of the solution of the invention, the pH may decrease overtime. For example, when the pH is adjusted to about 5 upon manufacturing, the pH may decrease within the range of 2.5 to 5, preferably 2.8 to 5. According to one embodiment, the pH of the injectable anesthetic solution of the invention is adjusted using a pH adjusting agent as defined above.
According to one embodiment, the injectable anesthetic solution of the invention does not comprise a buffering agent. Advantageously, the absence of buffering agent in the solution avoids that the pH is maintained during the shelf-life of the solution at level which is not adapted to the active agents present within the solution. For example, when a vasoconstrictor such as epinephrine is present in the solution, the pH should be acid in order to avoid its degradation overtime. If the pH remains at a too high value due to the presence of a buffering agent, this would shorten the shelf-life of the solution.
The buffering agent is for example selected from alkaline, neutral or acid substances of sodium bicarbonate; Hartmann's solution; Ringer's solution; lactated Ringer's solution; acetated Ringer's solution; bicarbonated Ringer's solution; colloids-based agents; and any combinations thereof.
According to one embodiment, the injectable anesthetic solution of the invention comprises a preservative compound and/or a stabilizer.
According to one embodiment, the preservative compound or the stabilizer is selected from: sodium bisulfites, potassium bisulfites or metabisulfites, ascorbic acid, citric acid, ethylene diamine tetra acetic acid (EDTA) and their salts (“edetate salts”) such as disodium edetate, sodium hydroxide, benzyl alcohol, phenylethyl alcohol, phenol, meta-cresol, chlorobutanol, thimerosal, phenylmercuric salts, and any combinations thereof. According to one embodiment, the preservative compound or the stabilizer is selected from: paraben derivatives, bisulfites or metabisulfites, compounds comprising one or more thiol functions such as acetylcysteine, cysteine, or thioglycerol, and any combinations thereof.
According to one embodiment, the preservative compound is a metabisulfite, preferably is potassium metabisulfite or sodium metabisulfite. According to one embodiment, the preservative compound is a metabisulfite, preferably is potassium metabisulfite.
According to one embodiment, the preservative compound is a chelating agent, preferably is ethylene diamine tetra acetic acid (EDTA) or a salt thereof (“edetate salt”) such as disodium edetate. According to one embodiment, the preservative compound disodium edetate.
According to one embodiment, the injectable anesthetic solution of the invention comprises a preservative compound selected from bisulfites or metabisulfites, EDTA or a salt thereof, and any combination thereof. According to one embodiment, the injectable anesthetic solution of the invention comprises a preservative compound selected from potassium metabisulfite, sodium metabisulfite, edetate salts such as disodium edetate, and any combination thereof. According to one embodiment, the injectable anesthetic solution of the invention comprises a preservative compound selected from potassium metabisulfite, disodium edetate, and any combination thereof.
According to one embodiment, the injectable anesthetic solution does not comprise EDTA.
According to one embodiment, the amount of the preservative compound (e.g. potassium metabisulfite and/or disodium edetate) in the injectable anesthetic solution ranges from 0% wt. to 1% wt., preferably from 0.01% to 0.5%, more preferably from 0.02% to 0.2%, to the total weight of said the injectable anesthetic solution. According to one embodiment, the amount of the preservative compound in the injectable anesthetic solution ranges from 0% wt. to 1% wt., preferably from 0.01% to 0.5%, more preferably is 0.12% wt., to the total weight of said the injectable anesthetic solution.
According to one embodiment, the injectable anesthetic solution comprises from 0.01% to 0.5% wt., preferably 0.12% wt., of potassium metabisulfite.
According to one embodiment, the injectable anesthetic solution comprises from 0.01% to 0.5% wt., preferably 0.025% wt., of disodium edetate.
According to one embodiment, the injectable anesthetic solution comprises:
According to one embodiment, the contrast media agent is selected from silver-based agents; barium-based agents; ionic iodine; non-ionic iodine; sodium iodide, sodium iothalamate, amino sugar derivates; amino sugar derivates combined with iodinated compounds; gadolinium-based agents; iron; iron oxide; iron platinum; manganese; perflubron; nitrogen; perfluorocarbon; protein-based and pharmaceutical prepared microbubble contrast media; and any combinations thereof.
The injectable anesthetic solution of the invention has an osmolarity adapted to the tissues in which it will be injected. The physiological range of osmolarity is from about 280 to 310 mOsm/L. For intra-tissular injection, there is a consensus in the art that the osmolarity should not exceed 600 mOsm/L, otherwise it may cause deleterious effects to the injected tissues. Especially, a hypertonic solution will induce when injected some movement of body fluids through the tissues which can induce tissue damage, pain, and/or irritation.
In one embodiment, the injectable anesthetic solution of the invention has an osmolarity of less than 600 mOsm/L; preferably ranging from 250 mOsm/L to 600 mOsm/L; more preferably ranging from 250 mOsm/L to 500 mOsm/L; from 250 mOsm/L to 450 mOsm/L; from 250 mOsm/L to 400 mOsm/L; from 250 mOsm/L to 350 mOsm/L. In one embodiment, the injectable anesthetic solution of the invention has an osmolarity ranging from 280 mOsm/L to 600 mOsm/L; more preferably ranging from 280 mOsm/L to 500 mOsm/L; from 280 mOsm/L to 450 mOsm/L; from 280 mOsm/L to 400 mOsm/L; more preferably from 280 mOsm/L to 380 mOsm/L.
According to one embodiment, the injectable anesthetic solution of the invention comprises:
According to one embodiment, the injectable anesthetic solution of the invention comprises:
According to one embodiment, the injectable anesthetic solution of the invention does not comprise a buffering agent.
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
According to one embodiment, the injectable anesthetic solution comprises or consists of:
The present description is written in connection with an injectable solution but any technical feature applies mutatis mutandis to other possible forms for the anesthetic composition.
The invention also relates to a method for manufacturing an anesthetic composition, preferably for manufacturing an injectable anesthetic solution.
According to one embodiment, the method of the invention comprises or consists of mixing:
The method for manufacturing the anesthetic composition of the invention may be implemented by any suitable method known in the art.
Mixing steps may for instance be implemented by mechanical stirring.
The different elements to be mixed for manufacturing the anesthetic composition according to the invention may be mixed in any order.
The invention also relates to an injection device comprising an injectable anesthetic solution as defined above. According to one embodiment, the injection device is a syringe, preferably a monosyringe; more preferably a pre-filled syringe with the injectable anesthetic solution as defined above.
The invention also relates to the use of the injectable anesthetic solution as defined above. According to one embodiment, the injectable anesthetic solution as defined above is useful in dentistry, oral surgery and/or maxillofacial surgery. According to one embodiment, the injectable anesthetic solution as defined above is useful for reducing pain in a patient. According to one embodiment, the injectable anesthetic solution as defined above has a reduced bitterness compared to an injectable anesthetic solution that does not comprise the bitterness suppressant of the present invention.
According to one embodiment, the present invention also relates to a method for reducing the bitterness of an anesthetic composition, preferably of an anesthetic solution, more preferably of an injectable anesthetic solution. According to one embodiment, the present invention also relates to a method for reducing the bitterness felt by a patient when an injectable anesthetic solution is administered to him/her. Preferably, the anesthetic composition which bitterness is reduced with the method of the invention comprises an anesthetic agent, preferably selected from lidocaine derivates; tetracaine derivates; xylocaine derivates; mepivacaine derivates; prilocaine derivates; bupivacaine derivates; etidocaine derivates; ropivacaine derivates; articaine derivates; and any combinations thereof, optionally a vasoconstrictor, and a pharmaceutically acceptable solvent.
According to one embodiment, the method for reducing the bitterness of an anesthetic composition comprises the addition to said anesthetic composition of a sweetener and/or an amino acid, preferably the addition of saccharin and an amino acid selected from serine and/or threonine, more preferably the addition of sodium saccharin and an amino acid selected from serine and/or threonine. According to one embodiment, the method for reducing the bitterness of an anesthetic composition comprises the addition to said anesthetic composition of 0.09% wt. of sodium saccharin and 2% wt. or 3% wt. of an amino acid selected from serine and/or threonine.
The invention also relates to a method for anesthetizing a part of or the whole oral cavity of a subject during dentistry, oral surgery and/or maxillofacial surgery, comprising administering an effective amount of an injectable anesthetic solution of the invention to said subject, preferably by injection, in particular implemented with an injection device of the invention. According to one embodiment, the injectable anesthetic solution is administered in a part of the oral cavity. According to one embodiment, the part of the oral cavity may be selected from: one or more teeth, hard palate, soft palate, tongue, uvula, floor of mouth, gums, retromolar trigone, tonsil and buccal mucosa.
According to one embodiment, the method for anesthetizing a part of or the whole oral cavity of a subject is implemented during filling dental root canals.
According to one embodiment, the method for anesthetizing a part of or the whole oral cavity of a subject is implemented during dental crowns positioning and/or root extractions.
The present invention is further illustrated by the following examples.
Several solutions according to the present invention have been prepared:
In this Table, the quantity of the components is given for 100 mL of the injectable solution.
According to the present invention, the lidocaine hydrochloride or the articaine used in the formulations 1-25 of the above table may be replaced by any anesthetic agent known by the skilled artisan, such as for example: any derivates of lidocaine, any derivates of articaine, tetracaine derivates; xylocaine derivates; mepivacaine derivates; prilocaine derivates; bupivacaine derivates; etidocaine derivates; ropivacaine derivates; and any combinations thereof.
The aim is to compare the taste of the injectable anesthetic solution of the invention with that of the corresponding non-masked taste formulation; and to determine if the bitterness of the injectable anesthetic solution of the invention is reduced.
For this goal, a taste comparison was carried out between the injectable anesthetic solution of the invention A1 (i.e. solution comprising 2.134% wt. of lidocaine hydrochloride and 0.002% wt. of epinephrin bitartrate including a bitterness suppressant consisting of 0.09% wt. of sodium saccharin and 3% wt. of sorbitol, by the total weight of said injectable anesthetic solution, corresponding to formulation 9 in example 1); the injectable anesthetic solution of the invention A2 (i.e. solution comprising 2.134% wt. of lidocaine hydrochloride and 0.002% wt. of epinephrin bitartrate including a bitterness suppressant consisting of 0.09% wt. of sodium saccharin and 2% wt. of serin, by the total weight of said injectable anesthetic solution, corresponding to formulation 3 in example 1); their corresponding placebos (P1 and P2, i.e. without lidocaine hydrochloride) and the corresponding non-masked formulations (A3: non-masked active formulation comprising 2.134% wt. of lidocaine hydrochloride and 0.002% wt. of epinephrin bitartrate; P3: non-masked corresponding placebo without lidocaine hydrochloride).
The masking effect of the injectable anesthetic solutions is estimated by the determination of the distances between a e-tongue signal of said formulation containing the active ingredients and the formulations without lidocaine hydrochloride (placebo). The best masking formulation is the one giving the optimum distance.
The assays were realized on Astree e-tongue system equipped with an Alpha M.O.S. sensor set composed of 7 specific sensors (AHS, PKS, CTS, NMS, CPS, ANS, SCS) on a 48-positions autosampler using 25 ml-beakers. Acquisition times were fixed at 120 s during 180 s per analysis. All the data generated on Astree system were treated using multidimensional statistics on AlphaSoft V15 software.
The e-tongue signal in each sample was measured at the equilibrium on 7 sensors (average between 100 and 120 s). Three replicates were taken into account for the analysis.
The Euclidian distances between placebos and formulations were calculated to assess taste proximity between samples: the lower the distance, the closer the taste. The results are presented in the taste map of
The taste map of
In conclusion, the addition of 0.09% wt. of sodium saccharin with either 2% wt. of serine or 3% wt. of sorbitol in an injectable solution of lidocaine hydrochloride and epinephrin bitartrate allows reducing its bitterness compared to non-masked taste formulations. Compared to non-masked formulations, the addition of sodium saccharin with either sorbitol or serin reduces the bitterness respectively of 21% and 26%.
The anesthetic solution of the invention should be suitable for injection, especially for injection in tissues of the oral cavity. An important parameter of injectable solutions is the osmolarity. Therefore, the osmolarity of solutions according to the invention was determined.
Solution B1 (sodium saccharine/sorbitol) and B2 (sodium saccharin/serine) whose compositions are detailed in the table below, were prepared by mixing the components in water in 200 mL vessels. The pH was adjusted to about 5.
The osmolarity was measured for each solution on 3 samples, using an osmometer (Loser 16I).
The osmolarity of solutions B1 and B2 is reported below:
The solutions of the invention have an osmolarity well below the 600 mOsm/L threshold for intra-tissular injection and being close to the physiological range.
The properties of the injectable anesthetic solutions of the invention were compared to the anesthetic solutions disclosed in US2020206351. Especially, the suitability for injection was assessed (including osmolarity and pH determination).
US20201206351 discloses local anesthetic solutions with diminished bitter taste thanks to the presence of dextrose as bitterness suppressant and comprising a lactated Ringer's solution as buffering agent of this bitterness suppressant.
The compositions of examples 1-3 of US20201206351 were reproduced for comparative purpose:
The 3 solutions Ex1-Ex3 comprise the same amount of lidocaine hydrochloride as solutions B1 and B2 of the invention (cf example 3). Solution Ex3 comprises the same amount of epinephrine.
The pH and osmolarity of solutions Ex1-Ex3 were measured and the results are reported in above table.
The pH of the anesthetic solutions disclosed in US2020/206351 is near 7 and is thus not acid enough to guaranty the stability of the active agents overtime, while the solutions of the present invention have an acidic pH.
The osmolarity of the anesthetic solutions disclosed in US2020/206351 is well above the 600 mOsm/L threshold for intra-tissular injection and are thus not suitable for injection. Conversely, for the same amounts of lidocaine and epinephrine, the presence of the bitterness suppressant according to the present invention enables to retain a suitable osmolarity (347 mOsm/L for B1 and 365 mOsm/L for B2) while efficiently reducing the bitter taste.
Conclusion. The selection of the specific bitterness suppressants according to the invention enables to obtain injectable anesthetic solution having a suitable osmolarity.
The active ingredients of an anesthetic solution, i.e. the anesthetic agent and the usually present vasoconstrictor, need to remain stable over the shelf-life even with addition of a bitterness suppressant.
The effect on the chemical stability of lidocaine and epinephrine was studied for the addition of a bitterness suppressant.
A solution of lidocaine hydrochloride and epinephrin bitartrate according to the invention, solution B3, was tested, which comprises 0.09% wt. of sodium saccharin and 2% wt. of serine as bitterness suppressant. For comparison purpose, the composition of example 3 of US2020/206351 was tested (Ex3), which comprises 5% of dextrose lactated Ringer's solution as bitterness suppressant.
A stability stress test was conducted at 70° C., over 12 days, corresponding to an accelerated stability study.
The solution B3 and Ex3 were prepared by mixing the components in a 6 L jacketed tank under nitrogen atmosphere with UPW (ultra Purified Water).
At the end of compounding, the solutions were filled in 1.7 mL glass cartridges and crimped. The cartridges were stored at 70° C. for at least 12 days.
The solutions were sampled and analyzed after 2, 6, 9 and 12 days.
The determination of the content in lidocaine, epinephrine and related degradation products was conducted using ion pairing reversed phase UPLC with fluorometric detection and internal standard spiking method.
The results showed that the content in lidocaine remained stable overtime for both compositions, as expected since this anesthetic is not very prone to degradation. On the contrary, epinephrine is more sensible to degradation. However, as shown in
Therefore, the selection of the specific bitterness suppressants according to the invention enables to obtain a stable anesthetic solution.
Furthermore, the injectable anesthetic solution of the invention fulfils the requirements of regulatory offices, such as, for example, FDA Office or EMA.
Thus, the injectable anesthetic solution of the invention provides a good alternative to the commercially available injectable anesthetic solutions.
| Number | Date | Country | Kind |
|---|---|---|---|
| 21305567.6 | Apr 2021 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2022/061597 | 4/29/2022 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63182097 | Apr 2021 | US |
