Olopatadine formulations for topical nasal administration

Information

  • Patent Grant
  • 7977376
  • Patent Number
    7,977,376
  • Date Filed
    Wednesday, February 7, 2007
    17 years ago
  • Date Issued
    Tuesday, July 12, 2011
    12 years ago
Abstract
Topical formulations of olopatadine for treatment of allergic or inflammatory disorders of the nose are disclosed. The aqueous formulations contain approximately 0.6% (w/v) of olopatadine.
Description
BACKGROUND OF THE INVENTION

1. Field of the Invention


The present invention relates to topical formulations used for treating allergic and inflammatory diseases. More particularly, the present invention relates to formulations of olopatadine and their use for treating and/or preventing allergic or inflammatory disorders of the nose.


2. Description of the Related Art


As taught in U.S. Pat. Nos. 4,871,865 and 4,923,892, both assigned to Burroughs Wellcome Co. (“the Burroughs Wellcome Patents”), certain carboxylic acid derivatives of doxepin, including olopatadine (chemical name: Z-11-(3-dimethylaminopropylidene)-6,11-dihydrodibenz[b,e]oxepine-2-acetic acid), have antihistamine and antiasthmatic activity. These two patents classify the carboxylic acid derivatives of doxepin as mast cell stabilizers with antihistaminic action because they are believed to inhibit the release of autacoids (i.e., histamine, serotonin, and the like) from mast cells and to inhibit directly histamine's effects on target tissues. The Burroughs Wellcome Patents teach various pharmaceutical formulations containing the carboxylic acid derivatives of doxepin, including nasal spray and ophthalmic formulations. See, for example, Col. 7, lines 7-26, and Examples 8 (H) and 8 (I) of the '865 patent.


U.S. Pat. No. 5,116,863, assigned to Kyowa Hakko Kogyo Co., Ltd., (“the Kyowa patent”), teaches that acetic acid derivatives of doxepin and, in particular, olopatadine, have anti-allergic and anti-inflammatory activity. Olopatadine is the cis form of the compound having the formula:




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Medicament forms taught by the Kyowa patent for the acetic acid derivatives of doxepin include a wide range of acceptable carriers; however, only oral and injection administration forms are mentioned.


U.S. Pat. No. 5,641,805, assigned to Alcon Laboratories, Inc. and Kyowa Hakko Kogyo Co., Ltd., teaches topical ophthalmic formulations containing olopatadine for treating allergic eye diseases. According to the '805 patent, the topical formulations may be solutions, suspensions or gels. The formulations contain olopatadine, an isotonic agent, and “if required, a preservative, a buffering agent, a stabilizer, a viscous vehicle and the like.” See Col. 6, lines 30-43. “[P]olyvinyl alcohol, polyvinylpyrrolidone, polyacrylic acid or the like” are mentioned as the viscous vehicle. See Col. 6, lines 55-57.


PATANOL® (olopatadine hydrochloride ophthalmic solution) 0.1% is currently the only commercially available olopatadine product for ophthalmic use. According to its labelling information, it contains olopatadine hydrochloride equivalent to 0.1% olopatadine, 0.01% benzalkonium chloride, and unspecified amounts of sodium chloride, dibasic sodium phosphate, hydrochloric acid and/or sodium hydroxide (to adjust pH) and purified water.


Topical olopatadine formulations that are effective as products for treating allergic or inflammatory conditions in the nose are desirable.


SUMMARY OF THE INVENTION

The present invention provides topical olopatadine formulations that are effective as products for treating allergic or inflammatory disorders of the nose. The formulations of the present invention are aqueous solutions that comprise approximately 0.6% olopatadine. Despite their relatively high concentration of olopatadine, they do not contain any polymeric ingredient as a physical stability enhancing ingredient. The formulations contain a phosphate salt that permits the pH of the formulations to be maintained within the range 3.5-3.95 and that also aids in solubilizing the olopatadine drug in the presence of sodium chloride.


Among other factors, the present invention is based on the finding that stable, nasal spray, solution formulations of olopatadine can be prepared within a pH range of 3.5-3.95 using a phosphate buffer without the need for any polymeric ingredient to enhance the solubility or physical stability of the formulation.





BRIEF DESCRIPTION OF THE DRAWINGS


FIGS. 1A and 1B show the pH-solubility profile of olopatadine.



FIG. 2 shows the effect of NaCl and Na2HPO4 on the dissolution of olopatadine in water.



FIG. 3 shows the effect of NaCl and Na2HPO4 on the dissolution of olopatadine in a nasal vehicle.



FIG. 4 shows the effect of NaCl and Na2HPO4 concentrations on the dissolution rate of olopatadine in a nasal vehicle.



FIG. 5 shows the buffer capacity of an olopatadine nasal spray composition.





DETAILED DESCRIPTION OF THE INVENTION

Unless indicated otherwise, all component amounts are presented on a % (w/v) basis and all references to amounts of olopatadine are to olopatadine free base.


Olopatadine is a known compound that can be obtained by the methods disclosed in U.S. Pat. No. 5,116,863, the entire contents of which are hereby incorporated by reference in the present specification. The solution formulations of the present invention contain 0.54-0.62% olopatadine. Preferably, the solution formulations contain 0.6% olopatadine.


Olopatadine has both a carboxylic functional group (pKa1=4.18) and a tertiary amino group (pKa2=9.79). It exists in different ionic forms depending upon the pH of the solution. Olopatadine exists predominantly as a zwitterion in the pH range between the two pKa values with a negatively-charged carboxylic group and a positively-charged tertiary amino group. The iso-electric point of the olopatadine zwitterion is at pH 6.99. At a pH lower than pKa1, cationic olopatadine (with ionized tertiary amino group) is dominant. At a pH higher than pKa2, anionic olopatadine (with ionized carboxylic group) is dominant.




embedded image


In many zwitterionic molecules, such as various amino acids, intra-molecular ionic interactions are not significant or do not exist. But the structure of olopatadine is such that intra-molecular interactions exist and are significant, possibly due to the distance and bonding angle between the oppositely charged functional groups. This interaction effectively reduces the ionic and dipole character of the molecule. The net effect of the intra-molecular interactions between the oppositely charged functional groups is the reduction of aqueous solubility of olopatadine. Olopatadine has the pH-solubility profile shown in FIGS. 1A (theoretical) and 1B (obtained using phosphate buffer).


Generally, olopatadine will be added in the form of a pharmaceutically acceptable salt. Examples of the pharmaceutically acceptable salts of olopatadine include inorganic acid salts such as hydrochloride, hydrobromide, sulfate and phosphate; organic acid salts such as acetate, maleate, fumarate, tartrate and citrate; alkali metal salts such as sodium salt and potassium salt; alkaline earth metal salts such as magnesium salt and calcium salt; metal salts such as aluminum salt and zinc salt; and organic amine addition salts such as triethylamine addition salt (also known as tromethamine), morpholine addition salt and piperidine addition salt. The most preferred form of olopatadine for use in the solution compositions of the present invention is the hydrochloride salt of (Z)-11-(3-dimethylaminopropylidene)-6,11-dihydro-dibenz-[b,e]oxepin-2-acetic acid. When olopatadine is added to the compositions of the present invention in this salt form, 0.665% olopatadine hydrochloride is equivalent to 0.6% olopatadine free base. Preferably the compositions of the present invention comprise approximately 0.665% olopatadine hydrochloride.


In addition to olopatadine, the aqueous solution compositions of the present invention comprise a phosphate salt. The phosphate salt not only helps maintain the pH of the compositions within the targeted pH range of 3.5-3.95 by contributing to the buffer capacity of the compositions, but also helps solubilize olopatadine. Suitable phosphate salts for use in the compositions of the present invention include monobasic sodium phosphate, dibasic sodium phosphate, tribasic sodium phosphate, monobasic potassium phosphate, dibasic potassium phosphate, and tribasic potassium phosphate. The most preferred phosphate salt is dibasic sodium phosphate. The compositions of the present invention comprise an amount of phosphate salt equivalent (on an osmolality contribution basis) to 0.2-0.8%, preferably 0.3-0.7%, and most preferably 0.4-0.6% of dibasic sodium phosphate. In a preferred embodiment, the phosphate salt is dibasic sodium phosphate at a concentration of 0.4-0.6% (w/v). In a most preferred embodiment, the compositions contain 0.5% (w/v) dibasic sodium phosphate.


Phosphate buffer is commonly used in aqueous pharmaceutical compositions formulated near neutral pH. Phosphate buffer (pKa1=2.12, pKa2=7.1, pKa3=12.67) would not normally be chosen for an aqueous composition with a target pH range of 3.5-3.95 because it has low buffer capacity in that region. Other buffering agents are commonly used in aqueous pharmaceutical compositions, including acetate, citrate and borate buffers, but are not suitable for use in the topical nasal compositions of the present invention. Borate buffers are not suitable because they do not have any significant buffer capacity in the pH range 3.5-3.95. Though acetate and citrate buffers have buffer capacity in this region, they are not preferred because they have the potential to cause irritation to nasal mucosal tissues and undesirable taste and/or smell.


In addition to olopatadine and phosphate salt, the compositions of the present invention comprise sodium chloride as a tonicity-adjusting agent. The compositions contain sodium chloride in an amount sufficient to cause the final composition to have a nasally acceptable osmolality, preferably 240-350 mOsm/kg. Most preferably, the amount of sodium chloride in the compositions of the present invention is an amount sufficient to cause the compositions to have an osmolality of 260-330 mOsm/kg. In a preferred embodiment, the compositions contain 0.3-0.6% sodium chloride. In a more preferred embodiment, the compositions contain 0.35-0.55% sodium chloride, and in a most preferred embodiment, the compositions contain 0.35-0.45% sodium chloride.


The compositions of the present invention also contain a pharmaceutically acceptable pH-adjusting agent. Such pH-adjusting agents are known and include, but are not limited to, hydrochloric acid (HCl) and sodium hydroxide (NaOH). The compositions of the present invention preferably contain an amount of pH-adjusting agent sufficient to obtain a composition pH of 3.5-3.95, and more preferably, a pH of 3.6-3.8.


In one embodiment, the aqueous compositions of the present invention consist essentially of olopatadine, phosphate buffer, sodium chloride, a pH-adjusting agent, and water, and have a pH from 3.5-3.95. These compositions can be manufactured as sterile compositions and packaged in multi-dose, pressurized aerosol containers to avoid microbial contamination. In another embodiment, the aqueous compositions of the present invention contain a preservative and a chelating agent such that the compositions pass United States Pharmacopeia/National Formulary XXX criteria for antimicrobial effectiveness, and more preferably the Pharm. Eur. 5th Edition criteria for antimicrobial preservation (Pharm. Eur. B preservative effectiveness standard). Suitable preservatives include p-hydroxybenzoic acid ester, benzalkonium chloride, benzododecinium bromide, and the like. Suitable chelating agents include sodium edetate and the like. The most preferred preservative ingredient for use in the compositions of the present invention is benzalkonium chloride (“BAC”). The amount of benzalkonium chloride is preferably 0.005-0.015%, and more preferably 0.01%. The most preferred chelating agent is edetate disodium (“EDTA”). The amount of edetate disodium in the compositions of the present invention is preferably 0.005-0.015%, and more preferably 0.01%.


The aqueous solution compositions of the present invention do not contain a polymeric ingredient intended to enhance the solubility of olopatadine or the physical stability of the solution. For example, the compositions of the present invention do not contain polyvinylpyrrolidone, polystyrene sulfonic acid, polyvinyl alcohol, polyvinyl acrylic acid, hydroxypropylmethyl cellulose, sodium carboxymethyl cellulose or xanthan gum.


The compositions of the present invention are preferably packaged in opaque plastic containers. A preferred container is a high-density polyethylene container equipped with a nasal spray pump. Preferably, the package is designed to provide the spray characteristics described in commonly-assigned, co-pending, U.S. Patent Application Publication No. 2006/0110328, which is incorporated herein by reference.


The present invention also relates to a method of treating allergic rhinitis comprising topically administering to the nasal cavities a composition containing 0.6% olopatadine, phosphate buffer, sodium chloride, a pH-adjusting agent, and water. The compositions optionally contain one or more preservative ingredients. Preferably, the compositions are administered such that 1200 mcg of olopatadine (e.g., 600/mcg per 100 microliter spray×two sprays) is delivered to each nostril twice per day.


Certain embodiments of the invention are illustrated in the following examples.


Example 1
Topically Administrable Nasal Solution











TABLE 1







Ingredient
Amount (%, w/v)









Olopatadine Hydrochloride
0.665a



Benzalkonium Chloride
0.01



Edetate Disodium, Dihydrate
0.01



Sodium Chloride
0.41



Dibasic Sodium Phosphate, Anhydrous
0.5



Hydrochloric Acid
Adjust to pH 3.7 ± 0.1



and/or



Sodium Hydroxide



Purified Water
qs to 100








a0.665% w/v olopatadine hydrochloride (665 mcg/100 microliter spray) is equivalent to 0.6% w/v olopatadine as base (600 mcg/100 microliter spray).








An exemplary compounding procedure for the nasal composition shown in Table 1 is described as below.
  • 1. Tare a suitable compounding vessel with magnetic stir bar. Add approximately 80% of the batch weight of purified water.
  • 2. While stirring, add dibasic sodium phosphate (anhydrous), sodium chloride, edetate disodium, benzalkonium chloride and olopatadine HCl.
  • 3. Add equivalent to approximately 0.55 g, 6N hydrochloric acid per 100 ml batch.
  • 4. Allow adequate time between each addition for dissolution of each ingredient
  • 5. Add purified water to approximately 90% of final batch weight.
  • 6. Measure pH and adjust, if necessary, to 3.7 with 6N (and/or 1N) hydrochloric acid and 1N sodium hydroxide.
  • 7. Adjust to final batch weight with purified water (QS).
  • 8. Measure final pH.
  • 9. Filter through 0.2 μm filtration membrane.


Example 2
Effect of NaCl and Phosphate Buffer on Dissolution of Olopatadine Hydrochloride

The effect of NaCl on the dissolution rate of olopatadine hydrochloride in water was determined. NaCl caused a significant reduction in the rate of dissolution of olopatadine. With addition of Na2HPO4, however, the dissolution of olopatadine was dramatically improved. The complete dissolution of 0.6% olopatadine solution without Na2HPO4 would take at least several hours assuming that the entire amount of olopatadine would eventually dissolve, but with Na2HPO4 it takes less than one minute. The results are shown in FIG. 2.


Example 3
Effect of NaCl and Na2HPO4 on the Dissolution Olopatadine Hydrochloride in a Nasal Vehicle

The effect of NaCl, Na2HPO4, and mannitol on the dissolution rate of olopatadine hydrochloride in a nasal formulation containing 0.01% EDTA and 0.01% BAC was determined. The results are shown in FIG. 3. The effect of phosphate salt in this vehicle is the same as that shown in water in Example 2.


Example 4
Effect of NaCl and Na2HPO4 Concentrations on Dissolution

The effect of NaCl and Na2HPO4 concentrations on the dissolution rate of olopatadine hydrochloride in a nasal formulation containing 0.01% EDTA and 0.01% BAC was determined. The results are shown in FIG. 4. The aqueous solubility of olopatadine HCl decreases with increasing concentration of NaCl. However, increasing phosphate buffer correlates with increased aqueous solubility of olopatadine HCl in the presence of NaCl.


Example 5
Effect of Phosphate Buffer on Olopatadine Nasal Spray Composition

The two compositions shown in Table 2 below were prepared using the procedure described in Example 1 and visual observations of the compositions clarity were made at different points during the compounding procedure. The results are shown in Table 2.











TABLE 2






Formulation 2A
Formulation 2B


Component
% w/v
% w/v

















Olopatadine HCl
0.665
0.665


Benzalkonium Chloride
0.01 + 3% xs
0.01 + 3% xs


Disodium EDTA
0.01
0.01


Sodium Chloride
0.37
0.7


Dibasic Sodium Phosphate
0.5
absent


Sodium Hydroxide
pH to 3.7
pH to 3.7


Hydrochloric Acid
pH to 3.7
pH to 3.7


Purified Water
qs 100
qs 100


Batch Size
2000 mL
2000 mL


Osmolality
266
250


Initial pH
6.704
3.189


Final pH
3.699
3.618


Visual Observations:


Upon addition of HCl
Solution appeared clear with
Solution appeared cloudy



a few particles
with many particles




suspended


After overnight stirring
Solution became cloudy with
Solution remained cloudy



many particles
with many particles


Final pH adjustment
Solution began to clear
Solution remained cloudy



during pH adjust down to 3.7
even after pH adjust down




to 3.6


Add final batch quantity of water
Solution remained clear
Solution was still cloudy


(approximately 10%)

with many particles










The results for Formulation A show that it is a clear solution. The results for Formulation B show that despite the pH-solubility profile indicating 0.6% olopatadine should dissolve at pH 3.189, the olopatadine did not go into solution. These results demonstrate that, without phosphate buffer, 0.665% olopatadine hydrochloride did not completely dissolve in water in the presence of 0.7% NaCl at a pH as low as 3.6 using the compounding procedure described in Example 1.


Example 6
Effect of Phosphate Buffer Added to Cloudy 0.6% Olopatadine Nasal Spray Composition

Formulations 3A, 3B, and 3C shown in Table 3 were prepared without phosphate buffer and, despite extensive stirring, the olopatadine HCl was not completely solubilized. A portion of Formulation 3C was removed and phosphate buffer was added to form Formulation 3D. The results, summarized in Table 3, demonstrate that 0.665% olopatadine hydrochloride is not soluble in the tested nasal vehicle without a phosphate salt.














TABLE 3







Formulation 3A
Formulation 3B
Formulation 3C
Formulation 3D




















Olopatadine HCl
0.665
0.665
0.665
0.665


Benzalkonium
0.01 + 3% xs
0.01 + 3% xs
0.01 + 3% xs
0.01 + 3% xs


Chloride


Disodium EDTA
0.01
0.01
0.01
0.01


Sodium Chloride
0.33
0.7
0.7
0.7


Sodium
pH to 3.7
pH to 3.7
pH to 3.7
pH to 3.7


Hydroxide


Hydrochloric
pH to 3.7
pH to 3.7
pH to 3.7
pH to 3.7


Acid


Purified Water
qs 100%
qs 100%
qs 100%
qs 100%


Batch Size
300 mL
800 mL
2000 mL
100 mL


Osmolality
137
246
250



Initial pH
3.002
3.176
3.189
6.908


Final pH
3.002
3.664
3.618
3.7


Visual


Observations:
Upon addition of Olopatadine HCl,
Upon addition of Olopatadine HCl,
Upon addition of
Used dibasic sodium phosphate



solution appeared cloudy, batch
solution appeared cloudy, batch was
Olopatadine HCl,
(0.5%) in attempts to clarify a



was qs to 100% and
qs to 90% and pH adjusted, solution
solution appeared
portion of the cloudy solution



still cloudy
still cloudy
cloudy
(Formulation 3C)



After 2.5 hours of stirring, solution
After 7 hours of stirring, the
After overnight
Within a minute of stirring, the



began to clear
solution was still cloudy.
stirring, the solution
solution became clear with a few



but still many particles*

remained cloudy with
particles** in solution (mostly



in solution

many particles*
fibrous in appearance)



After 3.5 hours of stirring, solution
After 7 days of stirring, the solution
After final qs to 100%
After qs to 100% (using solution



appeared clear with particles*
was still cloudy with many particles*
and pH adjust, the
from the original batch), the





solution was still
solution remained clear with





cloudy with
a few fibrous particles**





many particles*



After overnight stirring, solution
The batch was qs to 100% and still
After approx. 7 hours



appeared clear with several
cloudy with
of stirring, the solution



particles*
many particles*
was cloudy with





many particles*





*Insoluble drug related


**Extraneous fibrous particles






Example 7
Effect of Compounding Sequence on 0.6% Olopatadine Nasal Spray Composition

The composition of Example 1 above was prepared using four different sequences for the addition of ingredients. The four sequences are indicated in Table 4 in the “OA” (order of addition) columns. In each case, visual observations relating to the composition's clarity were recorded. The results are shown in Table 4. In all four cases (Formulations 4A-4D), at the end of the compounding procedure, the solutions were clear. (The solutions contained some extraneous fibrous particles that did not appear to be related to the drug or the formulation excipients and were likely attributable to laboratory equipment and glassware.)














TABLE 4









4A
4B
4C
4D















Component
% w/v
OAa
% w/v
OAa,c
% w/v
OAa
% w/v
OAa


















Olopatadine HCl
0.665
3
0.665
5
0.665
2
0.665
2


Benzalkonium Chloride
0.01
4
0.01
4
0.01
3
0.01
4


Disodium EDTA
0.01
5
0.01
3
0.01
4
0.01
5


Sodium Chloride
0.41
6
0.41
2
0.41
5
0.41
6


Dibasic Sodium
0.5
1
0.5
1
0.5
6
0.5
1


Phosphate (Anhydrous)


Sodium Hydroxide
pH to 3.7
NAb
pH to 3.7
NAb
pH to 3.7
NAb
pH to 3.7
NAb


Hydrochloric Acid
pH to 3.7
2
pH to 3.7
6
pH to 3.7
1
pH to 3.7
3


Purified Water
qs 100%
NA
qs 100%
NA
qs 100%
NA
qs 100%
NA











Batch Size
100 mL
100 mL
100 mL
100 mL


Sodium Hydroxide added
0.238 g (1N)
None
None
None


Hydrochloric Acid added
0.576 g (6N)
0.550 g (6N)
0.550 g (6N)
0.550 g (6N)


Initial Observations
Cloudy, many suspended
Cloudy, many suspended
Cloudy, many suspended
Cloudy, many suspended



particles
particles
particles
particles


Additional observations
After 10 minutes - solution
After 1 minute - clear with
After 2 minutes - clear with a
After 5 minutes - clear with a



began to clear, many
several suspended particles
few suspended particles
few suspended particles



suspended particles



After 30 minutes - clear with
After 6 minutes - clear with a
After 7 minutes - clear with a
After 20 minutes - clear with



several suspended particles
few suspended particles
few suspended particles
a few suspended particles



After 1 hour - clear with many
After 1 hour - clear with a few
After 1 hour - clear with
After 1 hour - clear with



suspended particles*
suspended particles*
several suspended particles*
several suspended particles*



Next day (approx 16 hours) -
Next day (approx 16 hours) -
Next day (approx 16 hours) -
Next day (approx 16 hours) -



clear with several particles*
clear with a few particles*
clear with a few particles*
clear with a few particles*


pH
3.698
3.692
3.718
3.724


Osmolality
274
283
279
280






bNA = not applicable




cPreferred method of manufacturing



*Extraneous fibrous particles






Example 8
Effect of Various Buffer Systems

The composition of Example 1 above was prepared but acetate, borate and citrate buffers, respectively, were substituted in place of the phosphate buffer. Visual observations regarding the clarity of each of the compositions were recorded and are shown in Table 5.













TABLE 5









5A
5B
5C








Component
% w/v













Olopatadine HCl
0.665
0.665
0.665


Benzalkonium
0.01
0.01
0.01


Chloride


Disodium EDTA
0.01
0.01
0.01


Sodium Chloride
0.41
0.41
0.41


Sodium Acetate
0.5




Sodium Borate


0.5


Sodium Citrate

0.5



Sodium Hydroxide
pH to 3.7
pH to 3.7
pH to 3.7


Hydrochloric Acida
pH to 3.7
pH to 3.7
pH to 3.7


Purified Water
qs 100%
qs 100%
qs 100%


Batch Size
100 mL
100 mL
100 mL


Sodium Hydroxide
0.332 g (1N)
0.244 g (1N)
0.963 g (1N)


added


Hydrochloric Acid
0.550 g (6N)
0.550 g (6N)
0.550 g (6N)


added


pH
3.711
3.710
3.716


Osmolality
257
246
270


Visual Observations:


Observations: Initial
Upon addition of
Upon addition of
Upon addition of



Olopatadine, batch
Olopatadine, batch
Olopatadine, batch



appeared cloudy but
appeared cloudy but
appeared cloudy but



began to clear within a
began to clear within
began to clear with in a



few seconds
one minute
few seconds


Additional
After 3 minutes of
After 17 minutes of
After 16 minutes of


observations:
stirring, solution
stirring, solution
stirring, solution



appeared clear with a
appeared clear with
appeared clear with a



few extraneous particles
several large flakey
few large flakey




particles
particles



After 20 additional
After 20 additional
After 20 additional



minutes of stirring,
minutes of stirring,
minutes of stirring,



solution appeared clear
solution appeared clear
solution appeared clear



with very few
with very few
with very few



extraneous particles
extraneous particles
extraneous particles



The pH was adjusted,
The pH was adjusted,
The pH was adjusted,



solution was brought to
solution was brought to
solution was brought to



100% of batch weight
100% of batch weight
100% of batch weight



and remained clear (with
and remained clear (with
and remained clear (with



very few extraneous
very few extraneous
very few extraneous



particles)
particles)
particles)









Example 9
Effect of Phosphate Buffer, NaCl, and Hot Water

The compositions shown in Table 6 were prepared to examine (1) the effect of adding phosphate buffer to a composition containing olopatadine hydrochloride, BAC, EDTA, NaOH/HCl, and NaCl, (2) the effect of adding NaCl to a composition containing olopatadine, BAC, EDTA, NaOH/HCl, and (3) the effect of hot water on the dissolution of olopatadine in a composition comprising olopatadine, BAC, EDTA, NaCl and NaOH/HCl. In each case, visual observations concerning the clarity of the composition were recorded. The results are shown in Table 6.














TABLE 6





Component
6A1
6A2
6B1
6B2
6C*







Olopatadine HCl
0.665 (3) 
Same
0.665 (3) 
Same
0.665 (4) 


Benzalkonium
0.01 (5)
Same
0.01 (2)
Same
0.01 (3)


Chloride


Disodium EDTA
0.01 (4)
Same
0.01 (1)
Same
0.01 (2)


Sodium Chloride
 0.8 (1)
Same

Added 0.8% to existing
 0.8 (1)






solution


Dibasic Sodium

Added 0.5% to existing





Phosphate

solution


Sodium
2 drops added (2)
Same

Same
pH to 3.7


Hydroxide
qs pH to 3.7 (6)


Purified Water
qs 100%
Same
qs 100%
Same
qs 100%


Batch Size
50 mL
25 mL
50 mL
25 mL
50 mL


Initial pH
3.329

2.838

2.873


1N NaOH added
0.087 g

0.343 g

0.318 g


Final pH
3.667

3.730

3.714


Observations:
Upon addition of
25 mL portion of batch
Upon addition of
25 mL portion of batch
Upon addition of



olopatadine HCl, solution
1 - phosphate added and
olopatadine HCl, solution
2 - NaCl added and
olopatadine HCl, the



appeared cloudy with
allowed to stir. Within 10
appeared cloudy with
allowed to stir. After
solution appeared cloudy



many small white
minutes, the solution
many small white
10 minutes of stirring,
with many white



suspended particles
appeared clear
suspended particles
the solution remained
suspended particles






clear



After addition of EDTA
After one day without
After 2 minutes of
After one day without
After 5 minutes of



and BAC, the solution
stirring, solution
stirring, the solution
stirring, solution
stirring, the solution



appeared the same
appeared clear with a
began to clear, still with
appeared clear with 2
began to clear, still with




few extraneous fibers
few many white particles
small white flakey
many small white




(7:30 am)

particles and a few
suspended particles






extraneous fibers






(7:30 am)



pH was adjusted to 3.7
Later that day (2:45 pm)
After 5 additional
Later that day (2:45 pm)
After 20 minutes of



and allowed to stir for 30
batch was observed to be
of stirring, the solution
the batch appeared clear
stirring, the solution



minutes, appearance was
clear with many crystals
was clear
with very few (~3–4)
remained clear with



the same
formed at the bottom of

small white flakey
many small white




the beaker

particles and a few
suspended particles






extraneous fibers



After one day without
Next day (8:00 am),
After pH adjust and qs to
Next day (8:00 am), the
After 30 additional



stirring, the solution
batch remained the same
100%, the batch
batch remained the same
minutes of stirring, the



appeared clear with many

remained clear

solution remained the



small white particles at



same



the bottom of the beaker



(7:30 am)



Next day (8:00 am),

After one day without

After pH adjust and qs to



batch remained the

stirring, the solution

100%, the solution was



same.

remained clear (7:30 am)

allowed to stir and







appeared the same





Next day (8:00 am) batch

After one day without





remained the same

stirring, the solution







appeared clear with many







small white particles







settled at the bottom of







the beaker





Note:


Number in parenthesis refers to order of addition of components.


*Hot purified water (~70° C.) was used.






Example 10
Buffer Capacity of Phosphate Buffer

The contribution of phosphate buffer to the buffer capacity of the composition of Example 1 was determined in a classical acid-base titration experiment. The results are shown in FIG. 5. The buffer capacity of the composition of Example 1 (without phosphate buffer) was 2.66 from pH 3.5-3.8 and 2.7 from pH 3.5-3.9. The buffer capacity of the composition of Example 1 (i.e., including phosphate buffer) was 2.93 from pH 3.5-3.8 and 3.1 from pH 3.5-3.8.


Example 11
Stability of Olopatadine Nasal Spray Compositions Lacking Phosphate Buffer

The compositions (without phosphate buffer) shown below in Table 7A were prepared. Visual observations of the clarity of each composition were recorded as each composition was prepared. The results are shown in Table 7A.













TABLE 7A









7A
7B
7C








Component
% w/v













Olopatadine HCl
0.665 (2)
0.665 (4) 
0.665 (5) 


Benzalkonium

0.01 (3)
0.01 (4)


Chloride


Disodium EDTA

0.01 (2)
0.01 (3)


Sodium Chloride
 0.8 (3)
 0.8 (5)
 0.8 (2)


Sodium Hydroxide
Adjust pH to 3.95
Adjust pH to 3.95
Adjust pH to 3.95


Hydrochloric Acid
Adjust pH to 3.95
Adjust pH to 3.95
Adjust pH to 3.95


Purified Water
qs 100% (1)
qs 100% (1)
qs 100% (1)


Batch Size
200 ml
200 mL
200 mL


Osmolality
286
286
n/a


Initial pH
2.898
2.930
3.098


Final pH
3.947
3.952
3.957


Observations:
Upon addition of drug, the solution
Upon addition of drug, solution appeared
Upon addition of drug, the solution



appeared cloudy with many large flakey
cloudy with many large flakey particles;
appeared cloudy with many large flakey



particles, after approx 20 minutes, the
within approx 25 minutes, solution
particles. After 3 hours of stirring the



solution appeared clear with very few
appeared clear with very few fibrous/small
solution remained cloudy with many



fibrous/small white particles (pH 2.845)
white particles (pH 2.880)
suspended particles



Upon addition of NaCl, solution remained
Upon addition of NaCl, solution remained
After pH adjust and final qs, the solution



the same (pH 2.898)
the same (pH 2.930)
remained cloudy with many suspended



After pH adjust, final qs and several
After pH adjust, final qs and several
particles (while stirring)



minutes of stirring, the final solution
minutes of stirring, the final solution



appeared clear with some fibrous
appeared clear with some fibrous



particles and a few small white
particles and a few small white



particles
particles





Note:


Numbers in parenthesis next to the components represents the order of addition.






Each of the compositions was then split. One portion of each was split again into three storage batches (“pre-filtration”) and the other portion was filtered through a 0.2 μM filter and then split into three storage batches (“post-filtration”). One of the storage batches of each set was stored at room temperature (˜22° C.), one in the refrigerator (˜4° C.), and one subjected to freeze-thaw cycling (one day in the freezer (˜−20° C.) and one day at room temperature, except over the weekends). Visual observations of the clarity of each sample of Formulation 7A (lacking BAC and EDTA) were recorded on the indicated days and the results were recorded. The results are shown in Tables 7B (pre-filtration) and 7C (post-filtration).











TABLE 7B









7A Pre-Filtration










Observations:
Bottle 1 (at RT)
Bottle 2 (at 4° C.)
Bottle 3 (at FTCa)





Initial
Clear, many fibrous particles, a few
Clear, many fibrous particles, a few
Clear, many fibrous particles, a few



small white particles
small white particles
small white particles


Day 1
Clear, some fibrous particles, a few
Same
FT Cycle 1 - same



small white particles


Day 2
Same
Same
FT Cycle 2 - same


Day 5
Clear, many fibrous particles, some
Same
FT Cycle 3 - same



small white particles


Day 6
Same
Same
FT Cycle 4 - same


Day 7
Same
Same
FT Cycle 5 - same


Day 8
Same
Same
FT Cycle 6 - Clear, many fibrous and


Day 9
Same
Same
small white particles


Day 12
Same
Clear, many fibrous and some small




white particles, crystallization on




bottom/sides of vial


Day 13
Same
Same


Day 14
Clear, many fibrous and small white
Same



particles (more than previous)





A portion of the pre-filtered solution was transferred into three 20 mL glass vials and placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.
















TABLE 7C









7A Post-filtration










Observations
Bottle 1 (at RT)
Bottle 2 (at 4° C.)
Bottle 3 (at FTCa)





Initial
Clear, very few fibrous particles
Clear, very few fibrous particles
Clear, very few fibrous particles


Day 1
Clear, a few fibrous particles,
Same
FT Cycle 1 - Clear, few fibrous particles,



one small white particle

few small white particles


Day 2
Same
Clear, a few fibrous particles, some small
FT Cycle 2 - Clear, few fibrous particles,




white particles
very few small white particles


Day 5
Clear, a few fibrous particles
Clear, a few fibrous particles, very few
FT Cycle 3 - same




small white particles


Day 6
Same
Same
FT Cycle 4 - same


Day 7
Same
Same
FT Cycle 5 - same


Day 8
Same
Same
FT Cycle 6 - same


Day 9
Same
Same


Day 12
Same
Same


Day 13
Same
Same


Day 14
Same
Clear, a few fibrous and small white




particles





Note:


A portion of the twice-filtered solution was transferred into three 50 mL media bottles and placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.







After nine days of observation, the post-filtration portion of Formulation 7A was split and a stir bar was added to each sample as a seeding agent (the stir bar was not rotating). Visual observations were recorded and the results are shown in Table 7 D.











TABLE 7D









7A Post-filtration











Bottle 1 (at RT)
Bottle 3 (at 4° C.)
Bottle 5 (at FTCa)








Observations
With Stir Bar Added As a Seeding Agent













Initialb
Clear, a few fibrous particles
Clear, a few fibrous particles
Clear, a few fibrous particles


Day 3
Same
Clear, a few fibrous particles, very few
FT Cycle 1 - Clear, a few fibrous




small white particles
particles, very few small white





particles


Day 4
Same
Same
FT Cycle 2 - same


Day 5
Same
Same






aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of stir bars.







To other portions of composition 7A split after nine days of observation, excess olopatadine (a few small granules) was added to both the pre-filtration and post-filtration samples to determine if seeding would cause olopatadine to precipitate. Visual observations were recorded on the indicated days. The results are shown in Tables 7 E (unfiltered composition) and 7 F (filtered composition).











TABLE 7E









7A Pre-filtration (with excess olopatadine HCl)









Observations
Bottle 1 (at RT)
Bottle 2 (at FTCa)





Initialb
Clear, many fibrous
Clear, many fibrous particles,



particles, some small white
some small white particles



particles


Day 3
Clear, many fibrous/small
FT Cycle 1 - clear, many



white particles (powdery
fibrous/small white particles



settling)
(powdery settling)


Day 4
Same
FT Cycle 2 - same


Day 5
Same






aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of excess olopatadine HCl.
















TABLE 7F









7A Post-filtration











Bottle 2 (at RT)
Bottle 4 (at 4° C.)
Bottle 6 (at FTCa)








Observations
With Excess Olopatadine HCl Added (1–2 small granules)













Initialb
Clear, a few fibrous particles
Clear, a few fibrous particles
Clear, a few fibrous particles


Day 3
Clear, many fibrous and small white
Clear, many fibrous and small white
FT Cycle 1 - Clear, many



particles
particles (powdery at bottom of vial,
fibrous/small white particles (powdery




settling)
at bottom of vial, settling)


Day 4
Same
Same
FT Cycle 2 - same


Day 5
Same
Same





A portion of the solutions that had been through nine days of observations at RT and 4° C. and four FT cycles were transferred into three 20 mL glass vials and spiked with olopatadine HCl. These units were then placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of excess olopatadine HCl.







The stability of the composition “7B” (containing BAC and EDTA) was evaluated in the same fashion. The results are shown in Tables 7G (Pre-filtration), 7H (Post-filtration), 7I (with stir bar added after 9 days), 7J (with excess olopatadine added after 9 days; pre-filtration), and 7K (with excess olopatadine added after 9 days; post-filtration).











TABLE 7G









7B Pre-filtration










Observations:
Bottle 1 (at RT)
Bottle 2 (at 4° C.)
Bottle 3 (at FTCa)





Initial
Clear, many fibrous particles, a few
Clear, many fibrous particles, a few
Clear, many fibrous particles, a few



small white particles
small white particles
small white particles


Day 1
Clear, some fibrous particles, small
Same
FT Cycle 1 - Same



white particles


Day 2
Same
Same
FT Cycle 2 - Same


Day 5
Clear, many fibrous particles, some
Same
FT Cycle 3 - Same



small white particles


Day 6
Same
Same
FT Cycle 4 - same


Day 7
Same
Same
FT Cycle 5 - same


Day 8
Same
Same
FT Cycle 6 - Clear, many fibrous and


Day 9
Same
Same
small white particles


Day 12
Same
Same


Day 13
Same
Same


Day 14
Clear, many fibrous and small white
Same



particles (more than previous)





A portion of the pre-filtered solution was transferred into three 20 mL glass vials and placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.
















TABLE 7H









7B Post-filtration










Observations
Bottle 1 (at RT)
Bottle 2 (at 4° C.)
Bottle 3 (at FTCa)





Initial
Clear, very few fibrous particles
Clear, very few fibrous particles
Clear, very few fibrous particles


Day 1
Clear, a few fibrous particles
Same
FT Cycle 1 - Clear, few fibrous particles,





few small white particles


Day 2
Same
Clear, a few fibrous particles, some small
FT Cycle 2 - Clear, few fibrous particles,




white particles
very few small white particles


Day 5
Same
Clear, a few fibrous particles, very few
FT Cycle 3 - same




small white particles


Day 6
Same
Same
FT Cycle 4 - same


Day 7
Same
Same
FT Cycle 5 - same


Day 8
Same
Same
FT Cycle 6 - same


Day 9
Same
Same


Day 12
Same
Clear, a few fibrous and small white




particles (more than previous)


Day 13
Same
Clear, a few fibrous/small white particles,




light layer of crystallization forming on




bottom/sides of bottle


Day 14
Same
Same





Note:


A portion of the twice-filtered solution was transferred into three 50 mL media bottles and placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.
















TABLE 7I









7B Post-filtration











Bottle 7 (at RT)
Bottle 9 (at 4° C.)
Bottle 11 (at FTCa)








Observations
With Stir Bar Added













Initialb
Clear, a few fibrous particles
Clear, a few fibrous particles
Clear, a few fibrous particles


Day 3
Clear, a few fibrous particles, very few
Clear, a few fibrous and small white
FT Cycle 1 - Clear, a few fibrous



small white particles
particles
particles, very few small white





particles


Day 4
Same
Clear, a few fibrous/small white
FT Cycle 2 - Clear, a few fibrous and




particles, powdery at bottom of vial,
small white particles




settling


Day 5
Same
Clear, settling on bottom, many very




fine white particles





Note:


A portion of the solutions that had been through nine days of observations at RT and 4° C. and four FT cycles were transferred into three 20 mL glass vials with stir bars added and placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of stir bars.















TABLE 7J







Obser-
7B Pre-filtration (with excess olopatadine HCl)









vations
Bottle 3 (at RT)
Bottle 4 (at FTCa)





Initialb
Clear, many fibrous particles,
Clear, many fibrous particles,



some small white particles
some small white particles


Day 3
Clear, many fibrous/small
FT Cycle 1 - clear, many



white particles (light powdery
fibrous/small white particles



settling)
(powdery settling)


Day 4
Same
FT Cycle 2 - same


Day 5
Same





A portion of the pre-filtered solutions that had been through nine days of observations at RT and 4° C. and four FT cycles were transferred into three 20 mL glass vials and spiked with olopatadine HCl. The units were then placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of excess olopatadine HCl.
















TABLE 7K









7B Post-filtration











Bottle 8 (at RT)
Bottle 10 (at 4° C.)
Bottle 12 (at FTCa)








Observations
With Excess Olopatadine Added (1–2 small granules)













Initialb
Clear, a few fibrous particles
Clear, a few fibrous particles
Clear, a few fibrous particles


Day 3
Clear, many fibrous and small white
Clear, many fibrous and small white
FT Cycle 1 - Clear, many



particles
particles (powdery at bottom of vial,
fibrous/small white particles (powdery




settling)
at bottom of vial, settling)


Day 4
Same
Clear, many fibrous/small white
FT Cycle 2 - same




particles, crystallization at bottom of




vial


Day 5
Same
Same





A portion of the solutions that had been through nine days of observations at RT and 4° C. and four FT cycles were transferred into three 20 mL glass vials and spiked with olopatadine HCl. These units were then placed at the respective storage conditions for visual observation.



aFreeze-thaw cycle performed at 24 hour freeze/24 hour thaw except over weekends.




bInitial observations were performed prior to addition of excess olopatadine HCl.







Example 12
Effect of Phosphate Buffer

The compositions shown below in Table 8 were prepared using a compounding procedure similar to that described in Example 1. In all four cases, the NaCl was added after olopatadine during the compounding. All four compositions contained the equivalent of 110% of a 0.6% targeted concentration. Two of the compositions were formulated at a pH of 3.95 and two at 4.10 to test an extreme condition. The results are shown in Table 8.














TABLE 8







Formulation 12A
Formulation 12B
Formulation 12C
Formulation 12D



% (w/v)
% (w/v)
% (w/v)
% (w/v)




















Olopatadine HCl
0.732
0.732
0.732
0.732


Benzalkonium Chloride
0.01
0.01
0.01
0.01


Disodium EDTA
0.01
0.01
0.01
0.01


Sodium Chloride
0.41
0.41
0.8
0.8


Dibasic Sodium Phosphate,
0.5
0.5




Anhydrous


Sodium Hydroxide
pH to 3.95
pH to 4.10
pH to 3.95
pH to 4.10


Hydrochloric Acid
pH to 3.95
pH to 4.10
pH to 3.95
pH to 4.10


Purified Water
qs 100%
qs 100%
qs 100%
qs 100%


Visual Observations:


Initial
Clear solution
Clear solution
Clear solution
Clear solution


Room Temperature (4 days)
Remained clear
Remained clear
Remained clear
Remained clear


4° C. (4 days)
Remained clear on
Remained clear on days 1, 2,
Remained clear on days 1, 2, 3,
Remained clear on days 1, 2,



days 1, 2, 3 and 4. No
and 3. On day 4, a very small
and 4. No precipitate was
and 3. On day 4, a significant



precipitate was found.
amount of clear crystals
found.
amount of clear crystals formed




formed at the bottom of

at the bottom of the glass vial.




the glass vial.





Comparing the results of Formulations B and D demonstrates that compositions with phosphate buffer are more stable against crystal formation than compositions without phosphate buffer.






Example 13
Storage Stability

The solution stability of the composition of Example 1 was examined by preparing variations of the composition at the pH's shown in Table 9 and subjecting the samples to 13 freeze-thaw cycles (same cycles as described in Example 11 above). Following the last cycle, the samples were stored in the freezer for approximately three weeks and then analyzed. The amount of olopatadine (pre- and post-filtration, 0.2 μM filter) was determined by HPLC assay as a percent of the labeled amount (0.6%). The samples were evaluated using four tests of solution clarity: “Nephelos” values were obtained using a turbidimeter (HF Scientific, Inc., Model No. DRT100B); “Clarity” was determined by visual observation using a method similar to the Ph. Eur. (5th Edition) method for evaluating solution clarity and degree of opalescence; “Precipitate” was determined by visual inspection and the presence of absence of precipitates was recorded; “Particles by Visual Observation” was determined by visual inspection under a light box where not more than 3 particles per 5 mL sample is considered “essentially particle free.” Osmolality and pH were also determined for each composition. The results are shown in Table 9. In four of the five cases (Samples 1-4), the compositions were clear solutions following the freeze-thaw cycling study, demonstrating the composition of Example 1 is a stable aqueous solution despite the absence of a polymeric physical stability-enhancing agent. The sample that did not remain a clear solution is Sample 5 (pH=4.45).












TABLE 9









Olopatadine Assay
Pre filtration Physical Test Results











(% of label)

Particles by
















Pre-
Post-
Nephelos1


Visual
Osmolality



Sample Lot
Filtration
Filtration
(In NTU)
Clarity
Precipitate
Observation
mOsm/Kg
pH


















1
99
100
0.3
Clear,
None
Essentially
280
3.83



99
99

NMT

particle-free






EP1


2
99
100
0.2
Clear,
None
Essentially
288
3.94



97
99

NMT

particle-free






EP1


3
100 
101
0.2
Clear,
None
Essentially
285
4.01



98
99

NMT

particle-free






EP1


4
 98,
98
0.5
Clear,
None
Essentially
287
4.15



 99,
99

NMT

particle-free






EP1


5
98
98
(a) Crystal
Clear,
None
Essentially
294
4.45



98
98
Form In one
NMT

particle-free





Test Tube
EP1





(b) Other





test tube





clear





(0.6, 0.5)2






1Nephelos (Turbidity) of ≦3 NTU is considered clear solution as per Ph. Eur. (5th Ed.)




2Pre and post olopatadine assay, nephalos, clarity, precipitate, particles by visual observation, osmolality and pH were performed using clear solution from second test tube.







This invention has been described by reference to certain preferred embodiments; however, it should be understood that it may be embodied in other specific forms or variations thereof without departing from its special or essential characteristics. The embodiments described above are therefore considered to be illustrative in all respects and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description.

Claims
  • 1. A topically administrable, aqueous, nasal spray solution composition consisting of a) 0.665% (w/v) olopatadine hydrochloride;b) a phosphate salt in an amount equivalent to 0.4-0.6% (w/v) dibasic sodium phosphate, wherein the phosphate salt selected from the group consisting of monobasic sodium phosphate; dibasic sodium phosphate; tribasic sodium phosphate; monobasic potassium phosphate; dibasic potassium phosphate; and tribasic potassium phosphate;c) 0.35-0.45% (w/v) NaCl;d) one or more pH-adjusting agents in an amount sufficient to cause the composition to have a pH of 3.6-3.8, wherein the pH-adjusting agents are selected from the group consisting of HCl and NaOH;e) 0.005-0.015% (w/v) benzalkonium chloride;f) 0.005-0.015% (w/v) edetate disodium; andg) water;wherein the composition has an osmolality of 260-330 mOsm/kg.
  • 2. A topically administrable, aqueous, nasal spray solution composition consisting of a) 0.665% (w/v) olopatadine hydrochloride;b) 0.4-0.6% (w/v) dibasic sodium phosphate;c) 0.35-0.45% (w/v) NaCl;d) one or more pH-adjusting agents in an amount sufficient to cause the composition to have a pH of 3.6-3.8, wherein the pH-adjusting agents are selected from the group consisting of HCl and NaOH;e) 0.01% (w/v) benzalkonium chloride;f) 0.01% (w/v) edetate disodium; andg) water;wherein the composition has an osmolality of 260-330 mOsm/kg.
Parent Case Info

This application is a continuation-in-part of Ser. No. 11/079,996, filed Mar. 15, 2005, now U.S. Pat. No. 7,402,609 which is a continuation of Ser. No. 10/175,106, filed Jun. 19, 2002, now U.S. Pat. No. 6,995,186 which claims priority to U.S. Provisional Application Ser. No. 60/301,315, filed Jun. 27, 2001, all of which are incorporated herein by reference.

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Related Publications (1)
Number Date Country
20070142458 A1 Jun 2007 US
Provisional Applications (1)
Number Date Country
60301315 Jun 2001 US
Continuations (1)
Number Date Country
Parent 10175106 Jun 2002 US
Child 11079996 US
Continuation in Parts (1)
Number Date Country
Parent 11079996 Mar 2005 US
Child 11703373 US