This application is a divisional of co-pending U.S. patent application Ser. No. 11/666,361 filed 11 Feb. 2008, which is the U.S. National Phase of PCT/GB2005/004147 filed 26 Oct. 2005.
BACKGROUND OF THE INVENTION
This invention relates to new, fast acting pharmaceutical formulations comprising short acting hypnotic agents that are useful in the short-term treatment of insomnia, such as transient insomnia.
Insomnia is a common disorder characterised by difficulty in the initiation and/or maintenance of sleep. Insomnia periodically affects 30% of adults. Furthermore, more than 90% of the total population have trouble with sleep at some point during their lives.
Inadequate sleep impairs quality of life and ability to function normally in a general sense. It often results in adverse personal, medical or psychiatric consequences, in addition to increasing the risk of accidents.
The disorder can be transient or chronic. Although isolated incidents of short-term insomnia may be caused by, for example, grief, stress, or short-term exposure to substances that are known to impair sleep, many patients who suffer from transient insomnia may experience the disorder regularly and/or periodically on a short-term basis.
In the treatment of short-term insomnia, consideration needs to be given to the potential side effects of the medicament employed, including any associated drug dependency. The practitioner also needs to be aware of the potential for undesirable absorption of drug taking place several hours after administration, which may give rise to decreased alertness and impaired psychomotor function during normal activity the following day. In this respect, wherever possible, it is important to expose patients only to short-term, or “on-demand”, use of the lowest effective dose of any particular drug.
Zolpidem (N,N-dimethyl-2-(6-methyl-2-p-tolylimidazo-[1,2-a]pyridin-3-yl)acet-amide) is a short-acting sedative that is used in the short-term management of insomnia. The drug possesses a short half-life and produces no active metabolites. It appears to act by binding to the benzodiazepine receptor component of the GABA receptor complex and accordingly possesses similar properties to the benzodiazepines. However, zolpidem has the general advantage of minimal anxiolytic, myorelaxant and convulsant properties.
Currently-available zolpidem formulations comprise doses of between 5 and 10 mg of the drug in the form of its hemitartrate salt (see, for example, British National Formulary, Volume 48, pages 174 and 175). These compositions are administered orally, typically before retiring, and rapidly disintegrate in the gastrointestinal tract to provide for systemic absorption of drug.
Although zolpidem is rapidly absorbed from the gastrointestinal tract, its bioavailability is reported to be 70% following oral administration. Peak plasma concentrations are thereby typically reached within 1 and 5 hours of oral administration using current formulations.
In view of this, onset of action can be delayed in many patients, leading to a frustrating lack of “on demand” sleep, in addition, in many cases, to undesirable residual effects (such as those mentioned hereinbefore) the following day. Equally importantly, in view of the first-pass and/or pre-systemic metabolism that is typically connected with oral administration, the use of currently-marketed zolpidem formulations is characterised by considerable inter- and intra-individual variability in terms of both onset of action and residual effects (see, for example, Holm et al, Drugs (2000) 59, 865; Darcourt et al, J. Pharmacol., (1999) 13, 81; Terzano et al, Drug Safety (2003) 26, 261; Salvá and Costa, Clin. Pharmacokinet. (1995) 29, 142; Drover et al, Clin. Ther. (2000) 22, 1443; and “Guidance for Industry; Labelling Guidance for Zolpidem Tablets”, US Department of Health and Human Service (1997)).
Thus, there is a clear unmet clinical need for an improved formulation comprising a short acting hypnotic agent, such as zolpidem, which exhibits, in a consistent fashion, a more rapid, and preferably almost instantaneous, onset of action (e.g. within minutes rather than hours), as well as fewer residual effects the following day.
A biphasic peroral dosage form comprising zolpidem has recently been described in inter alia U.S. Pat. No. 6,514,531 B1. This system provides for an initial immediate release phase to induce sleep as rapidly as is possible with existing commercial formulations. This is followed by a controlled-release phase with the objective of maintaining sleep following induction. Other biphasic tablets comprising zolpidem are disclosed in European patent application EP 1 260 216 A1.
U.S. Pat. No. 6,638,535 B2 also discloses sustained release pellets comprising short acting hypnotic agents, such as zolpidem, zopiclone and zaleplon which provides for an in vitro release of less than 60% of active ingredient within the first 5 minutes of the in vitro test.
International patent application WO 00/16750 discloses a drug delivery system for the treatment of acute disorders by mucosal administration, in which the active ingredient is in microparticulate form and is adhered to the surface of larger carrier particles in the presence of a bioadhesion and/or mucoadhesion promoting agent.
International patent application WO 03/059349 discloses oral dosage forms comprising inter alia zolpidem, in addition to a solubility enhancer (e.g. a surfactant) and a spheronization agent (e.g. a distilled monoglyceride).
The skilled person would expect that transmucosal administration of an active ingredient across the pulmonary, nasal or oral mucosa (e.g. sublingual administration) would give rise to an enhanced rate of absorption of that active into plasma (as compared to an oral formulation), and thereby result in a vastly increased bioavailability at an early stage following administration. In the treatment of insomnia with a short acting hypnotic agent such as zolpidem, such an enhanced rate of absorption might be expected to give rise to potential safety problems in patients that are sensitive to the drug, potentially giving rise to undesirable pharmacological effects, such as a more rapid onset of sleep than is convenient (e.g. when preparing for sleep; see, for example col. 2, lines 9 to 18 of U.S. Pat. No. 6,638,535 B2). Moreover, the skilled person would also expect such a rapid absorption to compromise the duration of action of the relevant drug, and thereby the ability to maintain sleep during the night, especially given that short acting compounds are known to rapidly eliminated from plasma (see, for example, col. 2, lines 19 to 31 of U.S. Pat. No. 6,638,535 B2).
Surprisingly, we have found that safe and reliable “on demand” sleep induction (and maintenance) may be provided by way of a formulation as described hereinafter.
SUMMARY OF THE INVENTION
According to a first aspect of the invention, there is provided a pharmaceutical formulation suitable for transmucosal administration comprising a short acting hypnotic drug, which formulation provides a measurable plasma concentration of that drug within 10 minutes of administration.
The measurement of drug plasma concentration may be achieved by techniques that are well known in the art, for example as described hereinafter.
However, as a guide, we have found that formulations suitable for transmucosal administration are capable of providing a measurable plasma concentration of drug within 10 minutes of administration if, when measured in a standard in vitro dissolution (paddle) apparatus according to the United States Pharmacopoeia, using a phosphate buffer at pH 6.8 (USP) as dissolution medium, at least 50% of the active ingredient is released within 5 minutes, preferably within 4 minutes, for example within 3, or even 2, minutes. By the term “released” we mean that the active ingredient is released from the formulation and dissolved in the dissolution medium.
We have found that formulations according to the present invention are capable of providing first measurable plasma drug concentrations with a surprising degree of consistency, as expressed as the coefficient of variation (CV; a statistical measure of the deviation of a variable from its mean) for the time to first measurable plasma concentration. Observed CV values may be less than 50%, for example less than 40% for this variable.
Thus, as formulations according to the present invention consistently provide measurable plasma concentrations of drug within 10 minutes they are effectively capable of providing for consistent “on demand” sleep induction.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 provides a graphical representation of plasma concentrations over time of zolpidem produced by way of two sublingual table formulations according to the present invention compared to plasma concentrations over time of a commercially-available peroral formulation.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Although the disclosure hereof is detailed and exact to enable those skilled in the art to practice the invention, the physical embodiments herein disclosed merely exemplify the invention which may be embodied in other specific structures. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.
According to a further aspect of the invention, there is provided a transmucosal formulation suitable for providing sleep on demand, which formulation comprises a short acting hypnotic drug.
By “sleep on demand”, we include that the formulation consistently induces sleep, i.e. in at least 90% of cases (on an intra- and/or inter-patient basis), within 60 minutes, preferably within 45 minutes, more preferably within 30 minutes and especially within 20 (e.g. 15) minutes.
We have also found, very surprisingly, that formulations according to the present invention are capable of providing rates of absorption of drug following administration that are not substantially different to those that are observed in currently-available oral formulations. In view of this, formulations according to the present invention are capable of reducing or preventing inconveniently rapid onset of sleep, or other undesirable pharmacological effects that might be associated with rapid absorption, for example, in patients that are particularly sensitive to the relevant drug, as discussed hereinbefore.
In this respect, there is also provided a transmucosal formulation suitable for providing sleep on demand, which formulation comprises a short acting hypnotic drug, wherein the formulation provides for a time difference between:
(a) the first measurable; and
(b) the maximum measured
plasma concentration of drug following administration of the formulation, which time difference is within the range of about 50 minutes to about 250 minutes, preferably about 55 minutes to about 230 minutes, more preferably about 70 minutes to about 180 minutes and particularly about 80 to about 160 minutes.
Equally surprisingly, we have also found that formulations according to the present invention are capable of providing levels of drug at an appropriate time after administration and following sleep induction that are not substantially different to those that are observed in currently-available oral formulations. In view of this, formulations according to the present invention are capable of maintaining a drug-induced sleep throughout the night.
In this respect, there is also provided a transmucosal formulation suitable for providing sleep on demand, which formulation comprises a short acting hypnotic drug, wherein the formulation provides for a plasma concentration of drug that is capable of maintaining sleep at least about 3 hours after administration of the formulation, preferably at least about 4 hours, more preferably at least about 5 hours and particularly at least about 6 hours, after administration. In otherwise healthy adult patients below the age of 60, plasma concentrations of drug that are capable of maintaining sleep are for example in the range of about 40 to about 100 ng/mL of plasma, for example about 50 to about 90 ng/mL, such as about 60 to about 85 ng/mL.
Furthermore, formulations according to the present invention are capable of providing levels of drug at an appropriate time after administration that do not give rise to the undesirable residual effects mentioned hereinbefore the following day.
In this respect, there is also provided a transmucosal formulation suitable for providing sleep on demand, which formulation comprises a short acting hypnotic drug, wherein the formulation provides for a plasma concentration of drug that that does not result in decreased alertness and/or impairment of psychomotor function in a patient following sleep at least about 8 hours, such as about 7 hours after administration. In otherwise healthy adult patients below the age of 60, plasma concentrations of drug that are not capable of producing such effects, which effects may be objective (i.e. measurable by some test or marker) or subjective (i.e. the subject gives an indication of, or feels, such effects), are, for example, less than about 40 ng/mL of plasma, for example less than about 30 ng/mL, such as less than about 25 ng/mL.
It will be appreciated by the skilled person that the aforementioned plasma concentration ranges of active ingredient are exemplary of the average case and are likely to vary with the severity of the insomnia that is to be treated, as well as the age, weight, sex, renal function, hepatic function and response of the particular patient to be treated. There can, of course, be individual instances where plasma concentrations that are outside the ranges specified above may give rise to the stated effects, and such are within the scope of this invention. For example, for children or elderly patients, the aforementioned plasma concentration ranges may be approximately halved in order to produce (or not produce) the relevant effect.
Transmucosal drug delivery may be provided over the pulmonary, the nasal or, more preferably, the oral, mucosa. Pulmonary transmucosal drug delivery may be provided, for example, by way of a inhaler comprising a powder formulation that includes the active ingredient. Nasal transmucosal drug delivery may be provided, for example, by way of a nasal spray comprising a powder formulation that includes the active ingredient. Oral transmucosal delivery may be provided, for example, by way of a spray comprising a powder formulation that includes the active ingredient for spraying, for example, under the tongue, or by way of effervescent formulations or freeze-dried rapid melting tablet formulations, all of which are known to those skilled in the art.
However, we prefer that formulations according to the present invention are in the form of sublingual tablets. Sublingual tablets that provide for sleep on demand may be prepared as described hereinafter.
According to a further aspect of the invention there is provided a sublingual tablet formulation that is suitable for providing sleep on demand, which formulation comprises particles of:
(a) a short acting hypnotic drug; and
(b) a mucoadhesion promoting agent,
which particles of components (a) and (b) are each presented, at least in part, upon the surfaces of larger carrier particles.
It will be clear to the skilled person that formulations according to the present invention will comprise a pharmacologically effective amount of short acting hypnotic drug (i.e. the “active” ingredient of the formulation). The term “pharmacologically effective amount” refers to an amount of active ingredient, which is capable of conferring the desired therapeutic effect on a treated patient, whether administered alone or in combination with another active ingredient. Such an effect may be objective (i.e. measurable by some test or marker) or subjective (i.e. the subject gives an indication of, or feels, an effect).
Short acting hypnotic drugs that may be employed in formulations according to the present invention include zopiclone, zaleplon, indeplon or, preferably, zolpidem, and pharmaceutically acceptable salts of all of these. Also included are diastereomeric (e.g. enantiomeric) forms, as well as active metabolites, of these compounds/salts.
Preferred salts of zolpidem that may be employed include hydrochloride salts, methanesulphonate salts, tosylate salts, fumarate salts, sulphate salts and tartrate salts, such as the hydrogen tartrate or the hemitartrate salt.
The active ingredient is preferably presented in the form of microparticles, preferably with a weight based mean diameter of between about 0.5 μm and about 15 μm, such as about 1 μm and about 10 μm. The term “weight based mean diameter” will be understood by the skilled person to include that the average particle size is characterised and defined from a particle size distribution by weight, i.e. a distribution where the existing fraction (relative amount) in each size class is defined as the weight fraction, as obtained e.g. by sieving.
Microparticles of active ingredients may be prepared by standard techniques, such as grinding, dry milling, wet milling, precipitation, micronisation, etc.
The amount of active ingredient that may be employed in a sublingual tablet may be determined by the physician, or the skilled person, in relation to what will be most suitable for an individual patient. This is likely to vary with the severity of the condition that is to be treated, as well as the age, weight, sex, renal function, hepatic function and response of the particular patient to be treated.
Suitable quantities of active ingredient that may be employed in tablet formulations may be in the range 2 to 20% by weight based upon the total weight of the formulation. More preferably, formulations may contain between 4 and 17% by weight of active ingredient, and especially from about 5 to about 15%. The amount of active ingredient may also be expressed as the absolute amount in a tablet formulation. In such a case, the total amount of active ingredient that may be present may be sufficient to provide a dose of drug per tablet that is in the range 3 to 15 mg, such as 4 to 13 mg and in particular between about 5 and about 12 mg.
The above-mentioned dosages are exemplary of the average case; there can, of course, be individual instances where higher or lower dosage ranges are merited, and such are within the scope of this invention.
Tablet formulations described herein comprise one or more mucoadhesion promoting agent and may thus facilitate the partial or complete adhesion of active ingredients to a biological surface, such as a mucosal membrane.
In the context of the present invention, the terms “mucoadhesive” and “mucoadhesion” refer to adhesion or adherence of a substance to a mucous membrane within the body. The skilled person will appreciate that the expressions “mucoadhesion” and “bioadhesion” may often be used interchangeably. In this respect, the presence of a mucoadhesion promoting agent helps facilitate the partial or complete adhesion of sublingual tablets comprising active ingredient to the mucosal membrane under the tongue.
A variety of substances known in the art can be used as mucoadhesion promoting agents, for example polymeric substances, preferably with an average (weight average) molecular weight above 5,000. It is preferred that such materials are capable of rapid swelling when placed in contact with water and/or, more preferably, mucous, and/or are substantially insoluble in water at room temperature and atmospheric pressure.
Examples of suitable mucoadhesion promoting agents include cellulose derivatives such as modified cellulose gum and, more particularly, hydroxypropylmethyl cellulose (HPMC), hydroxyethyl cellulose (HEC), hydroxypropyl cellulose (HPC), methyl cellulose, ethyl hydroxyethyl cellulose, carboxymethyl cellulose and sodium carboxymethyl cellulose (NaCMC); starch derivatives such as modified starch, sodium starch glycolate and, more particularly, moderately cross-linked starch; acrylic polymers such as carbomer and its derivatives (Polycarbophyl, Carbopol®, etc.); polyvinylpyrrolidone; polyethylene oxide (PEO); chitosan (poly-(D-glucosamine)); natural polymers such as gelatin, sodium alginate, pectin; scleroglucan; xanthan gum; guar gum; poly co-(methylvinyl ether/maleic anhydride); and crosscarmellose (e.g. crosscarmellose sodium). Such polymers may be crosslinked. Combinations of two or more bio/mucoadhesive polymers can also be used.
Suitable commercial sources for representative bio/mucoadhesive polymers include: Carbopol® acrylic copolymer (BF Goodrich Chemical Co, Cleveland, 08, USA); HPMC (Dow Chemical Co., Midland, Mich., USA); NEC (Natrosol; Hercules Inc., Wilmington, Del. USA); HPC (Klucel®; Dow Chemical Co., Midland, Mich., USA); NaCMC (Hercules Inc. Wilmington, Del. USA); PEO (Aldrich Chemicals, USA); sodium alginate (Edward Mandell Co., Inc., Carmel, N.Y., USA); pectin (BF Goodrich Chemical Co., Cleveland, Ohio, USA); crosslinked polyvinylpyrrolidone (Kollidon CL®, BASF, Germany, Polyplasdone XL®, Polyplasdone XL-10® and Polyplasdone INF-10®, ISP Corp., US); Ac-Di-Sol® (modified cellulose gum with a high swellability; FMC Corp., USA); Actigum (Mero-Rousselot-Satia, Baupte, France); Satiaxana (Sanofi Biolndustries, Paris, France); Gantrez® (ISP, Milan, Italy); chitosan (Sigma, St. Louis, Mo., USA); and sodium starch glycolate (Primojel®, DMV International BV, Netherlands, Vivastar®, J. Rettenmaier & Söhne GmbH & Co., Germany, Explotab®, Roquette America, US).
However, preferred mucoadhesion promoting agents that may be employed in sublingual tablet formulations described herein include sodium carboxymethylcellulose.
Suitable forms of sodium carboxymethylcellulose include internally crosslinked sodium carboxymethylcellulose, such as crosscarmellose sodium NF (e.g. Ac-Di-Sol® (FMC Corp., USA)).
Suitably, the amount of mucoadhesion promoting agent that is present in a tablet formulation may be in the range 0.1 to 25%, such as 0.5 to 15% and preferably 1 to 10% by weight based upon the total weight of the formulation. A preferred range is from 2 to 8%, such as from about 3.5 to about 6.5% (e.g. about 5%) by weight.
Tablet formulations described herein may comprise one or more binder and/or disintegrating agent or “disintegrant”. A binder may be defined as any material that is capable of acting as a bond formation enhancer, facilitating the compression of the powder mass into coherent compacts.
A disintegrant may be defined as any material that is capable of accelerating to a measurable degree the disintegration/dispersion of a tablet formulation, and in particular carrier particles, as defined herein. This may be achieved, for example, by the material being capable of swelling and/or expanding when placed in contact with water and/or mucous (e.g. saliva), thus causing the tablet formulations/carrier particles to disintegrate when so wetted.
Suitable disintegrants include cross-linked polyvinylpyrrolidone, carboxymethyl starch and natural starch, and suitable binders include cellulose gum and, particularly, microcrystalline cellulose.
Preferred forms of microcrystalline cellulose include silicified microcrystalline cellulose (a mixture of microcrystalline cellulose and a small amount of colloidal silicon dioxide), such as ProSolv® (JRS Pharma, Germany).
If present, binders and/or disintegrating agents are preferably employed in an amount of between 0.5 and 10% by weight based upon the total weight of the formulation. A preferred range is from 1 to 8% (e.g. 5%), such as from about 2.0 to about 3.0% (e.g. about 2.25%) by weight.
It should be noted that sodium carboxymethylcellulose may function in tablet formulations described herein both as mucoadhesion promoting agent and as a disintegrating agent.
Preferably, carrier particles for use in tablet formulations described herein are of a size that is between about 50 and about 750 Tm, and preferably between about 100 and about 600 Tm, such as between about 150 Tm and about 400 Tm (e.g. about 200 Tm). Suitable carrier particle materials include carbohydrates, e.g. sugar, mannitol and lactose; pharmaceutically-acceptable inorganic salts, such as sodium chloride, calcium phosphate, dicalcium phosphate hydrate, dicalcium phosphate dehydrate, tricalcium phosphate, calcium carbonate, and barium sulfate; polymers, such as microcrystalline cellulose, cellulose and crosslinked polyvinylpyrrolidone; or mixtures thereof. It is preferred that the carrier particle material comprises a pharmaceutically-acceptable substance that is adequately soluble in water (e.g. exhibits a solubility of greater than 0.01 g/mL at room temperature and atmospheric pressure). Preferred materials thus include sugar alcohols and/or sugars, such as mannitol and lactose, or pharmaceutically-acceptable inorganic salts, such as sodium chloride.
Preferred carrier particle materials include mannitol, such as granulated mannitol (Pearlitol 400 DC; Roquette, France) and spray-dried mannitol (Parteck M200; Merck, Germany).
Carrier particles preferably comprise an amount of between 50 and 95% by weight based upon the total weight of the formulation. A preferred range is from 60 to 90%, such as from 65 to 85% (e.g. between about 70 and about 85%) by weight.
It is preferred that the relative sizes and amounts of the particles of active ingredient and the carrier particles that are employed are sufficient to ensure that the carrier particles may be at least about 90% covered by the active ingredient, for example at least about 100% and up to about 200% (e.g. between about 130% and about 180%) covered. The skilled person will appreciate in this context that “100% coverage” of the carrier particles by the active ingredient means that the relative particle sizes and amounts of the relevant particles that are employed are sufficient to ensure that the entire surface area of each carrier particle could be covered by the particles of the active ingredient notwithstanding that other ingredients (e.g. mucoadhesion promoting agent) may also be present in a tablet formulation. Obviously, if other such ingredients are employed, then the actual degree of coverage of carrier particles by active ingredient may be less than the amounts specified above. 200% coverage means that there is sufficient particles of active ingredient to cover the surfaces of the carrier particles twice over, notwithstanding the presence of other ingredients.
It is surprising that such tablet formulations with greater than 90% theoretical coverage are effective. Based on current knowledge, the skilled person would understand that, in order to ensure rapid dissolution, it would be important to ensure that the relative sizes/amounts of active ingredient/carrier particles are sufficient to ensure that 70% or less of the surfaces of the latter could be covered by the former. Tablet formulations may be prepared by standard techniques, using standard equipment known to the skilled person.
Active ingredient and other essential constituents mentioned hereinbefore may be combined with conventional pharmaceutical additives and/or excipients used in the art for such preparations, and thereafter preferably directly compressed/compacted into tablets. (See, for example, Pharmaceutical Dosage Forms: Tablets. Volume 1, 2nd Edition, Lieberman et al (eds.), Marcel Dekker, New York and Basel (1989) p. 354-356 and the documents cited therein.)
Suitable further additives and/or excipients may thus comprise:
(a) surfactants or wetting agents, which may enhance that hydration of the active ingredient and carrier particles, resulting in faster initiation of both mucoadhesion and dissolution. If present, the surfactant should be provided in finely dispersed form and mixed intimately with the active ingredients. Examples of suitable surfactants include sodium lauryl sulphate, polysorbates, bile acid salts and mixtures thereof. If present, the surfactant may comprise between 0.3 and 5% by weight based upon the total weight of the tablet formulation, and preferably between 0.5 and 3% by weight;
(b) lubricants (such as sodium stearyl fumarate or, preferably, magnesium stearate). When a lubricant is employed it should be used in very small amounts (e.g. up to about 3%, and preferably up to 2%, by weight based upon the total weight of the tablet formulation);
(c) flavourings (e.g. lemon, menthol or, preferably, peppermint powder), sweeteners (e.g. neohesperidin) and dyestuffs; and/or