WO2023224960A1 - Rapidly infusing cannabinoid compositions, processes of manufacture, and methods of use - Google Patents

Rapidly infusing cannabinoid compositions, processes of manufacture, and methods of use Download PDF

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Publication number
WO2023224960A1
WO2023224960A1 PCT/US2023/022338 US2023022338W WO2023224960A1 WO 2023224960 A1 WO2023224960 A1 WO 2023224960A1 US 2023022338 W US2023022338 W US 2023022338W WO 2023224960 A1 WO2023224960 A1 WO 2023224960A1
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composition
infusing
rapidly
rapidly infusing
subject
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PCT/US2023/022338
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French (fr)
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WO2023224960A9 (en
Inventor
Mark RIDALL
Vincent T. MILETO
Daniel Hitchcock
Simon WINSLOW
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Orcosa Inc.
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Publication of WO2023224960A1 publication Critical patent/WO2023224960A1/en
Publication of WO2023224960A9 publication Critical patent/WO2023224960A9/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/19—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles lyophilised, i.e. freeze-dried, solutions or dispersions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
    • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches

Definitions

  • the present disclosure relates to a bioefficient rapidly infusing composition for oral mucosal uptake.
  • rapidly infusing compositions formulated with tetrahydrocannabinol or a derivative/analog thereof as an active therapeutic ingredient (ATI) in combination with two or more other cannabinoids useful for providing subjects psychoactive effects, for example to treat conditions such as, inter aha, pain, emesis, loss of appetite, and weight loss.
  • ATI active therapeutic ingredient
  • Cannabinoids are compounds derived from plants of the Cannabis genus such as Cannabis sativa and Cannabis indica commonly known as marijuana. The plant contains more than 400 chemicals and from about 60 to 113 cannabinoids.
  • the most active chemical compound of the naturally occurring cannabinoids is (— )-trans-A 9 -tetrahydrocannabinol (A 9 - THC) — known more simply as tetrahydrocannabinol (THC).
  • THC is known to possess many therapeutic benefits, and has been used for the treatment of AIDS-associated anorexia and cachexia, nausea and emesis due to cancer chemotherapy, cancer-associated pain, spasticity related to multiple sclerosis and spinal cord injury, fibromyalgia, overactive bladder, sleep apnea, and glaucoma.
  • THC is also a well- known recreational drug that subjects take to provide a “high” and a feeling of joy and satisfaction.
  • recreational THC is used without medical justification, recreational use of THC may still provide desirable secondary benefits such as pain relief, appetite stimulation, and anxiolytic effects.
  • THC is thermolabile and photolabile, and long-term storage can lead to a cumulative decrease in THC content by an oxidation reaction forming cannabinol (CBN)
  • THC administration routes there are numerous disadvantages associated with traditional THC administration routes.
  • the most common method for administering THC is through inhalation of the vapors of cannabis by smoking the dried plant material. While smoking cannabis provides a rapid onset of pharmacological activity, typically within 10 minutes of administration, such impure cannabis preparations contain unknown or non-standardized amounts of THC, other active ingredients, as well as other potential toxins such as unhealthy tars and associated carcinogens which the subject must inhale into their lungs.
  • THC Trigger-Chisol X-(2-aminoethyl)-2-aminoethylcholine
  • Delivery of THC by smoking is thus an undesirable route of administration in view of the inherent dangers of smoking (e.g., emphysema and lung cancer), uncertainty in dose delivery, and inconsistent pharmacological outcomes.
  • THC Trigger-on-Cadextrative
  • physiochemical properties e.g., instability
  • slow rate of absorption e.g., slow rate of absorption
  • first pass metabolism e.g., slow rate of absorption
  • THCs physiochemical properties e.g., instability
  • slow rate of absorption e.g., slow rate of absorption
  • first pass metabolism e.g., slow rate of absorption
  • THCs physiochemical properties e.g., instability
  • slow rate of absorption e.g., slow rate of absorption
  • first pass metabolism e.g., delayed rate of absorption, and first pass metabolism give rise to poor bioavailability, delayed onset of pharmacological effects, and inconsistent levels of THC in systemic circulation when THC is ingested.
  • the drug is next immediately presented to the liver — the major detoxifying organ of the body — whereby the drug is metabolized and then returned to the left side of the heart via the hepatic portal vein and sent into systemic circulation.
  • This first pass metabolism through the liver may result in the removal of a substantial proportion of an ingested drug, and is more pronounced for some drugs than others; in the case of cannabinoids such as THC, extensive first pass metabolism contributes to a bioavailability of only about 10 to 20% when ingested orally.
  • oral THC has a highly variable pharmacokinetic profile that differs between formulations (e.g., cannabis edibles, capsules, tablets, and decoctions), subjects, as well as whether the subject is in a fed or fasted state, with the end result being a wildly inconsistent pharmacological effect.
  • formulations e.g., cannabis edibles, capsules, tablets, and decoctions
  • fasting or food deprivation may provide poor or partial response to oral THC therapy as a result of a decreased rate of absorption of THC, thus requiring the subject to orally administer two to three times a day to obtain equivalent acute physiological effects achieved from smoking marijuana.
  • Such variability in pharmacological effects coupled with slow onset times increases the likelihood of inadvertent over-administration of THC.
  • MARINOL available from Alkem laboratories, Ltd.
  • THC dissolved in sesame oil and encapsulated in gelatin capsules registered for anorexia in AIDS patients, and nausea and vomiting in cancer patients
  • MARINOL has an onset of action of approximately 0.5 to 1 hour, with a peak effect of 2 to 4 hours, see Oh DA, Parikh N, Khurana V, Cognata Smith C, Vetticaden S. Effect of food on the pharmacokinetics of dronabinol oral solution versus dronabinol capsules in healthy volunteers.
  • Clin Pharmacol. 2017;9:9-17 incorporated herein by reference in its entirety.
  • the duration of action for psychoactive effects is 4 to 6 hours, but the appetite stimulant effect may continue for 24 hours or longer after administration.
  • NAMISOL available from Echo Pharmaceuticals b.v., Nijmegen, the Netherlands
  • AL1TRA Echo Pharmaceuticals b.v., Nijmegen, the Netherlands
  • Oral NAMISOL provides a time to maximal THC concentration of 39 to 56 min, with less inter-subject variability in THC maximal concentration compared to other oral THC dosage forms.
  • NAMISOL While not specifically formulated for sublingual delivery, attempts have been made to deliver NAMISOL via the sublingual mucosa in hopes of bypassing absorption from the G1 tract and first pass metabolism, thereby leading to a more rapid and consistent clinical response.
  • sublingually administered NAMISOL has been found to be inferior to oral administration, with slow absorption from the oral mucosa, a flat THC concentration profile, and a delayed onset of effect compared to oral NAMISOL, see Klumpers LE, Beumer TL, van Hasselt JG, et al. Novel A(9)-tetrahydrocannabinol formulation Namisol® has beneficial pharmacokinetics and promising pharmacodynamic effects. Br J Clin Pharmacol.
  • NAMISOL also requires a relatively long in vitro disintegration time of up to 15 min, likely contributing to the inferior performance when dosed sublingually. For example, sublingual administration tends to stimulate the flow of saliva which makes enteral oral administration more likely through voluntary or involuntary swallowing. The long residence time required for disintegration of NAMISOL increases the likelihood of swallowing. Any amount of THC that is swallowed would be subject to first pass metabolism and thus overall lower bioavailability and greater variability in the pharmacological effects achieved using a fixed dose.
  • THC in naturally occurring and/or genetically engineered or bred cannabis plants is accompanied by other cannabinoids, including but not limited to: cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), cannabichromene (CBC), and cannabidivarin (CBDV).
  • CBD cannabidiol
  • CBG cannabigerol
  • CBN cannabinol
  • CBC cannabichromene
  • CBDV cannabidivarin
  • the present invention provides:
  • a rapidly infusing composition comprising: a pharmaceutically acceptable binder and/or excipient system comprising gelatin and a sugar alcohol, and tetrahydrocannabinol, and two or more other cannabinoids.
  • composition of any one of (1) to (9), wherein the other cannabinoids include cannabidiol and at least one of cannabinol, cannabigerol, and cannabi chromene.
  • a method of activating cannabinoid receptors in a subject comprising administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of any one of (1) to (19).
  • a method of treating at least one condition selected from the group consisting of anorexia, cachexia, nausea, emesis, pain, spasticity, fibromyalgia, overactive bladder, sleep apnea, and glaucoma, in a subject comprising: administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of any one of (1) to (19).
  • the method of (27), wherein the rapidly infusing composition is administered buccally to the subject via the buccal mucosa.
  • Optically active forms may be prepared by resolution of racemic forms or by synthesis from optically active starting materials. All processes used to prepare these compounds and intermediates made therein are considered to be part of the present disclosure. When enantiomeric or diastereomeric products are prepared, they may be separated by conventional methods, for example, by chromatography, fractional crystallization, or through the use of a chiral agent Depending on the process conditions, the end products referenced in the present disclosure are obtained either in free (neutral) or salt form. Both the free form and the salts of these end products are within the scope of the disclosure. If so desired, one form of a compound may be converted into another form.
  • a free base or acid may be converted into a salt; a salt may be converted into the free compound or another salt; a mixture of isomeric compounds may be separated into the individual isomers.
  • Compounds referenced in the present disclosure, free form and salts thereof, may exist in multiple tautomeric forms, in which hydrogen atoms are transposed to other parts of the molecules and the chemical bonds between the atoms of the molecules are consequently rearranged. It should be understood that all tautomeric forms, insofar as they may exist, are included within the disclosure Further, a given chemical formula or name shall encompass all conformers, rotamers, or conformational isomers thereof where such isomers exist. Different conformations can have different energies, can usually interconvert, and are very rarely isolatable.
  • Atropisomers are isomers resulting from hindered rotation about single bonds where the steric strain barrier to rotation is high enough to allow for the isolation of the conformers. It should be understood that all conformers, rotamers, or conformational isomer forms, insofar as they may exist, are included within the present disclosure.
  • solvate refers to a physical association of a referenced compound with one or more solvent molecules, whether organic or inorganic. This physical association includes hydrogen bonding. In certain instances, the solvate will be capable of isolation, for example when one or more solvent molecules are incorporated in the crystal lattice of the crystalline solid.
  • the solvent molecules in the solvate may be present in a regular arrangement and/or a non-ordered arrangement.
  • the solvate may comprise either a stoichiometric or nonstoichiometric amount of the solvent molecules.
  • Solvate encompasses both solution phase and isolable solvates
  • Exemplary solvent molecules which may form the solvate include, but are not limited to, water, methanol, ethanol, //-propanol , isopropanol, n- butanol, isobutanol, tert-butanol, ethyl acetate and other lower alkanols, glycerin, acetone, dichloromethane (DCM), dimethyl sulfoxide (DMSO), dimethyl acetate (DMA), dimethylformamide (DMF), isopropyl ether, acetonitrile, toluene, A-methylpyrrolidone (NMP), tetrahydrofuran (THF), tetrahydropyran, other cyclic mono-, di- and tri-ethers, polyalkylene glycols (e.g., polyethylene glycol, polypropylene glycol, propylene glycol), and mixtures thereof
  • Exemplary solvates include, but are not limited to, hydrates, ethanolates, methanolates, isopropanolates and mixtures thereof. Methods of solvation are generally known to those of ordinary skill in the art.
  • pharmaceutically acceptable is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
  • “pharmaceutically acceptable salt” refers to derivatives of the disclosed compounds wherein the parent compound is modified by making acid or base salts thereof.
  • pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic groups such as amines; and alkali or organic salts of acidic groups such as carboxylic acids and phenols.
  • the phannaceutically acceptable salts include the conventional non-toxic salts or the quaternary ammonium salts of the parent compound formed, for example, from non-toxic inorganic or organic acids.
  • such conventional non-toxic salts include those derived from inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric, and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, and isethionic, and the like.
  • inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric
  • organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic,
  • the pharmaceutically acceptable salts of the present disclosure can be synthesized from the parent compound that contains a basic or acidic moiety by conventional chemical methods.
  • such salts can be prepared by reacting the free acid or base forms of these compounds with a stoichiometric amount of the appropriate base or acid in water or in an organic solvent, or in a mixture of the two; generally, non- aqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred.
  • Lists of suitable salts are found in Remington’s Pharmaceutical Sciences, 18th Edition, Mack Publishing Company, Easton, Pa. (1990) — which is incorporated herein by reference in its entirety.
  • the phrase “consists essentially of’ means that the particular composition/material may include minor amounts of impurities so long as those impurities do not affect the basic and novel property of the invention — the ability to activate cannabinoid receptors in a subject resulting in a pharmacological effect.
  • the terms “optional” or “optionally” means that the subsequently described event(s) can or cannot occur or the subsequently described component(s) may or may not be present (e g., 0 wt.%).
  • the terms “treat”, “treatment”, and “treating” in the context of the administration of a therapy to a subject in need thereof refers to the reduction or amelioration of severity of symptoms of the condition being treated; reduction of duration of symptoms of the condition being treated; reduction, inhibition, slowing, or arresting of the progression of symptoms associated with the condition; reduction of frequency of symptoms of the condition being treated; elimination of symptoms and/or underlying cause of the condition;
  • prevention of the occurrence of symptoms of the condition for example in a subject that may be predisposed to the condition but does not yet experience or exhibit symptoms of the condition; improvement or remediation or amelioration of damage following a condition, for example improving, remediating, or ameliorating inflammation; and/or causing regression of the condition.
  • pain should be understood to include any unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
  • This term generally includes nociceptive pain, neuropathic pain, and psychogenic pain; including any subset of pain associated therewith such as phantom pain, breakthrough pain, incident pain, inflammatory pain, postsurgical (postoperative) pain, cancer-associated pain, peripheral pain, central pain, spastic pain, and the like; as well as both acute pain and chronic pain conditions.
  • subject and “patient” are used interchangeably. As used herein, they refer to any subject for whom or which administration or therapy is desired. In most embodiments, the subject is a human.
  • administer refers to the methods that may be used to enable delivery of the active therapeutic ingredient (ATI) to the desired site of biological action. Routes or modes of administration are as set forth herein.
  • the disclosed rapidly infusing compositions are thus a different dosage form than, for example, a chewable tablet, a lozenge intended to be dissolved slowly in the mouth, or a tablet that should be swallowed whole with food or liquid.
  • the dosage amount and treatment/administration duration are dependent on factors, such as bioavailability of a drug, administration mode, toxicity of a drug, gender, age, lifestyle, body weight, the use of other drugs and dietary supplements, the disease stage, tolerance and resistance of the body to the administered drug, etc., and then determined and adjusted accordingly.
  • the terms “effective amount”, “effective dose”, or “therapeutically effective amount” refer to a sufficient amount of an active therapeutic ingredient (ATI) being administered which provides the desired therapeutic or physiological effect or outcome, for example, the amount of ATI sufficient for activating cannabinoid receptors in a subject.
  • the result can be a reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system.
  • this is the amount of ATI sufficient to relieve to some extent one or more of symptoms of a condition being treated. In some instances, this is the amount of ATI sufficient to provide the subject a “high” and a feeling of joy and satisfaction.
  • Undesirable effects e.g. side effects, are sometimes manifested along with the desired effect; hence, a practitioner balances the potential benefits against the potential risks in determining what is an appropriate “effective amount”.
  • the exact amount required will vary from subject to subject, depending on the age and general condition of the subject, mode of administration, and the like.
  • An appropriate “effective amount” in any individual case may be determined by one of ordinary skill in the art using only routine experimentation, for example through the use of dose escalation studies.
  • tetrahydrocannabinol refers to (-)-trans- A 9 -tetrahydrocannabinol (A 9 -THC).
  • the present disclosure provides a rapidly infusing composition which is suitable for administration of lipophilic active therapeutic ingredients (ATIs) such as tetrahydrocannabinol (THC) in combination with two or more other cannabinoids via a non- gastric mucosal surface.
  • ATIs lipophilic active therapeutic ingredients
  • THC tetrahydrocannabinol
  • the novel RITeTM platform allows otherwise difficult to formulate and/or administer ATIs — such as THC — to be presented in unit dosage form for easy, accurate, and safe dosing, and for achieving rapid-onset and reliable pharmacological effects.
  • the rapidly infusing composition may be presented in tablet form and packaged in individual blister units.
  • the RITeTM platform enables oral mucosal administration of lipophilic ATIs in a solid dosage form directly into systemic circulation via the sublingual mucosa or the buccal mucosa.
  • Direct introduction of ATI into systemic circulation via one or more of the oral mucosae avoids the pharmacokinetic disadvantages that trouble oral delivery — e.g., exposure to the gastric environment that causes degradation, and first pass metabolism.
  • the rapidly infusing composition of the present disclosure thus presents lipophilic ATIs such as THC in an enhanced bioefficient dosage form.
  • Such exemplary dosage forms may include, inter alia, enhanced bioavailability, typically with a bioavailability of at least 20%, preferably at least 30%, preferably at least 40%, preferably at least 50%, preferably at least 60%, preferably at least 70%, , preferably at least 80%, preferably at least 90%, and up to 95%, preferably up to 90%, preferably up to 80%, preferably up to 70%, preferably up to 60%, preferably up to 50%, preferably up to 40%, preferably up to 30%
  • the bioefficient rapidly infusing composition enables a defined dose of ATI to be absorbed via the oral mucosae, prior to the gastric mucosa, thereby presenting a defined and consistent level of ATI into systemic circulation for consistent and reliable pharmacological effects.
  • the reliability/consistency in effects which can be achieved using the disclosed RITeTM platform are a significant improvement over those which can be achieved using other forms of administration such as oral THC formulations. That is because oral THC formulations are dependent on the rate of absorption of THC from the GI tract, which is known to be slow and highly variable on both an intersubject and intra-subject basis.
  • compositions described herein present ATIs such as THC in an enhanced bioefficient dosage form that is not subject to such gastrointestinal absorption variability, and thus consistent pharmacological outcomes can be achieved.
  • Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue).
  • Preferred rapidly infusing compositions are those which are lyophilized products formulated for rapid disintegration when placed in such an oral environment for rapid release of the ATI.
  • the rapidly infusing compositions of the present disclosure may have a disintegration time of from approximately 1 second to 30 seconds or less, preferably 25 seconds or less, preferably 20 seconds or less, preferably 15 seconds or less, preferably 10 seconds or less, preferably 5 seconds or less, preferably 3 seconds or less, according to the United States Pharmacopeia (USP) ⁇ 701> Disintegration Test performed in deionized water maintained at 37° C ⁇ 2°.
  • USP United States Pharmacopeia
  • Particularly preferred rapidly infusing compositions are those formulated for oral disintegration in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably in approximately 1 second, according to the United States Pharmacopeia (USP) ⁇ 701> Disintegration Test performed in deionized water maintained at 37° C ⁇ 2°.
  • USP United States Pharmacopeia
  • a disintegration profile no higher than the above-mentioned upper limit when in intimate contact with a non-gastric mucosal surface provides for rapid absorption of the ATI and short onset times for pharmacological/therapeutic action.
  • the rapidly infusing composition may provide desirable pharmacological effects in (have an onset time of) under 15 minutes, preferably under 10 minutes, preferably under 5 minutes, preferably under 4 minutes, preferably under 3 minutes, preferably under 2 minutes, preferably under 1 minute, preferably under 45 seconds, preferably under 30 seconds, preferably under 20 seconds, preferably under 10 seconds, preferably approximately 5 seconds.
  • Such short onset times are superior to those which can be obtained with traditional orally disintegrating tablets made through compression tabletting or oral dosage forms such as e.g., MARINOL and NAMISOL.
  • the short residence time spent in the oral cavity also reduces the tendency for enteral oral administration through voluntary or involuntary swallowing, and as a result, the aforementioned high levels of bioavailability and consistency in therapeutic response may be achieved when the rapidly infusing composition is administered via one or more of the oral mucosae.
  • RITeTM platform Another advantage of the RITeTM platform is that it enables effective taste masking of foul-tasting ATIs.
  • Two main strategies contribute to the taste masking success of the present disclosure.
  • any issues related to foul taste are fundamentally mitigated by the short oral residence times provided by the rapid disintegration profile described heretofore. One “takes it and it’s gone.”
  • the effective taste masking provided by the RITeTM platform may be particularly advantageous when combinations of ATIs are provided in one dosage form, such as the case with rapidly infusing compositions formulated with both THC and two or more other cannabinoids.
  • the rapidly infusing composition herein generally contains (a) a pharmaceutically acceptable binder and/or excipient system that includes gelatin and a sugar alcohol e g., mannitol, and optionally one or more of a sweetener, a flavorant, and a colorant; and (b) an effective amount of an active therapeutic ingredient such as tetrahydrocannabinol (THC) in combination with two or more other cannabinoids.
  • a pharmaceutically acceptable binder and/or excipient system that includes gelatin and a sugar alcohol e g., mannitol, and optionally one or more of a sweetener, a flavorant, and a colorant
  • an effective amount of an active therapeutic ingredient such as tetrahydrocannabinol (THC) in combination with two or more other cannabinoids.
  • Carriers and/or excipients are ingredients which do not provide a therapeutic effect themselves, but which are designed to interact with, and enhance the properties of, the active therapeutic ingredient.
  • carriers and/or excipients may act as a vehicle for transporting the active therapeutic ingredient from one organ, or portion of the body, to another organ, or portion of the body.
  • the selection of appropriate carrier/excipient ingredients may impact the solubility, distribution, release profile/kinetics, absorption, serum stability, therapeutic onset time, and ultimately the efficacy of the ATI, as well as the shelflife, dosage forms, and processability of the drug product.
  • Each ingredient in the pharmaceutically acceptable carrier and/or excipient system must be “pharmaceutically acceptable” in the sense of being compatible with the other ingredients of the rapidly infusing composition and not injurious to the subject
  • compositions which include gelatin and a sugar alcohol (e.g., mannitol).
  • a sugar alcohol e.g., mannitol
  • Gelatin is to be included in the pharmaceutically acceptable carrier and/or excipient system in order to effect matrix formation in the lyophilized product, i.e., gelatin may act primarily as a matrix former.
  • gelatin may act primarily as a matrix former.
  • lyophilization from an aqueous drug product suspension results in the removal of water thereby leaving behind a gelatin matrix/scaffolding upon which the ATI can be evenly dispersed or suspended.
  • gelatin has a propensity to establish a stable matrix in lyophilized form, yet allow for rapid disintegration when brought into contact with the aqueous oral environment, thereby providing efficient transfer of the ATI from the hydrophilic vehicle to the oral mucosa.
  • mammalian gelatins such as bovine gelatin and porcine gelatin, are preferred, with bovine gelatin being particularly preferred.
  • the rapidly infusing composition does not contain fish gelatin.
  • the amount of gelatin used may be varied. Generally, gelatin may be present in the rapidly infusing composition in an amount of at least 10 wt.%, preferably 12 wt.%, preferably 14 wt.%, preferably 16 wt.%, preferably 18 wt.%, preferably 20 wt.%, preferably 22 wt.%, and up to 50 wt.%, preferably up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 32 wt.%, preferably up to 30 wt.%, preferably up to 28 wt.%, preferably up to 26 wt.%, preferably up to 24 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
  • the pharmaceutically acceptable carrier and/or excipient system is also formulated with one or more sugar alcohols, which may act primarily as a bulking agent.
  • sugar alcohols include, but are not limited to, erythritol, xylitol, sorbitol, maltitol, mannitol, lactitol, and glycerin, which may be used singly or in combinations Advantage can also be taken of the effect of certain sugar alcohols in terms of taste (sweetness and coolness due to endothermal heat of solution), as well as their ability to aid/speed tablet disintegration. In this regard, particular preference is given to mannitol.
  • the sugar alcohol preferably mannitol
  • the sugar alcohol may be present in the rapidly infusing composition in any amount which provides the desired bulking/taste/disintegration effects. Generally, this amount will range from of at least 5 wt.%, preferably at least 10 wt.%, preferably at least 12 wt.%, preferably at least 14 wt.%, preferably at least 16 wt.%, preferably at least 18 wt.%, and up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 30 wt.%, preferably up to 28 wt.%, preferably up to 26 wt.%, preferably up to 24 wt.%, preferably up to 22 wt.%, preferably up to 20 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
  • a weight ratio of gelatin to sugar alcohol ranges from 1 :3, preferably from 1 :2, preferably from 1: 1, preferably from 1.1: 1, and up to 3: 1, preferably up to 2: 1, preferably up to 1.5: 1, preferably up to 1.2:1.
  • the pharmaceutically acceptable carrier and/or excipient system may also optionally include one or more of a sweetener, a flavorant, and a colorant.
  • the sweetener may be used in any amount which provides the desired sweetening effect, generally in amount of 0 to 10 wt.%, for example in an amount of up to 10 wt.%, preferably up to 9 wt.%, preferably up to 8 wt.%, preferably up to 7 wt.%, preferably up to 6 wt.%, preferably up to 5 wt.%, preferably up to 4.5 wt.%, preferably up to 4 wt.%, preferably up to 3.5 wt.%, preferably up to 3 wt.%, preferably up to 2.5 wt.%, preferably up to 2 wt.%, preferably up to 1.5 wt.%, preferably up to 1 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
  • sweeteners include, but are not limited to, aspartame, saccharin (as sodium, potassium or calcium saccharin), cyclamate (as a sodium, potassium or calcium salt), sucralose, acesulfame-K, thaumatin, neohisperidin, dihydrochalcone, ammoniated glycyrrhizin, dextrose, maltodextrin, fructose, levulose, sucrose, glucose, and isomalt, which may be used singly or in combinations, with particular preference given to sucralose and acesulfame-K.
  • flavorants may be optionally included in the rapidly infusing composition to mask any unpleasant taste imparted by certain ingredients (e.g., an unpleasant tasting ATI) or to otherwise impart an acceptable taste profile to the composition, and the composition is not limited to any particular flavor.
  • flavorants suitable with the present disclosure require trial and error in order to achieve desired effectiveness.
  • Suitable flavorants include, but are not limited to, oil of wintergreen, oil of peppermint, oil of spearmint, oil of sassafras, oil of clove, cinnamon, anethole, menthol, thymol, eugenol, eucalyptol, green-apple, lemon, lime, lemon-lime, orange, and other such flavor compounds to add fruit notes (e.g., citrus, cherry etc.), spice notes, etc., to the composition.
  • the flavorants may be constitutionally composed of aldehydes, ketones, esters, acids, alcohols (including both aliphatic and aromatic alcohols), as well as mixtures thereof. Specific mention is made to green-apple flavor powder.
  • the flavorant may be used in any amount which provides the desired flavor, generally in an amount of 0 to 10 wt.%, for example in an amount of up to 10 wt.%, preferably up to 9 wt.%, preferably up to 8 wt.%, preferably up to 7 wt.%, preferably up to 6 wt.%, preferably up to 5 wt.%, preferably up to 4 wt.%, preferably up to 3 wt.%, preferably up to 2 wt.%, preferably up to 1.5 wt.%, preferably up to 1 wt.%, preferably up to 0.5 wt.%, preferably up to 0.1 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
  • the rapidly infusing composition may be colored or tinted through the optional use of one or more colorants Suitable colorants are those approved by appropriate regulatory bodies such as the FDA and those listed in the European Food and Pharmaceutical Directives and include both pigments and dyes such as FD&C and D&C dyes, with specific mention being made to FD&C Yellow #5 and FD&C Blue #5, which together produce a green hue.
  • Suitable colorants are those approved by appropriate regulatory bodies such as the FDA and those listed in the European Food and Pharmaceutical Directives and include both pigments and dyes such as FD&C and D&C dyes, with specific mention being made to FD&C Yellow #5 and FD&C Blue #5, which together produce a green hue.
  • the pharmaceutically acceptable carrier and/or excipient system may optionally include one or more other pharmaceutically acceptable carriers and/or excipients known to those of ordinary skill in art, in art appropriate levels.
  • fillers or extenders such as starches (e.g., com starch and potato starch), sugars (e.g., lactose or milk sugar, maltose, fructose, glucose, trehalose, sucrose), dextrates, dextrin, polydextrose, high molecular weight polyethylene glycols, silicic acid, aluminum monostearate, polyesters, polycarbonates, and polyanhydrides; binders, such as cellulose, and its derivatives, (e.g., carboxymethyl cellulose, sodium carboxymethyl cellulose, hydroxypropyl cellulose, hydroxyethyl cellulose, hydroxypropylmethyl cellulose, hydroxyethyl methyl cellulose, methyl cellulose, ethyl cellulose, cellulose acetate, and microcrystalline cellulose), alginates (e.g., sodium alginate), polyvinyl pyrrolidone, powdered tragacanth, malt, a
  • sugars e.g.,
  • Preferred rapidly infusing compositions are those which contain less than 1 wt %, preferably less than 0 5 wt %, preferably less than 0 1 wt %, preferably less than 0 05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.%, of other pharmaceutically acceptable carriers and/or excipients, such as those listed above, with particular mention being made to surfactants.
  • the rapidly infusing compositions contain less than 1 wt.%, preferably less than 0.5 wt.%, preferably less than 0.1 wt.%, preferably less than 0.05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.%, of oily mediums, whether synthetic, semi-synthetic, or naturally occurring, such as long chain triglycerides, mixed glycerides, and free fatty acids, with specific mention being made to borage oil, coconut oil, cottonseed oil, soybean oil, safflower oil, sunflower oil, sesame oil, castor oil, corn oil, olive oil, palm oil, peanut oil, peppermint oil, poppy seed oil, canola oil, hydrogenated soybean oil, hydrogenated vegetable oils, glyceryl distearate, behenic acid, caprylyic/capric glycerides, lauric acid, linoleic acid, linolenic acid,
  • the amount of active therapeutic ingredient (ATI) which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce the rapidly infusing composition may vary depending upon the subject being treated, and other factors.
  • the amount of ATI which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce a single dosage form will generally be that amount which produces a pharmacological/therapeutic effect.
  • this amount will range from 0.3 to 50 wt.% of ATT (e g., THC in combination with two or more other cannabinoids), for example, at least 0.3 wt.%, preferably at least 0.5 wt.%, preferably at least 1 wt.%, preferably at least 2 wt.%, preferably at least 3 wt.%, preferably at least 4 wt.%, preferably at least 5 wt.%, preferably at least 6 wt.%, preferably at least 7 wt.%, preferably at least 8 wt.%, preferably at least 9 wt.%, preferably at least 10 wt.%, and up to 50 wt.%, preferably up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 30 wt.%, preferably up to 25 wt.%, preferably up to 24 wt.%, preferably up
  • the rapidly infusing composition is generally formulated with 2 to 100 mg of ATI per unit (e.g. tablet), for example at least 2 mg, preferably at least 4 mg, preferably at least 6 mg, preferably at least 8 mg, preferably at least 10 mg, preferably at least 12 mg, preferably at least 14 mg, preferably at least 16 mg, preferably at least 18 mg, preferably at least 20 mg, preferably at least 22 mg, preferably at least 24 mg, and up to 100 mg, preferably up to 75 mg, preferably up to 70 mg, preferably up to 65 mg, preferably up to 60 mg, preferably up to 55 mg, preferably up to 50 mg, preferably up to 45 mg, preferably up to 40 mg, preferably up to 35 mg, preferably up to 30 mg, preferably up to 25 mg of ATI per unit (e.g., tablet).
  • ATI per unit e.g. tablet
  • the rapidly infusing composition is formulated with, as an active therapeutic ingredient, tetrahydrocannabinol (i.e., (-)-trans-A 9 - tetrahydrocannabinol), and/or any pharmaceutically acceptable derivative/analog, salt, solvate, or stereoisomer thereof
  • THC useful herein may be synthetic, semi -synthetic, or THC obtained from natural sources (e g., Cannabis sativa or Cannabis indica plants) that is unbound from plant material, i.e., naturally-occurring THC which is at least partially purified and not contained within a plant structure such as the leaf matter or trichomes of Cannabis sativa/indica.
  • THC can be chemically synthesized according to methods disclosed in the art.
  • THC can be synthesized from (+)-p-mentha-2,8-dien-l-ol, or ethers or esters thereof, with olivetol in the presence of an acid catalyst such as p-toluenesulfonic acid, trifluoroacetic acid, boron trifluoride diethylether (“BF 3 -Et 2 O”), etc., or synthesized through an esterification-hydrolysis sequence starting from a crude synthetic mixture, and purified using known methods (see e.g., US9744151; US3560528A; R. Mechoulam et al., J. Am. Chem. Soc.
  • Rapidly infusing compositions may be formulated with THC that has been extracted and purified from natural sources.
  • THC may be extracted and purified from a Cannabis sativa plant, a Cannabis indica plant, or specific portions thereof (e.g., hashish) according to methods disclosed in the art, including, but not limited to, through extraction of macerated or powdered plant material with a non-polar solvent such as hexane, followed by purification methods including fractional distillation, chromatography (e.g., high performance liquid chromatography, silica gel chromatography), and the like see e.g. US7524881B2; US6365416B1; and Turk et al. J. Pharm. Pharmac. 1971, 23: 190-195 — each incorporated herein by reference in its entirety).
  • chromatography e.g., high performance liquid chromatography, silica gel chromatography
  • Preferred rapidly infusing compositions are those which are formulated with a solid form of THC. That is, the rapidly infusing composition is prepared through lyophilization from a drug product suspension in which the THC is in the form of a solid In particular, micronized particles of THC are preferred.
  • the rapidly infusing composition is formulated with solid THC in the form of micronized particles having a D50 particle size in the range of 1 pm to 50 pm, for example, those having a D50 particle size of at least 1 pm, preferably at least 10 pm, preferably at least 20 pm, preferably at least 30 pm, preferably at least 40 pm, and up to 50 pm, preferably up to 40 pm, preferably up to 30 pm, preferably up to 20 pm, preferably up to 10 pm.
  • Even more preferred rapidly infusing compositions are those formulated with a solid form of THC having a purity of at least 95 wt.%, preferably at least 96 wt.%, preferably at least 97 wt.%, preferably at least 98 wt.%, preferably at least 99 wt.%, and up to 99.1 wt.%, preferably up to 99.2 wt.%, preferably up to 99.3 wt.%, preferably up to 99.4 wt.%, preferably up to 99.5 wt.%, preferably up to 99.6 wt.% , preferably up to 99.7 wt.%, preferably up to 99.8 wt.%, preferably up to 99.9 wt.%, preferably up to 100 wt.%.
  • the percent purity of THC refers to the percent of THC by mass relative to a total weight of THC containing material — the THC containing material being the sum of THC plus any additional impurities which may be present, such as those impurities originating from the biomass from which the THC is obtained (e.g., Cannabis sativa/indica) or encountered during manufacture.
  • the purity may be determined by methods known to those of ordinary skill in the art, for example, one or more of liquid chromatography such as high performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LCMS), and liquid chromatography with tandem mass spectrometry (TCMSMS); gas chromatography such as headspace gas chromatography with flame ionization detection (HS-GC-FID), gas chromatography mass spectrometry (GC/MS), and headspace gas chromatography-mass spectrometry (HSGCMS); inductively coupled plasma-mass spectrometry (ICP-MS); and polymerase chain reaction (PCR).
  • liquid chromatography such as high performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LCMS), and liquid chromatography with tandem mass spectrometry (TCMSMS
  • gas chromatography such as headspace gas chromatography with flame ionization detection (HS-GC-FID), gas chromatography mass spectrometry (GC/MS), and headspace
  • Examples of potential impurities include, but are not limited to, cannabinoids (other than THC) including, but not limited to, cannabidiol (CBD), cannabidivarin (CBDV), cannabichromene (CBC), cannabidiolic acid (CBDa), cannabigerol (CBG), cannabigerolic acid (CBGa), cannabinol (CBN), tetrahydrocannabinolic acid (THCa), tetrahydrocannabivarin (THCV), tetrahydrocannabivarin acid (THCVa), (+)-trans-A 9 -tetrahydrocannabinol, and (-)-trans-A 8 -tetrahydrocannabinol; pesticides including, but not limited to, aldicarb, carbo
  • mycotoxins including, but not limited to, aflatoxins (e.g., aflatoxin Bl, aflatoxin B2, aflatoxin Gl, and aflatoxin G2) and ochratoxin A; heavy metals including, but not limited to, arsenic, cadmium, lead, and mercury; terpenes including, but not limited to, (1) monoterpenes such as camphene, camphor, 3 -carene, a-cedrene, cedrol, endo-fenchyl alcohol, eucalyptol, fenchone, geraniol, geranul acetate, hexahydrothymol, isobomeol, isopulegol, limonene, linalool, p-mentha- 1,5 -diene, 0-myrcene, a- and P-pinene, pulegone, sabinene and hydrate, a- and y-terpinene, ter
  • the rapidly infusing composition is formulated with a form of THC which contains less than 1 wt.%, preferably less than 0.5 wt.%, preferably less than 0.1 wt.%, preferably less than 0.05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.% of any/all of the above listed impurities, based on a total weight of the THC material, with specific mention being made to CBD.
  • the rapidly infusing composition is formulated with a form of THC which contains no impurity, such as those listed above, in an amount above the limits of detection (LOD) and/or limits of quantification (LOQ) for the technique/instrumentation being used to make such a determination.
  • preferred rapidly infusing compositions are those formulated with a pure form of THC which has a CBD content of less than 0.1 wt.%, preferably less than 0.01 wt.%, preferably less than 0.001 wt.%, based on a total weight of the THC material.
  • the rapidly infusing composition is formulated with a pure form of THC which consists of, or consists essentially of, THC.
  • the rapidly infusing composition comprises, consists essentially of, or consists of gelatin, mannitol, sweetener, flavorant, colorant, and as the ATI, THC.
  • Also contemplated for use as an active therapeutic ingredient are derivatives/ analogs of THC that retain at least some of the pharmacological activity of THC, for example, through activation of cannabinoid receptors.
  • Derivatives/analogs that retain substantially the same activity as THC, or more preferably exhibit improved activity may be produced according to standard principles of medicinal chemistry, which are well known in the art. Such derivatives/analogs may exhibit a lesser degree of activity than THC, so long as they retain sufficient activity to be therapeutically or pharmacologically effective.
  • Derivatives/analogs may exhibit improvements in other properties that are desirable in active therapeutic agents such as, for example, improved solubility, reduced toxicity, enhanced uptake, increased bioavailability, etc.
  • Contemplated THC derivatives/analogs include, but are not limited to, isomeric derivatives/analogs of THC (e.g., (+)-trans-A 9 -tetrahydrocannabinol, (-)-trans-A 8 - tetrahydrocannabinol); hydroxy derivatives/analogs (e.g., 11 -hydroxy- A 9 - tetrahydrocannabinol, 11 -hydroxy- A 8 -tetrahydrocannabinol, AM-919, AM-926, AM-938, AM-2389, 1 l-nor-9p-hydroxyhexahydrocannabinol, l l-nor-9p- hydroxyhexahydrocannabinol-DMH, HU-210, HU-211, desacetyl-L-nantradol, JWH-051); oxo derivatives/analogs (e.g., nabilone
  • THC may be combined with two or more other cannabinoids, with particular mention to cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), cannabi chromene (CBC), and cannabidivarin (CBDV).
  • CBD cannabidiol
  • CBG cannabigerol
  • CBN cannabinol
  • CBC cannabi chromene
  • CBDV cannabidivarin
  • CBD cannabidivarin
  • CBD cannabidivarin
  • Each of the above listed other cannabinoids can currently be sourced in a substantially pure (e.g. 95%-99.9% purity) isolate form and combined into the RITeTM platform using the techniques described below in appropriate dosages.
  • Other major and minor cannabinoids that are or become available in similar substantially pure isolate form could also be used according to the same techniques.
  • a mass percentage of THC in the rapidly infusing composition, relative to a combined mass of all cannabinoids (including THC), may be at least 10 wt.%, at least 20 wt.%, at least 30 wt.%, at least 40 wt.%, at least 50 wt.%, at least 60 wt.%, at least 70 wt.%, at least 80 wt.%, at least 90 wt.%, or less than 100 wt.%, less than 90 wt.%, less than 80 wt.%, less than 70 wt %, less than 60 wt %, less than 50 wt %, less than 40 wt %, less than 30 wt %, less than 20 wt.%.
  • a mass percentage of a first cannabinoid, relative to a combined mass of a first and second cannabinoid in the rapidly infusing composition may be at least 10 wt.%, at least 20 wt.%, at least 30 wt.%, at least 40 wt.%, at least 50 wt.%, at least 60 wt.%, at least 70 wt.%, at least 80 wt.%, at least 90 wt.%, or less than 100 wt.%, less than 90 wt.%, less than 80 wt.%, less than 70 wt.%, less than 60 wt.%, less than 50 wt.%, less than 40 wt.%, less than 30 wt.%, less than 20 wt.%.
  • the first and second cannabinoids are not THC.
  • the rapidly infusing composition may comprise at least 2, at least 3, at least 4 other cannabinoids that are not THC. Process for manufacturing the rapidly infusing composition
  • Processes to be used for preparing the RITeTM platform are preferably pharmaceutical-GMP compliant, and may include generally bringing into association the ATI (e.g., THC) with the gelatin and sugar alcohol (e.g., mannitol), and, optionally, one or more accessory pharmaceutically acceptable carrier and/or excipient ingredients, in water to form a drug product suspension which is then lyophilized.
  • ATI e.g., THC
  • sugar alcohol e.g., mannitol
  • Purified water, gelatin, and sugar alcohol e.g., mannitol
  • a mixer for example a pot equipped with an overhead stirrer, and heated (e.g., 40 to 80 °C) with agitation until complete solvation.
  • Any desired sweetener e.g., a mixture of sucralose and acesulfame-K
  • a mixture of sucralose and acesulfame-K may then be added and allowed to dissolve.
  • the solution may next be transferred to a homogenizer, and the ATI (e g., THC and two or more other cannabinoids) may be subsequently sequentially charged and dispersed using the homogenizer or in the alternative the THC and other cannabinoid isolates are thoroughly mixed in dry form and charged and dispersed in a single step, with preferable micronization of the ATI, to form a drug product suspension. Any desired flavorant and colorant may be added at this point with continued mixing.
  • the drug product suspension may be transferred to a second mixer whilst maintaining a cooled temperature (e.g., 20 to 35 °C).
  • blister pockets may next be filled with the drug product suspension until achieving a target dose weight, followed by freezing in a suitable cryochamber.
  • the blister trays may be transferred from the cryochamber to a suitable refrigerated storage cabinet (e.g., at a temperature below 0 °C) to keep the product frozen prior to lyophilization.
  • the frozen blisters may be loaded into a lyophilizer and subject to lyophilization to sublimate the water and form the rapidly infusing compositions.
  • final sealing e.g., heat sealing of blister lidding
  • the present disclosure relates generally to methods of administering tetrahydrocannabinol (THC) in combination with two or more other cannabinoids to a subject via the RITeTM platform of the present disclosure, in one or more of its embodiments.
  • the methods may be performed in order to provide a desired pharmacological effect for example through activation of one or more cannabinoid receptors, to treat a clinical disorder or medical condition responsive to THC or derivatives/analogs thereof with two or more other cannabinoids, recreationally for example for the purpose of providing a “high” and a feeling of joy and satisfaction, or for any other purpose where administration of THC (or related compounds) may be desirable.
  • the subject is a human.
  • the methods herein are used to treat pain in a subject, for example, to manage pain/induce an analgesic response prior to, during, or following treatment of a disease, condition, or pathology. Both palliative and curative treatment methods are contemplated herein.
  • the pain may be categorized as nociceptive pain, neuropathic pain, or psychogenic pain. This includes subsets thereof including, but not limited to, phantom pain, breakthrough pain, incident pain, inflammatory pain, postsurgical (postoperative) pain, cancer-associated pain, peripheral pain, central pain, and spastic pain.
  • the types of pain that may be treated with the methods herein may be acute pain types, or may be considered chronic pain types.
  • the methods of the present disclosure may be used to treat neuropathic pain.
  • the neuropathic pain may be central neuropathic pain, peripheral neuropathic pain, or both.
  • the neuropathic pain may also be categorized as acute neuropathic pain or chronic neuropathic pain Examples of categories of neuropathic pain that may be treated by the methods of the present disclosure include, but are not limited to, autonomic neuropathy; focal neuropathy; proximal neuropathy; diabetic neuropathy; compression neuropathy; phantom limb pain; neuralgia (e.g., trigeminal neuralgia, postherpetic neuralgia); thoracic or lumbar radiculopathy; complex regional pain syndromes; neuropathic pain associated with AIDS and infection with the human immunodeficiency vims; cancer- associated pain such as neuropathic cancer pain (NCP) attributable to the cancer per se and/or the various cancer treatments (e.g., chemotherapy, radiotherapy, and surgery) that a subject
  • the present disclosure provides a method of treating pain in a subject who has a disease or condition which causes neuropathic pain.
  • diseases or conditions which cause neuropathic pain include, but are not limited to, an abdominal wall defect, an abdominal migraine, achondrogenesis, acquired immunodeficiency syndrome (AIDS), porphyria (e g., acute porphyrias), acute brachial neuritis, acute toxic epidermolysis, adiposa dolorosa, adrenal neoplasm, adrenomyeloneuropathy, adult or childhood dermatomyositis, amyotrophic lateral sclerosis, arachnoiditis, arteritis giant cell and cranial arteritis, arthritis, astrocytoma athetoid cerebral palsy, tumors of the central nervous system, brachial neuritis, brachiocephalic ischemia, brain tumors, Burkitt's lymphoma, neurofibromatosis
  • AIDS acquired
  • a preferred therapeutic application involves treatment of postsurgical (postoperative) pain in a subject who has undergone a surgical procedure by administering the rapidly infusing composition post-operatively to the subject.
  • Postsurgical pain is a type of pain that usually differs in quality and location from pain experienced prior to surgery, and is usually associated with iatrogenic neuropathic pain caused by surgical injury to a major peripheral nerve (surgically-induced neuropathic pain or SNPP).
  • the postsurgical pain may be acute, or if the pain state persists well after the surgical procedure, for example, more than 2 months after surgery, then the postsurgical pain may be of the chronic variety.
  • a wide variety of surgical procedures may cause postsurgical pain, and the methods disclosed herein may be used for treating pain stemming from any surgical procedure including, but not limited to, those involving excision of an organ (-ectomy), those involving cutting into an organ or tissue (-otomy), those involving minimally invasive procedures like making a small incision and insertion of an endoscope (-oscopy), those involving formation of a permanent or semi-permanent stoma in the body (-ostomy), those involving reconstruction or cosmetic procedures (-oplasty), those involving repair of damaged or congenital abnormal structure (- rraphy), reoperation procedures, amputations, and resections, including those surgical procedures of the manual or robot-assisted varieties.
  • Types of surgical procedures may include, but are not limited to bariatric surgery, breast surgery, colon and rectal surgery, endocrine surgery, surgeries which fall under the general surgery classification, gynecological surgery, head and neck surgery, hernia surgery, neurosurgery, orthopedic surgery, ophthalmological surgery, oral or maxillofacial surgery, surgeries which fall under the outpatient surgery classification, thoracic surgery, urologic surgery, and vascular surgery.
  • inguinal hernia repair e.g., leg amputation
  • caesarean section e.g., coronary artery bypass surgery, gastric bypass surgery, hand surgery, Achilles tear surgery, open-knee surgery, spinal surgery, arthroscopy of the knee, shoulder, hip, ankle, elbow, or wrist, and arthroplasty of the knee, shoulder, hip, ankle, elbow, or wrist.
  • the methods disclosed herein may be particularly well- suited for the treatment of postsurgical pain associated with orthopedic procedures including, but not limited to, knee arthroplasty (knee replacement surgery) and shoulder arthroscopy.
  • the disclosed methods may also be particularly well-suited for treating postsurgical pain in subjects whom have not responded well to opioids or whom have experienced one or more significant opioid-related side effects such as addiction, cognitive impairment, constipation, nausea, and myoclonus.
  • Cancer-associated pain may be caused by the cancer itself, i.e., from the cancer growing into/destroying nearby tissue, nerves, bones, organs, etc.
  • the cancer-associated pain may be caused by the chemicals released by certain tumor types, or the subject’s response (e g , immunoresponse) to the released chemicals.
  • the cancer- associated pain may also be caused by various types of cancer treatment that the subject may undergo after diagnosis, such as surgery, radiation therapy, and therapy with agents having cytostatic or antineoplastic activity (e.g., chemotherapy). Cancer-associated pain stemming from any/all of the above causes may be treated with the methods disclosed herein.
  • the subject may have any cancer that fails to undergo apoptosis, including both solid tumor types (e g., carcinomas, sarcomas including Kaposi’s sarcoma, erythroblastoma, glioblastoma, meningioma, astrocytoma, melanoma, myoblastoma, and the like) and non-solid tumor cancers such as leukemia.
  • solid tumor types e g., carcinomas, sarcomas including Kaposi’s sarcoma, erythroblastoma, glioblastoma, meningioma, astrocytoma, melanoma, myoblastoma, and the like
  • non-solid tumor cancers such as leukemia.
  • Types of cancers which can cause cancer-associated pain treatable by the disclosed methods include, but are not limited to, brain cancers, skin cancers, bladder cancers, ovarian cancers, breast cancers, gastric cancers, pancreatic cancers, prostate cancers, colon/colorectal cancers, blood cancers, lung cancers, and bone cancers, including a combination of two or more cancer types.
  • cancer types include, but are not limited to, neuroblastoma, intestine carcinoma such as rectum carcinoma, colon carcinoma, familiar adenomatous polyposis carcinoma and hereditary non-polyposis colorectal cancer, esophageal carcinoma, labial carcinoma, larynx carcinoma, hypopharynx carcinoma, tong carcinoma, salivary gland carcinoma, gastric carcinoma, adenocarcinoma, medullary thyroid carcinoma, papillary thyroid carcinoma, renal carcinoma, kidney parenchymal carcinoma, ovarian carcinoma, cervix carcinoma, uterine corpus carcinoma, endometrium carcinoma, chorion carcinoma, pancreatic carcinoma, prostate carcinoma, testis carcinoma, breast carcinoma, urinary carcinoma, melanoma, brain tumors such as glioblastoma, astrocytoma, meningioma, medulloblastoma and peripheral neuroectodermal tumors, Hodgkin lymphoma, non-Hodgkin lymphoma, Burkitt lympho
  • the methods of the present disclosure may be particularly advantageous for treating cancer-associated pain in subjects having advanced stage cancer, or who are otherwise in a chronic progressive cancer-associated pain state, with particular mention being made to those subjects having pancreatic cancer, and especially advanced pancreatic cancer, and are experiencing pancreatic cancer-associated pain.
  • the disclosed methods may also be particularly well-suited for treating cancer-associated pain in subjects whom have not responded well to opioids or whom have experienced one or more significant opioid-related side effects such as addiction, cognitive impairment, constipation, nausea, and myoclonus.
  • the rapidly infusing composition of the present disclosure may be administered to subjects who have not received cancer treatment, who are undergoing cancer treatment (i.e., the rapidly infusing composition is co-administered with a cancer treatment), or who have previously completed one or more rounds of cancer treatment.
  • cancer treatments include, but are not limited to, surgery, radiation therapy, and therapy with one or more agents having cytostatic or antineoplastic activity.
  • Agents having cytostatic or antineoplastic activity may generally fall into the following categories: (i) antimetabolites; (ii) DNA-fragmenting agents; (iii) DNA- crosslinking agents; (iv) intercalating agents; (v) protein synthesis inhibitors; (vi) topoisomerase I poisons; (vii) topoisomerase II poisons; (viii) microtubule- directed agents; (ix) kinase inhibitors; (x) miscellaneous investigational agents; (xi) hormones; (xii) hormone antagonists; (xiii) anti angiogenic agents; and (xiv) targeted therapies; with specific mention being made to mitotic/tubulin inhibitors, alkylating agents, cell cycle inhibitors, enzymes, topoisomerase inhibitors, biological response modifiers, anti-hormones, tyrosine-kinase inhibitors, inhibitors of MMP-2, MMP-9, or COX-2, anti androgens, platinum coordination complexe
  • Yet another therapeutic application involves treating inflammatory pain in a subject who is experiencing acute or chronic pain that results from inflammatory processes, such as may arise in the case of infections, arthritis, tissue damage, and neoplasia or tumor related hypertrophy. Cancer-associated pain may, therefore, in certain circumstances, be considered to fall within the category of inflammatory pain.
  • inflammatory diseases or conditions which can cause inflammatory pain include, but are not limited to, arthritis (e.g., osteoarthritis, rheumatoid arthritis, etc.), lupus, aspiration pneumonia, empyema, gastroenteritis, necrotizing pneumonia, pelvic inflammatory disease, pharyngitis, pleurisy, urinary tract infections, and chronic inflammatory demyelinating polyneuropathy.
  • arthritis e.g., osteoarthritis, rheumatoid arthritis, etc.
  • lupus aspiration pneumonia
  • empyema empyema
  • gastroenteritis e.g., gastroenteritis, necrotizing pneumonia
  • pelvic inflammatory disease e.g., pharyngitis, pleurisy, urinary tract infections
  • chronic inflammatory demyelinating polyneuropathy e.g., chronic inflammatory demyelinating polyneuropathy.
  • Muscle spasticity is a relatively common problem among subjects suffering from central neurologic problems, such as cerebrovascular pathology, medullar injuries, multiple sclerosis, and cerebral palsy, as well as subjects suffering from adductor muscle spasms associated with hemiplegia or paraplegia.
  • the methods of the present disclosure may be used to treat a variety of conditions or indications responsive to THC or related derivatives/analogs.
  • the methods herein are used to treat anorexia and/or cachexia, particularly AIDS -associated anorexia and cachexia.
  • the methods herein are used to treat nausea and/or emesis, with particular mention being made to nausea and/or emesis due to cancer chemotherapy.
  • the methods herein are used to treat spasticity or muscle control disorders, particularly spasticity related to cerebral palsy, traumatic brain injury, stroke, multiple sclerosis or spinal cord injury.
  • the methods herein are used to treat overactive bladder syndrome.
  • the methods herein are used to treat sleep apnea, for example obstructive sleep apnea. In some embodiments, the methods herein are used to treat glaucoma. In some embodiments, the methods herein are used to treat movement disorders — examples of which include, but are not limited to, dystonia, Parkinson’s disease, Huntington’s disease, Tourette’s syndrome, and tremor. Other conditions/indications which may respond to the treatment methods herein include, but are not limited to, one or more of allergies, inflammation, infection, epilepsy, depression, migraine headaches, bipolar disorders, anxiety disorder, drug dependency and withdrawal syndromes, and Alzheimer’s disease.
  • the methods herein are used to provide THC in combination with two or more other cannabinoids to a subject for recreational purposes, e.g., to provide a “high” and a feeling of joy and satisfaction.
  • a subject for recreational purposes e.g., to provide a “high” and a feeling of joy and satisfaction.
  • desirable benefits may still be obtained from such recreational use, such as pain relief, appetite stimulation, and anxiolytic effects.
  • the subjective characteristics of the “high” can be modulated using different relative quantities of the two or more other cannabinoids.
  • the rapidly infusing composition is preferably administered to the subject via one or more of the oral mucosae, preferably via the buccal mucosa (buccally) or the sublingual mucosa (sublingually).
  • Advantages of oral mucosal delivery include the ease of administration, the ability to bypass first pass metabolic processes thereby enabling higher bioavailability than through enteral delivery via the gastrointestinal tract, less variability between subjects, sustained drug delivery, and extensive drug absorption and rapid onset of therapeutic/pharmacological action due to either a large surface area in the case of sublingual administration or high-levels of vascularization in the case of buccal administration.
  • Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue). While the sublingual mucosa has a large surface area and extremely good permeability, the blood supply (blood flow) is lesser than that of the buccal cavity. Furthermore, sublingual administration tends to stimulate the flow of saliva more than buccal administration, and the increased saliva production may make it more difficult for patients to avoid swallowing. Any amount of ATI that is swallowed would be subject to first pass metabolism and thus overall lower bioavailability.
  • the rapidly infusing composition is administered buccally (through the buccal mucosa).
  • the rapid disintegration of the rapidly infusing composition, approximately in 1 to 5 seconds in preferred embodiments, and buccal administration together combine to provide optimal dosing control by limiting the time for potential swallowing and ensuring that the vast majority of the ATI is absorbed through the buccal mucosa.
  • Administration may be performed by the subject (self-administered) or by someone other than the subject, for example, a healthcare provider, family member, etc.
  • the actual amount of ATI administered to the subject may be varied so as to achieve the desired pharmacological response for a particular subject, composition, and mode of administration, without being toxic to the subject.
  • the selected amount of ATI administered to the subject will depend upon a variety of factors including the activity of the ATI employed, the route of administration, the time of administration, the rate of excretion or metabolism of the particular compound being employed, the rate and extent of absorption, the duration of the treatment, other drugs, compounds, and/or materials used in combination with the rapidly infusing composition, the age, sex, weight, condition, general health, and prior medical history of the subject being treated, and like factors well known in the medical arts.
  • a physician having ordinary skill in the art can readily determine and prescribe the effective amount of the ATI required, by starting doses of the ATI at levels lower than that required in order to achieve the desired therapeutic effect and gradually increasing the dosage until the desired effect is achieved.
  • a suitable dose of the ATI will be that amount which is the lowest dose effective to produce a desired effect, which will generally depend upon the factors described above.
  • the effective amount of THC or a derivative/analog thereof will range from at least 0.1 mg, preferably at least 0.2 mg, preferably at least 0.4 mg, preferably at least 0.6 mg, preferably at least 0.8 mg, preferably at least 1 mg, preferably at least 1.2 mg, preferably at least 1.4 mg, preferably at least 1.6 mg, preferably at least 1.8 mg, preferably at least 2 mg, preferably at least 5 mg, and up to 20 mg, preferably up to 15 mg, preferably up to 10 mg, preferably up to 9 mg, preferably up to 8 mg, preferably up to 7 mg, preferably up to 6.5 mg, preferably up to 6 mg, preferably up to 5.5 mg, preferably up to 5 mg, preferably up to 4.5 mg, preferably up to 4 mg per dose
  • the rapidly infusing composition is administered to the subject to provide a total of 5 to 20 mg of THC or derivative
  • the effective amount of other cannabinoids that are not THC or a derivative/analog of THC will range from at least 0.5 mg, preferably at least 1 mg, preferably at least 2 mg, preferably at least 4 mg, preferably at least 5 mg, preferably at least 8 mg, preferably at least 10 mg, preferably at least 15 mg, preferably at least 20 mg, preferably at least 25 mg, preferably at least 30 mg, preferably at least 40 mg, preferably at least 50 mg, preferably at least 60 mg, preferably at least 70 mg, and up to 80 mg, preferably up to 70 mg, preferably up to 60 mg, preferably up to 50 mg, preferably up to 40 mg, preferably up to 30 mg, preferably up to 25 mg, preferably up to 20 mg, preferably up to 15 mg, preferably up to 10 mg, preferably up to 9 mg, preferably up to 8 mg, preferably up to 7 mg, preferably up to 6.5 mg, preferably up to 6 mg, preferably up to 5.5 mg,
  • the effective amount of the rapidly infusing composition is that which provides THC and/or a derivative/analog thereof in combination with two or more other cannabinoids to the subject in an amount of at least 0.01 mg/kg, preferably at least 0.05 mg/kg, preferably at least 0.1 mg/kg, preferably at least 0.2 mg/kg, preferably at least 0.4 mg/kg, preferably at least 0.5 mg/kg, preferably at least 0.6 mg/kg, preferably at least 0.7 mg/kg, preferably at least 1.0 mg/kg, preferably at least 1.2 mg/kg, preferably at least 1.5 mg/kg, preferably at least 1.8 mg/kg, and up to 3.0 mg/kg, preferably up to 2.5 mg/kg, preferably up to 2.2 mg/kg, preferably up to 2.0 mg/kg, preferably up to 1.8 mg/kg, preferably up to 1.5 mg/kg, preferably up to 1.2 mg/kg, preferably up to 1.0 mg/kg, preferably up to 1.2 mg/kg, preferably up to
  • the methods herein may involve administering one, or more than one, unit of the rapidly infusing composition per dose (dosing event).
  • ATI e g., THC and two or more other cannabinoids
  • the subject may be given two (2) units (e.g., tablets) to achieve the desired therapeutically effective amount of 40 mg ATI per dose.
  • the effective amount of ATI prescribed, etc., 1, 2, 3, 4, 5, or more units may be administered to the subject per dose.
  • the phrases “administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition”, “the rapidly infusing composition is administered”, etc. are intended herein to include administration of a single unit (e.g., tablet), or multiple units (e.g., tablets), to the subject in order to provide an effective amount of ATI, e.g., THC and two or more other cannabinoids. While it may be possible to administer partial (e.g., half) tablets to the subject, for practical reasons, it is preferred that one or more whole tablets are administered to the subject.
  • the dose schedule (frequency of administration) may be determined simply on the basis of when the subject requires or desires effects from THC or its derivative/analogs with other cannabinoids, e.g., to provide a high, to provide relief from pain symptoms, etc.
  • the rapidly infusing composition may be administered ‘as needed’ (PRN).
  • the subject may be prescribed a dosage regimen that involves multiple, separate dosing events at appropriate time intervals throughout the day.
  • the subject may be administered an effective amount of ATI 1 time, 2 times, 3 times, 4 times, 5 times, 6 times, or even more times, optionally at appropriate intervals, throughout the day
  • a particularly preferred dosing schedule involves administration of the rapidly infusing composition 2 times per day (b i d ).
  • the rapidly infusing composition may also be administered on an hourly dosing schedule (q), for example, administration may take place every 4, 6, 8, 10, 12, 14, 18, 24 hours, or otherwise, as appropriate.
  • the maximum daily dosage of THC or derivative/analog thereof and the other cannabinoids in total is preferably no more than 500 mg, preferably no more than 450 mg, preferably no more than 400 mg, preferably no more than 350 mg, preferably no more than 200 mg per day.
  • Administration may be performed once or multiple times a day, on consecutive days or otherwise, to achieve desired results (e.g., relief from pain symptoms, a feeling of satisfaction, etc.).
  • the subject may be administered an effective dose of the rapidly infusing composition, at least 1 time per day for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, or more, such as weeks, months, or even years.
  • Preferred dosing regimens are those involving a consistent dosing amount and schedule.
  • a dosing regimen may involve the subj ect taking one unit of the rapidly infusing composition (e g., 25 mg THC and other cannabinoids) two times per day (b.i.d.), for 14 consecutive days.
  • Another non-limiting example of a dosing regimen may involve the subject taking two units of the rapidly infusing composition (e.g., 25 mg THC and other cannabinoids) — therapeutically effective amount of 50 mg THC and other cannabinoids per dose — two times per day (b.i.d.), for 10 consecutive days.
  • the rapidly infusing composition Upon being administered buccally (between the cheek and gum) or sublingually (under the ventral surface of the tongue), the rapidly infusing composition preferably disintegrates in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably about 1 second
  • Such a disintegration profile provides for rapid absorption of the ATI and short onset times of under 15 minutes, preferably under 10 minutes, preferably under 5 minutes, preferably under 4 minutes, preferably under 3 minutes, preferably under 2 minutes, preferably under 1 minute, preferably under 45 seconds, preferably under 30 seconds, preferably under 20 seconds, preferably under 10 seconds, preferably approximately 5 seconds.
  • this route of administration may provide a single dose bioavailability of at least 20%, preferably at least 30%, preferably at least 40%, preferably at least 50%, preferably at least 60%, preferably at least 70%, preferably at least 80%, preferably at least 90%, and up to 95%, preferably up to 90%, preferably up to 80%, preferably up to 70%, preferably up to 60%, preferably up to 50%, preferably up to 40%, preferably up to 30%.
  • the RITeTM platform may be used as a stand-alone agent or may be used in combination therapy — wherein the rapidly infusing composition (a first therapy) is used in combination with a second therapy such as one or more second therapeutic agents.
  • the combination therapy may be applied to one condition, for example where both/all therapies target pain.
  • the combination therapy may also be applied to treat a combination of conditions, for example where the first therapy targets pain and the second therapy targets a different condition such as cancer.
  • the rapidly infusing composition formulated with THC in combination with two or more other cannabinoids may be used for any purpose in which the pharmacological effects from THC are desired, for example to treat pain, anorexia and/or cachexia, nausea and/or emesis, spasticity or muscle control disorders, overactive bladder syndrome, sleep apnea, glaucoma, movement disorders, allergies, inflammation, infection, epilepsy, depression, migraine headaches, bipolar disorders, anxiety disorder, drug dependency and withdrawal syndromes, and Alzheimer’s disease.
  • the rapidly infusing composition may also be used simply for recreational purposes
  • Examples of second therapies which can be co-administered with the rapidly infusing composition of the present disclosure include, but are not limited to, analgesics, cancer therapies, antidepressants, anxiolytics, anticonvulsants, expectorants, antihypertensive agents, bronchodilators, anti-inflammatory agents, antibacterial/antiviral/anti- parasitic/antifungal agents, mucolytics, antiemetics, and antaci ds/acid-reducing drugs — which can be used, e.g., for the treatment of pain, cancer, depression, anxiety, seizures, irritation of the respiratory tract, hypertension, dyspnea, inflammation, infection, chronic sputum production, nausea/vomiting, acid reflux, heartburn, and indigestion.
  • analgesics e.g., for the treatment of pain, cancer, depression, anxiety, seizures, irritation of the respiratory tract, hypertension, dyspnea, inflammation, infection, chronic sputum production, nausea/vomiting, acid
  • Analgesics suitable for use in combination therapy may include, but are not limited to, opioid analgesics, such as natural opiates, esters/ethers of morphine opiates, semisynthetic opioids, synthetic opioids, and endogenous opioid peptides, examples of which include, but are not limited to, morphine, codeine, thebaine, oripavine, papaveretum, diacetylmorphine, nicomorphine, dipropanoylmorphine, diacetyldihydromorphine, acetylpropionylmorphine, desomorphine, methyldesomorphine, dibenzoylmorphine, dihydrocodeine, ethylmorphine, heterocodeine, buprenorphine, etorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl, alphamethylfentanyl, alfentanil, sufentanil, remif
  • compositions formulated with THC in combination with two or more other cannabinoids may advantageously function as an opioidsparing medication, that when co-administered with opioids, enables a reduced opioid dose or shorter opioid dosage period, without a loss of analgesic efficacy.
  • Cancer therapies suitable for use in combination therapy may include, but are not limited to, surgery, radiation therapy, and therapy with agents having cytostatic or antineoplastic activity, such as those described previously.
  • the methods of the present disclosure involve co-administration of the rapidly infusing composition (e.g., for pain relief, to stem nausea and/or emesis, etc.) and a cancer treatment such as radiation therapy and/or an agent with cytostatic or antineoplastic activity (for cancer treatment), including any of those agents with cytostatic or antineoplastic activity falling into the 14 classes described above, as well as any future agents that may be developed.
  • Antidepressants and anxiolytics suitable for use in combination therapy may include, but are not limited to, selective serotonin reuptake inhibitors such as citalopram, escitalopram, fluoxetine, paroxetine, sertraline; serotonin and norepinephrine reuptake inhibitors such as duloxetine and venlafaxine; norepinephrine and dopamine reuptake inhibitors such as bupropion; tetracyclic antidepressants such as mirtazapine; combined reuptake inhibitors and receptor blockers such as trazodone, nefazodone, maprotiline; tricyclic antidepressants such as amitriptyline, amoxapine, desipramine, doxepin, imipramine, nortriptyline, protriptyline and trimipramine; monoamine oxidase inhibitors such as phenelzine, tranylcypromine, is
  • Expectorants suitable for use in combination therapy may include, but are not limited to, glycerol iodination products, for example, domiodol and organidin, as well as purinergic receptor agonists such as uridine triphosphate and adenosine triphosphate.
  • Anti-hypertensive agents suitable for use in combination therapy may include, but are not limited to, diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, alpha-2 receptor agonists, and combined alpha and beta-blockers, with specific mention being made to amiloride.
  • Bronchodilators suitable for use in combination therapy may include, but are not limited to p 2 -adrenergic agonists (e.g., salbutamol and terbutaline), anticholinergics, and theophylline.
  • Anti-inflammatory agents suitable for use in combination therapy may include, but are not limited to, oxicams, salicylates, acetic acid derivatives, fenamates, propionic acid derivatives, pyrazoles/pyrazolones, coxibs, and sulfonanilides
  • Antibacterial/antiviral/anti-parasitic/antifungal agents suitable for use in combination therapy may include, but are not limited to, macrolide antibiotics such as erythromycin; sulfonamides such as sulfanilamide, sulfadiazine, and sulfacetamide; topical antibiotics such as mupirocin; tetracyclines such as tetracycline and doxycycline; synthetic and semisynthetic penicillins and beta-lactams; chloramphenicol; imidazoles; dicarboxylic acids such as azelaic acid; salicylates; peptide antibiotics; and cyclic peptides such as cyclosporine, tacrolimus, pimecrolimus and sirolimus (rapamycin).
  • macrolide antibiotics such as erythromycin
  • sulfonamides such as sulfanilamide, sulfadiazine, and sulfacetamide
  • topical antibiotics
  • Mucolytics suitable for use in combination therapy may include, but are not limited to, n-acetylcysteine, ambroxol, bromhexine, carbocisteine, erdosteine, and mecysteine.
  • Antiemetics suitable for use in combination therapy may include, but are not limited to, 5-HT 3 receptor antagonists such as dolasetron, granisetron, ondansetron, and tropisetron; dopamine antagonists such as domperidone, olanzapine, alizapride, and prochlorperazine; NK1 receptor antagonists such as aprepitant and rolapitant; antihistamines such as diphenyhydramine, dimenhydrinate, meclizine, and promethazine; and steroids such as dexamethasone.
  • 5-HT 3 receptor antagonists such as dolasetron, granisetron, ondansetron, and tropisetron
  • dopamine antagonists such as domperidone, olanzapine, alizapride, and prochlorperazine
  • NK1 receptor antagonists such as aprepitant and rolapitant
  • antihistamines such as diphenyhydramine, dimenhydrinate, meclizine, and
  • Antacids/acid-reducing drugs suitable for use in combination therapy may include, but are not limited to, salts of aluminium, calcium, magnesium, or sodium, for example, magnesium oxide, magnesium carbonate, aluminium hydroxide, sodium citrate, sodium bicarbonate, and magnesium trisillicate; and H 2 -receptor antagonists such as cimetidine, famotidine, nizatidine, and lafutidine; and proton pump inhibitors such as omeprazole, lansoprazole, dexlansoprazole, and esomeprazole.
  • salts of aluminium, calcium, magnesium, or sodium for example, magnesium oxide, magnesium carbonate, aluminium hydroxide, sodium citrate, sodium bicarbonate, and magnesium trisillicate
  • H 2 -receptor antagonists such as cimetidine, famotidine, nizatidine, and lafutidine
  • proton pump inhibitors such as omeprazole, lansoprazole, dexlanso
  • Combination therapy is intended to embrace administration of these therapies in a sequential manner, that is, wherein the rapidly infusing composition and one or more second therapies are administered at a different time, as well as admini tration of these therapies, or at least two of the therapies, in a substantially simultaneous manner.
  • Substantially simultaneous administration can be accomplished, for example, by administering to the subject multiple, single dosage forms for each of the therapeutic agents.
  • Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, transdermal, and direct absorption through mucous membrane tissues.
  • the therapeutic agents can be administered by the same route or by different routes.
  • the rapidly infusing composition formulated with THC in combination with two or more other cannabinoids may be administered via buccal administration while a second therapeutic agent of the combination may be administered intravenously.
  • a second therapeutic agent of the combination may be administered intravenously.
  • all therapeutic agents may be administered buccally.
  • Combination therapy also can embrace the administration of the rapidly infusing composition in further combination with other biologically active ingredients and non-drug therapies (e.g., surgery or radiation treatment).
  • the combination therapy further comprises a non-drug treatment
  • the nondrug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agent(s) and non-drug treatment is achieved.
  • the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks.
  • Rapidly Infusing Composition Comprising THC and other cannabinoids
  • Example rapidly infusing compositions will be made using the formulations given in Tables 2 and 3.
  • the amount of each component is expressed in terms of weight percentage relative to a total weight (100%).
  • the weight percentage of each component in the drug product suspension is on a wet basis (prior to removal of water).
  • the weight percentage of each component in the rapidly infusing composition is on a dry basis (after removal of water).
  • Purified water is charged to a pot and is mixed using an overhead stirrer as an agitating device.
  • the sweeteners sucralose and acesulfame-K are added and allowed to dissolve.
  • THC tetrahydrocannabinol
  • the resulting drug product suspension is transferred to a second overhead mixer and maintained at a temperature of 30 °C for the ensuing dosing operation.
  • blister pockets are filled with a target dose weight of 300.0 mg of the drug product suspension.
  • the product is frozen in a suitable cryochamber and then the blister trays are transferred from the cryochamber to a suitable refrigerated storage cabinet (temperature below 0 °C) prior to lyophilizing to keep the product frozen.
  • a suitable refrigerated storage cabinet temperature below 0 °C
  • the frozen blisters are loaded from the refrigerated storage cabinet into lyophilizers and the product is lyophilized (water was sublimated) to form the rapidly infusing compositions.

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Abstract

A bioefficient rapidly infusing composition that includes (a) a pharmaceutically acceptable binder and/or excipient system containing gelatin and a sugar alcohol, and (b) active therapeutic ingredient (ATI). Preferred rapidly infusing compositions are those formulated with tetrahydrocannabinol or a derivative/analog thereof in combination with two or more other cannabinoids as the ATI. A process for manufacturing the rapidly infusing composition and a method of administering an ATI such as tetrahydrocannabinol in combination with two or more other cannabinoids or a derivative/analog thereof, to a subject is also disclosed. The subject is administered the rapidly infusing composition via the oral mucosa to activate cannabinoid receptors in the subject, for example to treat conditions such as, inter alia, anorexia, cachexia, nausea, emesis, pain, spasticity, fibromyalgia, overactive bladder, sleep apnea, and/or glaucoma.

Description

TITLE
RAPIDLY INFUSING CANNABINOID COMPOSITIONS, PROCESSES OF
MANUFACTURE, AND METHODS OF USE
CROSS-REFERENCE TO RELATED APPLICATION
[0001] The present application claims the benefit of priority to U.S. Provisional Application No. 63/342,937, filed May 17, 2022, which is incorporated herein by reference in its entirety.
BACKGROUND OF THE INVENTION
TECHNICAL FIELD
[0002] The present disclosure relates to a bioefficient rapidly infusing composition for oral mucosal uptake. Specifically, rapidly infusing compositions formulated with tetrahydrocannabinol or a derivative/analog thereof as an active therapeutic ingredient (ATI) in combination with two or more other cannabinoids, useful for providing subjects psychoactive effects, for example to treat conditions such as, inter aha, pain, emesis, loss of appetite, and weight loss.
DESCRIPTION OF THE RELATED ART
[0003] The “background” description provided herein is for the purpose of generally presenting the context of the disclosure. Work of the presently named inventors, to the extent it is described in this background section, as well as aspects of the description which may not otherwise qualify as prior art at the time of filing, are neither expressly or impliedly admitted as prior art against the present invention. [0004] Cannabinoids are compounds derived from plants of the Cannabis genus such as Cannabis sativa and Cannabis indica commonly known as marijuana. The plant contains more than 400 chemicals and from about 60 to 113 cannabinoids. The most active chemical compound of the naturally occurring cannabinoids is (— )-trans-A9-tetrahydrocannabinol (A9- THC) — known more simply as tetrahydrocannabinol (THC).
[0005] THC is known to possess many therapeutic benefits, and has been used for the treatment of AIDS-associated anorexia and cachexia, nausea and emesis due to cancer chemotherapy, cancer-associated pain, spasticity related to multiple sclerosis and spinal cord injury, fibromyalgia, overactive bladder, sleep apnea, and glaucoma. THC is also a well- known recreational drug that subjects take to provide a “high” and a feeling of joy and satisfaction. Although recreational THC is used without medical justification, recreational use of THC may still provide desirable secondary benefits such as pain relief, appetite stimulation, and anxiolytic effects.
[0006] Despite these benefits, acceptable delivery systems for THC have remained elusive One reason being that THC suffers from poor physiochemical properties — it is chemically unstable to light, oxygen, and heat, and is thus not readily adapted for incorporation into standard dosage forms that are typically available for pharmaceutical compounds. For instance, THC is thermolabile and photolabile, and long-term storage can lead to a cumulative decrease in THC content by an oxidation reaction forming cannabinol (CBN)
[0007] Additionally, there are numerous disadvantages associated with traditional THC administration routes. The most common method for administering THC is through inhalation of the vapors of cannabis by smoking the dried plant material. While smoking cannabis provides a rapid onset of pharmacological activity, typically within 10 minutes of administration, such impure cannabis preparations contain unknown or non-standardized amounts of THC, other active ingredients, as well as other potential toxins such as unhealthy tars and associated carcinogens which the subject must inhale into their lungs. Additionally, the bioavailability of THC following smoking is highly variable, ranging from 2—56%, due in part to intra- and inter-subject variability in smoking topography (e.g., number, duration, and spacing of puffs, hold time, and inhalation volume), see Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers . 2007;4(8): 1770-1804 — incorporated herein by reference in its entirety. Delivery of THC by smoking is thus an undesirable route of administration in view of the inherent dangers of smoking (e.g., emphysema and lung cancer), uncertainty in dose delivery, and inconsistent pharmacological outcomes.
[0008] Oral administration of THC is a safer and more convenient alternative to smoking marijuana. However, the combined effects of THCs physiochemical properties (e.g., instability), slow rate of absorption, and first pass metabolism give rise to poor bioavailability, delayed onset of pharmacological effects, and inconsistent levels of THC in systemic circulation when THC is ingested.
[0009] Specifically, drugs taken by mouth and swallowed must first be absorbed into the blood perfusing the gastrointestinal (GI) tract. It has been found that THC administered orally is absorbed at a relatively slow rate, which manifests in a delayed onset of pharmacological action (approximately 0.5 to 4 hours). Such slow absorption and delayed onset of pharmacological activity is not acceptable in many settings, but particularly so for example in patients suffering from nausea or emesis, as the oral dosage form does not remain in the gastro-intestinal tract for a sufficient time to achieve desirable effects.
[0010] Once absorbed from the lumen of the GI tract, the drug is next immediately presented to the liver — the major detoxifying organ of the body — whereby the drug is metabolized and then returned to the left side of the heart via the hepatic portal vein and sent into systemic circulation. This first pass metabolism through the liver may result in the removal of a substantial proportion of an ingested drug, and is more pronounced for some drugs than others; in the case of cannabinoids such as THC, extensive first pass metabolism contributes to a bioavailability of only about 10 to 20% when ingested orally.
[0011] Based on these factors, oral THC has a highly variable pharmacokinetic profile that differs between formulations (e.g., cannabis edibles, capsules, tablets, and decoctions), subjects, as well as whether the subject is in a fed or fasted state, with the end result being a wildly inconsistent pharmacological effect. For example, it has been found that fasting or food deprivation may provide poor or partial response to oral THC therapy as a result of a decreased rate of absorption of THC, thus requiring the subject to orally administer two to three times a day to obtain equivalent acute physiological effects achieved from smoking marijuana. Such variability in pharmacological effects coupled with slow onset times increases the likelihood of inadvertent over-administration of THC.
[0012] One example of an oral THC dosage form is MARINOL (available from Alkem laboratories, Ltd.), which is THC dissolved in sesame oil and encapsulated in gelatin capsules registered for anorexia in AIDS patients, and nausea and vomiting in cancer patients After oral administration, MARINOL has an onset of action of approximately 0.5 to 1 hour, with a peak effect of 2 to 4 hours, see Oh DA, Parikh N, Khurana V, Cognata Smith C, Vetticaden S. Effect of food on the pharmacokinetics of dronabinol oral solution versus dronabinol capsules in healthy volunteers. Clin Pharmacol. 2017;9:9-17 — incorporated herein by reference in its entirety. The duration of action for psychoactive effects is 4 to 6 hours, but the appetite stimulant effect may continue for 24 hours or longer after administration.
[0013] Another example of an oral THC dosage form is NAMISOL (available from Echo Pharmaceuticals b.v., Nijmegen, the Netherlands), which is a tablet formulation of pure THC that was produced using AL1TRA (Echo Pharmaceuticals b.v., Nijmegen, the Netherlands), an emulsifying drug delivery technology that uses less than 10% w/w of surfactant. Oral NAMISOL provides a time to maximal THC concentration of 39 to 56 min, with less inter-subject variability in THC maximal concentration compared to other oral THC dosage forms. While not specifically formulated for sublingual delivery, attempts have been made to deliver NAMISOL via the sublingual mucosa in hopes of bypassing absorption from the G1 tract and first pass metabolism, thereby leading to a more rapid and consistent clinical response. However, sublingually administered NAMISOL has been found to be inferior to oral administration, with slow absorption from the oral mucosa, a flat THC concentration profile, and a delayed onset of effect compared to oral NAMISOL, see Klumpers LE, Beumer TL, van Hasselt JG, et al. Novel A(9)-tetrahydrocannabinol formulation Namisol® has beneficial pharmacokinetics and promising pharmacodynamic effects. Br J Clin Pharmacol. 2012;74(l):42-53 — incorporated herein by reference in its entirety. NAMISOL also requires a relatively long in vitro disintegration time of up to 15 min, likely contributing to the inferior performance when dosed sublingually. For example, sublingual administration tends to stimulate the flow of saliva which makes enteral oral administration more likely through voluntary or involuntary swallowing. The long residence time required for disintegration of NAMISOL increases the likelihood of swallowing. Any amount of THC that is swallowed would be subject to first pass metabolism and thus overall lower bioavailability and greater variability in the pharmacological effects achieved using a fixed dose.
[0014] Furthermore, THC in naturally occurring and/or genetically engineered or bred cannabis plants is accompanied by other cannabinoids, including but not limited to: cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), cannabichromene (CBC), and cannabidivarin (CBDV). These other cannabinoids in combination with THC are believed to provide beneficial entourage effects. However, none of the pharmaceutical dosage forms containing THC are capable of reproducing these entourage effects. SUMMARY OF THE INVENTION
[0015] In view of the forgoing, there exists a need for a new delivery platform capable of delivering THC in combination with two or more other cannabinoids to a subject in bioefficient unit dosage form without absorption from the gastrointestinal tract, which is safe, effective, and provides rapid-onset and reliable pharmacological effects.
[0016] Accordingly, it is an object of the present invention to provide novel rapidly infusing compositions formulated with THC in combination with two or more other cannabinoids hereof that meet the above criteria.
[0017] It is another object of the present invention to provide novel processes for manufacturing the rapidly infusing composition.
[0018] It is another object of the present invention to provide novel methods of activating cannabinoid receptors in a subject.
[0019] It is another object of the present invention to provide novel methods of treating in a subject at least one condition selected from the group consisting of anorexia, cachexia, nausea, emesis, pain, spasticity, fibromyalgia, overactive bladder, sleep apnea, and glaucoma.
[0020] These and other objects, which will become apparent during the following detailed description, have been achieved by the inventors’ discovery of its Rapid Infusion Technology™ (RITe) platform through which THC in combination with two or more other cannabinoids can be successfully formulated into a lyophilized, rapidly infusing composition using gelatin and a sugar alcohol as a pharmaceutically acceptable binder and/or excipient system with a rapid disintegration profile for oral mucosal administration.
[0021] Thus, the present invention provides:
(1) A rapidly infusing composition, comprising: a pharmaceutically acceptable binder and/or excipient system comprising gelatin and a sugar alcohol, and tetrahydrocannabinol, and two or more other cannabinoids.
(2) The rapidly infusing composition of (1), which is lyophilized.
(3) The rapidly infusing composition of (1) or (2), which has a disintegration time of approximately 1 to 30 seconds in deionized water maintained at 37° C ± 2° C.
(4) The rapidly infusing composition of any one of (1) to (3), which has a disintegration time of approximately 1 to 5 seconds in deionized water maintained at 37° C ± 2° C.
(5) The rapidly infusing composition of any one of (1 ) to (4), wherein the gelatin is present in the rapidly infusing composition in an amount of 10 to 50 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
(6) The rapidly infusing composition of any one of (1) to (5), wherein the gelatin is a bovine gelatin.
(7) The rapidly infusing composition of any one of (1) to (6), wherein the sugar alcohol is present in the rapidly infusing composition in an amount of 5 to 45 wt.%, based on a total weight of the rapidly infusing composition on a dry basis. (8) The rapidly infusing composition of any one of (1) to (7), wherein the sugar alcohol is mannitol.
(9) The rapidly infusing composition of any one of (1) to (8), wherein the tetrahydrocannabinol is present in the rapidly infusing composition in an amount of 0.3 to 25 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
(10) The rapidly infusing composition of any one of (1) to (9), wherein the other cannabinoids include cannabidiol and at least one of cannabinol, cannabigerol, and cannabi chromene.
(11) The rapidly infusing composition of (10), wherein the tetrahydrocannabinol and other cannabinoids are in the form of a solid.
(12) The rapidly infusing composition of (10) or (11), wherein the tetrahydrocannabinol and other cannabinoids are in the form of a solid that has been micronized to have a D50 diameter between 1 and 50 pm.
(13) The rapidly infusing composition of any one of (10) to (12), wherein the tetrahydrocannabinol has a purity between 95 and 99.9 wt.%.
(14) The rapidly infusing composition of any one of (1) to (13), wherein the rapidly infusing composition further comprises at least one selected from the group consisting of a sweetener, a flavorant, and a colorant. (15) The rapidly infusing composition of (14), wherein the rapidly infusing composition comprises the flavorant, and the flavorant comprises green-apple flavor.
(16) The rapidly infusing composition of (14) or (15), wherein the rapidly infusing composition comprises the colorant, and the colorant comprises FD&C Yellow #5 and FD&C Blue #5.
(17) The rapidly infusing composition of any one of (14) to (16), wherein the rapidly infusing composition comprises the sweetener, and the sweetener comprises a mixture of sucralose and acesulfame-K.
(18) The rapidly infusing composition of any one of (1) to (17), further comprising glycine.
(19) The rapidly infusing composition of any one of (1) to (18), further comprising citric acid.
(20) A process for manufacturing the rapidly infusing composition of any one of (1) to (19), comprising: dissolving gelatin and a sugar alcohol in water to form a solution; adding the tetrahydrocannabinol and the two or more other cannabinoids to the solution to form a drug product suspension; and lyophilizing the drug product suspension to remove water and form the rapidly infusing composition. (21) A method of activating cannabinoid receptors in a subject, comprising administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of any one of (1) to (19).
(22) The method of (21), wherein the rapidly infusing composition is administered buccally to the subject via the buccal mucosa.
(23) The method of (21) or (22), wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 20 mg of tetrahydrocannabinol per dose.
(24) The method of any one of (21) to (23), wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 50 mg of total cannabinoids per dose.
(25) The method of any one of (21) to (24), wherein the rapidly infusing composition is administered to the subject 1 to 5 times per day.
(26) The method of any one of (21) to (25), wherein the subject is a human.
(27) A method of treating at least one condition selected from the group consisting of anorexia, cachexia, nausea, emesis, pain, spasticity, fibromyalgia, overactive bladder, sleep apnea, and glaucoma, in a subject, the method comprising: administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of any one of (1) to (19). (28) The method of (27), wherein the rapidly infusing composition is administered buccally to the subject via the buccal mucosa.
(29) The method of (27) or (28), wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 20 mg of tetrahydrocannabinol per dose.
(30) The method of any one of (27) to (29), wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 50 mg of total cannabinoids per dose.
(31) The method of any one of (27) to (30), wherein the rapidly infusing composition is administered to the subject 1 to 5 times per day.
(32) The method of any one of (27) to (31), wherein the subject is a human.
[0022] The foregoing paragraphs have been provided by way of general introduction, and are not intended to limit the scope of the following claims. The described embodiments, together with further advantages, will be best understood by reference to the following detailed description.
DETAILED DESCRIPTION OF THE INVENTION
[0023] In the following description, it is understood that other embodiments may be utilized and structural and operational changes may be made without departure from the scope of the present embodiments disclosed herein. Definitions
[0024] Throughout the specification and the appended claims, a given chemical formula or name shall encompass all stereo and optical isomers and racemates thereof where such isomers exist. Unless otherwise indicated, all chiral (enantiomeric and diastereomeric) and racemic forms are within the scope of the disclosure. Many geometric isomers of C C double bonds, C=N double bonds, ring systems, and the like can also be present, and all such stable isomers are contemplated in the present disclosure. Cis- and trans- (or E- and Z-) geometric isomers, when present, may be isolated as a mixture of isomers or as separated isomeric forms. Compounds referenced in the disclosure can be isolated in optically active or racemic forms. Optically active forms may be prepared by resolution of racemic forms or by synthesis from optically active starting materials. All processes used to prepare these compounds and intermediates made therein are considered to be part of the present disclosure. When enantiomeric or diastereomeric products are prepared, they may be separated by conventional methods, for example, by chromatography, fractional crystallization, or through the use of a chiral agent Depending on the process conditions, the end products referenced in the present disclosure are obtained either in free (neutral) or salt form. Both the free form and the salts of these end products are within the scope of the disclosure. If so desired, one form of a compound may be converted into another form. A free base or acid may be converted into a salt; a salt may be converted into the free compound or another salt; a mixture of isomeric compounds may be separated into the individual isomers. Compounds referenced in the present disclosure, free form and salts thereof, may exist in multiple tautomeric forms, in which hydrogen atoms are transposed to other parts of the molecules and the chemical bonds between the atoms of the molecules are consequently rearranged. It should be understood that all tautomeric forms, insofar as they may exist, are included within the disclosure Further, a given chemical formula or name shall encompass all conformers, rotamers, or conformational isomers thereof where such isomers exist. Different conformations can have different energies, can usually interconvert, and are very rarely isolatable. There are some molecules that can be isolated in several conformations. For example, atropisomers are isomers resulting from hindered rotation about single bonds where the steric strain barrier to rotation is high enough to allow for the isolation of the conformers. It should be understood that all conformers, rotamers, or conformational isomer forms, insofar as they may exist, are included within the present disclosure.
[0025] As used herein, the term “solvate” refers to a physical association of a referenced compound with one or more solvent molecules, whether organic or inorganic. This physical association includes hydrogen bonding. In certain instances, the solvate will be capable of isolation, for example when one or more solvent molecules are incorporated in the crystal lattice of the crystalline solid. The solvent molecules in the solvate may be present in a regular arrangement and/or a non-ordered arrangement. The solvate may comprise either a stoichiometric or nonstoichiometric amount of the solvent molecules. Solvate encompasses both solution phase and isolable solvates Exemplary solvent molecules which may form the solvate include, but are not limited to, water, methanol, ethanol, //-propanol , isopropanol, n- butanol, isobutanol, tert-butanol, ethyl acetate and other lower alkanols, glycerin, acetone, dichloromethane (DCM), dimethyl sulfoxide (DMSO), dimethyl acetate (DMA), dimethylformamide (DMF), isopropyl ether, acetonitrile, toluene, A-methylpyrrolidone (NMP), tetrahydrofuran (THF), tetrahydropyran, other cyclic mono-, di- and tri-ethers, polyalkylene glycols (e.g., polyethylene glycol, polypropylene glycol, propylene glycol), and mixtures thereof in suitable proportions. Exemplary solvates include, but are not limited to, hydrates, ethanolates, methanolates, isopropanolates and mixtures thereof. Methods of solvation are generally known to those of ordinary skill in the art. [0026] The phrase “pharmaceutically acceptable” is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
[0027] As used herein, “pharmaceutically acceptable salt” refers to derivatives of the disclosed compounds wherein the parent compound is modified by making acid or base salts thereof. Examples of pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic groups such as amines; and alkali or organic salts of acidic groups such as carboxylic acids and phenols. The phannaceutically acceptable salts include the conventional non-toxic salts or the quaternary ammonium salts of the parent compound formed, for example, from non-toxic inorganic or organic acids. For example, such conventional non-toxic salts include those derived from inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric, and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, and isethionic, and the like. The pharmaceutically acceptable salts of the present disclosure can be synthesized from the parent compound that contains a basic or acidic moiety by conventional chemical methods. Generally, such salts can be prepared by reacting the free acid or base forms of these compounds with a stoichiometric amount of the appropriate base or acid in water or in an organic solvent, or in a mixture of the two; generally, non- aqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred. Lists of suitable salts are found in Remington’s Pharmaceutical Sciences, 18th Edition, Mack Publishing Company, Easton, Pa. (1990) — which is incorporated herein by reference in its entirety.
[0028] When referencing a particular composition/material, the phrase “consists essentially of’, means that the particular composition/material may include minor amounts of impurities so long as those impurities do not affect the basic and novel property of the invention — the ability to activate cannabinoid receptors in a subject resulting in a pharmacological effect.
[0029] As used herein, the terms “optional” or “optionally” means that the subsequently described event(s) can or cannot occur or the subsequently described component(s) may or may not be present (e g., 0 wt.%).
[0030] As used herein, the terms “treat”, “treatment”, and “treating” in the context of the administration of a therapy to a subject in need thereof refers to the reduction or amelioration of severity of symptoms of the condition being treated; reduction of duration of symptoms of the condition being treated; reduction, inhibition, slowing, or arresting of the progression of symptoms associated with the condition; reduction of frequency of symptoms of the condition being treated; elimination of symptoms and/or underlying cause of the condition;
[0031] prevention of the occurrence of symptoms of the condition, for example in a subject that may be predisposed to the condition but does not yet experience or exhibit symptoms of the condition; improvement or remediation or amelioration of damage following a condition, for example improving, remediating, or ameliorating inflammation; and/or causing regression of the condition.
[0032] The term “pain” should be understood to include any unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. This term generally includes nociceptive pain, neuropathic pain, and psychogenic pain; including any subset of pain associated therewith such as phantom pain, breakthrough pain, incident pain, inflammatory pain, postsurgical (postoperative) pain, cancer-associated pain, peripheral pain, central pain, spastic pain, and the like; as well as both acute pain and chronic pain conditions.
[0033] The term “subject” and “patient” are used interchangeably. As used herein, they refer to any subject for whom or which administration or therapy is desired. In most embodiments, the subject is a human.
[0034] The terms “administer”, “administering”, “administration”, and the like, as used herein, refer to the methods that may be used to enable delivery of the active therapeutic ingredient (ATI) to the desired site of biological action. Routes or modes of administration are as set forth herein.
[0035] The terms “Rapid Infusion Technology™ (RITe) platform” or “rapidly infusing composition”, as used herein, mean a solid dosage form containing a medicinal substance(s) that disintegrates rapidly in the oral cavity (when contacted with saliva) with no need for chewing or swallowing liquids (e g , water, liquid carriers, saliva, etc ) to ingest these medicinal substances, with an in-vitro disintegration time of 30 second or less according to the United States Pharmacopeia (USP) <701> Disintegration Test performed in deionized water maintained at 37° C ± 2°. The disclosed rapidly infusing compositions are thus a different dosage form than, for example, a chewable tablet, a lozenge intended to be dissolved slowly in the mouth, or a tablet that should be swallowed whole with food or liquid.
[0036] The dosage amount and treatment/administration duration are dependent on factors, such as bioavailability of a drug, administration mode, toxicity of a drug, gender, age, lifestyle, body weight, the use of other drugs and dietary supplements, the disease stage, tolerance and resistance of the body to the administered drug, etc., and then determined and adjusted accordingly. The terms “effective amount”, “effective dose”, or “therapeutically effective amount” refer to a sufficient amount of an active therapeutic ingredient (ATI) being administered which provides the desired therapeutic or physiological effect or outcome, for example, the amount of ATI sufficient for activating cannabinoid receptors in a subject. The result can be a reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system. In some instances, this is the amount of ATI sufficient to relieve to some extent one or more of symptoms of a condition being treated. In some instances, this is the amount of ATI sufficient to provide the subject a “high” and a feeling of joy and satisfaction. Undesirable effects, e.g. side effects, are sometimes manifested along with the desired effect; hence, a practitioner balances the potential benefits against the potential risks in determining what is an appropriate “effective amount”. The exact amount required will vary from subject to subject, depending on the age and general condition of the subject, mode of administration, and the like. An appropriate “effective amount” in any individual case may be determined by one of ordinary skill in the art using only routine experimentation, for example through the use of dose escalation studies.
[0037] As used herein, and unless otherwise specified, tetrahydrocannabinol (THC) refers to (-)-trans- A9 -tetrahydrocannabinol (A9-THC).
Rapid Infusion Technology™ (RITe) Platform
[0038] The present disclosure provides a rapidly infusing composition which is suitable for administration of lipophilic active therapeutic ingredients (ATIs) such as tetrahydrocannabinol (THC) in combination with two or more other cannabinoids via a non- gastric mucosal surface. As described in more detail below, the novel RITe™ platform allows otherwise difficult to formulate and/or administer ATIs — such as THC — to be presented in unit dosage form for easy, accurate, and safe dosing, and for achieving rapid-onset and reliable pharmacological effects. For example, the rapidly infusing composition may be presented in tablet form and packaged in individual blister units.
[0039] In particular, the RITe™ platform enables oral mucosal administration of lipophilic ATIs in a solid dosage form directly into systemic circulation via the sublingual mucosa or the buccal mucosa. Direct introduction of ATI into systemic circulation via one or more of the oral mucosae avoids the pharmacokinetic disadvantages that trouble oral delivery — e.g., exposure to the gastric environment that causes degradation, and first pass metabolism. The rapidly infusing composition of the present disclosure thus presents lipophilic ATIs such as THC in an enhanced bioefficient dosage form. Such exemplary dosage forms may include, inter alia, enhanced bioavailability, typically with a bioavailability of at least 20%, preferably at least 30%, preferably at least 40%, preferably at least 50%, preferably at least 60%, preferably at least 70%, , preferably at least 80%, preferably at least 90%, and up to 95%, preferably up to 90%, preferably up to 80%, preferably up to 70%, preferably up to 60%, preferably up to 50%, preferably up to 40%, preferably up to 30%
[0040] Additionally, the bioefficient rapidly infusing composition enables a defined dose of ATI to be absorbed via the oral mucosae, prior to the gastric mucosa, thereby presenting a defined and consistent level of ATI into systemic circulation for consistent and reliable pharmacological effects. In the case of THC, the reliability/consistency in effects which can be achieved using the disclosed RITe™ platform are a significant improvement over those which can be achieved using other forms of administration such as oral THC formulations. That is because oral THC formulations are dependent on the rate of absorption of THC from the GI tract, which is known to be slow and highly variable on both an intersubject and intra-subject basis. For example, psychoactive effects from oral THC administration vary widely depending upon whether a subject is in a fed or fasted state. Instead, the rapidly infusing compositions described herein present ATIs such as THC in an enhanced bioefficient dosage form that is not subject to such gastrointestinal absorption variability, and thus consistent pharmacological outcomes can be achieved.
[0041] Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue). Preferred rapidly infusing compositions are those which are lyophilized products formulated for rapid disintegration when placed in such an oral environment for rapid release of the ATI. The rapidly infusing compositions of the present disclosure may have a disintegration time of from approximately 1 second to 30 seconds or less, preferably 25 seconds or less, preferably 20 seconds or less, preferably 15 seconds or less, preferably 10 seconds or less, preferably 5 seconds or less, preferably 3 seconds or less, according to the United States Pharmacopeia (USP) <701> Disintegration Test performed in deionized water maintained at 37° C ± 2°. Particularly preferred rapidly infusing compositions are those formulated for oral disintegration in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably in approximately 1 second, according to the United States Pharmacopeia (USP) <701> Disintegration Test performed in deionized water maintained at 37° C ± 2°.
[0042] A disintegration profile no higher than the above-mentioned upper limit when in intimate contact with a non-gastric mucosal surface (for direct introduction of the ATI into systemic circulation) provides for rapid absorption of the ATI and short onset times for pharmacological/therapeutic action. For example, the rapidly infusing composition may provide desirable pharmacological effects in (have an onset time of) under 15 minutes, preferably under 10 minutes, preferably under 5 minutes, preferably under 4 minutes, preferably under 3 minutes, preferably under 2 minutes, preferably under 1 minute, preferably under 45 seconds, preferably under 30 seconds, preferably under 20 seconds, preferably under 10 seconds, preferably approximately 5 seconds. Such short onset times are superior to those which can be obtained with traditional orally disintegrating tablets made through compression tabletting or oral dosage forms such as e.g., MARINOL and NAMISOL.
[0043] The short residence time spent in the oral cavity also reduces the tendency for enteral oral administration through voluntary or involuntary swallowing, and as a result, the aforementioned high levels of bioavailability and consistency in therapeutic response may be achieved when the rapidly infusing composition is administered via one or more of the oral mucosae.
[0044] Another advantage of the RITe™ platform is that it enables effective taste masking of foul-tasting ATIs. Two main strategies contribute to the taste masking success of the present disclosure. First, any issues related to foul taste are fundamentally mitigated by the short oral residence times provided by the rapid disintegration profile described heretofore. One “takes it and it’s gone.” Second, when formulated with a flavorant, a robust mixture of flavors will hit the tongue at essentially the same time — the unpleasant flavor of the ATI still hits the tongue, but the perception of the flavor is canceled or mitigated by the simultaneous arrival of other flavors. Even then, the robust mixture of flavors will quickly subside as the composition is rapidly absorbed through the oral mucosa. The effective taste masking provided by the RITe™ platform may be particularly advantageous when combinations of ATIs are provided in one dosage form, such as the case with rapidly infusing compositions formulated with both THC and two or more other cannabinoids.
[0045] The rapidly infusing composition herein generally contains (a) a pharmaceutically acceptable binder and/or excipient system that includes gelatin and a sugar alcohol e g., mannitol, and optionally one or more of a sweetener, a flavorant, and a colorant; and (b) an effective amount of an active therapeutic ingredient such as tetrahydrocannabinol (THC) in combination with two or more other cannabinoids.
Pharmaceutically acceptable carrier and/or excipient system
[0046] Carriers and/or excipients are ingredients which do not provide a therapeutic effect themselves, but which are designed to interact with, and enhance the properties of, the active therapeutic ingredient. In particular, carriers and/or excipients may act as a vehicle for transporting the active therapeutic ingredient from one organ, or portion of the body, to another organ, or portion of the body. The selection of appropriate carrier/excipient ingredients may impact the solubility, distribution, release profile/kinetics, absorption, serum stability, therapeutic onset time, and ultimately the efficacy of the ATI, as well as the shelflife, dosage forms, and processability of the drug product. Each ingredient in the pharmaceutically acceptable carrier and/or excipient system must be “pharmaceutically acceptable” in the sense of being compatible with the other ingredients of the rapidly infusing composition and not injurious to the subject
[0047] In light of the above, particular preference is given herein to pharmaceutically acceptable carrier and/or excipient systems which include gelatin and a sugar alcohol (e.g., mannitol).
[0048] Gelatin is to be included in the pharmaceutically acceptable carrier and/or excipient system in order to effect matrix formation in the lyophilized product, i.e., gelatin may act primarily as a matrix former. During manufacture of the rapidly infusing composition, lyophilization from an aqueous drug product suspension results in the removal of water thereby leaving behind a gelatin matrix/scaffolding upon which the ATI can be evenly dispersed or suspended. It has been found that gelatin has a propensity to establish a stable matrix in lyophilized form, yet allow for rapid disintegration when brought into contact with the aqueous oral environment, thereby providing efficient transfer of the ATI from the hydrophilic vehicle to the oral mucosa. In this regard, mammalian gelatins, such as bovine gelatin and porcine gelatin, are preferred, with bovine gelatin being particularly preferred. In some embodiments, the rapidly infusing composition does not contain fish gelatin.
[0049] The amount of gelatin used may be varied. Generally, gelatin may be present in the rapidly infusing composition in an amount of at least 10 wt.%, preferably 12 wt.%, preferably 14 wt.%, preferably 16 wt.%, preferably 18 wt.%, preferably 20 wt.%, preferably 22 wt.%, and up to 50 wt.%, preferably up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 32 wt.%, preferably up to 30 wt.%, preferably up to 28 wt.%, preferably up to 26 wt.%, preferably up to 24 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
[0050] The pharmaceutically acceptable carrier and/or excipient system is also formulated with one or more sugar alcohols, which may act primarily as a bulking agent. Examples of sugar alcohols include, but are not limited to, erythritol, xylitol, sorbitol, maltitol, mannitol, lactitol, and glycerin, which may be used singly or in combinations Advantage can also be taken of the effect of certain sugar alcohols in terms of taste (sweetness and coolness due to endothermal heat of solution), as well as their ability to aid/speed tablet disintegration. In this regard, particular preference is given to mannitol.
[0051] The sugar alcohol, preferably mannitol, may be present in the rapidly infusing composition in any amount which provides the desired bulking/taste/disintegration effects. Generally, this amount will range from of at least 5 wt.%, preferably at least 10 wt.%, preferably at least 12 wt.%, preferably at least 14 wt.%, preferably at least 16 wt.%, preferably at least 18 wt.%, and up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 30 wt.%, preferably up to 28 wt.%, preferably up to 26 wt.%, preferably up to 24 wt.%, preferably up to 22 wt.%, preferably up to 20 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
[0052] In some embodiments, a weight ratio of gelatin to sugar alcohol ranges from 1 :3, preferably from 1 :2, preferably from 1: 1, preferably from 1.1: 1, and up to 3: 1, preferably up to 2: 1, preferably up to 1.5: 1, preferably up to 1.2:1.
[0053] The pharmaceutically acceptable carrier and/or excipient system may also optionally include one or more of a sweetener, a flavorant, and a colorant.
[0054] The sweetener may be used in any amount which provides the desired sweetening effect, generally in amount of 0 to 10 wt.%, for example in an amount of up to 10 wt.%, preferably up to 9 wt.%, preferably up to 8 wt.%, preferably up to 7 wt.%, preferably up to 6 wt.%, preferably up to 5 wt.%, preferably up to 4.5 wt.%, preferably up to 4 wt.%, preferably up to 3.5 wt.%, preferably up to 3 wt.%, preferably up to 2.5 wt.%, preferably up to 2 wt.%, preferably up to 1.5 wt.%, preferably up to 1 wt.%, based on a total weight of the rapidly infusing composition on a dry basis. Suitable examples of sweeteners include, but are not limited to, aspartame, saccharin (as sodium, potassium or calcium saccharin), cyclamate (as a sodium, potassium or calcium salt), sucralose, acesulfame-K, thaumatin, neohisperidin, dihydrochalcone, ammoniated glycyrrhizin, dextrose, maltodextrin, fructose, levulose, sucrose, glucose, and isomalt, which may be used singly or in combinations, with particular preference given to sucralose and acesulfame-K.
[0055] It is to be readily appreciated by those of ordinary skill in the art that one or more flavorants may be optionally included in the rapidly infusing composition to mask any unpleasant taste imparted by certain ingredients (e.g., an unpleasant tasting ATI) or to otherwise impart an acceptable taste profile to the composition, and the composition is not limited to any particular flavor. However, flavorants suitable with the present disclosure require trial and error in order to achieve desired effectiveness. Suitable flavorants include, but are not limited to, oil of wintergreen, oil of peppermint, oil of spearmint, oil of sassafras, oil of clove, cinnamon, anethole, menthol, thymol, eugenol, eucalyptol, green-apple, lemon, lime, lemon-lime, orange, and other such flavor compounds to add fruit notes (e.g., citrus, cherry etc.), spice notes, etc., to the composition. The flavorants may be constitutionally composed of aldehydes, ketones, esters, acids, alcohols (including both aliphatic and aromatic alcohols), as well as mixtures thereof. Specific mention is made to green-apple flavor powder.
[0056] The flavorant may be used in any amount which provides the desired flavor, generally in an amount of 0 to 10 wt.%, for example in an amount of up to 10 wt.%, preferably up to 9 wt.%, preferably up to 8 wt.%, preferably up to 7 wt.%, preferably up to 6 wt.%, preferably up to 5 wt.%, preferably up to 4 wt.%, preferably up to 3 wt.%, preferably up to 2 wt.%, preferably up to 1.5 wt.%, preferably up to 1 wt.%, preferably up to 0.5 wt.%, preferably up to 0.1 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
[0057] Likewise, the rapidly infusing composition may be colored or tinted through the optional use of one or more colorants Suitable colorants are those approved by appropriate regulatory bodies such as the FDA and those listed in the European Food and Pharmaceutical Directives and include both pigments and dyes such as FD&C and D&C dyes, with specific mention being made to FD&C Yellow #5 and FD&C Blue #5, which together produce a green hue.
[0058] In addition to gelatin and a sugar alcohol (e.g., mannitol), and optionally one or more of a sweetener, a flavorant, and a colorant, the pharmaceutically acceptable carrier and/or excipient system may optionally include one or more other pharmaceutically acceptable carriers and/or excipients known to those of ordinary skill in art, in art appropriate levels. Examples of which include, but are not limited to, fillers or extenders such as starches (e.g., com starch and potato starch), sugars (e.g., lactose or milk sugar, maltose, fructose, glucose, trehalose, sucrose), dextrates, dextrin, polydextrose, high molecular weight polyethylene glycols, silicic acid, aluminum monostearate, polyesters, polycarbonates, and polyanhydrides; binders, such as cellulose, and its derivatives, (e.g., carboxymethyl cellulose, sodium carboxymethyl cellulose, hydroxypropyl cellulose, hydroxyethyl cellulose, hydroxypropylmethyl cellulose, hydroxyethyl methyl cellulose, methyl cellulose, ethyl cellulose, cellulose acetate, and microcrystalline cellulose), alginates (e.g., sodium alginate), polyvinyl pyrrolidone, powdered tragacanth, malt, acacia (gum arabic), carbomer, carrageenan, chitosan, copovidone, cyclodextrins, guar gum, inulin, pectin, polycarbophil or a salt thereof, polyvinyl alcohol, pullulan, and xanthan gum; disintegrating agents, such as agar-agar, calcium carbonate, tapioca starch, alginic acid, certain silicates, sodium carbonate, sodium starch glycolate, and cross-linked sodium carboxymethyl cellulose; surfactants/absorption accelerators/wetting agents/emulsifying agents/solubilizers, including any of the anionic, cationic, nonionic, zwitterionic, amphoteric and betaine variety, such as polyalkylene oxide copolymers (e.g., poloxamer), sodium lauryl sulfate, sodium dodecyl benzene sulfonate, sodium docusate, sodium lauryl sulfoacetate, alkali metal or ammonium salts of lauroyl sarcosinate, myristoyl sarcosinate, palmitoyl sarcosinate, stearoyl sarcosinate and oleoyl sarcosinate, cetyl alcohol, glycerol monoesters of fatty acids (e.g., glycerol monostearate), polyoxyethylene sorbitol, fatty acid esters of sorbitan, polysorbates (polyalkolyated fatty acid esters of sorbitan) (e.g., polyoxyethylene sorbitan monostearate, monoisostearate and monolaurate), polyethylene oxide condensates of alkyl phenols, cocoamidopropyl betaine, lauramidopropyl betaine, palmityl betaine, fatty alcohols (e.g., cetostearyl and cetyl alcohol), medium chain triglycerides, poly ethoxylated castor oil and hydrogenated castor oil, polyethoxylated alkyl ethers (e.g., ethoxylated isostearyl alcohols), polyethylene glycols (Macrogols), polyethylene glycol-fatty acid esters such as polyoxyethylene stearates, anionic and nonionic emulsifying waxes, propylene glycol, propylene glycol alginates, polyglycolized glycerides, polyoxyethylene glycerides, poly ly ceryl 10-oleate, polygly ceryl 3 -oleate, poly glyceryl 4-oleate, polyglyceryl 10-tetralinoleate, polyethylene glycol glycerol fatty acid esters, transesterification products of oils and alcohols, polyglycerized fatty acids, glycerol fatty acid esters, polyglycerol fatty acid esters, propylene glycol fatty acid esters, mono and diglycerides, d-a-tocopheryl polyethylene glycol 1000 succinate, polyoxyethyleneglycol 660 12-hydroxy stearate, as well as those disclosed in CA2618705 — incorporated herein by reference in its entirety; absorbents, such as kaolin and bentonite clay; lubricants, such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, zinc stearate, sodium stearate, stearic acid, ethyl oleate, and ethyl laurate; controlled release agents such as cross-linked polyvinyl pyrrolidone (crospovidone); opacifying agents such as titanium dioxide; buffering agents, including alkaline buffering agents, such as sodium hydroxide, sodium citrate, magnesium hydroxide, aluminum hydroxide, sodium carbonate, sodium bicarbonate, potassium phosphate, potassium carbonate, and potassium bicarbonate; diluents/tableting agents such as dicalcium phosphate; antioxidants, including (1) water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, and sodium sulphite, (2) oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha-tocopherol, and gamma-tocopherol; and (3) metal chelating agents, such as citric acid, ethylenediamine tetraacetic acid (EDTA), tartaric acid, and phosphoric acid; antibacterial and antifungal agents, such as paraben, chlorobutanol, phenol, sorbic acid; as well as other non-toxic compatible substances employed in pharmaceutical formulations, such as liposomes, and micelle forming agents; including mixtures thereof.
[0059] Preferred rapidly infusing compositions are those which contain less than 1 wt %, preferably less than 0 5 wt %, preferably less than 0 1 wt %, preferably less than 0 05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.%, of other pharmaceutically acceptable carriers and/or excipients, such as those listed above, with particular mention being made to surfactants.
[0060] In some embodiments, the rapidly infusing compositions contain less than 1 wt.%, preferably less than 0.5 wt.%, preferably less than 0.1 wt.%, preferably less than 0.05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.%, of oily mediums, whether synthetic, semi-synthetic, or naturally occurring, such as long chain triglycerides, mixed glycerides, and free fatty acids, with specific mention being made to borage oil, coconut oil, cottonseed oil, soybean oil, safflower oil, sunflower oil, sesame oil, castor oil, corn oil, olive oil, palm oil, peanut oil, peppermint oil, poppy seed oil, canola oil, hydrogenated soybean oil, hydrogenated vegetable oils, glyceryl distearate, behenic acid, caprylyic/capric glycerides, lauric acid, linoleic acid, linolenic acid, myristic acid, palmitic acid, palmitoleic acid, palmitostearic acid, ricinoleic acid, stearic acid, soy fatty acids, oleic acid, glyceryl esters of fatty acids such as glyceryl behenate, glyceryl isostearate, glyceryl laurate, glyceryl palmitate, glyceryl palmitostearate, glyceryl ricinoleate, glyceryl oleate, glyceryl stearate, as well as those oily mediums disclosed in CA2618705 — incorporated herein by reference in its entirety.
Active therapeutic ingredient (ATI)
[0061] The amount of active therapeutic ingredient (ATI) which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce the rapidly infusing composition may vary depending upon the subject being treated, and other factors. The amount of ATI which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce a single dosage form will generally be that amount which produces a pharmacological/therapeutic effect. Generally, this amount will range from 0.3 to 50 wt.% of ATT (e g., THC in combination with two or more other cannabinoids), for example, at least 0.3 wt.%, preferably at least 0.5 wt.%, preferably at least 1 wt.%, preferably at least 2 wt.%, preferably at least 3 wt.%, preferably at least 4 wt.%, preferably at least 5 wt.%, preferably at least 6 wt.%, preferably at least 7 wt.%, preferably at least 8 wt.%, preferably at least 9 wt.%, preferably at least 10 wt.%, and up to 50 wt.%, preferably up to 45 wt.%, preferably up to 40 wt.%, preferably up to 35 wt.%, preferably up to 30 wt.%, preferably up to 25 wt.%, preferably up to 24 wt.%, preferably up to 23 wt.%, preferably up to 22 wt.%, preferably up to 21 wt.%, preferably up to 20 wt.%, preferably up to 19 wt.%, preferably up to 18 wt.%, preferably up to 17 wt.%, preferably up to 16 wt.%, preferably up to 15 wt.%, preferably up to 14 wt.%, preferably up to 13 wt.%, preferably up to 12 wt.%, preferably up to 11 wt.%, of the ATI, based on a total weight of the rapidly infusing composition on a dry basis.
[0062] In terms of unit dose, the rapidly infusing composition is generally formulated with 2 to 100 mg of ATI per unit (e.g. tablet), for example at least 2 mg, preferably at least 4 mg, preferably at least 6 mg, preferably at least 8 mg, preferably at least 10 mg, preferably at least 12 mg, preferably at least 14 mg, preferably at least 16 mg, preferably at least 18 mg, preferably at least 20 mg, preferably at least 22 mg, preferably at least 24 mg, and up to 100 mg, preferably up to 75 mg, preferably up to 70 mg, preferably up to 65 mg, preferably up to 60 mg, preferably up to 55 mg, preferably up to 50 mg, preferably up to 45 mg, preferably up to 40 mg, preferably up to 35 mg, preferably up to 30 mg, preferably up to 25 mg of ATI per unit (e.g., tablet).
[0063] In preferred embodiments, the rapidly infusing composition is formulated with, as an active therapeutic ingredient, tetrahydrocannabinol (i.e., (-)-trans-A9- tetrahydrocannabinol), and/or any pharmaceutically acceptable derivative/analog, salt, solvate, or stereoisomer thereof THC useful herein may be synthetic, semi -synthetic, or THC obtained from natural sources (e g., Cannabis sativa or Cannabis indica plants) that is unbound from plant material, i.e., naturally-occurring THC which is at least partially purified and not contained within a plant structure such as the leaf matter or trichomes of Cannabis sativa/indica.
[0064] THC can be chemically synthesized according to methods disclosed in the art. For example, THC can be synthesized from (+)-p-mentha-2,8-dien-l-ol, or ethers or esters thereof, with olivetol in the presence of an acid catalyst such as p-toluenesulfonic acid, trifluoroacetic acid, boron trifluoride diethylether (“BF3-Et2O”), etc., or synthesized through an esterification-hydrolysis sequence starting from a crude synthetic mixture, and purified using known methods (see e.g., US9744151; US3560528A; R. Mechoulam et al., J. Am. Chem. Soc. 1972, 94:6159; US4025516A; EP1901734; R. K. Razdan et al., J. Am. Chem. Soc. 1974, 96:5860; US4381399A; US5227537A; W02002096899— each incorporated herein by reference in its entirety).
[0065] Rapidly infusing compositions may be formulated with THC that has been extracted and purified from natural sources. THC may be extracted and purified from a Cannabis sativa plant, a Cannabis indica plant, or specific portions thereof (e.g., hashish) according to methods disclosed in the art, including, but not limited to, through extraction of macerated or powdered plant material with a non-polar solvent such as hexane, followed by purification methods including fractional distillation, chromatography (e.g., high performance liquid chromatography, silica gel chromatography), and the like see e.g. US7524881B2; US6365416B1; and Turk et al. J. Pharm. Pharmac. 1971, 23: 190-195 — each incorporated herein by reference in its entirety).
[0066] Preferred rapidly infusing compositions are those which are formulated with a solid form of THC. That is, the rapidly infusing composition is prepared through lyophilization from a drug product suspension in which the THC is in the form of a solid In particular, micronized particles of THC are preferred. In some embodiments, the rapidly infusing composition is formulated with solid THC in the form of micronized particles having a D50 particle size in the range of 1 pm to 50 pm, for example, those having a D50 particle size of at least 1 pm, preferably at least 10 pm, preferably at least 20 pm, preferably at least 30 pm, preferably at least 40 pm, and up to 50 pm, preferably up to 40 pm, preferably up to 30 pm, preferably up to 20 pm, preferably up to 10 pm.
[0067] Even more preferred rapidly infusing compositions are those formulated with a solid form of THC having a purity of at least 95 wt.%, preferably at least 96 wt.%, preferably at least 97 wt.%, preferably at least 98 wt.%, preferably at least 99 wt.%, and up to 99.1 wt.%, preferably up to 99.2 wt.%, preferably up to 99.3 wt.%, preferably up to 99.4 wt.%, preferably up to 99.5 wt.%, preferably up to 99.6 wt.% , preferably up to 99.7 wt.%, preferably up to 99.8 wt.%, preferably up to 99.9 wt.%, preferably up to 100 wt.%. The percent purity of THC refers to the percent of THC by mass relative to a total weight of THC containing material — the THC containing material being the sum of THC plus any additional impurities which may be present, such as those impurities originating from the biomass from which the THC is obtained (e.g., Cannabis sativa/indica) or encountered during manufacture. The purity may be determined by methods known to those of ordinary skill in the art, for example, one or more of liquid chromatography such as high performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LCMS), and liquid chromatography with tandem mass spectrometry (TCMSMS); gas chromatography such as headspace gas chromatography with flame ionization detection (HS-GC-FID), gas chromatography mass spectrometry (GC/MS), and headspace gas chromatography-mass spectrometry (HSGCMS); inductively coupled plasma-mass spectrometry (ICP-MS); and polymerase chain reaction (PCR).
[0068] Examples of potential impurities, such as those originating from the biomass from which the THC is obtained (e g., Cannabis sativa/indica) or encountered during manufacture, include, but are not limited to, cannabinoids (other than THC) including, but not limited to, cannabidiol (CBD), cannabidivarin (CBDV), cannabichromene (CBC), cannabidiolic acid (CBDa), cannabigerol (CBG), cannabigerolic acid (CBGa), cannabinol (CBN), tetrahydrocannabinolic acid (THCa), tetrahydrocannabivarin (THCV), tetrahydrocannabivarin acid (THCVa), (+)-trans-A9 -tetrahydrocannabinol, and (-)-trans-A8-tetrahydrocannabinol; pesticides including, but not limited to, aldicarb, carbofuran, chlordane, chlorfenapyr, chlorpyrifos, coumaphos, daminozide, dichlorvos (DDVP), dimethoate, ethoprophos, etofenprox, fenoxycarb, fipronil, imazalil, methiocarb, methyl parathion, paclobutrazol, propoxur, spiroxamine, and thiacloprid; residual solvents including, but not limited to, 1,4-di oxane, 2-butanol, 2- ethoxyethanol, 1,2-di chloroethane, acetone, acetonitrile, benzene, butane, cumene, cyclohexane, chloroform, ethanol, ethyl acetate, ethyl benzene, ethylene oxide, ethylene glycol, ethyl ether, heptane, isopropanol, methanol, methylene chloride, hexanes, isopropyl acetate, pentanes, propane, toluene, tetrahydrofuran, tri chloroethene, and xylenes; microbials including, but not limited to, Aspergillus flavus, Aspergillus fumigalus, Aspergillus niger, Aspergillus terreus, Salmonella, and Shiga toxin-producing E. coli,' mycotoxins including, but not limited to, aflatoxins (e.g., aflatoxin Bl, aflatoxin B2, aflatoxin Gl, and aflatoxin G2) and ochratoxin A; heavy metals including, but not limited to, arsenic, cadmium, lead, and mercury; terpenes including, but not limited to, (1) monoterpenes such as camphene, camphor, 3 -carene, a-cedrene, cedrol, endo-fenchyl alcohol, eucalyptol, fenchone, geraniol, geranul acetate, hexahydrothymol, isobomeol, isopulegol, limonene, linalool, p-mentha- 1,5 -diene, 0-myrcene, a- and P-pinene, pulegone, sabinene and hydrate, a- and y-terpinene, terpineol, terpinolene, a-, P-, and y-terpineol, nerol, borneol, and ocimene isomers I and II, and (2) sesquiterpenes such as a-bisabolol, P-caryophyllene, caryophyllene oxide, guaiol, a-humulene, cis- and transnerolidol, and valencene; as well as mixtures thereof.
[0069] In some embodiments, the rapidly infusing composition is formulated with a form of THC which contains less than 1 wt.%, preferably less than 0.5 wt.%, preferably less than 0.1 wt.%, preferably less than 0.05 wt.%, preferably less than 0.001 wt.%, preferably 0 wt.% of any/all of the above listed impurities, based on a total weight of the THC material, with specific mention being made to CBD. In some embodiments, the rapidly infusing composition is formulated with a form of THC which contains no impurity, such as those listed above, in an amount above the limits of detection (LOD) and/or limits of quantification (LOQ) for the technique/instrumentation being used to make such a determination. For example, preferred rapidly infusing compositions are those formulated with a pure form of THC which has a CBD content of less than 0.1 wt.%, preferably less than 0.01 wt.%, preferably less than 0.001 wt.%, based on a total weight of the THC material. In preferred embodiments, the rapidly infusing composition is formulated with a pure form of THC which consists of, or consists essentially of, THC.
[0070] In preferred embodiments, the rapidly infusing composition comprises, consists essentially of, or consists of gelatin, mannitol, sweetener, flavorant, colorant, and as the ATI, THC.
[0071 ] Also contemplated for use as an active therapeutic ingredient are derivatives/ analogs of THC that retain at least some of the pharmacological activity of THC, for example, through activation of cannabinoid receptors. Derivatives/analogs that retain substantially the same activity as THC, or more preferably exhibit improved activity, may be produced according to standard principles of medicinal chemistry, which are well known in the art. Such derivatives/analogs may exhibit a lesser degree of activity than THC, so long as they retain sufficient activity to be therapeutically or pharmacologically effective. Derivatives/analogs may exhibit improvements in other properties that are desirable in active therapeutic agents such as, for example, improved solubility, reduced toxicity, enhanced uptake, increased bioavailability, etc. [0072] Contemplated THC derivatives/analogs include, but are not limited to, isomeric derivatives/analogs of THC (e.g., (+)-trans-A9 -tetrahydrocannabinol, (-)-trans-A8- tetrahydrocannabinol); hydroxy derivatives/analogs (e.g., 11 -hydroxy- A9- tetrahydrocannabinol, 11 -hydroxy- A8-tetrahydrocannabinol, AM-919, AM-926, AM-938, AM-2389, 1 l-nor-9p-hydroxyhexahydrocannabinol, l l-nor-9p- hydroxyhexahydrocannabinol-DMH, HU-210, HU-211, desacetyl-L-nantradol, JWH-051); oxo derivatives/analogs (e.g., nabilone); carboxy derivatives/analogs (e.g., 1 l-nor-9-carboxy- THC, ajulemic acid); alkyl side chain modified derivatives/analogs (e.g., (-)-trans-A9- tetrahydrocannabinol-DMH, (-)-trans-A8-tetrahydrocannabinol-DMH, dimethylheptylpyran, tetrahydrocannabivarin, 5’-azido-A8-tetrahydrocannabinol, AMG-1, AMG-3, AM-411, AM- 087, L-759,633, 0-1184); conformationally restricted side chain derivatives/analogs (e.g., AM-855); side-chain ester derivatives/analogs (e.g., AM7438); cannabinol (CBN); CP cannabinoids (e.g, CP 47,497, CP 55,940, CP 55,244, CP 50,556-1); prodrugs of THC such as ester, oxygenated ester, oxaester, pegylated ester, hydroxylated ester, branched hydroxylated ester, succinic acid monoester, oxalic acid mixed pegylated ester, amino ester, cyclic amino ester, acylated amino ester, carbonate, oxygenated carbonate, oxacarbonate, pegylated carbonate, hydroxylated carbonate, branched hydroxylated carbonate, aminoalkyl carbonate, cyclic aminoalkyl carbonate, acylated aminoalkyl carbonate, hydroxycarbonylalkyl carbonate, carbamate, alkyl carbamate, aminoalkyl carbamate, acylated aminoalkyl carbamate, cyclic aminoalkyl carbamate, oxacarbamate, pegylated carbamate, hydroxylated carbamate, branched hydroxylated carbamate, hydroxycarbonylalkyl carbamate, dihydrogen phosphate, alkali metal phosphate salt, alkaline earth metal phosphate salt, and phosphate salt of organic base prodrugs of THC, e.g., those disclosed in US9957246 — incorporated herein by reference in its entirety; as well as any pharmaceutically acceptable salts, solvates, and/or stereoisomers of such compounds. [0073] In some embodiments, THC may be combined with two or more other cannabinoids, with particular mention to cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), cannabi chromene (CBC), and cannabidivarin (CBDV). Such a combination may be advantageous in order to simulate the entourage effects resulting from the presence of these other cannabinoids along with THC in naturally-occurring or genetically engineered or bred cannabis plants. Each of the above listed other cannabinoids can currently be sourced in a substantially pure (e.g. 95%-99.9% purity) isolate form and combined into the RITe™ platform using the techniques described below in appropriate dosages. Other major and minor cannabinoids that are or become available in similar substantially pure isolate form could also be used according to the same techniques.
[0074] A mass percentage of THC in the rapidly infusing composition, relative to a combined mass of all cannabinoids (including THC), may be at least 10 wt.%, at least 20 wt.%, at least 30 wt.%, at least 40 wt.%, at least 50 wt.%, at least 60 wt.%, at least 70 wt.%, at least 80 wt.%, at least 90 wt.%, or less than 100 wt.%, less than 90 wt.%, less than 80 wt.%, less than 70 wt %, less than 60 wt %, less than 50 wt %, less than 40 wt %, less than 30 wt %, less than 20 wt.%.
[0075] A mass percentage of a first cannabinoid, relative to a combined mass of a first and second cannabinoid in the rapidly infusing composition, may be at least 10 wt.%, at least 20 wt.%, at least 30 wt.%, at least 40 wt.%, at least 50 wt.%, at least 60 wt.%, at least 70 wt.%, at least 80 wt.%, at least 90 wt.%, or less than 100 wt.%, less than 90 wt.%, less than 80 wt.%, less than 70 wt.%, less than 60 wt.%, less than 50 wt.%, less than 40 wt.%, less than 30 wt.%, less than 20 wt.%. Here, the first and second cannabinoids are not THC.
[0076] In one embodiment, the rapidly infusing composition may comprise at least 2, at least 3, at least 4 other cannabinoids that are not THC. Process for manufacturing the rapidly infusing composition
[0077] Processes to be used for preparing the RITe™ platform are preferably pharmaceutical-GMP compliant, and may include generally bringing into association the ATI (e.g., THC) with the gelatin and sugar alcohol (e.g., mannitol), and, optionally, one or more accessory pharmaceutically acceptable carrier and/or excipient ingredients, in water to form a drug product suspension which is then lyophilized.
[0078] One exemplary process for manufacturing the rapidly infusing composition is presented below, although it should be understood that numerous modifications and variations are possible, and the rapidly infusing composition may be produced using methods or techniques otherwise than as specifically described.
[0079] Purified water, gelatin, and sugar alcohol (e.g., mannitol) may be charged to a mixer, for example a pot equipped with an overhead stirrer, and heated (e.g., 40 to 80 °C) with agitation until complete solvation. Any desired sweetener (e.g., a mixture of sucralose and acesulfame-K) may then be added and allowed to dissolve.
[0080] Upon cooling, for example to 20 to 35 °C, the solution may next be transferred to a homogenizer, and the ATI (e g., THC and two or more other cannabinoids) may be subsequently sequentially charged and dispersed using the homogenizer or in the alternative the THC and other cannabinoid isolates are thoroughly mixed in dry form and charged and dispersed in a single step, with preferable micronization of the ATI, to form a drug product suspension. Any desired flavorant and colorant may be added at this point with continued mixing. The drug product suspension may be transferred to a second mixer whilst maintaining a cooled temperature (e.g., 20 to 35 °C).
[0081] In a blistering machine equipped with a dosing system, blister pockets may next be filled with the drug product suspension until achieving a target dose weight, followed by freezing in a suitable cryochamber. The blister trays may be transferred from the cryochamber to a suitable refrigerated storage cabinet (e.g., at a temperature below 0 °C) to keep the product frozen prior to lyophilization. Then, the frozen blisters may be loaded into a lyophilizer and subject to lyophilization to sublimate the water and form the rapidly infusing compositions. Finally, when the lyophilization cycle is deemed complete, final sealing (e.g., heat sealing of blister lidding) may be performed to provide the rapidly infusing compositions in single dose units in individual blister units.
[0082] It is believed that during the manufacture of the rapidly infusing composition, when the THC and other cannabinoids are in solid form and of sufficiently high purity, lyophilization from a drug product suspension generates a structured and robust matrix of gelatin as the water is removed via sublimation, and an even distribution of the THC and other cannabinoids throughout the gelatin matrix. Such a structured assembly of THC and other cannabinoids suspended within a gelatin matrix is believed to afford the rapidly infusing composition with rapid disintegration properties and efficient transfer of ATI from the hydrophilic vehicle to the mucous membrane of the buccal cavity, or the ventral surface under the tongue, upon administration
Therapeutic applications and methods
[0083] The present disclosure relates generally to methods of administering tetrahydrocannabinol (THC) in combination with two or more other cannabinoids to a subject via the RITe™ platform of the present disclosure, in one or more of its embodiments. The methods may be performed in order to provide a desired pharmacological effect for example through activation of one or more cannabinoid receptors, to treat a clinical disorder or medical condition responsive to THC or derivatives/analogs thereof with two or more other cannabinoids, recreationally for example for the purpose of providing a “high” and a feeling of joy and satisfaction, or for any other purpose where administration of THC (or related compounds) may be desirable. In preferred embodiments, the subject is a human.
[0084] In some embodiments, the methods herein are used to treat pain in a subject, for example, to manage pain/induce an analgesic response prior to, during, or following treatment of a disease, condition, or pathology. Both palliative and curative treatment methods are contemplated herein. The pain may be categorized as nociceptive pain, neuropathic pain, or psychogenic pain. This includes subsets thereof including, but not limited to, phantom pain, breakthrough pain, incident pain, inflammatory pain, postsurgical (postoperative) pain, cancer-associated pain, peripheral pain, central pain, and spastic pain. The types of pain that may be treated with the methods herein may be acute pain types, or may be considered chronic pain types.
[0085] In particular, the methods of the present disclosure may be used to treat neuropathic pain. The neuropathic pain may be central neuropathic pain, peripheral neuropathic pain, or both. The neuropathic pain may also be categorized as acute neuropathic pain or chronic neuropathic pain Examples of categories of neuropathic pain that may be treated by the methods of the present disclosure include, but are not limited to, autonomic neuropathy; focal neuropathy; proximal neuropathy; diabetic neuropathy; compression neuropathy; phantom limb pain; neuralgia (e.g., trigeminal neuralgia, postherpetic neuralgia); thoracic or lumbar radiculopathy; complex regional pain syndromes; neuropathic pain associated with AIDS and infection with the human immunodeficiency vims; cancer- associated pain such as neuropathic cancer pain (NCP) attributable to the cancer per se and/or the various cancer treatments (e.g., chemotherapy, radiotherapy, and surgery) that a subject with cancer may endure; and peripheral neuropathies such as drug-induced neuropathy and postsurgical (postoperative) neuropathy. [0086] Thus, the present disclosure provides a method of treating pain in a subject who has a disease or condition which causes neuropathic pain. Examples of diseases or conditions which cause neuropathic pain include, but are not limited to, an abdominal wall defect, an abdominal migraine, achondrogenesis, acquired immunodeficiency syndrome (AIDS), porphyria (e g., acute porphyrias), acute brachial neuritis, acute toxic epidermolysis, adiposa dolorosa, adrenal neoplasm, adrenomyeloneuropathy, adult or childhood dermatomyositis, amyotrophic lateral sclerosis, arachnoiditis, arteritis giant cell and cranial arteritis, arthritis, astrocytoma athetoid cerebral palsy, tumors of the central nervous system, brachial neuritis, brachiocephalic ischemia, brain tumors, Burkitt's lymphoma, neurofibromatosis, cervical spinal stenosis, Charcot-Marie-Tooth disease, chronic inflammatory demyelinating polyneuropathy, complex regional pain syndrome, congenital dysmyelinating neuropathy, tethered (spinal) cord syndrome, demyelinating disease, diabetes mellitus, disseminated sclerosis, Ehlers-Danlos syndrome, endometriosis, fibromyalgia, fibromyositis, fibrositis, Guillain-Barre syndrome, hereditary sensory and autonomic neuropathy, Hodgkin’s disease (lymphoma), hypertrophic interstitial neuropathy, idiopathic cervical dystonia, lumbar spinal stenosis, lupus, mononeuritis (multiplex, peripheral, etc ), multiple myeloma, multiple osteochondromatosis, multiple sclerosis, musculoskeletal pain syndrome, neuropathic amyloidosis, neuropathic beriberi, brachial plexus neuropathy, Niemann-Pick disease, osteoarthritis, osteogenesis imperfecta, peripheral neuritis, polymyositis, postherpetic neuralgia, radial nerve palsy, radicular neuropathy, sickle cell disease, spina bifida, spinal arteriovenous malformation, Still’s disease, syringomyelia, systemic sclerosis, and thalamic pain syndrome.
[0087] A preferred therapeutic application involves treatment of postsurgical (postoperative) pain in a subject who has undergone a surgical procedure by administering the rapidly infusing composition post-operatively to the subject. Postsurgical pain is a type of pain that usually differs in quality and location from pain experienced prior to surgery, and is usually associated with iatrogenic neuropathic pain caused by surgical injury to a major peripheral nerve (surgically-induced neuropathic pain or SNPP). The postsurgical pain may be acute, or if the pain state persists well after the surgical procedure, for example, more than 2 months after surgery, then the postsurgical pain may be of the chronic variety. A wide variety of surgical procedures may cause postsurgical pain, and the methods disclosed herein may be used for treating pain stemming from any surgical procedure including, but not limited to, those involving excision of an organ (-ectomy), those involving cutting into an organ or tissue (-otomy), those involving minimally invasive procedures like making a small incision and insertion of an endoscope (-oscopy), those involving formation of a permanent or semi-permanent stoma in the body (-ostomy), those involving reconstruction or cosmetic procedures (-oplasty), those involving repair of damaged or congenital abnormal structure (- rraphy), reoperation procedures, amputations, and resections, including those surgical procedures of the manual or robot-assisted varieties.
[0088] Types of surgical procedures may include, but are not limited to bariatric surgery, breast surgery, colon and rectal surgery, endocrine surgery, surgeries which fall under the general surgery classification, gynecological surgery, head and neck surgery, hernia surgery, neurosurgery, orthopedic surgery, ophthalmological surgery, oral or maxillofacial surgery, surgeries which fall under the outpatient surgery classification, thoracic surgery, urologic surgery, and vascular surgery. Specific mention is made herein to inguinal hernia repair, amputation (e.g., leg amputation), caesarean section, coronary artery bypass surgery, gastric bypass surgery, hand surgery, Achilles tear surgery, open-knee surgery, spinal surgery, arthroscopy of the knee, shoulder, hip, ankle, elbow, or wrist, and arthroplasty of the knee, shoulder, hip, ankle, elbow, or wrist. The methods disclosed herein may be particularly well- suited for the treatment of postsurgical pain associated with orthopedic procedures including, but not limited to, knee arthroplasty (knee replacement surgery) and shoulder arthroscopy. The disclosed methods may also be particularly well-suited for treating postsurgical pain in subjects whom have not responded well to opioids or whom have experienced one or more significant opioid-related side effects such as addiction, cognitive impairment, constipation, nausea, and myoclonus.
[0089] Another preferred therapeutic application involves treating cancer-associated pain in a subject who has cancer. Cancer-associated pain may be caused by the cancer itself, i.e., from the cancer growing into/destroying nearby tissue, nerves, bones, organs, etc. The cancer-associated pain may be caused by the chemicals released by certain tumor types, or the subject’s response (e g , immunoresponse) to the released chemicals. The cancer- associated pain may also be caused by various types of cancer treatment that the subject may undergo after diagnosis, such as surgery, radiation therapy, and therapy with agents having cytostatic or antineoplastic activity (e.g., chemotherapy). Cancer-associated pain stemming from any/all of the above causes may be treated with the methods disclosed herein.
[0090] Tn general, the subject may have any cancer that fails to undergo apoptosis, including both solid tumor types (e g., carcinomas, sarcomas including Kaposi’s sarcoma, erythroblastoma, glioblastoma, meningioma, astrocytoma, melanoma, myoblastoma, and the like) and non-solid tumor cancers such as leukemia. Types of cancers which can cause cancer-associated pain treatable by the disclosed methods include, but are not limited to, brain cancers, skin cancers, bladder cancers, ovarian cancers, breast cancers, gastric cancers, pancreatic cancers, prostate cancers, colon/colorectal cancers, blood cancers, lung cancers, and bone cancers, including a combination of two or more cancer types. Examples of such cancer types include, but are not limited to, neuroblastoma, intestine carcinoma such as rectum carcinoma, colon carcinoma, familiar adenomatous polyposis carcinoma and hereditary non-polyposis colorectal cancer, esophageal carcinoma, labial carcinoma, larynx carcinoma, hypopharynx carcinoma, tong carcinoma, salivary gland carcinoma, gastric carcinoma, adenocarcinoma, medullary thyroid carcinoma, papillary thyroid carcinoma, renal carcinoma, kidney parenchymal carcinoma, ovarian carcinoma, cervix carcinoma, uterine corpus carcinoma, endometrium carcinoma, chorion carcinoma, pancreatic carcinoma, prostate carcinoma, testis carcinoma, breast carcinoma, urinary carcinoma, melanoma, brain tumors such as glioblastoma, astrocytoma, meningioma, medulloblastoma and peripheral neuroectodermal tumors, Hodgkin lymphoma, non-Hodgkin lymphoma, Burkitt lymphoma, acute lymphatic leukemia (ALL), chronic lymphatic leukemia (CLL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), adult T-cell leukemia lymphoma, diffuse large B-cell lymphoma (DLBCL), hepatocellular carcinoma, gall bladder carcinoma, bronchial carcinoma, small cell lung carcinoma, non-small cell lung carcinoma, multiple myeloma, basalioma, teratoma, retinoblastoma, choroid melanoma, seminoma, rhabdomyosarcoma, craniopharyngioma, osteosarcoma, chondrosarcoma, myosarcoma, liposarcoma, fibrosarcoma, Ewing sarcoma, plasmocytoma, and adrenal tumors.
[0091 ] The methods of the present disclosure may be particularly advantageous for treating cancer-associated pain in subjects having advanced stage cancer, or who are otherwise in a chronic progressive cancer-associated pain state, with particular mention being made to those subjects having pancreatic cancer, and especially advanced pancreatic cancer, and are experiencing pancreatic cancer-associated pain. The disclosed methods may also be particularly well-suited for treating cancer-associated pain in subjects whom have not responded well to opioids or whom have experienced one or more significant opioid-related side effects such as addiction, cognitive impairment, constipation, nausea, and myoclonus.
[0092] The rapidly infusing composition of the present disclosure may be administered to subjects who have not received cancer treatment, who are undergoing cancer treatment (i.e., the rapidly infusing composition is co-administered with a cancer treatment), or who have previously completed one or more rounds of cancer treatment. Examples of cancer treatments include, but are not limited to, surgery, radiation therapy, and therapy with one or more agents having cytostatic or antineoplastic activity.
[0093] Agents having cytostatic or antineoplastic activity may generally fall into the following categories: (i) antimetabolites; (ii) DNA-fragmenting agents; (iii) DNA- crosslinking agents; (iv) intercalating agents; (v) protein synthesis inhibitors; (vi) topoisomerase I poisons; (vii) topoisomerase II poisons; (viii) microtubule- directed agents; (ix) kinase inhibitors; (x) miscellaneous investigational agents; (xi) hormones; (xii) hormone antagonists; (xiii) anti angiogenic agents; and (xiv) targeted therapies; with specific mention being made to mitotic/tubulin inhibitors, alkylating agents, cell cycle inhibitors, enzymes, topoisomerase inhibitors, biological response modifiers, anti-hormones, tyrosine-kinase inhibitors, inhibitors of MMP-2, MMP-9, or COX-2, anti androgens, platinum coordination complexes, adrenocortical suppressants, progestins, antiestrogens, androgens, aromatase inhibitors, thymidylate synthase inhibitors, thymidine phosphorylase (TPase) inhibitors, and DNA synthesis inhibitors Specific examples of which include, but are not limited to, paclitaxel, epothilone, docetaxel, discodermolide, etoposide, vinblastine, vincristine, teniposide, vinorelbine, vindesine, imatinib, nilotinib, dasatinib, bosutinib, ponatinib, bafetinib, busulfan, carmustine, chlorambucil, cyclophosphamide, cyclophosphamide, dacarbazine, ifosfamide, lomustine, mechlorethamine, melphalan, mercaptopurine, procarbazine, cladribine, cytarabine, fludarabine, gemcitabine, pentostatin, 5-fluorouracil, clofarabine, capecitabine, methotrexate, thioguanine, daunorubicin, doxorubicin, idarubicin, mitomycin, actinomycin, epirubicin, irinotecan, mitoxantrone, topotecan, camptothecin, tipiracil, trifluridine, oxaliplatin, bicalutamide, tamoxifen, anastrozole, exemestane, testosterone propionate, cetuximab, bevacizumab, panitumumab, zivaflibercept, ramucirumab, and mixtures thereof. [0094] Yet another therapeutic application involves treating inflammatory pain in a subject who is experiencing acute or chronic pain that results from inflammatory processes, such as may arise in the case of infections, arthritis, tissue damage, and neoplasia or tumor related hypertrophy. Cancer-associated pain may, therefore, in certain circumstances, be considered to fall within the category of inflammatory pain. Other examples of inflammatory diseases or conditions which can cause inflammatory pain include, but are not limited to, arthritis (e.g., osteoarthritis, rheumatoid arthritis, etc.), lupus, aspiration pneumonia, empyema, gastroenteritis, necrotizing pneumonia, pelvic inflammatory disease, pharyngitis, pleurisy, urinary tract infections, and chronic inflammatory demyelinating polyneuropathy.
[0095] Yet another therapeutic application involves treatment of pain associated with muscle spasticity. Muscle spasticity is a relatively common problem among subjects suffering from central neurologic problems, such as cerebrovascular pathology, medullar injuries, multiple sclerosis, and cerebral palsy, as well as subjects suffering from adductor muscle spasms associated with hemiplegia or paraplegia.
[0096] Beyond pain therapy, the methods of the present disclosure may be used to treat a variety of conditions or indications responsive to THC or related derivatives/analogs. For example, in some embodiments, the methods herein are used to treat anorexia and/or cachexia, particularly AIDS -associated anorexia and cachexia. In some embodiments, the methods herein are used to treat nausea and/or emesis, with particular mention being made to nausea and/or emesis due to cancer chemotherapy. In some embodiments, the methods herein are used to treat spasticity or muscle control disorders, particularly spasticity related to cerebral palsy, traumatic brain injury, stroke, multiple sclerosis or spinal cord injury. In some embodiments, the methods herein are used to treat overactive bladder syndrome. In some embodiments, the methods herein are used to treat sleep apnea, for example obstructive sleep apnea. In some embodiments, the methods herein are used to treat glaucoma. In some embodiments, the methods herein are used to treat movement disorders — examples of which include, but are not limited to, dystonia, Parkinson’s disease, Huntington’s disease, Tourette’s syndrome, and tremor. Other conditions/indications which may respond to the treatment methods herein include, but are not limited to, one or more of allergies, inflammation, infection, epilepsy, depression, migraine headaches, bipolar disorders, anxiety disorder, drug dependency and withdrawal syndromes, and Alzheimer’s disease.
[0097] In some embodiments, the methods herein are used to provide THC in combination with two or more other cannabinoids to a subject for recreational purposes, e.g., to provide a “high” and a feeling of joy and satisfaction. Even though recreational use of the disclosed rapidly infusing composition may be performed without medical justification, desirable benefits may still be obtained from such recreational use, such as pain relief, appetite stimulation, and anxiolytic effects. Furthermore, the subjective characteristics of the “high” can be modulated using different relative quantities of the two or more other cannabinoids.
[0098] With respect to administration, the rapidly infusing composition is preferably administered to the subject via one or more of the oral mucosae, preferably via the buccal mucosa (buccally) or the sublingual mucosa (sublingually). Advantages of oral mucosal delivery include the ease of administration, the ability to bypass first pass metabolic processes thereby enabling higher bioavailability than through enteral delivery via the gastrointestinal tract, less variability between subjects, sustained drug delivery, and extensive drug absorption and rapid onset of therapeutic/pharmacological action due to either a large surface area in the case of sublingual administration or high-levels of vascularization in the case of buccal administration. Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue). While the sublingual mucosa has a large surface area and extremely good permeability, the blood supply (blood flow) is lesser than that of the buccal cavity. Furthermore, sublingual administration tends to stimulate the flow of saliva more than buccal administration, and the increased saliva production may make it more difficult for patients to avoid swallowing. Any amount of ATI that is swallowed would be subject to first pass metabolism and thus overall lower bioavailability. Swallowing further results in greater variability in the effective amount of dosing, as a result of, including but not limited to, the variability in the amount swallowed and the greater patient variability of GI absorption and bioavailability through first pass metabolism for the amount swallowed. Therefore, in preferred embodiments, the rapidly infusing composition is administered buccally (through the buccal mucosa). The rapid disintegration of the rapidly infusing composition, approximately in 1 to 5 seconds in preferred embodiments, and buccal administration together combine to provide optimal dosing control by limiting the time for potential swallowing and ensuring that the vast majority of the ATI is absorbed through the buccal mucosa. Administration may be performed by the subject (self-administered) or by someone other than the subject, for example, a healthcare provider, family member, etc.
[0099] The actual amount of ATI administered to the subject may be varied so as to achieve the desired pharmacological response for a particular subject, composition, and mode of administration, without being toxic to the subject. The selected amount of ATI administered to the subject will depend upon a variety of factors including the activity of the ATI employed, the route of administration, the time of administration, the rate of excretion or metabolism of the particular compound being employed, the rate and extent of absorption, the duration of the treatment, other drugs, compounds, and/or materials used in combination with the rapidly infusing composition, the age, sex, weight, condition, general health, and prior medical history of the subject being treated, and like factors well known in the medical arts. [0100] By way of example, a physician having ordinary skill in the art can readily determine and prescribe the effective amount of the ATI required, by starting doses of the ATI at levels lower than that required in order to achieve the desired therapeutic effect and gradually increasing the dosage until the desired effect is achieved. In general, a suitable dose of the ATI will be that amount which is the lowest dose effective to produce a desired effect, which will generally depend upon the factors described above. Typically, when the ATI is THC or a derivative/ analog thereof with two or more other cannabinoids, the effective amount of THC or a derivative/analog thereof will range from at least 0.1 mg, preferably at least 0.2 mg, preferably at least 0.4 mg, preferably at least 0.6 mg, preferably at least 0.8 mg, preferably at least 1 mg, preferably at least 1.2 mg, preferably at least 1.4 mg, preferably at least 1.6 mg, preferably at least 1.8 mg, preferably at least 2 mg, preferably at least 5 mg, and up to 20 mg, preferably up to 15 mg, preferably up to 10 mg, preferably up to 9 mg, preferably up to 8 mg, preferably up to 7 mg, preferably up to 6.5 mg, preferably up to 6 mg, preferably up to 5.5 mg, preferably up to 5 mg, preferably up to 4.5 mg, preferably up to 4 mg per dose In preferred embodiments, the rapidly infusing composition is administered to the subject to provide a total of 5 to 20 mg of THC or derivative/analog thereof per dose (dosing event).
[0101] In one embodiment, the effective amount of other cannabinoids that are not THC or a derivative/analog of THC will range from at least 0.5 mg, preferably at least 1 mg, preferably at least 2 mg, preferably at least 4 mg, preferably at least 5 mg, preferably at least 8 mg, preferably at least 10 mg, preferably at least 15 mg, preferably at least 20 mg, preferably at least 25 mg, preferably at least 30 mg, preferably at least 40 mg, preferably at least 50 mg, preferably at least 60 mg, preferably at least 70 mg, and up to 80 mg, preferably up to 70 mg, preferably up to 60 mg, preferably up to 50 mg, preferably up to 40 mg, preferably up to 30 mg, preferably up to 25 mg, preferably up to 20 mg, preferably up to 15 mg, preferably up to 10 mg, preferably up to 9 mg, preferably up to 8 mg, preferably up to 7 mg, preferably up to 6.5 mg, preferably up to 6 mg, preferably up to 5.5 mg, preferably up to 5 mg, preferably up to 4.5 mg, preferably up to 4 mg per dose. In preferred embodiments, the rapidly infusing composition is administered to the subject to provide a total of 10 to 30 mg cannabinoids other than THC per dose (dosing event).
[0102] Relative to subject body weight, the effective amount of the rapidly infusing composition is that which provides THC and/or a derivative/analog thereof in combination with two or more other cannabinoids to the subject in an amount of at least 0.01 mg/kg, preferably at least 0.05 mg/kg, preferably at least 0.1 mg/kg, preferably at least 0.2 mg/kg, preferably at least 0.4 mg/kg, preferably at least 0.5 mg/kg, preferably at least 0.6 mg/kg, preferably at least 0.7 mg/kg, preferably at least 1.0 mg/kg, preferably at least 1.2 mg/kg, preferably at least 1.5 mg/kg, preferably at least 1.8 mg/kg, and up to 3.0 mg/kg, preferably up to 2.5 mg/kg, preferably up to 2.2 mg/kg, preferably up to 2.0 mg/kg, preferably up to 1.8 mg/kg, preferably up to 1.5 mg/kg, preferably up to 1.2 mg/kg, preferably up to 1.0 mg/kg, preferably up to 0 8 mg/kg, per dose
[0103] In order to achieve the above described effective amount per dose, the methods herein may involve administering one, or more than one, unit of the rapidly infusing composition per dose (dosing event). For example, in circumstances where each unit of the rapidly infusing composition contains 20 mg of ATI (e g., THC and two or more other cannabinoids), and it has been determined that the subject requires a therapeutically effective amount of 40 mg of ATI per dose, then the subject may be given two (2) units (e.g., tablets) to achieve the desired therapeutically effective amount of 40 mg ATI per dose. Accordingly, depending on the unit dose of ATI in each unit of the rapidly infusing composition, the effective amount of ATI prescribed, etc., 1, 2, 3, 4, 5, or more units (e g., tablets) may be administered to the subject per dose. Accordingly, the phrases “administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition”, “the rapidly infusing composition is administered”, etc., are intended herein to include administration of a single unit (e.g., tablet), or multiple units (e.g., tablets), to the subject in order to provide an effective amount of ATI, e.g., THC and two or more other cannabinoids. While it may be possible to administer partial (e.g., half) tablets to the subject, for practical reasons, it is preferred that one or more whole tablets are administered to the subject.
[0104] In many instances, the dose schedule (frequency of administration) may be determined simply on the basis of when the subject requires or desires effects from THC or its derivative/analogs with other cannabinoids, e.g., to provide a high, to provide relief from pain symptoms, etc. Thus in some embodiments, the rapidly infusing composition may be administered ‘as needed’ (PRN). In other embodiments, the subject may be prescribed a dosage regimen that involves multiple, separate dosing events at appropriate time intervals throughout the day. In any case, the subject may be administered an effective amount of ATI 1 time, 2 times, 3 times, 4 times, 5 times, 6 times, or even more times, optionally at appropriate intervals, throughout the day A particularly preferred dosing schedule involves administration of the rapidly infusing composition 2 times per day (b i d ). The rapidly infusing composition may also be administered on an hourly dosing schedule (q), for example, administration may take place every 4, 6, 8, 10, 12, 14, 18, 24 hours, or otherwise, as appropriate. When the ATI is THC or a derivative/analog thereof in combination with two or more other cannabinoids, the maximum daily dosage of THC or derivative/analog thereof and the other cannabinoids in total is preferably no more than 500 mg, preferably no more than 450 mg, preferably no more than 400 mg, preferably no more than 350 mg, preferably no more than 200 mg per day.
[0105] Administration may be performed once or multiple times a day, on consecutive days or otherwise, to achieve desired results (e.g., relief from pain symptoms, a feeling of satisfaction, etc.). For example, the subject may be administered an effective dose of the rapidly infusing composition, at least 1 time per day for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, or more, such as weeks, months, or even years.
[0106] Preferred dosing regimens are those involving a consistent dosing amount and schedule. One non-limiting example of a dosing regimen may involve the subj ect taking one unit of the rapidly infusing composition (e g., 25 mg THC and other cannabinoids) two times per day (b.i.d.), for 14 consecutive days. Another non-limiting example of a dosing regimen may involve the subject taking two units of the rapidly infusing composition (e.g., 25 mg THC and other cannabinoids) — therapeutically effective amount of 50 mg THC and other cannabinoids per dose — two times per day (b.i.d.), for 10 consecutive days.
[0107] Upon being administered buccally (between the cheek and gum) or sublingually (under the ventral surface of the tongue), the rapidly infusing composition preferably disintegrates in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably about 1 second Such a disintegration profile provides for rapid absorption of the ATI and short onset times of under 15 minutes, preferably under 10 minutes, preferably under 5 minutes, preferably under 4 minutes, preferably under 3 minutes, preferably under 2 minutes, preferably under 1 minute, preferably under 45 seconds, preferably under 30 seconds, preferably under 20 seconds, preferably under 10 seconds, preferably approximately 5 seconds.
[0108] Further, this route of administration may provide a single dose bioavailability of at least 20%, preferably at least 30%, preferably at least 40%, preferably at least 50%, preferably at least 60%, preferably at least 70%, preferably at least 80%, preferably at least 90%, and up to 95%, preferably up to 90%, preferably up to 80%, preferably up to 70%, preferably up to 60%, preferably up to 50%, preferably up to 40%, preferably up to 30%. [0109] The RITe™ platform may be used as a stand-alone agent or may be used in combination therapy — wherein the rapidly infusing composition (a first therapy) is used in combination with a second therapy such as one or more second therapeutic agents. The combination therapy may be applied to one condition, for example where both/all therapies target pain. The combination therapy may also be applied to treat a combination of conditions, for example where the first therapy targets pain and the second therapy targets a different condition such as cancer.
[0110] In combination therapy, the rapidly infusing composition formulated with THC in combination with two or more other cannabinoids may be used for any purpose in which the pharmacological effects from THC are desired, for example to treat pain, anorexia and/or cachexia, nausea and/or emesis, spasticity or muscle control disorders, overactive bladder syndrome, sleep apnea, glaucoma, movement disorders, allergies, inflammation, infection, epilepsy, depression, migraine headaches, bipolar disorders, anxiety disorder, drug dependency and withdrawal syndromes, and Alzheimer’s disease. The rapidly infusing composition may also be used simply for recreational purposes
[0111] Examples of second therapies which can be co-administered with the rapidly infusing composition of the present disclosure include, but are not limited to, analgesics, cancer therapies, antidepressants, anxiolytics, anticonvulsants, expectorants, antihypertensive agents, bronchodilators, anti-inflammatory agents, antibacterial/antiviral/anti- parasitic/antifungal agents, mucolytics, antiemetics, and antaci ds/acid-reducing drugs — which can be used, e.g., for the treatment of pain, cancer, depression, anxiety, seizures, irritation of the respiratory tract, hypertension, dyspnea, inflammation, infection, chronic sputum production, nausea/vomiting, acid reflux, heartburn, and indigestion.
[0112] Analgesics suitable for use in combination therapy may include, but are not limited to, opioid analgesics, such as natural opiates, esters/ethers of morphine opiates, semisynthetic opioids, synthetic opioids, and endogenous opioid peptides, examples of which include, but are not limited to, morphine, codeine, thebaine, oripavine, papaveretum, diacetylmorphine, nicomorphine, dipropanoylmorphine, diacetyldihydromorphine, acetylpropionylmorphine, desomorphine, methyldesomorphine, dibenzoylmorphine, dihydrocodeine, ethylmorphine, heterocodeine, buprenorphine, etorphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl, alphamethylfentanyl, alfentanil, sufentanil, remifentanil, carfentanyl, ohmefentanyl, pethidine, ketobemidone, desmethylprodine, allylprodine, prodine, phenethylphenylacetoxypiperidine, promedol, propoxyphene, dextropropoxyphene, dextromoramide, bezitramide, piritramide, methadone, dipipanone, levomethadyl acetate, difenoxin, diphenoxylate, loperamide, dezocine, pentazocine, phenazocine, dihydroetorphine, butorphanol, nalbuphine, levorphanol, levomethorphan, racemethorphan, lefetamine, meptazinol, mitragynine, tilidine, tramadol, tapentadol, eluxadoline, AP-237, and 7-hydroxymitragynine; non-steroidal anti-inflammatory drugs (NSAIDs) including, but not limited to, oxicams, salicylates, acetic acid derivatives, fenamates, propionic acid derivatives, pyrazoles/pyrazolones, coxibs, and sulfonanilides, with specific mention being made to piroxicam, isoxicam, tenoxicam, sudoxicam, salicylic acid, ethyl salicylate, methyl salycilate, aspirin, disalcid, benorylate, trilisate, safapryn, solprin, diflunisal, fendosal, diclofenac, fenclofenac, indomethacin, sulindac, tolmetin, isoxepac, furofenac, tiopinac, zidometacin, acematacin, fentiazac, zomepirac, clindanac, oxepinac, felbinac, ketorolac, mefenamic, meclofenamic, flufenamic, niflumic, tolfenamic acids, ibuprofen, naproxen, benoxaprofen, flurbiprofen, ketoprofen, fenoprofen, fenbufen, indopropfen, pirprofen, carprofen, oxaprozin, pranoprofen, miroprofen, tioxaprofen, suprofen, alminoprofen, tiaprofenic, phenylbutazone, oxyphenbutazone, feprazone, azapropazone, trimethazone, ramifenazone, lonazolac, meloxicam, and celecoxib; analgesics without anti-inflammatory activity such as paracetamol (acetaminophen); other Standard of Care for pain management such as (i) antidepressants, including, but not limited to, tricyclic antidepressants such as amitriptyline, doxepin, imipramine, desipramine, and nortriptyline; selective serotonin reuptake inhibitors such as paroxetine and citalopram; venlafaxine; bupropion; and duloxetine; and (ii) anticonvulsants, including, but not limited to, voltage-gated ion channel blockers, ligand-gated ion channel blockers, antagonists of the excitatory receptors for glutamate and N-methyl-D-aspartate, and enhancers of the y-aminobutyric acid, with specific mention being made to, carbamazepine, gabapentin, lamotrigine, pregabalin, baclofen, and phenytoin; regional nerve blockades, including, but not limited to, a brachial plexus block such as an intrascalene block, an occipital nerve block, an intercostal nerve block, a sciatic nerve block, a spinal block, an intraarticular block, and an adductor canal peripheral nerve block; and mixtures thereof, for example, where combination therapy involves administering the rapidly infusing composition formulated with e.g., THC or a derivative/analog thereof with two or more other cannabinoids, in combination with two or more second therapeutic agents that provides an analgesic effect, with specific mention being made to oxycodone/paracetamol, propoxyphene/paracetamol, codeine/paracetamol, hydrocodone/paracetamol, and the like.
[0113] In particular, rapidly infusing compositions formulated with THC in combination with two or more other cannabinoids may advantageously function as an opioidsparing medication, that when co-administered with opioids, enables a reduced opioid dose or shorter opioid dosage period, without a loss of analgesic efficacy.
[0114] Cancer therapies suitable for use in combination therapy may include, but are not limited to, surgery, radiation therapy, and therapy with agents having cytostatic or antineoplastic activity, such as those described previously. Thus, in some embodiments, the methods of the present disclosure involve co-administration of the rapidly infusing composition (e.g., for pain relief, to stem nausea and/or emesis, etc.) and a cancer treatment such as radiation therapy and/or an agent with cytostatic or antineoplastic activity (for cancer treatment), including any of those agents with cytostatic or antineoplastic activity falling into the 14 classes described above, as well as any future agents that may be developed.
[0115] Antidepressants and anxiolytics suitable for use in combination therapy may include, but are not limited to, selective serotonin reuptake inhibitors such as citalopram, escitalopram, fluoxetine, paroxetine, sertraline; serotonin and norepinephrine reuptake inhibitors such as duloxetine and venlafaxine; norepinephrine and dopamine reuptake inhibitors such as bupropion; tetracyclic antidepressants such as mirtazapine; combined reuptake inhibitors and receptor blockers such as trazodone, nefazodone, maprotiline; tricyclic antidepressants such as amitriptyline, amoxapine, desipramine, doxepin, imipramine, nortriptyline, protriptyline and trimipramine; monoamine oxidase inhibitors such as phenelzine, tranylcypromine, isocarboxazid, selegiline; benzodiazepines such as lorazepam, clonazepam, alprazolam, and diazepam; serotonin 1 A receptor agonists such as buspirone, aripiprazole, quetiapine, tandospirone, and bifeprunox; and beta-adrenergic receptor blockers such as propranolol.
[0116] Expectorants suitable for use in combination therapy may include, but are not limited to, glycerol iodination products, for example, domiodol and organidin, as well as purinergic receptor agonists such as uridine triphosphate and adenosine triphosphate.
[0117] Anti-hypertensive agents suitable for use in combination therapy may include, but are not limited to, diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha blockers, alpha-2 receptor agonists, and combined alpha and beta-blockers, with specific mention being made to amiloride.
[0118] Bronchodilators suitable for use in combination therapy may include, but are not limited to p2-adrenergic agonists (e.g., salbutamol and terbutaline), anticholinergics, and theophylline.
[0119] Anti-inflammatory agents suitable for use in combination therapy may include, but are not limited to, oxicams, salicylates, acetic acid derivatives, fenamates, propionic acid derivatives, pyrazoles/pyrazolones, coxibs, and sulfonanilides
[0120] Antibacterial/antiviral/anti-parasitic/antifungal agents suitable for use in combination therapy may include, but are not limited to, macrolide antibiotics such as erythromycin; sulfonamides such as sulfanilamide, sulfadiazine, and sulfacetamide; topical antibiotics such as mupirocin; tetracyclines such as tetracycline and doxycycline; synthetic and semisynthetic penicillins and beta-lactams; chloramphenicol; imidazoles; dicarboxylic acids such as azelaic acid; salicylates; peptide antibiotics; and cyclic peptides such as cyclosporine, tacrolimus, pimecrolimus and sirolimus (rapamycin).
[0121] Mucolytics suitable for use in combination therapy may include, but are not limited to, n-acetylcysteine, ambroxol, bromhexine, carbocisteine, erdosteine, and mecysteine. [0122] Antiemetics suitable for use in combination therapy may include, but are not limited to, 5-HT3 receptor antagonists such as dolasetron, granisetron, ondansetron, and tropisetron; dopamine antagonists such as domperidone, olanzapine, alizapride, and prochlorperazine; NK1 receptor antagonists such as aprepitant and rolapitant; antihistamines such as diphenyhydramine, dimenhydrinate, meclizine, and promethazine; and steroids such as dexamethasone.
[0123] Antacids/acid-reducing drugs suitable for use in combination therapy may include, but are not limited to, salts of aluminium, calcium, magnesium, or sodium, for example, magnesium oxide, magnesium carbonate, aluminium hydroxide, sodium citrate, sodium bicarbonate, and magnesium trisillicate; and H2-receptor antagonists such as cimetidine, famotidine, nizatidine, and lafutidine; and proton pump inhibitors such as omeprazole, lansoprazole, dexlansoprazole, and esomeprazole.
[0124] Combination therapy is intended to embrace administration of these therapies in a sequential manner, that is, wherein the rapidly infusing composition and one or more second therapies are administered at a different time, as well as admini tration of these therapies, or at least two of the therapies, in a substantially simultaneous manner. Substantially simultaneous administration can be accomplished, for example, by administering to the subject multiple, single dosage forms for each of the therapeutic agents. Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, transdermal, and direct absorption through mucous membrane tissues. The therapeutic agents can be administered by the same route or by different routes. For example, the rapidly infusing composition formulated with THC in combination with two or more other cannabinoids may be administered via buccal administration while a second therapeutic agent of the combination may be administered intravenously. Alternatively, for example, all therapeutic agents may be administered buccally. Combination therapy also can embrace the administration of the rapidly infusing composition in further combination with other biologically active ingredients and non-drug therapies (e.g., surgery or radiation treatment). Where the combination therapy further comprises a non-drug treatment, the nondrug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agent(s) and non-drug treatment is achieved. For example, in appropriate cases, the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks.
[0125] Where a numerical limit or range is stated herein, the endpoints are included. Also, all values and subranges within a numerical limit or range are specifically included as if explicitly written out.
[0126] As used herein the words “a” and “an” and the like carry the meaning of “one or more ”
[0127] The present disclosure also contemplates other embodiments “comprising”, “consisting of’ and “consisting essentially of’, the embodiments or elements presented herein, whether explicitly set forth or not.
[0128] All patents and other references mentioned above are incorporated in full herein by this reference, the same as if set forth at length.
[0129] Obviously, numerous modifications and variations of the present invention are possible in light of the above teachings. It is therefore to be understood that, within the scope of the appended claims, the invention may be practiced otherwise than as specifically described herein. EXAMPLES
Rapidly Infusing Composition Comprising THC and other cannabinoids
Ingredients
[0130] The ingredients that will be used to make the rapidly infusing composition are given in Table 1. USP = United States Pharmacopeia. EP = European Pharmacopoeia. NF = National Formulary.
Table 1. Ingredients
Figure imgf000059_0001
[0131] Example rapidly infusing compositions will be made using the formulations given in Tables 2 and 3. The amount of each component is expressed in terms of weight percentage relative to a total weight (100%). The weight percentage of each component in the drug product suspension is on a wet basis (prior to removal of water). The weight percentage of each component in the rapidly infusing composition is on a dry basis (after removal of water).
Table 2. Example 1 rapidly infusing composition
Drug product
Rapidly Infusing Composition
Figure imgf000060_0001
Figure imgf000061_0001
[0132] Methods of making the rapidly infusing compositions
[0133] Purified water is charged to a pot and is mixed using an overhead stirrer as an agitating device.
[0134] With agitation, the requisite amount of gelatin and mannitol are dispersed, and the mixture is heated until the excipients were dissolved.
[0135] Once dissolved, the sweeteners sucralose and acesulfame-K are added and allowed to dissolve.
[0136] The solution is cooled to 30 °C, moved to an overhead homogenizer, and then the requisite amount of tetrahydrocannabinol (THC) isolate and other cannabinoids isolates are charged and dispersed sequentially, or in the alternative the THC and other cannabinoid isolates are thoroughly mixed in dry form and charged and dispersed in a single step, using the homogenizer to micronize the THC and create a drug product suspension.
[0137] The requisite amount of Green-Apple flavor is charged and is mixed for 10 minutes, then the FD&C Yellow #5 and FD&C Blue #5 colorant are added.
[0138] The resulting drug product suspension is transferred to a second overhead mixer and maintained at a temperature of 30 °C for the ensuing dosing operation.
[0139] In a blistering machine equipped with a dosing system, blister pockets are filled with a target dose weight of 300.0 mg of the drug product suspension.
[0140] The product is frozen in a suitable cryochamber and then the blister trays are transferred from the cryochamber to a suitable refrigerated storage cabinet (temperature below 0 °C) prior to lyophilizing to keep the product frozen. [0141] The frozen blisters are loaded from the refrigerated storage cabinet into lyophilizers and the product is lyophilized (water was sublimated) to form the rapidly infusing compositions.
[0142] When the lyophilizing cycle is completed, the rapidly infusing compositions are transferred from the lyophilizers to the blistering machine where the blister trays are heat sealed with lidding material. The resulting tablets are flat-topped circular units approximately 15 mm in diameter with a convex bottom packaged in individual blister units (see also U.S. Provisional Application 63/114,181 — incorporated herein by reference in its entirety). [0143] The following tests are performed: o A seal integrity test is performed at -0.5 Bar for 30 seconds, 1 -minute soak time o Visual inspection is performed o Dry weight testing is performed

Claims

1. A rapidly infusing composition, comprising: a pharmaceutically acceptable binder and/or excipient system comprising gelatin and a sugar alcohol, tetrahydrocannabinol, and two or more other cannabinoids.
2. The rapidly infusing composition of claim 1, which is lyophilized.
3. The rapidly infusing composition of claim 1, which has a disintegration time of approximately 1 to 30 seconds in deionized water maintained at 37° C ± 2° C.
4. The rapidly infusing composition of claim 1, which has a disintegration time of approximately 1 to 5 seconds in deionized water maintained at 37° C ± 2° C.
5. The rapidly infusing composition of claim 1, wherein the gelatin is present in the rapidly infusing composition in an amount of 10 to 50 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
6. The rapidly infusing composition of claim 1, wherein the gelatin is a bovine gelatin.
7. The rapidly infusing composition of claim 1, wherein the sugar alcohol is present in the rapidly infusing composition in an amount of 5 to 45 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
8. The rapidly infusing composition of claim 1, wherein the sugar alcohol is mannitol.
9. The rapidly infusing composition of claim 1, wherein the tetrahydrocannabinol is present in the rapidly infusing composition in an amount of 0.3 to 25 wt.%, based on a total weight of the rapidly infusing composition on a dry basis.
10. The rapidly infusing composition of claim 1, wherein the other cannabinoids include cannabidiol, and at least one of cannabinol, cannabigerol, and cannabichromene.
11. The rapidly infusing composition of claim 10, wherein the tetrahydrocannabinol and other cannabinoids are in the form of a solid.
12. The rapidly infusing composition of claim 10, wherein the tetrahydrocannabinol and other cannabinoids are in the form of a solid that has been micronized to have a D50 diameter between 1 and 50 pm.
13. The rapidly infusing composition of claim 10, wherein the tetrahydrocannabinol has a purity between 95 and 99.9 wt.%.
14. The rapidly infusing composition of claim 1, wherein the rapidly infusing composition further comprises at least one selected from the group consisting of a sweetener, a flavorant, and a colorant.
15. The rapidly infusing composition of claim 14, wherein the rapidly infusing composition comprises the flavorant, and the flavorant comprises green-apple flavor.
16. The rapidly infusing composition of claim 14, wherein the rapidly infusing composition comprises the colorant, and the colorant comprises FD&C Yellow #5 and FD&C Blue #5.
17. The rapidly infusing composition of claim 14, wherein the rapidly infusing composition comprises the sweetener, and the sweetener comprises a mixture of sucralose and acesulfame-K.
18. The rapidly infusing composition of claim 1, further comprising glycine.
19. The rapidly infusing composition of claim 1, further comprising citric acid.
20. A process for manufacturing the rapidly infusing composition of claim 1, comprising: dissolving gelatin and a sugar alcohol in water to form a solution; adding the tetrahydrocannabinol and the two or more cannabinoids to the solution to form a drug product suspension; and lyophilizing the drug product suspension to remove water and form the rapidly infusing composition.
21. A method of activating cannabinoid receptors in a subject, comprising administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of claim 1.
22. The method of claim 21, wherein the rapidly infusing composition is administered buccally to the subject via the buccal mucosa.
23. The method of claim 21, wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 20 mg of tetrahydrocannabinol per dose.
24. The method of claim 21, wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 50 mg of total cannabinoids per dose.
25. The method of claim 21, wherein the rapidly infusing composition is administered to the subject 1 to 5 times per day
26. The method of claim 21, wherein the subject is a human.
27. A method of treating at least one condition selected from the group consisting of anorexia, cachexia, nausea, emesis, pain, spasticity, fibromyalgia, overactive bladder, sleep apnea, and glaucoma, in a subject, the method comprising: administering to the subject in need thereof, via the oral mucosa, an effective amount of the rapidly infusing composition of claim 1.
28. The method of claim 27, wherein the rapidly infusing composition is administered buccally to the subject via the buccal mucosa.
29. The method of claim 27, wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 20 mg of tetrahydrocannabinol per dose.
30. The method of claim 27, wherein the effective amount of the rapidly infusing composition is that which provides from 0.1 to 50 mg of total cannabinoids per dose.
31. The method of claim 27, wherein the rapidly infusing composition is administered to the subject 1 to 5 times per day.
32. The method of claim 27, wherein the subject is a human.
PCT/US2023/022338 2022-05-17 2023-05-16 Rapidly infusing cannabinoid compositions, processes of manufacture, and methods of use WO2023224960A1 (en)

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