AU2014253537A1 - Delivery of viscous formulations by needle-free injection - Google Patents

Abstract

C:NRPortbl\DCC\FMT\4864914_ .DOC-16/01/2013 Formulations are described that are viscous and will benefit from needle-free delivery at high driving pressures. Conventional delivery of these viscous formulations by hypodermic syringes is inconvenient as well as painful. Formulations include those which have a viscosity of about 5 cS or more at about 20'C and which can have 0.5 ml or more administered by a needleless injector in about 0.1 second.

Description

DELIVERY OF VISCOUS FORMULATIONS BY NEEDLE-FREE INJECTION FIELD OF THE INVENTION 100011 This is a divisional of Australian Patent Application No. 2013200286, the entire contents of which are incorporated herein by reference. [0001a] The present invention relates to the delivery of viscous formulations by needle-free injection for parenteral and other pharmaceutical applications. Various classes of formulations and carriers are listed for their applicability for needle- free delivery. BACKGROUND OF THE INVENTION [00021 Modem drug development means that the market for injectable drugs is growing, since the majority of these molecules are too large and fragile to be delivered by other methods such as orally. However, it is difficult to formulate many of these molecules into stable solutions that are sufficiently concentrated to inject an efficacious amount in a reasonable sized dose (<1ml). As a result, the formulation may be quite viscous, often up to 10,000 times thicker than water i.e. I 0,OOOcS (centistokes) or higher. Also, the advent of controlled release strategies has opened new areas for development and delivery of formulations. For parenteral applications, the viscosity of enhanced formulations has been an issue with several controlled release formulations. Liquids with viscosities significantly larger than a given level relative to the needle size and temperature are difficult, if not impractical, to inject using a conventional needle and syringe. [0003] Viscous formulations containing polymers, for example, are employed for the controlled release of drugs after subcutaneous (SC), intra-dermal (ID) or intra-muscular (IM) injection. These formulations are notoriously difficult to inject and often quite painful for the patient. The difficulty in injection is associated with viscous drag of the formulation while traversing the length of the needle. Consequently, large bore needles are employed (creating even greater levels of pain), but still the injection time can be in the order of minutes or more. [0004] The ability to inject a drug incorporated into a polymer to a localized site and have the polymer form a semi-solid drug depot has a number of advantages. Among these advantages is ease of application and localized, prolonged drug delivery. For these reasons a large number of in situ setting polymeric delivery systems have been developed and investigated for use in delivering a wide variety of drugs. 100051 Currently, there are few synthetic or natural polymeric materials which can be used for the controlled delivery of drugs, including peptide and protein drugs, because of the strict 1 WO 2007/061896 PCT/US2006/044778 -A e erirements, such as biocompatibility, clearly defined degradation pathway, and safety of the degradation products. The most widely investigated and advanced biodegradable polymers in regard to available toxicological and clinical data are the aliphatic poly(.alpha.-hydroxy acids), such as poly(D,L- or L- lactic acid) (PLA) and poly(glycolic acid) (PGA) and their copolymers (PLGA). These polymers are commercially available and are presently being used as bioresorbable sutures. An FDA-approved system for controlled release of leuprolide acetate, the Lupron Depot.TM., is also based on PLGA copolymers. The Lupron Depot.TM. consists of injectable microspheres, which release leuprolide acetate over a prolonged period (e.g., about days) for the treatment of prostate cancer. A list of protein/peptide controlled release systems based on PLGA are listed in Table 2. [0006] A. S. Sawhney and J. A. Hubbell, J. Biomed. Mat. Res., 24, 1197-1411 (1990), synthesized terpolymers of D,L-lactide, glycolide and c-caprolactone which degrade rapidly in vitro. The hydrophilicity of the material was increased by copolymerization with a poloxamer surfactant (Pluronic F-68). This poloxamer is a block copolymer comprising about 80% by weight of a relatively hydrophobic poly(oxypropylene) block and 20% by weight of a hydrophilic poly(oxyethylene) block. Copolymerization with the poloxamer resulted in a stronger and partly crystalline material which was mechanically stable at physiological temperatures (e.g. 37.degree. C.) in water. [0007] One system, which can be fabricated in aqueous solution, is a class of block copolymers referenced above and marketed under the Pluronic.TM. tradename. These copolymers are composed of two different polymer blocks, i.e. hydrophilic poly(oxyethylene) blocks and hydrophobic poly(oxypropylene) blocks to make up a triblock of poly(oxyethylene)-poly(oxypropylene)-poly(oxyethylene). The triblock copolymers absorb water to form gels which exhibit reverse thermal gelation behavior. [0008] Churchill et al, U.S. Pat. Nos. 4,526,938 and 4,745,160 show copolymers that are either self-dispersible or can be made self-dispersible in aqueous solutions. These copolymers are ABA triblock or AB block copolymers composed of hydrophobic A-blocks, such as polylactide (PLA) or poly(lactide-co-glycolide)(PLGA), and hydrophilic B-blocks, such as polyethylene glycol (PEG) or polyvinyl pyrrolidone. [0009] . Dunn et al, in patent no. 5,324,519, disclose the composition of a liquid formulation of a thermoplastic polymer and a phannaceutically acceptable organic solvent (trade name Atrigel). The composition is administered as a liquid to an implant site, whereupon the solvent diffuses or dissipates into the surrounding aqueous tissue fluids. The thermoplastic 2 WO 20071061896 PCT/US2006/044778 6FrLi t lilies aqueous fluids so that it coagulates or solidifies to form a microporous solid or gelatinous matrix. The composition is a liquid formulation of a thermoset prepolymer or copolymer, preferably an acrylic ester-terminated biodegradable prepolymer, which is capable of cross-linking in situ to form a polymeric or copolymeric solid or gelatinous matrix. [0010) In US patent no. 6,117,949, Rathi et al. disclose A water soluble biodegradable ABA or BAB-type triblock polymer is disclosed that is made up of a major amount of a hydrophobic polymer made of a poly(lactide-co-glycolide) copolymer or poly(lactide) polymer as the A-blocks and a minor amount of a hydrophilic polyethylene glycol polymer B-block, that possesses reverse thermal gelation properties. [0011] US patent No. 5,980, 948 describes a composition comprised of a product including a biologically active agent encapsulated in a matrix comprising a polyetherester copolymer, such as a polyethylene glycol terephthalate/polybutylene terephthalate copolymer. The polyetherester copolymer protects the biologically active agent (including proteins, peptides, and small drug molecules) from degradation or denaturation. [00121 One other interesting possibility to apply an injectable protein delivery system in situ is the use of sucrose acetate isobutyrate (SAIB). Sucrose acetate isobutyrate is a highly lipophilic sugar derivative, which is currently used as stabiliser and emulsifying agent to human diets in the Food Industry. The so-called SABERTM technology was patented by Tipton and Richard (Southern Biosystems, Inc.) in 1995. The high viscosity of the liquid sucrose acetate isobutyrate carrier is lowered by the addition of a water soluble or miscible solvent such as ethanol or dimethylsulfoxide. After addition of the drug, the composition is injected and forms a highly viscous implant in situ, which releases the drug over time US patent No. 5,747,058 describes the high viscosity formulation further in detail. [0013] EP 1184032 describes a method for producing hydrogels, based on crystallization of dextran or derivatives thereof. These hydrogels find use in pharmaceutical, medical and biotechnological applications, e.g. as controlled release systems for the delivery of active ingredients in in vivo and in vitro applications. The hydrogels according to the present invention are priced by crystallization from an aqueous solution that is essentially free of organic solvents or crystallization enhancers. [0014] EP0842657 describes a two phase controlled release system containing dextran and polyethylene glycol. EP0941068 describes a two phase dextran containing controlled release system for proteins. 3 WO 2007/061896 PCT/US2006/044778 '"'Ii i)A lV zle configuration in a needle-free injector that has a substantially larger orifice/length ratio than a needle, it is possible to minimize or negate the effects of viscous drag resulting from fully developed laminar flow and therefore safely, conveniently, and reproducibly deliver the injectate independent of formulation viscosity. [0016] Needle-free injectors are available using many different types of energy, and the energy may be supplied by the user, for example where a spring is manually compressed and latched to temporarily store the energy until it is required to "fire" the injector. Alternatively, the injector may be supplied having the energy already stored--for instance by means of a precompressed spring (mechanical or gas), or pyrotechnic charge. [0017] Some injectors are intended for disposal after a single use, whereas others have a re loadable energy storage means and a disposable medicament cartridge, and there are many combinations to suit particular applications and markets. For the purposes of the present disclosure, the term ?'actuator" will be used to describe the energy storage and release. mechanism, whether or not it is combined with the medicament cartridge. In all cases, it is necessary to arrange for sufficient force at the end of the piston stroke to deliver the entire medicament at the required pressure: if a spring is used, this is called "pre-loading". [0018] EP 0 063 341 and EP 0 063 342 disclose a needle-free injector which includes a piston pump for expelling the liquid to be injected, which is driven by a motor by means of a pressure agent. The liquid container is mounted laterally to the piston pump. The amount of liquid required for an injection is sucked into the pump chamber by way of an inlet passage and a flap check valve when the piston is retracted. As soon as the piston is moved in the direction of the nozzle body the liquid is urged through the outlet passage to the nozzle and expelled. The piston of the piston pump is a solid round piston. [00191 EP 0 133 471 describes a needle-free vaccination unit which is operated with carbon dioxide under pressure, from a siphon cartridge by way of a special valve. [0020] EP 0 347 190 discloses a vacuum compressed gas injector in which the depth of penetration of the injected drug can be adjusted by means of the gas pressure and the volume of the drug can be adjusted by way of the piston stroke. [0021] EP 0 427 457 discloses a needle-free hypodermic syringe which is operated by means of compressed gas by way of a two-stage valve. The injection agent is disposed in an ampoule which is fitted into a protective casing secured to the injector housing. The ampoule is fitted on to the end of the piston rod. Disposed at the other end of the ampoule is the nozzle whose diameter decreases towards the end of the ampoule. 4 WO 2007/061896 PCT/US2006/044778 UI %W s8)U6Jif9>ses a needle-free injector for one-off use. WO 92/08508 sets forth a needle-free injector which is designed for three injections. The ampoule containing the drug is screwed into one end of the drive unit, with the piston rod being fitted into the open end of the ampoule. At its one end, the ampoule contains the nozzle through which the drag is expelled. A displaceable closure plug is provided approximately at the center of the length of the ampoule. The dose to be injected can be adjusted by changing the depth of the ampoule. The piston rod which projects from the drive unit after actuation of the injector is pushed back by hand. Both units are operated with compressed gas. [00231 WO 93/03779 discloses a needle-free injector with a two-part housing and a liquid container which is fitted laterally to the unit. The drive spring for the piston is stressed by means of a drive motor. The spring is released as soon as the two parts of the housing are displaced relative to each other by pressing the nozzle against the injection location. Respective valves are provided in the intake passage for the liquid and in the outlet of the metering chamber. [0024] WO 95/03844 discloses a further needle-free injector. It includes a liquid-filled cartridge which at one end includes a nozzle through which the liquid is expelled. At the other end the cartridge is closed by a cap-type piston which can be pushed into the cartridge. A piston which is loaded by a prestressed spring, after release of the spring, displaces the cap type piston into the cartridge by a predetennined distance, with the amount of liquid to be injected being expelled in that case. The spring is triggered as soon as the nozzle is pressed sufficiently firmly against the injection location. This injector is intended for one-off or repeated use. The cartridge is arranged in front of the spring-loaded piston and is a fixed component of the injector. The position of the piston of the injector which is intended for a plurality of uses is displaced after each use by a distance in a direction towards the nozzle. The piston and the drive spring cannot be reset. The pre stressing of the spring is initially sufficiently great to expel the entire amount of liquid in the cartridge all at once. The spring can only be stressed again if the injector is dismantled and the drive portion of the injector assembled with a fresh, completely filled cartridge. [0025] U.S. Patent No. 5,891,086 describes a needle-free injector, combining an actuator and a medicament cartridge. The cartridge is pre-filled with a liquid to be injected in a subject, and having a liquid outlet and a free piston in contact with the liquid, the actuator comprising an impact member urged by a spring and temporarily restrained by a latch means, the impact member being movable in a first direction under the force of the spring to first strike the free 5 WO 2007/061896 PCT/US2006/044778 JF9 tt ~ ef3 t to move the piston in the first direction to expel a dose of liquid through the liquid outlet, the spring providing a built-in energy store and being adapted to move from a higher energy state to a lower energy state, but not vice versa. The actuator may comprise trigger means to operate the said latch, and thus initiate the injection, only when a predetermined contact force is achieved between the liquid outlet of the said cartridge and the subject. [0026] U.S. Pat. No. 3,859,996, Mizzy, discloses a controlled leak method to ensure that the injector orifice is placed correctly at the required pressure on the subject's skin at the correct normal to the skin attitude. When placement conditions are met, controlled leak is sealed off by contact pressure on the subject's skin, the pressure within the injector control circuit rises until a pressure sensitive pilot valve opens to admit high pressure gas to drive the piston and inject the medicament. [0027] WO Patent 82/02835. Cohen and Ep-A-347190, Finger, discloses a method to improve the seal between the orifice and the skin and prevent relative movement between each. This method is to employ a vacuum device to suck the epidermis directly and firmly onto the discharge orifice. The discharge orifice is positioned normal to the skin surface in order to suck the epidermis into the orifice. This method for injection of the medicament into the skin and the injector mechanism are different and do not apply to the present invention because of its unique ampule design. [0028] U.S. Pat. No. 3,859,996, Mizzy, discloses a pressure sensitive sleeve on the injector which is placed on the subject, whereby operation of the injector is prevented from operating until the correct contact pressure between orifice and the skin is achieved. The basic aim is to stretch the epidermis over the discharge orifice and apply the pressurized medicament at a rate which is higher than the epidermis will deform away from the orifice. [0029] U.S. Pat. No. 5,480,381, T. Weston, discloses a means of pressuring the medicament at a sufficiently high rate to pierce the epidermis before it has time to deform away from the orifice. In addition, the device directly senses that the pressure of the discharge orifice on the subject's epidermis is at a predetermined value to permit operation of the injector. The device is based on a cam and cam follower mechanism for mechanical sequencing, and contains a chamber provided with a liquid outlet for expelling the liquid, and an impact member, to dispell the liquid. [0030] U.S. Pat. No. 5,891,086, T. Weston, describes a needle-free injector that contains a chamber that is pre-filled with a pressurized gas which exerts a constant force on an impact 6 WO 2007/061896 PCT/US2006/044778 'i" components of a cartridge and expulse a dose of medicament. This device contains an adjustment knob which sets the dose and the impact gap, and uses direct contact pressure sensing to initiate the injection. [0031] A number of biologically-active agents in viscous formulations can be delivered using the needle-free injector. This group could consist of (but not limited to) anti-inflammatory agents, antibacterial agents, antiparasitic agents, antifungal agents, antiviral agents, anti neoplastic agents, analgesic agents, anaesthetics, vaccines, central nervous system agents, growth factors, hormones, antihistamines, osteoinductive agents, cardiovascular agents, anti ulcer agents, bronchodilators, vasodilators, birth control agents and fertility enhancing agents, interferon alpha, growth hormone, osteoporosis drugs including PTH and PTH analogs and fragments, obesity drugs, psychiatric drugs, anti-diabetes, female infertility, AIDS, treatment of growth retardation in children, hepatitis, multiple sclerosis, migraine headaches, and allergic reactions. SUMMARY OF THE INVENTION [00321 U.S. Patent No. 5,891,086 (incorporated by reference in its entirety) describes a device for delivering viscous formulations by needle-free injection for SC, ID or IM, but not limited to theses applications. An actuator for use in conjunction with a cartridge to form a needle-free injector, the cartridge being pre-filled with a liquid to be injected in a subject, the cartridge having a liquid outlet and a free piston inward of the liquid outlet in contact with the liquid, said actuator comprising: (a) a housing having a forward portion adapted to be connected with the cartridge; (b) impact member mounted within. said housing inward of the forward portion so as to be movable from a first position toward the forward portion to strike the free piston when a cartridge is connected and to continue to move the free piston toward the liquid outlet whereby a dose of the liquid is expelled through the liquid outlet in the cartridge; (c) a chamber within said housing pre-filled with pressurized gas and connected with said impact member such that said pressurized gas is constantly in communication with and constantly exerts a force on said impact member to normally urge said impact member toward the liquid outlet; and (d) a latch within said housing which engages said impact member to prevent movement of the impact member toward the forward portion in response to said force exerted 7 WO 2007/061896 PCTIUS2006/044778 P. hin9 1 ajd ~JfJle 4 #eing mounted to be movable out of engagement with said impact member to a firing position, in which said latch permits such movement. [00331 The current invention describes various viscous formulations that can be delivered using a needle-free injector including the injector of 5,891,086. These formulations include various polymers, carriers, as well as API's in various physical forms. [0034] An aspect of the invention-is a desirable delivery time of high viscosity formulations. [0035] Another aspect of the invention is acceptable pain associated with injection of high viscosity formulations. [0036] Another aspect of the invention relates to fear of needles associated with injection of high viscosity formulations [00371 Another aspect of the invention relates to the danger of needle stick injury and cross contamination associated with injection of high viscosity formulations. [00381 Another aspect of the invention relates to the preparation associated with injection of high viscosity formulations, by supplying a pre-filled, single use disposable injector. [00391 Another aspect of the invention relates to the drug release profile associated with injection of high viscosity depot formulation, especially surface eroding systems. [00401 These and other aspects of the invention will become apparent to those-persons skilled in the art upon reading the details of the devices and methodology as more fully described below. BRIEF DESCRIPTION OF THE DRAWINGS [00411 The invention is best understood from the following detailed description when read in conjunction with the accompanying drawings. It is emphasized that, according to common practice, the various features of the drawings are not to-scale. On the contrary, the dimensions of the various features are arbitrarily expanded or reduced for clarity. Included in the drawings are the following figures: [0042] Figure 1 shows the ratio of hole length to critical length for the exit opening of the nozzle of the needle-free injector. The ratio is less than 10 for viscosities less than 10,000 cS - hence there is no viscous loss, even with viscous fluids [0043] Figure 2 is a graph showing the effect of viscosity on injection time for needles (white) versus Needle-free (black) delivery. Both methods delivered 0.5 mL of non thixotropic fluid. Needle injections were using 23G needle, with maximum hand force that could be applied by tester (approx. 20 N / 5 lbF). 8 WO 2007/061896 PCT/US20061044778 ILs' MirO d p hoping the injection times of a needle & syringe against the needle-free injector; both axes are using logarithmic scales. DETAILED DESCRIPTION OF THE INVENTION [00451 Before the present devices, formulations and methods are described, it is to be understood that this invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims. [00461 Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated value or intervening value in a stated range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range where either, neither or both limits are included in the smaller ranges is also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention. [00471 Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, some potential and preferred methods and materials are now described. All publications mentioned herein are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. It is understood that the present disclosure supercedes any disclosure of an incorporated publication to the extent there is a contradiction. [0048] It must be noted that as used herein and in the appended claims, the singular forms "a", "an", and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a formulation" includes a plurality of such formulations and reference to "the polymer" includes reference to one or more polymers and equivalents thereof known to those skilled in the art, and so forth. 9 WO 2007/061896 PCT/US2006/044778 Ij04.4[f/ ILD '& riNj~ t AIRt &cussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed. DEFINITIONS [00501 Specific gravity: ratio of a compound's density to that of water. [00511 Centipoise and centistokes: different measurements of viscosity, not just different units. Centipoise is a dynamic measurement of viscosity whereas centistoke is a kinematic measurement of viscosity. The conversion from centistoke and centipoise to s.i. units is given below: IcS = 0.0001m 2 /s 1cP =0.00Ns/m2 [0052] Conversion from centistoke to centipoise: centipoise= centistoke x specific gravity of liquid [0053] Formulation shall mean any liquid solid or other state of matter that can be injected. Preferred formulations are liquid formulations. Formulations include but are not limited to those containing excipients that are suitable for injection, and contain one or more active pharmaceutical ingredients. Aspects of the invention are generally apparent when using formulations with viscosities sufficiently high that the formulation can not administered by injection without significant problems. [00541 "Depot" means a drug delivery liquid following administration to a warm-blooded animal which has formed a gel. [00551 Bulk erosion :The rate of water penetration into the solid device exceeds the rate at which the polyner is eroded (i.e. transformed into water soluble products)-leads to an erosion process that occurs throughout the entire volume of the device---true with most hydrophilic polymers used in drug delivery currently. [0056] Surface Erosion: The rate of water penetration into the solid device is slower than the rate at which the polymer is eroded-The polymer starts eroding before water has penetrated the entire volume of the device. [0057] "Biodegradable" means that the polymer, copolymer or drug delivery system can chemically break down or degrade within the body to form nontoxic components. The rate of degradation can be the same or different from the rate of drug release. 10 WO 2007/061896 PCT/US2006/044778 S1 j'5Li 9 9ti ANiM~nal system of units [0059] API: Active Pharmaceutical Ingredient or drug Diu Tride nate Ompany Polymer - Route Application buserelin Profact@Depot, Hoechst Prostate acetate Suprefact@Depot Marion PLGA sic implant cancer Roussel goserelin Prostate acetate ZoladexoDepot Astra Zeneca PLGA s/c implant cancer, endometrioses Lupron@Depot, 3-month Enantone@Depot, depot leuprorelin Enantone@Gyn Takeda- suspension, Prostate acetate Depot Abbott 1-month cancer, Trenantone@ suspension endometrioses PLGA 3-month PLA suspension octreotide Sandostatin Novartis sic GH acetate LAR@Depot Pharma PLGA suspension suppression, ____ ___ __ _ ___ ____ ___ _ _ ____ ___ ___ ___ ___ anti cancer triptorein Decapeptyl@ Debiopharma PLGA s/c depot LHRH agonist, titrln Depot Delpam LA injection Prostate -- ,--,...--,,__ -. -_c cancer recombinant Nutropln@Dpot, Growh 'human [discontinued- Genentech- monthly s/c PLGA ijconhormone growth commercialisatior Alkermes PLGAihormnc hormone since 0612004] deficiency . Table 1: Examples of peptidelprotein controlled, release systems based on PLGA. [0060] Conversion from centistoke to centipoise: [00611 centipoise centistoke x specific gravity of liquid [0062] The specific gravity of a liquid is equivalent to its density where water has a density of one. [0063] Centipoise and centistokes are different measurements of viscosity, not just different units. Centipoise is a dynamic measurement of viscosity whereas centistoke is a kinematic measurement of viscosity. The conversion from centistoke and centipoise to si. units is given below: [00641 1cS =0.000lm2/s 1cP 0.001Ns/m2 INVENTION IN GENERAL [0065] The invention includes needleless injector devices which devices are loaded with containers which containers include high viscosity formulations comprised of pharmaceutically active drug wherein the high viscosity formulation is difficult to inject 11 WO 2007/061896 PCT/US2006/044778 dPCA!dhd'e iless injector device. As shown within Figure 3 a needleless injector device of the invention can include formulations which have viscosities over a relatively wide range such as from 1 cS to 10,000 cS or more at about 20"C and still deliver about 0.5 ml of formulation in less than about 0.10 second. This is obtained by utilizing a needlesless injector device with a nozzle having an opening and a length such that 0.5 mg or more of formulation having the viscosity in the range of I cS to about 10,000 cS can be delivered out of the needleless injector device through the nozzle and into the patient in about 0.1 second. [0066] An aspect of the method of injecting a patient which may be any patient and includes human patients. The method includes loading a liquid formulation into a needleless injector device. The formulation is comprised of a pharmaceutically acceptable drug in a carrier. The formulation has a viscosity as described herein which viscosity is preferably about 5 cS or more at about 20"C. When the formulation is loaded into the needleless injector about 5 ml of formulation or more of the formulation is extruded from the device in a narrow stream through an exit nozzle of the device. The stream is extruded at a rate of speed such that the stream punctures the skin of the patient such as a human patient. The 5 ml of formulation is extruded from the nozzle of the device through the skin in about 0.1 second or less. [00671 The formulation may include particles such as microparticles and may include an agent which affects the viscosity of the formulation which may enhance the viscosity or decrease the viscosity as needed. Such viscosity enhancing agents are described within U.S. Patent 6,667,061 and include compounds such as sodium carboxymethylcellulose. The formulation may also include wetting agents or other components which may generally be found within injectable formulations. The invention includes containers which are specifically designed for use in connection with needleless injector devices which containers have loaded therein formulations of the invention which are particularly suitable for injection in a manner as described here. Some formulations are designed such that when the formulation is injected the viscosity of the formulation increases due to body temperature forming a solid or semi-solid implant within the patient. Such formulations are useful particularly with respect to providing controlled release of the drug contained within the formulation. [0068] The global pharmaceutical market is growing rapidly. This growth is expected to continue and probably increase further. The genomics and proteomics revolutions, combined with huge advances in protein development, monoclonal antibodies and other areas, have 12 WO 2007/061896 PCT/US2006/044778 Pi e i fl'TIiDk t ;jec tale drugs is probably growing faster than most since the majority of these molecules are too large and/or fragile to be delivered by other methods such as orally. [00691 Controlled release (CR) drug delivery systems are used to improve the therapeutic response by providing blood levels that are more consistent and stable compared to immediate release dosage forms. They can result in a reduction in adverse reactions since less drug is required and since the drug may be targeted to the site in vivo avoiding high systemic levels. As a consequence of targeted and controlled release, patient compliance may be improved diie to lower dosing frequencies and simpler dosing regimens. With targeting and more sustained, predictable levels, efficacy may also be enhanced. CR parenteral drug delivery systems include: suspensions, liposomes, microspheres, gels and implants. Tiny microspheres and larger implantable devices can be used to modify release over periods of months to years. These delivery systems are becoming increasingly utilized by the pharmaceutical industry to deliver drugs for treatment or prevention of a variety of diseases. [00701 Furthermore, many pharmaceutical companies have developed or are developing sustained release formulations, to give a better pharmacological effect and/or a decreased frequency of injection. [0071] However, it is difficult to formulate many of these molecules into stable solutions that are sufficiently concentrated to inject a reasonable sized dose (<Iml). These formulations are also usually highly viscous - some are even gel-like with a viscosity of many Poise. This means that they are impractical to inject using a conventional needle and syringe. Viscosity versus Injection Time [00721 A laboratory trial was then performed to understand the difficulties of injecting viscous liquids using a needle and syringe and to detennine whether the theory is applicable. Viscous fluids were forced through the needle using a hand-powered syringe and the injection time was recorded for a given applied force. Experimental details and results are described in detail in the example section. [00731 Results from this study indicated that needle-free injectors with a nozzle that has a substantially larger orifice/length ratio as compared to a conventional needle, are capable of delivering formulations at a high driving pressure, have the potential to deliver liquids that are thousands of times more viscous than those that can be delivered using a needle and syringe. 13 WO 2007/061896 PCT/US2006/044778 Pt: . # dAid iKea rofie for surface eroding formulations [00741 When injected with a needle and syringe, most depots will form a substantially spherical depot. In contrast, a needle-free injector can form a more spread out, complex form with a larger surface-to-volume ratio than a sphere. A spherical depot is less preferred for surface eroding systems, because as the depot erodes, the surface area decreases as the volume decreases. A preferred shape would be a sheet, or sheet-like shape. This type of shape would not substantially decrease in surface area as the depot erodes. Therefore, needle free injectors have the capability of actually improving the drug release kinetics of a depot, resulting in a more constant rate of drug release. [0075] Examples of surface eroding systems include polymer families of polyanhydrides and poly(ortho esters) In 1985, Langer and his group developed the polyanhydride poly[bis(p carboxyphenoxy)] propanesebacic acid (P(CPP:SA)), an extremely hydrophobic polymer with surface-controlled erosion. Gliadel entered the U.S. market in 1996, and is today approved in several countries of the world. Studies have been reported where poly ortho esters were used for small molecule as well as macromolecule applications (Heller et al. European Journal of Pharmaceutics and Biopharmaceutics 50 (2000) 1211128, US patent no. 6,667,371). Pain during injection [0076] Pain and discomfort at the injection site may result in patients' refusal of depot injections. J Clin Psychiatry. 2001 Nov; 62(11):855-9 reported a study where long-acting depot injections of antipsychotic medications for patients suffering from schizophrenia were evaluated for pain. The depot injections caused pain, which was maximal immediately after the injection. A correlation existed between reported injection site pain and the effect it had on patients' attitude toward the depot injection as reported by the patients. [00771 As per the package insert for Nutropin Depot, in studies involving 138 pediatric patients treated with Nutropin Depot, the most frequent adverse reactions were injection-site reactions, which occurred in nearly all patients. On average, 2 to 3 injection-site adverse reactions were reported per injection. These reactions included nodules (61% of injections), erythema(53%), pain post-injection (47%), pain during injection (43%), bruising (20%), itching (13%), lipoatrophy (13%), and swelling or puffiness (8%). The intensity of these reactions was generally rated mild to moderate, with pain during injection occasionally rated as severe (7%). Cooper et al. reported (Anaesthesia, Volume 55 Issue 3 Page 247, March 14 WO 2007/061896 PCT/US2006/044778 "'$Tim46t6es in on injection with the needle-free injector than with the 250 needle. [0078] In a study that included comparing pain for needle-free and needle and syringe delivery, using a visual analogue scale, 60% of subjects reported no injection pain with the needle-free injector as compared to 30% of subjects with the needle and syringe. 41% of subjects reported pain levels of 4 or less, whereas 65% of subjects reported this degree of pain with needle and syringe (stout et al, Drug Delivery Technology, April 2004, Vol 4, No.3). Viscous Controlled Release Formulations [0079] A number of specific compounds as well as generic descriptions of compounds which may be used in needleless injector formulations are disclosed here. Further, numerous patents and publications which are incorporated herein by reference are disclosed for teaching other formulations which could be used in connection with the invention. However, it is important to note that the invention is directed towards high viscosity formulations and such high viscosity formulations are, in general, formulations which behave in a manner such as that shown within Figure 3. Specifically, the formulation will have a viscosity at about 20'C such that the viscosity reading is in a range of 1 to about 10,000 cS and can be delivered by needleless injector device in about 0.1 second. Examples of specific formulations include those which have a viscosity in the range of 100 to about 10,000 cS at about 20"C and which can be delivered (0.5 ml) by a needleless injector device in about 0.1 second. In general, when such formulations are administered by hypodermic needle injection the injection requires about 10 seconds or more. Accordingly, the formulations and compounds described below should be reviewed and considered by those skilled in the art with consideration to obtaining the desired viscosity levels such that the formulation (0.5 ml) could be delivered using a needleless injector device in about 0.1 second and could not be readily delivered by a hypodermic needle injecting device in such a short period of time or more specifically, those formulations wherein the hypodermic needle injector device requires more than 1 second, more than 2 seconds, more than 3 seconds, or more than 10 seconds to complete the injection. [0080] An example of a sustained release polymer fonnulation that can be delivered by needle-free injection could use poly(ortho esters) as the vehicle. For example, see US Patent No.s 4,304,767, 4,957,998, 5,968,543 and WO 02/092661 as well as Adv. Polymer Sci., 107, 41-92 (1993) and references therein. Viscosities of these controlled release polymers were reported to be in the 1,500 cP range (see Biomaterials, 23, 2002, 4397-4404). Considerably 15 WO 2007/061896 PCT/UTS2006/044778 c ilfrr S for higher molecular weight polymers (see Adv. Drug Del Reviews, 53, 2001, 45-73). [0081] The invention may be used wherein the pharmaceutical agent is selected from a group consisting of antibodies or monoclonal antibodies, anti-inflammatory agents, antibacterial agents, antiparasitic agents, antifungal agents, antiviral agents, anti-neoplastic agents, analgesic agents, anaesthetics, vaccines, central nervous system agents, growth factors, hormones, antihistamines, osteoinductive agents, cardiovascular agents, anti-ulcer agents, bronchodilators, vasodilators, birth control agents and fertility enhancing agents, interferon alpha, osteoporosis drugs including PTH and PTH analogs and fragments, obesity drugs, psychiatric drugs, anti-diabetes, female infertility, AIDS, treatment of growth retardation in children, hepatitis, multiple sclerosis, migraine headaches, and allergic reactions. [0082] The invention may be used wherein the pharmaceutical agent is a polypeptide or protein member selected from the group consisting of oxytocin, vasopressin, adrenocorticotropic hormone, epidermal growth factor, platelet-derived growth factor (PDGF), prolactin, luliberin, luteinizing hormone releasing hormone (LHRH), LHRH agonists, LHRH antagonists, growth hormone (human, porcine, bovine, etc.), growth hormone releasing factor, insulin, erythropoietin, somatostatin, glucagon, interleukin-2 (IL 2), interferon-.alpha.,.beta., or .gamma., gastrin, tetragastrin, pentagastrin, urogastrone, secretin, calcitonin, enkephalins, endorphins, angiotensins, thyrotropin releasing hormone (TRH), tumor necrosis factor (TNF), nerve growth factor (NGF), granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage-colony stimulating factor (GM-CSF), macrophage-colony stimulating factor (M-CSF), heparinase, bone morphogenic protein (BMP), hANP, glucagon-like peptide (GLP-1), interleukin-1 1 (IL-1 1), renin, bradykinin, bacitracins, polymyxins, colistins, tyrocidine, gramicidins, cyclosporins and synthetic analogues, modifications and pharmacologically active fragments thereof, enzymes, cytokines, antibodies, vaccines and polymers, which may be copolymers or conjugates comprised of poly(ortho esters). [0083] Formulations of the invention may include a polymer selected from the group consisting of but not limited to poly-lactic acid, poly glycolic acid, copolymers of lactic acid and glycolic acid and mixtures thereof or the formulation includes [00841 Formulations of the invention may include a polymeric material selected from the group consisting of but not limited to copolymers of lactic acid and glycolic acid, and mixtures thereof. 16 WO 2007/061896 PCT/US2006/044778 JUS $nrl of the invention the formulation is capable of forming a depot. [0086] In one embodiment of the invention the formulation is in a polymeric, copolymeric or conjugated form using peptides or other conjugates wherein the [0087] polymers, copolymers or conjugates are comprised of methacralate or [0088] wherein said polymers, copolymers or conjugates are comprised of caprolactone or [0089] wherein said polymers, copolymers or conjugates are comprised of chitosan or [0090j wherein said polymers, copolymers or conjugates are comprised of polyanhydrides or [0091] wherein said polymers, copolymers or conjugates are comprised of polyethylene glycol or [0092] wherein said polymers or copolymers are comprised of polyphosphoesters or [0093] wherein said polymers, copolymers or conjugates are comprised of polyphosphosphazenes or [0094] wherein said polymers, copolymers or conjugates are comprised of dextran or other carbohydrate or sugars or [0095] wherein said polymers, copolymers or conjugates are comprised of dendrimers or other star polymers such as fullerenes or [0096] wherein said polymers, copolymers or conjugates are in a colloidal or suspension form or [0097] wherein said polymers, copolymers or conjugates are in a cross-linked form or present as crystals or nanocrystals or [0098] wherein said polymers, copolymers or conjugates are calcium phosphate particles or nanoparticles or [00991 wherein said polymers, copolymers or conjugates are comprised of polyetherester or [001001 wherein said polymers, copolymers or conjugates are comprised of hyaluronic acid or [001011 wherein said polymers, copolymers or conjugates are comprised of collagen or [001021 wherein said polymers, copolymers or conjugates are comprised of gelatin or [001031 wherein said polymers, copolymers or conjugates are comprised of dextran or [00104] wherein said polymers, copolymers or conjugates are comprised of amphiphiles or [00105] wherein said polymers, copolymers or conjugates are comprised of lipids and various physical agglomorates of lipids with or without polymer hybrids including but not limited to liposomes, hexagonal shapes or [00106] wherein said polymers, copolymers or conjugates are comprised of methacrylamides or 17 WO 2007/061896 PCT/US2006/044778 Ia ]li 1u I A J Aers, copolymers or conjugates are comprised of polyethylene oxides or [00108] wherein said polymers, copolymers or conjugates are comprised of emulsifiable lipids or [001091 wherein the non-polymeric non-water soluble liquid carrier material is sucrose acetate isobutyrate or [00110] wherein said polymers, copolymers or conjugates are comprised of calcium phosphate or [00111] wherein it is comprised of but not limited to a polymeric, encapsulated, dispersed, suspended sugar or carbohydrate constituents or wherein [00112] the formulation is in an oil suspension or [001131 the formulation is in the form of liquid crystals. Liposomes [00114] Phospholipid vehicles as drug delivery systems were rediscovered as "liposomes" in 1965 by Bangham [Bangham et al., J.Mol.Biol. 13 (1) (1965) 238-252.]. In the early 90's, three products for intravenous injection entered the market: Ambisome@ for the systemic fingal treatment, and two chemotherapeutic liposomal formulations (Doxil(@ and Daunosome@). Vasopressin entrapped in PEGylated long-circulating liposomes even remained bioactive one month after intravenous injection. [00115] A new approach, rather than using unilamellar or multilamellar liposomes, is based on the DepoFoamTM system. These multivesicular liposomes (1-100 pm) contain multiple non concentric internal aqueous compartments and lead to an increase in the encapsulation efficiency. After subcutaneous injection, the release of encapsulated peptide and protein was shown to be prolonged up to 7 days for DepoInsulin and up to 3 weeks for the DepoLeuprolide@ formulation [Ye, Q et a., DepoFoam technology,, J.Control.Rel. 64 (1-3) (2000), 155-166.]. (00116] The company Novosom AG has patented a novel liposome-based depot system for proteins and peptides. The Cagicles@ depots are produced by a two step method: first, proteins are dissolved in an aqueous medium and then added to solutions of membrane forming substances, which are selected such that the resulting membrane enters into a reversible mutual reaction with the protein. This mild-condition process enables to increase the encapsulation rate over 30 % of incorporated protein. Furthermore, a one month sustained protein release was feasible after subcutaneous or intramuscular injection of the Cagicles@ 18 WO 2007/061896 PCT/US2006/044778 P~ IC T g# " Wpom AG, Application No. 2000-EP 11079, Patent No. WO 2001034115 (2000)]. These studies have proven the basic applicability of liposomes. The solubility benefits of liposomes are well known and reported. Lipid nanoparticles and microspheres [00117] -Solid lipid nanoparticles (SLNs) represent a colloidal carrier system mainly based on triglycerides. Due to their hydrophobic nature and their small size, SLNs may be more appropriate for incorporation of lipophilic drugs, which can be easily dissolved in the melted mixture. For instance, only small quantities of lysozyme can be incorporated into various lipids (Almeida et al, Int.J.Pharm. 149 (2) (1997) 255-265). Solid lipid nanoparticles own potential for the encapsulation of drugs with a low solubility (e.g. pacitaxel), for the application of surface-modified SLNs in drug targeting, or maybe for the use as adjuvant for vaccines. Furthermore, it can be hypothesised that SLNs can be applied for oral drug delivery in the form of aqueous dispersions or that they can alternatively be used as additives in traditional dosage forms such as tablets, capsules or pellets. [001181 US Patent No. 6,277,413 describes a biodegradable microsphere having a matrix, the matrix comprising at least one type of biodegradable polymer, and at least one type of lipid; and a physiologically active substance which is releasable from the biodegradable microsphere. Lipid Crystals [00119] EP 0767,656B1 describes a pharmaceutical composition, which is glycerol-ester based and contains diacyl glycerol as well as phospholipid(s), or a polar group containing water, glycerol, ethylene glycol or propylene glycol. The proportions between the components are adjusted to form an L2 phase or a liquid crystalline phase, with the biological material being dispersed or dissolved in the L2 or liquid crystalline phase. Oil suspensions (00120} Generally, the viscosity of oily media is considerably higher than the viscosity of an aqueous phase such as buffer. Therefore, drug release can be prolonged by implementing oil suspensions. In addition, the viscosity of the oily carrier can be further increased by the addition of gelling agents such as aluminium monostearate -thus enabling the control of process parameters like drug solubility and drug transfer rate. A further important aspect using oils as drug carrier refers to the distribution coefficient of compounds in the oily medium and the surrounding tissue. A lipophilic drug with a high distribution coefficient will 19 WO 2007/061896 PCT/US2006/044778 i g pa & $ iiida oily medium resulting in further deceleration of effective drug actions. [00121] For several years, various peptides and proteins have been dispersed in oils to engineer sustained-release formulations. Nestor et al. patented as early as 1979 the development of long-acting injectable depot formulations for super-agonist analogues of luteinizing hormone-releasing hormone (LH-RH), applying oils such as peanut oil or sesame oil and a gelling agent such as aluminium stearate [Nestor et al, Syntex Inc., Patent No. US 4,256,737 (1979).]. Hydrogels [00122] Thermoreversible hydrogels are of great interest in drug delivery. These include thermosensitive gel materials including poly(ethylene glycol)/poly(propylene glycol) block copolymers (poloxamers), poly(ethylene glycol)/ poly(butylenes glycol) block copolymers, poloxamer-g-poly(acrylic acid) and copolymers of Nisopropylacrylamide that exhibit a sol to-gel transition in aqueous solutions. Diblock copolymers of poly(ethylene oxide) (PEG) and poly(lactic acid) (PLA), and triblock copolymers of PEG-PLGA- PEG are also used as alternative hydrogels that would provide biodegradable and injectable drug-delivery systems under physiological conditions. Some natural polymers including gelatin, agarose, amylase, amylopectin, cellulose derivatives, carrageenans, and gellan, exhibit thermoreversible gelation behavior. Some cellulose derivatives of natural polymers, such as methyl cellulose and hydroxypropyl cellulose, exhibit reverse thermogelation behavior (gelation at elevated temperatures). Viscosity of these hydrogels is a concern for parenteral delivery. Viscosity of these hydrogels can be extremely high at low shear rates (Eur. J. of Pharm. and Biopharm., 59, 2005, 333-342). Poly hydroxyl methacralate is extensively used in hydrogel formulations (Peppas et al., European Journal of Pharmaceutics and Biopharmaceutics 50, 2000, 27). US Patent No. 6,602,952 describes a polymeric structure comprising a multifunctional poly(alkylene oxide), such as a poly(ethylene glycol) derivative, covalently cross-linked to a polymer selected from the group consisting of chitosan and conjugates of chitosan and a monofunctional poly(alkylene oxide), such as methoxy poly(ethylene glycol). In aqueous media, the polymeric structure forms a hydrogel. Depot formulations and Implantables [00123] hplantable drug delivery devices provide an attractive therapeutic tool for treatment of a variety of diseases and conditions, especially when a sustained release effect is also added to the therapy. Various implantable dug delivery devices have been developed, and 20 WO 2007/061896 PCT/US2006/044778 nQ"f 't Lechanisms to accomplish movement of drug from a reservoir to the treatment site. U.S. patent no. 4,938,763 discloses a method for forming an implant in situ by dissolving a non-reactive, water insoluble thermoplastic polymer in a biocompatible, water soluble solvent to form a liquid, placing the liquid within the body, and allowing the solvent to dissipate to produce a solid implant. U.S. patent no. 5,747,058 describes a composition for the controlled release of substances that includes a non-polymeric non-water soluble high viscosity liquid carrier material of viscosity of at least 5,000 cP at body temperature that does not crystallize neat under ambient or physiological conditions. Delivery of Macromolecules [00124] Protein formulations at high concentrations may also have physical properties that impact the ability to easily deliver the protein drug. For example, higher viscosity preparations may be difficult to administer by injection. Syringes for SC injection are often equipped with 26 or 27 gauge needles (J of Pharmaceutical Sciences, Volume 93, Issue 6, p 1390-1402). [00125] Proteins such as monoclonal antibodies are often administered with frequent dosing regimens and at high doses (several mg/kg). Two antibodies, Rituxanl and Herceptini that have been approved for the treatment of cancer are intravenously administered in hospitals, but several programs are underway for use of monoclonal antibodies to treat diseases that may require outpatient administration, and hence require the development of SC route of administration. Treatments with high doses, e.g., more than 1 mg/kg or 100 mg per dose, require development of formulations at concentrations exceeding 100 mg/mL because of the small volume (<1.5 mL) that can be given by the SC routes (J of Phannaceutical Sciences, Volume 93, Issue 6, p 1390-1402). (00126] US Patent No. 6,541,606 describes protein crystals or crystal formulations that are encapsulated within a matrix comprising a polymeric carrier to form a composition. The formulations and compositions enhance preservation of the native biologically active tertiary structure of the proteins and create a reservoir which can slowly release active protein where and when it is needed. Conjugated Systems [00127] Polymer carrier systems may have certain advantages over'non-polymeric carriers in terms of avoiding uptake by macrophages. Because liposomes are spherical vesicles made of phospholipids are particles, they get taken up by macrophages. High levels can be found in the liver and spleen, even when the liposomes are given "stealth" characteristics by coating 21 WO 2007/061896 PCT/US2006/044778 P T& meanwhile, have the disadvantage that most receptors on tumor cells are also present on normal cells, making it hard to find ones that are unique to cancer. [001281 In contrast, water-soluble polymers allow working with a single molecule rather than a large particle. To avoid the liver and spleen, uncharged hydrophilic polymers, such as PEG and N-(2-hydroxypropyl) methacrylamide can be used. When these polymers are hydrated, they can circulate in the blood for periods of up to about 24 hours (C&E News, Volume 80, Number 34, 39-47). [00129] Examples of other conjugated systems include PEGylation. PEGylation decreases the rate of clearance from the bloodstream by increasing the apparent molecular weight of the molecule. Up to a certain size, the rate of glomerular filtration of proteins is inversely proportional to the size of the protein. Decreased clearance can lead to increased efficiency over the non-PEGylated material (see Conforti et al., Pharm. Research Commun. vol. 19, pg. 287, 1987 and Katre et al., Proc. Natl. Acad. Sci. U.S.A. vol. 84, pg. 1487, 1987). The conjugation could be either in-vitro or in-vivo. [00130] W02005034909A2 describes a hyperbranched polymer attached to a core and a biologically active moiety. The biologically active moiety is attached to the core by means of a substantially non-enzymatically cleavable linker L. The composition can be used to deliver the biologically active moiety to its target. [00131] US Patent No. 6,946,134 describes therapeutic proteins fused to albumin or fragments or variants of albumin, that exhibit extended shelf-life and/or extended or therapeutic activity in solution. The role of albumin as a carrier molecule and its inert nature are desirable properties for use as a carrier and transporter of polypeptides in vivo. The use of albumin as a component of an albumin fusion protein as a carrier for various proteins has been suggested in WO 93/15199, WO 93/15200, and EP 413 622. The use of N-terminal fragments of HA for fusions to polypeptides has also been proposed (EP 399 666). [001321 US Patent No. 5,367,051 describes fullerene-functionalized amine-containing polymers and polymerizable monomers characterized by high temperature stability, i.e., capable of withstanding a temperature of at least about 300.degree. C., when in polymerized form. The fullerene groups are bonded to the polymers through the amine groups on the polymer. 1001331 WO Patent No. 2005073383 describes novel heterodimeric fusion proteins comprising a first polypeptide including an alpha subunit of FSH (aFSH) linked directly or indirectly to a binding partner of neonatal Fe receptor (FcRn) and a second polypeptide 22 WO 2007/061896 PCT/US20061044778 p C Tiff MNE 411'.Ndt dFSH (IIFSH) linked directly or indirectly to an FcRn binding partner. The conjugated polypeptide has increased half-life and bioavailability as compared to traditional forms of FSH therapy. Dendrimers [00134] Dendrimers are well-defined polymeric structures. Dendrimers are based on repeating hyperbranched structures emanating from a central core (US 4, 507,466). Typical dendrimers are based on polyamidoamine (PAMAM), polyethylene imine (PEI), polypropylene imine or polylysine. These synthetic macromolecules are assembled in a stepwise fashion, with each reaction cycle adding another layer of branches (dubbed,,generation"). Dendrimers are synthetically accessed by stepwise, divergent,,bottom-up" or convergent,,top-down" synthesis. Central structural component is the core unit from which hyperbranched dendrimers extend in a radially symmetric fashion. The core may provide at least two reactive groups for dendrimer conjugation, it may also be of heterofunctional nature and protecting groups may be used. In the latter case, the dendrimer may be assembled, and a guest compound may be subsequently conjugated to an anilin core by means of orthogonal chemistries (WO 88/01180). The core and dendrimers form the interior or backbone of a dendrimer. As a consquence of the spherical symmetry supported by sterical crowding, the terminal groups of the hyperbranches are defining the exterior. In higher generation dendrimers, the terminal branches form rather dense shells and flexible internal voids have been discovered. It is understood, that for a given dendrimer these cavities are filled up by backfolded end groups and tightly coordinated solvent molecules. Dendrimers are related to micelles, similary well suited to complex hydrophobic compounds. But in contrast they exhibit higher structural order because of their monomolecular nature and the absence of a dynamic equilibrium of various species. Synthetic compounds can only diffuse into dendrimers if certain structural requirement such as conformational rigidity and flatness as well as charge distribution such as affinity to tertiary amines are met. Various apolar compounds such as pyrene or naphthalene have been encapsulated in dendrimers. [001351 In US 5,714,166 and WO 95/24221', dendrimer-protein conjugates are revealed. PAMAM dendrimers of G4 are. covalently coupled through their terminal functional groups to insulin, fluorescently labeled insulin, avidin, monoclonal antibodies and bradykinin. The reactive groups used for conjugation are only present at the surface of the dendrimers, and therefore any covalent adduct generated by the leached method will be associated with the dendrimer exterior. 23 WO 2007/061896 PCT/US2006/044778 [64Z3Y 3 Fij1 W hfNiA s contain free amine groups on their surfaces and readily associate with DNA through electrostatic interactions. 1001371 WO 01/07469 details water-soluble polypeptide dendrimers constituted of ornithin and glycine amino acids. The patent application also teaches the non-covalent encapsulation of an oligosaccharide, heparin, by dendrimerization of the dendrimer core in presence of heparin under mild conditions. The oligosaccharide is released from the dendrimer by light induced cleavage of W-labile bonds within the dendritic backbone. The core structure used here was tris(2-maleimidoethyl)amine. Other Polymeric Systems [00138] Passirani et al. evaluated the use of heparin, dextran and methyl methacralate in a biomimetric approach in the development of drug carriers escaping early capture by phagocytosis (Passirani et al, Pharm Res, 1998, 15, 1046). 1001391 The synthesis of hybrid block and graft copolymers of polyphosphazenes and polystyrene is a way to combine the attributes of both polymers and generate new properties. Many of the valuable properties of the respective phosphazene and styrene homopolymers can be combined without sacrificing the overall solid state or solution properties of both polystyrene and polyphosphazene polymers. US Patent No. 6,392,008 describes such compositions of polyphosphazene-containing polymers. [00140] US Patent No. 5,176,907 describes biocompatible and biodegradable poly(phosphoester-urethanes), compositions comprising the poly(phosphoester-urethanes), and methods of use as a drug delivery device and an implant. Needle-Free Injectors [001411 Specific injector devices which might be used with the present invention include injectors chosen from IntraJect@, Biojector 2000, Iject*, Intelliject, Injex, HSI 500, Medijector vision, Mini-Ject, PenJet@, Vitajet, PMED, Avant Guardian 101, Activa, Antares, Ypsomed, Medjet, The Medical house, Am-0-JetT, CrossiectTM, Dermolet@ & Vacci-Jet, HyjettorTv, IM-O-JETTM, and an LectraletTm 1001421 Needle-free injection of medications and vaccines represents an alternative route of administration that is as effective as needle and syringe but free of many of the problems. This method of injection utilizes a fine stream of medication at high pressure to penetrate the skin. The absence of hypodermic needles from the injection process removes the potential for needle-stick injuries and simplifies disposal. The rapidity of needle-free injections (typically 0.5 second or less) ftither enhances patient compliance and acceptance. 24 WO 2007/061896 PCT/US2006/044778 ijyigi10n' A."i-free injection devices in current use are distinguishable by the source of the power for injections - either a spring or compressed gas. Each of these designs has particular advantages and disadvantages. [00144] Spring-powered devices have the advantage of being small and light. They are also relatively inexpensive and durable. The disadvantages of this type of injector result from the limited amount of force that is generated by a coiled spring, which to some extent reduces the versatility of this class of injector. (001451 Examples of spring-powered, needle-free injection devices include the Activa AdvantaJet, which is designed primarily for subcutaneous injection of 0.5-50 units of insulin. The Equidyne Injex is directed primarily at the diabetes market, and can deliver 0. 02-D.5 ml of insulin subcutaneously. Use of the Injex for delivering vaccines is being explored as well (Sarno MJ et al,, 2000. Pediatr. Infect. Dis. 1. 19:839-842). The Bioject/Vitajet 3 was originally developed for subcutaneous injection of insulin, and has recently been adapted by Serono as a delivery platform for their Saizen (Silverstein et al, 2001 Endocrine 15:15-17) and Serostim (Murray et al, 2001, Today's Therapeutic Trends 19:137-155) formulations of recombinant human growth hormone. Needle-free delivery of growth hormone has considerable appeal from the perspective of acceptance and compliance in the paediatric market (Saizen) and improved safety for injecting HIV-positive patients (Serostim). [00146 The Antares/Medi-Jector VISION is a spring-powered device intended for subcutaneous injections of 2 to 50 units of insulin (Bremseth et al, 2001, Diabetes Technol. Ther. 3:225-232). Medi-Ject devices have also proven to be effective in delivering other medications (Verrips et al, 1998, Acta Paediatr. 87(2):154-8) and DNA vaccines (Anwer et al., 1999, Pharm. Research 16:889-895). The Medi-Jector VISION uses a replaceable transparent needle- free syringe, which is available in three orifice sizes. Changing the orifice size modulates the injection pressure to accommodate differences in the thickness and penetrability of various skin types and anatomical locations. Other similar Medi-Jector devices are marketed for administering recombinant human growth hormone (GH, Hirasing et al., , 1998Acta Paediatr. 87(2):154-8). [001471 Gas-powered devices present the advantages of the more sustained force provided by compressed gas relative to a coiled spring. Thus, larger volumes of injection (up to 1.0 ml) can be administered via either the subcutaneous or intramuscular route. The primary disadvantage of gas-powered devices is that, unlike a spring, the source of power is exhaustible and must therefore be replaced periodically. Other disadvantages include the 25 WO 2007/061896 PCT/US2006/044778 bg-LIj90' tU1idg ater cost of many current gas-powered injectors, compared with spring-powered devices. [00148] Examples of gas-powered injection devices include the C02-powered Biojector 2000, the advantages of which include versatility, as it can provide IM and SQ injections of volumes ranging from 0.1 to 1 .0 ml (Stout R, Miller R, 1997 ). Visionary Medical Products manufactures the PenJet, a small disposable injector that uses pre-filled arnpoules to deliver up to 0.5 ml of medication. Activation of the device is pressure-sensitive, which ensures that the user applies the appropriate amount of force when administering an injection. To provide increased convenience, National Medical Products has developed the 1-Tip, a C02-powered disposable injector designed to deliver subcutaneous injections of 0.02 to 0.25 ml of insulin. Injection of lidocaine and low molecular weight heparin with the J-Tip has been evaluated as well (Hollingsworth SJ et al., , 2000. Ann. R. Coo. Surg. Eng. 82:428-431). [00149] US Patent No. 5,911,703 (Avant) describes a two-stage jet injector of the present invention includes, in combination, a syringe unit, a drive mechanism for advancing the syringe plunger in a two-stage sequence, and a suction compartment which surrounds an injection tube of the syringe. The drive mechanism includes a push rod which is positioned longitudinally co-linear with the plunger of the syringe, when the syringe unit is operably connected to the drive mechanism. Accordingly, advancement of the plunger into the syringe chamber is caused by movement of the push rod. In accordance with the present invention, the push rod is driven by two separate springs, which are engaged with the push rod, and which are coaxially positioned around the push rod. Specifically, the first of the two coaxial springs is an impulse spring which is characterized by a relatively high spring constant and the fact that it is dimensioned to have a relatively short action distance. In comparison with the first spring, the second spring, a perfusion spring, has a lower spring constant and a longer action distance. EXAMPLES [00150] The following examples are put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how to make and use the present invention, and are not intended to limit the scope of what the inventors regard as their invention nor are they intended to represent that the experiments below are all or the only experiments performed. Efforts have been made to ensure accuracy with respect to numbers used (e.g. amounts, temperature, etc.) but some experimental errors and deviations should be accounted for. 26 WO 2007/061896 PCTIUS2006/044778 t i e,, arts are parts by weight, molecular weight is weight average molecular weight, temperature is in degrees Centigrade, and pressure is at or near atmospheric. EXAMPLE 1 VISCOSITY VERSUS INJECTION TIME [001511 Two trials were undertaken to determine the injection time of viscous fluids with both Intraject and a needle and syringe. The viscous fluids used in the trials were a range of different viscosity Dow Corning silicone oils. For the needle and syringe a range of the fluids were ejected by hand and the times recorded, for Jntraject the jet tester was used to measure injection time and jet parameters for all available viscosities, however high-speed video was used for the thickest of the fluids because they would not flow properly off the jet tester sensor and so did not give useable readings. [001521 For the needle trial a 3ml syringe and a 23G needle were used; the needle had an internal diameter of 0.38nm and was the closest available needle size to that of the Intraject orifice (0.3mm). The needle had a length of 31mm and the syringe had an intemal cross sectional area of 58.5mm 2 . Liquid formulation in an amount of 0,5ml with viscosities of 50, 100, 500 and 1,000 cS were ejected from the needle and syringe by hand and the times taken were recorded and averaged. As much force as possible was applied by hand to the syringe and a similar force was applied to all the oils used. However, with the thinner fluids it was hard to apply as large a force as with the thicker ones because the syringe plunger was moving faster. When a similar force was applied to a load cell about 15N was recorded. [001531 A standard Intraject device was used for the jet test trial; this included a standard 00.3mm orifice glass capsule, 2,100psi actuators, a 3mm impact gap and a standard piston. The same glass capsule was used for all the firings to remove any variations that may arise from differences between capsules. Liquid formulations in an amount of 0.5ml with viscosities of 1, 5, 10, 20, 50, 100, 500 and 1,000 cS was used in each device. To determine the injection time of both the 12,500cS and 30,OOOcS fluids high-speed video was used. [00154] Both sets of injection time data have been plotted together in Figure 3. However, because of the large differences in injection times for a needle and Intraject the only way to see both lines clearly is to plot the graph using logarithmic scales for both axes. Using the theory for fully developed flow and a force of 15N the theoretical time to inject 0.5ml of the viscous liquids was calculated and also plotted. 27 WO 2007/061896 PCT/US2006/044778 u E4R6iQ&Ml ;4 (see figures 2 and 3): 100156) A 23G needle, 31mm long, would take 90 seconds to inject 0.5ml of a 1,000cS solution with the user applying as much force as possible with their thumb on the end of the syringe (approx 15N). This compares to less than a second for a drug with the viscosity of water. [001571 By contrast, Intraject took 0.085 seconds to inject a 1,000cS solution. [001581 The injection time for highly viscous fluids can be extrapolated from trial data. For Intraject this gave a 1 second injection with 0.5ml of 150,OOOcS fluid and 7 seconds for a 1,000,000cS fluid. Using a 23G needle and syringe with these fluids would give injection times of 5hr and 33hr respectively. [001591 There are two reasons for the difference in performance. Firstly an Intraject nozzle is considerably shorter than the needle, which means that viscous flow does not have a chance to develop. Secondly, the driving pressure in Intraject is much greater than in a needle and syringe, this leads to a faster flow of liquid and a shorter injection time. [00160] The application of fully developed laminar pipe flow theory allows us to predict the injection times for different combinations of needle lengths and diameters, as well as understand the limits of Intraject with highly viscous fluids. [00161] Results from this study indicate that needle-free injectors with a nozzle that has a substantially larger orifice/length ratio than a needle, and/or capable of delivering formulations at a high driving pressure, have the potential to deliver liquids that are thousands of times more viscous than those that can be delivered using a needle and syringe. [00162] While the present invention has been described with reference to the specific embodiments thereof, it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, process step or steps, to the objective, spirit and scope of the present invention. All such modifications are intended to be within the scope of the claims appended hereto. 28 C:\NRPotbl\DCC\KXG4]80170 1.DOC-29/02/2012 [001631 Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps. [001641 The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates. 28A

Claims (19)

1. A device for delivery of an active pharmaceutical ingredient, comprising a needle-free injector, and a formulation having a viscosity of about ScS or more at about 20"C.

2. The device of claim 1, wherein the needle-free injection comprises an actuator and a drive member movable through a stroke to cause about 0.5 ml of formulation or more to be delivered by the injector in less than 0.5 second.

3. The device of claim 2, wherein the actuator is chosen from a gas-powered actuator and a spring powered actuator.

4. The device of claim 2, wherein the formulation comprises 0.5 ml or more and is administered in about 0.1 second or less.

5. The device of claim 4, wherein the formulation has a viscosity of about 10 cS or greater.

6. The device of claim 4, wherein the formulation has a viscosity of about 100 cS or greater.

7. The device of claim 4, wherein the formulation has a viscosity of about 1000 cS or greater.

8. The device of claim 4, wherein the formulation has a viscosity of about 10,000 cS or greater.

9. The device of claim 4 wherein said formulation is comprised of a polymer.

10. The device of claim 4, wherein the formulation upon injection forms an in-situ implant. 29 WO 2007/061896 PCT/US2006/044778 .I f "W80h4t improving delivery from a surface eroding depot, comprising: delivering the surface eroding depot with a needle free injector.

12. The method of claim 11, wherein the improvement comprises: causing the rate of release of active compound to be more constant in time.

13. The method of claim 14, wherein the surface eroding depot comprises of, but not limited to polyanhydrides and poly ortho esters.

14. A needleless injector device, comprising: a drive member which on actuation provides force; an actuation component which actuates the drive member; a power supply which provides force to the device member; a container of liquid formulation comprises a phannaceutically active drug and a carrier; a channel leading from the container to a nozzle exit opening; wherein the formulation has a viscosity of about 5 cS or more at about 20*C and wherein on actuation about 0.5 ml or more of formulation is forced from the nozzle in about 0.1 second or less.

15. The device of claim 14, wherein the formulation has a viscosity of about 10 cS or greater.

16. The device of claim 14, wherein the formulation has a viscosity of about 100 cS or greater.

17. The device of claim 14, wherein the formulation has a viscosity of about 1000 cS or greater.

18. The device of claim 14, wherein the formulation has a viscosity of about 10,000 cS or greater.

19. A method of injecting, comprising: 30 WO 2007/061896 PCT/US2006/044778 C "fU S; "dii' quid mulation into a needleless injector device, wherein the formulation comprises a pharmaceutically acceptable drug and carrier, the formulation having a viscosity of about 5 cS or more at about 20*C; extruding about 5 ml or more of the formulation from the device in a stream and at a rate of speed such that the stream punctures skin of a human patient; wherein the 0.5 ml is extruded from the device and through the skin in about 0.1 second or less.

20. The method of claim 19, wherein the viscosity is about 100 cS or more. 31