CA1075605A - Infusion solutions with salts of glycerophosphates - Google Patents

Infusion solutions with salts of glycerophosphates

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Publication number
CA1075605A
CA1075605A CA238,444A CA238444A CA1075605A CA 1075605 A CA1075605 A CA 1075605A CA 238444 A CA238444 A CA 238444A CA 1075605 A CA1075605 A CA 1075605A
Authority
CA
Canada
Prior art keywords
solution
glycerophosphate
phosphorus
sodium
phosphate
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
CA238,444A
Other languages
French (fr)
Inventor
Werner Fekl
Helmut Mader
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Pfizer Health AB
Original Assignee
Kabi Pharmacia AB
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Kabi Pharmacia AB filed Critical Kabi Pharmacia AB
Application granted granted Critical
Publication of CA1075605A publication Critical patent/CA1075605A/en
Expired legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00Medicinal preparations containing inorganic active ingredients
    • A61K33/24Heavy metals; Compounds thereof
    • A61K33/30Zinc; Compounds thereof
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/66Phosphorus compounds
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/70Carbohydrates; Sugars; Derivatives thereof
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00Medicinal preparations containing inorganic active ingredients
    • A61K33/14Alkali metal chlorides; Alkaline earth metal chlorides

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Epidemiology (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Inorganic Chemistry (AREA)
  • Molecular Biology (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Medicinal Preparation (AREA)

Abstract

ABSTRACT OF THE DISCLOSURE
Infusion solutions have a glycerophosphate dissolved therein to provide the source of phosphorus therefor and thereby overcome problems of hypophosphataemia and hypercal-caemia. The presence of the glycerophosphate does not inhibit the ability to sterilize the infusion solutions, especially at pH's above 6.

Description

~7~i~;05i The invention relates to solutions for parenteral perfusion ~or nutrition and/or supply,of calories, containing phosphorus, and for the treatment of hypophosphataemia and hypercalcaemia.
In parenteral nutrition, which iis usually carried out with perfusion solutions, which coIltain amino acids, carbohydrates, vitamins and essential minerals, it is also necessary to include an ade~uate supply of phosphorus (see, for example RVBERG R.L. Allen, et al.: Hypophosphatemia with H~pophosphaturia in Hyperalimentation. Surg. Forum~
2~:87, 1971). The simul~aneous administration of essent1al nutrients, Pspecially amino acias, carbohydrates and minerals, together with calcium and phosphorus, is particular-ly important, and the availability o~ inorganic phosphate is absolutely essential for "total parenteral nu~rition" ~ -("hyperalimentation"). Because of the use of highly purified amino acids in present-day parenteral nutrition, this phosphorus~
~iciency is particulæly liable to manifest itself since, in contrast to the situation when casein hydrolysis products were employed, there is now no phosphate available from the raw materials.
Moreover, the administration of phosphorus is not only necessar~ to cover the daily requirements of parenteral nutrition, but also to treat existing hypophosphataemias and hypercalcaemias. (D. Schwander, Intravenose Applikation ;von Phosphat (Intravenous Administration of Phosphate), Med.
: ~ .
Neuheiten No. 3/4, 1973~.
Furthermore, it is ~nown that in carbohydrate therapy an undesired lowering of the inor~anic serum phosphate level may occur. CDer initiale Phosphatabfall im Serum von .~ .
Gesunden und Leberkranken nach intravenoser Verabreichung . ~ . ....................... , ~ , .

~ ~ -"', .~ .

von Hexosen und 2ucheralkoholen (The Initial Decrease in Phosphate in the Serum of Healthy Persons and Patients Sllffering from Liver Diseases, after Intravenous Adminis-tration of Hexoses and Sugar Alcohols), H.P. Wolf, W.
Queisser and K. Beck, Klin, Wochenschrift 47th year of publication, issue 20, pages 1084-1086, 1969)~
These reasons make clear the importance of the intravenous administration of sources of phosphorus.
Hitherto it was unfortunately only possible to inject phosphorus, during the perfusion, in the form of inorganic phosphate, or to mix it with other substrates, shortly before administration, under aseptic conditions in the dispensary. The high level of technical effort and expenditure on personnel required for this, and the great danger of bacterioloyical contamination ~S.J. Dudrick, American Journal of Hospital Pharmacy 28:82-91 (Feb.) 1971 necessarily imposes se~ere limits on its routine use in clinics.
The preparation of a complete, sterilisable, phosphorus-containing parenteral nutrient solution which can be handled easily and safely has hitherto not proved possible. This was due, inter alia, to the calcium content and the relatively high pH value of these solutions lpH > 6).
In addition, heat sterilisation causes precipltation of calcium phosphate. Furthermore~ these solutions mostly also contain magnesium~ This also leads to precipitates of magnesium jammonium phosphate in the presence o inorganic .
phosphate and of the small amounts of ammonia (from the amino acids~ produced during stPrilisation, and as a result ~ -significantly .
- 3 -~

- . . ...
.: ... : . . . . .

~756~5 limits the stability of the preparation even at low concen-~, trations. In addition, incompatibilities result if trace elements and inorganic phosphate are present, since precipitates (for example iron phosphate) can again be formed.
Even in perfusion solutions which are ~ree from electrolytes, precipitates with inorganic phosphate are frequently formed, since they may be caused by traces of, for example, calcium ions and iron ions, which may come rom the filters and/or the raw materials.
According to the present inventionl all these problems can surprisingly be eliminated if the perfusion sol ~ ution contains a glycerophosphate as source of phosphorus in ; addition to the other requisite ingredients. Surprisingly, it has also proved possible to prepare the solution with a ph ~ 6 and make it stable and heat-sterilizable.
The present invention accordingly provides, in one aspect, a stable, heat sterilizable solution for parenteral perfusion having a pH value greater than 6 for the treatment or prophylaxis of hypophosphataemia consisting essentially of amino acids,lcarbohydrates, essential minerals, and, as the source of phosphorus, a therapeutically active amount providing up to 95 mmols of phosphorus per liter of the solution of a water-soluble non-toxic glycerophosphate.
The present invention also provides, in another aspect, a sta~le, heat sterilizable solution for parenteral perfusion having a pH value greater than 6 for the treatment or prophylaxis of hypercalcaemia consisting essentially of ; amino acids, carbohydrates, essential minerals, and, as a source of phosphorus, a therapeutically active amolmt provi-ding up to 95 mmols of phosphorus per liter of the solution of a water-soluble non-toxic glycerophosphate selected from ~ 4 -~07s~a5 the group consisting of magnesium, sod.ium and potassium glycerophosphates.
In the solutions of the present invention useful for the treatment or prophylaxis of hypophosphataemia, the phosphorus may be present as sodium, potassium, magnesium or calcium glycerophosphate, or as a combination of these.
In the case of solutions useful for the treatment or prophylaxis of hypercalcaemia, the glycerophosphate salt is selected from the magnesium, sodium and potassium salts, 10or combinations thereof. By combining the various salts it is possible, for a given intended phosphorus content, so to provide part of the cation requirements of the solution and to provide the remainder of the latter by addition of other salts containing the desired ' ' ,, '~
.

~ 4a -....... , . . :

: .

~56~5 cations. It has been demonstrated that glycexophosphates are on the one hand effective phosphate donors and on the other hand toxicologically harmless when used in the requisite amount.
The effectiveness has been demonstrated by the experimental results shown graphically in the Figure.
Curve 1 shows the liberation of inorganic phosphate after injection o glycerophosphate. Curve II shows the complete normalisation o~ the serum inorganic phosphate level following simultaneous injection of fructose and glycero-phosphate, while Curve III shows that the administration of fructose alone, in the same amount, causes a drop in the phosphate level.
In vitro experiments have shown that at pH 7.4 both acid phosphata~e and alkaline phosphatase splits glycero-phosphate to form glycerine and inorganic phosphate.
Further it has ~een found ln vitro that the phospha- -tases present in blood plasma produce a time-dependent, satisfactory splitting of the glycerophosphate. Thus, for example, addi~ion of 1~ mol of glycerophosphate to 250~1~
.
of plasma at an incubation temperature of 37C causes the liberation of about 50% of the glycerine and in~rganic phosphate after one hour and 75% after two hours.
Toxicity te6ts have demonst~ated that glycerophosphates are toxicologically harmless. The actute toxicity is about the same for ~- and ~ -sodium glycerophosphate (LD50= 3.8 ~and 3.4 g/kg, respectively, in ratsl. In dogs, the subacute toxicity is of a similar order of magn1tude. Doses of up to 2 g~kg administered intravenously were tolerated without any symptoms over the course of 14 days.

.!
The Examples given below of perfusion solutions ~ 5 :

:

:. . . . .. ..

1~7561~

containing glycerophosphate illustrate the inventionO
The solutions can be prepared in the usual manner in accordance with the present state of the technique of preparation (of such solutions) and are heat-sterilisable, sterile, free from pyrogen and stable.

Laevulose 60.00 g/l G1UCQSe monohydrate 33.00 g/l Xylitol 30.00 g/l 10 Sodium glycerophosphate.5H2O 9.184 g/l Potassiwm chloride 1.864 g/l Magnesium chloride.6H2O . - 0.610 g/l Zinc sulphate.7H2O 0.022 g/l Vitamin Bl chloride.HCl 0.004 g/l L,Malic acid 2.270 g/l Laevulose 100.00 g/l Glucose monohydrate 55.00 g/l ~ .
Xylitol 50.00 g/l . ~ , .
20 Calcium glycerophosphate 0.630 g/1 Sodium glycerophosphate.5H2O 5o204 g/l EXAMP~E 3 Sodium glycerophosphate.5H2O . 3.061 g/l .: Sodium chloride . 0.409 g/l `:
.
: : Sodium acetate.3H2O 1.905 g/l Potassium chloriae~ 1.118 g~l : P~tasaium acetate . 0.491 g/l Sodium hydroxide ~ 0.420 g/l Potassium h~droxide 0.561 g~l Calcium chloride.2H2~ 0.36~ g/1 Magnesium acetate.4H2O 0~643 g/1 .

' . . `; .` ~' : : ' : ' ~L075G05 L-Isoleucine 0.755 g/l L-Leucine 1.100 g/l L-Lysine.HCl. 1.250 g/l L-Methionine 1.050 g/l L-Phenylalanine lolO0 g/l L-Threonine 0.500 g/l L-Tryptophane 0.225 g/l L-~Iistidine 0.500 g/l L-Arginine 2.000 gJl L-Alanine 3.000 g/l L-Proline 3.500 g/l L-Glutamic acid 4.500 g/l L-Valine 0.750 g/l Glycine 5.000 g/l Sorbitol 125.000 g/l Nicotinic acid amide 0.020 g/l Pyridoxine hydrochloride 0.015 g/l Na riboflavin-5'-phosphate 0.002 g/1 20Potassium glycerophosphate : 1.692 g/1 Sodium glycerophosphate 5.204 g/1 Calcium glycerophosphate 0.630 g/1 Sodium chloride 0.409 g/l : Potassîum chloride 0.372 g/l Potassium acetate 0.491 g/l Sodium hydroxide , 0.410 g/l Potassium hydroxide 0.561 g/1 Sodium acetate.3H2O 1.224 gJl . 30 _ 7 -.

~07S61)5 Magnesium acetate~4H20 0.643 gh L~Isoleucine 0.775 g/l L,Leucine . ~.1.100 g/l h-Lysine.HCl 1O250 g~1 .
L,~Iethionine 1,050 ~/1 L,Phenylalanine 1.100 g/l L-Threonine 0.500 g/l L-Tr~ptophane 0.225 g/l ~-~istidine 0~500 g/l L-Arginine 2O000 g/l L,~lanine .3~000 g/l . .
L-Proline 3O500 g/l ~
.
~-Glutamic acid 4~500 g/1 L Valine 0.750 g/l Glycine S.000 g/l Sorbitol 70.000 g/l ~yli~ol . ~.0~0 ~
Glycerine 35O000 g/l ~icotinic acid amide 0.020 g~l Pyridoxine hydrochloride 0~015 g~l ~a riboflavin-5'-phosphate 0.002 g/l : ~
.' ', ' : :
~ . .

, . .
1 '' ~, ' ' . I

.

,,1 ~ ` ' . ' , . -: ,

Claims (6)

The embodiments of the invention in which an exclusive property or privilege is claimed are defined as follows:
1. A stable, heat sterilizable solution for parenteral perfusion having a pH value greater than 6 for the treatment or prophylaxis of hypophosphataemia consisting essentially of amino acids, carbohydrates, essential minerals, and, as the source of phosphorus, a therapeutically active amount providing up to 95 mmols of phosphorus per liter of the solution of a water-soluble non-toxic glycerophosphate.
2. The solution of claim 1, also containing one or more assimilable polyols.
3. The solution of claim 2, wherein said polyol is selected from the group consisting of sorbitol, xylitol, glycerine and mixtures thereof.
4. The solution of claim 1, 2 or 3, wherein the glycerophosphate is selected from the group consisting of a calcium, magnesium, sodium and potassium salt.
5. The solution of claim 1, 2 or 3, also containing a calcium salt other than a glycerophosphate.
6. A stable, heat sterilizable solution for parenteral perfusion having a pH value greater than 6 for the treatment or prophylaxis of hypercalcaemia consisting essentially of amino acids, carbohydrates, essential minerals, and, as a source of phosphorus, a therapeutically active amount providing up to 95 mmols of phosphorus per liter of the solution of a water-soluble non-toxic glycerophosphate selected from the group consisting of magnesium, sodium and potassium glycerophosphates.
CA238,444A 1975-01-23 1975-10-22 Infusion solutions with salts of glycerophosphates Expired CA1075605A (en)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE2502735A DE2502735B2 (en) 1975-01-23 1975-01-23 Use of glycerophosphates

Publications (1)

Publication Number Publication Date
CA1075605A true CA1075605A (en) 1980-04-15

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ID=5937143

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CA (1) CA1075605A (en)
DE (1) DE2502735B2 (en)
GB (1) GB1516738A (en)
ZA (1) ZA755795B (en)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8431086B2 (en) 2006-07-20 2013-04-30 Baxter International Inc. Medical fluid access device with antiseptic indicator
US8485727B2 (en) 2005-08-02 2013-07-16 Baxter International Inc. Multiple chamber container

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS5916818A (en) * 1982-07-20 1984-01-28 Shimizu Seiyaku Kk Solution for fluid therapy by administration through vein
SE8701662L (en) * 1987-04-22 1988-10-23 Gelder Nico M Van SETTING AND AGENTS FOR TREATING NEUROLOGICAL DISEASES, EXAMPLE, MIGRAEN THROUGH THE OPERATION OF NERV CELLS
EP1032403B1 (en) * 1997-10-24 2012-05-02 John P. Blass Nutritional supplement for cerebral metabolic insufficiencies
GB2544782B (en) * 2015-11-26 2020-07-15 Fontus Health Ltd Solution

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8485727B2 (en) 2005-08-02 2013-07-16 Baxter International Inc. Multiple chamber container
US8431086B2 (en) 2006-07-20 2013-04-30 Baxter International Inc. Medical fluid access device with antiseptic indicator

Also Published As

Publication number Publication date
GB1516738A (en) 1978-07-05
ZA755795B (en) 1976-09-29
DE2502735B2 (en) 1978-11-23
AU8450175A (en) 1977-03-10
DE2502735A1 (en) 1976-08-05

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