CN101804068B - Polyethylene glycol-electrolyte oral solution - Google Patents

Polyethylene glycol-electrolyte oral solution Download PDF

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CN101804068B
CN101804068B CN2010101278779A CN201010127877A CN101804068B CN 101804068 B CN101804068 B CN 101804068B CN 2010101278779 A CN2010101278779 A CN 2010101278779A CN 201010127877 A CN201010127877 A CN 201010127877A CN 101804068 B CN101804068 B CN 101804068B
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polyethylene glycol
solution
sodium
water
oral solution
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CN101804068A (en
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陶忠华
张红妹
刘静
朱莉亚
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Beijing Shengyong Pharmaceutical Co., Ltd.
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桑苏君
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Abstract

The invention provides polyethylene glycol-electrolyte oral solution, which comprises 59 to 60 grams of polyethylene glycol, 1.0 to 1.5 grams of sodium chloride, 0.5 to 1.0 gram of potassium chloride, 1.5 to 2.0 grams of sodium bicarbonate, 5.5 to 6.0 grams of sodium sulfate, 0.02 to 0.5 gram of edentate, 0.02 to0.5 gram of sweetener, 1 to 2 milliliters of flavoring essence and the balance of deionized water, wherein the solution is 1,000 milliliters. The polyethylene glycol-electrolyte oral solution is used in bowel cleansing and has the characteristics of quick response, safety, reliability and good cleansing effect. The oral solution is mainly suitable for cleansing bowels before colonoscopy, barium enema X-ray examination and gastrointestinal operation. The small-dose (about one eighth of a bowel cleansing dose) products of the oral solution can be used for treating chronic constipation.

Description

Polyethylene glycol-electrolyte oral solution
The application is dividing an application of one Chinese patent application 200610056712.0.
Original application day: 2006-3-6
Original applying number: 200610056712.0
Original application invention and created name: polyethylene glycol-electrolyte oral solution
Technical field
The present invention relates to a kind of polyethylene glycol-electrolyte oral solution, belong to field of medicine preparations.
Background technology
Improving constantly of Along with people's living standard, the increase of intestinal cancer and various intestinal illness, intestinal surgery and enteroscopy quantity grow with each passing day.
According to preliminary survey; Only the colon disease patient of Beijing, Shanghai, Tianjin three city large hospitals has 4~50,000 people need seek medical advice, check treatment every year approximately, and intestinal cleans traditional intestinal cleaning method that the pretreatment method stays in external the 60 to 70's level basically; That is: before enteroscopy, only obeyed liquid or low residue diet on 2nd~3, add before cathartic and the microscopy coloclysis etc. again, isosmotic solution is also processed with mannitol by many hospitals, the untoward reaction that it has fermentation to produce gas at enteral, and cleaning performance is not ideal enough.Before intestinal microscopy or the gastrointestinal surgery, require digestive tract is cleaned up, to guarantee that diagnosis is definite, to perform the operation smoothly.
U.S. FDA is produced polyethylene glycol-electrolyte intestinal abluent (powder) in approval Braintree Labs pharmaceutical factory in 1999 with commodity " Golytely " by name; Generally use at present; 24 editions (2000) 1348 pages of the loaded American Pharmacopeia of its basic recipe and quality standard (USP); During American Pharmacopeia prescription (USP side) was formed, the solution of pressing 1000ml calculated, and contains Polyethylene Glycol (molecular weight is 3350); Inorganic salt content sees the following form, and content is the millimole number (mmol) and the milliequivalent (mEq) of various inorganic salts in the table:
Figure GSA00000037925500011
Figure GSA00000037925500021
Golytely powder method for preparing is for to grind to form fine powder with Polyethylene Glycol and each electrolyte (four kinds of inorganic salts) composition, and mixing is processed powder, and packing is dissolved in water before taking, and is mixed with solution temporarily.
The situation of powder:
The at present domestic product that imitated external powder is also arranged, like the just clear WBI liquid of Heng Kang, it is divided into 3 fractional packs with complete dosage packaged powders, faces with before being poured in the container dissolved dilution and takes." Liaoning medicine and clinical " 2004 the 7th the 2nd phases of volume disclose " clinical practice and the observation in the intestinal preparation before art of the just clear WBI liquid of Heng Kang " literary composition; This powder is described and estimates: every box is made up of A, B, each 1 bag of C; A comprises potassium chloride 0.74g, sodium bicarbonate 1.68g; B comprises sodium chloride 1.46g, sodium sulfate 5.68g; C comprises the 60g Macrogol 4000, add water and be made into 1000ml solution, contain Na +125mmol/L, K +10mmol/L, HCO 3-20mmol/L, SO 4 2-40mmol/L, Cl -The just clear WBI liquid of the Heng Kang of the isotonicity of 35mmol/L and PEG (4000) 15mEq/L can cause diarrhoea, the rapid cleaning intestinal in the 4h.
The problem of its existence is, has the component loss during obtain solution, caused the each component proportioning inhomogeneous; Or because of there not being measuring container accurately; And the problem of user self specially increases or reduces amount of water; Make the solution concentration of final products have deviation, can not guarantee that the osmotic pressure ratio of solution is 1, can not guarantee the inside and outside isotonicity of intestinal; Not only influence cleaning performance, and might cause serious adverse effects.
The composition of the necessary assurance of the pharmacological action characteristics requirement medicine of this powder and concentration are in the scope of regulation; Could guarantee that like this its osmotic pressure ratio that has in intestinal is 1; Guarantee the inside and outside isotonicity of intestinal; Make that wherein component is unlikely to be absorbed by human body intestinal canal, excrete, make its intestinal cleaning action through intestinal.
The hospital that intestinal cleans is carried out in present domestic employing " powder "; The condition that truly has is carried out strict Quality Control person to drug solution preparation and is merely minority; Most hospitals only issue patient with medicine powder lets patient take behind the wiring solution-forming voluntarily, thereby produces the serious consequence that causes because preparation is improper.
So, be necessary this medicine is further improved, so that it has better therapeutic effect.
Summary of the invention
The object of the present invention is to provide a kind of polyethylene glycol-electrolyte oral solution.
Described polyethylene glycol-electrolyte oral solution is made up of following component:
Polyethylene Glycol 59-60g
Sodium chloride 1.0-1.5g
Potassium chloride 0.5-1.0g
Sodium bicarbonate 1.5-2.0g
Sodium sulfate (anhydrous) 5.5-6.0g
Edetate 0.02-0.5g
Sweeting agent 0.02-0.5g
Edible essence 1-2ml
Deionized water adds to 1000ml.
In the above-mentioned polyethylene glycol-electrolyte oral solution, preferably contain following component:
Polyethylene Glycol 59g
Sodium chloride 1.47g
Potassium chloride 0.74g
Sodium bicarbonate 1.69g
Sodium sulfate (anhydrous) 5.69g
Edetate 0.05g
Described edetate can be calcium disodium edetate or disodium edetate.
Described sweeting agent can be saccharin sodium or stevioside.
Edible essence can be flavoring pineapple essence, strawberry essence or flavoring banana essence.
The method for preparing of above-mentioned polyethylene glycol-electrolyte oral solution is: Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are placed same container, under 40-50 ℃ of temperature conditions, add water to dissolving, stir; It is an amount of to add active carbon, is heated to and boils, and keeps boiling 5-10min; Stop heating, when treating that solution temperature is reduced to below 30 ℃, remove by filter active carbon; Must filtrate, and with suitable quantity of water detergent active charcoal layer, washing liquid is incorporated filtrating into; Sodium bicarbonate, edetate, sweeting agent are added the suitable quantity of water dissolving, get solution; Above-mentioned filtrating and solution are merged, add edible essence, adding water to cumulative volume is 1000ml, stirs, and makes mix homogeneously; The sampling and measuring pH value should meet the requirements; Carry out fine straining with filter stick, be sub-packed in 250ml or the 500ml infusion bottle, jump a queue gland seal; Heating sterilization in 15-30 minute gets product in 100 ℃ of boiling water or steam.
In the preparation of solution of the present invention, Polyethylene Glycol and sodium chloride, potassium chloride, three kinds of salt of sodium sulfate as one group, are dissolved in water, the heating after-filtration has been removed wherein impurities, helps guaranteeing the steady quality of solution.The oral administration solution of preparation can be sub-packed in the infusion bottle, handles through heat sterilization; Also can under aseptic condition, be sub-packed in the suitable sterile chamber, like used duroplasts, the Flesible plastic container of beverage packing.
In the composition of product of the present invention, added unexistent stabilizing agent edetate in the Golytely powder, made the solution that makes have good clarity.Compare with powder, oral administration solution of the present invention is colourless, clear and bright sterile solution, the each component mix homogeneously; The osmotic pressure of solution remains 1 than stable and accurate, has kept the inside and outside isotonicity of good intestinal; Thereby guaranteed not influence after oral liquid and electrolytical balance in the body, moisture and electrolyte are not absorbed by human body basically, directly discharge together with foreign material through intestinal; Thereby the intestinal cleaning performance is good; Avoided " powder " to be mixed with the pollution that exists in the solution process, thereby caused the generation of other diseases, like bacteroidal diarrhoea.
The once adult dosage of oral administration solution of the present invention can be divided into several bottles of packings, is beneficial to all ages and classes section patient and carries out dosage adjustments in use.
For powder, the mixed solution of Polyethylene Glycol and salt can produce new dregs again after filtering, traces it to its cause; Be that trace metal ion causes in sodium sulfate and the chloride; The inventive method adds the proper amount of active carbon decolouring before heating, through heating, cooling, the precipitation process of accelerating impurity; Filter then and remove, solved the impurity problem in the solution.
Another problem that the present invention solves is, process homogeneous solution after, constituent content is measured becomes difficulty, seems the interference that intermeshes of simple several salt.To this problem, American Pharmacopeia has adopted ion chromatograph method and high performance liquid chromatograph method, though can deal with problems, it is high to detect cost.The present invention realizes through following process the detection of solution component content:
Generally be in the (medicine) being taken before meal usefulness in morning on the same day of going to a doctor, (1~1.25L/h becomes clear until the rectum effluent, and is general 2~3h), can carry out colonoscopy after maximum 5 hours to obey 2-3L approximately according to body weight.
With traditional pretreatment method ratio, obey these article back presence of residual feces and obviously be less than traditional method (P<0.002), mucous membrane of colon radiography more clear (P<0.002); The best check result also more (P<0.002) of gained.Used morning on the same day on an empty stomach, carries out colonoscopy after several hours, and administration time obviously shortens.
Characteristics of the present invention are: this " solution " dosage form is compared with former " powder " dosage form, and products obtained therefrom is colourless, clear and bright sterile solution, the each component mix homogeneously, quality controllable, mouthfeel good, also safety and reliability of easy to use, determined curative effect; The pharmacological action that can guarantee its osmotic pressure=1 requires to avoid medicine in intestinal absorption.
Polyethylene glycol-electrolyte oral solution of the present invention is used for intestinal and cleans, and has rapid-action, safe and reliable, cleaning performance characteristics preferably.Be applicable to that mainly the intestinal before colonoscopy, barium coloclysis X-ray examination and the gastrointestinal surgery cleans, its low dose of product (be about intestinal clean dosage 1/8) can also be used to treating chronic constipation.
Traditional powder when taking, the water consumption inaccuracy, osmotic pressure is wayward; And, do not controlled owing to add the temperature of entry, so cause the state labile of solution by strictness.When temperature was hanged down, the dissolved state of salt was incomplete, was prone to muddiness, and deposition is arranged; When temperature is high; Sodium bicarbonate is decomposed into sodium carbonate and carbon dioxide easily, causes solution composition to change, when in raw material, having calcium, magnesium ion impurity; Carbanion in the solution system is also with causing trickle deposition to produce the instability that will cause product quality of this situation simultaneously.
Therefore; Compare with powder, product of the present invention is considered from temperature two aspects of water consumption and water, is adopted new technical scheme; Change into direction with dosage form; Solve all drawbacks that traditional Polyethylene Glycol powder in use exists, reduced the side effect odds, provide a kind of intestinal of better effects if to clean medicine.
The application of edetate, the drawback that more effectively traditional powder is existed is reduced to minimum.Calcium in the raw material, magnesium ion impurity can form stable coordination compound under the edetate effect, like this, under high temperature sterilize disinfectant situation, calcium, magnesium ion impurity can not form deposition yet, influence the quality of product.That is to say, inevitably have calcium, magnesium ion impurity in the raw material, under the controlled prerequisite of water temperature; Can avoid precipitating or muddy generation; But under the condition of high temperature sterilize,, also will cause same problem to occur if there is not the effect of edetate.
So; The present invention is taking all factors into consideration under the prerequisite of above-mentioned each link, and creationary employing brand-new scheme is under the prerequisite that does not change traditional powder effective ingredient; Solved the problem of its existence cleverly; And from the statistics of operating position, its effect is very significant, and technological progress wherein is mathematical.
The specific embodiment
Embodiment 1
Get 59g Polyethylene Glycol (PEG-4000), sodium chloride 1.47g, potassium chloride 0.74g, sodium bicarbonate 1.69g, sodium sulfate (anhydrous) 5.69g, calcium disodium edetate 0.02g, saccharin sodium 0.5g, flavoring pineapple essence 1ml;
Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are put in the same container, added 50mL water, heat, and stir to 40 ℃ of dissolvings; Add active carbon 1g, be heated to and boil, keep boiling 10min; Stop heating, when treating that solution temperature is reduced to 30 ℃, filter; Remove active carbon, and with 50mL water washing active carbon layer, washing liquid is incorporated filtrating into;
Sodium bicarbonate, calcium disodium edetate, saccharin sodium are added the 50mL water dissolution;
Above-mentioned filtrating and solution are merged, add flavoring pineapple essence, adding water to cumulative volume is 1000ml, mix homogeneously;
The sampling and measuring pH value is 8.0, carries out fine straining with filter stick, is sub-packed in the 500ml infusion bottle, jumps a queue gland seal.
Heating sterilization in 30 minutes gets product in 100 ℃ of boiling water or steam, wherein, and Na +125mmol/L, K +10mmol/L, HCO 3 -20mmol/L, SO 4 2-40mmol/L, Cl-35mmol/L and PEG (4000) 15mEq/L.
Embodiment 2
Get 60g Polyethylene Glycol (PEG-4000), sodium chloride 1.1g, potassium chloride 0.8g, sodium bicarbonate 1.7g, sodium sulfate (anhydrous) 5.8g, disodium edetate 0.5g, stevioside 0.02g, strawberry essence 2ml;
Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are put in the same container, added 100mL water, heat, and stir to 50 ℃ of dissolvings; Add active carbon 0.5g, be heated to and boil, keep boiling 5min; Stop heating, when treating that solution temperature is reduced to 25 ℃, filter; Remove active carbon, and with 50mL water washing active carbon layer, washing liquid is incorporated filtrating into;
Sodium bicarbonate, disodium edetate, stevioside are added the 50mL water dissolution;
Above-mentioned filtrating and solution are merged, add strawberry essence, adding water to cumulative volume is 1000ml, mix homogeneously;
The sampling and measuring pH value is 8.5, carries out fine straining with filter stick, is sub-packed in the 250ml infusion bottle, jumps a queue gland seal.Heating sterilization in 15 minutes gets product in 100 ℃ of boiling water or steam.
Embodiment 3
Get 59g Polyethylene Glycol (PEG-4000), sodium chloride 1.5g, potassium chloride 0.5g, sodium bicarbonate 2.0g, sodium sulfate (anhydrous) 5.9g, calcium disodium edetate 0.1g, saccharin sodium 0.3g, flavoring banana essence 1.5ml;
Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are put in the same container, added 100mL water, heat, and stir to 45 ℃ of dissolvings; Add active carbon 1g, be heated to and boil, keep boiling 5min; Stop heating, when treating that solution temperature is reduced to 30 ℃, filter; Remove active carbon, and with 100mL water washing active carbon layer, washing liquid is incorporated filtrating into;
Sodium bicarbonate, calcium disodium edetate, saccharin sodium are added the 80mL water dissolution;
Above-mentioned filtrating and solution are merged, add flavoring banana essence, adding water to cumulative volume is 1000ml, mix homogeneously;
The sampling and measuring pH value is 7.5, carries out fine straining with filter stick, is sub-packed in the 500ml infusion bottle, jumps a queue gland seal.
Heating sterilization in 15 minutes gets product in 100 ℃ of boiling water or steam.
Embodiment 4
Get 60g Polyethylene Glycol (PEG-4000), sodium chloride 1.25g, potassium chloride 0.6g, sodium bicarbonate 1.5g, sodium sulfate (anhydrous) 5.5g, disodium edetate 0.2g, stevioside 0.1g, flavoring pineapple essence 2ml;
Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are put in the same container, added 50mL water, heat, and stir to 45 ℃ of dissolvings; Add active carbon 1g, be heated to and boil, keep boiling 10min; Stop heating, when treating that solution temperature is reduced to 30 ℃, filter; Remove active carbon, and with 50mL water washing active carbon layer, washing liquid is incorporated filtrating into;
Sodium bicarbonate, disodium edetate, stevioside are added the 50mL water dissolution;
Above-mentioned filtrating and solution are merged, add flavoring pineapple essence, adding water to cumulative volume is 1000ml, mix homogeneously;
The sampling and measuring pH value is 8.5, carries out fine straining with filter stick, is sub-packed in the 500ml infusion bottle, jumps a queue gland seal.
Heating sterilization in 20 minutes gets product in 100 ℃ of boiling water or steam.
Comparative example
This example is the clinical trial comparative result of embodiment 1 product, and the excellent results of product of the present invention has been described.
Use the polyethylene glycol electrolyte oral solution of embodiment 1, the three tame hospitals through Beijing (Beijing Friendship Hospital, BJ Univ Hospital, Beijing, Xuan Wu, Beijing hospital) clinical experimental study is verified its effectiveness and safety.
Method adopts at random, opening, positive drug (Heng Kang produces Polyethylene Glycol powder just clearly) parallel control, polycentric II clinical trial phase, two groups of 120 examples respectively.
Result of the test:
Embodiment 1 group of products, total effective rate are 99.15%, and wherein intestine cleaning effect reaches excellent, good level person and is respectively 67.80% and 31.36%, goes out obvious apparent untoward reaction person 1% (1 people).
The just clear powder matched group of Heng Kang, total effective rate is 91.45%, wherein reaches excellent, good level person and is respectively 58.97% and 32.48%, goes out obvious apparent untoward reaction person 5% (5 people).
Test shows that embodiment 1 group of products intestine cleaning effect is superior to the just clear matched group of Heng Kang, and simultaneously, untoward reaction is starkly lower than matched group.
Main analysis result: this research goes into to organize patient's 240 examples altogether; Two groups of each 120 examples, 235 examples are accomplished test, have used the research medicine behind the 237 routine randomizations and have carried out corresponding evaluation; The ITT crowd of entering and safety crowd; 3 routine patients have only used the random number of research, and reality is not used the research medicine, does not get into analysis.The data audit judges that there is not the situation that obviously affects the treatment and estimate in 232 routine patients under the ignorant of the economics attitude, gets into PP crowd.See table 1-3 for details.
Table 1 case distributes
Figure GSA00000037925500071
Table 2 goes into to organize case and safety, efficiency analysis crowd
Table 3 does not get into PP crowd person inventory
Figure GSA00000037925500073
Figure GSA00000037925500081
General information: two groups of patients are all close in aspect situation such as age, sex, height, body weight, blood pressure, hearts rate, and difference not statistically significant (p>0.05) is seen table 4.
Table 4 general information is (ITT) relatively
Figure GSA00000037925500082
Figure GSA00000037925500091
Main curative effect: intestinal is prepared condition evaluation
ITT crowd: the Polyethylene Glycol group has 67.80%, 31.36% to reach excellent, good respectively; Total effective percentage is 99.15%; Heng Kang organizes just clearly has 58.97%, 32.48% to reach excellent, good respectively; Total effective percentage is 91.45%, and the CMH assay shows that two groups of differences have statistical significance (p<0.05), see table 5, table 6.
Each center intestinal of table 5 is prepared the description and the CMH assay thereof of condition evaluation
Figure GSA00000037925500092
Efficient description in each center of table 6 and CMH assay thereof
Figure GSA00000037925500101
95% credibility interval of two groups of effective poor (Heng Kang organize 1 group of an embodiment just clearly) is (13.03% ,-2.37%), shows that 1 group of intestine cleaning effect of embodiment is superior to Heng Kang and organizes just clearly, sees table 7.
95% credibility interval of table 7 effective percentage difference
Figure GSA00000037925500102
PP crowd result is similar with ITT crowd result.
Secondary efficacy:
First in the defecation first organized just clearly of 1 group of defecation time: embodiment and Heng Kang bit time (50% patient's defecation) be respectively after the medication 40 minutes with medication after 50 minutes; See table 8; The defecation rate of different time is seen table 9, and two groups of difference not statistically significants (p>0.05) are seen table 10.
Defecation time distribution first and Log-Rank assay (time and 95%CI) after the table 8 liang group administration
Figure GSA00000037925500111
Different time defecation patient ratio and Log-Rank assay (rate (standard error)) first after the administration of table 9 liang group
After the administration of table 10 liang group first defecation time relatively reach the check of Log-Rank assay
Figure GSA00000037925500113
The bit time (50% patient reaches watery stool clearly) that reaches clearly in the watery stool that reaches that 1 group of watery stool time: embodiment clearly and Heng Kang organize just clearly is after the medication 120 minutes; See table 11; The defecation rate of different time is seen table 12, and two groups of difference not statistically significants (p>0.05) are seen table 13.
Reaching clearly after the table 11 liang group administration, the watery stool time distributes and Log-Rank assay (time and 95%CI)
Figure GSA00000037925500114
Different time reaches watery stool ratio and Log-Rank assay (rate (standard error)) clearly after the table 12 liang group administration
Figure GSA00000037925500121
Reach clearly the watery stool time ratio after the administration of table 13 liang group and the check of Log-Rank assay
Figure GSA00000037925500122
Safety evaluatio:
Medication rear section patient stomachache occurs, feels sick, abdominal distention, clinical symptoms such as weak, and two groups of ratios are close, see table 14.
The description (Safety Population) of the clinical symptoms of following after the table 14 liang group medication
Adverse events appears in 1 group of 7 routine patient of embodiment, and Heng Kang organizes 9 routine patients just clearly and adverse events occurs, and details is seen table 15-17.
Table 15 adverse events conclusive table (Safety)
Figure GSA00000037925500131
Relevant with the research medicine: as to contain with research medicine relation and be " relevant certainly " " maybe be relevant " " can't judge "
The occurrence frequency of every kind of adverse events of table 16 (Safety)
Figure GSA00000037925500132
The occurrence frequency (Safety) of the relevant adverse events of each system of table 17
Figure GSA00000037925500133

Claims (1)

1. a polyethylene glycol-electrolyte oral solution is characterized in that, said solution is made up of following component:
59g Polyethylene Glycol-4000, sodium chloride 1.47g, potassium chloride 0.74g, sodium bicarbonate 1.69g, anhydrous sodium sulfate 5.69g, calcium disodium edetate 0.02g, saccharin sodium 0.5g, flavoring pineapple essence 1ml;
Described polyethylene glycol-electrolyte oral solution adopts following method preparation:
Polyethylene Glycol, sodium chloride, potassium chloride, sodium sulfate are put in the same container, added 50mL water, heat, and stir to 40 ℃ of dissolvings; Add active carbon 1g, be heated to and boil, keep boiling 10min; Stop heating, when treating that solution temperature is reduced to 30 ℃, filter; Remove active carbon, and with 50mL water washing active carbon layer, washing liquid is incorporated filtrating into;
Sodium bicarbonate, calcium disodium edetate, saccharin sodium are added the 50mL water dissolution;
Above-mentioned filtrating and solution are merged, add flavoring pineapple essence, adding water to cumulative volume is 1000ml, mix homogeneously;
The sampling and measuring pH value is 8.0, carries out fine straining with filter stick, is sub-packed in the 500ml infusion bottle, jumps a queue gland seal;
Heating sterilization in 30 minutes gets product in 100 ℃ of boiling water or steam, wherein, and Na +125mmol/L, K +10mmol/L, HCO 3 -20mmol/L, SO 4 2-40mmol/L, Cl -35mmol/L and PEG15mEq/L.
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