Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/42—Oxazoles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/27—Esters, e.g. nitroglycerine, selenocyanates of carbamic or thiocarbamic acids, meprobamate, carbachol, neostigmine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
  • A61K31/52—Purines, e.g. adenine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole

Definitions

• the present invention relates generally to novel pharmaceutical compositions of matter comprising one or more non-steroidal anti-inflammatory drugs in combination with at least one skeletal muscle relaxant, and optionally a xanthine or xanthine derivative, such as caffeine, and to methods of using said compositions in the treatment of a variety of skeletal muscle disorders including skeletal muscle spasms, certain orthopedic conditions, disk syndromes, low back pain and the like.
• Centrally acting skeletal muscle relaxants are generally prescribed either as single agents or as components of combination products.
• the Food and Drug Administration has approved indications for these medications as adjuncts to rest and physical therapy for relief of acute, painful musculoskeletal problems.
• Clinically the mild pain associated with the majority of cases of minor muscle strains and minor injuries are self limiting. Most patients usually respond rapidly to rest.
• An anti-inflammatory drug may be useful when there is tissue damage and edema.
• severe musculoskeletal strains and sprains, trauma, and cervical or lumbar radiculopathy as a consequence of degenerative osteoarthritis, herniated disk, spondylitis or laminectomy often cause moderate or severe and more chronic painful skeletal muscle spasm.
• the principal symptoms include local pain, tenderness on palpation, increased muscle consistency and limitation of motion.
• skeletal muscle relaxants alone or in combination with an analgesic are frequently prescribed.
• Results of some studies have suggested that a formulation of a muscle relaxant and an analgesic provides greater benefit in patients with acute musculoskeletal problems than similar doses of an analgesic alone.
• Table I lists several commercial combinations currently available.
• a current commercial muscle relaxant formulation is Soma ® Compound by Carter-wallace, Inc., which contains 200 mg carisoprodol and 325 mg aspirin.
• Carisoprodol is a centrally-acting muscle relaxant that does not directly relax tense skeletal muscles in man.
• Aspirin is a conventional non-narcotic analgesic with anti-inflammatory and antipyretic activity.
• the most common adverse reactions associated with the use of aspirin in this product have been gastrointestinal, including nausea, vomiting, gastritis, occult bleeding, constipation and diarrhea. Allergic type reactions associated with aspirin may also involve the respiratory tract and skin.
• Another commercial skeletal muscle relaxant formulation is Parafon Forte ® by McNeil Pharmaceutical. Parafon Forte contains 250 mg chlorzoxazone and 300 mg acetaminophen. Chlorzoxazone is a centrally-acting agent which does not directly relax tense skeletal muscles in man.
• Acetaminophen, a nonsalicylate analgesic is a conventional non-narcotic analgesic with anti-pyretic activity.
• Robaxisal ® by A.H. Robins Company, Inc. is another commercial muscle relaxant combination which contains 400 mg methocarbamol and 325 mg aspirin.
• the mechanism of action of methocarbamol in humans has not been established, but may be due to general central nervous system depression. Methocarbamol does not directly relax tense skeletal muscles in man.
• Adverse reactions that have been associated with aspirin in this formulation include: nausea and other gastrointestinal discomfort, gastritis, gastric erosion, vomiting, constipation, diarrhea, angioedema, asthma, rash, pruritis and urticaria.
• Norgesic ® and Norgesic ® Forte are commercial products by Riker Laboratories, Inc. that go one step beyond the previously mentioned products in that Norgesic and Norgesic Forte contain not only a muscle relaxant and aspirin, but they alsb include caffeine.
• Norgesic is 25 mg orphenadrine citrate, 385 mg aspirin and 30 mg caffeine.
• Norgesic Forte contains 50 mg orphenadrine citrate, 770 mg aspirin and 60 mg caffeine.
• Orphenadrine citrate is 2-dimethylaminoethyl 2-methylbenzhydryl ether citrate. The common side effects and concerns associated with the use of aspirin occur with the use of Norgesic and Norgesic Forte as well.
• Parafon Forte a skeletal muscle relaxant formulation containing acetaminophen
• the Director of the Bureau of Drugs of the FDA in a notice published in the Federal Register, 1982, 47 F.R. 22599 concluded that he was unaware of any adequate and well-controlled clinical investigation conducted by experts qualified by scientific training and experience ... [that] demonstrates the effectiveness of Parafon Forte.
• the present position of the Commissioner of Food and Drugs is set forth below [Federal Register, 1984, 49(200): 48212-48214]:
• the principal advantages of these new non-steroidal anti-inflammatory drugs include not only the clinically superior analgesic and anti-inflammatory activity of these agents compared to aspirin, acetaminophen or phenacetin, but also a lessening of the adverse side effects experienced with these conventional agents; more specifically, the gastrointestinal ulcerations and bleeding experienced with aspirin and the hepatic toxicity prevalent with the use of large doses of acetarninophen.
• xanthine or a xanthine derivative such as caffeine
• the central nervous system stimulant effect of the caffeine is advantageous to counterbalance the sedative effect often resulting from the use of skeletal muscle relaxants.
• a xanthine or a xanthine derivative with a non-steroidal anti-inflammatory drug.
• An enhanced analgesic or anti-inflammatory response is achieved and lowers amounts of the select non-steroidal anti-inflammatory effect are required for the same analgesic or anti-inflammatory effect.
• the newer non-steroidal anti-inflammatory drugs which differ substantially in chemical structure from aspirin, acetaminophen and phenacetin, and which have significantly different biological profiles therefrom can be advantageously formulated into a novel composition together with a skeletal muscle relaxant, and optionally xanthine or a xanthine derivative and administered to mammals, especially to humans, to obtain more pain relief and lessened adverse side effects.
• compositions of matter for use in eliciting an analgesic or anti-inflammatory and musculoskeletal relaxing response, said composition comprising an effective analgesic or anti-inflammatory amount of a newer non-steroidal anti-inflammatory drug, an effective amount of a skeletal muscle relaxant, and optionally an amount of xanthine or xanthine derivative, such as caffeine, sufficient to enhance the analgesic or anti- inflammatory effect.
• active ingredients are further associated with a non-toxic pharmaceutically acceptable inert carrier therefrom.
• Another object of the present invention is to provide suitable unit dose forms of said composition comprising an effective amount of a non-steroidal anti-inflammatory drug, an effective amount of a skeletal muscle relaxant, and optionally an effective amount of xanthine or a xanthine derivative.
• xanthine or a xanthine derivative such as caffeine
• certain newer non-steroidal anti-inflammatory agents are ideally suited for use in a formulation with skeletal muscle relaxants, and optionally xanthine or a xanthine derivative, such as caffeine, by reason of their enhanced analgesic, anti-inflammatory and antipyretic activity and low incidence of untoward side effects, particularly at the optimum dosages provided for in the present invention, in comparison to aspirin or acetaminophen.
• Naproxen sodium 550 mg was compared with 650 mg of aspirin and was found to provide earlier and better pain relief than aspirin by Seveli ⁇ s, H., J. Clin. Pharmacol. 20: 480-485, 1980. "Comparative Analgesic Effects of Naproxen Sodium, Aspirin and Placebo.”
• NSAID's non-steroidal anti-inflammatory drugs
• pharmaceutical compositions and methods of use of the present invention may be selected from any of the following categories:
• NSAID any non-narcotic analgesic non- steroidal anti-inflammatory compound, including the pharmaceutically acceptable non-toxic salts thereof, falling within one of the five structural categories above but excluding aspirin, acetaminophen and phenacetin.
• non-steroidal anti-inflammatory drugs for use in the present invention are well known to those skilled in the art and reference may be had to various literature reference sources for their chemical structures, pharmacological activities, side effects, normal dosage ranges, etc. See, for example, Physician's Desk Reference, 38th Edition, 1984 and The Merck Index, 9th Edition, Merck and Company, Rahway, New Jersey (1976) and Cutting's Handbook of
• the propionic acid derivatives for use herein include, but are not limited to, ibuprofen, naproxen, naproxen sodium, flurbiprofen, fenoprofen, fenbufen, ketoprofen, pirprofen, carprofen, oxaprozin, prano profen, miroprofen, tioxaprofen, suprofen, alminoprofen, tiaprofenic acid, fluprofen and bucloxic acid.
• Structurally related propionic acid derivatives having similar analgesic and anti-inflammatory properties are also intended to be encompassed by this group.
• Representative members of the propionic acid group include ibuprofen, naproxen, flurbiprofen, fenbufen, fenoprofen, ibuprofen aluminum, ketoprofen, fluprofen and bucloxic acid. Structural formulas for these representative group members are set forth below:
• ⁇ are non-narcotic analgesics/non-steroidal anti- inflammatory drugs having a free -CH(CH 3 )COOH or -CH 2 CH 2 COOH group (which optionally can be in the form of a pharmaceutically acceptable salt group, e.g. -CH(CH 3 )COO-Na + or -CH 2 CH 2 COO-Na + ), typically attached directly or via a carbonyl function to a ring system, preferably to an aromatic ring system.
• a pharmaceutically acceptable salt group e.g. -CH(CH 3 )COO-Na + or -CH 2 CH 2 COO-Na +
• acetic acid derivatives for use herein include, but are not limited to, indomethacin, sulindac, tolmetin, diclofenac, fenclofenac, alclofenac, ibufenac, isoxepac, furofenac, tiopinac, zidometacin, acemetacin, fentiazac, clidanac and oxepinac.
• Structurally related acetic acid derivatives having similar analgesic and anti-inflammatory properties are also intended to be encompassed by this group.
• Representative members of the acetic acid group include tolmetin, sulindac, indomethacin, diclofenac, alclofenac, fenclozic acid and ibufenac. Structural formulas for these representative group members are set forth below:
• acetic acid derivatives as defined herein are non-narcotic analgesics/non-steroidal anti- inflammatory drugs having a free -CH 2 COOH group. (which optionally can be in the form of a pharmaceutically acceptable salt group, e.g. -CH 2 COO-Na + ), typically attached directly to a ring system, preferably to an aromatic or heteroaromatic ring system.
• a pharmaceutically acceptable salt group e.g. -CH 2 COO-Na +
• fenamic acid derivatives for use herein include, but are not limited to, mefenamic acid, meclofenamic acid, flufenamic acid, niflumic acid and tolfenamic acid. Structurally related fenamic acid derivatives having similar analgesic and anti-inflammatory properties are also intended to be encompassed by this group.
• Representative members of the fenamic acid group include mefenamic acid, meclofenamate sodium (meclofenamic acid, sodium salt) and flufenamic acid. Structural formulas for representative group members are set forth below:
• fenamic acid derivatives as defined herein are non-narcotic analgesics/non-steroidal anti-inflammatory drugs which contain the basic structure
• biphenylcarboxylic acid derivatives for use herein include, but are not limited to, diflunisal and flufenisal. Structurally related biphenylcarboxylic acid derivatives having. similar analgesic and anti-inflammatory properties are also intended to be encompassed by this group. Representative members of this group are diflunisal and flufenisal, whose structural formulas are set forth below: BIPHENYLCARBOXYLIC ACID DERIVATIVES
• biphenylcarboxylic acid derivatives as defined herein are non-narcotic analgesics/non- steroidal anti-inflammatory drugs which contain the basic structure
• oxicams for use herein include, but are not limited to, piroxicam, sudoxicam, isoxicam and CP-14,304. Structurally related oxicams having similar analgesic and anti-inflammatory properties are also intended to be encompassed by this group. Representative members of this group are depicted below:
• oxicams as defined herein are non-narcotic analgesics/non-steroidal anti-inflammatory drugs which have the general formula
• R is an aryl or heteroaryl ring system.
• ibuprofen, naproxen, naproxen sodium, flurbiprofen, fenoprofen, ketoprofen, suprofen, fenbufen, and fluprofen may be mentioned as particularly preferred compounds.
• acetic acid derivatives presently preferred members include tolmetin sodium, sulindac and indomethacin.
• fenamic acid derivatives particularly preferred compounds include mefenamic acid and meclofenamate sodium.
• the particularly preferred biphenylcarboxylic acid derivatives for use in the present invention include diflunisal and flufenisal.
• the particularly advantageous oxicams include piroxicam, sudoxicam and isoxicam.
• non-steroidal anti-inflammatory drugs in the practice of the preferred embodiments of the present invention, ibuprofen and naproxen are most preferred.
• typical effective analgesic amounts of presently preferred NSAID's for use in unit dose compositions of the invention presented in milligrams are set forth in Table II; however, greater or lesser amounts may be employed if desired or necessary.
• a description of unit dose dispensing is presented in Remington's Pharmaceutical Sciences, Fifteenth Edition, pages 1698-9.
• suitable dosage ranges for these compounds will generally fall within the range of about 12.5 mg to 900 mg in each unit dose.
• a general dosage range for those compounds that fall within the acetic acid derivative category is about 25 mg to 400 mg in each unit dose.
• a general dosage range for those compounds falling within the fenamic acid derivative category is about 50 mg to 500 mg in each unit dose.
• a general dosage range for those compounds falling within the biphenylcarboxylic acid derivative category is about 125 mg to 1000 mg in each unit dose.
• a general dosage range for those compounds falling within the oxicam category is about 10 mg to 40 mg in each unit dose.
• skeletal muscle relaxant as used herein is intended to mean any compound having skeletal muscle relaxing properties. Any skeletal muscle relaxant is useful in the practice of the present invention.
• the skeletal muscle relaxants may be broadly classified as those that act directly on skeletal muscle and those that act on the level of the central nervous system.
• the centrally acting muscle relaxants block impulses at the interneurons of polysynaptic reflex arcs, mainly at the level of the spinal cord. This is demonstrated by the abolishment of the diminution of the flexor and crossed extensor reflexes which possess one or more interneurons between the sensory and motor fibers.
• the knee-jerk response which acts through a monosynaptic reflex system and therefore possesses no interneurons, is unaffected by this class of drugs.
• glycerylmonoethers and derivatives glycerylmonoethers and derivatives
• oxazoles substituted alkanediols
• benzazoles benzodiazepines
• 1,3-dioxalanes 1,3-dioxalanes and miscellaneous. Since not all of the skeletal muscle relaxants readily lend themselves to such categorization, a miscellaneous category is required.
• the skeletal muscle relaxant formulations of the present invention comprise, in addition to the non-steroidal anti-inflammatory drugs, at least one active ingredient from the above-described chemical groups.
• Typical examples of drugs contained within each chemical group are presented below: a. glycerylmonoethers and derivatives mephenesin mephenesin carbamate mephenesin acid succinate methocarbamol chlorphenesin carbamate b. oxazoles mephenoxalone metaxalone c. substituted alkanediols meprobamate carisoprodol d. benzazoles zoxazolamine chlorzoxazone e.
• benzodiazepines chlordiazepoxide HCl diazepam f. miscellaneous analexin baclofen chlormezanone cyclobenzaprine HCl orphenadrine citrate
• Table III Some centrally-acting muscle relaxants are presented in Table III along with their chemical structure, dosage forms and usual unit dose.
• Mephensin has been the most extensively studied drug among the skeletal muscle relaxants. Although rarely used today it is a prototype for other skeletal muscle relaxants which have similar pharmacological actions. These include carisoprodol, chlorphenesin carbamate, chlorzoxazone, metaxalone, methocarbamol and orphenadrine citrate. Methocarbamol and orphenadrine citrate can be administered either orally or intraveneously. In the latter case, it is used to relieve severe, acute muscle spasm of local origin caused by inflammation or trauma.
• benzodiazepines e.g., diazepam
• baclofen e.g., baclofen
• cyclobenzaprine e.g., cyclobenzaprine
• Diazepam and other benzodiazepines are used for a variety of spastic states but may be most useful in painful spasms of flexor muscles.
• Baclofen is used for the treatment of spasticity in patients with multiple sclerosis. Baclofen's usefulness is limited by its adverse effects which include drowsiness, insomnia, dizziness, etc. Cyclobenzaprine is closely related to the tricyclic antidepressants both structurally and pharmacologically and has side effects which are common with that group of drugs.
• dantrolene is a typical non-centrally-acting muscle relaxant which exerts its effects by direct actions on skeletal muscle.
• Dantrolene has the following chemical structure:
• Dantrolene reduces contraction of skeletal muscle by direct action on excitation-contraction coupling, perhaps by decreasing the amount of calcium released from the sarcoplamic reticulum. Although dantrolene produces some central nervous system depressant effects, it does not impair polysynaptic reflexes preferentially as do the centrally-acting muscle relaxants. Dantrolene sodium is available for oral use at 25 - 100 mg in a single dose or for intravenous administration up to a total of 10 mg/kg.
• the preferred muscle relaxants intended for use in the practice of the present invention include diazepam, carisoprodol, chlorzoxazone, methocarbamol and orphenadrine citrate.
• dosage amount of the skeletal muscle relaxant in the formulations of the invention although the specific dose will vary depending upon the age and weight of the patient, the severity of the symptoms, the incidence of side effects and the like, for humans, typical effective amounts of the presently preferred skeletal muscle relaxants for use in unit dose compositions of the invention are about 2 - 10 mg diazepam, 100 - 600 mg carisoprodol, 100 - 1000 mg chlorzoxazone, 200 mg - 1500 mg methocarbamol and 25 - 100 mg orphenadrine citrate.
• the skeletal muscle relaxant may be centrally-acting or it may directly affect skeletal muscle tissue.
• the skeletal muscle relaxant may fall within one of the five structural categories indicated hereinabove.
• the newer non-steroidal anti-inflammatory drugs which differ substantially in chemical structure from aspirin, acetaminophen and phenacetin, and which have significantly different biological profiles therefrom can be advantage.ously formulated into a novel composition together with a skeletal muscle relaxant, and optionally xanthine or a xanthine derivative and administered to mammals, especially to humans, to obtain more pain relief and lessened adverse side effects.
• Both Norgesic and Norgesic Forte contain caffeine. Many agents with muscle relaxant properties and which are in wide use in the treatment of muscle tension and pain associated with anxiety states and/or psychosomatic disorders produce notable sedation. An open question is whether the clinical benefits produced are the result of the sedative effect itself or whether they are actually eliciting muscle relaxant activity. A two-fold purpose could thus be achieved by adding a xanthine or a xanthine derivative such as caffeine to muscle relaxant formulations; the xanthine or xanthine derivative would enhance the activity of the non-steroidal anti-inflammatory agent while providing some degree of central nervous stimulation to compensate for the sedative effect of the skeletal muscle relaxant component itself.
• xanthine or a xanthine derivative in particular, caffeine
• the xanthine derivatives of the invention comprise compounds of the general formula
• R 1 -R 3 inclusive independently represent hydrogen, C 1 -C 6 alkyl (straight or branched), C 1 -C 6 alkoxy, C 1 -C 6 haloalkyl, C 3 -C 6 cycloalkyl, hydroxy (C 1 -C 6 )alkyl, halogen, hydroxy (C 1 -C 4 )-alkylamino (C 1 - C 4 )alkyl, C 1 -C 4 (dialkyl)amino- (C 1 -C 4 )alkyl, C 1 -C 4 alkylcarbonyl (C 1 - C 4 )alkyl, C 1 -C 6 alkylamino, C 1 - C 6 (dialkyl)amino, indolyl, phenyl or allyl; R 4 is hydrogen, C 1 -C 6 alkyl, halo(C 1 -C 6 )alkyl,
• R 5 is halo, C 1 -C 6 alkyl
• Caffeine or 3,7-dihydro-1,3,7-trimethyl-1H-purine-2,6-dione, has the structural formula
• caffeine as used herein is intended to encompass not only caffeine as the anhydrous powder, but any salt or derivative of caffeine or any compounded mixture thereof which is non-toxic, pharmaceutically acceptable and which is capable of enhancing an analgesic or anti-inflammatory response when employed as described herein. See, for example, The Merck Index, ninth edition, Merck & Co., Inc.,
• caffeine as the anhydrous powder base is presently preferred and, where specific amounts of caffeine are set forth below, such amounts are given in mg of the anhydrous base.
• xanthine or a xanthine derivative such as caffeine
• xanthine or a xanthine derivative such as caffeine
• This finding permits the use of the selected NSAID in quantities substantially less than the dosages presently suggested as an analgesic or anti-inflammatory agent in humans. Use of lower doses should in turn lower the incidence and/or severity of undesirable side effects.
• approximately one-fifth to one-third less of the NSAID can be used in the caffeine formulation to achieve the same analgesic or anti-inflammatory effect as that obtained by use of the selected NSAID alone; in other words, the addition of xanthine or a xanthine derivative, such as caffeine, decreases the amount of the selected non-steroidal anti-inflammatory agent used in the skeletal muscle relaxant formulation to about two-thirds to four-fifths of the usual amount to achieve the same effect.
• These ratios may vary, however, depending on the patient's individual response, the selected dosage level of the active ingredients, etc. Alternatively, at a given dosage level, a greater analgesic or anti-inflammatory response can be achieved.
• the amount of xanthine or xanthine derivative in the analgesic composition will be an amount sufficient to enhance analgesia.
• a unit dose composition will typically contain from about 60 to about 200 mg (preferably about 65 to about 150 mg) caffeine; this dosage level of caffeine is generally sufficient to enhance analgesia.
• Certain NSAID's are particularly long-acting and need be administered less frequently than the usual every 4 to 6 hours; for example, diflunisal and naproxen are typically administered only twice daily and piroxicam only once a day. When such long-acting drugs are employed, it is often desirable to include an additional amount of a muscle relaxant and/or an additional analgesia-enhancing amount of caffeine in the composition in sustained release form.
• Typical therapeutically active components of the present invention along with their usual adult dosage, for use in the pharmaceutical compositions and methods of the present invention are set forth in the following Table IV.
• the third column indicates that caffeine is an optional third component in the compositions of the present invention.
• non-steroidal anti-inflammatory drugs in combination with caffeine applicants have already demonstrated a surprisingly enhanced analgesic and anti-inflammatory response in a mammalian organism. Again, compare U.S. Patent Nos. 4,420,483, 4,464,376 and 4,479,956.
• Illustrative of typical unit dose forms are tablets or capsules containing the amounts indicated in Table IV.
• the asterisk (*) indicates that the adjacent amount is in sustained release form, e.g. "130 mg + 130 mg*" means that the first 130 mg is formulated for immediate release, while the second 130 mg is in sustained release form.
• Skeletal Muscle OPTIONAL Relaxant NSAID Caffeine diazepam ibuprofen 2 mg 100 mg 65 or 130 mg 5 mg 200 mg 65 or 130 mg 10 mg 400 mg 65 or 130 mg diazepam naproxen 2 mg + 2 mg* 125 mg 65 mg + 65 mg* 5 mg + 5 mg* 250 mg 130 mg + 130 mg* 10 mg + 10 mg* 500 mg 130 mg + 130 mg* diazepam fenoprofen 2 mg 100 mg 65 mg or 130 mg 5 mg 200 mg 65 mg or 130 mg 10 mg 200 mg 65 mg or 130 mg chlorzoxazone ibuprofen 250 mg 200 mg 65 or 130 mg 500 mg 400 mg 65 or 130 mg chlorzoxazone naproxen 250 mg + 250 mg* 125 mg 65 mg + 65 mg* 500 mg + 500 mg* 250 mg 130 mg + 130 mg* 500 mg + 500 mg* 500 mg 130 mg + 130 mg* chlorzoxazone fenoprofen 250 mg 100 mg 65 or 130 mg 500 mg 200 mg 65 or 130 mg chlorzox
• the active drug components may be combined with any oral non-toxic pharmaceutically acceptable inert carrier such as lactose, starch, sucrose, cellulose, magnesium stearate, dicalcium phosphate, calcium sulfate, mannitol and the like.
• suitable binders, lubricants, disintegrating agents and coloring agents can also be incorporated in the mixture.
• suitable binders include starch, gelatin, natural sugars, corn sweeteners, natural and synthetic gums such as acacia, sodium alginate, carboxymethylcellulose, polyethylene glycol and waxes.
• lubricants there may be mentioned for use in these dosage forms, boric acid, sodium-benzoate, sodium acetate, sodium chloride, etc.
• Disintegrators include, without limitation, starch, methylcellulose, agar, bentonite, guar gum, etc. Sweetening and flavoring agents and preservatives can also be included where appropriate.
• compositions of the present invention may be formulated in sustained release form to provide the rate controlled release of any one or more of the components to optimize the therapeutic effects, i.e., analgesia, skeletal muscle relaxation, etc. while minimizing undesirable side effects.
• Suitable dosage forms for sustained release include layered tablets containing layers of varying disintegration rates or controlled release polymeric matrices impregnated with the active components and shaped in tablet form or capsules containing such impregnated or encapsulated porous polymeric matrices.
• injectable dosage units may be utilized to accomplish intravenous, intramuscular or subcutaneous administration and, for such parenteral administration, suitable sterile aqueous or non-aqueous solutions or suspensions, optionally containing appropriate solutes to effectuate isotonicity, will be employed.
• compositions of the present invention may also be formulated and administered by other methods which are known for administering analgesics.
• the composition may be adapted for rectal administration, for example, as a suppository.
• the composition may also be adapted for topical application, for example, the composition may be applied in a pharmaceutically acceptable topical vehicle selected from the group consisting of creams, gels, ointments, powders, aerosols and solutions suitable for topical administration.
• a pharmaceutically acceptable topical vehicle selected from the group consisting of creams, gels, ointments, powders, aerosols and solutions suitable for topical administration.
• Triturate active ingredients and q.s. with lactose to selected capsule size Triturate active ingredients and q.s. with lactose to selected capsule size
• Triturate active ingredients and q.s. with lactose to selected capsule size Triturate active ingredients and q.s. with lactose to selected capsule size
• Triturate active ingredients and q.s. with lactose to selected capsule size Triturate active ingredients and q.s. with lactose to selected capsule size
• Triturate active ingredients and q.s. with lactose to selected capsule size Triturate active ingredients and q.s. with lactose to selected capsule size

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