Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
  • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
• • 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
  • A61K31/60—Salicylic acid; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/14—Antitussive agents

Definitions

• This invention is concerned with novel antitussive composi- tions containing dextro ethorphan. More particularly, it is concerned with compositions and methods for rapidly achieving therapeutic systemic levels of dextromethorphan.
• Dextromethorphan (racemethorphan), 3-methoxy-17-methylmor- phinan, is disclosed in the Merck Index. 10th edition (1983), M. Windholz, ed., No. 8009, p. 1170; it is disclosed to be an antitussive agent.
• Dextromethorphan hydrobro ide is used extensively as an antitussive agent in commercial products as disclosed in the Physician's Desk Reference for Nonprescription Drugs. 11th Edition (1990), E.R. Barnhardt, pub., p. 306, and in Physician's Desk Reference. 44th Edition (1990), E.R. Barnhardt, pub., p.
• Delsym Cough Suppressant Syrup by McNeil Consumer contains dextromethorphan polistirex as an antitussive agent. It is believed that all of the above commercial products containing dextromethorphan are included in compositions at about neutral pH or lower.
• Beckett and Triggs would not be expected to be very pertinent to liquid products which are generally not held in the mouth but are swallowed quickly, or even to solid products such as lozenges which are allowed to dissolve in the mouth where the dissolution liquid is rapidly swallowed.
• U. S. Patent No. 4,892,877 issued to Sorrentino on January 9, 1990 discloses liquid compositions for the treatment of coughs comprising both dextromethorphan and phenol, the composi ⁇ tions having a pH of 5-9.
• U.S. Patent No. 4,427,681 issued to Munshi on January 24, 1984 discloses thixotropic compositions for the treatment of coughs comprising both dextromethorphan and Avicel® RC-591. These patents are hereby incorporated by reference.
• compositions for oral administration consist essentially of a safe and effective amount of dextromethorphan and an orally-acceptable pharmaceutical carrier, the composition having a pH of from about 8 to about 11.
• the subject invention also involves pharmaceutical co posi- tions for oral administration which comprise a safe and effective amount of dextromethorphan, safe and effective amounts of cough/cold drug actives other than phenol, and an orally-accept ⁇ able pharmaceutical carrier, the composition having a pH of from about 8 to about 11.
• pharmaceutical composi ⁇ tions for oral administration which comprise a safe and effective amount of dextromethorphan, a safe and effective amount of phenol, and an orally-acceptable pharmaceutical carrier, the composition having a pH of from greater than 9 to about 11.
• compositions and methods of the subject invention comprise a safe and effective amount of dextromethorphan, and possibly other drug actives.
• safe and effective amount means an amount of drug active high enough to provide a significant positive modification of the condition to be treated, but low enough to avoid serious side effects (at a reasonable benefit/risk ratio), within the scope of sound medical judgment.
• a safe and effective amount of drug active will vary with the particular condition being treated, the age and physical condition of the patient being treated, the severity of the condition, the duration of the treatment, the nature of concurrent therapy and like factors.
• Dextromethorphan is known to have pharmacological activity as an antitussive agent.
• "dextromethorphan” means racemethorphan, 3-methoxy-17-methylmorphi nan (dl -ci s- 1 ,3 , 4, 9, 10, 10a-hexahydro-6-methoxy-ll-methyl -2H- 10, 4a- imino- ethanophenanthrene :
• salts of dextromethorphan include the hydrobromide salt.
• compositions of the subject invention preferably com ⁇ prise from about 1 mg to about 50 mg dextromethorphan per dose, more preferably from about 2.5 mg to about 30 mg dextromethorphan per dose.
• Liquid compositions preferably comprise from about 0.02% to about 1.5% dextromethorphan, more preferably from about 0.05% to about 1% dextromethorphan, most preferably from about 0.1% to about 0.3% dextromethorphan.
• a typical dose for a liquid antitussive composition is from about 1 ml to about 30 ml .
• a dose of liquid cough syrup is more typically from about 5 ml to about 20 ml, especially about 15 ml.
• a dose of concentrated liquid cough spray is more typically from about 2 ml to about 5 ml, especially about 3.5 ml.
• compositions of the subject invention consist essentially of a safe and effective amount of dextromethorphan, and an orally-acceptable pharmaceutical carrier, the composition having a pH of from about 8 to about 11, preferably of from about 8.4 to about 10, more preferably still of from about 8.5 to about 9.5, most preferably of about 9.
• Other preferred compositions of the subject invention comprise a safe and effective amount of dextromethorphan, safe and effective amounts of other cough/cold drug actives other than phenol, and an orally-acceptable pharma ⁇ ceutical carrier, the composition having a pH of from about 8 to about 11, preferably from about 8.4 to about 10, more preferably still from about 8.5 to about 9.5, most preferably about 9.
• compositions of the subject invention comprise a safe and effective amount of dextromethorphan, a safe and effective amount of phenol, and an orally-acceptable pharmaceutical carrier, the composition having a pH of from greater than 9 to about 11, preferably from about 9.5 to about 10, also preferably from about 9.1 to about 9.5. It has been found that the compositions of the subject invention result in faster attainment of therapeutic blood levels of dextromethorphan, maintenance of such therapeutic blood levels for a longer time, and/or higher peak blood levels of dextro ⁇ methorphan, compared to conventional lower pH dextromethorphan compositions.
• compositions of the subject invention preferably have a basic buffering strength sufficient to overcome that provided by the saliva and mucus membranes of the mouth and throat, such that the composition mixed with saliva is retained in the above pH ranges during the period that it is in the mouth and throat. Consequently, the compositions of the subject invention prefera ⁇ bly have a basic buffer strength of at least about 0.01 milliequivalents (mEq) base per unit dose, more preferably from about 0.05 mEq to about 2.5 mEq per unit dose, most preferably from about 0.1 mEq to about 1.5 mEq per unit dose.
• mEq milliequivalents
• compositions of the subject invention comprise a pharma- ceutically-acceptable carrier preferably comprising a pharmaceu- tically-acceptable buffer system.
• phar aceutically- acceptable buffer systems useful in the compositions of the subject invention include, but are not limited to, phosphate buffer systems which are a mixture of salts of onohydrogen and dihydrogen phosphate, sodium hydroxide/glycine buffer systems, and carbonate and hydrogen carbonate buffer systems.
• Preferred buffer systems useful in the compositions of the subject inven- tion are phosphate buffer systems.
• a preferred component of the carrier of the compositions of the subject invention is microcrystalline cellulose or a mixture of mycrocrystalline cellulose and carboxymethylcellulose sodium.
• Microcrystalline cellulose and mixtures of microcrystalline cellulose and carboxymethylcellulose sodium are available from FMC Corporation under the trade name Avicel ® .
• Such mixtures preferably have a ratio of microcrystalline cellulose to carboxymethylcellulose sodium of from about 20:1 to about 1:1; more preferably from about 15:1 to about 3:1, more preferably still from about 10:1 to about 5:1.
• a preferred mixture of microcrystalline cellulose and carboxymethylcellulose sodium is Avicel ® RC591, a commercially available microcrystalline cellulose marketed by FMC Corporation, Food and Pharmaceutical Products Division, Philadelphia, Pennsyl ⁇ vania.
• Avicel ® RC591 is said to be a colloidal form of about 89% microcrystalline cellulose gel blended with about 11% sodium carboxymethylcellulose which is dried; the product is easily dispersed in water. It is insoluble in water, organic solvents and dilute acids. It is partially soluble in dilute alkali. Its chemical and physical specifications are as follows: loss on drying: less than 6% at time of shipment; heavy metals: less than 10 parts per million; viscosity of a 1.2% solution: 65 + 1%; particle size: less than 0.1% retained on 60 mesh screen, less than 20% retained on a 325 mesh screen. Average particle size is about 28 microns. Its bulk density is about 37 lbs/ft 3 loose pack and about 52 lbs/ft 3 tight pack.
• compositions of the subject invention are intended for peroral administration. Examples of such compositions include preferred liquid compositions, especially aqueous-based liquid compositions, such as syrups, elixirs, suspensions, sprays, and drops.
• solid compositions which are dissolved or masticated in the mouth such as lozenges, chewable lozenges, powders, and chewable tablets.
• the pH of such solid dosage forms is determined by dissolving the solid dosage form in artificial saliva at a concentration of 10% of the solid composition and determining the pH of the resulting solution or suspension.
• Artificial saliva formulation is disclosed in Fusayema, T., T. Katayori & S. Nomoto, "Artificial Saliva", Journal of Dental Research. Vol. 42 (1963), pp. 1183-1197, which is incorporated herein by reference).
• Dextromethorphan is relatively insoluble in water at the pH of the compositions of the subject invention. Therefore, it is preferable that sufficient levels of one or more cosolvents be incorporated in the carrier to provide for dissolution of the dextromethorphan in the composition and in the oral cavity.
• cosolvents for this purpose include ethanol, propylene glycol, polyethylene glycol, glycerin and sorbitol; more pre- ferred cosolvents include ethanol, propylene glycol and glycerin.
• the carrier preferably includes some of the following optional ingredients: water; sweetening agents, such as sucrose, corn syrup, invert sugar, dextrose, sodium saccharin, aspartame, sorbitol, honey, and magnasweet; aromatic ingredients, such as menthol, anethol, camphor, thymol, methyl salicylate, eucalyptus oil and peppermint oil; other flavoring agents; thickening agents, such as carboxymethylcellulose, sodium carboxymethyl- cellulose, cellulose, glycerine and polyethylene glycol; coloring agents; preservatives, such as sodium benzoate and cetylpyri- dinium chloride; miscellaneous ingredients, such as potassium sorbate, sodium chloride, titanium dioxide, polysorbate 80, sodium citrate, sodium bicarbonate, sodium hydroxide, aluminum hydroxide and magnesium hydroxide.
• sweetening agents such as sucrose, corn syrup, invert sugar, dextrose, sodium saccharin, aspartame, sorbitol
• the carrier preferably includes one or more of the optional ingredi ⁇ ents provided hereinabove for the liquid compositions, and additionally the following optional ingredients may be included in such compositions: solid diluents, binders, disintegrants and opacifiers, such as silicon dioxide, talc, povidone, Kaolin, dicalcium phosphate, calcium sulfate, lactose and starch; and miscellaneous ingredients, such as acacia, capsicum, annitol, sodium alginate, alginic acid, veegum, guar gum, gelatin, ethylcellulose, magnesium stearate, bentonite and sodium lauryl sulfate.
• solid diluents such as silicon dioxide, talc, povidone, Kaolin, dicalcium phosphate, calcium sulfate, lactose and starch
• miscellaneous ingredients such as acacia, capsicum, annitol, sodium alginate,
• compositions of the subject invention also may comprise one or more other active drug agents useful for treating coughs and/or colds (cough/cold drug actives).
• Cough/cold drug actives commonly combined with antitussive agents in commercial products are preferred.
• Cough/cold drug actives useful in the composi- tions of the subject invention include antihistamines, bronchodilators, decongestants, expectorants, local anesthetics and anti-inflammatory/analgesics.
• antihistamines such as chlorpheniramine (preferably from about 1 mg to about 8 mg, more preferably from about 2 mg to about 4 mg) and its salts (e.g., maleate), diphenhydramine (preferably from about 6 mg to about 50 mg, more preferably from about 12 mg to about 25 mg) and its salts (e.g., hydrochloride), brompheniramine (preferably from about 1 mg to about 8 mg, more preferably from about 2 mg to about 4 mg) and its salts, doxylamine (preferably from about 2 mg to about 20 mg, more preferably from about 6 mg to about 12 mg) and its salts (e.g., succinate), triprolidine (preferably from about 0.5 mg to about 4 mg, more preferably from about 1 mg to about 3 mg) and its salts (e.g., hydrochloride); bronchodilators, such as ephedrine (preferably from about 5
• benzyl alcohol preferably from about 50 mg to about 750 mg, more preferably from about 100 mg to about 500 mg
• dibucaine preferably from about 0.1 mg to about 4 mg, more preferably from about 0.5 mg to about 2 mg
• tetracaine preferably from about 0.1 mg to about 4 mg, more preferably from about 0.5 mg to about 2 mg
• phenolate sodium preferably from about 10 mg to about 150 mg, more preferably from about 20 mg to about 50 mg
• sal cyl alcohol preferably from about 20 mg to about 200 mg, more preferably from about 50 mg to about 100 mg
• hexylresorcinol preferably from about 1 mg to about 10 mg, more preferably from about 2 mg to about 4 mg
• menthol preferably from about 2 mg to about 50 mg, more preferably from about 5 mg to about 25 mg
• anti-inflammatory/analgesics preferably from about 50 mg to about 750 mg, more preferably from about 100 mg to about 500 mg
• dibucaine preferably from about 0.1
• the subject invention also includes methods for treating or preventing cough in humans or lower animals by orally admini- stering a composition disclosed hereinabove.
• the daily dosage of dextromethorphan is preferably from about 0.1 mg/kg to about 10 mg/kg of body weight, more preferably from about 0.5 mg/kg to about 5 mg/kg, more preferably still from about 1 mg/kg to about 3 mg/kg.
• a dextro ⁇ methorphan composition be orally administered to a patient from about 1 to about 10 times daily, more preferably from about 2 to about 8 times daily, more preferably still from about 3 to about 6 times daily.
• a typical manufacturing process for making the above liquid cough composition is to prepare separate liquid phases by mixing together the following ingredients: (1) dextromethorphan HBr, propylene glycol, ethanol, menthol, eucalyptus oil and flavorants; (2) sucrose, CMC, Avicel, polysorbate 80, glycerin, sorbitol, and part of the water; and (3) colorant, glycine, sodium hydroxide and part of the water.
• the three liquid phases are then blended together with the remainder of the water to produce the liquid cough composition.
• Example XII The liquid of Example XII is made by adding the dextromethorphan base to the propylene glycol with stirring.
• the polyethylene glycol, alcohol, flavorants, and sodium saccharin are added incrementally with stirring.
• the monobasic sodium phosphate is added as a 10% solution in purified water with stirring.
• the dye is added as a water solution with stirring. Purified water is added to volume with stirring.

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• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Medicinal Preparation (AREA)

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• 1991
  • 1991-10-21 AU AU89158/91A patent/AU663857B2/en not_active Ceased
  • 1991-10-21 CZ CS93795A patent/CZ79593A3/cs unknown
  • 1991-10-21 JP JP4500771A patent/JPH06502428A/ja active Pending
  • 1991-10-21 HU HU9301254A patent/HUT64216A/hu unknown
  • 1991-10-21 SK SK42593A patent/SK42593A3/sk unknown
  • 1991-10-21 WO PCT/US1991/007773 patent/WO1992007559A1/en not_active Application Discontinuation
  • 1991-10-21 CA CA002129676A patent/CA2129676C/en not_active Expired - Fee Related
  • 1991-10-21 EP EP92902567A patent/EP0555411A1/de not_active Ceased
  • 1991-10-21 PL PL91298950A patent/PL168968B1/pl unknown
  • 1991-10-29 MX MX9101831A patent/MX9101831A/es not_active IP Right Cessation
  • 1991-10-30 PT PT99380A patent/PT99380B/pt not_active IP Right Cessation
  • 1991-10-30 IE IE379291A patent/IE913792A1/en not_active Application Discontinuation
• 1993
  • 1993-04-29 FI FI931934A patent/FI931934A/fi unknown

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