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
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • 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
• • 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
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
  • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
• • 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
  • A61K31/415—1,2-Diazoles
• • 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
  • A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
  • A61K31/542—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/545—Compounds containing 5-thia-1-azabicyclo [4.2.0] octane ring systems, i.e. compounds containing a ring system of the formula:, e.g. cephalosporins, cefaclor, or cephalexine
• • 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
  • A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
  • A61K31/542—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/545—Compounds containing 5-thia-1-azabicyclo [4.2.0] octane ring systems, i.e. compounds containing a ring system of the formula:, e.g. cephalosporins, cefaclor, or cephalexine
  • A61K31/546—Compounds containing 5-thia-1-azabicyclo [4.2.0] octane ring systems, i.e. compounds containing a ring system of the formula:, e.g. cephalosporins, cefaclor, or cephalexine containing further heterocyclic rings, e.g. cephalothin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/44—Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
  • A61P15/14—Drugs for genital or sexual disorders; Contraceptives for lactation disorders, e.g. galactorrhoea
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/04—Centrally acting analgesics, e.g. opioids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/16—Otologicals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to a method of treatment and/or prevention of an inflammatory condition in a fluid-containing organ having a natural exterior orifice, such as the udder of a milk-producing animal or an ear of a subject.
• the invention also relates to a dispersible pharmaceutical composition suitable for infusion into the organ according to the method of the invention, and a process for preparing such a composition.
• Mastitis is an inflammation of the mammary gland of milk-producing animals, for example dairy cows, most often caused by bacterial infection. Bacteria enter through the teat canal of the animal and can cause acute, clinical or sub-clinical mastitis. Over 135 organisms have been documented as causative pathogens for bovine mastitis. Three of the major groups of pathogens are gram-positive cocci, gram-negative bacilli and gram- positive bacilli. Hygiene, environmental factors and metabolic disturbances deriving from high milk yield combine to create conditions favorable to the onset of mastitis. An increased somatic cell count, associated with mastitis, is positively correlated with infection and negatively correlated with milk production.
• 3,636,194 to Parizeau discloses a composition for treating mastitis by intramammary infusion, comprising an antibiotic, a vegetable oil, an alcohol- soluble fraction of natural lecithin phospholipid material for promoting dispersion of the ' oil in milk, the phospholipid being selected from the group consisting of phosphatidyl choline and phosphatidyl ethanolamine and mixtures thereof and present in an amqunt of at least 0.25% in said oil.
• Such compositions are said to provide rapid dispersion into milk and short milkout times.
• British Patent Application No. 1 J 81 ,527 discloses a composition for treating mastitis comprising an active substance and a pharmaceutically acceptable oil base, said composition containing phospholipid material consisting substantially entirely of alcohol- soluble material for promoting dispersion of the composition in milk.
• European Patent Application No. 0222712 discloses a composition which contains one or more antimicrobial agents dispersed in an oil consisting of a mixture of triglycerides of palmitic and stearic acid together with polyoxyethylenated cetyl alcohol and stearyl alcohol, and held in an oily medium of mineral, vegetable, synthetic or mixed extraction.
• compositions are said to speed up release of the antimicrobial agent in the udder, enhancing its biological potential, and reducing milkout time.
• anti-inflammatory agents to treat mastitis has also been proposed.
• U.S. Patent No. 5,756,529 to Isakson & Talley discloses a method of using pyrazolyl benzenesulfonamide compounds to treat inflammation in a companion animal.
• Such compounds are said to be useful for treatment of pain, fever, joint disease, traumatic injury, arthritis, myositis, tendinitis, equine colic, mastitis, peritonitis, skin conditions, burns, gingivitis, hypersensitivity, conjunctivitis, eye inflammation, swelling and myocardial ischemia.
• compositions comprising one or more bioactive agents in a liquid carrier, which has been modified to have an increased level of oxidation products, wherein the bioactive agents include anti- infectives, antineoplastics, immunomodulators, antipyretics, analgesics and anti- inflammatory agents (e.g., COX-2 inhibitors).
• bioactive agents include anti- infectives, antineoplastics, immunomodulators, antipyretics, analgesics and anti- inflammatory agents (e.g., COX-2 inhibitors).
• Such compositions can be administered by a parenteral (e.g., subcutaneous, intramammary, intravenous, intraperitoneal or intramuscular), topical, intravaginal, oral or rectal route.
• a parenteral e.g., subcutaneous, intramammary, intravenous, intraperitoneal or intramuscular
• topical e.g., subcutaneous, intramammary, intravenous, intraperitoneal or intramuscular
• WO 02/006865 discloses one or more bioactive substances in a non-aqueous carrier, wherein the composition has been adjusted to have a water activity of between about 0.2 and about 0.5.
• Parenteral, topical, oral, intravaginal, rectal and intramammary routes of administration are proposed.
• bioactive agents listed are anti-infectives, antinepplastics, immunomodulators, antipyretics, analgesics and anti- inflammatory agents (e.g., COX-2 inhibitors).
• International Patent Publication No. WO 99/20259 discloses a combination of thiamphenicol and diclofenac for use in veterinary medicine to treat infections with associated inflammatory conditions.
• WO 01/60409 discloses a paste composition
• a therapeutic agent is selected from insecticides, acaricides, parasiticides, antibiotics, growth enhancers, oil-soluble NSAIDs, avermectins, milbemycins, nordulisporic acid, estrogens, progestins, phenylpyrazoles, substituted pyridyl methyl derivatives and COX-2 inhibitors.
• Oral, topical, dermal and subdermal routes of administration are contemplated for the paste composition.
• Such compositions are said to have application in veterinary practice in treatment of diseases such as pneumonia, mastitis, metritis, rhinitis and bronchitis.
• U.S . Patent Application Publication No. 2002/0032228 discloses use of a heterocycle containing compound, for example a diphenyl heterocycle derivative, to treat diarrheal diseases, whooping cough, anthrax, smooth muscle contraction conditions and mastitis.
• Celecoxib and rofecoxib are listed as preferred diphenyl heterocycle derivatives.
• a Labrafil product brochure (Notice OL 0050/5th edition) from Gattefosse Corporation contains an extract from a thesis by Valette (1957), discussing characteristics of LabrafilTM M-1944CS in the ear canal. The same thesis describes an experiment involving injecting LabrafilTM M-1944CS mixed with gentian violet into a cow teat. It was shown that LabrafilTM wetted the entire surface of the mammary parenchyma section and reached the retromammary ganglion.
• An otic infection may be of bacterial, fungal or viral origin and determination of the precise etiology is not practical since the causative organism is often difficult to isolate and culture.
• Otitis externa external ear infections
• otitis media middle ear infections
• otorrhea otitis media with ruptured ear drum causing effusion
• Otitis externa involving the ear canal portion of the external ear, is a common otological problem occurring mainly during hot, humid weather, and five times more frequently in swimmers than in non-swimmers.
• symptoms include itching and pain in the ear canal, and tenderness when pressure is applied around the external auditory canal, the ear lobe is pulled or the jaw is moved.
• suppuration occurs in the ear canal and hearing may be decreased.
• Over 90% of cases of otitis extema are due to bacterial and fungal infections.
• Pathological conditions can arise from, and can cause, changes in the surface tension of air/liquid interfaces of tissue surfaces, especially epithelial surface tissues.
• the external auditory canal is lined with epithelium.
• the cerumen exudate normally secreted upon the epithelial tissue lining the external auditory canal, imparts a particularly high surface tension thereto.
• Inflammatory by-products can further increase such surface tension.
• Increased surface tension is an important factor in both the symptoms and treatment of otitis.
• the increased surface tensions resident upon the epithelial lining of the outer ear canal tends to inhibit uniform and/or effective application of therapeutic agents.
• otitis externa has been treated with topical application of therapeutic agents demonstrating antimicrobial activity as well as anti-inflammatory action.
• Broad spectrum topically effective antibiotic otic suspensions containing antibacterial agents for example neomycin sulfate, colistin sulfate, polymyxin B, or combinations thereof, all broad spectram in effect, have been utilized to destroy causative bacteria.
• Antimycotic topically acting agents for example nystatin and clotrimazole, have been employed to destroy underlying fungal disease.
• the antiviral agent acyclovir has been utilizedjo reat viral otitis extema including herpes zoster.
• Anti-inflammatory agents including, for example, hydrocortisone, hydrocortisone acetate and dexamethasone sodium phosphate, often included in the topically acting suspensions identified above, have been employed to control the inflammatory process of otitis extema.
• antimicrobial and anti-inflammatory agents are utilized in combination to treat the causative, triggering disorder, e.g., bacterial infection, as well as the inflammatory process itself. They are also most often administered as suspensions in drop form for topical administration to the affected ear.
• wicks made of absorbent material such as cotton, are utilized to draw the suspension into the ear canal.
• 2002/0044920 discloses treating immune-mediated ear disorders by administering a TNF antagonist and a pyrimidine synthesis inhibitor with a steroid, an anti-inflammatory compound (for example a non- steroidal anti-inflammatory drug also known as a NSAID or a COX-2 inhibitor), a cytotoxic compound, an anti-neoplastic metabolite, or a secondary antirheumatic agent.
• an anti-inflammatory compound for example a non- steroidal anti-inflammatory drug also known as a NSAID or a COX-2 inhibitor
• cytotoxic compound for example a non- steroidal anti-inflammatory drug also known as a NSAID or a COX-2 inhibitor
• a secondary antirheumatic agent for example a non- steroidal anti-inflammatory drug also known as a NSAID or a COX-2 inhibitor
• compositions as an aerosol through the external auditory canal, the composition comprising a lipid surfactant in an amount effective in lowering surface tension of an air/liquid interface upon epithelial tissue lining, a spreading agent and a propellant, wherein the spreading agent is selected from the group consisting of lipids, sterols, fatty acid, cholesterol esters, phospholipids, carbohydrates and proteins, all in powder form.
• the composition is said to increase external auditory canal patency while providing protection against occurrence of otitis extema.
• compositions as an aerosol through an external airway, wherein the composition comprises a lipid surfactant in an amount effective in lowering surface tension of an air/liquid interface upon epithelial tissue lining, and a spreading agent selected from a group consisting of sterols, lipids, fatty acids, cholesterol esters, phospholipids, carbohydrates and proteins, all in powder form.
• the composition is said to increase the patency and pressure equalization performance of the eustachian tube lumen.
• Ear drops have been contemplated as a formulation type for selective COX-2 inhibitors, for example in the patents and publications individually cited below.
• compositions intended for intramammary administration to treat or prevent mastitis in milk-producing animals are constructed of oxygen-permeable plastic materials, for example polyethylene, polypropylene, etc. and mixtures thereof.
• oxygen-permeable packaging containers and delivery devices for anti-mastitis compositions and for compositions for treatment or prevention of otic disorders poses serious problems for long term chemical and/or physical stability of a composition contained therein, if the composition comprises an ingredient, for example an active medicament or an excipient, that is prone to oxidative degradation.
• compositions for treatment of mastitis or for treatment of otic disorders none addresses the problem of providing extended chemical and/or physical stability of a composition packaged in an oxygen-permeable container, where the composition comprises a pharmaceutically active agent and/or excipient that is prone to oxidative degradation.
• compositions having one or more of the following advantages over prior art compositions used in treatment of mastitis or over prior art compositions used in treatment or prevention of otic disorders: (a) extended chemical and/or physical stability even when packaged in oxygen-permeable containers and delivery devices, particularly where the composition comprises a pharmaceutically active agent or excipient that is prone to oxidative degradation, (b) safe, effectivetreatmentof the inflammatory.
• mastitis or of an otic disorder a component of mastitis or of an otic disorder, (c) safe, effective treatment of the pain, inflammation, edema, fever and swelling associated with mastitis or an otic disorder, (d) minimal to no irritation after administration of the composition, (e) rapid dispersibility of an anti-mastitis composition in milk and in udder > fluids to quickly achieve efficacious medicament levels at sites of inflammation, (f) rapid dispersibility of an otic composition in the waxy moist environment of an ear to qqickly achieve efficacious medicament levels at sites of inflammation, (g) a lowering of the surface tension of the air/liquid interface of epithelial tissue, increasing patency of the auditory canal, and (h) a protective coating for inflamed mucous membranes of the ear.
• Novel methods of treatment and pharmaceutical compositions having some or all of the advantageous attributes described above have now been developed.
• a novel method of treatment and/or prevention of an inflammatory condition in a fluid-containing organ having a natural exterior orifice for example an udder of a milk-producing animal or an ear of a human or animal subject.
• the method comprises administering an anti-inflammatory agent to the organ via the exterior orifice and administering in combination therapy therewith a second agent as defined herein.
• the anti-inflammatory agent is administered as a pharmaceutical composition
• a pharmaceutical composition comprising, in addition to said agent, a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier.
• Such a composition has low interfacial tension when placed in contact with an aqueous medium. It is believed, without being bound by theory, that this low interfacial tension results in the composition dispersing readily in udder fluids such as milk'as well as in the more waxy moist environment of an ear. In a preferred method of the invention, therefore, upon administration to the fluid-containing organ, the composition disperses in the fluid.
• a preferred anti-inflammatory agent for use in the method of the invention is a selective COX-2 inhibitor.
• the method can, for example, comprise intramammary infusion of such a composition for treatment of mastitis or other diseases of the udder in a milk-producing animal, or otic infusion of such a composition for treatment and/or prevention of otic disorders, and-is- efficacious-in a-wide variety of inflammatory disorders which can be associated with a wide variety of infectious organisms.
• infusion herein embraces any operation wherein a liquid composition is caused to flow into the fluid- containing organ via the exterior orifice, for example the teat canal in the case of intramammary infusion or the external auditory canal in the case of otic infusion, regardless of the timescale involved.
• infusion and "injection” are substantially synonymous.
• the composition can be intramammarily administered by inserting the cannula nozzle of a mastitis syringe into the external orifice of a teat canal and injecting the composition through the nozzle into the udder.
• the anti-inflammatory agent for example a selective COX-2 inhibitor
• the ' second agent can be any therapeutically active agent useful in treatment of mastitis or otic disorders.
• Such second agents include, without limitation, antibacterial agents, antineoplastic agents, anesthetics, sodium channel blockers, antipyretics, analgesics, antiedemic agents, and the like, and combinations thereof.
• the second agent can be administered by a route that is other than the route of administration of the anti-inflammatory agent.
• both agents can be administered by the same route, i.e., via the exterior orifice of the organ, for example the teat canal in the case of an udder or the external auditory canal in the case of an ear.
• both agents be administered by intramammary or otic infusion in the form of a liquid composition comprising a vehicle as described above. It is especially preferred that the anti-inflammatory agent and the second agent be administered in a single composition containing both agents.
• a pharmaceutical composition comprising a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non- aqueous carrier.
• the vehicle has stably dispersed therein an anti-inflammatory agent, for example a selective COX-2 inhibitor, in an anti-inflammatorily effective amount.
• an anti-inflammatory agent for example a selective COX-2 inhibitor
• the anti-inflammatory agent and/or an excipient in the composition is prone to oxidative degradation, and the composition exhibits extended chemical and/or physical stability when packaged in a container or delivery device having an oxygen permeable wall.
• the novel composition has a low interfacial tension in aqueous fluids, thereby increasing dispersibility of the composition in milk and udder fluids, as compared to a conventional oil based formulation. This results in rapid distribution of the composition throughout the udder and thereby allows the anti-inflammatory agent and/or the second agent to reach inflamed tissue quickly, providing an efficacious level of medicament at a site of inflammation.
• the interfacial tension of a composition in an aqueous fluid determines the energy needed for dispersion and spreading of the composition in the fluid, as well as the energy necessary for a suspended particle in the composition to cross the oil/milk or oil/udder fluid interfacial boundary.
• the low interfacial tension of the composition also increases dispersibility of the composition in the waxy moist environment of an ear, as compared to a conventional composition.
• the resulting rapid distribution of the composition throughout mucous membranes and lipid containing wax of the ear canal allows the anti-inflammatory agent and/or the second agent to reach inflamed tissue quickly, providing an efficacious level of the medicament at the site of inflammation.
• Such a composition can also produce a protective coating for inflamed mucous membranes of the ear.
• the method or composition provides effective treatment of the inflammatory component of a mammary or otic disorder.
• the method or composition provides effective treatment and/or prevention of pain, inflammation, swelling, edema, and/or fever associated with such a disorder.
• a preferred method When administered by intramammary infusion, for example in treatment of mastitis, preferred methods and compositions can have additional advantages. For example, a preferred method enables suitably short milkout times. Milkout time for a lactating cow is the period of time from administration of a mastitis treatment to , resumption of production of saleable milk. Following such administration, the concentration of active agent(s) in milk must fall to a level acceptable to the appropriate regulatory body before the milk is deemed suitable for human consumption. A suitably short milkout time reduces monetary losses to a dairy farmer caused by a mastitis outbreak.
• a preferred method enables a low milk withholding time post calving after dry cow mastitis treatment, with no active agent residues in the offspring.
• a preferred method enables a zero day slaughter meat withdrawal period following mastitis treatment. This attribute is especially important since it allows a farmer to dispose of a treated cow at any time it is financially advantageous to do so, rather than being required to keep and feed a cow for a specified amount of time after its treatment.
• a preferred method increases patency of the auditory canal and thereby reduces resistance to conduction of sound, improving the clarity and sensitivity of hearing.
• a preferred method provides a coating on the epithelial lining of the ear that protects against deleterious effects of water and water- borne toxins, irritants and antigenic materials, and helps prevent otic disorders.
• a further benefit of methods and compositions of the invention, whether for intramammary or otic use, is that they permit targeted delivery of at least the anti- inflammatory agent to the site of inflammation. Where a composition of the invention is used comprising both an anti-inflammatory agent and ' a second agent as defined herein, targeted delivery of both agents is provided to the site of infection and/or inflammation.
• a still further benefit of preferred compositions, whether for intramammary or otic administration, is that they cause minimal to no irritation after administration.
• a still further benefit of a composition of the invention is improved physical stability when compared to conventional oil and aqueous compositions, for example by virtue of improved composition resuspendability.
• a composition of the invention has been shown to cause flocculation of certain drugs, thereby improving resuspendability and eliminating the problem of suspension caking and possible delivery of a subpotent or non- efficacious dose.
• a process for preparing a pharmaceutical composition of the invention comprises mixing, in any suitable order, an amphipathic oil that is water dispersible and ethanol insoluble, microcrystalline wax, a pharmaceutically acceptable non-aqueous carrier and an anti-inflammatory agent, for example a selective COX-2 inhibitor, to provide the composition, such a composition preferably having extended chemical and/or physical stability as described herein.
• an amphipathic oil that is water dispersible and ethanol insoluble, microcrystalline wax
• an anti-inflammatory agent for example a selective COX-2 inhibitor
• the invention provides a method of treatment and/or prevention of an inflammatory condition in a fluid-containing organ having a natural exterior orifice, the method comprising administering an anti-inflammatory agent to the organ via the exterior orifice, in the form of a pharmaceutical composition comprising the anti-inflammatory agent in an anti-inflammatorily effective amount and a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier.
• the invention also provides for the use of a composition of the present invention in the manufacture of a medicament to treat or prevent an inflammatory condition in a fluid-containing organ having a natural exterior orifice.
• the invention further provides for a composition for use in a method of treatment or prevention of an inflammatory condition in a fluid-containing organ having a natural exterior orifice.
• an "infective condition” herein includes any disease, disorder or condition mediated by a pathogenic bacterium or that is otherwise responsive to treatment with an antibacterial agent such as an antibiotic drag.
• an antibacterial agent such as an antibiotic drag.
• reference herein to methods involving and compositions comprising "an anti-inflammatory agent” embraces such methods and compositions wherein more than one anti-inflammatory agent is used. Further, riiore than one therapeutically active agent other than an anti-inflammatory agent can optionally form the "second agent” herein.
• anti-inflammatorily effective amount refers to an amount of an anti-inflammatory agent that is sufficient, when administered by the method of the invention, to reduce, relieve, prevent or delay onset of one or more symptoms of an inflammatory condition being treated.
• therapeutically effective amount refers to an amount of an active agent that is sufficient, when administered by the method of the invention, to reduce, relieve, prevent or delay onset of one or more symptoms"of a condition beingJreated, or urreduce numbers and/or activity of a causal organism.
• therapeutically effective amounts of each means that when administered in combination therapy according to the method of the invention, the amount of the anti-inflammatory agent and the amount of the second agent are sufficient to provide both an anti-inflammatory effect and an effect selected from anti-bacterial, anesthetic, sodium channel blocker, anti-edemic, analgesic, antineoplastic, and/or antipyretic effects. Such amounts can be the same as, greater or less than the amount of anti-inflammatory agent or the amount of the second agent that are therapeutically effective when used in monotherapy.
• a fluid-containing organ as contemplated herein includes a mammary organ, for example an udder of a milk-producing animal such as a cow, a goat or a, sheep.
• a 1 "milk-producing animal" can be a female of any mammalian species but is preferably an animal raised for the purpose of providing milk, e.g., a cow, a goat or a sheep, and encompasses such animals whether or not they are lactating at the time of the inflammatory and/or infective condition or at the time of treatment.
• the natural exterior orifice of the mammary organ is the orifice of the teat canal.
• a fluid-containing organ also includes an ear of a human or animal subject. The natural exterior orifice of the ear is the orifice of the external auditory canal.
• the invention further provides a method of treatment of an inflammatory condition in a fluid-containing organ having a natural exterior orifice, the method comprising administering an anti-inflammatory agent to the organ via the exterior orifice and administering in combination therapy therewith a second agent as defined herein in therapeutically effective amounts of each; wherein the anti-inflammatory agent is administered as a pharmaceutical composition comprising said agent and a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier.
• combination therapy means a treatment regimen wherein the anti-inflammatory agent and the second agent are administered individually or together in such a way as to provide a beneficial effect from co-action of these therapeutic agents.
• beneficial effect can include, but is not limited to, pharmacokinetic or pharmacodynamic co-action of the therapeutic agents.
• Combination therapy can, for example, enable administration of a lower dose of one or both agents than would normally be administered during monotherapy, thus decreasing risk or incidence of adverse effects associated , with higher doses.
• combination therapy can result in increased therapeutic effect at the normal dose of each agent in monotherapy.
• “Combination therapy” herein is not intended to encompass administration of two or more therapeutic agents as part of separate monotherapy regimens that incidentally and arbitrarily result in sequential or simultaneous treatment.
• Administration of the anti-inflammatory agent ' and the second agent typically is carried out over a defined time period (usually minutes, hours, days or weeks depending upon the combination selected). These therapeutic agents can be administered in a sequential manner, that is, at different times, typically separated by no more than about 24 hours, or in a substantially simultaneous manner.
• the anti-inflammatory agent and the second agent can be administered in separate dosage forms or in coformulation, i.e., in a single dosage form.
• the second agent can be administered by any suitable route and in any pharmaceutically acceptable dosage form, for example by a route and/or in a dosage form other than that used for the anti-inflammatory agent.
• the second agent like the anti-inflammatory agent, can be dispersed in a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier and administered via the natural exterior orifice of the fluid-containing organ.
• both agents are co-dispersed in the same vehicle and administered in a single operation.
• the second agent is formulated in a pharmaceutically acceptable vehicle, and both the anti-inflammatory agent and the second agent are administered into the same fluid containing organ, for example by intramammary or otic infusion.
• a pharmaceutically acceptable carrier or vehicle is one that has no unacceptably injurious or toxic effect on the subject when administered as a component of a composition in an amount required herein. No excipient ingredient of such a carrier or vehicle reacts in a deleterious manner with another excipient or with the therapeutic agent(s) in a composition.
• the pharmaceutical composition comprising the anti-inflammatory agent is a liquid injectable or infusible composition having said agent dispersed in a vehicle as .descrihedJierein.
• the anti-inflammatory agent is suspended in solid particulate form in the vehicle.
• the vehicle comprises three essential ingredients, optionally together with additional ingredients.
• amphipathic oil that is water dispersible and ethanol insoluble.
• An "amphipathic oil” is defined as a substance having a molecular structure with a distinctly polar region and a distinctly non-polar region.
• amphipathic oil Structurally these two regions of , the amphipathic oil are sufficiently far apart that the unique properties of the two regions are distinctly separate.
• ethanol insoluble means that the amphipathic oil is essentially insoluble in ethanol at 20°C.
• the second essential ingredient of the vehicle is microcrystalline wax.
• the third essential ingredient of the vehicle is a pharmaceutically acceptable non-aqueous carrier.
• a carrier is typically an oil, as described more fully hereinbelow.
• vehicle components are important in providing a composition that, upon administration to the fluid-containing organ, disperses in the fluid. It is believed, without being bound by theory, that such dispersion in the fluid within the organ results in targeted delivery of the anti-inflammatory agent and, optionally, the second agent, to the site of inflammation in the organ.
• the method of the invention comprises injection or infusion of the composition into an udder via the teat canal
• it can provide effective treatment of mastitis, other diseases of the udder, and/or a condition associated with a mammary disease.
• “Intramammary infusion” is an operation wherein a liquid composition is caused to flow into an udder via a teat canal, regardless of the timescale involved.
• “infusion” and “injection” are substantially synonymous.
• the method of the invention comprises injection or infusion of the composition into an ear via the external auditory canal
• a process described herein as "otic infusion" regardless of the timescale involved, it can provide effective treatment and/or prevention of an otic disorder and/or a complication associated therewith.
• the subject suffering such otic disorder or complication associated therewith can be a human, companion animal, horse, farm livestock or the like.
• otic disorders include, but are not limited to, otitis externa (external ear infections), otitis media (middle ear infections), including acute, secretory, serous and chronic forms of otitis media,' otorrhea (otitis media with ruptured ear dram causing effusion), acute mastoiditis, infections related to otic surgical procedures (such as tympanostomy and the like), otosclerosis, otalgia, otic pain, otic inflammation, otic bleeding, Lerm Liste's syndrome, Meniere's disease, vestibular neuronitis, benign , paroxysmal positional vertigo, herpes zoster oticus, Ramsay Hunt's syndrome, viral neuronitis, ganglionitis, geniculate herpes, labyrinthitis, including purulent labyrinthitis and viral endolymphatic labyrinthitis, perilymph fis
• the otic disorder is a neoplasia.
• neoplasia examples include, but are not limited to, otic neoplasia, squamous cell carcinoma, basal cell carcinoma, malignant external otitis, malignant nonchromaffin paraganglioma, malignant jugulare tumor, malignant glomus tympanicum tumor, a pre-cancerous otic condition and the like.
• Combination therapy of the anti-inflammatory agent together with the second agent provides enhanced treatment options as compared to administration of either agent alone.
• t] ⁇ e ⁇ nti-inflam ⁇ atory_agent is dispersed in a vehicle that comprises (a) an amphipathic oil that is water, dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier, and is administered for example by intramammary or otic infusion, while the second agent is formulated into any acceptable immediate release or sustained release pharmaceutical dosage form.
• Suitable dosage forms for the second agent include, but are not limited to, a suspension, solution, emulsion, tablet, capsule, pill, powder, granules, elixir, tincture, syrup, lozenge, dragee, gel, ointment, spreadable paste, slurry, aerosol spray, ear drops, nasal drops, eye drops, suppository, implant and the like, and can be administered via any route including, but not limited to, oral, including peroral and intraoral, e.g., sublingual, buccal, etc.; parenteral, e.g., intramuscular, subcutaneous, intravenous, intraperitoneal intra-articular, intradermal, intraspinal, intrastemal, intramedullary, intrasynovial, intrathecal, intracardiac, intraventricular, intracapsular, intracranial, etc.
• administering can take place in further combination with other biologically active agents and non-drag therapies.
• administration of the therapeutic agents described above can take place in further combination with other biologically active agents and non-drag therapies.
• at least the anti-inflammatory agent is administered locally.
• An advantage of such local administration is that the anti- inflammatory agent is preferentially directed toward its site of action, resulting in more rapid onset of therapeutic action and more complete delivery to the site of inflammation, compared with other routes of administration such as intramuscular, subcutaneous and oral routes. Local administration can allow the total therapeutic dose for a given effect to be decreased and avoids the hepatic first pass effect.
• Therapeutic index is a measure of the margin between a therapeutically effective dose and a toxic dose of a drug and is typically expressed as the ratio of LD 50 (a dose lethal to 50% of a population) to ED 50 (a dose therapeutically effective in 50% of the population).
• a pharmaceutical composition adapted for intramammary and/or otic infusion comprising a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier; the vehicle having stably dispersed therein an anti-inflammatory agent, for example a selective COX-2 inhibitor, in an anti-inflammatorily effective amount.
• a pharmaceutical composition adapted for intramammary and/or otic infusion, comprising a vehicle that comprises (a) an amphipathic oil that is water dispersible and ethanol insoluble, (b) microcrystalline wax, and (c) a pharmaceutically acceptable non-aqueous carrier; the vehicle having stably dispersed therein an anti-inflammatory agent, for example a selective COX-2 inhibitor, in an anti-inflammatorily effective amount.
• an anti-inflammatory agent for example a selective COX-2 inhibitor
• Resistance to conduction of sound results from reduction of the volume, partial obstruction, or complete occlusion of the auditory canal due to swelling of the epithelial walls as a result of inflammation, the accumulation of increased amounts of cerumen secreted thereupon, and/or collection of fluids therewi ' thin, including fluids containing waste products of the immune response or exogenous water.
• an ingredient of the composition (the anti-inflammatory agent and/or a second agent and/or an excipient ingredient) is prone to oxidative degradation.
• Such a composition exhibits extended chemical and/or physical stability even when packaged in an oxygen permeable container or delivery device.
• extended chemical and/or physical stability herein means that a composition of the present embodiment has greater chemical and/or physical stability than a reference composition comprising the same medicament at the same concentration.
• reference composition in the present context means a composition lacking one or both of the amphipathic oil and the microcrystalline wax, but otherwise similar to the composition of the invention.
• Oxygen permeable containers or delivery devices can be made of any suitable thermoplastic material. Examples of such materials include, but are not limited to, polymers and copolymers of polystyrene, polyacrylonitrile, polyvinyl chloride, and particularly polyolefins. Polyolefins include, for example, polyethylene, polypropylene, polybutenes, polyisoprenes, polypentenes, copolymers thereof and mixtures thereof.
• Compositions for intramammary administration are commonly packaged in syringes that are provided with a cannula nozzle for insertion into the teat to allow extrusion of the composition directly into the mammary gland via the teat canal. Intramammary suspension formulations are generally prepared in thickened vehicles to prevent settling of drug particles in the cannula nozzle, which can cause nozzle plqgging resulting in incomplete expulsion of the composition.
• the anti-inflammatory agent herein can have one or both of analgesic and antipyretic properties in addition to its anti-inflammatory activity.
• anti- inflammatory agent herein embraces compounds that are primarily analgesics or antipyretics but that have a secondary anti-inflammatory effect.
• anti- inflammatory agents useful herein include, but are not limited to, aceclofenac, ⁇ acemetacin, e-acetamidocaproic acid, acetaminophen, acetaminosalol, acetanilide, acetylsalicylic acid (aspirin), S-adenosylmethionine, alclofenac, alclometasone, alfentanil, algestone, allylprodine, alminoprofen, aloxiprin, alphaprodine, aluminum bis(acetylsalicylate), amcinonide, amfenac, aminochlorthenoxazin, 3-amino-4- hydroxybutyric acid, 2-amino-4-picoline, aminopropylon, aminopyrine, amixetrine, ammonium salicylate, ampiroxicam, amtolmetin guacil, anileridine, antipyrine, antrafenine, apazone, beclomethasone
• the anti-inflammatory agent is a steroid.
• Suitable steroids include, but are not limited to, alclometasone, amcinonide, betamethasone, betamethasone 17-valerate, clobetasol, clobetasol propionate, clocortolone, cortisone, dehydrotestosterone, deoxycorticosterone, desonide, desoximetasone, dexamethasone, dexamethasone 21-isonicotinate, diflorasone, fluocin ⁇ nide, fluocinolone, fluorometholone, flurandrenolide, fluticasone, halcinonide, halobetasol, hydrocortisone, hydrocortisone acetate, hydrocortisone cypionate, hydrocortisone hemisuccinate, hydrocortisone 21-lysinate, hydrocortisone sodium succinate, isoflupredone, iso
• the anti-inflammatory agent is an analgesic, selected for example from alfentanil, allylprodine, alphaprodine, anileridine, benzylmorphine, bezitramide, buprenorphine, butorphanol, clonitazene, codeine, cyclazocine, desomorphine, dextromoramide, dextropropoxyphene, dezocine, diampromide, diamorphone, dihydrocodeine, dihydromorphine, dimenoxadol, dimepheptanol, dimethylthiambutene, dioxaphetyl butyrate, dipipanone, eptazocine, ethoheptazine, ethylmethylthiambutene, ethylmorphine, etonitazene, fentanyl, heroin, hydrocodone, hydromorphone, hydroxypethidine, isomethadone, ketobemidone
• the anti-inflammatory agent is an NSAID, selected for example, from salicylic acid derivatives (such as salicylic acid, acetylsalicylic acid, methyl salicylate, diflunisal, olsalazine, salsalate, sulfasalazine and the like), indole and indene acetic acids (such as indomethacin, etodolac, sulindac and the like), fenamates (such as etofenamic, meclofenamic, mefenamic, flufenamic, nifmmic and tolfenamic acids and the like), heteroaryl acetic acids (such as acemetacin, alclofenac, clidanac, diclofenac, fenchlofenac, fentiazac, furofenac, ibufenac, isoxepac, ketorolac, oxipinac,
• the anti-inflammatory agent is a selective COX-2 inhibitor.
• a selective COX-2 inhibitor is a compound that selectively inhibits cyclooxygenase-2 (COX-2) activity.
• selective COX-2 inhibitor and “selective cyclooxygenase-2 inhibitor” interchangeably refer to a therapeutic compound that selectively inhibits the COX-2 isoform of the enzyme cyclooxygenase, with less significant inhibition of cyclooxygenase- 1 (COX-1).
• selective COX-2 inhibitor also refers to a prodrug or salt that is converted in vivo to a compound that exhibits selective inhibition of COX-2 relative to COX-1.
• Preferred selective COX-2 inhibitors exhibit a selectivity factor of at least about 10, more preferably at least about 50 and still more preferably at least about 100, wherein "selectivity factor" is defined as IC 5 o(COX-l)/IC 50 (COX-2), IC 5 o being the concentration of a compound producing 50% inhibition of enzyme activity in an in vitro or in vivo test.
• Selective COX-2 inhibitors applicable to the invention include, but are not limited to, the compounds described below and include tautomers, stereoisomers, enantiomers, salts, hydrates, prodfugs and combinations thereof. Any such selective •
• COX-2 inhibitory drug or prodrug known in the art can be used.
• a preferred selective COX-2 inhibitory drug useful herein is a cqmpound of formula (I):
• A is a substituent selected from partially unsaturated or unsaturated heterocyclyl and partially unsaturated or unsaturated carbocyclic rings, preferably a heterocyclyl group selected from pyrazolyl, furanonyl, isoxazolyl, pyridinyl, cyclopentenonyl and pyridazinonyl groups;
• X is O, S or CH 2 ; n is 0 or 1 ;
• R 1 is at least one substituent selected from heterocyclyl, cycloalkyl, cycloalkenyl and aryl, and is optionally substituted at a substitutable position with one or more radicals selected from alkyl, haloalkyl, cyano, carboxyl, alkoxycarbonyl, hydroxyl, hydroxyalkyl, haloalkoxy, amino, alkylamino, arylamino, nitro, alkoxyalkyl, alkylsulfinyl, halo, alkoxy and alkyl thio;
• R 2 is methyl, amino or aminocarbonylalkyl
• R 3 is one or more radicals selected from hydrido, halo, alkyl, alkenyl, alkynyl, oxo, cyano, carboxyl, cyanoalkyl, heterocyclyloxy, ' alkyloxy, alkylthio, alkylcarbonyl, cycloalkyl, aryl, haloalkyl, heterocyclyl, cycloalkenyl, aralkyl, heterocyclylalkyl, acyl, alkylthioalkyl, hydroxyalkyl, alkoxycarbonyl, arylcarbonyl, aralkylcarbonyl, aralkenyl, alkoxyalkyl, arylthioalkyl, aryloxyalkyl, aralkylthioalkyl, aralkoxyalkyl, alkoxyaralkoxyalkyl, alkoxycarbonylalkyl, aminocarbonyl, aminocarbo ⁇ ylalky
• a particularly preferred group of selective COX-2 inhibitory drags are compounds having the formula (H):
• R is a methyl or amino group
• R is hydrogen or a C ⁇ _ ⁇ alkyl or alkoxy group
• X' is N or CR where R is hydrogen or halogen
• Y and Z are independently carbon or nitrogen atoms defining adjacent atoms of a five- to six-membered ring that is optionally substituted at one or more positions with oxo, halo, methyl or halomethyl groups, or an isomer, tautomer, pharmaceutically-acceptable salt or prodrug thereof.
• Preferred such five- to six-membered rings are cyclopentenqne, furanone, methylpyrazole, isoxazole and pyridine rings substituted at no more than one position.
• Another particularly preferred group of selective COX-2 inhibitory drugs are compounds having the formula (III):
• a particularly useful compound of formula (Iff) is (S)-6,8-dichloro-2- (trifluoromethyl)-2H- 1 -benzopyran-3-carboxylic acid.
• Another particularly preferred group of selective COX-2 inhibitory drugs are 5-alkyl-2-arylaminophenylacetic acids and derivatives thereof.
• Particularly useful compounds of this class are lumiracoxib and pharmaceutically acceptable salts thereof.
• celecoxib, deracoxib, valdecoxib, parecoxib, rofecoxib, etoricoxib lumiracoxib, 2-(3 ,5 -difluorophenyl)-3 - [4-(methylsulf onyl)phenyl] -2- cyclopenten-1-one, (S)-6,8-dichloro-2-(trifluoromethyl)-2H-l-benzopyran-3-carboxylic acid, 2-(3,4-difluorophenyl)-4-(3-hydroxy-3-methyl-l-butoxy)-5-[4- (methylsulfonyl) ⁇ henyl]-3-(2H)-pyridazinone,
• Valdecoxib used in compositions of the invention can be prepared by any known process, for example in the manner set forth in U.S. Patent No. 5,633,272 to Talley et al.
• Parecoxib and salts thereof used in compositions of the invention can be prepared by any known process, for example in the manner set forth in U.S. Patent No. 5,932,598 to Talley et al.
• Rofecoxib used in compositions of the invention can be prepared by any known process, for example in the manner set forth in U.S. Patent No. 5,474,995 to Ducharme et al.
• Etoricoxib used in compositions of the invention can be prepared by any known process, for example in the manner set forth in International Patent Publication No.
• WO 98/0348 2-(3,5-Difluorophenyl)-3-[4-(methylsulfonyl) phenyl] -2-cyclopenten-l -one used in compositions of the invention can be prepared by any known process, for example in the manner set forth in European Patent No. 0 863 134.
• Deracoxib used in compositions of the invention can be prepared by any known process, for example in the manner set forth in U.S. Patent No. 5,466,823 to Talley et al.
• 2-(3,4-Difluorophenyl)-4-(3-hydroxy-3-methyM-butoxy)-5-[4- (methylsulfonyl)phenyl]-3-(2H)-pyridazinone used in compositions of the invention can be prepared by any known process, for example in the manner set forth in International
• Patent Publication No. WO 00/24719 Other selective COX-2 inhibitory drugs can be prepared by any known process, including processes set forth in patent publications disclosing such drugs; for example in the case of celecoxib in above-cited U.S. Patent No. 5,466,823 or in U.S. Patent No. 5,892,053 to Zhi et al. All patents and publications cited above are incorporated herein by reference.
• a preferred concentration range in a composition of the invention is about 0.01 to about 1000 mg/ml, more preferably about 0.1 to about 750 mg/ml, and still more preferably about 5 to about 250 mg/ml.
• suitable concentration ranges can be determined by one of skill in the art based upon published data.
• the second agent administered in combination therapy with the selective COX-2 inhibitor is an antibacterial agent.
• Antibacterial agents applicable for use according to the invention include any such agents that are effective for treatment and/or prevention of mammary disorders and/or otic disorders and/or complications associated therewith.
• Suitable antibacterial agents include, but are not limited to, beta- lactam antibacterials such as natural and synthetic penicillin type agents including penam penicillins (such as benzyl penicillin, phenoxymethyl penicillin, coxacillin, nafcillin, methicillin, oxacillin, amoxycilliri, temocillin, ticarcillin and the like), penicillinase-stable penicillins, acylamino and carboxypenicillins (such as piperacillin, azlocillin, mezlocillin, carbenicillin, temocillin, ticarcillin and the like), and broader spectrum penicillins (such as streptomycin, neomycin, framycetin, gentamicin, apramycin, amikacin, spectinomycin, amoxycillin, ampicillin and the like), cephalosporins, macrolides (such as tylosin, tilmicosin,
• Preferred antibacterial agents are cephalosporins including, but not limited to, ceftiofur hydrochloride, ceftiofur free acid, e.g., ceftiofur crystalline free acid, ceftiofur sodium, other ceftiofur salts, cephalexin, cephradine, cefquinome, cephacetrile, cephalonium, cefuroxime, cefazidime, cefoperazone, sodium cephemethcarboxylate, cephem heptahydrate, cephalosporin di- or tri-hydrate, cephadroxil monohydrate, cephazolin sodium monohydrate, cefiximine, ceftaxime, ceftizoxime, ceftriaxone, o- formylcefamandole, salts of 3-acetoxymethyl-7-(iminocetamido)-cephalosporanic acid derivatives, monohydrate of 7-(D-alpha-amino-alpha-(p
• cephalosporins for use according to the present invention are ceftiofur and pharmaceutically acceptable salts thereof. Especially preferred are ceftiofur free acid, most especially in crystalline form, and ceftiofur hydrochloride.
• a preferred concentration range in a compositiqn of the invention is about 1 to about 1000 mg/ml, more preferably about 5 to about 750 mg/ml, and still more preferably about 10 to about 100 mg/ml.
• suitable concentration ranges that are antibacterially equivalent can be determined by one of skill in the art based upon published data.
• the second agent is an antineoplastic agent.
• Suitable antineoplastic agents include, but are not limited to, anastrozole, calcium carbonate, capecitabine, carboplatin, cisplatih, docetaxel, eflornifhine, etoposide, exemestane, fluoxymestrine, gemcitabine, goserelin, irinotecan, ketoconazole, letrozol, leucovorin, levamisole, megsetrol, paclitaxel, raloxifene, retinoic acid, selenium (selenqmefhionirie), sulindac sulfone, tamoxifen, thiotepa, topotecan, toremifen, vinbastine, vincristin, . vinorelbine and the like, and combinations thereof.
• the second agent is an anesthetic agent.
• Anesthetic agents include, but are not limited to, ambucaine, amolanone, amylocaine, benoxinate, benzocaine, betoxycaine, biphenamine, bupivacaine, butacaine, butamben, butamben picrate, butanilicaine, butethamine, butoxycaine, carticaine, chloroprocaine, cocaethylene, cocaine, cyclomethycaine, dibucaine, dimethisoquin, dimethocaine, diperodon, diphenylhydramine, dyclonine, ecgonidine, ecgonine, ethyl chloride, etidocaine, ⁇ - eucaine, fomocaine, hexylcaine, hydroprocaine, hydroxyprocaine, hydroxytetracaine, isobucaine, isobutyl p-aminobenzoate, ketocaine,
• Preferred anesthetic agents include lidocaine, bupivacaine, prilocaine, ropivacaine, and tautomers, stereoisomers, enantiomers, salts, hydrates, prodrags and combinations thereof.
• the second agent is a sodium channel blocker.
• Sodium channel blockers useful for the invention comprise those which complement the effect of the anti-inflammatory agent by any mechanism, including but not limited to, reduction of pain, reduction of edema, and the like.
• sodium channel blockers useful according to the invention can be selected from the following non-limiting list: NaV1.8 (PN3) subtype sodium channel blockers, NaV1.3 (Type IH) subtype sodium channel blockers, carboxamides, fenamates, oxicams, propanamides, pyrazinoylguanidine semicarbazones, semicarbazides, and the like.
• sodium channel blockers applicable for use according to the invention can be selected from the following non-limiting list: amiloride, 4-amino-2-(4- methylpiperazin-l-yl)-5-(2,3,5-trichlorophenyl)pyrimidine, amitryptiline, anhydrotetrodotoxin, aprindine, azure A, benzamil, benzothiazole, benzoxazinate, carvediloL'deoxytetrodotoxin, disopyramide, encainide, ethoxytetro
• Amphipathic oils applicable to the current invention include all amphipathic oils that are water dispersible and ethanol insoluble.
• Preferred such amphipathic oils are polyglycolized glycerides prepared by an alcoholosis reaction of natural triglycerides with polyethylene glycols, and examples include, but are not limited to, the following Gattefosse oils or substantially equivalent oils from another manufacturer: LabrafilTM M-1944CS, LabrafilTM M-1966CS, LabrafilTM M-1969CS, LabrafilTM M-1980CS, LabrafilTM M-2125CS, LabrafilTM WL-2609BS, LabrafilTM ISO and combinations thereof.
• amphipathic oils are polyglycolized glycerides prepared as above, comprising a main fatty acid component of either oleic acid or linoleic acid, and examples include, but are not limited to, the following Gattefosse oils or substantially equivalent oils from another manufacturer: LabrafilTM M-1944CS, LabrafilTM M-1966CS, LabrafilTM M-1969CS, LabrafilTM M-1980CS, LabrafilTM M-2125CS, LabrafilTM WL- 2609BS and combinations thereof.
• amphipathic oils are polyglycolized glycerides prepared as above, comprising a main fatty acid component of oleic acid, and examples include, but are not limited to, the following Gattefosse qils or substantially equivalent oils from another manufacturer: LabrafilTM M-1944CS, LabrafilTM M-1966CS, LabrafilTM
• amphipathic oil is pegicol 5-oleate, for example LabrafilTM
• a preferred concentration range for the amphipathic oil in a composition of the invention is about 0.01% to about 99% weight/volume, more preferably about 1% to about 80% weight/volume, and still more preferably about 3% to about 25% weight/volume.
• Microcrystalline wax is as defined for example in Handbook of
• a preferred concentration range for microcrystalline wax in a composition of the invention is about 0.001% to about 50% weight/volume, more preferably about 0.1% to about 40% weight/volume, and still more preferably about 1% to about 15% weight/volume.
• Non-aqueous carriers of the invention can be fully saturated, or partially or fully unsaturated.
• non-aqueous carriers include, but are not limited to, vegetable oils, mineral oils, synthetic oils and combinations thereof.
• Fully saturated non-aqueous carriers include, but are not limited to, esters of medium to long chain fatty acids (such as fatty acid triglycerides with a chain length of about C 6 to about C 2 ). Mixtures of fatty acids are split from the natural oil (for example coconut oil, palm kernel oil, babassu oil or the like) and are refined. In some embodiments, medium chain (about C 8 to about C 12 ) triglycerides are useful.
• An illustrative saturated non-aqueous carrier comprises capric acid (about 20% to about 45%) and caprylic acid (about 45% to about_80%).
• Other fully saturated non-aqueous carriers include, but are not limited to, saturated coconut oil (which typically includes a mixture of lauric, myristic, palmitic, capric and caproic acids), including those sold under the
• carbon atoms such as, for example hexanoic acid, octanoic (caprylic), nonanoic (pelargonic), decanoic (capric), undecanoic, lauric, tridecanoic, tetradecanoic (myristic), pentadecanoic; hexadecanoic (palmitic), heptadecanoic, octadecanoic (stearic), nonadecanoic, heptadecanoic, eicosanoic, heneicosanoic, docosanoic and lignoceric acids and the like.
• hexanoic acid octanoic (caprylic), nonanoic (pelargonic), decanoic (capric), undecanoic, lauric, tridecanoic, tetradecanoic (myristic), pentadecanoic; hexadecanoic (palmitic),
• non-aqueous carrier can comprise the mono-, di- and triglyceryl esters of fatty acids or mixed glycerides and/or propylene glycol diesters wherein at least one molecule of glycerol has been esterified with fatty acids of varying carbon atom length.
• a non- limiting example of a "non-oil" useful as a carrier in compositions of the invention is polyethylene glycol.
• Preferred non-aqueous carriers are vegetable oils such as cottonseed oil, com oil, sesame oil, soybean oil, olive oil, fractionated coconut oil, peanut oil, sunflower oil, safflower oil, almond oil, avocado oil, palm oil, palm kernel oil, babassu oil, beechnut oil, linseed oil, rape oil and the like.
• the most preferred non-aqueous carrier is cottonseed oil.
• cottonseed oil is available in a preparation of 70% unsaturated fatty acids from Sigma Chemical Co.
• a preferred concentration range for the non-aqueous carrier in a composition of the invention is about 0.5% to about 99% weight/volume, more preferably about 10% to about 95% weight/volume, and still more preferably about 40% to about 90% weight/volume.
• a composition of the invention can optionally further comprise any conventional pharmaceutical excipient that does not deleteriously react with the essential ingredients of the composition.
• excipients include, but are not limited to, antioxidants, preservatives, suspending agents, stabilizers, solubilization agents, wetting agents, lubricants, emulsifiers, salts for influencing osmotic pressure, coloring agents, alcohols, isotonic agents, buffering agents, permeation agents, anti-irritants, and combinations thereof.
• a composition of the invention can be administered for treatment of mastitis by inserting the cannula nozzle of a mastitis syringe into the external orifice of the teat canal of an udder of a milk-producing animal and infusing the composition into the udder.
• a composition of the invention can be administered for treatment or prevention of an otic disorder by inserting the nozzle of an ear syringe, otic drop dispenser or other appropriate otic delivery device into the external auditory canal of the ear of a
• compositions to be administered in a specific case will vary according to the specific composition being utilized, the mode of application, the particular situs and organism being treated, and other factors. Dosages for a given purpose can be determined using conventional considerations, for example, by customary comparison of the differential activities of the subject compositions and of a known agent, e.g., by means of an appropriate conventional pharmaceutical protocol.
• compositions of the invention are also useful for systemic delivery of the anti-inflammatory agent to a milk-producing animal via intramammary infusion.
• a composition as herein described can be administered by intramammary infusion.
• An illustrative suspension composition of the invention containing an anti- inflammatory agent, e.g., the selective COX-2 inhibitor deracoxib, has the following composition: selective COX-2 inhibitor 1-350 mg/ml
• a suspension to be administered by intramammary infusion is prepared having the following composition: parecoxib free acid 100 mg/ml
• the microcrystalline wax and approximately 27% of the total amount of the cottonseed oil are heated to 85-98°C with mixing, in a kettle.
• the balance of the cottonseed oil is heated to 85-98°C with mixing, in a manufacturing tank.
• the microcrystalline wax/cottonseed oil mixture in the kettle is transferred to the manufacturing tank containing cottonseed oil and mixed thoroughly.
• the resulting mixture is cooled to 38-45°C and the LabrafilTM M-1944CS is added to the manufacturing tank with mixing to form a vehicle.
• the parecoxib is then added to the vehicle and the resulting composition is mixed to form a uniform suspension.
• the suspension is screened and filled into 12 ml high density polyethylene mastitis syringes.
• the packaged product is terminally sterilized by gamma irradiation at a dose of 25-40 kGy.
• a suspension to be administered by intramammary infusion is prepared having the following composition: deracoxib 170 mg/ml
• microcrystalline wax and the corn oil are heated to 85-98°C with mixing, in a manufacturing tank. After the microcrystalline wax is completely melted, the mixture is cooled to 30-45°C and the LabrafilTM M-1966CS is added to the manufacturing tank with mixing to form a vehicle. The deracoxib is added to the vehicle and mixed to form a uniform suspension. The suspension is screened and filled into 12 ml high density polyethylene mastitis syringes. The packaged product is terminally sterilized by gamma irradiation at a dose of 25-40 kGy. [0144] The above suspension is administered to all four quarters of a dry cow at a dose of 3,400 mg deracoxib/quarter by intramammary infusion. The suspension is effective in treatment of dry cow mastitis.
• a suspension to be administered by otic infusion is prepared having the following composition: rofecoxib 25 mg/ml
• the microcrystalline wax and approximately 27% of the total amount of mineral oil are heated to 85-98°C with mixing, in a kettle.
• the balance of the mineral oil is heated to 85-98°C with mixing, in a manufacturing tank.
• the microcrystalline wax/mineral oil mixture in the kettle is transferred to the manufacturing tank containing mineral oil and mixed thoroughly.
• the resulting mixture is cooled to 38-45°C and the LabrafilTM M-1980CS is added to the manufacturing tank with mixing.
• the propyl gallate is added to the manufacturing tank with mixing to form the vehicle.
• the rofecoxib is added to the resulting vehicle and mixed to form a uniform suspension.
• the suspension is screened and filled into 20 ml polypropylene containers.
• the above suspension is administered at a dose of 2.5 mg rofecoxib/kg of body weight, by infusion to the ear of a dog.
• the suspension is effective in treatment of canine otitis extema.
• a suspension to be administered by intramammary infusion is prepared having the following composition: deracoxib 300 mg/ml
• the microcrystalline wax and approximately 27% of the total amount of the cottonseed oil are heated to 85-98°C with mixing, in a kettle.
• the balance of the cottonseed oil is heated to 85-98°C with mixing, in a manufacturing tank.
• the microcrystalline wax/cottonseed oil mixture in the kettle is transferred to the manufacturing tank containing cottonseed oil and mixed thoroughly.
• the resulting mixture is cooled to 38-45°C and the LabrafilTM M- 1944CS is added to the manufacturing tank with mixing to form the vehicle.
• the deracoxib is added to the resulting vehicle and mixed to form a uniform 1 suspension.
• the suspension is screened and filled into 12 ml high density polyethylene mastitis syringes.
• the packaged product is terminally sterilized by gamma irradiation at a dose of 25-40 kGy.
• the above suspension is administered to all four quarters of a dry cow at a dose of 12,000 mg deracoxib/quarter by intramammary infusion.
• the suspension is effective in treatment of dry cow mastitis.
• a suspension to be administered by intramammary infusion is prepared having the following composition: valdecoxib 1.5 mg/ml
• Labrafil TM WL-2609BS 75 mg/ml microcrystalline wax NF 100 mg/ml
• the microcrystalline wax and approximately 30% of the total amount of the MiglyolTM 812 are heated to 85-98°C with mixing, in a kettle.
• the balance of the MiglyolTM 812 is heated to 85-98°C with mixing, in a manufacturing tank.
• the microcrystalline wax/MiglyolTM 812 mixture in the kettle is transferred to the manufacturing tank containing the MiglyolTM -811--and ⁇ mixed thoroughly.
• -The ⁇ esulting ⁇ nixtureJS' cooled to 38 -5°C and the LabrafilTM WL-2609BS is added to the manufacturing tank with mixing to form the vehicle.
• the valdecoxib is added to the resulting vehicle and mixed to form a uniform suspension.
• the suspension is screened and filled into 12 ml high density polyethylene mastitis syringes.
• the packaged product is terminally , sterilized by gamma irradiation at a dose of 25-40 kGy.
• the above suspension is administered to all four quarters of a dry cow at a dose of 30 mg valdecoxib/quarter by intramammary infusion-
• the suspension is effective in treatment of dry cow mastitis., :
• a suspension to be administered by otic infusion is prepared having the following composition: ceftiofur hydrochloride (micronized) 100 mg/ml deracoxib 100 mg/ml
• Labrafil TM M-1944CS 700 mg/ml microcrystalline wax NF 0.05 mg/ml mineral oil q.s.
• the microcrystalline wax and approximately 27% of the total amount of mineral oil are heated to 85-98°C with mixing, in a kettle.
• the balance of the mineral oil is heated to 85-98°C with mixing, in a manufacturing tank.
• the microcrystalline wax/mineral oil mixture in the kettle is transferred to the manufacturing tank containing mineral oil and mixed thoroughly.
• the resulting mixture is cooled to 38-45°C and the LabrafilTM M-1944CS is added to the manufacturing tank with mixing to form the vehicle.
• the ceftiofur hydrochloride and the deracoxib are added to the resulting vehicle and mixed to form a uniform suspension.
• the suspension is screened and filled into 50 ml polypropylene containers.
• the above suspension is administered at a dose of 4 mg ceftiofur hydrochloride/kg body weight and 4 mg deracoxib/kg of body weight by infusion to the ear of a subject.
• the suspension is effective in treatment and/or prevention of otitis media.
• a suspension to be administered by otic infusion is prepared having the following, composition: ceftiofur hydrochloride (micronized) 100 mg/ml parecoxib free acid 100 mg/ml
• microcrystalline wax and cottonseed oil are heated to 85-98°C with mixing, in a manufacturing tank. After the microcrystalline wax is completely melted, the mixture is cooled to 38-45°C and the LabrafilTM M-1944CS is added to the manufacturing tank with mixing to form the vehicle. The ceftiofur hydrochloride and parecoxib are added to the resulting vehicle and mixed to form a uniform suspension. The suspension is screened and filled into 60 ml polypropylene containers. [0159] The above suspension is administered at a dose of 4 mg ceftiofur hydrochloride kg body weight and 4 mg parecoxib/kg of body weight by infusion into the ear of a subject. The combination therapy is effective in treatment and/or prevention of otitis extema.
• a suspension to be administered by otic infusion is prepared having the following composition: lidocaine 100 mg/ml parecoxib free acid 100 mg/ml
• microcrystalline wax and cottonseed oil are heated to 85-98°C with mixing, in a manufacturing tank. After the microcrystalline wax is completely melted, the mixture is cooled to 38-45°C and the LabrafilTM M-1944CS is added to the manufacturing tank with mixing to form the vehicle. The lidocaine and parecoxib are added to the resulting vehicle and mixed to form a uniform suspension. The suspension is screened and filled into 60 ml polypropylene containers.

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