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
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
  • A61K9/006—Oral mucosa, e.g. mucoadhesive forms, sublingual droplets; Buccal patches or films; Buccal sprays
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/34—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
  • A61K31/343—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide condensed with a carbocyclic ring, e.g. coumaran, bufuralol, befunolol, clobenfurol, amiodarone
• • 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
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • 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
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
  • A61K31/404—Indoles, e.g. pindolol
  • A61K31/4045—Indole-alkylamines; Amides thereof, e.g. serotonin, melatonin
• • 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
  • A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/437—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 ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a five-membered ring having nitrogen as a ring hetero atom, e.g. indolizine, beta-carboline
• • 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
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4402—Non condensed pyridines; Hydrogenated derivatives thereof only substituted in position 2, e.g. pheniramine, bisacodyl
• • 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
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/451—Non condensed piperidines, e.g. piperocaine having a carbocyclic group directly attached to the heterocyclic ring, e.g. glutethimide, meperidine, loperamide, phencyclidine, piminodine
• • 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
  • A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
• • 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
• • 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
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
• • 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
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
  • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
  • A61K31/5517—1,4-Benzodiazepines, e.g. diazepam or clozapine condensed with five-membered rings having nitrogen as a ring hetero atom, e.g. imidazobenzodiazepines, triazolam
• • 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
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • 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
  • A61K9/08—Solutions
• • 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
  • A61P25/08—Antiepileptics; Anticonvulsants
• • 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
  • A61P25/20—Hypnotics; Sedatives

Definitions

• the present invention relates to a dosage form for the administration of an active ingredient for the accelerated induction of sleep and / or the treatment of sleep disorders and / or the instantaneous emergency treatment of diseases of the central nervous system, such as an epileptic seizure.
• the present invention relates to such a galenic form capable of providing instant oral mucosal systemic delivery of an active ingredient, intended to act rapidly on the central nervous system receptors to promote psychomotor appeasement. or fast falling asleep of the subject to which it is administered and / or resynchronizing an imbalance between the phases of sleep and sleep.
• a first constraint is that of a required efficiency in a reduced time, for example a few minutes after the administration of the active principle in question.
• the invention also relates to its very specific compositions and to its various uses which make it possible to obtain a fast pharmacodynamic efficiency by exploiting very low effective dosages of these active principles.
• insomnia is defined as the inability to initiate or maintain sleep within the times recognized as being satisfactory for health, namely between 6 and 8 hours of sleep per night.
• the consumption of hypnotics is increasing, while no study offers a really convincing explanation for this phenomenon.
• half of the people in general medicine suffer from insomnia, which is described as mild in 15% to 17% of cases, as moderate as 12% to 17%, and as severe as 19% to 23%, but many insomniacs do not never discuss this issue with their doctor.
• insomnia hypnotic consumers
• US a recent study reported a prevalence of insomnia in one-third of adults for a total annual cost of insomnia between $ 92.5 and $ 107.5 billion. Insomnia also leads to less efficiency at work: it seems that good sleepers spend twice as much time working, studying and communicating as insomniacs.
• insomnia Sleep disorders are perfectly defined and explored by medical science and are schematically described by the Health authorities: so-called mild insomnia is reported for one night or less per week and has a minimal diurnal repercussion; so-called moderate insomnia is reported for two or three nights a week and presents a diurnal repercussion type fatigue, moody state, tension, irritability; so-called severe insomnia is reported for four nights or more per week and has a diurnal effect type fatigue, moodiness, tension, irritability, diffuse hypersensitivity, impaired concentration and impaired psychomotor performance.
• sleep-wake disorders are caused by day / night desynchronization, which most often occurs in air travelers over very long distances, by rapidly crossing many time zones.
• jet lag commonly known as jet lag
• asymmetry a very unstable sleep, known as asymmetry, which will improve only gradually. Sleep / sleep disorders can also be induced by repeated nighttime professional activities.
• the amount of active ingredient (s) that is truly bioavailable and therefore active in the induction of sleep can therefore be extremely low and examples will be provided for this purpose: only a very residual part of the quantity administered will then remain valid to produce the expected pharmacological effect.
• the first problem is that a sufficient dose should be given to the patient, taking into account the slow digestive absorption that remains fragmentary, and the loss associated with hepatic metabolism, then the dilution in body fluids of the body. plasma, blood cells, interstitial and intracellular fluids; this dispersion in the body of dosages administered orally reduces accordingly the useful molecular fraction of the active ingredient which can ultimately reach quickly and in pharmacodynamically sufficient amount, its specific receptors in the central nervous system to either induce sleep, to rebalance a desynchronization of the sleep / wake function.
• the route of administration and especially the mode of administration and the absorption and bioavailability efficiency of the active ingredient administered are therefore decisive for rapidly distributing to the circulatory flow and in the shortest possible time, a useful dose of active principle and to allow him to act without delay on his effectors of the central nervous system.
• injectable forms are suitable forms of administration for delivering a rapid and determining action of the active principles: in particular as regards the induction of sleep and the reduction of vigilance, the Anesthetist knows how to induce it instantly by the use of the intravenous route, which is therefore a vascular administration requiring a highly qualified staff and adequate supervision.
• the oral mucosal route which makes it possible to administer drugs by passive crossing of the oral mucosa, and then these molecules, if they have been sufficiently absorbed by these mucous membranes.
• the existing oral mucosal formulations are unsatisfactory and remain very little used for treatments of abnormal sleep, particularly because these active ingredients consist of molecules that are inherently sparingly soluble or insoluble in biological fluids such as saliva.
• these lipophilic molecules generally remain in crystalline and / or aggregative form, thus making it impossible for them to be absorbed per mucosa and thus for their passage into the general circulation; they are then mostly swallowed and undergo the previously described effects relating to the oral administration of drugs.
• Another difference relates to the use by the invention of a high content of ethanol (at least 35% by weight), which is not provided in the documents of the state of the art. These documents are therefore unable to provide the technical benefits provided by this high ethanol content. Other differences also exist.
• the present invention aims to provide a dosage form that does not reproduce the aforementioned disadvantages.
• the present invention also aims to provide a simplified dosage form and very quickly bioavailable in the arterial circulation, since the cerebral arterial flow is the first of the body, up to two liters of blood per minute, and a particular mode of administration by complete deposition of the solution of the invention in the gingivo-juale gutter, which are accessible to the average consumer and allow to administer a precise amount of an active ingredient, becoming immediately bioavailable in the circulation, so as to be able to very quickly and effectively treat particular syndromes such as difficulties of falling asleep, disorders of instability of sleep, disturbances of sleep / wake rhythm or epileptic seizures, with reduced useful doses of active principle, immediately available in circulation and pharmacologically immediately active on the central nervous system receptors. This is in line with what an intravenous administration allows but of course, without the related technical requirements or the infectious risks, nor the costs of equipment and specialized medical personnel dedicated to them.
• the subject of the present invention is therefore a galenic form for the oral transmucosal administration of an active principle allowing the accelerated induction of sleep and / or the treatment of sleep disorders and / or the treatment of a crisis of the system.
• central nervous system said active ingredient being lipophilic or amphiphilic and being in a stable and complete dissolution state in an aqueous-alcoholic solution comprising between 35% and 70% in mass of ethanol and between 30% and 65% by weight of water, generating within this hydro-alcoholic solution the constitution of nanostructures of said active principle in question, facilitating its passage through the blood-brain barrier, said active ingredient being in the form of base and / or salt and belonging to the chemical families of inductors or sleep modulators of lipophilic or amphiphilic nature and with a molecular weight of less than 1000 Daltons, said active ingredient being chosen from the family of Imidazopyridines, including Zolpidem, cyclopyrrolone family, including Eszopiclone, the family of Pyrazolopyrim
• the hydroalcoholic solution comprises between 40% and 65% by weight of ethanol and between 35% and 60% by weight of water.
• the hydro-alcoholic solution comprises a pH-correcting agent.
• said active ingredient contains a carbonyl acid function, said hydro-alcoholic solution comprising a pH-correcting agent and / or a sequestering agent.
• the hydro-alcoholic solution consists exclusively of ethanol, water and an active ingredient.
• the dissolution of an active principle in a hydro-alcoholic solution allows the creation of nanostructures, whose average size is about 1 nanometer, particularly concentrated in an equilibrium constituted from 35 ° of ethanol, the concentrations of said nanostructures being Optimally revealed in the high degrees of ethanol, between 45 ° and 65 °, these hydro-alcoholic solutions according to the invention.
• these nanostructures of active principle have demonstrated a specific affinity and a crossing capacity of the blood-brain barrier at least ten times greater than that of an intravenous solution of the same active ingredient.
• the transmucosal absorption of the totality of said active ingredient is carried out in less than 10 seconds, advantageously in less than 6 seconds.
• the molecular weight of said active ingredient is less than 600 Daltons.
• the unit dosage of said active ingredient is less than
• the volume of the hydroalcoholic solution is less than or equal to 1 ml.
• said active ingredient requires no adjuvant dissolution or solubilization or stabilization within said hydro-alcoholic solution.
• this solution can be prepared extemporaneously before its administration, for example by means of devices designed for this purpose, allowing instantaneous perfect dissolution and then administration. of the active ingredient, such as the devices described in documents FR 2 939 321 and FR 2 930 140.
• Trans-mucosal or peri-mucous means any passive crossing of a lipophilic or amphiphilic molecule presented in a state of dissolution, which makes it possible, because of its intrinsic lipophilicity, to be spontaneously absorbed through the mucous membranes.
• lipophilic especially the mucous membranes of the eyes, gingival, para-gingival or sublingual, all of which constitute the floor of the oral cavity, which serves them both as physical support and as a kind of container.
• these particular mucous membranes make it possible to concentrate the liquid deposit on a preferential absorption surface, which is particularly suitable for the better functioning of this application.
• stable and complete dissolution state of the active principle is meant a state of dissolution restoring an active ingredient in the molecular state in its dissolution medium, dissolution state obtained in a water / ethanol solution with a high degree of ethanol, this which allows the structural constitution of nanostructures of the active ingredients around an average size of 1 nanometer and which are preferentially absorbed at the level of the blood-brain barrier, said dissolution state also preventing any eventuality of an untimely recrystallization.
• hydro-alcoholic solution titrating X degrees of alcohol is meant a solution having an alcohol degree of X, corresponding to the ratio between the volume of pure alcohol (100 °) contained in the aqueous-alcoholic solution and the total volume of this solution.
• the degree of alcohol of the hydroalcoholic solution varies according to a proportion of the degree of alcohol used to form the solution and secondly the water / alcohol ratio of the solution. For example for an initial alcohol at 100 degrees and a 50/50 water / alcohol ratio, the hydroalcoholic solution titrates 50 degrees alcohol.
• the cerebral arterial flow provided by the two carotid arteries is the most important of the body, of the order of 2 liters per minute. This cerebral arterial pathway therefore represents a privileged direct access for a molecule intervening on the parameters of psychomotor equilibrium or sleep.
• the active ingredient acting on the central nervous system and / or inducing sleep and / or acting on the resynchronization of sleep / wake functions is present in base form and / or salt form, by example (not limited to) in the form of Succinate, Hydrochloride, Sulfate, Acetate, Tartrate, Citrate, Methylsulfate or Borate, or any pharmaceutically compatible salts.
• the active principle according to the invention is chosen from all lipophilic or amphiphilic active ingredients of low molecular weight, typically less than or equal to 1000 Daltons (Da), which have an inducing or rebalancing activity of the central nervous system and / or or sleep, while remaining devoid of adverse effects that may appear on waking.
• Da Daltons
• hypnotics from the family of benzodiazepines which are anxiolytic and hypnotic molecules belonging to the class of psychotropic drugs that is to say, substances likely to modify the psyche and the human behaviors while acting on the central nervous system
• molecules related to benzodiazepines such as imidazopyridines or cyclopyrrolones or pyrazolopyrimidines; or else sedative-type H1 antihistamines such as Doxylamine; or molecules such as Melatonin and Melatonin analogues, which are both active in the induction of sleep and the resynchronization of sleep / wake rhythms.
• GABA Gamma AminoButyric Acid
• CNS central nervous system
• benzodiazepines so-called related molecules, such as Cyclopyrrolones, including Eszopiclone, or imidazopyridines, whose Zolpidem (Stilnox®).
• Cyclopyrrolones including Eszopiclone
• imidazopyridines whose Zolpidem (Stilnox®).
• Zolpidem Tinumeric X-ray diffraction diffraction dazopyridines
• the pharmacological potency of these substances is noteworthy, since they are administered orally at low unit doses, for example between 0.5 mg and 5 mg.
• the active principles that can be formulated according to the invention are lipophilic or amphiphilic molecules made soluble in particular hydro-alcoholic solutions, for each of the said active ingredients involved in the central nervous system in crisis and / or on the induction of sleep or the regulation of the sleep / wake balance.
• These active principles are preferably of lipophilic or amphiphilic nature and of low molecular weight, typically less than 1000 Da.
• the dosage form according to the invention is in the form of a hydro-alcoholic solution comprising between 35% and 70% by weight of alcohol and between 30% and 65% by weight of water.
• the hydroalcoholic solution comprises between 40% and 65% by weight of alcohol and between 35% and 60% by weight of water.
• the passage into the systemic circulation of the active ingredient (s) is thus carried out in a hydro-alcoholic solution which has a variable degree of alcohol, preferably between 35 ° and 70 ° and more preferably still between 40 ° and 65 °.
• nanostructures due to the particular equilibrium of dissolution produced between the high degree of ethanol and water, the only constituent elements of the dissolution, the invention increases in an unprecedented manner and scientifically demonstrated ability to cross the blood-brain barrier by the active ingredient considered.
• the constitution of these nanostructures requires a high degree of ethanol, at least equal to 35 °, and the absence of any complementary ingredient dissolution or stabilization, as well as the absence of any accessory ingredient that would be related to the organoleptic characteristics of the composition.
• the alcohol used in the present invention is preferably ethanol.
• the alcohol not only plays the role of solvent and constituent, with water, of said nanostructures of active principle, but also that of promoter of an accelerated peri-mucous absorption, of which the speed increases according to the elevation of the degree of alcohol used.
• the small molecule of ethanol dissolves the superficial layer of the oral mucosa, consisting of lipid structures. It thus facilitates the access of dissolved lipophilic molecules to the lipophilic outer membrane of the epithelium of the oral mucosa.
• the hydroalcoholic solution is based on water and ethanol.
• it comprises only water, ethanol and an active ingredient.
• excipient (s) can weaken the constitution of the nanostructures of the active principle in question but also the stability in time of the hydro-alcoholic solution and thereby amputate the ratio of the absorbed dose at the same time as can reduce the rate of per-mucosal absorption of the active principle considered. It should be noted that even known to be very unpleasant, the taste of some of these active ingredients, deposited in stable and complete hydro-alcoholic dissolution according to the invention in the territories of the mucous membranes of the gingival, para-gingival or sublingual, does not are not perceived by patients.
• these particular mucous membranes in particular the gingivo-jugal mucosae, are not provided with taste receptors and the low-volume aqueous-alcoholic solutions according to the invention are found, because of their high alcohol content, to be absorbed by these mucous membranes in a delay of a few seconds.
• These molecules never reach the oral taste receptors located in the lingual papillae of the upper face of the tongue or in the upper part of the back mouth called cavum.
• the invention thus makes it possible to avoid possible taste hazards common to a large number of medicaments, because of a selective administration of the composition of the invention in contact with certain mucous membranes which are physiologically deprived of taste receptors.
• the Dosage form according to the invention may also comprise a pH-correcting agent and / or a sequestering agent.
• the active ingredients containing a carbonyl acid function can react with the primary alcohols and the secondary alcohols to form an ester. This reaction leads to the reduction of the content of active ingredient and the appearance of impurities, which is incompatible with the preparation of a drug.
• the addition of at least one pH-correcting agent makes it possible to modulate the proportion of the hydrophilic lipophilic and ionized base forms of the active ingredient in order to optimize the per-mucosal bioavailability of each active principle, for the fastest and complete absorption of the administered dose.
• the pH-correcting agent is chosen from sodium carbonates and bicarbonates, monosodium or disodium phosphates, triethanolamine, sodium hydroxide (NaOH) and potassium hydroxide (KOH).
• the sequestering agent is preferably chosen from ethylene-diamine tetraacetic acid (EDTA), calcium disodium ethylene diamine tetra-acetate (E385), glucono delta-lactone (E575), sodium gluconate (E576), potassium gluconate (E577) and sodium tripolyphosphate, or acid pH correctors such as hydrochloric acid, tartaric acid, lactic or citric acids, or any pharmaceutically acceptable salts thereof.
• the hydro-alcoholic solution may be previously established in a stable manner or constituted extemporaneously at the time of use, for example by means of a device suitable for its preparation and administration, such as those described in documents FR 2 939 321 and FR 2,930,140.
• the dosage form according to the invention allows the active ingredient to pass passively the lipophilic oral mucosa, mainly jugal, gingival or para-gingival or sublingual, within less than 10 seconds after the deposition of this hydro-alcoholic solution on contact.
• This very fast absorption time thus makes it possible to prevent any stagnation of the solution and of the active ingredient (s) in the oral atmosphere, as well as to prevent their untimely mixing with saliva, which may alter either the active ingredient itself is the specific equilibrium its complete and stable dissolution, which would introduce a break in continuity and stability of the dissolution of the active ingredient and negatively impact the establishment of nanostructures of said active ingredient.
• This short absorption period also makes it possible to prevent any reflex deglutition of the hydro-alcoholic solution administered and the active ingredient it contains.
• the transmucosal passage of such an active ingredient presented in the state of dissolution according to the invention is based on an osmotic call to the other side of said membrane, in which together the concentration of dissolved active ingredient and that of the alcoholic solution considered.
• the osmotic call is all the more perennial and powerful as the lipophilic molecule in the state of dissolution is of low molecular weight and the degree of alcohol which serves as an absorption promoter is high.
• the lipophilic oral mucosa mainly jugal, gingival or para-gingival or sublingual
• This phenomenon is accentuated by the presence of alcohol which causes vasodilation and an increase in the local microvascular flow of the mucous membranes. Because of this high circulatory flow, locally increased by alcohol, there is never any equilibrium on either side of the membrane: the concentration in the mouth remaining ever greater, until the depletion of the default mechanism of molecules to absorb.
• the hydroalcoholic solution with an alcohol content of at least 35% by mass also has the advantage of solubilizing active ingredients even if they are poorly soluble, and of protecting the pharmaceutical formulation against a microbiological contamination without the need for Paraben antimicrobial preservative (s), known to cause significant safety concerns.
• the dosage form according to the invention will allow instantaneous systemic administration at reduced and useful doses, of pharmacological substances, active to treat a crisis in the central nervous system and / or in the rapid induction of sleep and / or in the resynchronization of physiological functions sleep / wake.
• the dosage form according to the invention can be used for producing a medicament for the treatment and / or prevention of sleep disorders and has many advantages over an oral or injectable form, and in particular a great simplicity of use and an almost instantaneous distribution to the central nervous system of a low useful dose of active principle, to induce without delay or organic loss the desired pharmacological effect.
• the cerebral arterial vascular flow is the first of the body and thus, the active ingredient administered by the invention directly reaches its pharmacological target arterially, first of all before being distributed and disseminated in the various compartments of the body. body.
• the invention provides a pharmacodynamic result in a longer period of time accessible than the one technically required by the use of the intravenous route, while administering an effective dosage well below that required for the oral route.
• the present invention offers a great simplicity of realization and a very good galenic stability: the adjustment of the equilibrium of the water / alcohol solution, specifically established for each molecule, guarantees the solubilization of the active ingredient in a reduced hydro-alcoholic volume , less than or equal to 2 ml of solution, and preferably less than or equal to 1 ml.
• the invention removes most of the excipients essential to conventional oral pharmaceutical forms and traditional sublingual forms, or to forms sprayed with spray. It thus makes it possible both to reduce manufacturing costs and to reduce the risks of intolerance and the possible interactions between active principle (s) and excipients.
• the basic dose administered may be very low, the closest to the dose needed to perform the required pharmacological activity.
• This dose is preferably less than or equal to 8 mg, and advantageously less than 5 mg.
• the action times are very short, especially compared to slow absorption of drugs by the digestive tract.
• the quasi-instantaneous pharmacological delivery allows a patient to self-administer a product for an effect almost equivalent to the efficacy of an intravenous flash injection into the circulation.
• lipophilic oral mucosa mainly jugal, gingival or para-gingival or sublingual, having a total absorption area multiplied by their character pleated epithelial tissue
• the administration of the dosage form according to the invention is devoid any risk of accidental swallowing or false route. Indeed, it allows an extremely fast peri-mucous passage that prevents any salivary dilution or swallowing of the active ingredients administered, with the advantage of not destabilizing the mucous membranes with surfactants, as is the case for example many preexisting formulations of the invention.
• the effects of alcohol are insignificant.
• the dose of alcohol administered in 1 ml of 50 ° ethanol hydroalcoholic solution would represent, if ingested, a systemic maximum blood systemic dose of 0.00785 g / l d ethanol, ie only about one-sixtieth of the alcohol limit of 0.5 g / l compliant with French legislation.
• the ethanol which has served as vector to the active ingredient is massively expired in a volatile state during its passage through the pulmonary alveoli, where it has was conducted in a few seconds by the pulmonary artery from the right ventricle.
• ethanol is a known vector that does not remain in the body after allowing the rapid passage into the systemic circulatory current of the active ingredient (s) administered at low effective dosage.
• the invention thus allows both the administration and the rapid pharmacodynamic action of the active principle (s), while substantially reducing the phenomena of intolerance that can be related to high dosages of the active ingredients. and / or the excipients and stabilizers of these active ingredients.
• the invention By using a vector such as ethanol, which is very early evacuated from the body by the respiratory route before having been able to exert an effect, and by not requiring excipients, the invention reduces the risks and costs. , relative to oral formulations and complex formulations, such as those previously cited for per mucosal administration in US 2007/0248548, WO 2007/123955, US 2008/013929, CA 2,582,007 and US 2004/265239.
• the galenic form of the invention is associated with a specific industrial packaging, in order to prevent the degradation of the active ingredient (s) in contact with the air.
• a particular embodiment consists, for example, in using a flexible, opaque unitary packaging, equipped with a delivery cannula whose length can reach several centimeters, thus making it possible to deposit punctually the entire hydro-alcoholic volume administered in contact with a mucosal area precisely determined for this purpose.
• the unit package can also be filled under a nitrogen atmosphere, for the best protection of the stability of the composition, and to have impermeability to oxygen and light. This conditioning guarantees the stability over time of the dissolved active principles in hydro-alcoholic solution according to the invention.
• the dosage form according to the invention is packaged in single-dose sticks of 0.1 ml to 2 ml, capable of providing an adequate dose of active ingredient, for a single administration.
• this small package is easy to transport and allows easy, discreet and rapid use of the dosage form.
• Said "stick” may furthermore have particular characteristics, enabling it, for example, to extemporaneously produce the instantaneous mixture between active ingredient and hydro-alcoholic solution and to allow its administration to be carried out precisely, in particular by means of a adapted cannula, as for example described in the documents WO 2010/063978 or WO 2009/016309.
• Other features and advantages will become apparent from the following examples of the invention.
• Said active ingredient which is of low molecular weight, typically less than 1000 Daltons, advantageously less than 600 Daltons, can be exploited in base form and / or salt, the base being preferred as far as possible.
• these active ingredients must have a duration of action limited to a few hours in order not to generate side effects, in particular after having produced the induction of the sleep in insomniacs, in order not to maintain these same subjects in a situation of residual somnolence that could interfere and harm the conditions of their active life, after waking up.
• the invention will allow the instantaneous bioavailability of the useful dose of the active principle considered at the level of the nerve centers and thereby a significant reduction in this useful dosage and thus a triple economy, delay of action, administered dose and therefore side effects that are mostly related to metabolites inevitably created by the hepatic activity receiving the same oral dosages.
• the active ingredients having what is called a "half-life" in the body much greater than the recommended duration of sleep, that is to say 7 to 9 hours, are not not preferred applications of the invention, even if these active principles could be exploited in the form of the invention.
• a formulation according to the invention therefore takes into account that a useful unit dosage administered per oral mucosa must not be greater than 8 mg, because of the rapidity of blood distribution available to the formulation according to the invention, in comparison with an oral form or a "spray” form. Therefore, the invention allows the use of reduced dosage formulations, which take into account the "bolus" effect related to the rapid systemic vascular passage of the active ingredient Zolpidem, during its oral mucosal administration.
• the dosage of Zolpidem is advantageously between 0.025 mg and 7 mg, preferably between 0.2 mg and 6 mg, and more preferably between 0.5 mg and 5 mg.
• Zolpidem tartrate for oral forms, it is a salt of Zolpidem, namely Zolpidem tartrate, which is often used, as described in particular in document US 2004/265239, which describes a treatment of insomnia called NovaDel's Zolpimist TM (Zolpidem Tartrate) 5 mg and 10 mg Oral Spray.
• Zolpidem tartrate described in this document is less soluble in water and ethanol than Zolpidem base, since Zolpidem base dissolves in ethanol at 50 mg / ml, which facilitates the application of Zolpidem base. 'invention. Nevertheless, Zolpidem tartrate could also be used in the context of the present invention.
• Formulation A1 1 ml for 5 ml of Zolpidem base:
• Formulation D1 0.3 ml for 1.5 mq of Zolpidem tartrate:
• Formulation F1 0.25 ml for 0.5 mq of Zolpidem base:
• the dormancy effect produced by Zolpidem appears at the cerebral level within a few minutes only for the assays of the invention provided by way of examples, since the arterial vascularization rate of the brain is the first in the body, whereas the effect of Zolpidem by the oral route can only be seen within a period of at least 15 minutes after taking doses of 5 or 10 mg.
• the dosage of Eszopiclone is advantageously between 0.025 mg and 2 mg, preferably between 0.2 mg and 2.5 mg, and more preferably between 0.15 mg and 1 mg.
• Formulation A2 1 ml for 1 ma of Eszopiclone base:
• the dosage of Zaleplon is advantageously between 0.025 mg and 5 mg, preferably between 0.2 mg and 4 mg, and more preferably between 0.5 mg and 3 mg.
• the dosage of Midazolam is advantageously between 0.15 mg and 5 mg, preferably between 0.3 mg and 4 mg, and more preferably between 0.5 mg and 3 mg.
• a particular application of Midazolam according to the invention, and which is a therapeutic emergency, is the instant treatment of epileptic seizures, in particular pediatric.
• the application according to the invention makes it possible, by spreading the patient's cheek, to deliver, in contact with its gingivo-juvenal mucosa, a small volume of hydro-alcoholic solution with a high degree of ethanol, which makes it possible to address the active principle to the cerebral circulation within a few seconds only and to obtain the sedation of the crisis.
• a formulation specifically adapted to the treatment of epileptic seizure may correspond in a non-limiting manner as a function of the weight and age of the subject in question, in terms of dosage and volume to the following formulations: :
• the dosage of Brotizolam is advantageously between 0.015 mg and 0.3 mg, preferably between 0.02 mg and 0.180 mg, and more preferably between 0.025 mg and 0.1 mg.
• Antiallergic antihistamines called H1 first generation are drugs whose purpose is to improve the comfort of allergic subjects. Some of them, when administered orally, also act by inducing a sedative effect inducing sleep. The invention makes it possible to potentiate this sedative effect, so as to make it occur at a low useful dosage within a time limit of only 5 to 10 minutes, consequently being particularly reduced compared to that obtained by the oral route.
• the example will be given by the application of the invention to Doxylamine and another anti-histamine sedative, Cyproheptadine.
• the base doxylamine or its salt for example succinate
• the base doxylamine or its salt for example succinate
• the base doxylamine or its salt are readily soluble in ethanol, which makes it possible to produce, by the specific means of the invention, a facilitation of the rapid start of sleep by causing somnolence within a certain period of time. a few minutes after oral mucosal administration according to the invention.
• they can fall asleep within a few minutes at a time that suits them, thanks to the almost instantaneous bioavailability of Doxylamine in the circulation as soon as it is absorbed by the oral mucosa.
• Doxylamine is not subject to pharmacovigilance problems and above all, its rather short half-life does not exceed on average the duration of a night's sleep (6 to 9 hours) . This allows the subject to wake up without being dependent on a persistent residual activity of this molecule, which would always induce drowsiness.
• the dose useful for rapid induction of sleep is not greater than a few milligrams, ie around 1 to 3 mg for an average useful dosage, this of course depending on weight status of the user and its particular sensitivity to the effect of Doxylamine.
• the Doxylamine reaches without prior loss its H1 receptors brain prior to any distribution / systemic / organic dispersion (which is not the case of oral dosing).
• the useful assays of the invention are therefore much lower than those used orally (7.5-15 mg) and above all, pharmacologically effective in a reduced time to a few minutes.
• the dosage of Doxylamine is advantageously between 0.025 mg and 7 mg, preferably between 0.075 mg and 5 mg, and more preferably between 0.5 mg and 4 mg.
• Formulation F5 0.3 ml for 0.5 mq of Doxylamine succinate:
• Cyproheptadine can advantageously benefit from the invention to produce a rapid induction of sleep.
• a formulation according to the invention for enabling rapid induction of sleep can be advantageously defined hereinafter for Cyproheptadine, as a non-limiting examples.
• the dosage of Cyproheptadine is advantageously between 0.025 mg and 3 mg, preferably between 0.075 mg and 2.5 mg, and more preferably between 0.5 mg and 1 mg.
• Melatonin or N-Acetyl-5-Methoxytryptamine is a cerebral hormone that regulates chronobiological rhythms and virtually all hormonal secretions in humans.
• This neuro-hormone is synthesized from a neurotransmitter, serotonin, which itself derives from tryptophan, an essential amino acid. It is secreted in the brain by the pineal gland, in response to the absence of light.
• Microbes, various algae and plants also produce Melatonin (called phytomelatonin in the case of plants).
• the body can also extract some of these plant sources (rice, bananas, pineapple, etc.). It regulates the sleep cycle and other circadian rhythms.
• the sleep hormone is secreted at night only (peak secretion at 5 am in humans because its production is inhibited by light) and it manages (in part) the circadian rhythms. Sleep / wake synchronization disorders appear mainly during long air travel and are linked to the crossing of multiple time zones, or occur in subjects subjected to long night work.
• WO 00/72843, EP 0 518 468, WO 2007/099172 and EP 0 835 652 describe the use of Melatonin in medical and cosmetic treatments. These applications are preferably forms that can be administered by the digestive tract or cosmetic compositions, all of which are free of ethanol.
• Melatonin is mainly used orally, in the form of tablets or capsules, as a clinically proven sleep inducer and also as a reduction in sleep access delay, and finally, to restore synchronization between sleep and sleep.
• the oral bioavailability of Melatonin is low, about 15% of the ingested dose, and its half-life is short, hardly more than 50 minutes.
• the formulations of the invention will therefore allow to administer a complete dose of Melatonin directly to the vascular system, a dose that will gain in totality and within seconds its specific brain receptors, to compensate without delay for alterations of the Sleep / wake rhythm or induce and facilitate access to sleep with low doses. Indeed, it is shown that when given orally, high doses of Melatonin may even be counterproductive: several Massachusetts Institute of Technology (MIT) studies show that Melatonin supplements over-the-counter contains 3 to 10 times more of this hormone than is necessary to exercise, orally, an activity on sleep. The doses usually administered orally in the studies range from 0.3 mg to 5 mg at bedtime.
• MIT Massachusetts Institute of Technology
• formulations of the invention cited as examples are preferably established on the basis of a high degree of alcohol, ie approximately 45 ° -50 ° of ethanol, in order to induce a rapid and instantaneous absorption of the totality of the solution as soon as it is deposited in contact with a privileged mucous zone, chosen for this purpose, for example gingivo-juale. Therefore, by the particular means of the invention it is possible to deliver a melatonin concentration in a reduced volume of circulating blood, this so-called "bolus" effect making it possible to increase the effectiveness of very low doses of melatonin, since they access their cerebral receptors without having undergone a phenomenon of too great dispersion in the arterial circulation which leads them.
• the invention is therefore particularly distinguished from other forms of oral mucosal administrations, which do not have this "bolus” effect, in particular gel forms or forms of lozenges or disintegrating tablets or adhesive forms.
• mucous membranes which slowly release the active ingredient, or the "spray” forms, which spread it broadly in contact with undelimited surfaces of the oral mucosa, with all of these forms previously mentioned a very significant loss related to reflex swallowing inevitable a large part of the dosage that has been issued.
• the dosage of melatonin is advantageously between 0.015 mg and 10 mg, preferably between 0.025 mg and 7.5 mg, and more preferably between 0.05 mg and 5 mg.
• the invention is also advantageously applicable to pharmaceutical analogues of melatonin, with non-limiting examples Ramelteon and Agomelatine.
• this molecule destroyed at 98.2% of its dose administered orally, can benefit exceptionally from its administration by oral mucosal route as exploited by the invention, which gives it a instantaneous vascular bioavailability at very small useful doses. Moreover, this molecule does not generate pharmacological dependence and has no addictive effect, as in the case of benzodiazepines or related drugs. Finally, Ramelteon is perfectly suited to formulations according to the invention, since this small lipophilic molecule is very easily soluble in ethanol.
• the dosage of Ramelteon is advantageously between 0.015 mg and 10 mg, preferably between 0.025 mg and 7.5 mg, and more preferably between 0.15 mg and 2.5 mg.
• Formulation B8 0.3 ml for 0.3 ma of Ramelteon base:
• the dosage of Agomelatine is advantageously between 0.015 mg and 5 mg, preferably between 0.025 mg and 3 mg, and more preferably between 0.8 mg and 2.5 mg.
• the invention allows a rapid induction of sleep for a very small dose of active ingredient, it is easily understood that it becomes difficult for a subject who has taken, per oral mucosa according to the invention, a reduced dose and very quickly effective to repeat this administration to obtain a number of successive doses and an administered amount of active ingredient that can generate autolysis, since it was quickly asleep by means of the invention, and this as early as minutes after taking initial, totally devoid of toxicity. This is not the case of the subject who accumulates and swallows in a single dose and in a few moments, a large number of high unit dose tablets which he can dispose.
• the economy of useful dose and the comfort of fast falling asleep provided by the invention are therefore associated with a much larger safety in terms of toxicology, provided to both users and the community.

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