KR20180094512A - Composition for reducing urinary frequency - Google Patents

Abstract

A pharmaceutical composition for reducing the frequency of urination is disclosed. The pharmaceutical composition comprises one or more analgesics and a PDE5 inhibitor. Also disclosed are methods of making and use of the pharmaceutical compositions.

Description

Composition for reducing urinary frequency

This application claims priority from U.S. Serial No. 14 / 949,220, filed on November 23, 2015. The entirety of the above application is incorporated by reference.

The present application relates generally to methods and compositions for inhibiting muscle contraction, and in particular to methods and compositions for inhibiting the contraction of the smooth muscle of a urinary bladder.

The detrusor muscle is a layer of bladder wall made of smooth muscle fibers arranged in bundles of spiral, longitudinal and circular. When the bladder is stretched, it signals the parasympathetic nervous system and contracts the detrusor. This allows the bladder to drain urine through the urethra.

In order for the urine to be excreted in the bladder, both the autonomously regulated sphincter and the spontaneously regulated external sphincter must be opened. Problems with these muscles can lead to incontinence. When the amount of urine reaches 100% of the absolute capacity of the bladder, the spontaneous sphincter becomes involuntary and the urine is immediately discharged.

An adult's bladder can usually hold about 300-350 ml of urine (working volume), but a full adult bladder can store about 1000 ml (absolute volume), which varies from person to person. As the urine accumulates, the wall of the bladder (the wrinkle, rugae) folds and ridges, and as the bladder stretches, the wall of the bladder becomes thinner, allowing the bladder to store more urine without significant increase in internal pressure.

In most individuals, the urge to urinate usually begins when the volume of urine within the bladder reaches about 200 ml. At this stage, the subject can easily cope with the urge to urinate if desired. As the bladder continues to fill, the urge to urinate becomes stronger and more difficult to ignore. Eventually, the bladder is filled to the point where the urination urge becomes overwhelming, and the subject can no longer ignore it. In some individuals, the urge to urinate begins when the bladder is less than 100% of the working volume. This increased need for urination may interfere with normal activities, including sleeping ability, during an uninterrupted enough break. In some cases, this increased need for urination may be associated with medical conditions such as benign prostatic hyperplasia in men, prostate cancer, or pregnancy in women. However, increased urination needs occur individually in both men and women who are not affected by other diseases.

Accordingly, there is a need for compositions and methods for the treatment of male and female subjects suffering from a urge to urinate even when the bladder is less than 100% associated with the operating volume of the bladder. The compositions and methods are needed for inhibition of muscle contraction such that the urination volume is initiated in the subject when the volume of urine in the bladder exceeds about 100% of the bladder working volume.

One aspect of the present application is a first component comprising an immediate release subcomponent and an extended release subcomponent, wherein the first component is administered immediately after administration Formulated to release said subcomponents; And a second component comprising an immediate-release subcomponent and an extended-release subcomponent, wherein the second component is a pharmaceutical composition comprising a formulation for delayed release of the subcomponents . In some embodiments, the at least one subcomponent in the first component or the second component comprises an active ingredient comprising at least one analgesic, and at least one of the first component or the second component The subcomponent is an active ingredient comprising a PDE5 inhibitor such as tadalafil.

Another aspect of the present application is a first component comprising an immediate release subcomponent, wherein the immediate release subcomponent comprises an active agent comprising one or more agents selected from the group consisting of analgesics and PDE5 inhibitors such as tadalafil Wherein the first component is formulated to release subcomponents immediately after oral administration; And a second component comprising an immediate-release subcomponent and an extended-release subcomponent, wherein the second component is adapted to release the subcomponent after gastric emptying of the second component, Wherein each of the subcomponents in the second component comprises an active ingredient comprising one or more agents selected from the group consisting of analgesics and PDE5 inhibitors such as tadalafil. will be.

Yet another aspect of the present application is a first component comprising an immediate release subcomponent and an extended release subcomponent, wherein the first component is formulated to release the subcomponents immediately after administration; And a second component comprising an immediate-release subcomponent and an extended-release subcomponent, wherein the second component is formulated as delayed-release of a subcomponent, Wherein each of the immediate release sub-component and the extended release sub-component in the first component comprises an active ingredient comprising at least one analgesic and a PDE5 inhibitor such as tadalafil, wherein the immediate-release sub-component in the second component Wherein each of the urea and prolonged release subcomponents comprises an active ingredient comprising one or more analgesics and a PDE5 inhibitor such as tadalafil wherein the pharmaceutical composition is administered to a patient in need thereof with a frequency of urination .

Another aspect of the present application relates to a pharmaceutical composition comprising an immediate release component and an extended release component. Each component comprises a pair of PDE5 inhibitors such as analgesics and tadalafil as described above. In some embodiments, the immediate release component and the extended release component comprise different pairs of analgesic agents. In some embodiments, the immediate release component and the extended release component comprise the same pair of analgesic agents. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and an NSAID. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and ibuprofen. In some embodiments, the immediate release component and the extended release component each comprise a PDE5 inhibitor such as acetaminophen, ibuprofen, and tadalafil.

Another aspect of the present application relates to a pharmaceutical composition comprising an immediate release component and an extended release component. Each component comprises a pair of PDE5 inhibitors such as analgesics and tadalafil as described above. In some embodiments, the immediate release component and the extended release component comprise different pairs of analgesic agents. In some embodiments, the immediate release component and the extended release component comprise the same pair of analgesic agents. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and an NSAID. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and ibuprofen. In some embodiments, the immediate release component and the extended release component each comprise a PDE5 inhibitor such as acetaminophen, ibuprofen, and tadalafil.

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method comprising: forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release; Coating the core structure with a delayed-release coating to form a coated core structure; Mixing the coated core structure with a third active ingredient formulated for immediate release and a fourth active ingredient formulated for extended release to form a final mixture. In some embodiments, at least one of the first, second, third, and fourth active ingredients comprises an analgesic agent, and at least one of the first, second, third, and fourth active ingredients is selected from the group consisting of tadalafil PDE5 inhibitor. In some embodiments, the method further comprises preparing the final mixture in tablet form. In another embodiment, the method further comprises forming an orally disintegrating tablet with the final mixture. In another embodiment, the method further comprises forming the final mixture into a liquid suspension.

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method comprising: forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release; Coating the core structure with a delayed-release coating to form a coated core structure; Coating the coated core structure with a third active ingredient formulated for immediate release to form a dual-coated core structure. In some embodiments, at least one of the first, second, third, and fourth active ingredients comprises an analgesic agent, and at least one of the first, second, third, and fourth active ingredients is selected from the group consisting of tadalafil PDE5 inhibitor.

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method comprising forming a core structure comprising a first pair of analgesic formulated as extended release and coating the core structure with a coating layer comprising a second pair of analgesic agents, The two pairs are formulated for immediate release, and the core structure or the coating layer, or both, further comprise a PDE5 inhibitor such as tadalafil.

Figures 1A and 1B are graphs showing that analgesics control the expression of co-stimulatory molecules by Raw 264 macrophages in the absence (Figure 1A) or presence (Figure IB) of LPS. Cells were treated with analgesics alone or with Salmonella typhimurium LPS (0.05 μg / ml) for 24 h. The results are expressed as an average relative percentage of CD40 + CD80 + cells.

The following detailed description is presented to enable a person skilled in the art to make and use the invention. For purposes of explanation, specific nomenclature is provided to provide a thorough understanding of the present invention. However, it will be apparent to those skilled in the art that such details are not required to practice the present invention. The description of the specific application is provided only as a representative embodiment. The present invention is not intended to be limited to the embodiments shown, but is to be accorded the widest possible scope consistent with the principles and features disclosed herein.

The term " effective amount " as used herein means the amount necessary to achieve a selected result.

The term " analgesic " as used herein refers to a medicament, compound or drug used to alleviate pain and includes anti-inflammatory compounds. Exemplary analgesic and / or anti-inflammatory drugs, compounds or drugs include, but are not limited to, non-steroidal anti-inflammatory drugs (NSAIDs), salicylates, aspirin, salicylic acid, Or a pharmaceutically acceptable salt, solvate or prodrug thereof, wherein the at least one compound is selected from the group consisting of at least one compound selected from the group consisting of atorvastatin, atorvastatin, Arylacetic acid derivatives, tolmetin, ketorolac, diclofenac, propionic acid derivatives, ibuprofen, naproxen sodium, naproxen, fenoprofen, ketoprofen, fluorevifrophen, oxaprozin; Wherein the at least one compound is selected from the group consisting of at least one selected from the group consisting of at least one selected from the group consisting of at least one selected from the group consisting of benzoic acid, Wherein the active ingredient is selected from the group consisting of paclitaxel, paclitaxel, paclitaxel, paclitaxel, paclitaxel, paclitaxel, paclitaxel, But are not limited to, thiazolidinediones such as thiazepine, thiazepine, thiazepine, thiazepine, thiazepine, thiazepine, thiazepine, thiazepine, -7-methylsulfonylamino-6-phenoxy-4H-1-benzopyran-4-one, meloxicam, loroxicam, d-indofuran, mofezolek, amolol methine, Methic acid, fluvifrophen, surpopen, oxaprozin, zalto propen, alminopropene, thiopropenoic acid, their pharmaceutical salts, their Cargo, and their solvates.

As used herein, the terms " coxib " and " COX inhibitor " refer to a compound that is capable of inhibiting the activity or expression of a COX1 or COX2 enzyme, or that is capable of inhibiting the severity of a severe inflammatory response, including pain and swelling, ≪ / RTI > of the compounds of the present invention.

As used herein, the term " derivative " means a chemically modified compound, which is a benzyl group for an ester or amide of an acid, an alcohol or a thiol, a protecting group such as a tert-butoxycarbonyl group for an amine Which is routinely considered by ordinary skilled chemists.

As used herein, the term " analogue " encompasses the chemically modified form of a particular compound or class, and maintains the pharmacological and / or pharmacologically active properties of the compound or class.

As used herein, " pharmaceutically acceptable salts " refers to derivatives of the disclosed compounds, and parent compounds are modified by making their acidic or basic salts. Examples of pharmaceutically acceptable salts include mineral or organic acid salts of basic residues such as amines; Alkali or organic salts of acidic residues such as carboxylic acids, and the like. Such pharmaceutically acceptable salts include, for example, quaternary ammonium salts or common non-toxic salts of parent compounds formed from non-toxic inorganic or organic acids. For example, such common non-toxic salts include salts derived from inorganic acids such as hydrochloric acid, hydrobromic acid, sulfuric acid, sulfamic acid, phosphoric acid, nitric acid and the like; And organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, fumaric, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, And salts prepared from organic acids such as benzoic acid, fumaric acid, toluenesulfonic acid, methanesulfonic acid, ethanedisulfonic acid, oxalic acid, isethionic acid and the like.

The phrase " pharmaceutically acceptable ", as used herein, is intended to refer to a medicinal product suitable for use in contact with the tissues of humans and animals without undue toxicity, irritation, allergic response, or other problems or complications commensurate with a reasonable benefit / Reference is made to compounds, materials, compositions, and / or formulations within the scope of judgment.

(SR), sustained-release, sustained-action, time-release, controlled-release, modified release ) Or "extended-release", also known as continuous-release (CR), is a mechanism used in drug tablets or capsules to slowly dissolve and release the active ingredient over time. The advantage of an extended-release tablet or capsule is that it can be taken less frequently than the immediate-release formulation of the same drug, maintaining the level of drug in the bloodstream constant to extend the duration of the drug action, Prolongs the duration and lowers the amount of drug peak in the bloodstream.

As used herein, " delayed-release " means that the release of the active ingredient (s) of a pharmaceutical composition is delayed or delayed for a period of time (e.g., a delay time) after administration of the pharmaceutical composition Drug release profile.

As used herein, " immediate-release " means a drug formulation that does not contain a dissolution rate controlling material. There is no substantial delay in the release of the active agent after administration of the immediate release formulation. Immediate release coatings may comprise suitable materials that are readily dissolved to release the drug substance after administration. In some embodiments, the term " immediate release " is used with reference to a pharmaceutical formulation in which the active ingredient is released within 2 hours of administration.

One aspect of the present invention relates to a method of reducing the frequency of urination by administering a pharmaceutical composition to a subject in need thereof. The pharmaceutical composition comprises one or more analgesics, one or more PDE5 inhibitors (phosphodiesterase type 5) and, optionally, one or more antimuscarinic agents, one or more antidiuretic agents and / or one or more antispasmodics. The pharmaceutical composition may be formulated into an immediate release, extended release, delayed release, or a combination thereof.

In one embodiment, the pharmaceutical composition is formulated in an extended-release form by embedding the active ingredient in a matrix of insoluble substance (s) such as acrylic or chitin. The extended-release form is designed to release the analgesic compound at a predetermined rate by maintaining a constant drug level for a specified period of time. This can be accomplished through a variety of formulations including, but not limited to, drug-polymer conjugates such as liposomes and hydrogels.

The prolonged release formulation is designed to release the active agent at a predetermined rate and can be up to about 12 hours, about 11 hours, about 10 hours, about 9 hours after the administration or after the delay time associated with delayed release of the drug , About 8 hours, about 7 hours, about 6 hours, about 5 hours, about 4 hours, about 3 hours, about 2 hours, or about 1 hour.

In certain preferred embodiments, the active agent is released over a time interval between about 2 to about 12 hours or between about 1 to about 24 hours. Alternatively, the active agent may be released over about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, or about 12 hours. In another embodiment, the active agent is released over a period of time between about 5 and about 8 hours after administration.

In some embodiments, the extended-release formulations comprise an active core comprised of one or more inert particles, each of which can be delivered to a drug-delivery device using, for example, fluid bed technology or other techniques known in the art, Pellets, pill, granular particles, microcapsules, microspheres, microparticles, nanocapsules, or nano-spheres in the form of coatings or film-forming compositions. The inert particles can be of various sizes as long as they are large enough to maintain poor dissolution. Alternatively, the active core may be prepared by granulation and milling and / or extrusion and spheronization of a polymeric composition containing the drug substance.

The active agent may be introduced into the inert carrier by techniques known to those skilled in the art, such as drug layering, powder coating, extrusion / spheronization, roller compaction, or granulation. The amount of drug in the core may be dependent upon the dosage required and will typically vary from about 5 to 90% by weight. Generally, the polymer coating on the active core will be from about 1 to 50% based on the required retardation time and / or the weight of the coated particles depending on the selected polymer and coating solvent. Those skilled in the art will be able to select the appropriate amount of drug for inclusion in the coating or core on the core to achieve the desired dosage. In one embodiment, the inert core may be an encapsulated buffer crystal such as a sugar sphere or buffer crystal or calcium carbonate, sodium bicarbonate, fumaric acid, tartaric acid, etc., which alters the microenvironment of the drug to promote drug release .

Extended-release formulations can utilize a variety of extended-release coatings or mechanisms to facilitate gradual release of the active agent over time. In some embodiments, the extended-release broth comprises a polymer whose release is controlled by dissolution controlled release. In certain embodiments, the active agent (s) is incorporated into a matrix comprising drug particles or granules coated with an insoluble polymer and a polymeric material of varying thickness. The polymeric material may be selected from the group consisting of carnauba wax, beeswax, wax wax, candelilla wax, shellac wax, cocoa butter, cetostearyl alcohol, partially hydrogenated vegetable oil, ceresin, paraffin wax, ceresine, A lipid barrier comprising a waxy material such as stearyl alcohol, stearyl alcohol, cetyl alcohol and stearic acid with a surfactant such as polyoxyethylene sorbitan monooleate. When in contact with an aqueous medium such as a biological fluid, the polymer coating is emulsified or eroded after a predetermined delay-time, depending on the thickness of the polymer coating. The delay time is independent of gastrointestinal motility, pH or gastrointestinal residues. In some embodiments, the extended release formulation is in the form of an oral disintegrating tablet, a powder or a liquid suspension. The one or more active ingredients are present in the coated particles or embedded in the particles, so that the active ingredient is slowly released over a desired period of time.

In another embodiment, the extended-release broth comprises a polymer matrix that causes diffusion controlled release. The matrix may comprise one or more hydrophilic and / or water-swellable, matrix-forming polymers, pH-dependent polymers, and / or pH-independent polymers.

In one embodiment, the extended-release formulation comprises a water-soluble or water-swellable matrix-forming polymer, optionally one or more solubility-enhancing excipients and / or a release-promoting agent. Upon solubilization of the water-soluble polymer, the active agent (s) dissolves (if soluble) and diffuses progressively through the hydrated portion of the matrix. Over time, as more water penetrates into the core of the matrix, the thickness of the gel layer increases and the gel layer grows, which provides a diffusion barrier to release the drug. As the outer layer is fully hydrated, the polymer chain is completely relaxed and can no longer maintain the integrity of the gel layer, leading to disassembly and erosion of the externally hydrated polymer on the surface of the matrix. The water continues to penetrate through the gel layer into the core until the core is completely eroded. While water soluble drugs are released due to a combination of these diffusion and erosion mechanisms, erosion is a major mechanism for insoluble drugs, regardless of dosage.

Similarly, a water-swellable polymer generally hydrates and expands in a biological fluid to maintain its shape during drug release and to form a homogeneous matrix structure that serves as a carrier, solubility enhancer and / or release promoter for the drug. The initial matrix polymer hydration step results in a slow-release of the drug (delayed step). When the water-swellable polymer is fully hydrated and expanded, the water in the matrix similarly dissolves the drug substance and spreads it through the matrix coating.

Additionally, the porosity of the matrix may increase due to the leaching of the pH-dependent release promoter and release the drug at a higher rate. The rate of release of the drug is then constant, which is the function of diffusing the drug through the hydrated polymer gel. The rate of release from the matrix can be varied depending on the type and level of polymer, drug solubility and capacity, polymer, drug ratio, filler type and level, polymer to filler ratio, particle size of the drug and polymer, and the porosity and morphology of the matrix It depends on various factors.

Examples of hydrophilic and / or water-swellable, matrix-forming polymers include cellulosic polymers such as hydroxyalkylcellulose and polymers such as hydroxypropylmethylcellulose (HPMC), hydroxypropylcellulose (HPC), hydroxyethylcellulose (HEC) Carboxyalkylcelluloses such as cellulose (MC), carboxymethylcellulose (CMC), powdered cellulose such as microcrystalline cellulose, cellulose acetate, ethylcellulose, salts thereof, and combinations thereof; Polysaccharide rubbers such as alginate, xanthane, tragacanth, pectin, acacia, carya, alginate, agar, guar, hydroxypropyl guar, bombyx, carrageenan, locust bean gum and gellan gum, Rubber, and derivatives thereof; Polymers and copolymers of acrylic acid, methacrylic acid, methyl acrylate and methyl methacrylate, and carbomers (e.g., CARBOPOL ^® 71G, containing NF Noveon Inc., Cincinnati, CARBOPOL, which can be obtained from a variety of molecular weight grades OH acrylic resin containing a combination of polyacrylic acid derivatives, such as crosslinked ^®); Carrageenan; Polyvinyl acetate (for example, KOLLIDON ^® SR); Derivatives of polyvinylpyrrolidone such as polyvinylpyrrolidone and crospovidone; Polyethylene oxide; And polyvinyl alcohols. Preferred hydrophilic and water-swellable polymers include cellulosic polymers, especially HPMC.

The extended-release formulation may further comprise at least one binder capable of cross-linking the hydrophilic compound in an aqueous medium comprising a biological fluid to form a hydrophilic polymer matrix (i.e., a gel matrix) .

Examples of the binder include homopolysaccharides such as galactomannan rubber, guar gum, hydroxypropyl guar gum, hydroxypropyl cellulose (HPC; for example, Klucel EXF) and locust bean gum. In another embodiment, the binder is an alginic acid derivative, HPC or microcrystalline cellulose (MCC). Other binders include, but are not limited to, starch, microcrystalline cellulose, hydroxypropylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, and polyvinylpyrrolidone.

 In one embodiment, the method of introduction is a drug layer emulsion by spraying a suspension of the active agent (s) and binder onto an inert carrier.

The binder may be present in the bead formulation in an amount from about 0.1 wt% to about 15 wt%, preferably from about 0.2 wt% to about 10 wt%.

In some embodiments, the hydrophilic polymer matrix further comprises an ionic polymer, a non-ionic polymer, or a water-insoluble hydrophobic polymer to reduce the size of the matrix and the stronger gel layer and / or pore volume, Slowing the rate and the accompanying release of the active agent (s). This can additionally inhibit the initial burst effect and create a more stable " zero order release " of the active agent (s).

Examples of ionic polymers that slow the rate of dissolution include both anionic and cationic polymers. Examples of anionic polymers include polymers of sodium carboxymethylcellulose (Na CMC), sodium alginate, acrylic acid or carbomer (e.g., CARBOPOL ^® 934, 940, 974P NF); Enteric coating (enteric) polymers, methacrylic acid copolymers (e.g., EUDRAGIT ^® L100, L 30D 55, A, and FS 30D), Bottom romel Los acetate succinate (AQUAT HPMCAS), such as polyvinyl acetate phthalate (PVAP) ; And xanthan gum. Examples of cationic polymers include dimethylaminoethyl methacrylate copolymer (e.g., EUDRAGIT ^® E100). The incorporation of anionic polymers, especially enteric polymers, is useful for developing a pH-independent release profile for weakly basic drugs as compared to hydrophilic polymers alone.

Non-ionic polymers that slow the dissolution rate include, for example, hydroxypropylcellulose (HPC) and polyethylene oxide (PEO) (e.g., POLYOX ( ^TM )).

Examples of the hydrophobic polymer is ethyl cellulose (e.g., ETHOCEL ^TM, SURELEASE ^®), cellulose acetate, methacrylic acid copolymers (e.g., EUDRAGIT ^® NE 30D), ammonium O-containing methacrylate copolymer (for example, , EUDRAGIT ^® RL 100 or PO RS100), polyvinyl acetate, glyceryl monostearate, fatty acids such as acetyl tributyl citrate, and combinations and derivatives thereof.

The swellable polymer may be included in the formulation in a ratio of 1 wt% to 50 wt%, preferably 5 wt% to 40 wt%, and most preferably 5 wt% to 20 wt%. The swellable polymer and binder may be included in the formulation before or after granulation. The polymer may be dispersed and sprayed in an organic solvent or hydro-alcohol during granulation.

Examples of release-promoting agents include pH-dependent enteric polymers that are maintained intact at pH values of less than about 4.0 and are soluble at pH values greater than 4.0, preferably greater than 5.0, most preferably about 6.0. Examples of pH- dependent polymers include methacrylic acid copolymers, methacrylic acid-methyl methacrylate copolymer (e.g., EUDRAGIT ^® L100 (type A), EUDRAGIT S100 ^® (type B), Rohm GmbH, Germany); Methacrylic acid-ethyl acrylate copolymer (e.g., EUDRAGIT ^® L100-55 (type C) and EUDRAGIT ^® L30D-55 copolymer dispersion, Rohm GmbH, Germany); Methacrylic acid-methyl methacrylate and methyl methacrylate copolymers of acrylate (EUDRAGIT ^® FS); Terpolymers of methacrylic acid, methacrylate and ethyl acrylate; Cellulose acetate phthalate (CAP); Hydroxypropyl methylcellulose phthalate (HPMCP) (e.g., HP-55, HP-50, HP-55S, Shinetsu Chemical, Japan); Polyvinyl acetate phthalate (PVAP) (e.g., COATERIC ^® , OPADRY ^® enteric white OY-P-7171); Polyvinyl butyrate acetate; Cellulose acetate succinate (CAS); Hydroxypropyl methyl cellulose acetate succinate (HPMCAS), e.g., HPMCAS Grade LF, MF Grade, AQOAT ^® LF and MF AQOAT ^® Grade HF containing (Shin-Etsu Chemical, Japan); Shellac (e.g., MARCOAT ^TM 125 and MARCOAT ^TM 125N); Vinyl acetate-maleic anhydride copolymer; Styrene-maleic acid monoester copolymer; Carboxymethylethylcellulose (CMEC, Freund Corporation, Japan); Cellulose acetate phthalate (CAP) (e.g., AQUATERIC ^® ); Cellulose acetate trimellitate (CAT); And those of the two at least about 2: 1 to about 5: 1 were mixed in a weight ratio between the mixture, for example, EUDRAGIT ^® L 100-55 and EUDRAGIT ^® S 100 to about 3: 1 to about 2: 1 , Or a mixture of EUDRAGIT ^® L 30 D-55 and EUDRAGIT ^® FS in a weight ratio of about 3: 1 to about 5: 1, but is not limited thereto.

These polymers may be used alone or in combination, or in combination with polymers other than those described above. A preferred enteric pH-dependent polymer is a pharmaceutically acceptable methacrylic acid copolymer. Such copolymers are anionic polymers based on methacrylic acid and methyl methacrylate, and preferably have an average molecular weight of about 135,000. The ratio of the free carboxyl groups to the methyl-esterified carboxy groups of such copolymers may be, for example, from 1: 1 to 1: 3, for example, 1: 1 or 1: 2. This polymer is Eudragit L series, for example, Eudragit ^® L 12.5, Eudragit L 12.5P ^®, Eudragit ^® L100, Eudragit ^® L 100-55, Eudragit L-30D ^®, Eudragit ^® L-30 D-55, Eudragit S ^® series, for example, Eudragit ^® S 12.5, Eudragit S 12.5P ^®, are sold under the trade name Eudragit ^®, such as Eudragit ^® S100. Release promoters are not limited to pH dependent polymers. Other hydrophilic molecules that dissolve rapidly and leave the porous structure quickly and the dosage form leaches out can be used for the same purpose.

In some embodiments, the matrix may comprise a combination of an emission enhancer and a solubility enhancer. The solubility enhancer may be selected from the group consisting of ionic and non-ionic surfactants, complexing agents, hydrophilic polymers, acidifiers and alkalizing agents, as well as molecules that increase the solubility of the poorly soluble drug through molecular entrapment It can be the same pH regulator. Several solubility enhancers can be used at the same time.

Solubility enhancing agents include sodium Tokyu glyphosate, sodium lauryl sulfate, sodium stearyl fumarate, Tweens ^® and span switch (PEO-modified sorbitan esters, and fatty sorbitan esters), poly (ethylene oxide) - polypropylene oxide - poly ( Surfactants such as ethylene oxide) block copolymers (aka PLURONICS ^TM ); Complexing agents such as low molecular weight polyvinylpyrrolidone and low molecular weight hydroxypropyl methylcellulose; Molecules that capture molecules to help solubility, such as cyclodextrin, and pH adjusting agents, including acidifying agents such as citric acid, fumaric acid, tartaric acid, and hydrochloric acid; And alkalizing agents such as meglumine and sodium hydroxide.

The solubility enhancer is generally composed of 1% by weight to 80% by weight, preferably 1% by weight to 60% by weight, more preferably 1% by weight to 50% by weight of the dosage form and may be included in various ways. The solubility enhancer may be included in the formulation prior to granulation in a dry or wet form. The solubility enhancer may also be added to the formulation after the remainder of the material has been granulated or otherwise processed. During granulation, the solubilizer may be sprayed with a solution with or without binder.

In one embodiment, the extended-release formulation comprises a water-insoluble, water-permeable polymer coating or matrix comprising one or more water-insoluble water-repellent film-forming on the active core. The coating may additionally comprise one or more water-soluble polymers and / or one or more plasticizers. The water-insoluble polymer coating comprises a barrier coating for release of the active agent in the core, and the low molecular weight (viscosity) grade exhibits a faster release rate compared to the high viscosity grade.

Preferred specific cases, the number in the water-insoluble film-forming polymer is ethyl cellulose, and mixtures thereof with one or more of the alkyl cellulose ethers (e.g., ethyl cellulose grade PR100, PR45, PR20, PR10 and PR7; ETHOCEL ^®, Dow) .

In some embodiments, the water-insoluble polymer provides suitable properties (e. G., Extended-release properties, mechanical properties, and coating properties) without the need for a plasticizer. For example, coatings comprising polyvinyl acetate (PVA), neutral copolymers of acrylate / methacrylate esters such as Eudragit NE30D, marketed by Evonik Industries, ethyl cellulose in combination with hydroxypropyl cellulose, waxes, etc. Can be applied without a plasticizer.

In another embodiment, the water-insoluble polymer matrix may further comprise a plasticizer. The amount of plasticizer depends on the plasticizer, the nature of the water-insoluble polymer, and the ultimate desired properties of the coating. A suitable level of plasticizer is from about 1 wt% to about 20 wt%, from about 3 wt% to about 20 wt%, from about 3 wt% to about 5 wt%, from about 7 wt% to about 10 wt% About 12% to about 15%, about 17% to about 20%, or about 1%, about 2%, about 3%, about 4%, about 5% %, About 7 wt%, about 8 wt%, about 9 wt%, about 10 wt%, about 15 wt%, or about 20 wt%, inclusive of all ranges and subranges therebetween.

Examples of plasticizers include triacetin, acetylated monoglycerides, oils (castor oil, hardened castor oil, rapeseed oil, sesame oil, olive oil, etc.); Citrate ester, triethyl citrate, acetyl triethyl citrate acetyl tributyl citrate, tributyl citrate, acetyl tri-n-butyl citrate, diethyl phthalate, dibutyl phthalate, dioctyl phthalate, paraben, butyl paraben, diethyl sebacate, dibutyl sebacate, glycerol butyrate, substituted triglycerides and glycerides, mono-acetyl and di-acetyl federated federated glycerides (e.g., MYVACET 9-45 ^®), glyceryl mono (Such as PEG-4000, PEG-400), propylene glycol, 1,2-propylene glycol, glycerin, sorbitol, diethyl oxalate, diethyl malate, Diethyl maleate, diethyl fumarate, diethyl succinate, diethyl malonate, dioctyl phthalate Terephthalate, dibutyl sebacate, and mixtures thereof. The plasticizer may have surfactant properties and thereby act as a release modifier. For example, non-ionic surfactants such as Brij 58 (polyoxyethylene (20) cetyl ether) may be used.

Plasticizers can be high boiling organic solvents used to impart flexibility to hard or brittle polymeric materials and can affect the release profile for the active agent (s). Plasticizers generally cause a decrease in aggregate intermolecular forces along the polymer chain and result in various changes in the polymer such as decreased tensile strength, increased enlongation, and decreased glass transition or softening temperature of the polymer. The amount and choice of plasticizer may affect the hardness of the tablet and may affect its physical and chemical stability, as well as its solubility or disintegration properties, for example. Certain plasticizers can increase the elasticity and / or flexibility of the coat, thereby reducing the brittleness of the coat.

In other embodiments, the extended-release formulation comprises a combination of at least two gel-forming polymers, including at least one non-ionic gel-forming polymer and / or at least one anionic gel- . The gel formed from a combination of gel-forming polymers provides controlled release and when the formulation is ingested and contacts the gastric fluid, the polymer closest to the surface hydrates to form a viscous gel layer. Because of the high viscosity, the viscous layer dissolves slowly and the following materials are exposed in the same process. The mass is slowly dissolving, thereby slowly releasing the active ingredient into the gastrointestinal fluid. The combination of at least two gel-forming polymers enables the properties of the resulting gel, such as viscosity, to be adjusted to provide the desired release profile.

In certain embodiments, the agent comprises at least one non-ionic gel-forming polymer and at least one anionic gel-forming polymer. In another embodiment, the formulation comprises two different non-ionic gel-forming polymers. In another embodiment, the agent is a combination of non-ionic gel-forming polymers having the same chemical nature but different solubility, viscosity, and / or molecular weight (such as HPMC K100 and HPMC K15M or HPMC K100M A combination of hydroxypropylmethylcellulose having different viscosity grades).

Examples of anionic gel-forming polymers include sodium carboxymethylcellulose (Na CMC), carboxymethylcellulose (CMC), sodium alginate, alginic acid, pectin, polyglucuronic acid (poly- alpha - and - (Carbopol ^® 934, 940, 974P NF), anionic polysaccharides such as polygalacturonic acid (pectic acid), chondroitin sulfate, carrageenan and persellaran, anionic rubbers such as xanthan gum , Carbopol ^® copolymers, Pemulen ^® polymers, polycarbophil and others.

Examples of non-ionic gel-forming polymers include copolymers of Povidone (PVP: polyvinylpyrrolidone), polyvinyl alcohol, PVP and polyvinyl acetate, HPC (hydroxypropylcellulose), HPMC (hydroxypropylmethylcellulose ), Hydroxyethylcellulose, hydroxymethylcellulose, gelatin, polyethylene oxide, acacia, dextrin, starch, polyhydroxyethylmethacrylate (PHEMA), water-soluble nonionic polymethacrylate and copolymers thereof, modified cellulose , Modified polysaccharides, nonionic rubbers, nonionic polysaccharides, and / or mixtures thereof.

The formulation optionally comprises at least one excipient, such as the enteric polymer described above and / or a filler, a binder (such as those described above), a disintegrant, and / or a flow aid or glidant can do.

Examples of fillers include "sugars" such as lactose, glucose, fructose, sucrose, dicalcium phosphate, sorbitol, mannitol, lactitol, xylitol, isomalt, erythritol, and hydrogenated starch hydrolyzate But are not limited to, sugar alcohols, also known as " polyols ", corn starch, potato starch, sodium carboxymethylcellulose, ethylcellulose and cellulose acetate, enteric polymers, or mixtures thereof.

Examples of binders include water soluble hydrophilic polymers such as Povidone (PVP: polyvinylpyrrolidone), copovidone (a copolymer of polyvinylpyrrolidone and polyvinyl acetate), low molecular weight HPC (hydroxypropyl cellulose), low molecular weight HPMC (Hydroxypropylmethylcellulose), low molecular weight carboxymethylcellulose, ethylcellulose, gelatin, polyethylene oxide, acacia, dextrin, magnesium aluminum silicate, starch and polymethacrylates such as Eudragit NE 30D, Eudragit RL, Eudragit RS, Eudragit E Polyvinyl acetate, and enteric polymers, or mixtures thereof.

Examples of disintegrants include low-substituted carboxymethylcellulose sodium, crospovidone (cross-linked polyvinylpyrrolidone), sodium carboxymethyl starch (sodium starch glycolate), cross-linked sodium carboxymethylcellulose, But are not limited to, gum starch (starch 1500), microcrystalline cellulose, water insoluble starch, calcium carboxymethylcellulose, low substituted hydroxypropylcellulose, and magnesium or aluminum silicate.

Examples of lubricants include, but are not limited to, magnesium, silicon dioxide, talc, starch, titanium dioxide and the like.

In another embodiment, the extended-release formulation may be prepared by coating a water-soluble / water-dispersible drug-containing particle such as beads or bead populations (such as those described above) with a coating material and optionally with a pore-former and other excipients . The coating material is preferably a cellulose polymer such as ethyl cellulose (e.g., SURELEASE ^®), methyl cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose, cellulose acetate, and cellulose acetate phthalate; Polyvinyl alcohol; Acrylic polymers such as polyacrylates, polymethacrylates and copolymers thereof, and other water-based or solvent-based coating materials. The release-controlled coating for bead populations may be controlled by at least one or more of the emission control coating parameters such as the nature of the coating, the coating level, the type and concentration of the pore-forming agent, the process parameters, and combinations thereof. Thus, alteration of parameters such as pore former concentration, or curing conditions, may cause the release of active agent (s) from all bead populations, thereby selectively modifying the agent to a pre-determined release profile Let's do it.

Pore formers suitable for use in the release control coatings herein may be organic or inorganic and include materials that can be dissolved, extracted or leached from the coating in an environment of use. Examples of pore-forming agents include mono-, oligo- and polysaccharides such as sucrose, glucose, fructose, mannitol, mannose, galactose, sorbitol, pullulan and dextran; Polymers soluble in the environment of use such as water-soluble hydrophilic polymers, hydroxyalkylcelluloses, carboxyalkylcelluloses, hydroxypropylmethylcelluloses, cellulose ethers, acrylic resins, polyvinylpyrrolidones, cross-linked polyvinylpyrrolidones, Poly (ethylene oxide), polyethylene oxide, carbo wax, carbopol, diol, polyol, polyhydric alcohol, polyalkylene glycol, polyethylene glycol, polypropylene glycol or block polymers thereof, polyglycol, poly (? -?) Alkylenediols; But are not limited to, inorganic compounds such as alkali metal salts, lithium carbonate, sodium chloride, sodium bromide, potassium chloride, potassium sulfate, potassium phosphate, sodium acetate, sodium citrate, suitable calcium salts, and combinations thereof.

 The release-controlling coating may further comprise other additives known in the art, such as plasticizers, anti-adherents, lubricants (or flow aids), and antifoam.

In some embodiments, the coated particles or beads additionally include an " overcoat " to provide the bead with, for example, moisture, static elimination, taste-blocking, flavoring, coloring, and / cosmetic appeal can be provided. Suitable coating materials for such overcoats are known in the art and include, but are not limited to, cellulose polymers such as hydroxypropylmethylcellulose, hydroxypropylcellulose and microcrystalline cellulose, or combinations thereof (various OPADRY ^® coating materials) It does not.

The coated particles or beads may be exemplified by a solubility enhancer, a dissolution enhancer, an absorption enhancer, a permeability enhancer, a stabilizer, a complexing agent, an enzyme inhibitor, a p-glycoprotein inhibitor, , But are not limited to, Alternatively, the formulation may contain an enhancer which is separate from the coated particles, for example as a group or powder of separate beads. In another embodiment, the enhancing agent (s) may be contained in a separate layer of the coated particles at the bottom or top of the release-controlling coating.

In other embodiments, the extended-release formulation is formulated to release the active (s) by an osmotic mechanism. By way of example, the capsule may comprise 2, 3, 4, 5, or 6 push-pull units that are formulated as a single osmotic unit or encapsulated within a hard gelatin capsule, and each double- The unit comprises an osmotic push layer and a drug layer surrounded by a semi-permeable membrane. One or more orifices are drilled through the membrane next to the drug layer. This membrane may additionally be covered with a pH-dependent enteric coating to prevent release until gastric drainage is complete. The gelatin capsules dissolve immediately after ingestion. When the push-pull unit (s) enter the small intestine, the enteric coating collapses, causing the fluid to flow through the semi-permeable membrane, and the osmotic push compartment expands to a rate that is precisely controlled by the rate of water movement through the anti- It is forced through the orifice (s) to exit the drug. Release of the drug may occur at a constant rate of up to 24 hours.

The osmotic push layer comprises at least one osmotic agent that creates a driving force to cause water to migrate through the semi-permeable membrane into the core of the vehicle. One class of osmotic agents includes water-swellable hydrophilic polymers, also termed "osmopolymers" and "hydrogels ", which include hydrophilic vinyl and acrylic polymers, polysaccharides such as calcium alginate, polyethylene oxide (PEO) (PEG), polypropylene glycol (PPG), poly (2-hydroxyethyl methacrylate), poly (acrylic acid), poly (methacrylic acid), polyvinylpyrrolidone (PVP) , Polyvinyl alcohol (PVA), PVA / PVP copolymers, PVA / PVP copolymers with hydrophobic monomers such as methyl methacrylate and vinyl acetate, hydrophilic polyurethanes containing large PEO blocks, sodium croscarmellose, carrageenan, Hydroxyethyl cellulose (HEC), hydroxypropyl cellulose (HPC), hydroxypropylmethyl cellulose (HPMC), carboxymethyl cellulose (CMC), carboxyethyl cellulose (CEC ), Sodium alginate, polycarbophil, gelatin, xanthan gum, and sodium starch glycolate.

Another class of osmotic agents includes osmogen which imbibes water to affect the osmotic gradient across the semi-permeable membrane. Examples of osmogens include inorganic salts such as magnesium sulfate, magnesium chloride, calcium chloride, sodium chloride, lithium chloride, potassium sulfate, potassium phosphate, sodium carbonate, sodium sulfite, lithium sulfate, potassium chloride, and sodium sulfate; Sugars such as dextrose, fructose, inositol, lactose, maltose, mannitol, raffinose, sorbitol, sucrose, trehalose, and xylitol; Organic acids such as ascorbic acid, benzoic acid, fumaric acid, citric acid, maleic acid, sebacic acid, sorbic acid, adipic acid, edetic acid, glutamic acid, p-toluenesulfonic acid, succinic acid and tartaric acid; Urea; And mixtures thereof.

Substances useful for forming a semipermeable membrane are those that are permeable and water-insoluble at physiologically relevant pHs, or that have various degrees of acryl, vinyl, ether, polyamide, polyester, And cellulose derivatives.

In some embodiments, the extended-release formulation may include a polysaccharide coating that is resistant to erosion in both the stomach and intestines. Such polymers may be degraded only in a colon containing large microflora containing biodegradable enzymes that degrade polysaccharide coatings, for example, to release drug content in a controlled, time-dependent manner . Polysaccharide coatings may include, for example, amylose, arabinogalactan, chitosan, chondroitin sulfate, cyclodextrin, dextran, guar gum, pectin, and xylan, and combinations or derivatives thereof.

In some embodiments, the pharmaceutical composition is formulated in a delayed extended-release form. As used herein, the term " delayed extended-release " is used for drug preparations having a release profile with a predetermined delay in release of the drug after administration. In some embodiments, the delayed extended-release formulation comprises an extended-release formulation coated with a barrier coating that is applied to an oral agent that prevents release of the drug prior to reaching the small intestine. Delayed-release formulations, such as enteric coatings, prevent gastrointestinal irritants such as aspirin from dissolving in the stomach. This coating protects acid labile drugs from acid exposure of the stomach and delivers them to a basic pH environment (pH above the gut) that can give the desired action without degrading them. Thus, an agent that releases a " post gastric emptying " component means a formulation that is delayed to release the active ingredient after the formulation is excreted from the stomach. The term " pulsatile release " is a type of delay-release that provides rapid and instantaneous release of a drug within a short period of time immediately after a predetermined delay time, thereby providing a " pulsed " plasma profile of the drug after drug administration It is used herein with respect to drug preparations. The formulation may also be formulated for prolonged release (e.g., administration of the active ingredient) over a period of time after a single beating release or multiple beating release, or pulsatile release (e.g., 20-60% Sustained release). ≪ / RTI > Delayed or pulsatile release formulations generally include one or more elements that are covered with a barrier coating that is dissolved, eroded, or rupted after a certain delay.

The delay-release barrier coating can be made of a variety of different materials depending on its purpose. Additionally, the formulation may include a plurality of barrier coatings to facilitate release in a temporary manner. The coating may be applied to a film coating (e.g., based on hydroxypropylmethylcellulose, methylcellulose, methylhydroxyethylcellulose, carboxymethylcellulose, acrylic copolymer, polyethylene glycol and / or polyvinylpyrrolidone) Or a coating based on methacrylic acid, cellulose acetate phthalate, hydroxypropylmethylcellulose phthalate, hydroxypropylmethylcellulose acetate succinate, polyvinylacetate phthalate, shellac, and / or ethylcellulose. In addition, the formulation may additionally comprise a time delay material, for example, glyceryl monostearate or glyceryl distearate.

In some embodiments, the delayed, extended-release formulation comprises an enteric coating comprising at least one polymer that facilitates release of the active agent in the proximal or distal region of the gastrointestinal tract. The term " enteric coating " as used herein is a coating comprising one or more polymers having a pH-dependent or pH-independent release profile. Enteric coated pills will not dissolve in acidic juices (pH ~ 3) in the stomach, but will dissolve in the alkaline (pH 7-9) environment of the small intestine or colon. The enteric polymer coating generally inhibits release of the active agent until after a delay of gastric emptying of about 3 to 4 hours after administration.

The pH-dependent intestinal coating maintains its structural integrity at low pH, such as the stomach, but retains one or more pH-dependent or pH-dependent conditions that dissolve in higher pH environments of the distal region of the gastrointestinal tract, such as the small intestine where the drug content is released. Sensitive polymer. For purposes of the present invention, " pH dependent " is defined as having properties (e.g., dissolution) that vary depending on the pH environment. Examples of pH-dependent polymers have been described above. pH-dependent polymers generally exhibit an optimum pH that is characteristic of dissolution. In some embodiments, the pH-dependent polymer exhibits an optimum pH between about 5.0 and 5.5, between about 5.5 and 6.0, between about 6.0 and 6.5, or between about 6.5 and 7.0. In another embodiment, the pH-dependent polymer exhibits an optimum pH of ≥5.0, ≥5.5, ≥6.0, ≥6.5, or ≥7.0.

In certain embodiments, the coating method utilizes blending of one or more pH-dependent and pH-independent polymers. When the soluble polymer reaches the optimum pH of solubilization, blending of the pH-dependent and pH-independent polymers can reduce the rate of release of the active ingredient.

In some embodiments, a "time-controlled" or "time-dependent" release profile can be obtained using a water-insoluble capsule body containing one or more active agents, the capsule body being insoluble but permeable and swellable, One end is closed. Upon contact with gastrointestinal fluids or dissolution media, the plug expands and pushes itself out of the capsule, releasing the drug after a predetermined delay time, which can be adjusted, for example, by the position and size of the plug . The capsule body may further be coated with an external pH-dependent intestinal coating that maintains the capsule intact until it reaches the small intestine. Suitable plug materials include, for example, polymethacrylates, erodible compressed polymers (e.g., HPMC, polyvinyl alcohol), cogealed melted polymers (e.g., glyceryl mono (Such as amylose, arabinogalactan, chitosan, chondroitin sulfate, cyclodextrin, dextran, guar gum, polysaccharides such as pectin and xylyl), as well as enzymatically controlled erodable polymers do.

In other embodiments, the capsule or bilayer tablet contains a drug-containing core that is formulated and covered with a swellable layer, and an external insoluble, but semi-permeable polymeric coating or film. The delay time before rupture can be controlled by the permeation and mechanical properties of the polymer coating and the swelling behavior of the swollen layer. Generally, the swell layer comprises at least one swelling agent, such as a swellable hydrophilic polymer that can expand and retain water in its structure.

Delay Examples of water-swellable materials used in the release coating is a polyethylene oxide (e. G., Those having an average molecular weight between 1,000,000 to 7,000,000, such as POLYOX ^®), methyl cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose; Polyalkylene oxides having an average molecular weight of 100,000 to 6,000,000, including, but not limited to, poly (methylene oxide), poly (butylene oxide); Poly (hydroxyalkyl methacrylates) having a molecular weight of from 25,000 to 5,000,000; Poly (vinyl) alcohols having a low acetal moiety cross-linked with glyoxal, formaldehyde or glutaraldehyde and having a degree of polymerization of from 200 to 30,000; Methylcellulose, a mixture of cross-linked agar and carboxymethylcellulose; The copolymer produced by forming a dispersion of a finely divided copolymer of cross-linked styrene, ethylene, propylene, butylene or isobutylene and maleic anhydride in a proportion of from 0.001 to 0.5 mol of a saturated crosslinking agent per mole of maleic anhydride in the copolymer ≪ / RTI > CARBOPOL ^占 acid carboxy polymer having a molecular weight of 450,000 to 4,000,000; CYANAMER ^® polyacrylamide; Cross-linked water swellable indene maleic anhydride polymer; GOODRITE ^® polyacrylic acid having a molecular weight of 80,000 to 200,000; Starch graft copolymers; AQUA-KEEPS ^® acrylate polymer polysaccharides composed of condensed glucose units, such as a combined de-ester-cross-linked poly-glucan; A carbomer having a viscosity of 3,000 to 60,000 mPa as an aqueous solution of 0.5% -1% w / v; Cellulose ethers such as hydroxypropylcellulose having a viscosity of about 1000-7000 mPa as a 1% w / v aqueous solution (25 캜); Hydroxypropylmethylcellulose having a viscosity of at least about 1000, preferably at least about 2,500 and at most about 25,000 mPa as a 2% w / v aqueous solution; Polyvinylpyrrolidone having a viscosity of about 300-700 mPa as a 10% w / v aqueous solution at 20 占 폚; And combinations thereof.

Alternatively, the release time of the drug may be controlled by a predetermined amount of micropore at the bottom of the body, and a water-insoluble polymer membrane containing an amount of a swollen excipient such as low substituted hydroxypropylcellulose (L-HPC) and sodium glycolate (Such as ethyl cellulose, EC), and the degradation delay time depending on the balance of the thickness. After oral administration, the gastric juice penetrates through the pores to cause swelling of the swellable excipient, which results in a first capsule body containing a swellable substance, a second capsule body containing the drug, and a second capsule body attached to the first capsule body Creating an internal pressure that separates the components in the capsule, including the cap.

The enteric layer further comprises an anti-tackiness agent such as talc or glyceryl monostearate and / or a plasticizer. Wherein the enteric layer is selected from the group consisting of triethyl citrate, acetyl triethyl citrate, acetyl tributyl citrate, polyethylene glycol acetylated monoglyceride, glycerin, triacetin, propylene glycol, phthalate esters (e.g., diethyl phthalate, dibutyl phthalate ), Titanium dioxide, ferric oxide, castor oil, sorbitol, and dibutyl sebacate.

In another embodiment, the delayed release formulation is a water permeable, but insoluble film coating that wraps the active ingredient and the osmotic agent. As water slowly diffuses from the interior through the film into the interior of the core, the core expands until the film ruptures, thereby releasing the active component. The film coating can be adjusted to allow for various rates of water permeation or release.

In another embodiment, the delayed release formulation utilizes a water-impermeable tablet coating whereby water enters through the controlled hole until the core is ruptured. When the tablets are ruptured, the drug content is released immediately or over a longer period of time. These and other techniques may be modified to allow a predetermined delay period before the release of the drug is initiated.

In another embodiment, the active agent is delivered into the formulation to provide both delayed-release and delayed-sustained (delayed-sustained) delivery. The term " delayed-extended-release " as used herein refers to a drug formulation that provides pulsatile release of the active agent at a predetermined time or delay time after administration, followed by prolonged release of the active agent .

In some embodiments, the immediate-release, extended-release, delayed-release, or delayed-extended-release formulation comprises an active core comprised of one or more inert particles, Other methods known in the art may be used to coat the drug in the form of a drug-containing film-forming composition on the surface of beads, pellets, pills, granular particles, microcapsules, microspheres, microparticles, nanocapsules, or nanospheres It is a form. The inert particles can be of various sizes as long as they are large enough to maintain poor dissolution. Alternatively, the active core may be prepared by granulating and milling the polymer composition containing the drug substance and / or by extrusion and spheronization.

The amount of drug in the core may be dependent upon the dosage required and will typically vary from about 5 to 90% by weight. Generally, the polymer coating on the active core will be from about 1 to 50% based on the required delay time and the type of release profile desired and / or the weight of the coated particles depending on the polymer selected and the coating solvent. Those skilled in the art will be able to select the appropriate amount of drug for inclusion in the coating or core on the core to achieve the desired dosage. In one embodiment, the inert core may be an encapsulated buffer crystal such as sugar or buffer crystals or calcium carbonate, sodium bicarbonate, fumaric acid, tartaric acid and the like, which alters the microenvironment of the drug to promote drug release.

In some embodiments, for example, the delayed-release or delayed-extended-release compositions may be formed by coating water-soluble / water-dispersible drug-containing particles such as beads with a mixture of a water- insoluble polymer and an enteric polymer, The water-insoluble polymer and the enteric polymer may be present in a ratio of from 4: 1 to 1: 1, and the total weight of the coating is 10 to 60 wt%, based on the total weight of the coated beads. The drug layer beads may optionally comprise an inner dissolution rate controlling membrane of ethyl cellulose. As well as the composition of the outer layer, the composition of the outer layer, as well as the individual weight of the inner and outer layers of the polymeric membrane, is optimized to achieve a desired circadian rhythm rhythm release profile for a given activity, Lt; / RTI >

In other embodiments, the formulation comprises a mixture of immediate-release drug-containing particles free of dissolution rate controlling polymeric film and delayed-extended-release beads exhibiting a delay time of, for example, 2-4 hours after oral administration And thus provides two pulse emission profiles.

In some embodiments, the active core is coated with one or more layers of a dissolution rate-regulating polymer to obtain a desired release profile with or without delay time. The outer layer membrane can provide the desired delay time (the period during which the drug is released or some drug released after the absorption of water or body fluids into the core) while the inner layer membrane releases drug Can be controlled greatly. The inner layer film may comprise a water insoluble polymer, or a mixture of water insoluble and water soluble polymers.

Suitable polymers for the outer membrane which greatly adjust the delay time of up to 6 hours may comprise 10 to 50% by weight of an enteric polymer and a water-insoluble polymer, as described above. The ratio of the water-insoluble polymer to the polymer can vary from 4: 1 to 1: 2, and preferably the polymers are present in a ratio of about 1: 1. The water-insoluble polymer generally used is ethylcellulose.

Examples of water-insoluble polymers include ethylcellulose, polyvinyl acetate (Kollicoat SR # 0D from BASF), neutral copolymers based on ethyl acrylate and methyl methacrylate, EUDRAGIT ^® NE, RS and RS30D, RL or RL30D 4 copolymers of acrylic and methacrylic acid esters with quaternary ammonium groups. Examples of the water-soluble polymer include low molecular weight HPMC, HPC, methyl cellulose, polyethylene glycol (molecular weight of PEG> 100 wt%) which is in the range of 1 wt% to 10 wt%, depending on the active solubility in a solvent or latex suspension based on water and the coating formulation used. 3000). The water-insoluble polymer to water-soluble polymer may generally vary from 95: 5 to 60:40, preferably 80:20 to 65:35. In some embodiments, the AMBERLITE ^TM IRP69 resin is used as an extended-release carrier. AMBERLITE ^™ IRP69 is an insoluble, strongly acidic, sodium-type cation-exchange resin suitable as a carrier for cationic (basic) materials. In another embodiment, the DUOLITE ^占 AP143 / 1093 resin is used as an extended-release carrier. DUOLITE ^™ AP143 / 1093 is an insoluble, strongly basic, anion exchange resin suitable as a carrier for anionic (acid) materials. When used as a drug carrier, the AMBERLITE IRP69 and / or DUOLITE ^占 AP143 / 1093 resins provide a means by which the drug can bind onto the insoluble polymer matrix. Extended-release is achieved through the formation of a resin-drug complex (drug regimen). When the drug reaches an equilibrium with a typical, high electrolyte concentration in the gastrointestinal tract, the drug is released from the resin in vivo. Due to the hydrophobic interaction with the aromatic structure of the cation exchange system, more hydrophobic drug is eluted at a lower rate from the resin.

In some embodiments, the pharmaceutical composition is formulated for oral administration. Oral dosage forms may also include, for example, tablets, capsules, dragees, and may contain a plurality of granules, beads, powders or pellets that may or may not be encapsulated. Tablets and capsules represent the most convenient oral dosage form when a solid pharmaceutical carrier is used.

In delayed-release formulations, the one or more barrier coatings may be applied to pellets, tablets or capsules to slow the dissolution and subsequent release of the drug in the small intestine. Typically, the barrier coating contains one or more polymers that wrap, surround, or form a layer around the pharmaceutical composition or active core, or the membrane. In some embodiments, the active agent is delivered to the formulation to provide delayed release at a predetermined time after administration. The delay may be up to about 10 minutes, about 20 minutes, about 30 minutes, about 1 hour, about 2 hours, about 3 hours, about 4 hours, about 5 hours, about 6 hours, or even longer.

Various coating techniques may be applied to the active agent-containing granules, beads, powders or pellets, tablets, capsules or combinations thereof to produce different and distinctly different release profiles. In some embodiments, the pharmaceutical composition is in the form of a tablet or capsule containing a single coating layer. In another embodiment, the pharmaceutical composition is in the form of a tablet or capsule containing multiple coating layers. In some embodiments, the pharmaceutical composition of the present application is formulated in an extended release or delayed extended release form of up to 100% of the active ingredient.

In another embodiment, the pharmaceutical compositions of the present application are administered in two steps, characterized by an " immediate release " component released within 2 hours of administration and an " extended release " component released over a 2-12 hour period Extended-release or delayed two-step extended-release type. In some embodiments, the "immediate release" component provides about 20-60% of the total dose of activator (s) delivered by the pharmaceutical agent and the "extended release" 80%. For example, the immediate release component may comprise about 20-60%, or about 20%, 25%, 30%, 35%, 40%, 45% or more of the total dose of activator (s) delivered by the pharmaceutical agent , 50%, 55%, 60%. The extended release component provides about 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75% or 80% of the total dose of activator (s) delivered by the formulation . In some embodiments, the immediate release component and the extended release component comprise the same active ingredient. In another embodiment, the immediate release component and the extended release component comprise different active ingredients (e.g., one component is an analgesic agent and the other component is an antimuscarinic agent). In some embodiments, the immediate release component and the extended release component each comprise an analgesic selected from the group consisting of aspirin, ibuprofen, naproxenododipine, indomethacin, nabumetone, and acetaminophen. In other embodiments, the immediate release component and / or the extended release component may comprise one or more additional compounds selected from the group consisting of antimuscarinic agents, antidiuretic agents, antispasmodics, phosphodiesterase type 5 (PDE5) Further comprising an activator.

In some embodiments, the pharmaceutical composition comprises a plurality of active ingredients selected from the group consisting of analgesics, antimuscarinics, antidiuresis, antispasmodics, and PDE5 inhibitors. Examples of antimuscarinic agents include, but are not limited to, oxybutynin, solifenacin, diperanacin, pesoterodine, tolterodine, trospium and atropine, and tricyclic antidepressants. Examples of antidiuretic agents include, but are not limited to, antidiuretic hormone (ADH), angiotensin II, aldosterone, vasopressin, vasopressin analogs (such as desmopressin, argifcine, lyphresin, pelifrecine, ornifresin, Lt; / RTI > An antagonist (e.g., HS-142-1, isatin, and the like) of a vasopressin receptor agonist, atrial natriuretic peptide (ANP) and a C-type natriuretic peptide (CNP) receptor (i.e., NPR1, NPR2, NPR3) [Asu7,23 '] b-ANP- (7-28)], anantine, cyclic peptides from Streptomyces coerulescens, and 3G12 monoclonal antibodies); But are not limited to, somatostatin type 2 receptor antagonists (for example, somatostatin), and pharmaceutically acceptable derivatives, analogs, salts and solvates thereof. Examples of antispasmodic agents include, but are not limited to, carisoprodol, benzodiazepine, baclofen, cyclobenzaprine, metansarone, methocarbamol, clonidine, clonidine analogs and dantrolene. Examples of PDE5 inhibitors include, but are not limited to, tadalafil, sildenafil and bardenafil.

In some embodiments, the pharmaceutical composition comprises at least one analgesic agent. In another embodiment, the pharmaceutical composition comprises one or more other active ingredients selected from the group consisting of (1) one or more analgesics and (2) an antimuscarinic agent, an anti-diuretic, an antispasmodic agent and a PDE5 inhibitor. In another embodiment, the pharmaceutical composition comprises (1) at least one analgesic agent and (2) at least one antimuscarinic agent. In another embodiment, the pharmaceutical composition comprises (1) at least one analgesic agent and (2) at least one antidiuretic agent. In another embodiment, the pharmaceutical composition comprises (1) at least one analgesic agent and (2) at least one antispasmodic agent. In another embodiment, the pharmaceutical composition comprises (1) one or more analgesics, and (2) one or more PDE5 inhibitors. In another embodiment, the pharmaceutical composition comprises (1) one or two analgesics, (2) one or two antimuscarinic agents, and (3) one or two antidiuretic agents do. In another embodiment, the pharmaceutical composition comprises (1) one or two analgesics, (2) one or two antimuscarinic agents, and (3) one or two antispasmodics . In another embodiment, the pharmaceutical composition comprises (1) one or two analgesics, (2) one or two antimuscarinic agents, and (3) one or two PDE5 inhibitors do. In another embodiment, the pharmaceutical composition comprises (1) one or more analgesics, (2) one or more anti-diuretics, and (3) one or more antispasmodics. In another embodiment, the pharmaceutical composition comprises (1) one or more analgesics, (2) one or more anti-diuretics, and (3) one or more PDE 5 inhibitors. In another embodiment, the pharmaceutical composition comprises (1) one or more analgesics, (2) one or more antispasmodics, and (3) one or more PDE5 inhibitors.

In one embodiment, the plurality of active ingredients is formulated to be immediate release. In another embodiment, the plurality of active ingredients is formulated in extended release form. In another embodiment, the plurality of active ingredients is formulated as both immediate release and extended release forms (e. G., The first portion of each active ingredient is formulated to be immediate release and the second The portion is formulated as extended release). In another embodiment, a portion of the plurality of active ingredients is formulated in an immediate release form, and a portion of the plurality of active ingredients is formulated in extended release form (e.g., the active ingredients A, B, And active ingredients C and D are formulated in extended release form). In yet another embodiment, the immediate release component and / or extended release component is further coated with a delayed release coating, such as an enteric coating.

In certain embodiments, the pharmaceutical composition comprises an immediate release component and an extended release component. The immediate release component may comprise one or more active ingredients selected from the group consisting of analgesics, antimuscarinics, antidiuresis, antispasmodics and PDE5 inhibitors. The extended release component may comprise one or more active ingredients selected from the group consisting of analgesics, antimuscarinics, antidiuresis, antispasmodics, PDE5 inhibitors, and zolpidem. In some embodiments, the immediate release component and the extended release component have exactly the same active ingredients. In another embodiment, the immediate release component and the extended release component have different active components. In another embodiment, the immediate release component and the extended release component have at least one common active ingredient. In some other embodiments, the immediate release component and / or extended release component is further coated with a delayed release coating, such as an enteric coating.

In one embodiment, the pharmaceutical composition comprises two or more active ingredients (e.g., two or more analgesics, or one or more analgesics and one or more antimuscarinic agents or antidiuretic agents formulated to be released at about the same time, Or a mixture of antispasmodic or PDE5 inhibitors). In another embodiment, the pharmaceutical composition comprises two or more active ingredients formulated to be prolonged simultaneous extended release. In another embodiment, the pharmaceutical compositions each comprise two or more active ingredients formulated into two extended release formulations, each providing a different extended release profile. For example, the first extended-release component emits a first active component at a first rate of release, and the second extended-release component releases a second active component at a second rate of release. In another embodiment, the pharmaceutical compositions all comprise two or more active ingredients formulated in a delayed release form.

In another embodiment, the pharmaceutical composition comprises two or more active ingredients formulated in a delayed release form. In another embodiment, the pharmaceutical compositions each comprise two or more active ingredients formulated into two delayed release formulations each providing a different delayed release profile. For example, the first immediate release component emits a first active ingredient at a first time point and the second immediate release component releases a second active ingredient at a second time point.

In another embodiment, the pharmaceutical composition comprises two active ingredients formulated in an immediate release form (e. G., Two analgesics, or one analgesic and one antimuscarinic or antidiarrheal or antispasmodic < Or a combination of a PDE5 inhibitor or a solipedim), and (2) two active ingredients formulated in extended release form (e.g., two analgesics, or one analgesic agent and one antimuscarinic agent or Diuretics or mixtures of antispasmodics or PDE5 inhibitors). In another embodiment, the pharmaceutical composition comprises three active ingredients formulated to be in immediate release form, and (2) three active ingredients formulated in extended release form. In another embodiment, the pharmaceutical composition comprises four active ingredients formulated for immediate release, and (2) four active ingredients formulated in extended release form. In these embodiments, the active ingredient (s) in the immediate release component may be the same as, or different from, the active ingredient (s) in the extended release component. In some other embodiments, the immediate release component and / or the extended release component is further coated with a sustained release coating, such as an enteric coating.

In some embodiments, the pharmaceutical composition comprises at least one analgesic agent and a PDE5 inhibitor, wherein the at least one analgesic agent is formulated in a delayed release form, and the PDE5 inhibitor is formulated in an immediate release form. In another embodiment, the pharmaceutical composition further comprises an additional agent selected from the group consisting of an antimuscarinic agent, an anti-diuretic agent, an antispasmodic agent, a PDE5 inhibitor, and a zolpidem, wherein the additional agent is formulated as immediate release or delayed release . In some embodiments, the delayed-release dosage form comprises an active ingredient (e.g., an analgesic, an antimuscarinic agent, an antidiuretic, antispasmodic, zolpidem and / or a PDE5 inhibitor) for a period of 1, 2, 3, ). ≪ / RTI >

The immediate release composition may comprise 100% of the total dose of active agent administered in a single unit dose. Alternatively, the immediate release component can be included as a component of a combined release profile formulation that can provide from about 1% to about 60% of the total dose of active agent to be delivered by the pharmaceutical agent. For example, the immediate release component can comprise from about 5% to about 60%, from about 10% to about 60%, from about 10% to about 50%, from about 10% to about 40% of the total dose of active agent %, About 10% to about 30%, about 10% to about 20%, about 20% to about 60%, about 20% to about 50%, about 20% to about 30%, about 30% About 30% to about 50%, about 40% to about 60%, about 40% to about 50%, about 45% to about 60%, or about 45% to about 50%. In an alternative embodiment, the immediate release component may be administered at a dosage of about 2, 4, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55 Or 60%.

In some embodiments, the extended-release formulations comprise an active core comprised of one or more inert particles, each of which can be delivered to a drug-delivery device using, for example, fluid bed technology or other techniques known in the art, Pellets, pill, granular particles, microcapsules, microspheres, microparticles, nanocapsules, or nano-spheres in the form of coatings or film-forming compositions. The inert particles can be of various sizes as long as they are large enough to maintain poor dissolution. Alternatively, the active core may be prepared by granulation and milling and / or extrusion and spheronization of a polymeric composition containing the drug substance.

The amount of drug in the core may be dependent upon the dosage required, and typically varies from about 5 to 90% by weight. Generally, the polymer coating on the active core will be from about 1 to 50% based on the required retardation time and / or the weight of the coated particles depending on the selected polymer and coating solvent. Those skilled in the art will be able to select the appropriate amount of drug for inclusion in the coating or core on the core to achieve the desired dosage. In one embodiment, the inert core may be an encapsulated buffer crystal such as sugar or buffer crystals or calcium carbonate, sodium bicarbonate, fumaric acid, tartaric acid and the like, which alters the microenvironment of the drug to promote drug release.

In some embodiments, the delayed-release formulation can be formed by coating a water soluble / water dispersible drug-containing particle, such as a bead, with a mixture of a water insoluble polymer and an enteric polymer, wherein the water insoluble polymer and the enteric polymer comprise 4 : 1 to 1: 1, and the total weight of the coating is 10 to 60% by weight, based on the total weight of the coated beads. The drug layer beads may optionally comprise an internal dissolution rate controlling membrane of ethyl cellulose. The composition of the outer layer, as well as the composition of the outer layer, as well as the individual weight of the inner and outer layers of the polymeric membrane, are optimized to achieve the desired biological cyclic rhythmic release profile for a given activity, ≪ / RTI >

In other embodiments, the formulation may include immediate-release drug-containing particles free of dissolution rate controlling polymeric film and delayed-release beads that exhibit a delay time of, for example, 2-4 hours after oral administration, Thus providing two pulse emission profiles. In another embodiment, the formulation comprises a mixture of two delay-emitting beads: a first type indicative of a delay time of 1-3 hours and a second type indicative of a 4-6 delay time. In another embodiment, the formulation comprises a mixture of two types of release beads: a first type that exhibits an immediate release form and a second type that exhibits an extended release form after a delay time of 1-4 hours.

In another embodiment, the formulation is designed as a release profile in which a portion (e.g., 20-60%) of the drug is released immediately or released within 2 hours of administration and the remainder is released over an extended period of time. The pharmaceutical composition may be administered daily or as needed. In certain embodiments, the pharmaceutical composition is administered to a subject prior to bedtime. In some embodiments, the pharmaceutical composition is administered just before bedtime. In some embodiments, the pharmaceutical composition is administered immediately prior to bedtime. In another embodiment, the pharmaceutical composition is administered within about 2 hours before sleeping, preferably within about 1 hour before sleeping. In another embodiment, the pharmaceutical composition is administered about 2 hours before bedtime. In a further embodiment, the pharmaceutical composition is administered at least 2 hours before bedtime. In another embodiment, the pharmaceutical composition is administered about 1 hour before bedtime. In a further embodiment, the pharmaceutical composition is administered at least one hour before bedtime. In another embodiment, the pharmaceutical composition is administered just before bedtime. Preferably, the pharmaceutical composition is administered orally.

A suitable dose ("therapeutically effective amount") of the active agent (s) in an immediate release component, an extended release component, a delayed release component or a delayed extended release component is, for example, The mode of administration, the bioavailability of the particular agent (s), the age and weight of the patient, the clinical history of the patient, the response to the active agent (s), and the judgment of the practitioner.

As generally suggested, a therapeutically effective amount of an active agent in an immediate release component, a delayed release component, or an extended release component is from about 10 [mu] g / kg body weight per day, About 100 mg / kg body weight per day. In some embodiments, the range of each active ingredient that is daily administered in a single dose or multiple doses is from about 10 μg / kg body weight / day to about 100 mg / kg body weight / day, from 10 μg / kg body weight / day to about 30 10 mg / kg body weight / day, about 10 mg / kg body weight / day, about 10 mg / kg body weight / day, about 10 mg / kg body weight / day, about 10 mg / Kg body weight / day, 10 ug / kg body weight / day, 10 ug / kg body weight / day to about 300 ug / kg body weight / day, 10 ug / kg body weight / day to about 100 ug / kg body weight / About 30 mg / kg body weight / day, about 30 mg / kg body weight / day, about 30 mg / kg body weight / day, about 30 mg / kg body weight / Day to about 1 mg / kg body weight / day, 30 占 퐂 / kg body weight / day, about 30 mg / kg body weight / day, Kg body weight per day to about 100 mg / kg body weight / day, from about 30 μg / kg body weight / day to about 100 μg / kg body weight / day, from about 100 μg / Day to about 30 mg / kg body weight / day, 100 占 퐂 / kg body weight / day to about 10 mg / kg body weight / day, 100 占 퐂 / kg body weight / day to about 3 mg / kg body weight / day, 100 占 퐂 / kg Kg body weight per day, about 100 mg / kg body weight / day, about 100 mg / kg body weight / day, about 300 mg / kg body weight / kg body weight / day to about 30 mg / kg body weight / day, 300 μg / kg body weight / day to about 10 mg / kg body weight / day, 300 μg / kg body weight / 1 mg / kg body weight / day to about 1 mg / kg body weight / day, 1 mg / kg body weight / day to about 100 mg / kg body weight / 1 mg / kg body weight / day to about 3 mg / kg body weight / day, 3 mg / kg body weight / day to about 100 mg / kg body weight / day, 3 mg / kg body weight / day, 10 mg / kg body weight / day to about 100 mg / kg body weight / day, , 10 mg / kg body weight / day to about 30 mg / kg body weight / day, or 30 mg / kg Day / day to about 100 mg / kg body weight / day.

The analgesic agent (s) described herein may be administered in an amount of from 1 mg to 2000 mg, from 1 mg to 1000 mg, or from 1 mg to 1000 mg, to the immediate release or extended release component, delayed release component, delayed extended release component, 1 mg to 300 mg, 1 mg to 100 mg, 1 mg to 30 mg, 1 mg to 10 mg, 1 mg to 3 mg, 3 mg to 2000 mg, 3 mg to 1000 mg, 3 mg to 300 mg, 3 mg From 10 mg to 100 mg, from 3 mg to 30 mg, from 3 mg to 10 mg, from 10 mg to 2000 mg, from 10 mg to 1000 mg, from 10 mg to 300 mg, from 10 mg to 100 mg, mg, 30 mg to 1000 mg, 30 mg to 300 mg, 30 mg to 100 mg, 100 mg to 2000 mg, 100 mg to 1000 mg, 100 mg to 300 mg, 300 mg to 2000 mg, May be included for daily oral administration in a single dose or in a combined dose ranging from 1000 mg to 2000 mg. As expected, the dosage may vary depending on the condition, size, and age of the patient.

In some embodiments, the pharmaceutical composition comprises a single analgesic. In one embodiment, the single analgesic is aspirin. In another embodiment, the single analgesic is ibuprofen. In another embodiment, the single analgesic is naproxen or naproxen sodium. In another embodiment, the single analgesic is indomethacin. In another embodiment, the single analgesic agent is nabumetone. In another embodiment, the single analgesic is acetaminophen.

In another embodiment, the pharmaceutical composition comprises a pair of analgesic agents. Examples of such a pair of analgesic agents include acetylsalicylic acid and ibuprofen, acetylsalicylic acid and naproxen sodium, acetylsalicylic acid and nabumetone, acetylsalicylic acid and acetaminophen, acetylsalicylic acid and indomethacin, ibuprofen and naproxen sodium, ibuprofen and nabumetone, ibuprofen And naproxen sodium, naproxen sodium, naproxen sodium and acetaminophen, naproxen sodium and indomethacin, nabumetone and acetaminophen, nabumetone and indomethacin, and acetaminophen and indomethacin. Including, but not limited to, God. The pair of analgesics are mixed in a weight ratio ranging from 0.1: 1 to 10: 1, from 0.2: 1 to 5: 1, or from 0.3: 1 to 3: 1. In one embodiment, the pair of analgesics are mixed in a weight ratio ranging from 1: 1.

In some other embodiments, the pharmaceutical composition comprises at least one antimuscarinic agent. Examples of the antimuscarinic agents include, but are not limited to, oxybutynin, zolifenacin, dipalpanacin, fezerodine, tolterodine, trospium, atropine, and tricyclic antidepressants. The daily dose of the antimuscarinic agent is 1 to 300 mg, 1 to 100 mg, 1 to 30 mg; 1 占 퐂 to 10 占 퐂, 1 占 퐂 to 3 占 퐂, 1 占 퐂 to 1 mg, 1 占 퐂 to 300 占 퐂, 1 占 퐂 to 100 占 퐂, 1 占 퐂 to 30 占 퐂, 1 占 퐂 to 10 占 퐂, To 100 mg, 3 to 100 mg, 3 to 30 mg; 3 to 10 mg, 3 to 3 mg, 3 to 1 mg, 3 to 300 mg, 3 to 100 mg, 3 to 30 mg, 3 to 10 mg, 10 to 300 mg, 10 mg To 100 mg, 10 [mu] g to 30 mg; 10 to 10 mg, 10 to 3 mg, 10 to 1 mg, 10 to 300 mg, 10 to 100 mg, 10 to 30 mg, 30 to 300 mg, 30 to 100 mg, 30 mg To 30 mg; 30 to 50 mg, 100 to 300 mg, 100 to 100 mg, 100 to 30 mg, and 30 μg to 10 mg, 30 μg to 3 mg, 30 μg to 1 mg, 30 μg to 300 μg, 30 μg to 100 μg, 100 占 퐂 to 10 mg, 100 占 퐂 to 3 mg, 100 占 퐂 to 1 mg, 100 占 퐂 to 300 占 퐂, 300 占 퐂 to 300 mg, 300 占 퐂 to 100 mg, 300 占 퐂 to 30 mg; 300 mg to 3 mg, 300 mg to 1 mg, 1 mg to 300 mg, 1 mg to 100 mg, 1 mg to 30 mg, 1 mg to 3 mg, 3 mg to 300 mg, 3 mg To 100 mg, 3 mg to 30 mg, 3 mg to 10 mg, 10 mg to 300 mg, 10 mg to 100 mg, 10 mg to 30 mg, 30 mg to 300 mg, 30 mg to 100 mg or 100 mg to 300 mg mg. < / RTI >

In some other embodiments, the pharmaceutical composition of the invention additionally comprises one or more antidiuretic agents. Examples of antidiuretic agents include, but are not limited to, antidiuretic hormone (ADH), angiotensin II, aldosterone, vasopressin, vasopressin analogs (eg, desmopressin, argifcine, lifresin, pelifresin, ornifresin, Lt; / RTI > (E.g., HS-142-1, Isastin, [Asu7, < / RTI > < RTI ID = 0.0 > 23 '] b-ANP- (7-28)], ananitine, cyclic peptides from streptomyces jellyfish, and 3G12 monoclonal antibodies); But are not limited to, somatostatin type 2 receptor antagonists (for example, somatostatin), pharmaceutically acceptable derivatives thereof, and analogs, salts, hydrates and solvates thereof. In some embodiments, the at least one antidiuretic agent comprises desmopressin. In another embodiment, the at least one antidiuretic is desmopressin. The daily dose of the antidiuretic is from 1 [mu] g to 300 mg, 1 [mu] g to 100 mg, 1 [mu] g to 30 mg; 1 占 퐂 to 10 占 퐂, 1 占 퐂 to 3 占 퐂, 1 占 퐂 to 1 mg, 1 占 퐂 to 300 占 퐂, 1 占 퐂 to 100 占 퐂, 1 占 퐂 to 30 占 퐂, 1 占 퐂 to 10 占 퐂, To 100 mg, 3 to 100 mg, 3 to 30 mg; 3 to 10 mg, 3 to 3 mg, 3 to 1 mg, 3 to 300 mg, 3 to 100 mg, 3 to 30 mg, 3 to 10 mg, 10 to 300 mg, 10 mg To 100 mg, 10 [mu] g to 30 mg; 10 to 10 mg, 10 to 3 mg, 10 to 1 mg, 10 to 300 mg, 10 to 100 mg, 10 to 30 mg, 30 to 300 mg, 30 to 100 mg, 30 mg To 30 mg; 30 to 50 mg, 100 to 300 mg, 100 to 100 mg, 100 to 30 mg, and 30 μg to 10 mg, 30 μg to 3 mg, 30 μg to 1 mg, 30 μg to 300 μg, 30 μg to 100 μg, 100 占 퐂 to 10 mg, 100 占 퐂 to 3 mg, 100 占 퐂 to 1 mg, 100 占 퐂 to 300 占 퐂, 300 占 퐂 to 300 mg, 300 占 퐂 to 100 mg, 300 占 퐂 to 30 mg; 300 mg to 3 mg, 300 mg to 1 mg, 1 mg to 300 mg, 1 mg to 100 mg, 1 mg to 30 mg, 1 mg to 3 mg, 3 mg to 300 mg, 3 mg To 100 mg, 3 mg to 30 mg, 3 mg to 10 mg, 10 mg to 300 mg, 10 mg to 100 mg, 10 mg to 30 mg, 30 mg to 300 mg, 30 mg to 100 mg or 100 mg to 300 mg mg. < / RTI >

In another embodiment, the pharmaceutical composition of the present application additionally comprises one or more antispasmodics. Examples of antispasmodic agents include, but are not limited to, carisoprodol, benzodiazepine, baclofen, cyclobenzaprine, metansarone, methocarbamol, clonidine, clonidine analogs and dantrolene. In some embodiments, the antispasmodic agent is administered in an amount of 0.1 mg to 1000 mg, 0.1 mg to 300 mg, 0.1 mg to 100 mg, 0.1 mg to 30 mg, 0.1 mg to 10 mg, 0.1 mg to 3 mg, From 0.1 mg to 0.3 mg, from 0.3 mg to 1000 mg, from 0.3 mg to 300 mg, from 0.3 mg to 100 mg, from 0.3 mg to 30 mg, from 0.3 mg to 10 mg, from 0.3 mg to 3 mg, From 1 mg to 300 mg, from 1 mg to 100 mg, from 1 mg to 30 mg, from 1 mg to 10 mg, 1 mg to 3 mg, 3 mg to 1000 mg, 3 mg to 300 mg, 3 mg to 100 mg mg, 3 mg to 30 mg, 3 mg to 10 mg, 10 mg to 1000 mg, 10 mg to 300 mg, 10 mg to 100 mg, 10 mg to 30 mg, 30 mg to 1000 mg, From 30 mg to 100 mg, from 100 mg to 1000 mg, from 100 mg to 300 mg, or from 300 mg to 1000 mg.

In other embodiments, the pharmaceutical compositions of the present application additionally comprise one or more PDE5 inhibitors. Examples of PDE5 inhibitors include, but are not limited to, tadalafil, sildenafil and bardenafil. In some embodiments, the at least one PDE5 inhibitor comprises tadalafil. In another embodiment, the at least one PDE5 inhibitor is tadalafil. In some embodiments, the PDE5 inhibitor is administered in an amount of 0.1 mg to 1000 mg, 0.1 mg to 300 mg, 0.1 mg to 100 mg, 0.1 mg to 30 mg, 0.1 mg to 10 mg, 0.1 mg to 3 mg, , 0.1 mg to 0.3 mg, 0.3 mg to 1000 mg, 0.3 mg to 300 mg, 0.3 mg to 100 mg, 0.3 mg to 30 mg, 0.3 mg to 10 mg, 0.3 mg to 3 mg, 0.3 mg to 1 mg, 1 mg to 1000 mg, 1 mg to 300 mg, 1 mg to 100 mg, 1 mg to 30 mg, 1 mg to 10 mg, 1 mg to 3 mg, 3 mg to 1000 mg, 3 mg to 300 mg, 100 mg, 3 mg to 30 mg, 3 mg to 10 mg, 10 mg to 1000 mg, 10 mg to 300 mg, 10 mg to 100 mg, 10 mg to 30 mg, 30 mg to 1000 mg, 30 mg to 300 mg , 30 mg to 100 mg, 100 mg to 1000 mg, 100 mg to 300 mg, or 300 mg to 1000 mg.

In another embodiment, the pharmaceutical composition of the present application additionally comprises zolpidem. The daily dose of zolpidem is from 100 μg to 100 mg, 100 μg to 30 mg, 100 μg to 10 mg, 100 μg to 3 mg, 100 μg to 1 mg, 100 μg to 300 μg, 300 μg to 100 mg, 300 μg To 30 mg, 300 mg to 10 mg, 300 mg to 3 mg, 300 mg to 1 mg, 1 mg to 100 mg, 1 mg to 30 mg, 1 mg to 10 mg, 1 mg to 3 mg, mg, 10 mg to 30 mg, or 30 mg to 100 mg.

The antimuscarinic, antidiuretic, antispasmodic, zolpidem and / or PDE5 inhibitor may be administered alone or in combination with other active ingredients (such as, for example, immediate release, extended release, delayed release, delayed extended release, May be formulated together.

In certain embodiments, the pharmaceutical composition is formulated as an extended release formulation and comprises (1) an analgesic selected from the group consisting of acetylsalicylic acid, ibuprofen, naproxen, naproxen sodium, nabumetone, acetaminophen, and indomethacin, and 2) PDE5 inhibitors such as tadalafil.

The pharmaceutical composition may be formulated into tablets, capsules, dragees, powders, granules, liquids, gels or emulsions. The liquid, gel or emulsion may be contained in a naked form or in a capsule to be ingested to the subject.

In some embodiments, the pharmaceutical composition comprises a single analgesic and a single PDE5 inhibitor. In one embodiment, the single analgesic is aspirin. In another embodiment, the single analgesic is ibuprofen. In another embodiment, the single analgesic is naproxen or naproxen sodium. In another embodiment, the single analgesic is indomethacin. In another embodiment, the single analgesic agent is nabumetone. In another embodiment, the single analgesic is acetaminophen. In another embodiment, the single PDE5 inhibitor is tadalafil. The analgesic and PDE5 inhibitors can be dosed within the ranges described above.

In some embodiments, the pharmaceutical composition comprises one or more analgesic agents selected from the group consisting of 10-1000 mg, 10-800 mg, 10-600 mg, 10-500 mg, 10-400 mg, 10-300 mg, 10-250 mg, 10 to 150 mg, 10 to 100 mg, 30 to 1000 mg, 30 to 800 mg, 30 to 600 mg, 30 to 500 mg, 30 to 400 mg, 30 to 300 mg, 30 to 250 mg, 30 200 mg, 30-150 mg, 30-100 mg, 100-1000 mg, 100-800 mg, 100-600 mg, 100-400 mg, 100-250 mg, 300-1000 mg, 300-800 mg, 300 In an amount of between 600 mg, 600 mg, 300 mg, 400 mg, 400 mg, 400 mg, 400 mg, 400 mg, 600 mg, 600 mg, 800 mg, or 800 mg to 1000 mg, The composition is formulated in an extended release form having one or more analgesic release profiles that are continuously released over a period of 2-12 hours or 5-8 hours.

In some embodiments, the composition is formulated in an extended release form having a release profile wherein at least 90% of the one or more analgesic agents are continuously released over a period of 2-12 hours or 5-8 hours.

In some embodiments, the composition is formulated in an extended release form having an release profile wherein the one or more analgesic agents are continuously released over a period of 5, 6, 7, 8, 10, or 12 hours. In some embodiments, the pharmaceutical composition further comprises an antimuscarinic agent, an antidiuretic, an antispasmodic agent, a zolpidem or a PDE5 inhibitor.

In another embodiment, the composition is formulated in an extended release form having an release profile wherein the analgesic is released at a constant rate over a period of 2-12 hours or 5-8 hours. In another embodiment, the composition is formulated in an extended release form having an release profile wherein the analgesic is released at a constant rate over a period of 5, 6, 7, 8, 10, or 12 hours. As used herein, "a steady rate over a period of time" means that the rate of release at any point during a given period of time is less than the rate of average rate of release over a given period of time. 30% - 300%. For example, if 80 mg of aspirin is released at a steady rate over a period of 8 hours, the average rate of release is 10 mg / hr for this period of time, and the actual rate of release is from 3 mg / hr to 30 mg / hr (i.e., within 30% to 300% of an average release rate of 10 mg / hr for an 8 hour period). In some embodiments, the composition further comprises an antimuscarinic agent, an anti-diuretic, an antispasmodic agent, a zolpidem or a PDE5 inhibitor.

In some embodiments, the analgesic is selected from the group consisting of aspirin, ibuprofen, sodium naproxen, naproxen, indomethacin, nabumetone, and acetaminophen. In one embodiment, the analgesic agent is acetaminophen. The pharmaceutical composition is formulated to provide a constant release of a small amount of analgesic to maintain an effective drug concentration in the blood such that the total amount of drug at a single dose is reduced relative to the immediate release formulation.

In some other embodiments, the pharmaceutical composition comprises 10-1000 mg, 10-800 mg, 10-600 mg, 10-500 mg, 10-400 mg, 10-300 mg, 10-250 mg of at least one analgesic agent , 10-200 mg, 10-150 mg, 10-100 mg, 30-1000 mg, 30-800 mg, 30-600 mg, 30-500 mg, 30-400 mg, 30-300 mg, 30-250 mg, 30 to 100 mg, 30 to 100 mg, 100 to 1000 mg, 100 to 800 mg, 100 to 600 mg, 100 to 400 mg, 100 to 250 mg, 300 to 1000 mg, 300 to 800 mg, 300-600 mg, 300-400 mg, 400-1000 mg, 400-800 mg, 400-600 mg, 600-1000 mg, 600-800 mg, or 800-1000 mg, individually or in combination , The analgesic agent (s) is released within 2 hours after administration of 20% to 60% of the analgesic agent (s) and the remainder is released 2 or 12 hours or continuously at a constant rate over a period of 5-8 hours RTI ID = 0.0 > release profile characterized by a step release profile. In another embodiment, the analgesic agent (s) is administered in an amount of 20, 30, 40, 50 or 60% of the analgesic agent (s) released within 2 hours after administration and the remainder in the period of 2-12 hours or 5-8 hours Is formed into an extended release type having a two-stage release profile that is continuously or continuously released at a constant rate over time. In one embodiment, the analgesic agent (s) is selected from the group consisting of aspirin, ibuprofen, sodium naproxen, naproxen, indomethacin, nabumetone, and acetaminophen. In one embodiment, the analgesic agent is acetaminophen. In another embodiment, the analgesic is acetaminophen. In some embodiments, the pharmaceutical composition further comprises an antimuscarinic agent, an anti-diuretic, an antispasmodic agent, a zolpidem, and / or a PDE5 inhibitor. In some embodiments, the antimuscarinic, antidiuretic, antispasmodic, zolpidem, and / or PDE5 inhibitors are formulated to be immediate release.

Another aspect of the present application relates to a method of reducing the frequency of urination by administering to a subject in need thereof two or more analgesic agents that prevent progression of drug resistance. In one embodiment, the method comprises administering a first analgesic agent for a first period of time followed by a second analgesic agent for a second period of time. In another embodiment, the method further comprises administering a third analgesic during a third period of time. The first, second and third analgesic agents are different from each other, and at least one of them is formulated as an extended release or delayed extended release type. In one embodiment, the first analgesic is acetaminophen, the second analgesic is ibuprofen, and the third analgesic is naproxen sodium. The length of each period can vary depending on the subject's response to each analgesic. In some embodiments, each period lasts from 3 days to 3 weeks. In another embodiment, both of the first, second and third analgesics are formulated as extended release or delayed extended release.

Another aspect of the invention relates to a method for reducing the frequency of urination by alternatively administering to a subject two or more analgesics that prevent progression of drug resistance. In one embodiment, the method comprises administering a first analgesic agent for a first period of time followed by a second analgesic agent for a second period of time. In another embodiment, the method further comprises administering a third analgesic agent during a third period of time. The first, second and third analgesics are different from each other, and at least one of them is formulated as an extended-release type or a delayed, extended-release type. In one embodiment, the first analgesic agent is acetaminophen, the second analgesic agent is ibuprofen, and the third analgesic agent is naproxen sodipine. The length of each period can vary depending on the subject's response to each analgesic. In some embodiments, each period lasts from 3 days to 3 weeks. In another embodiment, both the first, second and third analgesics are formulated as extended-release or delayed, extended-release.

Another aspect of the present application relates to a method of treating nocturnal enuresis by administering the pharmaceutical composition of the present application to a subject in need thereof. The diuretic is dosed and formulated to have a diuretic effect within 6 hours of administration and administered at least 8 hours or 7 hours before bedtime. The pharmaceutical composition of the present application is formulated into an extended release or delayed, extended release form and administered within 2 hours before bedtime.

Examples of diuretics include acidifying salts such as CaCl ₂ and NH ₄ Cl; Arginine vasopressin receptor 2 antagonists such as amphotericin B and lithium citrate; Aquaretics such as Goldenrod and Junipe; Na-H exchange antagonists such as dopamine; Carbonic anhydrase inhibitors such as acetazolamide and dorzolamide; Loop diuretics such as bumetanide, ethacrynic acid, furosemide, and torsemide; Osmotic diuretics such as glucose and mannitol; Potassium-sparing diuretics such as amylolide, spironolactone, triamterene, potassium carenoate; Thiazides such as benzofluorometazide and hydrochlorothiazide; And xanthines such as caffeine, theophylline and theobromine.

Another aspect of the present invention relates to a method of reducing voiding frequency comprising administering to a subject an effective amount of botulinum toxin, wherein the botulinum toxin is administered by injection into the bladder muscle; Orally administering the pharmaceutical composition of the present application to a subject. In some embodiments, the step of injecting comprises injecting 10-200 units of a botulinum toxin at 5-20 positions in the bladder muscle with a 2-10 unit dose of dose per site. In one embodiment, the step of injecting comprises injecting a botulinum toxin at 5 positions in the bladder muscle with a 2-10 unit dose of injection per position. In another embodiment, the step of injecting comprises injecting a botulinum toxin at 10 positions in the bladder muscle with a 2-10 unit injection dose per position. In another embodiment, the step of injecting comprises the injection of a botulinum toxin at position 15 in the bladder muscle with a 2-10 unit injection dose per position. In another embodiment, the step of injecting comprises injecting a botulinum toxin at 20 positions in the bladder muscle at a dose of 2 to 10 units per position. In some embodiments, the injecting step is repeated every 3, 4, 6, 8, 10, or 12 months, and the oral administration step is repeated daily.

In some embodiments, the pharmaceutical composition of the present application comprises as an active ingredient at least one analgesic agent having a dose of 50 to 400 mg per analgesic agent, wherein the at least one analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, , Nabumetone, and acetaminophen, and the pharmaceutical composition is formulated in an extended release form. In another embodiment, the botulinum toxin is administered every 3 or 4 months, and the pharmaceutical composition of the present application is administered daily. The method can be used for the treatment of nocturnal or irritable bladder.

Another aspect of the present invention relates to a method of reducing urinary frequency. The method comprises administering to the subject an effective amount of one or more analgesic agents and an effective amount of tadalafil.

In one embodiment, the at least one analgesic is formulated in an extended release form, and the tadalafil is formulated in an immediate release form.

In another embodiment, the at least one analgesic is formulated in a delayed release form, and the tadalafil is formulated in an immediate release form.

Another aspect of the present invention relates to a method of reducing urinary frequency. Said method comprising administering to said patient one or more analgesic agents having a dose of from 1 to 2000 mg per analgesic; And a PDE5 inhibitor as an active ingredient, wherein the one or more analgesic agents are selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen Is selected.

In one embodiment, the pharmaceutical composition is coated with an enteric coating.

In another embodiment, the pharmaceutical composition is characterized by a two-stage release profile wherein 20 to 60% of the active ingredient is released within 2 hours of administration and the remainder of the active ingredient is continuously released for 2 to 12 hours Is formulated as an extended release type. In a related embodiment, the pharmaceutical composition is coated with an enteric coating.

In another embodiment, the at least one analgesic agent comprises acetaminophen.

In another embodiment, the active ingredient further comprises an additional agent selected from the group consisting of antimuscarinics, antidiuretics, antispasmodics and zolpidem.

In another embodiment, the PDE5 inhibitor is tadalafil.

Another aspect of the present invention relates to a method of reducing urinary frequency. The method comprising: providing a first active ingredient comprising at least one analgesic and tadalafil; And a second active ingredient comprising at least one agent selected from the group consisting of analgesics, antimuscarinics, antidiuresis, antispasmodics, PDE5 inhibitors, and zolpidem, The first active ingredient is formulated into an immediate release form, and the second active ingredient is formulated into an extended release form.

In one embodiment, the pharmaceutical composition is further coated with an enteric coating.

In another embodiment, the at least one analgesic agent comprises acetaminophen.

In another embodiment, the first active ingredient further comprises an antimuscarinic agent, an anti-diuretic, an antispasmodic agent or a zolpidem.

Another aspect of the present invention relates to a pharmaceutical composition comprising at least one analgesic, a PDE5 inhibitor and a pharmaceutically acceptable carrier.

In one embodiment, the at least one analgesic is formulated in an extended release form, and the PDE5 inhibitor is formulated in an immediate release form.

In another embodiment, the at least one analgesic is formulated in a delayed release form, and the PDE5 inhibitor is formulated in an immediate release form.

In another embodiment, the at least one analgesic and the PDE5 inhibitor are formulated as extended release formulations that are released for 2 to 12 hours.

In another embodiment, 20 to 60% of the PDE5 inhibitor and the at least one analgesic agent, respectively, are formulated into an immediate release formulation and each of the remaining one or more of the one or more analgesics is formulated into an extended release formulation. In a related embodiment, the pharmaceutical composition is further coated with an enteric coating.

In some embodiments, the pharmaceutical composition comprises at least one analgesic agent selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen in an amount of 5 to 2000 mg per agent At least one antispasmodic agent selected from the group consisting of valproic acid, carisoprodol, benzodiazepine, baclofen, cyclobenzaprine, metocarbone, methocarbamol, clonidine, clodinin analogs, Wherein said pharmaceutical composition is characterized in that 20 to 80% of said active ingredient is released within 2 hours of administration and the remainder is in the range of 5 to 24 hours, 5 to 8 hours, 8 to 16 hours or 16 to 24 hours Lt; RTI ID = 0.0 > release profile, < / RTI >

Another aspect of the present application includes a first component having an immediate release subcomponent and an extended release subcomponent, wherein the first component is formulated to release its subcomponents immediately after administration ; And a second component comprising an immediate release subcomponent and an extended release subcomponent, wherein the second component is formulated as a delayed release version of the subcomponent. In some embodiments, at least one of the subcomponents in the first component or the second component comprises an active ingredient comprising at least one analgesic agent, wherein the first component or the second component Wherein at least one of the subcomponents comprises an active ingredient comprising a PDE5 inhibitor such as tadalafil.

In some embodiments, the first component or each of the subcomponents in the second component comprises an active ingredient comprising a PDE5 inhibitor such as one or more analgesics and / or tadalafil.

In some embodiments, the one or more analgesics are selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen.

In some related embodiments, the immediate release sub-component and the extended release sub-component in the first component each comprise an active ingredient comprising one or more analgesics, and / or a PDE5 inhibitor such as tadalafil. In another embodiment, the immediate release sub-component and the extended release sub-component in the second component each comprise an active ingredient comprising one or more analgesics, and / or a PDE5 inhibitor such as tadalafil.

In some embodiments, the at least one analgesic agent comprises acetaminophen. In another embodiment, at least one of the subcomponents in the first component or the second component comprises an active ingredient comprising one or more analgesics and a PDE5 inhibitor such as tadalafil.

In some related embodiments, the second component is coated with an enteric coating.

In some related embodiments, the second component is formulated to release its subcomponents after a delay of 1 to 4 or 2 to 4 hours or 4 to 8 hours after oral administration.

In some related embodiments, the extended release subcomponent within the first component is formulated to release its active ingredient over a time interval of about 2 to 10 hours.

In some related embodiments, the extended release subcomponent in the second component is formulated to release its active ingredient over a time interval of about 2 to 10 hours.

In some related embodiments, the immediate release sub-component and the extended release sub-component in the first component further comprise an antimuscarinic agent. In some embodiments, the immediate release subcomponent and the extended release subcomponent in the second component further comprise an antimuscarinic agent. In some embodiments, the active ingredient in both the immediate release sub-component and the extended release sub-component in both the first and second components further comprises an antimuscarinic agent.

In some related embodiments, the active ingredient in the immediate release sub-component and the extended release sub-component in the first component further comprises an anti-diuretic. In some embodiments, the active ingredient in the immediate release sub-component and the extended release sub-component in the second component further comprises an anti-diuretic. In some embodiments, the immediate release sub-component in both the first and second components and the active ingredient in the extended release sub-component further comprise an anti-diuretic.

In some related embodiments, the active ingredient in the immediate release sub-component and the extended release sub-component in the first component further comprises an antispasmodic agent. In some embodiments, the immediate release sub-component in the second component and the active ingredient in the extended release sub-component further comprise antispasmodics. In some embodiments, the immediate release sub-component in both the first and second components and the active ingredient in the extended release sub-component further comprise antispasmodic agents.

In some related embodiments, the active ingredient in the immediate release sub-component and the extended release sub-component in the first component comprise an analgesic agent such as acetaminophen in an amount of 5 to 2000 mg. In some embodiments, the active ingredient in the immediate release sub-component and the extended release sub-component in the second component comprises an amount of 5 to 2000 mg of an analgesic agent such as acetaminophen. In some embodiments, the active ingredient in both the immediate release subcomponent and the extended release subcomponent in both the first and second components comprises an analgesic agent such as acetaminophen in an amount of 5 to 2000 mg do.

In some related embodiments, the active ingredient in the immediate release subcomponent of the first component and the active ingredient in the immediate release subcomponent of the second component comprise an analgesic, such as acetaminophen. In some embodiments, the active ingredient in the immediate release subcomponent of the first component and the active ingredient in the immediate release subcomponent of the second component comprise a different analgesic.

Another aspect of the present application is a first component comprising an immediate release subcomponent, wherein the immediate release subcomponent comprises an active agent comprising one or more agents selected from the group consisting of analgesics and PDE5 inhibitors such as tadalafil Wherein said first component is formulated to release its subcomponents immediately after oral administration; And a second component comprising an immediate release subcomponent and an extended release subcomponent, wherein the second component is formulated to release its subcomponents after gastric emptying, and wherein the second component Wherein each of said subcomponents comprises at least one active ingredient selected from the group consisting of analgesics and PDE5 inhibitors such as tadalafil.

In some embodiments, the one or more analgesics are selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen.

In some related embodiments, the second component releases its subcomponents after a delay of 2 to 12 hours, 2 to 4 hours, 2 to 6 hours, 2 to 8 hours, or 4 to 8 hours after oral administration Lt; / RTI >

In some related embodiments, the immediate release sub-component of the second component and the active ingredient in the extended release sub-component comprise one or more analgesics.

In some related embodiments, the first component further comprises an extended release sub-component, wherein the extended release sub-component comprises an active ingredient comprising one or more agents selected from the group consisting of analgesics and PDE5 inhibitors . In some embodiments, the at least one medicament comprises an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen.

In some embodiments, the immediate release sub-component and the extended release sub-component in the second component each comprise a PDE5 inhibitor such as tadalafil.

In some related embodiments, at least one of the immediate release subcomponent of the first and second components and / or the active ingredient in the extended release subcomponent is in the group consisting of an antimuscarinic agent, an anti-diuretic agent and an antispasmodic agent And further includes a selected agent.

In some related embodiments, the active ingredient in the immediate release subcomponent and / or the extended release subcomponent of the first component further comprises an agent selected from the group consisting of an antimuscarinic agent, an anti-diuretic agent and an antispasmodic agent do.

In some related embodiments, the active ingredient in the immediate release subcomponent and / or the extended release subcomponent of the second component further comprises an agent selected from the group consisting of an antimuscarinic agent, an anti-diuretic agent and an antispasmodic agent do.

Another aspect of the present application is a first component comprising an immediate release subcomponent and an extended release subcomponent, wherein the first component is formulated to release its subcomponents immediately after administration; And a second component comprising an immediate release subcomponent and an extended release subcomponent, wherein the second component is formulated as a delayed release version of the subcomponents, and wherein the immediate release Type subcomponent and the extended release subcomponent each comprise an active ingredient comprising at least one analgesic and a PDE5 inhibitor such as tadalafil, wherein the immediate release subcomponent and the extended release subcomponent in the second component Each comprising an active ingredient comprising one or more analgesics and a PDE5 inhibitor such as tadalafil, said pharmaceutical composition reducing the frequency of urination in a patient in need thereof.

In some embodiments, the at least one analgesic agent comprises an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen. In some embodiments, the at least one analgesic agent comprises acetaminophen.

In another embodiment, the pharmaceutical composition comprises a pair of analgesic agents. These pairs of analgesics include acetaminophen and NSAID, acetylsalicylic acid and ibuprofen, acetylsalicylic acid and naproxen sodium, acetylsalicylic acid and nabumetone, acetylsalicylic acid and acetaminophen, acetylsalicylic acid and indomethacin, ibuprofen and naproxen sodium, ibuprofen and nabumetone, NIBROXENE SODIUM AND NAPHAMETHENE, NAPROXEN SODIUM AND ACETAMINOPEN, NAPHROXEN SODIM AND INDOMETHANE, NAVUMETONE AND ACETAMINOPEN, NAVUMETONE AND INDYMETHYN, ACETAMINOPEN AND INDYMETHYCIN, But are not limited to, Wherein the pair of analgesic agents is selected from the group consisting of 5 mg to 2000 mg, 20 mg to 2000 mg, 100 mg to 2000 mg, 200 mg to 2000 mg, 500 mg to 2000 mg, 5 mg to 1500 mg, 20 mg to 1500 mg, From 500 mg to 2000 mg, from 5 mg to 1000 mg, from 20 mg to 1000 mg, from 100 mg to 1000 mg, from 250 mg to 500 mg, from 250 mg to 1000 mg, from 250 mg to 1500 mg (For each analgesic agent) in the range of from 500 mg to 1000 mg, 500 mg to 1500 mg, 1000 mg to 1500 mg, and 1000 mg to 2000 mg, 1, 0.2: 1 to 5: 1, or 0.3: 1 to 3: 1. In some embodiments, the pair of analgesics are mixed in a weight ratio of 1: 1.

Another aspect of the present application relates to a pharmaceutical composition comprising an immediate release component and an extended release component. Each component comprises a pair of analgesic agents such as those described above and a PDE5 inhibitor such as tadalafil. In some embodiments, the immediate release component and the extended release component comprise a different pair of analgesics. In some embodiments, the immediate release component and the extended release component comprise the same pair of analgesics. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and an NSAID. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen and ibuprofen. In some embodiments, the immediate release component and the extended release component each comprise acetaminophen, ibuprofen, and tadalafil.

In some embodiments, the extended release component is formulated to be prolonged release over a period of from 0.5 to 24, from 2 to 6, from 6 to 10, from 10 to 14, or from 14 to 24 hours. In some embodiments, the extended release component is formulated to be extended release over a period of about 8 hours. In some embodiments, the extended release component is coated with a delayed release coating. In some embodiments, the delayed release coating is applied to the elongated release component during a period of from 0.1 to 12, from 0.5 to 12, from 1 to 12, from 2 to 12, from 1 to 4, from 2 to 4, from 4 to 8, Lt; / RTI > In some embodiments, the delayed release coating is an enteric coating. In some embodiments, the pharmaceutical composition having an immediate release component and an extended release component is formulated into an oral disintegration tablet.

As used herein, the term " oral disintegration tablet " or " oral disintegrating agent " means a drug tablet or formulation that rapidly disintegrates or dissolves at the mouth. Oral disintegrating preparations differ from traditional tablets in that they are designed to dissolve on the tongue rather than swallow as a whole. In some embodiments, the oral disintegrating agent is intended to be completely disintegrated or dissolved within 5, 10, 20, 30, 60, 90, 120, 180, 240 or 300 seconds without additional water assistance at the mouth .

In some embodiments, the pharmaceutical composition having an immediate release component and an extended release component is formulated in a liquid form for oral administration. Such liquid forms include, but are not limited to, for example, gels, emulsions and particle suspensions. For example, the extended release component can be formulated in the form of a solidifying gel in the stomach. In some embodiments, the pharmaceutical composition having an immediate release component and an extended release component is formulated into a Pixie Pack of powder that can be rapidly melted on the tongue. In some embodiments, the immediate release component or the extended release component or both further comprise one or more additional agents selected from the group consisting of antimuscarinics, antispasmodics, and antidiuretic agents.

Manufacturing method

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing prolonged release urinary frequency. In some embodiments, the method comprises: forming a first mixture having a first active ingredient formulated to be immediate release and a second active ingredient formulated to be in an extended release form; Coating the first mixture with a delayed-release coating to form a core structure; And then coating the core structure with a second mixture comprising a third active ingredient that is formulated to be immediate release and a fourth active ingredient that is formulated to be an extended release form. In some embodiments, at least one of the first, second, third and fourth active ingredients comprises an analgesic, and the first, second, third and fourth active ingredients comprise a PDE5 inhibitor such as tadalafil do.

In some embodiments, the analgesic is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen, and at least one of the first, second, third, One contains from 5 mg to 2000 mg of analgesic.

In some embodiments, at least one of the first, second, third and fourth active ingredients is selected from the group consisting of (1) aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen Analgesics, and (2) PDE5 inhibitors such as tadalafil.

In some embodiments, at least one of the first, second, third and fourth active ingredients comprises a PDE5 inhibitor such as (1) acetaminophen, and (2) tadalafil.

In some embodiments, at least one of the first, second, third, and fourth active ingredients comprises an agent selected from the group consisting of an antimuscarinic agent, an antidiuretic agent, and an antispasmodic agent.

In some embodiments, the delayed release coating is an enteric coating. In some embodiments, the enteric coating comprises a pH-dependent polymer. In some embodiments, the delayed-release coating comprises a swellable layer covered with a semipermeable polymer layer on the outside. In some embodiments, the delayed release coating is administered in a dose of from 0.1 to 12 hours, 0.5 to 12 hours, 1 to 12 hours, 2 to 12 hours, 1 to 4 hours, 2 to 4 hours, 2 to 6 hours, 8 hours, 4 to 6 hours, or 4 to 8 hours.

In some embodiments, the second active ingredient, or the fourth active ingredient, or both, comprises an active core comprising an extended release coating or polymer matrix that causes diffusion controlled release.

In some embodiments, the first mixture is prepared in an extended release form by mixing the first active ingredient with the second active ingredient in liquid or powder form. As noted above, the second active ingredient may be formulated as an extended release formulation having an active core comprised of one or more inert particles, each of which may be, for example, a fluidized bed technique or other known in the art Pellets, pellets, granular particles, microcapsules, microspheres, microparticles, nanocapsules, or nano-spheres in the form of a drug-containing coating or film-forming composition using the technique of the present invention. The inert particles can be of various sizes as long as they are large enough to maintain poor dissolution. Alternatively, the active core may be prepared by granulating and milling the polymer composition containing the drug substance and / or by extrusion and spheronization. In some embodiments, the active core comprises an extended-release coating or polymer matrix that causes diffusion controlled release, as described in detail above. In some embodiments, the polymer matrix is a water-soluble or water-swellable matrix. In some embodiments, the second active ingredient is simply mixed with the first active ingredient. One or both components may be in the form of beads, pellets, granules, pellets, microcapsules, microspheres, microparticles, nanocapsules or nanospheres as a powder or liquid suspension. In another embodiment, the second active ingredient forms an active core coated with the first active ingredient. In some embodiments, the second active ingredient in the first mixture is formulated to release the active ingredient over a period of 2-4 hours, 2-6 hours, 2-8 hours, or 2-10 hours.

In some embodiments, the second active ingredient is maintained in a compartment that is partially or completely separated from the first active ingredient. In another embodiment, the first mixture is formed by holding a second active ingredient in a compartment that is partially or completely separated from the first active ingredient.

The first mixture is then coated with a delayed-release coating to form a core structure. In some embodiments, the delayed release coating is an enteric coating. In some embodiments, the enteric coating comprises a pH-dependent polymer that maintains structural integrity at low pH, such as pH within the stomach (typically in the range of 1.5-3.5). In some embodiments, the term " low pH " means a pH value of 4.0, 3.5, 3.0, 2.5, 2.0, 1.5, 1.0 or lower. In some embodiments, the enteric coating comprises one or more pH-dependent polymers and one or more polysaccharides that are resistant to erosion in both the stomach and intestines, thus allowing release of the first mixture only in the colon. In some embodiments, the delayed release coating comprises two or more coating layers. In some embodiments, the delayed release coating comprises a swellable layer and an outer semipermeable polymer layer that covers the swellable layer.

In the next step, the coated core structure is re-coated with a second mixture comprising a third active ingredient formulated for immediate release and a fourth active ingredient formulated for extended release. In some embodiments, the second mixture is prepared by mixing a third active ingredient in liquid or powder form with a fourth active ingredient formulated in extended release form. The fourth active ingredient may be formulated into an extended release formulation having an active core comprised of one or more inert particles, each of which may be administered to a patient in need of such treatment using, for example, fluid bed techniques or other techniques known in the art Pellets, pills, granular particles, microcapsules, microspheres, microparticles, nanocapsules, or nanospheres in the form of a drug-containing coating or film-forming composition. The inert particles can be of various sizes as long as they are large enough to maintain poor dissolution. Alternatively, the active core may be prepared by granulating and milling the polymer composition containing the drug substance and / or by extrusion and spheronization. In some embodiments, the active core comprises an extended-release coating or polymer matrix that causes diffusion controlled release, as described in detail above. In some embodiments, the polymer matrix is a water-soluble or water-swellable matrix. In some embodiments, the fourth active ingredient is simply mixed with the third active ingredient. One or both components may be in the form of beads, pellets, granules, pellets, microcapsules, microspheres, microparticles, nanocapsules or nanospheres as a powder or liquid suspension.

In another embodiment, the coated core structure is first re-coated with the fourth active component, followed by coating with the third active component. In some embodiments, the fourth active ingredient is formulated to release the active ingredient over a period of 2-4 hours, 2-6 hours, 2-8 hours, or 2-10 hours.

In some embodiments, the fourth active ingredient is maintained in a compartment that is partially or completely separated from the third active ingredient. In another embodiment, the second mixture is formed by retaining a fourth active ingredient in a compartment that is partially or completely separated from the third active ingredient.

In another embodiment, the method comprises forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release, coating the core structure with a delayed release coating To form a coated core structure, and mixing the coated core structure with a third active ingredient formulated to be an immediate release form and a fourth active ingredient formulated to an extended release form to form a final mixture do. The first, second, third and fourth active ingredients may be the active ingredients described above. In one embodiment, the first, second, third and fourth active ingredients each comprise a PDE5 inhibitor such as analgesic and / or tadalafil. In some embodiments, the analgesic is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen. In some embodiments, the method further comprises preparing the dosage form with the final mixture. In some embodiments, the dosage form is in tablet form. In some embodiments, the dosage form is in the form of an oral disintegration tablet, for example, an oral disintegration tablet. In some embodiments, the dosage form is in bead form in a capsule. In some embodiments, the dosage form is in the form of a liquid (e.g., emulsion).

In another embodiment, the method comprises forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release, coating the core structure with a delayed release coating To form a coated core structure, mixing the coated core structure with a third component formulated for immediate release and a fourth component formulated for extended release.

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method comprising: forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release; Coating the core structure with a delayed-release coating to form a coated core structure; Mixing the coated core structure with a third active ingredient formulated for immediate release and a fourth active ingredient formulated for extended release to form a final mixture and compressing the resulting mixture into tablets do. In some embodiments, at least one of the first, second, third, and fourth active ingredients comprises an analgesic agent and at least one of the first, second, third, and fourth active ingredients is selected from the group consisting of PDE5 Inhibitor.

In some embodiments, the analgesic is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen, wherein at least one of the first, second, third, Includes 5-2000 mg of analgesic.

In some embodiments, the first, second, third and fourth active ingredients are (1) acetaminophen; And (2) PDE5 inhibitors such as tadalafil.

In some embodiments, the first, second, third, and fourth active ingredients include agents selected from the group consisting of antimuscarinics, antidiuresis, and antispasmodics.

Another aspect of the present invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method comprising: forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release; Coating the core structure with a delayed-release coating to form a coated core structure; Coating the coated core structure with a third active ingredient formulated for immediate release to form a dual-coated core structure. In some embodiments, at least one of the first, second, and third active ingredients comprises an analgesic agent, and at least one of the first, second, and third active components comprises a PDE5 inhibitor such as tadalafil.

In some embodiments, the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen, wherein the first, second and third active ingredients are analgesics 5-2000 mg .

In some embodiments, the first, second, and third active ingredients are (1) acetaminophen; And (2) PDE5 inhibitors such as tadalafil.

In some embodiments, the first, second, and third active ingredients comprise a medicament selected from the group consisting of an antimuscarinic agent, an antidiuretic agent, and an antispasmodic agent.

Another aspect of the invention relates to a method of making a pharmaceutical composition for reducing urinary frequency. The method includes forming a core structure comprising a first pair of analgesic formulated for prolonged release and coating the core structure with a coating layer comprising a second pair of analgesic agents, The second pair is formulated for immediate release, and the core structure or the coating layer, or both, further comprises a PDE5 inhibitor such as tadalafil.

In some embodiments, the core structure is first coated with a delay-release coating and then coated with a coating layer comprising a second pair of analgesic agents, the second pair of analgesic agents being formulated for immediate release.

In some embodiments, the method comprises forming a first mixture comprising a first pair of analgesic formulated for extended-release, a second mixture comprising a second pair of analgesic formulated for immediate-release, And forming a final mixture by mixing said first mixture and said second mixture, wherein said first mixture or said second mixture, or both, further comprises a PDE5 inhibitor such as tadalafil do.

In some embodiments, the first mixture, the second mixture, and the final mixture are mixtures of solid materials. In some embodiments, the final mixture is in the form of a powder or granules. In some embodiments, the method further comprises compressing the final mixture into tablets. In some embodiments, the final mixture is in the form of a liquid, gel, or emulsion.

Examples of pairs of analgesic agents include acetaminophen and NSAID, acetylsalicylic acid and ibuprofen, acetylsalicylic acid and naproxen sodium, acetylsalicylic acid and nabumetone, acetylsalicylic acid and acetaminophen, acetylsalicylic acid and indomethacin, ibuprofen and naproxen sodium, ibuprofen and nabu Methionine, ibuprofen and acetaminophen, ibuprofen and indomethacin, naproxen sodium and napromethone, naproxen sodium and acetaminophen, naproxen sodium and indomethacin, nabumetone and acetaminophen, nabumetone and indomethacin, and acetaminophen and indomethacin But are not limited to, methasone. In some embodiments, the first pair of analgesic agents is different from the second pair of analgesic agents. In another embodiment, the first pair of analgesic agents is the same as the second pair of analgesic agents. In one embodiment, the first pair of analgesic agents and the second pair of analgesic agents are both acetaminophen and ibuprofen.

For example, the extended-release component can be formulated into a gel form which stiffen in the stomach. In some embodiments, the pharmaceutical composition having an immediate-release component and an extended-release component can be formulated into a PixiePack of powder that is rapidly soluble in the tongue. In some embodiments, the pharmaceutical composition having the immediate-release component or the extended-release component is formulated into oral disintegration tablets using loose compression tableting. In loose compression, oral disintegrating agents are compressed to much lower forces (4-20 kN) than traditional tablets. In some embodiments, the oral disintegrating agent contains a sugar form such as mannitol to enhance taste. In some embodiments, the oral disintegration tablet is prepared using a lyophilized oral disintegrating agent.

The invention is further illustrated by the following examples, which should not be construed as limiting. All references, patents and published patent applications cited throughout this application are incorporated herein by reference.

Example 1: Suppression of urination urge

A total of 20 men and women who experienced premature urge urination or urge to urinate had their sleep interrupted for a sufficient period of time to get enough rest. Each subject ingested 400-800 mg of ibuprofen in a single dose before bedtime. At least 14 subjects reported that they were able to take a break because they had not been awakened often due to urge incontinence.

Some subjects reported that after a few weeks of ingesting ibuprofen at night, the effect of feeling less urge urge was no longer felt. However, all of these subjects further reported that the effects reappear a few days after stopping their use.

Example 2: Effect of botulinum neurotoxin and antimuscarinic agent as analgesic agents in macrophage response to inflammatory and non-inflammatory stimuli

Experimental Design

This experiment confirmed the dose and in vitro efficacy of analgesics and antimuscarinics that control macrophage responses to inflammatory and non-inflammatory stimuli mediated by Cox-2 and prostaglandins (PGE, PGH, etc.) Respectively. This established a baseline response (dose and exercise) to inflammatory and non-inflammatory effectors in bladder cells. Briefly, the cultured cells are exposed to analgesics and / or antimuscarinics in the absence or presence of various reactors.

The reactor includes: LPS (lipopolysaccharide), an inflammatory agent and a Cox2 inducer as an inflammatory stimulant; Carbachol or acetylcholine, a smooth muscle contraction stimulator, as a non-inflammatory stimulant; As a positive control, botulinum neurotoxin A known as acetylcholine release inhibitor; , Arachidonic acid (AA), DGLA (gamma (DGLA)), which are prostaglandin precursors produced by continuous oxidation of AA, DGLA or EPA in cells by cyclooxygenases (COX1 and COX2) and terminal prostaglandin synthases linolenic acid or EPA (eicosapentaenoic acid).

Such painkillers include: salicylates such as aspirin; Isobutyl propane phenolic acid derivatives such as adbill, motrin, nuprin and medifrene (ibuprofen); Nemo Progressive, EC-I, Neprean, Nafrogen, Nafrogen, Nafrogen, Nafrogen, Nafrogen, Naproxen sodium, such as prozin, narocin, proxen, synplex and genovid; Acetic acid derivatives such as indomethacin (india); 1-naphthalene acetic acid derivatives such as nabumetone or reraphen; N-acetyl-para-aminophenol (APAP) derivatives such as acetaminophen or paracetamol (Tylenol); And celecoxib.

The antimuscarinic agents include: oxybutynin, solifenacin, dipalpanacin, and atropine.

Macrophages were stimulated for short (1-2 hours) or long (24-48 hours)

(1) Various doses of each analgesic agent alone.

(2) each analgesic at various doses in the presence of LPS.

(3) Various analgesic agents in various doses in the presence of carbachol or acetylcholine.

(4) Various analgesic agents at various doses in the presence of AA, DGLA, or EPA.

(5) Various doses of botulinum neurotoxin A alone.

(6) Various doses of botulinum neurotoxin in the presence of LPS.

(7) Various doses of botulinum neurotoxin in the presence of carbachol or acetylcholine.

(8) Various doses of botulinum neurotoxin A. in the presence of AA, DGLA, or EPA.

(9) Various doses of each antimuscarinic agent alone.

(10) Various doses of each antimuscarinic agent in the presence of LPS.

(11) Various doses of each antimuscarinic agent in the presence of carbachol or acetylcholine.

(12) Various doses of each antimuscarinic agent in the presence of AA, DGLA, or EPA.

These cells are then used for the release of PGH ₂ , PGE, PGE ₂ , Prostacydin, Thromboxane, IL-1β, IL-6 and TNF-α, production of COX2 activity, cAMP and cGMP, IL -1β, IL-6, TNF-α and COX2 mRNA and surface expression of CD80, CD86 and MHC class II molecules.

Materials and methods

Macrophage

Murine RAW264.7 or J774 macrophage cells (obtained from ATCC) were used in this experiment. Cells were cultured in media containing RPMI 1640 supplemented with 10% fetal bovine serum (FBS), 15 mM HEPES, 2 mM L-glutamine, 100 U / ml penicillin and 100 ug / ml streptomycin. Cells were cultured at 37 ° C in 5% CO ₂ and subcultured once a week.

In vitro  Analgesic treatment of macrophages

RAW 264.7 macrophages were plated in 96-well plates at a density of ^1.5 x ¹⁰ cells per well in 100 μl of the culture. Cells were exposed to various concentrations of LPS, which are (1) various concentrations of analgesics (acetaminophen, aspirin, ibuprofen or naproxen), (2) various concentrations of LPS as reactors for inflammatory stimuli to macrophages, and (3) Carbachol or acetylcholine, (4) analgesics and LPS or (5) analgesics and carbachol or acetylcholine. Briefly, analgesics were dissolved in FBS-free medium (i.e., RPMI 1640 supplemented with 15 mM HEPES, 2 mM L-glutamine, 100 U / ml penicillin and 100 ug / ml streptomycin) and serially diluted in an equal volume And diluted to a desired concentration. For experiments on cells treated with analgesics in the absence of LPS, 50 진 of analgesic solution and 50 F of FBS-free medium were added to each well. For experiments on cells treated with analgesics in the presence of LPS, 50 [mu] l of analgesic solution and 50 [mu] l of LPS (isolated from Salmonella typhimurium ) in FBS-free media were added to each well. All conditions were duplicated.

After incubation for 24 or 48 hours, 150 占 퐇 of the culture supernatant was obtained, and the cells and debris were removed by centrifugation at 4 占 폚 for 8 minutes at 8,000 rpm for 2 minutes, and analyzed for cytokine response by ELISA using -70 ≪ / RTI > To the obtained cells, 500 μl of PBS (phosphate buffer) was added, followed by centrifugation (at 4 ° C for 5 minutes at 1,500 rpm). Half of the cells were frozen in liquid nitrogen and stored at -70 ° C. The remaining cells were stained with a fluorescent monoclonal antibody and analyzed by flow cytometry.

Flow cytometry analysis of co-stimulatory molecule expression

For flow cytometry analysis, macrophages were diluted in 100 μl of FACS buffer (PBS with 2% BSA and 0.01% NaN ₃ ) and incubated with FITC-conjugated anti-CD40 antibody, PE-conjugated anti-CD80 antibody, PE- Conjugated anti-CD86 antibody, anti-MHC class II (IA ^d ) PE (BD Bioscience) was added and stained for 30 minutes at 4 ° C. Then, 300 F of FACS buffer was added to the cells, and the cells were washed by centrifugation (at 1,500 rpm for 5 minutes at 4 캜). After a second wash, the cells were resuspended in 200 [mu] l of FACS buffer and the percentage of cells expressing the desired marker (single positive) or the percentage of cells expressing the combined marker (double positive) were measured using an Accuri C6 flow cytometer Bioscience).

Analysis of cytokine response using ELISA

The IL-1β, IL-6 and TNF-α responses were confirmed by cytokine-specific ELISA in culture supernatants obtained by culturing macrophages treated with analgesics, LPS alone or in combination with LPS and analgesics. Nunc MaxiSorp Immunoplates (Nunc) coated overnight with 100 μl of IL-6, TNF-α mAbs (BD Biosciences) or IL-1β mAb (R & D Systems) in 0.1 M sodium bicarbonate buffer Analysis. After washing twice with PBS (200 μl per well), 200 μl of PBS 3% BSA was added (blocked) to each well and the plate was incubated at room temperature for 2 hours. 200 [mu] l per well was added, the plate was washed twice again, 100 [mu] l of cytokine standard and serial dilutions of the culture supernatant were added, and the plate was incubated overnight at 4 [deg.] C. Finally, the plate was washed twice and incubated with 100 μl of secondary biotin-conjugated anti-mouse IL-6, TNFα mAbs (Biosciences) or IL-1β (R & D Systems), followed by peroxidase- And incubated with anti-biotin mAb (Vector Laboratories). The color reaction was confirmed by the addition of 2,2'-azino-bis (3) -ethylbenzylthiazoline-6-sulfonic acid (ABTS) substrate and H ₂ O ₂ (Sigma), and a Victor ^® V multi-label plate reader (PerkinElmer ) Was measured at 415 nm.

Determination of COX2 activity and production of cAMP and cGMP

The COX2 activity of cultured macrophages was determined by sequential competition ELISA (R & D Systems). Production of cAMP and cGMP was determined by cAMP assay and cGMP assay. Such assays are generally performed in the art.

result

Table 1 summarizes the experimental and major experimental results of the Raw 264 macrophage cell line in terms of the effect of analgesics on the cell surface expression of the co-stimulatory molecules CD40 and CD80. Expression of these molecules was stimulated by COX1 / 2 and inflammatory signals, thus evaluating the expression of the molecules to determine the functional outcome of inhibition of COX1 / 2.

As shown in Table 2, acetaminophen, aspirin, ibuprofen and naproxen, the highest dose (i.e., 5x 10 ⁶ nM) except all tested doses (that ^{is, 5x 10 5 nM, 5x 10} 4 nM, 5x 10 ³ nM, 5x10 ² nM, 50 nM, and 5 nM) inhibited macrophage-mediated basal expression of the co-stimulatory molecules CD40 and CD80, and at the highest dose the expression of co-stimulatory molecules appeared to be enhanced rather than inhibited . As shown in Figures 1A and 1B, this inhibitory effect on CD40 and CD50 expression was also observed at analgesic doses as low as 0.05 nM (i.e. 0.00005 [mu] M). This supports that controlled release of low doses of analgesic may be preferable to acute delivery of large doses. In addition, these experiments show that acetaminophen, aspirin, ibuprofen, and naproxen exhibit similar inhibitory effects on LPS-induced expression of CD40 and CD80.

Experimental summary Control group LPS
Salmonella typhimurium Acetaminophen aspirin Ibuprofen Naproxen TESTS One X 2 X Dose response
(0, 5, 50, 1000) ng / ml 3 X Dose response
(0, 5, 50, 500, 5 x 10 ³ , 5 x 10 ⁴ , ⁵ x 10 ⁵ , ⁵ x 10 ⁶ ) nM 4 X X (5 ng / ml)
X (50 ng / ml
X (1000 ng / ml) Dose response
(0, 5, 50, 500, 5.10 ³ , 5.10 ⁴ , 5.10 ⁵ , 5.10 ⁶ ) nM ANALYSIS a Activation / Stimulation Characteristics: Flow cytometry analysis of CD40, CD80, CD86 and MHC class II b Mediator of inflammatory response: IL-1β, IL-6, TNF-α ELISA analysis

Summary of Key Experimental Results Reactor % positivity Negative control group LPS
5 ng / ml Analgesic dose (nM) 5x10 ⁶ 5x10 ⁵ 5x10 ⁴ 5x10 ³ 500 50 5 CD40 ⁺ CD80 ⁺ 20.6 77.8 Acetaminophen CD40 ⁺ CD80 ⁺ 63 18 12 9.8 8.3 9.5 7.5 aspirin CD40 ⁺ CD80 ⁺ 44 11 10.3 8.3 8 10.5 7.5 Ibuprofen CD40 ⁺ CD80 ⁺ ND * 6.4 7.7 7.9 6.0 4.9 5.8 Naproxen CD40 ⁺ CD80 ⁺ 37 9.6 7.7 6.9 7.2 6.8 5.2 Analgesics and LPS Acetaminophen CD40 ⁺ CD80 ⁺ 95.1 82.7 72.4 68.8 66.8 66.2 62.1 aspirin CD40 ⁺ CD80 ⁺ 84.5 80 78.7 74.7 75.8 70.1 65.7 Ibuprofen CD40 ⁺ CD80 ⁺ ND 67 77.9 72.9 71.1 63.7 60.3 Naproxen CD40 ⁺ CD80 ⁺ 66.0 74.1 77.1 71.0 68.8 72 73

* ND: not done (toxicity)

Table 3 summarizes the results of several studies that measured serum concentrations of analgesics after ingesting an oral dose of treatment. As shown in Table 3, the maximum serum concentration of analgesic after oral treatment administration ranged from 10 ⁴ to 10 ⁵ nM. Thus, the doses of the analgesic agents tested in vitro of Table 2 include a range of concentrations achievable in vivo in humans.

Serum concentration of human blood analgesic after oral administration painkiller Molecular Weight The maximum serum concentration after oral administration Reference Mg / L nM Acetaminophen
(Tylenol) 151.16 11-18 7.2 x ^{10 4} -1.19 x 10 ⁵ * BMC Clinical Pharmacology.2010, 10:10
* Anaesth Intensive Care. 2011, 39: 242 aspirin
(Acetylsalicylic acid) 181.66 30-100 1.65x10 ⁵ -5.5x10 ⁵ * Disposition of Toxic Drugs and Chemicals in Man , 8th Edition, Biomedical Public, Foster City, CA, 2008, pp. 22-25

* J Lab Clin Med. 1984 Jun; 103: 869 Ibuprofen
(Adville, Motrin) 206.29 24-32 1.16 x 10 ⁵ -1.55 x 10 ⁵ * BMC Clinical Pharmacology 2010, 10:10
* J Clin Pharmacol. 2001, 41: 330

Example 3: Effect of painkillers, botulinum neurotoxins and antimuscarinics on bladder smooth muscle cell response to inflammatory and non-inflammatory stimuli

Experimental Design

This experiment characterizes the effect of the optimal dose of analgesic agent determined in Example 2 on cell culture or tissue cultured bladder smooth muscle cells and shows that different types of analgesics can produce synergies that more effectively inhibit COX2 and PGE2 responses To verify whether or not it is.

The reactor, analgesic agent and antimuscarinic agent were described in Example 2.

Primary cultures of mouse bladder smooth muscle cells were stimulated for short (1-2 hours) or long (24-48 hours)

(1) Various doses of each analgesic agent alone.

(2) each analgesic at various doses in the presence of LPS.

(3) Various analgesic agents in various doses in the presence of carbachol or acetylcholine.

(4) Various analgesic agents at various doses in the presence of AA, DGLA, or EPA.

(5) Various doses of botulinum neurotoxin A alone.

(6) Various doses of botulinum neurotoxin in the presence of LPS.

(7) Various doses of botulinum neurotoxin in the presence of carbachol or acetylcholine.

(8) Various doses of botulinum neurotoxin A. in the presence of AA, DGLA, or EPA.

(9) Various doses of each antimuscarinic agent alone.

(10) Various doses of each antimuscarinic agent in the presence of LPS.

(11) Various doses of each antimuscarinic agent in the presence of carbachol or acetylcholine.

(12) Various doses of each antimuscarinic agent in the presence of AA, DGLA, or EPA.

These cells are then used for the release of PGH ₂ , PGE, PGE ₂ , Prostacydin, Thromboxane, IL-1β, IL-6 and TNF-α, production of COX2 activity, cAMP and cGMP, IL -1β, IL-6, TNF-α and COX2 mRNA and surface expression of CD80, CD86 and MHC class II molecules.

Materials and methods

Isolation and purification of mouse bladder cells

Bladder was isolated from euthanized C57BL / 6 mice (8-12 weeks of age), enzymatically digested, and then purified by Percoll gradient to separate cells. Briefly, 10 bladder mice were scraped into 10 ml of digestion buffer (RPMI 1640, 2% fetal bovine serum, 0.5 mg / ml collagenase, 30 / / The resultant was enzymatically digested at 37 DEG C for 30 minutes. The undegraded pieces were further dispersed through a cell-trainer. The cell suspensions were pooled, followed by continuous 20%, 40% and 75% Percol gradient for mononuclear cell purification. Each experiment used 50-60 blad- ers.

After washing with RPMI 1640, bladder cells were resuspended in RPMI 1640 supplemented with 10% fetal bovine serum, 15 mM HEPES, 2 mM L-glutamine, 100 U / ml penicillin and 100 ug / ml streptomycin, Well cell culture micro-culture plates at a density of 3 x ¹⁰ cells / well in clear-bottom black 96-well culture media. The cells were cultured at 37 ° C in 5% CO ₂ .

In vitro  Cellulite treatment

Bladder cells were treated with analgesic solution (50 [mu] l / well) alone or with LPS (1 [mu] g / ml) of Salmonella typhimurium as a noninflammatory stimulus, , 50 [mu] l / well) were treated together. If no other reactors for the cells were added, 50 μl of RPMI 1640 medium without fetal bovine serum was added to the wells to final volume to 200 μl.

24 hours of incubation, the obtained culture supernatant of 150 ㎕, centrifuged for 2 minutes, and 8,000 rpm at 4 ℃ to remove the cells and debris and, ℃ -70 for analysis of PEG ₂ (Prostaglandin E2) reaction by ELISA Lt; / RTI > To detect COX2 (Cyclooxygenase-2), cells were fixed and permeabilized and blocked using a fluorescent substrate. In selected experiments, cells were stimulated in vitro for 12 hours to analyze the COX2 response.

Analysis of COX2 response

The COX2 response was analyzed by cell-based ELISA using human / mouse whole COX2 immunoassay (R & D Systems) according to the manufacturer's instructions. Briefly, after cell fixation and permeabilization, mouse anti-total COX2 and rabbit anti-total GAPDH were added to the wells of clear-bottom black 96-well cell culture microculture plates. After incubation and washing, HRP-conjugated anti-mouse IgG and AP-conjugated anti-rabbit IgG were added to the wells. After further incubation and washing, HRP- and AP- fluorescent substrates were added. Finally, the fluorescence was read using a Victor V multi-label plate reader ^® (PerkinElmer) emitted from the 600 nm (COX2 fluorescence) and 450 nm (fluorescent GAPDH). Results were expressed as relative levels of total COX2 determined by RFU (relative fluorescence unit) and normalized to GAPDH, a housekeeping protein.

Analysis of PGE2 Reaction

Prostaglandin E2 responses were analyzed using sequential competitive ELISA (R & D Systems). More specifically, the culture supernatant or PGE2 standard was added to a 96-well polystyrene microplate coated with a goat anti-mouse polyclonal antibody. After incubation in a microplate stirrer for 1 hour, HRP-conjugated PGE2 was added and the plate was incubated for an additional 2 hours at room temperature. The plate was then washed and HRP substrate solution was added to each well. The reaction was stopped for 30 minutes and the reaction was stopped by addition of sulfuric acid, followed by wavelength correction at 570 nm and reading at 450 nm. The results are expressed as the average pg / ml of PGE2.

Other analysis

As described in Example 2, the release of PGH ₂ , PGE, PGE ₂ , Prostacydin, Thromboxane, IL-1β, IL-6 and TNF-α, production of cAMP and cGMP , IL-1β, IL-6, TNF-α and COX2 mRNA and surface expression of CD80, CD86 and MHC class II molecules.

Analgesics inhibit the COX2 response of mouse bladder cells to inflammatory stimuli

Various analgesics (acetaminophen, aspirin, ibuprofen and naproxen) at concentrations of 5 μM or 50 μM were tested in mouse bladder cells to determine whether analgesics could induce a COX2 response. After 24-hour incubation, the results showed that any analgesics treated did not induce a COX2 response in in vitro mouse bladder cells.

We also examined the effect of these analgesics on the COX2 response of mouse bladder cells to carbachol or LPS stimulation in vitro . As shown in Table 1, the dose of carbachol tested does not have a significant effect on COX2 levels in mouse bladder cells. On the other hand, LPS significantly increased total COX2 levels. Interestingly, acetaminophen, aspirin, ibuprofen, and naproxen were all able to inhibit the effect of LPS on COX2 levels. The inhibitory effect of the analgesic was shown when these drugs were 5 [mu] M or 50 [mu] M (Table 4).

Expression of COX2 by mouse bladder cells treated with stimuli and analgesics in vitro Stimulation painkiller Total COX2 levels (Normalized RFUs) None None 158 ± 18 Carbachol (mM) None 149 ± 21 LPS (1 [mu] g / ml) None 420 ± 26 LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 275 ± 12
240 ± 17
253 ± 32
284 ± 11 LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 243 ± 15
258 ± 21
266 ± 19
279 ± 23

Analgesics inhibit the PGE2 response of mouse bladder cells to inflammatory stimuli

The secretion of PGE2 in the culture supernatants of mouse bladder cells was measured to confirm the biological significance of changes in mouse bladder cell COX2 levels by analgesics. As shown in Table 5, PGE2 was not detected in the culture supernatant of blast cell cultured in the presence of unstimulated bladder cells or carbachol. Consistent with the COX2 response described above, stimulation of mouse bladder cells with LPS induced a high level of secretion of PGE2. Addition of the analgesic agents acetaminophen, aspirin, ibuprofen, and naproxen suppressed the effects of LPS on PGE2 secretion and showed no difference between the cell responses treated with 5 or 50 μM doses of analgesics.

PGE2 secretion by mouse bladder cells treated with stimuli and analgesics in vitro Stimulation painkiller PGE2 levels (pg / ml) None None <20.5 Carbachol (mM) None <20.5 LPS (1 [mu] g / ml) None 925 ± 55 LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 619 ± 32
588 ± 21
593 ± 46
597 ± 19 LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml)
LPS (1 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 600 ± 45
571 ± 53
568 ± 32
588 ± 37

In summary, these data show that no 5 μM or 50 μM analgesic treatment alone in mouse bladder cells induces COX2 and PGE2 responses. However, 5 μM or 50 μM of analgesic significantly inhibited COX2 and PGE2 responses in vitro in mouse bladder cells stimulated in vitro with LPS (1 μg / ml). No significant effects of analgesics on COX2 and PGE2 responses were observed in mouse bladder cells stimulated with carbachol (1 mM).

Example 4: Effect of painkillers, botulinum neurotoxins and antimuscarinics on contraction of bladder smooth muscle cells

Experimental Design

Cultured mouse or rat bladder smooth muscle cells and mouse or rat bladder smooth muscle tissue were exposed to inflammatory stimuli and non-inflammatory stimuli in the presence of various concentrations of analgesic and / or antimuscarinic agents. Stimulation-induced muscle contraction was measured to assess the inhibitory effect of analgesics and / or antimuscarinics.

The reactor, analgesic agent and antimuscarinic agent were described in Example 2.

The primary cultures of mouse bladder smooth muscle cells were stimulated for a short period (1-2 hours) or for a prolonged period (24-48 hours) as follows:

(1) Various doses of each analgesic agent alone.

(2) each analgesic at various doses in the presence of LPS.

(3) Various analgesic agents in various doses in the presence of carbachol or acetylcholine.

(4) Various analgesic agents at various doses in the presence of AA, DGLA, or EPA.

(5) Various doses of botulinum neurotoxin A alone.

(6) Various doses of botulinum neurotoxin in the presence of LPS.

(7) Various doses of botulinum neurotoxin in the presence of carbachol or acetylcholine.

(8) Various doses of botulinum neurotoxin A. in the presence of AA, DGLA, or EPA.

(9) Various doses of each antimuscarinic agent alone.

(10) Various doses of each antimuscarinic agent in the presence of LPS.

(11) Various doses of each antimuscarinic agent in the presence of carbachol or acetylcholine.

(12) Various doses of each antimuscarinic agent in the presence of AA, DGLA, or EPA.

Materials and methods

As described in Example 3, early mouse bladder cells were isolated. In selected experiments, cultured bladder tissue was used. Bladder smooth muscle cell contractions were recorded with a Grass polygraph (Quincy Mass, USA).

Example 5: Effect of oral analgesics and antimuscarinics on COX2 and PGE2 responses of mouse bladder smooth muscle cells

Experimental Design:

It has been reported that mice that are in normal mouse and over active bladder syndrome (OAB) are exposed to aspirin, naproxen sodium, ibuprofen, india, nabumetone, tylenol, celecoxib, oxybutynin, A combination of these was taken orally. The control group was a normal mouse without any treatment and an OAB mouse without any treatment. After 30 minutes, the final dose, to obtain a bladder in vitro with carbachol or acetylcholine (ex vivo) stimulated. In selected experiments, the bladder was treated with botulinum neurotoxin A prior to carbaco stimulation. The experimental animals were placed in a metabolic cage and the frequency (and amount) of urination was measured. The output of the bladder was determined by monitoring the water intake and the weight of the dirt in the cage. Levels of serum PGH ₂ , PGE, PGE ₂ , prostasidine, thromboxane, IL-1β, IL-6, TNF-α, cAMP, and cGMP were confirmed by ELISA. Expression of CD80, CD86, and MHC class II in whole blood cells was confirmed by flow cytometry.

At the end of the experiment, animals were euthanized and in vitro bladder contractions were recorded with a Grass polygraph. A portion of the bladder was fixed in formalin and analyzed for COX2 response by immunohistochemistry.

Example 6: Effect of analgesic, botulinum neurotoxin and antimuscarinic agents on human bladder smooth muscle cell response to inflammatory and non-inflammatory stimuli

Experimental Design

This experiment characterizes the effect of the optimal dose of analgesic agent determined in Examples 1 to 5 on cell culture or tissue culture of human bladder smooth muscle cells and shows synergistic effects that different types of analgesics inhibit the COX2 and PGE2 responses more efficiently It is designed to confirm whether or not it can be put out.

The reactor, analgesic agent and antimuscarinic agent were described in Example 2.

Human bladder smooth muscle cells were stimulated for a short period (1-2 hours) or for a prolonged period (24-48 hours) as follows:

(1) Various doses of each analgesic agent alone.

(2) each analgesic at various doses in the presence of LPS.

(3) Various analgesic agents in various doses in the presence of carbachol or acetylcholine.

(4) Various analgesic agents at various doses in the presence of AA, DGLA, or EPA.

(5) Various doses of botulinum neurotoxin A alone.

(6) Various doses of botulinum neurotoxin in the presence of LPS.

(7) Various doses of botulinum neurotoxin in the presence of carbachol or acetylcholine.

(8) Various doses of botulinum neurotoxin A. in the presence of AA, DGLA, or EPA.

(9) Various doses of each antimuscarinic agent alone.

(10) Various doses of each antimuscarinic agent in the presence of LPS.

(11) Various doses of each antimuscarinic agent in the presence of carbachol or acetylcholine.

(12) Various doses of each antimuscarinic agent in the presence of AA, DGLA, or EPA.

Thereafter, the cells were stimulated with the release of PGH ₂ , PGE, PGE ₂ , prostasidine, thromboxane, IL-1 ?, IL-6 and TNF- ?, COX2 activity, production of cAMP and cGMP, , NF- alpha and COX2 mRNA production, and surface expression of CD80, CD86 and MHC class II molecules.

Example 7: Effect of painkillers, botulinum neurotoxins and antimuscarinics on the contraction of human bladder smooth muscle cells

Experimental Design

Cultured human bladder smooth muscle cells were exposed to inflammatory stimuli and non-inflammatory stimuli in the presence of various concentrations of analgesic and / or antimuscarinic agents. Stimulation-induced muscle contraction was measured to assess the inhibitory effect of analgesics and / or antimuscarinics.

The reactor, analgesic agent and antimuscarinic agent were described in Example 2.

Human bladder smooth muscle cells were stimulated for a short period (1-2 hours) or for a prolonged period (24-48 hours) as follows:

(1) Various doses of each analgesic agent alone.

(2) each analgesic at various doses in the presence of LPS.

(3) Various analgesic agents in various doses in the presence of carbachol or acetylcholine.

(4) Various analgesic agents at various doses in the presence of AA, DGLA, or EPA.

(5) Various doses of botulinum neurotoxin A alone.

(6) Various doses of botulinum neurotoxin in the presence of LPS.

(7) Various doses of botulinum neurotoxin in the presence of carbachol or acetylcholine.

(8) Various doses of botulinum neurotoxin A. in the presence of AA, DGLA, or EPA.

(9) Various doses of each antimuscarinic agent alone.

(10) Various doses of each antimuscarinic agent in the presence of LPS.

(11) Various doses of each antimuscarinic agent in the presence of carbachol or acetylcholine.

(12) Various doses of each antimuscarinic agent in the presence of AA, DGLA, or EPA.

Bladder smooth muscle cell contractions were recorded with a Grass polygraph (Quincy Mass, USA).

Example 8 Effect of Analgesics on Normal Human Bladder Smooth Muscle Cell Response to Inflammatory and Non-Saline Neutral Signals

Experimental Design

Culture of Normal Human Bladder Smooth Muscle Cells

Normal human bladder smooth muscle cells were isolated using enzymatic degradation from normal tissue of human bladder. 10% fetal calf serum, the cells in 5% CO _2, 37 ℃ by containing 15 mM HEPES, 2 mM of L- glutamine, 100 U / ㎖ penicillin and 100 ㎍ / ㎖ streptomycin the addition of RPMI 1640 medium After culturing in vitro , the cells were removed by treatment with trypsin once a week, and subcultured in a new flask. In the first week of culture, 0.5 ng / ml EGF (epidermal growth factor), 2 ng / ml FGF (fibroblast growth factor) and 5 / / ml insulin were added to the culture medium.

In vitro  Analgesic treatment of normal human bladder smooth muscle cells

Human bladder smooth muscle cells were treated with trypsin and then dispensed into a micro-culture plate at a density of 3 x ¹⁰ cells / 100 μl per well. Analgesics solution to the cells alone handle (50 ㎕ / well), or non - LPS (1 ㎍ / ㎖ of Salmonella typhimurium as an inflammatory stimulus, - an inflammatory stimulus carbachol (10-Molar, 50 ㎕ / well), or non- 50 [mu] l / well) were treated together. If no other reactors for the cells were added, 50 μl of RPMI 1640 medium without fetal bovine serum was added to the wells to final volume to 200 μl.

After 24 hours of culture, 150 占 퐇 of the culture supernatant was obtained, and the cells and debris were removed by centrifugation at 4 占 폚 and 8,000 rpm for 2 minutes, and analyzed at -70 占 폚 for analysis of PEG2 (Prostaglandin E2) Respectively. To detect COX2 (Cyclooxygenase-2), cells were fixed and permeabilized and blocked using a fluorescent substrate. In selected experiments, cells were stimulated in vitro for 12 hours to analyze COX2, PGE2 and cytokine response.

Analysis of COX2, PGE2 and cytokine responses

As described in Example 3, the COX2 and PGE2 reactions were analyzed. The cytokine response was analyzed as described in Example 2.

result

Analgesics inhibit the COX2 response of normal human bladder smooth muscle cells to inflammatory and noninflammatory stimuli - Analysis of cell and culture supernatants after 24 hours of incubation shows that any analgesic administered alone has a COX2 response in normal human bladder smooth muscle cells . However, as summarized in Table 6, carbachol induced a weak but significant COX2 response in normal human bladder smooth muscle cells. On the other hand, LPS treatment resulted in a high COX2 response in normal human bladder smooth muscle cells. Acetaminophen, aspirin, ibuprofen, and naproxen were all able to inhibit the effects of carbachol and LPS on COX2 levels. The inhibitory effect of the analgesic showed LPS-induced response when these drugs were 5 [mu] M or 50 [mu] M.

COX2 expression by normal human bladder smooth muscle cells stimulated by inflammatory and noninflammatory stimuli in vitro and treated with analgesics
Stimulation
painkiller Total COX2 level ^#
(Normalized RFUs)
Target 1 Total COX2 level
(Normalized RFUs)
Target 2 None None 230 199 Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M None (50 μM)
Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 437
298
312
309
296 462
310
297
330
354 LPS (10 [mu] g / ml) None 672 633 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 428
472
417
458 457
491
456
501 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 399
413
427
409 509
484
466
458

# Data represents the average of duplicate experiments.

Analgesics inhibit the PGE2 response of normal human bladder smooth muscle cells to inflammatory and noninflammatory stimuli- Consistent with the induction of the COX2 response described above, both carbachol and LPS induce the production of PGE2 by normal human bladder smooth muscle cells Respectively. In addition, acetaminophen, aspirin, ibuprofen and naproxen at a dose of 5 μM or 50 μM inhibited the LPS-induced PGE2 response (Table 7).

PGE2 secretion by normal human bladder smooth muscle cells stimulated by inflammatory and noninflammatory stimuli in the test tube and treated with analgesics Stimulation painkiller PGE2 level ^#  (pg / ml)
Target 1 PGE2 levels (pg / ml)
Target 2 None None <20.5 <20.5 Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M None (50 μM)
Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 129
76
89
84
77 104
62
59
73
66 LPS (10 [mu] g / ml) None 1125 998 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 817
838
824
859 542
598
527
506 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 803
812
821
819 540
534
501
523

# Data represents the average of duplicate experiments.

Analgesics inhibit the cytokine response of normal human bladder smooth muscle cells to inflammatory stimuli -Analysis of the cell and culture supernatants after 24 hours of incubation shows that any analgesic administered alone does not release IL-6 or TNF [alpha] secretion in normal human bladder smooth muscle cells . As shown in Tables 8 and 9, carbachol induced a weak but significant TNFa and IL-6 response in normal human bladder smooth muscle cells. On the other hand, LPS treatment resulted in the mass induction of these proinflammatory cytokines. Acetaminophen, aspirin, ibuprofen and naproxen inhibited the effects of carbachol and LPS on TNFa and IL-6 responses. The inhibitory effect of the analgesic showed LPS-induced response when these drugs were 5 [mu] M or 50 [mu] M.

TNFα secretion by normal human bladder smooth muscle cells stimulated with inflammatory and non-inflammatory stimuli in vitro and treated with analgesics Stimulation painkiller TNF? (Pg / ml)  ^#
Target 1 TNF? (Pg / ml)
Target 2 None None <5 <5 Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M None
Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 350
138
110
146
129 286
164
142
121
137 LPS (10 [mu] g / ml) None 5725 4107 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 2338
2479
2733
2591 2267
2187
2288
2215 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 2184
2266
2603
2427 2056
2089
1997
2192

# Data represents the average of duplicate experiments.

IL-6 secretion by normal human bladder smooth muscle cells stimulated with inflammatory and non-inflammatory stimuli in the test tube and treated with analgesics Stimulation painkiller IL-6 (pg / ml)  ^#
Target 1 IL-6 (pg / ml)
Target 2 None None <5 <5 Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M
Carbachol 10 ^-3 M None
Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 232
119
95
107
114 278
135
146
118
127 LPS (10 [mu] g / ml) None 4838 4383 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (5 μM)
Aspirin (5 μM)
Ibuprofen (5 μM)
Naproxen (5 μM) 2012
2199
2063
2077 2308
2089
2173
2229 LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml)
LPS (10 [mu] g / ml) Acetaminophen (50 μM)
Aspirin (50 μM)
Ibuprofen (50 μM)
Naproxen (50 μM) 2018
1987
2021
2102 1983
2010
1991
2028

# Data represents the average of duplicate experiments.

Early normal human bladder smooth muscle cells were isolated and cultured to assess response to analgesics in the presence of non-inflammatory (carbachol) and inflammatory (LPS) stimuli. The purpose of this experiment is to confirm whether normal human bladder smooth muscle cells reproduce the observation results in the prior murine bladder cells.

The above-mentioned experiments were performed using analgesics of delayed-release, extended-release, or delayed-and-extended-release formulations and / or anti- It can be repeated zero.

The above description is intended to teach those skilled in the art how to practice the invention and is not intended to be exhaustive of all obvious modifications and variations that may become apparent to those skilled in the art upon a reading of the above description. However, all such obvious modifications and variations are intended to be included within the scope of the present invention as defined by the following claims. The claims are intended to include the claimed elements and steps in any order effective for achieving the intended purpose, unless the context otherwise requires.

Claims (47)

Forming a first mixture comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release;
Coating the first mixture with a delayed release coating to form a core structure;
Coating the core structure with a second mixture comprising a third active ingredient formulated for immediate release and a fourth active ingredient formulated for extended release,
Wherein at least one of the first, second, third and fourth active ingredients comprises an analgesic,
Wherein at least one of the first, second, third and fourth active ingredients comprises a PDE5 inhibitor.
A method for preparing a pharmaceutical composition for reducing urinary frequency. The method according to claim 1,
Wherein the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen, and at least one of the first, second, third, mg to 2000 mg of the composition. The method according to claim 1,
Wherein at least one of the first, second, third and fourth active ingredients is selected from the group consisting of (1) an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen, and Lt; RTI ID = 0.0 &gt; PDE5 &lt; / RTI &gt; inhibitor. The method of claim 3,
Wherein the analgesic is acetaminophen and the PDE5 inhibitor is tadalafil. The method according to claim 1,
Wherein at least one of said first and third active ingredients comprises a PDE5 inhibitor. 6. The method of claim 5,
Wherein at least one of said second and fourth active ingredients comprises acetaminophen. The method according to claim 1,
Wherein at least one of the first, second, third and fourth active ingredients comprises a medicament selected from the group consisting of an antimuscarinic agent, an anti-diuretic agent, an antispasmodic agent and a zolpidem. Gt; The method according to claim 1,
Wherein said delayed release coating is an enteric coating. 9. The method of claim 8,
Wherein the enteric coating comprises a pH-dependent polymer. &Lt; RTI ID = 0.0 &gt; 21. &lt; / RTI &gt; The method according to claim 1,
Wherein the delayed release coating comprises a swellable layer covered externally with a semipermeable polymer layer. The method according to claim 1,
Wherein the second active component or the fourth active component, or both, comprises an active core comprising an extended-release coating or a polymer matrix that causes diffusion controlled release, &Lt; / RTI &gt; The method according to claim 1,
Wherein the PDE5 inhibitor is tadalafil. A pharmaceutical composition prepared by the method of claim 1. Forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release;
Coating the core structure with a delayed-release coating to form a coated core structure;
Mixing the coated core structure with a third active ingredient formulated for immediate release and a fourth active ingredient formulated for extended release to form a final mixture; and
Preparing the final mixture in a tablet form,
Wherein at least one of the first, second, third and fourth active ingredients comprises an analgesic,
Wherein at least one of the first, second, third and fourth active ingredients comprises a PDE5 inhibitor.
A method for preparing a pharmaceutical composition for reducing urinary frequency. 15. The method of claim 14,
Wherein the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen,
Wherein at least one of said first, second, third and fourth active ingredients comprises 5-2000 mg of said analgesic agent. 15. The method of claim 14,
Wherein the PDE5 inhibitor is tadalafil. 15. The method of claim 14,
At least one of the first, second, third and fourth active ingredients is
Acetaminophen; And
Lt; RTI ID = 0.0 &gt; PDE5 &lt; / RTI &gt; inhibitor. 15. The method of claim 14,
Wherein at least one of said first, second, third and fourth active ingredients comprises a medicament selected from the group consisting of an antimuscarinic agent, an antidiuretic agent and an antispasmodic agent and a solipedim. Gt; 14. A pharmaceutical composition produced by the method of claim 14. Forming a core structure comprising a first active ingredient formulated for immediate release and a second active ingredient formulated for extended release;
Coating the core structure with a delayed-release coating to form a coated core structure;
Coating the coated core structure with a third active ingredient formulated for extended release to form an extended release layer coated core structure; And
Coating the extended release layer coated core structure with a fourth active component,
Wherein at least one of the first, second and third active ingredients comprises an analgesic,
Wherein at least one of the first, second and third active ingredients comprises a PDE5 inhibitor.
A method for preparing a pharmaceutical composition for reducing urinary frequency. 21. The method of claim 20,
Wherein the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen,
Wherein at least one of said first, second, third and fourth active ingredients comprises 5-2000 mg of said analgesic agent. 21. The method of claim 20,
Wherein the PDE5 inhibitor is tadalafil. 21. The method of claim 20,
At least one of the first, second, third and fourth active ingredients is
Acetaminophen; And
Lt; RTI ID = 0.0 &gt; and / or &lt; / RTI &gt; tadalafil. 21. The method of claim 20,
Wherein at least one of said first, second, third and fourth active ingredients comprises a medicament selected from the group consisting of an antimuscarinic agent, an antidiuretic agent and an antispasmodic agent and a solipedim. Gt; 20. A pharmaceutical composition prepared by the method of claim 20. A first component comprising an immediate-release subcomponent and an extended-release subcomponent, wherein the first component is one that is formulated to release the subcomponents immediately after administration ; And
A second component comprising an immediate-release sub-component and an extended-release sub-component, said second component comprising one formulated for delayed release of said sub-components,
Wherein at least one subcomponent within the first component or the second component comprises an active ingredient comprising at least one analgesic agent,
Wherein at least one sub-component in the first component or the second component comprises an active ingredient comprising a PDE5 inhibitor. 27. The method of claim 26,
Wherein the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen. 27. The method of claim 26,
Wherein the active ingredient in at least one subcomponent comprises (1) an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen, and (2) a PDE5 inhibitor , &Lt; / RTI &gt; 27. The method of claim 26,
Wherein the analgesic is acetaminophen and the PDE5 inhibitor is tadalafil. 27. The method of claim 26,
Wherein the active ingredient in the immediate release subcomponent of the first component and the second component comprises tadalafil. 27. The method of claim 26,
Wherein the active ingredient in the extended release subcomponent of the first and second components comprises acetaminophen. 27. The method of claim 26,
Wherein the active ingredient in the immediate release subcomponent of said first and second components is selected from the group consisting of (1) an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen, and 2) a PDE5 inhibitor. 27. The method of claim 26,
Wherein the active ingredient in the immediate release and extended release subcomponents of the first component is selected from the group consisting of (1) an analgesic selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone, and acetaminophen, and (2) a PDE5 inhibitor. 27. The method of claim 26,
Wherein the second component is coated with an enteric coating. 27. The method of claim 26,
Wherein the second component is formulated to release the subcomponents after a delay time of 1-4 hours after oral administration. 27. The method of claim 26,
Wherein the extended-release sub-component in the first component is formulated to release the active ingredient over a time interval of about 2-10 hours. 37. The method of claim 36,
Wherein the extended-release sub-component in the second component is formulated to release the active ingredient over a time interval of about 2-10 hours. 27. The method of claim 26,
Wherein at least one of the subcomponents of the first or second component comprises a medicament selected from the group consisting of an antimuscarinic agent, an anti-diuretic agent and an antispasmodic agent and a solipedim. 1. A first component comprising an immediate-release sub-component, wherein the immediate-release sub-component comprises an active ingredient comprising at least one agent selected from the group consisting of analgesics and a PDE5 inhibitor, The component is formulated to release subcomponents immediately after oral administration; And
A second component comprising an immediate-release subcomponent and an extended-release subcomponent, wherein the second component is formulated to release a subcomponent after gastric emptying of the second component, However,
Wherein at least one of the subcomponents in the first and second components comprises an active ingredient comprising at least one agent selected from the group consisting of analgesics and PDE5 inhibitors. 40. The method of claim 39,
Wherein the analgesic agent is selected from the group consisting of aspirin, ibuprofen, naproxen, naproxen sodium, indomethacin, nabumetone and acetaminophen. 40. The method of claim 39,
Wherein the second component is formulated to release the subcomponents after a delay time of 1-4 hours after oral administration. 40. The method of claim 39,
Wherein the active ingredient in the immediate release subcomponent of the first component and the active ingredient in the immediate release subcomponent and the extended release subcomponent of the second component comprise acetaminophen, Composition. 40. The method of claim 39,
Wherein said first component further comprises an extended release subcomponent and wherein said extended release subcomponent comprises an active ingredient comprising at least one agent selected from the group consisting of analgesics and tadalafil, Gt; 40. The method of claim 39,
Wherein the active ingredient in the immediate release sub-component of the first component and the active ingredient in the immediate release sub-component and the extended release sub-component of the second component are selected from the group consisting of an antimuscarinic agent, Zolpidem, &lt; / RTI &gt; and a pharmaceutically acceptable salt thereof. An immediate-release component comprising acetaminophen and an NSAID in an amount of 5 to 2000 mg each; And
An extended-release component comprising acetaminophen and an NSAID in an amount of 5-2000 mg each,
Wherein the immediate-release component, or the extended-release component, or both further comprise a PDE5 inhibitor. 46. The method of claim 45,
Wherein the PDE5 inhibitor is tadalafil. 46. The method of claim 45,
Wherein the extended release component is further coated with a delayed release coating.

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