Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
  • A61K9/1605—Excipients; Inactive ingredients
  • A61K9/1617—Organic compounds, e.g. phospholipids, fats
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/4015—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil having oxo groups directly attached to the heterocyclic ring, e.g. piracetam, ethosuximide
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
  • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
  • A61K9/145—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
  • A61K9/1682—Processes
  • A61K9/1688—Processes resulting in pure drug agglomerate optionally containing up to 5% of excipient
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/02—Nasal agents, e.g. decongestants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/06—Antiasthmatics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/08—Bronchodilators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/14—Antitussive agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/08—Antiallergic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• This invention relates to organic compounds and their use as pharmaceuticals, or more specifically a process for preparing dry powders of glycopyrronium salts.
• Glycopyrronium bromide i.e. 3-[(cyclopentyl-hydroxyphenylacetyl)oxy]-1,1-dimethylpyrrolidinium bromide but also known as glycopyrrolate is an antimuscarinic agent that is currently administered by injection to reduce secretions during anaesthesia and or taken orally to treat gastric ulcers. It has the following chemical structure:
• glycopyrrolate can be formulated as a dry powder for pulmonary delivery in controlled release formulation.
• micronised glycopyrrolate is mixed with magnesium stearate in the ratio of 75:25 by mass and that mixture is ball milled and dried to give a dry powder.
• the present invention provides a process for preparing dry powder formulations of a glycopyrronium salt for inhalation that comprises the steps of (a) micronising a glycopyrronium salt together with an anti-adherent agent, and (b) admixing carrier particles to form the dry powder formulation.
• glycopyrronium salt in this way reduces the tendency for the resulting drug substance to agglomerate, a commonly known behaviour of micronised quaternary ammonium compounds particularly when stored in humid conditions or otherwise exposed to moisture.
• glycopyrronium salt is glycopyrrolate.
• glycopyrronium salt and the anti-adherent agent are pre-mixed to give a homogeneous blend before being micronised together.
• the anti-adherent agent is one or more metal stearates, one or more crystalline sugars or a mixture thereof.
• metal stearates include magnesium stearate and calcium stearate.
• Especially preferred crystalline sugars include lactose, more especially lactose monohydrate or anhydrous lactose.
• the glycopyrronium salt is suitably micronised with from 1 to 20% by mass of the anti-adherent agent, more preferably from 2 to 10% by mass of the anti-adherent agent, but most preferably from 3 to 5% by mass of the anti-adherent agent.
• the crystalline sugar is suitably micronised with the glycopyrronium salt in a ratio of from 0.5:1 to 10:1 by mass, more preferably from 1:1 to 5:1 by mass, but most preferably from 2:1 to 3:1 by mass.
• the carrier particles are mixed with the micronised glycopyrronium salt and anti-adherent agent in a ratio of from 2000:1 to 5:1 by mass, especially from 200:1 to 20:1 by mass.
• the carrier particles are preferably crystalline sugars, for example lactose monohydrate or anhydrous lactose.
• glycopyrronium salt and the anti-adherent agent are optionally micronised together with one, two, three or more additional active ingredients.
• the glycopyrronium salt and the anti-adherent agent and one or more additional active ingredients are micronised and the resulting product is mixed with one or more additional active ingredients that have already been micronised.
• the or each additional active ingredient is suitably selected from the group consisting of anti-inflammatory, bronchodilatory, antihistamine, decongestant and anti-tussive drug substances.
• glycopyrronium salt as used herein is intended to encompass any salt form or counterion of glycopyrronium, including but not limited to glycopyrronium bromide (glycopyrrolate), glycopyrronium chloride, or glycopyrronium iodide, as well as any and all isolated stereoisomers and mixtures or stereoisomers thereof. Derivatives of glycopyrronium salts are also encompassed.
• Suitable counter ions are pharmaceutically acceptable counter ions including, for example, fluoride, chloride, bromide, iodide, nitrate, sulfate, phosphate, formate, acetate, trifluoroacetate, propionate, butyrate, lactate, citrate, tartrate, malate, maleate, succinate, benzoate, p-chlorobenzoate, diphenyl-acetate or triphenylacetate, o-hydroxy-benzoate, p-hydroxybenzoate, 1-hydroxynaphthalene-2-carboxylate, 3-hydroxynaphthalene-2-carboxylate, methanesulfonate and benzene-sulfonate.
• Anti-adherent agent as used herein means a material that reduces the cohesion between particles and prevents fine particles becoming attached to the inner surfaces of an inhaler device, or a mixture of such materials. Anti-adherent agents also include anti-friction agents or glidants, which give the powder formulation better flow properties in the inhaler. They usually lead to better dose reproducibility and higher fine particle fractions. Typical anti-adherent agents include amino acids such as leucine, phospholipids such as lecithin or fatty acid derivatives such as magnesium stearate or calcium stearate.
• Methodered dose” or “MD” of a dry powder formulation as used herein is the total mass of active agent present in the metered form presented by the inhaler device in question.
• the MD might be the mass of glycopyrronium salt present in a capsule for a particular dry powder inhaler, or in a foil blister for use in a particular dry powder inhaler device.
• Emitted dose or “ED” as used herein is the total mass of the active agent emitted from the device following actuation. It does not include the material left inside or on the surfaces of the device. The ED is measured by collecting the total emitted mass from the device in an apparatus frequently referred to as a dose uniformity sampling apparatus (DUSA), and recovering this by a validated quantitative wet chemical assay.
• DUSA dose uniformity sampling apparatus
• FPD Frequency particle dose
• TSI twin stage impinger
• MSLI multi-stage liquid impinger
• ACI Andersen Cascade Impactor
• NBI Next Generation Impactor
• the FPD value is obtained by interpretation of the stage-by-stage active agent recovery quantified by a validated quantitative wet chemical assay where either a simple stage cut is used to determine FPD or a more complex mathematical interpolation of the stage-by-stage deposition is used.
• FPF Frine particle fraction
• FPD FPD divided by the ED and expressed as a percentage.
• FPF(ED) the FPF of ED
• FPF(ED) (FPD/ED) ⁇ 100%
• FPF(MD) (FPD/MD) ⁇ 100%.
• the present invention provides a process for preparing dry powder formulations of a glycopyrronium salt.
• Dry powder formulations for inhalation in the treatment of respiratory diseases are generally formulated by mixing a micronised active pharmaceutical ingredient with coarse carrier particles to give to an ordered mixture.
• the carrier particles make the micronised active pharmaceutical ingredient less cohesive and improve its flowability. This makes the powder easier to handle during the manufacturing process.
• the micronised active particles tend to adhere to the surface of the carrier particles when stored in a dry powder inhaler device but are dispersed from the surfaces of the carrier particles on inhalation into the respiratory tract to give a fine aerosol.
• the larger carrier particles are mostly deposited in the oropharyngeal cavity.
• micronise a glycopyrronium salt together with an anti-adherent agent, for example magnesium stearate or lactose monohydrate, and then admix carrier particles. That reduces the tendency for the resulting micronised glycopyrronium salt to agglomerate, which is a problem that is commonly observed in micronised quaternary ammonium derivatives.
• the process of the invention minimises dosing and delivery problems associated with agglomeration. It also enhances stability of the micronised glycopyrronium salt, which makes handling of the drug substance much easier and significantly enhances storage stability under various storage conditions (e.g. 25° C./60% relative humidity (RH), 30° C./75% RH).
• the present invention provides a process for preparing dry powder formulations of a glycopyrronium salt for inhalation that comprises the steps of (a) micronising a glycopyrronium salt together with an anti-adherent agent, and (b) admixing carrier particles to form the dry powder formulation.
• a glycopyrronium salt and an anti-adherent agent are micronised together or “co-micronised”.
• This in general terms, provides pulverising the glycopyrronium salt and an anti-adherent agent using mechanical means such that at least 90% but preferably at least 95% of the resulting particulate material has an average particle size that is less than about 7 microns in diameter.
• Glycopyrrolate is commercially available or may be prepared using the method described in U.S. Pat. No. 2,956,062. It is preferably crystalline and contains minimal amorphous parts.
• Glycopyrrolate has two stereogenic centres and hence exists in four isomeric forms, namely (3R,2′R)-, (3S,2′R)-, (3R,2′S)- and (3S,2′S)-3-[(cyclopentyl-hydroxyphenylacetyl)oxy]-1,1-dimethylpyrrolidinium bromide, as described in United States patent specifications U.S. Pat. No. 6,307,060 and U.S. Pat. No. 6,613,795. The contents of these patent specifications are incorporated herein by reference.
• the present invention embraces using one or more of these isomeric forms, especially the 3S,2′R isomer, the 3R,2′R isomer or the 2S,3′R isomer, thus including single enantiomers, mixtures of diastereomers, or racemates, especially (3S,2′R/3R,2′S)-3-[(cyclopentyl-hydroxy-phenylacetyl)oxy]-1,1-dimethylpyrrolidinium bromide.
• the anti-adherent agent reduces the cohesion between particles and stabilizes activated surfaces from glycopyrrolate, thus preventing fine particles becoming agglomerated. It provides a general stabilization of the particle size distribution of the micronised materials and thus improves the stability of the final dry powder blends with the carrier agent. Furthermore it enhance the stability of the micronised material upon handling and storage significantly
• Suitable anti-adherent agents include fatty acid derivatives including metal stearates such calcium stearate and magnesium stearate; crystalline sugars including monosaccharides, disaccharides, polysaccharides and sugar alcohols such as arabinose, glucose, fructose, ribose, mannose, sucrose, trehalose, lactose, maltose, starches, dextran, mannitol or sorbitol, especially lactose, but particularly lactose monohydrate or anhydrous lactose; amino acids such as leucine, phospholipids such as lecithin; sodium stearyl fumarate; sodium stearyl lactylate; phospatidylcholines, phosphatidylglycerols and other examples of natural and synthetic lung surfactants; liposomal formulations; lauric acid and its salts, for example, sodium lauryl sulphate, magnesium lauryl sulphate; trigly
• the anti-adherent agent is preferably in particulate form.
• glycopyrronium salt and/or the anti-adherent agent are sieved prior to co-micronising.
• glycopyrronium salt is mixed with the anti-adherent agent (or mixture of anti-adherent agents) to give a homogeneous blend prior to being co-micronised.
• the glycopyrronium salt is suitably micronised with from 1 to 20% by mass of the anti-adherent agent, more preferably from 2 to 10% by mass of the anti-adherent agent, but most preferably from 3 to 5% by mass of the anti-adherent agent.
• Micronising reduces the particle size of the glycopyrronium salt to a size that is suitable for administration by inhalation.
• the mass median aerodynamic diameter (MMAD) of these particles is preferably less than 10 microns ( ⁇ m). Particles having aerodynamic diameters greater than about 10 ⁇ m are likely to impact the walls of the throat and generally do not reach the lung. Particles having aerodynamic diameters in the range of about 2 ⁇ m to about 5 ⁇ m will generally be deposited in the respiratory bronchioles whereas smaller particles having aerodynamic diameters in the range of about 0.05 ⁇ m to about 2 ⁇ m are likely to be deposited in the alveoli and to be absorbed into the bloodstream.
• Co-micronising a glycopyrronium salt with an anti-adherent agent significantly reduces the micronised drug substance forming aggregates/agglomerates.
• Particles of the anti-adherent agent form a layer on the glycopyrronium salt particles that reinforce the desired effects of the anti-adherent agent, e.g. by reducing the tendency of the particles to agglomerate, particularly when exposed to humid conditions.
• the anti-adherent agent thus increases the physical stability of the micronised glycopyrronium salt particles. This overcomes or at least improves the problem of obtaining a suitable and stable fine particle fraction (FPF), which is commonly seen when formulating antimuscarinic agents.
• FPF fine particle fraction
• Micronising equipment is well known in the art and includes a variety of grinding and milling machinery, for example compressive-type mills such as mechanofusion mills, impact mills such as ball mills, homogenizers and microfluidizers, and jet mills.
• compressive-type mills such as mechanofusion mills
• impact mills such as ball mills
• homogenizers and microfluidizers and jet mills.
• crystalline glycopyrronium salt is jet milled in a Hosokawa Alpine® 100 AFG fluid bed opposed jet mill.
• Other suitable jet milling equipment includes Hosokawa Alpine® AFG140, AFG200, AFG280 and AFG400 jet mills.
• Suitable mixing equipment for any initial blending of the anti-adherent agent and the glycopyrronium salt includes low shear mixers such as a Turbula® powder blender and high-shear mixers such as a MiPro® powder blender.
• carrier particles are admixed with the co-micronised glycopyrronium salt and anti-adherent agent to form the dry powder formulation.
• the carrier particles are mixed with the micronised glycopyrronium salt and anti-adherent agent in a ratio of from 2000:1 to 5:1 by mass, especially from 200:1 to 20:1 by mass.
• the carrier particles may be composed of any pharmacologically inert material or combination of materials which is acceptable for inhalation. They are suitably composed of one or more crystalline sugars including monosaccharides, disaccharides, polysaccharides and sugar alcohols such as arabinose, glucose, fructose, ribose, mannose, sucrose, trehalose, lactose, maltose, starches, dextran, mannitol or sorbitol.
• An especially preferred carrier is lactose, for example lactose monohydrate or anhydrous lactose.
• substantially all (by weight) of the carrier particles have a diameter of 20 to 1000 ⁇ m, more preferably 50 to 500 ⁇ m, but especially 20 to 250 ⁇ m.
• the diameter of substantially all (by weight) of the carrier particles is suitably less than 355 ⁇ m. This provides good flow and entrainment characteristics and improved release of the active particles in the airways to increase deposition of the active particles in the lower lung. It will be understood that, throughout, the diameter of the particles referred to is the aerodynamic diameter of the particles.
• step (b) the dry powder obtained by step (b) is subjected to a final size reduction so that the dry powder meets desired physical properties.
• the glycopyrronium salt and the anti-adherent agent are micronised together with at least one (preferably one, two or three) additional active ingredient to give a fixed dose combination.
• That or each additional active ingredient is preferably selected from the group consisting of anti-inflammatory, bronchodilatory, antihistamine, decongestant and anti-tussive drug substances that are suitable for administration by inhalation, for example for the treatment of a respiratory disease.
• the or each additional active ingredient is most preferably selected from the group consisting of ⁇ 2 -adrenoceptor agonists, antimuscarinic agents, steroids, PDE4 inhibitors, A 2 , agonists and calcium blockers.
• Suitable ⁇ 2 -adrenoceptor agonists include albuterol (salbutamol), metaproterenol, terbutaline, salmeterol, fenoterol, indacaterol, procaterol, and especially, formoterol, carmoterol, TA-2005, GSK159797 and pharmaceutically acceptable salts thereof, and also compounds of EP 1440966, EP 1460064, EP 1477167, JP 05025045, US 2002/0055651, US 2004/0242622, US 2004/0229904, US 2005/0133417, US 2005/5159448, WO 93/18007, WO 99/64035, WO 00/75114, WO 01/42193, WO 01/83462, WO 02/66422, WO 02/70490, WO 02/76933, WO 03/24439, WO 03/42160, WO 03/42164, WO 03/72539, WO 03/91204, WO 03/99
• Suitable bronchodilatory drugs include anticholinergic or antimuscarinic agents, in particular ipratropium bromide, oxitropium bromide, tiotropium salts, CHF 4226 (Chiesi) and SVT-40776, but also those described in EP 424021, U.S. Pat. No. 3,714,357, U.S. Pat. No.
• Suitable dual anti-inflammatory and bronchodilatory drugs include dual ⁇ 2 -adrenoceptor agonist/muscarinic antagonists such as those disclosed in US 2004/0167167, US 2004/0242622, US 2005/182092, US 2005/256114, US 2006/35933, WO 04/74246, WO 04/74812, WO 04/89892 and WO 06/23475.
• Suitable steroids include glucocorticosteroids such as budesonide, beclamethasone, fluticasone, ciclesonide or mometasone, or those described in WO 02/88167, WO 02/12266, WO 02/100879 or WO 02/00679, especially those of Examples 3, 11, 14, 17, 19, 26, 34, 37, 39, 51, 60, 67, 72, 73, 90, 99 and 101, and non-steroidal steroid agonists such as those described in WO 00/00531, WO 02/10143, WO 03/082280, WO 03/082787, WO 03/104195 and WO 04/005229.
• Suitable PDE4 inhibitors include cilomilast (Ariflo® GlaxoSmithKline), Roflumilast (Byk Gulden), V-11294A (Napp), BAY19-8004 (Bayer), SCH-351591 (Schering-Plough), Arofylline (Almirall Prodesfarma), PD189659/PD168787 (Parke-Davis), AWD-12-281 (Asta Medica), CDC-801 (Celgene), KW-4490 (Kyowa Hakko Kogyo), VM554/UM565 (Vernalis), T-440 (Tanabe), KW-4490 (Kyowa Hakko Kogyo) and GRC 3886 (Oglemilast, Glenmark), but also those described in WO 92/19594, WO 93/19749, WO 93/19750, WO 93/19751, WO 98/18796, WO 99/16766,
• Suitable A2a agonists include those described in EP 409595A2, EP 1052264, EP 1241176, WO 94/17090, WO 96/02543, WO 96/02553, WO 98/28319, WO 99/24449, WO 99/24450, WO 99/24451, WO 99/38877, WO 99/41267, WO 99/67263, WO 99/67264, WO 99/67265, WO 99/67266, WO 00/23457, WO 00/77018, WO 00/78774, WO 01/23399, WO 01/27130, WO 01/27131, WO 01/60835, WO 01/94368, WO 02/00676, WO 02/22630, WO 02/96462, WO 03/086408, WO 04/039762, WO 04/039766, WO 04/045618 and WO 04/046083.
• Suitable calcium channel blockers include diltiazem, verapamil, amlodipine, felodipine, isradipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine and nisoldipine.
• the or each additional active ingredient is salmeterol, indacaterol or mometasone.
• Preferred triple combinations contain glycopyrronium bromide, salmeterol and mometasone; glycopyrronium bromide, indacaterol and mometasone; glycopyrronium bromide, salmeterol and ciclesonide; glycopyrronium bromide, indacaterol and ciclesonide; glycopyrronium bromide, salmeterol and 3-methyl-thiophene-2-carboxylic acid (6S,9R,10S,11S,13S,16R,17R)-9-chloro-6-fluoro-11-hydroxy-17-methoxycarbonyl-10,13,16-trimethyl-3-oxo-6,7,8,9,10,11,12,13,14,15,16,17-dodeca-hydro-3H-cyclopenta[a]phenanthren-17-yl ester; or glycopyrronium bromide, indacaterol and 3-methyl-thiophene-2-carboxylic acid (6S,9R,10S,11
• the dry powder of the present invention may be contained as unit doses in capsules of, for example, gelatin or hydroxypropylmethyl cellulose (HPMC), or in blisters (e.g. of aluminium or plastic), for use in a dry powder inhalation device, which may be a single dose or multi-dose device.
• a dry powder inhalation device which may be a single dose or multi-dose device.
• the total weight of powder per capsule or pre-metered unit is from 2 mg to 50 mg.
• the dry powder may be contained in a reservoir in a multi-dose dry powder inhalation (MDDPI) device adapted to deliver, for example, 3-25 mg of dry powder per actuation.
• MDDPI multi-dose dry powder inhalation
• a suitable device for delivery of dry powder in encapsulated form is described in U.S. Pat. No.
• MDDPI devices include those described in WO 97/20589 (including the CERTIHALERTM device), WO 97/30743 (including the TWISTHALERTM device) and WO 05/37353 (including the GYROHALERTM device).
• the magnesium stearate is well distributed over the drug substance surface.
• Lactose carrier particles (99.7% w/w of final composition) are admixed to give an inhalable dry powder.
• Drug substance 1 50 g of magnesium stearate are mixed with 1 kg of crystalline glycopyrronium bromide in a Turbula® blender for 5 hours. The resulting mixture is micronised using a Hosokawa Alpine® 100 AFG fluid bed opposed jet mill (equipped with 3 nozzles of 1.9 mm diameter) with the following parameters: classifier speed, 13000 rpm; milling gas pressure, 3.5 bar, to give particles that have an average particle size of less than 5 microns.
• Drug substance 2 1 kg of crystalline glycopyrronium bromide is micronised using a Hosokawa Alpine® 100 AFG fluid bed opposed jet mill (equipped with 3 nozzles of 1.9 mm diameter) with the following parameters: classifier speed, 13000 rpm; milling gas pressure, 3.5 bar, to give particles that have an average particle size of less than 5 microns.
• Formulation 1 Lactose carrier particles (99% w/w of final composition) are admixed with drug substance 2 to give an inhalable dry powder.
• Formulation 2 Lactose carrier particles (98.8% w/w of final composition) and magnesium stearate (0.15%) are admixed with drug substance 2 to give an inhalable dry powder.
• Formulation 3 Lactose carrier particles (98.8% w/w of final composition) and magnesium stearate (0.15%) are admixed with drug substance 1 to give an inhalable dry powder.
• the resulting powders are filled in aliquots of 25 mg into size 3 hydroxypropylmethylcellulose (HPMC) capsules.
• HPMC hydroxypropylmethylcellulose
• the resulting capsules are tested for aerodynamic particle size distribution (fine particle fraction) either immediately after manufacture or after storage under different conditions as outlined in Table 3 below.
• the fine particle fraction (FPF) and emitted dose (ED) of the powder in each capsule is measured using the Next Generation Impactor (NGI) particle-classifying cascade impactor at a flow rate of 85 L/min.
• NTI Next Generation Impactor
• the fine particle fraction relative to the emitted dose FPF(ED) of the various samples is shown in Table 1 below.
• the relative change in FPF(ED) as compared from initial is also shown in that Table.

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