Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
  • A61K31/05—Phenols
• • 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
  • A61K31/075—Ethers or acetals
  • A61K31/08—Ethers or acetals acyclic, e.g. paraformaldehyde
• • 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
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/235—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids having an aromatic ring attached to a carboxyl group
• • 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
  • A61K31/74—Synthetic polymeric materials
  • A61K31/765—Polymers containing oxygen
• • 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
  • A61K31/74—Synthetic polymeric materials
  • A61K31/765—Polymers containing oxygen
  • A61K31/77—Polymers containing oxygen of oxiranes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay
  • A61K33/10—Carbonates; Bicarbonates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/14—Alkali metal chlorides; Alkaline earth metal chlorides
• • 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
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
  • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/10—Laxatives

Definitions

• the present invention relates to solutions for the treatment of constipation or faecal impaction.
• it relates to concentrates for use in the preparation of solutions comprising polyethylene glycol (PEG) and electrolytes.
• PEG polyethylene glycol
• Constipation is a widespread condition which generally gives rise to discomfort.
• the physical presence of faeces retained in the colon and/or the rectum gives rise to a feeling of malaise and headaches.
• dyschezia may result from the presence of scybala or faecaliths in the rectum.
• Laxatives are agents that promote and assist defecation.
• Osmotic laxatives act to retain water in the colonic lumen thereby counteracting the normal dehydrating action of the colon. By suppressing the dehydration action of the colon, the osmotic laxative produces a faecal stream which is softer, bulkier and easier to expel.
• a number of osmotic laxative treatments currently in use comprise polyethylene glycol (PEG) and electrolytes.
• PEG polyethylene glycol
• electrolytes Various such PEG/electrolyte products are on the market in many countries.
• An example of such a product is MOVICOL (registered trademark of Edra AG, exclusively licensed to the Norgine group of companies, and marketed in the UK by Norgine Limited, Chaplin House, Widewater Place, Moorhall Road, Harefield, Uxbridge, Middlesex UB9 6NS, United Kingdom).
• MOVICOL is provided in a sachet containing 13.8 g powder for making up into an oral solution.
• Each sachet contains: 13.1250 g Macrogol (polyethylene glycol (PEG)) 3350, 0.3507 g sodium chloride, 0.1785 g sodium bicarbonate and 0.0466 g potassium chloride. This is the standard dose of MOVICOL. It also contains flavouring and sweetener. MOVICOL has been on the market since 1995. MOVICOL PLAIN is essentially the same as MOVICOL but it does not contain flavouring or sweetener, so to adjust for the potassium content of the sweetener, it contains slightly more potassium chloride.
• Each sachet of MOVICOL PLAIN contains: 13.1250 g Macrogol (polyethylene glycol (PEG)) 3350, 0.3508 g sodium chloride, 0.1786 g sodium bicarbonate and 0.0502 g potassium chloride.
• Macrogol polyethylene glycol (PEG)
• PEG polyethylene glycol
• each sachet gives the equivalent of: 65 millimoles/litre sodium, 53 millimoles/litre chloride, 17 millimoles/litre bicarbonate and 5.4 millimoles/litre potassium.
• MOVICOL One standard dose of MOVICOL is provided as a unit treatment in powder form in one sachet. Patients are advised to combine the powder contents of a sachet with water to make up a drink of 125 ml. It is found that dissolution can, in practice, take some time. It is important with a solution of the MOVICOL type that the patient does not to attempt to speed the dissolution by heating as that will lead to decomposition of the bicarbonate component. The time taken for the powder to dissolve causes inefficiency in the care-home or hospital setting where solutions are prepared by professional care-providers. In the self-administration domestic setting, it can cause frustration in the patient and risks the patient taking an incompletely dissolved preparation, which would reduce the efficacy of the treatment.
• the sachets are made of a laminate consisting of four layers: low density polyethylene, aluminium, low density polyethylene and paper. Some patients have difficulties manipulating and tearing open the sachets. The sachets are not re-usable.
• MOVICOL For the treatment of constipation, patients are advised to take one sachet dissolved to 125 ml 1-3 times a day, according to the severity of the constipation. Treatment with MOVICOL usually lasts about 2 weeks. There are various situations in which MOVICOL is recommended for longer treatments than 2 weeks, particularly in patients who take drugs that cause constipation (eg opioids, such as morphine) or have a disease that has associated constipation (for example Parkinson's disease or multiple sclerosis (MS)). Usually, for long term treatment in such chronic treatment situations, the number of doses per day can be adjusted down to either one or two.
• drugs that cause constipation eg opioids, such as morphine
• MS multiple sclerosis
• the recommended treatment is 8 sachets a day (each dissolved to 125 ml), taken within 6 hours. That number of doses may be needed for up to 3 days.
• MOVICOL sachets can be provided in boxes of 2, 6, 8, 10, 20, 30, 50, 60 or 100 sachets. Not all pack size boxes are necessarily marketed at any one time. Examples of marketed boxes are those containing 6, 30 or 100 sachets in the box (ie 6, 30 or 100 standard doses). Those boxes have the following dimensions:
• Each sachet measures roughly 12 cm by 7 cm and is flat, bulging to around 1 cm thickness when full.
• Concentrated solutions of some pharmaceuticals for dilution are known, and a small number are on the market.
• no concentrated solutions of PEG/electrolyes for dilution to PEG-containing laxatives have been developed to commercialisation.
• Concentrated solutions of PEG/sodium sulphate lavage solutions have been proposed (see WO 2005/049049 and JP 1-11-132527), but no such solutions have been commercialised.
• WO2005/049049 it was disclosed that “concentrated solutions of polyethylene glycol are chemically stable and do not support microbial growth” and thus do not need preservatives.
• a preservative is essential in solutions comprising N ⁇ (70 to 130) g/L PEG having an average molecular weight of 2500 to 4500, (b) N ⁇ (1.6 to 4.0) g/L sodium chloride, (c) N ⁇ (0.2 to 0.6) g/L potassium chloride, and (d) N ⁇ (0.6 to 2.2) g/L sodium bicarbonate (and no sodium sulphate), where N is in the range 2 to 8, for example in solutions comprising 350 to 600 g/L PEG having an average molecular weight of 2500 to 4500, 8.0 to 20 g/L sodium chloride, 1.0 to 3.0 g/L potassium chloride and 3.0 to 11 g/L sodium bicarbonate (and no sodium sulphate). Inclusion of a suitable amount of a suitable preservative in such a solution allows microbial growth to be limited or eliminated.
• the solution is a concentrate for N-fold dilution with water to provide a solution for ingestion comprising the following components at the following concentrations:
• the concentrate solution is preferably accompanied by instructions instructing the user to dilute with water by N-fold.
• N need not be an integer, but it is the same number for each component.
• Dilution of a solution of volume V by N-fold requires the addition of a volume (N ⁇ 1) ⁇ V of water.
• N is from 3 to 7, for example from 4 to 6, for example 5.
• the amount of PEG is N ⁇ (70 to 120) g /L, more preferably N ⁇ (80 to 120) g/L, more preferably N ⁇ (95 to 115) g/L, for example N ⁇ 105 g/L.
• the amount of sodium chloride N ⁇ (2.1 to 3.5) g/L, more preferably N ⁇ (2.4 to 3.2) g/L, more preferably N ⁇ (2.6 to 3.0) g/L, for example approximately N ⁇ 2.8 g, for example N ⁇ 2.8056 g/L.
• the amount of potassium chloride is N ⁇ (0.28 to 0.45) g/L, more preferably N ⁇ (0.32 to 0.42) g/L, more preferably N ⁇ (0.35 to 0.40) g/L, for example approximately N ⁇ 0.37 g/L, for example N ⁇ 0.3728 g/L.
• the amount of sodium bicarbonate is N ⁇ (1.1 to 1.7) g/L, more preferably N ⁇ (1.2 to 1.6) g/L, more preferably N ⁇ (1.35 to 1.50) g/L, for example approximately N ⁇ 1.4 g/L, for example N ⁇ 1.428 g/L.
• the invention provides a concentrate solution in water comprising the following components at the following concentrations:
• Solutions of the invention are preferably substantially free from any sulphate component.
• solutions of the invention are preferably substantially free from sodium sulphate.
• substantially free from any sulphate component is taken to mean free from any added sulphate component.
• Negligible amounts of sulphate salts may be present in other added components, or in the water that is used in the solutions. Such amounts are not substantial in this context.
• the solution of the invention is diluted with additional water to provide a medicament for drinking by a patient.
• the solution of the invention can thus be regarded as a concentrate.
• a solution of the invention is, for example, diluted with approximately four times its volume of water to generate an approximately five-fold diluted solution.
• a 25 ml unit of the concentrate solution may be diluted with from 75 to 125 ml of water to give a solution of from 100 ml to 150 ml.
• a “solution” in the context of the present invention includes any mixture resulting from admixture of or combination of the components (a) to (g) with water, whether fully dissolved or not. In a preferred embodiments, the components (a) to (g) are fully dissolved.
• the solutions of the invention can be diluted to the concentration required for ingestion more rapidly than the dry powders of the prior art.
• the solution at the concentration for ingestion is prepared essentially instantly once the concentrate solution of the invention is mixed with the diluting water. There is no delay for the dissolution of dry powder.
• the rapid preparation of the solution for ingestion reduces the time taken to prepare the medicament. That reduction in time brings about improved efficiency in the care-home or hospital setting where solutions are prepared by professional care-providers. In the self-administration, domestic setting, it reduces the risk of patient frustration and improves patient compliance.
• a unit treatment may be provided in a unit container.
• Suitable containers include bottles, pouches, vials or sealed cups. Such containers suitably have the volume required to accommodate the unit treatment. Preferably, they do not include air-pockets or significant wasted space. In that way, storage space is minimized.
• the unit containers are appropriately shaped for efficient packing (eg cylindrical, cuboid or hexagonal, though many other shapes are possible), and provided wasted volume is minimised, a unit treatment can be stored in a volume only little greater than its own volume.
• a solution of the invention comprises 525 g of PEG 3350 per litre and N is 5, then 25 ml of that is required to provide the 13.125 g of PEG in a standard dose and, in storage, that will occupy (with its container) only slightly more than 25 cm 3 , for example 30 cm 3 . That represents a space saving of around 20 cm 3 compared with the over 50 cm 3 storage space required per unit treatment (ie per standard dose) mentioned above in relation to sachets of dry powder comprising the same quantity of ingredients.
• the solution of the invention may be provided in a container having a volume that is for multiple unit treatments.
• the invention thus further provides a container that contains sufficient solution for any convenient number of unit treatments.
• the container might provide 1, 2, 4, 5, 8, 10, 12, 15, 20, 25, 30, 35, 40, 50, 60, 70, 75, 80 or 100 unit treatments.
• a container may provide 25 ml, 50 ml, 100 ml, 125 ml, 150 ml, 200 ml, 250 ml, 300 ml, 375 ml, 500 ml, 625 ml, 750 ml, 875 ml or 1 l of solution.
• a container may contain one or more unit treatments of solution, each unit treatment having a volume of 20 to 50 ml, for example 25 ml, or each unit treatment having a volume of 7.5 to 25 ml, for example 12.5 ml.
• a container (for example a bottle) of the invention provides 100 ml, 150 ml, 250 ml or 500 ml of solution of the invention.
• Suitable containers include bottles, for example with a re-closable closure.
• a re-closable closure may be child-proof.
• a re-closable closure may be tamper-evident.
• Containers may for example be made of plastic or glass, for example polyethylene terephthalate (PET). They may be circular in cross-section, for example they may be a right circular cylinder. They may be transparent, translucent or opaque; containers may be coloured, for example amber.
• PET polyethylene terephthalate
• 20 unit treatments are provided in a container of 500 ml volume.
• the container can be designed with a shape that takes up minimal unnecessary space and thus the 20 unit treatments may be stored in a volume of only a little over 500 cm 3 . That is to say that they occupy only slightly over 25 cm 3 each. That represents a space saving of around 20 cm 3 compared with the over 50 cm 3 storage space required per standard dose mentioned above in relation to sachets of dry powder comprising the same quantity of ingredients.
• a container containing multiple unit treatments has further practical and environmental advantages in that it is easier to use and generates less waste than multiple sachets. Such a container can potentially be re-used or recycled, something that is not possible with sachets.
• a solution must satisfy the following: 3 log units drop in number of viable micro-organisms for bacteria over 14 days (typically assessed using Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus, the drop being required for each), and I log unit drop for yeasts and moulds over 14 days (typically assessed using Candida albicans and Aspergilus niger ). Also, for bacteria and yeasts/moulds, there must then be no increase from 14 days to 28 days.
• preservatives are known for use in liquid oral preparations.
• examples of such preservatives include sodium propyl paraben, methyl paraben, ethyl paraben, propyl paraben, benzyl alcohol and phenoxyethanol.
• Further preservatives that are known for use in liquid oral preparations (including foods) include benzoic acid, dehydroacetic acid, sorbic acid, Bronopol, propylene glycol and glyceryl triacetate. Alcohols are used as preservatives in some preparations.
• the preservative component may comprise one, two or more preservatives.
• the preservative may be (i) a separate component from the other components of the solution and mixed therewith, (ii) a constituent part of a flavouring component (f), sweetener component (g) or other component of a solution of the invention, or (iii) both (i) and (ii).
• Particularly preferred preservatives are those that are active and/or do not degrade over time at alkaline pH.
• Preferred preservatives include sodium propyl paraben, methyl paraben, ethyl paraben, propyl paraben, benzyl alcohol, phenoxyethanol, propylene glycol, glyceryl triacetate and blends of two or more of those.
• Methyl paraben, ethyl paraben, propyl paraben, benzyl alcohol and phenoxyethanol and blends of two or more of those are particularly preferred.
• Appropriate preservatives may be provided as salts, for example sodium salts.
• a preservative is preferably not provided as a salt; if a preservative is provided as a salt, then the electrolyte components (b) to (d) may need to be adjusted so that the total concentration of each electrolyte remains at the required level. For example, if a preservative is used in the form of a sodium salt, it may be necessary to reduce the amount of sodium chloride present.
• preservative level does not exceed recommended safe levels for oral use.
• ADI accepted daily intake
• suitable regulatory bodies for example the EFSA.
• the preservative may be present at a level of from 0.5 to 10 g per litre of solution (ie 0.05 to 1 w/v %), for example 1.5 to 7.0 g per litre of solution (ie 0.15 to 0.7 w/v %).
• a preservative may be present at a level of from 1.0 to 5.0 g per litre of solution (ie 0.1 to 0.5 w/v %), for example 2.0 to 4.0 g per litre of solution (ie 0.2 to 0.4 w/v %).
• a preservative may be present at a level of from N ⁇ (0.1 to 2.0) g per litre of solution, for example from N ⁇ (0.3 to 1.4) g per litre of solution, for example from N ⁇ (0.2 to 1.0) g per litre of solution, for example N ⁇ (0.4 to 0.8) g per litre of solution.
• Certain preservatives have limited solubility in water.
• the effectiveness of a preservative can be improved by the inclusion of a solubilising agent.
• solubilising agents include benzyl alcohol, phenoxyethanol and propylene glycol.
• a solubilising agent may be (i) a separate component from the other components of the solution and mixed therewith, (ii) a constituent part of a preservative component (e), a flavouring component (f), sweetener component (g) or other component of a solution of the invention, or (iii) both (i) and (ii). It is important that the level of a solubilising agent in any oral formulation does not exceed recommended safe levels.
• a preservative comprises 20-30% by weight (relative to the weight of the preservative) paraben (which may be a single paraben or a mixture of parabens), and 70-80% by weight solubiliser. It is thus preferred that, in one embodiment, a solution of the invention includes one or both of methyl paraben and ethyl paraben, and benzyl alcohol. In an embodiment, a solution of the invention includes one or both of methyl paraben and ethyl paraben, and phenoxyethanol.
• suitable preservatives should fulfil multiple criteria: they should be active and/or not degrade over time at alkaline pH, and be sufficiently effective to fulfill national and regional pharmacopoeial criteria regarding micro-organism growth when used in an amount that is safe for human consumption.
• a blend of methyl paraben, ethyl paraben and benzyl alcohol is particularly effective as a preservative component in a solution of the invention (not containing sodium sulphate), and that effective anti-microbial preservation is achieved with a particularly low level of preservative.
• a solution of the invention includes all three of methyl paraben, ethyl paraben and benzyl alcohol.
• they may be present in a weight ratio methyl paraben: ethyl paraben: benzyl alcohol of 1 to 3:1:5 to 12, for example 1.5 to 2.5:1 7 to 9.
• a weight ratio methyl paraben: ethyl paraben: benzyl alcohol of 1 to 3:1:5 to 12, for example 1.5 to 2.5:1 7 to 9.
• the ratio 18:9:73 in the ratio 18:9:73.
• a blend of methyl paraben, ethyl paraben and benzyl alcohol is present at a level of from N ⁇ (0.3 to 1.4) g per litre of solution, preferably from 1.5 to 7.0 g per litre of solution (ie 0.15 to 0.70 w/v %), preferably from 2.0 to 7.0 g per litre of solution (ie 0.20 to 0.70 w/v %), for example (particularly when the solution comprises an Orange Juice flavour) from 2.5 to 7.0 g per litre of solution (ie 0.25 to 0.7 w/v %), for example 2.5 to 5.0 g per litre of solution (ie 0.25 to 0.5 w/v %).
• a preferred solution comprises 2.5 g or 3.5 g of a blend of methyl paraben, ethyl paraben and benzyl alcohol per litre, for example 2.5 g or 3.5 g per litre of a blend of methyl paraben (18%), ethyl paraben (9%) and benzyl alcohol (73%), the weight % being based on the weight of the preservative component.
• a preferred concentrate solution of the invention comprises:
• N is in the range of 2 to 8.
• a preferred concentrate solution of the invention comprises the following components at the following concentrations:
• a solution of the invention includes all three of methyl paraben, ethyl paraben and phenoxyethanol.
• they may be present in a weight ratio methyl paraben:ethyl paraben:phenoxyethanol of 1 to 3:1:5 to 12, for example 1.2 to 2.5:1:7 to 9.
• methyl paraben:ethyl paraben:phenoxyethanol 1 to 3:1:5 to 12, for example 1.2 to 2.5:1:7 to 9.
• the ratio 18:9:73, or 15:10:75 in the ratio 18:9:73, or 15:10:75.
• a blend of methyl paraben, ethyl paraben and phenoxyethanol may be present at a level of from N ⁇ (1.0 to 2.0 g) per litre of solution, preferably from 5.0 to 10 g per litre of solution (ie 0.5 to 1.0 w/v %), for example 5.0 to 8.0 g per litre of solution (ie 0.5 to 0.8 w/v %).
• a solution comprises 5.0 g of a blend of methyl paraben, ethyl paraben and phenoxyethanol per litre, for example 5.0 g per litre of a blend of methyl paraben (18%), ethyl paraben (9%) and phenoxyethanol (73%), the weight % being based on the weight of the preservative component.
• a concentrate solution of the invention comprises:
• N is in the range of 2 to 8.
• a concentrate solution in water comprising the following components at the following concentrations:
• the polyethylene glycol (PEG) used in solutions of the invention has an average molecular weight (for example a weight average molecular weight), of 2500 Da to 4500 Da.
• the PEG may have an average molecular weight of 3000 to 4000.
• the PEG may be PEG 3350 or PEG 4000 as defined in national pharmacopoeias.
• suitable PEGs recognized in some national pharmacopoeias include Macrogols, for example Macrogol 4000.
• the PEG used in compositions of the invention may comprise two or more different PEG compounds.
• the upper limit of concentration of the PEG may be limited by the water solubility of the PEG.
• Solutions of the invention therefore preferably comprise PEG in an amount of 350 to 600 g per litre, preferably within a range wherein the lower limit is 400, 450 or 500 g per litre and the upper limit is, independently, 600, 575 or 550 g per litre; for example 500 to 550 g per litre.
• a solution of the invention may comprise 525 g of PEG per litre, for example 525 g of PEG 3350 per litre.
• Solutions of the invention preferably comprise sodium chloride in an amount of 8.0 to 20 g per litre of solution to be made, preferably within a range wherein the lower limit is 10, 11, 12 or 13 g per litre and the upper limit is, independently, 18, 17, 16 or 15 g per litre; for example 13 to 15 g per litre.
• a solution of the invention may comprise approximately 14 g of sodium chloride per litre, for example 14.028 g per litre.
• Solutions of the invention preferably comprise potassium chloride in an amount of 1.0 to 3.0 g per litre, preferably within a range wherein the lower limit is 1.2, 1.4, 1.6, 1.7 or 1.8 g per litre and the upper limit is, independently, 2.7, 2.5, 2.3, 2.1 or 2.0 g per litre; for example 1.6 to 2.1 g per litre, for example 1.8 to 1.9 g per litre.
• a solution of the invention may comprise 1.864 g of potassium chloride per litre.
• An alternative solution of the invention may comprise 1.268 g or 2.008 g of potassium chloride per litre.
• the potassium ion content may be provided by a potassium salt other than potassium chloride.
• Solutions of the invention preferably comprise sodium bicarbonate (also known as sodium hydrogen carbonate) in an amount of 3.0 to 11 g per litre, preferably within a range wherein the lower limit is 5.0, 6.0, 6.5 or 7.0 g per litre and the upper limit is, independently, 10, 9.0, 8.0 or 7.5 g per litre; for example 6.5 to 8.0 g per litre.
• a solution of the invention may comprise approximately 7.1 g per litre, for example 7.140 g per litre.
• the weight ratio of the components PEG, sodium chloride, potassium chloride and sodium bicarbonate is preferably approximately 13.125(PEG): 0.3507 (NaCl): 0.0466 (KCl): 0.1785 (NaHCO 3 ), ie approximately 282 (PEG): 7.5 (NaCl): 1 (KCl): 3.8 (NaHCO 3 ).
• the molar ratio of the individual ions in the components sodium chloride, potassium chloride and sodium bicarbonate is preferably approximately 65(Na + ): 53 (CO: 5.0 (K + ): 17 (HCO 3 ⁇ ), ie approximately 13 (Na + ): 10.6 (Cl ⁇ ): 1 (K + ): 3.4 (HCO 3 ⁇ ).
• the invention provides a solution in water comprising the following components at the following concentrations:
• the solution is a concentrate for N-fold dilution with water to provide a solution for ingestion comprising the following components at the following concentrations:
• the concentrate solution is preferably accompanied by instructions instructing the user to dilute with water by N-fold.
• N need not be an integer, but it is the same number for each component.
• Dilution of a solution of volume V by N-fold requires the addition of a volume (N ⁇ 1) ⁇ V of water.
• N is from 3 to 7, for example from 4 to 6, for example 5.
• the concentration of PEG is N ⁇ (28 to 36) mmol/L, for example N ⁇ 31.3mmol/L.
• the concentration of sodium ions is N ⁇ (49 to 80) mmol/L, more preferably N ⁇ (60 to 70) mmol/L, for example N ⁇ 65 mmol/L.
• the concentration of potassium ions is N ⁇ (3.8 to 6.0) mmol/L, more preferably N ⁇ (5.1 to 5.7) mmol/L, for example N ⁇ 5.4 mmol/L.
• the concentration of chloride ions is N ⁇ (40 to 66) mmol/L, more preferably N ⁇ (47 to 59) mmol/L, for example N ⁇ 53 mmol/L.
• the concentration of bicarbonate ions is N ⁇ (13 to 20) mmol/L, more preferably N ⁇ (15 to 19) mmol/L, for example N ⁇ 17 mmol/L.
• the invention provides a solution in water comprising the following components at the following concentrations:
• Solutions of the invention preferably comprise sodium present as sodium ions in an amount of 173 to 473 mmol per litre, preferably within a range wherein the lower limit is 231, 259, 282 or 305 mmol per litre and the upper limit is, independently, 427, 398, 369 or 345 mmol per litre; for example 305 to 345 mmol per litre.
• a solution of the invention may comprise approximately 325 mmol sodium present as sodium ions per litre.
• solutions of the invention preferably comprise potassium present as potassium ions in an amount of 14 to 43 mmol per litre, preferably within a range wherein the lower limit is 17, 23 or 26 mmol per litre and the upper limit is, independently, 39, 34 or 29 mmol per litre; for example from 26 to 29 mmol per litre.
• a solution of the invention may comprise approximately 27 mmol potassium present as potassium ions per litre.
• solutions of the invention preferably comprise potassium present as potassium ions in an amount of 13 to 40 mmol per litre, preferably within a range wherein the lower limit is 16, 19, 21, 23 or 24 mmol per litre and the upper limit is, independently, 36, 34, 31, 28 or 27 mmol per litre; for example 21 to 28 mmol per litre, for example from 24 to 25 mmol per litre.
• a solution of the invention may comprise approximately 25 mmol potassium present as potassium ions per litre.
• Solutions of the invention preferably comprise chloride ions in an amount of 150 to 382 mmol per litre, preferably within a range wherein the lower limit is 187, 207, 226 or 245 mmol per litre and the upper limit is, independently, 344, 325, 305 or 284 mmol per litre; for example from 246 to 281 mmol per litre.
• a solution of the invention may comprise approximately 265 mmol chloride ions per litre.
• Solutions of the invention preferably comprise bicarbonate ions in an amount of 36 to 131 mmol per litre, preferably within a range wherein the lower limit is 60, 71, 77 or 83 mmol per litre and the upper limit is, independently, 119, 107, 95 or 89 mmol per litre; for example 77 to 95 mmol per litre.
• a solution of the invention may comprise approximately 85 mmol per litre.
• Solutions of the invention optionally comprise one or more flavourings.
• Flavourings assist in making the solutions in their diluted form for ingestion more palatable to certain patients.
• a flavouring may be present at a level of N ⁇ (0.2 to 2) g per litre, for example 1 to 10 g per litre, for example from 1 to 5 g per litre, especially from 2 to 4 g per litre, for example 3.2 g per litre.
• flavours that can be used include orange, lemon-lime, lemon, citrus, chocolate, tropical fruit, aloe vera, tea, strawberry, grapefruit, blackcurrant, pineapple and vanilla.
• Preferred flavours are orange juice flavour and tropical fruit flavour.
• Citrus flavour may also be used.
• flavourings are available from various flavour manufacturers and suppliers, for example International Flavours and Fragrances Inc. (Duddery Hill, Haverhill, Suffolk, CB9 8LG, England), Ungerer & Company (Sealand Road, Chester, England CH1 4LP), Firmenich (Firmenich UK Ltd., Hayes Road, Southall, Middlesex UB2 5NN) or S. Black Ltd (Foxholes Business Park, John Tate Road, Hertford, Herts, SG13 7YH, United Kingdom).
• Solutions of the invention may comprise one or more sweeteners.
• Preferred sweeteners include aspartame, acesulfame potassium (acesulfame K), sucralose and saccharine and combinations thereof.
• solutions of the invention may comprise one or both of sucralose and acesulfame potassium (acesulfame K).
• a sweetener may be present at a level of N ⁇ (0.02 to 0.2) g per litre, for example 0.1 to 1 g per litre
• acesulfame K is present in an amount of N ⁇ (0.04 to 0.12)g per litre, preferably 0.20 to 0.60 g per litre, preferably within in a range in which the lower limit is 0.20, 0.30 or 0.35 g per litre and the upper limit is, independently, 0.60, 0.50 or 0.45 g per litre.
• a solution of the invention may comprise 0.40 g acesulfame K per litre.
• solutions of the invention preferably comprise acesulfame ions in an amount of 1.0 to 3.0 mmol per litre, preferably within in a range in which the lower limit is 1.0, 1.5 or 1.7 mmol per litre and the upper limit is, independently, 3.0, 2.5 or 2.2 mmol per litre.
• a solution of the invention may comprise approximately 2.0 mmol acesulfame ions per litre.
• the invention provides a solution in water comprising the following components at the following concentrations:
• the solution is a concentrate for N-fold dilution with water to provide a solution for ingestion comprising the following components at the following concentrations:
• the concentrate solution is preferably accompanied by instructions instructing the user to dilute with water by N-fold.
• N need not be an integer, but it is the same number for each component.
• Dilution of a solution of volume V by N-fold requires the addition of a volume (N ⁇ 1) ⁇ V of water.
• N is from 3 to 7, for example from 4 to 6, for example 5.
• the invention provides a solution in water, comprising the following components at the following concentrations:
• the molar ratio of the individual ions in the components sodium chloride, potassium chloride, sodium bicarbonate and acesulfame K is preferably approximately 65(Na + ): 53 (Cl ⁇ ): 5.4 (K + ): 17 (HCO 3 ⁇ ), ie approximately 12 (Na + ): 10 (Cl ⁇ ): 1 (K + ): 3 (HCO 3 ⁇ ),
• sucralose is present in an amount of N ⁇ (0.012 to 0.04) g per litre, preferably 0.06 to 0.20 g per litre, preferably within in a range in which the lower limit is 0.06, 0.08 or 0.10 g per litre and the upper limit is, independently, 0.20, 0.18, 0.16 or 0.14 g per litre.
• a solution of the invention may comprise 0.12 g sucralose per litre.
• the solution comprises both sucralose and acesulfame potassium (acesulfame K).
• acesulfame K is present in an amount of 0.20 to 0.60 g per litre and sucralose is present in an amount of 0.06 to 0.20 g per litre.
• acesulfame K is present in an amount within a range in which the lower limit is 0.20, 0.30 or 0.35 g per litre and the upper limit is, independently, 0.60, 0.50 or 0.45 g per litre
• sucralose is present in an amount within a range in which the lower limit is 0.06, 0.08 or 0.10 g per litre and the upper limit is, independently, 0.20, 0.18, 0.16 or 0.14 g per litre.
• a solution of the invention may comprise 0.40 g acesulfame K per litre and 0.12 g sucralose per litre.
• Solutions of the invention are preferably substantially free from added citrate ions.
• Citrate ions are provided for example by citric acid and sodium citrate.
• Some fruit flavourings may intrinsically contain a small amount of citric acid. Those amounts are not considered substantial in this context.
• Solutions of the invention are preferably substantially free from added acid.
• Hydrogen ions are provided for example by organic acids (for example citric acid or ascorbic acid) or inorganic acids (for example hydrochloric acid).
• Some fruit flavourings may intrinsically contain small amounts of organic acids. Those amounts are not considered substantial in this context.
• Solutions of the invention preferably have a pH of 8.0 to 11.0, preferably 8.0 to 10.5, for example 8.4 to 9.0. Measurements of pH may, for example, be carried out with a Hanna Instruments “pH ep” temperature compensating pH meter.
• the invention further provides a method of preparing a concentrate solution of the invention comprising combining the following components with water to the following concentrations:
• the method comprises combining the following components with water to the following concentrations:
• preservative optional flavouring or optional sweetener and the amounts of the components
• a concentrate solution comprising (a) 525 g/L PEG having an average molecular weight of 2500 to 4500; (b) 14,028 g/L sodium chloride; (c) 1.864 g/L potassium chloride; (d) 7.140 g/L sodium bicarbonate; (e) 2.5 or 3.5 g/L preservative; (f) 3.2 g/L flavouring; and (g) 0.52 g/L sweetener (for example it may comprise 0.40 g/L acesulfame K and 0.12 g/L sucralose), approximately 549 ml of water are needed.
• a concentrate solution in water comprising the following components at the following concentrations:
• the solution is a concentrate for N-fold dilution with water to provide a solution for ingestion comprising the following components at the following concentrations:
• the concentrate solution is preferably accompanied by instructions instructing the user to dilute with water by N-fold.
• N need not be an integer, but it is the same number for each component.
• Dilution of a solution of volume V by N-fold requires the addition of a volume (N ⁇ 1) ⁇ V of water.
• N is from 3 to 7, for example from 4 to 6, for example 5.
• such a solution has the following components at the following concentrations:
• the solution has the preferred features described elsewhere herein.
• Containers and kits comprising such solutions, methods of preparing such solutions are also provided.
• the preservative may be present in a concentration of 2.5 or 3.5 g/L.
• the flavouring may be present in a concentration of 3.2 g/L.
• the sweetener may be present in a concentration of 0.52 g/L (for example it may comprise 0.40 g acesulfame K and 0.12 g sucralose). Such a solution is typically diluted five-fold for use.
• the preservative may be present in a concentration of 2.0 or 2.8 g/L.
• the flavouring may be present in a concentration of 2.56 g/L.
• the sweetener may be present in a concentration of 0.416 g/L (for example it may comprise 0.32 g acesulfame K and 0.096 g sucralose). Such a solution is typically diluted four-fold for use.
• the solution of the invention is combined with additional water to provide a medicament for drinking by a patient.
• a 25 ml unit of the solution may be diluted with from 75 to 125 ml of water to give a solution of from 100 ml to 150 ml.
• very accurate dilution is not generally possible or convenient.
• the dilution step might be referred to as diluting a 25 ml unit of solution (which might be referred to as “5 teaspoons”) with water to make a 125 ml solution (which might be referred to as “approximately half a glass of solution”).
• a 25 ml unit of solution is diluted in 100 ml of water to give 125 ml of final solution for drinking.
• a typical dose is 125 ml of diluted solution, and such a dose preferably contains the active ingredients in the amounts shown in the Table below (in addition to any preservative, flavouring and sweetener).
• the active ingredients in the amounts shown in the Table below (in addition to any preservative, flavouring and sweetener).
• a separate set of amounts is shown for a “plain” solution.
• a typical dose is 62.5 ml of diluted solution and such a dose preferably contains the alternative amounts of active ingredients shown in the Table below:
• an appropriate volume of the concentrate solution of the invention is diluted with water to make 125 ml.
• the invention further provides a unit treatment of a solution of the invention, the unit treatment having the volume necessary to provide 11 to 15 g of PEG when diluted with water to 125m1.
• An alternative unit treatment of a solution of the invention has the volume necessary to provide 5.5 to 7.5 g of PEG when diluted to 62.5 ml.
• a unit treatment has the volume necessary to provide the components in the amounts shown in the table immediately above.
• a unit treatment may be from 10 to 50 ml of the concentrate solution of the invention.
• a solution of the invention comprises 525 g of PEG 3350 per litre, then 25 ml are required to provide the amount of PEG shown in the table above.
• a unit treatment is thus preferably from 20 to 40 ml, for example 25 to 30 ml, especially 25 ml.
• the invention further provides a unit treatment of from 10 to 50 ml of the solution of the invention.
• a unit treatment is from 20 to 40 ml, for example 25 to 30 ml, especially 25 ml.
• all of the quantities in a unit treatment are halved.
• the invention provides a unit treatment comprising 7.8 to 62.5 ml of water comprising the following components at the following concentrations:
• N is in the range of 2 to 8.
• a unit treatment may comprise 10 to 50 ml of a solution in water comprising the following components at the following concentrations:
• the solution in a unit treatment has the features mentioned above in relation to the solutions of the invention.
• a unit treatment may comprise 7.8 to 62.5 ml, for example 10 to 50 ml of a solution in water comprising the following components in the following weights:
• a preferred unit treatment comprises 10 to 50 ml of a solution in water comprising the following components in the following weights:
• a preferred unit treatment comprises 20 to 50 ml of a solution in water comprising the following components in the following weights:
• Such a unit treatment is, for example, for dilution with water in a volume dependent on the concentration of the ingredients.
• a 20 ml unit treatment would typically be combined with 105 ml of water; a 25 ml unit treatment would typically be combined with 100 ml of water; a 30 ml unit treatment would typically be combined with 95 ml of water; a 40 ml unit treatment would typically be combined with 85 ml of water and a 50 ml unit treatment would typically be combined with 75 ml of water.
• an alternative preferred unit treatment comprises 10 to 25 ml of a solution in water comprising the following components in the following weights:
• Such a unit treatment is, for example, for dilution with water in a volume dependent on the concentration of the ingredients.
• a 10 ml unit treatment would typically be combined with 52.5 ml of water; a 15 ml unit treatment would typically be combined with 47.5 ml of water; a 20 ml unit treatment would typically be combined with 42.5 ml of water; a 25 ml unit treatment would typically be combined with 37.5 ml of water.
• the invention provides a container containing a solution of the invention.
• a container may, for example, contain:
• a container may contain:
• Such a container may, for example, contain:
• An alternative container may contain:
• An alternative container may contain:
• An alternative container may contain:
• preservative, flavouring and sweetener are as described above in relation to solutions of the invention, adjusted where necessary for the amount of water in the containers.
• the solutions of the present invention are preferably provided with instructions for use.
• the instructions may instruct the user to dilute a stated volume of the solution of the invention with a stated volume of water.
• the instructions may instruct the user to dilute the solution to a volume of 125 ml for use. If the solution of the invention comprises 525 g of PEG 3350 per litre, then 25 ml are required to provide the amount of PEG shown in the table above, and the instructions may instruct the user to dilute 25 ml of the solution with 100 ml of water. 25 ml equates to 5 conventional teaspoons. 100 ml equates to a conventional “half glassful of water”.
• the instructions may instruct the user to dilute 12.5 ml of the solution with 50 ml of water. 12.5 ml equates to 2.5 conventional teaspoons. 50 ml equates to a conventional “quarter glassful of water”.
• the invention further provides a kit comprising a container containing a solution of the invention together with instructions as set out above, for example instructing the user to dilute a stated volume of the solution of the invention with a particular volume of water.
• the invention further provides a kit comprising a container containing a solution of the invention together with a measuring accessory for measuring out a defined volume of the solution. Examples of measuring accessories include measuring cups, measuring spoons, measuring tubes, and syringes. If the solution of the invention comprises 525 g of PEG 3350 per litre, then 25 ml are required to provide the amount of PEG shown in the table above.
• the measuring accessory preferably enables the measurement of a 25 ml unit treatment out of the bottle.
• the measuring accessory may be adapted to attach to the container, for example it may be in the form of a cap that fits over and grips onto the closure of the container in storage and can be held separately from the container for measuring out a required volume of solution.
• the measuring accessory may have a measurement volume such that several measurement accessories-ful provide the required unit treatment volume. For example, for the provision of a 25 ml unit treatment volume, a measuring accessory might provide for measuring a volume of 25 ml, 12.5 ml (two needed), 8.333 ml (three needed), 6.25 ml (4 needed) or 5 ml (5 needed).
• a suitable measuring accessory may have the required volume as its total capacity, or it may be provided with one or more gradation lines to indicate the required volume.
• the measuring accessory is a cap that provides for the measurement of a 25 ml unit volume.
• a container may be provided in an outer packaging, such as a carton. Instructions may be provided on a medium, for example paper, inside the outer packaging. Instructions may be printed onto the outer packaging, or onto the container itself.
• a carton may contain the container, a measuring accessory and instructions.
• the invention provides a method of preparing a solution for the treatment of constipation or faecal impaction, which method comprises combining a volume (for example a treatment unit volume) of a solution of the invention with water.
• the invention provides a method of preparing a laxative solution comprising combining a volume (for example a treatment unit volume) of a solution of the invention with water.
• the invention further provides a laxative solution or a faecal impaction treatment solution that has been prepared by combining a solution of the invention with water.
• the present invention also provides a method of treating constipation or faecal impaction comprising administering orally to a subject a laxative solution prepared by combining a solution of the invention with water.
• the invention also provides a solution prepared by combining a solution of the invention with water for use as a medicament; for example the medicament can be for use in the treatment of constipation or faecal impaction.
• a solution for use in a method of the invention has the preferred features described above in respect of the solutions of the invention.
• a patient is instructed to take 25 ml of a solution of the invention diluted in 100 ml water 1-3 times daily in divided doses, according to the individual response or the severity of the constipation.
• a patient is instructed to take 25 ml of a solution of the invention diluted in 100 ml water 1-8 times daily, according to the individual response or the severity of the faecal impaction.
• the invention further provides a solution in water, of the following components at the following concentrations:
• Sucralose may, for example, be present in an amount of 0.012 to 0.04 g per litre, preferably within in a range in which the lower limit is 0.012, 0.016 or 0.020 g per litre and the upper limit is, independently, 0.004, 0.036, 0.032 or 0.028 g per litre.
• a solution may comprise 0.024 g sucralose per litre.
• the solution may comprise optional preservative (e), optional flavouring (f) and optional additional sweetener (g2) of the types described elsewhere herein.
• concentrations of the components (a) to (g2) in such a solution are preferably the amounts arrived at after dilution of a concentrate solution of the invention described above, for example the concentration of a component may be one fifth of the concentration described above for that component in relation to a concentrate solution of the invention.
• the solution is suitable for use as a medicament, for example for the treatment of constipation, or faecal impaction, and a method of treatment of such conditions is also provided.
• the stated components may be provided in a form for combination with water to provide such a solution.
• the components may be provided as a concentrated solution in water, or as a dry powder.
• a dry powder may be provided in a sachet, for example containing a unit dose.
• a sachet may contain 13.1250 g Macrogol (Polyethylene glycol) 3350, 0.3507 g sodium chloride, 0.1785 g sodium bicarbonate, 0.0466 or 0.0502 g potassium chloride and sucralose.
• the invention further provides a solution in water, of the following components at the following concentrations:
• the solution has been found to have a particularly acceptable taste.
• the flavouring selected from orange juice and tropical fruit flavouring may be present at a level of from 0.2 to 2.0 g per litre, for example from 0.2 to 1 g per litre, especially from 0.4 to 0.8 g per litre, for example 0.64 g per litre.
• the solution may comprise optional preservative (e) and optional sweetener (g) of the types described elsewhere herein.
• the concentrations of the components (a) to (g) in such a solution are preferably the amounts arrived at after dilution of a concentrate solution of the invention described above, for example the concentration of a component may be one fifth of the concentration described above for that component in relation to a concentrate solution of the invention.
• the solution is suitable for use as a medicament, for example for the treatment of constipation, or faecal impaction, and a method of treatment of such conditions is also provided.
• the stated components may be provided in a form for combination with water to provide such a solution.
• the components may be provided as a concentrated solution in water, or as a dry powder.
• a dry powder may be provided in a sachet, for example containing a unit dose.
• a sachet may contain 13.1250 g Macrogol (Polyethylene glycol) 3350, 0.3507 g sodium chloride, 0.1785 g sodium bicarbonate, 0.0466 or 0.0502 g potassium chloride and flavouring selected from orange juice and tropical fruit.
• the microbiological condition of the samples was determined following the European Pharmacopoeia (EP) 5.6 Section 2.6 12 “Microbiological Examination of Non-Sterile Products (Total Viable Aerobic Count)”. In each case in Examples 1, 2 and 3, no microbial contaminants could be detected in the samples and they were concluded to be in good visible and microbiological condition containing less than 10 colony forming units per g (CFU/g).
• the pH of the sample was measured. pH measurements can be carried out with a Hanna Instruments “pH ep” temperature compensating pH meter. In some instances, the pH of a sample was adjusted before the testing was commenced (as indicated).
• test species Five 20 g portions of each sample were transferred to sterile glass bottles and inoculated separately with 0.2 ml culture of the test species as detailed below.
• the test species used include the following shown in Table 2, which are referred to in the Table with the abbreviations used hereinafter.
• Solutions 1A and 1B were prepared, containing the components in the amounts shown in Table 1 above (except that, for solution 1B, there was no Acesulfame K, and the quantity of potassium chloride was 0.0502 g) together with the components in Table 4 per 32.5 ml. (1 litre of solution was prepared in each case, containing a total weight of 424.95 g of solid in the case of 1A and 421.68 g of solid in the case of 1B).
• Solution 1B Component (g/32.5 mL) (g/32.5 mL) Lemon-Lime Flavour 0.1000 — Water to 32.5 ml to 32.5 ml Measured pH 8.8 8.8
• the Lemon-Lime Flavour is the flavouring in the MOVICOL powder marketed in the UK by Norgine Limited (Chaplin House, Widewater Place, Moorhall Road, Harefield, Uxbridge, Middlesex UB9 6NS, United Kingdom).
• Solutions 1A and 1B are most readily prepared by dissolution of the commercially available MOVICOL Lemon-Lime flavour powder, and MOVICOL PLAIN (ie unflavoured) powder, respectively. Such solutions may be prepared by dissolving 20 commercially available sachets in water to 650 ml.
• Test Results Table 5 Test Species and Initial Solution 1A Solution 1B Inoculum Level CFU per g after: CFU per g after: (CFU/g) 14 days 28 days 14 days 28 days P: NCTC 12924 ⁇ 10 ⁇ 10 ⁇ 10 3.3 ⁇ 10 7 E: NCTC 12923 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 1.1 ⁇ 10 6 S: NCTC 10788 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 1.6 ⁇ 10 6 C: NCPF 3179 6.1 ⁇ 10 4 7.3 ⁇ 10 3 3.8 ⁇ 10 5 2.9 ⁇ 10 5 1.0 ⁇ 10 6 A: NCPF 2275 1.4 ⁇ 10 5 4.0 ⁇ 10 4 9.0 ⁇ 10 3 8.0 ⁇ 10 4 1.3 ⁇ 10 4 C. Albicans Factor 14 d 16 2.6 A. Niger Factor 14 d 3.5 1.75
• the 1B solution did not achieve the required log reduction for yeast.
• the 1A solution did not achieve the required log reduction for either yeast or mould. Accordingly, the solutions without any preservative were found not to be suitable for use as concentrates for the preparation of oral medicaments.
• Solutions 2A to 2Q were prepared. Each solution contained the components shown in Table 1, together with the individual components shown in Tables 6a and 6b.
• Sodium propyl paraben (sodium propyl 4-hydroxbenzoate) is available under the tradename Iscaguard PS.
• a blend of methyl paraben (18%), ethyl paraben (9%) and benzyl alcohol (73%) is available under the tradename Iscaguard MEB.
• Phenoxyethanol is available under the tradename Iscaguard PE.
• Methyl paraben is available under the tradename Iscaguard M.
• Ethyl paraben is available under the tradename Iscaguard E.
• Propyl paraben is available under the tradename Iscaguard P.
• a blend of methyl paraben (18%), ethyl paraben (9%) and phenoxyethanol (73%) is available under the tradename Iscaguard MEP. All of those Iscaguard products are available from ISCA UK Ltd (Nine
• Tables 6a and 6b the flavour “TF” is Tropical Fruit and the flavour “OJ” is Orange Juice. They are available from Firmenich UK Ltd. (Hayes Road, Southall, Middlesex UB2 5NN). A summary of the preservative efficacy test results ( C. Albicans and A. Niger only) is shown in Tables 6a and 6b. Details are shown in tables 7 to 11b.
• Test Run II - Test Results Table 7 Test Species and Initial Solution 2A Solution 2B Inoculum CFU per g after: CFU per g after: Level (CFU/g) 14 days 28 days 14 days 28 days P: NCTC 12924 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 4.7 ⁇ 10 6 E: NCTC 12923 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 2.7 ⁇ 10 6 S: NCTC 10788 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 3.3 ⁇ 10 6 C: NCPF 3179 1.4 ⁇ 10 5 1.3 ⁇ 10 5 3.6 ⁇ 10 4 3.5 ⁇ 10 4 1.4 ⁇ 10 6 A: NCPF 2275 2.8 ⁇ 10 5 3.0 ⁇ 10 5 2.0 ⁇ 10 5 2.0 ⁇ 10 5 4.0 ⁇ 10 5
• Test Run III Test Run III—Test Results Table 8: Test Species and Solution 2C CFU Solution 2D CFU Solution 2E CFU Initial Inoculum per g after: per g after: per g after: Level (CFU/g) 14 days 28 days 14 days 28 days 14 days 28 days P: NCTC 12924 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 3.8 ⁇ 10 6 E: NCTC 12923 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 6.0 ⁇ 10 6 S: NCTC 10788 50 ⁇ 10 1.1 ⁇ 10 2 ⁇ 10 ⁇ 10 ⁇ 10 4.2 ⁇ 10 6 C: NCPF 3179 1.9 ⁇ 10 2 ⁇ 10 2.4 ⁇ 10 2 ⁇ 10 1.6 ⁇ 10 2 ⁇ 10 3.5 ⁇ 10 5 A: NCPF 2275 1.2 ⁇ 10 3 10 4.0 ⁇ 10 3 30 9.0 ⁇ 10 2 ⁇ 10 4.0 ⁇ 10 5
• Test Run IV - Test Results Table 9 Test Species and Initial Solution 2F Solution 2G Inoculum CFU per g after: CFU per g after: Level (CFU/g) 14 days 28 days 14 days 28 days P: ATCC 9027 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 1.9 ⁇ 10 6 S: ATCC 6538 2.5 ⁇ 10 3 ⁇ 10 6.8 ⁇ 10 5 5.0 ⁇ 10 2 1.5 ⁇ 10 6 C: NCTC NCPF 3179 40 ⁇ 10 50 ⁇ 10 1.3 ⁇ 10 6 A: ATCC 16404 1.8 ⁇ 10 5 4.1 ⁇ 10 4 3.8 ⁇ 10 4 3.2 ⁇ 10 2 3.5 ⁇ 10 5
• the 2A, 2B, 2M, 2N, 2P and 2Q solutions did not achieve the required log reduction for mould ( A. niger ) to pass the European Pharmacopoeial criteria, though a reduction in the number of viable micro-organisms was observed.
• the 2F solution did not achieve the required log reduction for bacteria ( S. aureus ) or mould ( A. niger ) at the 14 day time point.
• the 2G solution did not achieve the required log reduction for bacteria ( S. aureus ) or mould ( A. niger ) at the 14 day time point.
• Solution 2I also failed to achieve the required log reduction for the bacterium S. aureus. In solution 2L, re-growth of A. niger was observed.
• solutions 2A, 2B, 2F, 2G, 21, 2L, 2M, 2N, 2P and 2Q showed a reduction in the number of viable micro-organisms for each organism, they were found not to be sufficiently preserved for oral pharmaceutical use with the tested level of preservative.
• the 2C, 2D, 2E, 2H, 2J, and 2K solutions achieved the required log reduction for bacteria, yeast and mould. Accordingly, the solutions were found to be suitable for oral pharmaceutical use.
• Solutions 3A to 3D were prepared. Each solution contained the components shown in Table 1, together with the individual components shown in Table 12.
• the flavour “OJ” is Orange Juice flavour, available from Firmenich UK Ltd. (Hayes Road, Southall, Middlesex UB2 5NN).
• Solutions 3A to 3D were each prepared as 200 ml batches.
• Test Run VII - Test Results Tables 13a and 13b Test Species and Solution 3A Solution 3B Initial Inoculum CFU per g after: CFU per g after: Level (CFU/g) 14 days 28 days 14 days 28 days P: NCTC 12924 ⁇ 10 ⁇ 10 ⁇ 10 ⁇ 10 7.9 ⁇ 10 6 E: NCTC 12923 ⁇ 10 ⁇ 10 ⁇ 10 9.2 ⁇ 10 6 S: NCTC 10788 1.4 ⁇ 10 3 ⁇ 10 1.6 ⁇ 10 3 ⁇ 10 1.1 ⁇ 10 7 C: NCPF 3179 9.7 ⁇ 10 2 ⁇ 10 4.6 ⁇ 10 2 ⁇ 10 1.9 ⁇ 10 6 A: NCPF 2275 4.0 ⁇ 10 4 1.0 ⁇ 10 4 6.0 ⁇ 10 4 4.0 ⁇ 10 4 3.4 ⁇ 10 5 Test Species and Solution 3C Solution 3D Initial Inoculum CFU per g after: CFU per g after: Level (CFU/g) 14 days 28 days 14 days 28 days P: NCTC 129
• flavour “TF” is Tropical Fruit, available from Firmenich UK Ltd. (Hayes Road, Southall, Middlesex UB2 5NN).
• Solutions 3E to 3G were each prepared as 500 ml batches by adding preservative to 500 ml of a stock solution of the other components, the stock solution having been prepared in a volume of 21.
• solution 3D did not achieve the required log reduction for mould ( A. niger ) at the 0.1, 0.15 and 0.2% levels of preservative.
• Solution 3D with the 0.25% level of preservative, achieved the required log reduction against all test species. Accordingly, solution 3D was found to be suitable for pharmaceutical use.
• Solutions 4A to 4B were prepared.
• the solutions contained the components shown in Table 16.
• Solutions with the components of 4A and 4B shown in Table 16 achieved the required log reduction against all test species ( Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Candida albicans, and Aspergilus niger ) as required by the European Pharmacopoeia as described above. Accordingly, solutions 4A and 4B are found to be suitable for oral pharmaceutical use.
• Bottle 5a A 500 ml polyethylene terephthalate (PET) bottle contains 500 ml of solution 4A described in Example 4 above.
• the bottle is provided with a re-closable closure, and a cap that fits over and grips onto the closure.
• the cap is suitable for measuring a 25 ml unit treatment volume.
• the bottle is provided in a carton with instructions for use.
• the instructions include the instruction that 25 ml of the solution should be measured out and diluted with 100 ml water to make a 125 ml treatment dose.
• Bottle 5b contains 500 ml of solution 4B described in Example 4 above;
• Bottle 5c is a 250 ml polyethylene terephthalate (PET) bottle containing 250 ml of solution 4A;
• Bottle 5d is a 250 ml polyethylene terephthalate (PET) bottle containing 250 ml of solution 4B described in Example 4 above.
• PET polyethylene terephthalate
• Bottles 5e, 5f, 5g and 5h are the same as bottles 5a, 5b, 5c and 5d respectively, but with a cap that is suitable for measuring a 12.5 ml unit treatment volume, and instructions that include instruction that 12.5 ml of the solution should be measured out and diluted with 50 ml water to make a 62.5 ml treatment dose.

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