US20160287573A1 - Combination dosage form of a mu opioid receptor antagonist and an opioid agent - Google Patents

Combination dosage form of a mu opioid receptor antagonist and an opioid agent Download PDF

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US20160287573A1
US20160287573A1 US15/086,816 US201615086816A US2016287573A1 US 20160287573 A1 US20160287573 A1 US 20160287573A1 US 201615086816 A US201615086816 A US 201615086816A US 2016287573 A1 US2016287573 A1 US 2016287573A1
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dosage form
axelopran
weight
polyvinyl alcohol
combination dosage
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Shaoling Li
Manshiu Leung
Hao Zhang
Venkat R. Thalladi
Yun Mo
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Theravance Biopharma R&D IP LLC
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Theravance Biopharma R&D IP LLC
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Priority to US15/086,816 priority Critical patent/US20160287573A1/en
Assigned to THERAVANCE BIOPHARMA R&D IP, LLC reassignment THERAVANCE BIOPHARMA R&D IP, LLC ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: LEUNG, MANSHIU, ZHANG, HAO, LI, SHAOLING, MO, YUN, THALLADI, VENKAT R.
Publication of US20160287573A1 publication Critical patent/US20160287573A1/en
Priority to US15/798,647 priority patent/US10369142B2/en
Priority to US16/454,353 priority patent/US10946009B2/en
Priority to US17/248,787 priority patent/US11452723B2/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/46—8-Azabicyclo [3.2.1] octane; Derivatives thereof, e.g. atropine, cocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
    • 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
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2072—Pills, tablets, discs, rods characterised by shape, structure or size; Tablets with holes, special break lines or identification marks; Partially coated tablets; Disintegrating flat shaped forms
    • A61K9/2086—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat
    • A61K9/209—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat containing drug in at least two layers or in the core and in at least one outer layer
    • 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
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
    • A61K9/2806—Coating materials
    • A61K9/282—Organic compounds, e.g. 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
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
    • A61K9/2806—Coating materials
    • A61K9/2833—Organic macromolecular compounds
    • A61K9/284—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone
    • 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
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
    • A61K9/2806—Coating materials
    • A61K9/2833—Organic macromolecular compounds
    • A61K9/2853—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, polyethylene oxide, poloxamers, poly(lactide-co-glycolide)
    • 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
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
    • A61K9/2893—Tablet coating processes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the invention is directed to a solid composition of a peripheral mu opioid receptor antagonist and to a combination of the mu opioid receptor antagonist composition and an opioid analgesic agent.
  • the invention is directed to a unit dosage form in which the mu opioid receptor antagonist is in an immediate release form and the opioid analgesic agent may be in an extended release, sustained release, modified release, or controlled release form and to methods of preparing such a unit dosage form.
  • opioid analgesics exert their beneficial effect chiefly by activation of mu opioid receptors in the brain and central nervous system.
  • opioid receptors are expressed throughout the body, both in the central nervous system and in peripheral regions including the gastrointestinal (GI) tract.
  • adverse side effects of the use of opioid analgesics may be caused by activation of these peripheral receptors.
  • patients receiving opioids analgesics for short or long term pain management frequently experience a range of adverse gastrointestinal symptoms, in particular opioid induced constipation (OIC). Encompassing constipation, delayed gastric emptying, abdominal discomfort, and nausea, OIC can be extremely debilitating and is not prone to tolerance. Gastrointestinal symptoms may be severe enough to seriously compromise pain management for some patients.
  • Patients taking opioid analgesics for pain management may find it useful to also take a peripheral opioid antagonist to manage adverse side effects of their pain medication.
  • Such patients who may be suffering from a variety of serious conditions, frequently are also prescribed additional drugs and thus are burdened with managing a complicated pharmaceutical regimen. Therefore, it may be desirable to combine multiple drugs in a combination dosage form for ease of administration and improved therapeutic compliance.
  • use of a combination of a peripheral opioid antagonist, such as axelopran, and an opioid agonist may address concerns of OIC before they develop.
  • opioid analgesics can be administered through oral, transdermal and parenteral routes for either chronic or acute use, of which oral administration is commonly preferred. While immediate release opioids provide efficacious pain management, especially for acute and break-through pain, controlled or extended release opioids have demonstrated significant clinical value. However, the prophylactic effect of a peripheral opioid antagonist is typically achieved by immediate release of the antagonist agent. It would be desirable to provide a dosage form that combines a peripheral opioid antagonist in an immediate release form with an opioid analgesic agent that may be in an immediate release or in a modified (controlled or extended or sustained) release dosage form.
  • peripheral opioid antagonist must be sufficiently stable during storage of the dosage form.
  • axelopran is known to degrade due to oxidation in its amorphous form.
  • the peripheral opioid antagonist should not significantly affect the release profile or other properties of the opioid analgesic agent.
  • the present invention provides a combination dosage form comprising a peripheral mu opioid receptor antagonist, such as axelopran, in an immediate release form and an opioid analgesic agent in a solid dosage form presented either in an immediate release or a modified release form.
  • a peripheral mu opioid receptor antagonist such as axelopran
  • an opioid analgesic agent in a solid dosage form presented either in an immediate release or a modified release form.
  • the present invention relates to a drug overcoat formulation comprising axelopran in an immediate release formulation and to a method of preparing such a drug over-coated opioid combination product.
  • Axelopran has been shown to be stable as the crystalline sulfate salt while amorphous axelopran is known to be insufficiently stable for use in a drug product.
  • the present invention is made possible by the discovery of the key requirements for the conversion of amorphous axelopran to crystalline axelopran during or after any drug product preparation process that may initially form amorphous axelopran. Specifically, by the judicious choice of excipients and relative ratio of excipients to axelopran and, optionally, further by control of process conditions, a solid composition comprising axelopran sulfate in crystalline form with desirable physical properties may be prepared.
  • the invention provides a solid composition comprising axelopran sulfate and a film forming polymer.
  • the film forming polymer is polyvinyl alcohol.
  • the solid composition further comprises a plasticizer and optionally an antioxidant.
  • the plasticizer is polyethylene glycol 3350 and the antioxidant is ascorbic acid.
  • the solid composition comprises
  • the solid composition of the invention comprises axelopran sulfate in crystalline form.
  • the solid composition comprising crystalline axelopran sulfate is stable upon storage at accelerated conditions for about 3 months.
  • the solid composition may form a solid bead or may serve as a film or coating on an inert solid tablet or on a solid dosage form.
  • the ability to provide formulations that can controllably convert amorphous axelopran to a stable crystalline form has broad utility for the development of stable combination products.
  • Commercial opioid products as well as those in development have resulted from significant research effort to provide modified release, as well as abuse-deterrent, properties.
  • the present approach allows axelopran to be combined with the broad range of opioid products currently on the market or in development without significantly affecting the release profile or abuse-deterrent properties of the opioid analgesic agent.
  • the combination dosage form comprises axelopran or a pharmaceutically acceptable salt thereof as an active coating layer, equivalently termed a drug overcoat layer, on an opioid analgesic dosage form.
  • the active coating layer comprises the solid composition of the invention.
  • the active coating layer comprises axelopran sulfate and a film forming polymer.
  • the active coating layer comprises axelopran sulfate, a film forming polymer, a plasticizer, and optionally an antioxidant.
  • the active coating layer comprises axelopran sulfate in a crystalline form.
  • the combination dosage form further comprises a subcoat layer between the active coating layer and the opioid dosage form.
  • the dosage form of the invention provides the benefit of a combination product that enables immediate release of a peripheral mu opioid receptor antagonist without affecting the drug release characteristics of an opioid analgesic agent from a modified (controlled or extended or sustained) release dosage form and further without affecting pharmacokinetic characteristics of each drug component.
  • the invention provides a combination dosage form comprising between about 2 mg and about 30 mg of axelopran in an immediate release formulation and an opioid analgesic agent in a modified release form.
  • the opioid analgesic dosage form comprises oxycodone hydrochloride or oxymorphone hydrochloride.
  • the invention provides a method of treating pain in a mammal, the method comprising administering to the mammal a combination dosage form comprising a peripheral mu opioid receptor antagonist overcoated on an opioid analgesic agent.
  • a combination dosage form comprising a peripheral mu opioid receptor antagonist overcoated on an opioid analgesic agent.
  • the peripheral mu opioid receptor antagonist in the combination dosage form is axelopran or a pharmaceutically acceptable salt thereof.
  • the peripheral mu opioid receptor antagonist in the combination dosage form is axelopran sulfate.
  • the invention provides a method of ameliorating a gastrointestinal side effect of opioid analgesic therapy, the method comprising administering the combination dosage form of axelopran or a pharmaceutically acceptable salt thereof and an opioid analgesic agent.
  • the invention provides a method of forming the combination dosage form of the invention, the method comprising providing an opioid analgesic agent in a solid dosage form and coating the solid dosage form with a coating layer comprising axelopran or a pharmaceutically acceptable salt thereof.
  • FIG. 1A and FIG. 1B show the percentage of drug (axelopran and oxycodone hydrochloride) dissolved as a function of time of a combination dosage form of axelopran (10 mg label claim) and oxycodone hydrochloride controlled-release tablet (20 mg label claim) for axelopran drug overcoat Formulation A and axelopran drug overcoat Formulation B, respectively.
  • FIG. 2A and FIG. 2B show the percentage of drug (axelopran and oxymorphone hydrochloride) dissolved as a function of time of a combination dosage form of axelopran (10 mg label claim) and oxymorphone hydrochloride extended release tablet (10 mg label claim) for axelopran drug overcoat Formulation A and axelopran drug overcoat Formulation B, respectively.
  • FIG. 3A and FIG. 3B show the mean plasma concentration ⁇ standard deviation (ng/mL) as a function of time of oxycodone hydrochloride and axelopran, respectively from a single dose pharmacokinetic study in beagle dogs administered the combination dosage form of axelopran and oxycodone hydrochloride, co-administered the two components as individual tablets, and administered the components individually.
  • ng/mL standard deviation
  • FIG. 4A and FIG. 4B show the mean plasma concentration ⁇ standard deviation (ng/mL) as a function of time of oxymorphone hydrochloride and axelopran, respectively, from a single dose pharmacokinetic study in beagle dogs administered the combination dosage form of axelopran and oxymorphone hydrochloride, co-administered the two components as individual tablets, and administered the components individually.
  • ng/mL standard deviation
  • FIG. 5 shows the mean oxycodone plasma concentration ⁇ standard deviation (ng/mL) as a function of time from a single dose pharmacokinetic study in healthy human subjects administered the combination dosage form of axelopran and oxycodone hydrochloride, co-administered the two components as individual tablets and administered the components individually.
  • FIG. 6 shows the mean axelopran plasma concentration ⁇ standard deviation (ng/mL) as a function of time from a single dose pharmacokinetic study in healthy human subjects administered the present combination dosage form of axelopran and oxycodone hydrochloride, co-administered the two components as individual tablets and administered the components individually.
  • FIG. 8 shows the weight change of a spray coated film of axelopran sulfate and polyvinyl alcohol in a 4:1 wt/wt ratio subjected to 70% relative humidity at 25° C.
  • solid dosage form refers to a pharmaceutical formulation in solid form for oral administration to a patient.
  • the term comprises pills, tablets, beads, beadlets, microparticulates, and capsules.
  • bead as used herein encompasses beadlets, microparticulates, and the like.
  • modified release form refers to a formulation of a drug product that alters the timing and/or rate of release of the active drug substance.
  • modified release form encompasses forms that are variously described as controlled-release, sustained-release, extended-release, and long-acting.
  • immediate release form refers to a formulation designed to release the active drug immediately upon oral administration. In immediate release formulations, no attempt has been made to modify the drug release rate.
  • a combination dosage form which includes a peripheral mu opioid receptor antagonist, such as axelopran or a pharmaceutically acceptable salt thereof and an opioid analgesic agent.
  • the opioid analgesic agent may be present in a modified release pharmaceutical formulation designed to affect the rate of release of the agent after administration to a patient, as defined herein.
  • the opioid analgesic dosage form may also include abuse-deterrent properties.
  • Suitable opioid analgesic agents for inclusion in the present invention include oxycodone, hydrocodone, morphine, oxymorphone, and hydromorphone. Numerous controlled release or extended release formulations of these agents are available as commercial products or in early or late-stage development. Examples of such agents include, but are not limited to:
  • OxyContin® oxycodone hydrochloride controlled release, Purdue Pharma
  • Oxycodone DETERxTM oxycodone, extended release, Collegium Pharma
  • Egalet-002 oxycodone, extended release, Egalet Corporation
  • hydrocodone HysinglaTM ER (hydrocodone bitartrate, extended release, Purdue Pharma), ZohydroTM ER (hydrocodone bitartrate, extended release, Zogenix, Inc.), VantrelaTM (hydrocodone bitartrate, extended release, Teva Pharmaceutical Industries, Ltd)
  • Opana® ER oxymorphone hydrochloride, extended release, Endo Pharmaceuticals
  • Col-172 Collegium Pharma
  • hydromorphone hydrochloride Exalgo® (hydromorphone hydrochloride, extended release, Mallinckrodt Pharmaceuticals)
  • Additional examples include products which also incorporate a non-opioid analgesic agent, in particular acetaminophen.
  • a non-opioid analgesic agent in particular acetaminophen. Examples of such combinations include, but are not limited to:
  • XartemisTM XR oxycodone hydrochloride and acetaminophen, extended release, Mallinckrodt Pharmaceuticals
  • MNK-155 hydrocodone bitartrate and acetaminophen, controlled release, Mallinckrodt Pharmaceuticals
  • axelopran sulfate forms a stable crystalline form while amorphous axelopran is not sufficiently stable for use in a drug product.
  • the crystalline form is characterized by a powder X-ray powder diffraction (PXRD) pattern having two or more diffraction peaks at 2 ⁇ values selected from 6.58 ⁇ 0.20, 7.52 ⁇ 0.20, 9.35 ⁇ 0.20, 14.69 ⁇ 0.20, 16.01 ⁇ 0.20, 17.45 ⁇ 0.20, 17.99 ⁇ 0.20, 18.62 ⁇ 0.20, 19.76 ⁇ 0.20, 21.11 ⁇ 0.20, 22.07 ⁇ 0.20, 23.18 ⁇ 0.20, 23.74 ⁇ 0.20, 24.56 ⁇ 0.20, 25.63 ⁇ 0.20, 26.45 ⁇ 0.20, 27.86 ⁇ 0.20, 28.31 ⁇ 0.20, 29.54 ⁇ 0.20, 30.59 ⁇ 0.20, 31.58 ⁇ 0.20, 33.89 ⁇ 0.20, and 36.02 ⁇ 0.20.
  • PXRD powder X-ray powder diffraction
  • Example 11 and FIG. 8 The present inventors have further demonstrated that high moisture content promotes crystallization as demonstrated in Example 11 and FIG. 8 .
  • a spray coated film of axelopran sulfate and polyvinyl alcohol in a 4:1 wt/wt ratio was subjected to 70% relative humidity for 48 hours at 25° C.
  • the weight gain over the first two hours may be attributed to absorption of moisture by amorphous axelopran sulfate.
  • the weight loss over the subsequent time period may be attributed to the crystallization of axelopran sulfate which releases the moisture absorbed by the amorphous form.
  • Oxidation has been identified as the main degradation pathway of amorphous axelopran. Therefore, in any process of preparing a layer containing crystalline axelopran from a solution in which the compound is amorphous, it is useful to control oxidation before crystallization takes place. While high moisture content was found to promote crystallization, at the same time, high moisture content promotes oxidation.
  • an inert gas such as nitrogen or argon
  • Another option is to use an antioxidant in the formulation to control oxidation during spray coating.
  • a solid composition that promotes crystallization of axelopran comprises axelopran sulfate and a film forming polymer.
  • the solid composition comprises axelopran sulfate, a plasticizer, and optionally an antioxidant.
  • the solid composition may be prepared from an aqueous solution or a combination of water with a lower alcohol, for example, up to about 40% methanol or ethanol in water, but is preferably prepared from an aqueous-based solution.
  • film forming polymers known in the art include, but are not limited to, polyvinyl alcohol, hydroxypropylmethyl cellulose, ethyl cellulose, hydroxypropyl cellulose, hydroxyethyl cellulose, copovidone, and combinations thereof. However, as exemplified below, it has been determined that not all film forming polymers are equally compatible with promoting axelopran crystallization and/or chemical stability.
  • the film forming polymer is polyvinyl alcohol.
  • Hydrophilic plasticizers known in the art include, but are not limited to, polyethylene glycols, glycerin, polyethylene glycol monomethyl ether, propylene glycol, triacetin, and sorbitol sorbitan solution. It has further been determined, that the choice of plasticizer is also important.
  • Polyethylene glycol 3350 is particularly useful in the present formulation. Polyethylene glycol is an ethylene glycol polymer having an average molecular number of 3350.
  • Antioxidants include, but are not limited to, ascorbic acid, propyl gallate, sodium sulfite, sodium metabisulfite, sodium bisulfite, thioglycerol, thioglycollic acid, butylated hydroxytoluene, butylated hydroxyanisole, and combinations thereof.
  • a preferred antioxidant is ascorbic acid.
  • axelopran sulfate is present in an amount ranging from about 50% to about 95% by weight, including from about 50% to about 85% by weight, and from about 50% to about 70% by weight.
  • the film forming polymer such as polyvinyl alcohol
  • the plasticizer such as polyethylene glycol 3350
  • the optional antioxidant is present in an amount between about 0% and about 10% by weight, including between about 0.5% and about 10% by weight, and between about 2% and about 6% by weight.
  • the invention provides a solid composition comprising:
  • the invention provides a solid composition comprising:
  • the solid composition comprises:
  • the solid composition of the invention may be prepared from an aqueous solution or suspension, in particular a solution or suspension comprising axelopran sulfate, polyvinyl alcohol, optionally polyethylene glycol 3350 and optionally ascorbic acid.
  • the solid composition is prepared from an aqueous solution.
  • axelopran, polyvinyl alcohol, optional polyethylene glycol 3350 and optional ascorbic acid are typically present in the same ratio as in the solid composition.
  • the components of the solid composition i.e. the non-aqueous components of the solution, collectively termed the ‘solid content’, may comprise between about 1% and about 50%, typically between about 5% and about 15%, for example, about 10%, of the aqueous solution, the remainder typically being purified water.
  • the invention provides an aqueous solution comprising between about 5% and about 15% solid content, wherein the solid content comprises axelopran sulfate, polyvinyl alcohol, optional polyethylene glycol 3350, and optinal ascorbic acid in the ratios of the solid composition described above.
  • the solid composition may constitute one layer, i.e. the active coating layer, of a combination dosage form, or may form a coating on an inert solid tablet to provide axelopran as a monotherapy.
  • the solid composition may be prepared as a solid beadlet which, for example, may be combined with beadlets of a different agent in a combination dosage form.
  • the invention provides a combination dosage form comprising the solid composition of the invention as an active coating layer, equivalently termed a drug overcoat layer, on an opioid analgesic dosage form.
  • the combination dosage form comprises crystalline axelopran sulfate.
  • the drug overcoat layer comprising crystlaline axelopran sulfate further comprises a film forming plymer and a plasticizer.
  • the active coating layer comprising axelopran is designed to release drug in an immediate release pattern.
  • the invention provides a combination dosage form comprising an opioid analgesic solid dosage form and a drug overcoat layer comprising:
  • the drug overcoat layer comprises:
  • a particularly useful active drug coating layer comprises about 68% axelopran sulfate by weight, about 14% polyvinyl alcohol by weight, about 14% polyethylene glycol 3350 by weight, and about 4% ascorbic acid by weight, which corresponds to a weight ratio of axelopran free base equivalent:polyvinyl alcohol: polyethylene glycol 3350: ascorbic acid of 12:3:3:1.
  • the combination dosage form further comprises a subcoat layer between the active coating layer and the opioid dosage form. It is convenient to employ the same film forming polymer and plasticizer in the subcoat layer as in the active coating.
  • the combination dosage form of the present invention includes an optional subcoat layer comprising polyvinyl alcohol and polyethylene glycol 3350, for example in about a 1:2 ratio of polyvinyl alcohol to polyethylene glycol 3350.
  • the active coating may be prepared from an aqueous coating solution described above as the aqueous solution for the preparation of the present solid composition.
  • a coating solution for applying the optional subcoat comprises between about 5% and about 15% subcoat components, i.e. polyvinyl alcohol and polyethylene glycol 3350, with the remainder being purified water.
  • the present combination dosage form may be prepared by applying the aqueous coating solution described herein onto an optionally subcoated opioid tablet, pill, bead, beadlet, or capsule.
  • the process of preparing the active coating layer and the optional subcoat layer may utilize a pan coater or fluid bed or wurster coating column.
  • a pan coater may be used to spray coat a subcoat coating solution and subsequently the aqueous active layer coating solution onto opioid tablets.
  • the process is typically performed at an exhaust temperature of about 40° C. Spray coating onto beads with a characteristic diameter of about 500 ⁇ m using a fluid bed has also been demonstrated.
  • the invention provides a method of preparing a combination dosage form, the method comprising (a) providing an opioid analgesic agent in a solid dosage form, and (b) coating the solid dosage form with a drug overcoat layer comprising axelopran sulfate and polyvinyl alcohol.
  • a method of preparing a combination dosage form comprises: (a) providing an opioid analgesic agent in a solid dosage form, and (b) applying an aqueous coating solution comprising axelopran sulfate, polyvinyl alcohol, polyethylene glycol 3350, and optionally ascorbic acid.
  • the method further comprises applying an aqueous subcoat coating solution comprising polyvinyl alcohol and polyethylene glycol 3350 onto the opioid solid dosage form before applying the active layer coating solution.
  • a combination dosage form prepared by a process such as that described in the examples has been shown to be stable upon storage. After three months at accelerated conditions of 40° C. and 75% relative humidity, no significant changes in axelopran content and impurity profile, as well as in the dissolution profile, were observed in a combination dosage of axelopran sulfate and oxycodone hydrochloride indicating good stability of the combination dosage form, which further may be taken as evidence of crystallinity.
  • Axelopran has been shown to be effective at ameliorating the symptoms of opioid-induced constipation at low dosages.
  • a combination dosage form containing between about 2 mg and about 30 mg axelopran per unit dosage may be prepared with good content uniformity.
  • the inventors have demonstrated a combination dosage form of about 10 mg axelopran coated onto 20 mg oxycodone hydrochloride controlled release tablets and onto 10 mg oxymorphone hydrochloride extended release tablets with a relative standard deviation of axelopran content of less than about 5%.
  • the present combination dosage form comprising an axelopran active coating and a modified release opioid exhibits immediate release of axelopran and extended release of the opioid.
  • the in vitro drug dissolution profile of an approximate 10 mg coating of axelopran overcoat on a controlled release oxycodone hydrochloride tablet shows essentially all of the axelopran was released in the first quarter hour while the oxycodone was released gradually over 12 hours.
  • the in vitro drug dissolution profile of the 10 mg axelopran coated oxycodone hydrochloride tablet that had been stored at 40° C. and 75% relative humidity was unchanged from the dissolution profile of time-zero tablets.
  • the present combination dosage form has been shown in vivo to provide systemic exposure of the two components consistent with the exposures observed on co-administration of the two components in separate dosage forms.
  • a pharmacokinetic study of axelopran coated oxycodone hydrochloride tablets and axelopran coated oxymorphone hydrochloride tablets in dogs is described in Example 8. Little difference is seen in the systemic exposure of oxycodone when administered as the combination dosage form with axelopran, as compared with the exposure from administration of axelopran and oxycodone in separate dosage forms, and with administration of oxycodone alone, in FIG. 3A .
  • the present combination dosage form of axelopran and oxycodone was also studied in healthy human subjects. Taking co-administration of the individual tablets as the reference product, the combination dosage form of 10 mg axelopran and 20 mg oxycodone hydrochloride demonstrated total exposure of axelopran within 16% of the reference value and total exposure of oxycodone within 5% of the reference value in healthy human subjects. Furthermore, the oxycodone exposure satisfied the US FDA guidelines for bioequivalence as compared with the reference product. Also, the total exposure of oxycodone from the combination was equivalent to the exposure experienced when oxycodone was administered alone. As illustrated in FIG. 5 , the combination dosage form of axelopran and oxycodone did not alter the systemic exposure of oxycodone.
  • the opioid therapeutic agents such as oxycodone, hydrocodone, morphine, and oxymorphone, are widely used for the treatment of pain including severe pain, chronic pain, and non-cancer pain such as musculoskeletal pain and post-operative pain.
  • the combination dosage form of axelopran and an opioid analgesic agent is expected to provide equivalent exposure of the opioid after oral administration, the present combination dosage form is expected to be useful for the treatment of pain.
  • the invention provides a method of treating pain in a mammal, particularly a human patient, the method comprising administering to the mammal a combination dosage form comprising axelopran and an opioid analgesic agent.
  • the invention provides a method of treating pain comprising administering a combination dosage form comprising axelopran in an immediate release formulation and an opioid analgesic agent in a modified release formulation.
  • the mu opioid receptor antagonist axelopran has been shown to ameliorate the symptoms of opioid-induced constipation in patients on a stable opioid regimen, that is to reduce one of the distressing side effects of opioid therapy.
  • the combination dosage form of axelopran and an opioid analgesic is also expected to provide equivalent exposure of axelopran as compared with administration of axelopran separately, the present combination is expected to be useful for the amelioration of opioid-induced gastrointestinal side effects.
  • the present invention provides a method of ameliorating a gastrointestinal side effect of opioid therapy in a mammal, in particular a human patient, the method comprising administering to the mammal a combination dosage form comprising axelopran and an opioid analgesic agent.
  • axelopran sulfate was synthesized according to the process described in U.S. Pat. No. 7,943,772.
  • a clinical tablet formulation of axelopran was used as the test article for the in vivo studies.
  • Oxycodone was provided as commercially-obtained OxyContin® (oxycodone hydrochloride controlled release, 20 mg) tablets.
  • the tablets contain 20 mg oxycodone per tablet as the hydrochloride salt and the following inactive ingredients: butylated hydroxytoluene, hypromellose, polyethylene glycol 400, polyethylene oxide, magnesium stearate, titanium dioxide, polysorbate 80, and red iron oxide.
  • Oxymorphone was provided as commercially-obtained Opana® ER (oxymorphone hydrochloride extended release,10 mg) tablets. According to the package insert, the oxymorphone tablets contain 10 mg oxymorphone hydrochloride per tablet and the following inactive ingredients: hypromellose, polyethylene oxide, polyethylene glycol, a-tocopherol, citric acid, polyvinyl alcohol, titanium dioxide, macrogel, talc, and FD&C yellow No. 6.
  • a Thomas Compu-Lab 19 inch pan coater was used to prepare the combination dosage forms of Examples 2 and 3. Processing parameters optimized for coating performance and efficiency are summarized in Table 1.
  • Placebo cores were manufactured to match the OxyContin® tablets and were used as the main load of the substrate for the coating.
  • polyvinyl alcohol 40 g was added to heated purified water USP.
  • the mixture was stirred and heated to dissolution and then polyethylene glycol 3350 (80 g) was added and the mixture was stirred to dissolution.
  • Purified water USP was added with stirring to provide a solution of approximately 10% solid content (i.e., non-aqueous content; the solid content is not in solid form).
  • Formulation Composition Component % wt Unit Dose (mg/Tab) Polyvinyl Alcohol, USP 33.3 1.56 Polyethylene Glycol 3350, NF, EP 66.7 3.12
  • Formulation B Unit Batch Unit Batch Dose Quantity Dose Quantity Part a (mg/Tab) (g) Part a (mg/Tab) (g) Axelopran sulfate 12 12.27 314.6 12 12.27 314.6 Ascorbic Acid, USP 1 0.83 21.4 2 1.67 42.7 Polyvinyl Alcohol, USP 3 2.5 64.1 3 2.5 64.1 Polyethylene Glycol 3350 3 2.5 64.1 6 5.0 128.2 a Axelopran free base equivalent
  • the sub-coated placebo cores and opioid tablets were retained in the pan coater and further spray coated with the active coating solution according to the processing parameters of Table 1 Set I to achieve the target weight gain.
  • Coated opioid tablets were separated from coated placebo cores by the difference in color upon completion of the coating.
  • Placebo cores were manufactured to match the Opana® ER tablets and were used as the main load of the substrate for the coating.
  • a subcoat coating solution was prepared as in Example 2(a).
  • a total of approximately 4 kg of placebo cores and a small number of Opana® ER tablets were spray coated according to the processing parameters of Table I Set II resulting in an approximate 3% weight gain of the sub-coat composition listed in Table 2.
  • Coating solutions for the two formulations of Table 3 were prepared as described in Example 2(a). Upon completion of the sub-coating, the sub-coated placebo cores and opioid tablets were retained in the pan coater and further spray coated with the active coating solutions according to the processing parameters of Table 1 Set I to achieve the target weight gain. Coated opioid tablets were separated from coated placebo cores by the difference in color upon completion of the coating.
  • Example 2 oxycodone
  • the axelopran coated opioid tablets of Examples 2 and 3 were tested for drug dissolution rate of the individual components according to USP monograph 711 and in-house developed methodologies. Sample aliquots were collected at 13, 30, 45, 60, minutes, and at 4 and 12 hour dissolution time points and analyzed by reverse-phase HPLC with UV detection. The dissolution rate results for the individual components from the axelopran coated oxycodone tablets are shown in Table 5 and in FIGS. 1A and 1B , while the analogous dissolution rate results for axelopran coated oxymorphone tablets are shown in Table 6 and in FIGS. 2A and 2B . In all cases, essentially all of the axelopran is observed to have dissolved by the first time point of 0.25 hour while the controlled release opioid dissolved gradually over 12 hours.
  • composition to prepare a nominal 10 mg axelopran coating per 450 mg of beads is listed in Table 9.
  • a subcoat coating solution and axelopran active coating layer solution were prepared according to the process described in Example 2.
  • Sugar beads were loaded into the bowl of a Glatt mini fluid bed and warmed to about 45° C.
  • the subcoat coating solution was sprayed onto the beads at a spray rate of 0.6 g/min until a 10% weight gain was achieved.
  • the active coating layer solution was sprayed onto the subcoated sugar beads at a spray rate of 0.6 g/min.
  • the product temperature was maintained at about 45° C. in the fluid bed with atomization air pressure of 0.8 to 1.0 bar.
  • the beads were dried at 45° C. for 10 min before discharging.
  • the resulting beads were tested for content uniformity and main degradant.
  • opioid oxycodone or oxymorphone
  • Example 2 Formulation A 11.85 mg axelopran, 19.42 mg oxycodone per tablet
  • individual tablets axelopran (10.21 mg), oxycodone (19.42 mg) were used for the axelopran/oxycodone study.
  • the combination dosage form of Example 3 Formulation A (9.26 mg axelopran, 10.39 mg oxymorphone) and individual tablets axelopran (10.21 mg), oxymorphone (10.39 mg) were used for the axelopran/oxymorphone study.
  • a washout period between each phase of at least 5 days was observed.
  • the dogs received an intramuscular pentagastrin (6 ⁇ g/kg) pretreatment to reduce stomach pH.
  • FIGS. 3A and 3B Plasma profiles of axelopran and opioid from the pharmacokinetic studies are shown in FIGS. 3A and 3B (oxycodone) and FIGS. 4A and 4B (oxymorphone), respectively.
  • Naltrexone was administered 15 and 3 hours prior to and 9 and 21 hours after administration of each treatment to block the adverse effects of the opioid.
  • a seven day washout period between each period was observed. The number of subjects who completed at least one period was 28 with 26 subjects completing all four study periods.
  • Overcoated combination tablets (9.66 mg axelopran, 19.42 mg oxycodone per tablet) were prepared according to the process of Example 2, axelopran layer in formulation A of Table 3. Individual tablets axelopran (10.21 mg), oxycodone (19.42 mg) were used for the study.
  • PK Pharmacokinetic
  • AUG 0-last area under the concentration-time curve from time of dosing to last measureable concentration
  • AUC 0- ⁇ area under the concentration-time curve extrapolated to infinity
  • Relative bioavailability for oxycodone and axelopran for the combination dosage as compared with the co-administration of the individual components is given in Tables 12 and 14, respectively.
  • the relative bioavailability of oxycodone for combination dosage compared with oxycodone alone is given in Table 13.
  • Plasma exposures of oxycodone and axelopran are shown in FIG. 5 and FIG. 6 , respectively.
  • the oxycodone pharmacokinetic parameters C max , AUC 0-last , and AUC 0- ⁇ geometric mean ratios and the associated confidence intervals are within 80% to 125% of the reference product.
  • the C max , AUC 0-last , and AUC 0- ⁇ geometric mean ratios for axelopran from the combination dosage with respect to co-administration of individual tablets are approximately 85%.

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