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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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
• • 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
  • A61K47/02—Inorganic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/0005—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts
  • A61L2/0011—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts using physical methods
  • A61L2/0023—Heat
• • 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
  • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

• the present invention relates to a process for producing a stable low concentration, injectable solution of noradrenaline.
• the present invention originates in the field of pharmaceutical technology and industrial processes for the production of active ingredients.
• the present invention relates to a process for producing an injectable solution containing noradrenaline at low concentration as active ingredient, and highly stable, injectable solutions of noradrenaline at low concentration, typically obtained with this process.
• Noradrenaline or norepinephrine is a catecholamine or an amine compound with the structure similar to that of catechol and having the chemical formula C 8 H 11 NO 3 .
• noradrenaline is a chemical mediator with sympathomimetic action on the transmission of nervous impulses at neuroeffector junctions of the sympathetic nervous system.
• Noradrenaline is released at the postganglionic ortho-sympathetic (or sympathetic) nerve endings and at adrenal medulla, and acts on both types of adrenergic receptors responsible for the action of sympathomimetics at the level of various effector organs, but with prevalence of alpha type actions.
• noradrenaline performs many activities, mainly confined to the level of the circulatory apparatus. It causes arteriolar vasoconstriction with increased peripheral resistance and blood pressure. Noradrenaline has no particularly evident effects on the heart, but can cause, by reflex paths, a decrease of the heart rate through a vagal reflex. Noradrenaline also produces a moderate relaxation of bronchial smooth muscle and gastrointestinal muscle and modest action at the level of the central nervous system and the cerebral circle.
• noradrenaline is short-lived, because this molecule is rapidly inactivated in the body through two metabolic pathways: oxidative deamination, operated by the oxidase, and methylation, operated by the methyltransferase.
• Noradrenaline is commonly administered in the form of solution, by intravenous slow infusion, and finds application in the case of cardiovascular collapse, in states of shock associated with low peripheral resistance, the so-called septic shock, and to restore and maintain physiological blood pressure levels.
• Noradrenaline solutions for injection at a concentration of 1 mg/ml, are available on the market.
• Noradrenaline such as the catecholamines in general, has the drawback of being easily decomposable substances, when exposed to oxygen of the air. On contact with oxygen, noradrenaline decomposes giving quinone by-products, i.e. compounds which impart a strong coloration to the pharmaceutical solution, thus highlighting the denaturation of the active principle.
• Sulfites are anti-oxidizing agents commonly used to stabilize injectable noradrenaline solutions.
• the use of sulfites is not without disadvantages, since their presence within the pharmaceutical formulations is associated with an increased risk of developing allergic or sensitization reactions.
• sulfites in an aqueous solution tend to interact with adrenaline through addition reactions. These reactions are accelerated because of the exposure of the solution to heat, such as occurs in the treatment of high temperature sterilization of injectable solutions.
• One of the objects of the present invention is to provide a process for producing an injectable solution of noradrenaline with low concentration of active ingredient, that is stable and provided with an improved compliance and safety profile for the patient.
• a further object is to provide an injectable solution at low concentration of noradrenaline, that is highly stable and free of preserving agents or anti-oxidizing allergenic agents such as sulphites.
• a noradrenaline solution for injection particularly stable even in the absence of preservatives and anti-oxidizing, is obtained by adopting a combination of specific conditions in the field of pharmaceutical production technology.
• the invention relates to a process for producing a low concentration injectable noradrenaline solution which is highly stable in the absence of anti-oxidizing or preservative agents, as defined in any one of claims 1 - 8 .
• the oxidation of noradrenaline is substantially prevented using degassed or deoxygenated water, typically by bubbling or blowing a stream of inert gas and performing the subsequent steps in substantial absence of air or oxygen, through the use of an inert gas.
• the noradrenaline solution obtained has a stability at least equal to that of an injectable solution of equal noradrenaline concentration added with sulphites, according to the prior art, while avoiding the risks associated with the use of preservatives.
• the present invention provides a noradrenaline injectable solution that is stable, substantially free of preservatives, complexing agent and/or anti-oxidizing agent, as defined in any one of claims 9 - 16 .
• noradrenaline is noradrenaline base or a pharmaceutically acceptable noradrenaline salt such as noradrenaline tartrate or bitartrate or bitartrate monohydrate.
• the stable noradrenaline solution is obtained by the process described above.
• the injectable solution has a low concentration of noradrenaline, in the range of 0.04 mg/ml to 0.20 mg/ml.
• a stable, injectable solution with a content of noradrenaline in the range of 0.04 mg/ml to 0.20 mg/ml is provided, for use in medicine, in particular for the treatment of cardiac circulatory collapse, in states of shock associated with low peripheral resistances or to restore and/or keep physiological pressure levels.
• a method for the treatment of cardiac circulatory collapse especially in states of shock associated with low peripheral resistances or to restore and/or keep physiological pressure levels is provided said method comprising the administration of an effective amount of a noradrenaline injectable solution that is stable, substantially free of preservatives and/or anti-oxidizing agents, as defined in any one of appended claims 9 - 16 .
• the stable noradrenaline solution of the invention is administered by intravenous or intra-arterial injection.
• an infusion of a therapeutically active amount of the above stable noradrenaline solution according to the invention is provided.
• the Applicant has identified a process for producing noradrenaline injectable solutions, in particular at low concentrations, which are particularly stable in the absence of anti-oxidizing, preservative and/or complexing agents.
• the invention thus relates to a process for the production of a noradrenaline injectable solution, in particular with a content of noradrenaline of 0.04 to 0.20 mg/ml comprising the following steps:
• the dissolving step includes dissolving 0.04 to 0.20 mg of noradrenaline per ml of infusion water.
• the water used to prepare the solution is degassed or deaerated, distilled, sterile, pyrogen-free water for pharmaceutical use.
• the deoxygenated or degassed water is obtained by blowing or bubbling an inert gas current, typically based on nitrogen or a noble gas such as argon.
• any inert gas can be used, such as nitrogen, argon and mixtures thereof, to remove oxygen or air in one or more of the steps and to limit risks of oxidation of the noradrenaline contained in the injectable aqueous solution.
• step a) noradrenaline and any optional excipients is dissolved in water for pharmaceutical sterile preparations, for example deaerated or degassed by bubbling or blowing an inert gas.
• Dissolution can be carried out within a suitable inert container, in which air or oxygen have been removed by passage of inert gas.
• an inert gas can be blown into the container or tank of the solution, to remove any residual oxygen.
• the noradrenaline injectable solution obtained has a residual oxygen content equal to or lower than 100 ppb.
• the pH of the noradrenaline aqueous solution is finely adjusted within the selected range of 3.2 to 3.6, preferably within a pH range of 3.3 to 3.6, in particular until a value close to 3.4 is reached, for example, typically by adding 1N HCl, in order to further stabilize the solution, reducing noradrenaline degradation.
• Step c) of filtration of the process is performed by passing the solution containing noradrenaline through a filter of the type for sterilization. Passage of the noradrenaline solution through the filter can be speeded up by blowing a current of inert gas which acts as a carrier.
• Suitable filters are those used in the pharmaceutical technology for preparation of sterile injectable solutions.
• the noradrenaline solution is distributed in suitable containers such vials or ampoules depyrogenated preferably in the presence of inert gas, typically nitrogen, in order to minimize the volume of residual oxygen in the head of the sealed bottle and to prevent oxidative effects that may affect the stability of the solution itself.
• suitable containers such vials or ampoules depyrogenated preferably in the presence of inert gas, typically nitrogen, in order to minimize the volume of residual oxygen in the head of the sealed bottle and to prevent oxidative effects that may affect the stability of the solution itself.
• the noradrenaline injectable solution obtained has a residual oxygen content equal to or lower than 100 ppb.
• the diluted noradrenaline solution sterilization step may be accomplished by heating, typically at temperatures above 100° C., for a time suitable for sterilization, for example equal to or greater than 15 minutes.
• the noradrenaline injectable solution at low concentration was stable after sterilization for 15 minutes at 121° C.
• the inventors have found that the substantial absence of air or oxygen and the correction of the pH of the solution to a value in the range of 3.2 to 3.6, in particular close to 3.4 units, increases the stability of the noradrenaline solution, allowing storage at room temperature for long periods of time, up to 6 months.
• the steps of the process of manufacture are carried out in sterile environments in order to avoid bacterial contamination of the noradrenaline solution.
• the present invention provides a noradrenaline injectable solution stable and substantially free of preservatives and/or anti-oxidizing agents, optionally containing an excipient, in which the concentration of noradrenaline is in the range of 0.04 to 0.2 mg/ml and pH is 3.2 to 3.6.
• the noradrenaline stable injectable solution is substantially free of preservatives and/or anti-oxidizing agents and the noradrenaline concentration is between 0.04 and 0.2 mg/ml, and pH is between 3.2 and 3.6, preferably between 3.3 and 3.6.
• preservatives and/or antioxidant agents are present as impurities, typically in an amount less than 0.005% by weight, as determined by HPLC-MS.
• the noradrenaline injectable solution is free of anti-oxidizing and/or preservative agents.
• the stable, injectable solution is a water-based solution and may be obtained by a process according to any one of the embodiments previously described.
• the injectable solution of the invention contains an excipient, typically NaCl, in particular at a concentration in the range of 8.2 to 8.6 mg/ml, for example equal to 8.4 mg/ml.
• the injectable solution of the invention has a particularly low content of oxygen dissolved in the solvent water, typically less than 100 ppb.
• the stable noradrenaline injectable solution of the invention contains less than 0.05% by weight of arterenone.
• the stable noradrenaline injectable solution of the invention has an acidic pH selected in the range of 3.2 to 3.6, preferably of 3.3 to 3.6, and may have a content of enantiomer d-noradrenaline equal to or less than 5% by weight, with respect to the total weight of active principle (noradrenaline in one of its active forms) present in the solution.
• the injectable solution of the invention has a pH value from 3.3 to 3.6 and a content of enantiomer d-noradrenaline equal to or less than 2% by weight or 1% by weight with respect to the total weight of noradrenaline present in the solution.
• the noradrenaline contained in the injectable solution is in the form of a pharmaceutically acceptable salt, for example, bitartrate.
• the noradrenaline injectable solution has a surprising stability, even at high temperatures.
• the inventors have conducted studies on the stability at 40° C. with the noradrenaline injectable solutions, and have found that, in these conditions of temperature, stability lasts at least 3 months.
• the inventors have achieved some significant advantages including a surprising increase of stability in injectable solutions with a concentration of 0.04 to 0.2 mg/ml and surprisingly low levels of impurities with a pH of 3.2-3.6, in particular of 3.3 to 3.6, which determine a significant increase in the product safety profile.
• the low concentration noradrenaline solution is surprisingly stable at room temperature for at least 6 months.
• the low concentration noradrenaline injectable solutions of the invention are filled into sterile containers such as vials or ampoules in a modified atmosphere, for example in the presence of an inert gas containing basically nitrogen and/or argon.
• the present invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising noradrenaline in a quantity of 0.04 to 0.2 mg/ml obtained by a process according to any one of the embodiments previously described, and a pharmaceutically acceptable carrier and/or excipient.
• Pharmaceutically acceptable carriers and excipients include substances commonly used in the production techniques of pharmaceutical and medical devices.
• the noradrenaline solutions were prepared using water deoxygenated by nitrification (residual oxygen ⁇ 100 ppb).
• the solution was filtered under nitrogen pressure in a nitrogen current and distributed in clear glass 50 ml bottles.
• the bottles were then subjected to terminal sterilization in autoclave under overkill conditions (121° C. for 15 minutes).
• Stability 4 batches with concentration of noradrenaline respectively of 0.04 mg/ml, 0.06 mg/ml, 0.12 mg/ml, 0.20 mg/ml were placed at 25° C. and 40° C.
• Noradrenaline 0.04 mg/ml Pro 1 ml Pro 50 ml Noradrenaline Bitartrate 0.08* mg 4.00* mg Sodium Chloride 8.4 mg 420.0 mg Hydrochloric acid q.s. ad q.s. ad pH 3.3-3.6 pH 3.3-3.6 Water for injections ad 1 ml ad 50 ml *Corresponding respectively to 0.04 mg and 2.00 mg of noradrenaline base
• Noradrenaline 0.06 mg/ml Pro 1 ml Pro 50 ml Noradrenaline Bitartrate 0.12* mg 6.00* mg Sodium Chloride 8.4 mg 420.0 mg Hydrochloric acid q.s. ad q.s. ad pH 3.2-3.6 pH 3.2-3.6 Water for injections ad 1 ml ad 50 ml *Corresponding respectively to 0.06 mg and 3.00 mg of noradrenaline base
• Noradrenaline 0.12 mg/ml Pro 1 ml Pro 50 ml Noradrenaline Bitartrate 0.24* mg 12.00* mg Sodium Chloride 8.4 mg 420.0 mg Hydrochloric acid q.s. ad q.s. ad pH 3.2-3.6 pH 3.2-3.6 Water for injections ad 1 ml ad 50 ml *Corresponding respectively to 0.12 mg and 6.00 mg of noradrenaline base

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