WO1992019226A1 - Systeme d'administration de medicaments a liberation prolongee et controllee pour le traitement des toxicomanies - Google Patents

Systeme d'administration de medicaments a liberation prolongee et controllee pour le traitement des toxicomanies Download PDF

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Publication number
WO1992019226A1
WO1992019226A1 PCT/US1992/003859 US9203859W WO9219226A1 WO 1992019226 A1 WO1992019226 A1 WO 1992019226A1 US 9203859 W US9203859 W US 9203859W WO 9219226 A1 WO9219226 A1 WO 9219226A1
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WIPO (PCT)
Prior art keywords
drug
dependence
lobeline
kit
substitute
Prior art date
Application number
PCT/US1992/003859
Other languages
English (en)
Inventor
Judith P. Kitchell
Indu A. Muni
Yvonne N. Boyer
Original Assignee
Dynagen, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Dynagen, Inc. filed Critical Dynagen, Inc.
Publication of WO1992019226A1 publication Critical patent/WO1992019226A1/fr

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    • 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
    • A61K9/70—Web, sheet or filament bases ; Films; Fibres of the matrix type containing drug
    • A61K9/7023—Transdermal patches and similar drug-containing composite devices, e.g. cataplasms
    • 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
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605—Excipients; Inactive ingredients
    • A61K9/1629—Organic macromolecular compounds
    • A61K9/1641—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poloxamers
    • A61K9/1647—Polyesters, e.g. 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
    • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
    • A61K9/009—Sachets, pouches characterised by the material or function of the envelope

Definitions

  • Embodiments of the present invention feature drug delivery systems which deliver a controlled, sustained release of a drug substitute for the treatment of drug dependency.
  • Drug addiction is typically characterized by a physical, as well as psychological dependence.
  • a drug substitute is administered to the addict according to an established treatment schedule.
  • Adherence to the treatment schedule determines the effectiveness of the treatment. Accordingly, such dependencies are treated as part of a drug cessation program which includes both administration of a drug substitute and behavior modification counseling.
  • Examples of drug dependencies displaying both physical and psychological addiction include dependences on heroin, non-opiate sedatives (including barbiturates), benzodiazepines, cocaine and alcohol. Nicotine dependence is one example of a drugug dependency in which the drug of abuse exerts both a physical and psychological addiction.
  • Lobeline is an alkaloid obtained from the dried leaves and tops of the Indian tobacco herb, Lobelia inflata.
  • Lobeline is a substituted piperidine compound that produces several physiological affects, some of which are similar to those produced by nicotine.
  • Lobeline's potency in causing these physiological effects is significantly less than that of nicotine.
  • lobeline's pharmacological similarities with nicotine it has been considered as a substitute for nicotine which assists individuals -in lessening addiction to nicotine and in ceasing to smoke cigarettes.
  • use of lobeline as a smoking cessation aid has been studied since at least the 1930's, its efficacy has been a matter of dispute. Moreover, severe, undesirable side-effects have been reported.
  • the presently available over-the-counter lobeline formulations for treating smoking addiction either do not appear to provide or do not appear to maintain therapeutic blood or tissue levels of lobeline. This may be because of the low dose of lobeline in the lobeline formulations, poor absorption of oral formulations or metabolism which does not allow lobeline to reach critical therapeutic levels.
  • Kalyuzhnyy J. of Neural Psychiat 68: 1864-1870 (1968) describes the use of intramuscular doses of lobeline hemi-sulfate up to 10 mg/per injection, administered twice daily. Although the amount of lobeline administered by Kalyuzhnyy was reported to be effective, the procedure for administration does not lend itself to practical application because it requires twice daily injections of lobeline.
  • Takagi et al. JP 1-197,435) describe a smoking-substitute adhesive agent containing 0.5 to 10 percent lobeline by weight. Takagi et al. report that blood concentrations of lobeline remained higher for several hours compared to blood concentrations of nicotine delivered using the same adhesive agent delivery system. Takagi et al. did not report the amounts of lobeline released from the adhesive agent.
  • the accepted program for treating heroin addiction has been to incorporate a drug substitute, e.g., methadone, into an oral formulation for administration to the drug addict.
  • a drug substitute e.g., methadone
  • the effectiveness of such treatment depends largely upon adherence to an established treatment schedule. Accordingly, out-patients are provided with a limited number of doses with specific instructions as to frequency of use. Oral doses are often provided as a powder or tablet which can be readily dissolved in fruit juices for administration.
  • One problem associated with such water soluble compositions is that the composition can alternatively be dissolved in water, filtered and concentrated to provide a solution sufficiently rich in the drug substitute to be abused by the addict, i.e., injected in lieu of the drug of abuse.
  • the present invention provides a drug delivery system useful in treating an individual for drug dependence.
  • drug dependencies include dependencies on nicotine, heroin, non-opiate sedatives, benzodiazepine, cocaine and alcohol.
  • drug substitute refers to a drug used to treat a drug dependence.
  • drug substitutes function by binding to receptors specific for the drug of abuse. Examples of drug substitutes for various types of dependencies are provided in Table I .
  • Non-opiate sedatives e.g., barbiturates
  • phenobarbitol chlordiazepoxide diazepam Benzodiazepines long-acting benzodiazepines such as: chlorzepate diazepam flurazepam
  • the system can be used in aiding individuals in the cessation of smoking or chewing nicotine containing products by providing a drug delivery system for releasing a controlled amount of lobeline.
  • the delivery system eliminates the need for twice daily injections or multiple daily doses of lobeline, and is capable of providing lobeline at therapeutically effective levels for long periods of time.
  • the drug delivery system has a physical constraint modulation system (hereinafter PCMS) containing the drug substitute, such as lobeline. It is constructed and arranged so that the dr.ig substitute, such as lobeline, is delivered to the individual at therapeutic levels in a controlled, sustained release manner.
  • PCMS physical constraint modulation system
  • the delivery of lobeline in such a manner is useful for treating nicotine dependence, i.e., lobeline delivery reduces or eliminates the individual's desire to smoke or chew nicotine containing products.
  • the delivery of a drug substitute is useful for treating other types of drug addictions, such as dependencies on heroin, non-opiate sedatives (including barbiturates), benzodiazepine, cocaine and alcohol.
  • the PCMS may involve a biodegradable polymer suitable for subcutaneous or intramuscular injection into the individual or may be part of a transdermal patch applied to the skin of an individual.
  • the form of the delivery system preferably is microparticles which are suspended in a pharmaceutically acceptable vehicle just prior to subcutaneous or intramuscular injection.
  • the PCMS utilizing the transdermal patch may employ, for example, a diffusion layer matrix containing the drug substitute, such as lobeline, or may be a multicompartmental patch containing the drug substitute in a first compartment and a delivery substance in a second compartment.
  • the drug substitute e.g., lobeline
  • the transdermal patch having the diffusion layer typically is replaced every seven days and, the multicompartmental transdermal patch typically is replaced on a daily basis.
  • the present invention also pertains to a method for treating an individual for drug dependence and includes, for example, treating an individual for nicotine dependence, i.e., cessation of smoking or chewing nicotine containing products.
  • the method includes administering the drug substitute, e.g., lobeline, to the individual in a controlled, sustained release manner such that long-term therapeutic levels of the drug substitute, e.g., lobeline, are provided to the individual.
  • This method preferably is carried out using the drug delivery systems described above.
  • the drug substitute, e.g., lobeline may be administered to the individual at time periods easily integrated with behavioral modification support programs.
  • kits useful in treating drug dependence such as nicotine dependence.
  • the kits are useful in aiding individuals in the cessation of smoking or chewing nicotine containing products.
  • the kits contain a sustained release system of the type herein described capable of delivering long-term therapeutic levels of a drug substitute, e.g., lobeline, along with instructions providing information to the user and/or health care provider regarding the use of the system for treating the drug dependence, e.g., a lobeline kit for treating nicotine dependence includes instructions useful for aiding in the cessation of smoking or chewing a nicotine containing product.
  • the preferred kits for treating nicotine dependence include a delivery system capable of providing sustained release of therapeutic levels of lobeline for at least three weeks.
  • Yet another object of the invention is to prov " 3 a method, drug delivery system and/or kit for treating various types of drug dependencies, e.g., nicotine, heroin, non-opiate sedative (including barbiturate), benzodiazepine, cocaine and alcohol dependencies.
  • drug dependencies e.g., nicotine, heroin, non-opiate sedative (including barbiturate), benzodiazepine, cocaine and alcohol dependencies.
  • a drug substitute e.g., lobeline
  • a drug substitute e.g., lobeline
  • a drug substitute e.g., lobeline
  • Still another object of the invention is to provide therapeutic levels of a drug substitute, e.g., lobeline, without the need for multiple, daily doses.
  • a drug substitute e.g., lobeline
  • Figures 1A, IB and 1C depict a lobeline containing microparticle, microcapsule and elongated rod, respectively.
  • Figure 2 depicts a transdermal patch having a diffusion layer matrix.
  • Figure 3 depicts a multicompartmental transdermal patch.
  • Figure 4 depicts a kit containing four packaged transdermal patches having a diffusion layer matrix along with instructions.
  • Figure 5 depicts a kit containing twenty-eight packaged multicompartmental transdermal patches along with instructions.
  • Figure 6 depicts a kit including a syringe containing microparticles of a biodegradable polymer containing lobeline, a container of a pharmaceutically acceptable vehicle, and instructions,
  • Figure 7 depicts the jji vitro release of lobeline free base from PLGA microparticles (150-180 ⁇ ) at 30%, 40%, and 50% lobeline loading.
  • Figure 8 depicts the in vitro release of lobeline free base from PLGA microparticles (38-106 ⁇ ) at 30% lobeline loading.
  • Figure 9 depicts the in vivo release of lobeline free base, expressed as the percentage of lobeline remaining at the injection site, from a formulation containing 30% lobeline free base and a formulation containing 40% lobeline free base.
  • Figure 10 depicts the in vivo effect of lobeline dose on the number of cigarettes smoked.
  • Figure 11 depicts the in vivo effect of lobeline dose on the number of smoking puffs.
  • Figure 12 depicts the in vivo release of lobeline free base, from PLGA microparticles at 35 % lobeline loading.
  • Figure 13 depicts the in vivo effect of a lobeline-containing microparticle formulation on the number of cigarettes smoked by human volunteers following subcutaneous injection of the microparticles.
  • the present invention pertains to a method for treating an individual for drug dependence.
  • the method comprises administering a therapeutic level of a drug substitute to the individual in a controlled, sustained release manner over a period of time having a duration of at least one day.
  • the method is useful for treating a broad spectrum of drug dependencies, including dependencies on nicotine, heroin, non- opiate sedatives (including barbiturate) benzodiazepine, cocaine and alcohol.
  • the method is particularly useful in combination with a drug cessation program.
  • Such programs combine therapies for treating an individual's physical drug dependence with behavior modification counseling directed to reducing the individual's psychological dependence on the drug.
  • the method is useful, for example, for treating nicotine dependence, wherein the preferred methods of the invention involve administration regimens that are easily integrated with smoking cessation behavioral modification programs.
  • methods for treating other drug dependencies can likewise involve administration regimens that are easily integrated with drug cessation programs including behavior modification counseling.
  • These programs are designeded to teach individuals how to quit or reduce their drug dependence, e.g., use of nicotine containing products, by modifying their behavior.
  • these programs involve regularly scheduled, e.g. weekly or biweekly, meetings with counselors.
  • time periods easily integrated with smoking cessation behavioral modification support programs is intended to include time periods which coincide with regularly scheduled meetings with counselors, e.g. weekly or biweekly.
  • the delivery system may be designed such that weekly subcutaneous or intramuscular injections are required to maintain a therapeutic level of lobeline in the individual's circulatory system.
  • the weekly injections are easily coordinated with a weekly appointment with a counselor from a behavioral modification support program.
  • the injection is administered by medical personnel or the counselor.
  • the individual may schedule a weekly appointment for obtaining both the injection and any necessary behavioral support counseling.
  • the present invention also pertains to a drug delivery system useful for treating a drug dependence.
  • the drug delivery system is useful for treating nicotine dependence, i.e., aiding an individual in the cessation of smoking or chewing nicotine containing products.
  • the delivery system includes a physical constraint modulation system (PCMS) containing a drug substitute, e.g., lobeline.
  • PCMS physical constraint modulation system
  • the system is constructed and arranged to deliver a therapeutic level of the drug substitute to the individual in a controlled, sustained release manner for a period of time having a duration of at least one day.
  • the delivery system is constructed and arranged such that the physical constraint modulation system subcutaneously, intramuscularly or transdermally delivers the drug substitute into the circulatory system.
  • the drug delivery system is used to provide long-term therapeutic levels of a drug substitute, such as lobeline, to the individual. Delivering the drug substitute in such a manner reduces or eliminates the individual's physical dependence on the drug of abuse. In connection with treating nicotine dependence, delivering lobeline in such a manner reduces or eliminates the individual's smoking or chewing habit.
  • a drug substitute such as lobeline
  • the term individual is intended to include individuals who suffer from a drug dependency. Typically, such individuals are physically, as well as psychologically, addicted to a drug of abuse. Treatment for such individuals is directed both to treating the physical addiction, e.g., by administration of a drug substitute, and behavior modification counseling.
  • drug dependence refers to a dependence on a drug, which dependence is treatable by administration to the individual of a drug substitute.
  • An exemplary list of drug dependencies with the corresponding drug substitutes is provided in Table I.
  • drug substitute is also intended to encompass structural equivalents of the drug substitute having the same or similar functional characteristics.
  • individuals refers to individuals who smoke or chew nicotine containing products.
  • the nicotine containing products may be any product containing nicotine, e.g. cigarettes, pipe tobacco, and chewing tobacco.
  • PCMS is intended to include substances or components, e.g. solids, liquids, gels or layers, capable of releasing a drug substitute, such as lobeline, in a sustained release manner.
  • a drug substitute such as lobeline
  • Examples of PCMS which are useful within the present invention include biodegradable polymers and parts of transdermal patches.
  • lobeline is intended to include 2-[6-(B-hydroxyphenethyl)-l-methyl-2-piperidyl] acetophenone as shown below.
  • the lobeline may be in its free base form or may be in the form of a water soluble salt, e.g. hydrochloride or sulfate salts, or a less soluble salt, e.g. palmoate.
  • lobeline also is intended to encompass structural equivalents of the above compound which share the same or similar functional characteristics.
  • Structural equivalents are structurally similar to the above compound but may have one or more substituents on the core structure.
  • substituents may be placed on either of the benzene rings as long as the substituents do not adversely affect the compound's ability to act as a substitute for nicotine.
  • substituents may include lower alkyl groups, e.g. methyl, ethyl and propyl groups.
  • the methyl group of the piperidyl nitrogen may be substituted with a different lower alkyl group, e.g. ethyl or propyl group.
  • controlled, sustained release manner is intended to include the delivery of the drug substitute, e.g., lobeline, in a manner in which only a portion of the drug substitute is released from the PCMS at a given moment while the remaining drug substitute is retained in the PCMS and released gradually over an extended period of time.
  • the extended period of time is a period of time having a duration of at least a day (twenty-four hours), but may be longer such as up to about thirty days or even ninety days.
  • the long-term therapeutic levels of lobel-ine are intended to include those levels of lobeline sufficient to significantly reduce or eliminate the individual's habit for smoking or chewing a nicotine containing product over an extended period of time, as defined above.
  • Examples of such therapeutic levels include from about five to about thirty milligrams of lobeline per day, preferably averaging between about ten to about twenty milligrams per day over time periods of about one to at least about thirty days. These doses are based on the free base form of lobeline. This dose of about five to about thirty mg of lobeline is the amount of lobeline released from the PCMS and does not refer to the level of lobeline detected in the individual's circulatory system.
  • the PCMS of the drug delivery system may be in a form suitable for subcutaneous or intramuscular injection, such as combined with a biodegradable polymer.
  • biodegradable polymer includes polymers capable of degrading jin vivo and delivering the drug substitute, e.g., lobeline, in a controlled, sustained release manner such that long-term therapeutic levels of the drug substitute are attainable.
  • the polymer is selected such that it does not cause significant adverse effects to the individual when administered in vivo.
  • biodegradable polymers which may be used in this invention include poly(lactic/glycolic)acid copolymers (PLGA), polylactic acid (PLA) , polyglycolic acid (PGA), polyesters, e.g.
  • the preferred biodegradable polymer is PLGA.
  • Polymers prepared from glycolide and lactide dimers e.g., PLGA, PLA and PGA, are known to undergo slow hydrolysis when implanted in tissue and the by-products of their hydrolysis (lactic and glycolic acids) both are normal metabolites.
  • PLGA, PLA, and PGA are believed to be non-toxic, are relatively non-inflammatory, and non-tissue reactive.
  • the polymers also exhibit moderate strength and tension, compression and pliability.
  • the term PLGAs will be used to encompass PLA, PGA, and PLGA.
  • the specific lactide/glycolide ratio of the PLGAs polymer and the molecular weight of the polymer are factors considered when designing the drug delivery system. There are differences in the hydrophobicity and crystallinity of lactic acid, and glycolic acid, and the use of a fast-hydrolyzing polymer (low molecular weight, low lactide content) for rapid ultimate clearance of a drug substitute such as lobeline, is balanced with the need for the sustained release of relatively soluble lobeline provided by a slow-hydrolyzing polymer (high molecular weight, high lactide content).
  • the preferred polymers for delivery of lobeline are in the range of about 50:50 lactide/glycolide to about 85:15 lactide/glycolide.
  • the preferred polymers also have molecular weights in the range of about 50,000 to about 150,000 dalton ⁇ , preferably about 100,000 daltons.
  • the preferred polymers are selected on the basis of the specific lactide/glycolide ratio of the PLGAs polymer, the molecular weight of the polymer, differences in the hydrophobicity and crystallinity of lactic acid, and glycolic acid, and the relative solubility of the drug substitute.
  • lobeline is loaded into the polymer in an amount which allows sustained release of the lobeline from the polymer at the desired therapeutic levels.
  • the preferred loading of lobeline into a PLGA polymer having a lactide/glycolide content of about 85:15 and a molecular weight of about 100,000 daltons, is about 20 to about 65%, more preferably about 30 to about 50%, most preferably about 30 to about 40% by weight of lobeline based on the weight of the polymer.
  • the formulation of the biodegradable polymer and the drug substitute, e.g., lobeline, should be such that it permits subcutaneous or intramuscular deposition.
  • injectable formulations such as microparticles, microcapsules or elongated rods of the polymer/lobeline composition.
  • the figures and examples discussed herein describe drug delivery systems in which the drug substitute is lobeline. These descriptions are exemplary only and are not intended to limit the invention in any way.
  • the lobeline controlled release delivery system is a model system for drug delivery systems for other drug substitutes as well.
  • Figures 1A-1C depict a lobeline containing microparticle, microcapsule and elongated rod respectively.
  • the lobeline may be distributed throughout the biodegradable polymer 2 as shown in Figures 1A and IC.
  • the lobeline 1 may be encapsulated within the biodegradable polymer 2 as shown in Figure IB.
  • microparticles, microcapsules, and elongated rods of the biodegradable polymer are of a size capable of being subcutaneously or intramuscular injected or implanted while releasing the drug substitute, e.g., lobeline, in a controlled, sustained release manner.
  • sizes for microparticles include in the range from about 38 to about 250 microns, most preferably 38 to about 106 microns.
  • sizes for microcapsules include in the range from about 10 to about 250 microns.
  • sizes for elongated rods include a diameter in the range of about 1 to 4 mm and a length in the range of about 0.5 to about 3 cm.
  • the preferred form of the biodegradable polymer is microparticles.
  • the microparticles preferably are suspended in a pharmaceutically acceptable vehicle just prior to the time of injection.
  • the pharmaceutically acceptable vehicle is selected such that it can form a suspension with and permit delivery of the microparticles and such that it does not have a significant adverse effect on lobeline's ability to substitute for nicotine when administered in vivo.
  • the pharmaceutically acceptable vehicle or diluent, for other drug substitutes is selected in a similar manner.
  • a pharmaceutically acceptable vehicle is selected which will permit delivery of the microparticles but which will not adversely effect the ability of the drug substitute to substitute for the drug of abuse when administered in vivo.
  • Examples of pharmaceutically acceptable vehicles useful for lobeline delivery include, for example, solutions prepared as follows: Formulation No. 1 - 0.38 g carboxymethylcellulose, 3.75 g mannitol, and 0.08 g Tween 80 in 20 ml. of distilled water; Formulation No. 2 (preferred) - 0.0127 g carboxymethylcellulose, 0.056 g mannitol, 0.027 g Tween 80 in 20 ml. of distilled water.
  • a syringe containing the microparticles can be used to draw up the pharmaceutically acceptable vehicle creating the suspension.
  • Other methods of preparing the suspension of course may be used.
  • the suspension may be created outside of the syringe and then drawn into the syringe.
  • the suspension is injected into the individual preferably at time periods easily integrated with behavioral modification support programs, such as smoking cessation programs.
  • the microparticles cannot be suspended in the vehicle for a prolonged period of time because significant amounts of the lobeline would be released from the microparticles into the vehicle.
  • the suspension is injected within about an hour after being prepared.
  • the rate at which a drug substitute is released from microparticles iji vitro is determined for each drug substitute.
  • the in vitro release rate is used to establish the recommended time period within which the suspension should be injected for each drug substitute-containing microparticle suspension.
  • microparticles When using microparticles (or other forms wherein the amount of drug released will gradually diminish over time) , specific dosing procedures may be desirable. For example, if at least 15 mg of a drug substitute per day were the desired level of sustained release, a dose of microparticles might be prepared to deliver 20 mg per day on day one, with release diminishing to 14 mg per day on day eight. As will be readily understood, the second dose would need to be smaller than the first dose to attain a level of 15 mg per day for the next seven days due to the continued release of the drug substitute from the residual microparticles of the first dose. Thus, certain PCMS delivery systems will require different dosing schemes.
  • lobeline is believed to be non-addictive and rapidly cleared from the circulatory system. It is believed that such rapid clearance is due to the binding of lobeline to nicotine receptors located in the brain. Thus, although lobeline may be rapidly cleared from the circulatory system, it may persist in the brain for a substantially longer period of time.
  • the PCMS also may be part of a transdermal patch.
  • Transdermal patches have a variety of advantages including avoidance of the gastro-intestinal tract, sustained action which readily can be adjusted, self-administration and the ability to immediately discontinue dosage.
  • the term transdermal patch is intended to include patches capable of being affixed to the skin of an individual and having a part or component capable of delivering a drug substitute, e.g., lobeline, in a controlled sustained release manner. Examples of types of patches useful in this invention include those having a diffusion layer matrix and/or multicompartmental type patches. These will be described in detail below.
  • the patch of Fig. 2 involves a diffusion matrix layer that uses a reticulated macroporous polymeric foam as a framework for holding a viscoelastic lobeline-polymer mixture.
  • the patch 10 is a 4-layer, laminated composite that is adapted to be adhered to the skin.
  • the outermost layer, backing layer 12 functions as the primary structural element of the device as well as serving as a protective covering to prevent the lobeline from being transmitted from the device via the outermost surface.
  • Backing layer 12 preferably is made of a sheet or film of a resilient elastomer of about 10-75 microns thick. Examples of such elastomers include polyether block amide copolymers, polyethylene methacrylate block copolymers, polyurethanes, silicon elastomers and the like.
  • the lobeline-containing matrix layer 14 functions as a reservoir for lobeline, an enhancer, and optionally a pressure sensitive adhesive.
  • the framework of the matrix is a reticulated macroporous polymeric foam 16.
  • the network is essentially completely open pores (90% or greater).
  • the pore rating of the reticulated foam will normally be in the range of about 10-40 pores per linear centimeter and the density (unfilled) will typically be in the range of about 0.01 to 0.5g/cm3.
  • Suitable polymers from which such foam frameworks may be manufactured include polyurethanes and polyethylenes.
  • a pressure sensitive adhesive layer 18 covers the exposed face of the matrix layer 14 and a release liner 20 covers the pressure sensitive adhesive.
  • the pressure sensitive adhesive layer 14 i ⁇ a medical grade adhesive compo ⁇ ition having a thickness normally between about 25 and 100 microns.
  • An example of such an adhesive is polydimethylsiloxane (Dow Corning 355 medical grade adhesive) .
  • the pores of the foam are wholly or partly filled with a viscoelastic hydrophobic lobeline-permeable polymer and an enhancer.
  • the polymer acts as a carrier for the lobeline and the enhancer acts to control the solubility of the lobeline in the polymer and/or absorption of the drug into the skin.
  • the hydrophobic polymer renders the device water-resistant and prevents liquid water from being absorbed by the device, thereby increasing its functionality and wearability.
  • Examples of such polymers are polysiloxanes (silicone polymers), hydrophobic polyacrylate ⁇ , polyurethane ⁇ , pla ⁇ ticized ethylene-vinyl acetate copolymers and the like.
  • An example of a useful enhancer includes AzoneTM.
  • the mixture including the lobeline optionally includes an anti-pruritic agent.
  • the optimum dose range i.e., the range of doses with which the drug exhibits maximum therapeutic effect and minimum adverse side effects is determined empirically, for any drug substitute.
  • the patch or other delivery system is configured and formulated to contain sufficient drug substitute to release a dose within the optimum dose range for the desired period of time.
  • the patch of Fig. 3 also is a 4-layer composite defining at least two separate compartments.
  • One compartment contains the drug substitute, e.g., lobeline, and the other compartment contains a delivery substance that when mixed with lobeline permits the delivery of the lobeline transdermally.
  • the patch 22 has a backing layer 24 sealed to a rate controlling membrane 26 in a manner to create two chambers, lobeline containing chamber 28 and a delivery substance containing chamber 30.
  • An adhesive layer 32 covers the rate controlling membrane and a release sheet 34 covers the adhesive layer.
  • a silanized polyester (or other suitable material treated with a releasing agent) approximately 75 microns thick, is used as a release sheet 34.
  • the adhe ⁇ ive layer 32 i ⁇ cast onto the release sheet, and may be for example polyisobutylene.
  • the adhesive layer then is laminated to the rate controlling membrane 26, which may be about 100 microns thick. Ethylene-vinyl acetate may be employed for the control membrane.
  • the materials which will become the contents of the lobeline containing chamber 28 and delivery ⁇ ubstance chamber 30 are placed in separate areas on the rate controlling membrane 26.
  • the material for the lobeline containing chamber 28 may be lobeline freebase and the material for the delivery substance containing chamber may be an alcoholic or aqueous/alcoholic solution.
  • a suitable backing 24 having a heat sealable coating on one surface is placed over the two area ⁇ which are to become chamber ⁇ 28 and 30, and the device is heat sealed 36 around the perimeter and between the two areas to form the two chambers, 28 and 30.
  • the heat seal 38 between the two chambers should be le ⁇ secure than the heat seal 36 about the perimeter, so that the seal between the chambers will selectively burst under pres ⁇ ure applied by the u ⁇ er.
  • pre ⁇ ure may be applied to either one of the chambers to burst the ⁇ eal between the chambers, thereby mixing the solution and the lobeline and dis ⁇ olving the lobeline.
  • the lobeline then is in a form which is capable of passing through the rate controlling membrane 26 for delivery to the skin of the user.
  • the chamber ⁇ may include enhancer ⁇ for affecting uptake of the lobeline acro ⁇ s the skin.
  • kits useful in treating a drug dependence such as those drug dependencies listed in Table I above.
  • Kits for treating nicotine dependence are designed to aid an individual in the cessation of smoking.
  • the kits for treating a drug dependence contain a PCMS delivery system according to the invention, as well as instructions for use.
  • the kit for treating nicotine dependence may contain at least one packaged transdermal patch 30 containing the lobeline along with instructions 32 providing information to the user and/or health care provider regarding the use of the patch.
  • the number of transdermal patches provided in the kit may depend on the type of transdermal patch and the length of the smoking cessation program for which the kit is being designed, e.g. a three week or a four week smoking cessation program. In general, the course of treatment is between four and eight weeks, with a six to eight week program being fairly typical.
  • a transdermal patch containing the lobeline in a diffu ⁇ ion layer matrix typically is designed for long term drug delivery, e.g. about seven days.
  • a kit for a four week smoking cessation program thus may contain four such packaged transdermal patches 30 as shown in Figure 4.
  • the instruction ⁇ 32 would inform the individual and/or health care provider to replace the patches on a weekly ba ⁇ i ⁇ , e.g. Day 1 - patch no. 1, Day 8 - patch no. 2, etc.
  • a kit for accompanying a three or four week ⁇ moking ce ⁇ ation program may contain twenty-one or twenty-eight, re ⁇ pectively, multicompartmental transdermal patche ⁇ 30 as shown in Figure 5.
  • the in ⁇ truction ⁇ 32 would inform an individual and/or health care provider to replace the tran ⁇ dermal patch on a daily ba ⁇ i ⁇ and al ⁇ o would instruct the individual how to contact the lobeline in the first compartment with the delivery substance in the second compartment. For example, the individual may have to break a pressure sensitive seal between the two compartments.
  • the kit al ⁇ o may include at least one container 34 of an injectable or implantable PCMS delivery system and instructions 32 for use as shown in Figure 6.
  • the kit may include four to eight containers of polymer/lobeline microparticles useful for a four to six week ⁇ moking ce ⁇ ation program.
  • each container may need to contain a different amount of microparticles/drug substitute to account for continued release of the drug sub ⁇ titute from microparticles remaining from each earlier dose.
  • each container may contain the same quantity of microparticles/drug sub ⁇ titute with in ⁇ truction ⁇ to inject a reduced volume of re ⁇ uspended microparticles/drug sub ⁇ titute on ⁇ ubsequent days of the treatment period.
  • it may not be necessary to decrease the dose level during the treatment program for drug substitutes which are non-addictive and/or rapidly cleared from the circulatory sy ⁇ tem.
  • the kit may further include at least one container 36 of a pharmaceutically acceptable vehicle.
  • a syringe 38 also may be provided in the kit. The syringe may be pre-loaded with microparticles.
  • Lobeline free base was obtained from Sigma Chemical company or prepared from lobeline sulfate obtained from Boehringer Ingelheim. The compound was characterized prior to use by UV spectroscopy, HPLC, and melting point.
  • MEDISORBTM 8515DL lactide/glycolide bioresorbable polymer was obtained from DuPont. By specification the polymer is 85 ⁇ 5% lactide and 15 ⁇ 5% glycolide.
  • the solvents (highest grade available) were obtained from Fisher Scientific.
  • the polymer (3.5044 g) was dissolved in methylene chloride (23 ml.) as a 15% solution by weight.
  • Lobeline (1.5006 g) was added to the polymer solution and the solution was stirred to insure complete mixing. The solution wa ⁇ then ca ⁇ t onto a clean, level piece of plate glass and spread with a Boston-Bradley adjustable blade. After evaporation of most of the solvent under a nitrogen stream, the film was peeled from the glass and vacuum desiccated.
  • the film formed in the casting step was of very low density because the solvent removal step left a very large void volume.
  • the void volume wa ⁇ reduced to decrea ⁇ e permeation of fluids into the microparticle ⁇ by a compre ⁇ ion step, utilizing heat and hydraulic pressure.
  • the film was extruded into rods with a Pa ⁇ adena Hydraulic Pre ⁇ s at about 70°C.
  • the extruded rod ⁇ were ground into ⁇ mall part-ole ⁇ u ⁇ ing a commercial grinder with a cooled grinding chamber. Following grinding, the powder or ⁇ mall particle ⁇ were passed through USP sieve ⁇ to collect microparticle ⁇ in the ⁇ ize range ⁇ of about 38 to 106 ⁇ , 106-150 ⁇ and 150-180 ⁇ . The microparticle ⁇ containing 30% lobeline were collected,
  • Example l was repeated except 1.0000 g of lobeline was placed in the jar with the polymer solution (1.501 g in 10 ml.). The microparticles containing 40% lobeline were formed and collected.
  • Example 1 was repeated except 2.0016 g of lobeline was placed in the jar with the polymer solution (2.0016 g in 13 ml.). The microparticle ⁇ containing 50% lobeline were formed and collected.
  • Example 4 The In vitro Release of Lobeline from
  • the PLGA/lobeline microparticles prepared in Examples 1, 2, and 3 were exposed to a phosphate buffered ⁇ aline (PBS) solution under ⁇ imulated sink condition ⁇ such that the drug would never reach more than 20% concentration in the buffer.
  • the microparticles were placed in a thimble which was further placed in a test tube. Each day the thimble was moved to a new test tube and the lobeline content in the PBS solution was measured by extraction and concentration in an organic solvent, followed by UV analysis. Analysis of the buffer for lobeline content was made on a daily basis in the first two to three days, then on a weekly schedule thereafter. The results are depicted in Figure 7.
  • Figure 7 depicts the release of lobeline free base from PLGA microparticles (150-180 ⁇ ) at 30%, 40%, and 50% lobeline loading.
  • the method of analysis for this example differs from example 5 above in that the amount of lobeline left in the microparticles was measured after leaching the microparticles in the PBS solution. The total amount left in the microparticle ⁇ was subtracted from the amount initially loaded into the microparticles to obtain the amount released.
  • the particles themselve ⁇ differed as well, in that 38-106 ⁇ sized microparticle, prepared a ⁇ described in Example l, were used.
  • the microparticles were placed in an extraction thimble and covered with a glass wool plug.
  • the thimbles were suspended in phosphate buffered saline containing 0.1% sodium azide. (9 thimbles/1.7 L) .
  • Each day the samples were removed, air dried, then vacuum dried.
  • Each dry thimble was transferred to a large test tube and enough CH 2 C1 2 was added to cover the thimble.
  • the tube was vortexed to aid in dissolving the microparticle. To each tube, a measured volume of 0.01 N H 2 S0. was added.
  • Two formulations were tested.
  • One formulation contained PLGA microparticle ⁇ at 30% lobeline free ba ⁇ e loading, and the other formulation contained PLGA microparticles at 40% lobeline free base loading.
  • a suspension containing 20 mg/ml of 30% formulation or 15 mg/ml of 40% formulation was prepared in diluent (.94 g carboxymethylcellulose, 9.38 g of D-Mannitol, .2 g polysorbate 80 (Tween 80) in 50 ml of water).
  • diluent .94 g carboxymethylcellulose, 9.38 g of D-Mannitol, .2 g polysorbate 80 (Tween 80) in 50 ml of water.
  • mice Female Sprague-Dawley Rat ⁇ (250-300 g) were used. Two animal ⁇ were used a ⁇ negative control ⁇ . An aliquot of 0.1 ml of vehicle wa ⁇ injected into the scapular region of each animal from a syringe fitted with a 22 gauge needle. On day 7, the two animals were sacrificed with C0 2 and the fatty tissue in the scapular region was removed.
  • the remaining animals were divided into two groups: those receiving the 30% formulation and those receiving the 40% formulation. From each group, four animals were used a ⁇ po ⁇ itive controls. These animals were sacrificed and the fatty ti ⁇ sue and facia in the scapular region wa ⁇ removed. Prior to the time of analy ⁇ i ⁇ , an aliquot of 0.1 ml of the formulation in vehicle was added to the tissue sample.
  • the formulation ⁇ were prepared for use a ⁇ described above, and in every case a 0.1 ml aliquot was given. At the time of sacrifice, the fatty tis ⁇ ue and facia in the scapular region of each animal wa ⁇ removed. In most, but not all cases, areas of tissue containing microparticles could be observed. It seems likely, however, that some of the microparticles migrated to area ⁇ beyond the exci ⁇ ion site and that this material was thus not recovered.
  • a tissue sample along with 2-3 ml CH_C1 2 was placed in a short glass test tube. lOOul of a l mg/ml solution of triprolidine in CH 2 C1 2 (internal standard) was added. Using the Tis ⁇ ue TearorTM at 4500 - 8000 rpm, the ⁇ ample was homogenized. The sample was transferred to a centrifuge tube with a teflon-lined screw cap and centrifuged for 7 min. The CH 2 C1 2 was carefully pipetted out and transferred to a test tube. To this solution 1 ml of 0.01N H 2 S0. wa ⁇ added and the mixture wa ⁇ vortexed for 15-20 seconds.
  • the top (acid) layer was carefully removed with a pipette and the volume of this acid solution was mea ⁇ ured.
  • the acid ⁇ olution wa ⁇ then tran ⁇ ferred to a new, clean te ⁇ t tube or vial and filtered through 0.45u nylon filter prior to injection.
  • the extraction of the CH 2 C1 2 with acid was repeated until no more lobeline was detected or a maximum of five repeats.
  • the acid samples were analyzed directly by HPLC.
  • the amount of lobeline recovered was based on a standard curve of extracted lobeline concentration/internal standard concentration from spiked tissue control samples at various lobeline levels.
  • HPLC System used was as follows: Waters 510 pump; Waters U6, injector; Waters Lambda Max 481 LC Spectrophotometer; spectra Physics SP 4270 Integrator; Phenomenex Partisil C g 5u 100X4.6 mm column with 30X4.6 mm guard column with same packing.
  • the mobile Phase was: 60% Phosphate Buffer, pH 3:40% (50:50 CHgCN/MeOH) .
  • the flow rate was 1.2 ml/min; AUFS 1.0; detection at 249 mn; with 4 ul sample injection volume.
  • the result ⁇ (shown in Figure 9) are presented graphically, with the percent of the dose found in the tissue sample plotted against different kinds of treatment duration.
  • the 30% loading exhibited a ⁇ omewhat more linear relea ⁇ e profile than the 40% loading.
  • the method of analysis for this example differs from example 6 above in that a single formulation containing PLGA microparticles at 35% lobeline free base loading was tested.
  • the formulation was sealed into polyethylene bags with 20 ⁇ pores prior to implantation in the scapular region of rats. These bags are porous enough for use in dissolution studies, yet have pores small enough to retain the microparticles (smallest particle diameter is 38 ⁇ ) .
  • Polyethylene pouche ⁇ (Biotek, Woburn, MA) were u ⁇ ed. Twelve pouche ⁇ were heat ⁇ ealed without filling and cut to a size of about 1 cm x 1 cm. The remaining pouches were filled with approximately 4 mg of the above formulation each and similarly sealed and trimmed.
  • Female Sprague Dawley rats of approximately 250 g each were obtained and quarantined. At time zero (T 0), each rat wa ⁇ anesthetized and an incision just larger than the width of the pouch was made in the scapular area. The pouch was held with forceps and dipped into normal saline, then the forceps were used to ⁇ lip the pouch under the ⁇ kin. The inci ⁇ ion wa ⁇ closed with one or two staples.
  • the pouches were removed from six controls (empty pouches) and six animals (for each time point) which had received the formulation.
  • the method of removal was to anesthetize the animal and then to make an "L" shaped incision around the site of the pouch.
  • the pouch was exposed by lifting the skin.
  • Each pouch was rinsed in a normal saline solution and patted dry on a paper towel.
  • the pouches were stored in sealed polyethylene bags overnight in the freezer and analyzed the next day. All animals were sacrificed immediately following removal of the pouches.
  • the acid samples were analyzed directly by HPLC.
  • the amount of lobeline released from each pouch was based on a standard curve of lobeline concentration/internal standard concentration at various lobeline levels.
  • HPLC analy ⁇ i ⁇ was performed as described above, with the following modifications.
  • Triprolidine (10.0 mg) was accurately weighed and quantitatively transferred to a 10 ml type A volumetric flask and Q.S. to volume with mobile phase to give an Internal Standard Stock Solution having a Triprolidine concentration of 1.0 mg/ml. This stock solution was used to prepare the Working Diluent.
  • Working Diluent A type A volumetric pipette was used to accurately transfer 1 ml of the Internal Standard Stock Solution to a 100 ml volumetric flask and Q.S. to volume with mobile phase (described below). Thereafter, 5 ml of the latter solution was accurately trai ferred (type A volumetric pipette) to a second 100 ml volumetric flask and Q.S. to volume with mobile phase to prepare the Working Diluent.
  • the Working Diluent had a Triprolidine concentration of 500 ng/ml .
  • Lobeline reference standard (10.0 mg) was accurately weighed and quantitatively transferred to a 10 ml type A volumetric flask and Q.S. to volume with mobile phase to provide a Lobeline Stock Solution having a lobeline concentration of 1.0 mg/ml.
  • a type A volumetric pipette wa ⁇ used to accurately transfer 1 ml of the Lobeline Stock Solution to a 10 ml volumetric fla ⁇ k and Q.S. to volume with Working Diluent. Thereafter, 1 ml of the latter solution was accurately transferred (type A volumetric pipette) to a second 10 ml volumetric flask and Q.S. to volume with Working Diluent to prepare the Standard Lobeline Solution.
  • the Standard Lobeline Solution had a lobeline concentration of 0.01 mg/ml.
  • Mobile Phase All solution ⁇ were degassed and filtered through a 0.2 micron membrane filter before use.
  • the mobile phase was prepared by adding 200 ⁇ l triethylamine to one liter of a mixture containing 62% 40 mM phosphoric acid (pH 3.00) and 38% acetonitrile.
  • the Column was Phenomenex/Partisil 5C8 (25.0 cm x 4.6 mm i.d.). The flow rate was 1.0 ml/min; detection wa ⁇ at 249 nm; with a 35 ⁇ l injection volume.
  • test subjects consisted of long-term or chronic smokers who were smoking regularly for more than five years. They were smoking habitually 20 or more cigarettes per day. All volunteers were healthy, non-obese, male adults without history of gastrointestinal, hepatic, neurological or hematological abnormalities. Prior to enrollment for the study, each volunteer was examined for normalcy.
  • a formulation comprising PLGA microparticles containing lobeline was prepared according to the method described in Example 1. However, the concentration of lobeline was adjusted to provide microparticles containing 35% lobeline by weight. Prior to injection, the formulation was resuspended in a diluent (D-mannitol (50 mg) , carboxymethyl cellulose ⁇ odium (5 mg), polysorbate-80 (l mg) and water for injection Q.S. to 1 ml) to form a homogeneous suspension.
  • D-mannitol 50 mg
  • carboxymethyl cellulose ⁇ odium 5 mg
  • polysorbate-80 l mg
  • the number of cigarettes smoked in the period following the injections decreased in comparison to the number of cigarettes con ⁇ umed prior to injection.
  • the re ⁇ ult ⁇ are illustrated in Figure 13. As shown in figure 13, the number of cigarettes smoked in a 24 hour period compared to the number of cigarettes smoked prior to treatment is reported as the % cigarettes smoked. This percentage decreased substantially following injection of the lobeline suspension.

Abstract

L'invention se rapporte à un système d'administration de médicaments, servant à traiter une personne pour une toxicomanie. Dans l 'un de ces modes de réalisation, ce système sert à aider des personnes à cesser de fumer ou de mâcher des produits contenant de la nicotine. Ce système d'administration comprend un système de modulation de contrainte physique (PCMSTM) contenant de la lobéline. Ce système d'administration de médicaments est capable de délivrer de la lobéline à une personne selon un mode de libération prolongé et contrôlé et de fournir à cette personne des niveaux t hérapeutiques de lobéline à long terme. En administrant de la lobéline de cette façon, on réduit ou on élimine l'habitude de fumer ou de mâcher chez la personne soignée. Le système PCMS peut être constitué par un polymère biodégradable contenant la lobéline, qui peut être injectée par voie sous-cutanée ou intramusculaire ou être implantée dans l'organisme de la personne traitée, ou peut faire partie d'un timbre transdermique contenant de la lobéline. L'invention se rapporte également à des procédés d'utilisation de ces systèmes d'administration de médicaments pour traiter d'autres toxicomanies, ainsi qu'à des kits contenant de tels systèmes d 'administration de médicaments.
PCT/US1992/003859 1991-05-07 1992-05-07 Systeme d'administration de medicaments a liberation prolongee et controllee pour le traitement des toxicomanies WO1992019226A1 (fr)

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Journal of Medicinal Chemistry, vol. 16, no. 8, August 1973, J.H.R. WOODLAND et al.: "Long-acting delivery systems for narcotic antagonists. 1", pages 897-901, see the whole article *
Journal of Pharmaceutical Sciences, vol. 64, no. 2, February 1975, S. YOLLES et al.: "Long acting delivery systems for narcotic antagonists II: release rates of naltrexone from poly(lactic acid) composites", pages 348-349, see the whole article *
P.B. DEASY: "Microencapsulation and related drug processes", 1984, Marcel Dekker, Inc., New York, US, see pages 223-224, chapter 10.1.2: "Narcotic antagonists" *

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NO933971L (no) 1994-01-07
AU2016092A (en) 1992-12-21
HUT69390A (en) 1995-09-28
WO1992019241A1 (fr) 1992-11-12
AU2154892A (en) 1992-12-21
FI934919A0 (fi) 1993-11-05
AU657973B2 (en) 1995-03-30
JPH06507416A (ja) 1994-08-25
HU9303146D0 (en) 1994-01-28
CA2102507A1 (fr) 1992-11-08
EP0720478A1 (fr) 1996-07-10
NO933971D0 (no) 1993-11-03

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