Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
• • 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
  • 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
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P23/00—Anaesthetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P23/00—Anaesthetics
  • A61P23/02—Local anaesthetics

Definitions

• This invention relates to a new formulation of long-acting local anaesthetics.
• a known class of long-acting local anaesthetics comprises l-alkyl-N-(2,6- dimethylphenyI)-2-piperidinecarboxamides. This class includes racemic bupivacaine, levobupivacaine, mepivacaine and ropivacaine. Racemic bupivacaine is widely used, and is available for both epidural and spinal administration.
• WO 90/00390 discloses aqueous solutions for spinal analgesia, comprising dezocine, bupivacaine and also 5-10% w/v glucose if it is desired that the solution should be hyperbaric.
• the solutions of the Examples which are hyperbaric are also hypertonic.
• Hytta et al Regionale-Anaesthesie (1982) 5:85-8, discloses the use of 0.5% bupivacaine, either "isobaric” (Marcain®) or hyperbaric (8% glucose). The former is presumably plain Marcain® which is in fact hypobaric.
• a hyperbaric formulation of bupivacaine comprising 2 ml ampoules of 0.75% bupivacaine (racemate) and 8.25% glucose.
• the use of 0.75% solutions of racemic bupivacaine is contra-indicated, in obstetrical anaesthesia.
• the Physician's Desk Reference® carries a "black box" warning.
• This invention is based at least in part on the realisation that, in order for a formulation of bupivacaine to be most useful for spinal administration, i.e. at least isobaric and also isotonic with respect to cerebrospinal fluid (CSF), the level of saccharide should be chosen with relation to the amount of bupivacaine, and should be in a range between those previously suggested.
• the ability to produce an isotonic formulation means that potential exchange of solutes with the cellular material in CSF is avoided.
• the beneficial effects of a l-alkyl-N-(2,6- dimethylphenyl)-2-piperidinecarboxamide such as bupivacaine can be provided in combination with a relatively small amount of glucose and, if necessary, a salt such as NaCl.
• a salt such as NaCl.
• the glucose provides adequate baricity, whilst the salt makes the composition isotonic. The use of large amounts of glucose is thus avoided, and the risk associated with contact between the composition and plasma or cerebrospinal fluid is reduced.
• a solution of the invention will usually be sterile, and typically comprises up to 1% w/v of the anaesthetic, e.g. at least 0.25%, and often 0.5 to 0.75% w/v.
• An advantage of the use of levobupivacaine over bupivacaine may be the ability to use higher concentrations.
• a composition of the invention is made up in unit dosages, e.g. of 2 or 3 ml, suitably in a sealed container, e.g. of glass or a transparent plastics material.
• a sealed container e.g. of glass or a transparent plastics material.
• One preferred formulation comprises 2 ml ampoules or vials of 0.75% levobupivacaine (this compound is described herein for the purposes of illustration only).
• Spinal administration may be by any conventional means.
• the formulation will generally be given to provide anaesthesia and analgesia during surgical procedures and also in Caesarean section and to treat chronic pain.
• Levobupivacaine used in the present invention is preferably substantially free of dextrobupivacaine, and is more preferably in at least 90%, and most preferably at least 99%, enantiomeric excess with respect to dextrobupivacaine.
• reference to bupivacaine and its enantiomers includes pharmaceutically- acceptable salts thereof.
• Such a compound is typically provided as the HC1 salt.
• Any other salt that is present must of course be physiologically-acceptable, and will usually comprise an inorganic cation. For example, it may be an alkali metal salt such as NaCl.
• levobupivacaine can be administered to a patient safely for at least 24 hours, often up to 72 hours, and even for periods of up to a week or a fortnight, or longer. It can, of course, be administered for similar periods already used for the racemic drug, e.g. between 3 and 6 hours.
• Example 1 The following Examples illustrate the invention. These Examples use levobupivacaine; using bupivacaine instead should have no effect on osmolality or baricity, at equimolar concentrations.
• Example 1 The following Examples illustrate the invention. These Examples use levobupivacaine; using bupivacaine instead should have no effect on osmolality or baricity, at equimolar concentrations.
• levobupivacaine levo
• dextrose dextrose
• Formulations containing more than 2.2% dextrose with 0.75% (7.5 mg/ml) levobupivacaine, or more than 2.5% dextrose with 0.5% (5.0 mg/ml) levobupivacaine, will be technically hyperbaric in all patients.
• Such formulations, containing less than 5% dextrose, are hypo-osmolar; a suitable salt (NaCl) is added to make the formulations isotonic.
• aqueous formulation comprising 0.5% or 0.75% w/v levobupivacaine, 4% w/v dextrose and 0.15% NaCl.
• This was an isotonic, hyperbaric composition suitable for spinal administration, to provide safe, effective anaesthesia.
• physiologically-acceptable inorganic salts such as sodium chloride
• an osmotically-balanced formulation which is isotonic with CSF and body fluids (approximating to 300 mOSm/kg) has been achieved.

Landscapes

• Health & Medical Sciences (AREA)
• Chemical & Material Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• General Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Medicinal Chemistry (AREA)
• Epidemiology (AREA)
• Chemical Kinetics & Catalysis (AREA)
• General Chemical & Material Sciences (AREA)
• Anesthesiology (AREA)
• Molecular Biology (AREA)
• Oil, Petroleum & Natural Gas (AREA)
• Biochemistry (AREA)
• Inorganic Chemistry (AREA)
• Engineering & Computer Science (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Organic Chemistry (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicinal Preparation (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Hydrogenated Pyridines (AREA)

Priority Applications (14)

Applications Claiming Priority (4)

Publications (1)

Family

ID=26312628

Family Applications (1)

Country Status (17)

Cited By (12)

Families Citing this family (4)

Citations (3)

• 1998
  • 1998-11-19 CN CN98811339A patent/CN1131033C/zh not_active Expired - Lifetime
  • 1998-11-19 PT PT98954639T patent/PT1032390E/pt unknown
  • 1998-11-19 AT AT98954639T patent/ATE253913T1/de active
  • 1998-11-19 CA CA002308495A patent/CA2308495C/en not_active Expired - Lifetime
  • 1998-11-19 AU AU11684/99A patent/AU740914B2/en not_active Expired
  • 1998-11-19 KR KR1020007005443A patent/KR100695588B1/ko not_active Expired - Lifetime
  • 1998-11-19 DE DE69819770T patent/DE69819770T2/de not_active Expired - Lifetime
  • 1998-11-19 BR BR9814883-4A patent/BR9814883A/pt not_active Application Discontinuation
  • 1998-11-19 US US09/195,908 patent/US5932597A/en not_active Expired - Lifetime
  • 1998-11-19 EP EP98954639A patent/EP1032390B1/en not_active Expired - Lifetime
  • 1998-11-19 WO PCT/GB1998/003479 patent/WO1999025349A1/en not_active Ceased
  • 1998-11-19 DK DK98954639T patent/DK1032390T3/da active
  • 1998-11-19 IL IL13592298A patent/IL135922A0/xx not_active IP Right Cessation
  • 1998-11-19 JP JP2000520782A patent/JP2001522888A/ja active Pending
  • 1998-11-19 HU HU0004665A patent/HU228143B1/hu unknown
  • 1998-11-19 ES ES98954639T patent/ES2209217T3/es not_active Expired - Lifetime
• 2000
  • 2000-05-18 NO NO20002545A patent/NO328684B1/no not_active IP Right Cessation

Patent Citations (3)

Non-Patent Citations (14)

Also Published As

Similar Documents

Legal Events