Classifications

• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
  • A61K31/568—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
  • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • 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
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
• • 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
• • 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
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4858—Organic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
  • A61P15/16—Masculine contraceptives
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/24—Drugs for disorders of the endocrine system of the sex hormones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/24—Drugs for disorders of the endocrine system of the sex hormones
  • A61P5/26—Androgens
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07J—STEROIDS
  • C07J1/00—Normal steroids containing carbon, hydrogen, halogen or oxygen, not substituted in position 17 beta by a carbon atom, e.g. estrane, androstane
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
• • 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
  • A61K47/44—Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin
• • 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
  • A61K9/10—Dispersions; Emulsions
  • A61K9/107—Emulsions ; Emulsion preconcentrates; Micelles
  • A61K9/1075—Microemulsions or submicron emulsions; Preconcentrates or solids thereof; Micelles, e.g. made of phospholipids or block copolymers
• • 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
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals

Definitions

• the present invention relates generally to pharmaceutical delivery systems of hydrophobic drugs and compositions comprising same. More particularly, the present invention relates to pharmaceutical compositions comprising testosterone and esters thereof with enhanced and extended absorption and pharmacokinetics.
• Sex hormones e.g., testosterone and its esters
• testosterone and its esters are marginally water soluble, and attempts have been made to increase their bioavailability, particularly when taken orally.
• administration of testosterone, per se presents additional challenges. Indeed, while testosterone given by mouth is essentially completely absorbed into the portal circulation, because of extensive first-pass hepatic metabolism, the serum concentration of testosterone following this route of administration is low unless very large doses are administered.
• attempts have been made to alkylate testosterone at the C- 17 position (e.g., with a methyl group to form methyltestosterone) thereby reducing metabolism by the liver.
• mere alkylation of testosterone has not yielded desirable bioavailability and has been associated with potentially serious hepatotoxicity.
• a pharmaceutical composition comprising testosterone palmitate (TP), or a testosterone ester thereof, and two or more lipid components at least the first of which comprises a hydrophilic surfactant and at least the second of which comprises a lipophilic surfactant that provides for the controlled release of TP, said lipid components together providing for the solubilization of TP.
• the pharmaceutical composition may further comprise at least three lipid components at least the first of which comprises a hydrophilic surfactant, at least the second of which comprises a lipophilic surfactant that provides for the controlled release of TP and at least the third of which comprises a lipophilic surfactant that further provides for the solubilization of TP.
• the pharmaceutical composition may further comprise a second lipid-soluble therapeutic agent, such as a synthetic progestin.
• a second lipid-soluble therapeutic agent such as a synthetic progestin.
• Formulations comprising same may be preferably in the form of an orally active male contraceptive.
• the first lipid component may exhibit an HLB of 10 to 45, preferably 10 to 30, and more preferably 10 to 20.
• the second lipid component may exhibit an HLB of less than about 10, preferably less than about 7, and more preferably less than about 5.
• the second lipid component may exhibit a melting point in the range of about 25 °C to about 80 0 C, preferably about 35 0 C to about 65 0 C, and more preferably about 40 °C to about 60 °C.
• the second lipid component may be chosen from the group consisting of stearic acid, palmitic acid, glycerol and PEG esters thereof, Precirol ATO 5 and Gelucires.
• the lipophilic surfactant further comprises a "sustained” or controlled-release" surfactant which may be chosen from the group consisting of stearic acid, palmitic acid, glycerol and PEG esters thereof, Precirol AT05, Imwitor 191, Myverol 18-06, Imwitor 370, Imwitor 375, Caprol ET, Cithrol 2MS, Marosol 183 and combinations thereof.
• the hydrophilic surfactant may be a poloxyl derivative of castor oil. Commercially available products of this class are supplied under the tradenames, Cremophor or Etocas and include, Cremophor EL and RH 40 and Etocas 35 and 40.
• compositions of the present invention may comprise, based on weight, 10- 70% a lipophilic surfactant; 1-40% a controlled release surfactant; and 5-60% a hydrophilic surfactant; and preferably 30-50% a lipophilic surfactant; 5-25% a controlled release surfactant; and 30-40% a hydrophilic surfactant.
• the compositions further comprise about 5 to about 50 percent, by weight, testosterone palmitate, preferably, about 20 to about 40 percent, by weight, testosterone palmitate.
• the inventive pharmaceutical compositions may also comprise one or more cosolvents and/or filled into a hard or soft gelatin capsule.
• a method of preventing or alleviating the symptoms of testosterone deficiency in a mammalian subject comprising administering to the mammalian subject an effective amount of testosterone palmitate (TP) solubilized in two or more lipid components, such that the administration of said solubilized TP raises the mammalian subject's steady state serum level of testosterone to within those levels found in mammalian subjects having no testosterone deficiency and providing at least some relief from such symptoms.
• the administering is preferably once or twice daily and the mammal's steady state serum level of testosterone is raised to fall within a range of about 300 ng/dl to about 1100 ng/dl.
• the method may raise the mammal's steady state serum level of testosterone by 150%, 200%, 300% or 400%.
• the method may further comprise administering an amount of a synthetic progestin sufficient to inhibit gonadotropin release in said mammalian subject and produce severe oligospermia or azospermia.
• a method of delivering steady- state serum levels of testosterone effective to provide at least some relief from symptoms of testosterone deficiency comprising solubilizing testosterone palmitate (TP) in two or more lipid components at least the first of which comprises a hydrophilic surfactant and at least the second of which comprises a lipophilic surfactant that provides for the controlled release of TP and administering an effective amount of the solubilized TP to a subject suffering from the symptoms of testosterone deficiency.
• TP testosterone palmitate
• the method can further comprise solubilizing TP in at least three lipid components at least the first of which comprises a hydrophilic surfactant, at least the second of which comprises a lipophilic surfactant that provides for the controlled release of TP and at least the third of which comprises a lipophilic surfactant that further provides for the solubilization of TP.
• a method of providing extended release of testosterone in vivo comprising solubilizing testosterone palmitate (TP) in a lipid mixture comprising two or more lipid components at least the first of which comprises a hydrophilic surfactant and at least the second of which comprises a lipophilic surfactant having a melting point of greater than about 35 0 C.
• TP testosterone palmitate
• a pharmaceutical composition comprising testosterone palmitate (TP) and two or more lipid components at least the first of which comprises a hydrophilic surfactant and at least the second of which comprises a lipophilic surfactant, in which the at least first hydrophilic component or the at least second lipophilic component provides for the controlled release of TP, and said lipid components together provide for the solubilization of TP.
• the at least first hydrophilic component provides for the controlled release of TP.
• Figure 1 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which maximizes diurnal variation while producing an early Tmax, preferably compatible with early morning, once-daily dosing.
• Figure 2 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP which maximizes diurnal variation while producing a late Tmax, preferably compatible with night-time, once-daily dosing.
• Figure 3 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP which provides physiological diurnal variation and an early Tmax, preferably compatible with early morning, once-daily dosing.
• Figure 4 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which provides physiological diurnal variation and a delayed Tmax, preferably compatible with early morning, once-daily dosing.
• Figure 5 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which provides a short elimination half-life and an early Tmax, preferably compatible with maximal patient activity soon after waking and twice-daily dosing.
• Figure 6 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which provides a relatively short elimination half-life and a delayed Tmax with maximal activity about waking time.
• One of the twice-daily doses is preferably scheduled before bedtime.
• Figure 7 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which provides and intermediate elimination half-life and a Tmax preferably compatible with maximal activity soon after walking while reducing the extent of fluctuation to the physiological level with twice-daily dosing.
• Figure 8 depicts a steady-state pharmacokinetic profile of the serum concentration of testosterone upon ingestion of a formulation of TP, which provides a longer elimination half-life and a delayed Tmax, preferably compatible with maximal activity about awakening time following bedtime administration.
• This formulation reduces the extent of fluctuation to the physiological levels of testosterone with twice- daily dosing.
• Figure 9 shows dissolution curves of TP from three formulations (9, 23 and 24 the compositions of which are listed in Table 2) in a phosphate buffered dissolution medium incorporating TritonX-100 as a surfactant in accordance with the present invention.
• Figure 10 shows dissolution curves of TP from three formulations (47, 50, 51 and 54 the compositions of which are listed in Table 3) in a phosphate buffered dissolution medium incorporating TritonX-100 as a surfactant in accordance with the present invention.
• Figure 11 provides the mean steady-state profile of treatment with three regimens for seven days.
• Figure 12 shows the mean steady-state serum T and DHT Levels after seven days of BID administration of formulation 54.
• Figure 13 provides a simulated mean steady-state profile of formulation 50 with respect to the observed profile for formulation 54 (both administered BID for seven days).
• Figure 14 shows representative in vitro dissolution profiles for various TP formulations in phosphate buffer (PBS)
• Figure 15 shows representative in vitro dissolution profiles for various TP formulations in fed-state simulated intestinal fluid (FeSSIF).
• the present invention provides pharmaceutical delivery systems, preferably oral, for hydrophobic drugs. Accordingly, while the instant invention will be described, to some extent, with reference to oral delivery systems, the present invention may be suitable for topical and intramuscular injection.
• hydrophobic drugs defined herein encompass both those drugs that are inherently hydrophobic (i.e., having a log P of at least 2) as well as otherwise hydrophilic medicaments that have been rendered hydrophobic with suitable modification (e.g., conjugation to fatty acids and/or lipids).
• Log P is the log of the octanol- water or buffer partition coefficient and can be determined by a variety of methods for those skilled in the art. The higher the value of log P, the greater the lipophilicity and thus lipid solubility of the chemical entity in question.
• testosterone and/or esters at the C- 17 position of the testosterone molecule may be orally delivered using the inventive delivery system. While many of the embodiments of the present invention will be described and exemplified with the palmitic acid ester of testosterone (also referred to as “testosterone palmitate” or "TP"), the scope of the present invention should not be construed nor limited solely to the delivery of TP or testosterone per se.
• TP palmitic acid ester of testosterone
• inventive drug delivery systems and compositions therefrom may be suitable for oral delivery of other testosterone esters, such as short-chain (C 2 -C 6 ), medium-chain (C 7 -C 13 ) and long- chain (C 14 -C 24 ) fatty acid esters, preferably long-chain fatty acid esters of testosterones and numerous hydrophobic medicaments.
• suitable medicaments which may be formulated in accordance with the present invention include, but should not be limited to, the following:
• Analgesics and anti-inflammatory agents aloxiprin, auranofin, azapropazone, benorylate, diflunisal, etodolac, fenbufen, fenoprofen calcim, flurbiprofen, ibuprofen, indomethacin, ketoprofen, meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxyphenbutazone, phenylbutazone, piroxicam, sulindac.
• Anthelmintics albendazole, bephenium hydroxynaphthoate, cambendazole, dichlorophen, ivermectin, mebendazole, nitazoxamide, oxamniquine, oxfendazole, oxantel embonate, praziquantel, pyrantel embonate, thiabendazole.
• Anti-arrhythmic agents amiodarone HCl, disopyramide, flecainide acetate, quinidine sulphate.
• Anti-bacterial agents benethamine penicillin, cinoxacin, ciprofloxacin HCl, clarithromycin, clofazimine, cloxacillin, demeclocycline, doxycycline, erythromycin, ethionamide, imipenem, nalidixic acid, nitrofurantoin, rifampicin, spiramycin, sulphabenzamide, sulphadoxine, sulphamerazine, sulphacetamide, sulphadiazine, sulphafurazole, sulphamethoxazole, sulphapyridine, tetracycline, trimethoprim.
• Anti-coagulants dicoumarol, dipyridamole, nicoumalone, phenindione.
• Anti-depressants amoxapine, maprotiline HCl, mianserin HCl, nortriptyline
• Anti-diabetics acetohexamide, chlorpropamide, glibenclamide, gliclazide, glipizide, tolazamide, tolbutamide.
• Anti-epileptics beclamide, carbamazepine, clonazepam, ethotoin, methoin, methsuximide, methylphenobarbitone, oxcarbazepine, paramethadione, phenacemide, phenobarbitone, phenytoin, phensuximide, primidone, sulthiame, valproic acid.
• Anti-fungal agents amphotericin, butoconazole nitrate, clotrimazole, econazole nitrate, fluconazole, flucytosine, griseofulvin, itraconazole, ketoconazole, miconazole, natamycin, nystatin, sulconazole nitrate, terbinaf ⁇ ne HCl, terconazole, tioconazole, undecenoic acid.
• Anti-gout agents allopurinol, probenecid, sulphin-pyrazone.
• Anti-hypertensive agents amlodipine, benidipine, darodipine, dilitazem HCl, diazoxide, felodipine, guanabenz acetate, isradipine, minoxidil, nicardipine HCl, nifedipine, nimodipine, phenoxybenzamine HCl, prazosin HCl, reserpine, terazosin
• Anti-malarials amodiaquine, chloroquine, chlorproguanil HCl, halofantrine
• Anti-migraine agents dihydroergotamine mesylate, ergotamine tartrate, methysergide maleate, pizotifen maleate, sumatriptan succinate.
• Anti-muscarinic agents atropine, benzhexol HCl, biperiden, ethopropazine
• Anti-neoplastic agents and Immunosuppressants aminoglutethimide, amsacrine, azathioprine, busulphan, chlorambucil, cyclosporin, dacarbazine, estramustine, etoposide, lomustine, melphalan, mercaptopurine, methotrexate, mitomycin, mitotane, mitozantrone, procarbazine HCl, tamoxifen citrate, testolactone.
• Anti-protazoal agents benznidazole, clioquinol, decoquinate, diiodohydroxyquinoline, diloxanide furoate, dinitolmide, furzolidone, metronidazole, nimorazole, nitrofurazone, ornidazole, tinidazole.
• Anti-thyroid agents carbimazole, propylthiouracil.
• Anxiolytic, sedatives, hypnotics and neuroleptics alprazolam, amylobarbitone, barbitone, bentazepam, bromazepam, bromperidol, brotizolam, butobarbitone, carbromal, chlordiazepoxide, chlormethiazole, chlorpromazine, clobazam, clotiazepam, clozapine, diazepam, droperidol, ethinamate, flunanisone, flunitrazepam, fluopromazine, flupenthixol decanoate, fluphenazine decanoate, flurazepam, haloperidol, lorazepam, lormetazepam, medazepam, meprobamate, methaqualone, midazolam, nitrazepam, oxazepam, pentobarbitone, perphenazin
• Beta-blockers acebutolol, alprenolol, atenolol, labetalol, metoprolol, nadolol, oxprenolol, pindolol, propranolol.
• Cardiac Inotropic agents amrinone, digitoxin, digoxin, enoximone, lanatoside C, medigoxin.
• Corticosteroids beclomethasone, betamethasone, budesonide, cortisone acetate, desoxymethasone, dexamethasone, fludrocortisone acetate, flunisolide, flucortolone, fluticasone propionate, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone.
• Diuretics acetazolamide, amiloride, bendrofluazide, bumetanide, chlorothiazide, chlorthalidone, ethacrynic acid, frusemide, metolazone, spironolactone, triamterene.
• Anti-parkinsonian agents bromocriptine mesylate, lysuride maleate.
• Gastro-intestinal agents bisacodyl, cimetidine, cisapride, diphenoxylate
• Histamine H,-Receptor Antagonists acrivastine, astemizole, cinnarizine, cyclizine, cyproheptadine HCl, dimenhydrinate, flunarizine HCl, loratadine, meclozine HCl, oxatomide, terrenadine.
• Lipid regulating agents bezafibrate, clofibrate, fenofibrate, gemfibrozil, probucol.
• Nitrates and other anti-anginal agents amyl nitrate, glyceryl trinitrate, isosorbide dinitrate, isosorbide mononitrate, pentaerythritol tetranitrate.
• Nutritional agents betacarotene, vitamin A 5 vitamin B 2 , vitamin D, vitamin
• Opioid analgesics codeine, dextropropyoxyphene, diamorphine, dihydrocodeine, meptazinol, methadone, morphine, nalbuphine, pentazocine.
• Sex hormones clomiphene citrate, danazol, ethinyloestradiol, medroxyprogesterone acetate, mestranol, methyltestosterone, norethisterone, norgestrel, oestradiol, conjugated oestrogens, progesterone, synthetic progestins (also referred to as progestogens), stanozolol, stiboestrol, tibolone, testosterone, esters of testosterone, including esters of oleic acid, linoleic acid, linolenic acid, stearic acid, myristic acid, lauric acid, palmitic acid, capric or decanoic acid octanoic or caprylic acid, pelargonic acid, undecanoic acid, tridecanoic acid, pentadecanoic acid, and the branched chain, cyclic analogues of these acids, testosterone analogues
• Synthetic progestins include, for example, levonorgestrel, levonorgestrel butanoate, drospirenone, norethisterone, desogestrel, etonorgestrel and medroxyprogesterone, .
• GnRH Gonadotropin releasing hormone
• Mixtures of hydrophobic drugs may, of course, be used where therapeutically effective.
• the combination of testosterone palmitate with an orally active inhibitor or Type I or Type II 5 ⁇ -reductase or the combination of testosterone palmitate with a synthetic progestin may be preferable in some embodiments.
• Drug delivery systems of the present invention and compositions comprising same comprise a hydrophobic drug or drugs dissolved in a lipophilic surfactant and a hydrophilic surfactant.
• a lipophilic surfactant as defined herein has a hydrophilic- lipophilic balance (HLB) less than 10, and preferably less than 5.
• a hydrophilic surfactant as defined herein has an HLB of greater than 10.
• HLB is an empirical expression for the relationship of the hydrophilic and hydrophobic groups of a surface active amphiphilic molecule, such as a surfactant. It is used to index surfactants and its value varies from about 1 to about 45. The higher the HLB, the more water soluble the surfactant.
• each of the components of the delivery system i.e., the lipophilic and hydrophilic surfactants individually have solvent characteristics and contribute, in part, to solubilizing the active ingredient.
• Those lipophilic surfactants that contribute substantially to dissolving the drug are defined herein as a "primary" solvent.
• Primary solvents can also provide "sustained- release” or “controlled-release” characteristics to the drug delivery system.
• “Secondary” solvents are hydrophilic surfactants that also solubilize the drug, albeit to a lesser extent than a primary solvent.
• secondary solvents facilitate the dispersion of the delivery system in aqueous media or intestinal fluids and subsequent release of the drug.
• hydrophilic surfactant component may be necessary to achieve desirable emission of the drug from within the formulation. That is, a hydrophilic surfactant may be required to free the drug from within the lipid carrier matrix, or primary solvent.
• a high HLB surfactant such as Cremophor RH40, can generally suffice.
• Cremophor RH40 Cremophor RH40
• levels of the high HLB surfactant can be adjusted to provide optimum drug release without compromising the solubilization of the active ingredient.
• the lipophilic surfactant component may further comprise a "controlled-release" surfactant.
• the lipophilic surfactant may also provide a semi-solid and sustained release (SR) matrix.
• SR sustained release
• Many semi-solid/SR excipients are available to one of ordinary skill in the art, but those that additionally are good solvents for the drug are desirable in the instant invention. Thus, preference should be given to semi-solid lipid excipients having high solubilization potential for the drug.
• "controlled-release" lipophilic surfactants exhibit a melting point of about 25 °C to about 80 °C, preferably about 35 °C to about 65 °C, and more preferably 40 °C to about 60 °C.
• controlled-release surfactants need not be limited to lipophilic surfactants alone. Indeed, some hydrophilic surfactants in compositions of the instant invention may also provide controlled-release characteristics in conjunction with a lipophilic surfactant.
• Lipophilic surfactants suitable in drug delivery systems of the present invention include:
• Fatty acids (C 6 -C 24 , preferably C 10 -C 24 , more preferably C 14 -C 24 ), for example, octanoic acid, decanoic acid, undecanoic acid, lauric acid, myristic acid, palmitic acid, stearic acid, oleic acid, linoleic acid, and linolenic acid. Stearic acid and palmitic acid are preferred.
• Mono- and/or di-glycerides of fatty acids such as Imwitor 988 (glyceryl mono-/di-caprylate), Imwitor 742 (glyceryl mono-di-caprylate/caprate), Imwitor 308 (glyceryl mono-caprylate), Imwitor 191 (glyceryl mono-stearate), Softigen 701 (glyceryl mono-/di-ricinoleate), Capmul MCM (glyceryl caprylate/caprate), Capmul MCM(L) (liquid form of Capmul MCM), Capmul GMO (glyceryl mono-oleate), Capmul GDL (glyceryl dilaurate), Maisine (glyceryl mono-linoleate), Peceol (glyceryl mono-oleate), Myverol 18-92 (distilled monoglycerides from sunflower oil) and Myverol 18-06 (distilled monoglycerides from hydrogenated soyabean oil), Precirol ATO
• Acetic, succinic, lactic, citric and/or tartaric esters of mono- and/or di- glycerides of fatty acids for example, Myvacet 9-45 (distilled acetylated monoglycerides), Miglyol 829 (caprylic/capric diglyceryl succinate), Myverol SMG (mono/di-succinylated monoglycerides), Imwitor 370 (glyceryl stearate citrate), Imwitor 375 (glyceryl monostearate/citrate/lactate) and Crodatem T22 (diacetyl tartaric esters of monoglycerides).
• Myvacet 9-45 distilled acetylated monoglycerides
• Miglyol 829 caprylic/capric diglyceryl succinate
• Myverol SMG mono/di-succinylated monoglycerides
• Imwitor 370 glyceryl stearate citrate
• Propylene glycol mono- and/or di-esters of fatty acids for example, Lauroglycol (propylene glycol monolaurate), Mirpyl (propylene glycol monomyristate), Captex 200 (propylene glycol dicaprylate/dicaprate), Miglyol 840 (propylene glycol dicaprylate/dicaprate) and Neobee M-20 (propylene glycol dicaprylate/dicaprate) .
• Polyglycerol esters of fatty acids such as Plurol oleique (polyglyceryl oleate), Caprol ET (polyglyceryl mixed fatty acids) and Drewpol 10.10.10 (polyglyceryl oleate).
• Castor oil ethoxylates of low ethoxylate content such as Etocas 5 (5 moles of ethylene oxide reacted with 1 mole of castor oil) and Sandoxylate 5 (5 moles of ethylene oxide reacted with 1 mole of castor oil.
• Sorbitan esters of fatty acids for example, Span 20 (sorbitan monolaurate), Crill 1 (sorbitan monolaurate) and Crill 4 (sorbitan mono-oleate).
• Transesterification products of natural or hydrogenated vegetable oil triglyceride and a polyalkylene polyol e.g. Labrafil Ml 944CS (polyoxyethylated apricot kernel oil), Labrafil M2125CS (polyoxyethylated corn oil) and Gelucire 37/06 (polyoxyethylated hydrogenated coconut).
• Labrafil M1944CS is preferred.
• Alcohol ethyoxylates e.g. Volpo N3 (polyoxyethylated (3) oleyl ether), Brij 93 (polyoxyethylated (2) oleyl ether), Marlowet LA4 (polyoxyethylated (4) lauryl ether) and
• lipophilic surfactants such as those listed above, may be used if desired, and in some instances are found to be advantageous.
• glycerol palmitate and glycerol stearate esters alone and in blends are preferred lipophilic surfactants and controlled-release matrices.
• lipophilic surfactants include, but are not limited to, stearic acid, palmitic acid, and their glycerol and PEG esters, Precirol AT05, Imwitor 191, Myverol 18-06, Imwitor 370, Imwitor 375, Caprol ET, Cithrol 2MS, Marosol 183, Gelucire 39/01 and combinations thereof.
• Any pharmaceutically acceptable hydrophilic surfactant i.e., having an HLB value greater than 10) may be used in the present invention.
• Some non-limiting examples include:
• Polyoxyethylene sorbitan fatty acid derivates e.g. Tween 20 (polyoxyethylene (20) monolaureate), Tween 80 (polyoxyethylene (20) monooleate), Crillet 4 (polyoxyethylene (20) monooleate) and Montanox 40 (polyoxyethylene (20) monopalmitate).
• Tween 80 Polysorbate 80 is preferred.
• Castor oil or hydrogenated caster oil ethoxylates HLB>10, e.g. Cremophor
• RH40 is preferred.
• Gelucires preferably Gelucire 50/13 (PEG mono- and diesters of palmitic and stearic acids.
• the first number i.e., 50
• the second i.e., 13
• Fatty acid ethoxylates (HLB>10), e.g. Myrj 45 (polyoxyethylene (8) stearate), Tagat L (polyoxyethylene (30) monolaurate), Marlosol 1820
• Myrj 45 is preferred.
• Alcohol ethoxylates (HLB>10), e.g. Brij 96 (polyoxyethylene (10) oleyl ether), Volpo 015 (polyoxyethylene (15) oleyl ether), Marlowet OA30
• Poloxamers such as Poloxamers 188 and 407 also known as Syperonic PE L44
• Anionic surfactants e.g. sodium lauryl sulphate, sodium oleate and sodium dioctylsulphosuccinate.
• Alkylphenol surfactants e.g. Triton N-101 (polyoxyethylene (9-
• hydrophilic surfactants listed above, those suitable as a "controlled- release" surfactant include, but are not limited to Gelucires of high HLB value, such as Gelucire 50/13.
• each of the components of the delivery system i.e., the lipophilic and hydrophilic surfactants individually has solvent characteristics and contributes, in part, to solubilizing the active ingredient.
• the present invention does not require additional solvents, such as additional digestible oils and/or cosolvents, but these may be optionally included in the inventive systems and formulations.
• a digestible oil is defined herein as an oil that is capable of undergoing de- esterification or hydrolysis in the presence of pancreatic lipase in vivo under normal physiological conditions.
• digestible oils may be complete glycerol triesters of medium chain (C 7 -C 13 ) or long chain (C 14 -C 22 ) fatty acids with low molecular weight (up to C 6 ) mono-, di- or polyhydric alcohols.
• digestible oils for use in this invention thus include: vegetable oils (e.g., soybean oil, safflower seed oil, corn oil, olive oil, castor oil, cottonseed oil, arachis oil, sunflower seed oil, coconut oil, palm oil, rapeseed oil, evening primrose oil, grape seed oil, wheat germ oil, sesame oil, avocado oil, almond, borage, peppermint and apricot kernel oils) and animal oils (e.g., fish liver oil, shark oil and mink oil).
• vegetable oils e.g., soybean oil, safflower seed oil, corn oil, olive oil, castor oil, cottonseed oil, arachis oil, sunflower seed oil, coconut oil, palm oil, rapeseed oil, evening primrose oil, grape seed oil, wheat germ oil, sesame oil, avocado oil, almond, borage, peppermint and apricot kernel oils
• animal oils e.g., fish liver oil, shark oil and mink oil
• optional cosolvents suitable with the instant invention are, for example, water, short chain mono-, di-, and polyhydric alcohols, such as ethanol, benzyl alcohol, glycerol, propylene glycol, propylene carbonate, polyethylene glycol with an average molecular weight of about 200 to about 10,000, diethylene glycol monoethyl ether (e.g., Transcutol HP), and combinations thereof.
• Other optional ingredients which may be included in the compositions of the present invention are those which are conventionally used in the oil-based drug delivery systems, e.g.
• antioxidants such as tocopherol, tocopherol acetate, ascorbic acid, butylhydroxytoluene, butylhydroxyanisole and propyl gallate; pH stabilizers such as citric acid, tartaric acid, fumaric acid, acetic acid, glycine, arginine, lysine and potassium hydrogen phosphate; thickeners/suspending agents such as hydrogenated vegetable oils, beeswax, colloidal silicon dioxide, mannitol, gums, celluloses, silicates, bentonite; flavoring agents such as cherry, lemon and aniseed flavors; sweeteners such as aspartame, acesulfane K, sucralose, saccharin and cyclamates; etc.
• pH stabilizers such as citric acid, tartaric acid, fumaric acid, acetic acid, glycine, arginine, lysine and potassium hydrogen phosphate
• thickeners/suspending agents such as hydrogenated vegetable oils, bees
• the relative proportions of the lipophilic surfactant and hydrophilic surfactant in the preferred hydrophobic drag carrier system of this invention are, in general, not especially critical, save that the concentration of lipophilic and hydrophilic surfactants must be sufficient to solubilize the hydrophobic drug, yet release same both in vitro and in vivo.
• one hydrophobic drug may serve as a lipid vehicle for another. More specifically, for example, a testosterone ester may serve as a carrier for testosterone. Even more specifically, TP may serve as a lipid vehicle for testosterone.
• TP may serve, in some embodiments, as its own “controlled-release” vehicle, which may obviate the need for additional "controlled-release” lipids mentioned above.
• concentrations by weight, are preferred (the percentages are based on the total content of hydrophilic surfactant and lipophilic surfactant(s)):
• Hydrophilic surfactant 5-60%, more preferably 15-45%, and most preferably 30-40% Lipophilic surfactant: 10-90%, more preferably 20-80%, and most preferably 30-60% Lipophilic "controlled-release" surfactant: 1-40%, more preferably 2.5 -30%, and most preferably 5-25%.
• the concentration of drug in the final pharmaceutical formulation will be that which is required to provide the desired therapeutic effect from the drug concerned, but generally will lie in the range 0.1% to 50% by weight, preferably between about 10% to 30% by weight, and most preferably about 10% and 20% by weight, based on the weight of the final composition.
• the drug concentration may be reduced as compared with the conventional preparations without loss of therapeutic effect.
• the present inventors have learned that the use of the palmitate ester of T, in particular, is desirable.
• formulations of the present invention comprising TP have a T half-life of about 8-9 hours.
• the half-life for T is about 30 minutes and that of T-undecanoate is about 1.5 hours.
• formulations of the present invention may have self- emulsifying properties, forming a fine emulsion upon dilution with aqueous media or intestinal fluids in vivo.
• the formulations may have high surfactant and lipid content designed for adequate dispersion upon mixing with an aqueous medium.
• Qualitative description of the self-emulsification property of the inventive formulations can be visually observed during the dissolution of same in vitro.
• quantitative measurements may be taken of the particle size of the emulsified droplets using laser light scattering and/or turbidity measurements in the dissolution medium by UV/VIS spectrophotometer. Any of these methodologies are available and known to one of ordinary skill in the art.
• compositions according to the present invention may be liquid, semi-solid, or solid at ambient temperatures, but preferably are presented as liquids or semi-solids.
• Solid preparations are defined as solid, powdered medicaments blended with powdered excipients and directly filled into hard gelatin or cellulose capsule or compressed into a tablet.
• the instant invention preferably comprises a solid, powdered medicament (e.g., TP) that is solubilized in the presence of the lipid surfactant excipients ⁇ e.g., any combination of the lipophilic and hydrophilic surfactants noted above). Accordingly, the melting point of the surfactants used is one factor that can determine whether the resulting composition will be liquid or semi-solid at ambient temperature.
• compositions of the present invention are liquid or semi-solid oral unit dosage forms, more preferably filled into hard or soft capsules, e.g. gelatin or cellulose capsules.
• the technology for encapsulating lipid-based pharmaceutical preparations is well known to one of ordinary skill in the art. As the inventive delivery systems and formulations described herein are not limited to any one encapsulation method, specific encapsulation techniques will not be further discussed.
• the drug carrier systems and pharmaceutical preparations according to the present invention may be prepared by conventional techniques for lipid-based drug carrier systems. In a typical procedure for the preparation of the preferred carrier systems of this invention, the lipophilic surfactant is weighed out into a suitable stainless steel vessel and the hydrophilic surfactant is then weighed and added to the container. Mixing of the two components may be effected by use of a homogenizing mixer or other high shear device. If the material is solid at room temperature, sufficient heat is applied to ensure metling and fluidity without chemical decomposition.
• the lipophilic "controlled-release" surfactant is then added, if desired, to the two other components in the stainless steel vessel and mixed using the appropriate equipment.
• the hydrophobic drug is then weighed and added to the combined lipid mixture and mixing continued until either a homogenous solution is prepared.
• the formulation may be de-aerated before encapsulation in either soft or hard capsules. In some instances the fill formulation may be held at elevated temperature using a suitable jacketed vessel to aid processing.
• testosterone is the main endogenous androgen in men. Leydig cells in the testes produce approximately 7 mg of testosterone each day resulting in serum concentrations ranging from about 300 to about 1100 ng/dL. Women also synthesize testosterone in both the ovary and adrenal gland, but the amount is about one-tenth that observed in eugonadal men. The majority (about 98%) of circulating testosterone is bound to sex hormone binding globulin and is biologically active only when released to the free form.
• free is thus defined as not being bound to or confined within, for example, biomolecules, cells and/or lipid matrices of the inventive formulations described herein.
• free medicaments described herein refer to medicament that is accessible to metabolic enzymes circulating in serum.
• TP has been found to offer unique chemical and physical characteristics that make its use preferable in some embodiments.
• the present inventors have learned that the palmitic acid ester of testosterone, in particular, can yield superior bioavailability to that found with other equivalent esters (e.g., testosterone undecanoate (TU)).
• esters e.g., testosterone undecanoate (TU)
• TU testosterone undecanoate
• TP absorbed into the bloodstream may passively diffuse into red blood cells (RBCs) circulating in the blood.
• RBCs red blood cells
• palmitic acid is both a significant component of the RBC membrane and has been shown to be transported across this membrane
• TP is better suited to be in an equilibrium with and pass said membrane. In this manner, some portion of the total concentration of free TP at any given time may be found within RBCs. Further, when confined to a RBC, any TP therein is shielded from the esterases found in the serum.
• Testosterone interacts with respective androgen receptors either directly or following its conversion to DHT via the action of 5 ⁇ -reductase.
• DHT is a more potent androgen than testosterone and its elevated levels are thought by some scientists to increase the risk of prostate cancer. Elevated levels of DHT are a noted problem with the administration of, for example, TU. In this way, TP provides yet another unexpected advantage over other testosterone esters.
• Table 1 provides composition details of various formulations of testosterone (T) or testosterone-esters (T-esters), in accordance with the teachings of the instant invention.
• T testosterone
• T-esters testosterone-esters
• 1 mg of T is equivalent to: 1.39 mg T- enanthate; 1.58 mg T-undecanoate; 1.43 mg T-cypionate, and 1.83 mg T-palmitate.
• TP is a preferred T-ester in some of the formulations listed below.
• the compositions details of Table 1 (mg/capsule and wt. percentage) are based on 800 mg fill weight per 1 OO' hard gelatin capsule.
• the formulations may be proportionally adjusted for smaller total fill weights that would permit use of smaller hard gelatin capsules (e.g., '0' size).
• a category e.g., lipophilic, hydrophilic, etc.
• Table 2 provides composition details of various TP formulations in accordance with the teachings of the instant invention and Figure 9 provides in vitro dissolution of select formulations therein.
• TP may be synthesized through esterification of testosterone with palmitoyl chloride in an acetone/pyridine mixture.
• Testosterone palmitate crude is purified by filtration, crystallized from a methanol/methylene chloride mixture and washed with methanol. When necessary, recrystallization can be done from heptane, followed by washing with methanol.
• TP Testosterone palmitate
• LBR Labrafil Ml 944CS
• PRC5 PrecirolATO5
• OA Refined Oleic acid
• SO Refined Soybean oil
• TPGS D- ⁇ -tocopheryl PEGlOOO succinate
• CRH 40 Cremophor RH40
• L'sol Labrasol
• M'tol Mannitol ** Filled into size'O" capsule (570 mg) or "OC'capsule (800mg)
• a preferred formulation of TP in accordance with the present invention is:
• TP 5 may in some cases, confer quicker release kinetics.
• a concentration of TP of less than about 23 percent by weight is preferred, more preferably a weight percentage of less than about 18, and most preferably a weight percentage of less than about 15.
• TP at levels greater than about 23 weight percent may, in fact, retard its own release.
• formulations according to the instant invention comprising less than about 23 weight percent TP can release 50 -70 % of the drug at 1 hour and 80 to near 100% at 2 hours.
• formulations according to the instant invention comprising greater than about 23 weight percent TP release less than 5 % of the drug at 1 hr and less than 70% at 6 hours.
• Table 3 provides composition details of various TP formulations, that in some cases, are at TP concentrations lower than those in Table 2 and in accordance with the teachings of the instant invention.
• Figure 10 provides in vitro dissolution of select Table 3 formulations.
• Formulation numbers 50, 51 and 54 are preferred embodiments.
• preferred solvents may have the following characteristics: C 4 -C 24 fatty acids and/or their glycerol-, propylene glycol-, polyethylene glycol, sorbitan- mono-/diesters alone and in mixtures.
• Preferred fatty acids and esters are C 8 -C 1S , saturated and unsaturated.
• the solvents include, fatty acid esters with lower alcohols, such as ethyl oleate, ethyl linoleate, isopropyl myristate, isopropylpalmitate, isopropyloleate and isopropyllinoleate.
• Formulations 50 and 54 were administered to 6 patients; number 50 was administered once-daily ("QD") in the form of two capsules per dose (100 mg T equivalents/capsule) and number 54 was administered once- and twice-daily ("BID”) in the form of three capsules per dose (66 mg T equivalents/capsule).
• QD once-daily
• BID twice-daily
• the mean steady-state profiles after 7 days of treatment with one of the three, respective, regimens are shown in Figure 11.
• the pharmacokinetic profile for formulation 54 BID was relatively uniform over the entire 24 hr period and had a trough of the mean profile about 70% of the peak of the mean profile. Additional data from formulation 54
• fatty acid esters particularly palmitate esters such as ascorbyl-palmitate, retinyl-palmitate, sorbitan-palmitate and blends thereof may establish competition between said ester and TP for endogenous esterase activity.
• testosterone ester metabolism generally, may be retarded with the administration of an effective amount of an ester of a medium or long chain fatty acid (e.g., esters of oleic acid, linoleic acid, linolenic acid, stearic acid, myristic acid, lauric acid, palmitic acid, capric or decanoic acid octanoic or caprylic acid, pelargonic acid, undecanoic acid, tridecanoic acid, pentadecanoic acid, and the branched chain, cyclic analogues of these acids).
• an ester of a medium or long chain fatty acid e.g., esters of oleic acid, linoleic acid, linolenic acid, stearic acid, myristic acid, lauric acid, palmitic acid, capric or decanoic acid octanoic or caprylic acid, pelargonic acid, undecanoic acid, tridecan
• the fatty acid ester may competitively inhibit esterases that would otherwise metabolize TP.
• Table 4 provides effective amounts of inhibitors of testosterone ester metabolism.
• esters or combinations thereof include botanical extracts or benign esters used as food additives (e.g., propylparben, octylacetate, and ethylacetate).
• TP absorption Other components that can modulate TP absorption include "natural" and synthetic inhibitors of 5 ⁇ -reductase, which is present in enterocytes and catalyze the conversion of T to DHT. Complete or partial inhibition of this conversion may both increase and sustain increases serum levels of T after oral dosing with TP while concomitantly reducing serum DHT levels.
• Borage oil which contains a significant amount of the 5 ⁇ -reductase inhibitor gamma-linoleic acid (GLA), is an example of a "natural" modulator of TP metabolism.
• GLA gamma-linoleic acid
• GLA could be directly added as a separate component of TP formulations described herein.
• 5 ⁇ -reductase inhibitors include epigallocatechin gallate, a catechin derived primarily from green tea and saw palmetto extract from berries of the Serenoa repens species, all of which may be suitable in the present invention.
• Non-limiting examples of synthetic 5 ⁇ -reductase inhibitors suitable in the present invention include finasteride and dutasteride.
• the present invention contemplates the use of inhibitors of T metabolism via other mechanisms.
• One such point of inhibition may be the cytochrome P450 isozyme CYP3A4 that is present in enterocytes and in liver cells and thus capable of metabolizing testosterone.
• formulations of the present invention include peppermint oil, which is known to contain factors capable of inhibiting CYP3A4.
• Table 4 provides composition details of various TP formulations comprising ingredients to modulate TP absorption (i.e., ascorbyl-palmitate, borage oil and peppermint oil).
• Figures 14 and 15 show representative in vitro dissolution profiles for select TP formulations therein in either phosphate buffer (PBS) or fed-state simulated intestinal fluid (FeSSIF), respectively.
• PBS phosphate buffer
• FeSSIF fed-state simulated intestinal fluid
• drug delivery systems disclosed herein may also be suitable for ameliorating some of the side-effects of certain strategies for male contraception.
• progestin-based male contraception substantially suppresses luteinizing hormone (LH) and follicle- stimulating hormone (FSH), and thereby suppresses spermatogenesis, resulting in clinical azoospermia (defined as less than about 1 million sperm/ml semen for 2 consecutive months).
• administration of progestins also has the undesirable side-effect of significantly reducing steady-state serum testosterone levels.
• a pharmaceutical preparation according to the invention comprising progestin — in an amount sufficient to substantially suppress LH and FSH production — in combination with testosterone.
• the pharmaceutical preparation is for once-daily, oral delivery.
• Drug delivery systems afford the flexibility to achieve desirable pharmacokinetic profiles. Specifically, the formulations can be tailored to deliver medicament in a relatively early peak serum concentration (T ma ⁇ ) or one that appears later. See Figures 1, 3, 5 and 7 versus Figures 2, 4, 6 and 8, respectively.
• compositions may be tailored to have a relative steep or wide drop in drug serum concentration upon obtaining T max . See Figures 1, 3, 5 and 7 versus Figures 2, 4, 6 and 8, respectively. Accordingly, pharmaceutical preparations of the instant invention may be administered once-daily, twice-daily, or in multiple doses per day, depending on, for example, patient preference and convenience.
• One way in which the formulations may be modified to affect these changes is to calibrate the ratio of lipophilic surfactants.
• the magnitude and timing of the T ma ⁇ can be affected by not only the type of lipids used, but also the ratios thereof.
• the concentration of the "controlled-release" lipophilic surfactant e.g., Precirol
• the concentration of the other lipophilic solvents e.g., Labrafil M1944CS.
• the percentage of "controlled-release" lipophilic surfactant in composition can be increased.
• Figures 9 and 10 show in vitro dissolution curves of TP from three formulations, respectively, in a phosphate buffered dissolution medium incorporating TritonX-100 as a surfactant in accordance with the present invention.
• inventive formulations described herein enhance absorption of a medicament therein by the intestinal lymphatic system.
• drug delivery systems of the present invention can provide extended release formulations that can deliver testosterone into the serum over several hours.
• the serum half-life of testosterone in men is considered to be in the range of 10 to 100 minutes, with the upper range for testosterone administered in a form (i.e., TU) that favors lymphatic absorption.
• oral dosages of the present invention can be taken by a patient in need of testosterone therapy once every about twelve hours to maintain desirable levels of serum testosterone.
• oral dosages are taken by a patient in need of testosterone therapy once every about twenty four hours.
• "desirable" testosterone levels are those levels found in a human subject characterized as not having testosterone deficiency.

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  • 2024-12-20 US US18/990,363 patent/US20250120983A1/en active Pending

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