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
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
• • 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
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/42—Oxazoles
  • A61K31/424—Oxazoles condensed with heterocyclic ring systems, e.g. clavulanic acid
• • 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
  • A61K9/1682—Processes
  • A61K9/1694—Processes resulting in granules or microspheres of the matrix type containing more than 5% of excipient
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/2027—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone, poly(meth)acrylates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
  • A61K9/2054—Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose

Definitions

• the present invention relates to solid oral dosage forms comprising clavulanic acid, pharmaceutically acceptable clavulanic acid salts, salt compositions and derivatives.
• the present invention provides immediate release compositions and extended release compositions of potassium clavulanate that are suitable for daily use and which achieve therapeutic levels of clavulanate.
• the present invention also relates to the processes for their preparation and to their use as medicaments, for example, for treatment of anxiety, depression, sexual dysfunction and neurological disorders.
• clavulanic acid is derived from the Streptomyces clavuligerus microorganisms from which clavulanic acid is derived.
• Clavulanic acid is biosynthetically generated from the amino acid arginine and the sugar glyceraldehyde 3-phosphate.
• Clavulanic acid has negligible intrinsic antimicrobial activity, despite sharing the beta-lactam ring that is characteristic of beta-lactam antibiotics. However, the similarity in chemical structure allows the molecule to act as a competitive inhibitor of beta-lactamases secreted by certain bacteria to confer resistance to beta-lactam antibiotics. When given in combination with some beta-lactam antibiotics like ticarcillin or amoxicillin, clavulanic acid can extend the spectrum and enhance the activity of the antibiotic (AHFS, 1991).
• clavulanic acid acts as an irreversible competitive inhibitor of bacterial beta-lactamases that naturally degrade and inactive beta-lactam antibiotics (Brown et al., J Antibiot (Tokyo). 1976, 29:668-669; Reading and Cole, Antimicrob Agents Chemother. 1977, 1 1 :852-857).
• Clavulanic acid is commercially available in the United States only in fixed combination with other drugs.
• Timentin ® the combination product of clavulanic acid and ticarcillin
• Timentin ® is normally given intravenously in doses ranging from 200-300 mg/kg/day (based on ticarcillin content) which corresponds to a dose of clavulanic acid of approximately 7-10 mg/kg/day (AHFS, 1991 ).
• AHFS ticarcillin content
• Augmentin ® co-amoxiclav
• the combination product of clavulanic acid and amoxicillin has shown the effectiveness against amoxicillin-resistant ⁇ -lactamase-producing strains.
• Standard adult dosages for respiratory tract, urinary, abdominal and dental infections as well as cellulitis and animal bites is co-amoxiclav 250/125 (250 mg of amoxicillin/125 mg of clavulanic acid) taken every 8 hours, which may be doubled in severe infections.
• Augmentin XR co-amoxiclav 1000/62.5
• Augmentin XR is marketed for use in community acquired pneumonia with two tablets taken twice a day
• clavulanic acid has shown effectiveness for neuroprotection, and in treating anxiety and sexual dysfunction.
• Koppel et al. in U.S. Pat. Nos. 6,489,319; 6,610,681; and 6,627,625 describe that clavulanic acid itself has an anxiolytic activity when administered i.p. at less than 1 microgram/kg.
• Koppel describes the potent neuroprotectant activity of clavulanic acid when treated rats with clavulanic acid at an i.p. dose of 1 ⁇ g/kg.
• 7,166,626 also discloses a method for treating sexual dysfunction with the administration of clavulanic acid.
• U.S. Pat. No. 6,489,319 reports that clavulanic acid could alter CNS activity and behavior at doses ranging from 10 ng to 10 ⁇ g/kg.
• Rothstein et al also demonstrated that several beta-lactam antibiotics could offer neuroprotection by the activation of the gene for glutamate neurotransmitter transporter (Nature, 2005, 433:73-77).
• beta-lactam antibiotics Since first identified with the discovery of penicillin in 1928, beta-lactam antibiotics have been among the most widely used antibiotics, but have not shown substantial toxic CNS actions at normal antibacterial doses. Therefore, beta-lactam antibiotics may be used as a new and safe therapeutic agent for the treatment of CNS related diseases.
• clavulanate The preparation of many of dry formulations containing clavulanic acid and derivatives or salts thereof (collectively referred to as clavulanate) has necessitated the inclusion of a complex formulation of excipients, including binders, glidants, disintegrants and even desiccants, etc. to yield a pharmaceutically acceptable carrier.
• excipients including binders, glidants, disintegrants and even desiccants, etc.
• clavulanate is a highly hygroscopic material which is highly unstable in aqueous media.
• Methods of formulation must therefore ensure that the product can retain its potency during storage, and yet can subsequently yield satisfactory dissolution rates.
• One such process is disclosed in WO 92/19227 and mandates the inclusion of both an intra-cellular and an extra-cellular disintegrant.
• potassium clavulanate is still extremely hygroscopic and susceptible to hydrolysis so that co-amoxicillin/clavulanate formulations are prone to degradation on storage even under low humidity conditions.
• the presence of water in crystallization of amoxicillin may contribute to instability of these dosage forms, accelerating the decomposition of clavulanate once any degradation has commenced.
• Clavulanate is an exceptionally difficult material to formulate because of its moisture and heat sensitive properties. There is a need to develop stable formulations of clavulanate alone, especially at low doses such as 10 ⁇ g to 10 mg, for example, from about 0.1 mg to about 5 mg, which is orally active and may be used for anxiety, depression, neuroprotection, sexual dysfunction, etc.
• the present invention is a stable oral dosage composition containing clavulanate, including an immediate release composition and an extended release composition, prepared from clavulanic acid or derivatives or salts thereof, for example potassium clavulanate or Clavitesse , that is suitable for daily use.
• the present invention overcomes and alleviates the above mentioned drawbacks and disadvantages through the development of novel oral clavulanate pharmaceutical compositions and methods.
• the present invention relates to stabilized solid pharmaceutical compositions and in particular, immediate release or extended release, stabilized pharmaceutical compositions that include clavulanate as the pharmaceutically active ingredient.
• the novel pharmaceutical compositions can be provided in a solid dosage form, such as a tablet, capsule, pill, troche or powder.
• the solid pharmaceutical composition can include a clavulanate in the presence of one or more pharmaceutically acceptable excipients, where the clavulanate present in an amount of between about 10 ⁇ g and about 10 mg or, for example, from about 0.1 mg to about 5 mg.
• the composition can provide a therapeutically useful amount of clavulanate upon administration.
• clavulanates include clavulanic acid, clavulanic acid derivatives and pharmaceutically acceptable salts of clavulanic acid.
• the clavulanate can be present in an amount between about 0.01% and about 10% by weight of the composition. In some embodiments, the moisture content of the composition is less than about 4% of the total weight.
• the formulation is the form of a tablet, capsule, pill, troche or powder.
• Exemplary solid pharmaceutical compositions according to the invention can have a moisture content of less than 10% after storage at 25°C and 60% relative humidity or after storage at 30°C at 65% relative humidity for three months.
• the clavulanate is potassium clavulanate.
• the potassium clavulanate can be provided as, for example, a powder or as a 1 : 1 mixture with silicon dioxide or microcrystalline cellulose.
• Exemplary compositions are immediate- release compositions which release more than 80% of clavulanate from the tablet within approximately 5 to approximately 30 minutes after administration.
• the composition is prepared by a method where potassium clavulanate powder is lyophilized in the presence of the one or more pharmaceutically acceptable excipients.
• the composition can contain from about 10% to about 20% by weight of a binder or diluent, about 45% to about 55% by weigh of a filler, about 20% to about 40% by weight of a disintegrant and about 3% to about 6% by weight of a lubricant.
• a binder or diluent is Maltrin Ml 50
• an exemplary filler is Prosolve SMCC 50
• an exemplary disintegrant is Pharmaburst and/or L HPC LH-1 1 and/or Acdisol
• an exemplary lubricant is stearic acid.
• the composition is prepared by a method where potassium clavulanate in a 1 : 1 mixture with silicon dioxide or microcrystalline cellulose is lyophilized in the presence of the one or more pharmaceutically acceptable excipients.
• the composition can contain from about 50-60% of a filler, about 20-30% of a disintegrant, about 0.5-5% of a flow enhancer/moisture protectant and/or about 3-6% of a lubricant.
• an exemplary filler is Prosolve SMCC 50
• an exemplary disintegrant is Pharmaburst and/or Acidisol
• an exemplary flow enhancer/moisture protectant is Carbosil
• an exemplary lubricant is magnesium stearate.
• the pharmaceutical composition is an extended-release composition which releases the potassium clavulanate over at least about 4 hours.
• An extended release composition can be prepared where a potassium clavulanate powder or a potassium clavulanate in a 1 :1 mixture with microcrystalline cellulose is lyophilized in the presence of the one or more pharmaceutically acceptable excipients.
• Exemplary excipients can include one or more of a matrix, a filler, a glidant and a lubricant.
• the composition can contain from about 20% to about 40% by weight of a matrix, about 50% to about 75% by weight of a filler, about 0.1 % to about 1% by weight of a glidant and about 1% to about 2% by weight of a lubricant.
• exemplary matrices are Klucel LF and/or Methocel KlOOLV Prem-M CR, Eudragit RS PO powder, or mixtures thereof;
• exemplary fillers are anhydrous lactose, Avicel PH-1 12, Avicel PH-113, Isomalt, or mixtures thereof;
• an exemplary glidant is Carbosil and an exemplary lubricant is at least one of magnesium stearate and talc.
• a solid pharmaceutical dosage form is prepared by providing a clavulanate such as clavulanic acid, clavulanic acid derivatives or a pharmaceutically acceptable salt of clavulanic acid; mixing the clavulanate with at least one excipient; granulating the mixture of clavulanate and the at least one excipient; and lyophilizing the granulated mixture of clavulanate and the at least one excipient.
• the granulating step can be, for example wet granulation.
• An exemplary clavulanate is potassium clavulanate, for example in the form of potassium clavulanate powder or potassium clavulanate as a 1 : 1 mixture with silicon dioxide or microcrystalline cellulose.
• the excipient at least one of a binder, a diluent, a filler, a disintegrant, a matrix, a filler, a glidant, a flow enhancer, a moisture protectant, and a lubricant.
• the method can include forming the dosage form into a tablet or bead, and optionally coating the tablet or beads with a delay-release polymer.
• the invention includes treatments such as administering a solid pharmaceutical composition according to the invention in to provide an amount of clavulanate effective for the treatment of a disorder such as sexual dysfunction and neurological disorders.
• a disorder such as sexual dysfunction and neurological disorders.
• an extended release composition is utilized a the disorder is anxiety and depression disorder.
• an immediate release composition is utilized and the disorder is sexual dysfunction.
• Still other embodiments of the present invention relate to immediate and extended release formulations of clavulanate that are suitable for oral administration.
• Yet other embodiments of the present invention relate to a freeze drying method for preparing the pharmaceutical formulation, wherein the freeze drying comprises the drying process to dehydrate the hydrated pharmaceutical composition.
• Other embodiments of the invention relate to a processes for the preparation of pharmaceutical compositions containing clavulanate and to their use as medicaments.
• Figurel shows in vitro dissolution profiles of clavulanate immediate release formulation, Sample B (•) and C (o).
• Figure 2 shows in vitro dissolution profiles of clavulanate extended release formulation, Sample F.
• Figure 3 shows in vitro dissolution profiles of clavulanate extended-release formulation, Sample I.
• Figure 4 illustrates the stability of Sample D (5 mg/tablet of 1 : 1 mixture of potassium clavulanate and microcrystalline cellulose) at 25 °C/60% humidity (•) and 30
• Figure 5 illustrates the stability of Sample E (5 mg/tablet of 1 : 1 mixture of potassium clavulanate and silicon dioxide) at 25 °C/60% humidity (•) and 30 °C/65% humidity ( A ).
• Figure 6 illustrates the stability of Sample F (5 mg/tablet of 1 : 1 mixture of potassium clavulanate and microcrystalline cellulose) at 2-8 0 C (O), 25 °C/60% humidity (•) and 30 °C/65% humidity (A).
• Figure 7 illustrates the stability of Sample G (5 mg/tablet) at 2-8 0 C (O), 25
• clavulanate herein includes clavulanic acid (I), pharmaceutically acceptable clavulanic acid salts, salt compositions and derivatives, such as esters.
• An example of pharmaceutically acceptable clavulanic acid salts is potassium clavulanate.
• Potassium clavulanate may be supplied as a pure compound or as Clavitesse ' * , a 1 : 1 mixture of potassium clavulanate and microcrystalline cellulose or a 1 : 1 mixture of potassium clavulanate and silicon dioxide (available from DSM Anti-Infectives B. V., The Netherlands).
• oral administration includes any form of delivery of a therapeutic agent or a composition thereof to a subject wherein the agent or composition is placed in the mouth of the subject, whether or not the agent or composition is swallowed.
• oral administration includes buccal and sublingual as well as esophageal administration. Absorption of the agent can occur in any part or parts of the gastrointestinal tract including the mouth, esophagus, stomach, duodenum, ileum and colon.
• a "subject" to which a therapeutic agent or composition thereof can be administered includes a human patient of either sex and of any age, and also includes any nonhuman animal, particularly a domestic or companion animal, illustratively a cat, dog or horse.
• neurological refers to conditions, disorders, and/or diseases that are associated with the nervous system.
• any condition, disorder and/or disease that effect any component or aspect of the nervous system are referred to as a neurological condition, disorder and/or disease.
• the term “neurological” encompasses the terms “neuropsychiatric” or “neuropsychiatry” and “neuropsychological” or “neuropsychology”.
• a neurological disease, condition, or disorder includes, but is not limited to cognitive disorders, affective disorders (e.g., depression and/or anxiety disorders), movement disorders, mental disorders, pain disorders, sleep disorders, etc.
• excipient means any substance, not itself a therapeutic agent, used as a carrier or vehicle for delivery of a therapeutic agent to a subject or added to a pharmaceutical composition to improve its processing, handling, storage, disintegration, dispersion, dissolution, release or organoleptic properties or to permit or facilitate formation of a dose unit of the composition into a discrete article such as a capsule or tablet suitable for oral administration.
• Excipients can include, by way of illustration and not limitation, diluents, disintegrants, binding agents, adhesives, wetting agents, polymers, lubricants, glidants, substances added to mask or counteract a disagreeable taste or odor, flavors, dyes, fragrances, and substances added to improve appearance of the composition.
• the present invention is thus directed to an immediate or extended release formulation of potassium clavulanate or Clavitesse'" which is suitable for oral administration.
• the formulations of the present invention comprise a quantity of a quick release preparation of clavulanate or a quantity of a slow release (or extended release) preparation of clavulanate.
• the immediate release formulation of the present invention is characterized by its rapid release of clavulanate, the rapid release characterized by obtaining a maximal release of clavulanate within approximately 5 to approximately 30 minutes after administration.
• the extended release formulation is characterized by a slower release of clavulanate over, for example, at least about 4 hours. In other exemplary embodiments, the extended release formulation can release clavulanate over at least about 6 or at least about 8 hours.
• the present invention is a tablet or a capsule containing the immediate or extended release formulation, which, based upon the total quantity of drug in the formulation rather than total weight of the formulation, comprises the amount of active compound from about 10 ⁇ g to 10 mg or about 0.01% to 10% of total weight of the active compound.
• oral administration of such pharmaceutical agents as tablets or capsules has certain advantages over parenteral administration such as i.v. or i.m. Diseases requiring treatment with painful injectable formulations are considered to be more serious than those conditions which can be treated with oral dosage forms.
• parenteral formulations have to be administered in most cases by a physician or paramedical personnel.
• the present invention relates to the preparation of the stable solid oral dosage forms of Clavulanate and their use in the treatment of sexual dysfunction, depression, or anxiety, or neurological disorders.
• Solid oral dosage forms according to the invention can comprise additives or excipients that are generally suitable for the preparation of the solid oral dosage form.
• Tabletting aids commonly used in tablet formulation can be used and reference is made to the extensive literature on the subject, see in particular Fiedler's "Lexicon der Hilfstoffe", 4th Edition, ECV Aulendorf 1996, which is incorporated herein by reference. These include, but are not limited to, fillers, binders, disintegrants, lubricants, glidants, stabilizing agents, fillers or diluents, surfactants, film formers, softeners, pigments and the like.
• Fillers include starches, e.g., potato starch, wheat starch, corn starch, hydroxypropyl cellulose, hydroxyethyl cellulose, hydroxypropyl methyl cellulose (HPMC) and, microcrystalline cellulose, e.g., products available under the registered trade marks AVICEL, FILTRAK, HEWETEN, Prosolve SMCC50 or PHARMACEL.
• Other examples of fillers include lactose, sucrose, glucose, mannitol, sorbitol, and calcium carbonate.
• Binders include starches, sugars, cellulose or modified cellulose such as hydroxypropyl cellulose, lactose, or sugar alcohols like xylitol, sorbitol or maltitol.
• An exemplary binder is maltodextrin (Maltrin Ml 50).
• CMC-Ca carboxymethylcellulose calcium
• CMC-Na carboxymethylcellulose sodium
• crosslinked PVP e.g. CROSPOVIDONE, POLYPLASDONE or KOLLIDON XL
• alginic acid sodium alginate and guar gum
• Crosslinked PVP CROSPOVIDONE
• Crosslinked CMC Ac-Di-SoI
• carboxymethylstarch-Na PIRIMOJEL and EXPLOTAB
• Pharmaburst and hydroxypropylcellulose L HPC LH-1 1
• L HPC LH-1 1 are exemplary disintegrants.
• a matrix can include, for example, Methocel KlOO Prem-M or Eudragit RS PO powder.
• glidants include colloidal silica, such as colloidal silicon dioxide, e.g., fumed silica (Cabosil, Aerosil), magnesium (Mg) trisilicate, powdered cellulose, starch, talc and tribasic calcium phosphate or combinations of these with fillers or binders, e.g., silicified microcrystalline cellulose (PROSOLV).
• Cabosil can also function as a flow enhancer/moisture protecting agent.
• fillers or diluents can include confectioner's sugar, compressible sugar, dextrates, dextrin, dextrose, lactose, mannitol, microcrystalline cellulose, for example microcrystalline cellulose having a density of about 0.45 g/cm 3 , such as AVICEL, powdered cellulose, sorbitol, sucrose and talc.
• Lubricants include stearic acid and salts thereof, such as magnesium stearate, aluminum stearate, and calcium stearate, PEG 4000 to PEG8000, talc, hydrogenated castor oil, glycerol esters, Na-stearylfumarate, hydrogenated cotton seed oil and others.
• a common lubricant are stearic acid and Mg stearate.
• Tablets and capsules can additionally be prepared with enteric coatings and other release-controlling coatings for the purpose of light protection, and swallowability.
• enteric coatings may include compounds prepared from, for example, methacrylic acid copolymers, cellulose acetate (and its succinate and phthalate version), styrol maleic acid co-polymers, polymethacrylic acid/acrylic acid copolymer, hydroxypropyl methyl cellulose phthalate, polyvinyl acetate phthalate, hydroxyethyl ethyl cellulose phthalate, hydroxypropyl methyl cellulose acetate succinate, cellulose acetate tetrahydrophtalate, acrylic resin, timellitate, and shellac.
• Exemplary polymers for enteric coatings include methacrylic copolymers such as Eudragit. Other suitable polymers for enteric coatings are known in the art.
• the coating may be colored with a pharmaceutically accepted dye. The amount of dye and other excipients in the coating liquid may vary and will not impact the performance of the immediate or extended release tablets.
• the coating liquid generally comprises film forming polymers such as hydroxy-propyl cellulose, hydroxypropylmethyl cellulose, cellulose ester or ether, an acrylic polymer or a mixture of polymers.
• the coating solution is generally an aqueous solution further comprising propylene glycol, sorbitan mono-oleate, sorbic acid, fillers such as titanium dioxide, a pharmaceutically acceptable dye.
• Solid oral dosage forms according to the present invention comprise a therapeutically effective amount of clavulanate as an active agent, and a filler as an additive.
• Further additives can include, but are not limited to, binders, disintegrants, lubricants, glidants, stabilizing agents, diluents, surfactants, film formers, pigments, softeners and antitacking agents and the like.
• Potassium clavulanate is both hygroscopic and readily hydrolyzed by water, so for handling and long term storage of potassium clavulanate it is generally necessary for the immediate environment to be kept extremely dry. This has been accomplished in the past by adding edible silicon dioxide to a composition or by storage of a composition in the presence of a desiccant within a sealed container.
• Potassium clavulanate has relatively low moisture content ( ⁇ 1% on a dry weight basis) when exposed to about 35% of relative humidity for 96 hr as shown in Table 7. However, it appears that deliquescence would eventually occur at any humidity above 40% relative humidity. Moisture absorption by dry potassium clavulanate exposed to 50% relative humidity occurs at a rate of approximately 1.44% per hour.
• stable pharmaceutical compositions can be prepared that include clavulanate as the pharmaceutically active ingredient (API) at doses ranging from about 10 ⁇ g to 10 mg, for example, from about 0.1 mg to about 5 mg.
• the clavulanate is a clavulanate salt, for example potassium clavulanate. It has been reported that clavulanic acid can alter CNS activity and behavior at doses ranging from 10 ng to 10 ⁇ g/kg (See U.S. Pat. No. 6,489,319). Methods for treating sexual dysfunction also include the administration of clavulanic acid at doses ranging from 10 ng to 10 ⁇ g/kg (See U.S. Pat. No. 7,166,626).
• various dosage forms of clavulanate can be prepared including immediate release and extended release dosage forms that contain from about 10 ⁇ g to about 10 mg clavulanate, for example from about 0.1 mg to about 5 mg clavulanate.
• Such dosage forms can be used for the treatment of sexual dysfunction, anxiety disorder and symptomst hereof.
• the immediate release form in the present invention can be used for the treatment of sexual dysfunction and symptoms thereof.
• the extended release formulation of this invention can be used for the treatment of anxiety, depression and symptoms thereof.
• Immediate release forms desirably provide at least about 80% (w/v) dissolution of the clavulanate in less than about 30 minutes as determined by standard assays disclosed herein.
• the immediate release pharmaceutical compositions according to embodiments of the invention can be rapidly dissolved in an appropriate aqueous solution (e.g., water, saline, juice) or colloidal suspension (e.g., baby formula or milk) for convenient administration to patients unable to handle solid dosage forms. Illustrative of such patients are infants, children, and adults who may experience swallowing difficulties.
• the invention features an immediate release pharmaceutical composition including clavulanate, such as a clavulanate salt.
• At least about 80% of the clavulanate is dissolved in aqueous solution by about 15 minutes from the time that the composition is placed in the aqueous solution. In other embodiments, at least about 90% of the clavulanate is released to the aqueous solution by about 30 minutes, or by about 15 minutes, after exposure of the composition to the aqueous solution. As shown in Figure 1, exemplary immediate release compositions in accordance with the present invention release 90% of the clavulanate within 15 minutes after exposure to an aqueous solution.
• Extended release compositions can release the active ingredient, i.e. clavulanate, over a long period, for example over about 8 hours or over about 10 hours.
• An extended release formulation can begin releasing the active ingredient as soon as the formulation reaches gastrointestinal track and continue to dissolve slowly and release the active ingredient in an approximately constant manner. This profile is desired because it provides steadier levels of the active ingredient in the bloodstream after administration.
• exemplary extended release compositions in accordance with the present invention can provide a substantially level release of the clavulanate up to about 8 to 10 hours after exposure to an aqueous solution.
• compositions according to embodiments of the invention provide important uses and advantages.
• One advantage of the present invention is the stability of the active ingredients in the composition. Control of water content is a major issue in the formulation and storage of clavulanate containing compositions because clavulanate is hygroscopic and is unstable or hydrolyzed in water.
• use of lyophilization to prepare a stabilized immediate release or extended release composition provides unexpectedly enhanced stability, particularly when the clavulanate is combined with excipients prior to lyophilization.
• a freeze dried composition of clavulanate can be used that includes: (1 ) forming a clavulanate composition by mixing clavulanate with at least one excipient; (2) freezing a quantity of the clavulanate composition ⁇ , e.g., clavulanate, at 0 0 C or below until converted into a frozen solid; and (3) dehydrating the clavulanate composition in an airtight container.
• the dehydrated (lyophilized) composition, including the drug, in powdered form can be mixed with other excipients before being compressed into tablets or prepared as sized beads.
• the moisture content of the final dry formulation is low.
• the various embodiments set forth herein will have a final moisture content not exceeding about 10% (by weight), not exceeding about 5%, or not exceeding about 4%, or even lower.
• Dry formulations according to such embodiments of the invention are highly storage stable for extended periods, such as, for example, stable for about 30 days, about 60 days or about 90 days at conditions such as 25°C and 60% relative humidity or 30°C and 65% relative humidity. Upon dilution with the appropriate liquid, they are fully potent at substantially their stated initial dosage.
• the formulations are prepared by dry blending a polymer, for example a matrix such as Eudragit (anionic copolymers of methacrylic acid and ethyl acrylate), a binder/diluent such as Maltrin M50 and/or a disintegrating agent such as Pharmaburst, filler, clavulanate, and other excipients (see examples), followed by granulating the mixture using water until proper granulation is obtained.
• the granulation is done by methods known in the art.
• the wet granules are freeze dried in a freeze dryer, sifted and ground to appropriate size. Lubricating agents can be mixed with the dried granulation to obtain the final formulation.
• clavulanate is hygroscopic and labile in water, it is necessary to minimize the time mixture remains wet, for example, the processing time from weighing and granulation to freeze drying can be about 1 hr.
• compositions of the invention can be administered orally in the form of tablets or capsules.
• the tablets can be prepared by techniques known in the art and contain a therapeutically useful amount of clavulanate and such excipients as necessary to form the tablet by such techniques.
• Placebo particles can also prepared without clavulanate but with same composition.
• Example 1 Preparation of Clavulanate Tablets
• Example IA Preparation of Immediate Release Clavulanate Tablet using
• Exemplary description of tablet preparation process A wet granulation tablet formulation process has been discovered where water is included in a granulation step, followed by drying to obtain granules of low water content ( ⁇ 3%).
• the dried formulation is non-hygroscopic compared with prior art formulations, but maintains equivalent physical characteristics (for example, dissolution, disintegration, bioavailability and other physical properties) of the tablet prepared therefrom.
• the tablet preparation was carried out by granulating the clavulanate with water in the presence of binder/diluent.
• Methocell KlOOLV Prem CR (90.0 g) , Isomalt (83.55 g), Avicel PH-112 (80.04 g), Cabosil (1.5 g), Talc (2.4 g) and magnesium stearate (1.5 g) were weighed and dried in Freeze dryer overnight with application in a gortex-lyoguard tray at 2-8 0 C. Each ingredient was screened and collected in a separate bag. API and Methocel KlOOLV Prem CRwere loaded into a V blender, mixed, screened through a suitable sieve and mixing was continued. Avicel PH-112 and Isomalt were added to the mixture and mixed. The resulting mixture was screened and mixed again.
• Sample G potassium clavulanate (API; 20.69 g) was screened through # 60 mesh and other excipients, Methocel KlOOLV Prem CR (90.02 g), Isomalt (83.56 g), Avicel PH-112 (100.41 g), Cabosil (1.52 g), Talc (2.4 g) and magnesium stearate (1.5 g), were screened through # 40 mesh. Each ingredient was collected in a separate bag. The API and Methocel Kl OOLV Prem CR were loaded into a V blender and mixed for 5 minutes. The mixture was screened and mixed for 5 additional minutes. The Avicel PH-112 and Isomalt were added to the mixture and mixed in the V blender for 5 minutes.
• API potassium clavulanate
• Example 3 Exemplary Formulation and Characteristics
• Example 3A Immediate release composition using potassium clavulanate
• Immediate release compositions were prepared from potassium clavulanate powder and excipients as shown in Table 1 using the method described above.
• API* Active pharmaceutical ingredient.
• Table 2 summarizes the characteristics of immediate release tablet using potassium clavulanate powder. Sample C tablet showed excellent stability, containing 94.4% of potassium clavulanate after 1 week at 2-8 0 C.
• Thickness mm 0.155 0.155 3.6 - 3.8
• API* Active pharmaceutical ingredient.
• Extended release compositions were prepared using ClavitesseTM or potassium clavulanate powder as shown in Table 5.
• API* Active pharmaceutical ingredient.
• FIG. 1 is a graph showing the in vitro dissolution profiles of clavulanate immediate-release formulations of Sample B and Sample C. As shown in Figure 1 , 90% or more of clavulanate in the immediate release tablet was dissolved within 15 min after exposure to the aqueous solution.
• FIG. 1 is a graph showing the in vitro dissolution profiles of clavulanate immediate-release formulations of Sample B and Sample C. As shown in Figure 1 , 90% or more of clavulanate in the immediate release tablet was dissolved within 15 min after exposure to the aqueous solution.
• FIG. 2 is a graph showing the in vitro dissolution profile of the clavulanate extended-release formulation of Sample F.
• FIG. 3 is a graph showing the in vitro dissolution profile of the clavulanate extended-release formulation of Sample I.
• the total dose of clavulanate in the extended release tablet was slowly released via erosion and dissolution mechanisms over a period of at least about 8 to 10 hours. Release of clavulanate in the extended release form was not detected in pH 1.2 solution.
• Potassium clavulanate in its solid form is both hygroscopic and unstable in the presence of water vapor.
• a stability study of clavulanate was conducted with monitoring by chromatographic methods. The static or equilibrium approach was approached by storing samples in chambers at different relative humidity in an attempt to generate a sorption isotherm. The sorption isotherm represents the quantitative relationship between the equilibrium moisture content and relative humidity (RH) in the atmosphere.
• Table 7 shows the change of the water content in potassium clavulanate powder after exposed to the different humidity conditions.
• potassium clavulanate has relatively low moisture content
• Potassium clavulanate is an exceptionally difficult material to formulate, being extremely moisture and heat sensitive. Degradation readily occurs in the presence of water and aqueous media. Several methods were tested to find a suitable condition for removing moisture after wet granulation that keeps the active ingredient clavulanate intact. The material in sample C was prepared by wet granulation and spheronized. The moisture containing spheronized formulation was transferred to trays and subjected to different storage conditions for the removal of moisture.
• FIG. 4 is a graph showing the stability of Sample D (5 mg/tablet of 1 : 1 mixture of potassium clavulanate and microcrystalline cellulose) at 25 °C/60% humidity and 30 °C/65% humidity.
• FIG. 5 is a graph showing the stability of Sample E (5 mg/tablet of 1 : 1 mixture of potassium clavulanate and silicon dioxide) at 25 °C/60% humidity and 30 °C/65% humidity.
• both tablets prepared according to Samples D and Sample E initially contained less than 4%-moisture and were degraded less than 7% at 25 °C/60% humidity, a relative high humidity condition for clavulanate.
• FIG. 6 is a graph showing the stability of Sample F (5 mg/tablet of 1 :1 mixture of potassium clavulanate and microcrystalline cellulose) at 2-8 0 C, 25 °C/60% humidity and 30°C/65% humidity.
• FIG. 7 is a graph of the stability of Sample G (5 mg/tablet) at 2-8 0 C, 25°C/60% humidity and 30°C/65% humidity.
• the tablets prepared according to Samples F and G initially contained less than 4%-moisture and were degraded less than 1.6% at 30°C/65% humidity, a relative high humidity condition for clavulanate. Therefore it appears that microcrystalline cellulose or silicon dioxide in Clavitesse may further contribute the increase of stability of potassium clavulanate by capturing the moisture in a tablet.
• LC/MS/MS method The chromatographic separation of the analytes was performed on a reverse-phase PLRP-S polymeric column. The retention time of potassium clavulanate and tazobactam (reference compound) were 8.51 and 8.54 min, respectively. The overall chromatographic run time was 25 min.
• the M/S analysis was performed on an Applied Biosystems' API 2000 triple-quardrupole mass spectrometer by multiple reaction monitoring in negative electrospray ionization mode. The mass spectral data were analyzed by Analyst 1.4.1 (Applied Biosystems). The pharmacokinetic analysis was conducted by using PK Solutions 2.0 (Summit Research Services).
• Example 6A Oral administration of immediate release (IR) tablet in male beagle dogs
• Example 6C Oral administration of extended release (ER) tablet in male beagle dogs
• Plasma 1 1 and 12 hr after dosing. Plasma was obtained via centrifugation at 3,000 rpm for 10 min and analyzed by an LC-MS/MS system. The associated mean pharmacokinetic parameters are provided in Table 9.
• Vd (1) 4.4 0.5 - - - - - - -
• T max time to maximum concentration
• C ma ⁇ maximal concentration
• AUC area under the curve
• CL clearance
• Vd volume of distribution
• Vss volume of distribution at steady state
• t] /2 half-life
• MRTj n mean residence time
• F bioavailability
• Potassium clavulanate was shown to be well absorbed in fasted animals, with an average bioavailability of 30 ⁇ 41 %, when given orally.
• the apparent terminal half-life was 0.5 hr.

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