Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
  • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism

Definitions

• the present invention relates to a pharmaceutical dosage form containing tetrahydrobiopterin, which can be used for the treatment of phenylketonuria variants which are caused by a tetrahydrobiopterin deficiency.
• Tetrahydrobiopterin is a cofactor of phenylalanine hydroxylase (PAH) and is also a cofactor of alkylglycerol monooxygenase, tyrosine hydroxylase (TH), tryptophan hydroxylase (TPH), and nitric oxide hydroxylases, the first to be identified for tetrahydrobiopterin. Therefore, tetrahydrobiopterin is required for the conversion of phenylalanine into tyrosine and for the production of the monoamine neurotransmitters dopamine, epinephrine, norepinephrine, and serotonin (Miwa et al., Arch. Biochem., Biophys. 1985; 239: 234-241).
• Hyperphenylalaninemia is a widespread congenital metabolic disease that results in most cases (approximately 98%) from a phenylalanine hydroxylase deficiency due to mutations in the phenylalanine hydroxylase gene (Scriver et al., Hum Mutat 2000; 15: 99-104).
• phenotypes range from classic phenylketonuria (> 1200 ⁇ mol / 1 phenylalanine in blood plasma) to mild phenylketonuria (600-1200 ⁇ mol / 1 phenylalanine in blood plasma) and mild hyperphenylalaninemia (120-600 ⁇ mol / 1 phenylalanine in the blood) blood plasma).
• Patients with both classic and mild phenylketonuria require a lifelong diet with protein restriction to prevent neurological sequelae and ensure normal cognitive development.
• the tetrahydrobiopterin-sensitive hyperphenylalaninemia may further be in a tetrahydrobiopterin-sensitive PAH deficiency and a mistake in the synthesis or Regeneration of tetrahydrobiopterin, ie, typical (severe) forms of deficiency of GTP cyclohydroteins 1 (GTPCH), dihydropteridine reductase (DHPR), and 6-pyruvoyl tetrahydropterine synthase (PTPS).
• GTPCH GTP cyclohydroteins 1
• DHPR dihydropteridine reductase
• PTPS 6-pyruvoyl tetrahydropterine synthase
• Dosage forms of tetrahydrobiopterin or of a metabolic precursor of tetrahydrobiopterin are known, for example, from EP 0 209 689, EP 0 906 913, JP 10 338 637, or JP 63 267 781. It has now surprisingly found a pharmaceutical dosage form for the oral administration of tetrahydrobiopterin or a metabolic precursor thereof, with the help of which it is easily possible to dose tetrahydrobiopterin or a metabolic precursor thereof according to the weight of the individual patient to be administered to neonates, children or adults, and in which tetrahydrobiopterin or a metabolic precursor thereof is in stable form.
• the present invention provides a pharmaceutical dosage form comprising tetrahydrobiopterin, or a metabolic precursor thereof, characterized by comprising an aqueous solution of tetrahydrobiopterin, or a metabolic precursor thereof, and an antioxidant in a delivery container, and a Dosing device for metered delivery of the aqueous solution comprises.
• a pharmaceutical dosage form provided in accordance with the present invention is also referred to herein as a "(pharmaceutical) dosage form according to (hereinafter) the present invention.
• a pharmaceutical dosage form according to the present invention comprises an oral dosage form for the liquid administration of tetrahydrobiopterin, or a metabolic precursor thereof, in the form of an aqueous solution.
• a dosage form according to the present invention comprises tetrahydrobiopterin, or a metabolic precursor thereof, and an antioxidant dissolved in an aqueous solvent and optionally one or more pharmaceutically acceptable excipients.
• the aqueous solvent in a dosage form according to the present invention is a solvent that allows protonation of salts or acids dissolved therein and includes water, or water in conjunction with another hydrophilic solvent, eg, ethanol, isopropanol, polyethylene glycol, glycerine, dimethylsulfoxide, or combinations from that.
• an aqueous solution in a dosage form according to the present invention comprises water as a solvent, preferably at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 99% water; 100% of water as solvent is particularly preferred.
• the metabolic precursor of tetrahydrobiopterin used has a low solubility in water, such as L-sepiolapterin, which has a solubility of 0.17 g / 100 g H 2 O in pure water
• mixtures of water with another hydrophilic Solvents such as propylene glycol or glycerin can be used to improve solubility. It is also possible to improve solubility by various methods which are known to improve solubility, including, for example, sonication.
• Tetrahydrobiopterin (5,6,7,8-tetrahydro-biopterin) in a dosage form according to the present invention is a compound of the formula
• tetrahydrobiopterin corresponds to the reduced form of biopterin.
• the chemical reduction of biopterin gives two diastereoisomers, namely (6S) - and (6R) -5,6,7,8-tetrahydro-L-biopterin, where (6R) -5,6,7,8-tetrahydro-L- biopterin corresponds to the natural form of tetrahydrobiopterin.
• Tetrahydrobiopterin is also known under the name sapropterin or BH 4 .
• (6R) -5,6,7,8-Tetrahydro-L-biopterine in the form of a dihydrochloride salt is marketed under the tradename Kuvan®.
• (6R, S) -5,6,7,8-tetrahydro-L-biopterin in the ratio of (6R) / (6S) 70/30, in the form of a dihydrochloride, available, for example, from Schircks Laboratories, Switzerland.
• a metabolic precursor of tetrahydrobiopterin in a dosage form according to the present invention includes a pterin or biopterin intermediate which can be converted / reduced intracellularly directly into 5,6,7,8-tetrahydrobiopterin or another pterin or biopterin intermediate, and either via the de novo pathway for the biosynthesis of tetrahydrobiopterin or via regeneration tetrahydrobiopterin responsible salvage pathway.
• the metabolic precursor of tetrahydrobiopterin may be in the form of a salt, for example a salt such as that of (6S) - and (6R) -5,6,7,8-tetrahydro-L-biopterin.
• a metabolic precursor of tetrahydrobiopterin according to the present invention is preferably L-sepapterin, e.g. in the form of a salt.
• An antioxidant in a dosage form according to the present invention comprises pharmaceutically acceptable sulfhydryl compounds, that is, compounds having one or more sulfhydryl groups, eg, sulfhydryl groups, which can be oxidized to covalent, bridging disulfide bonds.
• cysteine compounds for example comprising cysteine, for example L-cysteine and compounds derived therefrom, for example N-acetylcysteine, homocysteine, N-acetylhomocysteine, cysteine methyl ester, cysteine ethyl ester, Homocysteine methyl ester or homocysteine ethyl ester; or mixtures of two or more different sulfhydryl compounds, optionally in the form a salt.
• a preferred antioxidant in a dosage form according to the present invention is cysteine, such as L-cysteine, or N-acetylcysteine, eg in the form of a salt, such as a hydrochloride.
• the molar ratio of tetrahydrobiopterin or the metabolic precursor thereof to the antioxidant in a dosage form according to the present invention comprises a ratio of 1.5: 1 to 1: 4 or more, e.g. 1.1: 1; 1: 1; 1: 1.1; 1: 1.2; 1: 1.3; 1: 1.4; 1: 1.5; 1: 2; 1: 3 or 1: 4; or more;
• the molar ratio is at least 1: 1, e.g. 1: 1 to 1: 4, e.g. 1: 1 to 1: 1.5, preferably about 1: 1.
• the upper limit of the antioxidant contained in the dosage form of the present invention is determined by the solubility of each antioxidant in the aqueous solvent used.
• a stabilization of the tetrahydrobiopterin or a metabolic precursor thereof in a dosage form according to the present invention is already observed at a molar ratio of 1.5: 1 (tetrahydrobiopterin: antioxidant), a considerable stabilization at a molar ratio of (about) 1: 1.
• (6R) -5,6,7,8-tetrahydro-L-biopterine in the form of a dihydrochloride as tetrahydrobiopterine and L-cysteine in the form of a hydrochloride as an antioxidant it is preferred to use 1 g of antioxidant to 1.5 g to 2 g, eg to 1.6 g, 1.7 g, 1.8 g, 1.9 g or 2.0 g tetrahydrobiopterin, e.g. 1 g of antioxidant per 2.0 g of tetrahydrobiopterin.
• the preferred concentration of tetrahydrobiopterin and / or a precursor thereof in a dosage form of the present invention should allow the administration of sufficient tetrahydrobiopterin and / or a metabolic precursor thereof.
• the amount of fluid should comprise sufficient tetrahydrobiopterin and / or a metabolic precursor thereof to induce a therapeutic response in a patient suffering from tetrahydrobiopterin-sensitive hyperphenylalaninemia.
• the exact dosage is determined by monitoring efficacy to alleviate the symptoms of tetrahydrobiopterin-sensitive hyperphenylalaninemia which are found in patients with tetrahydrobiopterin synthesis deficiency, eg at normal physiological phenylalanine levels and normal production of catecholamines serotonin are recognizable.
• the required dose is typically in the range between 5 mg and 80 mg of tetrahydrobiopterin and / or a metabolic precursor thereof per kg of body weight, preferably in the range of 10 mg to 40 mg per kg of body weight.
• This dose may be administered in a single dose or in several smaller dosages per day during the day, especially in two doses of 2.5 mg to 40 mg of tetrahydrobiopterin and / or a metabolic precursor thereof, per kg of body weight, preferably 5 mg up to 20 mg per kg of body weight at each dose. It is particularly preferred that 10 mg / kg of body weight be administered twice a day, and thus it is necessary for a newborn of eg 4 kg to contain about 40 mg of tetrahydrobiopterin in a fixed amount of the liquid formulation, while in an adult of 100 kg should contain about 1000 mg of tetrahydrobiopterin in a fixed amount of the liquid formulation.
• a dosage form according to the present invention comprises tetrahydrobiopterin or a metabolic precursor thereof, in particular (6R) -5,6,7,8-tetrahydro-L-biopterin-2HCl and / or a metabolic precursor thereof, in the range of 0.5% to 50.0% by weight, preferably 2.0% by weight to 25% by weight, such as 2.0% by weight to 20% by weight, more preferably from 4.0% by weight to 15% by weight, e.g. B. 5.0% by weight to 15% by weight, for example about 10% by weight.
• the concentration of the antioxidant in a dosage form according to the present invention is adjusted to obtain a sufficient molar ratio for stabilizing the tetrahydrobiopterin.
• the aqueous solution in a dosage form according to the present invention preferably has an acidic pH, for example a pH below 5, preferably below 3 and more preferably below 2, such as 5.0, 4.5, 4.0 , 3.5, 3.0, 2.5, 2.0, 1.5, 1.0 or less, eg 1.0 to 5.5.
• the desired "acidity" is typically • solely by dissolving tetrahydrobiopterin acid addition salts, for example, (6R) -5,6,7,8-tetrahydro-L-biopterin dihydrochloride acid addition salt obtained.
• 6R -5,6,7,8-tetrahydro-L-biopterin dihydrochloride acid addition salt obtained.
• an adaptation of the desired pH by means of an acidifying substance is preferred.
• the desired acidic pH below 2 can be reached at an Sepiapterin-containing acidic liquid formulation, which is available in a 99% pure crystalline form (Cayman Chemical), for example, be adjusted by supplementation with a suitable
• a pharmaceutical dosage form according to the present invention may further comprise one or more pharmaceutically acceptable excipients.
• Pharmaceutically acceptable excipients which may be present in a dosage form according to the present invention include excipients which find use in galenics. Flavor additives, preservatives, acidifying substances and / or colorants.
• a pharmaceutical dosage form of the present invention may be prepared by adding an aqueous solvent to a solid pharmaceutical composition comprising tetrahydrobiopterin, or a metabolic precursor thereof, an antioxidant, and optionally pharmaceutically acceptable excipients, or by preparing an aqueous solution of tetrahydrobiopterin, or a metabolic precursor and an antioxidant, optionally with the addition of a pharmaceutically acceptable excipient, wherein the aqueous solution is introduced or introduced into a dispensing container, which can be connected to a dosing device for the metered dispensing of the aqueous solution or is introduced, wherein the Water content of a solid pharmaceutical composition preferably in the range of 1.0% to 5.0%, eg 1.5% to 4.0%.
• Such a solid pharmaceutical composition comprises, for example, powders, pellets, granules or compacts, such as tablets, in which besides flavor additives, preservatives, acidifying substances and / or colorants, other pharmaceutically acceptable excipients, such as drying agents, fillers and / or granulating agents may be present as pharmaceutically acceptable excipients .
• other pharmaceutically acceptable excipients such as drying agents, fillers and / or granulating agents may be present as pharmaceutically acceptable excipients
• the aqueous solution in a dosage form according to the present invention may also contain such further pharmaceutically acceptable excipients.
• a flavoring additive according to the present invention comprises a compound which can be used to improve the taste of a pharmaceutical formulation according to the present invention, such as naturally occurring sweeteners, artificial food sweeteners, flavoring agents containing, for example, a cinnamon, vanilla, cherry, strawberry, Orange, banana and / or apple flavor can cause.
• a naturally occurring sweetener which can be used in a dosage form according to the present invention comprises monosaccharides, such as glucose, galactose, mannose, xylitol; Disaccharides such as fructose, sucrose, lactose, maltose, mixtures of mono- and disaccharides, as well as mixtures of mono- and / or disaccharides with polysaccharides, for example maltodextrin, an artificial food sweetener include calorie-free or low calorie sugar substitutes such as sorbitol, mannitol, aspartame (eg Nutrasweet TM, Equal TM), saccharin, acesulfame K, a.
• monosaccharides such as glucose, galactose, mannose, xylitol
• Disaccharides such as fructose, sucrose, lactose, maltose, mixtures of mono- and disaccharides, as well as mixtures of mono- and / or
• a sweetener which may be present in a dosage form according to the present invention preferably comprises glucose, galactose, mannose, xylitol, fructose, sucrose, lactose, maltose and / or maltodextrin.
• a preservative which can be used in a dosage form according to the present invention includes any natural or synthetic compounds that are pharmaceutically-approved and can be added to foods, beverages or pharmaceuticals to delay spoilage, whether through microbial growth or unwanted chemical changes such as antimicrobial compounds that inhibit the growth of bacteria and fungi, eg benzoates, borates, sorbates, carbonates, acetates, such as.
• preservatives may also have an antioxidant effect and contribute to the stabilization of tetrahydrobiopterin in a dosage form according to the present invention.
• Preservatives having antioxidant activity include, for example, phenolic compounds such as butylated hydroxyanisole (BHA) and the related compound butylated hydroxytoluene (BHT).
• BHA butylated hydroxyanisole
• BHT butylated hydroxytoluene
• a preservative in a dosage form according to the present invention preferably comprises sodium benzoate, sodium borate, dimethyl dicarbonate, dimethyl acetate, butylated hydroxyanisole, or butylated hydroxytoluene.
• An acidifying substance which may be present in a dosage form according to the present invention includes pharmaceutically-acceptable, salt-forming acids, see e.g. Berge et al., Pharmaceutical Salts 1977 J. Pharm. Sci .; 66 (1): 1-19, e.g. solid acids.
• An acidifying substance according to the present invention may also have an antioxidant effect and thus further improve the stability of a dosage form according to the present invention. Examples of such acidifying substances include citric acid, tartaric acid, benzoic acid.
• aqueous solution containing tetrahydrobiopterin and / or a metabolic precursor thereof may optionally change color upon storage for an extended period of time, such discoloration not necessarily indicating that therapeutic efficacy is impaired.
• a dosage form of the present invention may comprise a colorant.
• a colorant that may be present in a dosage form of the present invention includes natural and synthetic dyes that are pharmaceutically acceptable.
• natural dyes such as annatto extract, anthocyanins, ⁇ -carotene, beta-APO 8, carotenal, black currant, burnt sugar, canthaxanthin, caramel, carbo-medicinalis, Carmine, carmine blue, carminic acid, carrot, chlorophyll, chlorophyllin, cochineal extract, copper chlorophyll, copper chlorophyllin, curcumin, curcumin / CU chlorine, elderberry, grape, hibiscus, lutein, mixed carotenoids, peppers, riboflavin, spinach, nettle , Titanium dioxide, turmeric, natural colors, aronia / red fruit, beet juice colors, paprika extract, paprika oleoresin; or synthetic dyes such as Allura Red, Amarant
• the dosage form according to the present invention may additionally comprise desiccants, fillers and / or granulating agents in addition to the already mentioned ingredients.
• a drying agent which may be present in a dosage form according to the present invention comprises a substance capable of compensating the hygroscopic property of a pharmaceutically active substance or pharmaceutically acceptable excipients; For example, SiO 2 , which is present for example in Syloid AL or in aerosils, or CaCO 3 .
• a filler which may be present in a dosage form of the present invention includes, for example, lactose, sucrose, cellulose and their derivatives (e.g., hydroxyethyl cellulose and hydroxypropyl cellulose), starch, talc, and / or calcium hydrogen phosphate
• a granulating agent which may be present in a dosage form according to the present invention comprises, for example, ethanol, gelatin, crospovidone and / or polyvinylpyrrolidone.
• a dispensing container in a dosage form according to the present invention comprises an air- and liquid-tight container, preferably made of glass, e.g. Amber, or plastic, e.g. optically opaque plastic.
• the dispensing container preferably has a capacity of 10 ml to 1000 ml, such as 25 ml to 1000 ml, z. B.
• 25 ml to 500 ml such as 50 ml to 200 ml, for example, 10 ml, 25 ml, 50 ml, 75 ml, 100 ml, 125 ml, 150 ml, 175 ml, 200 ml, 300 ml, 400 ml, 500 ml, 600 ml, 700 ml, 800 ml, 900 ml or 1000 ml; on.
• fastening means such as screw threads, for connecting, for example, for fastening, the Dosing device, which is suitable for metered delivery of the aqueous solution, with or on the dispensing container.
• a metering device for the metered delivery of the aqueous solution in a dosage form according to the present invention comprises a liquid metering device, e.g. a pump, syringe or pipette pump suitable for dispensing desired amounts of an aqueous solution.
• a liquid metering device e.g. a pump, syringe or pipette pump suitable for dispensing desired amounts of an aqueous solution.
• the metering device preferably comprises an actuator which may be located in the dispensing container or may extend into the dispensing container.
• the metering device preferably comprises a pump device as an actuator, which may be movably mounted on the dispensing container and may be e.g. via a cannula into the dispensing container. By moving the pumping device to the outlet port of the dispensing container, a precisely metered amount of the aqueous solution exits the outlet port of the dispensing container.
• the metering device is suitable for delivering aliquots of the aqueous solution, e.g. from 100 ⁇ l to 2000 ⁇ l, such as 200 ⁇ l to 1500 ⁇ l, e.g. 500 ⁇ l to 1000 ⁇ l; For example, 100 ⁇ l, 200 ⁇ l, 300 ⁇ l, 400 ⁇ l, 500 ⁇ l, 600 ⁇ l, 700 ⁇ l, 800 ⁇ l, 900 ⁇ l, 1000 ⁇ l, 1100 ⁇ l, 1200 ⁇ l, 1300 ⁇ l, 1400 ⁇ l, 1500 ⁇ l, 1600 ⁇ l, 1700 ⁇ l, 1800 ⁇ l, 1900 ⁇ l or 2000 ⁇ l.
• the exact volume of the aliquot of the aqueous solution dispensed by the metering device may either be predetermined or mechanically adaptable to the desired volume.
• the present invention provides a dosage form according to the present invention in which the metering device is fixedly connected to the dispensing container.
• the dispensing container with or without the metering device can additionally be welded into a foil made of aluminum composite in order to prevent oxidation of the active ingredient before use.
• the present invention provides a kit comprising the aqueous solution in a dispensing container and the dispenser separately but packaged together in a package.
• An aqueous solution in a dosage form according to the present invention may be administered to a patient in a suitable dose by means of a metered dose metering device connected to the dispensing container, or connected thereto. Administration may be by direct receipt of the appropriate dose by the patient, or the appropriate dose, if possible immediately prior to consumption, may be given to a foodstuff such as milk, yoghurt, soft drinks, juices, e.g. Orange juice or apple juice, coca cola, soup, water, baby formula to be taken by the patient for ingestion.
• a foodstuff such as milk, yoghurt, soft drinks, juices, e.g. Orange juice or apple juice, coca cola, soup, water, baby formula to be taken by the patient for ingestion.
• an aqueous solution in a dosage form according to the present invention can also be administered together with breast milk or with a solution of a dry milk formula, such as Aptamil®, HA Pre®, Milupa®, or also with baby food, as e.g. is to be purchased.
• the preparation of a dosage form according to the present invention may be accomplished by the preparation of an aqueous solution of tetrahydrobiopterin, or a metabolic precursor thereof and an antioxidant, optionally with the addition of excipients, the aqueous solution being dispensed into a dispensing container equipped with a metering device metered delivery of the aqueous solution is connected or connected, is introduced or introduced.
• the preparation method for a dosage form according to the present invention comprises in one aspect the following steps:
• Tetrahydrobiopterin or a metabolic precursor thereof and optionally pharmaceutically acceptable excipients
• the dissolution of the antioxidant, tetrahydrobiopterin or a metabolic precursor thereof and optionally pharmaceutically acceptable excipients may be either by separate dissolution of the ingredients in an aqueous solvent, or one or more, optionally all, ingredients are dissolved together in an aqueous solvent.
• the introduction of the aqueous solution or aqueous solutions into a dispensing container connected or connected to a dosed dispenser of the aqueous solution can be accomplished by dispensing an aqueous solution or aqueous solutions of one, several or all of the ingredients into the dispensing container, or an aqueous solution of one, several or all of the ingredients is made directly in the dispensing container and optionally aqueous solutions of one or more ingredients are added.
• the preparation of a dosage form according to the present invention may consist of a solid dosage form, eg in the form of powders, pellets, granules, compacts, tablets, tetrahydrobiopterin, or a metabolic precursor thereof and an antioxidant, and optionally pharmaceutically acceptable excipients, are obtained by adding an aqueous solvent, wherein the aqueous solution in a dispensing container, which is connected or connected to a metering device for the metered dispensing of the aqueous solution, is introduced or introduced.
• Such a solid dosage form may, for example, be present in a container, preferably airtight.
• a manufacturing method includes e.g. the following steps:
• Tetrahydrobiopterin or a metabolic precursor thereof and, if desired, of pharmaceutically acceptable excipients,
• solid dosage form e.g. in airtight containers, such as sachets, in
• a manufacturing process comprises e.g. the following
• Dispensing container which is connected or connected to a metering device for metered delivery of the aqueous solution.
• the solid composition is e.g. in the form of pellets, comprises
• Powders, pellets or granules of a solid composition may optionally, e.g. using suitable pharmaceutically acceptable excipients, into compacts, e.g. Be compressed tablets.
• a manufacturing process comprises the following steps: (I) the dissolution of the compacts, for example tablets, in an aqueous solvent, optionally in a dispensing container, which is connected or connected to a dosing device for the metered dispensing of the aqueous solution, and (ii) optionally introducing the aqueous solution of (i ) in a dispensing container which is connected to or connected to a metering device for the metered dispensing of the aqueous solution.
• an aqueous solution in a dosage form according to the present invention at a temperature of 2 ° C to 60 ° C, such as 4 ° C to 40 ° C, e.g. is stable at room temperature.
• aqueous solution in a dosage form according to the present invention is referred to herein as "stable” if it contains at least 95%, eg 96%, 97%, 98% or 99% of the initial concentration of tetrahydrobiopterin, or a metabolic precursor thereof, in particular (6R) -5,6,7,8-tetrahydro-L-biopterin-2HCl, after storage for at least one month, for example of 2, 3, 4, 5, 6, 9 or 12 months
• the initial concentration of tetrahydrobiopterin, or a metabolic precursor thereof is defined as that concentration which is determined immediately after the preparation of the aqueous solution in a dosage form according to the present invention by suitable means, eg HPLC.
• a dosage form according to the present invention is particularly suitable for administering tetrahydrobiopterin, or a metabolic precursor thereof, to infants or children, for example, the aqueous solution in a dosage form according to the present invention advantageously being administered together with a food for example, together with milk, such as breast milk and milk, made from dried milk formula, soft drinks, soups, baby food.
• a food for example, together with milk, such as breast milk and milk, made from dried milk formula, soft drinks, soups, baby food.
• the present invention provides a pharmaceutical dosage form particularly suitable for administering tetrahydrobiopterin, or a metabolic precursor thereof, to infants or children, eg the use of a pharmaceutical dosage form of the present invention for the manufacture of a medicament for the treatment of phenylketonuria variants caused by tetrahydrobiopterin deficiency, in particular hyperphenylalaninemia, by administering tetrahydrobiopterin or a metabolic precursor thereof to children or infants, in particular by administration in combination with milk or baby food.
• the present invention provides the use of an antioxidant, e.g. the use of a sulfhydryl compound for stabilizing an aqueous solution of tetrahydrobiopterin, or a metabolic precursor thereof, for a storage period, e.g. for storage in the open state, of at least one month, e.g. of 2, 3, 4, 5, 6, 9 or 12 months, in particular the molar ratio of the tetrahydrobiopterin or the metabolic precursor thereof to the antioxidant being a ratio of about 1.5: 1 to 1: 4, especially 1: 1 to 1: 1.5.
• an antioxidant e.g. the use of a sulfhydryl compound for stabilizing an aqueous solution of tetrahydrobiopterin, or a metabolic precursor thereof, for a storage period, e.g. for storage in the open state, of at least one month, e.g. of 2, 3, 4, 5, 6, 9 or 12 months, in particular the molar ratio of the tetrahydrobiopterin or the metabolic precursor thereof to the antioxidant
• the present invention provides the use of an antioxidant, in particular a sulfhydryl compound, in particular a cysteine, for stabilizing an aqueous solution of tetrahydrobiopterin, or a metabolic precursor thereof, the tetrahydrobiopterin, or the metabolic precursor thereof, at 40 ° C ⁇ 2 ° C and 75% ⁇ 5% relative humidity and / or stable at 25 ° C ⁇ 2 ° C at 60% ⁇ 5% relative humidity, especially where 95%, in particular 96%, 97%, 97.5%, 98 % or 99% of the initial concentration of tetrahydrobiopterin, or a metabolic precursor thereof after storage for at least one month, in particular 2, 3, 4, 5, 6, 9 or 12 months.
• an antioxidant in particular a sulfhydryl compound, in particular a cysteine
• An aqueous solution in a dosage form according to the present invention may be used as a medicine, or for the production of a medicine, for treating, alleviating or curing a disease requiring the administration of tetrahydrobiopterin and / or a metabolic precursor thereof, such as hyperphenylalaninemia, eg tetrahydrobiopterin. sensitive hyperphenylalaninemia, type II diabetes, multiple forms of hypertension, erectile dysfunction and subgroups of disorders with altered neurotransmitter metabolism, such as Parkinson's disease.
• hypophenylalaninemia includes a metabolic disorder in a mammal, preferably in humans, characterized by elevated blood serum levels of phenylalanine, typically in the range of 120 and 600 ⁇ mol / l.
• tetrahydrobiopterin-sensitive hyperphenylalaninemia encompasses that variant of hyperphenylalaninemia defined by a phenylalanine hydroxylase deficiency or an error in the synthesis of tetrahydrobiopterin that is alleviated by the administration of tetrahydrobiopterin and / or a precursor thereof , treated or cured.
• the treatment of hyperphenylalaninemia requires daily administration of a total dose that depends on the body weight of the patient.
• the total daily required dose is generally administered in two portions, but may also be administered in more than two servings.
• Figure 1 Effect of N-acetylcysteine used in the indicated concentrations (w / v) on the stability of tetrahydrobiopterine in an aqueous solution.
• the values given are mean values of at least 3 experiments ⁇ standard deviation.
• Dosage parameters for a single administration of a dosage form according to the present invention in the infant to the adult are a single administration of a dosage form according to the present invention in the infant to the adult.
• Table 1 illustrates the exact dosage using a 10% liquid formulation of tetrahydrobiopterin using a metering pump to deliver 500 ⁇ l aliquots (the appropriate amount of tetrahydrobiopterin used to treat, alleviate or cure tetrahydrobiopterin-sensitive hyperphenylalaninemia required to be administered, however, the dose described must be used twice a day).
• a metering pump capable of delivering 1.0, 1.5 or 2.0 ml aliquots may be used .
• Liquid Formulation A comprising 10% w / w BH 4 2HCl
• Liquid Formulation B comprising 10% w / w BH 4 2HCl (6R) -5,6,7,8-tetrahydro-L-biopterin-2HCl 10g
• Liquid formulation AB comprising 10% w / w BH 4 2HCl (6R) -5,6,7,8-tetrahydro-L-biopterin-2HCl 10g
• the dry formulations of tetrahydrobiopterin are designed to give, after reconstitution in an appropriate amount of demineralized water, 100 ml of a 10% liquid tetrahydrobiopterin formulation.
• the dry formulation preferably comprises a drying agent.
• a solid composition D (with 1% Syloid ®)
• N-acetylcysteine ( Figure 1) and L-cysteine ( Figure 2) at various concentrations on the stability of a 10% (w / w) tetrahydrobiopterin solution is evaluated.
• Liquid formulations are stored at room temperature and aliquots are taken at predetermined times and analyzed for tetrahydro-biopterin content, according to the procedure described by Fukushima et al.
• the BH 4 powders containing Formulation A are transferred to Valois brown glass bottles, which are filled with up to 100 g of Millipore Ultrapure water and sealed with Valois aluminum discs and caps. Half of the bottles are additionally packed in aluminum bags.
• the samples are placed in the climatic chamber at accellerated conditions (40 ° C ⁇ 2 ° C and 75% ⁇ 5% relative humidity) and long term conditions (25 ° C ⁇ 2 ° C at 60% ⁇ 5% relative humidity) for 6 months stored.
• the BH4 content at the beginning of the experiment and after the 6 month period is determined using the acidic and alkaline oxidation method of Fukushima et al. rated.
• Table 2 shows the relative amounts of BH 4 , which after a Lagerang be measured by 6 months or 12 months, compared to the initial amount.

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• Diabetes (AREA)
• Urology & Nephrology (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicinal Preparation (AREA)

Priority Applications (5)

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Publications (2)

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ID=41111155

Family Applications (1)

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• 2009
  • 2009-08-07 ES ES09775591T patent/ES2736730T3/es active Active
  • 2009-08-07 PL PL09775591T patent/PL2309983T3/pl unknown
  • 2009-08-07 RU RU2011109210/15A patent/RU2011109210A/ru not_active Application Discontinuation
  • 2009-08-07 WO PCT/AT2009/000306 patent/WO2010017570A2/de not_active Ceased
  • 2009-08-07 TR TR2019/10287T patent/TR201910287T4/tr unknown
  • 2009-08-07 JP JP2011522346A patent/JP2011530540A/ja active Pending
  • 2009-08-07 US US13/058,625 patent/US20110144117A1/en not_active Abandoned
  • 2009-08-07 EP EP09775591.2A patent/EP2309983B1/de active Active

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