WO2010038234A1

WO2010038234A1 - Combination product of spironolactone and doxycycline

Info

Publication number: WO2010038234A1
Application number: PCT/IL2009/000968
Authority: WO
Inventors: Jacob Levitt; Avraham Yacobi
Original assignee: Taro Pharmaceutical Industries Ltd.
Priority date: 2008-10-02
Filing date: 2009-10-11
Publication date: 2010-04-08

Abstract

The present invention provides a pharmaceutical composition comprising a combination of an anti-androgen agent and an antibiotic/anti-inflammatory agent or pharmaceutically acceptable salts thereof, useful for treating a subject with a dermatological disorder. The combination of this invention preferably provides a synergistic effect in treating a subject with a dermatological disorder, specifically a subject with acne. In a preferred embodiment, the present invention provides a pharmaceutical composition comprising combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof.

Description

COMBINATION PRODUCT OF SPIRONOLACTONE AND

DOXYCYCLINE

FIELD OF THE INVENTION

[001] The present invention provides a pharmaceutical composition comprising a combination of an anti-androgen agent and an antibiotic/anti-inflammatory agent or pharmaceutically acceptable salts thereof, useful for treating a subject with a dermatological disorder. The combination of this invention preferably provides a synergistic effect in treating a subject with a dermatological disorder, specifically a subject with acne, hi a preferred embodiment, the present invention provides a pharmaceutical composition comprising combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof.

BACKGROUND OF THE INVENTION

[002] Acne is a disorder of the pilosebaceous units located on the face, chest and back. It is an almost universal disease, occurring in all races, predominantly among adolescents. The pathogenesis of acne is multi-factorial involving increased sebum production by the sebaceous glands, such as caused by increased activity of sebocytes, sometimes via peroxisome proliferator-activated receptor ligands; ductal hypercornification of the pilosebaceous unit of the dermis and epidermis and hyperkeratinization (increased activity of keratinocytes); inflammation; and the presence of the anaerobic bacteria Propionibacterium acnes (P. acnes).

[003] There is no permanent cure for acne. Many medications are available for treating acne including topical retionoids (i.e., adapalene, tazarotene, tretinoin), antimicrobial and antibacterial agents (i.e., benzoyl peroxide, clindamycin, erythromycin, sodium sulfacetamide with or without sulfur), oral antibiotics (i.e., doxycycline, minocycline, tetracycline, azithromycin, trimethoprim-sulfamethoxazole (TMP/SMX), that primarily reduces the population of P. acnes, hormonal agents as anti-androgens (i.e., oral contraceptives) that decrease sebum secretion, systemic retinoids (i.e., isotretinoin), and topical aminolevulinic acid plus blue light (also known as photodynamic theory).

[004] Various agents administered in acne treatment exhibit direct or indirect antibiotic activity but also directly suppress inflammation by decreasing neutrophil chemotaxis and down-regulate the expression of pro-inflammatory mediators. Oral antibiotics are indicated for several groups of patients with inflammatory acne. They include tetracyclines (i.e., tetracyclines, doxycycline, minocycline, erythromycin, clindamycin, and cotrimoxazole).

[005] Spironolactone has anti-androgen activity by binding to the androgen receptor and preventing it from interacting with dihydrotestosterone. Spironolactone is in a class of medications called aldosterone receptor antagonists. Spironolactone is a diuretic approved primarily to treat heart failure, ascites in patients with liver disease, low-renin hypertension, hypokalemia, and Conn's syndrome. Spironolactone is used also as an acne treatment for women only, and has been described as a topical medication for treatment of male baldness.

[006] Doxycycline is a tetracycline antibiotic. Doxycycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, and chlamydia, periodontitis (gum disease), and others. It also has. been shown to inhibit metalloproteinases in the dermis and ultimately functions as an antibiotic in acne rosacea.

[007] Given the high incidence of acne and other dermatological disorders, and that they are of a major clinical health concern to both males and females, new innovative approaches are urgently needed at both the basic science and clinical levels to decrease the incidence of dermatological disorders, such as acne.

SUMMARY OF THE INVENTION

[008] The present invention provides a pharmaceutical composition comprising a combination of an anti-androgen agent and an antibiotic/anti-inflammatory agent or pharmaceutically acceptable salts thereof, useful for treating a subject with a dermatological disorder. The combination of this invention preferably provides a synergistic effect in treating a subject with a dermatological disorder, specifically a subject with acne. In one embodiment, the anti-androgen agent is oral contraceptives, spironolactone, inocoterone acetate, cyproterone acetate, flutamide, 5 -alpha reductase inhibitors or any combination thereof. In another embodiment, the antibiotic/anti-inflammatory agent is tetracyclines, doxycycline, minocycline, erythromycin, clindamycin, and cotrimoxazole or any combination thereof. In a preferred embodiment, the present invention provides a pharmaceutical composition comprising combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof. [009] The present invention is also directed to a method of treating or preventing dermatological disorders comprising administering a pharmaceutical composition comprising a combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof.

[0010] The pharmaceutical composition of the present invention may be a sustained or extended release composition or an immediate release composition comprising a combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof. In a preferred embodiment, the pharmaceutical composition is a sustained or extended release composition comprising a combination of spironolactone and doxycycline or pharmaceutically acceptable salts or hydrates thereof.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

[0011] In the following detailed description, numerous specific details are set forth in order to provide a thorough understanding of the invention. However, it will be understood by those skilled in the art that the present invention may be practiced without these specific details. In other instances, well-known methods, procedures, and components have not been described in detail so as not to obscure the present invention.

[0012] In some embodiments, any of the compositions of this invention will comprise a combination of spirnolactone and doxycycline, in any form or embodiment as described herein. In some embodiments, any of the compositions of this invention will consist of a combination of spirnolactone and doxycycline, in any form or embodiment as described herein. In some embodiments, the compositions of this invention will consist essentially of a combination of spirnolactone and doxycycline, in any form or embodiment as described herein. The term "comprise" refers to the inclusion of the indicated active agents, such as the a combination of spirnolactone and doxycycline, as well as inclusion of other active agents, and pharmaceutically acceptable carriers, excipients, emollients, stabilizers, etc., as are known in the pharmaceutical industry. The term "consisting essentially of refers to a composition, whose only active ingredients are the indicated active ingredients, however, other compounds may be included which are for stabilizing, preserving, etc. the formulation, but are not involved directly in the therapeutic effect of the indicated active ingredients. The term "consisting essentially of may refer to components which facilitate the release of the active ingredients. The term "consisting" refers to a composition, which contains the active ingredient and a pharmaceutically acceptable carrier or excipient.

[0013] hi one embodiment the combination of this invention provides a synergistic effect for suppressing, inhibiting, preventing, or treating the dermatological disorders of this invention. The term "synergistic" refers to where the joint action of the drugs is such that the combined effect is greater than the algebraic sum of their individual effects. Thus, reduced amounts of the drugs can be administered, e.g., reducing toxicity or other deleterious or unwanted effects, and/or using the same amounts as used when the agents are administered alone, but achieving greater efficacy. The reduced amounts of the drugs can be lower then used in a standard method wherein e.g., the single drug is administered. [0014] The combination of the present invention can be administered at any time and in any effective form, hi one embodiment, the anti-androgen agent and the antibiotic/anti- inflammatory agent are administered simultaneously, e.g., as a single composition (referred herein also as a "combined composition") or dosage unit (e.g., a pill or liquid containing both compositions), or they are administered as separate compositions, but at the same time (e.g., where one drug is administered intravenously and the other is administered orally or intramuscularly). In another embodiment, the anti-androgen agent and the antibiotic/anti- inflammatory agent are administered sequentially at different times. In a preferred embodiment, spironolactone and doxycycline are administered simultaneously, or in another embodiment, they are administered in a staggered fashion. The staggered fashion may be dictated by the stage or phase of the disease. In another embodiment, spironolactone and doxycycline are administered successively.

[0015] It is to be understood that this invention encompasses any embodiment of a pharmaceutical composition comprising an anti-androgen agent and an antibiotic/anti- inflammatory agent as described herein, which in some embodiments is referred to as "a combined composition" or in another embodiment is referred to as "a separate composition", wherein each separate composition comprises an anti-androgen agent or an antibiotic/anti- inflammatory agent, hi a preferred embodiment, the pharmaceutical composition of this invention refers to "a combined composition" comprising spironolactone and doxycycline. In another embodiment, the pharmaceutical composition of this invention refers to combination of "separate compositions" comprising spironolactone or doxycycline.

[0016] The active ingredients can be formulated into the composition as neutralized pharmaceutically acceptable salt forms. Pharmaceutically acceptable salts include the acid addition salts, which are formed with inorganic acids such as, for example, hydrochloric, sulfuric or phosphoric acids, or such organic acids as acetic, oxalic, tartaric, mandelic, citric and the like. Salts formed from the free carboxyl groups can also be derived from inorganic bases such as, for example, sodium, potassium, ammonium, calcium, or ferric hydroxides, and such organic bases as isopropylamine, trimethylamine, 2-ethylamino ethanol, histidine, procaine, and the like.

[0017] In one embodiment, the pharmaceutical composition of this invention is administered in any form by any effective route, including, e.g., oral, parenteral, enteral, intravenous, suppository, intraperitoneal, topical, transdermal (e.g., using any standard patch), ophthalmic, nasally, local, non-oral, such as aerosal, inhalation, subcutaneous, intramuscular, buccal, sublingual, rectal, vaginal, intra-arterial, and intrathecal, etc. They can be administered alone, or in combination with any ingredient(s), active or inactive. In a preferred embodiment, the combination is administered orally.

[0018] In another embodiment, this invention is directed to methods and compositions comprising a combination of spironolactone and doxycycline. In a preferred embodiment, the methods and composition comprise a combined composition of a solid dosage form such as a tablet or a capsule. In another embodiment, the methods and composition comprise a combined composition of a liquid dosage form. In a preferred embodiment, the solid dosage form and liquid dosage form are administered orally. In another embodiment, the solid dosage form is administered as suppositories.

[0019] This invention provides methods of use which comprise administering a composition comprising a combination of an anti-androgen agent and an antibiotic/anti-inflammatory agent or pharmaceutically acceptable salt thereof. Specifically, this invention provides methods of use which comprise administering a composition comprising a combination of spironolactone and doxycycline or pharmaceutically acceptable salt thereof in a therapeutically effective amount. As used herein, "pharmaceutical composition" means a "therapeutically effective amount" of the active ingredient, i.e., spironolactone and doxycycline, together with a pharmaceutically acceptable carrier or diluent. A "therapeutically effective amount" as used herein refers to that amount which provides a therapeutic effect for a given condition and administration regimen.

[0020] As used herein, the term "pharmaceutically acceptable" refers to any formulation which is safe, and provides the appropriate delivery for the desired route of administration of an effective amount of at least one compound for use in the present invention. A safe formulation refers to a formulation that does not produce adverse, allergic, or other untoward reactions when administered to an animal or a human. As such, all of the above-described formulations of the present invention are hereby referred to as "pharmaceutically acceptable". This term refers to the use of buffered formulations as well, wherein the pH is maintained at a particular desired value, ranging from pH 3.0 to pH 10.0, in accordance with the stability of the compounds and route of administration.

[0021] As used herein, the term "administering" refers to bringing a subject in contact with the combination of the present invention. [0022] In a preferred embodiment, the pharmaceutical composition is administered orally, and is thus formulated in a form suitable for oral administration, i.e., as a solid or a liquid preparation. Suitable solid oral formulations include tablets, capsules, pills, granules, pellets, powders, and the like. Suitable liquid oral formulations include solutions, suspensions, dispersions, emulsions, foams, gels, oils and the like. [0023] In a preferred embodiment, the composition of this invention is a solid dosage form. In one embodiment of the present invention, the anti-androgen agent and/or the antibiotic/anti- inflammatory agent are formulated in a capsule. In accordance with this embodiment, the compositions of the present invention comprise in addition to a compound of this invention an inert carrier or diluent and a gelatin capsule. In another embodiment of the present invention, the anti-androgen agent and/or the antibiotic/anti-infiammatory agent are formulated as a tablet.

[0024] According to a preferred embodiment of the invention, an effective amount of spironolactone and doxycycline is formulated for sustained release. By sustained release is meant that the active agents become available for bio-absorption in the gastrointestinal tract over a prolonged period of time, such as about 1 to about 18 hours, preferably about 5-12 hours. The term sustained release also encompasses extended release, controlled release, or sustained delivery. The release rate of the active agents is primarily controlled by dissolution of the active agents in gastrointestinal fluid and subsequent diffusion out of the tablet or capsule independent of pH, but can also be influenced by physical processes of disintegration and erosion of the tablet or capsule. Pharmaceutical compositions according to the invention achieve a therapeutic blood/plasma concentration of spironolactone and doxycycline in an individual for at least about 8 to about 14 hours from a single dose. In some embodiments, spironolactone and doxycycline are released from the tablet or capsule to result in a therapeutic blood/plasma concentration for at about 8, 9, 10, 11, 12, 13 or 14 hours from a single dose. In a preferred embodiment, spironolactone and doxycycline are released from the tablet or capsule to result in a therapeutic blood/plasma concentration of spironolactone and doxycycline for at least about 12 hours from a single dose.

[0025] As used herein, the term a "therapeutic blood/plasma concentration of spironolactone and doxycycline " means concentration equal to at least about 50%, preferably at least about 80% to 125% of the AUC and/or C_max of spironolactone and doxycycline obtained when three doses of a standard or conventional immediate release formulation comprising spironolactone and doxycycline or salt thereof is administered to a human subject.

[0026] According to the present invention, the solid dosage form preferably comprises one or more hydrophilic polymers. The hydrophilic polymers that may be used in the present invention include cellulose ethers such as hydroxypropyl methylcellulose, hydroxypropylcellulose, methylcellulose, or other water soluble or swellable polymers. Preferred hydrophilic polymers are hydroxypropyl methylcellulose and methylcellulose

(Metolose ™).

[0027] In one embodiment, the present invention provides methods of use comprising administering a pharmaceutical composition comprising a) any embodiment of an anti- androgen agent and/or antibiotic/anti-inflammatory agent as described herein; and b) a pharmaceutically acceptable carrier or diluent; which is to be understood to include an analog, isomer, metabolite, derivative, pharmaceutically acceptable salt, N-oxide, hydrate or any combination thereof of the active agent as herein described. In a preferred embodiment, the compositions of the present invention comprise doxycycline hyclate (hydrochloride hemiethanol hemihydrates of doxycycline). [0028] In some embodiments, the present invention provides methods of use of a pharmaceutical composition comprising a) any embodiment of the active agents as described herein, including an analog, isomer, metabolite, derivative, pharmaceutically acceptable salt, pharmaceutical product, N-oxide, hydrate thereof or any combination thereof; b) a pharmaceutically acceptable carrier or diluent; c) a flow-aid; and d) a lubricant. [0029] In another embodiment, the present invention provides methods of use of a pharmaceutical composition comprising a) any embodiment of the active agents as described herein, including an analog, isomer, metabolite, derivative, pharmaceutically acceptable salt, pharmaceutical product, iV-oxide, hydrate thereof or any combination thereof; b) filler; c) polymer; d) lubricant; and e) glidant. [0030] The filler can be chosen among powdered cellulose, sorbitol, mannitol, various types of lactose, phosphates and the like. [0031] Matrix forming polymer can be chosen among hydrophilic or hydrophobic polymers such as derivatives of cellulose (for example methylcellulose, hydroxypropyl cellulose, hypromellose, ethylcellulose); polyvinylpirolidone (for example povidone, crospovidone, copovidone); polymethacrylates (for example Eudragit RS, RL); lypophillic components (for example glyceryl monostearate, glyceryl behenate); and various other substances such as for example hydroxypropyl starch, polyethylene oxide and carrageenan. Most commonly, hydrophilic swelling polymers of suitable viscosity such as hypromellose are used, preferably in amounts above 5%, and more preferably above 8%. [0032] Glidant is preferably selected among one of the following excipients: colloidal silicon dioxide, talc, magnesium stearate, calcium stearate, aluminium stearate, palmitic acid, stearic acid, stearol, cetanol and polyethylene glycol. Preferably, colloidal silicon dioxide is used.

[0033] Lubricant can be selected among one of the following excipients: stearic acid, magnesium stearate, calcium stearate, aluminium stearate, sodium stearyl fumarate, talc, hydrogenated castor oil and polyethylene glycols.

[0034] In a preferred embodiment, the present invention provides a pharmaceutical composition comprising a) spironolactone and doxycycline hyclate as active ingredients; b) microcrystalline cellulose as a filler; c) methyl cellulose and hydroxypropylmethylcellulose as polymer; d) magnesium stearate as a lubricant; and e) calcium silicate as a glidant. [0035] hi another preferred embodiment, the present invention provides a pharmaceutical composition comprising a) spironolactone and doxycycline hyclate as active ingredients; b) microcrystalline cellulose as a filler; c) methyl cellulose (Methocel) as a binder d) methyl cellulose and hydroxypropylmethylcellulose (Metolose) as a polymer; d) magnesium stearate as a lubricant; and e) calcium silicate as a glidant. [0036] In another preferred embodiment, the pharmaceutical composition of the invention is a single tablet wherein both spironolactone and doxycycline are incorporated into the intragranular portion. Alternatively, spironolactone is incorporated into the granules and a portion or all of the doxycycline is in the extragranular portion. In another embodiment, doxycycline is incorporated into the granules and a portion or all of the spironolactone in the extragranular portion.

[0037] In a particularly preferred embodiment, both spironolactone and doxycycline are blended with Methylcellulose and Colloidal Silicon Dioxide. This blend is granulated with the granulation liquid, using a fluidized bed dryer. The dried granules are then blended with microcrystalline cellulose, Hypromellose, Calcium silicate and Magnesium Stearate. The blend is then compressed into a single tablet. Alternatively, spironolactone may be incorporated into the granules by blending part or all of it with the other intragranular components before granulation. A portion or all of the doxycycline active agent can be in the extragranular portion. In another embodiment, doxycycline is incorporated into the granules and a portion or all of the spironolactone in the extragranular portion.

[0038] In one embodiment of the present invention, the anti-androgen agent and/or the antibiotic/anti-inflammatory agent are formulated as granules. In another embodiment of the present invention, the anti-androgen agent and/or antibiotic/anti-inflammatory agent are formulated as a pellet, hi another embodiment of the present invention, the anti-androgen agent and/or the antibiotic/anti-inflammatory agent are formulated as a particulate. The term "particulate" refers to particles with particle size of between 1 nm to 1000 nm. hi another embodiment, particulate refers to nanoparticles. hi accordance with this embodiment, the compositions of the present invention comprise in addition to the compound of this invention an inert carrier or diluent. [0039] The anti-androgen agent and antibiotic/anti-inflammatory agent may be formulated as micronized or non-micronized particles. The non-micronized particles refer to particles having a particle size between 20-90 microns. The micronized particles refer to particles having a particle size between 1-20 microns.

[0040] In one embodiment, the particles have a particle size of between about 20-50 microns. hi another embodiment, the particles have a particle size of between about 1-20 microns. Said particles are formulated as solid dosage form for oral administration or as liquid dosage form for oral administration. In another embodiment, said particles are formulated as suppository form.

[0041] In one embodiment of the present invention, the anti-androgen agent and the antibiotic/anti-inflammatory agent are formulated in capsules or tablets comprising micronized particles of the anti-androgen agent and the antibiotic/anti-inflammatory agent, wherein the term "micronized" used herein refers to particles having a particle size of less than 20 microns, or in another embodiment, less than 15 microns, or in another embodiment, less than 10 microns, or in another embodiment less than 5 microns.

[0042] hi another embodiment, the pharmaceutical composition of this invention is administered by intravenous, intraarterial, or intramuscular injection of a liquid preparation. Suitable liquid formulations include solutions, suspensions, dispersions, emulsions, oils and the like, hi one embodiment, the pharmaceutical composition is administered intravenously, and is thus formulated in a form suitable for intravenous administration, hi another embodiment, the pharmaceutical composition is administered intraarterially, and is thus formulated in a form suitable for intraarterial administration, hi another embodiment, the pharmaceutical composition is administered intramuscularly, and is thus formulated in a form suitable for intramuscular administration.

[0043] hi another embodiment, the pharmaceutical composition is administered topically to body surfaces, and is thus formulated in a form suitable for topical administration. Suitable topical formulations include gels, ointments, creams, lotions, drops and the like. For topical administration, the anti-androgen agent and the antibiotic/anti-inflammatory agent are prepared and applied as solutions, suspensions, or emulsions in a physiologically acceptable diluent with or without a pharmaceutical carrier. For topical application, admixture of the compounds with conventional creams, lotions, or delayed release patches is acceptable. Such a cream or lotion may comprise any agent described herein, and, may be used to treat a dermatological disorder, hi a preferred embodiment, the dermatological disorder is acne.

[0044] In another embodiment, the pharmaceutical composition is administered as a suppository, for example a rectal suppository or a urethral suppository. Further, in another embodiment, the pharmaceutical composition is administered by subcutaneous implantation of a pellet. In a further embodiment, the pellet provides for controlled release of a compound as herein described over a period of time. In a further embodiment, the pharmaceutical compositions are administered intravaginally.

[0045] In another embodiment, the active agent can be delivered in a vesicle, in particular a liposome (see Langer, Science 249:1627-1633 (1990); Treat et al., in Liposomes in the

Therapy of Infectious Disease and Cancer, Lopez- Berestein and Fidler (eds.), Liss, New

York, pp. 363-366 (1989); Lopez-Berestein, ibid., pp. 317-327; see generally ibid).

[0046] As used herein "pharmaceutically acceptable carriers or diluents" are well known to those skilled in the art. The carrier or diluent may be a solid carrier or diluent for solid formulations, a liquid carrier or diluent for liquid formulations, or mixtures thereof. In another embodiment, the carrier or excipient comprises any of the substances described in Remington:

The Science and Practice of Pharmacy (Gennaro and Gennaro, Eds, 20th edition, Lippincott

Williams & Wilkins, 2000); Theory and Practice of Industrial Pharmacy (Lachman et al., eds., 3rd edition, Lippincott Williams & Wilkins, 1986); Encyclopedia of Pharmaceutical

Technology (Swarbrick and Boylan, eds., 2nd edition, Marcel Dekker, 2002). These can be referred to herein as "pharmaceutically acceptable carriers" to indicate they are combined with the active drug and can be administered safely to a subject for therapeutic purposes.

[0047] In one embodiment, the combination composition of the invention is admixed with conventional excipients, i.e., pharmaceutically acceptable organic or inorganic carrier substances suitable for parenteral, enteral (e.g., oral) or topical application which do not deleteriously react with the active compounds may be used. Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils, benzyl alcohols, polyethylene glycols, gelatin, carbohydrates such as lactose, amylose or starch, magnesium stearate, talc, silicic acid, viscous paraffin, white paraffin, glycerol, alginates, hyaluronic acid, collagen, perfume oil, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxy methylcellulose, polyvinyl pyrrolidone, etc. The pharmaceutical preparations can be sterilized and if desired mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or aromatic substances and the like.

[0048] For liquid formulations, pharmaceutically acceptable carriers may be aqueous or nonaqueous solutions, suspensions, emulsions or oils. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, and injectable organic esters such as ethyl oleate. Aqueous carriers include water, alcoholic/aqueous solutions, cyclodextrins, emulsions or suspensions, including saline and buffered media. Examples of oils are those of petroleum, animal, vegetable, or synthetic origin, for example, peanut oil, soybean oil, mineral oil, olive oil, sunflower oil, and fish-liver oil.

[0049] Parenteral vehicles (for subcutaneous, intravenous, intraarterial, or intramuscular injection) include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's and fixed oils. Intravenous vehicles include fluid and nutrient replenishes, electrolyte replenishes such as those based on Ringer's dextrose, and the like. Examples are sterile liquids such as water and oils, with or without the addition of a surfactant and other pharmaceutically acceptable adjuvant. In general, water, saline, aqueous dextrose and related sugar solutions, and glycols such as propylene glycols or polyethylene glycol are preferred liquid carriers, particularly for injectable solutions. Examples of oils are those of petroleum, animal, vegetable, or synthetic origin, for example, peanut oil, soybean oil, mineral oil, olive oil, sunflower oil, and fish-liver oil.

[0050] hi addition, the compositions may further comprise binders (e.g., acacia, cornstarch, gelatin, carbomer, ethyl cellulose, guar gum, hydroxypropyl cellulose, hydroxypropyl methyl cellulose, povidone), disintegrating agents (e.g., cornstarch, potato starch, alginic acid, silicon dioxide, croscarmelose sodium, crospovidone, guar gum, sodium starch glycolate), buffers (e.g., Tris-HCl, acetate, phosphate) of various pH and ionic strength, additives such as albumin or gelatin to prevent adsorption to surfaces, detergents (e.g., Tween 20, Tween 80, Pluronic F68, bile acid salts), protease inhibitors, surfactants (e.g., sodium lauryl sulfate), permeation enhancers, solubilizing agents (e.g., cremophor, glycerol, polyethylene glycerol, benzalkonium chloride, benzyl benzoate, cyclodextrins, sobitan esters, stearic acids), antioxidants (e.g., ascorbic acid, sodium metabisulfite, butylated hydroxyanisole), stabilizers (e.g., hydroxypropyl cellulose, hyroxypropylmethyl cellulose), viscosity increasing agents (e.g., carbomer, colloidal silicon dioxide, ethyl cellulose, guar gum), sweeteners (e.g., aspartame, citric acid), preservatives (e.g., thimerosal, benzyl alcohol, parabens), coloring agents, lubricants (e.g., stearic acid, magnesium stearate, polyethylene glycol, sodium lauryl sulfate), flow-aids (e.g., colloidal silicon dioxide), plasticizers (e.g., diethyl phthalate, triethyl citrate), emulsifiers (e.g., carbomer, hydroxypropyl cellulose, sodium lauryl sulfate), polymer coatings (e.g., poloxamers or poloxamines), coating and film forming agents (e.g., ethyl cellulose, acrylates, polymethacrylates), and/or adjuvants. [0051] In a preferred embodiment, the pharmaceutical compositions provided herein are controlled or extended release compositions, i.e., compositions in which the anti-androgen agent and/or the antibiotic/anti-inflammatory agent of this invention are released over a period of time after administration. Controlled, modified or sustained release compositions include formulation in lipophilic depots (e.g., fatty acids, waxes, oils).

[0052] In another embodiment, the combination composition is an immediate release composition, i.e., a composition in which the whole quantity of the anti-androgen agent and/or the antibiotic/anti-inflammatory agent is released immediately after administration. Sustained or directed release compositions can be formulated, e.g., liposomes or those wherein the active agent is protected with differentially degradable coatings, e.g., by microencapsulation, multiple coatings, etc. It is also possible to freeze-dry the new compounds and use the lyophilisates obtained, for example, for the preparation of products for injection.

[0053] In yet another embodiment, the pharmaceutical composition is delivered in a controlled release system. For example, the agent may be administered using intravenous infusion, an implantable osmotic pump, a transdermal patch, liposomes, or other modes of administration. In one embodiment, a pump may be used (see Langer, supra; Sefton, CRC Crit. Ref. Biomed. Eng. 14:201 (1987); Buchwald et al., Surgery 88:607 (1980); Saudek et al., N. Engl. J. Med. 321:674 (1989). In another embodiment, polymeric materials can be used. In yet another embodiment, a controlled release system can be placed in proximity to the therapeutic target, thus requiring only a fraction of the systemic dose (see, e.g., Goodson, in Medical Applications of Controlled Release, supra, vol. 2, pp. 116-138 (1984). Other controlled release systems are discussed in the review by Langer (Science 249:1627-1633

(1990).

[0054] The compositions may also include incorporation of the active material into or onto particulate preparations of polymeric compounds such as polylactic acid, polyglycolic acid, hydrogels, etc., or onto liposomes, microemulsions, micelles, unilamellar or multilamellar vesicles, erythrocyte ghosts, or spheroplasts. Such compositions will influence the physical state, solubility, stability, rate of in vivo release, and rate of in vivo clearance. [0055] The pharmaceutical composition of this invention may be delivered in a controlled release system, immediate release system or combination thereof. In one embodiment, the anti-androgen agent is delivered in a controlled release system and the antibiotic/anti- inflammatory agent is delivered in an immediate release system as a separate or combined composition. In another embodiment, the anti-androgen agent is delivered in an immediate release system and the antibiotic/anti-inflammatory agent is delivered in a controlled release system as a separate or combined composition. In a preferred embodiment, the anti-androgen agent and the antibiotic/anti-inflammatory agent are delivered in a controlled release system as a combined or separate composition. In yet another embodiment, the anti-androgen agent and the antibiotic/anti-inflammatory agent are delivered in an immediate release system as a separate or combined composition. The combined composition is preferably a capsule or a tablet.

[0056] The preparation of pharmaceutical compositions which contain an active component is well understood in the art, for example by mixing, granulating, or tablet-forming processes. The active therapeutic ingredient is often mixed with excipients which are pharmaceutically acceptable and compatible with the active ingredient. For oral administration, the anti- androgen agent and/or the antibiotic/anti-inflammatory agent of this invention or their physiologically tolerated derivatives such as salts, esters, iV-oxides, and the like are mixed with additives customary for this purpose, such as vehicles, stabilizers, or inert diluents, and converted by customary methods into suitable forms for administration, such as tablets, coated tablets, hard or soft gelatin capsules, aqueous, alcoholic or oily solutions. For parenteral administration, the compounds of this invention or their physiologically tolerated derivatives such as salts, esters, iV-oxides, and the like are converted into a solution, suspension, or emulsion, if desired with the substances customary and suitable for this purpose, for example, solubilizers or other. [0057] For administration to mammals, and particularly humans, it is expected that the physician will determine the actual dosage and duration of treatment, which will be most suitable for an individual and can vary with the age, weight and response of the particular individual.

[0058] In one embodiment, the compositions for administration may be sterile solutions, or in other embodiments, aqueous or non-aqueous, suspensions or emulsions. In one embodiment, the compositions may comprise propylene glycol, polyethylene glycol, injectable organic esters, for example ethyl oleate, or cyclodextrins. In another embodiment, compositions may also comprise wetting, emulsifying and/or dispersing agents, hi another embodiment, the compositions may also comprise sterile water or any other sterile injectable medium. [0059] In some embodiments, the composition will comprise the compounds as described herein, as well as another therapeutic compound, including inter alia, additional pharmaceutically or cosmetically active ingredients, in particular for preventing or reducing acne, wrinkles, lines, atrophy, inflammation, as well as topical anesthetics, artificial tanning agents and accelerators, antimicrobial agents, and antifungal agents, and sunscreening actives. Examples are peptides (e.g., Matrixyl™ [pentapeptide derivative]), farnesol, bisabolol, phytantriol, glycerol, urea, guanidine (e.g., amino guanidine); vitamins and derivatives thereof such as ascorbic acid, vitamin A (e.g., retinoid derivatives such as retinyl palmitate or retinyl propionate), vitamin E (e.g., tocopherol acetate), vitamin B3 (e.g., niacinamide) and vitamin B5 (e.g., octyl palmitate and tribehenin and sorbitan isostearate and palmitoyl- oligopeptide), anti-acne medicaments (resorcinol, salicylic acid, and the like); antioxidants (e.g., phytosterols, lipoic acid); flavonoids (e.g., isoflavones, phytoestrogens); skin soothing and healing agents such as aloe vera extract, allantoin and the like; chelators and sequestrants; and agents suitable for aesthetic purposes such as essential oils, fragrances, skin sensates, opacifiers, aromatic compounds (e.g., clove oil, menthol, camphor, eucalyptus oil, and eugenol), desquamatory actives, anti-acne actives, vitamin B3 compounds, anti-oxidants, peptides, hydroxy acids, radical scavengers, chelators, farnesol, antibiotic/anti-inflammatory agents, topical anesthetics, tanning actives, skin lightening agents, anti- cellulite agents, flavonoids, antimicrobial actives, and antifungal actives, in particular bisabolol, alkyldiols such as 1 ,2-pentandiol, hexandiol or 1 ,2-octandiol, vitamins, panthenol, phytol, phytantriol, ceramide and pseudoceramides, amino acids and bioactive peptides, protein hydrolysates, AHA acids, polyunsaturated fatty acids, plant extracts, DNA or RNA and their fragmentation products, carbohydrates. Preferred additional active ingredients are also biotin, lipoic acid, conjugated fatty acids, Camitin, Acyl-Carnitin, Vit. E , Vit A, Vit C, B3, B6, B12, Panthenol,

Kl, Phytantriol, Oligopeptides, Carnosin, Biochinonen, Phytofluen, Phytoen, folic acid and their corresponding derivatives. 60] In some embodiments, the composition will comprise the compounds as described herein, as well as another therapeutic compound, including inter alia, a five-alpha-reductase inhibitors (5 ARI) such as finasteride, dutasteride, izonsteride; other selective androgen receptor modulators (SARMs), such as, RU-58642, RU-56279, WS9761 A and B, RU-59063, RU-58841, bexlosteride, LG-2293, L-245976, LG-121071, LG-121091, LG-121104, LGD- 2226, LGD-2941, YM-92088, YM-175735, LGD-1331, LGD-3303, BMS-357597, BMS- 391197, S-40503, BMS-482404, EM-4283, EM-4977, BMS-564929, BMS-391197, BMS- 434588, BMS-487745, BMS-501949, SA-766, YM-92088, YM-580, LG-123303, LG-

123129, PMCoI, YM-175735, BMS-591305, BMS-591309, BMS-665139, BMS-665539, CE- 590, 116BG33, 154BG31, arcarine, ACP-105; Steroidal or nonsteroidal androgen receptor

(AR) antagonists such as flutamide, hydroxyflutamide, bicalutamide, nilutamide, hydroxysteroid dehydrogenase inhibitors, PP ARa ligand such as bezafϊbrate, fenofibrate, gemfibrozil; PPARγ ligands such as darglitazone, pioglitazone, rosiglitazone, isaglitazone, rivoglitazone, netoglitazone; Dual acting PPAR ligands, such as naveglitazar, farglitazar, tesaglitazar, ragaglitazar, oxeglitazar, PN-2034, PPAR δ; a 17-ketoreductase inhibitors, 3β-

DHΔ4,6-isomerase inhibitors, 3β-DHΔ4,5-isomerase inhibitors, 17,20 desmolase inhibitors, p450cl7 inhibitors, p450ssc inhibitors, 17,20-lyase inhibitors, or combinations thereof.

[0061] It is to be understood that any of the above means, timings, routes, or combinations thereof, of administration of two or more agents is to be considered as being encompassed by the phrase "administered in combination", as described herein.

[0062] In one embodiment, the present invention provides combined preparations, hi one embodiment, the term "a combined preparation" defines especially a "kit of parts" in the sense that the combination partners as defined above can be dosed independently or by use of different fixed combinations with distinguished amounts of the combination partners (i.e., simultaneously, concurrently, separately or sequentially), or can be dosed in one embodiment as a single dosage unit comprising the combined agents, hi some embodiments, the parts of the kit of parts can then be administered simultaneously or chronologically staggered that is at different time points and with equal or different time intervals for any part of the kit of parts. The ratio of the total amounts of the combination partners, in some embodiments, can be administered in the combined preparation, hi one embodiment, the combined preparation can be varied, e.g., in order to cope with the needs of a patient subpopulation to be treated or the needs of the single patient which different needs can be due to a particular disease, severity of a disease, age, sex, or body weight as can be readily made by a person skilled in the art. [0063] In general, the doses utilized for suppressing, inhibiting, preventing, or treating dermatological disorders will vary but will be in an effective amount to exert the desired anti- disease effect. As used herein, the term "pharmaceutically effective amount" refers to an amount of an anti-androgen reagent and antibiotic/anti-inflammatory reagent which will produce the desired alleviation in symptoms or signs of disease in a patient. The doses utilized for any of the above-described purposes will generally be from 0.1 to about 1000 milligrams per kilogram of body weight (mg/kg), administered one to four times per day, or by continuous IV infusion. When the compositions are dosed topically, they will generally be in a concentration range of from 0.1 to about 10% w/v, administered 1-4 times per day.

[0064] This invention provides methods and composition comprising an anti-androgen agent, in an amount of at least 0.0001 % by weight of the total composition. The anti-androgen agent if administered as a separate composition or as a combined composition, is in an amount of at least 0.001 % by weight of the total composition, hi another embodiment, the anti-androgen agent if administered as a separate composition or as combined composition is up to 10 % by weight of the total composition, hi another embodiment up to 5% by weight of the total composition, hi another embodiment, up to 1% by weight of the total composition. In another embodiment, the pharmaceutical composition of this invention comprises an anti-androgen agent between about 1% to 90% by weight of the total composition, hi another embodiment, the pharmaceutical composition of this invention comprises an anti-androgen agent between about 10% to 80%, by weight of the total composition, hi a preferred embodiment, the anti- androgen agent is spironolactone. [0065] This invention provides methods and composition comprising an antibiotic/anti- inflammatory agent, in an amount of at least 0.0001 % by weight of the total composition. The antibiotic/anti-inflammatory agent if administered as a separate composition or as a combined composition, is in an amount of at least 0.001% by weight of the total composition, hi another embodiment, the antibiotic/anti-inflammatory agent if administered as a separate composition or as combined composition is up to 10% by weight of the total composition. In another embodiment up to 5% by weight of the total composition, hi another embodiment, up to 1% by weight of the total composition, hi another embodiment, the pharmaceutical composition of this invention comprises an antibiotic/anti-inflammatory agent between about 1% to 90% by weight of the total composition, hi another embodiment, the pharmaceutical composition of this invention comprises an antibiotic/anti-inflammatory agent between about 10% to 80%, by weight of the total composition, hi a preferred embodiment, the antibiotic/anti-inflammatory agent is doxycycline.

[0066] The methods and compositions of this invention comprise administering spironolactone as a separate composition or as a combined composition at various dosages, hi one embodiment, spironolactone is administered at a dosage of 10 - 300 mg per day. hi another embodiment, spironolactone is administered once or twice a day at a dose of about 25,

50, 100, 150, 200, 250 or 300 mg, more preferably at a dose of about 25, 50 or 100 mg. LQ another preferred embodiment, spironolactone is administered once a day in an extended release composition at a dose of about 100 mg.

[0067] The methods and compositions of this invention comprise administering doxycycline as a separate composition or as a combined composition at various dosages. In one embodiment, doxycycline is administered at a dosage of between 10 - 200 mg per day. In another embodiment, doxycycline is administered once or twice a day at a dose of about 25, 40, 50, 60, 75 or 100 mg. In a preferred embodiment, doxycycline is administered once or twice a day at a dose of about 50, 75 or 100 mg. In another preferred embodiment, doxycycline is administered once a day in an extended release composition at a dose of about 40 mg.

[0068] This invention provides pharmaceutical compositions comprising a combination of an anti-androgen agent and an antibiotic/anti-inflammatory agent of this invention as a combination of separate compositions or as a combined composition comprising both active agents. Such compositions are useful for suppressing, inhibiting, preventing, or treating the dermatological disorders of this invention.

[0069] The term "suppressing, inhibiting, preventing, or treating" refers to delaying the onset of symptoms, reducing the severity of symptoms, reducing the severity of an acute episode, reducing the number of symptoms, reducing the incidence of disease-related symptoms, reducing the latency of symptoms, ameliorating symptoms, reducing secondary symptoms, reducing secondary infections, preventing relapse to a disease, decreasing the number or frequency of relapse episodes, increasing latency between symptomatic episodes, increasing time to sustained progression, expediting remission, inducing remission, augmenting remission, speeding recovery, or increasing efficacy of or decreasing resistance to alternative therapeutics. [0070] In one embodiment, symptoms are primary, while in another embodiment, symptoms are secondary. The term "primary" refers to a symptom that is a direct result of infection with a pathogen, while the term "secondary" refers to a symptom that is derived from or consequent to a primary cause. The term "symptoms" may be any pathological condition, comprising inflammation, rash, bleeding, itching, redness, self-consciousness, irritation, etc., or a combination thereof.

[0071] The term "treating" refers to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent or lessen the targeted pathologic condition or disorder as described hereinabove. Thus, in one embodiment, treating may include suppressing, inhibiting, preventing, treating, or a combination thereof. [0072] The spironolactone and doxycycline of the invention may be administered acutely for acute treatment of temporary conditions, or may be administered chronically, especially in the case of progressive, recurrent, or degenerative disease.

[0073] The use of the compositions and methods of this invention comprise suppressing, inhibiting, preventing or treating a dermatological disorder. The dermatological disorder is dermatological pain, dermatological inflammation, acne, acne vulgaris, inflammatory acne, non-inflammatory acne, acne fulminans, nodular papulopustular acne, acne conglobata, acne rosacea, rosacea, acne excoriee, acne associated with endocrine disorders such as polycystic ovarian syndrome (PCOS) or Stein-Leventhal syndrome, dermatitis, bacterial skin infections, fungal skin infections, viral skin infections, parasitic skin infections, skin neoplasia, skin neoplasms, pruritus, cellulitis, acute lymphangitis, lymphadenitis, erysipelas, cutaneous abscesses, necrotizing subcutaneous infections, scalded skin syndrome, folliculitis, furuncles, hidradenitis suppurativa, carbuncles, paronychial infections, rashes, erythrasma, impetigo, ecthyma, yeast skin infections, warts, molluscum contagiosum, trauma or injury to the skin, post-operative or post-surgical skin conditions, scabies, pediculosis, creeping eruption, eczemas, psoriasis, pityriasis rosea, lichen planus, pityriasis rubra pilaris, edematous, erythema multiform, erythema nodosum, grannuloma annulare, epidermal necrolysis, sunburn, photosensitivity, pemphigus, bullous pemphigoid, dermatitis herpetiformis, keratosis pilaris, callouses, corns, ichthyosis, skin ulcers, ischemic necrosis, miliaria, hyperhidrosis, moles, Kaposi's sarcoma, melanoma, malignant melanoma, basal cell carcinoma, squamous cell carcinoma, poison ivy, poison oak, contact dermatitis, atopic dermatitis, purpura, moniliasis, candidiasis, baldness, alopecia, Behcet's syndrome, cholesteatoma, Dercum disease, ectodermal dysplasia, gustatory sweating, nail patella syndrome, lupus, hives, hair loss, Hailey-Hailey disease, chemical or thermal skin burns, scleroderma, aging skin, wrinkles, sun spots, necrotizing fasciitis, necrotizing myositis, gangrene, scarring, and vitiligo.

[0074] The composition of this invention may be useful, in some embodiments, for dermatological disorders. In other embodiments, the composition is useful for treatment of a) acne.; b) acne vulgaris; c) dermatological pain; d) dermatological inflammation, e) inflammatory acne; f) non-inflammatory acne; g) acne fulminans; i) acne excoriee; j) rosacea; k) acne associated with polycystic ovarian syndrome (PCOS); 1) nodular papulopustular acne; m) acne conglobata; n) dermatitis o) bacterial skin infections; p) fungal skin infections; q) viral skin infections; r) parasitic skin infections or any combination thereof. [0075] In a preferred embodiment, the dermatological disorder is acne. Acne vulgaris is a common skin disorder that makes up 20% of the visits to a dermatology practice, and affects the majority of the teenage population. Management of acne is challenging, especially when considering the chronicity of the disease and the variability in response to treatment. [0076] Acne vulgaris has been categorized into 3 types: comedonal (non-inflammatory), papulopustular (inflammatory), and nodular/cystic (inflammatory). Comedonal acne consists of comedones known as whiteheads and blackheads. Whiteheads are closed plugged sebaceous glands and blackheads are open plugged sebaceous glands. Papulopustular acne consists of papules (bumps less than 5mm wide) and pustules or pimples (filled with pus). Nodular acne consists of cysts and nodules (bumps greater than 5 mm wide). Cysts are fluid-filled closed sacs below the skin and nodules are hard swellings deep below the skin. Nodular acne is sometimes called cystic acne. Acne atrophica refers to small scars or pitting due to a previous bout of acne vulgaris.

[0077] In one embodiment, the compositions and methods of this invention are used in the therapeutic treatment of acne, including the inflammation associated with acne vulgaris, but will often be used in a cosmetic method, the objective of which is to reduce or eliminate externally visible, and often unsightly, symptoms of acne vulgaris. In particular, the above described combination may be used to regulate the condition of the skin associated with acne vulgaris, in a patient suffering from acne. In one embodiment, the acne is secondary to polycystic ovarian syndrome (PCOS). This may include treating the appearance of the skin, for example inflamed lesions (such as example pustules and/or papules). In particular, the treatment may include a reduction in the number and/or the intensity of blemishes, for example pustules and/or papules, on the skin. The treatment may also provide a reduction in the redness of the skin. Such regulation will generally serve to cosmetically improve the appearance of the skin, in particular in ameliorating the redness of the afflicted area. These effects may be achieved with the composition of this invention. [0078] Acne conglobata is the most severe form of acne vulgaris and is more common in males. It is characterized by numerous large lesions, which are sometimes interconnected, along with widespread blackheads. It can cause severe, irrevocable damage to the skin and disfiguring scarring. It is found on the face, chest, back, buttocks, upper arms, and thighs. The age of onset for acne conglobata is usually between 18 and 30 years, and the condition can stay active for many years. As with all forms of acne, the cause of acne conglobata is unknown. [0079] Acne fulminans is an abrupt onset of acne conglobata which normally afflicts young men. Symptoms of severe nodulocystic, often ulcerating acne are apparent. As with acne conglobata, extreme, disfiguring scarring is common. Acne fulminans is unique in that it also includes a fever and aching of the joints. Acne fulminans does not respond well to antibiotics. Isotretinoin (Accutane®) and oral steroids are normally prescribed. [0080] Non limiting examples of viral skin infection include herpes simplex, varicella, herpes zotra, molluscum contagiosum, warts and orf.

[0081] Non limiting examples of fungal skin infections include candidiasis (yeast infection), ringworm, tinea versicolor, dermatophytoses (ringworm, tinea), such as tinea barbae (beard), tinea capitis (scalp), tinea corporis (body), tinea cruris (groin), tinea manuum (hand), tinea pedis (athlete's foot), tinea unguium (nail); pityriasis versicolor (tinea versicolor), blastomycosis, chromoblastomycosis, mycetoma, mucormycosis, sporotrichosis, penicillium marneffei. Fungal infections that may involve the skin by dissemination, such as aspergillosis, coccidioidomycosis, cryptococcosis, histoplasmosis, lobomycosis, paracoccidioidomycosis, sometimes a fungal infection may affect mucous membranes, nails, or subcutaneous tissue, and there can be spread to deeper tissue and dissemination especially in immunosuppressed patients.

[0082] Non limiting examples of bacterial skin infection include cellulitis, impetigo, folliculitis, boils, and carbuncles, staphylococcal scalded skin syndrome, erythrasma, impetigo, paronychia, furunculosis, erysipelas, ecthyma, erysipeloid, pitted keratolysis, trychomycosis, secondary infections complicating pre-existing skin lesions, such as diabetic or other chronic superficial skin ulcers, burns, bites and stings, eczema, atopic dermatitis, psorisis, or as opportunistic infections after skin trauma; skin disorders of uncertain or mixed aetiology, such as acne and rosacea; systemic infections with cutaneous involvement such as anthrax, diphtheria, and mycetoma. [0083] Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species.

Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect. Folliculitis is an inflammation of the hair follicles.

[0084] Elevations in androgens causing acne most frequently occur in patients with polycystic ovarian syndrome (PCOS). In one embodiment, this invention provides a method of treating acne induced by polycystic ovarian syndrome (PCOS).

[0085] While certain features of the invention have been illustrated and described herein, many modifications, substitutions, changes, and equivalents will now occur to those of ordinary skill in the art. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and changes as fall within the true spirit of the invention.

EXAMPLES

FORMULATION EXAMPLES

[0085] An example of a tablet preparation according to the present invention would be for instance: spironolactone, doxycycline hyclate, Methylcellulose (Methocel E5 LV) 3.5-5% w/w and Colloidal Silicon Dioxide (Cab-O-Sil) 0.1-0.3% w/w are sieved through 30 mesh screen and are pre-blended (dry) for 5 minutes. The granulation liquid (alcoholic) is then sprayed from the top of the high shear granulator into the moving powder. The drying process followed a wet milling process is conducted using a fluidized bed dryer. The dried granules are blended for 15 minutes with sieved microcrystalline cellulose (Avicel PH200) 15-17% w/w, Hypromellose (Metolose 90SH 100,000) 15-17% w/w and Calcium silicate 4-6% w/w and with added sieved Magnesium Stearate 0.3-0.5% w/w for another 5 minutes. Tablets are then compressed using RIMEK Tablet Compression Machine (Karnavati Engineering Ltd.). Each tablet comprises about lOOmg spironolactone and about 40mg doxycycline Hyclate.

[0086] Another example of a tablet preparation according to the present invention would be for instance: spironolactone, Methylcellulose (Methocel E5 LV) 3.5-5% w/w and Colloidal Silicon Dioxide (Cab-O-Sil) 0.1-0.3% w/w are sieved through 30 mesh screen and are pre-blended (dry) for 5 minutes. The granulation liquid (alcoholic) is then sprayed from the top of the high shear granulator into the moving powder. The drying process followed a wet milling process is conducted using a fluidized bed dryer. The dried granules are blended for 15 minutes with sieved doxycycline hyclate, microcrystalline cellulose (Avicel PH200) 15-17% w/w, Hypromellose (Metolose 90SH 100,000) 15-17% w/w and Calcium silicate 4-6% w/w and with added sieved Magnesium Stearate 0.3-0.5% w/w for another 5 minutes. Tablets are then compressed using RIMEK Tablet Compression Machine (Karnavati Engineering Ltd.). Each tablet comprises about lOOmg spironolactone and about 40mg doxycycline hyclate.

[0087] Another example of a tablet preparation according to the present invention would be for instance: doxycycline hyclate, Methylcellulose (Methocel E5 LV) 3.5-5% w/w and Colloidal Silicon Dioxide (Cab-O-Sil) 0.1-0.3% w/w are sieved through 30 mesh screen and are pre- blended (dry) for 5 minutes. The granulation liquid (alcoholic) is then sprayed from the top of the high shear granulator into the moving powder. The drying process followed a wet milling process is conducted using a fluidized bed dryer. The dried granules are blended for 15 minutes with sieved spironolactone, microcrystalline cellulose (Avicel PH200) 15-17% w/w, Hypromellose (Metolose 90SH 100,000) 15-17% w/w and Calcium silicate 4-6% w/w and with added sieved Magnesium Stearate 0.3-0.5% w/w for another 5 minutes. Tablets are then compressed using RIMEK Tablet Compression Machine (Karnavati Engineering Ltd.). Each tablet comprises about lOOmg spironolactone and about 40mg doxycycline hyclate.

Claims

What is claimed is:

1. A sustained release oral composition comprising a combination of spironolactone and doxycycline as active ingredients or pharmaceutically acceptable salts thereof.

2. The composition of claim 1, wherein the composition is a solid dosage form selected from a tablet or a capsule.

3. The composition of claim 1 or 2, wherein said composition comprises between about 25 mg to 100 mg spironolactone and between about 30 mg to 100 mg doxycycline.

4. The composition of claim 3, wherein said composition comprises about 100 mg spironolactone and about 40 mg doxycycline.

5. The composition of claims 1 to 4, wherein spironolactone and doxycycline are released from the tablet or the capsule to result in a therapeutic blood/plasma concentration of spironolactone and doxycycline for at least about 12 hours from a single dose.

6. The composition of claim 5, wherein the sustained release composition comprises one or more hydrophilic swellable polymers.

7. The composition of claim 6, wherein the hydrophilic swellable polymers are selected from hydroxypropyl methylcellulose, hydroxypropylcellulose, and methylcellulose.

8. The composition of claims 1 to 7, wherein the doxycycline is doxycycline hyclate.

9. The composition of claim 8, comprising spironolactone and doxycycline hyclate as active ingredients, microcrystalline cellulose as a filler, methyl cellulose as a binder, methyl cellulose and hydroxypropylmethylcellulose as a polymer, magnesium stearate as a lubricant and calcium silicate as a glidant.

10. The composition of claim 9, wherein the tablet or the capsule comprises granules, wherein both active ingredients are incorporated into the intragranular portion of the composition, or wherein only one of the active ingredients is incorporated into the intragranular portion of the composition.

11. The composition of claim 10, wherein spironolactone is incorporated into the intragranular portion and a portion or all of the doxycycline is in the extragranular portion of the composition.

12. The composition of claim 10, wherein doxycycline is incorporated into the intragranular portion and a portion or all of the spironolactone is in the extragranular portion of the composition.

13. A method of treating or preventing a dermatological disorder, comprising administering the composition of claims 1 to 12.

14. The method of claim 13, wherein the dermatological disorder is selected from dermatological inflammation, acne, acne vulgaris, inflammatory acne, noninflammatory acne, acne fulminans, nodular papulopustular acne, acne conglobata, acne rosacea, rosacea, dermatitis, bacterial skin infections, or any combination thereof.

15. The method of claim 14, wherein the dermatological disorder is acne.

16. The method of claim 15, wherein the composition is administered once a day.