Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
  • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
  • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/20—Hypnotics; Sedatives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/22—Anxiolytics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/24—Antidepressants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to an injectable, pharmaceutical composition
• a Ci-6 alkyl ester of a Cio-20 fatty acid In an embodiment, the fatty acid is ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate.
• These compositions are useful for the delivery of anti-psychotic drugs.
• U.S. patent Nos. 4,734,416 and 5,006,528 discloses aripiprazole, 7- ⁇ 4-[4-(2,3- dichlorophenyl)- 1 -piperazinyljbutoxy ⁇ -3 ,4-dihydro-2(lH)-quinolinone or 7- ⁇ 4- [4-(2,3 - dichlorophenyl)-l-piperazinyl]butoxy ⁇ -3,4-dihydro carbostyril, as an atypical antipsychotic agent useful in the treatment of schizophrenia, bipolar disease, depression and other CNS disorders.
• Aripiprazole 7- ⁇ 4-[4-(2,3- dichlorophenyl)- 1 -piperazinyljbutoxy ⁇ -3 ,4-dihydro-2(lH)-quinolinone or 7- ⁇ 4- [4-(2,3 - dichlorophenyl)-l-piperazinyl]butoxy ⁇ -3,4-
• Aripiprazole is sold under the tradename Abilify®. It acts as a dopamine D 2 partial agonist, serotonin 5-HTIA receptor agonist and is an antagonist of the serotonin 5-HT 2 A receptor.
• Abilify® is currently administered orally on a once-a-day dosing schedule as Abilify® (aripiprazole) Tablets, Abilify Discmelt® (aripiprazole) Orally Disintegrating Tablets and Abilify® (aripiprazole) Oral Solution.
• Abilify® Injection for intramuscular use is a rapid-acting solution product for treating agitation associated with schizophrenia and bipolar disease. Poor and variable patient compliance with a once-a-day dosing schedule of psychiatric drugs has been reported.
• U.S. Patent No. 7,115,587 discloses an injectable formulation that delivers an aripiprazole solution complexed with a substituted ⁇ -cyclodextrin to the muscular site with diminished irritation as compared to injectable suspensions containing uncomplexed aripiprazole.
• the Abilify® injection for intramuscular use is a single-dose, ready to use vial consisting of 9.75 mg/1.3ml of aripiprazole and 150 mg/ml of sulfobutylether ⁇ -cyclodextrin.
• Formulation challenges due to drug loading and poor solubility of aripiprazole in ⁇ - cyclodextrin at neutral pH have been reported.
• Olanzapine ( 1 ,2-methyl-4-(4-methyl- 1 -piperazinyl)- 10H-thieno [2,3 -b] [1 ,5 ]be- nzodiazepine) is a second generation antipsychotic drug marketed as Zyprexa®. It is useful for the treatment of disorders such as schizophrenia, bipolar disorder, psychotic depression and Tourette's syndrome. This active pharmaceutical ingredient acts as an antagonist on 5- HT 2 serotonin receptors as well as the Di/D 2 dopamine receptors, while also exhibiting anticholinergic and antimuscarinic properties. Olanzapine belongs to the benzodiazepine family, and has the following structure:
• compositions comprising (a) a water-insoluble antipsychotic agent, and (b) a Ci_6 alkyl ester of a Cio- 2 o fatty acid.
• the alkyl ester of the fatty acid is ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate.
• the composition can be in the form of an aqueous, flocculated, injectable suspension.
• the composition can comprise additional components, such as a polyoxyethylene derivative of a sorbitan ester of a carboxylic acid, wherein the carboxylic acid comprises 8-20 carbon atoms (e.g. , polysorbate 20).
• the pharmaceutical composition can be injectable.
• compositions can take a variety of forms. Such forms include, but are not limited to, completely dispersed and flocculated systems.
• the pharmaceutical compositions described herein have a number of advantages.
• the compositions can be easily resuspended by the user, e.g. , through shaking by hand, in a short time prior to administration.
• the pharmaceutical compositions e.g. , flocculated systems, can be used to improve the local tissue reaction of antipsychotic drugs in extended release formulations. By mitigating the adverse results associated with the injection of these drugs, drug compliance will be greatly improved.
• composition comprising:
• composition forms an aqueous, flocculated, injectable suspension.
• the pharmaceutical composition has a water-insoluble
• antipsychotic agent that is aripiprazole, a compound of formula I, or a compound of formula II, or pharmaceutically acceptable salts, hydrates, or solvates thereof:
• R a is absent, and R b is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or - C(0)R 1 ; or
• R b is absent, and R a is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or - C(0)R 1 ;
• R c is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or -C(0)R 1 ;
• each R 1 is independently selected from the group consisting of hydrogen, substituted or unsubstituted aliphatic, and substituted or unsubstituted aryl;
• each R 2 is selected from the group consisting of substituted or unsubstituted aryl and substituted or unsubstituted heteroaryl;
• Y ⁇ is a pharmaceutically acceptable counterion
• the pharmaceutical composition has a water-insoluble antipsychotic agent that is Compound A-4 or Compound A-7 :
• the pharmaceutical composition has a water-insoluble antipsychotic agent that is olanzapine, a compound of formula III, a compound of formula IV, or a compound of formula V, or pharmaceutically acceptable salts, hydrates, or solvates thereof:
• R 3a , R 3b and R 3c are independently -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , CH 2 OC(0)N(R 1 ) 2 , -C(0)R 1 or -C(0)OC(R 4 )(R 5 )-OC(0)(G 12 ) m R 6 ;
• R 1 is independently selected from the group consisting of hydrogen, substituted or unsubstituted aliphatic, and substituted or unsubstituted aryl; wherein each R 4 and R 5 is independently selected from hydrogen, C1-C3 alkyl, aryl or substituted aryl;
• G 12 is selected from NH, CH 2 , -S- or -0-;
• m is 0 or 1 ;
• R 6 is selected from Ci 3 -C26-alkyl, substituted Ci 3 -C26-alkyl, Ci 3 -C26-alkenyl, substituted Ci 3 -C26-alkenyl, Ci 3 -C2 6 -alkynyl, substituted Ci 3 -C2 6 -alkynyl, Ci 3 -C2 6 -cycloalkyl, and substituted Ci 3 -C2 6 -cycloalkyl, aryl-Ci 3 -C2 6 -alkyl, substituted aryl-Ci 3 -C2 6 -alkyl, C1-C1 0 - aryl, substituted Ci-Cio-aryl, heteroaryl-Ci 3 -C2 6 -alkyl, substituted heteroaryl-Ci 3 -C2 6 -alkyl; optionally substituted Ci 3 -C2 6 -alkylaryl, optionally substituted Ci 3 -C2 6 -alkeny
• Y ⁇ is a pharmaceutically acceptable counterion
• the pharmaceutical composition has a water-insoluble
• the pharmaceutical composition has a water-insoluble antipsychotic agent that is lurasidone (compound VI) or pharmaceutically acceptable salts, hydrates, or solvates thereof.
• the pharmaceutical composition contains components (b) and (c) at a ratio that results in floes of component (a) wherein the floes settle to greater than a predetermined sediment bed height, such that components (a), (b) and (c) can be resuspended for injection.
• the pharmaceutical composition has a bed height that is at least a 20 to 160% increase in sediment height compared to a non-flocculated composition after 24 hours of undisturbed sitting.
• the pharmaceutical composition has a bed height that is at least a 20 to 80% increase in sediment height compared to a non-flocculated composition after 24 hours of undisturbed sitting.
• the bed height has at least a 20 to 150, 20 to 140, 20 to 130, 20 to 120, 20 to 110, 20 to 100, 20 to 90, 20 to 70, 20 to 60, 20 to 50, 20 to 40 or 20 to 30% increase in sediment height compared to a non- flocculated composition after 24 hours of undisturbed sitting.
• components (a), (b) and (c) that can be resuspended for injection within 1-60 seconds of handshaking.
• the pharmaceutical composition contains the ratio of components (b) to (c) such that the composition can be injected using a 20 or greater gauge needle.
• the pharmaceutical composition contains the ratio of components (b) to (c) that is approximately 2.5 to 1 , by weight.
• the pharmaceutical composition contains the ratio of components
• the pharmaceutical composition contains the ratio of components (b) to (c) that is approximately 2.4 to 1, 2.3 to 1 , 2.2 to 1, 2.1 to 1 , 2.0 to 1 , 1.9 to 1 , 1.8 to 1 , 1.7 to 1, 1.6 to 1 , 1.5 to 1 , 1.4 to 1 , 1.3 to 1 , 1.2 to 1 or 1.1 to 1 by weight.
• the polyoxyethylene derivative of a sorbitan ester (c) is polysorbate 20.
• the pharmaceutical composition comprises about 0.2 - 1 weight percent Ci- 6 alkyl ester of a Cio-20 fatty acid.
• the alkyl ester of the fatty acid is ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate.
• the pharmaceutical composition comprises about 0.3 - 1 , 0.4 - 1 , 0.5 - 1 , 0.6 - 1 , 0.7 - 1 , 0.8 - 1, 0.9 - 1 , 0.3 - 0.9, 0.3 - 0.7, 0.3 - 0.6, 0.3 - 0.5 or 0.3 - 0.4 weight percent Ci-6 alkyl ester of a Cio-20 fatty acid.
• the alkyl ester of the fatty acid is ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate.
• the pharmaceutical composition comprises about 0.05 - 0.8 weight percent polysorbate 20, about 0.1 - 0.3 weight percent polysorbate 20, or comprises about 0.2 weight percent polysorbate 20.
• the pharmaceutical composition comprises approximately 15 - 35 , or approximately 20 - 30 weight percent aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof.
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof, wherein component (a) is in a weight ratio of approximately 15 - 35%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 15 - 35 %;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 15 - 35 %;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• an injectable pharmaceutical composition comprising: (a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof, wherein component (a) is in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• an injectable composition comprising a water- insoluble antipsychotic agent and a Ci_6 alkyl ester of a Cio-20 fatty acid.
• the fatty acid is ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate.
• the injectable composition is formulated for modulating tissue reaction associated with the delivery of a water-insoluble antipsychotic agent is aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V or VI, compounds A-4 or A-7, 0-56, O-l l l, 0-112, 0-7, 0-8 and 0-9.
• the injectable composition is formulated for modulating tissue reaction through a reduction in the irritation at the site of injection.
• the injectable composition further comprises a surfactant, wherein the surfactant is polysorbate 20 and also comprises a buffer wherein the buffer is a phosphate, citrate, tartrate or acetate buffer.
• the pharmaceutical composition comprises a water-insoluble antipsychotic agent, about 0.2 - 1 % percent of a C e alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, and about 0.05 - 0.8% percent of polysorbate 20 and phosphate buffer.
• a water-insoluble antipsychotic agent about 0.2 - 1 % percent of a C e alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, and about 0.05 - 0.8% percent of polysorbate 20 and phosphate buffer.
• a method for treating disorders of the central nervous system is provided by administering an effective amount of the pharmaceutical composition to an individual in need of such treatment.
• the disorder is anxiety or depression, bipolar disorder, autism-related irritability, a psychotic condition, schizophrenia or schizophreniform diseases, or acute mania.
• an injectable pharmaceutical composition comprising an antipsychotic agent, a Ci_6 alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, and a polyoxyethylene derivative of a sorbitan ester of a carboxylic acid, wherein the carboxylic acid comprises 8-20 (e.g. , 11-13) carbon atoms.
• This composition is particularly useful for the formulation of a water-insoluble antipsychotic agent into an injectable pharmaceutical composition.
• the polyoxyethylene derivative is polysorbate 20.
• the pharmaceutical composition can further comprise and aqueous vehicle, such as phosphate buffered saline, as well as any of the pharmaceutical components described herein.
• compositions described herein possess a number of advantages.
• the compositions offer minimized excipient levels while co-optimizing both resuspendability and acceptable injectability, and maintain good physiochemical attributes of the antipsychotic agent.
• these properties can be determined based on comparisons of vehicle performance based on settled bed height and qualitative ease of resuspension.
• the redispersibility of a pharmaceutical composition can be assessed by preparing a number of different formulations (antipsychotic agent with a variety of excipients), and comparing the relative height of the settled beds. In general, higher settled bed heights are indicative of flocculated, or loosely aggregated, particles.
• the pharmaceutical compositions e.g. , a pharmaceutical composition of components (a) and (b), or (a), (b) and (c), can be resuspended for injection within 1-60 seconds of shaking by hand.
• the term "flocculation” refers to the formation of a loose aggregation of discrete particles held together in a network-like structure by physical adsorption of macromolecules, bridging during chemical interaction (precipitation), or when the longer range van der Waals forces of attraction exceed the shorter range forces of attraction. (See Pharmaceutical dosage forms: Disperse systems Volume 2. Edited by Herbert A. Lieberman, Martin M. Rieger, and Gilbert S. Banker. (1996) Pg. 18).
• the "loose aggregation of discrete particles” can be referred to herein as “floes.
• compositions containing component (b) a Ci_6 alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate,
• component (c) e.g. , polysorbate 20
• component (b) a Ci_6 alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate
• component (c) e.g. , polysorbate 20
• this bed height increases as the amount of Ci_6 alkyl ester of a Cio-20 fatty acid increases.
• the time needed for re-suspension decreases.
• the flocculation phenomenon is uniquely attributed to the additional influence of component (b).
• a composition comprising components (a), (b) and (c) at a ratio that results in floes, wherein the floes settle to greater than a predetermined sediment bed height, such that components (a), (b) and (c) can be resuspended for injection.
• the floes can be comprised of component (a), components (a) and (b), or components (a), (b) and (c).
• a predetermined sediment bed height refers to a bed height that is higher than the bed height of a comparative pharmaceutical composition that has none of component (b), or none of components (b) or (c).
• the bed height is comprised of at least a 10, 20, 30, 40, 50, 60, 70, 80, 100% or greater than 100% (e.g. , about 160%) increase in sediment height compared to a non- flocculated pharmaceutical composition after 24 hours of undisturbed sitting. In another embodiment, the bed height is comprised of at least a 20 to 160% increase in sediment height compared to a non flocculated pharmaceutical composition after 24 hours of undisturbed sitting.
• the pharmaceutical compositions provided herein can result in reduced tissue reactions. Specifically, the composition provided herein results in a decreased tissue reaction normally associated with antipsychotic agents, such as aripiprazole, olanzapine, derivatives thereof, prodrugs thereof, and salts thereof.
• antipsychotic agents such as aripiprazole, olanzapine, derivatives thereof, prodrugs thereof, and salts thereof.
• tissue reaction refers to foreign body responses to a drug product (active agent and/or vehicle used for administration).
• tissue reaction results in the influx of immune cells, the subsequent encapsulation of the drug product and usually the development of a fluid filled central cavity. The presence of fibroblasts, neutrophils, macrophages and giant cells are often observed via histological examination.
• unacceptable TR refers to moderate to severe TR which is unacceptable to the patient and thereby impacts unfavorably on patient comfort and compliance.
• reduced TR refers to generally minimal to mild TR, which is acceptable to the patient and therefore does not engender an adverse event related nor impact unfavorably on patient compliance.
• the injectable composition provided herein is characterized by a decreased undue TR and a more acceptable TR following injection of drug product.
• a "tissue reaction” is a form of "injection site reaction. "
• the modulation of tissue response following SC administration is described by the reduction of the injection site weight (comprising the drug depot and surrounding tissue) which provides a quantitative assessment of the severity of the response.
• the modulation of the tissue response following IM administration is described by the spreadability of the drug and resulting depot morphology; spreading of the drug along the fascial planes of muscle is desirable rather than the formation of a concentrated mass of drug in a small area.
• the modulation of the tissue reaction is the reduction in tissue reaction at the site of injection.
• the injection site reaction is reduced by a particular amount, e.g. , about 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 5%, etc.
• composition When the antipsychotic agent/ polyoxyethylene derivative of a sorbitan ester/ Ci_6 alkyl ester of a Cio-20 fatty acid, composition is to be used as an injectable composition, including but not limited to injection through a needle or needle-less injection, it can be formulated into a conventional injectable carrier. Suitable carriers include biocompatible and pharmaceutically acceptable solutions.
• the pharmaceutical composition comprising components (a) and (b) can comprises component (c): a polyoxyethylene derivative of a sorbitan ester of a carboxylic acid, wherein the carboxylic acid comprises 8-20 carbon atoms.
• component (c) is polysorbate 20, sold under the trademark TWEEN ® .
• the polysorbate can be added in an amount that reduces surface tension of a drug product or aids in suspension stability of the drug product.
• the ratios of (b) and (c) can vary.
• the ratio of components (b) to (c) is approximately 10 to 0.5, e.g. , 10 to 1 , e.g. , 8 to 1 , e.g. , 0.5 to 1 , by weight.
• the ratio of components (b) to (c) is approximately 2.5 to 1 , by weight.
• the ratio of components (b) to (c) is approximately 1 to 1 , by weight.
• the composition comprises component (a), a 0 -6 alkyl ester of a Cio-20 fatty acid, and polysorbate 20, wherein the ratio of Ci_6 alkyl ester of a Cio-20 fatty acid, and polysorbate 20 is approximately 4.5 to 1 , by weight.
• the composition comprises component (a), Ci_6 alkyl ester of a Cio-20 fatty acid, and polysorbate 20, wherein the ratio of Ci- 6 alkyl ester of a Cio-20 fatty acid and polysorbate 20 is approximately 2.5 to 1, by weight.
• the composition comprises component (a), Ci_6 alkyl ester of a Cio-20 fatty acid and polysorbate 20, wherein the ratio of Ci-6 alkyl ester of a Cio-20 fatty acid and polysorbate 20 is approximately 1 to 1 , by weight.
• the composition comprises component (a), Ci- 6 alkyl ester of a C1 0 - 20 fatty acid and polysorbate 20, wherein the ratio of Ci- 6 alkyl ester of a Cio-20 fatty acid and polysorbate 20 is within the range of approximately 3 to 2 - 1 to 1 , by weight.
• the weight percent of (b) and (c) can vary.
• the composition comprises about 0.2 - 1 weight percent component (b) (a Ci_6 alkyl ester of a Cio-20 fatty acid, e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate,).
• the composition comprises about 0.05 - 0.8 weight percent component (c), e.g. , polysorbate 20. In yet another embodiment, the composition comprises about 0.1 - 0.3 weight percent component (c), e.g. , polysorbate 20. In still another embodiment, the composition comprises about 0.2 weight percent polysorbate 20.
• the ratio of components (b) to (c) is such that the composition can be injected using a 20-25 gauge needle.
• the needle can be a 20, 21, 23 or 23.5 gage needle.
• the ratio of components (b) to (c) is such that the composition can be injected through a sieve screen of 150 - 350 ⁇ using a 20-25 gauge needle.
• the ratio of components (b) to (c) is such that the composition can be injected using a 20 or greater gauge needle.
• compositions provided herein can also have varying amounts of antipsychosis agent.
• the antipsychosis agent can be aripiprazole, or olanzapine, salts of these compounds, hydrates of these compounds, and/or prodrugs of these compounds.
• the composition comprises approximately 15 - 35 weight percent aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V or VI (lurasidone), or pharmaceutically acceptable salts, hydrates, or solvates thereof.
• the composition comprises approximately 20 - 30 weight percent aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V or VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof.
• the aqueous vehicle of the pharmaceutical compositions provided herein can be a buffer.
• the buffer may be selected from a phosphate, citrate, tartrate or acetate buffer.
• the buffer is a phosphate buffer.
• compositions provided herein can further comprise additional components.
• additional wetting agents or surfactants in a pharmaceutical composition may promote one or more of the following: (1) Surface tension reduction, which may aid in wetting, since a 'lower surface tension' liquid will wet surfaces or particles more readily than a 'high surface tension' liquid. Lowering the surface tension of a liquid may also decrease the incidence of foaming. The surface tension of a liquid will be lower as more surfactant is added;
• micelles i.e., spherical or non-spherical surfactant structures in solution that have the capability to dissolve non-soluble components
• the pharmaceutical compositions can also contain an aqueous vehicle, which is a vehicle that dilutes and suspends the drug.
• the diluent of interest herein is one which is pharmaceutically acceptable (safe and no n- toxic for administration to a human) and is useful for the preparation of a reconstituted formulation.
• Exemplary diluents include sterile water, sterile water for injection (WFI), bacteriostatic water for injection (BWFI), a pH buffered solution (e.g. , phosphate-buffered saline), sterile saline solution, Ringer's solution or dextrose solution.
• the buffer can be phosphate, citrate, tartrate or acetate.
• the diluent is phosphate-buffered saline, which is a water-based salt solution containing either sodium chloride or potassium chloride, and sodium phosphate or potassium phosphate.
• the phosphate buffer comprises isotonic saline with 5-50 mM phosphate buffer at pH 4.0 - 9.0, e.g. , 5.0 - 8.0, e.g. , 5.0 - 7.5.
• the pharmaceutical compositions can further contain an additional surfactant that preferentially adsorbs to an interface between two immiscible phases, such as the interface between water and an organic polymer solution, a water/air interface or organic solvent/air interface.
• additional surfactant include but are not limited to fatty alcohols such as polyethylene glycols (PEGs) and cetyl alcohol.
• the pharmaceutical compositions can further comprise a dispersant, such as, for example, carboxymethyl cellulose (CMC), carboxymethyl cellulose sodium, cross- linked sodium carboxymethyl cellulose, calcium carboxymethyl cellulose, and low substituted hydroxypropyl cellulose magnesium aluminum silicate, or a mixture thereof.
• a dispersant such as, for example, carboxymethyl cellulose (CMC), carboxymethyl cellulose sodium, cross- linked sodium carboxymethyl cellulose, calcium carboxymethyl cellulose, and low substituted hydroxypropyl cellulose magnesium aluminum silicate, or a mixture thereof.
• the pharmaceutical composition comprises carboxymethyl cellulose.
• mono- and diglycerides can be used as excipients for the pharmaceutical compositions provided herein.
• examples of commercially available mono- and diglycerides include: monopalmitolein (C16:l) (Larodan), monoelaidin (trans C18: l) (Larodan), monocaproin (C6) (Larodan), monocaprylin (Larodan), monocaprin (Larodan), monolaurin (Larodan), glyceryl monomyristate (CI 4) (Nilol MGM, Nikko), glyceryl monooleate (cis C18:l) (PECEOL, Gattefosse), glyceryl monooleate (Myverol, Eastman), glycerol monooleate/linoleate (OLICINE, Gattefosse), glycerol monolinoleate (Maisine, Gattefosse), glyceryl ricinoleate (Softigen 701 , Huls), glyce
• palmitic/stearic (CUTINA MD-A, ESTAGEL-G18), glyceryl acetate (Lamegin EE, Grunau GmbH), glyceryl laurate (Imwitor 312, Huls), glyceryl citrate/lactate/oleate/linoleate
• the pharmaceutical compositions may also optionally comprise an antioxidant to inhibit the oxidation of ingredients.
• antioxidants include, but are not limited to, ascorbic acid, ascorbyl palmitate, butylated hydroxyanisole, a mixture of 2 and 3 tertiary-butyl-4-hydroxyanisole, butylated hydroxytoluene, sodium iso-ascorbate, dihydroguaretic acid, potassium sorbate, sodium bisulfate, sodium metabisulfate, sorbic acid, potassium ascorbate, vitamin E, 4-chloro-2,6-ditertiary butylphenol, alpha-tocopherol, and propylgallate.
• compositions can further include a lipid, e.g. , a neutral lipid.
• Neutral lipids include any lipid that remains neutrally charged at a pH between about 4 and 9.
• Neutral lipids include, without limitation, cholesterol, other sterols and derivatives thereof, phospholipids, and combinations thereof and other neutral lipids.
• the phospholipids include any one phospholipid or combination of phospholipids capable of forming liposomes. They include phosphatidylcholines, phosphatidylethanolamines, lecithin and fractions thereof, phosphatidic acid, phosphatidylglycerols, phosphatidylinositols, phosphatidylserines, plasmalogens and sphingomyelins.
• the phosphatidylcholines include, without limitation, those obtained from egg, soy beans or other plant sources or those that are partially or wholly synthetic or of variable lipid chain length and unsaturation, POPC, OPPC, natural or hydrogenated soy bean PC, natural or hydrogenated egg PC, DMPC, DPPC, DSPC, DOPC and derivatives thereof.
• phosphatidylcholines are POPC, non- hydrogenated soy bean PC and non-hydrogenated egg PC.
• Phosphatidylethanolamines include, without limitation, DOPE, DMPE and DPPE and derivatives thereof.
• Phosphatidylglycerols include, without limitation, DMPG, DLPG, DPPG, and DSPG.
• Phosphatidic acids include, without limitation, DSPA, DMPA, DLPA and DPPA.
• compositions can also advantageously employ a density enhancing agent, such as a sugar, e.g., mannitol, or sorbitol and/or a tonicity adjusting agent, such as sodium chloride or glycerol.
• a density enhancing agent such as a sugar, e.g., mannitol, or sorbitol
• a tonicity adjusting agent such as sodium chloride or glycerol.
• compositions provided herein also include water, aqueous methylcellulose solutions, saline, dextrose solutions, fructose solutions, ethanol, or oils of animal, vegetative, or synthetic origin.
• the pharmaceutical carrier may also contain preservatives, and buffers as are known in the art.
• compositions described herein may also be in the form of an emulsion.
• emulsion as used in this specification denotes a two-phase system in which one phase is finely dispersed in the other phase.
• An emulsifier can be used in the pharmaceutical compositions to form the emulsion.
• emulsifier denotes an agent that can reduce and/or eliminate the surface and the interfacial tension in a two-phase system. Such an agent possesses both hydrophilic and lipophilic groups in the emulsifier agent.
• compositions described herein may also be in the form of a dispersion.
• dispersion is to be understood as a mixture in which fine particles of one substance (e.g. , a drug) are scattered throughout another substance (e.g. , a liquid).
• Dispersions include suspensions, and colloids.
• the methods of the invention include administering the compositions described herein, thereby obtaining an extended release or sustained release profile in the patient.
• Extended-release or “sustained-release” includes dosage forms whose drug-release characteristics of time course and/or location are chosen to accomplish therapeutic or convenience objectives not offered by conventional dosage forms such as a solution or an immediate release dosage form.
• An extended release profile includes deliveries that achieve a therapeutically effective amount of the antipsychotic agent, e.g. , aripiprazole, or olanzapine, or a compound of formula I, II, III, IV or V, is present in the plasma of the individual for at least about 7 days, preferably at least about 14 days, or more preferably at least about 21 days alternatively for at least 2, 3, 4, 6 or 8 weeks or as much as three months.
• the pharmaceutical compositions can be administered as a single or sole (undivided) dose.
• the composition is also useful for those individuals that require constant or chronic therapy, such as those that receive repeated doses over several hours, days, weeks, months, or more.
• the method can comprise a first administration of a first extended release composition and a second administration of a second extended release composition.
• the second composition can be the same, substantially the same or different as the first and can include the same active agent or a different active agent.
• the second composition can be administered at about 7 days, or more, such as at least about 14 days, or at least about 17 days, after the first administration, where the first administration results in the release of agent for a period of 1 , 2, 3 , 4, 5 , 6, 7, 8, 9, 10, 11, 12, 13, 14 days, or more.
• injectable, pharmaceutical compositions described herein can be injected into a patient in any number of ways.
• injectable refers to a composition that is suitable to be delivered to an individual in an injection, such as with an injection device, including one that employs a syringe or a cartridge, which may be housed in a manual injection device or an auto-injection device, for example.
• the injectable composition is suitable for parenteral administration.
• parenteral administration refers to administration through injection or infusion. Parenteral
• intravenous administration includes, but is not limited to, intravenous administration, intradermal administration, subcutaneous administration or intramuscular administration.
• intravenous administration means administration into a vein.
• Intravenous administration is injection into the upper layer of skin (i. e. , the dermis), just beneath the epidermis.
• Subcutaneous administration refers to administration just below the skin.
• Intramuscular administration is the injection directly into a muscle.
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof, wherein component (a) is in a weight ratio of approximately 15 - 35%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 15 - 35 %;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 15 - 35 %;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof, wherein component (a) is in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1 %;
• the injectable pharmaceutical composition comprises:
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V, VI, or pharmaceutically acceptable salts, hydrates, or solvates thereof in a weight ratio of approximately 20 - 30%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, compound A-4, or compound A-7, wherein component (a) is in a weight ratio of approximately 15 - 35%;
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, compound A-4, or compound A-7, wherein component (a) is in a weight ratio of approximately 20 - 30%;
• a Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• the injectable pharmaceutical composition comprises:
• Ci-6 alkyl ester of a Cio-20 fatty acid e.g., ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate, in a weight ratio of approximately 0.2 - 1%;
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, compound A-4, or compound A-7, wherein component (a) is in a weight ratio of approximately 15 - 35%;
• the injectable pharmaceutical composition comprises:
• the injectable pharmaceutical composition comprises:
• an injectable pharmaceutical composition comprising:
• component (a) aripiprazole, compound A-4, or compound A-7, wherein component (a) is in a weight ratio of approximately 20 - 30%;
• the injectable pharmaceutical composition comprises:
• the injectable pharmaceutical composition comprises:
• compositions provided herein are useful for the administration of antipsychotic drugs to a subject.
• antipsychotic drugs As used herein the term
• antipsychotic refers all drugs used to treat psychosis. Common conditions for which antipsychotics are prescribed include schizophrenia, mania and delusional disorder, although antipsychotics are also used to counter psychosis associated with a wide range of other diagnoses. Antipsychotics also act as mood stabilizers making them suitable for the treatment of bipolar disorder (even when no symptoms of psychosis are present).
• the pharmaceutical compositions provided herein are particularly useful for formulating a water- insoluble antipsychotic into an injectable composition.
• the pharmaceutical compositions described herein are useful for administration of water-insoluble antipsychotic agents.
• a water-insoluble antipsychotic agent is one that dissolves in a quantity of water to an extent of less than 100%.
• water- insoluble does not necessarily refer to complete or 100% water-insolubility. In certain embodiments, the water-insoluble material dissolves to an extent of less than 50%. In other embodiments, the water-insoluble material dissolves to an extent of less than 10%. In a particular embodiment, the water-insoluble material dissolves to an extent of less than 1%.
• water- insoluble can refer to solubility as prescribed in the United
• the antipsychotic drug of the pharmaceutical composition is aripiprazole.
• the aripiprazole drug substance can comprise, consist essentially of, or consist of aripiprazole (in a crystalline, non-crystalline or amorphous form), an aripiprazole salt, an aripiprazole solvate (including ethanolates and hydrates), or other aripiprazole polymorphs.
• Preferred salts include those salts insoluble in an aqueous vehicle.
• Pharmaceutical salts such as the hydrochloride and various pharmaceutically acceptable carboxylate salts are suitable.
• the aripiprazole drug substance can also include aripiprazole prodrugs.
• prodrug is art-recognized and is intended to encompass compounds which, under physiological conditions, are converted into active compounds, e.g., those described herein.
• a common method for making a prodrug is to select moieties which are hydrolyzed or otherwise cleaved under physiological conditions to provide the desired compound.
• the prodrug is converted by an enzymatic activity of the host animal.
• Preferred aripiprazole prodrugs that can be used in the pharmaceutical compositions include the prodrugs described in U.S. Publication No. 2011/0003828, which is incorporated herein by reference in its entirety.
• the aripiprazole prodrug is a compound of formula (I) or formula (II):
• R a is absent, and R b is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or - C(0)R 1 ;
• R b is absent, and R a is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or - C(0)R 1 ;
• R c is -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , -CH 2 OC(0)N(R 1 ) 2 or -C(0)R 1 ;
• each R 1 is independently selected from the group consisting of hydrogen, substituted or unsubstituted aliphatic, and substituted or unsubstituted aryl;
• each R 2 is selected from the group consisting of substituted or unsubstituted aryl and substituted or unsubstituted heteroaryl;
• Y ⁇ is a pharmaceutically acceptable counterion
• Suitable counterions include, e.g., chloride, bromide, iodide, sulfate, phosphate, acetate, benzoate, tartrate, citrate, propionate, gluconate, lactate, maleate, fumarate, camsylate, glucepate, mesylate, napsylate, pamoate, conjugate bases of organic carboxylic acids, and the like.
• R a is CH 2 OC(0)R 1 and wherein R 1 is selected from substituted or unsubstituted aliphatic.
• R 1 is -CH 2 OC(0)-(CH 2 )4CH 3 (Compound A-4).
• R 1 is -CH 2 OC(O)-(CH 2 )i 0 CH 3 (Compound A-7).
• Compounds A-4 and A-7 are depicted below:
• the antipsychotic drug of the pharmaceutical composition is olanzapine.
• the olanzapine drug substance can comprise, consist essentially of, or consist of olanzapine (in a crystalline, non-crystalline or amorphous form), an olanzapine salt, an olanzapine solvate (including for example ethanolates and hydrates), or other olanzapine polymorphs.
• a preferred olanzapine salt is olanzapine pamoate.
• the antipsychotic drug can also be an olanzapine prodrug.
• the olanzapine drug substance can also include olanzapine prodrugs of Formula (III), (IV) or
• R 3a , R 3b and R 3c are independently -CH 2 OC(0)R 1 , -CH 2 OC(0)OR 1 , - CH 2 OC(0)N(R 1 ) 2 , -C(0)R 1 or -C(0)OC(R 4 )(R 5 )-OC(0)(G 12 ) m R 6 ;
• R 1 is independently selected from the group consisting of hydrogen, substituted or unsubstituted aliphatic, and substituted or unsubstituted aryl;
• each R 4 and R 5 is independently selected from hydrogen, C1-C3 alkyl, aryl or substituted aryl; preferably, hydrogen or methyl;
• Gi 2 is selected from NH, CH 2 , -S- or -0-;
• m is 0 or 1 ;
• R 6 is selected from Ci 3 -C 2 6-alkyl, substituted Ci 3 -C 2 6-alkyl, Ci 3 -C 2 6-alkenyl, substituted Ci 3 -C 2 6-alkenyl, Ci 3 -C 2 6-alkynyl, substituted Ci 3 -C 2 6-alkynyl, Ci 3 -C 2 6-cycloalkyl, and substituted Ci 3 -C 2 6-cycloalkyl, aryl-Ci 3 -C 2 6-alkyl, substituted aryl-Ci 3 -C 2 6-alkyl, C1-C1 0 - aryl, substituted Ci-Cio-aryl, heteroaryl-Ci 3 -C 2 6-alkyl, substituted heteroaryl-Ci 3 -C 2 6-alkyl; optionally substituted Ci 3 -C2 6 -alkylaryl, optionally substituted Ci 3 -C2 6 -alkenylaryl and optionally substituted Ci 3 -C2 6 -
• Y ⁇ is a pharmaceutically acceptable counterion
• Suitable counterions include, e.g., chloride, bromide, iodide, sulfate, phosphate, acetate, benzoate, tartrate, citrate, propionate, gluconate, lactate, maleate, fumarate, camsylate, glucepate, mesylate, napsylate, pamoate, conjugate bases of organic carboxylic acids, and the like.
• R 3a is -C(0)OCH 2 OC(0)R 6 and R 6 is selected from Ci 3 -C2 6 -alkyl.
• R 3a is - C(0)OCH 2 OC(0)(CH 2 )i 4 CH 3 (Compound 0-56).
• R 3a is -C(0)OCH 2 OC(0)(CH 2 )i 6 CH 3 (Compound 0-111).
• R 3a is -C(0)OCH 2 OC(0)(CH 2 )i 8 CH3 (Compound O- 112).
• Compounds 0-56, 0-111 and 0-112 are depicted below:
• R 3b is -C(0)OCH 2 OC(0)R 6 and R 6 is selected from Ci 3 -C2 6 -alkyl.
• R is - C(0)OCH 2 OC(0)(CH 2 )i4CH 3 (Compound 0-7).
• R 3b is -C(0)OCH 2 OC(0)(CH 2 )i 6 CH 3 (Compound 0-8).
• R 3b is -C(0)OCH 2 OC(0)(CH 2 )i 8 CH 3 (Compound O- 9).
• Compounds 0-7, 0-8 and 0-9 are depicted below:
• the antipsychotic drug of the pharmaceutical compositions is lurasidone.
• Lurasidone is an atypical antipsychotic that is useful for the treatment of a variety of psychiatric disorders, including schizophrenia and bipolar disorder. This compound is described in, e.g. , U.S. Patent No. 5,532,372, which is incorporated herein by reference.
• Lurasidone is the generic name of the compound (3a/?,45',7/?,7a5')-2-[((l/?,2/?)-2- ⁇ [4-(l,2- benzisothiazol-3-yl)-piperazin-l-yl]methyl ⁇ cyclohexyl)methyl]hexahydro-lH-4,7- methanisoindol- 1 ,3 -dione:
• the lurasidone drug substance can comprise, consist essentially of, or consist of lurasidone free base (in a crystalline, non-crystalline or amorphous form), a lurasidone salt, a lurasidone solvate (including for example ethanolates and hydrates), or other lurasidone polymorphs.
• the lurasidone drug substance can also include lurasidone prodrugs.
• aripiprazole, or olanzapine or a compound of formula I, II, III, IV, V or VI can be referred to as an "antipsychotic agent.
• an "aliphatic group” or “aliphatic” is non-aromatic moiety that may be saturated (e.g. single bond) or contain one or more units of unsaturation, e.g. , double and/or triple bonds.
• An aliphatic group may be straight chained, branched or cyclic, contain carbon, hydrogen or, optionally, one or more heteroatoms and may be substituted or unsubstituted.
• An aliphatic group when used as a linker, preferably contains between about 1 and about 24 atoms, more preferably between about 4 to about 24 atoms, more preferably between about 4 to about 12 atoms, more typically between about 4 and about 8 atoms.
• aliphatic groups include, for example, polyalkoxyalkyls, such as polyalkylene glycols, polyamines, and polyimines, for example. Such aliphatic groups may be further substituted. It is understood that aliphatic groups may include alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl groups described herein.
• the aliphatic groups of the present invention are alkyl chains containing from 5 to 11 carbon atoms. In other embodiments, the aliphatic groups are alkyl chains containing from 15 to 19 carbon atoms.
• aryl alone or in combination, means a carbocyclic aromatic system containing one, two or three rings wherein such rings may be attached together in a pendent manner or may be fused.
• aryl embraces aromatic radicals such as phenyl, naphthyl, tetrahydronaphthyl, indane and biphenyl.
• aryl is unsubstituted or independently substituted one or more times with halogen, Ci_6 alkyl, or O- Ci_6 alkyl.
• heteroaryl embraces unsaturated heterocyclyl radicals.
• heteroaryl radicals include unsaturated 3 to 6 membered heteromonocyclic group containing 1 to 4 nitrogen atoms, for example, pyrrolyl, pyrrolinyl, imidazolyl, pyrazolyl, pyridyl, pyrimidyl, pyrazinyl, pyridazinyl, triazolyl (e.g. , 4H-l ,2,4-triazolyl, lH-l ,2,3-triazolyl, 2H- 1,2,3-triazolyl, etc.) tetrazolyl (e.g.
• unsaturated condensed heterocyclyl group containing 1 to 5 nitrogen atoms for example, indolyl, isoindolyl, indolizinyl, benzimidazolyl, quinolyl, isoquinolyl, indazolyl, benzotriazolyl, tetrazolopyridazinyl (e.g. , tetrazolo[l,5-b]pyridazinyl, etc.), etc.
• unsaturated 3 to 6- membered heteromonocyclic group containing an oxygen atom for example, pyranyl, furyl, etc.
• benzoxazolyl, benzoxadiazolyl, etc. unsaturated 3 to 6-membered heteromonocyclic group containing 1 to 2 sulfur atoms and 1 to 3 nitrogen atoms, for example, thiazolyl, thiadiazolyl (e.g. , 1,2,4- thiadiazolyl, 1,3,4-thiadiazolyl, 1 ,2,5-thiadiazolyl, etc.) etc. ; unsaturated condensed heterocyclyl group containing 1 to 2 sulfur atoms and 1 to 3 nitrogen atoms (e.g., benzo thiazolyl, benzo thiadiazolyl, etc.) and the like.
• substituted refers to the replacement of one or more hydrogen radicals in a given structure with the radical of a specified substituent including, but not limited to: halo, alkyl, alkenyl, alkynyl, aryl, heterocyclyl, thiol, alkylthio, arylthio, alkylthioalkyl, arylthio alkyl, alkylsulfonyl, alkylsulfonylalkyl, arylsulfonylalkyl, alkoxy, aryloxy, aralkoxy, aminocarbonyl, alkylaminocarbonyl, arylaminocarbonyl, alkoxycarbonyl, aryloxycarbonyl, haloalkyl, amino, trifluoromethyl, cyano, nitro, alkylamino, arylamino, alkylaminoalkyl, arylamino alkyl, amino alkylamino, hydroxy
• chemical moieties that are defined and referred to throughout can be univalent chemical moieties (e.g. , alkyl, aryl, etc.) or multivalent moieties under the appropriate structural circumstances clear to those skilled in the art.
• an "alkyl” moiety can be referred to a monovalent radical (e.g. CH 3 -CH 2 -), or in other instances, a bivalent linking moiety can be "alkyl,” in which case those skilled in the art will understand the alkyl to be a divalent radical (e.g., -CH 2 -CH 2 -), which is equivalent to the term
• alkylene alkylene.
• compound is defined herein to include pharmaceutically acceptable salts, solvates, hydrates, polymorphs, enantiomers, diastereoisomers, racemates and the like of the compounds having a formula as set forth herein.
• compositions provided herein can be used for treatment of a variety of disorders in a subject in need thereof.
• the disclosed compositions may be used to treat conditions selected from: disorders such as cerebral deficit subsequent to cardiac bypass surgery and grafting, stroke, cerebral ischemia, spinal cord trauma, head trauma, perinatal hypoxia, cardiac arrest, hypoglycemic neuronal damage, dementia
• AIDS-induced dementia including AIDS-induced dementia
• Alzheimer's disease Huntington's Chorea, amyotrophic lateral sclerosis, ocular damage, retinopathy, cognitive disorders, idiopathic and drug-induced Parkinson's disease, muscular spasms and disorders associated with muscular spasticity including tremors, epilepsy, convulsions, cerebral deficits secondary to prolonged status epilepticus, migraine (including migraine headache), urinary incontinence, substance tolerance, substance withdrawal (including, substances such as opiates, nicotine, tobacco products, alcohol, benzodiazepines, cocaine, sedatives, hypnotics, etc.), psychosis, schizophrenia, anxiety (including generalized anxiety disorder, panic disorder, social phobia, obsessive compulsive disorder, and post- traumatic stress disorder (PTSD)), attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), mood disorders (including depression, mania, bipolar disorders), circadian rhythm disorders (including jet lag and shift work), trigeminal neuralgia, hearing
• the present invention provides a method of treating cardiac and cardiovascular disorders such as angina, arrhythmia, and hypertension, in a patient in need thereof.
• the method comprises administering to the subject a therapeutically effective amount of a composition of the invention or a pharmaceutically acceptable salt thereof.
• the invention further relates to the treatment of fever, diabetes, allergy, asthma, infection, inflammation, and ulcers in a patient in need thereof, comprising administering to the subject a therapeutically effective amount of a composition of the invention or a pharmaceutically acceptable salt thereof.
• the invention further relates to the treatment of sleep modulation comprising administration of a composition of the invention.
• Sleep modulation includes decreasing the time to sleep onset, increasing the average sleep bout length, and increasing the maximum sleep bout length.
• compositions described herein can be used to treat anxiety, depression, bipolar disorder, autism-related irritability, and psychotic conditions including acute mania, schizophrenia and schizophreniform diseases in a subject.
• treated includes the diminishment or alleviation of at least one symptom associated with psychosis or a related CNS disorder.
• the term “treated,” “treating” or “treatment” as used in reference to a disease or condition shall mean to intervene in such disease or condition so as to prevent or slow the development of, prevent or slow the progression of, halt the progression of, or eliminate the disease or condition.
• modulating refers to an effect of altering a biological activity, especially a biological activity associated with an injection site reaction.
• subject is intended to include animals, which are capable of suffering from or afflicted with dementia associated with psychosis or a related CNS disorder, including, without limitation, psychotic conditions including acute mania, schizophrenia and schizophreniform disorders, bipolar disorder, anxiety and depression.
• subjects include mammals, e.g. , humans, dogs, cows, horses, pigs, sheep, goats, cats, mice, rabbits, rats, and transgenic non-human animals.
• the subject is a human, e.g. , a human suffering from, at risk of suffering from, or potentially capable of suffering from any of the diseases described herein.
• the term “about” or “approximately” usually means within 20%, more preferably within 10%, and most preferably still within 5% of a given value or range. Alternatively, especially in biological systems, the term “about” means within about a log (i.e., an order of magnitude), preferably within a factor of two of a given value.
• a therapeutically effective amount of the agent is given to a subject using the pharmaceutical compositions provided herein.
• the term "therapeutically effective amount” is further meant to define an amount resulting in the improvement of any parameters or clinical symptoms.
• the actual dose may vary with each patient and does not necessarily indicate a total elimination of all disease symptoms.
• the management of exacerbations and maintenance of remission of psychiatric symptoms are main goals of therapy, and selection of the appropriate drug and dosage in a particular disease balances these goals with the minimization of adverse events attributable to the drug.
• a therapeutically effective amount of the compound used in the treatment described herein can be readily determined by the attending diagnostician, as one skilled in the art, by the use of conventional techniques and by observing results obtained under analogous circumstances.
• determining the therapeutically effective dose a number of factors are considered by the attending diagnostician, including, but not limited to: the species of mammal; its size, age, and general health; the specific disease involved; the degree of or involvement or the severity of the disease; the response of the individual patient; the particular compound administered; the mode of administration; the bioavailability characteristic of the preparation administered; the dose regimen selected; the use of concomitant medication; and other relevant circumstances.
• Preferred suitable dosages for the compounds used in the treatment described herein are on the order of about 1 mg to about 600 mg, preferably about 3, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 90, 95, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280, 300, 320, 340, 360, 380, 400, 420, 440, 460, 480, 500, 520, 540, 560, 580 to about 600 mgs total of active. Dosing schedules may be adjusted to provide the optimal therapeutic response. For example, administration can be one to three times daily for a time course of one day to several days, weeks, months, and even years, and may even be for the life of the patient.
• a unit dose of any given composition used in the treatment described herein can be administered in a variety of dosing schedules, depending on the judgment of the clinician, needs of the patient, and so forth.
• the specific dosing schedule will be known by those of ordinary skill in the art or can be determined experimentally using routine methods.
• Exemplary dosing schedules include, without limitation, administration five times a day, four times a day, three times a day, twice daily, once daily, every other day, three times weekly, twice weekly, once weekly, twice monthly, once monthly, and so forth.
• Unit dose preparations provided herein can contain aripiprazole, a compound of Formula I or a compound of Formula II in the range of about 60 to about 800 mgs (aripiprazole base equivalents).
• Unit dose preparations provided herein can contain olanzapine, a compound of Formula III, a compound of Formula IV or a compound of Formula V in the range of 40 to about 500 mgs (olanzapine base equivalents).
• Unit dose preparations provided herein can contain a compound of Formula VI in the range of 160 to about 1000 mgs (lurasidone base equivalents).
• compositions can be manufactured utilizing techniques known in the art. Typically the therapeutically effective amount of the compound will be admixed with a pharmaceutically acceptable carrier.
• Ci_6 alkyl ester of a Cio-20 fatty acid e.g. , ethyl oleate, isopropyl oleate, ethyl myristate, or isopropyl myristate
• reaction mixture was cooled, diluted with saturated aqueous NaHCC>3 (50 mL/g of [A]) and diethyl ether (75 mL/g of [A]). After being stirred for 15 min the mixture was filtered through celite and the organic phase separated. This was dried over MgS0 4 and evaporated. The residue was purified by column chromatography on silica eluting with 30% THF in EtOAc and the product containing fraction combined and evaporated. The residue was co-evaporated from hexanes.
• the reaction mixture was cooled, diluted with saturated aqueous NaHCC> 3 (50 mL/g of [C]) and ethyl acetate (75 mL/g of [C]). After being stirred for 15 min the mixture was filtered through celite and the organic phase separated. This was dried over MgS0 4 and evaporated. The residue was further purified by column chromatography on silica eluting with 1:9 methanol ethyl acetate and after evaporation of the product containing fractions, the residue was co-evaporated with hexane (2 x 10 mL/g [C]).
• Compound 0-9 can be made using the general procedure described above, and by employing arachidic acid and the intermediate [C], which could then provide

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