Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
• • 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
  • A61K47/02—Inorganic compounds
• • 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
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/02—Non-specific cardiovascular stimulants, e.g. drugs for syncope, antihypotensives

Definitions

• Ephedrine sulfate ((1 F?,2S)-(-)-2-methylamine-1 -phenylpropan-1 -ol sulfate) is an alpha- and beta-adrenergic agonist and a norepinephrine-releasing agent that is FDA-approved for the treatment of clinically important hypotension occurring in the setting of anesthesia. However, all FDA-approved formulations must be diluted ten-fold before administration to a patient.
• shelf-stable ready-to-use formulations commonly include excipients, such as preservatives and/or chelating agents.
• excipients such as preservatives and/or chelating agents.
• the use of such agents while advantageous from a stability perspective, prevents broad use of prediluted compositions due to risks of allergic reactions, patient sensitivities, and undesirable cross-reactivities with other medications. These risks are significant in certain settings, such as the emergency room, where quick action is required, often in the absence of complete patient records.
• ephedrine sulfate compositions are prepared using aseptic compounding techniques, whether by a compounding lab or on-site by a medical professional. While generally considered to be safe, aseptic compounding still results in frequent (circa 1/1 ,000) contamination by biological materials. For example, Sandoz, US Compounding, Pharmakon Pharmaceuticals, Allergy Laboratories, Cantrell Drug Company, SCA Pharmaceuticals, Banner Pharmaceuticals and PherMEDium have recalled dozens of lots of compounded ephedrine sulfate, representing several million doses, for lack of sterility assurance since 2012. Current methods of
• Ephedrine sulfate compositions are known to be susceptible to light, pH changes, and humidity. FDA-approved formulations have short shelf lives, typically about 24 months. Ready-to-use (e.g., prediluted) preparations of ephedrine sulfate are not known to be stable for more than 60 days; ready-to-use formulations of other ephedrine salts are not known to be stable for more than 12 months.
• the present disclosure provides formulations comprising ephedrine sulfate.
• compositions comprising ephedrine sulfate in water, wherein the ephedrine sulfate is present at a concentration of about 1 mg/mL to about 10 mg/mL.
• the present disclosure provides a sterile prediluted medicament comprising about 3.8 mg/mL of ephedrine or an equimolar amount of an ephedrine salt; about 9 mg/mL sodium chloride; and water.
• the present disclosure provides a packaged pharmaceutical product comprising a vial; and a solution housed within the vial, wherein the solution comprises, consists essentially of, or consists of about 5 mg/mL of ephedrine sulfate; about 9 mg/mL sodium chloride; and water.
• the present disclosure provides a method of administering ephedrine sulfate to a subject in need thereof, the method comprising drawing a composition comprising ephedrine sulfate from a sterile premixed pharmaceutical product into a syringe; and injecting the composition into the subject using the syringe, wherein the ephedrine sulfate is present in the composition in an amount of about 5 mg/mL.
• the present disclosure provides a method of making a ready-to-use pharmaceutical composition comprising ephedrine or an ephedrine salt, the method comprising combining ephedrine or an ephedrine salt, sodium chloride and water to provide a solution comprising about 3.8 mg/mL ephedrine or an equimolar amount of an ephedrine salt, and about 9 mg/mL sodium chloride; and thereafter sterilizing the solution to provide a ready-to-use pharmaceutical composition comprising ephedrine or an ephedrine salt.
• compositions e.g., ready-to-use premixed pharmaceutical compositions
• ephedrine or an ephedrine salt that are ready for immediate use in a clinical setting.
• compositions consistent with those disclosed herein and comprising an ephedrine salt (e.g., ephedrine sulfate) in a premixed (e.g., ready-to-use) formulation that does not require reconstitution or dilution prior to administration to a subject remains stable and active after prolonged storage.
• an ephedrine salt e.g., ephedrine sulfate
• a premixed e.g., ready-to-use
• compositions of the present disclosure comprise ephedrine or a biologically active salt thereof.
• Ephedrine has an empirical formula of C10H15NO, a molecular weight of 165.2 g/mol and a structural formula, in its clinically important 1 R,2S enantiomer, as shown below:
• Ephedrine sulfate has an empirical formula of C20H32N2O6S, a molecular weight of 428.5 g/mol and a structural formula, in its clinically important ⁇ ⁇ F!,2S enantiomer, as shown below:
• Ephedrine hydrochloride has an empirical formula of C I 0 H I6 NOCI, a molecular weight of 201.7 g/mol and a structural formula, in its clinically important 1 R,2S enantiomer, as shown below:
• Ephedrine and its salts feature at least two chemically reactive centers, namely a secondary amine at C-2 and a secondary alcohol at C-1 .
• ephedrine compositions are known to degrade during storage in a transparent container, including when contacted by light.
• a composition of the present disclosure comprises ephedrine.
• the ephedrine is enantiopure (-)-ephedrine or substantially enantiopure
• the composition comprises not more than about 30 wt.% (+)-ephedrine, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 wt.%, not more than about 15 wt.
• the composition comprises not more than about 30 wt.% (+)-ephedrine, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 wt.%, not more than about 15 w
• a composition of the present disclosure comprises ephedrine sulfate.
• the ephedrine sulfate is enantiopure (-)-ephedrine sulfate or substantially enantiopure (-)-ephedrine sulfate.
• the composition comprises not more than about 30 wt.% (+)-ephedrine or salt thereof, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 w
• the composition comprises not more than about 30 wt.% (+)-ephedrine or salt thereof, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 w
• composition of the present disclosure comprises ephedrine
• the ephedrine hydrochloride is enantiopure (-)-ephedrine hydrochloride or substantially enantiopure (-)-ephedrine hydrochloride.
• the composition comprises not more than about 30 wt.% (+)-ephedrine or salt thereof, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 wt.
• the composition comprises not more than about 30 wt.% (+)-ephedrine or salt thereof, for example not more than about 30 wt.%, not more than about 29 wt.%, not more than about 28 wt.%, not more than about 27 wt.%, not more than about 26 wt.%, not more than about 25 wt.%, not more than about 24 wt.%, not more than about 23 wt.%, not more than about 22 wt.%, not more than about 21 wt.%, not more than about 20 wt.%, not more than about 19 wt.%, not more than about 18 wt.%, not more than about 17 wt.%, not more than about 16 wt.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine sulfate after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine sulfate after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine sulfate after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine sulfate after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine hydrochloride after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine hydrochloride after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine hydrochloride after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine hydrochloride after storage at about 20°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine sulfate after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine sulfate after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine sulfate after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine sulfate after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 70% of the initial amount of (-)-ephedrine hydrochloride after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 80% of the initial amount of (-)-ephedrine hydrochloride after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 90% of the initial amount of (-)-ephedrine hydrochloride after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure comprises at least about 95% of the initial amount of (-)-ephedrine hydrochloride after storage at about 40°C. +/- 2°C. for at least about 12 months, for example at least about 12 months, at least about 14 months, at least about 16 months, at least about 18 months, at least about 20 months, at least about 22 months, at least about 24 months, at least about 26 months, at least about 28 months, at least about 30 months, at least about 32 months, at least about 34 months, at least about 36 months, at least about 38 months, at least about 40 months, at least about 42 months, at least about 44 months, at least about 46 months, at least about 48 months.
• a composition of the present disclosure includes not more than about 2 pg/mL of dichlorobenzoic acid after storage at about 25°C. +/- 2°C. for at least about 12 months, for example not more than about 2 pg/mL, not more than about 1 .9 pg/mL, not more than about 1 .8 pg/mL, not more than about 1 .7 pg/mL, not more than about 1 .6 pg/mL, not more than about
• 0.3 pg/mL not more than about 0.2 pg/mL, or not more than about 0.1 pg/mL.
• a composition of the present disclosure includes not more than about 2 pg/mL of dichlorobenzoic acid after storage at about 25°C. +/- 2°C. for at least about 24 months, for example not more than about 2 pg/mL, not more than about 1 .9 pg/mL, not more than about 1 .8 pg/mL, not more than about 1 .7 pg/mL, not more than about 1 .6 pg/mL, not more than about
• 0.3 pg/mL not more than about 0.2 pg/mL, or not more than about 0.1 pg/mL.
• a composition of the present disclosure comprises ephedrine or an ephedrine salt, an isotonic agent, and water.
• a composition of the present disclosure does not include a preservative.
• preservatives include (e.g., benzyl alcohol, chlorobutanol, phenyl ethyl alcohol), parabens (e.g., methylparaben, ethylparaben, propylparaben, butylparaben), phenols (e.g., phenol, chlorocresol, o-phenyl phenol), mercurial compounds (e.g., thiomersal, nitromersol, phenylmercuric nitrate, phenylmercuric acetate), and quaternary ammonium compounds (e.g., benzalkonium chloride, cetyl pyridinium chloride).
• the composition does not include benzyl alcohol.
• a composition of the present disclosure does not include a chelating agent.
• chelating agents include EDTA, calcium disodium edetate, and disodium edetate.
• the composition does not include EDTA.
• the composition does not include a preservative or a chelating agent. In some embodiments, the composition does not include benzyl alcohol or EDTA.
• the ephedrine or ephedrine salt is present in an amount equivalent to about 3.8 mg/ml_ of ephedrine free base.
• the ephedrine free base may be present in an amount of about 3.8 mg/ml_.
• the ephedrine or the ephedrine salt consists of ephedrine sulfate
• the ephedrine sulfate may be present in an amount of about 5 mg/ml_.
• the ephedrine or the ephedrine salt consists of ephedrine hydrochloride
• the ephedrine hydrochloride may be present in an amount of about 4.6 mg/mL.
• the isotonic agent is sodium chloride. In other embodiments, the isotonic agent is dextrose. In embodiments in which the isotonic agent is sodium chloride, the sodium chloride may be present in an isotonic amount, such as about 9 mg/mL. In
• the sodium chloride may be present in an isotonic amount, such as about 5%.
• a composition of the present disclosure comprises ephedrine (e.g., (-)- ephedrine), sodium chloride and water (e.g., water for injection).
• ephedrine e.g., (-)- ephedrine
• sodium chloride e.g., sodium bicarbonate
• water e.g., water for injection
• the ephedrine is present in an amount of about 3.8 mg/mL
• the sodium chloride is present in an amount of about 9 mg/mL.
• a composition of the present disclosure comprises ephedrine sulfate (e.g., (-)-ephedrine sulfate), sodium chloride and water (e.g., water for injection).
• ephedrine sulfate e.g., (-)-ephedrine sulfate
• sodium chloride e.g., sodium bicarbonate
• water e.g., water for injection.
• the ephedrine sulfate is present in an amount of about 5 mg/mL
• the sodium chloride is present in an amount of about 9 mg/mL.
• a composition of the present disclosure comprises ephedrine hydrochloride (e.g., (-)-ephedrine hydrochloride), sodium chloride and water (e.g., water for injection).
• ephedrine hydrochloride e.g., (-)-ephedrine hydrochloride
• sodium chloride e.g., sodium bicarbonate
• water e.g., water for injection
• the ephedrine hydrochloride is present in an amount of about 4.6 mg/ml_
• the sodium chloride is present in an amount of about 9 mg/ml_.
• a composition of the present disclosure comprises ephedrine (e.g., (-)- ephedrine), dextrose and water (e.g., water for injection).
• ephedrine e.g., (-)- ephedrine
• dextrose e.g., water for injection
• the ephedrine is present in an amount of about 3.8 mg/ml_
• the dextrose is present in an amount of about 5%.
• a composition of the present disclosure comprises ephedrine sulfate (e.g., (-)-ephedrine sulfate), dextrose and water (e.g., water for injection).
• ephedrine sulfate e.g., (-)-ephedrine sulfate
• dextrose e.g., dextrose
• water e.g., water for injection.
• the ephedrine sulfate is present in an amount of about 5 mg/ml_, and the dextrose is present in an amount of about 5%.
• a composition of the present disclosure comprises ephedrine hydrochloride (e.g., (-)-ephedrine hydrochloride), dextrose and water (e.g., water for injection).
• ephedrine hydrochloride e.g., (-)-ephedrine hydrochloride
• dextrose e.g., dextrose
• water e.g., water for injection
• the ephedrine hydrochloride is present in an amount of about 4.6 mg/ml_, and the dextrose is present in an amount of about 5%.
• the composition may have a total volume sufficient to provide an efficacious dose of ephedrine to a subject.
• the total volume is about 5 ml. to about 25 ml_, for example about 5 ml_, about 10 ml_, about 15 ml_, about 20 ml_, or about 25 ml_. In some embodiments, the total volume is about 10 mL.
• the composition may be housed within a container, such as a single-use container.
• the single-use container is a vial, such as a glass vial.
• the single-use container is a syringe, such as a polypropylene syringe.
• the present disclosure provides a single-use container comprising about 10 mL of a composition comprising about 38 mg of ephedrine (e.g., (-)-ephedrine), about 90 mg of sodium chloride, and water (e.g., water for injection).
• the single-use container is a glass vial.
• the single-use container is a syringe.
• the present disclosure provides a single-use container comprising about 10 mL of a composition comprising about 50 mg of ephedrine sulfate (e.g., (-)-ephedrine sulfate), about 90 mg of sodium chloride, and water (e.g., water for injection).
• the single-use container is a glass vial.
• the single-use container is a syringe.
• the present disclosure provides a single-use container comprising about 10 mL of a composition comprising about 46 mg of ephedrine hydrochloride (e.g., (-)-ephedrine hydrochloride), about 90 mg of sodium chloride, and water (e.g., water for injection).
• the single-use container is a glass vial.
• the single-use container is a syringe.
• the present disclosure provides a shelf-stable composition
• ephedrine or an ephedrine salt e.g., ephedrine sulfate
• a preservative such as benzyl alcohol
• the shelf-stable composition comprises ephedrine or an ephedrine salt (e.g., ephedrine sulfate), an isotonic agent (e.g., sodium chloride) and water, but does not include a preservative (e.g., benzyl alcohol).
• the shelf-stable composition comprises ephedrine sulfate (e.g., (-)-ephedrine sulfate), sodium chloride and water, but does not include benzyl alcohol.
• the prese disclosure provides a shelf-stable composition comprising ephedrine or an ephedrine salt (e.g., ephedrine sulfate) that does not include a chelating agent, such as EDTA.
• the shelf-stable composition comprises ephedrine or an ephedrine salt (e.g., ephedrine sulfate), an isotonic agent (e.g., sodium chloride) and water, but does not include a chelating agent (e.g., EDTA).
• the shelf-stable composition comprises ephedrine sulfate (e.g., (-)-ephedrine sulfate), sodium chloride and water, but does not include EDTA.
• the present disclosure provides a shelf-stable composition
• a shelf-stable composition comprising ephedrine or an ephedrine salt (e.g., ephedrine sulfate) that does not include a preservative (e.g., benzyl alcohol) or a chelating agent (e.g., EDTA).
• the shelf-stable composition comprises ephedrine or an ephedrine salt (e.g., ephedrine sulfate), an isotonic agent (e.g., sodium chloride) and water, but does not include a preservative (e.g., benzyl alcohol) or a chelating agent (e.g., EDTA).
• the shelf-stable composition comprises ephedrine sulfate (e.g., (-)-ephedrine sulfate), sodium chloride and water, but does not include benzyl alcohol or EDTA.
• ephedrine sulfate e.g., (-)-ephedrine sulfate
• sodium chloride e.g., sodium chloride
• EDTA ephedrine sulfate
• benzyl alcohol or EDTA ephedrine sulfate
• a composition of the present disclosure has a pH value of 4.5 to 7.0. In some embodiments, the composition has a pH value of 5.5 to 6.5. In some embodiments, the composition has a pH value of about 5.6 to 6.2. In some embodiments, the composition has a pH value of about 4.5, about 4.6, about 4.7, about 4.8, about 4.9, about 5.0, about 5.1 , about 5.2, about 5.3, about 5.4, about 5.5, about 5.6, about 5.7, about 5.8, about 5.9, about 6.0, about 6.1 , about 6.2, about 6.3, about 6.4, about 6.5, about 6.6, about 6.7, about 6.8, about 6.9, or about 7.0.
• a composition of the present disclosure includes no more than 10 colony forming units (“CFU”) per ml_, for example no more than 10 CFU/mL, no more than 9 CFU/mL, no more than 8 CFU/mL, no more than 7 CFU/mL, no more than 6 CFU/mL, no more than 5 CFU/mL, no more than 4 CFU/mL, no more than 3 CFU/mL, no more than 2 CFU/mL, no more than 1 CFU/mL, no more than 0,5 CFU/mL, no more than 0.4 CFU/mL, no more than 0.3 CFU/mL, no more than 0.2 CFU/mL, or no more than 0.1 CFU/mL.
• CFU colony forming units
• a composition of the present disclosure includes bacterial endotoxins in an amount of no more than 1 .7 Eu/mg, no more than 1 .6 Eu/mg, no more than 1.5 Eu/mg, no more than 1 .4 Eu/mg, no more than 1.3 Eu/mg, no more than 1.2 Eu/mg, no more than 1.1 Eu/mg, no more than 1.0 Eu/mg, no more than 0.9 Eu/mg, no more than 0.8 Eu/mg, no more than 0.7 Eu/mg, no more than 0.6 Eu/mg, no more than 0.5 Eu/mg, no more than 0.4 Eu/mg, no more than 0.3 Eu/mg, no more than 0.2 Eu/mg, or no more than 0.1 Eu/mg.
• the present disclosure provides a composition comprising ephedrine sulfate in water, wherein the ephedrine sulfate is present at a concentration of about 1 mg/mL to about 10 mg/mL. In some embodiments, the ephedrine sulfate is present at a concentration of about 2 mg/mL to about 8 mg/mL. In some embodiments, the ephedrine sulfate is present at a concentration of about 3 mg/mL to about 7 mg/mL. In some embodiments, the ephedrine sulfate is present at a concentration of about 4 mg/mL to about 6 mg/mL. In some
• the ephedrine sulfate is present at a concentration of about 5 mg/mL.
• the composition further comprises sodium chloride.
• the sodium chloride is present in an amount of about 9 mg/mL.
• the composition is stable when stored at 20°C. for at least 12 months.
• the composition does not include dextrose.
• the composition does not include a preservative such as benzyl alcohol.
• the composition does not include a chelating agent such as EDTA.
• the composition consists essentially of ephedrine sulfate, sodium chloride and water.
• the composition consists of ephedrine sulfate, sodium chloride and water.
• the ephedrine sulfate is (-)-ephedrine sulfate.
• the present disclosure provides a sterile prediluted medicament comprising about 3.8 mg/mL of ephedrine or an equimolar amount of an ephedrine salt; about 9 mg/mL sodium chloride; and water.
• the medicament does not include dextrose.
• the medicament does not include benzyl alcohol.
• a total volume of the medicament is about 10 ml_.
• the medicament is housed in a vial.
• the medicament comprises at least 3 mg/ml_ of the ephedrine or a molar equivalent of the ephedrine salt.
• the ephedrine or ephedrine salt is ephedrine sulfate. In some embodiments, the ephedrine sulfate is (-)-ephedrine sulfate.
• the present disclosure provides a ready-to-use unit dose form
• the ready-to-use unit dose form is housed in a vial. In some embodiments, the ready-to-use unit dose form has a total volume of about 10 ml_. In some embodiments, the ready-to-use unit dose form does not include dextrose. In some embodiments, the ready-to-use unit dose form does not include benzyl alcohol.
• the ready-to-use unit dose form comprises at least 3 mg/ml_ of the ephedrine or an equimolar amount of the ephedrine salt (e.g., at least 4 mg/ml_ of ephedrine sulfate).
• the present disclosure provides a packaged pharmaceutical product comprising a vial; and a solution housed within the vial, wherein the solution comprises, consists essentially of, or consists of about 5 mg/ml_ of ephedrine sulfate; about 9 mg/ml_ sodium chloride; and water.
• the solution has a total volume of about 10 ml_.
• the solution does not include dextrose.
• the vial comprises, consists essentially of, or consists of glass.
• the vial comprises, consists essentially of, or consists of polypropylene.
• the solution is stable when stored at about 20°C. for at least 12 months.
• the solution comprises ephedrine sulfate at a concentration of about 4 mg/ml_ to about 6 mg/mL. In some embodiments, after storage at about 20°C. for at least 12 months, the solution comprises at least 4 mg/mL of ephedrine sulfate. In some embodiments, after storage at about 20°C. for at least 12 months, the solution comprises at least 4.5 mg/mL ephedrine sulfate. In some embodiments, the ephedrine sulfate is (-)-ephedrine sulfate.
• the present disclosure provides methods of using ready-to-use compositions comprising ephedrine or an ephedrine salt. Generally, the methods disclosed herein do not require a clinician to dilute the ready-to-use composition before administering the ready-to-use
• the risk of microbial contamination to the subject is lower, such as substantially lower, when administered ready-to-use ephedrine compositions consistent with the present disclosure compared to the risk of microbial contamination to subjects (e.g., similarly situated subjects) who are administered ephedrine compositions that require dilution of a concentrated packaged ephedrine pharmaceutical composition.
• the present disclosure provides a method of reducing a risk of microbial infection associated with administration of ephedrine or an ephedrine salt (e.g., ephedrine sulfate) to a subject in need thereof.
• ephedrine or an ephedrine salt e.g., ephedrine sulfate
• a risk of microbial contamination to a subject administered a ready-to- use composition comprising ephedrine or an ephedrine salt (e.g., ephedrine sulfate) consistent with the present disclosure is lower, or substantially lower, than a risk of microbial contamination to a second subject administered ephedrine sulfate diluted (e.g., diluted by a clinician) to a concentration of 5 mg/ml_.
• the second subject receives ephedrine sulfate prepared by mixing (e.g., diluting) a concentrated ephedrine sulfate composition from a sterilized packaged pharmaceutical product comprising 50 mg/ml_ ephedrine sulfate with a diluent, such as saline, to form the diluted ephedrine sulfate composition.
• a concentrated ephedrine sulfate composition from a sterilized packaged pharmaceutical product comprising 50 mg/ml_ ephedrine sulfate with a diluent, such as saline, to form the diluted ephedrine sulfate composition.
• the present disclosure provides a method of administering ephedrine sulfate to a subject in need thereof, the method comprising drawing a composition comprising ephedrine sulfate from a sterile premixed pharmaceutical product into a syringe; and injecting the composition into the subject using the syringe, wherein the ephedrine sulfate is present in the composition in an amount of about 5 mg/ml_.
• the composition further comprises sodium chloride in an amount of about 9 mg/ml_.
• the composition further comprises water.
• the composition does not include dextrose.
• the method does not include diluting the sterile premixed pharmaceutical product before the step of injecting the composition into the subject using the syringe.
• the composition housed within the vial of the sterile premixed pharmaceutical product is stable when stored at about 20°C. for at least 12 months.
• the composition comprises ephedrine sulfate in an amount of about 4 mg/mL to about 6 mg/mL
• the ephedrine sulfate is (-)-ephedrine sulfate.
• the present disclosure provides a method of treating hypotension in a subject in need thereof, the method comprising drawing an effective amount of a packaged composition comprising ephedrine or an ephedrine salt into a syringe; and injecting the effective amount of the packaged composition into the subject in need thereof.
• the packaged composition comprises ephedrine or an ephedrine salt in an amount equivalent to about 3.8 mg/mL ephedrine.
• the packaged composition further comprises sodium chloride in an amount of about 9 mg/mL.
• the packaged composition further comprises water.
• the packaged composition does not include dextrose.
• the method does not include diluting the packaged composition before the step of injecting the effective amount of the packaged composition into the subject in need thereof.
• the packaged composition is stable when stored at about 20°C. for at least 12 months.
• the packaged composition comprises ephedrine sulfate in an amount of about 4 mg/mL to about 6 mg/mL.
• the ephedrine or ephedrine salt is (-)-ephedrine sulfate.
• the method further comprises determining a low blood pressure reading in the subject before the step of drawing the effective amount of the packaged composition comprising ephedrine or an ephedrine salt into the syringe.
• the hypotension is clinically important hypotension.
• the clinically important hypotension is clinically important hypotension in the setting of anesthesia.
• the method further comprises detecting a hypotensive state (e.g., a clinically important hypotensive state) associated with the subject before injecting the effective amount of the packaged composition into the subject.
• the present disclosure provides a method of increasing a blood pressure in a subject in need thereof, the method comprising determining a low blood pressure reading associated with a subject; drawing about 1 mL to about 10 mL of a packaged composition comprising about 5.0 mg/mL ephedrine sulfate into a syringe; injecting about 1 mL to about 10 mL of the packaged composition into the subject in need thereof, wherein the blood pressure reading associated with the subject increases after the step of injecting the packaged
• the packaged composition further comprises sodium chloride in an amount of about 9 mg/mL
• the packaged composition further comprises water.
• the packaged composition does not include dextrose.
• the method further comprises determining a second blood pressure reading associated with the subject after the step of injecting the packaged
• the method further comprises injecting about 1 ml. to about 10 mL of the packaged composition into the subject after the step of determining the second hypotensive blood pressure reading associated with the subject.
• the packaged composition is stable when stored at about 20°C. for at least 12 months.
• the packaged composition comprises ephedrine sulfate in an amount of at least about 4 mg/mL.
• the packaged composition comprises ephedrine sulfate in an amount of at least about 4.5 mg/mL.
• the ephedrine sulfate is (-)- ephedrine sulfate.
• the present disclosure further provides methods of making ready-to-use compositions comprising ephedrine or an ephedrine salt.
• ephedrine or an ephedrine salt e.g., ephedrine sulfate
• sodium chloride or dextrose e.g., ephedrine sulfate
• the pH of the solution is adjusted to 4.5 to 7.0 using an acid (e.g., glacial acetic acid) or a base (e.g., sodium hydroxide).
• the final concentration of ephedrine or the ephedrine salt in the optionally pH-adjusted solution is equivalent to about 3.8 mg/mL of ephedrine free base. Accordingly, in embodiments wherein the ephedrine or the ephedrine salt is ephedrine sulfate, the final concentration of ephedrine sulfate in the optionally pH-adjusted solution is about 5.0 mg/mL.
• the final concentration of ephedrine hydrochloride in the optionally pH- adjusted solution is about 4.6 mg/mL.
• the concentration of sodium chloride or dextrose in the optionally pH-adjusted solution should be isotonic to human serum (e.g., about 9 mg/mL sodium chloride or about 5% dextrose).
• the ephedrine or ephedrine salt solution must be sterilized before use by a clinician.
• the ephedrine or ephedrine salt solution is placed in vials (e.g., glass or plastic single-use vials) and then sterilized by any suitable method known in the art.
• the present disclosure provides a method of making a ready-to-use pharmaceutical composition comprising ephedrine or an ephedrine salt, the method comprising combining ephedrine or an ephedrine salt, sodium chloride and water to provide a solution comprising about 3.8 mg/ml_ ephedrine or an equimolar amount of an ephedrine salt, and about 9 mg/ml_ sodium chloride; and thereafter sterilizing the solution to provide a ready-to-use pharmaceutical composition comprising ephedrine or an ephedrine salt.
• the method further comprises placing the solution in one or more vials before the step of sterilizing.
• the solution does not include dextrose.
• the pharmaceutical composition is stable when stored at about 20°C. for at least 12 months. In some embodiments, after storage at about 20°C. for at least 12 months, the pharmaceutical composition comprises an amount of the ephedrine or the ephedrine salt that is at least 80% of the about 3.8 mg/ml_ ephedrine or the equimolar amount of the ephedrine salt.
• the ephedrine or the ephedrine salt is ephedrine sulfate. In some embodiments, the ephedrine salt is (-)-ephedrine sulfate. In some embodiments, the equimolar amount of the ephedrine salt is about 5 mg/ml_ of the ephedrine sulfate. In some embodiments, the ephedrine or the ephedrine salt is ephedrine hydrochloride. In some embodiments, the ephedrine hydrochloride is (-)-ephedrine hydrochloride. In some embodiments, the equimolar amount of the ephedrine salt is about 4.6 mg/ml_ of the ephedrine hydrochloride.
• a ready-to-use injectable composition of ephedrine sulfate was prepared at 50 L scale by combining ephedrine sulfate USP/EP powder (Lot #18130597, Siegfried PharmaChemikalien, Minden Germany), sodium chloride USP/EP (Lot #18804697, Merck & Co., Kenilworth, NJ), and water for injection in the amounts shown in Table 1 , below, in a 200 L stainless steel vessel. Table 1.
• the pH level of the solution in the vials ranged from 5.6-6.2, well within the acceptable range of 4.5-7.0.
• Ephedrine sulfate was present in the solution in the vials in amounts ranging from 100.8% to 102.5% of the desired 50 mg/mL concentration. Bioburden testing of the solution in the vials revealed 0 CFU/mL.
• the capped vials were crimped and sterilized by the overkill approach at 122.1 °C. for 15 minutes in steel cassettes in an A601 A autoclave.
• the vials were stored at 25 +/- 2°C and 60 +/- 5% relative humidity (RH) for 24 months in a controlled access, secure cabinet or security chamber and only withdrawn for testing. Some vials were stored upright, while others were stored inverted (e.g., liquid in contact with the vial closures). Samples were identified and records were kept in a stability study log.
• RH relative humidity
• the vials were stored at 40 +/- 2°C and 75 +/- 5% relative humidity (RH) for 6 months in a controlled access, secure stability chamber and only withdrawn for testing. Some vials were stored upright, while others were stored inverted (e.g., liquid in contact with the vial closures). Samples were identified and records were kept in a stability study log.
• RH relative humidity
• Quantitative analyses were plotted as mean values as a function of time, while qualitative analyses were recorded and summarized so that profile changes can be reviewed and conclusions drawn.
• Ephedrine Sulfate in 0.9% Sodium Chloride Injection 50 mg/ 10 ml_, (5 mg/ml_) was packaged in a 10 cc Type I glass vial with a Flurotec coated Chlorobutyl rubber stopper (20 mm 41 10/40, Grey, B2-40 from West).
• This Extractable and Leachable (E&L) study was designed based on the guidelines provided in USP ⁇ 1663>, ⁇ 1664>.
• the extracts from the extractable study performed on stoppers were analyzed by GC-MS for volatile and semi-volatile compounds and by LC-MS for non-volatile compounds.
• the control samples were also prepared and analyzed along with all exposed extractable samples and the drug product stability samples.
• the MS study was performed by an independent laboratory using LC-MS and GC-MS to identify and relatively quantify the extractables and leachables in the extracts or in the ready-to-use ephedrine sulfate compositions. Subsequently, a leachable study was also performed by a High-Pressure Liquid Chromatography (HPLC) based validated method (EPH-006).
• HPLC High-Pressure Liquid Chromatography
• Extractables included siloxane oligomers, non-ionic surfactants (Laureth-9 and related), sulfur compounds, Butylated hydroxytoluene (BHT) and fatty acids (mineral fillers) commonly used in the production of elastomeric components.
• Another extractable found in the LC-MS analysis was Triethylene glycol which is a common plasticizer used in the production of vinyl polymers.
• DCBA detected both by the MS study and the HPLC analysis was also detected previously during the leachable analysis of the 18- month samples of the ready-to-use ephedrine sulfate compositions.
• DCBA found was -1.4 ppm (-0.02% with respect to Ephedrine Sulfate) in one sample of ready-to-use ephedrine sulfate composition stored in the inverted position for 24 months.
• the identification threshold for any impurities that may be present in Ephedrine Sulfate is 0.2% and the qualification threshold is 0.5%.
• the amount of DCBA found in this inverted stored sample was below the limit of quantitation (LOQ) i.e. ⁇ 0.1 ppm.
• Stoppers were extracted using three extraction solvents mentioned below a) Water adjusted to pH 3.4 using 1 N HCI b) Water adjusted to pH 9.4 using 1 N NaOH c) IPA/Water 50%/50% (v/v) Three sets of 10 stoppers (weight ⁇ 16.8 g each) were transferred into three separate 250 all ⁇ round bottom flasks. 100 ml. each of pH 3.4 aqueous solution, pH 9.4 aqueous solution and IPA/Water (50:50 v/v) mixture were transferred into the three separate above-mentioned round bottom flasks. Each solvent containing 10 stoppers was refluxed to boiling overnight (minimum 12 hours). Reflux was performed for 12 hours each for the IPA/water mixture and the pH 3.4 solution and 20 hours for the pH 9.4 solution. Resulting solution from each reflux solvent was analyzed for extractables using QTOF LC-MS and GC-MS.
• the extractable study intended to extract metals was performed on rubber stoppers and glass vials. 10 stoppers were weighed (weight ⁇ 17 g) and transferred into a 1 L plastic container. Approximately 200 ml. (appropriate volume to immerse the stoppers) of 2% HN0 3 solution was transferred into the container having the stoppers and placed in an oven maintained at 60°C for ⁇ 24h. Similarly, 5 vials (weight ⁇ 20g each) were transferred into a 1 L plastic container.
• Extracts from each reflux solvent were analyzed for extractables using QTOF LC-MS and GC- MS. Extractables included siloxane oligomers, non-ionic surfactants (Laureth-9 and related), sulfur compounds, Butylated hydroxytoluene (BHT) and fatty acids (mineral fillers) commonly used in the production of elastomeric components.
• Another extractable found in the LC-MS analysis was Triethylene glycol which is a common plasticizer used in vinyl polymers. Extractable compounds detected in the extracts along with relative quantitation are provided in Tables 29-32. According to the manufacturer, Bisphenol A (BPA), Melamine, 2- Mercaptobenzothiazole, Nitrosamines, Phthalates and Polyvinylchlorides (PVC) are not intentionally added to the stoppers.
• This compound is considered as a drug related compound, which is unique in the pH 3.4 extract compared to the pH 3.4 Control.
• the 2% nitric acid stopper extracts and the pH 3.4 reflux extract were screened according to USP ⁇ 233> based ICP-MS analysis and results are compared against established PDEs of the respective elements. Ten elements (Class 1 , 2A and 3) were selected. Results obtained from the ICPMS analysis of the extracting solutions indicates that the Class 1 , 2A and 3 elements were found to be below the respective established PDEs. ICP-MS results from the extractable study are summarized in Table 33.
• PDE value in ppb Parental PDE value (pg/day) ⁇ maximum daily volume (mL/day), i.e., 10 mL/day * 1000.
• a control sample was also prepared in a volumetric flask by dissolving 5 g of Ephedrine Sulfate API and 9 g of NaCI in 1 L purified water. The pH of the resulting solution was ⁇ 5.6.
• EPH-006 was previously validated in terms of accuracy, precision, linearity and LOQ using Dichlorobenzoic Acid, Diethyl Phthalate (same functional class as Bis(2-ethylhexyl) Isophthalate), BPA and an Irganox related leachable.
• Dichlorobenzoic acid was also detected during the HPLC analysis using test method EPH-006 and the results are summarized in Table 35.
• the LOQ of the method was determined to be 0.1 ppm which is lower than the AET i.e., 0.15 ppm.
• the only compound detected above the LOQ level in the drug product samples was 2,4- Dichlorobenzoic acid or its possible isomer which is consistent with the LC-MS data. It is to be noted that dichlorobenzoic acid detected both by the MS study and the HPLC analysis was also detected previously during the leachable analysis of the 18M samples. Formation of DCBA may be attributed to possible interaction of benzoic acid with the chloride ions in the drug product formulation.
• PDE value in ppb Parental PDE value (pg/day) ⁇ maximum daily volume (mL/day), i.e., 10 mL/day * 1000.
• Extractables and leachables were identified using a combination of QTOF-GCMS and QTOF- LCMS-UV-CAD. Most of the identified extractables seem to be originating from the elastomeric components or additives.
• the same test methods were employed for extractables and leachables identification and relative-quantitation with an instrumental analytical evaluation threshold (AET) set at 0.1 pg/mL for LC-MS analysis and at 0.2 pg/mL for GC-MS analysis.
• AET instrumental analytical evaluation threshold
• a compound consistent with bis(2-ethylhexyl) isophthalate was detected in Ephedrine Sulfate Injection samples at a concentration of 0.15 pg/mL or lower by QTOF-GCMS.
• Example 1 A composition comprising ephedrine sulfate in water, wherein the ephedrine sulfate is present at a concentration of about 1 mg/mL to about 10 mg/mL. Further Example 2. The composition of Further Example 1 , wherein the ephedrine sulfate is present at a concentration of about 2 mg/ml_ to about 8 mg/mL.
• Example 3 The composition of Further Example 1 , wherein the ephedrine sulfate is present at a concentration of about 3 mg/mL to about 7 mg/mL.
• Example 4 The composition of Further Example 1 , wherein the ephedrine sulfate is present at a concentration of about 4 mg/mL to about 6 mg/mL.
• Example 5 The composition of Further Example 1 , wherein the ephedrine sulfate is present at a concentration of about 5 mg/mL.
• composition of any preceding Further Example further comprising sodium chloride.
• Further Example 7 The composition of Further Example 6, wherein the sodium chloride is present in an amount of about 9 mg/mL.
• composition of any preceding Further Example, wherein the composition does not include dextrose does not include dextrose.
• composition of any preceding Further Example, wherein the composition does not include benzyl alcohol does not include benzyl alcohol.
• Example 1 1 .
• Example 13 The composition of any preceding Further Example, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• a sterile prediluted medicament comprising:
• Example 16 The sterile prediluted medicament of Further Example 14 or Further Example 15, wherein the medicament does not include benzyl alcohol.
• Example 17 The sterile prediluted medicament of any one of Further Examples 14 to 16, wherein a total volume of the medicament is about 10 ml_.
• Example 18 The sterile prediluted medicament of any one of Further Examples 14 to 17, wherein the medicament is housed in a vial.
• Example 19 The sterile prediluted medicament of any one of Further Examples 14 to 18, wherein after storage at about 20°C. under light the medicament comprises at least 3 mg/ml_ of the ephedrine or an molar equivalent of the ephedrine salt.
• Example 20 The sterile prediluted medicament of any one of Further Examples 14 to 19, wherein the ephedrine or ephedrine salt is ephedrine sulfate.
• Example 21 The sterile prediluted medicament of Further Example 20, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• a ready-to-use unit dose form comprising:
• a packaged pharmaceutical product comprising:
• Example 29 The packaged pharmaceutical product of Further Example 28, wherein the solution has a total volume of about 10 ml_.
• Example 30 The packaged pharmaceutical product of Further Example 28 or Further Example 29, wherein the solution does not include dextrose.
• Example 31 The packaged pharmaceutical product of any one of Further Examples 28 to 30, wherein the vial comprises, consists essentially of, or consists of glass.
• Example 32 The packaged pharmaceutical product of any one of Further Examples 28 to 31 , wherein the vial comprises, consists essentially of, or consists of polypropylene.
• Example 33 The packaged pharmaceutical product of any one of Further Examples 28 to 32, wherein the solution is stable when stored at about 20°C. under light for at least 12 months.
• Example 34 The packaged pharmaceutical product of Further Example 33, wherein after storage at about 20°C. under light for at least 12 months, the solution comprises ephedrine sulfate at a concentration of about 4 mg/ml_ to about 6 mg/mL.
• Example 35 The packaged pharmaceutical product of Further Example 33, wherein after storage at about 20°C. under light for at least 12 months, the solution comprises at least 4 mg/mL of ephedrine sulfate.
• Further Example 36 The packaged pharmaceutical product of Further Example 33, wherein after storage at about 20°C. under light for at least 12 months, the solution comprises at least 4.5 mg/ml_ ephedrine sulfate.
• Example 37 The packaged pharmaceutical product of any one of Further Examples 28 to 36, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• Example 38 A method of administering ephedrine sulfate to a subject in need thereof, the method comprising:
• composition comprising ephedrine sulfate from a sterile premixed
• ephedrine sulfate is present in the composition in an amount of about 5 mg/ml_.
• composition further comprises sodium chloride in an amount of about 9 mg/ml_.
• composition further comprises water.
• Example 41 The method of any one of Further Examples 38 to 40, wherein the composition does not include dextrose.
• Example 42 The method of any one of Further Examples 38 to 41 , wherein the method does not include diluting the sterile premixed pharmaceutical product before the step of injecting the composition into the subject using the syringe.
• Example 43 The method of any one of Further Examples 38 to 42, wherein the composition housed within the vial of the sterile premixed pharmaceutical product is stable when stored at about 20°C. under light for at least 12 months.
• composition comprises ephedrine sulfate in an amount of about 4 mg/ml_ to about 6 mg/mL.
• Example 45 The method of any one of Further Examples 38 to 44, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• Example 46 A method of making a ready-to-use pharmaceutical composition comprising ephedrine or an ephedrine salt, the method comprising:
• Further Example 47 The method of Further Example 46 further comprising placing the solution in one or more vials before the step of sterilizing.
• Example 49 The method of any one of Further Examples 46 to 48, wherein the pharmaceutical composition is stable when stored at about 20°C. under light for at least 12 months.
• Example 50 The method of Further Example 49, wherein after storage at about 20°C. under light for at least 12 months, the pharmaceutical composition comprises an amount of the ephedrine or the ephedrine salt that is at least 80% of the about 3.8 mg/ml_ ephedrine or the equimolar amount of the ephedrine salt.
• Example 51 The method of any one of Further Examples 46 to 50, wherein the ephedrine or the ephedrine salt is ephedrine sulfate.
• Example 52 The method of Further Example 51 , wherein the ephedrine salt is (-)- ephedrine sulfate.
• Example 53 The method of Further Example 51 or Further Example 52, wherein the equimolar amount of the ephedrine salt is about 5 mg/ml_ of the ephedrine sulfate.
• Example 54 The method of any one of Further Examples 46 to 50, wherein the ephedrine or the ephedrine salt is ephedrine hydrochloride.
• hydrochloride is (-)-ephedrine hydrochloride.
• Further Example 56 The method of Further Example 54 or Further Example 55, wherein the equimolar amount of the ephedrine salt is about 4.6 mg/ml_ of the ephedrine hydrochloride.
• Example 57 A method of treating hypotension in a subject in need thereof, the method comprising:
• Example 58 The method of Further Example 57, wherein the packaged composition comprises ephedrine or an ephedrine salt in an amount equivalent to about 3.8 mg/mL ephedrine.
• Example 59 The method of Further Example 57 or Further Example 58, wherein the packaged composition further comprises sodium chloride in an amount of about 9 mg/mL.
• Example 60 The method of any one of Further Examples 57 to 59, wherein the packaged composition further comprises water.
• Example 61 The method of any one of Further Examples 57 to 60, wherein the packaged composition does not include dextrose.
• Example 62 The method of any one of Further Examples 57 to 61 , wherein the method does not include diluting the packaged composition before the step of injecting the effective amount of the packaged composition into the subject in need thereof.
• Example 63 The method of any one of Further Examples 57 to 62, wherein the packaged composition is stable when stored at about 20°C. under light for at least 12 months.
• Example 64 The method of Further Example 63, wherein after storage at about 20°C. under light for at least 12 months, the packaged composition comprises ephedrine sulfate in an amount of about 4 mg/mL to about 6 mg/mL.
• Example 65 The method of any one of Further Examples 57 to 64, wherein the ephedrine or ephedrine salt is (-)-ephedrine sulfate.
• Example 66 The method of any one of Further Examples 57 to 65 further comprising determining a low blood pressure reading in the subject before the step of drawing the effective amount of the packaged composition comprising ephedrine or an ephedrine salt into the syringe.
• Example 67 A method of increasing a blood pressure in a subject in need thereof, the method comprising:
• the method does not include diluting the packaged composition before the step of injecting the packaged composition into the subject in need thereof.
• Example 68 The method of Further Example 67, wherein the packaged composition further comprises sodium chloride in an amount of about 9 mg/mL.
• Example 69 The method of Further Example 67 or Further Example 68, wherein the packaged composition further comprises water.
• Example 70 The method of any one of Further Examples 67 to 69, wherein the packaged composition does not include dextrose.
• Example 71 The method of any one of Further Examples 67 to 70, wherein the method further comprises determining a second blood pressure reading associated with the subject after the step of injecting the packaged composition into the subject, wherein the second blood pressure reading is hypotensive.
• Further Example 72 The method of Further Example 71 further comprising injecting about 1 mL to about 10 mL of the packaged composition into the subject after the step of determining the second hypotensive blood pressure reading associated with the subject.
• Example 73 The method of any one of Further Examples 67 to 72, wherein the packaged composition is stable when stored at about 20°C. under light for at least 12 months.
• Further Example 74 The method of Further Example 73, wherein after storage at about 20°C. under light for at least 12 months, the packaged composition comprises ephedrine sulfate in an amount of at least about 4 mg/mL.
• Example 75 The method of Further Example 73, wherein after storage at about 20°C. under light for at least 12 months, the packaged composition comprises ephedrine sulfate in an amount of at least about 4.5 mg/mL.
• Example 76 The method of any one of Further Examples 67 to 75, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• Example 77 A ready-to-use packaged pharmaceutical composition comprising ephedrine or a pharmaceutically acceptable salt thereof, wherein the pharmaceutical composition exhibits no more than about 5% decrease in a concentration of the ephedrine or pharmaceutically acceptable salt thereof upon storage for at least 24 months.
• Example 78 The ready-to-use packaged pharmaceutical composition of Further Example 77 further comprising sodium chloride.
• Example 79 The ready-to-use packaged pharmaceutical composition of Further Example 77 or 78, wherein the ready-to-use packaged pharmaceutical composition is stored in a sealed glass container.
• Example 80 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-79, wherein the composition does not include dextrose.
• Example 81 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-80, wherein the composition does not include benzyl alcohol.
• Example 82 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-81 , wherein the composition consists essentially of ephedrine or a pharmaceutically acceptable salt thereof, sodium chloride and water.
• Example 83 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-82 comprising about 5 mg/mL ephedrine sulfate.
• Example 84 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-82 comprising about 3.8 mg/mL ephedrine base.
• Example 85 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-84, wherein the ephedrine sulfate is (-)-ephedrine sulfate.
• Example 86 The ready-to-use packaged pharmaceutical composition of any one of Further Examples 77-85, wherein the composition is formulated as a total volume of about 10 mL.
• ephedrine refers to (-)-ephedrine (i.e., (1 ?,2S)-2-methylamino-1 -phenylpropan-1 -ol sulfate).

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