Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
• • 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
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2013—Organic compounds, e.g. phospholipids, fats
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/2031—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, polyethylene oxide, poloxamers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
  • A61K9/2806—Coating materials
  • A61K9/2813—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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
  • A61K9/2806—Coating materials
  • A61K9/2833—Organic macromolecular compounds
  • A61K9/2853—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, polyethylene oxide, poloxamers, poly(lactide-co-glycolide)
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
  • A61K9/2806—Coating materials
  • A61K9/2833—Organic macromolecular compounds
  • A61K9/286—Polysaccharides, e.g. gums; Cyclodextrin
  • A61K9/2866—Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose
• • 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
  • A61P25/22—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

Definitions

• the major side effects of injected ketamine include dissociative symptoms that occur mainly in the first hour after dosing, and minor increases in blood pressure and heart rate, which occur in the first 30 minutes An oral ketamine formulation could minimize these side effects, and be less onerous/time consuming to administer than injected ketamine.
• PEG Polyethylene oxide
• Maggi 2002 a number of positive attributes including nontoxicity, high water solubility and swellability (Maggi 2002).
• tablets formulations based on a high concentration of PEG are able to be annealed (heated) to give tablets of very high hardness that are resistant to crushing.
• compositions and methods as disclosed herein have the advantage of releasing the active agent(s) as disclosed herein sufficiently quickly to give a rapid treatment response but avoid or minimize any dissociative side effects in a patient.
• pharmaceutical compositions and methods as disclosed herein have the advantage of releasing the active agent(s) as disclosed herein sufficiently quickly to give a rapid treatment response but release the active agent(s) slowly enough to minimize or avoid dissociative side effects in a patient.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and provides a mean tmax of said active agent at least about 4 hours after administration of a single tablet to a patient.
• a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one
• the disclosure provides a tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a tablet wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a tablet wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the disclosure provides a tablet wherein the dosage amount of active agent is selected from the group consisting of about 30 mg, about 60mg, about 120 mg, and about 240 mg.
• the disclosure provides a tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a tablet wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a tablet wherein said tablet provides a ketamine Cmax between about 12 and about 42 ng/mL.
• the disclosure provides a tablet wherein said tablet provides a ketamine AUC 0-inf between about 79 and about 385 ng h/mL.
• the disclosure provides a tablet wherein said tablet provides a norketamine Cmax between about 74 and about 315 ng/mL.
• the disclosure provides a tablet wherein said tablet provides a norketamine AUC 0-inf between about 872 and about 4087ng h/mL.
• the disclosure provides a tablet wherein the mean Tmax of said active agent is selected from the group consisting of: a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 60 mg or 120 mg or 240 mg; a mean tmax of said active agent between about 1 .5 and about 3.5 hours after administration of 5 doses of 60 mg administered every 12 hours; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 120 mg administered every 12 hours; and a mean tmax of said active agent between about 1 5 and about 3.5 hours after administration of 5 doses of 240 mg administered every 12 hours.
• the disclosure provides a tablet wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a tablet wherein the tablet has no or minimal dissociative side effects upon administration to a patient or clinically significantly reduced side effects relative to prior means of administration.
• the disclosure provides a method of treating a patient for treatment-resistant depression, comprising: selecting a patient in need of such treatment; and orally administering to the patient a tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and provides a mean tmax of said active agent less than about 4 hours after administration of a single tablet to a patient, wherein the tablet treats the symptoms of said treatment-resistant depression.
• a core comprising: i)
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 2,000,000, at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a method wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the dosage amount of active agent is selected from the group consisting of about 1 mg, about 2 mg, about 5 mg, about 10 mg, about 30mg, about 60mg, about 120 mg, and about 240 mg. 20.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a method wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein said tablet provides a ketamine Cmax between about 12 and about 42 ng/mL.
• the disclosure provides a method wherein said tablet provides a ketamine AUC 0-inf between about 79 and about 385 ng h/mL.
• the disclosure provides a method wherein said tablet provides a norketamine Cmax between about 74 and about 315 ng/mL.
• the disclosure provides a method wherein said tablet provides a norketamine AUCo- inf between about 872 and about 4087 ng h/mL.
• the disclosure provides a method wherein the mean t max of said active agent is selected from the group consisting of a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 60 mg or 120 mg or 240 mg; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 60 mg administered every 12 hours; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 120 mg administered every 12 hours; and a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 240 mg administered every 12 hours.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression are alleviated within 2 hours of oral administration of said ketamine.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said ketamine.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said ketamine.
• the disclosure provides a method wherein a single oral administration of said ketamine in doses between 30-180 mg is sufficient to alleviate the effects of said depression for 3-7 days.
• the disclosure provides a method wherein tablet has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein maximal mean improvements in ratings of depressed mood were noted after approximately 6 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional agent, wherein said second or additional agent has antidepressant properties.
• the disclosure provides a method wherein said method further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, n
• the disclosure provides a method of treating a patient for treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder , comprising: selecting a patient in need of such treatment; and orally administering to the patient a tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and provides a mean t
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 2,000,000, at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a method wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the dosage amount of active agent is selected from the group consisting of about 1 mg, about 2 mg, about 5 mg, about 10mg , about 30mg, about 60mg, about 120 mg, and about 240 mg.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a method wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein said tablet provides a ketamine Cmax between about 12 and about 42 ng/mL.
• the disclosure provides a method wherein said tablet provides a ketamine AUC 0-inf between about 79 and about 385 ng h/mL.
• the disclosure provides a method wherein said tablet provides a norketamine Cmax between about 74 and about 315 ng/mL.
• the disclosure provides a method wherein said tablet provides a norketamine AUC 0-inf between about 872 and about 4087 ng h/mL.
• the disclosure provides a method wherein the mean tmax of said active agent is selected from the group consisting of at least about 4 hours, at least about 6 hours, at least about 8 hours, at least about 10 hours, at least about 11 hours, and at least about 12 hours.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the tablet has no or minimal dissociative side effects upon administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant anxiety are alleviated within 2 hours of oral administration of said ketamine.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said ketamine.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said ketamine.
• the disclosure provides a method wherein a single oral administration of said ketamine in doses between 30-180mg is sufficient to alleviate the effects of said anxiety for 3-7 days.
• the disclosure provides a method wherein maximal mean improvements in ratings of anxious mood were noted after approximately 2 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional agent, wherein said second or additional agent has antianxiety properties.
• the disclosure provides a method which further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, nefazo
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of: after administration of a single dose of 60 mg ketamine a mean ketamine Cmax of about 10 ng/mL or a ketamine Cmax between about 5 and about 15 ng/mL; after administration of
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein said high molecular weight PEO comprises at least about 50% (by weight) of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the dosage amount of active agent is selected from the group consisting of about 30 mg, about 60 mg, about 120 mg, and about 240 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is suitable for once daily administration or twice- daily administration to a patient
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet has no or minimal dissociative side effects upon administration to a patient.
• the disclosure provides a method of treating a patient for a condition selected from the group consisting of treatment-resistant depression, and treatment- resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive- Compulsive Disorder, comprising: selecting a patient in need of such treatment; and orally administering to the patient the tablet as disclosed herein, wherein the tablet treats the symptoms of said treatment-resistant depression or treatment-resistant anxiety.
• the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within 2 hours of oral administration of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said tablet.
• the disclosure provides a method wherein a single oral administration of said tablet is sufficient to alleviate the effects of said depression or said treatment-resistant anxiety for 3-7 days.
• the disclosure provides a method wherein tablet has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein maximal mean improvements in ratings of depressed mood or anxious mood were noted after approximately 6 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional therapy, wherein said second or additional therapy has antidepressant properties.
• the disclosure provides a method wherein said method further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, n
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of: after administration of 5 doses of 60 mg ketamine administered every 12 hours a mean ketamine Cmax of about 12 ng/mL or a ketamine Cmax between about 8 and about 23 ng/mL; after
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the dosage amount of active agent is selected from the group consisting of about 30 mg, about 60 mg, about 120 mg, and about 240 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating comprises, for example: i) hydroxypropylmethylcellulose; ii) titanium dioxide, and iii) polyethylene glycol.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet has no or minimal dissociative side effects upon administration to a patient.
• the disclosure provides a method of treating a patient for a condition selected from the group consisting of treatment- resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, comprising: selecting a patient in need of such treatment; and orally administering to the patient the tablet as disclosed herein, wherein the tablet treats the symptoms of said treatment-resistant depression or said treatment- resistant anxiety.
• the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within 2 hours of oral administration of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said tablet.
• the disclosure provides a method wherein a single oral administration of said tablet is sufficient to alleviate the effects of said depression or said treatment-resistant anxiety for about 3-7 days.
• the disclosure provides a method wherein tablet has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein maximal mean improvements in ratings of depressed mood or anxious mood were noted after approximately 6 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional therapy, wherein said second or additional therapy has antidepressant properties.
• the disclosure provides a method wherein said method further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, n
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of: a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 60 mg or 120 mg or 240 mg; a mean tmax of said active agent between about 1.5 and about 3.5
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the dosage amount of active agent is selected from the group consisting of about 30 mg, about 60 mg, about 120 mg, and about 240 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet has no or minimal dissociative side effects upon administration to a patient.
• the disclosure provides a method of treating a patient for a condition selected from the group consisting of treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post- Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, comprising: selecting a patient in need of such treatment; and orally administering to the patient the tablet as disclosed herein, wherein the tablet treats the symptoms of said treatment-resistant depression or said treatment-resistant anxiety.
• the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within 2 hours of oral administration of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said tablet.
• the disclosure provides a method wherein a single oral administration of said tablet is sufficient to alleviate the effects of said depression or said treatment-resistant anxiety for about 3-7 days
• the disclosure provides a method wherein tablet has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein maximal mean improvements in ratings of depressed mood or anxious mood were noted after approximately 6 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional therapy, wherein said second or additional therapy has antidepressant properties.
• the disclosure provides a method wherein said method further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, n
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from 2 million to 7 million, based upon rheological measurements, and is present in an amount of at least about 30% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered at a single dose of about 60 mg to a patient provides a pharmacokinetic parameter selected from the group consisting of a ratio of norketamine Cmax: ketamine Cmax of between about 4 to about 15; and a ratio of norketamine AUC:ketamine AUC of between about 7 to about 15.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein said high molecular weight PEO comprises at least about 50% (by weight) of said core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the dosage amount of active agent is selected from the group consisting of about 30 mg, about 60 mg, about 120 mg, and about 240 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is suitable for once daily administration or twice- daily administration to a patient.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet has no or minimal dissociative side effects upon administration to a patient.
• the disclosure provides a method of treating a patient for a condition selected from the group consisting of treatment-resistant depression; and treatment- resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive- Compulsive Disorder, comprising: selecting a patient in need of such treatment; and orally administering to the patient the tablet as disclosed herein, wherein the tablet treats the symptoms of said treatment-resistant depression or said treatment-resistant anxiety.
• the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the tablet is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within 2 hours of oral administration of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of a single dose of said tablet.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said tablet.
• the disclosure provides a method wherein a single oral administration of said tablet is sufficient to alleviate the effects of said depression or said treatment-resistant anxiety for about 3-7 days
• the disclosure provides a method wherein tablet has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein maximal mean improvements in ratings of depressed mood or anxious mood were noted after approximately 6 weeks of maintenance treatment.
• the disclosure provides a method further comprising administering a pharmaceutically effective dose of a second or additional therapy, wherein said second or additional therapy has antidepressant properties.
• the disclosure provides a method wherein said method further comprises an additional therapy selected from: at least one antidepressant selected from the group consisting of citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, n
• the disclosure provides a method for the prevention, treatment, and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, comprising: selecting a patient in need of the prevention, treatment, and/or management of said condition; and administering to the patient a first dosage course comprising a dosage of about 60mg, about 120mg or about 180mg of an active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, administered as an oral dosage form daily for 4 - 7 days, further wherein the dosage course prevents, treats, and/or manages said condition in said patient.
• a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder
• the disclosure provides a method wherein the dosage course comprises about 120mg of said active agent administered as an oral dosage form daily for 4-7 days.
• the disclosure provides a method wherein the dosage is administered for 5 days.
• the disclosure provides a method wherein the dosage is administered for 7 days.
• the disclosure provides a method where the dosage comprises one about 120 mg oral dosage form.
• the disclosure provides a method where the dosage comprises two or more oral dosage forms totalling about 120 mg daily.
• the disclosure provides a method wherein the oral dosage form is a tablet.
• the disclosure provides a method further comprising a second maintenance dosing phase comprising: administering to the patient a dosage comprising about 30, about 60, about 120 or about 180 mg of an active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, wherein said dosage is administered as an oral dosage form twice weekly for at least about 4 weeks following completion of said first dosage course, further wherein the said second maintenance dosing phase prevents, treats, and/or manages said condition in said patient
• the disclosure provides a method wherein the dosage is suitable for once daily administration or twice-daily administration to a patient.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within 48 hours of oral administration of said dosage.
• the disclosure provides a method wherein said method comprises oral administration of multiple doses of said dosage.
• the disclosure provides a method wherein a single said course is sufficient to alleviate the effects of said depression or said anxiety for at least 2 days, or at least 3 days, after completion of said course.
• the disclosure provides a method wherein the dosage has no or minimal dissociative side effects in the patient.
• the disclosure provides a method wherein the dosage is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, and is present in an amount of at least about 75% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of after administration of a single dose of 120 mg ketamine a mean ketamine Cmax of about 16 ng/mL or a ketamine Cmax between about 7 and about 32
• the disclosure provides a method wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a method wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the dosage is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, and is present in an amount of at least about 75% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of after administration of 5 doses of 120 mg ketamine administered every 12 hours a mean ketamine Cmax of about 21 ng/mL or a ketamine Cmax between about 7
• the disclosure provides a method wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a method wherein the coating comprises: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the dosage is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, and is present in an amount of at least about 75% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered to a patient said tablet provides a pharmacokinetic parameter selected from the group consisting of: a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 120 mg; a mean tmax of said active agent between about 1.5
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method 24.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the coating comprises: i) hydroxypropylmethylcellulose, ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method wherein the dosage is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, and is present in an amount of at least about 75% (by weight) of the core; (B) a coating on said core, wherein said tablet is crush resistant and has a breaking strength of at least about 200 N; and wherein when said tablet is administered at a single dose of about 120 mg to a patient provides a pharmacokinetic parameter selected from the group consisting of a ratio of norketamine Cmax: ketamine Cmax of between about 4 to about 15; and a ratio of norketamine AUC:ketamine
• the disclosure provides a method wherein the active agent comprises at least about 1% (by weight) of the core.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a method wherein the coating comprises for example: i) hydroxypropylmethylcellulose; ii) titanium dioxide; and iii) polyethylene glycol.
• the disclosure provides a method for the prevention, treatment, and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, comprising: selecting a patient in need of the prevention, treatment, alleviation and/or management of said condition; administering to said patient a treatment regimen comprising: a first dosage course of about 60 mg daily, about 120 mg daily, or about 180 mg daily, of an active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, administered as an oral dosage form, optionally, after said first dosage course, administering to the patient a maintenance course comprising a second dosage course of active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, administered as an oral dosage form, further wherein the condition is prevented, treated, alleviated and/or managed in said
• the disclosure provides a method wherein said first dosage course comprises about 120 mg daily of said active agent.
• the disclosure provides a method wherein said first dosage course comprises about 120 mg of said active agent administered daily for 4 - 7 days.
• the disclosure provides a method wherein the first dosage course is administered for 5 days.
• the disclosure provides a method wherein the first dosage course is administered for 7 days.
• the disclosure provides a method wherein said first dosage course comprises two or more oral dosage forms totalling about 120 mg of said active agent daily.
• the disclosure provides a method wherein said maintenance course is administered.
• the disclosure provides a method wherein the maintenance course comprises administration of a second dosage of said active agent to a patient once a week, twice a week, three times a week, or four times a week or seven times a week (daily).
• the disclosure provides a method wherein the second dosage course comprises a dosage of about 30 mg of said active agent, about 60 mg of said active agent, about 120 mg of said active agent, or about 180 mg of said active agent.
• said maintenance course comprises administration of a second dosage of said active agent to the patient for at least about 1, at least about 2, at least about 3, at least about 4, at least about 5, at least about 6, at least about 7, at least about 8 months, or at least one year, or more than one year.
• said oral dosage form is suitable for once daily administration or twice-daily administration to a patient.
• said disclosure provides a method wherein said oral dosage form is a tablet.
• the disclosure provides a method wherein the symptoms of said treatment-resistant depression or said treatment-resistant anxiety are alleviated within a time period selected from the group consisting of about 48 hours, about 72 hours, about 96 hours, about 120 hours, about 6 days, about one week, and about two weeks, of said treatment regimen.
• said treatment regimen comprises oral administration of multiple doses of said dosage.
• the disclosure provides a method wherein a single said treatment regimen is sufficient to alleviate the effects of said condition for at least one day, two days, three days, four days, five days, six days, 7 days (a week), 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, two weeks, three weeks, a month, two months, 3 months, 4 months, 5 months, 6 months, 7 months, or 8 months, after completion of said course.
• the disclosure provides a method wherein said treatment regimen has no or minimal dissociative side effects in the patient.
• the dosage form is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20%, or at least about 10%, at least about 12% or at least about 15% by weight; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements; and iii) a lubricant selected from the group consisting of magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl sulfate,
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C
• the dosage form is a solid, oral, extended- release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 % , or at least about 10%, at least about 12% or at least about 15% by weight; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements; and iii) a lubricant selected from the group consisting of magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl s
• an active agent selected from
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the dosage form is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements; and iii) a lubricant selected from the group consisting of magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl sulfate, magnesium lauryl sulfate, and light mineral oil, (B) a core comprising:
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000, at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the dosage form is a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %, or at least about 10%, at least about 12% or at least about 15% by weight; ii) at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEG has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements; and iii) a lubricant selected from the group consisting of magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl sulf
• the disclosure provides a method wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a method wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %, or at least about 10%, at least about 12% or at least about 15% by weight; ii) at least one matrix polymer comprising at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, optionally in combination with at least one additional matrix polymer selected from the group consisting of hydroxypropyl methyl cellulose (HPMC), ethyl cellulose (EC), polyvinyl pyrrolidone, xanthan gum, pullulan, polyvinyl alcohol, polyvinyl acetate, glycerol
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising a core, wherein the core comprises: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %, or at least about 10%, at least about 12% or at least about 15% by weight of the core; and ii) a matrix polymer, wherein the matrix polymer is a high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements.
• an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %, or at least about 10%, at least about 12% or at least about 15% by weight of the core
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the molecular weight of said high molecular weight PEO is selected from the group consisting of at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; and at least about 7,000,000.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the PEO is selected from the group consisting of POLYOX WSR-80, POLYOX WSR N-750, POLYOX WSR-205, POLYOX WSR-1105, POLYOX WSRN-12K, POLYOX WSR N-60K, WSR-301, WSR Coagulant, WSR-303, and combinations thereof.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the matrix polymer is present in an amount of at least about 50%, about 55%, about 60%. about 65%. about 70%. about 75%, or about 80% by weight of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent is present in an amount of about 6% to about 20 % by weight of the core.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent is present in an amount greater than about 20 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the active agent is present in an amount of about 25 mg, about 30 mg, about 60 mg, about 120 mg, about 180 mg, or about 240 mg.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the core further comprises a lubricant, optionally a lubricant selected from the group consisting of magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl sulfate, magnesium lauryl sulfate, and light mineral oil.
• a solid, oral, extended release pharmaceutical tablet wherein the tablet comprises a coating on said core, optionally a sealant coating.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating material comprises a polymer, a plasticizer, or a pigment, or any combination thereof.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating material comprises polyvinvyl alcohol (PVA), cellulose acetate phthalate (CAP), polyvinyl acetate phthalate (PVAP), methacrylic acid copolymers, cellulose acetate trimellitate (CAT), hydroxypropyl methylcellulose phthalate (HPMCP), hydroxypropyl methylcellulose (HPMC), hydroxypropyl methylcellulose acetate succinate, shellac, sodium alginate or zein.
• PVA polyvinvyl alcohol
• CAP cellulose acetate phthalate
• PVAP polyvinyl acetate phthalate
• methacrylic acid copolymers cellulose acetate trimellitate
• CAT hydroxypropyl methylcellulose phthalate
• HPMC hydroxypropyl methylcellulose
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the coating material comprises hydroxypropyl methylcellulose (HPMC).
• HPMC hydroxypropyl methylcellulose
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is cured at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet wherein the tablet is crush resistant and has a breaking strength of at least about 200 N, such as at least about 300N, 350N, 400N, 450N, or at least about 500N.
• the disclosure provides a method for the prevention, treatment, and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder wherein the dosage form is a solid, oral, extended release pharmaceutical tablet according to the disclosure.
• the disclosure provides a process of preparing the solid, oral, extended release pharmaceutical tablet as disclosed herein which comprises the steps of: (i) applying an initial coating to the tablet; (ii) curing the coated tablet; and (iii) optionally applying an additional coating to the tablet.
• the disclosure provides a process of preparing the solid, oral, extended release pharmaceutical tablet as disclosed herein which comprises the steps of: (i) applying an initial coating to the tablet; (ii) curing the coated tablet; and (iii) optionally applying an additional coating to the tablet, wherein the curing is carried out at a temperature of about 70°C to about 75°C.
• the disclosure provides a solid, oral, extended release pharmaceutical tablet comprising: (A) a core comprising: i) a therapeutically effective amount of an active agent selected from the group consisting of ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, wherein the active agent is present at a concentration of about 6% to about 20 %, or at least about 10%, at least about 12% or at least about 15% by weight; ii) at least one matrix polymer comprising at least one high molecular weight polyethylene oxide (PEO) that is cured, wherein said high molecular weight PEO has an approximate molecular weight of from about 2 million to about 7 million, based upon rheological measurements, optionally in combination with at least one additional matrix polymer selected from the group consisting of hydroxypropyl methyl cellulose (HPMC), ethyl cellulose (EC), polyvinyl pyrrolidone, xanthan gum, pullulan, polyvinyl alcohol, polyvinyl acetate, glycerol
• compositions of the disclosure for the production of a medicament for preventing and/or treating the indications and/or for performing the methods as set forth herein.
• the present disclosure provides a use of the pharmaceutical compositions described above, in an amount effective for use in a medicament, and most preferably for use as a medicament for treating a disease or disorder, for example, as set forth in herein, in a subject.
• the present disclosure provides a use of the pharmaceutical compositions described above, and at least one additional therapeutic agent, in an amount effective for use in a medicament, and most preferably for use as a medicament for treating a disease or disorder associated with disease, for example, as set forth herein, in a subj ect.
• the disclosure provides a method for treating and/or preventing a disease or condition as set forth herein in a patient, wherein said method comprises: selecting a patient in need of treating and/or preventing said disease or condition as set forth herein; administering to the patient a composition of the disclosure in a therapeutically effective amount, thereby treating and/or preventing said disease in said patient.
• Figure l is a chart showing dissolution profiles of the 60mg sustained release ketamine tablet at 3 different pHs
• Figure 2A is a chart showing the mean dissociation scale scores, using the Clinician- Administered Dissociative States Scale (CADSS) after a single dose of the sustained release tablet;
• Figure 2B is a chart showing mean CADSS scores after multiple doses of the tablet, Cohorts 1-3.
• CADSS Clinician- Administered Dissociative States Scale
• Figure 3A is a chart showing mean concentration-time profiles of ketamine and norketamine after single dose, Cohorts 1-3;
• Figure 3B is a chart showing mean concentration- time profiles of ketamine and norketamine after multiple doses, Cohorts 1-3.
• Figure 4A is a chart showing ketamine maximum concentration (Crnax) dose- proportionality after single doses of 60mg, 120 mg and 240 mg extended release ketamine tablets
• Figure 4B is a chart showing ketamine Area under the Concentration-Time curve (AUC) after single doses of 60mg, 120 mg and 240 mg extended release ketamine tablets
• Figure 4C is a chart showing ketamine maximum concentration (Cmax) dose-proportionality after multiple doses of 60mg, 120 mg and 240 mg extended release ketamine tablets
• Figure 4D is a chart showing ketamine Area under the Concentration-Time curve (AUC) after multiple doses of 60mg, 120 mg and 240 mg extended release ketamine tablets
• Figure 4E is a chart showing norketamine maximum concentration (Cmax) dose-proportionality after single doses of 60mg, 120 mg and 240 mg extended release norketamine tablets
• Figure 4F is a chart showing norketamine Area under the Concentration-Time curve (AUC) after single
• Figure 5A is a chart showing the individual and mean CADSS scores, Cohort 4 after dosing with extended release ketamine tablets.
• Figure 5B is a chart showing the comparison of mean CADSS scores over 3 hours after initial dosing with ketamine tablets (filled symbols) and subcutaneous ketamine (open symbols) in the 6 Cohort 4 participants with both sets of data.
• Figure 6A is a chart showing the individual and mean Hamilton Anxiety Scale (HAMA) scores, Cohort 4 after dosing with extended release ketamine tablets.
• Figure 6B is a chart showing the individual and mean Fear Questionnaire (FQ) scores, Cohort 4 after dosing with extended release ketamine tablets.
• Figure 7 is a chart showing comparison of mean HAMA scores after initial dosing with ketamine tablets (filled symbols) and subcutaneous ketamine (open symbols) in the 6 Cohort 4 participants with both sets of data.
• HAMA Hamilton Anxiety Scale
• FQ Fear Questionnaire
• Figure 8 is a chart showing individual and mean Montgomery-Asberg Depression Rating Scale (MADRS) scores, Cohort 4 after dosing with extended release ketamine tablets.
• MADRS Montgomery-Asberg Depression Rating Scale
• Figure 9A is a chart showing the smoothed mean depression (MADRS) scores in 3 patients in Cohort 4, who entered a subsequent 3 month open-label extension (OLE) phase
• Figure 9B is a chart showing anxiety (FQ) scores in the 3 patients in Cohort 4 who entered a subsequent 3 month open-label extension (OLE) phase
• Figure 9C is a chart showing anxiety (HAMA) scores in the 3 patients in Cohort 4 who entered a subsequent 3 month open-label extension (OLE) phase. All three patients reported improvements in mood ratings during this time. Mean depression ratings appeared to take 6 weeks for maximal improvement (Figure 9 A), whereas mean maximal anxiety scale improvement appeared to occur by week 2 ( Figures 9B, 9C).
• Figure 10 is a chart showing individual and mean concentration-time profiles of ketamine and norketamine, Cohort 4. Mean dose administered at each 12 hour interval is shown above the concentration-time plots.
• Figure 11 is a chart showing changes in individual norketamine: ketamine ratios associated with 12 hourly dosing of extended release ketamine tablets, with a fitted regression.
• Figure 12 is a chart showing the manufacturing process for Ketamine 30 mg, 60 mg, 120 mg, 180 mg and 240 mg Extended Release Tablets.
• Figure 13 is a chart showing the average depression score of patients at Day 1, Day 5 and Day 8 in a clinical trial treated with 120 mg ketamine daily for 5 days.
• active pharmaceutical ingredient or “pharmaceutically active agent” is a drug or agent which can be employed for the invention and is intended to be used in the human or animal body in order to heal, to alleviate, to prevent or to diagnose diseases, ailments, physical damage or pathological symptoms; allow the state, the condition or the functions of the body or mental states to be identified; to replace active substances produced by the human or animal body, or body fluids; to defend against, to eliminate or to render innocuous pathogens, parasites or exogenous substances or to influence the state, the condition or the functions of the body or mental states.
• Drugs in use can be found in reference works such as, for example, the Rote Liste or the Merck Index.
• an amount is “effective” as used herein, when the amount provides an effect in the subject.
• the term “effective amount” means an amount of a compound or composition sufficient to significantly induce a positive benefit, including independently or in combinations the benefits disclosed herein, but low enough to avoid serious side effects, i.e., to provide a reasonable benefit to risk ratio, within the scope of sound judgment of the skilled artisan.
• the effective amount, as well as dosage and frequency of administration may easily be determined according to their knowledge and standard methodology of merely routine experimentation based on the present disclosure.
• the term “subject” and “patient” are used interchangeably.
• the term “patient” refers to an animal, preferably a mammal such as a non-primate (e.g., cows, pigs, horses, cats, dogs, rats etc.) and a primate (e.g., monkey and human), and most preferably a human.
• the subject is a non-human animal such as a farm animal (e.g., a horse, pig, or cow) or a pet (e.g., a dog or cat).
• the subject is an elderly human.
• the subject is a human adult.
• the subject is a human child.
• the subject is a human infant.
• the phrase "pharmaceutically acceptable” means approved by a regulatory agency of the federal or a state government, or listed in the U.S. Pharmacopeia, European Pharmacopeia, or other generally recognized pharmacopeia for use in animals, and more particularly, in humans.
• the terms "prevent,” “preventing” and “prevention” in the context of the administration of a therapy to a subject refer to the prevention or inhibition of the recurrence, onset, and/or development of a disease or condition, or a combination of therapies (e g , a combination of prophylactic or therapeutic agents).
• the term “alleviate” means achievement of a MADRS score of 12 or less, or a decline from the baseline MADRS score of at least 50% and “alleviates”, “alleviating”, “alleviation” and “alleviated” have corresponding meanings.
• therapies and “therapy” can refer to any method(s), composition(s), and/or agent(s) that can be used in the prevention, treatment and/or management of a disease or condition, or one or more symptoms thereof.
• the terms “treat,” “treatment,” and “treating” in the context of the administration of a therapy to a subject refer to the reduction or inhibition of the progression and/or duration of a disease or condition, the reduction or amelioration of the severity of a disease or condition, and/or the amelioration of one or more symptoms thereof resulting from the administration of one or more therapies.
• maintenance course means a treatment course or regimen which is administered after a subject has responded or remitted as a result of an acute or short-term treatment, aiming for prevention of relapse and/or recurrence, and continued for a period of at least one, preferably more than 1, more than 2, more than 3, at least 4 to 9, at least 6 or more months duration.
• Depression is characterized by depressed mood, and markedly diminished interest or pleasure in activities. Other symptoms include significant weight loss or weight gain, decrease or increase in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate or indecisiveness, recurrent thoughts of death, suicidal ideation or suicidal attempts. A variety of somatic symptoms may also be present. Though depressive feelings are common, especially after experiencing setbacks in life, depressive disorder is diagnosed only when the symptoms reach a threshold and last at least two weeks. Depression can vary in severity from mild to very severe. It is most often episodic but can be recurrent or chronic. Some people have only a single episode, with a full return to premorbid function. However, more than 50 percent of those who initially suffer a single major depressive episode eventually develop another.
• Treatment resistant depression includes unipolar depression that does not respond satisfactorily to one or more treatments that are optimally delivered. If the depression has not benefited from at least two adequate trials of medications from different classes in the current episode, clinically significant treatment resistance is present.
• Any chronic, treatment-resistant depression may be treated by the methods described herein.
• Such depression may include but is not limited to any of: major depressive disorder, single episode, recurrent major depressive disorder-unipolar depression, seasonal affective disorder-winter depression, bipolar mood disorder-bipolar depression, mood disorder due to a general medical condition — with major depressive-like episode, or mood disorder due to a general medical condition — with depressive features, wherein those disorders are resistant to treatment in a given patient.
• any patient that presents one of those disorders and who has not responded to an adequate trial of one antidepressant in the current episode and has recurrent or chronic depressive symptoms for greater than 2 years can be treated by the methods of the invention.
• Manic Depressive illnesses are also described in Goodwin, et al. 2007.
• Anxiety is a mood disorder characterized by nervousness, fear, apprehension, and worrying. Patients with anxiety disorders may report symptoms such as excessive worry, panic attacks, or avoidance of specific situations (e.g social interactions, supermarkets).
• Treatment resistant anxiety TRA; anxiety that has not resolved or improved despite adequate medication and psychotherapy
• TRA is relatively common, with approximately 30% of patients showing no response to treatment, and a further 30-40% of patients having a partial response (Brown 1996) No drug treatments are approved at present for TRA.
• Autoinduction is the ability of a drug to induce enzymes that enhance its own metabolism, which may result in tolerance.
• the pharmaceutical composition of the invention may comprise an active agent, selected from the group consisting of, for example, ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof.
• “Ketamine” as used herein is understood to comprise the compound of formula (I) having the IUPAC name 2-(2-chlorophenyl)-2-(methylamino)cyclohexan-l-one. Accordingly, ketamine comprises the R and S enantiomers as well as pharmaceutically acceptable salts or solvates thereof.
• ketamine is (R)-ketamine or pharmaceutically acceptable salts or solvates thereof.
• ketamine is (S)- ketamine or pharmaceutically acceptable salts or solvates thereof.
• ketamine is a racemate of (S)-ketamine and (R)-ketamine or pharmaceutically acceptable salts or solvates thereof, or any mixture of (S)-ketamine and (R)-ketamine or pharmaceutically acceptable salts or solvates thereof.
• Ketamine can preferably comprise the pharmaceutically acceptable acid addition salts thereof.
• the acids which are used to prepare the pharmaceutically acceptable acid addition salts are preferably those which form non-toxic acid addition salts, i.e.
• salts containing pharmacologically acceptable anions such as chloride, bromide, iodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, acetate, lactate, citrate, (D,L)- and L-tartrate, (D,L)- and L-malate, bitartrate, succinate, maleate, fumarate, gluconate, saccharate and benzoate.
• a preferred salt is the hydrochloride of ketamine.
• Ketamine as used herein can also comprise its metabolites.
• the metabolite is norketamine or dehydronorketamine, preferably norketamine.
• Norketamine has the IUPAC name 2-amino-2-(2-chlorophenyl)cyclohexan-l-one of formula (II) and is obtained from ketamine through N-demethylation.
• Norketamine can be provided as (R)- norketamine or pharmaceutically acceptable salts or solvates thereof, or (S)-norketamine or pharmaceutically acceptable salts or solvates thereof, racemate of (S)-norketamine and (R)- norketamine or pharmaceutically acceptable salts or solvates thereof, or any mixture of (S)- norketamine and (R)-norketamine or pharmaceutically acceptable salts or solvates thereof.
• formulations of the invention may comprise active agent at a concentration of about 1%, about 2%, about 3%, about 4%, about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 11%, about 12%, about 13%, about 14%, about 15%, about 16%, about 17%, about 18%, about 19%, about 20%, about 21%, about 22%, about 23%, about 24%, about 25%, about 26%, about 27%, about 28%, about 29%, about 30%.
• formulations of the invention may comprise active agent at a concentration of about 1 to about 20%, of about 6% to about 20%, of about 5% to about 25%, about 10% to about 20%, or about 15% to about 18%.
• compositions of treating and/or preventing a condition in a subject include administering, in combination, a compound of the invention as set forth herein and at least one additional therapy, such as a therapeutic agent selected from the group consisting of at least one anti- anxiety drug, at least one anti-depressant drug, at least one neuroleptic medication, at least one mood stabilizer drug, at least one antipsychotic drug, at least one hypnotic, and combinations thereof.
• a therapeutic agent selected from the group consisting of at least one anti- anxiety drug, at least one anti-depressant drug, at least one neuroleptic medication, at least one mood stabilizer drug, at least one antipsychotic drug, at least one hypnotic, and combinations thereof.
• the active agent is administered in combination with or concurrently with another therapeutic intervention to enhance the efficacy thereof.
• Examples of other therapeutic interventions include, but are not limited to, counseling, psychotherapy, cognitive therapy or the like, electroconvulsive therapy, hydrotherapy, hyperbaric oxygen therapy, electrotherapy and electrical stimulation, transcutaneous electrical nerve stimulation or "TENS” (e.g., for the treatment of pain such as neuropathic pain), deep brain stimulation (e.g., for the treatment of pain such as neuropathic pain, Parkinson's disease, tremor, dystonia, etc.), vagus nerve stimulation and/or transcranial magnetic stimulation, etc.
• TENS transcutaneous electrical nerve stimulation
• TENS transcutaneous electrical nerve stimulation
• deep brain stimulation e.g., for the treatment of pain such as neuropathic pain, Parkinson's disease, tremor, dystonia, etc.
• vagus nerve stimulation and/or transcranial magnetic stimulation etc.
• At least one anti-anxiety drug is alprazolam, bromazepam, diazepam, lorazepam, clonazepam, temazepam, oxazepam, flunitrazepam, triazolam, chlordiazepoxide, flurazepam, estazolam, nitrazepam, and pharmaceutically acceptable salts, isomers, and mixtures thereof.
• anxiolytic drugs include, but are not limited to, benzodiazepines (e.g., alprazolam, bromazepam (LEXOTAN), chlordiazepoxide (LIBRIUM), clobazam, clonazepam, clorazepate, diazepam, midazolam, lorazepam, nitrazepam, , nimetazepam, estazolam, flunitrazepam, oxazepam (Serax), temazepam (RESTORIL, NORMISON, PLANUM, TENOX, and TEMAZE), triazolam, serotonin 1A agonists (e.g., buspirone (BUSPAR)), barbiturates (e.g., amobarbital (amytal sodium), pentobarbital (NEMBUTAL), secobarbital (SECONAL), phenobarbital, methohexital,
• At least one anti-depressant drug is citalopram, escitalopram oxalate, fluoxetine, fluvoxamine, paroxetine, sertraline, dapoxetine; venlafaxine and duloxetine; harmaline, iproniazid, isocarboxazid, nialamide, pargyline, phenelzine, selegiline, toloxatone, tranylcypromine, brofaromine, moclobemide; amitriptyline, amoxapine, butriptyline, clomipramine, desipramine, dibenzepin, dothiepin, doxepin, imipramine, iprindole, lofepramine, melitracen, nortriptyline, opipramol, protriptyline, trimipramine; maprotiline, mianserin, nefazodone, trazodone, and pharmaceutically acceptable
• Herbal antidepressants may include, for example, St. John’s Wort; kava kava; echinacea; saw palmetto; holy basil; valerian; milk thistle; Siberian ginseng; Korean ginseng; ashwagandha root; nettle; ginkgo biloba; gotu kola; ginkgo/gotu kola supreme; astragalus; goldenseal; dong quai; ginseng; St.
• antidepressants include, but are not limited to, selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine (PROZAC), paroxetine (PAXIL, SEROXAT), escitalopram (LEXAPRO, ESIPRAM), citalopram (CELEXA), and sertraline (ZOLOFT)), serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., venlafaxine (EFFEXOR), and duloxetine (CYMBALTA)), noradrenergic and specific serotonergic antidepressants (NASSAs) (e.g., mirtazapine (AV ANZA, ZISPIN, REMERON)), norepinephrine (noradrenaline) reuptake inhibitors (NRIs) (e g., reboxetine (EDRONAX)), norepinephrine- dopamine reuptake
• At least one neuroleptic drug is haloperidol (HALDOL), droperidol, benperidol, triperidol, melperone, lenperone, azaperone, domperidone, risperidone, chlorpromazine, fluphenazine, perphenazine, prochlorperazine, thioridazine, trifluoperazine, mesoridazine, periciazine, promazine, triflupromazine, levomepromazine, promethazine, pimozide, cyamemazine, chlorprothixene, clopenthixol, flupenthixol, thiothixene, zuclopenthixol, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, amisulpride, asenapine, paliperidone, iloperidone, z
• At least one mood stabilizer drugs includes, but is not limited to, Lithium carbonate, lithium orotate, lithium salt, Valproic acid (DEPAKENE), divalproex sodium (DEPAKOTE), sodium valproate (DEPACON), Lamotrigine (LAMICTAL), Carbamazepine (TEGRETOL), Gabapentin (NEURONTIN), Oxcarbazepine (TRILEPTAL), and Topiramate (TOPAMAX), and combinations thereof.
• antipsychotic drugs include, but are not limited to, butyrophenones (e g., haloperidol), phenothiazines (e g., chlorpromazine (THORAZINE), fluphenazine (PROLIXIN), perphenazine (TRILAFON), prochlorperazine (COMPAZINE), thioridazine (MELLARIL), trifluoperazine (STELAZINE), mesoridazine (SERENTIL), promazine, triflupromazine (VESPRIN), levomepromazine (NOZINAN), promethazine (PHENERGAN)), thioxanthenes (e.g., chlorprothixene (TRUXAL), flupenthixol (DEPIXOL and FLUANXOL), thiothixene (NAVANE), zuclopenthixol (CLOPIXOL & ACUPHASE)), clozapine, olanzapine, r
• hypnotics include, but are not limited to, barbiturates, opioids, benzodiazepines (e.g., alprazolam, bromazepam (Lexotan), chlordiazepoxide (Librium), clobazam, clonazepam, clorazepate, diazepam, midazolam, lorazepam, nitrazepam, , nimetazepam, estazolam, flunitrazepam, oxazepam (SERAX), temazepam (RESTORIL, NORMISON, PLANUM, TENOX, and TEMAZE), triazolam), nonbenzodiazepines (e g., ZOLPIDEM, ZALEPLON, ZOPICLONE, ESZOPICLONE), antihistamines (e g., diphenhydramine, doxylamine, hydroxyzine, promethazine), gamma-hydroxy-
• sedatives include, but are not limited to, barbituates (e.g., amobarbital (Amytal), pentobarbital (Nembutal), secobarbital (Seconal), phenobarbital, methohexital, thiopental, methylphenobarbital, metharbital, barb exacl one), benzodiazepines (e.g., alprazolam, bromazepam (LEXOTAN), chlordiazepoxide (LIBRIUM), clobazam, clonazepam, clorazepate, diazepam, midazolam, lorazepam, nitrazepam, , nimetazepam, estazolam, flunitrazepam, oxazepam (SERAX), temazepam (RESTORIL, NORMISON, PLANUM, TENOX, and TEMAZE), triazolam), and
• Elerbal sedatives e.g., ashwagandha, catnip, kava (Piper methysticum), mandrake, marijuana, valerian
• solvent sedatives e.g., chloral hydrate (NOCTEC), diethyl ether (Ether), ethyl alcohol (alcoholic beverage), methyl trichloride (chloroform)
• nonbenzodiazepine sedatives e g., eszopiclone (LUNESTA), zaleplon (SONATA), zolpidem (AMBIEN), zopiclone (IMOVANE, ZIMOVANE)
• clomethiazole gamma-hydroxybutyrate (GHB), thalidomide, ethchlorvynol (PLACID YL), glutethimide (DORIDEN), ketamine (KETALAR, KETASET), methaqualone (SOPOR, QUAALUDE), methypryl
• alpha-2-delta ligand examples include gabapentin, pregabalin, 3-methylgabapentin, (lalpha,3 alpha, 5alpha)(3-amino-methyl-bicyclo[3.2.0]hept-3-yl)-acetic acid, (3S,5R)-3 aminomethyl-5 methyl-heptanoic acid, (3S,5R)-3 amino-5 methyl-heptanoic acid, (3S,5R)-3 amino-5 methyl-octanoic acid, (2S,4S)-4-(3-chlorophenoxy)proline, (2S,4S)-4-(3- fluorobenzyl)-proline, [(lR,5R,6S)-6-(aminomethyl)bicyclo[3.2.0]hept-6-yl]acetic acid, 3- (l-aminomethyl-cyclohexylmethyl)-4H-[l,2,4]oxadiazol-5-one, C-[l-(lH-te
• serotonin la partial agonist examples include buspirone, gepirone, eltoprazine, or tandospirone, pharmaceutically acceptable salts, isomers, and combinations thereof.
• antiadrenergic agents examples include clonidine, prazosin, propranolol, fuanfacine, methyldopa, guanabenz; doxazosin, prazosin, terazosin, silodosin, alfuzosin, tamsulosin, dutasertide/tamsulosin, guanadrel, mecemylamine, guanethidine, pharmaceutically acceptable salts, isomers, and combinations thereof.
• benzodiazepine agents include alprazolam, bromazepam (LEXOTAN), chlordiazepoxide (LIBRIUM), clobazam, clonazepam, clorazepate, diazepam, midazolam, lorazepam, nitrazepam, nimetazepam, estazolam, flunitrazepam, oxazepam (SERAX), temazepam (RESTORIL, NORMISON, PLANUM, TENOX, and TEMAZE), triazolam, pharmaceutically acceptable salts, isomers, and combinations thereof.
• alprazolam bromazepam
• LEXOTAN bromazepam
• LIBRIUM chlordiazepoxide
• clobazam clonazepam
• clorazepate diazepam
• midazolam lorazepam
• nitrazepam nimet
• the agents are administered in therapeutically effective amounts. In certain embodiments the agents are administered in the same dosage form In certain embodiments the therapeutic agents are administered separately.
• Cmax refers to peak drug concentrations in blood or plasma after dosing.
• Cmax can be influenced by drug dose (higher doses usually produce higher Cmax values), how a drug is administered (e.g., higher Cmax values may occur after IV bolus dosing compared with oral dosing), and the type of formulation (a higher Cmax may occur after dosing with an immediate release oral formulation compared with an extended release formulation).
• Other drug characteristics such as solubility, permeability, ways in which it is absorbed into the body, metabolism and metabolic products etc., can also influence Cmax, which means that although certain projections may be made based on the factors mentioned above, the actual behavior observed is difficult to predict without significant experimentation in humans and may be unexpected.
• the Specification discloses that the compositions and methods as disclosed herein provide upon administration to a patient, for example, a pharmacokinetic parameter selected from the group consisting of:
• ketamine Cmax of about 10 ng/mL or a ketamine Cmax between about 5 and about 15 ng/mL;
• ketamine Cmax of about 16 ng/mL or a ketamine Cmax between about 7 and about 32 ng/mL;
• ketamine Cmax of about 38 ng/mL or a ketamine Cmax between about 19 and about 47 ng/mL;
• ketamine Cmax of about 12 ng/mL or a ketamine Cmax between about 8 and about 23 ng/mL;
• ketamine Cmax of about 21 ng/mL or a ketamine Cmax between about 7 and about 45 ng/mL;
• ketamine Cmax of about 42 ng/mL or a ketamine Cmax between about 33 and about 53 ng/mL;
• Tmax refers to the time at which peak drug concentration (Cmax) occurs.
• the formulations and methods as disclosed herein provide, for example, a mean tmax of the active agent selected from the group consisting of at least about 0.5 hours, at least about 1 hour, at least about 1.5 hours, at least about 2 hours, at least about 2.5 hours, at least about 3 hours, at least about 3.5 hours, and between about 1.5 and about 3.5 hours, and less than about 4 hours.
• compositions and methods as disclosed herein provide upon administration to a patient, for example, a pharmacokinetic parameter selected from the group consisting of: a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 60 mg or 120 mg or 240 mg; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 60 mg administered every 12 hours; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 120 mg administered every 12 hours; and a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 240 mg administered every 12 hours.
• a pharmacokinetic parameter selected from the group consisting of: a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of a single dose of 60 mg or 120 mg or 240 mg; a mean tmax of said active agent between about 1.5 and about 3.5 hours after administration of 5 doses of 60 mg administered every 12 hours;
• AUC means Area Under the drug concentration-time Curve in blood or plasma.
• the AUC reflects the total body exposure to drug after dosing. Again, the size of AUC is influenced by several factors - what dose is administered; ease and speed of drug absorption; how widely the drug is distributed in the body; and rate of drug elimination from the body. All of these variables make it difficult to predict AUC accurately without significant experimentation in humans.
• compositions and methods as disclosed herein provide upon administration to a patient, for example, a pharmacokinetic parameter selected from the group consisting of:
• ketamine AUC 0- ⁇ of about 79 or a ketamine AUC 0- ⁇ between about 36 and about 135 ng.h/mL;
• ketamine AUC 0- ⁇ about 197 ng.h/mL or a ketamine AUC 0- ⁇ between about 93 and about 460 ng.h/mL;
• ketamine a mean ketamine AUC 0- ⁇ about 389 ng.h/mL or a ketamine AUC 0- ⁇ between about 292 and 521 ng.h/mL; - after administration of a single dose of 60 mg of the active agent a mean norketamine AUC 0- ⁇ of about 872 ng.h/mL or a norketamine AUC 0- ⁇ between about 549 and about 1543 ng.h/mL;
• ketamine AUC 0-12 of about 74 ng.h/mL or a ketamine AUC 0-12 between about 35 and about 156ng.h/mL;
• ketamine AUC 0-12 of about 133 ng.h/mL or a ketamine AUC 0-12 between about 58 and about 287 ng.h/mL;
• ketamine AUC 0-12 of about 221 ng.h/mL or a ketamine AUC 0-12 between about 145 and about 328 ng.h/mL;
• the formulation of the disclosure provides extended release of ketamine of, for example, over 4 hours, over 5 hours, over 6 hours, over 7 hours, over 8 hours, over 9 hours, over 10 hours, or more. Elimination half-life estimates for ketamine and norketamine for the formulation as set forth herein are much longer that previously reported for immediate release tablet formulations (e.g. 8h vs ⁇ 2h; Yanagihara 2003) There is evidence that the formulations of the invention provide for autoinduction (Figure 10). This appears to have stabilized after 3-4 days of repeat dosing. There is no prior human data on this.
• the oral formulation as set forth herein has no dissociative side effects after 60-120mg doses, and minimal dissociative side effects at 240 mg ( Figures 2A and 2B). This contrasts markedly with injected ketamine by any route of administration (e.g. Loo 2016), where there are marked dissociative symptoms for up to 60 minutes after dosing.
• the present invention is directed to a process of preparing a solid oral extended release pharmaceutical dosage form, comprising at least the steps of:
• At least one polyethylene oxide having, based on rheological measurements, an approximate molecular weight selected from the group consisting of at least about 1,000,000; at least about 2,000,000; at least about 3,000,000; at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; at least about 6,000,000; at least about 7,000,000; and at least about 8,000,000; and
• (c) curing said extended release matrix formulation comprising at least a curing step of subjecting the extended release matrix formulation to a temperature which is at least the softening temperature of said polyethylene oxide for a time period selected from the group consisting of at least about 1 minute, at least about 2 minutes, at least about 3 minutes, at least about 4 minutes, at least about 5 minutes, at least about 6 minutes, at least about 7 minutes, at least about 8 minutes, at least about 9 minutes, and at least about 10 minutes.
• the curing is conducted at atmospheric pressure
• the dosage form is coated.
• the composition is shaped in step b) to form an extended release matrix formulation in the form of tablet.
• a direct compression process can be used for shaping the extended release matrix formulation in the form of tablet.
• Direct compression is an efficient and simple process for shaping tablets by avoiding process steps like wet granulation.
• any other process for manufacturing tablets as known in the art may be used, such as wet granulation and subsequent compression of the granules to form tablets.
• the curing of the extended release matrix formulation in step c) comprises at least a curing step wherein the high molecular weight polyethylene oxide in the extended release matrix formulation at least partially melts.
• the high molecular weight polyethylene oxide in the extended release matrix formulation at least partially melts.
• the curing of the extended release matrix formulation in step c) comprises at least a curing step wherein the extended release matrix formulation is subjected to an elevated temperature for a certain period of time.
• the temperature employed in step c), i.e. the curing temperature is at least as high as the softening temperature of the high molecular weight polyethylene oxide.
• the curing temperature is at least about 60°C or at least about 62°C, or ranges from about 62°C, to about 90°C, or from about 62°C to about 85°C or from about 62°C to about 80°C or from about 65°C to about 90°C or from about 65°C to about 85°C or from about 65°C to about 80°C.
• the curing temperature preferably ranges from about 68°C to about 90°C or from about 68°C to about 85°C or from about 68°C to about 80°C, more preferably from about 70°C to about 90°C or from about 70°C to about 85°C or from about 70°C to about 80°C, most preferably from about 75°C to about 90°C or from about 75°C to about 85°C or from about 72°C to about 80°C, or from about 70°C to about 75°C.
• the curing temperature may be at least about 60°C. or at least about 62°C, but less than about 90°C or less than about 80°C.
• the curing temperature is at least as high as the lower limit of the softening temperature range of the high molecular weight polyethylene oxide or at least about 62°C or at least about 68°C. More preferably, the curing temperature is within the softening temperature range of the high molecular weight polyethylene oxide or at least about 70°C. Even more preferably, the curing temperature is at least as high as the upper limit of the softening temperature range of the high molecular weight polyethylene oxide or at least about 72°C. In an alternative embodiment, the curing temperature is higher than the upper limit of the softening temperature range of the high molecular weight polyethylene oxide, for example the curing temperature is at least about 75°C or at least about 80°C
• the curing time may vary from about 1 minute to about 24 hours or from about 5 minutes to about 20 hours or from about 10 minutes to about 15 hours or from about 15 minutes to about 10 hours or from about 30 minutes to about 5 hours depending on the specific composition and on the formulation and the curing temperature.
• the parameter of the composition, the curing time and the curing temperature are chosen to achieve the tamper resistance as described herein. According to certain embodiments the curing time varies from about 15 minutes to about 30 minutes.
• the sustained release formulation may be achieved via a matrix optionally having a controlled release coating as set forth herein.
• the present invention may also utilize a sustained release matrix that affords in-vitro dissolution rates of the API within desired ranges and releases the API in a pH-dependent or pH- independent manner.
• hydrophilic and/or hydrophobic materials such as gums, cellulose ethers, acrylic resins, protein derived materials, waxes, shellac, and oils such as hydrogenated castor oil and hydrogenated vegetable oil.
• any pharmaceutically acceptable hydrophobic or hydrophilic sustained-release material which is capable of imparting sustained-release of the API may be used in accordance with the present invention.
• Preferred sustained-release polymers include alkylcelluloses such as ethylcellulose, acrylic and methacrylic acid polymers and copolymers; and cellulose ethers, especially hydroxyalkylcelluloses (especially hydroxypropylmethylcellulose) and carboxyalkylcelluloses.
• Preferred acrylic and methacrylic acid polymers and copolymers include methyl methacrylate, methyl methacrylate copolymers, ethoxyethyl methacrylates, ethyl acrylate, trimethyl ammonioethyl methacrylate, cyanoethyl methacrylate, aminoalkyl methacrylate copolymer, poly(acrylic acid), poly(methacrylic acid), methacrylic acid alkylamine copolymer, poly(methylmethacrylate), poly (methacrylic acid) (anhydride), polymethacrylate, polyacrylamide, poly(methacrylic acid anhydride), and glycidyl methacrylate copolymers Certain preferred embodiments utilize mixtures of any of the foregoing sustained-release materials in the matrix of the invention.
• the matrix also may include a binder.
• a sustained-release matrix may also contain suitable quantities of other materials, e g., diluents, lubricants, binders, granulating aids and glidants that are conventional in the pharmaceutical art.
• a sustained-release matrix can be prepared by, e.g., melt-granulation or melt-extrusion techniques.
• melt-granulation techniques involve melting a normally solid hydrophobic binder material, e.g., a wax, and incorporating a powdered drug therein.
• a hydrophobic sustained-release material e.g., ethylcellulose or a water-insoluble acrylic polymer
• the additional hydrophobic binder material may comprise one or more water- insoluble wax-like thermoplastic substances possibly mixed with one or more wax-like thermoplastic substances being less hydrophobic than said one or more water-insoluble wax- like substances.
• the individual wax-like substances in the formulation should be substantially non-degradable and insoluble in gastrointestinal fluids during the initial release phases.
• Useful water-insoluble wax-like binder substances may be those with a water-solubility that is lower than about 1 :5,000 (w/w).
• the preparation of a suitable melt-extruded matrix according to the present invention may, for example, include the steps of blending the API with a sustained release material and preferably a binder material to obtain a homogeneous mixture.
• the homogeneous mixture is then heated to a temperature sufficient to at least soften the mixture sufficiently to extrude the same.
• the resulting homogeneous mixture is then extruded, e.g., using a twin-screw extruder, to form strands.
• the extrudate is preferably cooled and cut into multiparticulates by any means known in the art.
• the matrix multiparticulates are then divided into unit doses.
• the extrudate preferably has a diameter of from about 0. 1 to about 5 mm and provides sustained release of the active agent or pharmaceutically acceptable salt thereof for a time period of at least about 24 hours.
• An optional process for preparing the melt extruded formulations of the present invention includes directly metering into an extruder a hydrophobic sustained release material, the API, and an optional binder material; heating the homogenous mixture; extruding the homogenous mixture to thereby form strands; cooling the strands containing the homogeneous mixture; cutting the strands into matrix multiparticulates having a size from about 0. 1 mm to about 12 mm; and dividing said particles into unit doses.
• a relatively continuous manufacturing procedure is realized.
• Plasticizers such as those described above, may be included in melt-extruded matrices.
• the plasticizer is preferably included as from about 0.1 to about 30% by weight of the matrix.
• Other pharmaceutical excipients e g , talc, mono or poly saccharides, lubricants and the like may be included in the sustained release matrices of the present invention as desired. The amounts included will depend upon the desired characteristic to be achieved.
• the diameter of the extmder aperture or exit port can be adjusted to vary the thickness of the extruded strands.
• the exit part of the extruder need not be round; it can be oblong, rectangular, etc.
• the exiting strands can be reduced to particles using a hot wire cutter, guillotine, etc.
• a melt extruded matrix multiparticulate system can be, for example, in the form of granules, spheroids or pellets depending upon the extruder exit orifice.
• melt-extruded matrix multiparticulate(s) and “melt-extruded matrix multiparticulate system(s)” and “melt-extruded matrix particles” shall refer to a plurality of units, preferably within a range of similar size and/or shape and containing one or more active agents and one or more excipients, preferably including a hydrophobic sustained release material as described herein.
• the melt-extruded matrix multiparticulates will be of a range of from about 0.1 to about 12 mm in length and have a diameter of from about 0.1 to about 5 mm.
• melt-extruded matrix multiparticulates can be any geometrical shape within this size range.
• the extrudate may simply be cut into desired lengths and divided into unit doses of the therapeutically active agent without the need of a spheronization step.
• oral dosage forms are prepared that include an effective amount of melt-extruded matrix multiparticulates within a capsule.
• a plurality of the melt-extruded matrix multiparticulates may be placed in a gelatin capsule in an amount sufficient to provide an effective sustained release dose when ingested and contacted by gastrointestinal fluid.
• a suitable amount of the multiparticulate extrudate is compressed into an oral tablet using conventional tableting equipment using standard techniques.
• Techniques and compositions for making tablets (compressed and molded), capsules (hard and soft gelatin) and pills are described in Remington's Pharmaceutical Sciences, (Arthur Osol, editor), 1553-1593 (1980).
• the spheroids, granules, or matrix multiparticulates may also contain suitable quantities of other materials, e g., diluents, lubricants, binders, granulating aids, and glidants that are conventional in the pharmaceutical art in amounts up to about 50% by weight of the formulation if desired.
• suitable quantities of these additional materials will be sufficient to provide the desired effect to the desired formulation.
• At least one active agent in solubility-improved form is incorporated into an erodible or non-erodible polymeric matrix-controlled release device.
• an erodible matrix is meant aqueous-erodible or water-swellable or aqueous-soluble in the sense of being either erodible or swellable or dissolvable in pure water or requiring the presence of an acid or base to ionize the polymeric matrix sufficiently to cause erosion or dissolution.
• the erodible polymeric matrix When contacted with the aqueous environment of use, the erodible polymeric matrix imbibes water and forms an aqueous-swollen gel or "matrix” that entraps the solubility- improved form of the active agent.
• the aqueous-swollen matrix gradually erodes, swells, disintegrates or dissolves in the environment of use, thereby controlling the release of the active agent to the environment of use.
• the erodible polymeric matrix into which the active agent is incorporated may generally be described as a set of excipients that are mixed with the solubility-improved form following its formation that, when contacted with the aqueous environment of use imbibes water and forms a water-swollen gel or "matrix" that entraps the drug form.
• Drug release may occur by a variety of mechanisms: the matrix may disintegrate or dissolve from around particles or granules of the drug in solubility-improved form; or the drug may dissolve in the imbibed aqueous solution and diffuse from the tablet, beads or granules of the device.
• a key ingredient of this water-swollen matrix is the water-swellable, erodible, or soluble polymer, which may generally be described as an osmopolymer, hydrogel or water-swellable polymer.
• Such polymers may be linear, branched, or crosslinked. They may be homopolymers or copolymers. Although they may be synthetic polymers derived from vinyl, acrylate, methacrylate, urethane, ester and oxide monomers, they are most preferably derivatives of naturally occurring polymers such as polysaccharides or proteins.
• Such materials include naturally occurring polysaccharides such as chitin, chitosan, dextran and pullulan; gum agar, gum arabic, gum karaya, locust bean gum, gum tragacanth, carrageenans, gum ghatti, guar gum, xanthan gum and scleroglucan, starches such as dextrin and maltodextrin; hydrophilic colloids such as pectin; phosphatides such as lecithin; alginates such as ammonium alginate, sodium, potassium or calcium alginate, propylene glycol alginate; gelatin; collagen; and cellulosics.
• polysaccharides such as chitin, chitosan, dextran and pullulan
• gum agar gum arabic, gum karaya, locust bean gum, gum tragacanth, carrageenans, gum ghatti, guar gum, xanthan gum and sclerogluc
• cellulosics is meant a cellulose polymer that has been modified by reaction of at least a portion of the hydroxyl groups on the saccharide repeat units with a compound to form an ester-linked or an ether-linked substituent
• the cellulosic ethyl cellulose has an ether linked ethyl substituent attached to the saccharide repeat unit
• the cellulosic cellulose acetate has an ester linked acetate substituent.
• a preferred class of cellulosics for the erodible matrix comprises aqueous-soluble and aqueous-erodible cellulosics such as ethyl cellulose (EC), methylethyl cellulose (MEC), carboxymethyl cellulose (CMC), CMEC, hydroxyethyl cellulose (HEC), hydroxypropyl cellulose (HPC), cellulose acetate (CA), cellulose propionate (CP), cellulose butyrate (CB), cellulose acetate butyrate (CAB), CAP, CAT, hydroxypropyl methyl cellulose (HPMC), HPMCP, HPMCAS, hydroxypropyl methyl cellulose acetate trimellitate (HPMCAT), and ethylhydroxy ethylcellulose (EHEC).
• EC ethyl cellulose
• MEC methylethyl cellulose
• CMC carboxymethyl cellulose
• CMEC hydroxyethyl cellulose
• HPC hydroxypropy
• a particularly preferred class of such cellulosics comprises various grades of low viscosity (MW less than or equal to 50,000 daltons) and high viscosity (MW greater than 50,000 daltons) HPMC.
• Commercially available low viscosity HPMC polymers include the Dow METHOCEL series E5, E15LV, E50LV and K100LY, while high viscosity HPMC polymers include E4MCR, E10MCR, K4M, K15M and K100M; especially preferred in this group are the METHOCEL K series.
• Other commercially available types of HPMC include the Shin Etsu METOLOSE 90 SH series.
• the matrix material is a concentration-enhancing polymer, as defined herein below.
• erodible matrix material examples include, but are not limited to, pullulan, polyvinyl pyrrolidone, polyvinyl alcohol, polyvinyl acetate, glycerol fatty acid esters, polyacrylamide, polyacrylic acid, copolymers of ethacrylic acid or methacrylic acid (EUDRAGIT®, Rohm America, Inc., Piscataway, N.J.) and other acrylic acid derivatives such as homopolymers and copolymers of butylmethacrylate, methylmethacrylate, ethylmethacrylate, ethylacrylate, (2-dimethylaminoethyl)methacrylate, and (trimethylaminoethyl) methacrylate chloride.
• pullulan polyvinyl pyrrolidone
• polyvinyl alcohol polyvinyl acetate
• glycerol fatty acid esters polyacrylamide
• polyacrylic acid copolymers of ethacrylic acid
• the erodible matrix polymer may contain a wide variety of the same types of additives and excipients known in the pharmaceutical arts, including osmopolymers, osmagens, solubility-enhancing or -retarding agents and excipients that promote stability or processing of the device.
• the formulation may comprise an excipient that is a swellable material such as a hydrogel in amounts that can swell and expand.
• swellable materials include polyethylene oxide, hydrophilic polymers that are lightly cross-linked, such cross-links being formed by covalent or ionic bond, which interact with water and aqueous biological fluids and swell or expand to some equilibrium state.
• Swellable materials such as hydrogels exhibit the ability to swell in water and retain a significant fraction of water within its structure, and when cross-linked they will not dissolve in the water.
• Swellable polymers can swell or expand to a very high degree, exhibiting a 2 to 50-fold volume increase.
• hydrophilic polymeric materials include poly(hydroxyalkyl methacrylate), poly(N-vinyl-2-pyrrolidone), anionic and cationic hydrogels, poly electrolyte complexes, poly(vinyl alcohol) having a low acetate residual and cross-linked with glyoxal, formaldehyde, or glutaraldehyde, methyl cellulose cross-linked with dialdehyde, a mixture of cross-linked agar and carboxymethyl cellulose, a water insoluble, water-swellable copolymer produced by forming a dispersion of finely divided copolymer of maleic anhydride with styrene, ethylene, propylene, butylene, or isobutylene cross-linked with from 0.001 to about 0.5 moles of a polyunsaturated cross-linking agent per mole of maleic anhydride in the copolymer, water-swellable polymers of N-vinyl lactams, cross-linked
• swellable materials include hydrogels exhibiting a cross-linking of 0.05 to 60%, hydrophilic hydrogels known as Carbopol acidic carboxy polymer, CyanamerTM polyacrylamides, cross-linked water- swellable indene-maleic anhydride polymers, Good-riteTM polyacrylic acid, starch graft copolymers, Aqua-Keeps.TM acrylate polymer, diester cross-linked polyglucan, and the like.
• hydrophilic hydrogels known as Carbopol acidic carboxy polymer, CyanamerTM polyacrylamides, cross-linked water- swellable indene-maleic anhydride polymers, Good-riteTM polyacrylic acid, starch graft copolymers, Aqua-Keeps.TM acrylate polymer, diester cross-linked polyglucan, and the like.
• the formulations may comprise additives such as polyethylene oxide polymers, polyethylene glycol polymers, cellulose ether polymers, cellulose ester polymers, homo- and copolymers of acrylic acid cross-linked with a polyalkenyl polyether, poly(meth)acrylates, homopolyers (e.g., polymers of acrylic acid crosslinked with allyl sucrose or allyl pentaerythritol), copolymers (e.g., polymers of acrylic acid and C10-C30 alkyl acrylate crosslinked with allyl pentaerythritol), interpolymers (e.g., a homopolymer or copolymer that contains a block copolymer of polyethylene glycol and a long chain alkyl acid ester), disintegrants, ion exchange resins, polymers reactive to intestinal bacterial flora (e g., polysaccharides such as guar gum, inulin obtained from plant or chitosan and chondrotin
• the pharmaceutical composition of the invention may comprise at least one polyalkylene oxide having an average molecular weight of no more than about 300,000 may be a polyethylene oxide, a polymethylene oxide, a polypropylene oxide, or a copolymer thereof.
• the first polyalkylene oxide is a polyethylene oxide.
• the polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 300,000.
• the polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 200,000.
• the polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 100,000.
• the pharmaceutical composition of the invention may comprise polyalkylene oxide having an average molecular weight of at least 1,000,000 may be a polyethylene oxide, a polymethylene oxide, a polypropylene oxide, or a copolymer thereof.
• the polyalkylene oxide is a polyethylene oxide.
• the second polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 2,000,000.
• the polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 4,000,000.
• the second polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 5,000,000.
• the polyalkylene oxide, which may be polyethylene oxide has an average molecular weight of about 7,000,000. In additional embodiments, the polyalkylene oxide, which may be polyethylene oxide, has an average molecular weight of about 8000,000. In other embodiments, the polyalkylene oxide, which may be polyethylene oxide, has an average molecular weight of about 15,000,000.
• the polymer may be selected from the group comprising polyalkylene oxides, preferably polymethylene oxide, polyethylene oxide, polypropylene oxide; polyethylene, polypropylene, polyvinyl chloride, polycarbonate, polystyrene, poly acrylate, copolymers thereof, and mixtures of at least two of the stated polymers.
• polyalkylene oxides preferably polymethylene oxide, polyethylene oxide, polypropylene oxide; polyethylene, polypropylene, polyvinyl chloride, polycarbonate, polystyrene, poly acrylate, copolymers thereof, and mixtures of at least two of the stated polymers.
• the polymer may be a water-soluble polymer for use either as a base polymer material or as a dissolution modifying agent such as polyethylene oxide (PEO), for example the brand name POLYOX® (Dow).
• PEO polyethylene oxide
• the thermoplastic polymers may be used in varying molecular weights, such as 100K, 200K, 300K, 400K, 600K, 900K, 1000K, 2000K, 4000K, 5000K, 7000K and 8000K, and optionally combinations thereof.
• the PEO is a high molecular weight PEO.
• the PEO has a molecular weight of about 7,000,000 In a preferred embodiment, the PEO has a molecular weight between about 4,000,000 and 8,000,000.
• polyethylene oxide include POLYOX water soluble resin, which is listed in the NF and has approximate molecular weights which range from 100,000 to about 8,000,000.
• a preferred polyethylene oxide is POLYOX WSR-80, POLYOX WSR N-750, POLYOX WSR-205, POLYOX WSR-1105, POLYOX WSR N-12K, POLYOX WSR N-60K, WSR-301, WSR Coagulant, WSR-303, and combinations thereof.
• the amount of polyalkylene oxide present in the pharmaceutical composition can and will vary and in general, the amount of the polyalkylene oxide present in the pharmaceutical composition may range from about 10% to about 95% by weight of the composition. In various embodiments, the amount of the polyalkylene oxide present in the pharmaceutical composition may range from about 20% to about 90%, from about 30% to about 80%, or from about 35% to about 70% by weight of the pharmaceutical composition. In various embodiments, the amount of the polyalkylene oxide present in the pharmaceutical composition may be about 50%, about 55%, about 60%. about 65%. about 70%. about 75%, about 80%, about 85%, about 90%, or about 95%.
• high molecular weight polyethylene oxide having, based on rheological measurements an approximate molecular weight of from 2,000,000 to 15,000,000 or from 2,000,000 to 8,000,000 may be used.
• polyethylene oxides having, based on rheological measurements an approximate molecular weight of 2,000,000, 4,000,000, 7,000,000 or 8,000,000 may be used.
• polyethylene oxides having, based on rheological measurements an approximate molecular weight of 4,000,000, may be used.
• composition further comprises at least one low molecular weight polyethylene oxide
• polyethylene oxides having, based on rheological measurements, an approximate molecular weight of less than 1,000,000, such as polyethylene oxides having, based on rheological measurements, an approximate molecular weight of from 100,000 to 900,000 may be used.
• the addition of such low molecular weight polyethylene oxides may be used to specifically tailor the release rate such as enhance the release rate of a formulation that otherwise provides a release rate to slow for the specific purpose.
• at least one polyethylene oxide having, based on rheological measurements, an approximate molecular weight of 100,000 may be used.
• the composition comprises at least one polyethylene oxide having, based on rheological measurements, an approximate molecular weight of at least 1,000,000 and at least one polyethylene oxide having, based on rheological measurements, an approximate molecular weight of less than 1,000,000, wherein the composition comprises at least about 10% (by wt) or at least about 20% (by wt) of the polyethylene oxide having, based on rheological measurements, an approximate molecular weight of less than 1,000,000.
• the curing temperature is less than about 80°C or even less than about 77°C.
• the overall content of polyethylene oxide in the composition is at least about 80% (by wt).
• the pharmaceutical composition of the invention may include lubricants such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof and other tableting aids such a magnesium stearate and microcrystalline cellulose
• the pharmaceutical compositions disclosed herein may also further comprise at least one lubricant, which facilitates preparation of solid dosage forms of the pharmaceutical composition.
• suitable lubricants include magnesium stearate, calcium stearate, zinc stearate, colloidal silicon dioxide, hydrogenated vegetable oils, sterotex, polyoxyethylene monostearate, polyethylene glycol, sodium stearyl fumarate, sodium benzoate, sodium lauryl sulfate, magnesium lauryl sulfate, and light mineral oil.
• the lubricant may be magnesium stearate.
• the amount of the lubricant may range from about 0.1% to about 3% by weight of the pharmaceutical composition. In various embodiments, the amount of the lubricant may range from about 0. 1% to about 0.3%, from about 0.3% to about 1%, or from about 1% to about 3% by weight of the pharmaceutical composition. In exemplary embodiments, the amount of the lubricant may be about 0 5%, about 1%, about 1.5%, about 2%, about 2.5%, about 3%, about 3.5%, about 4%, about 4.5%, or about 5% by weight of the pharmaceutical composition.
• the pharmaceutical composition can be coated with one or more enteric coatings, seal coatings, film coatings, barrier coatings, compress coatings, fast disintegrating coatings, or enzyme degradable coatings.
• the formulation disclosed herein is coated with a coating material, e g., a sealant.
• the coating material is water soluble.
• the coating material comprises a polymer, plasticizer, a pigment, or any combination thereof.
• the coating material is a form of a film coating, e g., a glossy film, a pH independent film coating, an aqueous film coating, a dry powder film coating (e g., complete dry powder film coating), or any combination thereof
• the coating material is highly adhesive.
• the coating material provides low level of water permeation.
• the coating material provides oxygen barrier protection.
• the coating material allows immediate disintegration for fast release of drug actives.
• the coating material is pigmented, clear, or white.
• the coating material is clear.
• Exemplary coating materials include, without limitation, polyvinyl alcohol (PVA), cellulose acetate phthalate (CAP), polyvinyl acetate phthalate (PVAP), methacrylic acid copolymers, cellulose acetate trimellitate (CAT), hydroxypropyl methylcellulose phthalate (HPMCP), hydroxypropyl methylcellulose (HPMC), hydroxy propyl methyl cellulose acetate succinate (hypromellose acetate succinate), shellac, sodium alginate, and zein.
• PVA polyvinyl alcohol
• CAP cellulose acetate phthalate
• PVAP polyvinyl acetate phthalate
• methacrylic acid copolymers cellulose acetate trimellitate
• CAT hydroxypropyl methylcellulose phthalate
• HPMC hydroxypropyl methylcellulose
• the coating material comprises or is PVA. In some embodiments, the coating material comprises or is HPMC.
• An exemplary PVA-based coating material includes Opadry II.
• the coating material is about 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10% of the weight of the formulation. In some instances, the coating material represent between about 1% and about 15% of the total weight of each first particulate, including, but not limited to, between about 5% and about 10%, between about 6% and about 10%, between about 7% and about 10%, between about 8% and about 10%, or between about 9% and about 10%.
• the coating material is greater than about 2%, greater than about 3%, greater than about 4%, greater than about 5%, greater than about 6%, greater than about 7%, greater than about 8%, greater than about 9%, or greater than about 10% of the weight of the formulation. In some instances, the coating material is less than about 2%, less than about 3%, less than about 4%, less than about 5%, less than about 6%, less than about 7%, less than about 8%, less than about 9%, or less than about 10% of the weight of the formulation.
• the dosage form can be designed for immediate release, pulsatile release, controlled release, extended release, delayed release, targeted release, synchronized release, or targeted delayed release.
• solid carriers can be made of various component types and levels or thicknesses of coats, with or without an active ingredient. Such diverse solid carriers can be blended in a dosage form to achieve a desired performance. The definitions of these terms are known to those skilled in the art.
• the dosage form release profile can be affected by a polymeric matrix composition, a coated matrix composition, a multiparticulate composition, a coated multiparticulate composition, an ion-exchange resin-based composition, an osmosis-based composition, or a biodegradable polymeric composition.
• a polymeric matrix composition e.g., polyethylene glycol dimethacrylate, polypropylene glycol dimethacrylate, polyethylene glycol dimethacrylate, polypropylene glycol dimethacrylate, polypropylene glycol, poly(ethylene glycol)-propylene glycol)-propylene glycol-propylene glycol-propylene glycol-propylene glycol-propylene glycol-propylene glycol-propylene glycol-propylene glycol-propylene glycol dimethacrylate, polypropylene glycol dimethacrylate, polypropylene glycol dimethacrylate, polypropylene glycol dimethacrylate graft copolymer, poly
• Dosage forms of the invention can further be coated with, for example, a seal coating, an enteric coating, an extended release coating, or a targeted delayed release coating
• seal coating, or coating with isolation layers Thin layers of up to 20 microns in thickness can be applied for variety of reasons, including for particle porosity reduction, to reduce dust, for chemical protection, to mask taste, to reduce odor, to minimize gastrointestinal irritation, etc.
• the isolating effect is proportional to the thickness of the coating.
• Water soluble cellulose ethers are preferred for this application. HPMC and ethyl cellulose in combination, or Eudragit El 00, may be particularly suitable.
• the coating may be OPADRY® Y- 1-7000, a coating ready mix from Colorcon.
• Opadry Y-l-7000 contains hypromellose 5 cP, titanium dioxide and macrogol/PEG 400.
• Traditional enteric coating materials listed elsewhere can also be applied to form an isolating layer.
• the sustained-release matrix multiparticulate systems, tablets, or capsules can be coated with a sustained release coating such as the sustained release coatings described herein.
• a sustained release coating such as the sustained release coatings described herein.
• Such coatings preferably include a sufficient amount of hydrophobic and/or hydrophilic sustained-release material to obtain a weight gain level from about 2 to about 25 percent, although the overcoat may be greater depending upon, e.g., the desired release rate.
• a sustained release coating is applied to the sustained release spheroids, granules, or matrix multiparticulates.
• the sustained-release coating may include a water insoluble material such as (a) a wax, either alone or in admixture with a fatty alcohol; or (b) shellac or zein.
• the coating is preferably derived from an aqueous dispersion of the hydrophobic sustained release material.
• the sustained release material comprising the sustained-release coating is a pharmaceutically acceptable acrylic polymer, including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate copolymers, ethoxyethyl methacrylates, cyanoethyl methacrylate, poly(acrylic acid), poly(methacrylic acid), methacrylic acid alkylamide copolymer, poly(methyl methacrylate), polymethacrylate, poly(methyl methacrylate) copolymer, polyacrylamide, aminoalkyl methacrylate copolymer, poly(methacrylic acid anhydride), and glycidyl methacrylate copolymers.
• acrylic acid and methacrylic acid copolymers including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate copolymers, ethoxyethyl methacrylates, cyanoethyl methacrylate, poly(acrylic acid), poly(methacrylic
• the acrylic polymer is comprised of one or more ammonio methacrylate copolymers.
• Ammonio methacrylate copolymers are well known in the art as fully polymerized copolymers of acrylic and methacrylic acid esters with a low content of quaternary ammonium groups.
• methacrylic acid ester-type polymers are useful for preparing pH-dependent coatings which may be used in accordance with the present invention.
• methacrylic acid copolymer or polymeric methacrylates commercially available as Eudragit® from Rohm GMBH and Co. Kg Darmstadt, Germany.
• Eudragit® is an example of a methacrylic acid copolymer which swells and dissolves in acidic media.
• Eudragit L is a methacrylic acid copolymer which does not swell at about pH ⁇ 5.7 and is soluble at about pH>6.
• Eudragit S does not swell at about pH ⁇ 6 5 and is soluble at about pH>7.
• Eudragit RL and Eudragit RS are water swellable, and the amount of water absorbed by these polymers is pH-dependent; however, dosage forms coated with Eudragit RL and RS are pH-independent.
• the acrylic coating comprises a mixture of two acrylic resin lacquers commercially available under the Tradenames Eudragit® RL30D and Eudragit® RS30D, respectively.
• Eudragit® RL30D and Eudragit® RS30D are copolymers of acrylic and methacrylic esters with a low content of quaternary ammonium groups, the molar ratio of ammonium groups to the remaining neutral (meth)acrylic esters being 1 :20 in Eudragit® RL30D and 1:40 in Eudragit® RS30D.
• the mean molecular weight is about 150,000.
• the code designations RL (high permeability) and RS (low permeability) refer to the permeability properties of these agents.
• Eudragit® RL/RS mixtures are insoluble in water and in digestive fluids. However, coatings formed from the same are swellable and permeable in aqueous solutions and digestive fluids.
• plasticizers for ethyl cellulose include water insoluble plasticizers such as dibutyl sebacate, diethyl phthalate, triethyl citrate, tributyl citrate, and triacetin, although it is possible that other water-insoluble plasticizers (such as acetylated monoglycerides, phthalate esters, castor oil, etc.) may be used.
• Methyl citrate is an especially preferred plasticizer for the aqueous dispersions of ethyl cellulose of the present invention.
• Extended release coatings are designed to effect delivery over an extended period of time.
• the extended release coating is a pH-independent coating formed of, for example, ethyl cellulose, hydroxypropyl cellulose, methylcellulose, hydroxymethyl cellulose, hydroxyethyl cellulose, acrylic esters, or sodium carboxymethyl cellulose.
• Various extended release dosage forms can be readily designed by one skilled in art to achieve delivery to both the small and large intestines, to only the small intestine, or to only the large intestine, depending upon the choice of coating materials and/or coating thickness.
• Enteric coatings are mixtures of pharmaceutically acceptable excipients which are applied to, combined with, mixed with or otherwise added to the carrier or composition.
• the coating may be applied to a compressed or molded or extruded tablet, a gelatin capsule, and/or pellets, beads, granules or particles of the carrier or composition.
• the coating may be applied through an aqueous dispersion or after dissolving in appropriate solvent.
• the pharmaceutical composition upon oral administration to a human or non-human patient in need thereof, provides controlled release for at least about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 16, 18, 20, 24, 36, 48, 72, 96, 120, 144, or 168 hours.
• sustained release refers release of a drug from its dosage form (e.g., tablet) at such a rate that its blood levels are maintained within the therapeutic range (i.e., at or above minimum effective concentration (MEC)) but below toxic levels over an extended period of time (e.g., about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 16, 18, 20, 22, 24, 36, 48, 72, 96, 120, 144, or 168 hours or greater).
• sustained release may be used interchangeably with “slow-release,” “controlled release,” or “extended release.”
• the sustained release property of a dosage form is typically measured by an in vitro dissolution method and confirmed by an in vivo blood concentration-time profile (i.e., a pharmacokinetic profile).
• the pharmaceutical compositions of the present invention release about 80% to 100% or about 90% to 100% of their pharmaceutically active agents in a linear or near linear fashion for at least about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 36, 48, 72, 96, 120, 144, or 168 hours in an in vitro dissolution analysis.
• Delayed release generally refers to the delivery so that the release can be accomplished at some generally predictable location in the lower intestinal tract more distal to that which would have been accomplished if there had been no delayed release alterations.
• the preferred method for delay of release is coating. Any coatings should be applied to a sufficient thickness such that the entire coating does not dissolve in the gastrointestinal fluids at pH below about 5, but does dissolve at pH about 5 and above. It is expected that any anionic polymer exhibiting a pH-dependent solubility profile can be used as an enteric coating in the practice of the present invention to achieve delivery to the lower gastrointestinal tract.
• Polymers for use in the present invention are anionic carboxylic polymers.
• the coating may comprise shellac, also called purified lac, a refined product obtained from the resinous secretion of an insect This coating dissolves in media of pH>7.
• Colorants, detackifiers, surfactants, antifoaming agents, lubricants, stabilizers such as hydroxy propyl cellulose, acid/base may be added to the coatings besides plasticizers to solubilize or disperse the coating material, and to improve coating performance and the coated product.
• the present invention is directed to a solid oral extended release pharmaceutical dosage form comprising an extended release matrix formulation, the extended release matrix formulation comprising a composition comprising: (1) at least one polyethylene oxide having, based on rheological measurements, an approximate molecular weight selected from the group consisting of at least about 1,000,000; at least about 2,000,000; at least about 3,000,000; at least about 4,000,000; at least about 5,000,000; at least about 6,000,000; at least about 6,000,000; at least about 7,000,000; and at least about 8,000,000; and
• the extended release matrix formulation when subjected to an indentation test has a “hardness” of at least about 200 N.
• the extended release matrix formulation has a hardness or cracking force of at least about 110 N, preferably of at least about 120 N, at least about 130 N or at least about 140 N, more preferably of at least about 150 N, at least about 160 N or at least about 170 N, most preferably of at least about 180 N, at least about 190 N, at least about 200 N, at least about 210 N, at least about 220 N, at least about 230 N, at least about 240 N, or at least about 250 N.
• the extended release matrix formulation optionally has a hardness or cracking force of at least about 110 N, preferably of at least about 120 N, at least about 130 N or at least about 140 N, more preferably of at least about 150 N, at least about 160 N or at least about 170 N, most preferably of at least about 180 N, at least about 190 N, at least about 200 N, at least about 210 N, at least about 220 N, at least about 230 N, at least about 240 N, or at least about 250 N Treatment Regimen
• the dosing protocol is oral ketamine 1 mg/kg 3 times a week for 3 weeks.
• the dosing is oral ketamine 50mg/day, 2 times a day(25 mg) for 6 weeks.
• the dosing protocol was oral 60-240mg twice a day for 4 days (beginning with 60 mg, and titrated to 240mg). Patients’ depression was improved, and the dosage form was well tolerated.
• an oral dosage form comprising an active agent selected from ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, for use in the prevention, treatment, alleviation and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, wherein the prevention, treatment, alleviation and/or management comprises:
• a first dosage course of about 60 mg daily, about 120 mg daily, or about 180 mg daily, of the active agent administered as the oral dosage form;
• a maintenance course comprising a second dosage course of the active agent administered as the oral dosage form.
• the active agent is ketamine, or a pharmaceutically acceptable salt thereof, such as the hydrochloride salt of ketamine
• condition is treatment-resistant depression.
• the patient has not previously received treatment comprising the active agent. In an embodiment, the patient has not previously received treatment comprising ketamine. In an embodiment, the patient has not previously received treatment comprising ketamine administered subcutaneously.
• the first dosage course is about 120 mg daily of the active agent administered as the oral dosage form.
• the first dosage course is administered once daily to the patient.
• the first dosage course is administered to the patient in a fasted state.
• the first dosage course is administered to the patient at least 30 minutes before or after a meal, such as at least 60 minutes before or after a meal.
• the first dosage course is at least 4 days duration, such as at least 5 days duration.
• the first dosage course is administered for 4-7 days, such as 4, 5, 6, or 7 days, conveniently 5 days.
• the second dosage course is about 30 mg, about 60 mg, about 120 mg daily or about 180 mg of the active agent administered as the oral dosage form.
• the second dosage course is administered once a week, twice a week, three times a week, four times a week or seven times a week (daily). Most conveniently, the second dosage course is administered twice a week In a convenient embodiment, the second dosage course is about 180 mg of the active agent administered as the oral dosage form twice weekly.
• the second dosage course is administered to the patient in a fasted state.
• the second dosage course is administered to the patient at least 30 minutes before or after a meal, such as at least 60 minutes before or after a meal.
• the second dosage course is at least 1 month duration, such as at least 2 months, 3 months, 4 months, 5 months, or 6 months duration.
• an oral dosage form comprising an active agent selected from ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, for use in the prevention, treatment, alleviation and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, wherein the prevention, treatment, alleviation and/or management comprises:
• an oral dosage form comprising an active agent selected from ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, for use in the prevention, treatment, alleviation and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, wherein the prevention, treatment, alleviation and/or management comprises:
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, wherein the prevention, treatment, alleviation and/or management comprises:
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of treatment-resistant depression, wherein the prevention, treatment, alleviation and/or management comprises:
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of treatment-resistant depression, wherein the prevention, treatment, alleviation and/or management comprises:
• a maintenance course comprising a second dosage course of about 30 mg to about 180 mg twice weekly of the active agent administered as the oral dosage form.
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of treatment-resistant depression, wherein the prevention, treatment, alleviation and/or management comprises:
• a maintenance course comprising a second dosage course of about 30 mg to about 180 mg twice weekly of the active agent administered as the oral dosage form for at least 4 weeks following completion of the first dosage course.
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of treatment-resistant depression, wherein the prevention, treatment, alleviation and/or management comprises:
• a maintenance course comprising a second dosage course of about 30 mg to about 180 mg twice weekly of the active agent administered as the oral dosage form for at least 4 months following completion of the first dosage course.
• an oral dosage form comprising an active agent of ketamine, or a pharmaceutically acceptable salt thereof, for use in the prevention, treatment, alleviation and/or management in a patient of treatment-resistant depression, wherein the prevention, treatment, alleviation and/or management comprises:
• a maintenance course comprising a second dosage course of about 180 mg twice weekly of the active agent administered as the oral dosage form for at least 4 months following completion of the first dosage course.
• an oral dosage form comprising an active agent selected from ketamine, norketamine, pharmaceutically acceptable salts thereof, and combinations thereof, for use in the prevention, treatment, alleviation and/or management in a patient of a condition selected from the group consisting of depression; treatment-resistant depression; and treatment-resistant anxiety, including but not limited to DSM-V Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder and/or Obsessive-Compulsive Disorder, wherein the prevention, treatment, alleviation and/or management comprises:
• a maintenance course comprising a second dosage course of the active agent administered as the oral dosage form.
• the dosage course or dosage regimen may generally involve regular, such as daily, administration of the compounds as disclosed herein for a period of treatment of, for example, one day, two days, three days, four days, five days, six days, 7 days (one week), 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, two weeks, three weeks, a month, two months, or more.
• the dosage course or dosage regimen may generally involve regular administration for a period of treatment of, for example, 1 - 10 days, 2 - 9 days, 3 - 8 days, or 4 - 7 days.
• the dosage course or dosage regimen may generally involve administration of the compounds as disclosed herein for one course of treatment, two courses of treatment, three courses of treatment, or four or more courses of treatment.
• the dosage course or dosage regimen is sufficient to alleviate the effects of said depression or said treatment-resistant anxiety. In certain embodiments, the dosage course or dosage regimen is sufficient to alleviate the effects of depression or treatment-resistant anxiety for 3 - 7 days after a single course. In certain embodiments, a single course as disclosed herein is sufficient to alleviate the effects of depression or treatment- resistant anxiety for one day, two days, three days, four days, five days, six days, 7 days (a week), 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, two weeks, three weeks, a month, two months, 3 months, 4 months, 5 months, 6 months, 7 months, or 8 months.
• the dosage course or dosage regimen comprises administering to a patient a first dosage course, or induction regimen, comprising a first dosage of about 60 mg, about 120 mg, or about 180 mg, of an active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, administered as an oral dosage form daily for 4 - 7 days.
• the dosage course or dosage regimen comprises administering to the patient a second dosage course, or maintenance regimen, of a second dose of active agent selected from the group consisting of ketamine, norketamine, and combinations thereof, administered as an oral dosage form, further wherein the dosage course prevents, treats, and/or manages a condition in the patient.
• the first dosage course, or induction regimen comprises a first dosage which comprises about 120 mg of said active agent administered as an oral dosage form daily for 4 - 7 days. In certain embodiments, the dosage course or dosage regimen comprises a first dosage course which is administered for 5 days. In certain embodiments, the dosage course or dosage regimen comprises a first dosage course which is administered for 7 days. In certain embodiments, the dosage course or dosage regimen comprises a first dosage comprises one about 120 mg of active agent oral dosage form. In certain embodiments, the dosage course or dosage regimen comprises a first dosage comprises two or more oral dosage forms totaling about 120 mg of active agent daily. In certain embodiments, the dosage course or dosage regimen comprises a second dosage course is administered and is a maintenance dosing phase.
• the dosage course or dosage regimen comprises a second phase, such a as maintenance regimen, dosage which comprises a dosage of about 30 mg of active agent, about 60 mg of active agent, about 120 mg of active agent, or about 180 mg of active agent.
• the dosage course or dosage regimen comprises a second dosage course which comprises administration of a second dosage of active agent to a patient once a week, twice a week, three times a week, or four times a week.
• the dosage course or dosage regimen comprises a second dosage course, such as a maintenance regimen, which comprises administration of a second dosage of active agent to the patient for 1, 2, 3, 4, 5, 6, 7, or 8 or 12 months, or more than one year, or two years, or three years, or four years or five years.
• the dosage course or dosage regimen comprises an oral dosage form which is, for example, a tablet.
• Dosage forms can be administered to the patient on a regimen of, for example, one, two, three, four, five, six, or other doses per day. Dosage forms can be administered to the patient on a regimen of, for example hourly, every 4 hours, every 6 hours, every 8 hours, and every 12 hours
• the dosage course or dosage regimen may generally involve administration of the compounds as disclosed herein at a dose of about 1 mg/day, about 2 mg/day, about 5 mg/day, about 10 mg/day, about 15 mg/day, about 20 mg/day, about 25 mg/day, about 30 mg/day, about 35 mg/day, about 40 mg/day, about 45 mg/day, about 50 mg/day, about 60 mg/day, about 70 mg/day, about 80 mg/day, about 90 mg/day, about 100 mg/day, about 120 mg/day, about 125 mg/day, about 140 mg/day, about 150 mg/day, about 160 mg/day, about 175 mg/day, about 180 mg/day, about 190 mg/day, about 200 mg/day, about 225 mg/day, about 240 mg/day, about 250 mg/day, about 275 mg/day, about 300 mg/day, about 325 mg/day, about 350 mg/day, about 375 mg/day, about 400 mg/day, about 425 mg/day, about 450
• the active substances in the amounts described above, may be compounded according to accepted pharmaceutical practice with a physiologically acceptable vehicle, carrier, excipient, binder, preservative, stabilizer, flavor, etc., in the particular type of unit dosage form
• a physiologically acceptable vehicle carrier, excipient, binder, preservative, stabilizer, flavor, etc.
• the present invention is not deemed to be limited thereto.
• Example 2 Study ZPS-603 (Study 603) was a hybrid study design with 4 cohorts and multiple study objectives. The objectives of Cohorts 1, 2 and 3 were to evaluate the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of an extended release ketamine oral formulation in healthy volunteers after single dose and multiple doses. The design was a double-blind, placebo-controlled single and multiple ascending dose study in healthy volunteers. Doses were 60mg, 120mg and 240mg for Cohorts 1, 2 and 3 respectively. Each dose level was initially given as a single dose, then one week later as 5 doses given at 12-hour intervals. Endpoints included safety, tolerability, ketamine and norketamine PK, and PD (suicidality assessments, and dissociative symptom rating scale scores).
• Cohort 4 was to evaluate efficacy, safety, PK and PD of an extended release ketamine oral formulation in patients with treatment-resistant depression and/or treatment-resistant anxiety (TRD/TRA). Patients were selected based on prior demonstrated mood response to subcutaneous ketamine, and clinically significant scores on the Montgomery Asberg Depression Rating Scale (MADRS; Montgomery 1979) and/or the Hamilton Anxiety Scale (HAMA; Hamilton 1 59). The design was an open label multiple ascending dose study. The initial dose was 60 mg, and could be escalated by an additional 60 mg 12 hourly, based on assessment of mood symptoms, to a maximum dose of 240 mg, with a total of 7 doses given 12 hourly between 0 and 72 hours. Endpoints included safety, tolerability, ketamine and norketamine PK, and PD (mood ratings including the Fear Questionnaire (FQ; Marks 1979), HAMA and MADRS, and dissociative symptom rating scale scores).
• a protocol amendment added a further obj ective to Cohort 4, namely to evaluate the safety and efficacy of up to 3 months dosing of the extended release ketamine oral formulation in patients with TRD/TRA, who responded to treatment in the initial 96 hour ascending dose phase of ZPS-603, in an open-label extension (OLE) treatment phase. Endpoints for the OLE were similar to those of the initial 96 hour ascending dose phase of ZPS-603.
• CADSS Mean CADSS scores over time are shown in Figure 2. Minor increases were noted at 3 hours after single dosing in Cohorts 1 and 3 ( Figure 2A), and at 3-12 hours after the first dose in the multiple dose phase for Cohort 3 ( Figure 2B). (It should be noted that the maximum score on this scale is 84 points and that these are minimal changes compared with subcutaneous or IV ketamine dosing). Suicidality Ratings: No participants reported suicidal ideation at any time in Cohorts 1-3, as assessed by the Columbia Suicide Severity Rating Scale.
• Figure 3 shows mean concentration-time profiles of ketamine and norketamine after single and multiple doses of 60, 120 and 240mg. Concentrations of both analytes were relatively stable for 5-10 hours after dosing, consistent with the sustained release characteristics of the tablet. Norketamine concentrations were approximately 10-fold higher than ketamine concentrations in both plots, reflecting extensive first pass metabolism after oral dosing. For all 3 cohorts, ketamine and norketamine pharmacokinetic parameters appeared to follow first order kinetics, specifically AUC and Cmax were dose proportional after single and multiple doses of ketamine 60mg, 120 mg and 240 mg extended release tablets (Figure 4).
• Table 5 Summary of pharmacokinetic characteristics for the R-107 tablet compared with published data for an immediate release ketamine tablet
• Table 5 provides a summary of pharmacokinetic characteristics after single dose oral administration of ketamine using the R-107 tablet compared with published data for an immediate release ketamine tablet (*Yanagihara, Y. et al. Plasma Concentration Profiles of Ketamine and Norketamine after Administration of Various Ketamine Preparations to Healthy Japanese Volunteers. Biopharm Drug Dispos 24: 37-43 (2003)), and for subcutaneous dosing of ketamine solution (Glue and Medlicott, unpublished data).
• the ratio of norketamine to ketamine for R-107 Cmax and AUC was substantially larger compared with injected ketamine solution and an oral immediate release tablet.
• Tmax for both ketamine and norketamine was delayed after R-107 oral dosing compared with injected ketamine solution and an oral immediate release tablet.
• the results for R-107 are unexpected, in that it is not possible to predict the pharmacokinetic behavior of an extended release tablet in humans, based on in vitro dissolution data.
• the ratio of norketamine to ketamine would be higher for the oral route of administration, because of first pass metabolism, it was unknown and could not be predicted what the magnitude or effect of this change would be prior to testing in humans.
• the norketamine:ketamine ratios for AUC and Cmax were larger than anticipated.
• Table 6 presents the individual data for the determination of the pharmacokinetic characteristics after single dose oral administration of ketamine using the R-107 tablet compared with published data for an immediate release ketamine tablet (*Yanagihara, Y. et al Plasma Concentration Profiles of Ketamine and Norketamine after Administration of
• Table 7 presents the Single Dose Ketamine and Norketamine Pharmacokinetic
• Table 8 presents the Multiple Dose Ketamine and Norketamine Pharmacokinetic
• Table 9 presents the Single Dose Pharmacokinetics for Ketamine in Cohorts 1 - 3.
• Table 10 presents the Single Dose Pharmacokinetics for Norketamine in Cohorts 1 - .
• Table 11 presents the Multiple Dose Pharmacokinetics for Ketamine in Cohorts 1 - 3.
• Table 12 presents the Multiple Dose Pharmacokinetics for Norketamine for Cohorts 1 - 3.
• CADSS Mean CADSS scores over time are shown in Figure 5 A. Mean CADSS scores tended to decrease over time. This contrasts markedly from the change in CADSS scores after subcutaneous (SC) ketamine.
• Figure 5B shows mean CADSS scores up to 3 hours after oral and SC dosing, in six of seven Cohort 4 participants with both sets of data Overall, multiple dose oral ketamine was not associated with dissociative symptoms, as evaluated by the CADSS scale.
• HAMA and FQ Individual and group mean HAMA and FQ scores by timepoint are shown in Figure 6 (6A: HAMA; 6B: FQ) There was a consistent trend for both scores to decrease over time, most noticeably in patients with higher baseline scores. The trend for gradual improvement in anxiety contrasts markedly from the rapid reduction in anxiety scores after subcutaneous (SC) ketamine.
• Figure 7 shows mean HAMA scores after oral and SC dosing, in six of seven Cohort 4 participants with both sets of data. All seven participants were assessed to be treatment responders (>50% reduction) based on changes in HAMA scores, and six of seven participants were responders based on changes in FQ scores.
• MADRS Individual and group mean MADRS scores by timepoint are shown in Figure 8.
• Figure 9 shows smoothed mean depression (MADRS; 9A) and anxiety (FQ, HAMA; 9B and C) scores in 3 patients in Cohort 4, who entered a subsequent 3 month open-label extension (OLE) phase. All three patients reported improvements in mood ratings during this time. Mean depression ratings appeared to take 6 weeks for maximal improvement (Figure 9A), whereas mean maximal anxiety scale improvement appeared to occur by week 2 ( Figures 9B, 9C).
• Figure 10 shows mean concentration-time profiles of ketamine and norketamine over 96 hours in Cohort 4. Dose-related increases in both ketamine and norketamine plasma concentrations were noted out to 48h, as patients continued to take higher doses. Norketamine concentrations were consistently higher than ketamine concentrations at all time points, reflecting extensive first pass metabolism. The data indicate a large inter- subject and intra-subject variation in the PK profiles.
• NK:K norketamine:ketamine
• Example 3 Phase 2a study evaluating R-107 for the treatment of patients with Treatment-Resistant Depression (TRD) BEDROC study
• the R107-C205 (BEDROC) study evaluated the efficacy of the extended release R- 107 tablets (prepared according to Example 1) as measured by the change in Montgomery- Asberg Depression Rating Scale (MADRS) score from baseline (Day 1) to Day 92 in subjects with TRD who have responded to 1 weeks’ treatment with R-107 120 mg daily.
• MADRS Montgomery- Asberg Depression Rating Scale
• the dosage regimen used in the BEDROC study was also different to that employed for cohort 4 of the study described in Example 2.
• Phase 1 4-week screening phase (Day -28 to -1);
• Phase 2 1-week rapid-action/enrichment phase (first treatment phase) (Days 1-5):
• Phase 3 12-week maintenance phase (second treatment phase) double-blind (Day 8- 92):
• Phase 4 4-week post-treatment follow-up phase.
• MADRS score - ‘response’ defined as >50% reduction in the initial score and ‘remission’ defined as a total score of ⁇ 10.
• CGI-S Clinical Global Impression Severity Score
• CADSS Clinician-Administered Dissociative States Scale
• the R107-C206 (BEDROC-1) study is an open-label extension of the BEDROC study lasting 169 days (6 months) for subjects with TRD who relapsed or responded to treatment in the BEDROC study. They were initially dosed with R-107 120 mg twice weekly. Site visits conducted on Days 15, 29, 57, 85, 113 and 141 assessed the dose and the dose could be adjusted up or down by one strength (e.g. 60 mg to 120 mg or 120 mg to 180 mg, or vice versa) by the treating Psychiatrist. That dose was taken twice weekly until the subsequent visit, or follow-up treatment. Preliminary results for BEDROC-1 are described below.
• Phase 3 (second treatment phase), a randomized blinded “maintenance” phase in 5 arms as described above.

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