WO2023031860A1 - Compositions, trousses et méthodes pour fournir des effets synergiques et/ou additifs d'ingrédients inclus pour la prévention, le traitement et la prise en charge des nausées et des vomissements - Google Patents

Compositions, trousses et méthodes pour fournir des effets synergiques et/ou additifs d'ingrédients inclus pour la prévention, le traitement et la prise en charge des nausées et des vomissements Download PDF

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WO2023031860A1
WO2023031860A1 PCT/IB2022/058241 IB2022058241W WO2023031860A1 WO 2023031860 A1 WO2023031860 A1 WO 2023031860A1 IB 2022058241 W IB2022058241 W IB 2022058241W WO 2023031860 A1 WO2023031860 A1 WO 2023031860A1
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salt
vitamin
ginger
phosphate
pharmaceutical composition
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Mihir PATEL
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PATEL, Natvarlal Hargovinddas
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    • 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
    • A61K31/66—Phosphorus compounds
    • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
    • 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
    • A61K31/12—Ketones
    • 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
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4402—Non condensed pyridines; Hydrogenated derivatives thereof only substituted in position 2, e.g. pheniramine, bisacodyl
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4415—Pyridoxine, i.e. Vitamin B6
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A61K31/52—Purines, e.g. adenine
    • A61K31/522—Purines, e.g. adenine having oxo groups directly attached to the heterocyclic ring, e.g. hypoxanthine, guanine, acyclovir
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
    • A61K31/5415—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame ortho- or peri-condensed with carbocyclic ring systems, e.g. phenothiazine, chlorpromazine, piroxicam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00—Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18—Magnoliophyta (angiosperms)
    • A61K36/88—Liliopsida (monocotyledons)
    • A61K36/906—Zingiberaceae (Ginger family)
    • A61K36/9068—Zingiber, e.g. garden ginger
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • 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
    • A61K9/0056—Mouth soluble or dispersible forms; Suckable, eatable, chewable coherent forms; Forms rapidly disintegrating in the mouth; Lozenges; Lollipops; Bite capsules; Baked products; Baits or other oral forms for animals
    • 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
    • A61K9/006—Oral mucosa, e.g. mucoadhesive forms, sublingual droplets; Buccal patches or films; Buccal sprays
    • 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
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A61K9/2054—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
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/08—Drugs for disorders of the alimentary tract or the digestive system for nausea, cinetosis or vertigo; Antiemetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • the present invention relates to compositions, kits and methods for the prevention, treatment and management of nausea and vomiting with a known or unknown underlying cause, including but not limited to pregnancy, motion sickness, drug use, alcohol use, gastroenteritis, polycystic ovary syndrome, anti-cancer treatment and surgery.
  • nausea refers to a sense of an urge to vomit, while ‘vomit’ is the oral expulsion of the gastrointestinal content.
  • Nausea and vomiting could be acute or chronic.
  • Nausea and vomiting are symptoms of an underlying condition such as pregnancy, motion sickness, drug use, alcohol use, gastroenteritis, polycystic ovary syndrome (PCOS), anti-cancer treatment and surgery.
  • Nausea and vomiting are an outcome of stimulation of receptors in the CNS and gut through various mechanisms.
  • NVP Nausea and vomiting in pregnancy referred herein as NVP could be frequent or infrequent and may even last throughout the pregnancy in some women. It could be mild or severe to the extent that it may require frequent pharmacological and/or non-pharmacological interventions. Severe NVP is known as hyperemesis gravidarum and may require treatment in the hospital. Pathophysiology of NVP are hormones, neurotransmitters and receptors mediated.
  • Drugs can trigger nausea, and/or vomiting in some patients, and it is subjective. Besides anticancer drugs, some other drugs may induce NV in some patients. Commonly known drugs that cause NV include anti-depressants, opioids, anti-inflammatories, contraceptives, hormone replacement therapy (HRT) drugs and anti-psychotics. Drug-induced NV generally occurs when new drug treatment is initiated and often goes away after several days of continuation of the drug. In some conditions, medication is necessary to prevent, treat and manage NV associated with a drug. Withdrawal of some medication can also cause NV.
  • HRT hormone replacement therapy
  • Motion sickness is the feeling of being sick because of a motion. Receptors in the CNS and gut are activated when the body struggles to adjust with the motion; the brain receives conflicting information from the inner ears, eyes and nerves. Common symptoms of motion sickness are nausea with or without vomiting. Travel sickness, seasickness, airsickness, train sickness are types of motion sickness. It can also be caused by swinging, bumping, rotation, deceleration movement and various reasons.
  • Gastroenteritis is the gut inflammation caused by the virus, bacteria, fungi, parasites, toxins or drugs, sometimes referred as ‘stomach bug’, stomach flu or food poisoning. Besides nausea and vomiting, diarrhoea, stomach cramps, fever, and headaches are also symptoms of gastroenteritis.
  • homocysteine In Polycystic ovary syndrome (PCOS), levels of an amino acid named homocysteine remain high. High levels of homocysteine increase inflammation, oxidative stress and increase the risk of atherosclerosis and thrombosis. In addition, high homocysteine level causes nausea, vomiting and fatigue. Vitamin B6 plays an essential role in the breakdown of homocysteine.
  • PCOS Polycystic ovary syndrome
  • CINV Chemotherapy- induced nausea and vomiting
  • AINV anti-cancer treatment induced nausea and vomiting
  • PONV Post-Operative Nausea and Vomiting
  • US patent no. 20070048367 relates to a herbal composition for treating morning sickness and includes a mixture of vitamin B6, folic acid, ginger root extract, and red raspberry leaf.
  • US patent no. US20170049759 & EP patent no. EP3337480 relates to transdermal delivery of doxylamine and pyridoxine.
  • the formulation includes doxylamine or its salts, pyridoxine or its salts or its active metabolites, and a vehicle system wherein pharmaceutical compositions are liquid formulations, semisolid formulations, and polymer matrices for treatment of nausea and vomiting in general and pregnant women in particular.
  • WO patent no 2000066082 & AU patent no. 2000049779 relates to anti-nausea compositions and methods. It discloses novel nutritional anti-nausea compositions, anti-emetic compositions, and methods of using the same.
  • the compositions comprise a vitamin B6 compound or derivative thereof; an alkaline buffering agent, an acceptable coating agent; and wherein the vitamin B6 compound or derivative thereof is separated from the alkaline buffering agent by the said acceptable coating agent.
  • US patent no. 6340695 relates to a rapid onset formulation, preferably in the form of an enteric- coated tablet, for a medicament comprising a synergistic duo of active ingredients, namely, doxylamine succinate and pyridoxine HC1, for the treatment of nausea and vomiting, especially, but not limited to, during pregnancy.
  • active ingredients namely, doxylamine succinate and pyridoxine HC1
  • US patent no. 20140314680 relates to a dual release oral dosage system/dosage form comprising an immediate release component/composition and a delayed-release component/ composition comprising one or more of doxylamine, an analog thereof, a derivative thereof, a prodrug thereof, a metabolite thereof and/or a salt thereof, and one or more of pyridoxine, a salt thereof, a metabolite thereof and/or a salt of the metabolite for the prevention and/or treatment of nausea and vomiting in pregnancy (NVP).
  • NDP nausea and vomiting in pregnancy
  • US patent no. 20140335176 relates to a delayed release formulation containing doxylamine succinate and pyridoxine hydrochloride as the active ingredients in a dis integrant-free formulation and processes for manufacturing the same.
  • US patent no. 20160058709 relates to plurimodal release formulation of metabolites and salts of doxylamine and pyridoxine.
  • the patent covers the formulation with these active ingredients as component of enteric coating within the enteric- coated formulation comprising these active ingredients.
  • Indian patent no. 202021002251 relates to a solid oral composition of doxylamine succinate, pyridoxine hydrochloride in combination with ginger powder as a natural extract as synergistic additive.
  • SUBSTITUTE SHEET (RULE 26) It provides the solid oral composition in the form of granules/powder filled into sachets or compressed into tablets, especially chewable tablets for the treatment of nausea and vomiting.
  • US patentno. 20110280976 relates to methods for making and using gingerols fortreating nausea and emesis associated with cancer chemotherapy.
  • the methods feature supercritical, critical and near- critical fluids with and without polar cosolvents.
  • US patent no. 20110028436 relates to oral combination of vitamins for treating and preventing nausea and other disorders.
  • the compositions comprise vitamins as active ingredients, including vitamin B6 and its metabolites, vitamin K, and vitamin C, and a method for treating nausea or morning sickness with the oral compositions.
  • US patent no. 20130171279 relates to composition for reducing side- and after-effects of cancer treatment. It includes three core components: whey protein, hepatoprotectant and/or nephroprotectant agents and, anti-emetic agent(s) such as ginger and/or peppermint.
  • US patent no. 20100291057 relates to a composition for reducing oxidative stress and/or side effects occurring during cancer chemotherapy or improving a nutritional status during cancer chemotherapy.
  • the composition comprises the following components (a) to (f): (a) an antioxidant agent; (b) at least one component selected from the group consisting of vitamin Bl, vitamin B2, vitamin B6, niacin, and pantothenic acid; (c) at least one component selected from the group consisting of folic acid, vitamin Bl 2, and vitamin A; (d) zinc; (e) selenium; and (f) coenzyme Q10.
  • WO patent no. 1986002553 is a nasal administration of known anti-nausea and anti-emetic therapeutic agents and dosage forms which discloses the use of selected antihistamines, anticholinergics, piperazines, phenothiazines, substituted butyprophenes and metoclopramide.
  • US patent no. 4624965 relates to novel method of administering anti-nausea and anti-emetic agents and to novel dosage forms which includes the use of brompheniramine, promethazine, cyproheptadine, dimenhydrinate, meclizine, cyclizine, chlorcyclizine, buclizine, trimethobenzamide, benzquinamide metoclopramide, diphenhydramine, doxylamine, methapyrilene and tripelennamine for nasal administration.
  • US patent no. 20200113856 relates to a compounded non-prescription medication for the treatment of motion sickness.
  • the medication comprises: at least one analgesic selected from the group consisting of acetaminophen, ibuprofen, naproxen and salicylates; at least one histamine H2-receptor antagonist selected from the group consisting of nizatidine, famotidine, cimetidine, ranitidine.
  • SUBSTITUTE SHEET (RULE 26) famotidine; and at least one antacid selected from the group consisting of calcium carbonate, sodium bicarbonate, magnesium hydroxide, aluminum hydroxide, and bismuth subsalicylate. It may optionally comprise at least one additional ingredient selected from the group consisting of spearmint extract and ginger extract.
  • US patent no. 08137709 relates to fast-acting nausea formula which comprise of ginger root, gelatin, a fruit flavouring, and mint.
  • CN patent no. 106492159 relates anti-motion sickness drug which discloses the use of fresh ginger, fructus amomi, orange peel, chrysanthemum, and wild jujube.
  • Sedative antihistamines such as doxylamine, promethazine, dexchlorpheniramine, cyclizine, diphenhydramine, dimenhydrinate is present in several products. Many formulations are available containing metoclopramide, prochlorperazine, ondansetron, and are used worldwide for NV.
  • Vitamin B6 is included in treatment guidelines by several health authorities worldwide to prevent, treat, and manage NVP.
  • a product called Elevit® morning sickness tablets containing vitamin B6, and ginger is available without prescription in Australia and is being marketed for NVP.
  • a fixed-dose combination of doxylamine succinate (20mg) and vitamin B6 (20mg pyridoxine hydrochloride) is being marketed under the brand name Bonjesta® in the USA for the management of NVP in women who have not improved with the change in diet or other non-medicine treatments.
  • Dicl ectin® a combination of 10 mg doxylamine succinate and 10 mg vitamin B6 (pyridoxine hydrochloride) in a delayed-release tablet formulation, is available in Canada for women who have not benefited from the other therapies.
  • Anti-emetics currently used for AINV include dopamine receptor antagonists such as metoclopramide, prochlorperazine, promethazine and haloperidol; serotonin (5HT3) receptor antagonists such as granisetron, ondansetron, palonosetron, tropisetron; neurokinin- 1 receptor antagonists (NK1 RA) such as aprepitant, netupitant.
  • dopamine receptor antagonists such as metoclopramide, prochlorperazine, promethazine and haloperidol
  • serotonin (5HT3) receptor antagonists such as granisetron, ondansetron, palonosetron, tropisetron
  • NK1 RA neurokinin- 1 receptor antagonists
  • Other anti-emetics used in AINV are dexamethasone (a steroid), olanzapine (for their inhibitory effects on 5HT3 and dopamine receptors) and cannabinoids (not commonly used).
  • SUBSTITUTE SHEET (RULE 26) with dimenhydrinate (sedative antihistamine) is available under the brand name Travacalm Original® to prevent and treat motion sickness.
  • Doxylamine succinate 25 mg is available as ‘Pharmacist Only Medication’ for the temporary relief of insomnia or sleeplessness.
  • the present invention is an improvement over the prior art in that it delivers the compositions, kits, and methods for the prevention, treatment, and management of NV via the pharmacological actions of the comprised ingredients into multiple pathophysiological mechanisms involved.
  • Prior-art (Restavit®, Phenergan®, Polaramine®) products with only sedative antihistamine as antiemetic ingredient increase sedation when administered at higher doses to achieve a higher anti-emetic effect.
  • the present invention provides compositions, kits, and methods that do not have the same disadvantage because these compositions achieve a higher anti-emetic effect with the lower dose of antihistamine via synergistic and/or additive effect of other comprised ingredients.
  • the present invention also provides compositions, kits and methods that enable the use of sedative antihistamines when sleep is desirable.
  • Prior art (Restavit®, Phenergan®, Polaramine®) products containing sedative antihistamine are ‘Pharmacist Only Medicine’. These products either do not have treatment of NV as an approved indication or has a warning statement on the packaging indicating possible harm if used during pregnancy 1 . Hence, the refusal by the pharmacist for the supply of these products for the treatment of NVP is common.
  • Prior art product containing doxylamine provides this sedative antihistamine at a higher dose of 25mg only. Therefore, the patient requires to cut the tablet in half to obtain a lower dose.
  • the present invention provides a lower dose of this antihistamine.
  • compositions with both short and long- acting antihistamines are useful when sedation for 8 hrs or more is desired, whereas a composition comprising dexchlorpheniramine or other short-acting antihistamines is helpful when sedation for more than 6 hrs is to avoid.
  • Products containing sedative antihistamine as a single ingredient are not always the treatment option for all patient following their accessibility issues and concerns over adverse effects.
  • the present invention alleviates the need for caffeine which is included in a prior art (Travacalm original®) to counterbalance the sedative effect of sedative antihistamine.
  • the present invention achieves this objective by not solely relying on sedative antihistamine to provide the anti-emetic effect.
  • the present invention provides compositions, kits, and methods comprising one or more (activated and/or one or more inactivated) forms of vitamin B6 and ginger (in standardised and/or non-standardised forms) to achieve the anti-emetic effect.
  • NV is one of the symptoms of deficiency of vitamin B6.
  • Vitamin B6 plays a vital role in the nervous system, metabolism pathways of NV. The body does not store vitamin B6, so people need to get from their daily diets 6 .
  • Pyridoxal 5 ’-phosphate, pyridoxine 5’ phosphate, and pyridoxamine 5’ phosphate are activated forms of vitamin B6 7 ; and are also known as P5P or PLP, PNP, PMP, respectively.
  • the conversion process from the inactive to the active form of vitamin B6 is enzymedependent 8,9 . Following the prevalence of relevant enzyme deficiencies, this conversion process does not occur the same way in all individuals.
  • vitamin B6 Activated and inactivated forms of vitamin B6 levels are affected in patients with impaired liver functions 10 . Activated vitamin B6 levels are lower in a patient with Methylenetetrahydrofolate reductase (MTHFR) gene deficiency 11 and PCOS 12 .
  • MTHFR Methylenetetrahydrofolate reductase
  • An activated and inactivated form of vitamin B6 may be a more efficient therapy for morning sickness 13 . Addressing underlying deficiency of vitamin B6 would result in better outcome compared to only managing the symptoms of NV using pyridoxine hydrochloride (an inactivated form of vitamin B6)
  • SUBSTITUTE SHEET (RULE 26) and/or sedative antihistamine and/or 5H3 receptor antagonist comprised in other prior art products which do not contain an activated form of vitamin B6.
  • the activated form of vitamin B6 is better anti-emetic than the inactive form of vitamin B6 for the management of NV 14 .
  • the present invention provides compositions, kits, and method that addresses this underlying cause better than other prior art (Elevit Morning Sickness Relief®’ Pyridox®) products.
  • the chemical constituents of ginger vary significantly with species and geographical source 15 . Also, all constituents of ginger do not have identical biological and physiological properties 16 , 17 . Ginger is dried using different drying methods, and the chosen method impacts the constituents of the product at the end 18 .
  • the anti-emetic properties of ginger are mainly due to active constituents from groups called ‘gingerols’ and ‘shogaols’ 19 . Hence the therapeutic effect of all products containing ginger in nonstandardised forms cannot be assumed the same.
  • volume after the extraction of gingerols and shogaols required to achieve the anti-emetic effect is much lesser than the volume of raw ginger powder containing the same amount of gingerols and shogaols.
  • the present invention provides compositions comprising gingerols and shogaols in standardised forms, thereby provide unit doses with smaller volume, which would be hard to administer otherwise.
  • the present invention provides scientifically identified anti-emetic ingredients of ginger in therapeutic doses. Compositions comprising such ingredients are more likely to be accepted and recommended by health care practitioners compared to ‘raw’ ginger present in prior art products.
  • Inconsistencies persist between guidelines accessed by GP, hospital doctors and, interpretation of the approved Indications and warnings on packaging, for management of NV by pharmacists.
  • the present invention also provides compositions, kits, and methods without scheduled ingredients. These embodiments achieve anti-nausea and anti-emetic effects via constituents of ginger (in standardised and/or in non-standardised forms) and vitamin B6 (activated and/or inactivated forms) only.
  • the present invention makes anti-emetic treatment options more accessible (without the intervention of a pharmacist or a doctor) to patients. Hence, it also reduces the health care cost of the government.
  • Schedule 4 treatment options such as 5HT3 antagonists are expensive and subsidised by Pharmaceutical Benefits Scheme (PBS) only for the management of AINV.
  • PBS Pharmaceutical Benefits Scheme
  • cost to the patient for 10 tabs of 8 mg Ondansetron is $32.19 21 , the cheapest 5HT3 antagonist available under PBS.
  • NV involves multiple pathophysiological mechanisms.
  • the present invention comprises multiple anti-emetic ingredients to provide additive and/or synergistic effects by acting on more than one pathophysiological mechanism.
  • compositions comprising standardised ginger and sedative antihistamines that target receptors present in both the CNS and gut. [0060] Some people do not endorse and/or suggest using anything that is not ‘organic’ and/or ‘natural’.
  • the present invention also provides compositions comprising one or more activated forms
  • SUBSTITUTE SHEET (RULE 26) and/or one or more inactivated forms of vitamin B6 and/or ginger in standardised or in nonstandardised forms, which would suit better to such population.
  • Uncomplicated NV does not always require attention from the doctor. Uncomplicated but uncontrolled NV leads to hospitalisations which increases the use of healthcare resources. Regardless of the underlying cause, NV increases socioeconomic cost and reduces the productivity of patient. A study concluded that the NVP often remains untreated or undertreated.
  • the present invention provides choices of anti-emetic compositions, kits, and methods to suit various patient populations.
  • the present invention has the advantage of providing flexibility to a subject experiencing NV to have a composition that treats NV at a time when a sedative or calmative effect is not required or to be avoided. For example, during work hours, when operating a machine or when attending to
  • SUBSTITUTE SHEET (RULE 26) dependents, but also provides a composition that treats NV that further includes a sedative or calmative for assisting the subject to relax or fall asleep.
  • the objective of the present invention is to achieve anti-nausea and anti-emetic effects via the actions of comprised ingredients on multiple pathophysiological mechanisms.
  • the present invention provides compositions, kits, and methods that deliver anti-nausea and anti-emetic effects from at least two of the pharmacological approaches below: a. Suppressing receptors in the gastrointestinal tract, b. Suppressing receptors in the central nervous system (CNS), c. Reduction in oxidative stress (antioxidant properties), d. Addressing underlying vitamin B6 deficiency.
  • Core ingredients of the present invention provide anti-nausea and anti-emetic properties by working on the same or different aspect of the pathophysiology of nausea and vomiting.
  • Core ingredients of the present invention are; a. inactivated form(s) of vitamin B6, b. activated form(s) of vitamin B6, c. ginger in non-standardised forms, d. ginger in standardised form(s), e. sedative antihistamine(s).
  • Vitamin B6 delivers anti-nausea and anti-emetic effect by reducing oxidative stress and addressing underlying vitamin B6 deficiency 22,23, 24 .
  • Vitamin B6 is one of the most central molecules in cellular metabolism. Nausea and/or vomiting can be a symptom of vitamin B6 deficiency because of various underlying reasons at the cellular level. Role of vitamin B6 extends to several metabolism processes.
  • Vitamin B6 levels are reduced during the pregnancy, and hence vitamin B6 is helpful to manage the NVP 25 .
  • Vitamin B6 is useful treatment option in other forms of nausea too 26,27
  • Amino acids are the building blocks of protein. Active co-enzyme or phosphorylated or also referred herein as the activated form of vitamin B6 plays the crucial role in the biosynthesis and degradation of amino acids. Neurotransmitters are required for communication in-between nerve cells
  • SUBSTITUTE SHEET (RULE 26) and between nerve cells and other cells. Synthesis of these neurotransmitters requires enzymes. These enzymes use vitamin B6 as co-enzymes.
  • Activation of vitamin B6 from an inactivated form is enzyme dependent. Considering the underlying cause of nausea, for some patients activated form of vitamin B6 could be more useful than the inactivated form of vitamin B6 or vice versa.
  • the present invention provides compositions comprising one or more activated forms of vitamin B6 with or without one or more inactivated forms of vitamin B6.
  • P5P Pyridoxal 5'-phosphate
  • Vitamin B6 plays positive role in glutathione reductase dependent antioxidant system and provides defence against free radicals 29 .
  • Alcohol consumption increases oxidative stress 30 and is primary cause of nausea related to alcohol use. Oxidative stress contributes to inflammation of GI tract during gastroenteritis. Hence managing inflammation would help to manage nausea related to gastroenteritis.
  • Ginger delivers anti-nausea and anti-emetic effect by suppressing receptors in the gastrointestinal tract 31 and in the central nervous system (CNS) 32 , and by reducing oxidative stress.
  • CNS central nervous system
  • the present invention delivers embodiments comprising ginger as in standardised and nonstandardised forms.
  • Pharmacological actions in both the forms of ginger are from the constituents of ginger. Some constituents of ginger act on receptors in GI tract whereas some on the receptors of the CNS 33 . Considering the cost and underlying cause of nausea, ginger in standardised forms may be more suitable than non-standardised forms or vice versa.
  • Anti-cancer treatments triggers chemoreceptor trigger zones and results in higher expression of 5HT receptors 34 .
  • antagonism of 5-HT receptors results in anti-nausea and anti-emetic effects.
  • Constituents of ginger with smaller molecular weight such as 6-gingerol, 8-gingerol and 6-shogaol can penetrate the blood brain barrier 36 .
  • the ginger acts peripherally, within the gastrointestinal tract, by increasing the gastric tone and motility due to anticholinergic and anti-serotonergic actions mainly due to action on serotonin (5 -hydroxytryptamine, 5-HT3, and 5-HT4) and cholinergic (M3) receptor activities.
  • Gingerol also has powerful anti-inflammatory and antioxidant effects and may help to reduce oxidative stress, which results from an excessive amount of free radicals in the body. Gingerols and shogaols have higher antioxidant properties 37 .
  • Sedative antihistamines deliver anti-nausea and anti-emetic effects via suppression of Hl receptors in the CNS and gut. Sedative antihistamines can also cross the blood brain barrier (BBB). Sedative antihistamines’ anti-nausea and anti-emetic effects are from their actions on receptors of vomiting centre after crossing the blood brain barrier, receptors of CTZ (also known as area postrema or AP) without crossing the BBB and receptors of the gut. Some sedative antihistamines have anticholinergic properties and ability to block muscarinic receptors in the CNS and gut. The sedating antihistamines also have a calmative, relaxant, and muscle relaxant properties.
  • BBB blood brain barrier
  • the sedating antihistamines used herein have an anti-emetic effect and are particularly useful for treating nausea and vomiting related to pregnancy, drugs induced, alcohol induced, motion sickness, gastroenteritis, PCOS, anti-cancer treatment and surgery. 38 ’ 39,40 ’ 41 ’ 42 -
  • CTZ also known as area postrema (AP) is located outside the blood brain barrier, within the dorsal surface of medulla oblongata, on the floor of the fourth ventricle of the brain.
  • Emetic agents in the blood are detected by the receptors present in the CTZ which induces vomiting.
  • the present invention provides compositions with ingredients that acts on receptors of CNS including receptors of CTZ (without crossing the BBB), receptors of vomiting centre (after crossing the BBB).
  • Chemoreceptor trigger zone contains dopamine (D2), serotonin (5-HT3), muscarinic (Ml), histamine (Hl), opioid and NK1 receptors.
  • Vestibular centre contains histamine(Hl) and muscarinic (Ml) receptors, serotonin (5-HT3), dopamine (D2) and NK1 receptors.
  • Vomiting centre contain serotonin (5-HT3) and muscarinic (Ml) receptors.
  • GI track nerves (and other periphery nerves) contains serotonin (5-HT3), dopamine(D2) and NK1 receptor.
  • the present invention delivers synergistic and/or additive anti-nausea and anti-emetic effects by combining Hl receptor antagonists (sedative antihistamines), muscarinic receptor antagonists (promethazine, doxylamine, diphenhydramine, dimenhydrinate, (6)-gingerol, (8)-gingerol, (10)- gingerol, and (6)-shogaol), dopamine receptor antagonists (promethazine, dimenhydrinate), cholinergic receptor antagonists (promethazine, cyclizine, dexchlorpheniramine, dimenhydrinate), 5-HT antagonists (promethazine, (6)-gingerol, (8)-gingerol, (lO)-gingerol, and (6)-shogaol), Neurokinin 1 (NK1) antagonists ((6)-gingerol, (8)-gingerol, (lO)-gingerol, and (6)-shogaol), and antioxidants (activated and inactivated B6, ginger
  • the present invention relates to a pharmaceutical composition
  • a pharmaceutical composition comprising:
  • a ginger extract containing gingerols, shogaols, paradols, or combination thereof is present in an amount in a range of about 0.5mg to 500 mg,
  • pyridoxal 5’ -phosphate is present in an amount in a range of about Img to 200mg,
  • the pharmaceutical composition comprise one or more form(s) of iron, wherein one or more form(s) of iron is selected from the group comprising ferrous sulfate, ferrous gluconate, ferric citrate, ferric sulfate, iron glycinate, ferric pyrophosphate, ferrous fumarate, iron bisglycinate, iron protein succinylate, or combination thereof.
  • the pharmaceutical composition further comprise one or more activated or inactivated form(s) of folic acid, or metabolite(s) of folic acid, or combination thereof, wherein one or more form(s) of folic acid is selected from the group comprising folic acid, folinic acid, calcium folinate, levomefolate calcium, levomefolic acid, 5- methyltetrahydrofolate, levomefolate glucosamine, or combination thereof.
  • the gingerol(s) is selected from the group consisting of (6)-gingerol, (8)-gingerol, (lO)-gingerol, (6)-gingerdione, (6)-gingerdiol, (6)-gingerdiol diacetate, (6)-ginger sulphonic acid, 6)-demethoxygingerol, (6)-methylgingerol or combination thereof;
  • the paradol(s) is selected from the group consisting of (6)-paradol, (8)-paradol, (lO)-paradol, or combination thereof;
  • the shogaol(s) is selected from the group consisting of (6)- demethoxyshogaol, (6)-shogaol, (8)-shogaol, (10) shogaol, (6)-methylshogaol, (6)-hydroxyshogaol, (6)-dehydroshogaol, or combination thereof
  • one or more activated form(s) of vitamin B6 is included with pyridoxal 5 ’-phosphate, or pyridoxal 5 ’-phosphate is replaced with one or more activated form(s) of vitamin B6, wherein activated form of vitamin B6 is selected from the group comprising pyridoxal, pyridoxamine, pyridoxine 5' -phosphate and pyridoxamine 5' -phosphate.
  • the one or more sedative antihistamine is selected from the group consisting of doxylamine and salt thereof, dexchlorpheniramine and salt thereof, diphenhydramine and salt thereof, dimenhydrinate and salt thereof, chlorpheniramine and salt thereof, brompheniramine and salt thereof, pheniramine and salt thereof, hydroxyzine and salt thereof, cyproheptadine and salt thereof, carbinoxamine and salt thereof, pyrilamine and salt thereof, tripelennamine and salt thereof, phenindamine and salt thereof, trimeprazine, and salt thereof,
  • SUBSTITUTE SHEET (RULE 26) cyclizine and salt thereof, promethazine and salt thereof, phenyltoloxamine and salt thereof, cyproheptadine and salt thereof, alimemazine and salt thereof, clemastine and salt thereof, ketotifen and salt thereof, mepyramine and salt thereof, antazoline and salt thereof, orphenadrine and salt thereof, bromazine and salt thereof, dexbrompheniramine and salt thereof, tripolidine and salt thereof, chlorcyclizine and salt thereof, hydroxyzine and salt thereof, meclizine and salt thereof, and azatadine and salt thereof.
  • the composition is designed as multivitamin preparation for use during preconception, pregnancy, breastfeeding, or combination thereof.
  • the present invention relates to a pharmaceutical composition
  • a pharmaceutical composition comprising of:
  • a ginger extract containing gingerols, shogaols, paradols, or combination thereof is present in an amount in a range of about 0.5mg to 500mg,
  • pyridoxal 5’ -phosphate is present in an amount in a range of about Img to 200mg,
  • a non-standardised form of ginger in an amount in a range of about 50mg to 2000mg
  • levomepromazine in an amount in a range of about 0.5mg to lOOmg
  • one or more sedative antihistamine(s) is present in an amount in a range of about 0.5mg to 200mg
  • metoclopramide in a range of about 2mg to lOOmg
  • prochlorperazine in a range of about 2mg to lOOmg, or combination thereof, and (e) excipients required to prepare a pharmaceutical composition.
  • the composition further comprises one or more of; antioxidants from the group comprising glutathione, reduced glutathione, vitamin A (e.g., retinol acetate), resveratrol, one or more form(s) vitamin C (e.g., ascorbic acid, sodium ascorbate, calcium ascorbate), one or more form(s) of magnesium (e.g., magnesium citrate, magnesium glycinate, and magnesium chelates, alpha-lipoic acid (R or S form); vitamins from the group comprising vitamin Bl, vitamin B2, vitamin B3, vitamin B5, vitamin B9 (e.g., folinic acid, 5-MTHF ), vitamin B12 ( e.g., hydroxocobalamin, cyanocobalamin, methylcobalamin) vitamin C (e.g., ascorbic acid, sodium ascorbate, calcium ascorbate) vitamin D3, vitamin E, biotin, vitamin KI, vitamin K2; minerals from the group comprising glutathione, reduced glutathi
  • SUBSTITUTE SHEET (RULE 26) probiotics; anti-inflammatory (e.g., ibuprofen, palmitoylethanolamide); steroids (dehydroepiandrosterone, progesterone); alpha tocotrienol, caffeine; hyoscine; Hl antagonists; H2 antagonists; dopamine antagonist; proton-pump inhibitors; probiotics (e.g. saccharomyces boulardii, lactobacillus plantarum); electrolytes (e.g. oral rehydration salts (ORS), carbohydrates (in form of sugar); N-acetyl cysteine, or combination thereof.
  • anti-inflammatory e.g., ibuprofen, palmitoylethanolamide
  • steroids dehydroepiandrosterone, progesterone
  • alpha tocotrienol caffeine
  • hyoscine e.g., Hl antagonists; H2 antagonists; dopamine antagonist; proton-pump inhibitors
  • lactose, gluten or dairy-derived excipients are excluded.
  • one, more or all pharmaceutical composition(s) are modified to release the ingredients at a specific location of the body and/or at a specific rate and/or for a specific time duration.
  • each pharmaceutical composition present therein comprises a different sedative antihistamine and/or dose of each sedative antihistamine is different in each pharmaceutical composition present therein.
  • the pharmaceutical composition is prepared in a compounding pharmacy or in a facility approved by the relevant authority of the local jurisdiction to manufacture therapeutic preparation.
  • the present invention relates to a method of administering the therapeutically effective amount of the pharmaceutical composition(s) as claimed in any one of the preceding claims, to a subject in need thereof; e.g., for the prevention, treatment and management of nausea, vomiting, or combination thereof (e.g., nausea or vomiting related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-cancer treatment and surgery), endometriosis, dehydration, wherein the subject is self-managing the symptoms, or being assisted by someone in homecare, aged care or hospital facility
  • one or more ingredients comprised therein is in the pharmaceutically acceptable salt(s) of the same ingredient(s) (e.g. succinate, maleate, esters, amines, hydrochloride, phosphate, calcium phosphate, hydrate, or dihydrochloride); is a metabolite(s), analog(s), polymorph(s), isomer(s), prodrug(s), solvate(s), derivative(s) of the same ingredient(s); is a rapidly absorbed form(s) of the same ingredient(s).
  • the pharmaceutically acceptable salt(s) of the same ingredient(s) e.g. succinate, maleate, esters, amines, hydrochloride, phosphate, calcium phosphate, hydrate, or dihydrochloride
  • form(s) of iron, folic acid, and activated vitamin B6, or a combination thereof is selected considering the results of biomarkers, genetic testing (e.g., pharmacogenetics, pharmacogenomics studies), enzymatic assays, intolerance test, relevant clinical
  • SUBSTITUTE SHEET (RULE 26) tests to achieve the same objective, or a combination thereof, to meet the needs of the individual subject.
  • gingerol(s), shogaol(s), mg citrate, ascorbic acid, or a combination thereof is included in the formulation as an antioxidant or preservative.
  • compositions, kits and methods comprising one or more of the core ingredients to achieve the objective described herein.
  • compositions, kits and methods of the present invention comprises;
  • SUBSTITUTE SHEET (RULE 26) (B) (i) one or more activated forms of vitamin B6 with or without one or more inactivated forms of vitamin B6 and, (ii) ginger in non-standardised forms and/or ginger in standardised forms.
  • the present invention relates to a pharmaceutical composition for the prevention, treatment, and management of nausea, vomiting or combination thereof comprising of:
  • the present invention relates to a pharmaceutical composition for the prevention, treatment, and management of nausea, vomiting or combination thereof comprising of:
  • the present invention relates to relates to a pharmaceutical composition for the prevention, treatment, and management of nausea, vomiting or combination thereof comprising of:
  • SUBSTITUTE SHEET (RULE 26) (d) (i) one or more sedative antihistamine(s), (ii) pyridoxine hydrochloride as an inactivated form of vitamin B6, (iii) a non-standardised form of ginger, (iv) Levomepromazine, (v) metoclopramide, (vi) prochlorperazine, or combination thereof and
  • activated form(s) of vitamin B6 is selected from the group consisting of pyridoxal 5’-phosphate, pyridoxine 5' phosphate and pyridoxamine 5' phosphate; also known as P5P or PLP, PNP, PMP respectively, and/or one or more pharmaceutically acceptable salt(s), metabolite(s), analog(s), polymorph(s), isomer(s), prodrug(s), solvate(s), hydrate(s), or derivative(s) thereof.
  • PLP also referred as pyridoxal 5 ’-phosphate, P5P.
  • inactivated form(s) of vitamin B6 is selected from the group consisting of pyridoxine and/or salts thereof, pyridoxal and/or salts thereof, pyridoxamine and/or salts thereof, also known as PYN, PYL, PYM respectively, and/or one or more pharmaceutically acceptable salt(s), metabolite(s), analog(s), polymorph(s), isomer(s), prodrug(s), solvate(s), hydrate(s), or derivative(s) thereof.
  • an inactivated form of B6 is pyridoxine hydrochloride (pyridoxine HCL).
  • activated and inactivated forms of vitamin B6 may be presented in any combination, such as but not limited to, PNP+PMP, PNP+PLP, PMP+PLP, PMP+PNP+PLP, PYL+PNP+PMP, PYM+PNP+PMP, PYL+PNP+PLP, PYM+PNP+PLP, PYL+PMP+PLP, PYM+PMP+PLP, PMP+PNP+PLP+PYL, PYM+PMP+PNP+PLP etc, or salt(s) thereof.
  • the combination of activated and inactivated forms is pyridoxal 5 ’-phosphate and pyridoxine HCL.
  • one or more pharmaceutically acceptable salts including for example and without limitation; esters, amines, hydrochloride, phosphate, calcium phosphate, or dihydrochloride of pyridoxine, pyridoxal, and pyridoxamine.
  • ginger in non-standardised forms can be powder, extract or any other form of mixture that is derived from one or more parts of the ginger plant, including, but not limited to leaves, root, rhizome, or stems, either from the same or different species from the family of Zingiberaceae, cultivated in any region of the world.
  • Standardisation of ginger herein means the process of establishing a set of quantitative parameters for the chemical compositions to ensure quantitative values for the assurance of definitive qualitative and quantitative values to achieve efficacy, safety and reproducibility. Furthermore, because constituents of ginger have different biological properties, the present invention, considering the indication and desired pharmacological action, comprises constituents of ginger in standardised form(s)
  • SUBSTITUTE SHEET (RULE 26) to ensure the minimum quantity of specific constituents and/or constituents from one or more 'chemical groups'.
  • standardisation by chemical group(s) means quantitative standardisation for the constituents that share the same chemical group(s).
  • quantitative standardisation of constituents from the gingerols and/or shogaols group(s) to ensure that an embodiment contains at least a specific amount of chemical constituents from a ‘gingerols’ and/or ‘shogaols’ and/or ‘paradols’ group(s).
  • Embodiments may be standardised for only one group of constituents, i.e., standardisation for only ‘gingerols’ group of constituents, standardisation of only ‘shogaols’ group of constituents, standardisation of only ‘paradols’ group of constituents.
  • Embodiments may be standardised for one or more individual constituents, i.e., standardisation for only (6)-gingerol, standardisation for the total quantity of (6)-gingerols and (6)-shogaols, standardisation for only (6)-gingerol, standardisation for the total quantity of (6)-gingerol, (8)-gingerol and (lO)-gingerol, standardisation for only (6)-shogaol, standardisation for the total quantity of (6)- shogaol, (8)- shogaol and (10)- shogaol.
  • Embodiments may be standardised for one constituent and 'chemical group(s)' i.e., standardisation for (6)-gingerol and shogaols.
  • ginger in standardised form is a mixture of constituents present in ginger, and these constituents are selected from the group consists of, including, but not limited to, (6)-gingerol, (8)-gingerol, (lO)-gingerol, (6)-gingerdione, (6)-gingerdiol, (6)-gingerdiol diacetate, (6)-ginger sulphonic acid, (6)-paradol, (8)- paradol, (lO)-paradol, (6)-demethoxygingerol, (6)-methylgingerol, (6)- demethoxyshogaol, (6)-shogaol, (8)-shogaol, (10) shogaol, (6)-methylshogaol, (6)-hydroxyshogaol, (6)- dehydroshogaol, 2-propyl-5(-(3-methoxy-4- hydroxyphenyl)ethyl)-
  • standardised forms of ginger constituents are (6)-gingerol, (8)-gingerol, (lO)-gingerol, (6)-shogaol, (8)- shogaol, (10) shogaol, (6)-paradol, (8)- paradol, (lO)-paradol, or more pharmaceutically acceptable
  • SUBSTITUTE SHEET (RULE 26) salt(s), metabolite(s), analog(s), polymorph(s), isomer(s), prodrug(s), solvate(s), hydrate(s), or derivative(s) thereof.
  • standardised forms of ginger are standardised for one or more groups of constituents of the ginger such as, including but not limited to gingerols, shogaols, hexahydrocurcumin, and its derivatives (curcuminoids), zingerones, gingerenones, gingerdiones, gingerdiols, paradols, gingerone A, diarylheptanoids.
  • standardised forms of ginger are standardised by gingerols, shogaols, paradols groups of constituents.
  • one or more sedative antihistamines are selected from the group consisting of doxylamine and salt thereof, dexchlorpheniramine and salt thereof, diphenhydramine and salt thereof, dimenhydrinate and salt thereof, chlorpheniramine and salt thereof, brompheniramine and salt thereof, pheniramine and salt thereof, hydroxyzine and salt thereof, cyproheptadine and salt thereof, carbinoxamine and salt thereof, pyrilamine and salt thereof, tripelennamine and salt thereof, phenindamine and salt thereof, trimeprazine, and salt thereof, cyclizine and salt thereof, promethazine and salt thereof, phenyltoloxamine and salt thereof, cyproheptadine and salt thereof, alimemazine and salt thereof, clemastine and salt thereof, ketotifen and salt thereof, mepyramine and salt thereof, antazoline and salt thereof, orphenadrine and salt thereof, bromazine and salt thereof, de
  • doxylamine and salt thereof Preferably, doxylamine and salt thereof, promethazine and salt thereof, diphenhydramine and salt thereof, dimenhydrinate and salt thereof, dimenhydrinate and salt thereof, and dimenhydrinate and salt thereof, and levomepromazine and salt thereof.
  • the one or more sedative antihistamine is present in an amount in a range of 0.5mg to 200mg per unit dose.
  • the gingerols, shogaols, paradols or combination thereof present in an amount in the range of 0.5mg to 300mg per unit dose.
  • Pyridoxal 5 ’-phosphate is present in an amount in a range of Img to 200mg.
  • Embodiments may include any short-acting antihistamine combined with a long-acting antihistamine.
  • Caffeine may be present in any aspect of the present invention to treat NV to counterbalance the sedation effect of one or more antihistamines.
  • Embodiments may include other antioxidants, including but not limited to, glutathione, reduced glutathione, vitamin A (e.g., retinol acetate), one or more forms of vitamin B12, vitamin B3, alpha-lipoic acid (R and/or S form), one or more forms of iron, one or more forms of vitamin C, alpha tocotrienol, coenzyme Q10 (activated or inactivated), ubiquinol, zinc, selenium, magnesium citrate, magnesium glycinate, and magnesium chelates or any other forms thereof.
  • vitamin A e.g., retinol acetate
  • vitamin B12 e.g., retinol acetate
  • R and/or S form alpha-lipoic acid
  • iron one or more forms of iron
  • one or more forms of vitamin C alpha tocotrienol
  • coenzyme Q10 activated or inactivated
  • ubiquinol zinc, selenium, magnesium citrate, magnesium glycinate
  • Flavin mononucleotide also known as riboflavin-5-phosphate or R5P
  • R5P riboflavin-5-phosphate
  • PLP pyridoxal 5 '-phosphate
  • Embodiments described herein may be given with FMN, folinic acid, 5-MTHF, and folic acid either in a single unit or separate unit doses.
  • Embodiments may include probiotics with or without prebiotic to achieve the same objective.
  • the ‘active ingredients’ or ‘core ingredients’ used in the present invention can be used as pharmaceutically acceptable salt(s), metabolite(s), analog(s), polymorph(s), isomer(s), prodrug(s), solvate(s), hydrate(s), or derivative(s) thereof.
  • kits and methods for prevention, treatment and management of nausea and vomiting comprising one or more dosage units each comprising one or more of:
  • sedative antihistamine(s) indicia distinguishing all comprised dosage units from each other; indicia distinguishing sedative dosage units causing sedation from the non-sedative dosage units; indicia distinguishing sedative dosage units for administration during a particular time of the day or event when sedation or sleep is desirable or not contraindicated; indicia distinguishing non-sedative dosage units for administration during a particular time of the day or event when sedation or sleep is not desirable or contraindicated; wherein instructions are provided for coordinating the administration of each dosage unit as a treatment regimen whereby a dosage unit is for administration during a particular time of the day or event; wherein a container or packaging that incorporates the indicia, the instructions and a plurality of each dosage units; wherein a blister card individually and releasably containing the unit doses; wherein said dosage units are arranged horizontally or vertically in order of their use across the blister card.
  • the invention provides kits for promoting the proper sequential oral administration of pharmaceutically active ingredients.
  • kits and methods may have one or all features described herein.
  • active ingredients may be free form, in various salt forms, various hydration states, etc. If, for example, a different salt form of an active ingredient is used in the invention, the skilled person will understand that the amount will need to be adjusted in accordance with the molecular weight.
  • 'Unit dose' or 'unit dosage' herein is a dosage form comprising an amount of therapeutically active ingredients suitable for administration in one single dose.
  • compositions, kits and methods comprising active ingredients in a range of doses considering the severity of nausea and vomiting, medical conditions, age, and underlying cause.
  • the dose range of each ingredient is described herein.
  • the dose range is for a unit dose.
  • the present invention is not limited to these dose ranges.
  • the dose of the comprised ingredient can be less or more than the described herein to achieve desired anti-nausea and anti-emetic effects.
  • a) Doxylamine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 200 mg.
  • b) Diphenhydramine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 200 mg.
  • Dimenhydrinate may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 300mg.
  • Promethazine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 200mg.
  • Cyclizine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 200mg.
  • Levomepromazine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to lOOmg.
  • Dexchlorpheniramine may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 25mg.
  • Ginger in non-standardised forms may be present in any aspect of the invention described herein at an amount per unit dose of about 100 mg to 2000mg or equivalent thereby.
  • Ginger extract in standardised forms may be present in any aspect of the invention described herein at an amount per unit dose of about 2mg to 2000mg.
  • gingerols, shogaols, paradols, or combination thereof may be present in any aspect of the invention described herein at an amount per unit dose of about 0.5mg to 500 mg
  • k) Pyridoxine may be present in any aspect of the invention described herein at an amount per unit dose of about Img to 200mg.
  • SUBSTITUTE SHEET (RULE 26) l) Pyridoxal 5 ’-phosphate may be present in any aspect of the invention described herein at an amount per unit dose of about Img to 200mg. m) Metoclopramide may be present in any aspect of the invention described herein at an amount per unit dose of about 2mg to 1 OOmg. n) Prochlorperazine may be present in any aspect of the invention described herein at an amount per unit dose of about 2mg to lOOmg. o) Magnesium citrate may be present in any aspect of the invention described herein at an amount per unit dose of about 2mg to 200mg. p) Ascorbic acid may be present in any aspect of the invention described herein at an amount per unit dose of about lOmg to 250mg.
  • Kits or methods can be designed using this unit dose ranges to achieve the same objective.
  • the present invention extends to any compositions, kits and methods recognised by one skilled in the art to achieve the effective concentration of one or more comprised ingredients to treat NV.
  • a compound or active agent or active ingredient or core ingredient is present in a composition or in combination, in an amount effective to provide the desired therapeutic or physiological effect or outcome.
  • This effect may be the treatment, alleviation, diminishment, or amelioration of nausea and/or vomiting.
  • Undesirable effects e.g., side effects, are sometimes manifested along with the desired therapeutic effect; hence, a practitioner balances the potential benefits against the potential risks in determining an appropriate ‘effective amount’.
  • the exact amount required will vary from subject to subject, depending on the species, age, medical condition, and general condition of the subject, mode of administration and the like. An appropriate ‘effective amount’ in any individual case may be determined using routine experimentation by one skilled in the art.
  • the specific dose level for any patient will depend upon a variety of factors, including the activity of the specific composition employed, the age, body weight, general health, sex, diet, time of administration, route of administration, rate of excretion, drug combination (i.e., other drugs being used to treat the patient), and the severity of the particular disorder.
  • drug combination i.e., other drugs being used to treat the patient
  • patient dosage may be adjusted by adjusting the number of fixed doses, for example, by changing the number of tablets taken or by adjusting the timing for the next dose.
  • the present invention provides compositions, kits, and methods for preventing, treating, and managing NV related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-NV related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-NV related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-NV related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-
  • Embodiments may be used to achieve any desired outcome, including but not limited to minimal reduction to complete elimination of nausea and/or vomiting any time prior, during or after episode of nausea and/or vomiting related to pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-cancer and surgery.
  • Embodiments may be used to design a kit or a method in combination with other anti-nausea and/or anti-emetic treatments. Depending on the objective and indication(s), which can be prevention, treatment or management, amount of the comprised ingredient may vary in embodiments.
  • Embodiments may be used to design kits or methods combined with other pharmacological or non- pharmacological interventions to achieve the same objective.
  • Embodiments of the present invention may be administered by a patient, a healthcare professional or a carer in a hospital, home, or caring facility.
  • Embodiments may be prepared in a community, hospital pharmacy, or facility approved by the relevant authority to manufacture therapeutic preparation for human or non-human use.
  • embodiments of the present invention may be used during the first, second or third trimester of the pregnancy to achieve the desired outcome, including but not limited to minimal reduction to complete elimination of nausea and/or vomiting for any particular time of the day, throughout the day or every day during the pregnancy.
  • Embodiments may be used as single or multiple dosage forms or to design a kit or a method to achieve the desired outcome for the pregnant woman.
  • Embodiments may be used to design a kit, or a method combined with ingredients such as folinic acid, 5-MTHF, folic acid, multivitamins; or may be combined with any other anti-nausea or anti-emetic treatments.
  • embodiments may be designed in combination with analgesics, benzodiazepines, other anti-emetics, anti-psychotics, or naloxone for the NV related to drug use or overdose.
  • embodiments may be designed comprising core ingredients of the present invention combined with non-sedative antihistamines and/or antioxidants for the prevention, treatment, and management of nausea and/or vomiting and/or facial flushing and/or erythema and/or hangover associated with alcohol use or overdose.
  • embodiments of the present invention may be used prophylactically to prevent the occurrence of motion sickness.
  • Prophylactic use of embodiments is preferably within 2 hrs, 15 to 30 minutes more preferred, before expected symptoms.
  • embodiments may be combined with anti-diarrhoeal, rehydration salts or antibiotics.
  • kits and/or methods can be used on an ad-hoc basis or designed to meet a patient’s requirements on one or more particular day(s) of the menstrual cycle.
  • Embodiments may be designed with coenzyme Q10 (activated or inactivated), ubiquinol, folinic acid, folic acid or 5-MTHF (methylfolate).
  • cancer herein meaning any form of abnormal growth of cells in a subject.
  • Anticancer treatment herein means all current and future treatments to prevent, treat and manage cancer and is not limited to chemotherapy, radiation, immunotherapy, stem cell transplant, surgery, targeted therapy, hormone therapy, pharmacological or non-pharmacological interventions.
  • Embodiments of the present inventions may be used for nausea and vomiting induced by mild, moderate, or highly emetogenic anticancer treatment regimens.
  • Embodiments may be used as single or multiple dosage forms or to design a kit or a method to achieve the desired outcome for the patient being treated for cancer.
  • Embodiments may be used or administered immediately, several seconds, hrs, days, or weeks prior to the treatment and/or during the treatment and/or after immediately, several seconds, hrs, days or weeks from initiation of the treatment.
  • embodiments may be designed in combination with other 5HT3 antagonists, metoclopramide, prochlorperazine, analgesics, anaesthetic agents considering age, type of surgery and patient history.
  • the analgesics is paracetamol.
  • the nausea or vomiting treated is one described herein, in both acute and chronic forms, for example, but not limited to, pregnancy, drug use, alcohol use, motion sickness, gastroenteritis, PCOS, anti-cancer treatment, and surgery, fibromyalgia, digestive disorders (gastritis, gastroparesis, gastroesophageal reflux disease, IBS, celiac disease, gallbladder conditions, pancreas conditions, gallstones, intestinal ischemia, intestinal obstruction, intracranial hematoma, intussusception (in children), irritable bowel syndrome, inflammatory bowel disease (crohn’s, ulcerative colitis), pancreatitis (pancreas inflammation), peptic ulcer, pseudotumor cerebri, pyloric stenosis (in infants), gastroparesis or slow stomach emptying, bowel obstruction, retch, (inflammation of the stomach lining), ulcers, appendicitis, mental health conditions, inner ear
  • SUBSTITUTE SHEET parathyroid
  • neurological conditions migraine, increased intracranial pressure due to a mass, blood clot, or haemorrhage, demyelinating disorders, seizure disorders
  • cardiovascular condition heart attack, heart failure
  • medication side effect antibiotics, antidepressants, OTC pain medication, such as aspirin or ibuprofen
  • certain supplements such as iron , opioids, chemotherapy, hormones (e.g., birth control pills), antibiotics, antivirals, anticonvulsants, opioids, nicotine, gastrointestinal medications, cardiovascular medications, medications to treat parkinson’s disease, oral contraceptives, digitalis, narcotics and antibiotics
  • anxiety disorders eating disorders, depression, cyclic vomiting syndrome, cancer, stress, general anaesthesia, acute liver failure, anaphylaxis (a severe allergic reaction), anorexia nervosa, appendicitis, benign paroxysmal positional vertigo (bppv), cardiovascular condition, bulimi
  • a subject in need of treatment is one experiencing or expecting to experience nausea and/or vomiting.
  • the subject may have been diagnosed with NV and/or recommended anti-emetic and/or antinausea treatment by a doctor, pharmacist, nurse, mid-wife, or any health care professional.
  • NV may also be self-diagnosed.
  • ‘treating’ or ‘treatment’ means reducing, ameliorating, or providing relief from NV before or after its onset. It also includes ameliorating the severity, incidence, progression, or duration of NV experienced by a subject. As compared with an equivalent untreated control, such amelioration or relief is at least 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100%, as measured by any biochemical or clinical measurement that may be measured by using standard medical methods of evaluating and scoring NV. The benefit to a subject to be treated is either statistically significant or perceptible to the patient or the physician.
  • treatment encompasses both disorder-modifying treatment and symptomatic treatment, either of which may be prophylactic, i.e., before the onset of symptoms, in order
  • SUBSTITUTE SHEET (RULE 26) to prevent, delay or reduce the severity of symptoms, or therapeutic, i.e., after the onset of symptoms, in order to reduce the severity and/or duration of symptoms.
  • the subject also referred to as patient herein may include but are not limited to primates, especially humans, domesticated companion animals such as dogs, cats, horses, and livestock such as cattle, pigs, sheep.
  • compositions comprise one or more excipients required to prepare formulation for therapeutic use.
  • Excipients are extra materials that are added to the active ingredients to prepare a dosage form.
  • Pharmaceutically acceptable excipients including for example and without limitation; one or more binders, adhesives, lubricants, diluents, fillers, coating agent, antiadherent, humectants, preservatives, antioxidants, buffering agents, flavouring agents, bulking agent, colouring agents, sweetening agents, plasticisers, solvent and co-solvent, organic solvents, topical solvents, sorbents, glidants, chelating agents, granulating agent, taste masking agent, thickening agents, disintegrants, plasticisers, solubilizer or solubility enhancer, any carrier oil, coatings, barrier layer formulations, surface active agents, viscosity imparting agents, viscosity increasing agent, stabilising agent, suspending agents, emulsifying agents, viscosity adjusters
  • Formulations may comprise microcapsules or gelatine-microcapsules, liposomes, albumin microspheres, microemulsions, nanoparticles or nano capsules.
  • the formulation may contain one or more electrolytes. It also extends to formulation changed to reduce the size of the unit dose being administered.
  • compositions herein refers to any excipient that does not interfere with the effectiveness of the biological activity of comprised active ingredients and is not contra-indicated, non-toxic and non- teratogenic, i.e., not harmful to a subject and embryo or foetus of a subject.
  • Dosage forms may be presented as flavoured dosage, unflavoured, or flavour free. This invention may be presented in any combinations and pharmaceutically acceptable dosage forms. Dosage forms of
  • SUBSTITUTE SHEET (RULE 26) the present invention may include various forms of release, which include but are not limited to immediate release, extended-release, variable release, controlled release, dissolution-controlled release, sustained release, dual release, delayed-release, long-acting, osmotically controlled release, monolithic dosage forms, multi-particulate forms, and combinations thereof. It can be presented in formulations designed to achieve the shortened and/or extended half-life of the individual ingredients comprised in this invention.
  • dosage forms may include one or more oral dosage forms as listed here but not limited to tablets, compressed tablets, enteric-coated tablets, controlled release tablets, film-coated tablets, effervescent tablets, reconstitute powders, capsules, soft gelatine capsules, hard gelatine capsules, caplets, multi-layer/dual layer capsule, bi-layer capsule, capsules may encapsulate a powder, liquid, or gel, quick dissolve tablets, multilayer tablets, bi-layer tablets, orally disintegrating tablets, powders, granules, dispersible granules, tablet/capsule combinations, coated core tablets, multi-layered with or without dual release or palletised form. It may be formulated containing ion exchange resins or formulations using responsive polymers.
  • Embodiments may be provided, including for example and without any limitation, in the form of lollipops, wafer, bars, sticks, chewable tablets, buccal films, gummies, troches, lozenges, chewable lozenges, beads, bite capsules, mouth soluble or dispersible forms like suckable, eatable, chewable coherent forms, biscuits, cereals, confections, cachets, douches, health bars, patches etc.
  • Compounds may be formulated for any appropriate route of administration including for example and without limitation, as oral preparations (solutions, emulsions, suspension, elixirs, syrups, etc.), topical preparations (nasal drops, nebulisers and inhalers, inhalants, pastes, creams and ointments for skin application, gels, lotions, creams, foams, powders, pessaries for vaginal administration etc.), sublingual and buccal administration, rectal administration (suppositories and enemas), ocular, implants, depot implants, ingestible, parental drug administration (intradermal administration, implants, subcutaneous injection, intramuscular injection, intravenous injection, infusions, intramuscular, intraocular, periocular, intraorbital, spinal, intracranial, intrathecal, intrasynovial and intraperitoneal injection), as well as any similar injection or infusion or inhalation technique, solid dosage form and solid modified release form, semi-solid
  • the present invention extends to any formulations designed to achieve release of comprised ingredient at a particular location of the subject and/or at any particular rate of release into the subject.
  • the dosage formulation may be modified to achieve release of comprised ingredients at a specific location of the body and/or at any specific rate and/or for any specific time duration
  • Typical modes of delivery for topical compositions include applying using the fingers, using a physical applicator such as cloth, tissue, swab, stick or brush, spraying including mist, aerosol or foam spraying, dropper application sprinkling, soaking, and rinsing.
  • a physical applicator such as cloth, tissue, swab, stick or brush
  • spraying including mist, aerosol or foam spraying, dropper application sprinkling, soaking, and rinsing.
  • compositions may be formulated as inhaled formulations, including sprays, mists, or aerosols and may be delivered via any inhalation methods known to a skilled person in the art. Such methods may include, for example including without limitation, metered-dose inhalers, nebulisers, multi-dose dry powder inhalers or any other conventional or novel inhalation methods.
  • the dosage may be supplied in any pharmaceutically acceptable container listed here but not limited to blister packs, composite blister packs, bottles, tubes, canisters, sachets, packets, child-resistant packaging, heat resistance packaging, light resistance packaging, moisture resistance, travelling kit, daily doses packaging, weekly or monthly dose packing, roll on etc.
  • the composition described herein may be presented in individual packaging, day/night combination, composite packaging, packing designed and/or marked to differentiate the unit dose to make it more suitable and/or compliant for any indication and/or any age group and/or any individual subject.
  • Embodiments may be combined with other pharmacological or non-pharmacological interventions for the prevention, treatment and management of nausea and vomiting.
  • This invention extends to formulations and packaging changed to meet the requirements of particular demographics and/or to obtain regulatory approval from relevant authorities.
  • 'daily' herein refers to administering one or more than one dose of the same or different ingredients within the 24-hr period or within the same day.
  • a single daily blister card may include multiple doses to be taken in a 24-hour period.
  • Embodiments of the invention may be designed with specific storage requirements in order to preserve comprised constituents.
  • compositions, kits, and methods comprising gingerols and shogaols may be designed with storage requirements to store such embodiments at temperature in the range of -20 to 8°C.
  • Embodiments may be designed with instructions for compounding or preparation prior to administration to the subject. Such instructions may be designed to suit patients, carers, or pharmacists. These embodiments may contain ingredients other than the core ingredients to prepare formulations to achieve the same objective.
  • the tablet of the above composition is prepared by following the steps given below:
  • Example 2 Orally Disintegrating Tablet / Sublingual tablet (Non-Drowsy Tablet)
  • step 3 To the blend of step 3 add magnesium stearate and mix further for 3 minutes.
  • step 3 To the blend of step 3 add magnesium stearate and mix further for 3 minutes.
  • Embodiments may be designed after establishing the individual needs by means of genetic or biomarkers or similar tests.
  • Vitamin B-6 Benefits, dosage, food sources, and deficiency symptoms, [online] Available at: https://www.medicalnewstoday.com/articles/219662.
  • SUBSTITUTE SHEET (RULE 26) 24 Hsu, C.-C., Cheng, C.-H., Hsu, C.-L., Lee, W.-J., Huang, S.-C. and Huang, Y.-C. (2015). Role of vitamin B6 status on antioxidant defenses, glutathione, and related enzyme activities in mice with homocysteine-induced oxidative stress. Food & Nutrition Research, 59(1), p.25702.

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Abstract

La présente invention concerne des compositions, des trousses et des méthodes contenant une ou plusieurs quantité(s) thérapeutiquement efficace(s) d'un ou de plusieurs ingrédients(s) choisi(s) dans le groupe constitué par : un extrait de gingembre contenant des gingérols, des shogaols, des paradols ou une combinaison correspondante, en particulier du 5'-phosphate de pyridoxal. La présente invention a des effets antinauséeux et antiémétiques émanant des actions pharmacologiques des ingrédients inclus dans de multiples mécanismes physiopathologiques. La présente invention concerne en particulier des effets synergiques et/ou additifs d'au moins deux ingrédients inclus.
PCT/IB2022/058241 2021-09-03 2022-09-02 Compositions, trousses et méthodes pour fournir des effets synergiques et/ou additifs d'ingrédients inclus pour la prévention, le traitement et la prise en charge des nausées et des vomissements WO2023031860A1 (fr)

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PCT/IB2022/058243 WO2023031861A1 (fr) 2021-09-03 2022-09-02 Compositions, kits et procédés pour le traitement de la nausée et des vomissements
PCT/IB2022/058241 WO2023031860A1 (fr) 2021-09-03 2022-09-02 Compositions, trousses et méthodes pour fournir des effets synergiques et/ou additifs d'ingrédients inclus pour la prévention, le traitement et la prise en charge des nausées et des vomissements

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PCT/IB2022/058243 WO2023031861A1 (fr) 2021-09-03 2022-09-02 Compositions, kits et procédés pour le traitement de la nausée et des vomissements

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