WO2024063661A1 - A pharmaceutical composition for topical application and use thereof in the treatment of hemangiomas in children - Google Patents
A pharmaceutical composition for topical application and use thereof in the treatment of hemangiomas in children Download PDFInfo
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- WO2024063661A1 WO2024063661A1 PCT/PL2023/050078 PL2023050078W WO2024063661A1 WO 2024063661 A1 WO2024063661 A1 WO 2024063661A1 PL 2023050078 W PL2023050078 W PL 2023050078W WO 2024063661 A1 WO2024063661 A1 WO 2024063661A1
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- Prior art keywords
- triamcinolone
- composition
- hemangiomas
- children
- pharmaceutical composition
- Prior art date
Links
- 239000008194 pharmaceutical composition Substances 0.000 title claims abstract description 14
- 201000011066 hemangioma Diseases 0.000 title claims abstract description 12
- 230000000699 topical effect Effects 0.000 title claims abstract description 12
- 239000003246 corticosteroid Substances 0.000 claims abstract description 16
- 102000012740 beta Adrenergic Receptors Human genes 0.000 claims abstract description 13
- 108010079452 beta Adrenergic Receptors Proteins 0.000 claims abstract description 13
- 239000000674 adrenergic antagonist Substances 0.000 claims abstract description 12
- 239000000203 mixture Substances 0.000 claims description 38
- 229960005294 triamcinolone Drugs 0.000 claims description 28
- GFNANZIMVAIWHM-OBYCQNJPSA-N triamcinolone Chemical compound O=C1C=C[C@]2(C)[C@@]3(F)[C@@H](O)C[C@](C)([C@@]([C@H](O)C4)(O)C(=O)CO)[C@@H]4[C@@H]3CCC2=C1 GFNANZIMVAIWHM-OBYCQNJPSA-N 0.000 claims description 28
- 239000000499 gel Substances 0.000 claims description 14
- 239000002674 ointment Substances 0.000 claims description 14
- 239000006071 cream Substances 0.000 claims description 11
- SGUAFYQXFOLMHL-UHFFFAOYSA-N 2-hydroxy-5-{1-hydroxy-2-[(4-phenylbutan-2-yl)amino]ethyl}benzamide Chemical group C=1C=C(O)C(C(N)=O)=CC=1C(O)CNC(C)CCC1=CC=CC=C1 SGUAFYQXFOLMHL-UHFFFAOYSA-N 0.000 claims description 5
- 229960001632 labetalol Drugs 0.000 claims description 5
- 150000003839 salts Chemical class 0.000 claims description 4
- 229960002117 triamcinolone acetonide Drugs 0.000 claims description 4
- YNDXUCZADRHECN-JNQJZLCISA-N triamcinolone acetonide Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@H]3OC(C)(C)O[C@@]3(C(=O)CO)[C@@]1(C)C[C@@H]2O YNDXUCZADRHECN-JNQJZLCISA-N 0.000 claims description 4
- VEXZGXHMUGYJMC-UHFFFAOYSA-N Hydrochloric acid Chemical compound Cl VEXZGXHMUGYJMC-UHFFFAOYSA-N 0.000 claims description 2
- XGMPVBXKDAHORN-RBWIMXSLSA-N Triamcinolone diacetate Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@@H](OC(C)=O)[C@@](C(=O)COC(=O)C)(O)[C@@]1(C)C[C@@H]2O XGMPVBXKDAHORN-RBWIMXSLSA-N 0.000 claims description 2
- TZIZWYVVGLXXFV-FLRHRWPCSA-N Triamcinolone hexacetonide Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@H]3OC(C)(C)O[C@@]3(C(=O)COC(=O)CC(C)(C)C)[C@@]1(C)C[C@@H]2O TZIZWYVVGLXXFV-FLRHRWPCSA-N 0.000 claims description 2
- 239000003937 drug carrier Substances 0.000 claims description 2
- 229960004320 triamcinolone diacetate Drugs 0.000 claims description 2
- 229960004221 triamcinolone hexacetonide Drugs 0.000 claims description 2
- WQVZLXWQESQGIF-UHFFFAOYSA-N Labetalol hydrochloride Chemical compound Cl.C=1C=C(O)C(C(N)=O)=CC=1C(O)CNC(C)CCC1=CC=CC=C1 WQVZLXWQESQGIF-UHFFFAOYSA-N 0.000 description 25
- 229960003091 labetalol hydrochloride Drugs 0.000 description 25
- OKKJLVBELUTLKV-UHFFFAOYSA-N Methanol Chemical compound OC OKKJLVBELUTLKV-UHFFFAOYSA-N 0.000 description 18
- 229940079593 drug Drugs 0.000 description 13
- 239000003814 drug Substances 0.000 description 13
- 238000012360 testing method Methods 0.000 description 13
- 150000001875 compounds Chemical class 0.000 description 11
- 238000009472 formulation Methods 0.000 description 11
- AQHHHDLHHXJYJD-UHFFFAOYSA-N propranolol Chemical compound C1=CC=C2C(OCC(O)CNC(C)C)=CC=CC2=C1 AQHHHDLHHXJYJD-UHFFFAOYSA-N 0.000 description 11
- IAZDPXIOMUYVGZ-UHFFFAOYSA-N Dimethylsulphoxide Chemical compound CS(C)=O IAZDPXIOMUYVGZ-UHFFFAOYSA-N 0.000 description 9
- 239000000243 solution Substances 0.000 description 9
- 239000000126 substance Substances 0.000 description 9
- 230000001225 therapeutic effect Effects 0.000 description 8
- 238000002560 therapeutic procedure Methods 0.000 description 8
- 230000000694 effects Effects 0.000 description 7
- 238000002347 injection Methods 0.000 description 6
- 239000007924 injection Substances 0.000 description 6
- 239000002609 medium Substances 0.000 description 6
- 239000004570 mortar (masonry) Substances 0.000 description 6
- 239000011550 stock solution Substances 0.000 description 6
- TWBNMYSKRDRHAT-RCWTXCDDSA-N (S)-timolol hemihydrate Chemical compound O.CC(C)(C)NC[C@H](O)COC1=NSN=C1N1CCOCC1.CC(C)(C)NC[C@H](O)COC1=NSN=C1N1CCOCC1 TWBNMYSKRDRHAT-RCWTXCDDSA-N 0.000 description 4
- 239000006145 Eagle's minimal essential medium Substances 0.000 description 4
- 230000009471 action Effects 0.000 description 4
- 239000002876 beta blocker Substances 0.000 description 4
- 229940097320 beta blocking agent Drugs 0.000 description 4
- 238000011534 incubation Methods 0.000 description 4
- 238000002360 preparation method Methods 0.000 description 4
- 229960003712 propranolol Drugs 0.000 description 4
- 230000009885 systemic effect Effects 0.000 description 4
- 229960004605 timolol Drugs 0.000 description 4
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 4
- MEAPRSDUXBHXGD-UHFFFAOYSA-N 3-chloro-n-(4-propan-2-ylphenyl)propanamide Chemical compound CC(C)C1=CC=C(NC(=O)CCCl)C=C1 MEAPRSDUXBHXGD-UHFFFAOYSA-N 0.000 description 3
- PEDCQBHIVMGVHV-UHFFFAOYSA-N Glycerine Chemical compound OCC(O)CO PEDCQBHIVMGVHV-UHFFFAOYSA-N 0.000 description 3
- 208000002125 Hemangioendothelioma Diseases 0.000 description 3
- 230000008901 benefit Effects 0.000 description 3
- 208000001969 capillary hemangioma Diseases 0.000 description 3
- 229960001334 corticosteroids Drugs 0.000 description 3
- 239000012153 distilled water Substances 0.000 description 3
- 238000002695 general anesthesia Methods 0.000 description 3
- 230000003902 lesion Effects 0.000 description 3
- 235000019271 petrolatum Nutrition 0.000 description 3
- 229960004604 propranolol hydrochloride Drugs 0.000 description 3
- NOOLISFMXDJSKH-UTLUCORTSA-N (+)-Neomenthol Chemical compound CC(C)[C@@H]1CC[C@@H](C)C[C@@H]1O NOOLISFMXDJSKH-UTLUCORTSA-N 0.000 description 2
- NOOLISFMXDJSKH-UHFFFAOYSA-N DL-menthol Natural products CC(C)C1CCC(C)CC1O NOOLISFMXDJSKH-UHFFFAOYSA-N 0.000 description 2
- NNJVILVZKWQKPM-UHFFFAOYSA-N Lidocaine Chemical compound CCN(CC)CC(=O)NC1=C(C)C=CC=C1C NNJVILVZKWQKPM-UHFFFAOYSA-N 0.000 description 2
- 206010028980 Neoplasm Diseases 0.000 description 2
- 238000002835 absorbance Methods 0.000 description 2
- 239000000654 additive Substances 0.000 description 2
- 230000000996 additive effect Effects 0.000 description 2
- CIWBQSYVNNPZIQ-XYWKZLDCSA-N betamethasone dipropionate Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@H](C)[C@@](C(=O)COC(=O)CC)(OC(=O)CC)[C@@]1(C)C[C@@H]2O CIWBQSYVNNPZIQ-XYWKZLDCSA-N 0.000 description 2
- 230000004663 cell proliferation Effects 0.000 description 2
- HVYWMOMLDIMFJA-DPAQBDIFSA-N cholesterol Chemical compound C1C=C2C[C@@H](O)CC[C@]2(C)[C@@H]2[C@@H]1[C@@H]1CC[C@H]([C@H](C)CCCC(C)C)[C@@]1(C)CC2 HVYWMOMLDIMFJA-DPAQBDIFSA-N 0.000 description 2
- 238000002648 combination therapy Methods 0.000 description 2
- 231100000263 cytotoxicity test Toxicity 0.000 description 2
- 238000011156 evaluation Methods 0.000 description 2
- 238000002474 experimental method Methods 0.000 description 2
- 238000000227 grinding Methods 0.000 description 2
- JYGXADMDTFJGBT-VWUMJDOOSA-N hydrocortisone Chemical compound O=C1CC[C@]2(C)[C@H]3[C@@H](O)C[C@](C)([C@@](CC4)(O)C(=O)CO)[C@@H]4[C@@H]3CCC2=C1 JYGXADMDTFJGBT-VWUMJDOOSA-N 0.000 description 2
- 238000000338 in vitro Methods 0.000 description 2
- 229960004194 lidocaine Drugs 0.000 description 2
- 229940057995 liquid paraffin Drugs 0.000 description 2
- 229940041616 menthol Drugs 0.000 description 2
- 210000000056 organ Anatomy 0.000 description 2
- 239000013641 positive control Substances 0.000 description 2
- GHMLBKRAJCXXBS-UHFFFAOYSA-N resorcinol Chemical compound OC1=CC=CC(O)=C1 GHMLBKRAJCXXBS-UHFFFAOYSA-N 0.000 description 2
- 231100000216 vascular lesion Toxicity 0.000 description 2
- 230000035899 viability Effects 0.000 description 2
- METKIMKYRPQLGS-GFCCVEGCSA-N (R)-atenolol Chemical compound CC(C)NC[C@@H](O)COC1=CC=C(CC(N)=O)C=C1 METKIMKYRPQLGS-GFCCVEGCSA-N 0.000 description 1
- WLRMANUAADYWEA-NWASOUNVSA-N (S)-timolol maleate Chemical compound OC(=O)\C=C/C(O)=O.CC(C)(C)NC[C@H](O)COC1=NSN=C1N1CCOCC1 WLRMANUAADYWEA-NWASOUNVSA-N 0.000 description 1
- 241000208293 Capsicum Species 0.000 description 1
- 235000002566 Capsicum Nutrition 0.000 description 1
- IROWCYIEJAOFOW-UHFFFAOYSA-N DL-Isoprenaline hydrochloride Chemical compound Cl.CC(C)NCC(O)C1=CC=C(O)C(O)=C1 IROWCYIEJAOFOW-UHFFFAOYSA-N 0.000 description 1
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 description 1
- LYCAIKOWRPUZTN-UHFFFAOYSA-N Ethylene glycol Chemical compound OCCO LYCAIKOWRPUZTN-UHFFFAOYSA-N 0.000 description 1
- 239000004166 Lanolin Substances 0.000 description 1
- XSQUKJJJFZCRTK-UHFFFAOYSA-N Urea Chemical compound NC(N)=O XSQUKJJJFZCRTK-UHFFFAOYSA-N 0.000 description 1
- 230000002411 adverse Effects 0.000 description 1
- 230000008485 antagonism Effects 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 229960002274 atenolol Drugs 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- KGBXLFKZBHKPEV-UHFFFAOYSA-N boric acid Chemical compound OB(O)O KGBXLFKZBHKPEV-UHFFFAOYSA-N 0.000 description 1
- 239000004327 boric acid Substances 0.000 description 1
- 201000011510 cancer Diseases 0.000 description 1
- 239000001390 capsicum minimum Substances 0.000 description 1
- 230000000747 cardiac effect Effects 0.000 description 1
- 210000000748 cardiovascular system Anatomy 0.000 description 1
- 238000012512 characterization method Methods 0.000 description 1
- 235000012000 cholesterol Nutrition 0.000 description 1
- 238000000315 cryotherapy Methods 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 230000008034 disappearance Effects 0.000 description 1
- 238000009509 drug development Methods 0.000 description 1
- 229940012356 eye drops Drugs 0.000 description 1
- 230000009760 functional impairment Effects 0.000 description 1
- 230000036541 health Effects 0.000 description 1
- 229960000890 hydrocortisone Drugs 0.000 description 1
- 229920003088 hydroxypropyl methyl cellulose Polymers 0.000 description 1
- 235000010979 hydroxypropyl methyl cellulose Nutrition 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 238000010253 intravenous injection Methods 0.000 description 1
- 229940039717 lanolin Drugs 0.000 description 1
- 235000019388 lanolin Nutrition 0.000 description 1
- 238000002647 laser therapy Methods 0.000 description 1
- 229960003511 macrogol Drugs 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 238000000034 method Methods 0.000 description 1
- 229920000609 methyl cellulose Polymers 0.000 description 1
- 239000001923 methylcellulose Substances 0.000 description 1
- 239000003883 ointment base Substances 0.000 description 1
- 239000007935 oral tablet Substances 0.000 description 1
- 239000000546 pharmaceutical excipient Substances 0.000 description 1
- 229960005205 prednisolone Drugs 0.000 description 1
- OIGNJSKKLXVSLS-VWUMJDOOSA-N prednisolone Chemical compound O=C1C=C[C@]2(C)[C@H]3[C@@H](O)C[C@](C)([C@@](CC4)(O)C(=O)CO)[C@@H]4[C@@H]3CCC2=C1 OIGNJSKKLXVSLS-VWUMJDOOSA-N 0.000 description 1
- 229960004618 prednisone Drugs 0.000 description 1
- XOFYZVNMUHMLCC-ZPOLXVRWSA-N prednisone Chemical compound O=C1C=C[C@]2(C)[C@H]3C(=O)C[C@](C)([C@@](CC4)(O)C(=O)CO)[C@@H]4[C@@H]3CCC2=C1 XOFYZVNMUHMLCC-ZPOLXVRWSA-N 0.000 description 1
- 230000002062 proliferating effect Effects 0.000 description 1
- 238000009738 saturating Methods 0.000 description 1
- 241000894007 species Species 0.000 description 1
- 150000003431 steroids Chemical class 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 230000002195 synergetic effect Effects 0.000 description 1
- 238000009121 systemic therapy Methods 0.000 description 1
- 150000003505 terpenes Chemical class 0.000 description 1
- 235000007586 terpenes Nutrition 0.000 description 1
- 238000011287 therapeutic dose Methods 0.000 description 1
- 229960005221 timolol maleate Drugs 0.000 description 1
- 229940098465 tincture Drugs 0.000 description 1
- RNWHGQJWIACOKP-UHFFFAOYSA-N zinc;oxygen(2-) Chemical compound [O-2].[Zn+2] RNWHGQJWIACOKP-UHFFFAOYSA-N 0.000 description 1
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
- A61K31/16—Amides, e.g. hydroxamic acids
- A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
- A61K31/166—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the carbon of a carboxamide group directly attached to the aromatic ring, e.g. procainamide, procarbazine, metoclopramide, labetalol
-
- 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
- A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
- A61K31/58—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin
-
- 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
- A61K9/0014—Skin, i.e. galenical aspects of topical compositions
-
- 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
- A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P17/00—Drugs for dermatological disorders
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
Definitions
- the subj ect matter of the invention is a pharmaceutical composition for topical application containing a beta- adrenergic receptor antagonist and a corticosteroid and use thereof in the treatment of hemangiomas in children .
- Hemangiomas are the most common mild tumors of early childhood that occur in children with an incidence of between 4 and 10 % .
- Early childhood angiomas develop on the face and neck ( approx . 80 % of cases ) as well as on the trunk and limbs .
- a phase of rapid proli ferative growth of angiomas starts which extends until the end of the child' s first year of age .
- the subsequent phase of slow regression di f fers in its duration and may extend until the age of 5-10 years . Approx . 10-15 % of early childhood angiomas grow to si zes that cause functional impairment of an organ or are li fe-threatening to the child .
- topical therapy has started to be used through the superficial application of medicines in the form of cream, gel or ointment on angiomas (1, 3, 4) .
- medicines in the form of cream, gel or ointment on angiomas (1, 3, 4) .
- ophthalmic drops timolol
- oral tablets or intravenous injections (propranolol) (3) , that is, medicines that according to manufacturers' instructions should be applied via different routes.
- intralesional therapies are known, which involve an injection of a formulation inside a lesion; the therapy, however, requires general anesthesia and, therefore, hospitalization and involvement of specialized staff, with a potential risk of local and systemic complications.
- the objective of the invention was to develop a pharmaceutical composition for topical application effective in the treatment of hemangiomas in children.
- the subj ect matter of the invention is a pharmaceutical composition for topical application, characteri zed in that it contains a beta-adrenergic receptor antagonist , a corticosteroid and a pharmaceutically acceptable carrier, wherein the beta-adrenergic receptor antagonist is labetalol or a pharmaceutically acceptable salt thereof , and the corticosteroid is selected from a group including triamcinolone , triamcinolone acetonide , triamcinolone hexacetonide and triamcinolone diacetate .
- the pharmaceutically acceptable salt of labetalol is the hydrochloride .
- the weight ratio of the beta-adrenergic receptor antagonist to the corticosteroid is 1 : 3 .
- the concentration of the beta-adrenergic receptor antagonist in the composition is 0 . 02-0 . 5 % by weight .
- the concentration of the corticosteroid in the composition is 0 . 02-0 . 5 % by weight .
- the composition is in the form of cream, ointment or gel .
- Another subj ect matter of the invention is a pharmaceutical composition as defined before for use in the treatment of hemangiomas in children .
- An advantage of the invention is that one formulation is used instead of several formulations .
- Two substances from two distinct therapeutic groups a beta-adrenergic receptor antagonist and a corticosteroid
- a beta-adrenergic receptor antagonist and a corticosteroid are combined in one formulation . Therefore , concomitant use of several formulations , whose combined ef fects ( antagonism, synergy) are unknown, is avoided .
- This is not only convenient but first of all safe , both for the child (patient) and for the person who applies the formulations (errors may occur when several formulations are used; the dose as required is ensured) .
- Another advantage of the invention is that the formulation is used externally. Even though most angiomas are located within the skin, previous therapeutic methods were based on the administration of formulations by mouth or in the form of injections, thus having systemic effects on the body; this involves a need for general anesthesia, hospitalization and hiring specialized personnel in small children.
- the pharmaceutical composition of the invention is used topically, that is, only in the affected site, which definitely reduces the systemic effects of medicines administered. Therefore, the risk of undesirable effects due to the medicines administered, and thus their adverse effect on the child's health, is minimized.
- the solution as developed facilitates the application of the formulation at home by the family. Hospitalization or involvement of medical professionals is not required, which is convenient for parents and children.
- Another advantage of the invention is a reduced dosage of medicines administered.
- the efficacy of any therapy depends on the administration of required drug doses.
- beta-adrenergic receptor antagonists (betablockers) administered by mouth have systemic effects, first of all on the cardiovascular system when used as indicated. After achieving the required therapeutic level in the patient's blood, they act by saturating all tissues and organs with the therapeutic substance. Vascular lesions in the skin are not the principal therapeutic target of betablockers, and a side effect is rather involved.
- drug doses administered topically can be reduced, because there is no need for loading the patient ' s whole body to achieve a drug concentration so that it can penetrate the lesion ( from inside ) .
- the pharmaceutical composition of the invention acts directly on the lesion .
- the doses could be reduced to increase the strength of action compared to conventionally used concentrations of the drugs administered separately : additive synergy was achieved .
- an angioma cell line was used : EOMA (ATCC® CRL-2586TM) Hemangioendothel ioma .
- the cells were grown in the EMEM (ATCC ) medium and seeded in a 96-well plate for 24 hours . Subsequently, they were incubated with the test compound in selected concentrations : 50-350 pM (the compound was dissolved in DMSO and water ) for 48 hours . The final methanol concentration in each well was 1 pL per 100 pL of the medium .
- the EMEM medium with 1 pL methanol added was used as control and pure methanol was the positive control .
- a cytotoxicity test was performed after 48 h of incubation according to the Vybrant MTT cell proli feration test kit : 10 pL of 12 mM MTT stock solution was added to the cells and further incubated at 37 ° C for 4 h . Volume of 25 pL was removed from the wells after incubation and 50 pL DMSO was added . The plates were incubated at 37 ° C for 10 min and absorbance at 540 nm was read .
- test compounds were four compounds acting on beta-adrenergic receptors : propranolol hydrochloride , labetalol hydrochloride , atenolol and isoprenaline hydrochloride, and four corticosteroids: prednisolone, prednisone, hydrocortisone, and triamcinolone.
- IC50 values for all eight test compounds were determined as a result of tests in cell lines. The lowest IC50 values were found for labetalol hydrochloride and triamcinolone. These were 308 pM and 844 pM, respectively.
- EOMA ATCC® CRL-2586TM
- Hemangioendothelioma Hemangioendothelioma
- a stock solution (S2) of triamcinolone with a concentration of 1 688.5 pM was prepared.
- a stock solution (SI) of labetalol hydrochloride with a concentration of 617.8 pM was prepared.
- the assumption was to prepare a combination of concentrations within the IC50 values determined in cell lines for the test compounds in stage one of the studies. Table 1 below shows how combinations of concentrations were prepared to determine the best synergic action of both substances.
- angioma cell line was used : EOMA (ATCC® CRL-2586TM) Hemangioendothel ioma .
- the cells were grown in the EMEM (ATCC ) medium and seeded in a 96-well plate for 24 hours . Subsequently, they were incubated with the test compound in selected concentrations as listed in Table 1 for 48 hours . The final methanol concentration in each well was 1 pL per 100 pL of the medium .
- the EMEM medium with 1 pL methanol added was used as control and pure methanol was the positive control .
- a cytotoxicity test was performed after 48 h of incubation according to the Vybrant MTT cell proli feration test kit : 10 pL of 12 mM MTT stock solution was added to the cells and further incubated at 37 ° C for 4 h . Volume of 25 pL was removed from the wells after incubation and 50 pL DMSO was added . The plates were incubated at 37 ° C for 10 min and absorbance at 540 nm was read .
- Cream was prepared .
- Cream was prepared .
- Cream was prepared .
- Ointment was prepared.
- Ointment was prepared.
- micronized substances are dissolved in the solution.
- the weighed gel bases were ground in a mortar, and a solution containing labetalol hydrochloride and triamcinolone was gradually added. The grinding was continued until a homogenous mass was obtained.
- Peng Xu et al. "A self-controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas”; Dermatologic Therapy 2018, 31, el2595; DOI: 10.1111/dth.12595;
Abstract
The subject matter of the invention is a pharmaceutical composition for topical application containing a beta- adrenergic receptor antagonist and a corticosteroid and use thereof in the treatment of hemangiomas in children.
Description
A pharmaceutical composition for topical application and use thereof in the treatment of hemangiomas in children
Description
Technical Field
The subj ect matter of the invention is a pharmaceutical composition for topical application containing a beta- adrenergic receptor antagonist and a corticosteroid and use thereof in the treatment of hemangiomas in children .
Background Art
Hemangiomas are the most common mild tumors of early childhood that occur in children with an incidence of between 4 and 10 % . Early childhood angiomas develop on the face and neck ( approx . 80 % of cases ) as well as on the trunk and limbs . As early as in the first weeks of li fe , a phase of rapid proli ferative growth of angiomas starts which extends until the end of the child' s first year of age . The subsequent phase of slow regression di f fers in its duration and may extend until the age of 5-10 years . Approx . 10-15 % of early childhood angiomas grow to si zes that cause functional impairment of an organ or are li fe-threatening to the child . Systemic therapy and/or surgical treatment need to be started immediately in such patients . Several therapeutic modalities are available for the other cases of angiomas : laser therapy, scleroti zation, cryotherapy, surgical excision, which require the patient to undergo general anesthesia . Another approach is the oral administration of cardiac medicines (propranolol ) ( 2 ) which accelerate the regression of vascular lesions , frequently all the way to their complete disappearance . Their ef fect on angiomas was revealed by accident ; nevertheless , they are currently routinely used worldwide based on accepted
standards owing to their high efficacy. An inconvenient aspect of the therapy is the need for initial hospitalization (2-3 days) , an ECG to be performed and a cardiology consultation to evaluate the patient's eligibility for therapy .
To eliminate these disadvantages, topical therapy has started to be used through the superficial application of medicines in the form of cream, gel or ointment on angiomas (1, 3, 4) . These are formulated on demand based on commercially available ready-made products, such as ophthalmic drops (timolol) (4) , oral tablets or intravenous injections (propranolol) (3) , that is, medicines that according to manufacturers' instructions should be applied via different routes. In addition, intralesional therapies are known, which involve an injection of a formulation inside a lesion; the therapy, however, requires general anesthesia and, therefore, hospitalization and involvement of specialized staff, with a potential risk of local and systemic complications.
The efficacy of any medicines administered was not tested in any of the therapeutic modalities previously used in practice, including those listed above, and their therapeutic doses considering the different application method or synergy of action, in particular combinations with corticosteroids, were not determined.
A publication of Peng Xu et al. : "A self-controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas"; Dermatologic Therapy 2018, 31, el2595; DOI: 10 .1111/dth .12595 disclosed a combination therapy of hemangiomas in children which involved an
intralesional injection of diprospan and topical application of cream containing 0.5 % timolol.
A publication of Alahmady H. Alsmman et al. : "Combined oral propranolol with intralesional injection of triamcinolone acetonide in treatment of infantile periocular hemangiomas"; Clinical Ophthalmology 2017, 11, 2177-2181; http://dx.doi.org/10.2147/OPTH.S153121 disclosed a combination therapy of hemangiomas in children which involved oral administration of propranolol and intralesional injection of triamcinolone acetonide.
A publication of Wenhu Zhou et al. : "Formulation, characterization and clinical evaluation of propranolol hydrochloride gel for transdermal treatment of superficial infantile hemangioma"; Drug Development and Industrial Pharmacy 2014, Informa Healthcare USA, Inc.; DOI: 10.3109/03639045.2014.931968 disclosed a manufacturing process for a pharmaceutical composition in the form of gel, containing propranolol hydrochloride, HPMC, a terpene, alcohol and other excipients for treating hemangiomas in children .
A publication of Retno Danarti et al. Topical Timolol Maleate 0.5 % for Infantile Hemangioma: Its Effectiveness Compared to Ultrapotent Topical Corticosteroids - A SingleCenter Experience of 278 Cases. Dermatology 2016; 232: 566- 571 disclosed a comparison of the efficacy of steroid ointment with ointment containing timolol.
Summary of Invention
The objective of the invention was to develop a pharmaceutical composition for topical application effective in the treatment of hemangiomas in children.
The subj ect matter of the invention is a pharmaceutical composition for topical application, characteri zed in that it contains a beta-adrenergic receptor antagonist , a corticosteroid and a pharmaceutically acceptable carrier, wherein the beta-adrenergic receptor antagonist is labetalol or a pharmaceutically acceptable salt thereof , and the corticosteroid is selected from a group including triamcinolone , triamcinolone acetonide , triamcinolone hexacetonide and triamcinolone diacetate .
Preferably, the pharmaceutically acceptable salt of labetalol is the hydrochloride .
Preferably, the weight ratio of the beta-adrenergic receptor antagonist to the corticosteroid is 1 : 3 .
Preferably, the concentration of the beta-adrenergic receptor antagonist in the composition is 0 . 02-0 . 5 % by weight .
Preferably, the concentration of the corticosteroid in the composition is 0 . 02-0 . 5 % by weight .
Preferably, the composition is in the form of cream, ointment or gel .
Another subj ect matter of the invention is a pharmaceutical composition as defined before for use in the treatment of hemangiomas in children .
An advantage of the invention is that one formulation is used instead of several formulations . Two substances from two distinct therapeutic groups ( a beta-adrenergic receptor antagonist and a corticosteroid) , previous ly used separately, are combined in one formulation . Therefore , concomitant use of several formulations , whose combined ef fects ( antagonism, synergy) are unknown, is avoided . This is not only convenient but first of all safe , both for the
child (patient) and for the person who applies the formulations (errors may occur when several formulations are used; the dose as required is ensured) .
Another advantage of the invention is that the formulation is used externally. Even though most angiomas are located within the skin, previous therapeutic methods were based on the administration of formulations by mouth or in the form of injections, thus having systemic effects on the body; this involves a need for general anesthesia, hospitalization and hiring specialized personnel in small children. The pharmaceutical composition of the invention is used topically, that is, only in the affected site, which definitely reduces the systemic effects of medicines administered. Therefore, the risk of undesirable effects due to the medicines administered, and thus their adverse effect on the child's health, is minimized. The solution as developed facilitates the application of the formulation at home by the family. Hospitalization or involvement of medical professionals is not required, which is convenient for parents and children.
Another advantage of the invention is a reduced dosage of medicines administered. The efficacy of any therapy depends on the administration of required drug doses. For example, beta-adrenergic receptor antagonists (betablockers) administered by mouth have systemic effects, first of all on the cardiovascular system when used as indicated. After achieving the required therapeutic level in the patient's blood, they act by saturating all tissues and organs with the therapeutic substance. Vascular lesions in the skin are not the principal therapeutic target of betablockers, and a side effect is rather involved. Owing to the pharmaceutical composition of the invention, drug doses
administered topically ( externally) can be reduced, because there is no need for loading the patient ' s whole body to achieve a drug concentration so that it can penetrate the lesion ( from inside ) . When administered topically, the pharmaceutical composition of the invention acts directly on the lesion . In addition, based on the results of in vitro studies into the synergy of medicines combined in appropriate concentrations ( the corticosteroid and the beta-blocker ) , the doses could be reduced to increase the strength of action compared to conventionally used concentrations of the drugs administered separately : additive synergy was achieved .
Examples
Example 1
Determination of IC50 for selected compounds
In the experiment , an angioma cell line was used : EOMA (ATCC® CRL-2586™) Hemangioendothel ioma . The cells were grown in the EMEM (ATCC ) medium and seeded in a 96-well plate for 24 hours . Subsequently, they were incubated with the test compound in selected concentrations : 50-350 pM ( the compound was dissolved in DMSO and water ) for 48 hours . The final methanol concentration in each well was 1 pL per 100 pL of the medium . The EMEM medium with 1 pL methanol added was used as control and pure methanol was the positive control . A cytotoxicity test was performed after 48 h of incubation according to the Vybrant MTT cell proli feration test kit : 10 pL of 12 mM MTT stock solution was added to the cells and further incubated at 37 ° C for 4 h . Volume of 25 pL was removed from the wells after incubation and 50 pL DMSO was added . The plates were incubated at 37 ° C for 10 min and absorbance at 540 nm was read . The test compounds were four compounds acting on beta-adrenergic receptors : propranolol hydrochloride , labetalol hydrochloride , atenolol and
isoprenaline hydrochloride, and four corticosteroids: prednisolone, prednisone, hydrocortisone, and triamcinolone.
IC50 values for all eight test compounds were determined as a result of tests in cell lines. The lowest IC50 values were found for labetalol hydrochloride and triamcinolone. These were 308 pM and 844 pM, respectively.
Example 2
In vitro evaluation of the labetalol hydrochloride and triamcinolone combination in various concentrations
Within stage two of the studies, a model was developed to test the therapeutic efficacy and interactions between the effects of labetalol hydrochloride and triamcinolone in various concentrations. The study was conducted using angioma cell lines: EOMA (ATCC® CRL-2586™) Hemangioendothelioma .
A stock solution (S2) of triamcinolone with a concentration of 1 688.5 pM was prepared. Subsequently, a stock solution (SI) of labetalol hydrochloride with a concentration of 617.8 pM was prepared. The assumption was to prepare a combination of concentrations within the IC50 values determined in cell lines for the test compounds in stage one of the studies. Table 1 below shows how combinations of concentrations were prepared to determine the best synergic action of both substances.
51 - stock solution of labetalol hydrochloride = 617 . 8 piM
52 - stock solution of triamcinolone = 1 688 . 5 piM
Sixteen combinations of various concentrations of the test substances were obtained as shown in the diagram below .
Subsequently, the resulting 16 combinations were tested in cell lines . The average viability for all combinations was determined .
In the experiment , an angioma cell line was used : EOMA (ATCC® CRL-2586™) Hemangioendothel ioma . The cells were grown in the EMEM (ATCC ) medium and seeded in a 96-well plate for 24 hours . Subsequently, they were incubated with the test compound in selected concentrations as listed in Table 1 for 48 hours . The final methanol concentration in each well was 1 pL per 100 pL of the medium . The EMEM medium with 1 pL methanol added was used as control and pure methanol was the positive control . A cytotoxicity test was performed after 48 h of incubation according to the Vybrant MTT cell proli feration test kit : 10 pL of 12 mM MTT stock solution was added to the cells and further incubated at 37 ° C for 4 h . Volume of 25 pL was removed from the wells after incubation and 50 pL DMSO was added . The plates were incubated at 37 ° C for 10 min and absorbance at 540 nm was read .
Conclusions
When the concentrations calculated based on IC50 values for the compounds were used, synergy was achieved; therefore , the ef fect of two substances used in speci fic concentrations resulted in the enhanced activity of the mixture of triamcinolone and labetalol compared to the ef fect
of the drugs administered separately. It was found that labetalol hydrochloride used in the IC50 concentration in combination with small amounts of triamcinolone had an effect on the reduced viability of angioma cells. Therefore, it was shown that synergy occurred already at low corticosteroid concentrations; as a result, the dose thereof in combination with the beta-blocker could be reduced while achieving the same therapeutic effect. The use of a mixture of both test substances achieved better efficacy against angioma cancer cells than when each substance was used separately. Therefore, an effect of additive synergy was achieved.
The results of studies in angioma cells in the concentration range tested for the combination of test compounds showed that the test compounds had synergy of action for all combinations of concentrations. However, the highest synergy of action was found at labetalol hydrochloride and triamcinolone concentrations as determined for mixture no. 13.
Example 3
Preparation of pharmaceutical compositions
(a) Preparation of cream
0.5 g triamcinolone and 0.166 g labetalol hydrochloride, respectively, were weighed out, placed in a mortar and micronized. Subsequently, the weighed cream base was added and ground until a homogenous mass was obtained.
If the recipe lists a solution, micronized substances are dissolved in the solution. The weighed cream bases were ground in a mortar, and a solution containing labetalol hydrochloride and triamcinolone was gradually added. The grinding was continued until a homogenous mass was obtained.
Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride ;
0.5 g triamcinolone )
3 % boric acid solution 15.0
Lekobaza to 100.0
Cream was prepared .
Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride ;
0.5 g triamcinolone )
Distilled water
Hascobaza in equal parts to 100.0
Cream was prepared .
Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride ;
0.5 g triamcinolone )
Distilled water q . s .
Lanolin 20.0
Petroleum jelly to 100.0
Cream was prepared .
Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride ;
0.5 g triamcinolone )
Eucerin
Distilled water in equal parts to 100.0
(b) Preparation of ointment
0.5 g triamcinolone and 0.166 g labetalol hydrochloride, respectively, were weighed out, placed in a mortar and micronized. Subsequently, the weighed ointment base was added and ground in the mortar until a homogenous mass was obtained.
1) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone)
Cholesterol ointment to 100.0
Ointment was prepared.
2) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone)
Petroleum jelly to 100.0 Ointment was prepared.
3) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone) Liquid paraffin 10.0
Yellow petroleum jelly to 100.0 Ointment was prepared.
4) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone) Resorcinol 5.0
Liquid paraffin 5.0 Ichthyol 2.0 Zinc paste to 100.0
Ointment was prepared.
(c) Preparation of gel
0.5 g triamcinolone and 0.166 g labetalol hydrochloride, respectively, were weighed out, placed in a mortar and micronized. Subsequently, the weighed gel base was added and ground until a homogenous mass was obtained.
If the recipe lists a solution, micronized substances are dissolved in the solution. The weighed gel bases were ground in a mortar, and a solution containing labetalol hydrochloride and triamcinolone was gradually added. The grinding was continued until a homogenous mass was obtained.
1) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone)
2 % lignocaine gel to 50.0
Gel was prepared.
2) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone) Methylcellulose ointment to 100.0 Gel was prepared.
3) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone)
Menthol 2.0
Glycerol ointment to 50.0
Gel was prepared.
4) Recipe: 1 : 3 mixture (0.166 g labetalol hydrochloride;
0.5 g triamcinolone)
Menthol 5.0
Capsicum tincture 2.0
2 % lignocaine gel Macrogol ointment in equal parts to 100.0
Gel was prepared.
Reference list
(1) Peng Xu et al. : "A self-controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas"; Dermatologic Therapy 2018, 31, el2595; DOI: 10.1111/dth.12595;
(2) Alahmady H Alsmman et al. : "Combined oral propranolol with intralesional injection of triamcinolone acetonide in treatment of infantile periocular hemangiomas"; Clinical Ophthalmology 2017, 11, 2177- 2181; http://dx.doi.org/10.2147/OPTH.S153121;
(3) Wenhu Zhou et al. : "Formulation, characterization and clinical evaluation of propranolol hydrochloride gel for transdermal treatment of superficial infantile hemangioma"; Drug Development and Industrial Pharmacy 2014, Informa Healthcare USA, Inc.; DOI: 10.3109/03639045.2014.931968;
(4) Retno Danarti et al. : "Topical Timolol Maleate 0.5 % for Infantile Hemangioma: Its Effectiveness Compared
to Ultrapotent Topical Corticosteroids - A SingleCenter Experience of 278 Cases"; Dermatology 2016, 232, 566-571.
Claims
Claims A pharmaceutical composition for topical application, characterized in that said composition contains a beta- adrenergic receptor antagonist, a corticosteroid and a pharmaceutically acceptable carrier, wherein the beta- adrenergic receptor antagonist is labetalol or a pharmaceutically acceptable salt thereof, and the corticosteroid is selected from a group including triamcinolone, triamcinolone acetonide, triamcinolone hexacetonide and triamcinolone diacetate. The composition of Claim 1, characterized in that the pharmaceutically acceptable salt of labetalol is the hydrochloride . The composition of Claim 1 or Claim 2, characterized in that the weight ratio of the beta-adrenergic receptor antagonist to the corticosteroid is 1 : 3. The composition of any one of Claims 1 to 3, characterized in that the concentration of the beta- adrenergic receptor antagonist in the composition is from 0.02 to 0.5 % by weight. The composition of any one of the preceding Claims 1 to
4, characterized in that the concentration of the corticosteroid in the composition is from 0.02 to 0.5 % by weight. The composition of any one of the preceding Claims 1 to
5, characterized in that said composition is in the form of cream, ointment or gel. A pharmaceutical composition as defined in Claims 1 to 6 for use in the treatment of hemangiomas in children.
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Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2009050567A2 (en) * | 2007-10-19 | 2009-04-23 | Université Victor Segalen-Bordeaux 2 | Use of a beta blocker for the manufacture of a medicament for the treatment of hemangiomas |
WO2010118340A1 (en) * | 2009-04-09 | 2010-10-14 | University Of Medicine And Dentistry Of New Jersey | Treatment of cutaneous hemangioma |
-
2022
- 2022-09-20 PL PL442316A patent/PL244294B1/en unknown
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Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2009050567A2 (en) * | 2007-10-19 | 2009-04-23 | Université Victor Segalen-Bordeaux 2 | Use of a beta blocker for the manufacture of a medicament for the treatment of hemangiomas |
WO2010118340A1 (en) * | 2009-04-09 | 2010-10-14 | University Of Medicine And Dentistry Of New Jersey | Treatment of cutaneous hemangioma |
Non-Patent Citations (4)
Title |
---|
COUTO JAVIER A. ET AL: "Management of problematic infantile hemangioma using intralesional triamcinolone: Efficacy and safety in 100 infants", JOURNAL OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, vol. 67, no. 11, 1 November 2014 (2014-11-01), GB, pages 1469 - 1474, XP093122445, ISSN: 1748-6815, DOI: 10.1016/j.bjps.2014.07.009 * |
GARZON M C ET AL: "Ultrapotent topical corticosteroid treatment of hemangiomas of infancy", JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, MOSBY, INC, US, vol. 52, no. 2, 1 February 2005 (2005-02-01), pages 281 - 286, XP004728887, ISSN: 0190-9622, DOI: 10.1016/J.JAAD.2004.09.004 * |
PAINTER SALLY L ET AL: "Review of topical beta blockers as treatment for infantile hemangiomas", SURVEY OF OPHTHALMOLOGY, vol. 61, no. 1, 25 September 2015 (2015-09-25), pages 51 - 58, XP029350950, ISSN: 0039-6257, DOI: 10.1016/J.SURVOPHTHAL.2015.08.006 * |
XU PENG ET AL: "A self-controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas", DERMATOLOGIC THERAPY, vol. 31, no. 3, 30 April 2018 (2018-04-30), US, XP093122421, ISSN: 1396-0296, Retrieved from the Internet <URL:https://onlinelibrary.wiley.com/doi/full-xml/10.1111/dth.12595> DOI: 10.1111/dth.12595 * |
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