WO2024100032A1

WO2024100032A1 - Vasopressin formulation

Info

Publication number: WO2024100032A1
Application number: PCT/EP2023/080981
Authority: WO
Inventors: Ivona JASPRICA; Marcel LAGEDROSTE; Edvin BRUSAC; Ivona Sosic
Original assignee: Xellia Pharmaceuticals Aps
Priority date: 2022-11-09
Filing date: 2023-11-07
Publication date: 2024-05-16

Abstract

The present disclosure relates to a ready-to-use formulation of vasopressin, the process for making such formulations and use of such formulations for treatment of a patient in need thereof.

Description

Vasopressin formulation

FIELD OF THE INVENTION

[1] The present disclosure is directed to a ready -to-administer vasopressin formulation, the preparation and uses thereof. Specifically, the disclosure is generally directed to storage stable ready-to-administer formulations of vasopressin.

BACKGROUND

[2] Vasopressin is a polypeptide hormone. The chemical name of vasopressin is cyclo (1-6) L- cysteinyl-L-tyrosyl-L-phenylalanyl-L-glutaminyl-L-asparaginyl-L-cysteinyl-L-prolyl-L- arginyl- L-glycinamide. Vasopressin may be in the form of synthetic arginine-vasopressin.

[3] The structural formula of arginine vasopressin is shown below:

[4] Vasopressin is indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines.

[5] Vasopressin formulations for injection are typically aqueous solutions of synthetic arginine vasopressin administered by intravenous injection.

[6] What is needed is a ready-to-administer aqueous vasopressin formulation which may be delivered to a patient without a need for dilution, and that is stable over a predefined period. SUMMARY OF THE INVENTION

[7] The present disclosure relates to a ready-to-administer formulation of vasopressin, or a pharmaceutically acceptable salt thereof.

[8] In the formulations described herein the present disclosure, stability of vasopressin is improved, and the shelf life of the formulations may be prolonged.

[9] In an aspect, pH of the vasopressin formulations is from 3.4 to 5.5.

[10] In an aspect, the vasopressin formulation is in unit dosage form.

[11] In an aspect, the concentration of vasopressin is from O.lU/ml to 20U/ml.

[12] In an aspect, the pharmaceutical formulation of the present disclosure is in aqueous form.

[13] This disclosure also provides a process for manufacturing disclosed pharmaceutical formulations.

[14] Pharmaceutical formulations according to the present disclosure may be used to increase the blood pressure of a subject in need thereof.

[15] It is to be understood that both the foregoing description and the following further description are exemplary and explanatory only and are not restrictive of the claims.

DETAILED DESCRIPTION OF THE INVENTION

[16] The present disclosure relates to a ready-to-administer vasopressin formulation.

[17] Unless otherwise mentioned, vasopressin is in the form of synthetic arginine vasopressin.

[18] In an aspect, vasopressin is synthetically produced as is known in the art.

[19] In an aspect, pH of the aqueous formulation is from 3.4 to 5.5.

[20] In an aspect, pH of the aqueous formulation is from 3.5 to 5.0.

[21] In an aspect, pH of the aqueous formulation is from 3.6 to 5.0.

[22] In an aspect, pH of the aqueous formulation is from 3.8 to 5.0.

[23] In an aspect, pH of the aqueous formulation is from 3.8 to 4.4.

[24] In an aspect, the pH of the formulation is 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4,

4.5, 4.6, 4.7, 4.8, 4.9, 5.0, 5.1, 5.2, 5.3, 5.4 or 5.5. [25] “pH” is the conventional measurement unit of hydrogen ion activity in a solution at controlled room temperature, unless another temperature is specified.

[26] In an aspect, the formulation is in a unit dosage form, that is, a form to be administered to a patient in a single dose.

[27] It was found that, when vasopressin is formulated in formulations according to the present disclosure, degradation of vasopressin is delayed, and accordingly, such formulations exhibit prolonged chemical and physical stability and provide more flexible storage conditions and handling when stored under controlled room temperature conditions.

[28] By the term "controlled room temperature" used herein, it means a controlled room temperature from 20 to 25°C.

[29] Further, the pharmaceutical formulation in accordance with the present disclosure has improved stability at a temperature of 30°C.

[30] Further, the pharmaceutical formulation in accordance with the present disclosure has improved stability at a temperature of 40°C.

[31] The term “stable” as used herein means that the pharmaceutical formulations meet one or more of the following criteria:

(i) The pharmaceutical formulation exhibits an acceptable vasopressin assay drop after a certain time period; and/or

(ii) The pharmaceutical formulation exhibits an acceptable amount of impurities being formed after a certain period compared to the amount of impurities present at the beginning of the period; and/or

(iii) The pharmaceutical formulation retains a pharmaceutically desirable appearance such as clarity, unchanged and /or improved color, and absence of visible particles (i.e., precipitate free or particle free formulation). Visual inspection for visible particles may be performed as follows: the container under inspection is gently swirled and inverted, ensuring that no air bubbles are produced, and inspected during certain period (approximately 5 to 20 sec) with naked eye and/or under the magnifier. Visual inspection for visible particles in bags may be performed as follows: verifying the solution into the bag against the light over a white surface and then over a black surface. Visual inspection for change of color may be performed as follows: The container is inspected by eye and a color is assigned to the formulation. The color may also be determined by a UV/VIS spectrometer and the difference in color between two samples may be expressed as delta E.

[32] As used herein, an acceptable vasopressin assay drop after a certain time period (i.e., a drop in vasopressin assay) is calculated as a difference in vasopressin assay determined immediately after formulation preparation (i.e., time 0) and vasopressin assay determined at specific stability testing point e.g., after 1 month, 2 months, 3 months, etc. The vasopressin assay may be analyzed, for example, by liquid chromatography, e.g., HPLC, UHPLC, LC/MS.

[33] In an aspect, the vasopressin assay may be analyzed by UHPLC. In an aspect, the vasopressin assay may be analyzed by UHPLC-FLD, UHPLC-D D or UHPLC-MS method.

[34] In an aspect, a ready-to-administer aqueous formulation according to the present disclosure is stable under controlled room temperature conditions for a certain period.

[35] In an aspect, the aqueous formulations are stable for at least 14 days, at least 1 month, at least 2 months, at least 3 months, at least 6 months, at least 9 months, or at least 12 months, when stored under controlled room temperature conditions.

[36] In an aspect, the aqueous formulations are stable for at least 1 month when stored under controlled room temperature conditions.

[37] In an aspect, the aqueous formulations are stable for at least 3 months when stored under controlled room temperature conditions.

[38] Formulations according to the present disclosure showed surprising stability for a reasonable period of time, when stored at a temperature of 30°C.

[39] In an aspect, the formulations are stable for at least 14 days, at least 1 month, at least 2 months, at least 3 months, or longer when stored at temperature of 30°C.

[40] In an aspect, the formulations are stable for at least 14 days, at least 1 month, at least 2 months, at least 3 months, or longer when stored at temperature of 40°C.

[41] In an aspect, “stability” may be defined by the amount of total or individual impurities in the formulation after a certain period. Stability may also be defined by an increase in total or individual impurities generated after a determined period of time.

[42] Stability may be determined by measuring the amount of individual impurities in the formulation according to the present disclosure after a predetermined time, preferably expressed as a percentage or area-percentage as analyzed by HPLC or UHPLC. In an aspect, the amount of individual impurity in the formulation is analyzed by UHPLC. In an aspect, the amount of individual impurity in the formulation is expressed as a percentage or areapercentage as analyzed by UHPLC-FLD or UHPLC-DAD method. In an aspect, the amount of individual impurity in the formulation is expressed as a percentage or area-percentage as analyzed by UHPLC-MS method.

[43] By the term “impurity” as used herein means a degradation product of the active pharmaceutical ingredient in the pharmaceutical formulation.

[44] Some of the individual impurities related to vasopressin are vasopressin trisulfide and monodeamidated vasopressin.

[45] The structure of vasopressin trisulfide is shown below as Structure 1.

[46] The disclosed formulations also minimize degradation of active pharmaceutical ingredient to impurities.

[47] In an aspect, the disclosed formulations retain pharmaceutically desirable appearance, such as avoiding the formation of visible particles. Thus, no visible particles are present in the disclosed formulations after storage during a determined period of time.

[48] The term “stable” may be defined as not more than 10% of vasopressin assay drop in the pharmaceutical formulation after predefined period analyzed by liquid chromatography, e.g., HPLC, UHPLC, LC/MS.

[49] For example, a stable formulation can be one which has not more than 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, of vasopressin assay drop after a predetermined time period. [50] In an aspect, a stable formulation can be one which has not more than 8% of vasopressin assay drop after a predetermined time period.

[51] In an aspect, a stable or stabilized formulation can be one which has not more than 10% of vasopressin assay drop after certain period.

[52] In an aspect, a stable or stabilized formulation can be one which has not more than 3% of vasopressin assay drop after 1 month under controlled room temperature as analyzed by UHPLC.

[53] In an aspect, a stable or stabilized formulation can be one which has not more than 3% of vasopressin assay drop after 2 months under controlled room temperature as analyzed by UHPLC.

[54] In an aspect, a stable or stabilized formulation can be one which has not more than 2% of vasopressin assay drop after 2 months under controlled room temperature as analyzed by UHPLC.

[55] In an aspect, a stable or stabilized formulation can be one which has not more than 1% of vasopressin assay drop after 2 months under controlled room temperature as analyzed by UHPLC.

[56] In an aspect, a stable or stabilized formulation can be one which has not more than 5% of vasopressin assay drop after 3 months under controlled room temperature as analyzed by UHPLC.

[57] In an aspect, a stable or stabilized formulation can be one which has not more than 3% of vasopressin assay drop after 3 months under controlled room temperature as analyzed by UHPLC.

[58] In an aspect, a stable or stabilized formulation can be one which has not more than 2% of vasopressin assay drop after 3 months under controlled room temperature as analyzed by UHPLC.

[59] In an aspect, a stable or stabilized formulation can be one which has not more than 5% of vasopressin assay drop after 5 months under controlled room temperature as analyzed by UHPLC.

[60] In an aspect, a stable or stabilized formulation can be one which has not more than 5% of vasopressin assay drop after 6 months under controlled room temperature as analyzed by UHPLC. [61] In an aspect, the term "stable” is defined as not more than 10% increase of total impurities in the formulation after a predetermined time.

[62] In an aspect, the term "stable” is defined as not more than 8% increase of total impurities in the formulation after a predetermined time.

[63] In an aspect, a stable formulation can be one that has not more than a 5% increase of total impurities formation after 6 months under controlled room temperature conditions and as analyzed by UHPLC.

[64] In an aspect, a stable formulation can be one that has not more than a 5% increase of total impurities formation after 5 months under controlled room temperature conditions and as analyzed by UHPLC.

[65] In an aspect, a stable formulation can be one that has not more than a 5% increase of total impurities formation after 3 months under controlled room temperature conditions and as analyzed by UHPLC.

[66] In an aspect, a stable formulation can be one that has not more than a 3% increase of total impurities formation after 3 months under controlled room temperature conditions and as analyzed by UHPLC.

[67] In an aspect, a stable formulation can be one that has not more than a 2% increase of total impurities formation after 3 months under controlled room temperature conditions and as analyzed by UHPLC.

[68] In an aspect, a stable formulation can be one that has not more than a 1% increase of total impurities formation after 2 months under controlled room temperature conditions and as analyzed by UHPLC. In an aspect, a stable formulation can be one that has not more than a 2% increase of total impurities formation after 2 months under controlled room temperature conditions and as analyzed by UHPLC.

[69] In an aspect, a stable formulation can be one that has not more than a 3% increase of total impurities formation after 2 months under controlled room temperature conditions and as analyzed by UHPLC.

[70]

[71] In an aspect, a stable formulation does not comprise more than 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10% increase of total impurity under controlled room temperature conditions after a predetermined time. [72] In an aspect, in case where more than one impurity of the individual active pharmaceutical ingredient can be formed over time, "stable” is defined as not more than a 5% increase of each individual impurity formation after a predetermined time.

[73] In an aspect, a stable formulation does not comprise more than 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, or 10% increase of an individual impurity after a predetermined time.

[74] In an aspect, where more than one impurity of the individual active pharmaceutical ingredient can be formed over time, a stable formulation does not comprise more than 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 2%, 3%, 4%, 5% of increase of individual impurity after a predetermined time.

[75] In an aspect, where more than one impurity of the individual active pharmaceutical ingredient can be formed over time, a stable formulation does not comprise more than 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 2%, 3%, 4%, 5% of increase of vasopressin trisulfide after a predetermined time.

[76] In an aspect, a stable formulation can be one that has not more than a 2% increase of individual impurity formation after 3 months under controlled room temperature conditions and as analyzed by UHPLC.

[77] In one aspect, a stable formulation can be one that has not more than a 2% increase of vasopressin trisulfide after 2 months under controlled room temperature analyzed by UHPLC.

[78] In one aspect, a stable formulation can be one that has not more than a 2% increase of vasopressin trisulfide after 3 months under controlled room temperature analyzed by UHPLC.

[79] In one aspect, a stable formulation can be one that has not more than a 1% increase of vasopressin trisulfide after 3 months under controlled room temperature analyzed by UHPLC.

[80] As used herein, “stable” may also refer to the absence of visible particles (“free of particles” or “particles/precipitate free”) in the pharmaceutical formulation after a predetermined time.

[81] In an aspect, the formulation is free of particles for at least 1 month at 30°C.

[82] In an aspect, the formulation is free of particles for at least 1 month, 2 months or 3 months under controlled room temperature. [83] By the terms "pharmaceutical formulation" or “pharmaceutically acceptable formulation” as used herein, is meant any formulation suitable and intended for in vivo use, for example suitable for administration to a patient or a subject. As used herein, the terms “patient” and “subject” are interchangeable and refer to any human or animal individual who is receiving a formulation as described herein.

[84] As used herein, the terms “pharmaceutical composition”, “pharmaceutically acceptable composition”, “pharmaceutical formulation”, “composition” and “formulation” are used interchangeably.

[85] In an aspect, the concentration of vasopressin is from 0.1 U/ml to 20 U/ml.

[86] In an aspect, the concentration of vasopressin is from 0.2 U/ml to 1 U/ml.

[87] In an aspect, the concentration of vasopressin is from 0.1 U/ml, 0.2 U/ml, 0.3 U/ml, 0.4

U/ml, 0.5 U/ml, 0.6 U/ml, 0.7 U/ml, 0.8 U/ml, 0.9 U/ml or 1 U/ml.

[88] In an aspect, the concentration of vasopressin is 0.2 U/ml, 0.4 U/ml, 0.6 U/ml or 1 U/ml.

[89] In an aspect, vasopressin may be in the form of synthetic lysine vasopressin.

[90] In an aspect, vasopressin is in the form of salt. Vasopressin salt may be a salt of lower aliphatic carboxylic acids. In an aspect, the vasopressin salt may be an acid addition salt, such as a succinate, maleate, citrate, tartrate, aspartate, gluconate, or acetate. In an aspect, vasopressin is in the form of acetate salt.

[91] In an aspect, vasopressin is in the form of synthetic arginine vasopressin acetate salt.

[92] According to this disclosure, by acetate salt of vasopressin arginine is meant vasopressin arginine having 15% or less acetic acid content in accordance with the USP monograph for Vasopressin.

[93] In an aspect, vasopressin is in the form of vasopressin acetate salt hydrate.

[94] In an aspect, the pharmaceutical formulation is aqueous.

[95] By the term “aqueous formulation”, “aqueous solution” or “aqueous” is understood any formulation in which water is present in or above 50% v/v, such as, e.g., a formulation comprising from 50% v/v to 99.5% v/v water, from 50 % v/v to 90% v/v, from 60% v/v to 85% v/v, from 70% v/v to 80 % v/v water. Accordingly, aqueous formulations include formulations comprising 50% v/v or more, 60% v/v or more, 70% v/v or more, 75% v/v or more, 80% v/v or more, 85% v/v or more, 90% v/v or more, 95% v/v or more or 99% v/v water or more.

[96] In an aspect, the aqueous formulation of vasopressin comprises 90% or more water. [97] In an aspect, the ready-to-administer pharmaceutical formulations comprise one or more osmolality adjusting agents. Exemplary osmolality adjusting agents for use in ready-to- administer pharmaceutical formulations include but are not limited to sodium chloride, Dextrose 5% or other osmolality agents.

[98] In an aspect, the formulation comprises sodium chloride.

[99] In an aspect, the formulation comprises 0.3 to 0.9% w/v sodium chloride for injection.

[100] In an aspect, the formulation comprises 0.3 to 0.5% w/v sodium chloride for injection.

[101] In an aspect, the formulation comprises 0.9% w/v sodium chloride, that is, 9 g NaCl/1 of water.

[102] In an aspect the formulation consists essentially of vasopressin in a concentration from 0.1 U/ml to 20 U/ml, an osmolality agent, water, and optionally a pH adjusting agent, wherein the formulation has a pH from 3.4 to 5.5. The pH can be adjusted with a pH adjusting agent such as sodium hydroxide or hydrochloric acid.

[103] In an aspect the formulation consists of vasopressin in a concentration from 0.1 U/ml to 20 U/ml, osmolality agent, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.0. The pH can be adjusted with a pH adjusting agent such as hydrochloric acid or sodium hydroxide.

[104] In an aspect the formulation consists essentially of vasopressin in a concentration from 0.1 U/ml to 20 U/ml, sodium chloride such as 0.9% w/v sodium chloride, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.4 to 5.5. The pH can be adjusted with a pH adjusting agent such as sodium hydroxide or hydrochloric acid.

[105] In an aspect, the formulation consists of vasopressin in a concentration from 0.1 U/ml to 20 U/ml, sodium chloride such as 0.9% w/v sodium chloride, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.0. The pH can be adjusted with a pH adjusting agent such as sodium hydroxide or hydrochloric acid.

[106] In an aspect, the formulation consists essentially of vasopressin in a concentration from 0.1 U/ml to 20 U/ml, an osmolality agent, water, and a pH adjusting agent and/or buffer to provide a pH from 3.5 to 5.0.

[107] In an aspect, the formulation consists of vasopressin in a concentration from 0.1 U/ml to 1 U/ml, an osmolality agent, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.0. The pH can be adjusted with hydrochloric acid or sodium hydroxide. [108] In an aspect, the formulation consists essentially of vasopressin in a concentration from 0.1 U/ml to 1 U/ml, sodium chloride, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.0. The pH can be adjusted with hydrochloric acid or sodium hydroxide.

[109] In an aspect, the formulation consists of vasopressin in a concentration from 0.1 U/ml to 1 U/ml, sodium chloride, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.0. The pH can be adjusted with hydrochloric acid or sodium hydroxide.

[110] In an aspect, the formulation consists essentially of vasopressin in a concentration from 0.1 U/ml to 1 U/ml, an osmolality agent, water, and a pH adjusting agent and/or buffer to provide a pH from 3.5 to 5.0.

[111] In an aspect, the formulation of vasopressin comprises at least one cyclodextrin.

[112] In an aspect, liquid formulations of vasopressin are comprising at least one beta cyclodextrin.

[113] In an aspect, cyclodextrins are 2-hydroxypropyl- beta -cyclodextrin (HPBCD) and sulfobutylether-beta-cyclodextrin (SBECD).

[114] In an aspect, beta cyclodextrin is SBECD.

[115] Sulfobutylether-beta-cyclodextrin (SBECD) is an anionic beta cyclodextrin derivative of a sodium sulfonate salt separated from the hydrophobic cavity by a butyl ether spacer group. The sulfobutyl ether substituent is introduced at the 2, 3, and 6 positions in one or more of the glucopyranose units in the cyclodextrin structure.

[116] “Degree of substitution” may be expressed as average degree of substitution, which is understood as the number of substituents per cyclodextrin ring. Degree of substitution may also be expressed as a molar substitution, which refers to the number of substituents per one glucose unit of cyclodextrin.

[117] In an aspect, the average degree of substitution of SBECD is from 5.9 to 7.1.

[118] In an aspect, the average degree of substitution of SBECD is 5.9, 6.0, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 7.0 or 7.1.

[119] In an aspect, the beta cyclodextrin is HPBCD.

[120] Hydroxypropyl-beta-cyclodextrin (HPBCD) is a partially substituted poly(2- hydroxpropyl) ether of beta-cyclodextrin. In an aspect, molar substitution of HPBCD is 0.4-1.5.

[121] In an aspect, the molar substitution of HPBCD is 0.5-1.1. [122] In another aspect, the molar substitution of HPBCD is 0.6- 1.0.

[123] In another aspect, the molar substitution of HPBCD is 0.6-0.9.

[124] In another aspect, the molar substitution of HPBCD is 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 or 1.1.

[125] In other aspect, at least one cyclodextrin is in concentration from 0.01 mg/ml to 10 mg/ml.

[126] In other aspect, at least one cyclodextrin is in concentration from 0.1 mg/ml to 1.4 mg/ml.

[127] In an aspect, at least one cyclodextrin is in concentration of 0.1 mg/ml, 0.2 mg/ml, 0.3 mg/ml, 0.4 mg/ml. 05 mg/ml, 0.6 mg/ml, 0.7 mg/ml, 0.8 mg/ml, 0.9 mg/ml, 1 mg/ml, 1.1 mg/ml, 1.2 mg/ml, 1.3 mg/ml, 1.4 mg/ml, 1.5 mg/ml, 2 mg/ml, 3 mg/ml, 4 mg/ml, 5 mg/ml, 6 mg/ml, 7 mg/ml, 8 mg/ml, 9 mg/ml, 10 mg/ml.

[128] In some aspect, the formulation comprises at least one amino acid. The term “amino acid” means any amino acid, including, but is not limited to the 20 amino acids naturally occurring in peptides and is also meant to cover any salt thereof, especially pharmaceutically acceptable salts and derivatives thereof. For example, the term “amino acid” includes alanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine, valine and ornithine, pharmaceutically acceptable salts and derivatives thereof.

[129] In an aspect, the amino acid is glutamic acid or its pharmaceutically acceptable salt.

[130] In an aspect, the amino acid is aspartic acid or its pharmaceutically acceptable salt.

[131] In an aspect, the amino acid is in the form of N-acetylated amino acid.

[132] In an aspect, formulation comprises at least two amino acids.

[133] In an aspect, the amino acid is alanine, a pharmaceutical salt or derivative thereof.

[134] In an aspect, the alanine derivative is N-acetyl-D -alanine (hereinafter “NADA”).

[135] In some aspect, the amino acids may be in L configuration, while in some other aspect it may be in D configuration.

[136] In an aspect, the glutamic acid is L-glutamic acid.

[137] In an aspect, the formulation comprises SBECD and N-acetyl-D-alanine.

[138] In an aspect, the formulation comprises SBECD and L-glutamic acid.

[139] In an aspect, the formulation comprises L-glutamic acid and N-acetyl-D-alanine.

[140] In an aspect, concentration of at least one amino acid is from 0.5 mM to 50 mM.

[141] In an aspect, the concentration of at least one amino acid is from 5.5 mM to 25 mM.

[142] In an aspect, the concentration of at least one amino acid is from 5.5mM to 15 mM. [143] In an aspect, the concentration of at least one amino acid is 0.5 mM, 1 mM, 2 mM, 3 mM,

4 mM, 5 mM, 5.5 mM, 6 mM, 7 mM, 8 mM, 9 mM, 10 mM, 11 mM, 12 mM, 13 mM, 14 mM,

15 mM, 16 mM, 17 mM, 18 mM, 19 mM, 20 mM, 21 mM, 22 mM, 23 mM, 24 mM or 25 mM.

[144] In an aspect, the concentration of N-acetyl-D-alanine is not more than 8 mg/ml.

[145] In an aspect, the concentration of N-acetyl-D-alanine is not more than 3 mg/ml.

[146] In an aspect, the formulation comprises gluconic acid or its pharmaceutically acceptable salt. In an aspect, the gluconate salt may be selected from calcium, sodium, potassium, manganese, zinc or iron.

[147] In an aspect, the formulation comprises sodium gluconate.

[148] In one aspect, the formulation comprises SBECD and sodium gluconate.

[149] In an aspect, the formulation comprises sodium gluconate and L-glutamic acid.

[150] In an aspect, the formulation comprises sodium gluconate and N-acetyl-D-alanine.

[151] In an aspect, the concentration of gluconic acid is from 0.5 mM to 50 mM.

[152] In an aspect, the concentration of sodium gluconate is from 5.5 mM to 25 mM.

[153] In an aspect, the concentration of sodium gluconate is from 5.5 mM to 15 mM.

[154] In an aspect, the concentration of sodium gluconate is 0.5mM, ImM, 2mM, 3mM, 4 mM,

5 mM, 5.5 mM, 6 mM, 7 mM, 8 mM, 9 mM, 10 mM, 11 mM, 12 mM, 13 mM, 14 mM, 15 mM,

16 mM, 17 mM, 18 mM, 19 mM, 20 mM, 21 mM, 22 mM, 23 mM, 24 mM or 25 mM.

[155] In an aspect, the formulation comprises betaine (N,N,N-trimethylglycine) or its pharmaceutically acceptable salt. In an aspect, betaine is in the form of betaine hydrochloride.

[156] In an aspect, the formulation comprises SBECD and betaine.

[157] In an aspect, the formulation comprises betaine and L-glutamic acid.

[158] In an aspect, the formulation comprises betaine and N-acetyl-D-alanine.

[159] In an aspect, the formulation comprises betaine and sodium gluconate.

[160] In an aspect, the concentration of betaine hydrochloride is 0.01 mg/ml to 2mg/ml.

[161] In an aspect, the concentration of betaine hydrochloride is 0.1 mg/ml to 1 mg/ml.

[162] In an aspect, the concentration of betaine hydrochloride is 0.1 mg/ml, 0.2 mg/ml, 0.3 mg/ml, 0.4 mg/ml, 0.5 mg/ml, 0.6 mg/ml, 0.7 mg/ml, 0.8 mg/ml, 0.9 mg/ml or 1 mg/ml.

[163] In an aspect, the pharmaceutical formulation comprises a buffer. Exemplary buffers for use in the herein described formulations include, but are not limited to, the buffers which may maintain the pH range of the formulation. In an aspect, buffers having a buffering capacity of a pH of approximately in range from 3.5 to 5.0 may be used.

[164] In an aspect, buffers may be selected from organic compounds having groups susceptible for protonation/deprotonation, such as carboxylic acids, amines.

[165] In an aspect, the pharmaceutical formulation does not comprise acetate buffer.

[166] In an aspect, the pharmaceutical formulation does not comprise citrate or lactate buffer.

[167] In an aspect, the pharmaceutical formulation does not comprise aspartic acid.

[168] In an aspect, the pharmaceutical formulation does not comprise chelating agent, such as

EDTA.

[169] In an aspect, the pharmaceutical formulation does not comprise chlorobutanol.

[170] The pH of the solutions may be adjusted in a suitable manner. The pH may be adjusted with one or more pH adjusting agents, which may be selected from mineral acids, organic acids, weak and strong bases, and salts and derivatives thereof. Examples of pH adjusting agents include hydrochloric acid, phosphoric acid, sulfuric acid, succinic acid, phenolic acids, sodium hydroxide, ammonium hydroxide, sodium bicarbonate, or similar agents, a combination thereof.

[171] In an aspect, pH is adjusted with sodium hydroxide and hydrochloric acid.

[172] In an aspect, the formulation is in the form of a ready -to-administer formulation.

[173] A "ready-to-administer" formulation is herein used synonymously with " ready -to-infuse" or “ ready -to-inject’ ’. A “ready-to-administer” formulation is suitable for administration directly to the patient and does not require any dilution steps.

[174] Ready-to-administer formulations according to the present disclosure may be used for increasing blood pressure in human subjects by administering said vasopressin formulation to a human subject in need thereof.

[175] In an aspect, the ready-to-administer formulation may be used to increase blood pressure in human patients with vasodilatory shock.

[176] This disclosure also provides a process for manufacturing the pharmaceutical formulations disclosed herein. In various embodiments, the process may comprise the steps of dissolving at least one predefined excipient and vasopressin in water or in a predefined standard diluent for parenteral use and filling a predefined container with the obtained formulation. If necessary, pH is adjusted to achieve the desired pH range. [177] In an aspect, the ready -to-administer formulations of vasopressin may be prepared by dissolving at least one excipient in water for injection (WFI) or predefined standard diluent for parenteral use under predefined conditions until a clear solution is obtained. Vasopressin is added to the solution containing dissolved excipient(s) and the solution is mixed until vasopressin is dissolved. If necessary, pH is adjusted to a predefined pH value, and then WFI or appropriate diluent is added to make up to a predefined volume. The prepared formulation is then mixed to ensure homogeneity, and afterwards filtered through a 0.2 pm filter, and aliquoted in predefined packaging.

[178] In another aspect, the pharmaceutical formulation may be manufactured by any process known to the person skilled in the art.

[179] In an aspect, the liquid formulation of vasopressin is packaged into a container. The container may be a vial or a bag. In an aspect, the container is a single unit dose container. In an aspect, the container is a single unit dosage container for IV administration.

[180] In an aspect, the volume of container is from 50 ml to 3000 ml.

[181] In an aspect, the volume of container is from 100 ml to 1000 ml.

[182] In an aspect, the volume of container is 50 ml, 100 ml, 200 ml, 250 ml, 300 ml, 400ml, 500 ml, 600 ml, 700 ml, 800 ml, 900 ml or 1000 ml.

[183] In an aspect, the volume of container is 100 ml.

[184] In an aspect, the formulation is stored in a container for intravenous formulations, which is preferably plastic based. In an aspect, the formulation is packaged in a flexible plastic bag. In an aspect, the formulation is packaged in a container produced by blow-fill-seal technology. In an aspect, the material of the container is PVC free. In an aspect, the formulation is not in contact with PVC material of the container.

[185] As used herein, the term “flexible plastic container” means flexible polymeric infusion bags or other polymeric containers. In an aspect, flexible plastic containers are made of polyolefins, such as polyethylene, polypropylene, copolymers and derivatives thereof, with or without other additives.

[186] In an aspect, the flexible plastic container may be made of cycloolefin polymers, cycloolefin copolymers, polycarbonates; ethylene vinyl acetate (EVA), ethylene vinyl alcohol (EVOH), modified poly olefin-poly ethylene polymers or styrene-poly olefin based polymers or block co-polymers thereof. [187] In an aspect, the plastic material of the container comprises polyethylene (PE).

[188] In an aspect, the plastic material of the container comprises ethylene vinyl alcohol (EVOH).

[189] In an aspect, the container is a single layer or multilayer container.

[190] In an aspect, the inner layer of the container, which is in contact with the formulation, comprises polyethylene.

[191] In an aspect, the inner layer of the plastic material, which is in contact with the formulation, is polyethylene.

[192] In an aspect, the barrier layer of the plastic material is EVOH.

[193] In an aspect, the container may further comprise an overwrap. In an aspect, said overwrap may be made of gas-barrier and/or light barrier material. The material for the overwrap may be one that has a low oxygen permeability.

[194] In an aspect, the overwrap is an aluminum pouch.

[195] In an aspect, the space between a container and an overwrap is filled with an inert gas or any other suitable gas. In an aspect, the space between a container and an overwrap is filled with N2, argon or any combination thereof.

[196] In an aspect, the space between a container and an overwrap is vacuumed.

[197] In an aspect, the space between a container and an overwrap comprises an oxygen scavenger.

[198] In an aspect, the formulation is sterilized by known means. Such known means in the art comprise sterile filtration, heat treatment and/or irradiation. The heat treatment may be accomplished at temperatures above 100°C for time suitable for sterilization. In one aspect, heat treatment can be a heat sterilization for 15 minutes at 121 °C.

[199] In an aspect, the present disclosure provides a method of treating a human subject in need thereof by administering a formulation disclosed herein comprising an effective dose of vasopressin by IV route.

[200] In an aspect, the present disclosure provides a method of treating a human subject by administering a ready-to-administer formulation disclosed herein comprising an effective dose of vasopressin formulation by IV injection.

[201] In an aspect, the disclosure provides a method of increasing blood pressure in a human subject in need thereof, the method comprising: intravenously administering to the human subject a pharmaceutical formulation disclosed herein that comprises, in a unit dosage form: i) from 0.2 U/ml to 1 U/ml of vasopressin or a pharmaceutically -acceptable salt thereof; wherein: the administration provides to the human subject from 0.01 units of vasopressin or the pharmaceutically-acceptable salt thereof per minute to 0.1 units of vasopressin or the pharmaceutically-acceptable salt thereof per minute; and the human subject is hypotensive.

[202] In an aspect, the disclosure provides a method of increasing blood pressure in a human subject in need thereof, the method comprising: intravenously administering to the human subject a pharmaceutical formulation disclosed herein that comprises, in a unit dosage form: i) lU/ml of vasopressin or a pharmaceutically-acceptable salt thereof; wherein: the administration provides to the human from 0.01 units of vasopressin or the pharmaceutically-acceptable salt thereof per minute to 0.1 units of vasopressin or the pharmaceutically-acceptable salt thereof per minute; and the human subject is hypotensive.

[203] In an aspect, the formulations described herein are intended to be administered via injection or infusion, for example intravenously.

[204] In an aspect, the formulation is an isosmotic formulation. It is to be understood that the term “isosmotic” in accordance with the present disclosure means having similar osmolality to the physiologic osmolality of blood.

[205] Typically, the ready to administer pharmaceutical formulations have osmolality from 240 to 340 mOsm/kg.

[206] In an aspect, the formulation has osmolality from 240 to 600 mOsm/kg.

[207] In an aspect, the ready-to-administer formulation included in the ready-to-administer product is both isotonic and has an osmolality similar to the physiological osmolality of blood as described above.

[208] If not otherwise stated, calculations of concentrations of vasopressin in the present disclosure are done based on vasopressin free base.

[209] If not otherwise stated, calculations of concentrations of excipients in the present disclosure are done based on free base of said excipients.

[210] Additionally, the compositions described herein may further comprise one or more pharmaceutical excipients such as antioxidants, surfactants, complexing agents, preservatives, vehicles, solubilizers, and combinations thereof. [211] Other objects, features and advantages will become apparent from the following detailed description and examples. It should be understood, however, that the detailed description and the examples, while indicating specific embodiments, are given by way of illustration only, and are not intended to limit the breadth or scope of the concepts in any manner.

[212] Stabilizing effect of different factors in ready -to administer were evaluated.

[213] General Techniques

[214] All formulations presented in examples below were prepared by providing a liquid solution of vasopressin. Comparative examples of vasopressin liquid formulations were prepared in water alone. If necessary, pH was adjusted to achieve the desired pH range.

[215] The prepared formulations were transferred into containers, such as vials or bags to achieve the desired amount of active component per container.

Analytical methods

[216] After preparation, an initial time point level of active pharmaceutical ingredient and impurities were determined by ultra-high-performance liquid chromatography (UHPLC) and afterwards containers were loaded to stability chambers at different storage conditions, 40°C, 30°C and 25°C.

[217] In order to determine the stability of the active pharmaceutical ingredient in the formulations according to the present disclosure, containers were taken from stability chambers at various time points, such as 14 days, 1 month, 2 months, 3 months, 4 months, 6 months, etc., and analyzed by UHPLC.

[218] Vasopressin assay and impurities were analyzed by UHPLC. For the assay analysis, a UV detector (diode array detector, DAD) was used. For the impurities analysis, a mass spectrometer (MS) was employed.

Assay procedure (UV)

Chromatographic system: Detector: UV detector, detection wavelength 205 nm Column: 2.1 -mm, 15-cm; 1.7 gm packing

LI, Stationary phase: octadecylsilyl silica gel for chromatography R

Column temperature: 50.0°C

Flow rate: 0.4 mL/min

Injection volume: 10 pL

Diluent: 0.3% acetic acid in 0.9% NaCl

Solution A: 10 mM sodium dihydrogen phosphate, pH 3.0 adjusted with phosphoric acid

Solution B: acetonitrile

Mobile phase: see table below

Stop time: 30 min

Sample solution: inject as is

Standard solution: Vasopressin Reference Standard in diluent

Impurities procedure (MS)

Chromatographic system:

Detector: Electrospray ionization - quadrupole mass spectrometer. Capillary voltage 3500 V, gas temperature 300°C, gas flow 7 L/min, nebulizer 40 psi, sheath gas temperature 300 °C, sheath gas flow 9 L/min, operated in positive ion mode

Acquisition: selected ion monitoring - m!z values in table below

Column: 2.1 -mm, 15-cm; 1.7 pm packing LI, Stationary phase: octadecylsilyl silica gel for chromatography R

Column temperature: 50°C

Flow rate: 0.4 mL/min

Injection volume: 10 pL

Solution A: 0.1% (V/V) formic acid in water

Solution B: 0.1% (V/V) formic acid in acetonitrile

Mobile phase: see table below

Stop time: 23 min

Sample solution: inject as is

Calculation of the assay of active compound

The assay of the active compound is calculated using the following equation:

Assay (%)=(Amps/Ampstd) x (cstd/cs) x 100% where:

Amps = peak area of the Vasopressin peak in Sample solution

Ampstd = peak area of the Vasopressin peak in Standard solution cs = concentration of Vasopressin in the Sample solution (lU/mL) cstd = concentration of Vasopressin in the Standard solution (lU/mL)

Calculation of the assay drop

Assay(tp) (%) - Value of the assay of the main peak at time point (tp) different than initial, for example: 7 days, 1 month, 2 months etc. at different storage conditions such as 25°C, 40°C, analyzed by UHPLC

Assay(st) (%) - Value of the assay of the main peak at initial time point

AAssay - Calculated assay drop of the main compound: (%)

AAssay(%) = Assay(st) (%) - Assay(tp)(%)

Calculation of the individual impurity

The content of the individual impurity, expressed as area%, is calculated as area of the peak of individual impurity at its respective extracted ion chromatogram divided with sum of peak areas across their respective extracted ion chromatograms (extracted chromatograms for each individual impurity and vasopressin). Each component (either individual impurity or vasopressin) is monitored only on one extracted chromatogram (corresponding to its double protonated adduct) at which its peak area is largest.

Calculation of total impurities and total impurity increase

The content of total impurities is calculated as sum of area% of each found individual impurity. Total impurities(tp) (%) - Value of the total impurity content at time point (tp) different than initial, for example: 7 days, 1 month, 2 months etc. at different storage conditions such as 25°C, 40°C, analyzed by UHPLC

Total impurities(st) (%) - Value of the total impurity content at initial time point

ATotal impurities - Calculated increase of total impurities (%)

ATotal impurities(%) = Total impurities(tp) (%) - Total impurities(st)(%)

Examples

In below Examples, vasopressin is added in a form of arginine vasopressin acetate salt. Example 1.

Ready-to-administer formulations of vasopressin were prepared by dissolving vasopressin and sodium chloride in water under predefined conditions. The solutions were stirred using a magnetic stirrer. If necessary, the pH was adjusted to a predefined pH using diluted hydrochloride acid and/or sodium hydroxide. The solutions were mixed to ensure homogeneity, filtered through a 0.2 pm fdter, transferred to a container and finally, WFI was optionally added to make up to predefined volume.

The obtained formulations were then stored under controlled room temperature and stability was determined on time points such as 2 months, 3 months and further.

Table 1 shows chemical stability of ready-to-use formulation comprising vasopressin and sodium chloride in bags and vials. Unless otherwise stated, formulations were stored in plastic bags comprising PE and EVOH and overwrapped with aluminum overwrap. Assay is analyzed using UHPLC-DAD method and assay drop is then calculated in accordance to the above mentioned calculation. Total impurities were analyzed by UHPLC-MS method.

Predicted shelf-life was calculated according to the amounts of total impurities determined on start, 2^nd and 3 ^rd month.

Prediction was done using the zero-order degradation assumption. A linear graph of A total impurities (%) as a dependent variable versus time as an independent variable was plotted. The predicted shelf life was calculated from the slope and intercept of the obtained linear graph by using 8% A total impurities as the shelf-life limit via the following formula: Predicted shelf life = (A total impurities - intercept)/slope

It has been predicted that the stability of formulation comprising Vasopressin and 0.9% NaCl is under controlled room temperature is more than 20 months. According to the results in table 1, predicted stability of formulation comprising Vasopressin and 0.9% NaCl packaged in vials under controlled room temperature is 21 months and the same formulation packaged in bags is 26 months.

Example 2.

Ready-to-administer formulations of vasopressin was prepared by dissolving excipients and vasopressin in 0.9% sodium chloride in water under predefined conditions. The solution was stirred using magnetic stirrer. If necessary, pH was adjusted to predefined pH. The solution was mixed to ensure homogeneity, filtered through a 0.2 pm filter, transferred to a container and finally, 0.9% sodium chloride in water was optionally added to make up to predefined volume. The obtained formulations were then stored under controlled room temperature and stability was determined on time points such as 2 months, 3 months and further.

Table 2 shows chemical stability of ready-to-use different vasopressin formulations in bags and vials. Unless otherwise stated, formulations were stored in plastic bags comprising PE and EVOH and overwrapped with aluminum overwrap. Assay is analyzed using UHPLC-DAD method and assay drop is then calculated in accordance with the above mentioned calculation. Total impurities were analyzed by UHPLC-MS method.

Items

Item 1 A ready -to-administer vasopressin formulation comprising: vasopressin or a pharmaceutically acceptable salt thereof in a concentration from 0.1 U/ml to 20 U/ml, and an osmolality agent, wherein the formulation has pH from 3.5 to 5.5.

Item 2 A ready-to-administer vasopressin formulation consisting essentially of: vasopressin or a pharmaceutically acceptable salt thereof in a concentration from 0.1 U/ml to 20 U/ml, an osmolality agent, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.5.

Item 3 A ready-to-administer vasopressin formulation consisting of: vasopressin of a pharmaceutically acceptable salt thereof in a concentration from 0.1 U/ml to 20 U/ml, an osmolality agent, water, and optionally a pH adjusting agent, wherein the formulation has pH from 3.5 to 5.5.

Item 4 The ready-to-administer vasopressin formulation according to items 1 to 3, wherein the formulation comprises at least one excipient selected from sodium gluconate, sulfobutylether-beta- cyclodextrin (SBECD), N-acetyl-D-alanine, glutamic acid and betaine.

Item 5 The ready-to-administer vasopressin formulation according to item 4, wherein the excipient is sodium gluconate.

Item 6 The ready-to-administer vasopressin formulation according to item 4, wherein the excipient is sulfobutylether-beta-cyclodextrin (SBECD).

Item 7 The ready-to-administer vasopressin formulation according to item 4, wherein the excipient is N-acetyl-D-alanine. Item 8 The ready-to-administer vasopressin formulation according to item 4, wherein the excipient is glutamic acid.

Item 9 The ready-to-administer vasopressin formulation according to item 4, wherein the excipient is betaine.

Item 10 The ready-to-administer vasopressin formulation according to items 1 to 3, wherein the osmolality agent is sodium chloride.

Item 11 The ready-to-administer vasopressin formulation according to item 10, wherein the osmolality agent is in a concentration of 0.9% w/v.

Item 12 The ready-to-administer vasopressin formulation according to item 11, wherein sodium chloride is 0.9% w/v sodium chloride.

Item 13 The ready-to-administer vasopressin formulation according to items 1-12, wherein the concentration of vasopressin is from 0.1 U/ml to 1 U/ml.

Item 14 The ready-to-administer vasopressin formulation according to items 1-12, wherein the concentration of vasopressin is from 0.2 U/ml to 1 U/ml.

Item 15 The ready-to-administer vasopressin formulation according to items 1-14, wherein the vasopressin is arginine vasopressin acetate salt.

Item 16 The ready-to-administer vasopressin formulation according to items 1-15, wherein the formulation is contained in a single unit dosage container.

Item 17 The ready-to-administer vasopressin formulation according to items 1-16, wherein the pH is from 3.5 to 5.0.

Item 18 The ready-to-administer vasopressin formulation of vasopressin according to items 1-16, wherein pH is from 3.8 to 5.0.

Item 19 The ready-to-administer vasopressin formulation of vasopressin according to items in items 1-16, wherein pH is from 3.8 to 4.4.

Item 20 The ready-to-administer vasopressin formulation of vasopressin according to according to any of preceding items, wherein the formulation comprises a buffer.

Item 21 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation is stable for at least 3 months under controlled room temperature conditions, and wherein stable formulation is having no more than 5% of vasopressin assay drop as analyzed by UHPLC. Item 22 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation is stable for at least 3 months under controlled room temperature conditions, and wherein stable formulation is having no more than 3% of vasopressin assay drop as analyzed by UHPLC.

Item 23 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation is stable for at least 3 months under controlled room temperature conditions, and wherein stable formulation is having no more than 2% of vasopressin assay drop as analyzed by UHPLC.

Item 24 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation has no more than a 3% increase of total impurities after 2 months under controlled room temperature conditions as determined by UHPLC.

Item 25 The ready-to-administer vasopressin formulation of vasopressin according to item 24, wherein the formulation has no more than a 2% increase of total impurities.

Item 26 The ready-to-administer vasopressin formulation to item 24, wherein the formulation has no more than a 1% increase of total impurities.

Item 27 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation has no more than a 5% increase of total impurities after 3 months under controlled room temperature conditions analyzed by UHPLC.

Item 28 The ready-to-administer vasopressin formulation according to item 27, wherein the formulation has no more than a 3% increase of total impurities.

Item 29 The ready-to-administer vasopressin formulation according to item 27, wherein the formulation has no more than a 2% increase of total impurities.

Item 30 The ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation has no more than a 2% increase of individual impurity formation after 3 months under controlled room temperature conditions as analyzed by UHPLC.

Item 31 A ready-to-administer vasopressin formulation according to any of the preceding items, wherein more wherein the formulation has no more than a 2% increase of vasopressin trisulfide after 2 months under controlled room temperature conditions as analyzed by UHPLC.

Item 32 A ready-to-administer vasopressin formulation according to any of the preceding items, wherein the formulation has no more than a 2% increase of vasopressin trisulfide after 3 months under controlled room temperature conditions as analyzed by UHPLC. Item 33 A ready -to-administer vasopressin formulation according to any of the preceding items, wherein the formulation has no more than a 1% increase of vasopressin trisulfide after 3 months under controlled room temperature conditions as analyzed by UHPLC.

Item 34 The ready -to-administer vasopressin formulation according to item 16, wherein the single unit dosage container is plastic container.

Item 35 The ready -to-administer vasopressin formulation according to item 34, wherein the single unit dosage container is plastic bag.

Item 36 The ready -to-administer vasopressin formulation according to item 35, wherein the plastic bag does not comprise PVC.

Item 37 The ready -to-administer vasopressin formulation according to item 35, wherein the plastic bag comprises an EVOH barrier material.

Item 38 The ready -to-administer vasopressin formulation according to item 35, wherein the plastic bag comprises polyethylene.

Item 39 The ready -to-administer vasopressin formulation according to item 16, wherein the single unit dosage container is overwrapped.

Item 40 The ready -to-administer vasopressin formulation according to item 39, wherein the space between the single unit dosage container and the overwrap is filled with an inert gas or another gas.

Item 41 The ready -to-administer vasopressin formulation according to item 40, wherein the space between the single unit dosage container and the overwrap is filled N2, argon, or a combination thereof.

Item 42 The ready-to-administer vasopressin formulation according to item 40, wherein the space between the single unit dosage container and the overwrap is vacuumed.

Item 43 The ready-to-administer vasopressin formulation of vasopressin according to items 1-16, wherein pH is from 3.6 to 5.0.

Item 44 The ready-to-administer vasopressin formulation according to items 1-3, wherein pH is adjusted with hydrochloric acid, sodium hydroxide, or a combination thereof.

Item 45 The ready-to-administer vasopressin formulation according to items 1-3, wherein formulation does not contain a buffer.

Item 46 The ready-to-administer vasopressin formulation according to items 1-3, wherein formulation does not contain acetate buffer. Item 47 The ready -to-administer vasopressin formulation according to items 1-3, wherein a predicted stability of the formulation stored under controlled room temperature conditions is more than 6 months.

Item 48 The ready -to-administer vasopressin formulation according to items 1-3, wherein a predicted stability of the formulation stored under controlled room temperature conditions is more than 10 months.

Item 49 The ready -to-administer vasopressin formulation according to items 1-3, wherein a predicted stability of the formulation stored under controlled room temperature conditions is more than 12 months.

Item 50 The ready -to-administer vasopressin formulation according to items 1-3, wherein a predicted stability of the formulation stored under controlled room temperature conditions is more than 20 months.

Item 51 The ready -to-administer vasopressin formulation according to items 1-3, wherein a predicted stability of the formulation packaged in the vials and stored under controlled room temperature conditions is 21 months.

Item 52 The ready -to-administer vasopressin formulation according to item 1-3, wherein a predicted stability of the formulation packaged in the plastic bag and stored under controlled room temperature conditions is 26 months.

Item 53 The ready-to-administer vasopressin formulation according to items 47-52, wherein prediction is done using the zero-order degradation assumption.

Item 54 The ready-to-administer vasopressin formulation according to items 47-53, wherein predicted shelf-life was calculated according to the amounts of total impurities determined on start, 2^nd and 3 ^rd month.

Item 55 A method of treating a human subject in need thereof by administering the ready-to- administer vasopressin formulation according to any of preceding items by an IV route.

Item 56 The method according to item 55, wherein the method comprises drawing a ready-to- administer formulation form a single unit container and administering the formulation into the human subject by the IV route.

Item 55 A method of increasing blood pressure in a human subject by administering the ready-to- administer formulation according to any of items 1 - 54 to the human subject by an IV route.

Claims

1. Ready-to-administer formulation of vasopressin, or a pharmaceutically acceptable salt thereof, wherein formulation comprises: vasopressin in concentration from 0.1 U/ml to 20 U/ml at least one osmolality adjusting agent and wherein the formulation has pH from 3.4 to 5.5

2. Ready-to-administer formulation of vasopressin as claimed in claim 1, wherein at least one osmolality agent is sodium chloride.

3. Ready-to-administer formulation of vasopressin as claimed in claim 1, wherein at least one excipient is sulfobutylether-beta-cyclodextrin (SBECD).

4. Ready-to-administer formulation of vasopressin as claimed in claim 1, wherein at least one excipient is glutamic acid.

5. Ready-to-administer formulation of vasopressin as claimed in claim 1, wherein at least one excipient is N-acetyl-D-alanine.