U.S. patent application number 14/592526 was filed with the patent office on 2015-06-18 for therapeutic compositions.
The applicant listed for this patent is CUBIST PHARMACEUTICALS, INC.. Invention is credited to Walter G. Gowan, JR., Dennis D. Keith, Sandra O'Connor.
Application Number | 20150165029 14/592526 |
Document ID | / |
Family ID | 36808384 |
Filed Date | 2015-06-18 |
United States Patent
Application |
20150165029 |
Kind Code |
A1 |
Gowan, JR.; Walter G. ; et
al. |
June 18, 2015 |
THERAPEUTIC COMPOSITIONS
Abstract
The present invention provides oral formulations of poorly
bioavailable and/or poorly absorbable, and/or poorly water soluble
therapeutic agents. The invention features harmaceutical
composition including a biopolymer, a therapeutic agent, for
example an antimicrobial agent such as ceftriaxone, and an
absorption enhancer, for example a polyoxyethylene alkyl ether
absorption enhancer. Methods of making and using the pharmaceutical
compositions is also described.
Inventors: |
Gowan, JR.; Walter G.;
(Westford, MA) ; Keith; Dennis D.; (Montclair,
NJ) ; O'Connor; Sandra; (Hudson, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
CUBIST PHARMACEUTICALS, INC. |
Lexington |
MA |
US |
|
|
Family ID: |
36808384 |
Appl. No.: |
14/592526 |
Filed: |
January 8, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11912833 |
Oct 26, 2007 |
8968781 |
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PCT/US06/16030 |
Apr 27, 2006 |
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14592526 |
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60676146 |
Apr 29, 2005 |
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Current U.S.
Class: |
424/465 ;
424/494; 514/196; 514/197; 514/2.9; 514/206; 514/210.1; 514/210.13;
514/210.15 |
Current CPC
Class: |
A61P 31/04 20180101;
Y02A 50/401 20180101; A61K 9/2013 20130101; A61K 38/164 20130101;
A61K 31/546 20130101; A61K 9/1617 20130101; Y02A 50/30 20180101;
A61K 9/2866 20130101; A61K 31/545 20130101; A61K 9/2081 20130101;
A61K 31/407 20130101; A61K 9/1652 20130101; A61K 47/10
20130101 |
International
Class: |
A61K 47/10 20060101
A61K047/10; A61K 31/407 20060101 A61K031/407; A61K 31/546 20060101
A61K031/546; A61K 38/16 20060101 A61K038/16; A61K 9/28 20060101
A61K009/28; A61K 9/20 20060101 A61K009/20 |
Claims
1. A pharmaceutical composition comprising; a biopolymer; a
therapeutic agent; and an enhancer.
2. The pharmaceutical composition of claim 1, wherein the
therapeutic agent is an antimicrobial agent.
3. The pharmaceutical composition of claim 2, wherein the
antimicrobial agent is poorly bioavailable.
4. The pharmaceutical composition of claim 2, wherein the
antimicrobial agent is poorly water soluble.
5. The pharmaceutical composition of claim 2, wherein the
antimicrobial agent is a cephalosporin, a glycopeptide, a
penicillin, a monobactam, an oxazolidinone, a lipopeptide, a
carbapenem, an aminoglycoside, a .beta.-lactamase inhibitor or
combinations thereof.
6. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is a cephalosporin.
7. The pharmaceutical composition of claim 6, comprising a
cephalosporin selected from ceftiofur, cefipime, cefixime,
cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftizoxime,
ceftriaxone, cefpirome, cefclidin, cefinenoxime, cefozoprane, or
combinations thereof.
8. The pharmaceutical composition of claim 7, wherein the
cephalosporin is ceftriaxone.
9. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is an aminoglycoside selected from amikacin,
gentamicin, tobramycin, polymixin-B, streptomycin, kanamycin or
combinations thereof.
10. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is a glycopeptide selected from vancomycin,
dalbavancin, oritavancin or combinations thereof.
11. The pharmaceutical composition of claim 10, wherein the
glycopeptide is vancomycin.
12. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is a carbapenem selected from meropenem,
imipenem, MK0826, R-115,685, J-114,870 or CP5068.
13. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is a monobactam selected from aztreonam or
carumonam.
14. The pharmaceutical composition of claim 5, wherein the
antimicrobial agent is a penicillin selected from piperacillin or
amoxicillin.
15. The pharmaceutical composition of claim 5, wherein the
lipopeptide is daptomycin.
16. The pharmaceutical composition of claim 1, wherein the
biopolymer is a neutral or an anionic polymer.
17. The pharmaceutical composition of claim 1, wherein the
biopolymer is a cellulosic polymer.
18. The pharmaceutical composition of claim 17, wherein the
biopolymer is a hydroxyethyl cellulose, methyl cellulose,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose or
hydroxyethyl cellulose.
19. The pharmaceutical composition of claim 1, wherein the
biopolymer is a carbopol, or a polycarbophil.
20. The pharmaceutical composition of claim 1, wherein the
biopolymer is a cationic polymer.
21. The pharmaceutical composition of claim 1, wherein the
biopolymer is a carageenan.
22. The pharmaceutical composition of claim 1, wherein the enhancer
is a polyoxyethylene alkyl ether, a monoglyceride of a fatty acid,
a diglyceride of a fatty acid, a triglyceride of a fatty acid, a
fatty acid, a fatty alcohol, or a salt of a fatty acid.
23. The pharmaceutical composition of claim 22, wherein the
enhancer is a monoglyceride of a C.sub.12-C.sub.18 fatty acid, a
diglyceride of a C.sub.6-C.sub.18 fatty acid, or a triglyceride of
a C.sub.12-C.sub.18 fatty acid.
24. The pharmaceutical composition of claim 1, wherein the enhancer
is a mixture of one or more of a monoglyceride of a
C.sub.12-C.sub.18 fatty acid, a diglyceride of a C.sub.6-C.sub.18
fatty acid, or a triglyceride of a C.sub.12-C.sub.18 fatty
acid.
25. The pharmaceutical composition of claim 1, wherein the enhancer
is gelicire.
26. The pharmaceutical composition of claim 1, wherein the enhancer
is a mixture of one or more of a polyoxyethylene alkyl ether, a
monoglyceride of a fatty acid, a diglyceride of a fatty acid, a
triglyceride of a fatty acid, or a salt of a fatty acid.
27. The pharmaceutical composition of claim 22, wherein the
enhancer is a polyoxyethylene alkyl ether.
28. The pharmaceutical composition of claim 27, wherein the
polyoxyethylene alkyl ether has a plurality of alkyl chain lengths
between 4 and 23.
29. The pharmaceutical composition of claim 28, wherein the
polyoxyethylene alkyl ether has a plurality of alkyl chain lengths
from 10 to 15.
30. The pharmaceutical composition of claim 27, wherein the
polyoxyethylene alkyl ether is laureth 12, ceteth 12, ceteth 15,
oleth 10.
31. The pharmaceutical composition of claim 22, wherein the fatty
acid or fatty alcohol has from 10 to 18 carbons.
32. The pharmaceutical composition of claim 31, wherein the fatty
acid or fatty alcohol has from 12 to 16 carbons.
33. The pharmaceutical composition of claim 1, wherein the enhancer
comprises a fatty acid or fatty alcohol comprising from 10 to 18
carbons linked to a polyoxyethylene group of 8-18 units.
34. The pharmaceutical composition of claim 33, wherein the
enhancer comprises a fatty acid or fatty alcohol comprising from 12
to 16 carbons linked to a polyoxyethylene group of 10-15 units.
35. The pharmaceutical composition of claim 1, wherein the ratio of
enhancer to antimicrobial is between about 10:1 to about 1:2.
36. The pharmaceutical composition of claim 35, wherein the ratio
of enhancer to antimicrobial is between about 10:1 to about
1:1.
37. The pharmaceutical composition of claim 36, wherein the ratio
of enhancer to antimicrobial is between about 6:1 to about 1:1.
38. The pharmaceutical composition of claim 37, wherein the ratio
of enhancer to antimicrobial is about 2:1.
39. The pharmaceutical composition of claim 38, wherein the
enhancer is laureth 12.
40. The pharmaceutical composition of claim 37, wherein the ratio
of enhancer to antimicrobial is about 4:1.
41. The pharmaceutical composition of claim 1, wherein the
pharmaceutical composition is substantially free of a cationic
binding agent.
42. The pharmaceutical composition of claim 1, wherein the
pharmaceutical composition is substantially free of a cationic
biopolymer.
43. The pharmaceutical composition of claim 1, wherein the enhancer
is ceteth 12 and the biopolymer is polycarbophil.
44. The pharmaceutical composition of claim 1, wherein the enhancer
is ceteth 12 and the biopolymer is hydroxyethyl cellulose.
45. The pharmaceutical composition of claim 1, wherein the enhancer
is a ceteth and the biopolymer is a carbopol.
46. The pharmaceutical composition of claim 1, wherein the
bioavailability of the therapeutic agent is at least about ten
times greater in the pharmaceutical formulation of claim 1 than a
formulation substantially free of an enhancer.
47. The pharmaceutical composition of claim 46, wherein the
bioavailability of the therapeutic agent is at least about 20 times
greater.
48. An enterically coated tablet or capsule comprising the
pharmaceutical composition of claim 1.
49. The enterically coated tablet or capsule of claim 48, wherein
the coating comprises a cellulosic polymer.
50. The enterically coated tablet or capsule of claim 49, wherein
the cellulosic polymer is hydroxyethyl cellulose, methyl cellulose,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose or
hydroxyethyl cellulose.
51. An enterically coated bead or particle comprising the
pharmaceutical composition of claim 1.
52. The enterically coated bead or particle of claim 51, wherein
the coating comprises a cellulosic polymer.
53. The enterically coated bead or particle of claim 52, wherein
the cellulosic polymer is hydroxyethyl cellulose, methyl cellulose,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose or
hydroxyethyl cellulose.
54. A tablet or capsule comprising an enterically coated bead or
particle of claim 51.
55. A preparation for an oral suspension comprising an enterically
coated bead or particle of claim 51.
56. An enterically coated tablet, capsule, bead or particle
comprising the pharmaceutical composition of claim 1 where the
components of the pharmaceutical composition are physically
separated within the dosage form.
57. An enterically coated tablet, capsule, bead or particle
comprising the pharmaceutical composition of claim 1 where the
components of the pharmaceutical composition are intimately mixed
within the dosage form.
58. The pharmaceutical composition of claim 1 in the form of a
solid, semi-solid, or liquid.
59. A method of making the pharmaceutical composition of claim 1,
the method comprising: hydrating the biopolymer; combining the
therapeutic agent with the hydrated biopolymer to form a complex;
and combining the complex with the enhancer to provide the
pharmaceutical composition of claim 1.
60. A method of making the pharmaceutical composition of claim 1,
the method comprising emulsifying one or more components of the
pharmaceutical composition.
61. A method of making the pharmaceutical composition of claim 1,
the method comprising spray drying or spray congealing one or more
components of the pharmaceutical composition.
62. A method of treating an animal comprising administering to the
animal the pharmaceutical composition of claim 1.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Application No. 60/676,146, filed Apr. 29, 2005, which is hereby
incorporated by reference in its entirety.
TECHNICAL FIELD
[0002] This invention relates to pharmaceutical compositions.
BACKGROUND
[0003] Many therapeutic agents exhibit poor oral bioavailability
and or absorption and therefore are administered by injection. For
example, cephalosporin is the general term for a group of
antibiotic derivatives of cephalosporin C, which is obtained from
the fungus Cephalsporium acremonium. First generation
cephalosporins and most second generation cephalosporins are
functional in oral dosage forms. However, in many instances the
third generation cephalosporins have poor oral bioavailability and
therefore are often administered by injection.
SUMMARY
[0004] Oral formulations of poorly available and/or poorly water
soluble therapeutic agents are described herein, for example a
pharmaceutical composition including ceftriaxone. In some
instances, the compositions described herein have improved systemic
uptake, e.g., improved uptake into the plasma of a subject. In some
instances, the compositions described herein have improved
stability of the therapeutic agent and/or enhanced pharmacokinetic
and pharmacodynamic profiles and/or improved post-antibiotic
effects.
[0005] In one aspect, the invention features pharmaceutical
composition including a biopolymer, a therapeutic agent, for
example an antimicrobial agent such as ceftriaxone, and an
absorption enhancer, for example a polyoxyethylene alkyl ether
absorption enhancer.
[0006] In some instance, the therapeutic agent is poorly
bioavailable and/or poorly absorbable, and/or poorly water soluble.
For example, in some instances the bioavailability or absorption of
the therapeutic can be improved when formulated in one of the
compositions described herein.
[0007] Examples of therapeutic agents include antimicrobial agents,
(e.g., antibiotics such as ceftriaxone), anti-inflammatory agents,
anti-neoplastic agents, anti-pyretic agents, metabolic agents,
polypeptides, antibodies, neucleic acids, hormones, or other
therapeutic agents and combinations thereof.
[0008] Examples of antimicrobial agents include, for example,
cephalosporins, glycopeptides, penicillins (e.g., piperacillin or
amoxicillin), monobactams (e.g., aztreonam or carumonam),
oxazolidinones, lipopeptides (e.g., daptomycin), carbapenems (e.g.,
meropenem, imipenem, MK0826, R-115,685, J-114,870 or CP5068),
aminoglycosides, .beta.-lactamase inhibitors and combinations
thereof.
[0009] In some instances, the cephalosporin can be ceftiofur,
cefipime, cefixime, cefoperazone, cefotaxime, cefpodoxime,
ceftazidime, ceftizoxime, ceftriaxone, cefpirome, cefclidin,
cefinenoxime, cefozoprane, or combinations thereof. In some
instances, the cephalosporin is a novel cephalosporin, such as CAB.
In some preferred embodiments, the cephalosporin is
ceftriaxone.
[0010] In some instances, the antimicrobial is an aminoglycoside,
for example amikacin, gentamicin, tobramycin, polymixin-B,
streptomycin, kanamycin or combinations thereof.
[0011] The therapeutic agent can be, for example a glycopeptide
such as vancomycin, dalbavancin, oritavancin or combinations
thereof.
[0012] The biopolymer can be, for example, a neutral or an anionic
polymer such as carageenan. For example, the biopolymer can be a
cellulosic polymer such as hydroxyethyl cellulose, methyl
cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose,
a carbopol, or a polycarbophil. In some preferred embodiments the
biopolymer is carageenan or a polycarbophil.
[0013] In some instances, the biopolymer is a cationic polymer such
as carageenan.
[0014] In some embodiments, the absorption enhancer is a
monoglyceride of a C.sub.12-C.sub.18 fatty acid, a diglyceride of a
C.sub.6-C.sub.18 fatty acid, a triglyceride of a C.sub.12-C.sub.18
fatty acid, or a mixture thereof, for example, gelucire.
[0015] In some preferred embodiments, the absorption enhancer is a
polyoxyethylene alkyl ether, a mono-, di-, or tri-glyceride of a
fatty acid, or a salt of a fatty acid. In more preferred
embodiments, the absorption enhancer is a polyoxyethylene alkyl
ether. The polyoxyethylene alkyl ether can have a plurality of
alkyl chain lengths, for example, between 4 and 23 units, for
example a plurality of alkyl chain lengths from 10 to 15 units.
[0016] In some embodiments, the polyoxyethylene alkyl ether is
linked to a fatty acid or a fatty alcohol, for example a fatty acid
or fatty alcohol having from about 10 to about 18 carbons (e.g.,
from about 12 to about 16 carbons).
[0017] In some embodiments, a fatty acid or fatty alcohol of 10-18
carbons is linked to a polyoxyethylene group of 8-18 units. For
example, a fatty acid or fatty alcohol of 12-16 carbons is linked
to a polyoxyethylene group of 10-15 units.
[0018] In some embodiments, the polyoxyethylene alkyl ether is
laureth 12, ceteth 12, ceteth 15, or oleth 10.
[0019] In some embodiments, the ratio of enhancer to therapeutic
agent (e.g., antimicrobial agent such as ceftriaxone) is between
about 10:1 to about 1:2. For example, the ratio can be from about
6:1 to about 1:1, such as about 4:1 or about 2:1.
[0020] In some embodiments, the pharmaceutical composition also
includes a binder.
[0021] In some embodiments, the pharmaceutical composition is
substantially free of a cationic binding agent.
[0022] In some embodiments, the pharmaceutical composition is
substantially free of a cationic biopolymer.
[0023] In some embodiments, the bioavailability of the
antimicrobial is at least about ten times greater in the
pharmaceutical composition than a formulation substantially free of
an enhancer. For example, the bioavailability of the antimicrobial
is at least about 20 times greater.
[0024] In some embodiments, the polymer is a polycarbophil, a
carageenen, or a cellulosic and the absorption enhancer is a
polyoxyethylene alkyl ether, e.g., laureth 12, ceteth 12, ceteth
15, or oleth 10.
[0025] In some embodiments, the absorption enhancer is a ceteth and
the biopolymer is a carbopol.
[0026] In some embodiments, the absorption enhancer is ceteth 12
and the biopolymer is polycarbophil.
[0027] In some embodiments, the absorption enhancer is ceteth 12
and the biopolymer is hydroxyethyl cellulose.
[0028] In some embodiments, the therapeutic agent is ceftriaxone,
the absorption enhancer is a polyoxyethylene alkyl ether, and the
biopolymer is a polycarbophil, a carageenen, or a cellulosic. For
example, the polyoxyethylene alkyl ether is laureth 12, ceteth 12,
ceteth 15, or oleth 10, and the biopolymer is carageenen or a
polycarbophil.
[0029] In some embodiments, the bioavailability of the therapeutic
agent in a pharmaceutical composition described herein is at least
about 10 times greater than the bioavailability of the therapeutic
agent alone, for example at least about 20 greater than the
bioavailability of the therapeutic agent alone.
[0030] In some embodiments, the invention includes an enterically
coated tablet or capsule including a pharmaceutical composition
described herein.
[0031] In some embodiments, the invention includes an enterically
coated bead or particle including a pharmaceutical composition
described herein. In general, the coated bead or particle is
suitable for a tablet or capsule dosage form. The bead or particle
can be coated with, for example, an enteric coating or polymer such
as hydroxyethyl cellulose, hydroxypropyl methyl cellulose, etc. In
some embodiments the enterically coated bead or particle is
suitable for mixing with a palatable diluent for the preparation of
an oral suspension.
[0032] In some embodiments, the invention features an enterically
coated tablet, capsule, bead or particle a pharmaceutical
composition described herein and an additional therapeutic agent
where the components are physically separated within the dosage
form. In other embodiments, the invention features an enterically
coated tablet, capsule, bead or particle including a pharmaceutical
composition described herein and an additional therapeutic agent
where the components are intimately mixed within the dosage
form.
[0033] The pharmaceutical compositions described herein can be
formulated, for example, as a solid, semi-solid, or liquid.
[0034] In some embodiments, the invention includes a method of
making a pharmaceutical composition described herein. The method
includes hydrating the biopolymer; combining the antimicrobial with
the hydrated biopolymer to form a complex; and combining the
complex with the enhancer to provide a pharmaceutical composition
described herein.
[0035] The pharmaceutical compositions described herein can also be
made using other methods, for example, spray drying/congealing, and
forming emulsions of one or more components of the pharmaceutical
composition.
[0036] In some embodiments, the invention features a method of
treating a subject (e.g., a mammal such as a human or a companion
animal) including administering to the animal the pharmaceutical
composition described herein.
DESCRIPTION OF DRAWINGS
[0037] FIG. 1 is a graph depicting % bioavailability of Laureth
analog enhancers in rats.
[0038] FIG. 2 is a graph depicting intestinal lumen content of
enhancer in rat after ID dosing. Like reference symbols in the
various drawings indicate like elements.
DETAILED DESCRIPTION
[0039] As used herein, terms have their common meaning unless
otherwise specified.
[0040] As used herein, the term "poorly absorbable" is used to
describe a therapeutic agent that exhibits low bioavailability in
oral or other non-parenteral dosage forms. In some instances, the
therapeutic agent is poorly absorbable due to relatively high
hydrophilicity and/or ionization properties of the therapeutic
agent (e.g., antimicrobial agent). The therapeutic agent can be
positively charged, negatively charged, neutral, zwiterionic or
amphiphilic.
[0041] As used herein, the term "oral absorption" is used to
describe the manner in which the compositions described herein are
delivered to the subject and the active ingredients absorbed into
the blood. Typically, the composition is administered orally and
the therapeutic agent of the composition then crosses a mucosal
membrane of the gastrointestinal tract, preferably in the
intestines. However, other methods of contacting the compositions
of the present invention with the mucosal membrane of the
gastrointestinal tract may be used.
[0042] Therapeutic compositions are described herein. In general,
the therapeutic compositions include a therapeutic agent, for
example a poorly absorbable or poorly water soluble agent, a
biopolymer, and an absorption enhancer, such as a polyoxyethylene
alkyl ether. In many instances, the compounds have improved
absorption characteristics, resulting in increased bioavailability.
In particular, it has been discovered that certain classes of
absorption enhancers provide compositions with improved
bioavailability of therapeutic agents. In some instances, these
absorption enhancers can be administered in compositions having a
reduced ratio of absorption enhancer to therapeutic agent,
resulting in a dosage with reduced bulk.
Therapeutic Agents:
[0043] In general, the compositions described herein can include
any therapeutic agent, in particular any poorly bioavailable or
poorly absorbable agent.
[0044] Examples of therapeutic agents include antimicrobial agents
(e.g., antibacterial agents, anti-fungal agents, anti-viral agents,
etc.), anti-inflammatory agents, anti-neoplastic agents,
anti-pyretic agents, metabolic agents, polypeptides, antibodies,
nucleic acids, hormones, or other therapeutic agents.
[0045] Examples of antimicrobial agents include cephalosporins,
aminoglycosides, carbapenems, .beta.-lactamase inhibitors,
antifungals, penicillins, lipopeptides, glycopeptides, monobactams,
and oxazolidinones.
[0046] In instances where the antimicrobial agent is a
cephalosporin, examples of cephalosporins include, for example,
ceftiofur, cefipime, cefixime, cefoperazone, cefotaxime,
cefpodoxime, ceftazidime, ceftizoxime, ceftriaxone, cefinenoxime,
cefozoprane, cefpirome, and cefclidin. In addition, cephalosporins
that are active against methicillin resistant Staph. aureus (MRSA),
and which are in development stages such as RO 65-5788 (U.S. Pat.
No. 6,232,306, hereby incorporated by reference in its entirety),
RWJ-54428 (U.S. Pat. No. 6,025,352, hereby incorporated by
reference in its entirety), RWJ-333441 (Curr. Opin. Invest. Drugs
(2001); 2(2) 209-211, hereby incorporated by reference) can also be
incorporated into the compositions described herein. Additionally,
cephalosporins such as those described in U.S. Pat. No. 6,693,095
(hereby incorporated by reference) are useful. In some instances
the cephalosporin is ceftriaxone, such as described in U.S. Pat.
No. 4,327,210.
[0047] Other examples of antimicrobial agents include
aminoglycosides, such as, for example amikacin, gentamicin,
tobramycin, polymixin-B, streptomycin, and kanamycin. The agent may
in some embodiments be a glycylcline.
[0048] Still other examples of antimicrobial agents are
carbapenems, such as for example, meropenem, imipenem, MK0826
(Invanz, WO 99/45010, hereby incorporated by reference), R-115,685
(Sankyo, WO 01/02401 hereby incorporated by reference), J-114,870
(Banyu, WO 99/31106 hereby incorporated by reference) and CP-5068
(Meiji, see R&D Focus, Feb. 19, 2001; IMS World
Publications).
[0049] In some instances, the therapeutic agent is a lactamase
inhibitor (e.g., .beta.-lactamase inhibitor) a such as tazobactam,
oxapenem, clavulanic acid, sublactam, or, for example, Zosyn.RTM.
which is a combination of tazobactam and pipericillin marketed by
Wyeth-Ayerst.
[0050] Lipopeptides such as daptomycin and A54145 are still other
examples of therapeutic agents. Analogs of daptomycin and A54145
are disclosed in U.S. Ser. Nos. 09/738,742, 09/737,908, 10/213,218
and 10,213,389, and U.S. Pat. No. 6,794,490, hereby incorporated by
reference in their entirety, and are also useful therapeutic agents
of the present invention.
[0051] Additional antimicrobials include glycopeptides such as
vancomycin, dalbavancin and oritavancin, monobactams such as
aztreonam or carumonam.
[0052] In some embodiments the therapeutic agent is an anti-fungal
agent, such as for example, amphotericin B, echinocandins and
cancidas.
[0053] In other embodiments, the therapeutic agent is a penicillin,
such as, for example, piperacillin and amoxicillin.
Biopolymers:
[0054] As used herein, the term "biopolymer" shall mean a
biologically compatible polymer which can be naturally occurring or
synthetic and shall also include liposomes and clathrates. The
biopolymer can be a neutral, an anionic polymer, or a cationic
polymer.
[0055] In general, the pharmaceutical compositions can include any
biopolymer that is not toxic to the subject to be treated, and
provides for the desired characteristics of the pharmaceutical
composition. In some instances, biopolymers that are mucoadhesive
and/or swellable biopolymers are preferred. Exemplary biopolymers
include, but are not limited to carrageenans, carbopols,
polycarbophils, cellulosics (e.g., hydroxyethyl cellulose, methyl
cellulose, hydroxypropyl cellulose or carboxymethylcellulose),
pectins, chondroitin sulfate, polymethacrylic acid, xylan,
hyaluronic acid, chitin, chitosan, sodium alginates,
polysaccharides, polypropylene glycols, polyethylene glycols,
polyacetates, liposomes, fatty acid complexes, cyclodextrins,
cycloamyloses, clathrates, cycloalkyl amyloses, polyxylose, gellan
gums and polylactic acids.
[0056] As used herein, the term "mucoadhesive" means a composition
that binds to the mucous membrane or a mucin layer of a biological
membrane. In some instances, a mucoadhesive biopolymer can be used
to administer a therapeutic agent through a mucin layer of a
biological membrane.
[0057] As used herein, the term "swellable" refers to a compound or
composition that can become swollen, for example in an aqueous
environment such as the stomach or intestinal tract of a
subject.
[0058] Carrageenan is the general term used to describe hydrophilic
polysaccharides extracted from a number of closely related species
of red seaweeds that are highly sulfated, linear molecules having a
galactose backbone. There are three different types of carrageenan,
Kappa, Lambda and Iota, which are differentiated by the amount of
3,6-anhydrogalactose residues and number and position of the
sulfate groups. For example, the following carrageenans can be
obtained from FMC Biopolymer: Gelcarin.RTM. GP 379 (Iota) and
Gelcarin.RTM. GP 911 (Kappa).
[0059] The preferred carrageenan for certain compositions of the
invention is a carrageenan having a low calcium content, i.e. a
calcium content of from about 0 to about 4% (preferably 3.6%), more
preferably about 0-2%, and most preferably about 0.1-1% calcium by
weight. The most preferred carrageenan has a sodium content of
about 0.4% or less, such as, for example, Viscarin.RTM. XP (FMC
Biopolymer).
[0060] In general, the biopolymer is present from about 5% to about
35% by weight in the pharmaceutical composition. In some preferred
embodiments, the biopolymer is present from about 10% to about
25.degree. (o by weight in the pharmaceutical composition. The
amount of polymer in the pharmaceutical compositions can vary with,
for example, the therapeutic agent and the absorption enhancer.
[0061] The therapeutic agent to biopolymer molar ratio can be from
about 5:1 to 1:5, preferably about 2:1. In some instance, for
example, if a cationic molecule is used as a binding agent, then
the therapeutic agent (e.g., an antimicrobial agent) to cationic
molecule molar ratio can be from about 1:4 to 1:1, preferably from
about 1:2 to 1:1, e.g., 1:2 for antimicrobial agent:amino acid
embodiments and 1:1 for antimicrobial agent:cetyl pyridinium
embodiments.
[0062] In some embodiments, polycarbophil polymers (PCP) are
preferred. An example of a preferred PCPs include AA1
(Noveon.TM.).
[0063] In some embodiments Carbopol polymers are preferred. Example
of preferred Carbopols include Carbopol 974 (Noveon.TM.) and
carbopol 971 (Noveon.TM.).
Absorption Enhancers:
[0064] As used herein, the term "absorption enhancer" shall mean
any substance which is effective to increase the absorption of a
therapeutic agent through the mucosa relative to absorption without
such agent.
[0065] The pharmaceutical compositions of the present invention
generally include an absorption enhancer, such as a polyoxyethylene
(POE), for example a polyoxyethylene alkyl ether or polyoxyethylene
ester, a fatty acid, for example a mono-, di-, or tri-glyceride of
a fatty acid, a salt of a fatty acid, a fatty alcohol, a lipid, or
a polymer or antimicrobial agent having lipid-like properties. In
some preferred embodiments, the invention includes a
polyoxyethylene (POE) alkyl ether.
[0066] Frequently used absorption enhancers include for example,
lipids, Gelucire, Gelmul, capric and caprylic acids, oleic acids,
palmitic acids, stearic acids, Capmuls, for example, CAPMUL MCM 90
(a mixture of mono- and di-glycerides of saturated C.sub.8-C.sub.10
fatty acids with monoglyceride; Abitec, Corp.) CAPMUL 8210 (similar
to MCM, but with about 70% monoglycerides) or Capmul C10. Gelicure
is commercially available, for example, from GatteFosse Corporation
(Westwood, N.J.). Gelmul is commercially available, for example
Gelmul 90. Captex is commercially available, for example, Captex
1000 and Captex 100.
[0067] In some instances, a polyoxyethylene (POE) alkyl ether is a
preferred absorption enhancer, for example, a polyoxyethylene (POE)
alkyl ether having an alkyl chain length units from about 4 to
about 23. A POE alkyl ether has the formula
R(OCH.sub.2CH.sub.2).sub.nOH, where n refers to the number of
oxyethylene units, and R refers to an alkyl moiety having a defined
number of carbons.
[0068] In some embodiments, where the POE is a POE ester, R refers
to the acyl moiety attached to the POE.
[0069] In one aspect, the oxyethylene unit (defined above as n) is
from about 4 to about 23 units, preferably 10 to 15 units.
[0070] Examples of polyoxyethylene (POE) alkyl ethers include an
alkyl moiety (R above) having from about 12 to about 22 carbons.
Examples of POE alkyl ethers include lauryl, cetyl and oleyl alkyl
ethers, such as laureth-12, ceteth-12, ceteth-15, and oleth-10.
[0071] A "Laureth" POE alkyl ether enhancer is meant to convey an
enhancer of the following structure:
C.sub.12H.sub.25(OCH.sub.2CH.sub.2).sub.nOH, wherein n is as
described above. When the Laureth POE alkyl ether enhancer is
denoted with a number (e.g. Laureth-12; Laureth-4 etc.), the number
following the term Laureth denotes the number of oxyethylene units.
For example, a Laureth-12 POE alkyl ether enhancer is
C.sub.12H.sub.25(OCH.sub.2CH.sub.2).sub.12OH.
[0072] An "Oleth" POE alkyl ether enhancer is meant to convey an
enhancer of the following structure:
CH.sub.3(CH.sub.2).sub.7CH.dbd.CH(CH.sub.2).sub.7CH.sub.2(OCH.sub.2CH.sub-
.2).sub.nOH, wherein n is as described above. When the Oleth POE
alkyl ether enhancer is denoted with a number (e.g. Oleth-12;
Oleth-10 etc.), the number following the term Oleth denotes the
number of oxyethylene units. For example, an Oleth-12 POE alkyl
ether enhancer is
CH.sub.3(CH.sub.2).sub.7CH.dbd.CH(CH.sub.2).sub.7CH.sub.2(OCH.sub.2CH.sub-
.2).sub.12OH.
[0073] A "Ceteth" POE alkyl ether enhancer is meant to convey an
enhancer of the following structure:
C.sub.16H.sub.34(OCH.sub.2CH.sub.2).sub.nOH, wherein n is as
described above. When the Ceteth POE alkyl ether enhancer is
denoted with a number (e.g. Ceteth-12; Ceteth-4 etc.), the number
following the term Ceteth denotes the number of oxyethylene units.
For example, a Ceteth-12 POE alkyl ether enhancer is
C.sub.16H.sub.34(OCH.sub.2CH.sub.2).sub.12OH.
[0074] A "Steareth" POE alkyl ether enhancer is meant to convey an
enhancer of the following structure:
C.sub.18H.sub.38(OCH.sub.2CH.sub.2).sub.nOH, wherein n is as
described above. When the Steareth POE alkyl ether enhancer is
denoted with a number (e.g. Steareth-12; Steareth-4 etc.), the
number following the term Steareth denotes the number of
oxyethylene units. For example, a Steareth-12 POE alkyl ether
enhancer is C.sub.18H.sub.36(OCH.sub.2CH.sub.2).sub.12OH.
[0075] An "Octydodecyl" POE alkyl ether enhancer is meant to convey
an enhancer of the following structure:
C.sub.20H.sub.42(OCH.sub.2CH.sub.2).sub.nOH, wherein n is as
described above. When the Octydodecyl POE alkyl ether enhancer is
denoted with a number (e.g. Octydodecyl-12; Octydodecyl-4 etc.),
the number following the term Octydodecyl denotes the number of
oxyethylene units. For example, an Octydodecyl-12 POE alkyl ether
enhancer is C.sub.20H.sub.42(OCH.sub.2CH.sub.2).sub.12OH.
[0076] A "Cholesteryl" "POE alkyl ether enhancer is meant to convey
an enhancer of the following structure:
##STR00001##
wherein n is as described above. When the Cholesteryl POE alkyl
ether enhancer is denoted with a number (e.g. Cholesteryl-12;
Cholesteryl-4 etc.), the number following the term Cholesteryl
denotes the number of oxyethylene units. For example, a
Cholesteryl-12 POE alkyl ether enhancer is
##STR00002##
[0077] An "Isosteareth" POE alkyl ether enhancer is meant to convey
an enhancer of the following structure:
(CH.sub.3).sub.2CH(CH.sub.2).sub.15(OCH.sub.2CH.sub.2).sub.nOH,
wherein n is as described above. When the Isosteareth POE alkyl
ether enhancer is denoted with a number (e.g. Isosteareth-12;
Isosteareth-4 etc.), the number following the term Isosteareth
denotes the number of oxyethylene units. For example, a
Isosteareth-12 POE alkyl ether enhancer is
(CH.sub.3).sub.2CH(CH.sub.2).sub.15(OCH.sub.2CH.sub.2).sub.12OH.
[0078] An "Isoceteth" POE alkyl ether enhancer is meant to convey
an enhancer of the following structure:
(CH.sub.3).sub.2CH(CH.sub.2).sub.13(OCH.sub.2CH.sub.2).sub.nOH,
wherein n is as described above. When the Isoceteth POE alkyl ether
enhancer is denoted with a number (e.g. Isoceteth-12; Isoceteth-4
etc.), the number following the term Isoceteth denotes the number
of oxyethylene units. For example, a Isoceteth-12 POE alkyl ether
enhancer is
(CH.sub.3).sub.2CH(CH.sub.2).sub.13(OCH.sub.2CH.sub.2).sub.12OH.
[0079] A "Beheneth" POE alkyl ether enhancer is meant to convey an
enhancer of the following structure:
C.sub.22H.sub.45(O)(OCH.sub.2CH.sub.2).sub.nOH, wherein n is as
described above. When the Beheneth POE alkyl ether enhancer is
denoted with a number (e.g. Beheneth-12; Beheneth-4 etc.), the
number following the term Beheneth denotes the number of
oxyethylene units. For example, an Beheneth-12 POE alkyl ether
enhancer is C.sub.22H.sub.45(OCH.sub.2CH.sub.2).sub.12OH.
[0080] In some embodiments, the polyoxyethylene (POE) alkyl ether
has an oxyethylene unit (n) of from about 4 to about 23 units
(e.g., from about 8 to about 20 units, such as from about 10 to
about 15 units) and has an alkyl moiety (R) of from about 12 to
about 22 carbons (e.g., from about 12 to about 18 carbons), for
example, 12, 16, 18, 20 or 22 carbons. In a preferred embodiment,
the POE alkyl ether has an oxyethylene unit (n) of from about 8 to
about 20 units and (R) of from about 12 to about 18 carbons. More
preferably, the POE alkyl ether has an oxyethylene unit (n) of from
about 10 to about 15 units and an alkyl moiety (R) of from about 12
to 18 carbons.
[0081] In some instances a fatty acid or fatty alcohol is an
absorption enhancer. In one aspect, the fatty acid or fatty alcohol
has a carbon chain length of from about 10 to about 18 carbons. In
another aspect of the invention, the carbon chain length is from
about 12 to about 16 carbons.
[0082] In some instances, a fatty acid salt is used as an
absorption enhancer, for example, sodium laurate, sodium hexanoate,
sodium caprylate, sodium decanoate, and sodium myristate.
Preferably, the fatty acid salt is sodium laurate.
[0083] In some instances, a combination of two or more enhancers is
used in a pharmaceutical composition. For example, a combination of
two fatty acid salts can be used or a combination of a POE enhancer
with a fatty acid or another POE.
[0084] In general, the absorption enhancer is present in the
pharmaceutical composition from between about 35% to about 85% by
weight, preferably from about 50% to about 75%.
[0085] The ratio of the absorption enhancer to the therapeutic
agent is generally from about 10:1 (absorption enhancer:therapeutic
agent) to about 1:2 (absorption enhancer:therapeutic agent). For
example, the ratio can be about 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1,
3:1, 2:1, 1:1, or 1:2. In some preferred embodiments, the ratio of
absorption enhancer to therapeutic agent is between about 5:1 and
about 1:1. In another preferred embodiment the ratio of absorption
enhancer to therapeutic agent is about 4:1 or about 2:1.
[0086] The preferred ratio of absorption enhancer to therapeutic
agent can vary depending on a number of factors, including the
nature of the therapeutic agent, the nature of the absorption
enhancer, the nature of the biopolymer, and the nature and/or
presence or absence of a salt or ion.
[0087] Alternatively, any known absorption enhancers may be used,
including any mixtures of the above.
Salts and/or Charged Ions
[0088] In some embodiments, the pharmaceutical compositions include
a salt or other charged ion. For example, a pharmaceutical
composition can include a cationic agent such as a positively
charged metal ion, or any charged cationic molecules, such as, for
example, calcium, potassium, magnesium, lithium, iron, copper,
zinc, sodium, aluminum, manganese, chromium, cobalt, nickel,
ammonium salts, quaternary ammonium salts such as benzalkonium
derivatives, cetyl pyridinium derivatives, dodecyl-trimethyl
ammonium salt derivatives, tetradecyl-trimethyl ammonium salt
derivatives and cetyl-trimethyl ammonium salt derivatives.
Additionally, basic amino acids such as arginine, lysine and
histidine can be included. Preferred metal cations include, for
example, calcium, potassium, magnesium, iron, copper, zinc,
aluminum, manganese, chromium, cobalt, nickel, and/or sodium.
Surfactants
[0089] In some instances, the pharmaceutical composition includes
one or more surfactants. For example, the composition can include
simethecone, SDS, or another surfactant.
Other Ingredients
[0090] The tablets and capsules of the invention can contain, in
addition to the active ingredients, conventional carriers such as
binding agents, for example, acacia gum, gelatin,
polyvinylpyrrolidone, sorbitol, or tragacanth; fillers, for
example, calcium phosphate, glycine, lactose, maize-starch,
sorbitol, or sucrose; lubricants for example, magnesium stearate,
polyethylene glycol, silica or talc; disintegrants, for example,
potato starch, flavoring or coloring agents, or acceptable wetting
agents. Oral liquid preparations generally may be in the form of
aqueous or oily solutions, suspensions, emulsions, syrups or
elixirs, and may contain conventional additives such as suspending
agents, emulsifying agents, non-aqueous agents, preservatives,
coloring agents and flavoring agents. In either case, the
composition is designed such that the therapeutic agent (e.g.,
antimicrobial agent) may be transmucosally delivered into the
bloodstream, preferably through the walls of the small
intestines.
Coatings
[0091] In some embodiments, the compositions of the invention are
formulated with enteric coatings in order to prevent the
degradation of the therapeutic agent by the acidity of the gastric
fluid and optimize delivery of the active agent to the desired
location in the intestine. Capsules can be coated with selected
materials depending upon the desired capsule characteristics, and
may include, for example, cellulose acetate phthalate,
hydroxypropyl methylcellulose phthalate, polyvinyl acetate
phthalate, shellac, methacrylic acid and esters thereof, zein, or
other materials known in the art. The enteric coating materials may
be applied with or without plasticizers, such as acetylated
glycerides, triethyl citrate, propylene glycol or
diethylphthalates. Preferred coating materials are those which
dissolve at a pH of 5 or above. The coatings therefore only begin
to dissolve when they have left the stomach and entered the small
intestine. A thick layer of coating can be provided which will
dissolve in about fifteen minutes thereby allowing the capsule
underneath to breakup only when it has reached the duodenum. Such a
coating can be made from a variety of polymers such as cellulose
acetate trimellitate (CAT), hydroxypropylmethyl cellulose phthalate
(HPMCP), polyvinyl acetate phthalate (PVAP), cellulose acetate
phthalate (CAP) and shellac as described by Healy in his article
"Enteric Coatings and Delayed Release" Chapter 7 in Drug Delivery
to the Gastrointestinal Tract, editors Hardy et al., Ellis Horwood,
Chichester, 1989. For coatings of cellulose esters, a thickness of
200-250 .mu.m would be suitable.
[0092] Examples of preferred materials include methylmethacrylates
or copolymers of methacrylic acid and methylmethacrylate. Such
materials are available as EUDRAGIT.TM. polymers (Rohhm Pharma,
Darmstadt, Germany). Eudragits are copolymers of methacrylic acid
and methylmethacrylate. Preferred compositions are based on
EUDRAGIT L 30 D-55, EUDRAGIT L1W-55, EUDRAGIT m L100 and EUDRAGIT
5100. EUDRAGIT L30-D55 AND L1W-55 dissolve at pH>5.5.
EUDRAGIT.TM.L100 dissolves at pH 6 and upwards and comprises 48.3%
methacrylic acid units per g dry substance; EUDRAGIT.TM. 5100
dissolves at pH 7 and upwards and comprises 29.2% methacrylic acid
units per g dry substance. Preferred coating compositions are based
on EUDRAGIT.TM. L100 and EUDRAGIT.TM. S100 in the range 100 parts
L100:0 parts 5100 to 20 parts L100:80 parts S100. The most
preferable range is 70 parts L100:30 parts S100 to 80 parts L100:20
parts S100. As the pH at which the coating begins to dissolve
increases, the thickness necessary to achieve colon specific
delivery decreases. For formulations where the ratio of
EUDRAGIT.TM. L100:S100 is high, a coat thickness of the order
150-200 .mu.m is preferable. This is equivalent to 70-110 mg of
coating for a size 0 capsule. For coatings where the ratio
EUDRAGIT.TM. L100:S100 is low, a coat thickness of the order 80-120
.mu.m is preferable, equivalent to 30 to 60 mg coating for a size 0
capsule.
Formulations
[0093] The pharmaceutical compositions described herein can be
formulated, for example, as a solid, semi-solid, or liquid.
[0094] The pharmaceutical compositions of this invention may be
orally administered in any orally acceptable dosage form including,
but not limited to, capsules, tablets, emulsions and aqueous
suspensions, dispersions and solutions. For pediatric and geriatric
applications, emulsions, suspensions, syrups and chewable tablets
may be especially suitable. In the case of tablets for oral use,
carriers which are commonly used can include lactose and corn
starch. Lubricating agents, such as magnesium stearate, can also be
added. For oral administration in a capsule form, useful diluents
can include lactose and dried corn starch. When suspensions and/or
emulsions are administered orally, the active ingredient may be
suspended or dissolved and combined with emulsifying and/or
suspending agents. If desired, certain sweetening and/or flavoring
and/or coloring agents may be added.
Dosage Regimes
[0095] The compositions described herein can, for example, be
administered orally. In general, a dosage ranging from about 0.001
to about 100 mg/kg of body weight, e.g., between 0.001-1 mg/kg,
1-100 mg/kg, or 0.01-5 mg/kg, every 4 to 120 hours, e.g., about
every 6, 8, 12, 24, 48, or 72 hours, or according to the
requirements of the particular compound. For example, the compound
can be administered having a dose of about 250 mg therapeutic agent
such as ceftriaxone. Typically, the pharmaceutical compositions of
this invention will be administered from about 1 to about 6 times
per day. The amount of active ingredient that may be combined with
the carrier materials to produce a single dosage form will vary
depending upon the host treated and the particular mode of
administration. A typical preparation will contain from about 5% to
about 95% therapeutic agent (w/w). Alternatively, such preparations
contain from about 20% to about 80% therapeutic agent.
[0096] Lower or higher doses than those recited above may be
required. Specific dosage and treatment regimens for any particular
patient will depend upon a variety of factors, including the
activity of the specific compound employed, the age, body weight,
general health status, sex, diet, time of administration, rate of
excretion, drug combination, the severity and course of the
disease, condition or symptoms, the patient's disposition to the
disease, condition or symptoms, and the judgment of the treating
physician.
[0097] Upon improvement of a patient's condition, a maintenance
dose of a compound, composition or combination of this invention
may be administered, if necessary. Subsequently, the dosage or
frequency of administration, or both, may be reduced, as a function
of the symptoms, to a level at which the improved condition is
retained. Patients may, however, require intermittent treatment on
a long-term basis upon any recurrence of disease symptoms.
Combination Therapies
[0098] In some instances, the pharmaceutical compositions described
herein can include more than one therapeutic agent, for example,
having a plurality of therapeutic agents in a single composition.
For example, a pharmaceutical composition described herein can
include an antimicrobial agent in combination with an
anti-inflammatory agent, and/or an analgesic agent, and or an
additional antimicrobial agent. When the compositions of this
invention include a combination of a compound of the formulae
described herein and one or more additional therapeutic or
prophylactic agents, both the compound and the additional compound
may be present at dosage levels of between about 1 to 100%, and
more preferably between about 5 to 95% of the dosage normally
administered in a monotherapy regimen. In other instances, the
pharmaceutical compositions described herein can be administered
with another pharmaceutical composition. For example, the
pharmaceutical composition can be administered in conjunction with
an additional pharmaceutical composition that includes an
additional therapeutic agent.
[0099] The combinations of therapeutic agents can be administered
either together, for example, at the same time in separate
formulations or in a single formulation; or they can be
administered separately, for example, administering a dose of a
first pharmaceutical composition at a first time and administering
a dose of a second pharmaceutical composition at a second,
different time.
Methods of Treatment:
[0100] In general, the pharmaceutical compositions described herein
can be used to treat or prevent one or more diseases or disorders
in a subject. In particular, the pharmaceutical compositions can be
used to treat an infection, for example an antimicrobial infection,
in a subject. For example, a pharmaceutical composition including a
cephalosporin such as ceftriaxone can be administered to a subject
to treat an infection. Other antimicrobials useful in the
pharmaceutical compositions described herein to treat infection
include daptomycin, cidofovir, meropenem, and caspofungin.
[0101] The methods include administering to a human or other animal
a therapeutically or prophylactically-effective amount of the
therapeutic agent. "Therapeutically effective amount" means an
amount of the therapeutic agent sufficient to prevent the onset,
alleviate the symptoms, or stop the progression of a condition,
disorder or disease, for example, a microbial infection. The
compositions of the invention can be administered as a single daily
dose or in multiple doses per day.
[0102] In certain embodiments, the compositions of the invention
can be used to treat respiratory tract infections, skin and soft
tissue infections, urinary tract infections, sinusitis, sexually
transmitted diseases, endocarditis, bacteremia, osteomyelitis,
septicemia and lyme disease.
Methods of Making
[0103] The pharmaceutical compositions described herein can be made
in a variety of ways. For example, in some instances, the
compositions can be prepared by hydrating a biodegradable polymer
with a therapeutic agent in water followed by lyophilization. The
lyophilized complex is then ground into finer particles using a
high shear mixer, and then granulated with an absorption enhancer.
The granulations can then be filled, for example, into a gelatin
capsule.
[0104] Other methods of making a pharmaceutical composition
described herein include spray drying/congealing, forming an
emulsion of therapeutic agent and biopolymer, and other techniques
known to those skilled in the art.
Bioavailability
[0105] In some instances, the compositions described herein are
orally bioavailable. For example, a composition can have an oral
bioavailability from about 5% to about 95%, e.g., about 10%, 20%,
35%, 50%, 55%, 60%, 70%, or 80%.
[0106] In some preferred embodiments, a therapeutic agent in a
composition described herein has a bioavailability that is greater
than the bioavailability of a therapeutic agent in the absence of
an enhancer (i.e., an absorption enhancer). For example, the
bioavailability can be about 1.5 times the bioavailability in the
absence of an enhancer. Preferably, the bioavailability of a
therapeutic agent is about 2 times, 3 times, 4 times, 5 times, 10
times, 15 times, 20 times, 50 times or greater than the
bioavailability of the therapeutic in the absence of an
enhancer.
[0107] In some preferred embodiments, where the enhancer (i.e.,
absorption enhancer) is a POE (e.g., a POE alkyl ether), the
bioavailability of the therapeutic agent is at least about 1.5
times the bioavailability of the therapeutic agent in a composition
with another enhancer (e.g., a fatty acid enhancer). Preferably,
the bioavailability of the therapeutic agent is about 2 times, 3
times, 5 times, 10 times, 15 times, 20 times, 50 times or greater
than the bioavailability of the therapeutic agent in a composition
with another enhancer.
[0108] Some useful compositions of the invention include: a
composition comprising ceftriaxone, Capmul C10 and carrageenan; a
composition comprising ceftriaxone, Gelmul 90 and carrageenan; a
composition comprising ceftriaxone, Captex 100 and carrageenan, a
composition comprising an antimicrobial such as daptomycin,
diofovir,
7-(((5-amino-1,2,4-thiadiazol-3-yl)-(Z)-(fluoromethoxyimino)acetyl)amino)-
-3(E)-((imino-1-piperazinylmethyl)-methylhydrazono)methyl-3-cephem-4-carbo-
xylic acid, meropenem, capsofungin, or ceftriaxone, a POE
absorption enhancer, and a biopolymer; a composition comprising
ceftriaxone, a laureth containing POE such as laureth 12, and
carrageenan; a composition comprising ceftriaxone, a ceteth
containing POE such as ceteth 10, and carrageenan; a composition
comprising ceftriaxone, an oleth containing POE such as oleth 10,
and carrageenan; a composition comprising ceftriaxone, a steareth
containing POE such as steareth 10, and carrageenan; a composition
comprising ceftriaxone, an octyldodecyl containing POE, and
carrageenan; a composition comprising ceftriaxone, cholesteryl, and
carrageenan. The number of oxyethylene units of a POE can vary, for
example from between 4 and 23 repeat units. The ratio of enhancer
to therapeutic agent ratio can vary, for example from between 6:1
to about 1:1, preferably from about 4:1 to about 2:1, such as 4:1
or 2:1. In some instances, the biopolymer in the compositions
described above is other than carrageenan, for example, the
biopolymer can be a cellulosic such as hydroxyethylcellulose, or a
carbopol, or a polycarbophil.
EXAMPLES
Example 1
Preparation of Therapeutic Compositions
[0109] Preparation of Ceftriaxone Pharmaceutical Composition Via
Complex Formation or Ceftriaxone/Polymer Dry Blend
(a) Preparation of Ceftriaxone/Polymer Complexes
[0110] Ceftriaxone/Carrageenan Complex
[0111] Preparation of the ceftriaxone/carrageenan complex was
prepared by dissolving 10 mg of calcium chloride in 90 mL of
purified water followed by hydrating 400 mg of the polymer
(carrageenan) calcium chloride/purified water solution. Once the
polymer was hydrated, 10 mL of a 100 mg/mL ceftriaxone solution in
purified water was added to the polymer solution yielding a final
ceftriaxone solution concentration of 10 mg/mL. The complex
solution was frozen at -80.degree. C. then lyophilized to dryness
according to the cycle parameters shown in Table 1. The lyophilized
complex was further ground into a fluffy, light yellow powder using
a mini-blender. The complex was stored in amber glass jars at
-20.degree. C.
[0112] Ceftriaxone/Hydroxyethyl Cellulose Complex (CTX/HEC);
Ceftriaxone/Polycarbophil (CTX/PCP) Complex; Ceftriaxone/Carbopol
(CTX/CP) Complex
[0113] Complexes of ceftriaxone and the polymers hydroxyethyl
cellulose, polycarbophil and carbopol were prepared by hydrating
the desired polymer in aqueous solution in purified water at
0.2-0.4% (w/v) followed by addition of a 100 mg/mL ceftriaxone
solution in purified water to yield a final solution concentration
of 10 mg/mL when added to the hydrated polymer. Complexes prepared
with polycarbophil or carbopol required neutralization with 2N NaOH
to pH 7.2 for hydration prior to addition of the stock ceftriaxone
solution to the polymer. The complex solution was frozen at
-40.degree. C. then lyophilized to dryness according to the cycle
parameters shown in Table 1. The lyophilized complex was further
ground into a powder using a mini-blender. The complex was stored
in amber glass jars at -20.degree. C.
TABLE-US-00001 TABLE 1 Lyophilization Cycle Parameters for
ceftriaxone/polymer complex Step Temperature (.degree. C.) Time
(hours) Pre-Freeze -40 2 Ramp -10 0.5 Hold -10 8 Ramp +10 0.5 Hold
+10 8 Ramp +25 0.5 Hold +25 8 Ramp +40 0.5 Hold +40 8 Ramp +25 0.5
Hold +25 12
Preparation of Ceftriaxone/Polymer Dry Blend
[0114] The dry blend of the formulation components is prepared by
weighing out 1.2 grams of ceftriaxone sodium (equivalent to 1.0
gram of ceftriaxone) or other drug molecule, and 0.4 grams of
carrageenan (or other polymer). The two dry components are mixed to
form a homogeneous powder using a mini-blender. The drug/polymer
powder is then granulated with the enhancer as described in section
(b) below.
(b) Preparation of Ceftriaxone Pharmaceutical Compositions
[0115] Ceftriaxone formulations were prepared as granulations with
the complex, dry blend of the components or ceftriaxone crystals.
Granulations are characterized as combining a semi-solid enhancer
with a ceftriaxone/polymer complex or dry blend (see 1(a)). Prior
to preparation of the granulations, the enhancer was pre-melted in
a water bath on a heater plate. The Enhancer: ceftriaxone
granulations were prepared by weighing out the ceftriaxone/polymer
complex or dry blend into a mini-blender container. The appropriate
amount of enhancer was added to yield the specified enhancer to
ceftriaxone/polymer complex or dry blend ratio. The components were
blended together in the mini-blender until the granulation was
uniform in appearance. The components were then cooled at
-15.degree. C. for 15-20 minutes to re-congeal, then ground into
smaller particles using the mini-blender.
Preparation of Capsules for Administration in Rats
[0116] Capsules were prepared by filling the granulations of 1(b)
into #9e1 (extra long) hard gelatin capsules by use of a specially
designed #9e1 filling funnel. The filling funnel is designed such
that the capsule body sits in the base of the unit. The funnel is
placed on top of the capsule body then the material is filled into
the funnel and pushed down into the capsule. Capsule fill weight is
based on the theoretical potency of the granulation or dry blend to
yield 10 mg of ceftriaxone per capsule.
Example 2
Screening of Compositions Comprising Polyoxyethylene Alkyl Ether
Enhancers
Screening of Compositions Comprising a Polyoxyethylene Alkyl Ether
Enhancer and Ceftriaxone/Carrageenan Complex at 4:1 and 2:1 in
Rats
The Following Rat Model was Used to Screen all Therapeutic
Compositions Tested:
[0117] Male Sprague Dawley rats weighing approximately 250 g with
free access to water were fasted overnight. These rats were
anesthetized with 40 mg/kg pentobarbital via jugular vein catheter.
The small intestine was exposed by a ventral midline incision. A
small incision was made into the duodenum and a #9el capsule was
inserted into the lumen of the small intestine. The duodenum and
the midline incisions were sutured closed. The rats regained
consciousness in 30-90 minutes. Blood samples were taken from the
jugular vein catheter at 0, 15, 30 and 60 minutes and 2, 3, 4 and 6
hours. Food was returned at 1 hour post surgery. Blood samples were
collected in heparinized tubes and subsequently centrifuged. The
plasma was stored at -20 C in heparinized tubes. The rats regained
consciousness in 30-90 minutes. After the 6 hr blood sample, the
rat was euthanized and a necropsy was performed to determine
accuracy and integrity of the surgery. The duodenum was examined
for blockage, leakage and any evidence of inflammation or
irritation at the site of the capsule implantation.
Laureth POE Analogs
[0118] Compositions including a variety of Laureth POE analogs,
including Laureth-4, -7, -9, -10, -12, -15, -20 and -23, were
screened to compare the percent bioavailability of the various
compositions in rats.
[0119] The compositions each included 21.4% ceftriaxone sodium;
7.2% polymer; 71.4% enhancer by weight, and were made according to
the methods described in Example 1 (a) and (b).
[0120] The percent bioavailability in rats with the lauryl POE
ether analogs are shown graphically in FIG. 1.
POE Alkyl Ether Derivatives to Compositions comprising
ceftriaxone/carrageenan complex and a POE alkyl ether were prepared
as described in Example 1. As shown in Tables 2 and 2.1, the POE
alkyl ether enhancers had different alkyl moiety carbon lengths and
different numbers of oxyethylene units ranging from POE oxyethylene
units of 4 to 23 units and an alkyl moiety of 12 to 18 carbons. The
ratio of enhancer:drug was 4:1 for these granulations with
ceftriaxone/carrageenan complex.
[0121] The compositions disclosed in Tables 2 and 2.1 included, in
each instance, 21.4% ceftriaxone sodium; 7.2% polymer; 71.4%
enhancer, by weight. (Note: The ratio of drug to enhancer is
determined by the weight of the drug, not the weight of the drug
salt. Therefore, although the ratio of enhancer to drug salt is
less than 4:1, the amount of enhancer to drug is 4:1.)
[0122] The percent bioavailabilty for each composition was
determined via the rat model (vide supra).
[0123] The percent bioavailability results for enhancer:
ceftriaxone/carrageenan at 4:1 are shown in Tables 2 and 2.1. The
results show enhancers having POE oxyethylene units ranging from 10
to 20 units and an alkyl moiety of 12 to 18 carbons resulted in the
greatest increase in ceftriaxone absorption when combined with the
complex of ceftriaxone/carrageenan.
TABLE-US-00002 TABLE 2 Summary of % bioavailability results for
enhancer:ceftriaxone/carrageenan granulations at a 4:1
(enhancer:ceftriaxone) ratio in rats Oxyethylene Units* Enhancer 4
5 7 9 10 Laureth 39 (16) 54 (2) 60 (19) Ceteth 59 (16) Oleth 73
(10) Steareth 60 (16) Octyldodecyl 10 (2) 15 (4) Cholesteryl 32
(14) *Numbers in parentheses correspond to standard deviation.
TABLE-US-00003 TABLE 2.1 Summary of % bioavailability results for
enhancer:ceftriaxone/carrageenan granulations at a 4:1
(enhancer:ceftriaxone) ratio in rats, continued Oxyethylene Units*
Enhancer 12 15 16 20 23 Laureth 83 (24) 30 (15) 17 (6) 10 (4)
Ceteth Oleth 62 (45) Steareth 65 (14) Octyldodecyl Cholesteryl 31
(18) 13 (4) *Numbers in parentheses correspond to standard
deviation.
[0124] Several of the enhancers exhibited bioavailabilites ranging
from 60-80%. Screening of the formulations possessing the highest
bioavailabilities at 4:1 were evaluated at an
enhancerceftriaxone/carrageenan ratio of 2:1 utilizing the same
protocol above, but substituting compositions comprising
enhancer:ceftriaxone/carrageenan complex of 2:1 for
enhancer:ceftriaxone/carrageenan complex of 4:1. These
compositions, in each instance, included 33.3% ceftriaxone sodium;
11.1% polymer; and 55.6% enhancer, by weight. The results of the
compositions having a 2:1 ratio of enhancer to drug are presented
in Table 3. (Note: As above, the ratio of drug to enhancer is
determined by the weight of the drug, not the weight of the drug
salt. Therefore, although the ratio of enhancer to drug salt is
less than 2:1, the amount of enhancer to drug is 2:1.)
TABLE-US-00004 TABLE 3 Summary of % bioavailability results for
enhancer:ceftriaxone/carrageenan granulations at a 2:1
(enhancer:ceftriaxone) ratio in rats Oxyethylene Units* Enhancer ID
8 10 12 15 20 Laureth 30 (8) 38 (10) Ceteth 49 (14) 43 (27) 59 (20)
Oleth 57 (20) 43 (28) 28 (11) 11 (2) Steareth 31 (6) 47 (19) 36 (8)
29 (8) Isoceteth 12 (8) Isosteareth 15 (6) 16 (5) Beheneth 9 (4) 7
(5) *Numbers in parentheses correspond to standard deviation.
[0125] The enhancer: ceftriaxone/carrageenan formulations resulting
in the highest % bioavailabilities were Ceteth-10, 12 & 15,
Oleth-10 & 12 and Steareth-10, all within the range form 40-60%
bioavailability.
Example 3
Screening of Compositions Comprising Polymers as Alternatives to
Carrageenan
[0126] Ceftriaxone was complexed with a polymer selected from
hydroxyethyl cellulose (HEC) 250 L (non-ionic), hydroxyethyl
cellulose 250H (non-ionic), carbopol (CP) 971(anionic), carbopol
974 (anionic) or polycarbophil (PCP) Noveon AA1 (anionic) as
described in Example 1 to form a ceftriaxone/polymer complex. The
complexes with the various polymers were prepared at polymer levels
of A % and B % (vide infra) in the lyophilized form.
[0127] Compositions comprising the various ceftriaxone/polymer
complexes and an enhancer were prepared in either a 4:1 or 2:1
ratio of enhancer to ceftriaxone/polymer complex as described in
Example 1. For the polymer percent designated A % in the table @
4:1, the composition included 22.2% drug salt; 3.7% polymer; and
74.1% enhancer. For the polymer percent designated B % in the table
@ 4:1, the composition included 21.4% drug salt; 7.2% polymer; and
71.4% enhancer. For the polymer percent designated A % in the table
@ 2:1, the composition included 35.3% drug salt; 5.9% polymer; and
58.8% enhancer. For the polymer percent designated B % in the table
@ 2:1 the composition included 33.3% drug salt; 11.1% polymer; and
55.6% enhancer.
[0128] Each complex was administered intraduodenally (ID) as
described in Example 2 above. The bioavailability of each of the
formulations was compared with formulation standard
Laureth-12:ceftriaxone/carrageenan at 4:1. The compositions and
bioavailability results are summarized in Table 4.
TABLE-US-00005 TABLE 4 Summary of % bioavailabilty for POE
enhancer: polymer complex formulation screening in rats %
Bioavailability results for ceftriaxone-polymer complexes
granulated with various POE enhancers in rats
(enhancer:ceftriaxone) ratio (in the table, ceftriaxone is
designated as CTX) Enhancer Type* Laureth- Laureth- Ceteth- Ceteth-
Oleth- Complex Percent 12 12 12 15 10 ID Polymer @ 4:1 @ 2:1 @ 2:1
@ 2:1 @ 2:1 CTX-HEC A 70 (13) 21 (10) NT NT NT 250L B 48 (12) 34
(27) 56 (4) 30 (6) 32 (19) CTX-HEC A 68 (21) NT NT NT NT 250H B 56
(17) 28 (8) NT NT NT CTX-CP A 69 (27) 30 (19) NT NT NT 971 B 74
(24) 37 (21) NT 46 (30) 36 (22) CTX-CF A 58 (19) 20 (5) NT NT NT
974 B 47 (29) 13 (5) 40 (16) NT NT CTX-PCP A 61 (9) 18 (8) NT NT NT
B 50 (20) 47 (22) 54 (10) 26 (4) 39 (15) *Numbers in parentheses in
the columns corresponding to Enhancer Type correspond to standard
deviation.
[0129] The results for the Laureth-12:polymer granulations at 4:1
demonstrate high percent bioavailabilities for several of the
formulations. Screening was continued with the Laureth-12:polymer
formulations which exhibited the highest bioavailability but at a
2:1 ratio. The percent bioavailability results for 2:1 ratio
formulations were lower than those achieved for the 4:1 ratio. The
highest % bioavailability achieved at 2:1 was the Laureth-12:
ceftriaxone-PCP complex (47%). Screening at a 2:1 ratio with the
best Laureth-12:polymer complex formulations was continued with
other POE alkyl ether enhancers. The formulations which resulted in
the highest bioavailabilities were Ceteth-12:ceftriaxone-HEC 250L
(B %), Ceteth-12:ceftriaxone-CP-974 (B %) and
Ceteth-15:ceftriaxone-CP 971 (B %) at 56%, 54%, and 46%,
respectively.
Example 4
Study of Ceteth-12:Ceftriaxone-Polycarbophil (PCP) in the
Intestinal Lumen
[0130] An intestinal lumen study was conducted as described in
Example 2 to determine if the Ceteth-12 (C-12):ceftriaxone-PCP
complex formulation at a 2:1 ratio described in Example 3 exhibited
different absorption and breakdown of the ceftriaxone and Ceteth-12
components in the intestines. The results obtained for the
ceftriaxone and Ceteth-12 (C-12) in the plasma are shown in FIG.
2.
[0131] Ceteth-12 formulations resulted in significantly greater
amounts of ceftriaxone in the plasma over time. The attached
graph/figure shows the monoglyceride Gelmul 90 at a 4:1
Gelmul:Ceftriaxone ratio has a shorter residence time in the rat
small intestine lumen than the POE alkyl ether in a 2:1
Ceteth-12:Ceftriaxone formulations. The 4:1 Gelmul:Ceftriaxone
formulations resulted in an average bioavailability of 30% whereas
the 2:1 Ceteth12:Ceftriaxone-PCP formulations resulted in an
average bioavailability of 54%.
Example 5
Oral Bioavailability of Ceftriaxone in Man
[0132] A single center, nonrandomized trial in which male subjects
received an intravenous dose followed by administration of five
oral formulations of ceftriaxone was conducted. The mean
ceftriaxone dose was 245 mg. These formulations were placed in a
mechanical capsule (Enterion.TM.) commonly used in scintigraphy
studies. Upon reaching the proximal small bowel, the capsule was
opened non-invasively via an external electrical signal and serial
blood sampling was initiated to study drug absorption up to and
including 24 hours post-capsule activation. There was a 5 day
washout period between each treatment. The oral ceftriaxone
formulations studied are in the Table 5 below. The oral
bioavailability of ceftriaxone without any absorption enhancer is
approximately 0-5%. There were no deaths or serious adverse events.
There were no clinically significant changes in vital signs or ECGs
that were attributable to study drug.
[0133] The oral ceftriaxone formulations included: T-2,
Ceteth-12:ceftriaxone complex (2:1), T-3, Oleth-10:ceftriaxone
complex (2:1), T-4, Laureth-12:ceftriaxone complex (2:1), T-5,
Ceteth-12:ceftriaxone complex (1:1) and T-6, Ceteth-12:
ceftriaxone/polycarbophil dry blend (2:1). Upon reaching the
proximal small bowel, the Enterion.TM. capsule was opened
non-invasively via an external signal and serial blood sampling was
initiated to study drug absorption up to and including 24 hours
post-capsule activation.
TABLE-US-00006 TABLE 5 Percent bioavailability of oral ceftriaxone
formulations CTX, En- En- Poly- Poly- % Bio- Na hancer hancer mer
mer availability (mg) (mg) Type (mg) Type (SD) T-1 308.6.sup.1 0 --
0 -- 100 T-2 308.6.sup.2 500 Ceteth-12 100.6 PCP.sup.4 29.01
(13.95) T-3 308.6.sup.2 500 Oleth-10 99.3 CGN.sup.5 11.38 (7.05)
T-4 308.6.sup.2 500 Laureth-12 99.3 CGN.sup.5 7.98 (2.99) T-5
308.6.sup.2 250 Ceteth-12 100.1 PCP.sup.4 9.03 (1.23) T-6
308.6.sup.3 500 Ceteth-12 100.0 PCP.sup.4 20.93 (8.81) .sup.1308.6
mg of CTX, Na = 250 mg CTX .sup.2CTX, Na + polymer + CaCl.sub.2 or
NaOH (as a pH adjuster) in a lyophilized complex granulated with an
enhancer .sup.3CTX, Na + polymer are dry blended then granulated
with Ceteth-12 .sup.4PCP = polycarbophil .sup.5CGN =
carrageenan
Example 6
Study of effect of enhancer on the bioavailability of daptomycin,
7-(((5-amino-1,2,4-thiadiazol-3-yl)-(Z)-(fluoromethoxyimino)acetyl)amino)-
-3(E)-((imino-1-piperazinylmethyl)-methylhydrazono)methyl-3-cephem-4-carbo-
xylic acid, and ceftriaxone/carrageenan
[0134] Daptomycin,
7-(((5-amino-1,2,4-thiadiazol-3-yl)-(Z)-(fluoromethoxyimino)acetyl)amino)-
-3(E)-((imino-1-piperazinylmethyl)-methylhydrazono)methyl-3-cephem-4-carbo-
xylic acid (CMPD 1), and ceftriaxone were tested to compare the
bioavailability using a POE alkyl ether enhancers versus other
enhancers such as Gelmul 90, Capmul C10 and Sodium Laurate. The
compositions, in each instance, included 21.4% drug salt; 7.2%
polymer; 71.4% enhancer, by weight. (Note: The ratio of drug to
enhancer is determined by the weight of the drug, not the weight of
the drug salt. Therefore, although the ratio of enhancer to drug
salt is less than 4:1, the amount of enhancer to drug is 4:1.)
[0135] In each instance, the compositions were administered ID in 3
rats, unless otherwise indicated. Cmax was determined as described
in Example 2. The results are shown in Table 6 below:
TABLE-US-00007 TABLE 6 Comparison of Enhancer Effect on Daptomycin,
CMPD 1 and ceftriaxone/carrageenan Oral Absorption Comparison of
Enhancer Effect on Daptomycin, CMPD 1 and ceftriaxone:carrageenan
complex Oral Absorption Cmax.sup.1 (.mu.g/mL) CMPD
ceftriaxone/carrageenan Daptomycin.sup.2 1.sup.3 complex.sup.4 Mean
Mean Mean Enhancer.sup.5 (.+-.SD) (.+-.SD) (.+-.SD) Laureth-12 18
(12) 22 (4) 76 (18).sup.6 Gelmul 90 6 (3) 13 (8) 51 (15).sup.7
Capmul 7 (0.4) 7 (7) 26 (15).sup.8 C10 Sodium 8 (3) 7 (1) 21
(17).sup. Laurate .sup.1Cmax normalized to 40 mg/Kg. All data was
generated using the rat model in Example 2. .sup.2Enhancer
granulated with lyophilized daptomycin (no polymer or cation)
.sup.3Enhancer granulated with lyophilized CMPD 1 (no polymer or
cation) .sup.4Enhancer granulated with ceftriaxone/carrageenan
complex ("complex" is lyophilized ceftriaxone + polymer + cation)
.sup.5Enhancer:drug ratio = 4:1 in all studies .sup.616 rats
.sup.76 rats .sup.810 rats
Example 7
Comparison of Percent Bioavailability of Therapeutic Compositions
with and without a POE Enhancer
[0136] Compositions including ceftriaxone, daptomycin, cidofovir,
7-(((5-amino-1,2,4-thiadiazol-3-yl)-(Z)-(fluoromethoxyimino)acetyl)amino)-
-3(E)-((imino-1-piperazinylmethyl)-methylhydrazono)methyl-3-cephem-4-carbo-
xylic acid, meropenem, and caspofungin were prepared with and
without a POE enhancer. As shown in Table 7, in most instances, the
bioavailability of the compositions including the POE enhancer was
greater than 25%, and in some instances even higher.
[0137] Ceftriaxone was present in the same percentages as Example 6
above. The formulation included ceftriaxone/carrageenan
complex+Laureth-12 as the enhancer.
[0138] Daptomycin was present in the same percentages as Example 6
above. The formulation consisted of daptomycin carrageenan
complex+Ceteth-15 as the enhancer
[0139] Cidofovir was drug and enhancer only. The percentage
included 23.8% drug and 76.2% Ceteth-12 as the enhancer, by
weight.
[0140]
7-(((5-amino-1,2,4-thiadiazol-3-yl)-(Z)-(fluoromethoxyimino)acetyl)-
amino)-3(E)-((imino-1-piperazinylmethyl)-methylhydrazono)methyl-3-cephem-4-
-carboxylic acid was drug and enhancer only. The percentage
included 21.9% drug and 78.1% Ceteth-15 as the enhancer, by
weight.
[0141] Meropenem was drug and enhancer only. The percentage
included 25% drug and 75% Ceteth-12 as the enhancer, by weight.
[0142] Caspofungin was drug and enhancer only. The percentage
included 38.5% drug and 61.5% Ceteth-12 as the enhancer, by
weight.
[0143] In each instance, the compositions were administered ID as
described in Example 2 above.
TABLE-US-00008 TABLE 7 Percent bioavailability of therapeutic
compositions with and without a POE alkyl ether enhancer Drug only
Drug plus enhancer.sup.1 % BA % BA Ceftriaxone 2 83.sup.2
Daptomycin --* 44.sup.2 Cidofovir 2 44 CMPD 1 --* 30 Meropenem 1 28
Caspofungin <1 <5 .sup.1All compounds were formulated at a
4:1 (enhancer:drug) ratio .sup.2Enhancer plus drug complex
*Compound known to have poor oral bioavailability.
[0144] A number of embodiments of the invention have been
described. Nevertheless, it will be understood that various
modifications may be made without departing from the spirit and
scope of the invention. Accordingly, other embodiments are within
the scope of the following claims.
* * * * *