U.S. patent application number 15/850732 was filed with the patent office on 2018-05-03 for enalapril compositions.
The applicant listed for this patent is Silvergate Pharmaceuticals, Inc., University of Kansas. Invention is credited to Michael C. BECKLOFF, Peter COLABUONO, John L. HASLAM, Kathleen HEPPERT, Robert MAURO, Lian G. RAJEWSKI, Roger A. RAJEWSKI, Frank SEGRAVE.
Application Number | 20180116954 15/850732 |
Document ID | / |
Family ID | 49448551 |
Filed Date | 2018-05-03 |
United States Patent
Application |
20180116954 |
Kind Code |
A1 |
RAJEWSKI; Lian G. ; et
al. |
May 3, 2018 |
ENALAPRIL COMPOSITIONS
Abstract
Provided herein are stable enalapril powder compositions for
oral liquid formulation. Also provided herein are methods of using
enalapril oral liquid formulations for the treatment of certain
diseases including hypertension, heart failure and asymptomatic
left ventricular dysfunction.
Inventors: |
RAJEWSKI; Lian G.;
(Lawrence, KS) ; RAJEWSKI; Roger A.; (Lawrence,
KS) ; HASLAM; John L.; (Lawrence, KS) ;
HEPPERT; Kathleen; (Lawrence, KS) ; BECKLOFF; Michael
C.; (Leawood, KS) ; SEGRAVE; Frank; (Dublin,
OH) ; MAURO; Robert; (Miller Place, NY) ;
COLABUONO; Peter; (Las Vegas, NV) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Silvergate Pharmaceuticals, Inc.
University of Kansas |
Greenwood Village
Lawrence |
CO
KS |
US
US |
|
|
Family ID: |
49448551 |
Appl. No.: |
15/850732 |
Filed: |
December 21, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15433743 |
Feb 15, 2017 |
9855214 |
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15850732 |
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14433502 |
Apr 3, 2015 |
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PCT/US2013/063096 |
Oct 2, 2013 |
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15433743 |
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13914452 |
Jun 10, 2013 |
8778366 |
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14433502 |
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13670355 |
Nov 6, 2012 |
8568747 |
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13914452 |
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61710489 |
Oct 5, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 9/0053 20130101;
A61P 9/12 20180101; A61K 9/145 20130101; A61K 9/0095 20130101; A61K
9/14 20130101; A61K 47/02 20130101; A61K 9/143 20130101; A61K 47/26
20130101; A61K 31/401 20130101; A61K 45/06 20130101; A61K 38/05
20130101; A61P 9/04 20180101; A43B 11/00 20130101 |
International
Class: |
A61K 9/00 20060101
A61K009/00; A61K 38/05 20060101 A61K038/05; A61K 9/14 20060101
A61K009/14 |
Claims
1. A method of treating hypertension or prehypertension in a
subject, the method comprising administering to that subject a
pharmaceutical powder that is reconstituted into an oral liquid
formulation, the powder consisting essentially of: (a) enalapril or
a pharmaceutically acceptable salt thereof, (b) a stability agent,
and (c) colloidal silicon dioxide, wherein, when the powder is
reconstituted into an oral liquid, the liquid is homogenous and
stable for at least 12 weeks at about 25.+-.5.degree. C. and
55.+-.10% relative humidity.
2. The method of claim 1, wherein the enalapril or pharmaceutically
acceptable salt thereof is enalapril maleate.
3. The method of claim 1, wherein the stability agent is lactose,
sucrose, or mannitol.
4. The method of claim 1, wherein the powder consists essentially
of: (a) about 14% (w/w) enalapril or a pharmaceutically acceptable
salt thereof, (b) about 85% (w/w) of the stability agent, and (c)
about 1% (w/w) colloidal silicon dioxide.
5. The method of claim 1, wherein the powder consists essentially
of about 150 mg enalapril, about 890 mg mannitol, and 10 mg
colloidal silicon dioxide.
6. The method of claim 1, wherein the powder is stable for at least
six months at ambient, accelerated or refrigerated conditions.
7. The method of claim 1, wherein the hypertension is primary
hypertension.
8. The method of claim 1, wherein the hypertension is secondary
hypertension.
9. The method of claim 1, wherein the subject has blood pressure
values greater than or equal to 140/90 mm Hg.
10. The method of claim 1, wherein the subject has blood pressure
values of about 120-139/80-89 mm Hg.
11. The method of claim 1, wherein the subject is an adult.
12. The method of claim 1, wherein the subject is elderly.
13. The method of claim 1, wherein the subject is a child.
14. A method of treating hypertension or prehypertension in a
subject, the method comprising administering to that subject a
pharmaceutical powder that is reconstituted into an oral liquid
formulation, the powder consisting essentially of: (a) enalapril or
a pharmaceutically acceptable salt thereof, (b) mannitol, and (c)
colloidal silicon dioxide, wherein, when the powder is
reconstituted into an oral liquid, the liquid is homogenous and
stable for at least 12 weeks at about 25.+-.5.degree. C. and
55.+-.10% relative humidity.
15. The method of claim 14, wherein the enalapril or
pharmaceutically acceptable salt thereof is enalapril maleate.
16. The method of claim 14, wherein the hypertension is primary
hypertension.
17. The method of claim 14, wherein the hypertension is secondary
hypertension.
18. The method of claim 14, wherein the subject has blood pressure
values greater than or equal to 140/90 mm Hg.
19. The method of claim 14, wherein the subject has blood pressure
values of about 120-139/80-89 mm Hg.
20. The method of claim 14, wherein the subject is an adult.
21. The method of claim 14, wherein the subject is elderly.
22. The method of claim 14, wherein the subject is a child.
23. A method of treating heart failure or left ventricular
dysfunction in a subject, the method comprising administering to
that subject a pharmaceutical powder that is reconstituted into an
oral liquid formulation, the powder consisting essentially of: (a)
enalapril or a pharmaceutically acceptable salt thereof, (b) a
stability agent, and (c) colloidal silicon dioxide, wherein, when
the powder is reconstituted into an oral liquid, the liquid is
homogenous and stable for at least 12 weeks at about
25.+-.5.degree. C. and 55.+-.10% relative humidity.
24. The method of claim 23, wherein the enalapril or
pharmaceutically acceptable salt thereof is enalapril maleate.
25. The method of claim 23, wherein the stability agent is lactose,
sucrose, or mannitol.
26. The method of claim 23, wherein the powder consists essentially
of: (a) about 14% (w/w) enalapril or a pharmaceutically acceptable
salt thereof, (b) about 85% (w/w) of the stability agent, and (c)
about 1% (w/w) colloidal silicon dioxide.
27. The method of claim 23, wherein the powder consists essentially
of about 150 mg enalapril, about 890 mg mannitol, and 10 mg
colloidal silicon dioxide.
28. The method of claim 23, wherein the powder is stable for at
least six months at ambient, accelerated or refrigerated
conditions.
29. A method of treating heart failure or left ventricular
dysfunction in a subject, the method comprising administering to
that subject a pharmaceutical powder that is reconstituted into an
oral liquid formulation, the powder consisting essentially of: (a)
enalapril or a pharmaceutically acceptable salt thereof, (b)
mannitol, and (c) colloidal silicon dioxide, wherein, when the
powder is reconstituted into an oral liquid, the liquid is
homogenous and stable for at least 12 weeks at about
25.+-.5.degree. C. and 55.+-.10% relative humidity.
30. The method of claim 29, wherein the enalapril or
pharmaceutically acceptable salt thereof is enalapril maleate.
Description
CROSS REFERENCE
[0001] This application is a continuation of U.S. patent
application Ser. No. 15/433,743, filed Feb. 15, 2017, which is a
continuation of U.S. patent application Ser. No. 14/433,502, filed
Apr. 3, 2015; which is a U.S. National Stage of PCT/US2013/063096,
filed Oct. 2, 2013; which is a continuation of U.S. patent
application Ser. No. 13/914,452, filed Jun. 10, 2013, now U.S. Pat.
No. 8,778,366, issued Jul. 15, 2014; which is a continuation of
U.S. patent application Ser. No. 13/670,355, filed on Nov. 6, 2012,
now U.S. Pat. No. 8,568,747, issued Oct. 29, 2013; which claims the
benefit of U.S. Patent Application No. 61/710,489, filed Oct. 5,
2012, all of which are incorporated herein by reference in their
entirety.
BACKGROUND OF THE INVENTION
[0002] Hypertension, or high blood pressure, is a serious health
issue in many countries. According to the National Heart Blood and
Lung Institute, it is thought that about 1 in 3 adults in the
United States alone have hypertension. Left unchecked, hypertension
is considered a substantial risk factor for cardiovascular and
other diseases including coronary heart disease, myocardial
infarction, congestive heart failure, stroke and kidney failure.
Hypertension is classified as primary (essential) hypertension or
secondary hypertension. Primary hypertension has no known cause and
may be related to a number of environmental, lifestyle and genetic
factors such as stress, obesity, smoking, inactivity and sodium
intake. Secondary hypertension can be caused by drug or surgical
interventions, or by abnormalities in the renal, cardiovascular or
endocrine system.
[0003] A number of antihypertensive drugs are available for
treating hypertension. Various therapeutic classes of
antihypertensive drugs include alpha-adrenergic blockers,
beta-adrenergic blockers, calcium-channel blockers, hypotensives,
mineralcorticoid antagonists, central alpha-agonists, diuretics and
renin-angiotensin-aldosterone inhibitors which include angiotensin
II receptor antagonists (ARB) and angiotensin-converting enzyme
(ACE) inhibitors. Angiotensin-converting enzyme (ACE) inhibitors
inhibit angiotensin-converting enzyme (ACE), a peptydyl dipeptidase
that catalyzes angiotension I to angiotension II, a potent
vasoconstrictor involved in regulating blood pressure.
[0004] Enalapril is a prodrug belonging to the
angiotensin-converting enzyme (ACE) inhibitor of medications. It is
rapidly hydrolyzed in the liver to enalaprilat following oral
administration. Enalaprilat acts as a potent inhibitor of ACE. The
structural formulae of enalapril and enalaprilat is as follows:
##STR00001##
[0005] Enalapril is currently administered in the form of oral
tablets, (e.g., Vasotec.RTM.). In addition to the treatment of
hypertension, enalapril tablets have been used for symptomatic
congestive heart failure, and asymptomatic left ventricular
dysfunction.
SUMMARY OF THE INVENTION
[0006] Provided herein are enalapril powder compositions for an
oral liquid formulation. In one aspect, the powder comprises (a)
about 1 to about 30% (w/w) enalapril or a pharmaceutically
acceptable salt thereof, and (b) about 60 to about 99% (w/w)
mannitol. In some embodiments, when the powder is reconstituted
into an oral liquid, the liquid is homogenous and stable for at
least 12 weeks at ambient or refrigerated conditions. In other
embodiments, the powder is stable for at least six months at
ambient, accelerated or refrigerated conditions. In certain
instances, ambient conditions are 25.+-.5.degree. C. and 55.+-.10%
relative humidity. In certain instances, refrigerated conditions
are 5.+-.3.degree. C. In certain instances, accelerated conditions
are about 40 .degree. C. or 60 .degree. C. and/or up to 80%
relative humidity.
[0007] In another aspect, the powder comprises (a) about 1 to about
30% (w/w) enalapril or a pharmaceutically acceptable salt thereof,
(b) about 60 to about 99% (w/w) mannitol, and (c) about 0.5 to
about 2% (w/w) colloidal silicon dioxide. In some embodiments, when
the powder is reconstituted into an oral liquid, the liquid is
homogenous and stable for at least 12 weeks at ambient or
refrigerated conditions. In other embodiments, the powder is stable
for at least six months at ambient, accelerated or refrigerated
conditions.
[0008] In certain embodiments, the enalapril is enalapril maleate.
In certain embodiments, the powder is reconstituted in water for
the oral liquid. In certain embodiments, the powder is
reconstituted in a syrup for the oral liquid. In certain
embodiments, the powder further comprises a pharmaceutically
acceptable excipient. In certain instances, the pharmaceutically
acceptable excipient is a sweetener, flavoring agent or
preservative. In certain instances, the pharmaceutically acceptable
excipient is a sweetener. In certain instances, the sweetener is a
solid. In certain instances, the powder further comprises a solid
(e.g., powder) sweetener. In certain instances, the sweetener is a
liquid. In certain instances, the powder is reconstituted in a
liquid sweetener (e.g., syrup). In certain embodiments, the
enalapril or pharmaceutically acceptable salt thereof is about 12
to about 15% (w/w). In certain embodiments, the mannitol is about
80 to 85% (w/w). In certain embodiments, the silicon dioxide is
about 1% (w/w). In certain embodiments, the enalapril or
pharmaceutically acceptable salt thereof is about 14% (w/w), the
mannitol is about 85% (w/w) and the silicon dioxide is about 1%
(w/w). In certain embodiments, the powder comprises about 150 mg
enalapril, about 890 mg mannitol and 10 mg colloidal silicon
dioxide.
[0009] In another aspect, the powder comprises (a) about 1 to about
30% (w/w) enalapril or a pharmaceutically acceptable salt thereof,
(b) about 60 to about 99% (w/w) mannitol, and (c) about 0.5 to
about 2% (w/w) colloidal silicon dioxide, wherein, when the powder
is reconstituted into an oral liquid, the liquid maintains no more
than 5% total impurities for at least 12 weeks at ambient or
refrigerated conditions. In another aspect, the powder comprises
(a) about 1 to about 30% (w/w) enalapril or a pharmaceutically
acceptable salt thereof, (b) about 60 to about 99% (w/w) mannitol,
and (c) about 0.5 to about 2% (w/w) colloidal silicon dioxide,
wherein, the powder maintains no more than 5% total impurities for
at least six months at ambient, accelerated or refrigerated
conditions.
[0010] In certain embodiments, the liquid maintains no more than
2.5% total impurities for at least 12 weeks. In certain
embodiments, the liquid maintains no more than 2.5% enalaprilat for
at least 12 weeks. In certain embodiments, the liquid maintains no
more than 2.5% diketopiperazine for at least 12 weeks. In certain
embodiments, the powder maintains no more than 2.5% total
impurities for at least six months. In certain embodiments, the
powder maintains no more than 1% enalaprilat for at least six
months. In certain embodiments, the powder maintains no more than
1% diketopiperazine for at least six months.
[0011] Also provided herein are enalapril oral liquid formulations.
In one aspect, the liquid formulation comprises (a) about 0.5 to
about 5 mg/mL enalapril or a pharmaceutically acceptable salt
thereof, (b) about 3 to about 10 mg/mL mannitol, and (c) a
sweetener; wherein, the liquid is homogenous and stable for at
least 12 weeks at ambient or refrigerated conditions.
[0012] In another aspect, the liquid formulation comprises (a)
about 0.5 to about 5 mg/mL enalapril or a pharmaceutically
acceptable salt thereof, (b) about 3 to about 10 mg/mL mannitol,(c)
about 0.03 to about 0.13 mg/mL colloidal silicon dioxide, and (d) a
sweetener; wherein, the liquid is homogenous and stable for at
least 12 weeks at ambient or refrigerated conditions.
[0013] In certain embodiments, the enalapril is enalapril maleate.
In certain embodiments, the liquid formulation comprises about 1
mg/mL enalapril. In certain embodiments, the liquid formulation
comprises about 5 mg/mL mannitol. In certain embodiments, the
liquid formulation comprises about 6 mg/mL mannitol. In certain
embodiments, the liquid formulation comprises about 0.06 mg/mL
colloidal silicon dioxide. In certain embodiments, liquid
formulation comprises about 1 mg/mL enalapril, about 6 mg/mL
mannitol and about 0.06 mg/mL colloidal silicon dioxide.
[0014] In certain embodiments, the sweetener is sorbitol. In
certain embodiments, the liquid formulation comprises an additional
pharmaceutically acceptable excipient. In certain instances, the
pharmaceutically acceptable excipient is a flavoring agent or
preservative. In certain embodiments, the liquid formulation
comprises water as the liquid vehicle. In certain embodiments, the
liquid formulation comprises a syrup as the liquid vehicle.
[0015] In another aspect, the liquid formulation comprises (a)
about 1 mg/ml enalapril or a pharmaceutically acceptable salt
thereof, (b) about 6 mg/ml mannitol, (c) about 0.07 mg/ml colloidal
silicon dioxide, and (d) a sweetener, wherein the liquid
formulation maintains an 80-125% C.sub.max of 58 ng/mL following
oral administration at a 10 mg enalapril dosage for at least 12
weeks.
[0016] In some embodiments, when the liquid formulation is stored
at up to 12 weeks at ambient or refrigerated conditions after
reconstitution, the liquid formulation provides an 80-125%
C.sub.max of 58 ng/mL enalapril following oral administration at a
10 mg enalapril dosage. In some embodiments, when the liquid
formulation is stored at up to 12 weeks at ambient or refrigerated
conditions, the liquid formulation provides an 80-125% C.sub.max of
41 ng/mL enalaprilat following oral administration at a 10 mg
enalapril dosage.
[0017] In some embodiments, when the liquid formulation is stored
at up to 12 weeks at ambient or refrigerated conditions after
reconstitution, the liquid formulation provides an 80-125%
AUC.sub.inf of 102.6 h*ng/mL enalapril following oral
administration at a 10 mg enalapril dosage. In some embodiments,
when the liquid formulation is stored at up to 12 weeks at ambient
or refrigerated conditions, the liquid formulation provides an
80-125% AUC.sub.inf of 405.3 h*ng/mL enalaprilat following oral
administration at a 10 mg enalapril dosage.
[0018] In some embodiments, when the liquid formulation is stored
at up to 12 weeks at ambient or refrigerated conditions after
reconstitution, the liquid formulation provides an 80-125%
T.sub.max of 0.87 h for enalapril following oral administration at
a 10 mg enalapril dosage. In some embodiments, when the liquid
formulation is stored at up to 12 weeks at ambient or refrigerated
conditions, the liquid formulation provides an 80-125% T.sub.max of
3.45 h for enalaprilat following oral administration at a 10 mg
enalapril dosage.
[0019] Also provided herein are processes for preparing an
enalapril oral liquid formulation. In one aspect, the process
comprises the steps of (i) providing an uniform powder comprising
about 10 to about 20% (w/w) enalapril or a pharmaceutically
acceptable salt thereof, about 60 to about 90% (w/w) mannitol, and
about 0.5 to about 1% (w/w) colloidal silicon dioxide in a bottle;
(ii) adding an amount of sweetener in liquid syrup form; (iii)
shaking the liquid formulation for at least 10 seconds; (iv) adding
a second amount of sweetener in liquid syrup form; (v) shaking the
liquid formulation for at least 10 seconds; and (vi) allowing the
formulation in the bottle to stand for at least one hour to allow
bubble dissipation.
[0020] Also provided herein are methods of treating hypertension or
heart failure comprising administering to a patient in need thereof
an oral liquid formulation reconstituted from an enalapril powder
as described herein. In one embodiment, the patient is a child. In
another embodiment, the patient is elderly.
INCORPORATION BY REFERENCE
[0021] All publications, patents, and patent applications mentioned
in this specification are herein incorporated by reference to the
same extent as if each individual publication, patent, or patent
application was specifically and individually indicated to be
incorporated by reference.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] The novel features of the invention are set forth with
particularity in the appended claims. A better understanding of the
features and advantages of the present invention will be obtained
by reference to the following detailed description that sets forth
illustrative embodiments, in which the principles of the invention
are utilized, and the accompanying drawings of which:
[0023] FIG. 1: Scaled-up enalapril powder composition A blended for
60 minutes showing formulation of balls and segregation.
[0024] Reconstitution of various enalapril powder compositions:
FIG. 2A: enalapril and mannitol, FIG. 2B: neat enalapril, and FIG.
2C: enalapril, mannitol and colloidal silicon dioxide.
[0025] FIG. 3: Mean enalapril concentration-time profiles (linear,
top; log, bottom) after administration of test formulation--fasted
(Treatment A), reference product--fasted (Treatment B), and test
formulation--fed (Treatment C).
[0026] FIG. 4: Mean enalaprilat concentration-time profiles
(linear, top; log, bottom) after administration of test
formulation--fasted (Treatment A), reference product--fasted
(Treatment B), and test formulation--fed (Treatment C).
DETAILED DESCRIPTION OF THE INVENTION
[0027] Provided herein are stable enalapril powder compositions for
oral liquid administration. Also provided herein are stable
enalapril oral liquid compositions. These enalapril compositions
described herein are useful for the treatment of hypertension,
heart failure as well as ventricular dysfunction. The compositions
are advantageous over conventional solid dosage administration of
enalapril ranging from ease of administration, better absorption,
accessibility to additional patient populations such as to children
and the elderly, and an increased patient compliance to
medication.
[0028] It is generally known that certain segments of the
population have difficulty ingesting and swallowing solid oral
dosage forms such as tablets and capsules. As many as a quarter of
the total population has this difficulty. Often, this leads to
non-compliance with the recommended medical therapy with the solid
dosage forms, thereby resulting in rending the therapy ineffective.
Further, solid dosage forms are not recommended for children or
elderly due to increased risk in choking.
[0029] For enalapril, the current solution to overcoming the use of
the tablet form is for a compounding pharmacist to pulverize and
crush the enalapril tablet(s) into a powder via mortar and pestle
and reconstitute the powder in some liquid form. However forming a
enalapril oral liquid in this fashion has significant drawbacks
including large variability in the actual dosage, incomplete
solubilizing of the enalapril tablet in the liquid, rapid
instability, inconsistent formulation methods per compounding
pharmacy, and a number other potential issues. The crushed tablet
liquid formulation may also be potentially unsafe due to
contamination with residual drugs and other substances from the
mortar and pestle or other crushing agent.
[0030] The present embodiments provide a safe and effective oral
administration of enalapril for the treatment of hypertension and
other disorders. In particular, the embodiments provide stable
enalapril oral liquid compositions as well as enalapril powder
compositions for oral liquid administration.
[0031] As used herein, "enalapril" refers to enalapril base, its
salt, or solvate or derivative or isomer or polymorph thereof.
Suitable compounds include the free base, the organic and inorganic
salts, isomers, isomer salts, solvates, polymorphs, complexes etc.
U.S. Pat. Nos. 4,374,829; 4,472,380 and 4,510,083 disclose
exemplary methods in the preparation of enalapril. In some
embodiments, the enalapril used in the compositions described
herein is an enalapril salt. In some instances, the enalapril salt
is enalapril maleate. In other instances, the enalapril salt is in
the form of enalapril sodium.
[0032] Other ACE inhibitors are contemplated in the formulations
within and include but are not limited to quinapril, indolapril,
ramipril, perindopril, lisinopril, benazepril, imidapril,
zofenopril, trandolapril, fosinopril, captopril, and their salts,
solvates, derivatives, polymorphs, complexes, thereof.
Enalapril Powder Compositions
[0033] In one aspect, enalapril powder compositions herein comprise
enalapril and mannitol as a stabilizing agent. By itself, enalapril
is temperature stable under dry or stable conditions. However, when
mixed in a matrix such as in a tablet with additional excipients,
enalapril is unstable and can degrade to an unwanted cyclized
diketopiperazine (DKP).
##STR00002##
[0034] It is contemplated that lactose in enalapril solid tablet
formulations aid in preventing degradation to diketopiperazine
and/or other related substances. However, surprisingly, as shown in
Example 1, powder blends of lactose with enalapril showed the
greatest degradation whereas enalapril/mannitol powder was most
stable under accelerated conditions. This was also observed for the
prepared solutions from the powder blends (Example 2).
[0035] In some embodiments, enalapril is present in about 1% w/w to
about 30% w/w of the powder composition. In some embodiments,
enalapril is present in about 2% w/w to about 25% w/w, about 5% w/w
to about 20% w/w, about 7% w/w to about 18% w/w, about 10% w/w to
about 16% w/w, or about 12% w/w to about 15% w/w of the powder
composition. In other embodiments, enalapril is present in about 1%
w/w, about 2% w/w, about 3% w/w, about 4% w/w, about 5% w/w, about
6% w/w, about 7% w/w, about 8% w/w, about 9% w/w, about 10% w/w,
about 11% w/w, about 12% w/w, about 13% w/w, about 14% w/w, about
15% w/w, about 16% w/w, about 17% w/w, about 18% w/w, about 19%
w/w, about 20% w/w, about 21% w/w, about 22% w/w, about 23% w/w,
about 24% w/w, about 25% w/w, about 26% w/w, about 27% w/w, about
28% w/w, about 29% w/w or about 30% w/w of the powder composition.
In certain embodiments, enalapril is present in about 1% w/w of the
powder composition. In certain other embodiments, enalapril is
present in about 2% w/w of the powder composition. In certain other
embodiments, enalapril is present in about 10% w/w of the powder
composition. In certain other embodiments, enalapril is present in
about 14% w/w of the powder composition. In certain other
embodiments, enalapril is present in about 15% w/w of the powder
composition. In certain other embodiments, enalapril is present in
about 20% w/w of the powder composition.
[0036] In some embodiments, mannitol is present in about 60% w/w to
about 99% w/w of the powder composition. In some embodiments,
mannitol is present in about 65% w/w to about 95% w/w, about 70%
w/w to about 90% w/w or about 75% w/w to about 85% w/w of the
powder composition. In other embodiments, mannitol is present in
about 99% w/w, about 98% w/w, about 97% w/w, about 96% w/w, about
95% w/w, about 94% w/w, about 93% w/w, about 92% w/w, about 91%
w/w, about 90% w/w, about 89% w/w, about 88% w/w, about 87% w/w,
about 86% w/w, about 85% w/w, about 84% w/w, about 83% w/w, about
82% w/w, about 81% w/w, about 80% w/w, about 79% w/w, about 78%
w/w, about 77% w/w, about 76% w/w, about 75% w/w, about 74% w/w,
about 73% w/w, about 72% w/w, about 71% w/w, about 70% w/w, about
69% w/w, about 68% w/w, about 67% w/w, about 66% w/w, about 65%
w/w, about 64% w/w, about 63% w/w, about 62% w/w, about 61% w/w or
about 60% w/w of the powder composition. In certain embodiments,
mannitol is present in about 1% w/w of the powder composition. In
certain other embodiments, mannitol is present in about 99% w/w of
the powder composition. In certain other embodiments, mannitol is
present in about 90% w/w of the powder composition. In certain
other embodiments, mannitol is present in about 85% w/w of the
powder composition. In certain other embodiments, mannitol is
present in about 80% w/w of the powder composition. In certain
other embodiments, mannitol is present in about 70% w/w of the
powder composition. In certain other embodiments, mannitol is
present in about 60% w/w of the powder composition.
[0037] In further embodiments, the enalapril powder compositions
herein comprises additional excipients including, but not limited,
to buffering agents, glidants, preservatives, sweeteners, flavoring
agents, coloring agents and thickeners. Additional excipients such
as bulking agents, tonicity agents and chelating agents are within
the scope of the embodiments.
[0038] Buffering agents maintain the pH when enalapril powder
compositions are reconstituted into a liquid form. Non-limiting
examples of buffering agents include, but are not limited to,
sodium bicarbonate, potassium bicarbonate, magnesium hydroxide,
magnesium lactate, magnesium glucomate, aluminum hydroxide,
aluminum hydroxide/sodium bicarbonate co precipitate, a mixture of
an amino acid and a buffer, a mixture of aluminum glycinate and a
buffer, a mixture of an acid salt of an amino acid and a buffer,
and a mixture of an alkali salt of an amino acid and a buffer.
Additional buffering agents include sodium citrate, sodium
tartarate, sodium acetate, sodium carbonate, sodium polyphosphate,
potassium polyphosphate, sodium pyrophosphate, potassium
pyrophosphate, disodium hydrogenphosphate, dipotassium
hydrogenphosphate, trisodium phosphate, tripotassium phosphate,
sodium acetate, potassium metaphosphate, magnesium oxide, magnesium
hydroxide, magnesium carbonate, magnesium silicate, calcium
acetate, calcium glycerophosphate, calcium chloride, calcium
hydroxide, calcium lactate, calcium carbonate, calcium bicarbonate,
and other calcium salts. Some buffering agents also impart
effervescent qualities when a powder is reconstituted in a
solution. In some embodiments, the enalapril powder compositions
described herein comprise a buffering agent.
[0039] Glidants are substances that improve flowability of a
powder. Suitable glidants include, but are not limited to, calcium
phosphate tribasic, calcium silicate, cellulose (powdered),
colloidal silicon dioxide, magnesium silicate, magnesium
trisilicate, silicon dioxide, starch, talc and the like. In some
embodiments, the enalapril powder compositions described herein
comprise a glidant. In certain instances, enalapril powder
compositions described herein comprise colloidal silicon
dioxide.
[0040] Preservatives include anti-microbials, anti-oxidants, and
agents that enhance sterility. Exemplary preservatives include
ascorbic acid, ascorbyl palmitate, BHA, BHT, citric acid,
erythorbic acid, fumaric acid, malic acid, propyl gallate, sodium
ascorbate, sodium bisulfate, sodium metabisulfite, sodium sulfite,
parabens (methyl-, ethyl-, butyl-), benzoic acid, potassium
sorbate, vanillin, and the like. In some embodiments, the enalapril
powder compositions described herein comprise a preservative.
[0041] Sweeteners or sweetening agents include any compounds that
provide a sweet taste. This includes natural and synthetic sugars,
natural and artificial sweeteners, natural extracts and any
material that initiates a sweet sensation in a subject. In some
embodiments, the enalapril powder compositions described herein
comprise a sweetener. Solid, powder sweeteners, in some
embodiments, are blended with the enalapril powder compositions
described herein. In other embodiments, sweeteners in liquid form
referred to as syrups are used to solvate or dissolve the enalapril
powder compositions described herein.
[0042] Sugars illustratively include glucose, fructose, sucrose,
xylitol, tagatose, sucralose, maltitol, isomaltulose, Isomalt.TM.
(hydrogenated isomaltulose), lactitol, sorbitol, mannitol,
erythritol, trehalose, maltodextrin, polydextrose, and the like.
Other sweeteners illustratively include glycerin, inulin,
erythritol, maltol, acesulfame and salts thereof, e.g., acesulfame
potassium, alitame, aspartame, neotame, sodium cyclamate, saccharin
and salts thereof, e.g., saccharin sodium or saccharin calcium,
neohesperidin dihydrochalcone, stevioside, thaumatin, and the like.
Sweeteners can be used in the form of crude or refined products
such as hydrogenated starch hydrolysates, maltitol syrup, high
fructose corn syrup, etc., and as branded products, e.g., Sweet
Am.TM. liquid (Product Code 918.003--propylene glycol, ethyl
alcohol, and proprietary artificial flavor combination, Flavors of
North America) and Sweet Am.TM. powder (Product Code
918.005--maltodextrin, sorbitol, and fructose combination and
Product Code 918.010--water, propylene glycol, sorbitol, fructose,
and proprietary natural and artificial flavor combination, Flavors
of North America), ProSweet.TM. (1-10% proprietary plant/vegetable
extract and 90-99% dextrose combination, Viriginia Dare),
Maltisweet.TM. (maltitol solution, Ingredion) and Sorbo.TM.
(sorbitol and sorbitol/xylitol solution, SPI Polyols),
Invertose.TM. (high fructose corn syrup, Ingredion) and
Ora-Sweet.RTM. sugar-free flavored syrup (Paddock Laboratories,
Inc.). Sweeteners can be used singly or in combinations of two or
more. Suitable concentrations of different sweeteners can be
selected based on published information, manufacturers' data sheets
and by routine testing. In certain instances, an above-described
syrup is used to solvate or dissolve the enalapril powder
compositions described herein. In further instances, Ora-Sweet.RTM.
sugar-free flavored syrup is used to solvate or dissolve the
enalapril powder compositions described herein.
[0043] In some embodiments, the sweetener imparts a sweet sensation
equivalent to an about 50 to about 95% w/v sucrose in water. In
some embodiments, the sweetener imparts a sweet sensation
equivalent to an about 50% w/v, about 55% w/v, about 60% w/v, about
65% w/v, about 70% w/v, about 75% w/v, about 85% w/v (e.g., simple
syrup NF), about 90% w/v, or about 95% w/v sucrose in water. In
some embodiments, the sweetener imparts a sweet sensation
equivalent to an about 60% to about 80% w/v sorbitol in water. In
some embodiments, the sweetener imparts a sweet sensation
equivalent to an about 60% w/v, about 65% w/v, about 70% w/v, about
75% w/v or about 80% w/v sorbitol in water. In some embodiments,
the sweetener imparts a sweet sensation equivalent to an about 64%
w/v sorbitol in water.
[0044] In another embodiment, the enalapril powder compositions
comprise a flavoring agent or flavorant to enhance the taste or
aroma of the composition in liquid form. Suitable natural or
synthetic flavoring agents can be selected from standard reference
books, for example Fenaroli's Handbook of Flavor Ingredients, 3rd
edition (1995). Non-limiting examples of suitable natural flavors,
some of which can readily be simulated with synthetic agents or
combinations thereof, include almond, anise, apple, apricot,
bergamot, blackberry, blackcurrant, blueberry, cacao, caramel,
cherry, cinnamon, clove, coffee, coriander, cranberry, cumin, dill,
eucalyptus, fennel, fig, ginger, grape, grapefruit, guava, hop,
lemon, licorice, lime, malt, mandarin, molasses, nutmeg, orange,
peach, pear, peppermint, pineapple, raspberry, rose, spearmint,
strawberry, tangerine, tea, vanilla, wintergreen, etc. Also useful,
particularly where the composition is intended primarily for
pediatric use, is tutti-frutti or bubblegum flavor, a compounded
flavoring agent based on fruit flavors. Presently preferred
flavoring agents include anise, cinnamon, cacao, orange,
peppermint, cherry (in particular wild cherry), grape, bubblegum
and vanilla. In some embodiments, the enalapril powder compositions
described herein comprise a wild cherry flavoring agent. Flavoring
agents can be used singly or in combinations of two or more.
[0045] In further embodiments, the enalapril powder compositions
comprise a coloring agent for identity and/or aesthetic purposes of
the resultant liquid form. Suitable coloring agents illustratively
include FD&C Red No. 3, FD&C Red No. 20, FD&C Red No.
40, FD&C Yellow No. 6, FD&C Blue No. 2, D&C Green No.
5, D&C Orange No. 5, caramel, ferric oxide and mixtures
thereof.
[0046] Thickeners impart viscosity or weight to the resultant
liquid forms from the enalapril compositions described herein.
Exemplary thickeners include dextrin, cellulose derivatives
(ethylcellulose, hydroxyethyl cellulose, methylcellulose,
hypromellose, and the like) starches, pectin, polyethylene glycol,
polyethylene oxide, trehalose and certain gums (xanthan gum, locust
bean gum, etc.). In certain embodiments, the enalapril powder
compositions comprise a thickener.
[0047] Additional excipients are contemplated in the enalapril
powder composition embodiments. These additional excipients are
selected based on function and compatibility with the enalapril
powder compositions described herein and may be found, for example
in Remington: The Science and Practice of Pharmacy, Nineteenth Ed
(Easton, Pa.: Mack Publishing Company, 1995); Hoover, John E.,
Remington's Pharmaceutical Sciences, (Easton, Pa.: Mack Publishing
Co 1975); Liberman, H. A. and Lachman, L., Eds., Pharmaceutical
Dosage Forms (New York, N.Y.: Marcel Decker 1980); and
Pharmaceutical Dosage Forms and Drug Delivery Systems, Seventh Ed
(Lippincott Williams & Wilkins 1999), herein incorporated by
reference in their entirety.
[0048] In certain embodiments, an additional excipient is present
in about 1% w/w to about 30% w/w of the enalapril powder
composition. In certain embodiments, an additional excipient is
present in about 2% w/w to about 25% w/w, about 5% w/w to about 20%
w/w, about 7% w/w to about 15 w/w or about 10% w/w to about 12% w/w
of the enalapril powder composition. In other embodiments, an
additional excipient is present in about 1% w/w, about 2% w/w,
about 3% w/w, about 4% w/w, about 5% w/w, about 6% w/w, about 7%
w/w, about 8% w/w, about 9% w/w, about 10% w/w, about 11% w/w,
about 12% w/w, about 13% w/w, about 14% w/w, about 15% w/w, about
16% w/w, about 17% w/w, about 18% w/w, about 19% w/w, about 20%
w/w, about 21% w/w, about 22% w/w, about 23% w/w, about 24% w/w,
about 25% w/w, about 26% w/w, about 27% w/w, about 28% w/w, about
29% w/w or about 30% w/w of the enalapril powder composition.
Preparation of Enalapril Powder Compositions
[0049] Preparation of enalapril powder compositions described
herein includes any known pharmaceutical method. In one embodiment,
the enalapril powder compositions described herein are prepared by
a granulation method. In an exemplary granulation method, enalapril
is dissolved in water or a solution (e.g., sodium bicarbonate)
which is subsequently sprayed onto mannitol. The wetted material is
then dried via heat (e.g., 40.degree.-60.degree. C. oven) or
air-dried. The dried granulation is then passed through a 40-mesh
screen, for example.
[0050] In another embodiment, the enalapril powder compositions
described herein are prepared by a direct blend method. In one
example, enalapril is blended with mannitol along with any other
excipients in a dry mixer or blender. In certain instances, the
powders are passed through a mesh screen prior to and/or after
mixing. The dry blend is facilitated by conventional large-scale
mixing equipment such as rotating-shell mixers (e.g., drum-type,
cubical shaped, double-cone and twin-shell blender), fixed-shell
(ribbon) mixers, sigma-blade and planetary paddle mixers, vertical
impeller mixers and motionless mixers. The mixing is performed to
blend uniformity of the enalapril powder compositions described
herein. In embodiments with additional excipients, mixing methods
can include all components together or incorporate certain
components together first with other components subsequently
added.
[0051] In an additional embodiment, the enalapril powder
compositions described herein additionally comprise colloidal
silicon dioxide in scale-up preparation. Although colloidal silicon
dioxide has been reported to decrease stability of enalapril,
(Rezende et al., Stability and Compatibility Study on Enalapril
Maleate using Thermoanalytical Techniques, J. Thermal Anal. &
calorimetry, 2008 (93) 881-886), the addition of colloidal silicon
dioxide surprisingly aided in the uniformity of the blend and the
bottle content as well as in preparation of the liquid form (see
Example 4).
[0052] In some embodiments, colloidal silicon dioxide is present in
about 0.1% w/w to about 2% w/w of the powder composition. In some
embodiments, colloidal silicon dioxide is present in about 0.1% w/w
to about 2% w/w, about 0.2% w/w to about 1.7% w/w, about 0.3% w/w
to about 1.5%, about 0.4% w/w to about 1.2% or about 0.5% w/w to
about 1.0% w/w of the powder composition. In other embodiments,
colloidal silicon dioxide is present in about 0.1% w/w, about 0.2%
w/w, about 0.3% w/w, about 0.4% w/w, about 0.5% w/w, about 0.6%
w/w, about 0.7% w/w, about 0.8% w/w, about 0.9% w/w, about 1.0%
w/w, about 1.1% w/w, about 1.2% w/w, about 1.3% w/w, about 1.4%
w/w, about 1.5% w/w, about 1.6% w/w, about 1.7% w/w, about 1.8%
w/w, about 1.9% w/w or about 2.0% w/w of the powder composition. In
certain embodiments, colloidal silicon dioxide is present in about
0.1% w/w of the powder composition. In certain other embodiments,
colloidal silicon dioxide is present in about 0.5% w/w of the
powder composition. In certain other embodiments, colloidal silicon
dioxide is present in about 1.0% w/w of the powder composition. In
certain other embodiments, colloidal silicon dioxide is present in
about 1.2% w/w of the powder composition. In certain other
embodiments, colloidal silicon dioxide is present in about 1.5% w/w
of the powder composition. In certain other embodiments, colloidal
silicon dioxide is present in about 1.7% w/w of the powder
composition. In certain other embodiments, colloidal silicon
dioxide is present in about 2.0% w/w of the powder composition.
Stability of Enalapril Powder Compositions
[0053] The enalapril powder compositions described herein are
stable in various storage conditions including refrigerated,
ambient and accelerated conditions. Stable as used herein refer to
enalapril powder compositions having about 95% enalapril and about
5% or less total impurities or substances at the end of a given
storage period. Stability is assessed by HPLC or any other known
testing method. In some embodiments, the stable enalapril powder
compositions have about 5%, about 4%, about 3%, about 2.5%, about
2%, about 1.5%, about 1%, or about 0.5% total impurities or
substances. In other embodiments, the stable enalapril powder
compositions have about 5% total impurities or substances. In yet
other embodiments, the stable enalapril powder compositions have
about 4% total impurities or substances. In yet other embodiments,
the stable enalapril powder compositions have about 3% total
impurities or substances. In yet other embodiments, the stable
enalapril powder compositions have about 2% total impurities or
substances. In yet other embodiments, the stable enalapril powder
compositions have about 1% total impurities or substances. In
further embodiments, the stable enalapril powder compositions have
about 95%, about 96%, about 97%, about 98% or about 99% enalapril
at the end of a given storage period.
[0054] At refrigerated and ambient conditions, the enalapril powder
compositions described herein are stable for at least 1 month, at
least 2 months, at least 3 months, at least 6 months, at least 9
months, at least 12 months, at least 15 months, at least 18 months,
at least 24 months, at least 30 months and at least 36 months. At
accelerated conditions, the enalapril powder compositions described
herein are stable for at least 1 month, at least 2 months, at least
3 months, at least 4 months, at least 5 months, at least 6 months,
at least 7 months, at least 8 months, at least 9 months, at least
10 months, at least 11 months or at least 12 months. Accelerated
conditions include temperature and/or relative humidity (RH) that
are above ambient levels (e.g. 25.+-.5.degree. C.; 55.+-.10% RH).
In some instances, an accelerated condition is at about 30.degree.
C., about 35.degree. C., about 40.degree. C., about 45.degree. C.,
about 50.degree. C., about 55.degree. C. or about 60.degree. C. In
other instances, an accelerated condition is above 65% RH, about
70% RH, about 75% RH or about 80% RH. In further instances, an
accelerated condition is about 40.degree. C. or 60.degree. C. at
ambient humidity. In yet further instances, an accelerated
condition is about 40.degree. C. at 75.+-.5% RH humidity. Ambient
conditions include temperature and/or relative humidity (RH) that
are at ambient levels (e.g. 25.+-.5.degree. C.; 55.+-.10% RH). In
some instances, an ambient condition is at about 20.degree. C.,
about 21.degree. C., about 22.degree. C., about 23.degree. C.,
about 24.degree. C., about 25.degree. C., about 26.degree. C.,
about 27.degree. C., about 28.degree. C., about 29.degree. C., or
about 30.degree. C. In other instances, an ambient condition is
about 45% RH, about 50% RH, about 55% RH, about 60% RH or about 65%
RH. Refrigerated conditions include temperature and/or relative
humidity (RH) in typical refrigeration units (e.g., 5.+-.3.degree.
C.). In some instances, a refrigerated condition is at about
2.degree. C., about 3.degree. C., about 4.degree. C., about
5.degree. C., about 6.degree. C., about 7.degree. C. or about
8.degree. C. In other instances, a a refrigerated condition is at
about 4.degree. C.
Enalapril Oral Liquid Compositions
[0055] In another aspect, enalapril powder compositions described
herein are useful for the preparation or reconstitution of an
enalapril oral liquid. Oral liquids include, but are not limited
to, solutions (both aqueous and nonaqueous), suspensions,
emulsions, syrups, slurries, juices, elixirs, dispersions, and the
like. It is envisioned that solution/suspensions are also included
where certain components of the enalapril powder compositions
described herein are in a solution while other components are in a
suspension. By way of illustrative example only, when an enalapril
powder composition comprising enalapril, mannitol and an excipient
such as colloidal silicon dioxide or a powdered cellulose is
dissolved in water or other aqueous solvent, the enalapril and
mannitol are in solution whereas the colloidal silicon dioxide or
powdered cellulose would form a suspension in the aqueous
environment. In some embodiments, the enalapril oral liquid
compositions are solutions. In other embodiments, the enalapril
oral liquid compositions are suspensions. In yet other embodiments,
the enalapril oral liquid compositions are
solution/suspensions.
[0056] Liquid vehicles suitable for the enalapril powder
compositions described herein are selected for a particular oral
liquid composition (solution, suspension, etc.) as well as other
qualities such as clarity, toxicity, viscosity, compatibility with
excipients, chemical inertness, palatability, odor, color and
economy. Exemplary liquid vehicles include water, ethyl alcohol,
glycerin, propylene glycol, syrup (sugar or other sweetener based,
e.g., Ora-Sweet.RTM. SF sugar-free flavored syrup), juices (apple,
grape, orange, cranberry, cherry, tomato and the like), other
beverages (tea, coffee, soft drinks, milk and the like), oils
(olive, soybean, corn, mineral, castor and the like), and
combinations or mixtures thereof. Certain liquid vehicles, e.g.,
oil and water, can be combined together to form emulsions. In some
embodiments, water is used for as a vehicle for an enalapril oral
liquid. In other embodiments, a syrup is used for as a vehicle for
an enalapril oral liquid. In yet other embodiments, a juice is used
for as a vehicle for an enalapril oral liquid.
[0057] The enalapril liquids prepared from the powder compositions
described herein, in some embodiments, are homogenous. Homogenous
liquids as used herein refer to those liquids that are uniform in
appearance, identity, consistency and drug concentration per
volume. Non-homogenous liquids include such liquids that have
varied coloring, viscosity and/or aggregation of solid
particulates, as well as non-uniform drug concentration in a given
unit volume. Homogeneity in liquids are assessed by qualitative
identification or appearance tests and/or quantitative HPLC testing
or the like. Such exemplary tests include visual inspection of the
resultant liquid for air bubbles and/or undissolved solids which
may cause variable dosing. Analytical HPLC testing can also
determine drug concentration uniformity by examining aliquots of
certain volume sections (e.g., 5 or 10 mL from the top, middle and
bottom of a 150 mL bottle). The mixing methods and excipients
described herein are selected to impart a homogenous quality to a
resultant enalapril liquid.
[0058] Mixing methods encompass any type of mixing that results in
a homogenous enalapril liquid composition. In some embodiments, a
quantity of an enalapril powder composition is added to a liquid
vehicle and then mixed by a stirring, shaking, swirling, agitation
element or a combination thereof. In certain instances, a fraction
of an enalapril powder composition (i.e., one-half, one-third,
one-fourth, etc.) is added to a liquid vehicle, mixed by stirring,
shaking, swirling, agitation or a combination thereof, and the
subsequent powder fraction(s) is added and mixed. In other
embodiments, a liquid vehicle is added to an enalapril powder
composition in a container, for example, a bottle, vial, bag,
beaker, syringe, or the like. The container is then mixed by
stirring, shaking, swirling, agitation, inversion or a combination
thereof. In certain instances, a fractional volume of the liquid
vehicle (i.e., one-half, one-third, one-fourth volume, etc.) is
added to an enalapril powder composition in a container, mixed by
stirring, shaking, swirling, agitation, inversion or a combination
thereof; and the subsequent liquid fraction(s) is added and mixed.
In certain instances, a one-half fractional volume of the liquid
vehicle is added to an enalapril powder composition in a container
and mixing by shaking; the other one-half fractional volume of the
liquid vehicle is then subsequently added and mixed. In any of the
above embodiments, mixing (i.e., stirring, shaking, swirling,
agitation, inversion or a combination thereof) occurs for a certain
time intervals such as about 10 seconds, about 20 seconds, about 30
seconds, about 45 seconds, about 60 seconds, about 90 seconds,
about 120 seconds, about 2.5 minutes, about 3 minutes, about 3.5
minutes, about 4 minutes, or about 5 minutes. In embodiments, where
there are two or more mixing steps, the time intervals for each
mixing can be the same (e.g., 2.times.10 seconds) or different
(e.g., 10 seconds for first mixing and 20 seconds for second
mixing). In any of the above embodiments, an enalapril liquid
composition is allowed to stand for a period of time such as about
10 minutes, about 20 minutes, about 30 minutes, about 45 minutes,
about 1 hour, about 1.5 hours or about 2 hours, to allow any air
bubbles resultant from any of the mixing methods to dissipate.
Stability of Enalapril Oral Liquid Compositions
[0059] The enalapril oral liquid compositions described herein are
stable in various storage conditions including refrigerated and
ambient conditions. Stable as used herein refer to enalapril oral
liquid compositions having at least about 90% enalapril and 5% or
less total impurities or substances at the end of a given storage
period. Stability is assessed by HPLC or any other known testing
method. In some embodiments, the stable enalapril oral liquid
compositions have about 5% , about 4%, about 3%, about 2.5%, about
2%, about 1.5%, about 1%, or about 0.5% total impurities or
substances. In other embodiments, the stable enalapril oral liquid
compositions have about 5% total impurities or substances. In yet
other embodiments, the stable enalapril oral liquid compositions
have about 4% total impurities or substances. In yet other
embodiments, the stable enalapril oral liquid compositions have
about 3% total impurities or substances. In yet other embodiments,
the stable enalapril oral liquid compositions have about 2% total
impurities or substances. In yet other embodiments, the stable
enalapril oral liquid compositions have about 1% total impurities
or substances. In further embodiments, the stable enalapril oral
liquid compositions have at least about 90%, at least about 91%, at
least about 92%, at least about 93%, or at least about 94%
enalapril at the end of a given storage period.
[0060] At refrigerated and ambient conditions, in some embodiments,
the enalapril oral liquid compositions described herein are stable
for at least 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks,
12 weeks, 16 weeks, 20 weeks, at least 24 weeks, at least 30 weeks,
or at least 36 weeks. In other embodiments, the enalapril oral
liquid compositions described herein are stable at refrigerated and
ambient conditions for at least 12 weeks. Ambient conditions
include temperature and/or relative humidity (RH) that are at
ambient levels (e.g. 25.+-.5.degree. C.; 55.+-.10% RH). In some
instances, an ambient condition is at about 20.degree. C., about
21.degree. C., about 22.degree. C., about 23.degree. C., about
24.degree. C., about 25.degree. C., about 26.degree. C., about
27.degree. C., about 28.degree. C., about 29.degree. C., or about
30.degree. C. In other instances, an ambient condition is about 45%
RH, about 50% RH, about 55% RH, about 60% RH or about 65% RH.
Refrigerated conditions include temperature and/or relative
humidity (RH) in typical refrigeration units (e.g., 5.+-.3.degree.
C.). In some instances, a refrigerated condition is at about
2.degree. C., about 3.degree. C., about 4.degree. C., about
5.degree. C., about 6.degree. C., about 7.degree. C. or about
8.degree. C. In other instances, a a refrigerated condition is at
about 4.degree. C.
[0061] In further embodiments, the stable enalapril oral liquid
compositions described herein that are stored at ambient or
refrigerated conditions for a give storage period after
reconstitution provide similar, consistent or equivalent
pharmacokinetic parameters as an enalapril oral liquid composition
that is formulated prior to administration to a subject (i.e.,
freshly made). In other words, the enalapril oral liquid
compositions described herein have stability after a storage period
to provide similar, consistent or equivalent pharmacokinetic
parameters as a freshly made enalapril oral liquid composition. For
example, a 12 week stable enalapril oral liquid composition
provides similar, consistent or equivalent pharmacokinetic
parameters as an enalapril oral liquid composition made five
minutes prior administration. Pharmacokinetic parameters include
C.sub.max, T.sub.max, AUC.sub.last, AUC.sub.inf, T.sub.1/2,
C.sub.last for enalapril and/or enalaprilat and exemplary values
are obtained and described in Example 7. In some instances, the
stable enalapril oral liquid compositions described herein provide
within 80% to 125%, 80% to 120%, 85% to 125%, 90% to 110%
pharmacokinetic parameters of a freshly made enalapril oral liquid
composition when the stable composition is stored at least 1 week,
2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 16 weeks,
20 weeks, at least 24 weeks, at least 30 weeks, or at least 36
weeks after reconstitution. In other instances, the stable
enalapril oral liquid compositions described herein provide within
80% to 125%, 80% to 120%, 85% to 125%, 90% to 110% pharmacokinetic
parameters of a freshly made enalapril oral liquid composition when
the stable composition is stored for 12 weeks after
reconstitution.
Kits and Articles of Manufacture
[0062] For the enalapril powder and liquid compositions described
herein, kits and articles of manufacture are also described. Such
kits can comprise a carrier, package, or container that is
compartmentalized to receive one or more containers such as vials,
tubes, and the like, each of the container(s) comprising one of the
separate elements to be used in a method described herein including
an enalapril powder or liquid composition. Suitable containers
include, for example, bottles, vials, syringes, and test tubes. The
containers can be formed from a variety of materials such as glass
or plastic.
[0063] A kit will typically may comprise one or more additional
containers, each with one or more of various materials (such as
reagents, optionally in concentrated form, and/or devices)
desirable from a commercial and user standpoint for an enalapril
powder or liquid composition described herein. Non-limiting
examples of such materials include, but not limited to, buffers,
diluents, filters, needles, syringes; carrier, package, container,
vial and/or tube labels listing contents and/or instructions for
use, and package inserts with instructions for use associated with
an enalapril powder or liquid composition. A set of instructions
will also typically be included.
[0064] A label can be on or associated with the container. A label
can be on a container when letters, numbers or other characters
forming the label are attached, molded or etched into the container
itself; a label can be associated with a container when it is
present within a receptacle or carrier that also holds the
container, e.g., as a package insert. A label can be used to
indicate that the contents are to be used for a specific
therapeutic application. The label can also indicate directions for
use of the contents, such as in the methods described herein.
Methods
[0065] Provided herein, in one aspect, are methods of treatment
comprising administration of the enalapril oral liquid compositions
described herein to a subject. In some embodiments, the enalapril
oral liquid compositions described herein treat hypertension in a
subject. Hypertension as used herein includes both primary
(essential) hypertension and secondary hypertension. In certain
instances, hypertension is classified in cases when blood pressure
values are greater than or equal to 140/90 (systolic/diastolic) mm
Hg in a subject. In certain instances, the enalapril oral liquid
compositions described herein treat a subject having a blood
pressure values are greater than or equal to 140/90 mm Hg. In
certain instances, the enalapril oral liquid compositions described
herein treat primary (essential) hypertension in a subject. In
other instances, the enalapril oral liquid compositions described
herein treat secondary hypertension in a subject.
[0066] In other embodiments, the enalapril oral liquid compositions
described herein treat prehypertension in a subject.
Prehypertension as used herein refers to cases where a subject's
blood pressure is elevated above normal but not to the level
considered to be hypertension. In some instances, prehypertension
is classified in cases when blood pressure values are 120-139/80-89
mm Hg. In certain instances, the enalapril oral liquid compositions
described herein treat a subject having a blood pressure value of
120-139/80-89 mm Hg.
[0067] In yet other embodiments, the enalapril oral liquid
compositions described herein are prophylactically administered to
subjects suspected of having, predisposed to, or at risk of
developing hypertension. In some embodiments, the administration of
enalapril oral liquid compositions described herein allow for early
intervention prior to onset of hypertension. In certain
embodiments, upon detection of a biomarker, environmental, genetic
factor, or other marker, the enalapril oral liquid compositions
described herein are prophylactically administered to subjects.
[0068] In further embodiments, the enalapril oral liquid
compositions described herein treat heart failure (e.g.,
symptomatic congestive), asymptomatic left ventricular dysfunction,
myocardial infarction, diabetic nephropathy and chronic renal
failure. In certain instances, the enalapril oral liquid
compositions described herein treat symptomatic congestive heart
failure. In other instances, the enalapril oral liquid compositions
described herein treat asymptomatic left ventricular dysfunction.
In further instances, the enalapril oral liquid compositions
described herein treat myocardial infarction. In yet further
instances, the enalapril oral liquid compositions described herein
treat diabetic nephropathy. In yet further instances, the enalapril
oral liquid compositions described herein treat chronic renal
failure.
Dosing
[0069] In one aspect, the enalapril oral liquid compositions are
used for the treatment of diseases and conditions described herein.
In addition, a method for treating any of the diseases or
conditions described herein in a subject in need of such treatment,
involves administration of enalapril oral liquid compositions in
therapeutically effective amounts to said subject.
[0070] Dosages of enalapril oral liquid compositions described can
be determined by any suitable method. Maximum tolerated doses (MTD)
and maximum response doses (MRD) for enalapril and/or enalaprilat
can be determined via established animal and human experimental
protocols as well as in the examples described herein. For example,
toxicity and therapeutic efficacy of enalapril and/or enalaprilat
can be determined by standard pharmaceutical procedures in cell
cultures or experimental animals, including, but not limited to,
for determining the LD.sub.50 (the dose lethal to 50% of the
population) and the ED.sub.50 (the dose therapeutically effective
in 50% of the population). The dose ratio between the toxic and
therapeutic effects is the therapeutic index and it can be
expressed as the ratio between LD.sub.50 and ED.sub.50. Enalapril
dosages exhibiting high therapeutic indices are of interest. The
data obtained from cell culture assays and animal studies can be
used in formulating a range of dosage for use in human. The dosage
of such compounds lies preferably within a range of circulating
concentrations that include the ED.sub.50 with minimal toxicity.
The dosage may vary within this range depending upon the dosage
form employed and the route of administration utilized. Additional
relative dosages, represented as a percent of maximal response or
of maximum tolerated dose, are readily obtained via the
protocols.
[0071] In some embodiments, the amount of a given enalapril oral
liquid composition that corresponds to such an amount varies
depending upon factors such as the particular enalapril salt or
form, disease condition and its severity, the identity (e.g., age,
weight, sex) of the subject or host in need of treatment, but can
nevertheless be determined according to the particular
circumstances surrounding the case, including, e.g., the specific
agent being administered, the liquid composition type, the
condition being treated, and the subject or host being treated.
[0072] In some embodiments, the enalapril oral liquid compositions
described herein are provided in a dose per day from about 0.01 mg
to 100 mg, from about 0.1 mg to about 80 mg, from about 1 to about
60, from about 2 mg to about 40 mg of enalapril. In certain
embodiments, the enalapril oral liquid compositions described
herein are provided in a daily dose of about 0.01 mg, about 0.05
mg, about 0.1 mg, about 0.2 mg, about 0.4 mg, about 0.6 mg, about
0.8 mg, about 1 mg, about 1.5 mg, about 2 mg, about 2.5 mg, about 3
mg, about 4 mg, about 5 mg, about 6 mg, about 7 mg, about 8 mg,
about 9 mg, about 10 mg, about 11 mg, about 12 mg, about 15 mg,
about 20 mg, about 25 mg, about 30 mg, about 35 mg, about 40 mg,
about 45 mg, about 50 mg, about 55 mg, about 60 mg, about 65 mg,
about 70 mg, about 76, mg, about 80 mg, about 85 mg, about 90 mg or
about 100 mg, or any range derivable therein. In certain instances,
the enalapril oral liquid compositions described herein are
provided in a dose per day of about 1 mg. In certain instances, the
enalapril oral liquid compositions described herein are provided in
a dose per day of about 2 mg. In certain instances, the enalapril
oral liquid compositions described herein are provided in a dose
per day of about 3 mg. In certain instances, the enalapril oral
liquid compositions described herein are provided in a dose per day
of about 4 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 5 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 6 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 7 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 8 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 9 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 10 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 11 mg. In certain instances, the enalapril oral liquid
compositions described herein are provided in a dose per day of
about 12 mg. The dose per day described herein can be given once
per day or multiple times per day in the form of sub-doses given
b.i.d., t.i.d., q.i.d., or the like where the number of sub-doses
equal the dose per day.
[0073] In further embodiments, the daily dosages appropriate for
the enalapril oral liquid compositions described herein are from
about 0.01 to about 1.0 mg/kg per body weight. In one embodiment,
the daily dosages appropriate for the enalapril oral liquid
compositions are from about 0.02 to about 0.8 mg/kg enalapril per
body weight. In another embodiment, the daily dosage appropriate
for the enalapril oral liquid compositions are from about 0.05 to
about 0.6 mg/kg per body weight. In another embodiment, the daily
dosage appropriate for the enalapril oral liquid compositions is
about 0.05 mg/kg, about 0.06 mg/kg, about 0.07 mg/kg, about 0.08
mg/kg, about 0.10 mg/kg, about 0.15 mg/kg, about 0.20 mg/kg, about
0.25 mg/kg, about 0.30 mg/kg, about 0.40 mg/kg, about 0.50 mg/kg,
or about 0.60 mg/kg. In a further embodiment, the daily dosage
appropriate for the enalapril oral liquid compositions is about
0.08 mg/kg.
[0074] In other embodiments the enalapril oral liquid compositions
are provided at the maximum tolerated dose (MTD) for enalapril
and/or enalaprilat. In other embodiments, the amount of the
enalapril oral liquid compositions administered is from about 10%
to about 90% of the maximum tolerated dose (MTD), from about 25% to
about 75% of the MTD, or about 50% of the MTD. In particular
embodiments, the amount of the enalapril oral liquid compositions
administered is from about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%,
45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, or
higher, or any range derivable therein, of the MTD for enalapril
and/or enalaprilat.
[0075] In further embodiments, the enalapril oral liquid
compositions are provided in a dosage that is similar, comparable
or equivalent to a dosage of a known enalapril tablet formulation.
In other embodiments, the enalapril oral liquid compositions are
provided in a dosage that provides a similar, comparable or
equivalent pharmacokinetic parameters (e.g., AUC, C.sub.max,
T.sub.max, C.sub.min, T.sub.1/2) as a dosage of a known enalapril
tablet formulation. Similar, comparable or equivalent
pharmacokinetic parameters, in some instances, refer to within 80%
to 125%, 80% to 120%, 85% to 125%, 90% to 110%, or increments
therein, of the given values. It should be recognized that the
ranges can, but need not be symmetrical, e.g., 85% to 105%.
Administration
[0076] Administration of a enalapril oral liquid composition is at
a dosage described herein or at other dose levels and compositions
determined and contemplated by a medical practitioner. In certain
embodiments, the enalapril oral liquid compositions described
herein are administered for prophylactic and/or therapeutic
treatments. In certain therapeutic applications, the enalapril oral
liquid compositions are administered to a patient already suffering
from a disease, e.g., hypertension, in an amount sufficient to cure
the disease or at least partially arrest or ameliorate the
symptoms, e.g., lower blood pressure. Amounts effective for this
use depend on the age of the patient, severity of the disease,
previous therapy, the patient's health status, weight, and response
to the enalapril compositions, and the judgment of the treating
physician. Therapeutically effective amounts are optionally
determined by methods including, but not limited to, a dose
escalation clinical trial.
[0077] In prophylactic applications, the enalapril oral liquid
compositions described herein are administered to a patient
susceptible to or otherwise at risk of a particular disease, e.g.,
hypertension. Such an amount is defined to be a "prophylactically
effective amount or dose." In this use, the precise amounts also
depend on the patient's age, state of health, weight, and the like.
When used in a patient, effective amounts for this use will depend
on the risk or susceptibility of developing the particular disease,
previous therapy, the patient's health status and response to the
enalapril compositions, and the judgment of the treating
physician.
[0078] In certain embodiments wherein the patient's condition does
not improve, upon the doctor's discretion the administration of an
enalapril oral liquid composition described herein are administered
chronically, that is, for an extended period of time, including
throughout the duration of the patient's life in order to
ameliorate or otherwise control or limit the symptoms of the
patient's disease. In other embodiments, administration of an
enalapril oral liquid composition continues until complete or
partial response of a disease.
[0079] In certain embodiments wherein a patient's status does
improve, the dose of an enalapril oral liquid composition being
administered may be temporarily reduced or temporarily suspended
for a certain length of time (i.e., a "drug holiday"). In specific
embodiments, the length of the drug holiday is between 2 days and 1
year, including by way of example only, 2 days, 3 days, 4 days, 5
days, 6 days, 7 days, 10 days, 12 days, 15 days, 20 days, 28 days,
35 days, 50 days, 70 days, 100 days, 120 days, 150 days, 180 days,
200 days, 250 days, 280 days, 300 days, 320 days, 350 days, and 365
days. The dose reduction during a drug holiday is, by way of
example only, by 10%-100%, including by way of example only 10%,
15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%,
80%, 85%, 90%, 95%, and 100%.
[0080] In some embodiments, enalapril oral liquid compositions
described herein are administered chronically. For example, in some
embodiments, an enalapril oral liquid composition is administered
as a continuous dose, i.e., administered daily to a subject. In
some other embodiments, enalapril oral liquid compositions
described herein are administered intermittently (e.g. drug holiday
that includes a period of time in which the composition is not
administered or is administered in a reduced amount).
[0081] In some embodiments an enalapril oral liquid composition is
administered to a subject who is in a fasted state. A fasted state
refers to a subject who has gone without food or fasted for a
certain period of time. General fasting periods include at least 4
hours, at least 6 hours, at least 8 hours, at least 10 hours, at
least 12 hours, at least 14 hours and at least 16 hours without
food. In some embodiments, an enalapril oral liquid composition is
administered orally to a subject who is in a fasted state for at
least 8 hours. In other embodiments, an enalapril oral liquid
composition is administered to a subject who is in a fasted state
for at least 10 hours. In yet other embodiments, an enalapril oral
liquid composition is administered to a subject who is in a fasted
state for at least 12 hours. In other embodiments, an enalapril
oral liquid composition is administered to a subject who has fasted
overnight.
[0082] In other embodiments an enalapril oral liquid composition is
administered to a subject who is in a fed state. A fed state refers
to a subject who has taken food or has had a meal. In certain
embodiments, an enalapril oral liquid composition is administered
to a subject in a fed state 5 minutes post-meal, 10 minutes
post-meal, 15 minutes post-meal, 20 minutes post-meal, 30 minutes
post-meal, 40 minutes post-meal, 50 minutes post-meal, 1 hour
post-meal, or 2 hours post-meal. In certain instances, an enalapril
oral liquid composition is administered to a subject in a fed state
30 minutes post-meal. In other instances, an enalapril oral liquid
composition is administered to a subject in a fed state 1 hour
post-meal. In yet further embodiments, an enalapril oral liquid
composition is administered to a subject with food.
[0083] In further embodiments described herein, an enalapril oral
liquid composition is administered at a certain time of day for the
entire administration period. For example, an enalapril oral liquid
composition can be administered at a certain time in the morning,
in the evening, or prior to bed. In certain instances, an enalapril
oral liquid composition is administered in the morning. In other
embodiments, an enalapril oral liquid composition can be
administered at different times of the day for the entire
administration period. For example, an enalapril oral liquid
composition can be administered on 8:00 am in the morning for the
first day, 12 pm noon for the next day or administration, 4 pm in
the afternoon for the third day or administration, and so on.
Further Combinations
[0084] The treatment of certain diseases or conditions (e.g.,
hypertension, heart failure, myocardial infarction and the like) in
a subject with an enalapril oral liquid composition described
herein encompass additional therapies and treatment regimens with
other agents in some embodiments. Such additional therapies and
treatment regimens can include another therapy, e.g., additional
anti-hypertensives, for treatment of the particular disease or
condition in some embodiments. Alternatively, in other embodiments,
additional therapies and treatment regimens include other agents
used to treat adjunct conditions associated with the disease or
condition or a side effect from the enalapril oral liquid
composition in the therapy.
[0085] Additional agents for use in combination with an enalapril
oral liquid composition described herein include, but are not
limited to, diuretics (loop, thiazide, potassium-sparing, and the
like), beta blockers (metoprolol, propanolol, pronethalol, and the
like), alpha blockers (phentolamine, phenoxybenzamine, tamsulosin,
prazosin, and the like), mixed alpha and beta blockers (bucindolol,
carvedilol, labetalol), calcium channel blockers (dihydropyridines
such as nifedipine, amlodipine, etc., dilitazem, verapamil and the
like), angiotensin II receptor antagonists (saralasin, lsartan,
eprosartin, irbesartan, valsartan, and the like), other ACE
inhibitors (captopril, quinapril, ramipril, lisinopril, zofenopril,
and the like), aldosterone antagonists (eplerenone, spironolactone
and the like), vasodilators (hydralazine and the like) and alpha-2
agonists (clonidine, moxonidine, guanabenz and the like).
Certain Definitions
[0086] Unless defined otherwise, all technical and scientific terms
used herein have the same meanings as commonly understood by one of
ordinary skill in the art. Although any methods and materials
similar or equivalent to those described herein can be used in the
practice or testing of embodiments described herein, certain
preferred methods, devices, and materials are now described.
[0087] As used herein and in the appended claims, the singular
forms "a", "an", and "the" include plural reference unless the
context clearly dictates otherwise. Thus, for example, reference to
"an excipient" is a reference to one or more excipients and
equivalents thereof known to those skilled in the art, and so
forth.
[0088] The term "about" is used to indicate that a value includes
the standard level of error for the device or method being employed
to determine the value. The use of the term "or" in the claims is
used to mean "and/or" unless explicitly indicated to refer to
alternatives only or the alternatives are mutually exclusive,
although the disclosure supports a definition that refers to only
alternatives and to "and/or." The terms "comprise," "have" and
"include" are open-ended linking verbs. Any forms or tenses of one
or more of these verbs, such as "comprises," "comprising," "has,"
"having," "includes" and "including," are also open-ended. For
example, any method that "comprises," "has" or "includes" one or
more steps is not limited to possessing only those one or more
steps and also covers other unlisted steps.
[0089] "Optional" or "optionally" may be taken to mean that the
subsequently described structure, event or circumstance may or may
not occur, and that the description includes instances where the
events occurs and instances where it does not.
[0090] As used herein, the term "therapeutic" means an agent
utilized to treat, combat, ameliorate, prevent or improve an
unwanted condition or disease of a patient. In some embodiments, a
therapeutic agent such as enalapril is directed to the treatment
and/or the amelioration of, reversal of, or stabilization of the
symptoms of hypertension described herein.
[0091] "Administering" when used in conjunction with a therapeutic
means to administer a therapeutic systemically or locally, as
directly into or onto a target tissue, or to administer a
therapeutic to a patient whereby the therapeutic positively impacts
the tissue to which it is targeted. Thus, as used herein, the term
"administering", when used in conjunction with an enalapril
composition, can include, but is not limited to, providing an
enalapril composition into or onto the target tissue; providing an
enalapril composition systemically to a patient by, e.g., oral
administration whereby the therapeutic reaches the target tissue or
cells. "Administering" a composition may be accomplished by
injection, topical administration, and oral administration or by
other methods alone or in combination with other known
techniques.
[0092] The term "animal" as used herein includes, but is not
limited to, humans and non-human vertebrates such as wild, domestic
and farm animals. As used herein, the terms "patient," "subject"
and "individual" are intended to include living organisms in which
certain conditions as described herein can occur. Examples include
humans, monkeys, cows, sheep, goats, dogs, cats, mice, rats, and
transgenic species thereof. In a preferred embodiment, the patient
is a primate. In certain embodiments, the primate or subject is a
human. In certain instances, the human is an adult. In certain
instances, the human is child. In further instances, the human is
under the age of 12 years. In certain instances, the human is
elderly. In other instances, the human is 60 years of age or older.
Other examples of subjects include experimental animals such as
mice, rats, dogs, cats, goats, sheep, pigs, and cows. The
experimental animal can be an animal model for a disorder, e.g., a
transgenic mouse with hypertensive pathology. A patient can be a
human suffering from hypertension, or its variants or etiological
forms.
[0093] By "pharmaceutically acceptable", it is meant the carrier,
diluent or excipient must be compatible with the other ingredients
of the formulation and not deleterious to the recipient
thereof.
[0094] The term "pharmaceutical composition" shall mean a
composition comprising at least one active ingredient, whereby the
composition is amenable to investigation for a specified,
efficacious outcome in a mammal (for example, without limitation, a
human). Those of ordinary skill in the art will understand and
appreciate the techniques appropriate for determining whether an
active ingredient has a desired efficacious outcome based upon the
needs of the artisan.
[0095] A "therapeutically effective amount" or "effective amount"
as used herein refers to the amount of active compound or
pharmaceutical agent that elicits a biological or medicinal
response in a tissue, system, animal, individual or human that is
being sought by a researcher, veterinarian, medical doctor or other
clinician, which includes one or more of the following: (1)
preventing the disease; for example, preventing a disease,
condition or disorder in an individual that may be predisposed to
the disease, condition or disorder but does not yet experience or
display the pathology or symptomatology of the disease, (2)
inhibiting the disease; for example, inhibiting a disease,
condition or disorder in an individual that is experiencing or
displaying the pathology or symptomatology of the disease,
condition or disorder (i.e., arresting further development of the
pathology and/or symptomatology), and (3) ameliorating the disease;
for example, ameliorating a disease, condition or disorder in an
individual that is experiencing or displaying the pathology or
symptomatology of the disease, condition or disorder (i.e.,
reversing the pathology and/or symptomatology). As such, a
non-limiting example of a "therapeutically effective amount" or
"effective amount" of a composition of the present disclosure may
be used to inhibit, block, or reverse the activation, migration, or
proliferation of cells or to effectively treat hypertension or
ameliorate the symptoms of hypertension.
[0096] The terms "treat," "treated," "treatment," or "treating" as
used herein refers to both therapeutic treatment in some
embodiments and prophylactic or preventative measures in other
embodiments, wherein the object is to prevent or slow (lessen) an
undesired physiological condition, disorder or disease, or to
obtain beneficial or desired clinical results. For the purposes
described herein, beneficial or desired clinical results include,
but are not limited to, alleviation of symptoms; diminishment of
the extent of the condition, disorder or disease; stabilization
(i.e., not worsening) of the state of the condition, disorder or
disease; delay in onset or slowing of the progression of the
condition, disorder or disease; amelioration of the condition,
disorder or disease state; and remission (whether partial or
total), whether detectable or undetectable, or enhancement or
improvement of the condition, disorder or disease. Treatment
includes eliciting a clinically significant response without
excessive levels of side effects. Treatment also includes
prolonging survival as compared to expected survival if not
receiving treatment. A prophylactic benefit of treatment includes
prevention of a condition, retarding the progress of a condition,
stabilization of a condition, or decreasing the likelihood of
occurrence of a condition. As used herein, "treat," "treated,"
"treatment," or "treating" includes prophylaxis in some
embodiments.
EXAMPLES
Example 1
Stability of Enalapril Formulated Powder
[0097] Enalapril Powder Formulation: The stability of enalapril
with lactose, sucrose or mannitol was assessed in various storage
conditions. 2% w/w enalapril powder was formulated via granulation
according to the following table.
TABLE-US-00001 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Batch (g) Enalapril Maleate 150 2.0 6.000 Stability Agent
7350 98.0 294.0 (Lactose, Sucrose or Mannitol) Sodium Bicarbonate
-- -- 3.074 Water -- -- 25.00 Total Solids 7500 100.0 300.0
[0098] Enalapril Maleate was slowly dissolved in a 12% sodium
bicarbonate solution. The stability agent (lactose, sucrose or
mannitol) was mixed in a mixer at slow speed and the enalapril
solution was slowly sprayed onto the stability agent over a period
of about 20 minutes. The wetted material was spread onto a dish and
placed in a 60.degree. C. oven for at least 4 h. The dried
granulation was passed through a 40-mesh screen.
[0099] Stability Studies: The effect of the three stability agents,
lactose, mannitol and sucrose on the stability of the granulated
powder was evaluated. 7.5 g of powder was placed in 8 oz amber,
graduated PET bottles and stored under refrigerated, 25.degree.
C./60% Relative Humidity (RH), 40.degree. C./ambient and 60.degree.
C./ambient conditions. At various time points the powder in the
bottle was analyzed for enalapril by HPLC/UV analysis. The
following tables depict the stability of enalapril+stability agent
powder in bottle in the various storage conditions.
TABLE-US-00002 2% w/w Enalapril/Lactose Powder in Bottle
Formulation Time 25.degree. C./ 40.degree. C./ 60.degree. C./
(Weeks) Refrigerated 60% RH ambient ambient 0 101.54 101.54 101.54
101.54 1 100.27 100.59 98.61 94.74 2 100.37 100.60 98.82 94.51 3
101.10 99.58 98.45 93.44 4 99.03 98.53 96.94 92.66 8 100.23 99.63
98.89 90.56 12 102.20 99.53 100.02 89.76 26 101.28 95.83 97.89
75.57 52 101.50 91.90 93.70 N/A
TABLE-US-00003 2% w/w Enalapril/Mannitol Powder in Bottle
Formulation Time 25.degree. C./ 40.degree. C./ 60.degree. C./
(Weeks) Refrigerated 60% RH ambient ambient 0 100.16 100.16 100.16
100.16 1 99.61 99.57 93.42 96.96 2 98.56 98.41 94.41 101.14 3 99.21
98.51 99.42 101.24 4 99.20 98.59 101.26 99.97 8 101.26 98.88 102.17
100.80 12 103.33 99.67 103.31 95.15 26 102.19 96.89 102.68 94.66 52
102.50 94.30 99.70 N/A
TABLE-US-00004 2% w/w Enalapril/Sucrose Powder in Bottle
Formulation Time 25.degree. C./ 40.degree. C./ 60.degree. C./
(Weeks) Refrigerated 60% RH ambient ambient 0 98.68 98.68 98.68
98.68 2 97.67 100.60 98.87 99.92 4 97.40 100.50 98.97 99.06 8 98.40
99.56 98.83 97.74 12 97.17 98.47 97.13 94.97 26 97.90 96.40 99.00
93.50 52 N/A N/A N/A N/A
[0100] Based on the powder in bottle stability at accelerated
conditions (25.degree. C./60% RH, 40.degree. C./ambient, 60.degree.
C./ambient), it was determined that the enalapril/mannitol
formulation was the most stable.
Example 2
Stability of Prepared Enalapril Solution
[0101] Enalapril Solution Formulation: 1.0 mg/mL enalapril
solutions were prepared from the lactose and mannitol granulations
(Example 1) made with the addition of OraSweet SF.RTM. flavored
syrup and placed under refrigerated, 25.degree. C./60% RH and
40.degree. C./ambient conditions. A enalapril/sucrose solution was
prepared at 2 mg/mL concentration to evaluate the effect of the
higher concentration on solution stability. The following tables
depict the stability of enalapril+stability agent solution in the
various storage conditions.
TABLE-US-00005 1 mg/mL Enalapril/Lactose Prepared Solution Time
(Weeks) Refrigerated 25.degree. C./60% RH 40.degree. C./ambient 0
101.66 101.66 101.66 1 100.63 100.33 97.18 2 101.35 99.77 93.69 3
101.25 98.68 90.03 4 100.65 97.25 86.21 8 101.27 94.19 73.69 12
102.15 92.99 65.91
TABLE-US-00006 1 mg/mL Enalapril/Mannitol Prepared Solution Time
(Weeks) Refrigerated 25.degree. C./60% RH 40.degree. C./ambient 0
95.86 95.86 95.86 1 94.56 94.08 91.28 2 94.98 93.90 87.48 3 95.06
92.59 83.86 4 94.42 91.28 80.45 8 95.10 88.39 68.52 12 95.74 86.99
60.43
TABLE-US-00007 2 mg/mL Enalapril/Sucrose Prepared Solution Time
(Weeks) Refrigerated 25.degree. C./60% RH 40.degree. C./ambient 0
99.16 99.16 99.16 2 101.1 98.71 89.05 4 101.3 95.48 79.86 8 99.79
90.35 62.94 12 99.40 86.18 40.24
[0102] In the prepared solutions, the enalapril+mannitol solution
was most stable at 40.degree. C./ambient conditions.
Example 3
Direct Blend Enalapril Powder Compositions
[0103] Enalapril Powder Composition A: An enalapril powder
composition as set forth in the following table is prepared.
TABLE-US-00008 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Enalapril Maleate 150 14.29 Mannitol 900 85.71 Total Solids
1050 100.0
[0104] The composition is prepared by adding the components
together. The powder is then screened and direct blended until
blend uniformity.
[0105] Enalapril Powder Composition B: An enalapril powder
composition as set forth in the following table is prepared.
TABLE-US-00009 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Enalapril Maleate 150 14.29 Mannitol 890 84.76 Colloidal
Silicon 10 0.95 Dioxide Total Solids 1050 100.0
[0106] The composition is prepared by adding the components
together. The powder is then screened and direct blended until
blend uniformity.
[0107] Enalapril Powder Composition C: An enalapril powder
composition as set forth in the following table is prepared.
TABLE-US-00010 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Enalapril Maleate 150 14.29 Mannitol 590 56.19 Colloidal
Silicon 10 0.95 Dioxide Sorbitol 300 28.57 Total Solids 1050
100.0
[0108] The composition is prepared by adding the components
together. The powder is then screened and direct blended until
blend uniformity.
[0109] Enalapril Powder Composition D: An enalapril powder
composition as set forth in the following table is prepared.
TABLE-US-00011 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Enalapril Maleate 150 12.5 Mannitol 590 49.17 Colloidal
Silicon 10 0.83 Dioxide Sorbitol 300 25.0 Wild Cherry Flavor 150
12.5 Total Solids 1200 100.0
[0110] Enalapril Powder Composition E: An enalapril powder
composition as set forth in the following table is prepared.
TABLE-US-00012 Amount in 150 mL Weight (% w/w Component Bottle (mg)
solids) Enalapril Maleate 150 7.5 Mannitol 590 29.5 Colloidal
Silicon 10 0.5 Dioxide Sorbitol 300 15 Sodium Bicarbonate 800 40
Lemon Flavor 150 7.5 Total Solids 2000 100.0
Example 4
Enalapril Composition Scale-up Optimization Studies
[0111] Scale-up studies investigated blend and bottle content
uniformity
[0112] Blend and Bottle Content Uniformity of Enalapril Powder
Composition A: Enalapril Powder Composition A (150 mg enalapril,
900 mg mannitol/bottle) was scaled-up and the resultant formulation
tested for blend and content uniformity. For blend uniformity, 10
lg samples were taken from the blender (top front right, middle
front right, bottom front, top front left, middle front left, top
back right, middle back right, bottom back, top back left, and
middle back left) by a suitable powder sampler at the below
times.
TABLE-US-00013 Blend Uniformity - Enalapril Powder Composition A
Blending Time (min) Avg drug assay (%) % RSD 10 96.0 2.80 15 96.6
2.13 20 99.5 3.69
[0113] Bottle content uniformity values were assessed via a hopper
study after filling and capping the Enalapril Powder Composition
blend into 150 mL bottles:
TABLE-US-00014 Bottle Content Uniformity - Enalapril Powder
Composition A Ace. Value Time Point Avg drug assay (%) % RSD (Limit
.ltoreq.15) Beginning 89.9 2.12 13.2 Middle 104.7 2.66 9.9 End 99.8
3.14 7.5
[0114] The content uniformity study revealed that some segregation
of the powder composition could have occurred post-blending.
[0115] Blend Time Variation for Enalapril Powder Composition A:
Blend time was assessed for possibility of contributing to
segregation of the powder composition. Blend time was shortened to
5 minutes and blend uniformity and bottle content uniformity was
assessed as above:
TABLE-US-00015 Blend Uniformity - Enalapril Powder Composition A
Blending Time (min) Avg drug assay (%) % RSD 5 96.7 1.25 Bottle
Content Uniformity - Enalapril Powder Composition A Study Avg drug
assay (%) % RSD Content Uniformity 95.9 6.14 By Weight 97.7
6.69
[0116] The high % RSD was observed in the bottle content uniformity
studies indicating variance in the filling and capping of the drug
powder composition.
[0117] Blend time was changed back to 10 minutes in an attempt to
optimize blend and fill, however, it was not successful.
[0118] Lengthening the blend time to 20, 30, 40 and 60 minutes
revealed the following observations:
TABLE-US-00016 Blend Uniformity - Enalapril Powder Composition A
Blending Time (min) Visual Observation Avg drug assay (%) 20
Homogenous 89.9, 102.8, 96.1 30 Small round balls 90.4, 90.1, 100.9
segregating in blend 40 Small round balls 105.4 segregating in
blend and gradually increasing in proportion 60 Much greater and
clear 139.8; fines: 55.8 segregation of round balls in the
blend
[0119] FIG. 1 shows a visual depiction of the enalapril powder
composition A blended for 60 minutes. Thus, a lower blend time
(e.g., about 10-20 minutes) is contemplated to be more optimal to
prevent `balling up` and segregation of the powder blend.
[0120] The scaled-up enalapril and mannitol powder compositions
(Enalapril Powder Composition A and the like) were examined in
reconstitution studies where 150 mL Ora-Sweet.RTM. SF sugar-free
flavored syrup was to the powder compositions. Scaled-up enalapril
and mannitol powder compositions such as Enalapril Powder
Composition A did not dissolve in the syrup, but instead resulted
in powder clumping and specking on the surface of the liquid,
termed `clouding`. Various enalapril and mannitol formulations were
examined at different concentrations, which resulted in similar
`clouding`. FIG. 2A shows the clouding phenomenon from an exemplary
enalapril and mannitol powder formulation.
[0121] Reconstitution of Neat Enalapril Powder in Bottle: Due to
the `clouding` in the reconstitution as well as the uniformity
issues in the scale-up studies of Enalapril Powder Composition A,
neat enalapril, i.e., drug alone, without any excipients, was
examined for scale-up bottle filling and subsequent reconstitution.
It was observed that during reconstitution with 150 mL
Ora-Sweet.RTM. SF sugar-free flavored syrup, the neat enalapril did
not dissolve but floated on the surface of the liquid, even after 2
hours standing after reconstitution (FIG. 2B).
[0122] Colloidal Silicon Dioxide Addition to form Enalapril Powder
Composition B:
[0123] Although colloidal silicon dioxide has been reported to
decrease stability of enalapril (Rezende et al., Stability and
Compatibility Study on Enalapril Maleate using Thermoanalytical
Techniques, J. Thermal Anal. & calorimetry, 2008 (93) 881-886),
the addition of colloidal silicon dioxide to an enalapril powder
composition during scale-up resulted in improved and acceptable
blend uniformity and bottle content uniformity levels. Enalapril
Powder Composition B (150 mg enalapril, 890 mg mannitol, 10 mg
colloidal silicon dioxide/bottle) was scaled-up and the resultant
formulation tested for blend and content uniformity as described
above. The blend and content uniformity assays showed that the
addition of colloidal silicon dioxide imparted uniformity in the
powder composition:
TABLE-US-00017 Blend Uniformity - Enalapril Powder Composition B
Blending Time (min) Avg drug assay (%) % RSD 10 99.8 1.34 10 99.7
1.08 Bottle Content Uniformity - Enalapril Powder Composition B
Study Avg drug assay (%) % RSD Content Uniformity 102.6 1.98
Content Uniformity 98.5 2.77
[0124] In reconstitution studies, surprisingly, the addition of
colloidal silicon dioxide resulted in a solution that, upon visual
inspection, was truly dissolved and homogenous (FIG. 2C).
[0125] A lower amount of colloidal silicon dioxide was also studied
(150 mg enalapril, 895 mg mannitol, 5 mg colloidal silicon
dioxide/bottle). However the enalapril powder composition had lower
flowability than that of enalapril powder composition B.
[0126] The stability of the enalapril powder and liquid composition
with respect to the addition of colloidal silicon dioxide was
analyzed in Example 6.
Example 5
Additional Reconstitution Methods and Studies
[0127] The overall mixing efficiency and solution/suspension drug
concentration homogeneity was evaluated over a series of mixing
methods and times.
[0128] Mixing Method A: 75 mL of Ora-Sweet.RTM. SF sugar-free
flavored syrup was added to a 150 mL bottle of Enalapril Powder
Composition B and the bottle was shaken vigorously. A second 75 mL
of Ora-Sweet.RTM. SF syrup was subsequently added and the bottle
was shaken vigorously.
[0129] Observations: The resultant liquid contained entrapped air
bubbles. It was determined that the bubbles would interfere with
dosing as a variable volume of the liquid could be administered in
dosing syringes for administration.
[0130] Mixing Method B: 75 mL of Ora-Sweet.RTM. SF sugar-free
flavored syrup was added to a 150 mL bottle of Enalapril Powder
Composition B and the bottle was gently swirled. A second 75 mL of
Ora-Sweet.RTM. SF syrup was subsequently added and the bottle was
gently swirled. The bottle was then inverted slowly for about 5
times.
[0131] Observations: The gently swirling and subsequent inversions
minimized the bubble formation. However, in a clinical trial
similar to Example 7, it was observed that the subjects had
received a lower dose (about 1.30 mg) of enalapril rather than
standard 10 mg dosage. Based on this observation, it was determined
that the mixing method did not introduce enough energy in the
process and resulted in improper wetting and mixing of the
powder.
[0132] Mixing Method C: 150 mL bottle of Enalapril Powder
Composition B was first tapped on a hard surface to disperse any
powder caking. 75 mL of Ora-Sweet.RTM. SF sugar-free flavored syrup
was added to the 150 mL bottle and the bottle was shaken for
specified time intervals (10, 20, 30, 45 and 60 seconds). A second
75 mL of Ora-Sweet.RTM. SF syrup was subsequently added and the
bottle was shaken for the specified time interval. Bubbles were
allowed to dissipate (for at least one hour). Two samples were
taken immediately after the second shaking. One sample was filtered
through a 0.45 micron filter. A third sample was taken 1 h after
the second shaking and after any bubbles dissipated from the
liquid. The three samples were assayed by HPLC. The mixing and
homogeneity results are as follows:
TABLE-US-00018 Mixing Method C: Enalapril by HPLC as % of 1 mg/mL
Time Sample 1 Sample 2 Sample 3 (seconds) (unfiltered) (filtered)
(1 h) 2 .times. 10 101.3 101.2 101.2 2 .times. 20 100.9 100.8 100.8
2 .times. 30 101.5 101.3 101.1 2 .times. 45 101.6 101.7 101.7 2
.times. 60 100.9 100.9 101.1
[0133] Observations: There was no perceived difference observed
between filtered and unfiltered samples indicating that the
reconstituted enalapril liquid is not a suspension. The addition of
75 mL of Ora-Sweet.RTM. SF syrup followed by shaking for 10 seconds
and the addition of another 75 mL of Ora-Sweet.RTM. SF syrup
followed by shaking for 10 seconds resulted in a homogenous
solution. All longer shaking times produced equivalent results.
Example 6
Additional Stability Studies
[0134] Powder Stability: Enalapril Powder Composition B and its
reconstituted oral liquid form were further investigated in
stability studies. 1050 mg enalapril Powder Composition B in 150 mL
white plastic bottles were examined for stability in
25.+-.2.degree. C./60.+-.5% RH at up to 9 months and
40.+-.2.degree. C./75.+-.5% RH (accelerated) conditions at up to 6
months. At each given time point, enalapril and related substances
were assayed via HPLC. The below tables depict stability of the
powder at the various conditions.
TABLE-US-00019 Enalapril Powder Composition B - 25.degree. C./60%
RH Time (Months) Enalapril (%) Enalaprilat (%) DKP (%) 0 97.8 0.05
0.02 1 98.6 0.05 0.03 2 97.6 0.12 0.05 3 98.6 0.06 0.07 6 96.8 0.09
0.11 9 98.6 0.12 0.15
TABLE-US-00020 Enalapril Powder Composition B - 40.degree. C./75%
RH Time (Months) Enalapril (%) Enalaprilat (%) DKP (%) 0 97.8 0.05
0.2 1 97.9 0.12 0.23 2 96.8 0.15 0.32 3 97.2 0.16 0.42 6 96.2 0.18
0.63
[0135] Enalapril Powder Composition B remained stable through 6
months under accelerated stability conditions and 9 months under
ambient (25.+-.2.degree. C./60.+-.5% RH) conditions at up to 9
months conditions with slight increase in the levels of enalaprilat
and DPK. However, none of the total related impurities exceeded 5%.
Stability at ambient conditions was also examined for two
additional lots of Enalapril Powder Composition B. Similar results
were observed for the levels of enalaprilat and DPK.
[0136] Reconstituted Liquid Stability: Enalapril Powder Composition
B was reconstituted in 150 mL bottles according to Mixing Method C
(2.times.30 s of shaking) and stored at ambient conditions.
Aliquots were taken during selected time points during the study
period. The below tables depict stability of the reconstituted
liquid at the various conditions.
TABLE-US-00021 Enalapril Reconstituted Liquid - Ambient Time
(Weeks) Enalapril (%) Enalaprilat (%) DKP (%) 0 97.4 0.43 0.04 2
96.8 0.73 0.08 4 96.9 0.87 0.08 8 95.4 1.35 0.12 12 93.7 2.22
0.17
[0137] After being reconstituted, the enalapril liquid was stable
in ambient conditions with essentially unchanged values of its
attributes, including microbial limits, preservative effectiveness
and preservative assay up to the end of the study period (12
weeks).
Example 7
Clinical Trial: Bioavailability Study of 10 mg Enalapril Maleate
Oral Liquid vs Vasotec.RTM. 10 mg Tablets Under Fasted Conditions
and 10 mg Enalapril Maleate Oral Liquid in Fed Conditions in
Healthy Adults
[0138] The objectives of this single-dose, open-label, randomized,
three-period, three-treatment, three-way crossover study were:
[0139] To assess the bioavailability of a test formulation of 10 mg
oral liquid reconstituted from Enalapril Powder Composition B
versus Vasotec.RTM. 10 mg enalapril tablets under fasted conditions
in healthy adults [0140] To assess the food effect on a test
formulation of 10 mg oral liquid reconstituted from
[0141] Enalapril Powder Composition B in healthy adults
[0142] Study Design: Healthy adult subjects were to receive each of
the following three treatments in a randomized fashion during three
study periods: [0143] Treatment A, Test Formulation: Enalapril
maleate oral liquid reconstituted from Enalapril Powder Composition
B via Mixing Method C (2.times.30 s of shaking), 10 mg/10 mL,
administered under fasted conditions [0144] Treatment B, Reference
Product: Vasotec.RTM., one 10 mg tablet, administered under fasted
conditions [0145] Treatment C, Test Formulation: Enalapril maleate
oral liquid reconstituted from Enalapril Powder Composition B via
Mixing Method C (2.times.30 s of shaking), 10 mg/10 mL,
administered under fed conditions
[0146] Screening assessments were performed by the investigator or
designee within 28 days prior to study start. Treatments A and B
were to be administered after an overnight fast of at least 10
hours; Treatment C was to be administered following an overnight
fast of at least 10 hours and an FDA standard high-calorie,
high-fat breakfast meal beginning 30 minutes prior to
administration of the study drug. Each dose was to be orally
administered with 240 mL (8 fl. oz.) of room temperature tap water;
after dosing, no food was allowed until 4 hours postdose. Each drug
administration was separated by a washout period of .gtoreq.7
days.
[0147] During each study period, meals were the same and scheduled
at approximately the same times relative to dose. In addition,
during each period, blood samples were obtained prior to and
following each dose at selected times through 72 hours postdose.
Plasma pharmacokinetic (PK) samples were analyzed for enalapril and
enalaprilat using a validated analytical method; appropriate PK
parameters were calculated for each formulation using
on-compartmental methods. Blood was also drawn and urine collected
for clinical laboratory testing at screening and at the end of the
study.
[0148] Each subject was to receive a total of three single doses,
one dose at each of three study periods; the duration of the study
for each subject would be approximately 45 days.
[0149] Subject Criteria: Subjects must have been a male or
non-pregnant, non-breastfeeding female; 18 to 55 years of age; with
body mass index (BMI) between 18 and 30 kg/m.sup.2 and weight a
minimum of 50 kg (110 lbs). Subjects were not to have a history or
presence of clinically significant cardiovascular, pulmonary,
hepatic, renal, hematologic, gastrointestinal, endocrine,
immunologic, dermatologic, neurologic, oncologic, or psychiatric
disease, or any other condition that, in the opinion of the
investigator, would jeopardize the safety of the subject or the
validity of the study results; and were not to have a history of
chronic cough, hyperkalemia, renal insufficiency, renal artery
stenosis, or angioedema related to previous treatment with an
angiotensin-converting enzyme inhibitor.
[0150] Results
[0151] Various pharmacokinetic parameters are summarized below for
enalapril and enalaprilat.
TABLE-US-00022 Mean PK Parameters Single 10 mg Doses AUC.sub.last
AUC.sub.inf C.sub.max (ng/mL) T.sub.max (h) (h*ng/mL) (h*ng/mL)
T.sub.1/2 (h) C.sub.last (ng/mL) Treatment A - Enalapril 58.0 0.87
102.6 103.7 1.70 0.460 Treatment B - Enalapril 61.8 0.92 106.5
107.5 1.45 0.467 Treatment C - Enalapril 31.3 1.21 88.47 88.70 1.34
0.507 Treatment A - Enalaprilat 41.0 3.45 405.3 443.3 30.49 0.841
Treatment B - Enalaprilat 44.5 3.51 417.1 455.9 30.78 0.860
Treatment C - Enalaprilat 26.4 4.49 315.7 360.1 33.94 0.889
[0152] Concentration-time data are summarized graphically for
enalapril in FIG. 3 (linear, top; log, bottom) and enalaprilat in
FIG. 4 (linear, top; log, bottom).
[0153] Test Formulation versus Reference Product (Fasted): Based on
the geometric mean ratios of enalapril and enalaprilat AUCs
(Test/Reference for AUC.sub.last and AUC.sub.inf), the
bioavailability of the test formulation relative to the reference
product was approximately 96% to 97%. The geometric mean ratios of
enalapril and enalaprilat C.sub.max were 92.45% and 90.94%,
respectively. The 90% confidence intervals about the geometric mean
ratios (Test/Reference) of enalapril and enalaprilat C.sub.max and
AUCs were within the accepted 80% to 125% range, indicating no
significant difference.
[0154] Test Formulation (Fasted) versus Test Product (Fed): Based
on the geometric mean ratios of enalapril AUCs (Fed/Fasted for
AUC.sub.last and AUC.sub.inf), a high-fat meal decreases the
bioavailability of enalapril from the test formulation by
approximately 14% to 15%; C.sub.max is decreased by approximately
46%. For enalaprilat, food decreases C.sub.max by approximately 36%
and AUCs by approximately 20% to 23%.
[0155] Clinical Trial with Mixing Method B: The above trial was
conducted with Enalapril maleate oral liquid reconstituted from
Enalapril Powder Composition B via Mixing Method A (shake
vigorously). The study was discontinued prior to dosing after it
was observed that the mixing method created entrapped air bubbles
in the liquid and could result in uneven dosing via dosing
syringes.
[0156] Clinical Trial with Mixing Method B: The above trial was
conducted with Enalapril maleate oral liquid reconstituted from
Enalapril Powder Composition B via Mixing Method B (gentle swirling
and inversion). A number of subjects on the test product only were
observed to have very low enalapril and enalaprilat levels in both
fasted and fed test treatments. Based on this observation, the
reconstituted enalapril maleate test formulation was assayed and it
was determined that the test dose administered was not a 10 mg dose
as specified in the study protocol, but was a mean dose of about
1.30 mg. Upon further investigation, it was determined that the low
concentration of enalapril in the dose occurred due to the mixing
method.
[0157] While preferred embodiments of the present invention have
been shown and described herein, it will be obvious to those
skilled in the art that such embodiments are provided by way of
example only. Numerous variations, changes, and substitutions will
now occur to those skilled in the art without departing from the
invention. It should be understood that various alternatives to the
embodiments of the invention described herein may be employed in
practicing the invention. It is intended that the following claims
define the scope of the invention and that methods and structures
within the scope of these claims and their equivalents be covered
thereby.
* * * * *