U.S. patent application number 17/548931 was filed with the patent office on 2022-04-07 for abuse-deterrent dosage forms containing esketamine.
The applicant listed for this patent is Clexio Biosciences Ltd.. Invention is credited to Derek Moe, Sagar Rane, Randal Seburg.
Application Number | 20220105055 17/548931 |
Document ID | / |
Family ID | 1000006027723 |
Filed Date | 2022-04-07 |
United States Patent
Application |
20220105055 |
Kind Code |
A1 |
Moe; Derek ; et al. |
April 7, 2022 |
ABUSE-DETERRENT DOSAGE FORMS CONTAINING ESKETAMINE
Abstract
Disclosed herein are immediate release oral dosage forms that
contain abuse-deterrent and abuse-resistant features. In
particular, the disclosed dosage forms can provide deterrence of
abuse by ingestion of multiple individual doses. The disclosed
dosage forms can likewise provide protection from overdose in the
event of accidental or intentional ingestion of multiple individual
doses. The dosage forms may also exhibit abuse resistant properties
when physically manipulated, and also when physically manipulated
and then administered in a manner not consistent with oral dosing.
The dosage forms may also exhibit abuse resistant properties when
administered in a manner intended to result in administration of
the esketamine in a higher than therapeutic dose.
Inventors: |
Moe; Derek; (Mound, MN)
; Seburg; Randal; (Louisville, KY) ; Rane;
Sagar; (Bellevue, WA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Clexio Biosciences Ltd. |
Jerusalem |
|
IL |
|
|
Family ID: |
1000006027723 |
Appl. No.: |
17/548931 |
Filed: |
December 13, 2021 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
16869309 |
May 7, 2020 |
|
|
|
17548931 |
|
|
|
|
62844286 |
May 7, 2019 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 31/135 20130101;
A61K 31/78 20130101; A61K 9/1676 20130101; A61K 33/10 20130101;
A61K 9/0053 20130101 |
International
Class: |
A61K 31/135 20060101
A61K031/135; A61K 9/00 20060101 A61K009/00; A61K 9/16 20060101
A61K009/16 |
Claims
1. An oral tablet comprising 40 mg of esketamine (base equivalent);
wherein the total weight of the tablet is of not less than 800 mg;
wherein the esketamine (base equivalent) comprises less than 5.0%
by weight of the total weight of the tablet; and wherein the tablet
exhibits an immediate release profile of esketamine having not less
than 90% of the esketamine released in 60 minutes, and wherein the
release profile is evaluated by dissolution of the tablet in 300 mL
of 0.1N HCl media using USP II apparatus at 50 RPM paddle speed and
37.degree. C.
2. The tablet according to claim 1, wherein the tablet exhibits an
immediate release profile of the esketamine when administered to a
human in therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic doses,
or wherein the tablet exhibits abuse resistant properties when
physically manipulated, or wherein the tablet exhibits abuse
resistant properties when physically manipulated and administered
in a manner not consistent with oral dosing, or wherein the tablet
exhibits abuse resistant properties when administered in a manner
intended to result in administration of the esketamine in a higher
than therapeutic dose.
3. The tablet according to claim 1, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 15% of the population comprises a
subpopulation of particles having a particle size of less than 75
.mu.m.
4. The tablet according to claim 1, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 40 wt % of the population of particles
comprises a subpopulation of particles having a particle size of
less than 106 .mu.m, and wherein said subpopulation contains less
than 10 wt % base equivalent of the esketamine of said tablet.
5. The tablet according to claim 1, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 35 wt % comprises a subpopulation of particles
having a particle size of 212-500 .mu.m and containing less than 70
wt % base equivalent of the esketamine of said tablet.
6. The tablet according to claim 1, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 30 wt % comprises a subpopulation of particles
having a particle size of 106-212 .mu.m and wherein the
subpopulation of particles contains less than 20 wt % base
equivalent of the esketamine of said tablet.
7. The tablet according to claim 1, wherein the tablet exhibits one
or more of the abuse resistant properties when the tablet is
physically manipulated by crushing and subsequent heating prior to
the administration in a manner not consistent with oral dosing or
in a manner intended to result in administration of the esketamine
in a higher than therapeutic dose.
8. The tablet according to claim 7, wherein the heating comprises
subjecting the physically manipulated tablet to a temperature of
about 200.degree. C-300.degree. C.
9. The tablet according to claim 7, wherein the physically
manipulated tablet is heated for at least one minute.
10. The tablet according to claim 7, wherein the heated, physically
manipulated tablet releases less esketamine (base equivalent) after
incubation in water or 0.1 N HCl for up to 18 hours, as compared to
the release of esketamine from a physically manipulated tablet
control that has not been heated prior to incubation in water or
0.1 N HCl for up to 18 hours.
11. The tablet according to claim 7, wherein the heated, physically
manipulated tablet releases at least 20 wt % less esketamine (base
equivalent), as compared to the release of esketamine (base
equivalent) from a physically manipulated tablet control that has
not been heated prior to incubation in water or 0.1 N HCl for up to
18 hours.
12. The tablet according to claim 1, wherein upon physically
manipulating the tablet by crushing, the physically manipulated
tablet exhibits less than 5 wt % the esketamine diffusion of
powdered pure esketamine or a pharmaceutically acceptable salt
thereof, over 60 minutes across a membrane having a molecular
weight cutoff of 12-14 kD from a receptor chamber containing a
phosphate buffer at pH 6.4 and maintained at 37.degree. C.
13. The tablet according to claim 1, wherein upon physically
manipulating the tablet by crushing, the physically manipulated
tablet exhibits less esketamine diffusion across nasal membranes of
a human subject when nasally insufflated by the subject, relative
to a solution of 140 mg/ml esketamine (base equivalent) in pH 4.5
citrate buffer.
14. The tablet according to claim 13, wherein upon physically
manipulating the tablet by crushing, the physically manipulated
tablet exhibits less than 5% the relative esketamine diffusion of a
solution of 140 mg/ml esketamine (base equivalent) in pH 4.5
citrate buffer, over 60 minutes across a membrane having a
molecular weight cutoff of 12-14 kD from a receptor chamber
containing a phosphate buffer at pH 6.4 and maintained at
37.degree. C.
15. The tablet according to claim 1, wherein upon physically
manipulating the tablet by crushing, the absorption of esketamine
from the physically manipulated tablet over 60 minutes across a
membrane having a molecular weight cutoff of 12-14 kD from a
receptor chamber containing a phosphate buffer at pH 6.4 and
maintained at 37.degree. C. is less than 20%.
16. The tablet according to claim 1 comprising esketamine HCl.
17. The tablet according to claim 1 comprising a total weight of no
less than 1000 mg.
18. An oral tablet for the administration of esketamine to a
subject comprising a total weight of not less than 1000 mg, and
having 40 mg of esketamine (base equivalent), the esketamine (base
equivalent) representing no more than 4.0% by weight of the total
weight of the tablet and wherein the tablet exhibits an immediate
release profile of esketamine having not less than 90% of the
esketamine released in 60 minutes, and wherein the release profile
is evaluated by dissolution of the tablet in 300 mL of 0.1N HCl
media using USP II apparatus at 50 RPM paddle speed and 37.degree.
C.
19. An oral, immediate release tablet comprising 40 mg esketamine
(base equivalent) and wherein the ratio of the percentage by weight
of esketamine (base equivalent) of the total weight of the tablet
(5%) to the weight of esketamine (base equivalent) (40 mg) is no
more than 0.125 to 1.
20. The tablet of claim 19, wherein the ratio is no more than 0.1
to 1.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] The present application is a continuation of U.S. Ser. No.
16/869,309, filed May 7, 2020, which claims the benefit of priority
to U.S. Provisional App. No. 62/844,286, filed May 7, 2019, the
entire contents of both of which are hereby incorporated by
reference.
TECHNICAL FIELD
[0002] The present disclosure pertains to oral dosage forms that
contain abuse-deterrent features.
BACKGROUND
[0003] Pharmaceutical products, including both prescription and
over-the-counter pharmaceutical products, while useful for
improving health or alleviating undesirable symptoms of a person in
need, are also susceptible to intentional and unintentional abuse
and overdosing. Commonly abused active pharmaceutical ingredients
include psychoactive drugs, anxiolytics, sedative hypnotics,
stimulants, depressants, and analgesics such as narcotic
analgesics, among others.
[0004] Some common techniques for intentionally abusing a drug may
begin with a prospective abuser obtaining a solid dosage form, such
as an orally administered tablet or capsule, and crushing the solid
dosage form into a powder. The powder may be administered by an
abuser by nasal insufflation to introduce the drug to the abuser's
bloodstream intranasally. Alternately, the crushed dosage form may
be combined with a solvent that is capable of dissolving the drug
(active pharmaceutical ingredient, or "API") and the solvent
containing the dissolved drug may then be injected directly into an
abuser's bloodstream. In the case of immediate release oral dosage
forms, an abuser might simply ingest multiple units (e.g., tablets)
of the dosage form together, e.g., simultaneously, or over an
abbreviated period of time. Each one of the multiple dosage form
units immediately releases an amount of drug, thereby producing a
short-term concentration spike of the drug in the user's
bloodstream and the desired "high" in the user.
[0005] The pharmaceutical industry has identified various
mechanisms of adapting drug compositions and oral dosage forms to
discourage abuse of oral dosage forms. Pharmaceutical companies
have studied dosage forms that contain a nasal irritant or an
effervescent agent, which can cause irritation or pain in a nasal
passage if the dosage form is crushed and then snorted, thus
discouraging abuse by nasal insufflation.
[0006] Pharmaceutical companies studied adding gelling polymers to
dosage forms to prevent abuse by injection. If the dosage form is
crushed to a powder and combined with a small amount of solvent,
the gelling polymer can cause the combination to take the form of a
highly viscous liquid or gel that cannot be administered by
injection. Another possible abuse deterrent may be addition of an
emetic agent which can deter abuse by causing emesis on ingestion
of multiple doses. Another abuse deterrent involves adding an
antagonist of an API to a dosage form that will substantially block
the effect of the drug.
[0007] Although the pharmaceutical industry has identified of a
variety of abuse deterrent (sometimes referred to as
"abuse-resistant") features useful with oral dosage forms, there is
continuing need to improve abuse deterrent features in order to
prevent abuse or overdosing of active pharmaceutical
ingredients.
SUMMARY
[0008] Disclosed herein are oral dosage forms comprising: (i) a
first population of core-shell particles, each of the core-shell
particles of the first population comprising a core that includes a
gelling polymer and a wax; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine; and at least one layer surrounding the active
pharmaceutical layer, the at least one layer comprising a
pH-sensitive film comprising a pH-sensitive polymer that is
insoluble in water at a pH greater than 5; and, (ii) a matrix
comprising a carbomer gelling polymer and sodium bicarbonate,
wherein the carbomer gelling polymer and sodium bicarbonate are
present in said dosage form in a ratio by weight percentage of
about 2:2 based on the total weight of the dosage form; wherein the
dosage form exhibits an immediate release profile of the esketamine
when administered to a human in therapeutic doses, and an extended
release profile of the esketamine when administered to a human in
supratherapeutic doses.
[0009] Also disclosed herein are abuse resistant oral dosage forms
for the administration of esketamine to a subject comprising: (i) a
first population of core-shell particles, each of the core-shell
particles of the first population comprising a core, an active
pharmaceutical layer surrounding the core comprising esketamine or
a pharmaceutically acceptable salt thereof, and at least one layer
surrounding the active pharmaceutical layer, the at least one layer
comprising a pH-sensitive film comprising a pH-sensitive polymer
that is insoluble in water at a pH greater than 5; and, (ii) a
matrix comprising a carbomer gelling polymer and sodium
bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in a ratio by weight percentage of about
2:2 based on the total weight of the dosage form; wherein the
dosage form exhibits an immediate release profile of esketamine
having not less than 90% of the esketamine released in 60 minutes,
wherein the release profile is evaluated by dissolution of the
tablet in 300 mL of 0.1N HCl media using USP II apparatus at 50 RPM
paddle speed and 37.degree. C.; wherein the dosage form exhibits an
immediate release profile of the esketamine when administered to a
human in therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic doses
or wherein the dosage form exhibits abuse resistant properties when
physically manipulated, or wherein the dosage form exhibits abuse
resistant properties when physically manipulated and administered
in a manner not consistent with oral dosing, or wherein the dosage
form exhibits abuse resistant properties when administered in a
manner intended to result in administration of the esketamine in a
higher than therapeutic dose.
[0010] The present disclosure also provides oral tablets for the
administration of esketamine to a subject comprising: a total
weight of not less than 800 mg, and having 40 mg of esketamine
(base equivalent), the esketamine (base equivalent) representing
less than 5.0% by weight of the total weight of the tablet, or a
total weight of not less than 571 mg, and having 20 mg of
esketamine (base equivalent), the esketamine (base equivalent)
representing less than 3.5% by weight of the total weight of the
tablet; wherein the tablet exhibits an immediate release profile of
esketamine having not less than 90% of the esketamine released in
60 minutes, and wherein the release profile is evaluated by
dissolution of the tablet in 300 mL of 0.1N HCl media using USP II
apparatus at 50 RPM paddle speed and 37.degree. C.; and wherein the
dosage form exhibits an immediate release profile of the esketamine
when administered to a human in therapeutic doses, and an extended
release profile of the esketamine when administered to a human in
supratherapeutic doses, or wherein the tablet exhibits abuse
resistant properties when physically manipulated, or wherein the
tablet exhibits abuse resistant properties when physically
manipulated and administered in a manner not consistent with oral
dosing, or
wherein the tablet exhibits abuse resistant properties when
administered in a manner intended to result in administration of
the esketamine in a higher than therapeutic dose.
[0011] Also disclosed are methods of reducing the potential for
abuse by a human of an active pharmaceutical ingredient comprising
esketamine, comprising providing to the human a dosage form as
described herein.
[0012] Also provided are methods of reducing the potential for
abuse by a human of an active pharmaceutical ingredient comprising
esketamine by simultaneous oral ingestion of multiple dosage units
comprising the active pharmaceutical ingredient, comprising
providing to the human a dosage form as described herein.
[0013] The present disclosure also provides methods for treating or
preventing pain or discomfort in a subject in need thereof by
administering to the subject a dosage form as described herein.
[0014] Also disclosed are methods for treating depression in a
subject in need thereof by administering to the subject a dosage
form as described herein.
[0015] The present disclosure also provides methods of reducing the
potential for abuse by nasal insufflation by a human of an active
pharmaceutical ingredient comprising esketamine, comprising
providing to the human a dosage form as described herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] FIG. 1A, FIG. 1B, and FIG. 1C illustrate embodiments of
core-shell particles, in cross section, for inclusion in the
presently disclosed dosage forms.
[0017] FIG. 2A and FIG. 2B also illustrate embodiments of
core-shell particles, in cross section.
[0018] FIG. 3 is a perspective view of an embodiment of a dosage
form as disclosed herein.
[0019] FIG. 4 shows the results of single-tablet dissolution
testing of an inventive dosage form according to the present
disclosure and of a comparative dosage form.
[0020] FIG. 5 shows the results of multiple-tablet dissolution
testing of a supratherapeutic dose of an inventive dosage form
according to the present disclosure and of a supratherapeutic dose
of comparative dosage form.
[0021] FIG. 6 provides an image of a dual screen apparatus that was
used to test a supratherapeutic dose of an inventive dosage form
with gel retained on the screens.
[0022] FIG. 7 provides an image of a dual screen apparatus that was
used to test a supratherapeutic dose of a comparative dosage form
with gel retained on the screens.
[0023] FIG. 8 provides an image of a dual screen apparatus that was
used to test a supratherapeutic dose of a comparative dosage form
with gel retained on the screens.
[0024] FIG. 9 provides an image of a gel resulting from a
supratherapeutic dose of inventive dosage forms, suspended in a
test medium.
[0025] FIG. 10 provides an image of a gel resulting from a
supratherapeutic dose of comparative dosage forms, suspended in a
test medium.
DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS
[0026] Abuse deterrent and resistant features can include the
ability of a dosage form to produce a highly viscous liquid or gel
when crushed and exposed to a solvent, when administered in
supratherapeutic doses (in doses that are higher than what is
prescribed pursuant to a legitimate treatment regimen), or both, in
order to prevent abuse by such methods as intravenous injection,
nasal insufflation, and oral supratherapeutic dosing. One challenge
associated with incorporating this type of abuse-deterrent feature
is whether the resulting viscous liquid or gel possesses
characteristics that are required for preventing the above-noted
abuse modalities. For example, in order to prevent drug from being
released in a dosage form in sufficient quantities to produce the
desired effect of the abuse, a gel must be appropriately viscous
and uniform. A gel that is runny or non-uniform (e.g., containing
portions that are more fluid and portions that are less fluid) will
be less effective in blocking commonly-attempted forms of abuse and
release of drug. The present disclosure pertains to dosage forms
that produce high quality abuse deterrent features when subjected
to attempted abuse. In basic terms, the dosage forms that are
disclosed herein exhibit an immediate release profile of drug when
administered to a human in therapeutic doses, and an extended
release profile of drug when administered to a human in
supratherapeutic doses.
[0027] More particularly, it has been discovered that specific
ratios of gelling polymer, particularly carbomer gelling polymer,
to pH adjusting compound within the matrix of the dosage forms can
be critical for allowing the dosage form, when administered in
supratherapeutic doses, to produce a gel having superior physical
characteristics for purposes of thwarting abuse of esketamine from
the dosage forms. This finding, among others, is described more
fully, infra.
[0028] Ideally, the abuse resistant and deterrent features include
those that thwart other commonly used approaches for extracting
higher doses of active ingredient than would be appropriate
pursuant to a therapeutic dosing regimen. One commonly used
approach for abusing an active ingredient involves crushing a
dosage form and nasally insufflating the crushed dosage form. As
disclosed more fully herein, the presently disclosed dosage forms
are capable of resisting attempts of this type by limiting the
amount of active ingredient that diffuses across nasal membranes
when the dosage form is crushed and then nasally insufflated.
[0029] Another commonly used approach for extracting a higher than
therapeutically appropriate dose of an active ingredient involves
physically manipulating the dosage form (e.g., crushing it)
followed by heating the material that results from the physical
manipulation. The heating step can function to defeat a gelling
mechanism that otherwise prevents the extraction of active
ingredient. However, as also described more fully herein, the
presently disclosed dosage forms prevent extraction of active
ingredient even when physically manipulated (e.g., crushed) and
subjected to heating.
[0030] A further commonly used approach for extracting active
ingredient involves physically manipulating (e.g., crushing) a
dosage form and selectively ingesting particles that have a higher
concentration of active ingredient and a lower concentration of
inactive excipient. The present inventors have discovered that the
dosage forms disclosed herein are able to resist attempts to abuse
the dosage form in this additional manner, and this feature is
described more fully infra.
[0031] In the present disclosure, the singular forms "a", "an", and
"the" include the plural reference, and reference to a particular
numerical value includes at least that particular value, unless the
context clearly indicates otherwise. Thus, for example, a reference
to "a filler" is a reference to one or more of such reagents and
equivalents thereof known to those skilled in the art, and so
forth. Furthermore, when indicating that a certain element "may be"
X, Y, or Z, it is not intended by such usage to exclude in all
instances other choices for the element.
[0032] When values are expressed as approximations, by use of the
antecedent "about", it will be understood that the particular value
forms another embodiment. As used herein, "about X" (where X is a
numerical value) preferably refers to .+-.10% of the recited value,
inclusive. For example, the phrase "about 8" can refer to a value
of 7.2 to 8.8, inclusive. This value may include "exactly 8". Where
present, all ranges are inclusive and combinable. For example, when
a range of "1 to 5" is recited, the recited range should be
construed as optionally including ranges "1 to 4", "1 to 3", "1-2",
"1-2 & 4-5", "1-3 & 5", and the like. In addition, when a
list of alternatives is positively provided, such a listing can
also include embodiments where any of the alternatives may be
excluded. For example, when a range of "1 to 5" is described, such
a description can support situations whereby any of 1, 2, 3, 4, or
5 are excluded; thus, a recitation of "1 to 5" may support "1 and
3-5, but not 2", or simply "wherein 2 is not included."
[0033] The entire disclosures of each patent, patent application,
and publication cited or described in this document are hereby
incorporated herein by reference.
[0034] Esketamine is the S-enantiomer of the racemic cyclohexanone
derivative ketamine, a glutamate N-Methyl-D-aspartate (NMDA)
receptor antagonist. It is indicated as an anesthetic, and is
approximately twice as potent as an anesthetic as racemic ketamine.
The chemical structure of esketamine is shown below:
##STR00001##
Esketamine is a schedule III controlled substance, and can produce
dissociative and hallucinogenic effects when subjected to misuse or
abuse. Thus, there exists a risk of abuse with respect to dosage
forms containing esketamine.
[0035] The present disclosure relates, inter alia, to oral dosage
forms comprising: (i) a first population of core-shell particles,
each of the core-shell particles of the first population comprising
a core that includes a gelling polymer and a wax; an active
pharmaceutical layer surrounding the core comprising esketamine;
and at least one layer surrounding the active pharmaceutical layer,
the at least one layer comprising a pH-sensitive film comprising a
pH-sensitive polymer that is insoluble in water at a pH greater
than 5; and, (ii) a matrix comprising a carbomer gelling polymer
and sodium bicarbonate, wherein the carbomer gelling polymer and
sodium bicarbonate are present in said dosage form in a ratio by
weight percentage of about 2:2 based on the total weight of the
dosage form. The disclosed dosage forms can exhibit an immediate
release profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0036] Unless otherwise specified, "esketamine" as used throughout
the present disclosure can also refer to isotopically-enriched
esketamine. "Esketamine" as used herein may also refer to that
compound in its free base form (i.e., base equivalent), or to a
salt of the compound, such as esketamine hydrochloride.
[0037] As used herein, esketamine that is "isotopically-enriched"
refers to a condition in which the abundance of deuterium
(.sup.2H), .sup.13C, or .sup.15N at any relevant site of the
compound is substantially more than the abundance of deuterium,
.sup.13C, or .sup.15N naturally occurring at that site in an amount
of the compound. A relevant site in a compound as used above is a
site which would be designated as "H" or "C" or "N" in a chemical
structure representation of the compound when not enriched. The
expression, "naturally occurring," as used above refers to the
abundance of the particular atom which would be present at a
relevant site in a compound if the compound was prepared without
any affirmative synthesis step to enrich the abundance of a
different isotope. Thus, for example in a "deuterium-enriched"
compound, the abundance of deuterium at any relevant site in the
chemical structure of the esketamine can range from an amount that
is substantially more than the natural abundance of deuterium
(about 0.0115%) all the way up to 100%, for example, from about 1%
to about 100%, or from about 10% to about 100%, or from about 50%
to about 100%, or from about 90% to about 100%.
[0038] Similarly, for a ".sup.13C-enriched" compound, the abundance
of .sup.13C at any relevant site in the chemical structure of the
API can range from an amount that is substantially more than the
natural abundance of .sup.13C (about 1.109%) all the way up to
100%, for example, from about 5% to about 100%, or from about 10%
to about 100%, or from about 50% to about 100%, or from about 90%
to about 100%. Similarly for a ".sup.15N-enriched" compound, the
abundance of .sup.15N at any relevant site in the chemical
structure of the esketamine can range from an amount that is
substantially more than the natural abundance of .sup.15N (about
0.364%) all the way up to 100%, for example, from about 1% to about
100%, or from about 10% to about 100%, or from about 50% to about
100%, or from about 90% to about 100%.
[0039] Isotopically-enriched compounds can generally be prepared by
conventional techniques known to those skilled in the art. Such
isotopically-enriched compounds can also be prepared by adapting
conventional processes as described in the scientific literature
for synthesis of esketamine as suitable for formulation according
to the invention, and using an appropriate isotopically-substituted
reagent (or reagents) in place of the corresponding non
isotopically-substituted reagent(s) employed in the conventional
synthesis of the non isotopically-enriched compounds. Examples of
ways to obtain a deuterium-enriched compound include exchanging
hydrogen with deuterium or synthesizing the compound with
deuterium-enriched starting materials.
[0040] As used herein, expressions such as "abuse deterrent" and
"abuse resistant", and "preventing", "deterring", "resisting", or
"inhibiting" abuse, relate to the ability of features of the
claimed formulations to provide significant physical or chemical
impediments to the use of an active pharmaceutical ingredient for
objectives other than its primary therapeutic indications. The
objective in such deterrence includes both making abuse practices
significantly more difficult to carry out, and making any product
resulting from an attempt to carry out such abuse practices on the
claimed formulations significantly less desirable, less profitable,
and less abusable to the potential abuser.
[0041] The term "immediate release", as used herein, refers to a
dosage form that upon oral ingestion by a human releases
substantially all of a contained active pharmaceutical ingredient
into a gastrointestinal tract for biological uptake in a short
time. In vitro methods of measuring a release profile of a dosage
form, for the purpose of determining whether a dosage form exhibits
an immediate release or extended release dissolution profile, are
known in the pharmaceutical arts. By such methods, examples of
immediate release dosage forms as described herein can be measured
to be capable of releasing substantially all of a total amount of
at least one type of active pharmaceutical ingredient ("API")
(e.g., esketamine), contained in the dosage form (e.g., at least
75, 80, 90, 95, 97 or 100 weight percent of the total amount of the
API in a dosage form) into a solution (e.g., acidic aqueous
solution) of a suitable pH within 240 minutes, e.g., in less than
180 minutes, less than 90 minutes, or less than 60, 30, 15, or 5
minutes. For example, a release profile of a dosage form of the
present description may be measured by a method that exposes the
dosage form to a volume of up to 900 mL (e.g., 300 mL, 500 mL, or
900 mL, based on various test methods) of hydrochloric acid (from
0.01N to 0.1N), e.g., aqueous hydrochloric acid, at a pH of from 1
to 2, and at a temperature of 37 degrees Celsius. According to some
embodiments, the dosage forms described herein release at least 90%
or at least 95% of API in less than 30 minutes when administered at
therapeutic doses (e.g., as one single dosage unit), wherein the
release profiles may be evaluated, for example, by dissolution in
500 mL of 0.01N HCl media using USP II apparatus at 50 RPM paddle
speed and 37.degree. C. In some embodiments, the 0.01N HCl medium
is subjected to deaeration based on the recommendations of USP
<1092>. A release profile of a dosage form of the present
description may alternatively be measured by a method that exposes
the dosage form to a volume of up to 900 mL (e.g., 200 mL, 300 mL,
400 mL, 500 mL, 600 mL, 700 mL, 800 mL, or 900 mL, based on various
test methods) of an aqueous buffer solution (e.g., an acetate
buffer solution) at a pH that is representative of the pH
conditions of a fed stomach, e.g., at a pH of about 4.5, and at a
temperature of 37 degrees Celsius, with or without deaeration.
[0042] The term "extended release" can be defined as not more than
75% release of the API at 30 minutes, wherein the release profiles
may be evaluated, for example, by dissolution in 400 mL of 0.1N HCl
media using USP II apparatus at 50 RPM paddle speed and 37.degree.
C. In some embodiments, the 0.1N HCl medium is subjected to
deaeration based on the recommendations of USP <1092>.
[0043] As used herein, the phrase, "administered in a manner
intended to result in administration of the esketamine in a higher
than therapeutic dose" includes administration in a manner that
would result in a C.sub.max of esketamine that is higher or
significantly higher than a therapeutic C.sub.max of esketamine
considered to be safe and efficacious for treating a particular
disease or disorder, if the esketamine was administered in a dosage
form that did not include the features of a dosage form described
herein.
[0044] According to some embodiments, the dosage forms described
herein demonstrate (i) not less than 95% of API released in 30
minutes when administered at therapeutic doses, wherein the release
profile is evaluated by dissolution in 500 mL of deaerated 0.01N
HCl media using USP II apparatus at 50 RPM paddle speed and
37.degree. C.; and (ii) not more than 75% release of the API at 30
minutes when administered at supratherapeutic doses, wherein the
release profiles may be evaluated by dissolution in 400 mL of
deaerated 0.1N HCl media using USP II apparatus at 50 RPM paddle
speed and 37.degree. C. In this context, a "supratherapeutic dose"
can be understood to correspond to administration of five or more,
six or more, seven or more, eight or more, nine or more, ten or
more, eleven or more, or twelve or more individual dose units,
e.g., tablets, simultaneously. It will also be understood that
administering multiple individual dose units simultaneously would
reasonably include administering those multiple doses sequentially
over a short time interval, e.g., over an interval of less than 60
minutes, less than 30 minutes, less than 15 minutes, less than 5
minutes, or less than one minute.
[0045] Dosage forms as described herein can be formulated to
provide an immediate release profile of esketamine, while including
effective or advantageous abuse deterrent features that are
effective to deter abuse of the API. The combination of immediate
release of esketamine with broad abuse resistance of the same API
for multiple abuse modalities including multi-tablet dosing, as
described herein, is not believed to be previously known. The
present dosage forms can also be more specifically characterized as
resistant to certain common methods of abuse, such as 1) abuse by
injection (e.g., by steps that include grinding a dosage form and
dissolving it), 2) abuse by nasal insufflation (e.g., also by
grinding and optionally dissolving the dosage form), and 3) abuse
by multi-tablet dosing by oral consumption, meaning simultaneous
oral ingestion of multiple, supratherapeutic quantities of orally
administered dosage forms such as tablets or capsules. The third
mode of abuse, multi-tablet dosing, is particularly common with
immediate release dosage forms and is particularly difficult to
defend against by design of a dosage form structure or by
formulation. Accordingly, the ability of the presently-described
dosage forms to prevent or deter abuse (or even accidental
overdose) by multi-tablet dosing represents a particularly
noteworthy feature.
[0046] In vitro testing as described herein demonstrated that the
presently disclosed dosage forms provide deterrence against abuse
by multi-tablet dosing. More specifically, in vitro testing of
exemplary dosage forms was performed by conducting dissolution
testing of one or more dosage forms (tablets) in 400 mL of
deaerated 0.1N HCL maintained at 37 degrees Celsius using a 50 RPM
paddle speed. See Example 5, infra. As shown in FIG. 4 and FIG. 5,
the amount (percentage per tablet) of esketamine released in the
media is reduced when multiple dosage units are administered
together, as opposed to when a single dosage unit is subjected to
release testing. The data also demonstrate that the tested dosage
forms are effective to prevent increased levels of esketamine
uptake by an individual who would accidentally ingest multiple
tablets, and are thereby effective to prevent or reduce the risk of
an unintentional overdose of the esketamine.
[0047] Accordingly, dosage forms as described herein provide a
method of preventing or attenuating a short-term concentration
spike of esketamine in the bloodstream of a patient who is
prescribed the drug, or in the bloodstream of an abuser who
consumes the drug for recreational purposes, in the event that a
patient or the abuser intentionally or unintentionally consumes a
supratherapeutic dose of the drug. Thus, dosage forms as described
herein can provide a method whereby a drug overdose may be
prevented, reduced, or attenuated when a subject intentionally or
unintentionally consumes a supratherapeutic dose of the drug. As a
result, dosage forms as described herein can provide a greater
amount of time for medical intervention in the case of intentional
or accidental overdose by ingestion of a supratherapeutic dose.
[0048] A "supratherapeutic dose" refers to a dose that exceeds what
would normally be prescribed for therapy with respect to a
particular disease or disorder, e.g., a dose that results in a
C.sub.max that exceeds what would normally be needed for effective
therapy of the particular disease or disorder. For example, a
supratherapeutic dose may represent four, five, six, seven, eight,
nine, ten, eleven, twelve, or more than twelve individual dosage
units (e.g., tablets, capsules, and the like).
[0049] Dosage forms as described herein can include one or more
gelling polymers. A gelling polymer can act as an abuse deterrent
feature by compromising abuse practices involving dissolution of
the active pharmaceutical ingredient of the dosage in a small
volume of solvent in an attempt to render the API more accessible
or easily isolatable. A gelling polymer can deter or prevent abuse
of the esketamine by increasing the viscosity of a combination of
the ground dosage form with solvent to an extent that is sufficient
to prevent the combination or the esketamine from being taken up by
and injected using a syringe. When exposed to a volume of solvent
such as a C.sub.1-4 alcohol (e.g., ethanol) or water, a gelling
polymer from a ground (e.g., crushed) dosage form can form a
non-injectable mass that ranges in type from an insoluble mass, to
a gel, to a viscous slurry, that exhibits a viscosity that
substantially prevents uptake by or injection from a needle of a
hypodermic syringe.
[0050] Suitable gelling polymers include one or a combination of
polymers that, as part of a dosage form, upon contact of the dosage
form with a volume of solvent, absorb the solvent and swells to
form a viscous or semi-viscous substance that significantly reduces
or minimizes the amount of free solvent that can contain an amount
of a solubilized esketamine and that can be drawn into a syringe.
The gelled polymer can also or alternatively function to reduce the
overall amount of drug that is extractable with the solvent by
entrapping the drug in a gel matrix.
[0051] At the same time, the gelling polymers used herein do not
interfere with desired dissolution of the dosage forms, the desired
release (immediate release) of esketamine from the dosage forms, or
the uptake of the esketamine by a patient ingesting the intact
immediate release dosage form for an intended therapeutic purpose.
The gelling polymer may be present in the dosage forms within a
core-shell particle that includes active pharmaceutical ingredient,
such as in a core or in a layer ("shell") surrounding the core,
wherein an amount of active pharmaceutical ingredient is contained
within the core, in a layer that is coated core, or both. Another
exemplary location is within a matrix. Gelling polymer may also or
alternatively be present in a core-shell particle that does not
include esketamine, such as in the core, or in a layer surrounding
the core.
[0052] The gelling polymer can be present in a dosage form at any
desired amount and within any portion of the present dosage forms.
The amount of gelling polymer can be any useful amount, meaning an
amount that can produce an abuse-deterrent viscous mixture or gel
if the dosage form is crushed, ground, powdered, or otherwise
similarly manipulated, and mixed with solvent. A useful amount of
total gelling polymer in a dosage form may be in a range from 0.5
to 90 weight percent gelling polymer based on a total weight of the
dosage form, e.g., from 0.7 to 20, 1 to 20, 2 to 15, 2 to 10, or 3
to 7 weight percent gelling polymer based on total weight of the
dosage form.
[0053] The presently disclosed dosage forms include core-shell
particles, and the cores of such particles preferably contain a
gelling polymer. A core (uncoated) of a core-shell particle can
contain any useful amount of gelling polymer, up to and including
100 percent gelling polymer in a core of a core-shell particle,
e.g., from 10 to 95 weight percent gelling polymer based on the
total weight of the core, such as 20 to 90, 25 to 85, 30 to 85, 40
to 85, 40 to 80, 45 to 75, 50 to 75, 55 to 70, 55 to 65, or 57 to
62 weight percent gelling polymer based on the total weight of the
core.
[0054] Described in terms of total weight of a dosage form, an
amount of gelling polymer present in a core of a core shell polymer
may be, e.g., in a range from 0.5 to 15 weight percent gelling
polymer (present in the core) per total weight of the dosage form,
such as from 1 to 10 weight percent gelling polymer (present in the
core) per total weight dosage form.
[0055] In certain embodiments, gelling polymer may also or
alternatively be provided in the matrix portion of the present
dosage forms. The types of gelling polymers in the respective
portions of the present dosage forms may be the same or different.
For example, when present, the gelling polymer in the core of the
core-shell particles may be the same or a different type as a
gelling polymer in the matrix of the dosage form.
[0056] A gelling polymer for use in the present dosage forms can be
any polymeric material that exhibits the ability to retain a
significant fraction of adsorbed solvent in its molecular
structure, e.g., the solvent being a solvent otherwise useful by an
abuser to extract API from a dosage form or a crushed or powdered
dosage form, the solvent for example being water or a C.sub.1 to
C.sub.4 alcohol such as ethanol or methanol. Exemplary gelling
polymers include materials that can swell or expand to a very high
degree when placed in contact with such a solvent. The swelling or
expansion may cause the gelling polymer to experience from a two-
to one-thousand-fold volume increase relative to the dry state.
More specific examples of gelling polymers include swellable
polymers sometimes referred to as osmopolymers or hydrogels. The
gelling polymer may be non-cross-linked, lightly crosslinked, or
highly crosslinked. The crosslinking may involve covalent or ionic
bonds with the polymer possessing the ability to swell in the
presence of a solvent, and when cross-linked will not dissolve in
the solvent.
[0057] A gelling polymer, upon dissolution or dispersion in an
aqueous solution or dispersion (e.g., water) at a concentration of
2% w/w (based on the dry material), preferably creates a
solution/dispersion with a viscosity of from about 100 to about
200,000 mPas (e.g., 4,000 to 175,000 mPas, and 4,000 to 50,000
mPas) as measured at 20 degrees Celsius (+/-0.2 degree Celsius)
using the analysis method described in the USP 33 monograph for
Hypromellose, incorporated herein by reference.
[0058] Generally suitable gelling polymers include pharmaceutically
acceptable polymers that undergo an increase in viscosity upon
contact with a solvent, as described. Various examples of polymers
are known to be useful in this manner, generally including natural
and synthetic starches (i.e., modified or pregelatinized modified
starch), natural and synthetic celluloses, acrylates, and
polyalkylene oxides. Examples of natural starches include natural
starches include corn starch, potato starch, rice starch, tapioca
starch and wheat starch, hydroxypropyl starch such as hydroxypropyl
corn starch, hydroxypropyl pea starch and hydropropyl potato starch
(derivative of natural starch). Examples of synthetic starches,
i.e., modified or pregelatinized modified starch, include
acetylated distarch adipate, waxy maize basis, acid-treated maize
starch, acid-treated waxy maize starch, distarch phosphate, waxy
maize basis, oxidized waxy maize starch, and sodium octenyl
succinate starch. Examples of celluloses include carboxymethyl
cellulose calcium, carboxymethylcellulose sodium, ethycellulose,
methylcellulose, cellulose ethers such as hydroxypropyl cellulose,
hydroxyethylcellulose, hydroxy ethyl methyl cellulose,
hydroxypropyl methyl cellulose, carboxymethylcellulose sodium, and
low substituted hydroxypropyl cellulose. Examples of acrylates
include Eudragit RS, RL, NE, NM. Examples of polyalkylene oxides
include polyethylene oxide such as POLYOX N10, N80, N60K, WSR-1105
LEO, or WSR-301 LEO, or WSR-303 LEO.
[0059] Accordingly, examples of suitable gelling polymers for use
in any component of the present dosage forms include, among others,
polyethylene oxide, polyvinyl alcohol, hydroxypropyl methyl
cellulose, hydroxypropyl cellulose, methyl cellulose, hydroxyethyl
methyl cellulose, sodium carboxymethylcellulose, hydroxyethyl
cellulose, and polyacrylic acid, and other high molecular weight
polymers capable of attaining a viscosity level effective to
prevent uptake in a syringe, if combined with a small volume of
solvent as described.
[0060] Other examples of suitable gelling polymers can include, if
of sufficiently high molecular weight: ethylcellulose, cellulose
acetate, cellulose acetate propionate, cellulose acetate butyrate,
cellulose acetate phthalate and cellulose triacetate, cellulose
ether, cellulose ester, cellulose ester ether, cellulose; acrylic
resins comprising copolymers synthesized from acrylic and
methacrylic acid esters, for example acrylic acid and methacrylic
acid copolymers, methyl methacrylate copolymers, ethoxyethyl
methacrylates, cyanoethyl methacrylate, poly(acrylic acid),
poly(methacrylic acid), methacrylic acid alkylamide copolymer,
poly(methyl methacrylate), polymethacrylate, poly(methyl
methacrylate) copolymer, polyacrylamide, aminoalkyl methacrylate
copolymer, poly(methacrylic acid anhydride), and glycidyl
methacrylate copolymers.
[0061] Exemplary gelling polymers also include natural polymers
such as those derived from a plant or animal, as well as polymers
prepared synthetically. Examples include polyhydroalkylcellulose
having a molecular weight greater than 50,000;
poly(hydroxy-alkylmethacrylate) having a molecular weight of from
5,000 to 5,000,000; poly(vinyl-pyrrolidone) having a molecular
weight of from 100,000 to 3,000,000; anionic and cationic
hydrogels; poly(electrolyte) complexes; poly(vinyl alcohol) having
a low acetate residual; a swellable mixture of agar and
carboxymethyl cellulose; a swellable composition comprising methyl
cellulose mixed with a sparingly cross-linked agar; a polyether
having a molecular weight of from 10,000 to 6,000,000;
water-swellable copolymer produced by a dispersion of finely
divided copolymer of maleic anhydride with styrene, ethylene,
propylene, or isobutylene; water swellable polymer of N-vinyl
lactams; and the like.
[0062] Other polymers useful as gelling polymers include pectin
having a molecular weight ranging from 30,000 to 300,000;
polysaccharides such as agar, acacia, karaya, tragacanth, algins
and guar; polyacrylamides; water-swellable indene maleic anhydride
polymers; Good-rite.RTM. polyacrylic acid having a molecular weight
of 80,000 to 200,000; Polyox.RTM. polyethylene oxide polymers
having a molecular weight of 100,000 to 7,000,000; starch graft
copolymers; Aqua-Keep.RTM. acrylate polymers with water
absorbability of 400 times its original weight; diesters of
polyglucan; a mixture of cross-linked polyvinyl alcohol and
poly(-vinyl-2-pyrrolidone); poly(ethylene glycol) having a
molecular weight of 4,000 to 100,000.
[0063] In certain embodiments, a gelling polymer may include
hydroxypropyl methyl cellulose (e.g., Hypromellose or HPMC), and
hydroxy methyl cellulose, methyl cellulose, hydroxyethylmethyl
cellulose, or sodium carboxymethyl cellulose. When present, a
hydroxypropyl methyl cellulose can have a molecular weight ranging
from 10,000 to 1,500,000. Examples of suitable, commercially
available hydroxypropyl methylcellulose polymers include HPMC
K100M, Methocel K100LV and Methocel K4M.
[0064] A specific class of gelling polymer of which one or more
members may be used in the present dosage forms is carbomer
polymers, which are polymers derived from acrylic acid (e.g.,
acrylic acid homopolymers) and crosslinked with polyalcohol allyl
ethers, e.g., crosslinked with polyalkenyl ethers of
pentaerythritol or sucrose. Carbomer polymers are hydrophilic and
are not substantially soluble in water. Rather, these polymers
swell when dispersed in water forming a colloidal, mucilage-like
dispersion. Carboxyl groups provided by acrylic acid residues of
the polymer backbone are responsible for certain behavior of the
polymers. Particles of this polymer can be viewed as a network
structure of polymer chains interconnected by crosslinks. The
structure can swell in water by up to one thousand times of an
original (dry) volume (and ten times an original diameter of
polymer particles) to form a gel when exposed to a pH environment
above 4-6. The pKa of these polymers can be 6.+-.0.5. Accordingly,
carboxylate groups pendant from the polymer backbone can ionize at
a pH above 6, producing a repulsion between the negatively-charged
particles, which adds to the swelling of the polymer if exposed to
solvent at this pH range.
[0065] For this reason, the presently disclosed dosage forms can
include a pH adjuster in an amount and location within the dosage
form to raise the pH of a carbomer polymer to at least 6, to
substantially neutralize the carboxylate groups. Exemplary types
and amounts of pH adjusters are discussed more fully, infra.
[0066] Carbomer polymers are often referred to in the art using
alternative terminology such as, for example, carbomer homopolymer,
acrylic acid polymers, carbomer, carboxy polymethylene,
carboxyvinyl polymer, polyacrylic acid, and poly(acrylic acid), The
USP-NF lists three umbrella monographs i.e. for "carbomer
copolymer," for "carbomer homopolymer," and for "carbomer
interpolymer."
[0067] Certain carbomer polymers that may be useful as a gelling
polymer can have an average equivalent weight of 76 per carboxyl
group. Examples of suitable commercially available carbomers
include Carbopol.RTM. 934, 934P NF, Carbopol.RTM. 974P NF and
Carbopol.RTM. 971P NF, Carbopol.RTM. 940, and Carbopol.RTM. 941,
Carbopol.RTM. 71G, commercially available from Lubrizol. Examples
of such polymers are described in U.S. Pat. Nos. 2,798,053 and
2,909,462, the entireties of which are incorporated herein by
reference. Theoretical molecular weight ranges of Carbopol.RTM.
products are in a range from 700,000 to 3 billion, theoretical
estimation. For dosage forms as described herein, a gelling polymer
(e.g., Carbopol.RTM.) can have a molecular weight and
viscosity-increasing performance that will reduce or substantially
inhibit an ability of an abuser to extract API from a combination
of dosage form and a small volume of solvent, as described, while
also being capable of being processed into a compressed dosage
form.
[0068] A gelling polymer can also be characterized by viscosity of
a solution prepared from the gelling polymer. Product information
for commercially available Carbopol.RTM. polymers reports that
viscosities of different Carbopol.RTM. polymers are as follows:
TABLE-US-00001 Type of Carbomer Viscosity specified (cP) Carbomer
Homopolymer Type A (compendial 4,000-11,000 name for Carbopol .RTM.
71G, Carbopol .RTM. 971P and Carbopol .RTM. 981) Carbomer
Homopolymer Type B (compendial 25,000-45,000 name for Carbopol
.RTM. 934P, and Carbopol .RTM. 934) Carbomer Homopolymer Type C
(compendial 40,000-60,000 name for Carbopol .RTM. 980)
(Type A and Type B viscosities measured using a Brookfield RVT, 20
rpm, neutralized to pH 7.3-7.8, 0.5 weight percent mucilage,
spindle #5.)
[0069] A further exemplary gelling polymer is the class of xanthan
gum polymers, which includes natural polymers useful as
hydrocolloids, and derived from fermentation of a carbohydrate. A
molecular weight of a Xanthan gum may be approximately 1,000,000.
Xanthan gum has been shown to provide particularly useful
extraction resistance in a dosage form as described, and therefore
may be preferred in dosage forms as described, especially if
present in an amount of at least 2 or 3 weight percent based on a
total weight of a dosage form.
[0070] Without limiting the scope of useful gelling polymers to any
specific type or molecular weight, examples of useful gelling
polymers, and useful respective molecular weights, are shown
below.
TABLE-US-00002 Gelling Polymer Weight Average Molecular Weight
Carbomer 700,000 to 3 billion (estimated) HPMC 2910 K types
164,000-1,200,000 HPMC 2910 E types 20,000-746,000
hydroxyethylcellulose 90,000-1,300,000 ethylcellulose
75,000-215,000 carboxymethylcellulose 49,000-725,000 sodium
carboxymethylcellulose 49,000-725,000 povidone 4,000-1,300,000
copovidone 47,000 hydroxypropyl cellulose 40,000-1,150,000 xanthan
gum 1,000,000 polyethylene oxide Average molecular wt:
100,000-7,000,000
[0071] The present dosage forms may optionally include another
abuse deterrent feature in the form of a wax, such as a wax/fat
material, e.g., as described in U.S. Pat. No. 8,445,018, the
entirety of which is incorporated herein by reference. The wax can
be a solid wax material that is present in the dosage form at a
location that inhibits an abuser from crushing, grinding, or
otherwise forming the dosage form into a ground powder that might
be abused by a nasal insufflation mode, or from which active
pharmaceutical agent can be easily accessed and removed such as by
dissolution or extraction using a solvent.
[0072] A wax may be present in the dosage form at a location and in
an amount to also not interfere with desired uptake of the active
pharmaceutical ingredient by a patient upon oral ingestion, in an
immediate release dosage form. An exemplary location is at a core
of a core-shell particle, especially a core that also contains
gelling polymer and that either may or may not contain active
pharmaceutical ingredient. In one embodiment, a wax is provided in
the core of core-shell particles in the present dosage forms, along
with a gelling polymer, in the absence of esketamine in the core.
Wax located at a core of a particle (e.g., a core-shell particle)
that also includes active pharmaceutical ingredient (e.g., at a
layer covering the core, or within the core) will become mixed with
the active pharmaceutical ingredient upon crushing or grinding,
etc., of the particle. In one embodiment, a wax is provided in the
core of core-shell particles in the present dosage forms, along
with a gelling polymer, in the absence of esketamine in the core.
Wax that is located at a core of such a particle (e.g., a
core-shell particle) wherein the core does not contain API will
also become mixed with the API (e.g., API present in API-containing
core-shell particles that are also present in the dosage form) upon
destructive manipulation (e.g., crushing or grinding) of the dosage
form. When the wax is mixed with the active pharmaceutical
ingredient, the active ingredient is inhibited or prevented from
becoming thereafter dissolved in a solvent such as water, or
otherwise efficiently accessed by an abuser.
[0073] A core (uncoated) of a core-shell particle can contain any
useful amount of wax, up to and including 100 percent wax, e.g.,
from 0.1 to 85 weight percent wax based on the total weight of the
core, such as 5 to 80, 10 to 70, 15 to 60, 20 to 50, 20-40, or
20-30, or in an amount of about 5, 10, 15, 20, 21, 22, 23, 24, 25,
26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 45, 50,
55, 60, 65, 70, 75, or 80 weight percent wax, based on the total
weight of the core.
[0074] The wax may be a wax (e.g., fat) material that is generally
hydrophobic and that may be either solid or liquid at room
temperature, preferably solid at room temperature (25 degrees
Celsius). Generally useful fats include those hydrophobic materials
that are fatty acid-based compounds generally having a
hydrophilic/lipophilic balance (HLB) of 6 or less, more preferably
4 or less, and most preferably 2 or less. A fat can have any
melting temperature, with preferred fats being solid at room
temperature and having a melting point that is at least 30 degrees
Celsius, e.g., at least 40 degrees Celsius, e.g., at least 50
degrees Celsius. Useful fats include fatty acids and fatty esters
that may be substituted or unsubstituted, saturated or unsaturated,
and that have a chain length of at least 10, 12, or 14 carbons. The
esters may include a fatty acid group bound to any of an alcohol,
glycol, or glycerol. With regard to glycercols, for example, mono-,
di-, and tri-fatty substituted glycerols can be useful as well as
mixtures thereof.
[0075] Suitable wax ingredients include fatty acid esters, glycerol
fatty acid esters, fatty glyceride derivatives, waxes, and fatty
alcohols such as, for example, glycerol behenate (also referred to
as glyceryl behenate, glycerin behenate, or glycerol docosanoate)
(available commercially as COMPRITOL.RTM.), glycerol
palmitostearate (PRECIROL.RTM.), glycerol monostearate, stearoyl
macroglycerides (GELUCIRE.RTM. 50/13). Other waxes more generally
include insect and animal waxes, vegetable waxes, mineral waxes,
petroleum waxes, and synthetic waxes; particularly examples include
beeswax, carnauba wax, candelilla wax, montan wax, ouricury wax,
rice-bran wax, jojoba wax, microcrystalline wax, cetyl ester wax,
cetyl alcohol, anionic emulsifying wax, nonionic emulsifying wax
and paraffin wax.
[0076] The dosage form may optionally include another component
contributing to abuse deterrence in the form of a filler or binder
material provided in a manner to compromise abuse practices wherein
an abuser crushes, grinds, or otherwise forms the dosage form into
a ground powder that might be abused by nasal insufflation, or from
which active pharmaceutical agent can be easily accessed and
removed such as by dissolution or extraction using a solvent.
[0077] The binder or filler may be present in the dosage form at a
location and in an amount to not interfere with desired uptake of
the active pharmaceutical ingredient by a patient upon oral
ingestion, in an immediate release dosage form. An exemplary
location is at a core of a core-shell particle. Suitable filler or
binder located at a core of a core-shell particle that also
includes active pharmaceutical ingredient (such as in a layer
covering the core, or within the core) will become mixed with the
active pharmaceutical ingredient upon destructive manipulation
(e.g., crushing or grinding) of the particle. As discussed
previously, the dosage form may also include core shell particles
that do not contain esketamine. A filler or binder that is located
at a core of such a particle that does not contain API will also
become mixed with the API (e.g., API present in API-containing core
shell particles that are also present in the dosage form) upon
manipulation (e.g., crushing or grinding) of the dosage form. When
a filler or binder is mixed with the active pharmaceutical
ingredient, the active pharmaceutical ingredient is inhibited or
prevented from becoming thereafter dissolved in a solvent such as
water or otherwise efficiently accessed by an abuser.
[0078] When present within the core of a core-shell particle of the
present dosage forms, filler or binder may be present in any useful
amount, up to and including 100 percent filler or binder (singly or
in combination) in a core of a core-shell particle. For example,
filler or binder may be present in the core of a core-shell
particle in an amount of from 5 to 95 weight percent filler or
binder based on total weight of the core, such as from 5 to 70, 5
to 50, 7 to 40, 10 to 30, 10 to 20, 10 to 17, 12 to 17, or 13 to 16
weight percent, or in an amount of about 5, 6, 7, 8, 9, 10, 11, 12,
13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,
30, 35, 40, 45, 50, 55, 60, 65, 70, or 80 percent by weight based
on the total weight of the core. Examples of cores that contain
high levels of filler include spherical particles that contain 100
percent sugar, and spherical particles that contain 100 percent
microcrystalline cellulose. Inert spherical filler products such as
these, having useful particle sizes, are commercially available
under the trade name Celphere.RTM., and under the trade name
Suglets.RTM. (sugar spheres, also containing starch), including as
follows: CELPHERE SCP-100 (Particle size (.mu.m) 75-212); CELPHERE
SCP-102 (Particle size (.mu.m) 106-212); CELPHERE SCP-203 (Particle
size (.mu.m) 150-300); CELPHERE SCP-305 (Particle size (.mu.m)
300-500); CELPHERE SCP-507 (Particle size (.mu.m) 500-710);
CELPHERE SCP-708 (Particle size (.mu.m) 710-850). The particle
sizes of these can be considered to be useful for any core as
described herein, prepared of any single filler, gelling polymer,
binder, any combination thereof, or any single or combination of
materials combined with API.
[0079] Another abuse deterrent feature that can be included in a
dosage form as provided herein is a film layer or coating as part
of the core-shell particles that is located over and surrounds the
portion of the particles that contains the active pharmaceutical
ingredient. When the dosage forms contain core-shell particles that
do not contain an API, the film layer may be present as a layer or
coating on such core-shell particles, as well. The film layer can
be any film layer capable of being applied as a partial or complete
film layer to core-shell particles, and to surround API (where
present).
[0080] The film layer may be prepared from, and will include any
pharmaceutically acceptable film forming polymer material, such as
one or more of a binder (e.g. as described herein, such as
hydroxypropyl cellulose, poly(methyl methacrylates), ethyl
cellulose, hydroxypropyl methyl cellulose, hydroxyl methyl
cellulose, polyvinyl alcohol, and the like), a solvent-resistant
layer, and a pH-sensitive layer (also sometimes referred to as a
reverse enteric material or layer), e.g., Eudragit.RTM. E 100. The
film layer may include any one of these materials alone (e.g., a
film layer may include 100 percent of a single one of these types
of materials), or a film layer may include a combination of two or
more of these types of materials.
[0081] A solvent-resistant layer is a film layer that retards or
prevents release of a drug in a solvent (e.g., one or more of
water, ethanol, and methanol) while still allowing the drug to
release normally in a gastrointestinal tract when ingested as an
immediate release oral dosage form. This type of abuse deterrent
feature, e.g., solvent-resistant film, can inhibit access to an API
of a dosage form by preventing or impeding an abuser from
dissolving an intact or powdered dosage form in a solvent type that
is often used by an abuser (e.g., water, ethanol, methanol). At the
same time, the solvent-resistant film can dissolve in a human
gastrointestinal tract with sufficient rapidity to allow for an
immediate release profile. As an abuse deterrent feature this type
of solvent-resistant film covers and encloses API of a core-shell
particle and acts as a film barrier or retardant to prevent or
retard access to the API by use of solvent.
[0082] A solvent-resistant film is one that does not readily or
immediately dissolve in a small volume of a solvent of the type
often used by an abuser to dissolve an API, such as any one of
water or a C.sub.1-C.sub.4 alcohol such as ethanol or methanol. A
"small volume" refers to an amount of such a solvent that can
contain an amount of dissolved API that is sufficiently
concentrated to be useful to an abuser to realize the intended
biological effect of the drug abuse, and that is also capable of
being administered for abuse of the API, e.g., a volume that can
contain an amount (concentration) of API that is effective to
achieve a desired "high" if administered by injection or nasal
insufflation, the volume also being sufficiently small to allow the
volume to be administered by injection or nasal insufflation. For a
dosage form to be useful for abuse as such, an API in the dosage
form must be capable of being accessed and dissolved at sufficient
concentration by an abuser without undue complication, into a
"small volume" of solvent, which is a volume that can be
administered by injection or by nasal insufflation. Generally, a
"small volume" of solvent means 50 milliliters or less, or 20
milliliters or less, or 10 milliliters or less, or 5 milliliters or
less (volumes which could be injected or used for nasal
insufflation).
[0083] A solvent-resistant film layer can be a film placed on a
core-shell particle that is difficult to dissolve in a "small
volume" of water or a C.sub.1-C.sub.4 alcohol such as ethanol or
methanol, e.g., that does not immediately dissolve in one or more
of water or any one of a C.sub.1-C.sub.4 alcohol, such as methanol
or ethanol. The solvent-resistant film thereby retards or prevents
an abuser from accessing an API portion of a core-shell particle if
the core-shell particle is placed in one of these solvents. The
solvent-resistant film need not be completely or substantially
insoluble in any one of these solvents, or in all of the solvents,
and it must be capable of allowing the API to be accessed with
sufficient rapidity, in a gastrointestinal tract, for the dosage
form to be useful as an immediate release dosage form.
[0084] A particular example of a solvent-resistant film is a film
that exhibits solubility properties that depend on the pH of a
solvent. An example of a solvent-resistant film may be a film that
is substantially or completely insoluble at a pH that is greater
than a pH condition of a human stomach, and that is sufficiently
soluble at a pH condition of a stomach (and gastrointestinal tract)
to allow the film to dissolve and release API with sufficient
rapidity that the dosage form can be useful as an immediate release
oral dosage form. A pH-sensitive layer is a type of
solvent-resistant film, and can be disposed in a dosage form to
surround an active pharmaceutical ingredient and inhibit or prevent
access to and dissolution of the active pharmaceutical ingredient
in a solvent outside of a stomach (e.g., at a neutral pH
environment), while still allowing the active pharmaceutical
ingredient to be efficiently released from an immediate release
dosage form at a lower pH environment of a user's stomach. This
type of abuse deterrent feature can prevent or significantly impede
an abuser's access to an active pharmaceutical agent of a dosage
form (e.g., at the core of a core-shell particle or in a layer
disposed on the core, or in both the core and the layer disposed on
the core) by use of a solvent that is outside of a stomach and that
does not have a relatively acidic pH, such as water or a
C.sub.1-C.sub.4 alcohol such as ethanol or methanol, or a mixture
thereof, having a pH that is higher than a pH found in a human
stomach, for example a pH greater than 4, greater than 5, or
greater than 5.5, or greater than 6.
[0085] A pH-sensitive layer may be useful as a solvent-resistant
film, placed in a dosage form as a layer of a core-shell particle
to surround, cover, or enclose a portion of the core-shell particle
that contains active pharmaceutical ingredient. For example, in a
core-shell particle, an active pharmaceutical ingredient may be
located at a core or in a layer outside of an uncoated or coated
core, and a solvent-resistant film in the form of a pH-sensitive
layer may be disposed as a separate layer surrounding or covering
the portion of the core-shell particle that contains the active
pharmaceutical ingredient. The pH-sensitive layer may be in direct
contact with (adjacent to) a core or a layer that includes active
pharmaceutical ingredient. Alternatively, a core-shell particle may
include one or more inter-mediate layers between a pH-sensitive
layer and a core or layer that includes active pharmaceutical
ingredient. In addition, a pH-sensitive layer may be included in
the dosage form as a layer of a core-shell particle that does not
contain either an API layer or any API.
[0086] A useful pH-sensitive layer may include a polymer or other
material that can be placed as a layer of a particle as described
herein, such as to cover a more inner layer or core that contains
active pharmaceutical ingredient, to form a pH-sensitive film
surrounding or covering active pharmaceutical ingredient. The
pH-sensitive film can be solubilized by exposure to a liquid that
exhibits a pH that may be present in a stomach of a user of the
dosage form, such as a pH below 6 or below 5.5. To function as an
abuse-deterrent feature, i.e., to inhibit or prevent efficient
access to the active pharmaceutical ingredient by exposing the
dosage form (optionally ground or powdered) to an easily-available
solvent, the pH-sensitive layer can contain polymer that is not
easily or substantially soluble at a pH that is higher than a pH
found in a human stomach, e.g., a pH greater than 6. By being
insoluble at a pH greater than 6, the pH-sensitive polymer will not
dissolve in many solvents that are readily available and commonly
used by attempted abusers to extract a water-soluble drug from a
dosage form. Examples of such solvents include water, ethanol, and
methanol.
[0087] Examples of pH-sensitive polymers that may be used in a
pH-sensitive layer in the present dosage forms include the class of
reverse enteric polymers that contain cationic-functional groups
and that exhibit pH-dependent solubility as described herein.
Examples include polymers that contain basic functional groups,
such as amino groups, and that exhibit solubility at pH conditions
found in a (human) stomach but not at relatively higher pH
conditions, e.g., not above a pH of 4, 5, or 5.5, or not above a pH
of 6. More specific examples of such pH-sensitive polymers include
copolymers of dimethyl aminoethyl methacrylates, and neutral
methacrylic acid esters; e.g., dimethyl aminoethyl methacrylate,
butyl methacrylates, and methyl methacrylates, such as at a ratio
of 2:1:1. Examples of such polymers are commercially available
under the trade name Eudragit.RTM. E 100, Eudragit.RTM. E PO,
Eudragit.RTM. E 12.5, and similar amino-functional pH-sensitive
polymers. A preferred pH-sensitive polymer is the polymer Eudragit
E 100, but any polymer that is sufficiently hydrophilic at a low pH
and hydrophobic at a higher pH to exhibit pH-dependent solubility,
may also be effective if otherwise acceptable for use in a
pharmaceutical dosage form, for example, as a non-toxic ingredient
of an oral dosage form. Reverse enteric compositions are also
described in EP 1694724 B1, titled "pH Sensitive Polymer and
Process for Preparation Thereof", incorporated herein by
reference.
[0088] When present in a coating layer of a core-shell particle,
whether that particle contains active pharmaceutical ingredient or
not, a solvent-resistant film layer may be present at any amount
useful as an abuse deterrent feature, such as in a range from 0.1
to 90 weight percent of a total weight of a core-shell particle,
e.g., from 3 to 50, 10 to 50, 20 to 50, 25 to 45, 25 to 40, 30 to
40, or 30 to 35 weight percent, or in an amount of about 3, 4, 5,
6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23,
24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40,
41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57,
58, 59, or 60 weight percent, relative to the total weight of the
core-shell particle. More generally, a useful amount
solvent-resistant film layer or polymer in a dosage form may be in
a range from 1 to 50 weight percent solvent-resistant film layer or
polymer based on a total weight of a dosage form, e.g., from 2 to
30 or from 3 to 15 weight percent solvent-resistant polymer based
on total weight dosage form.
[0089] A dosage form as presently described further includes a
disintegrant, which functions to cause the dosage form to expand
and break up during use, e.g., under the conditions within a human
stomach, to allow the active pharmaceutical ingredient of the
dosage form to be released in a manner to achieve an immediate
release profile. Disintegrants are known ingredients of
pharmaceutical dosage forms, with various examples being known and
commercially available. Examples of disintegrants include
compositions of or containing sodium starch glycolate, starch
(e.g., maize starch, potato starch, rice starch, tapioca starch,
wheat starch, corn starch and pregelatinized starch),
croscarmellose sodium, crospovidone (crosslinked polyvinyl
N-pyrrolidone or PVP) (polyplasdone XL-10), sodium starch glycolate
(EXPLOTAB.RTM. or PRIMOJEL.RTM.), any combination of the foregoing,
and other pharmaceutically acceptable materials formed into
particles having a particle size, density, and other
characteristics that are suitable to allow processing of the
disintegrant into a useful immediate release dosage form.
[0090] The disintegrant can be present in an immediate release
dosage form at any location that allows the disintegrant to
function as desired, to expand within the intact dosage form, upon
ingestion, to cause the ingested dosage form to break apart and
allow for desired immediate release of active pharmaceutical
ingredient from the dosage form, in a stomach. An exemplary
location for the disintegrant can be within the matrix, where it
can function as an excipient used to contain the core-shell
particles in a dosage form such as a compressed tablet or
capsule.
[0091] When included as an excipient of a dosage form, a
disintegrant may be present in an amount useful to achieve
immediate release of an API of a dosage form. For example, the
disintegrant may be present in an amount of 0.5 to 50, 5 to 40, 10
to 35, 15 to 30, 15 to 25, 17 to 22, or 19 to 21 weight percent, or
in an amount of about 5, 10, 12, 14, 16, 18, 19, 20, 21, 22, 24,
26, 28, 30, 35, 40, 45, or 50 weight percent, based on a total
weight of the dosage form. The amount of disintegrant in the matrix
of a dosage form can be consistent with these amounts. For example,
disintegrant can be included in a matrix (e.g., total of a dosage
form that is other than the core-shell particles) of a dosage form
in an amount in a range from 0.5 to 50 weight percent disintegrant
based on a total weight of the matrix, for example, 1 to 30 weight
percent disintegrant based on total weight matrix.
[0092] The presently disclosed dosage forms also include a pH
adjuster. A pH-adjuster can be included at a location of the dosage
form to affect pH at a specific location of the dosage form that is
only a portion of a total dosage form. As an example, a pH-adjuster
in the form of a base may be included at a location of a gelling
polymer that contains acid functionalities, to neutralize the acid
functionalities. Suitable agents that can act as a pH-adjuster
include, for example, phosphate buffering agents such as, disodium
hydrogen phosphate, sodium dihydrogen phosphate and the equivalent
potassium salts; carbonate or bicarbonate salts, such as sodium
bicarbonate, sodium carbonate, potassium bicarbonate, potassium
carbonate, magnesium carbonate and calcium carbonate; hydroxide
bases such as, sodium hydroxide, potassium hydroxide, ammonium
hydroxide; and amine bases such as, triethanolamine, tromethamine,
aminomethyl propanol, and tetrahydroxypropyl ethylenediamine.
[0093] The amount of pH-adjuster included at the location of the
gelling polymer can be an amount effective to neutralize the acid
functionalities of the gelling polymer at that location. More
specifically, a component of a dosage form as described that
includes an acid-functional gelling polymer such as a carbomer may
include a base in an amount and location to neutralize the acid
functionalities of that polymer. The pH-adjuster can be located at
a location effective to cause such neutralization, e.g., at the
location of the dosage form that contains the acid-functional
gelling polymer, for example at a core of a core-shell particle or
as part of a matrix.
[0094] According to some embodiments, the pH adjuster is in the
present dosage forms in an amount that is from about 0.5 to about 5
percent by weight, from about 1 to about 4 percent by weight, from
about 1.5 to about 4 percent by weight, from about 2 to about 3
percent by weight, or in an amount of about 0.5, 1, 1.5, 2, 2.5, 3,
3.5, 4, 4.5, or 5 percent by weight, based on the total weight of
the dosage form.
[0095] As noted above, it has presently been discovered that
specific ratios of gelling polymer, particularly carbomer gelling
polymer, to pH adjusting compound, within the matrix of the present
dosage forms can be critical for allowing the dosage form, when
administered in supratherapeutic doses, to produce a gel having
superior physical characteristics for purposes of thwarting abuse
of esketamine from the dosage forms. In one embodiment, the dosage
form includes a matrix that includes a carbomer gelling polymer and
a pH adjuster that are present in a ratio of 2:2 weight percent,
based on the total weight of the dosage form. For example, the
dosage form can include a matrix that includes a carbomer gelling
polymer and sodium bicarbonate pH adjuster that are present in a
ratio of 2:2 weight percent, based on the total weight of the
dosage form. As described more fully in the Examples that follow,
the gels that result from such dosage forms when administered in
supratherapeutic doses possess traits that are optimal for
functioning as an abuse deterrent feature, as compared with gels
that are formed following administration of previous dosage forms
in supratherapeutic doses.
[0096] For example, with respect to the dosage forms that contain a
carbomer gelling polymer and sodium bicarbonate pH adjuster that
are present in a ratio of 2:2 weight percent, based on the total
weight of the dosage form, supratherapeutic doses of such dosage
forms can produce a gel in 15 minutes or less, such as in 15, 14,
13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 minute following
exposure to an aqueous medium comprising 0.025 N HCl and 70 mM NaCl
at 37.degree. C. The supratherapeutic dose may be, for example, 15,
14, 13, 12, 11, 10, 9, or 8 individual dosage units.
[0097] In certain embodiments, the dosage forms are such that when
a dual screen apparatus with a top screen and a bottom screen is
used to extract at least a portion of a gel that is formed in an
aqueous medium comprising 0.025 N HCl and 70 mM NaCl at 37.degree.
C. from a supratherapeutic dose of the dosage forms from the
medium, a first quantity of the gel adheres to a lower surface of
the top screen of the apparatus, and a second quantity of the gel
adheres to a upper surface of the bottom screen of the apparatus,
and the vertical thickness of the second quantity is at least twice
the vertical thickness of the first quantity.
[0098] The gels that are formed in an aqueous medium comprising
0.025 N HCl and 70 mM NaCl at 37.degree. C. from a supratherapeutic
dose of the present dosage forms may also be characterized as being
substantially uniformly dispersed with the medium. This means, for
example, that the gel that is formed within the medium does not
include a greater concentration of gel within any particular
portion of the medium, such as within the upper portion or within
the lower portion of the medium. In other words, the concentration
of gel within the medium is substantially homogenous upon visual
inspection within all portions of the medium, including within the
upper portion of the medium and within the lower portion of the
medium, respectively. A gel that is substantially uniformly
dispersed within the medium in which it is formed may also be
characterized by an absence of portions of gel that are
interspersed with portions of medium that do not contain gel. This
can be described as the condition wherein visually readily apparent
clumps of gel are suspended in the medium. As described below, FIG.
9 illustrates the characteristic of a gel formed from dosage forms
as disclosed herein of being substantially uniformly dispersed.
[0099] The above-described characteristics are indicative of the
fact that the gels that are formed from the present dosage forms in
a medium as described herein are thick and viscous, with a uniform
dispersion within the medium. These attributes, in turn, enhance
the ability of the present dosage forms to resist uptake by or
injection from a needle of a hypodermic syringe when combined with
a solvent in supratherapeutic doses, and also or alternatively to
reduce the overall amount of drug that is extractable with a
solvent by entrapping the drug in a gel matrix.
[0100] A dosage form as described can also include any of various
known and conventional pharmaceutical excipients that may be useful
to achieve desired processing and performance properties of an
immediate release dosage form. These excipients may include
disintegrants, fillers, binders, lubricants, glidants, and coloring
agents, and can be included in core-shell particles or in a matrix
(e.g., compressed matrix) of a tablet or capsule. A more detailed
description of pharmaceutical excipients that may also be included
in the tablets of the present invention can be found in The
Handbook of Pharmaceutical Excipients, 5th ed. (2006). As noted
above, one or more of these excipients, such as the binder, filler,
or both, may contribute to abuse deterrence in a manner to
compromise abuse practices wherein an abuser crushes, grinds, or
otherwise forms the dosage form into a ground powder that might be
abused by nasal insufflation, or from which active pharmaceutical
agent can be easily accessed and removed such as by dissolution or
extraction using a solvent.
[0101] Examples of fillers that may be useful in an immediate
release dosage form as described include lactose, starch, dextrose,
sucrose, fructose, maltose, mannitol, sorbitol, kaolin,
microcrystalline cellulose, powdered cellulose, calcium sulfate,
calcium phosphate, dicalcium phosphate, lactitol or any combination
of the foregoing. As compared to non-filler ingredients such as
gelling polymers, a filler will have a molecular weight that does
not result in a substantial viscosity increase or formation of a
gel as described herein for a gelling polymer, if combined with a
solvent such as water.
[0102] A filler may be present in any portion of a dosage form as
described, including a core-shell particle; the filler may be
present in a core, in a layer containing an active pharmaceutical
ingredient that is disposed on the core, in a solvent resistant
film, in the matrix, or in two or more of these portions of the
dosage form. The filler may be present at any one or more of these
portions of a dosage form in an amount to provide desired
processing or functional properties of a portion of the dosage form
and of the entire dosage form. The amount of total filler in a
dosage form can also be as desired to provide desired
functionality, including an immediate release profile, for example,
in an amount of greater than 0 to 80, 5 to 50, 5 to 40, 10 to 30,
12 to 25, or 12 to 15 weight percent, or in an amount of about 2,
4, 5, 7, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, or
40 weight percent filler based upon the total weight of the dosage
form.
[0103] Examples of binders that may be included in a dosage form as
described herein include polymeric material such as alginic acid,
sodium carboxymethylcellulose, microcrystalline cellulose, dextrin,
ethylcellulose, gelatin, starch, pregelatinized starch, polyvinyl
alcohol, polyethylene oxide, polyvinylpyrrolidone, polyacrylamides,
polyvinyloxoazolidone, polyvinylalcohols, methylcellulose,
hydroxypropyl cellulose, hydroxymethyl cellulose and any
combination of two or more of these. A binder may be a
water-soluble material. As compared to non-binder ingredients such
as a gelling polymer, a binder is of a molecular weight that does
not result in formation of a gel or a highly viscous composition
upon combining with a small volume of water. A binder can exhibit a
relatively low molecular weight as compared to a gelling polymer,
and a relatively lower viscosity (e.g., when measured in a 2%
aqueous solution). Polymer useful as a binder may typically have a
molecular weight of less than 50,000, e.g., less than 30,000, or
less than 10,000.
[0104] A binder may be present in any portion of the present dosage
forms, including in a core or a film or coating of a core-shell
particle, or as part of an excipient mixture to contain or bind
core-shells particles in a dosage form, i.e., within the matrix of
a dosage form as described herein. Filler may be included in a core
of a core-shell particle in combination with active pharmaceutical
ingredient, gelling polymer or both; as part of an active
pharmaceutical layer located over a core or another layer of a
core-shell particle; as part of a solvent-resistant film; or,
within an excipient mixture (matrix) useful to bind particles into
a dosage form. A binder may be present at any one or more of these
portions of an immediate release dosage form as described, in an
amount to provide desired processing or functional properties in
each portion of the dosage form and of the overall dosage form. The
amount of total binder in a dosage form can also be as desired to
provide desired functionality, including immediate release
functionality. For example, a binder may be provided in an amount
of about 0.1 to 40, 5 to 40, 10 to 30, 12 to 25, or 12 to 15 weight
percent, or in an amount of about 2, 4, 5, 7, 9, 10, 12, 13, 14,
15, 16, 17, 18, 19, 20, 25, 30, 35, or 40 weight percent binder
based upon the total weight of the dosage form.
[0105] Examples of lubricants include inorganic materials such as
talc (a hydrated magnesium silicate; polymers, such as, PEG 4000;
fatty acids, such as stearic acid; fatty acid esters, such as
glyceride esters (e.g., glyceryl monostearate, glyceryl
tribehenate, and glyceryl dibehenate); sugar esters (e.g., sorbitan
monostearate and sucrose monopalmitate); glyceryl dibehenate
(Compritol.RTM. 888 ATO); and metal salts of fatty acids (e.g.,
magnesium stearate, calcium stearate, and zinc stearate).
Accordingly, commonly used lubricants include talc, glyceryl
monostearates, calcium stearate, magnesium stearate, stearic acid,
glyceryl behenate, polyethylene glycol, poloxamer and combinations
of the foregoing. A lubricant may be included in an immediate
release dosage form as described, in any useful amount, such as an
amount of about 0.1 to 10 weight percent lubricant based on a total
weight of a dosage form, e.g., from 0.2 to 7, 0.3 to 5, 0.5 to 3,
0.7 to 2, or 0.9 to 1.5 weight percent, or in an amount of about
0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 2, 3, 4, or 5
weight percent, based on the total weight of the dosage form.
[0106] Examples of glidants include colloidal silicon dioxide,
untreated fumed silica (e.g., as available under the trade name
Cab-O-Sil.RTM.), and crystalline or fused quartz. Glidant may be
included in an immediate release dosage form as described, in any
useful amount. For example, a glidant may be included in an amount
of 0.05 to 5, 0.08 to 3, 0.1 to 2, 0.15 to 1.5, 0.15 to 1, or 0.2
to 0.5 weight percent, or in an amount of about 0.01, 0.03, 0.05,
0.1, 0.13, 0.15, 0.17, 0.2, 0.22, 0.25, 0.27, 0.3, 0.35, 0.4, 0.5,
0.7, 0.9, 1.0, 1.2, 1.4, 1.5, 1.6, 1.8, or 2 percent by weight,
based on the total weight of the dosage form.
[0107] Examples of coloring agents include FD&C-type dyes and
lakes, fruit and vegetable extracts, titanium dioxide, iron oxides
and mixtures thereof. A coloring agent may be incorporated into a
dosage form by blending (e.g., co-milling and blending) the
coloring agent with any other ingredient. Alternately, coloring
agent may be applied to an outer surface of a dosage form.
[0108] Esketamine, alone or in combination with one or more other
active pharmaceutical ingredients, are included in the immediate
release dosage forms as described herein. The esketamine may be
present in its free base form or as a salt. An exemplary esketamine
salt is esketamine hydrochloride.
[0109] With abuse deterrent features as described herein, some
being operative based on specific structural or compositional
features of a core-shell particle, the esketamine can be located in
the dosage form at a location to cause the API to be subject to
abuse deterrent features of the core-shell particles, e.g., at a
core or inner layer of a core-shell particle.
[0110] The amount of esketamine in the dosage forms disclosed
herein can be any useful amount, as is known and as may be found in
relevant literature. For example, typical therapeutic amounts of
esketamine are 5 mg, 10 mg, 20 mg, 30 mg, 40 mg. 50 mg, 60 mg, 70
mg. 80 mg, 90 mg, or 100 mg. Often, when processed into a suitable
immediate release dosage form, the esketamine can be present in
such dosage form in an amount normally prescribed, typically 0.5 to
25 percent on a dry weight basis, based on the total weight of the
dosage form. In other embodiments, a dosage form contains any
appropriate amount of esketamine to provide a therapeutic effect.
When present in the core-shell particles of the dosage forms, the
amount of esketamine in a core-shell particle may be about 10 to
about 40% by weight, based on the total weight of the core-shell
particle. For example, the esketamine may be present in an amount
of about 10 to 35, 12 to 35, or 15 to 35 weight percent, or in an
amount of about 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,
23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, or 35 weight
percent, based on the total weight of the core-shell particle.
[0111] The presently disclosed dosage forms can optionally include
one or more additional active pharmaceutical ingredients of a type
that is not commonly susceptible to abuse. These additional APIs
may be any suitable or desired API, such as those in the class of
non-steroidal analgesic drugs. The expression "non-steroidal
analgesic drugs" as used herein refers to drugs that include those
commonly referred to as non-steroidal anti-inflammatory drugs, or
"NSAIDS," and acetaminophen, which is non-steroidal, but does not
act via an inflammation mechanism. Accordingly, the term
"non-steroidal analgesic drugs" would include acetaminophen, and
also include NSAIDS such as aspirin, ibuprofen, and naproxen. The
present dosage forms also exhibit immediate release properties with
respect to these APIs that are not commonly subject to abuse. Such
APIs can be present in the dosage form at any useful level,
typically 0.5 to 25, e.g., 1 to 10 weight percent of the API on a
dry weight basis, based on a total weight of the dosage form, e.g.,
at a level of or between 5, 25, 50, 75, 100, 125, 150, 175, 200,
300, 325, 500, 750 or up to or exceeding 1000 milligram (mg) per
dosage form unit. As a general matter, the present dosage forms can
contain an appropriate amount of an API that is not commonly
subject to abuse in order to provide a therapeutic effect that is
associated with such additional API.
[0112] The present dosage forms can include one or more of the
described abuse deterrent features alone or in combination; e.g.,
one or more of gelling polymer as part of a core-shell particle
(e.g., at a core of the core-shell particle); wax as part of a
core-shell particle (e.g., at a core of the core-shell particle);
binder or filler as part of a core-shell particle (e.g., at a core
of the core-shell particle); a film layer that may optionally be a
solvent-resistant film (e.g., pH-sensitive film) as part of a
core-shell layer; or gelling polymer as a component of an excipient
or binder (i.e., a matrix) used to hold core-shell particles
together. With these abuse deterrent features, other types of known
abuse deterrent features may not be necessary and may be
specifically excluded from the present dosage forms. Thus, certain
embodiments of the described dosage forms can specifically exclude
any of the abuse deterrent features described herein.
[0113] As for additional abuse deterrent features, the present
dosage forms can optionally include a nasal irritant to discourage
or prevent abuse by nasal insufflation. The nasal irritant can be a
mucous membrane irritant or nasal passageway irritant that, if
inhaled through a nasal passageway when contained in a ground or
powdered dosage form, can induce pain or irritation of the abuser's
nasal passageway tissue. Examples include surfactants such as
sodium lauryl sulfate, poloxamer, sorbitan monoesters, and glyceryl
monooleates. Certain particular embodiments of dosage forms of the
present description do not require, and can specifically exclude,
nasal irritant agents such as those described above.
[0114] The present dosage forms can include an emetic agent, to
cause vomiting. Certain particular embodiments of dosage forms of
the present description do not require and can specifically exclude
an emetic agent.
[0115] The present dosage forms can include an effervescent agent
that acts as a deterrent to abuse by nasal insufflation. The
effervescent includes an acidic component and a basic component
that release a gas such as oxygen or carbon dioxide when combined
in the presence of an aqueous media, such as upon nasal
insufflation. See, e.g., WO 2013/077851, the entirety of which is
incorporated herein by reference. The acid source may be, for
example, citric acid, tartaric acid, malic acid, maleic acid,
lactic acid, glycolic acid, ascorbic acid, fumaric acid, adipic
acid, succinic acid, salts thereof, and combinations thereof. The
base may be, for example, a carbonate or bicarbonate. Dosage forms
of the present description do not require, and can specifically
exclude, an effervescent agent in the form of an acid and a base
that can combine to a gas such as oxygen or carbon dioxide.
[0116] In one exemplary embodiment, the present oral dosage forms
represent compressed tablets and comprise
[0117] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine; and at least one layer surrounding the active
pharmaceutical layer, the at least one layer comprising a
pH-sensitive film comprising Eudragit E 100; and,
[0118] (ii) a matrix comprising a carbomer gelling polymer, and
sodium bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in said dosage form in a ratio by weight
percentage of about 2:2 based on the total weight of the dosage
form, and optionally one or more of a disintegrant, a filler, or a
binder;
[0119] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0120] In a further embodiment, the present oral dosage forms
represent compressed tablets and comprise
[0121] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine; and at least one layer surrounding the active
pharmaceutical layer, the at least one layer comprising a
pH-sensitive film comprising Eudragit E 100; and,
[0122] (ii) a matrix comprising a carbomer gelling polymer, and
sodium bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in said dosage form in a ratio by weight
percentage of about 2:2 based on the total weight of the dosage
form, and optionally one or more of a disintegrant, a filler, a
glidant, a lubricant, or a binder;
[0123] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses
[0124] In a further embodiment, the present oral dosage forms
represent compressed tablets and comprise
[0125] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine and hydroxypropylmethycellulose; and at least one layer
surrounding the active pharmaceutical layer, the at least one layer
comprising a pH-sensitive film comprising Eudragit E 100 and
magnesium stearate; and,
[0126] (ii) a matrix comprising crospovidone, mannitol,
microcrystalline cellulose, silicon dioxide, magnesium stearate, a
carbomer gelling polymer, and sodium bicarbonate, wherein the
carbomer gelling polymer and sodium bicarbonate are present in said
dosage form in a ratio by weight percentage of about 2:2 based on
the total weight of the dosage form;
[0127] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0128] In a further exemplary embodiment, the present oral dosage
forms represent compressed tablets and comprise
[0129] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine; and at least one layer surrounding the active
pharmaceutical layer, the at least one layer comprising a
pH-sensitive film comprising Eudragit E 100;
[0130] (ii) a second population of core-shell particles that do not
include an active pharmaceutical layer;
[0131] and,
[0132] (iii) a matrix comprising a disintegrant, a filler, a
binder, a carbomer gelling polymer, and sodium bicarbonate, wherein
the carbomer gelling polymer and sodium bicarbonate are present in
said dosage form in a ratio by weight percentage of about 2:2 based
on the total weight of the dosage form;
[0133] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0134] In yet another embodiment, the present oral dosage forms
represent compressed tablets and comprise
[0135] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine and hydroxypropylmethycellulose; and at least one layer
surrounding the active pharmaceutical layer, the at least one layer
comprising a pH-sensitive film comprising Eudragit E 100 and
magnesium stearate;
[0136] (ii) a second population of core-shell particles that do not
include an active pharmaceutical layer; and,
[0137] (iii) a matrix comprising crospovidone, mannitol,
microcrystalline cellulose, silicon dioxide, magnesium stearate, a
carbomer gelling polymer, and sodium bicarbonate, wherein the
carbomer gelling polymer and sodium bicarbonate are present in said
dosage form in a ratio by weight percentage of about 2:2 based on
the total weight of the dosage form;
[0138] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0139] In still another embodiment, the present oral dosage forms
represent compressed tablets and comprise
[0140] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate; an active pharmaceutical layer
surrounding the core, the active pharmaceutical layer comprising
esketamine and hydroxypropylmethycellulose; and at least one layer
surrounding the active pharmaceutical layer, the at least one layer
comprising a pH-sensitive film comprising Eudragit E 100 and
magnesium stearate;
[0141] (ii) a second population of core-shell particles that do not
include an active pharmaceutical layer, wherein each of the
core-shell particles of the second population comprises a core that
includes a gelling polymer that is hydroxypropylmethycellulose and
a wax that is glyceryl behenate, and a shell that includes a
pH-sensitive film comprising Eudragit E 100 and magnesium stearate;
and,
[0142] (iii) a matrix comprising crospovidone, mannitol,
microcrystalline cellulose, silicon dioxide, magnesium stearate, a
carbomer gelling polymer, and sodium bicarbonate, wherein the
carbomer gelling polymer and sodium bicarbonate are present in said
dosage form in a ratio by weight percentage of about 2:2 based on
the total weight of the dosage form;
[0143] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic
doses.
[0144] According to further embodiments, provided herein are abuse
resistant oral dosage forms for the administration of esketamine to
a subject comprising: (i) a first population of core-shell
particles, each of the core-shell particles of the first population
comprising a core, an active pharmaceutical layer surrounding the
core, the active pharmaceutical layer comprising esketamine or a
pharmaceutically acceptable salt thereof, and at least one layer
surrounding the active pharmaceutical layer, the at least one layer
comprising a pH-sensitive film comprising a pH-sensitive polymer
that is insoluble in water at a pH greater than 5; and, (ii) a
matrix comprising a carbomer gelling polymer and sodium
bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in a ratio by weight percentage of about
2:2 based on the total weight of the dosage form; wherein the
dosage form exhibits an immediate release profile of esketamine
having not less than 90% of the esketamine released in 60 minutes,
wherein the release profile is evaluated by dissolution of the
tablet in 300 mL of 0.1N HCl media using USP II apparatus at 50 RPM
paddle speed and 37.degree. C.; wherein the dosage form exhibits an
immediate release profile of the esketamine when administered to a
human in therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic doses,
or wherein the dosage form exhibits abuse resistant properties when
physically manipulated, or wherein the dosage form exhibits abuse
resistant properties when physically manipulated and administered
in a manner not consistent with oral dosing, or wherein the dosage
form exhibits abuse resistant properties when administered in a
manner intended to result in administration of the esketamine in a
higher than therapeutic dose.
[0145] In accordance with some of these embodiments, when the
dosage form is physically manipulated by crushing to form a
population of particles, a relatively low proportion of the
population comprises a subpopulation of particles having a particle
size of less than 75 .mu.m. For example, less than 25, 20, 19, 18,
17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, or 5 wt % of such
particles can comprise a subpopulation of particles having a
particle size of less than 75 .mu.m. In some embodiments, 1, 2, 3,
4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 27, 18, 19, or 20% of
the population of particles comprises a subpopulation of particles
having a particle size of less than 75 .mu.m.
[0146] As used throughout the present disclosure, "crushing" or
"crushed" refers to a sample that has been physically manipulated
by mechanical means thereby leading to the sample's partial or
complete disintegration, wherein the manipulation takes place for a
time period of up to about 90 seconds and wherein at the completion
of the manipulation, less than 10% of the recovered sample has a
particle size of >500 .mu.m and, by weight, more than about 99%
of the sample can be recovered.
[0147] In certain of these embodiments, when the dosage form is
physically manipulated by crushing to form a population of
particles, less than 40 wt. % (e.g., 0 wt % to 39.5 wt. %, 10 wt. %
to 39.5 wt. %, 10 wt % to 30 wt. %, 10 wt % to 20 wt. %, about 39.5
wt. %, 39 wt. %, 38.5 wt. %, 38 wt. %, 37.5 wt. %, 37 wt. %, 36.5
wt. %, 36 wt. %, or 35.5 wt. %) of the population of particles
comprises a subpopulation of particles having a particle size of
less than 106 .mu.m, and wherein said subpopulation contains less
than 10 wt. % base equivalent (e.g., less than about 9.5 wt. %, 9
wt. %, 8.5 wt. %, 8 wt. %, 7.5 wt. %, 7 wt. %, 6.5 wt. %, 6 wt. %,
5.5 wt. %, 5 wt. %) of the esketamine of said dosage form. In some
embodiments, when the dosage form is physically manipulated by
crushing to form a population of particles, less than 35 wt. %
(e.g., less than about 34.5, 34, 33.5, 33, 32.5, or 32 wt. %)
comprises a subpopulation of particles having a particle size of
212-500 .mu.m and containing less than 70 wt. % base equivalent
(e.g., less than about 69, 68, 67, 66, 65, 64, 63, 62, 61, 60, 58,
55 or 50 wt. %) of the esketamine of said dosage form. In some
embodiments, when the dosage form is physically manipulated by
crushing to form a population of particles, less than 30 wt. %
(e.g., less than about 29, 28, 27, 26, 25, 24, 22 or 20 wt. %)
comprises a subpopulation of particles having a particle size of
106-212 .mu.m and wherein the subpopulation of particles contains
less than 20 wt. % base equivalent (e.g., less than about 19.5, 19,
18, 17, 16, 15, 14, 13, 12, 11, or 10 wt. %) of the esketamine of
said dosage form.
[0148] In certain embodiments, the present dosage forms exhibit one
or more of the abuse resistant properties when the dosage form is
physically manipulated by crushing and subsequently heating prior
to the administration in a manner not consistent with oral dosing
or in a manner that would result in administration of the
esketamine in a higher than therapeutic dose (e.g., higher than
therapeutic C.sub.max), if a control dosage form were similarly
administered. As described more fully in the examples below, one or
more of the abuse resistant properties of the present dosage forms
remain effective to prevent successful attempts to administer the
active ingredient in a dose that is not consistent with therapeutic
use of the dosage form, even when subjected to physical
manipulation (e.g., crushing) and subsequent heating, which
otherwise represents a commonly used approach to defeat, for
example, gelling properties of a dosage form. In certain
embodiments, the heating comprises subjecting the physically
manipulated (e.g., crushed) dosage form to a temperature of about
200.degree. C-300.degree. C. For example, the heating may be
performed at a temperature of about 200, 210, 220, 230, 240, 250,
260, 270, 280, 290, or 300.degree. C. The heating of the physically
manipulated dosage form may have a duration of at least one minute.
For example, the heating may have a duration of about 1, 2, 3, 4,
5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20
minutes, or longer. The heated, physically manipulated dosage forms
according to the present disclosure may release less esketamine
(base equivalent) after incubation in water or 0.1 N HCl for up to
18 hours, as compared to the release of esketamine from a
physically manipulated dosage form control that has not been heated
prior to incubation in water or 0.1 N HCl for up to 18 hours. In
some embodiments, the heated, physically manipulated dosage form
releases at least 20 wt. % less esketamine, as compared to the
release of esketamine (base equivalent) from a physically
manipulated dosage form control that has not been heated prior to
incubation in water or 0.1 N HCl for up to 18 hours. For example,
the heated, physically manipulated dosage form may release about
20-55, 20-50, 23-50, 25-45, 30-40, or 35-40 wt. % less esketamine,
or about 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33,
34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50,
51, 52, 53, 54, or 55 wt. % less esketamine, as compared to the
release of esketamine (base equivalent) from a physically
manipulated dosage form control that has not been heated prior to
incubation in water or 0.1 N HCl for up to 18 hours.
[0149] The present dosage forms may also resist attempted abuse by
physical manipulation (e.g., crushing and optionally wetting)
followed by nasal insufflation, which represents a further commonly
used approach for attempted abuse of an active ingredient from a
dosage form. This characteristic is described more fully in
connection with the examples, infra. With respect to certain
embodiments, upon physically manipulating the dosage form by
crushing, the physically manipulated dosage form exhibits less than
5 wt. % (e.g., less than about 4.9, 4.8, 4.7, 4.6, 4.5, 4.4, 4.3,
4.2, 4.1, 4, 3.9, 3.8, 3.7, 3.6, 3.5, 3.4, 3.3, 3.2, 3.1, 3 wt. %)
the esketamine diffusion of powdered pure esketamine or a
pharmaceutically acceptable salt thereof, over 60 minutes across a
membrane having a molecular weight cutoff of 12-14 kD from a
receptor chamber containing a phosphate buffer at pH 6.4 and
maintained at 37.degree. C. In some embodiments, wherein upon
physically manipulating the dosage form by crushing, the physically
manipulated dosage form exhibits less esketamine diffusion across
nasal membranes of a human subject when nasally insufflated by the
subject, relative to a solution of 140 mg/ml esketamine (base
equivalent) in pH 4.5 citrate buffer. With respect to some
embodiments, wherein upon physically manipulating the dosage form
by crushing, the physically manipulated dosage form exhibits less
than 5% the relative esketamine diffusion of a solution of 140
mg/ml esketamine (base equivalent) in pH 4.5 citrate buffer, over
60 minutes across a membrane having a molecular weight cutoff of
12-14 kD from a receptor chamber containing a phosphate buffer at
pH 6.4 and maintained at 37.degree. C. In some embodiments, wherein
upon physically manipulating the dosage form by crushing, the
absorption of esketamine from the physically manipulated dosage
form over 60 minutes across a membrane having a molecular weight
cutoff of 12-14 kD from a receptor chamber containing a phosphate
buffer at pH 6.4 and maintained at 37.degree. C. is less than 20%,
e.g., about 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5,
4, 3, or 2%. With respect to these embodiments, the physically
manipulated dosage form according to the present disclosure may be
dry or pre-wetted prior to the aforementioned assessment of
absorption across a membrane.
[0150] The present disclosure also provides oral tablets for the
administration of esketamine to a subject comprising: a total
weight of not less than 800 mg (e.g., not less than about 800, 816,
833, 851, 870, 889, 909, 930, 952, 976, 1000, 1026, 1053, 1081,
1111, 1143, 1176, 1212, 1250, 1290, 1333 mg), and having 40 mg of
esketamine (base equivalent), the esketamine (base equivalent)
representing less than 5.0% (e.g., less than about 4.9, 4.8, 4.7,
4.6, 4.5, 4.4, 4.3, 4.2, 4.1, 4.0, 3.9, 3.8, 3.7, 3.6, 3.5, 3.4,
3.3, 3.2, 3.1, 3.0%) by weight of the total weight of the tablet.
In other aspects, the disclosure provides oral tablets for the
administration of esketamine to a subject comprising: a total
weight of not less than 571 mg (e.g., not less than about 571, 588,
606, 625, 667, 690, 714, 741, 769, 800, 833, 870, 909, 952, 1000,
1053, 1111, 1176, 1250, 1333 mg), and having 20 mg of esketamine
(base equivalent), the esketamine (base equivalent) representing
less than 3.5% (e.g., less than about 3.5, 3.4, 3.3, 3.2, 3.1, 3.0.
2.9.2.8, 2.7, 2.6, 2.5, 2.4, 2.3, 2.2, 2.1, 2.0, 1.9, 1.8, 1.7,
1.6, 1.5%) by weight of the total weight of the tablet. In these
aspects, the tablet exhibits an immediate release profile of
esketamine, having not less than 90% of the esketamine released in
60 minutes, and wherein the release profile is evaluated by
dissolution of the tablet in 300 mL of 0.1N HCl media using USP II
apparatus at 50 RPM paddle speed and 37.degree. C.; and wherein the
tablet exhibits an immediate release profile of the esketamine when
administered to a human in therapeutic doses, and an extended
release profile of the esketamine when administered to a human in
supratherapeutic doses, or wherein the tablet exhibits abuse
resistant properties when physically manipulated, or wherein the
tablet exhibits abuse resistant properties when physically
manipulated and administered in a manner not consistent with oral
dosing, or wherein the tablet exhibits abuse resistant properties
when administered in a manner intended to result in administration
of the esketamine in a higher than therapeutic dose.
[0151] Also disclosed herein are methods for reducing the potential
for abuse by a human of an active pharmaceutical ingredient
comprising esketamine by simultaneous oral ingestion of multiple
dosage units comprising the active pharmaceutical ingredient,
comprising providing to the human a dosage form according to any of
the embodiments described herein.
[0152] The present disclosure also provides methods for reducing
the potential for abuse by nasal insufflation by a human of an
active pharmaceutical ingredient comprising esketamine, comprising
providing to the human a dosage form according to any of the
embodiments described herein.
[0153] Also provided are methods for treating or preventing pain or
discomfort in a subject in need thereof by administering to the
subject a dosage form according to any of the embodiments described
herein. Likewise, the present disclosure provides methods for
treating depression in a subject in need thereof by administering
to the subject a dosage form according to any of the embodiments
described herein.
[0154] Referring to FIGS. 1A and 1B, a dosage form can include
particles 10A that contain esketamine. The particle (e.g., coated
particle or "core-shell" particle) can include a core 12A (or
"uncoated core"), which may be coated with one or more layers,
films or coatings, e.g., 14a, 16a, or any additional layer or
coating that is coated over, underneath, or intermediate to these.
In FIGS. 1B and 1C, the layer designated 16A may be a
drug-containing layer, and the layer designated as 14A may be a
solvent resistant, e.g., a pH sensitive film layer. Particle 10A
can contain one or more of the ingredients described herein, such
as esketamine, a gelling polymer, optional wax, optional
solvent-resistant layer, as well as one or more additional layer or
layers under, over, or intermediate to these layers or between
either layer and the core. Each layer can be present in size or
amount (e.g., thickness) that will result in a useful immediate
release dosage form having one or more of the presently described
abuse deterrent features. Other optional components of a core or
layer of particle 10A can be filler, binder, other excipient, or
solvent (not more than a residual amount, if any) such as water or
ethanol for use in preparing the coated particle, and that is
substantially removed after formation of the core, coating, or
coated particle. Examples of the core 10A can include any amount or
combination of the different ingredients of: a gelling polymer
(e.g., from 0 to 100 percent of a core), filler as described herein
such as sugar (mannitol) or microcrystalline cellulose (e.g., from
0 to 100 percent of a core), binder (e.g., from 0 to 100 percent of
a core), and wax (e.g., from 0 to 100 percent of a core).
[0155] While the present dosage forms containing core-shell
particles 10A are new and inventive, certain method steps useful to
prepare these particles may be known. Available methods include
certain methods and processing steps known to be useful for
preparing particles and coated particles in the pharmaceutical
arts. A core-shell particle 10A can be prepared by an initial step
of mixing ingredients of core 12A with a solvent such as water or
ethanol and forming the mixture into a spherical core particle by
known methods. The particle may be dried and separated by size, and
then one or more coating in the form of a continuous film or layer
can be applied to the core, optionally successively to produce
multiple layers surrounding the core. General processing to produce
a multi-layer coated particle can include a series of steps such as
compounding, mixing, granulation, wet milling, coating (by any
method such as fluidized bed coating, spray coating, etc.), and one
or more drying steps such as by use of a fluidized bed or other
drying method. Intermittently between core-forming and coating
steps, e.g., after a drying step, coated or uncoated particles can
be sorted or separated based on size to produce a composition or a
collection of particles having a desired size range and
distribution. Accordingly, coated granulate compositions according
to the invention may be prepared by a process comprising: [0156]
(i) granulating a wax or a gelling polymer, or a mixture thereof,
in the presence of a hydroalcoholic solution or suspension
comprising a suitable binder, to form granules; [0157] (ii)
layering the granules formed in step (i) with a solution or
suspension comprising esketamine; and [0158] (iii) coating the
layered granules formed in step (ii) with a solution or suspension
comprising a film forming polymer material to form a coated layered
granulate. The process above may further comprise steps of milling
and drying the granulate formed in step (i).
[0159] In instances wherein the core comprises a sugar sphere or a
microcrystalline cellulose sphere, the steps of the process above
would be modified as follows: [0160] (i) providing a sugar sphere
(or microcrystalline cellulose sphere); [0161] (ii) layering the
sugar sphere (or microcrystalline cellulose sphere) with a solution
or suspension comprising an API; and [0162] (iii) coating the
layered sphere formed in step (ii) with a solution or suspension
comprising a film forming polymer material to form a coated layered
sphere.
[0163] Compressed tablets according to the invention may be
prepared by a process comprising: [0164] (i) combining the coated
layered granulate (or the coated layered sphere) prepared according
to either of the above processes with a second API (e.g.,
acetaminophen), a gelling polymer, and a disintegrant, and
optionally, with at least one additional excipient selected from a
filler, a colorant, and a pH adjusting agent, to form a first
mixture and then blending the first mixture for a suitable time;
[0165] (ii) adding a lubricant to the blended mixture formed in
step (i) to form a second mixture, and then blending the second
mixture for a suitable time; [0166] (iii) compressing the blended
mixture formed in step (ii) to form compressed tablets.
[0167] A suitable time for the blending in step (i) may be, for
example, from about 5 to about 90 minutes, or from about 10 to
about 60 minutes, or from about 20 to about 40 minutes, or about 30
minutes. A suitable time for the blending in step (ii) may be, for
example, from about 1 to about 30 minutes, or from about 5 to about
20 minutes, or about 10 minutes.
[0168] In certain embodiments as shown at FIGS. 1A, 1B, and 1C, an
immediate release dosage form as described can include a core-shell
particle 10A that includes a core 12A that contains no drug, only a
minor amount of API, or an insubstantial amount of API. Core 12A
may contain less than 5 weight percent, e.g., less than 1 or less
than 0.5 weight percent active pharmaceutical ingredient based on a
total weight of the core of the core-shell particle. Alternatively,
core 12A may contain less than 5 weight percent of a total amount
of pharmaceutical ingredient in a core-shell polymer, e.g., less
than 5, less than 1, or less than 0.5 weight percent active
pharmaceutical ingredient based on total weight of API in the
core-shell particle. In these embodiments a major portion of API
can be contained outside of core 12A, e.g., in an API layer 16A,
which can contain at least 50, at least 75, or at least 90, or at
least 95 weight percent of a total amount of the API in a
core-shell polymer.
[0169] Core 12A can include binder, gelling polymer (e.g., HPMC),
wax, filler, or any combination thereof, each in an amount to allow
the materials of the core to function as one or more abuse
deterrent features as described herein. See the examples included
herewith for examples of useful amounts and ranges of amounts of
these ingredients. In a preferred embodiment, core 12A includes
HPMC, glyceryl behenate, and ethylcellulose.
[0170] Referring to FIG. 1A, core 12A contains gelling polymer,
wax, binder, or filler, or any combination of these, and no API
(meaning not more than an insignificant amount, such as less than
0.5, less than 0.1, or zero weight percent based on the weight of
core 12A). As shown at FIGS. 1B and 1C, core 12A, not containing
API, can be coated with a coating layer that contains API, e.g., an
active pharmaceutical layer or API layer 16A. As shown at FIG. 1B,
core-shell particle 10A includes core 12A, which does not contain
any API, and API layer 16A, which contains an amount of API, such
as a total amount of API (e.g., API commonly susceptible to abuse)
to be contained in a dosage form prepared from particles 10A. API
layer 16A can contain one or more ingredients as described herein
useful to form API layer 16A as a layer over an outer surface of
core 12A. API in API layer 16A can account for all of or most of
(e.g., at least 70, at least 80, at least 90, or at least 95
percent) the total amount of that type of API in the core-shell
particles and in the dosage form; in this embodiment, the core can
contain less than 10, less than 5, or less than 1 percent of the
total amount of API in the core-shell particles, and less than 10,
5, or 1 percent of the total amount of API in the dosage form.
Useful non-API ingredients in an API layer can include a binder or
a gelling polymer along with the API. The API and non-API
ingredients can be carried in a solvent (e.g., water, ethanol, or
both) and coated and dried to form a preferably continuous film
layer on an outer surface of core 12A, i.e., API layer 16A. See the
examples included herewith for examples of useful amounts and
ranges of amounts of these ingredients. In a preferred embodiment,
the API layer 16A includes esketamine and hypromellose (HPMC).
[0171] A core-shell particle 10A can also optionally include a film
layer, e.g., a solvent-resistant layer (e.g., a pH-sensitive layer)
14A as described herein.
[0172] In certain alternate embodiments a dosage form as described
can include a core-shell particle 10B that includes a core 12B that
does contain a useful amount of API, such as an amount of API
useful in an immediate release dosage form having one or more abuse
deterrent features as described herein, prepared to include
particles 10B. See FIGS. 2A and 2B. According to such embodiments,
core 12B of particle 10B can contain a gelling polymer, optional
wax, optional binder or filler, and an amount of API.
[0173] Referring to FIG. 2A, core 12B contains gelling polymer,
optional wax, optional binder, and API. Referring to FIG. 2B, core
12B, containing API, can optionally be coated with
solvent-resistant layer (e.g., a pH-sensitive layer) 14B as
described herein for use in an immediate release dosage form. Core
12B may also optionally be coated with a coating layer that
contains API, e.g., an active pharmaceutical layer or API layer
prior to application of the solvent-resistant layer. Accordingly,
API containing core-shell particles as described herein may contain
API of a type that is susceptible to abuse: [0174] in an API layer
surrounding the core and in a substantial amount in the core;
[0175] in an API layer surrounding the core and in an insubstantial
amount in the core; [0176] only in an API layer surrounding the
core; or [0177] only in the core.
[0178] In certain alternative embodiments, a dosage form as
described can include a core-shell particle 10B, as depicted in
FIG. 2B, that that does not contain an API layer, and does not
contain any API. Referring to FIG. 2C, such a particle 10B,
containing no API, may include core 12B containing gelling polymer,
optional wax, and optional binder, which core 12B may optionally be
coated with solvent-resistant layer (e.g., a pH-sensitive layer)
14B as described herein for use in an immediate release dosage
form. In a preferred embodiment of a core-shell particle 10B that
does not contain an API layer, the core includes Hypromellose,
glyceryl behenate, and ethylcellulose.
[0179] A coated particle 10A or 10B that includes API, and
optionally, a coated particle 10B that does not include API, can be
included in any of a variety of dosage forms, examples including a
compressed tablet or compressed capsule, a suppository, capsule,
caplet, pill, gel, soft gelatin capsule, etc. As one example, a
dosage form 12 can be prepared as a compressed tablet or compressed
capsule. Tablet or capsule 12 can contain core-shell particles 10
(e.g., 10A or 10B) distributed within a matrix 20, compressed to
form the compressed tablet or capsule 12. Core-shell particles 10A
or 10B can be as described herein, generally or specifically, and
can contain an amount of API suited to provide a desired dosage
upon ingestion of tablet or capsule 12; e.g., matrix 20 does not
include any substantial amount of API, or contains no API at
all.
[0180] Matrix 20 can include ingredients useful in combination with
the core-shell particles 10A, 10B, to produce an immediate release
dosage form. Examples of useful excipients of an immediate release
dosage form can include ingredients that allow the dosage form to
break up or disintegrate upon ingestion and facilitate exposure to
fluid in a stomach, such as a useful amount of disintegrant.
Examples of such excipients for such a dosage form can also include
one or more ingredients that act as an abuse deterrent feature,
such as a gelling polymer as described herein. Other excipients can
be useful for processing to form a compressed dosage form, and also
may allow the compressed dosage form to function as an immediate
release dosage form, with one or more abuse deterrent features. In
certain embodiments, the matrix includes a filler, a disintegrant,
a binder, a gelling polymer, a pH adjuster, a glidant, and a
lubricant.
[0181] The present disclosure also pertains to and includes at
least the following aspects: [0182] Aspect 1. An abuse resistant
oral dosage form for the administration of esketamine to a subject
comprising:
[0183] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprising
[0184] a core,
[0185] an active pharmaceutical layer surrounding the core, the
active pharmaceutical layer comprising esketamine or a
pharmaceutically acceptable salt thereof, and
[0186] at least one layer surrounding the active pharmaceutical
layer, the at least one layer comprising a pH-sensitive film
comprising a pH-sensitive polymer that is insoluble in water at a
pH greater than 5; and,
[0187] (ii) a matrix comprising a carbomer gelling polymer and
sodium bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in a ratio by weight percentage of about
2:2 based on the total weight of the dosage form;
[0188] wherein the dosage form exhibits an immediate release
profile of esketamine having not less than 90% of the esketamine
released in 60 minutes, wherein the release profile is evaluated by
dissolution of the tablet in 300 mL of 0.1N HCl media using USP II
apparatus at 50 RPM paddle speed and 37.degree. C.;
[0189] and,
[0190] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic doses,
or
[0191] wherein the dosage form exhibits abuse resistant properties
when physically manipulated, or
[0192] wherein the dosage form exhibits abuse resistant properties
when physically manipulated and administered in a manner not
consistent with oral dosing, or
[0193] wherein the dosage form exhibits abuse resistant properties
when administered in a manner intended to result in administration
of the esketamine in a higher than therapeutic dose. [0194] Aspect
2. The dosage form according to aspect 1, wherein when the dosage
form is physically manipulated by crushing to form a population of
particles, less than 15% of the population comprises a
subpopulation of particles having a particle size of less than 75
.mu.m. [0195] Aspect 3. The dosage form according to any preceding
aspect, wherein when the dosage form is physically manipulated by
crushing to form a population of particles, less than 40 wt. % of
the population of particles comprises a subpopulation of particles
having a particle size of less than 106 .mu.m, and wherein said
subpopulation contains less than 10 wt. % base equivalent of the
esketamine of said dosage form. [0196] Aspect 4. The dosage form
according to any preceding aspect, wherein when the dosage form is
physically manipulated by crushing to form a population of
particles, less than 35 wt. % comprises a subpopulation of
particles having a particle size of 212-500 .mu.m and containing
less than 70 wt. % base equivalent of the esketamine of said dosage
form. [0197] Aspect 5. The dosage form according to any preceding
aspect, wherein when the dosage form is physically manipulated by
crushing to form a population of particles, less than 30 wt. %
comprises a subpopulation of particles having a particle size of
106-212 .mu.m and wherein the subpopulation of particles contains
less than 20 wt. % base equivalent of the esketamine of said dosage
form. [0198] Aspect 6. The dosage form according to aspect 1,
wherein the dosage form exhibits one or more of the abuse resistant
properties when the dosage form is physically manipulated by
crushing and subsequent heating prior to the administration in a
manner not consistent with oral dosing or in a manner intended to
result in administration of the esketamine in a higher than
therapeutic dose. [0199] Aspect 7. The dosage form according to
aspect Error! Reference source not found., wherein the heating
comprises subjecting the physically manipulated dosage form to a
temperature of about 200.degree. C-300.degree. C. [0200] Aspect 8.
The dosage form according to aspect Error! Reference source not
found. or aspect Error! Reference source not found., wherein the
physically manipulated dosage form is heated for at least one
minute. [0201] Aspect 9. The dosage form according to aspect Error!
Reference source not found. or aspect 8, wherein the heated,
physically manipulated dosage form releases less esketamine (base
equivalent) after incubation in water or 0.1 N HCl for up to 18
hours, as compared to the release of esketamine from a physically
manipulated dosage form control that has not been heated prior to
incubation in water or 0.1 N HCl for up to 18 hours. [0202] Aspect
10. The dosage for according to aspect Error! Reference source not
found. or aspect 8, wherein the heated, physically manipulated
dosage form releases at least 20 wt. % less esketamine (base
equivalent), as compared to the release of esketamine (base
equivalent) from a physically manipulated dosage form control that
has not been heated prior to incubation in water or 0.1 N HCl for
up to 18 hours. [0203] Aspect 11. The dosage form according to any
one of the preceding aspects, wherein upon physically manipulating
the dosage form by crushing, the physically manipulated dosage form
exhibits less than 5 wt. % the esketamine diffusion of powdered
pure esketamine or a pharmaceutically acceptable salt thereof, over
60 minutes across a membrane having a molecular weight cutoff of
12-14 kD from a receptor chamber containing a phosphate buffer at
pH 6.4 and maintained at 37.degree. C. [0204] Aspect 12. The dosage
form according to any one of the preceding aspects, wherein upon
physically manipulating the dosage form by crushing, the physically
manipulated dosage form exhibits less esketamine diffusion across
nasal membranes of a human subject when nasally insufflated by the
subject, relative to a solution of 140 mg/ml esketamine (base
equivalent) in pH 4.5 citrate buffer. [0205] Aspect 13. The dosage
form according to aspect 12, wherein upon physically manipulating
the dosage form by crushing, the physically manipulated dosage form
exhibits less than 5% the relative esketamine diffusion of a
solution of 140 mg/ml esketamine (base equivalent) in pH 4.5
citrate buffer, over 60 minutes across a membrane having a
molecular weight cutoff of 12-14 kD from a receptor chamber
containing a phosphate buffer at pH 6.4 and maintained at
37.degree. C. [0206] Aspect 14. The dosage form according to any
one of the preceding aspects, wherein upon physically manipulating
the dosage form by crushing, the absorption of esketamine from the
physically manipulated dosage form over 60 minutes across a
membrane having a molecular weight cutoff of 12-14 kD from a
receptor chamber containing a phosphate buffer at pH 6.4 and
maintained at 37.degree. C. is less than 20%. [0207] Aspect 15. The
dosage form according to any one of the preceding aspects, wherein
the dosage is in a compressed tablet form. [0208] Aspect 16. The
dosage form according to any one of the preceding aspects, wherein
the dosage form further comprises a second population of core-shell
particles that do not contain an active pharmaceutical layer.
[0209] Aspect 17. The dosage form according to aspect Error!
Reference source not found., wherein each of the core-shell
particles of the second population comprise a core that includes a
gelling polymer and a wax, and at least one layer surrounding the
core, the at least one layer comprising a pH-sensitive film
comprising a pH-sensitive polymer that is insoluble in water at a
pH greater than 5. [0210] Aspect 18. The dosage form according to
any one of the preceding aspects, wherein the core of each of the
core-shell particles of the first population does not include a
sugar sphere or an active pharmaceutical ingredient. [0211] Aspect
19. The dosage form according to any one of the preceding aspects,
wherein the gelling polymer in the core of the core-shell particles
of the first population is selected from the group consisting of
ethylcellulose, cellulose acetate, cellulose acetate propionate,
cellulose acetate butyrate, cellulose acetate phthalate, cellulose
triacetate, cellulose ether, cellulose ester, cellulose ester
ether, cellulose, hydroxypropyl methyl cellulose, hydroxy methyl
cellulose, methyl cellulose, hydroxyethylmethyl cellulose, sodium
carboxymethyl cellulose, a carbomer polymer, polyethylene oxide,
and combinations thereof. [0212] Aspect 20. The dosage form
according to aspect Error! Reference source not found., wherein the
gelling polymer in the core of the core-shell particles of the
first population is hydroxypropyl methyl cellulose. [0213] Aspect
21. The dosage form according to any one of the preceding aspects,
wherein the wax in the core of the core-shell particles of the
first population is a fatty alcohol that is selected from glycerol
behenate, glycerol palmitostearate, glycerol monostearate, and
stearoyl macroglycerides. [0214] Aspect 22. The dosage form
according any one of the preceding aspects, wherein the
pH-sensitive polymer in the core-shell particles of the first
population is a copolymer of dimethyl aminoethyl methacrylate,
butyl methacrylate, and methyl methacrylate monomers. [0215] Aspect
23. The dosage form according to any one of the preceding aspects,
wherein the supratherapeutic dose is five or more dosage form
units. [0216] Aspect 24. The dosage form according to any one of
the preceding aspects, wherein the supratherapeutic dose is 10
dosage form units. [0217] Aspect 25. The dosage form according any
one of the preceding aspects, wherein supratherapeutic doses of
said dosage form produce a gel in 15 minutes or less, following
exposure to an aqueous medium comprising 0.025 N HCl and 70 mM NaCl
at 37.degree. C. [0218] Aspect 26. The dosage form according to
aspect Error! Reference source not found., wherein when a dual
screen apparatus comprising a top screen and a bottom screen is
used to extract at least a portion of said gel from said medium, a
first quantity of the gel adheres to a lower surface of the top
screen of the apparatus and a second quantity of the gel adheres to
a upper surface of the bottom screen of the apparatus, wherein the
vertical thickness of the second quantity is at least twice the
vertical thickness of the first quantity. [0219] Aspect 27. The
dosage form according to aspect Error! Reference source not found.,
wherein said gel is substantially uniformly dispersed within said
medium. [0220] Aspect 28. The dosage form according to any one of
the preceding aspects comprising esketamine HCl. [0221] Aspect 29.
An oral tablet for the administration of esketamine to a subject
comprising:
[0222] a total weight of not less than 800 mg, and having 40 mg of
esketamine (base equivalent), the esketamine (base equivalent)
representing less than 5.0% by weight of the total weight of the
tablet, [0223] or [0224] a total weight of not less than 571 mg,
and having 20 mg of esketamine (base equivalent), the esketamine
(base equivalent) representing less than 3.5% by weight of the
total weight of the tablet;
[0225] wherein the tablet exhibits an immediate release profile of
esketamine having not less than 90% of the esketamine released in
60 minutes, and wherein the release profile is evaluated by
dissolution of the tablet in 300 mL of 0.1N HCl media using USP II
apparatus at 50 RPM paddle speed and 37.degree. C.; and
[0226] wherein the tablet exhibits an immediate release profile of
the esketamine when administered to a human in therapeutic doses,
and an extended release profile of the esketamine when administered
to a human in supratherapeutic doses, or
[0227] wherein the tablet exhibits abuse resistant properties when
physically manipulated, or
[0228] wherein the tablet exhibits abuse resistant properties when
physically manipulated and administered in a manner not consistent
with oral dosing, or
[0229] wherein the tablet exhibits abuse resistant properties when
administered in a manner intended to result in administration of
the esketamine in a higher than therapeutic dose. [0230] Aspect 30.
The tablet according to aspect 29, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 15% of the population comprises a
subpopulation of particles having a particle size of less than 75
.mu.m. [0231] Aspect 31. The tablet according to aspect 29 or 30,
wherein when the tablet is physically manipulated by crushing to
form a population of particles, less than 40 wt. % of the
population of particles comprises a subpopulation of particles
having a particle size of less than 106 .mu.m, and wherein said
subpopulation contains less than 10 wt. % base equivalent of the
esketamine of said tablet. [0232] Aspect 32. The tablet according
to any one of aspects 29 to 31, wherein when the tablet is
physically manipulated by crushing to form a population of
particles, less than 35 wt. % comprises a subpopulation of
particles having a particle size of 212-500 .mu.m and containing
less than 70 wt. % base equivalent of the esketamine of said
tablet. [0233] Aspect 33. The tablet according to anyone of aspects
29 to 32, wherein when the tablet is physically manipulated by
crushing to form a population of particles, less than 30 wt. %
comprises a subpopulation of particles having a particle size of
106-212 .mu.m and wherein the subpopulation of particles contains
less than 20 wt. % base equivalent of the esketamine of said
tablet. [0234] Aspect 34. The tablet according to aspect 29,
wherein the tablet exhibits one or more of the abuse resistant
properties when the tablet is physically manipulated by crushing
and subsequent heating prior to the administration in a manner not
consistent with oral dosing or in a manner intended to result in
administration of the esketamine in a higher than therapeutic dose.
[0235] Aspect 35. The tablet according to aspect 34, wherein the
heating comprises subjecting the physically manipulated tablet to a
temperature of about 200.degree. C-300.degree. C. [0236] Aspect 36.
The tablet according to aspect 34 or aspect 35, wherein the
physically manipulated tablet is heated for at least one minute.
[0237] Aspect 37. The tablet according to aspect 34 or aspect 35,
wherein the heated, physically manipulated tablet releases less
esketamine (base equivalent) after incubation in water or 0.1 N HCl
for up to 18 hours, as compared to the release of esketamine from a
physically manipulated tablet control that has not been heated
prior to incubation in water or 0.1 N HCl for up to 18 hours.
[0238] Aspect 38. The tablet according to aspect 34 or aspect 35,
wherein the heated, physically manipulated tablet releases at least
20 wt. % less esketamine (base equivalent), as compared to the
release of esketamine (base equivalent) from a physically
manipulated tablet control that has not been heated prior to
incubation in water or 0.1 N HCl for up to 18 hours. [0239] Aspect
39. The tablet according to any one of aspects 29 to 38, wherein
upon physically manipulating the tablet by crushing, the physically
manipulated tablet exhibits less than 5 wt. % the esketamine
diffusion of powdered pure esketamine or a pharmaceutically
acceptable salt thereof, over 60 minutes across a membrane having a
molecular weight cutoff of 12-14 kD from a receptor chamber
containing a phosphate buffer at pH 6.4 and maintained at
37.degree. C. [0240] Aspect 40. The tablet according to any one of
aspects 29 to 39, wherein upon physically manipulating the tablet
by crushing, the physically manipulated tablet exhibits less
esketamine diffusion across nasal membranes of a human subject when
nasally insufflated by the subject, relative to a solution of 140
mg/ml esketamine (base equivalent) in pH 4.5 citrate buffer. [0241]
Aspect 41. The tablet according to aspect 40, wherein upon
physically manipulating the tablet by crushing, the physically
manipulated tablet exhibits less than 5% the relative esketamine
diffusion of a solution of 140 mg/ml esketamine (base equivalent)
in pH 4.5 citrate buffer, over 60 minutes across a membrane having
a molecular weight cutoff of 12-14 kD from a receptor chamber
containing a phosphate buffer at pH 6.4 and maintained at
37.degree. C. [0242] Aspect 42. The tablet according to any one of
aspects 29 to 41, wherein upon physically manipulating the tablet
by crushing, the absorption of esketamine from the physically
manipulated tablet over 60 minutes across a membrane having a
molecular weight cutoff of 12-14 kD from a receptor chamber
containing a phosphate buffer at pH 6.4 and maintained at
37.degree. C. is less than 20%. [0243] Aspect 43. The dosage form
according to any one of aspects 29 to 42 comprising esketamine HCl.
[0244] Aspect 44. An oral dosage form comprising:
[0245] (i) a first population of core-shell particles, each of the
core-shell particles of the first population comprising [0246] a
core that includes a gelling polymer and a wax; [0247] an active
pharmaceutical layer surrounding the core, the active
pharmaceutical layer comprising esketamine; and [0248] at least one
layer surrounding the active pharmaceutical layer, the at least one
layer comprising a pH-sensitive film comprising a pH-sensitive
polymer that is insoluble in water at a pH greater than 5; and,
[0249] (ii) a matrix comprising a carbomer gelling polymer and
sodium bicarbonate, wherein the carbomer gelling polymer and sodium
bicarbonate are present in a ratio by weight percentage of about
2:2 based on the total weight of the dosage form;
[0250] wherein the dosage form exhibits an immediate release
profile of the esketamine when administered to a human in
therapeutic doses, and an extended release profile of the
esketamine when administered to a human in supratherapeutic doses.
[0251] Aspect 45. The dosage form according to aspect 44, wherein
the dosage is in a compressed tablet form. [0252] Aspect 46. The
dosage form according to aspect 44 or aspect 45, wherein the dosage
form further comprises a second population of core-shell particles
that do not contain an active pharmaceutical layer. [0253] Aspect
47. The dosage form according to aspect 46, wherein each of the
core-shell particles of the second population comprise a core that
includes a gelling polymer and a wax, and at least one layer
surrounding the core, the at least one layer comprising a
pH-sensitive film comprising a pH-sensitive polymer that is
insoluble in water at a pH greater than 5. [0254] Aspect 48. The
dosage form according to any one of aspects 44-47, wherein the core
of each of the core-shell particles of the first population does
not include a sugar sphere or an active pharmaceutical ingredient.
[0255] Aspect 49. The dosage form according to any one of aspects
44-48, wherein the gelling polymer in the core of the core-shell
particles of the first population is selected from the group
consisting of ethylcellulose, cellulose acetate, cellulose acetate
propionate, cellulose acetate butyrate, cellulose acetate
phthalate, cellulose triacetate, cellulose ether, cellulose ester,
cellulose ester ether, cellulose, hydroxypropyl methyl cellulose,
hydroxy methyl cellulose, methyl cellulose, hydroxyethylmethyl
cellulose, sodium carboxymethyl cellulose, a carbomer polymer,
polyethylene oxide, and combinations thereof. [0256] Aspect 50. The
dosage form according to aspect 49, wherein the gelling polymer in
the core of the core-shell particles of the first population is
hydroxypropyl methyl cellulose. [0257] Aspect 51. The dosage form
according to any one of aspects 44-50, wherein the wax in the core
of the core-shell particles of the first population is a fatty
alcohol that is selected from glycerol behenate, glycerol
palmitostearate, glycerol monostearate, and stearoyl
macroglycerides. [0258] Aspect 52. The dosage form according any
one of aspects 44-51, wherein the pH-sensitive polymer in the
core-shell particles of the first population is a copolymer of
dimethyl aminoethyl methacrylate, butyl methacrylate, and methyl
methacrylate monomers. [0259] Aspect 53. The dosage form according
to any one of aspects 44-52, wherein the supratherapeutic dose is
five or more dosage form units. [0260] Aspect 54. The dosage form
according to any one of aspects 44-53, wherein the supratherapeutic
dose is 10 dosage form units. [0261] Aspect 55. The dosage form
according any one of aspects 44-54, wherein supratherapeutic doses
of said dosage form produce a gel in 15 minutes or less, following
exposure to an aqueous medium comprising 0.025 N HCl and 70 mM NaCl
at 37.degree. C. [0262] Aspect 56. The dosage form according to
aspect 55, wherein when a dual screen apparatus comprising a top
screen and a bottom screen is used to extract at least a portion of
said gel from said medium, a first quantity of the gel adheres to a
lower surface of the top screen of the apparatus and a second
quantity of the gel adheres to a upper surface of the bottom screen
of the apparatus, wherein the vertical thickness of the second
quantity is at least twice the vertical thickness of the first
quantity. [0263] Aspect 57. The dosage form according to aspect 56,
wherein said gel is substantially uniformly dispersed within said
medium. [0264] Aspect 58. The dosage form according to any one of
aspects 44-57 comprising esketamine HCl. [0265] Aspect 59. A method
of reducing the potential for abuse by a human of an active
pharmaceutical ingredient comprising esketamine, comprising
providing to the human a dosage form according to any one of
aspects 1-58. [0266] Aspect 60. A method of reducing the potential
for abuse by a human of an active pharmaceutical ingredient
comprising esketamine by simultaneous oral ingestion of multiple
dosage units comprising the active pharmaceutical ingredient,
comprising providing to the human a dosage form according to any
one of aspects 1-58. [0267] Aspect 61. A method for treating or
preventing pain or discomfort in a subject in need thereof by
administering to the subject a dosage form according to any one of
aspects 1-58. [0268] Aspect 62. A method for treating depression in
a subject in need thereof by administering to the subject a dosage
form according to any one of aspects 1-58. [0269] Aspect 63. A
method of reducing the potential for abuse by nasal insufflation by
a human of an active pharmaceutical ingredient comprising
esketamine, comprising providing to the human a dosage form
according to any one of aspects 1-58.
[0270] The following non-limiting examples show various dosage
forms as described herein. The described and exemplified dosage
forms can be made from methods that include granulating, coating,
and compressing steps as follows.
EXAMPLE 1
General Procedure for Preparation of Tablet Dosage Form
[0271] Granulation [0272] 1. Glyceryl behenate and hypromellose
K100M were dry mixed in a high shear granulator. Hydroalcoholic
solution of ethylcellulose was added. Alternatively, the
granulation can be produced through top spraying the hydroalcoholic
solution in a fluid bed granulator. Optionally, a portion of the
ethyl cellulose, for example from about 10 to about 50% by weight,
or from about 10 to about 40% by weight, or from about 15 to about
30% by weight, may be dry mixed with the glyceryl behenate and
hypromellose K100M prior to adding the hydroalcoholic solution
containing the balance of the ethyl cellulose. [0273] Alternative
approach when API is included in the core: Glyceryl behenate and
hypromellose K100M and API are dry mixed in a high shear
granulator. Hydroalcoholic solution of ethylcellulose is added.
Alternatively, the granulation can be produced through top spraying
the hydroalcoholic solution in a fluid bed granulator. Optionally,
a portion of the ethyl cellulose, for example from about 10 to
about 50% by weight, or from about 10 to about 40% by weight, or
from about 15 to about 30% by weight, is dry mixed with the
glyceryl behenate and hypromellose K100M prior to adding the
hydroalcoholic solution containing the balance of the ethyl
cellulose. [0274] 2. The granules were then wet milled using a size
reduction mill (Granumill) and then dried using a fluid bed, and
optionally screened.
[0275] Layering [0276] 3. The polymer granules were then layered
using Wurster fluid bed layering process with esketamine and
hypromellose K100M (or alternatively, granulated using high shear
granulation or top spray fluid bed granulation process). [0277]
Alternative approach when API is not in the coated granule: the
layering step is omitted and the coating of Step 4 below is applied
to the granulate prepared in Step 1.
[0278] Coating [0279] 4. The layered granules of Step 3 (or
alternatively, when the coated granule will not contain API, the
granules prepared in Step 1) were then coated using a fluid bed
coater equipped with a Wurster insert (bottom spray assembly) with
ethanolic suspension of Eudragit E100 copolymer and magnesium
stearate. Coated particles were then screened and blended.
[0280] Blending and Tablet Compression
[0281] The blending, compression and bottling process for
esketamine tablets manufactured using the coated intermediate is as
follows: [0282] 1. The API-containing coated granules,
crospovidone, Carbopol.RTM. 71G, sodium bicarbonate, mannitol,
microcrystalline cellulose, optionally, coated granules containing
no API, optionally, a glidant such as colloidal silicon dioxide,
and optionally a desired colorant, were then added to the blender
and mixed. [0283] 2. Magnesium stearate (and optionally colorant)
was then added to the blender and mixed. The blend was compressed
into tablets using a rotary tablet press.
Example 2
Preparation of Polymer Granules
[0284] Granules were manufactured in a high shear granulator, where
hypromellose and glyceryl behenate were dry mixed for 3 minutes.
Then, a 10% hydroalcoholic solution of ethylcellulose N10 was
slowly added while maintaining the granulator impeller and chopper
speed at pre-selected values that provide enough shear for granule
formation and growth. Solution addition was continued until the
entire amount of ethylcellulose was added. The granules were then
wet milled using a size reduction mill (Granumill) and were
subsequently loaded into fluid bed for drying. Table 1, below,
provides the relative proportions of the reagents used for forming
the granules.
TABLE-US-00003 TABLE 1 Components for granule formulation Component
% w/w Hypromellose K100M 60.09 Glyceryl behenate 25.75
Ethylcellulose N-10 14.16 TOTAL 100
[0285] The prepared granules were then layered in a bottom spray
fluid bed coater with an aqueous coating dispersion esketamine HCl
and hypromellose 2910.
TABLE-US-00004 TABLE 2 Components for coating dispersion used for
coating of polymer granules g/Batch, g/Batch, Component 19.5% 39.1%
within Coating Dispersion % w/w Esketamine Esketamine Esketamine
HCl 13 195 390 Hypromellose 2910 5 75 150 Purified Water 82 1260
2520 TOTAL 100 1500 3000
TABLE-US-00005 TABLE 3 Components for layered granule formulation,
19.5% or 39.1% Esketamine HCl g/Batch, g/Batch, 19.5% 39.1% Layered
Granule % w/w Esketamine Esketamine Polymer granules from Table 1
68.83 596.1 325.4 Solids from Coating Dispersion 31.17 270 540 from
Table 2 TOTAL 100 866.1 865.4
[0286] The esketamine HCl layered granules were then coated in a
bottom spray fluid bed coater with the alcoholic suspension of
Eudragit E-100 copolymer and magnesium stearate. The resulting
coated granules (containing either 16% or 32% esketamine HCl) were
subsequently used for further blending and compression process.
TABLE-US-00006 TABLE 4 Components for coating dispersion used for
coating of Esketamine HCl layered granules g/Batch, g/Batch,
Component 19.5% 39.1% within Coating Dispersion % w/w Esketamine
Esketamine Eudragit E100 16.67 102 102 Magnesium Stearate 8.33 51
51 Alcohol USP 75 489 489 TOTAL 100 612 612
TABLE-US-00007 TABLE 5 Components for coated esketamine granules
containing 16% Esketamine HCl Component % w/w Esketamine HCl
layered granules, 19.5% 82 Solids from coating dispersion from
Table 4 18 TOTAL 100
TABLE-US-00008 TABLE 6 Components for coated esketamine granules
containing 32% Esketamine HCl Component % w/w Esketamine HCl
layered granules, 39.1% 82 Solids from coating dispersion from
Table 4 18 TOTAL 100
[0287] Coated polymer granules that did not contain esketamine HCl
were formed using the polymer granules of Table 1.
[0288] In order to form the coated polymer granules, polymer
granules of Table 1 were coated in a bottom spray fluid bed coater
with the alcoholic suspension of Eudragit E-100 copolymer and
magnesium stearate (Table 7). The resulting coated granules were,
along with the coated esketamine granules, subsequently used for
further blending and compression process.
TABLE-US-00009 TABLE 7 Components for coating dispersion used for
coating of polymer granules Component within Coating Dispersion %
w/w g/Batch Eudragit E100 16.67 366 Magnesium Stearate 8.33 182.8
Alcohol USP 75 1676 TOTAL 100 2194.8
TABLE-US-00010 TABLE 8 Components for coated polymer granules (no
esketamine) Component % w/w Polymer granules from Table 1 50 Solids
from coating dispersion from Table 7 50 TOTAL 100
EXAMPLE 3
Esketamine HCl Tablet Formulation
[0289] The coated granules prepared according to Example 2, supra,
were mixed with excipients as listed in Tables 9-13, below, and
blended in a V-blender for 30 minutes. Both coated esketamine
granules (Tables 4/5 or 4/6) and coated polymer granules (Tables
7/8) were included as indicated. Magnesium stearate was then added
to lubricate the blend and the mixture was blended for an
additional 5 minutes prior to compressing into esketamine HCl
tablets.
TABLE-US-00011 TABLE 9 Tablets, 100 mg Esketamine % w/w Coated
Esketamine Granules, 33% 30.77 Coated Polymer Granules from Tables
7/8 17.6 Mannitol (Mannogem EZ) 13.39 Crospovidone (Polyplasdone
XL) 20 Microcrystalline Cellulose (Avicel PH113) 13 Carbomer
(Carbopol .RTM. 71G) 2 Sodium Bicarbonate 2 Colloidal silicon
dioxide 0.2 Magnesium stearate 1 Total 100
TABLE-US-00012 TABLE 10 Tablets, 40 mg Esketamine % mg/Tab g/batch
Coated Esketamine Granules, 16.0% 25.00 250.0 2500 Coated Polymer
Granules 7.06 70.6 706 Mannitol (Mannogem EZ) 29.74 297.4 2974
Crospovidone (Polyplasdone XL) 20 200 2000 Microcrystalline
Cellulose (Avicel PH113) 13 130 1300 Carbomer (Carbopol .RTM. 71G)
2 20 200 Sodium Bicarbonate 2 20 200 Colloidal silicon Dioxide 0.2
2 20 Magnesium stearate 1 10 100 Total 100 1000 10000
TABLE-US-00013 TABLE 11 Tablets, 20 mg Esketamine % mg/Tab g/batch
Coated Esketamine Granules, 16.0% 12.5 125 1250* Coated Polymer
Granules 21.17 211.7 2117* Mannitol (Mannogem EZ) 28.13 281.3 2813
Crospovidone (Polyplasdone XL) 20 200 2000 Microcrystalline
Cellulose (Avicel PH113) 13 130 1300 Carbomer (Carbopol .RTM. 71G)
2 20 200 Sodium Bicarbonate 2 20 200 Colloidal silicon Dioxide 0.2
2 20 Magnesium stearate 1 10 100 Total 100 1000 10000 *Polymer
granules required 1766 (707 + 1059)
TABLE-US-00014 TABLE 12 Tablets, 10 mg Esketamine % mg/Tab g/batch
Coated Esketamine Granules, 16.0% 6.25 62.5 625* Coated Polymer
Granules 27.42 274.2 2742* Mannitol (Mannogem EZ) 28.13 281.3 2813
Crospovidone (Polyplasdone XL) 20 200 2000 Microcrystalline
Cellulose (Avicel PH113) 13 130 1300 Carbomer (Carbopol .RTM. 71G)
2 20 200 Sodium Bicarbonate 2 20 200 Colloidal silicon Dioxide 0.2
2 20 Magnesium stearate 1 10 100 Total 100 1000 10000 *Polymer
granules required 1725 (354 + 1371)
TABLE-US-00015 TABLE 13 Tablets, 5 mg Esketamine % mg/Tab g/batch
Coated Esketamine Granules, 16.0% 3.125 31.25 312.5* Coated Polymer
Granules 30.545 305.45 3054.5* Mannitol (Mannogem EZ) 28.13 281.3
2813 Crospovidone (Polyplasdone XL) 20 200 2000 Microcrystalline
Cellulose 13 130 1300 (Avicel .RTM. PH113) Carbomer (Carbopol .RTM.
71G) 2 20 200 Sodium Bicarbonate 2 20 200 Colloidal silicon Dioxide
0.2 2 20 Magnesium stearate 1 10 100 Total 100 1000 10000 *Polymer
granules required 1704 (177 + 1527)
EXAMPLE 4
Preparation of Comparative Embodiment
[0290] Comparative 100 mg esketamine HCl embodiments having a
matrix containing carbomer gelling polymer and sodium bicarbonate
in a ratio of 2:10 percentage by weight, based on the total weight
of the dosage form.
[0291] Esketamine HCl layered granules were coated in a bottom
spray fluid bed coater with the alcoholic suspension of Eudragit
E-100 copolymer and magnesium stearate. The resulting coated
granules (containing 33% esketamine HCl) were subsequently used for
further blending and compression process.
[0292] The coated granules were mixed with excipients as listed in
Table 14, below, and blended in a V-blender for 30 minutes.
Magnesium stearate was then added to lubricate the blend and the
mixture was blended for an additional 5 minutes prior to
compressing into esketamine HCl tablets.
TABLE-US-00016 TABLE 14 100 mg esketamine tablet formulations with
2:10 carbomer to sodium bicarbonate ratio % w/w Coated Esketamine
Granules, 33% 30.77 Coated Polymer Granules from Tables 7/8 17.6
Mannitol (Mannogem EZ) 5.37 Crospovidone (Polyplasdone XL) 20
Microcrystalline Cellulose (Avicel PH113) 13 Carbomer (Carbopol
.RTM. 71G) 2 Sodium Bicarbonate 10 Colloidal silicon dioxide 0.2
Magnesium stearate 1 Red Iron Oxide 0.06 Total 100
EXAMPLE 5
Evaluation of Esketamine Release
[0293] Tablet dosage forms according to the present disclosure (100
mg esketamine HCl--see Table 9, supra) were tested for
single-tablet dissolution by depositing a single tablet into a USP
II apparatus containing 500 mL of deaerated 0.01N hydrochloric acid
medium and a paddle speed set at 50 RPM.
[0294] Also tested were comparative 100 mg esketamine HCl
embodiments having a matrix containing carbomer gelling polymer and
sodium bicarbonate in a ratio of 2:10 percentage by weight, based
on the total weight of the dosage form, that were prepared as
described in Example 4, supra.
[0295] FIG. 4 shows the results of single-tablet dissolution
testing of the inventive 2:2 dosage form (triangles) and the
comparative 2:10 dosage form (squares). Both embodiments displayed
complete release within 15 minutes following deposition into the
testing apparatus.
[0296] The respective dosage forms were also tested for the ability
to provide multiple table abuse resistance ("MTAR") when 12
individual dosage units are deposited into a USP II apparatus
containing 400 mL of deaerated 0.1N hydrochloric acid medium and a
paddle speed set at 50 RPM. These conditions are intended to
simulate oral ingestion by a potential abuser of a beverage with a
supratherapeutic dose of the dosage forms.
[0297] FIG. 5 shows the results of multiple-tablet dissolution
testing of the inventive 2:2 dosage form (triangles) and the
comparative 2:10 dosage form (squares). Also tested was a second
comparative dosage form containing 10 mg hydrocodone bitartrate and
325 mg acetaminophen (diamonds) as disclosed in WO 2016/094358 (see
Example 23 on pages 81-82). The inventive 2:2 dosage form displayed
release of less than 60% of the active agent 30 minutes following
deposition into the testing apparatus, and no more than 80% of the
active agent 240 minutes following deposition into the testing
apparatus.
EXAMPLE 6
QbD Analysis
[0298] An evaluation was conducted to identify the optimized
formulation with maximized immediate release (IR) and MTAR
dissolution properties. Sixteen different formulations varying the
weight ratios of four variables (carbopol, sodium bicarbonate,
crospovidone, coated polymer granules) in 100 mg API formulations
were prepared according to the ranges disclosed in Table 15.
TABLE-US-00017 TABLE 15 Ranges of Ingredients Evaluated Ingredient
% w/w Carbopol 1-5 Sodium bicarbonate 1-4 Crospovidone 10-30 Coated
polymer granules 1.82-28.82
[0299] The formulations were each assayed in dissolution media to
assess the release at 30 minutes for a single tablet (maximal IR)
and the release for a multiple tablet at 60 minutes (minimal MTAR).
The results are disclosed in Table 16a (immediate release) and 20b
(MTAR).
TABLE-US-00018 TABLE 16a Fastest Release At 30 Minutes Fastest
formulation (ranking) % Carbopol % Sodium Bicarbonate 1 1.2 2.0 2
1.8 1.0 3 1.1 3.0 4 2.0 2.0 5 1.3 4.0 . . . 15 4.8 3.2
TABLE-US-00019 TABLE 16b minimum release at 60 minutes Slowest
formulation (ranking) % Carbopol % Sodium Bicarbonate 1 1.1 3.0 2
1.3 4.0 3 3.9 3.6 4 2.2 2.1 5 2.0 2.0 . . . 10 4.8 3.2
[0300] The optimized formulations with the overall desirability
maximized combining the contribution from IR and MTAR were analyzed
based on a truncated 13 term model for MTAR and a 15 term model for
IR with equal weightage to the two responses. The predicted
optimized formulation is disclosed in Table 17.
TABLE-US-00020 TABLE 17 Predicted Optimized Formulations Maximize
IR (15-term model) and minimize MTAR Approach for Optimization
(13-term model) with equal weightage Optimized formulation
composition (% w/w) Carbopol 1.02 Sodium bicarbonate 2.62
EXAMPLE 7
Evaluation of Gel Characteristics
[0301] An evaluation was conducted to assess the quality of the
gels that were formed when respective supratherapeutic doses of the
inventive 2:2 weight percent dosage form and the comparative 1:2
and 2:10 weight percent dosage forms were exposed to dissolution
medium.
[0302] In particular, a supratherapeutic dose consisting of 10
tablets of the inventive 2:2 weight percent dosage form of Example
3 (Table 9) was placed into an aqueous medium of 0.025 N HCl+70 mM
NaCl at 37.degree. C. The medium also contained a dual mesh screen
featuring a horizontally-oriented circular top screen, a
horizontally-oriented circular bottom screen, and a handle for
lifting the dual mesh apparatus from the medium. Fifteen minutes
after mixing the deposited supratherapeutic dose into the test
medium, the dual mesh apparatus was removed from the medium and the
characteristics of the gel were visually assessed.
[0303] The same procedure was performed with respect to a
supratherapeutic dose of 10 tablets of the comparative 1:2 and 2:10
dosage forms of Table 18 and Example 4 (Table 14), and the
characteristics of the resulting gel were assessed and compared to
the gel resulting from the supratherapeutic dose of the 2:2
inventive dosage form.
TABLE-US-00021 TABLE 18 100 Mg Esketamine Tablet Formulations With
1:2 Carbomer To Sodium Bicarbonate Ratio % w/w Coated Esketamine
Granules, 32% 29.94 Coated Polymer Granules from Tables 7/8 16.82
Mannitol (Mannogem EZ) 16.04 Crospovidone (Polyplasdone XL) 20
Microcrystalline Cellulose (Avicel PH113) 13 Carbomer (Carbopol
.RTM. 71G) 1 Sodium Bicarbonate 2 Colloidal silicon dioxide 0.2
Magnesium stearate 1 Total 100
[0304] All samples formed gels in under 15 minutes. Visual
inspection of the dual screen apparatus that was lifted from the
medium into which the supratherapeutic dose of the 2:2 inventive
dosage form was tested revealed that the gel from the
supratherapeutic dose (i) was retained on the upper surface of the
top screen in a very thin layer; (ii) was retained on the lower
surface of the top screen in a thin layer; (iii) was retained on
the upper surface of the bottom screen in a robust layer that was
at least twice as thick (vertically) as the layer that was retained
on the lower surface of the top screen; and, (iv) overall,
represented a good quality gel that was not overly rigid, nor was
it watery (was retained on the bottom screen and did not flow
through the screen when the apparatus was lifted from the medium).
FIG. 6 provides an image of the dual screen apparatus that was used
to test the supratherapeutic dose of the 2:2 inventive dosage form
with gel retained on the screens as described above.
[0305] Visual inspection of the dual screen apparatus that was
lifted from the medium into which the supratherapeutic dose of the
1:2 comparative dosage form was tested revealed that the gel from
the supratherapeutic dose (i) was retained on the upper surface of
the top screen in a weak layer that was thinner than a layer that
was retained on the upper surface of the bottom screen; (ii) was
retained on the lower surface of the top screen in a thin layer;
(iii) was not retained between the top and bottom screens; and,
(iv) appeared to flow through the screens as a weak gel. FIG. 7
provides an image of the dual screen apparatus that was used to
test the supratherapeutic dose of the 1:2 comparative dosage form
with gel retained on the screens as described above.
[0306] Visual inspection of the dual screen apparatus that was
lifted from the medium into which the supratherapeutic dose of the
2:10 comparative dosage form was tested revealed that the gel from
the supratherapeutic dose (i) was retained on the upper surface of
the top screen in a robust layer that was thicker than a layer that
was retained on the upper surface of the bottom screen; (ii) was
retained on the lower surface of the top screen in a thin layer;
(iii) was retained on the upper surface of the top screen in a
layer that was not as thick as the layer that was retained on the
upper surface of the top screen; (iv) included "runners" (portions
of gel) between the layer of gel on the lower surface of the top
screen and the layer of gel on the upper surface of the bottom
screen, and, (v) overall, represented a rigid, thick gel. FIG. 8
provides an image of the dual screen apparatus that was used to
test the supratherapeutic dose of the 2:10 comparative dosage form
with gel retained on the screens as described above.
[0307] A further evaluation was conducted as to the quality of the
gels that were formed when respective supratherapeutic doses of the
inventive 2:2 dosage form and the comparative 2:10 dosage form were
exposed to dissolution medium.
[0308] A supratherapeutic dose consisting of 10 tablets of the
inventive 2:2 dosage forms of Example 3 (Table 9) was placed into
an aqueous medium of 0.025 N HCl+70 mM NaCl at 37.degree. C. The
same procedure was performed in a second test vessel with respect
to a supratherapeutic dose of 10 tablets of the comparative 2:10
dosage form of Example 4 (Table 18), and the characteristics of the
material within the vessel were assessed and compared to the
material within the vessel containing the supratherapeutic dose of
the 2:2 inventive dosage form.
[0309] FIG. 9 provides an image of the gel resulting from the
supratherapeutic dose of the inventive 2:2 dosage forms, suspended
in the test medium. As shown, the gel/test medium mixture appeared
turbid and opaque, indicating that the gel material was
substantially homogeneously dispersed within the medium. There were
no uneven concentrations of gel in any particular region of the
medium (e.g., in the upper, middle, or lower portions of the medium
within the test vessel), such as in the form of clumps, and
likewise no regions without association between medium and gel,
wherein medium is clearly visible in the absence of gel material.
These results suggest that supratherapeutic doses of the inventive
dosage form would provide good resistance to an attempt to extract
drug from the supratherapeutic dose by combining it with a solvent
and then either orally ingesting the mixture or attempting uptake
of the mixture using a syringe, because of the ability of the
resulting gel to entrap the drug within a consistent, uniform gel
matrix, and due to the ability to resist uptake by or injection
from a needle of a hypodermic syringe because of the thickness and
uniformity of the gel matrix.
[0310] FIG. 10 provides an image of the gel resulting from the
supratherapeutic dose of the comparative 2:10 dosage forms,
suspended in the test medium. As shown, the gel/test medium mixture
was non-uniform, and included a concentration of gel material
within the upper portion of the medium, indicating that the gel
material was not uniformly dispersed within the medium. In fact,
gel material was absent from a significant volume of the medium.
Also apparent were clumps of gel and portions of medium that were
clearly visible in the absence of gel material. These results
suggest that supratherapeutic doses of the comparative dosage form
would provide poor resistance to an attempt to extract drug from
the supratherapeutic dose by combining it with a solvent and then
either orally ingesting the mixture or attempting uptake of the
mixture using a syringe, because of the likelihood of the presence
of regions of the mixture of drug and solvent in which gel is
absent (i.e., regions in which the solvent predominates), and from
which drug could be readily extracted.
EXAMPLE 8
Physical Manipulation Studies
[0311] Initial Analysis. A single 40 mg tablet of esketamine HCl of
Example 3 was crushed using a mortar and pestle. The tablet was
initially fractured by the gentle striking of the pestle, followed
by rotation of the pestle against the tablet pieces. After visual
inspection showed that no further particle size reduction was
possible, the procedure was terminated. The sample was then
collected onto a piece of (pre-tared on an analytical balance)
3.times.3 weigh paper by gently brushing the material from the
mortar and weighed. 1000 .mu.m and 500 .mu.m sieves were stacked
sequentially and set in a sieve shaker following which, the samples
was transferred from the weigh paper by distributing it across the
top sieve (1000 .mu.m). Each sample was sieved for a total of 5
minutes during which for the first 60 seconds, the shaker was set
to an amplitude of 80 Hz, and for the following 4 minutes, at an
amplitude of 50 Hz. After sieving, each sieve was carefully removed
and the weight of the sieve and manipulated material was recorded.
The material from each sieve was then transferred into a tarred and
labeled collection vessel and weighed. The procedure was repeated
in triplicate and the results averaged to show an average
manipulation time of 52 seconds, 99.7% weight recovery, 0.2%
particle size above 1000 .mu.m and 3.0% particle size between 500
and 1000 .mu.m.
[0312] Advanced Analysis. A single 40 mg tablet of esketamine HCl
of Example 3 was crushed using a mortar and pestle. The tablet was
initially fractured by the gentle striking of the pestle, followed
by rotation of the pestle against the tablet pieces for 52 seconds.
The sample was then collected onto a piece of (pre-tared on an
analytical balance) 3.times.3 weigh paper by gently brushing the
material from the mortar and weighed. 1000 .mu.m, 500 .mu.m, 212
.mu.m, 106 .mu.m and 75 .mu.m sieves were stacked sequentially and
set in a sieve shaker following which, the samples was transferred
from the weigh paper by distributing it across the top sieve (1000
.mu.m). Each sample was sieved for a total of 5 minutes during
which, for the first 60 seconds, the shaker was set to an amplitude
of 80 Hz, and for the following 4 minutes, at an amplitude of 50
Hz. After sieving, each sieve was carefully removed and the weight
of the sieve and manipulated material was recorded. The material
from each sieve was the collected onto a piece of (pre-tared on an
analytical balance) 3.times.3 weigh paper by gently brushing the
material from the sieve and weighed. Sample fractions that resulted
in 4% recovery or less were transferred into 20 mL scintillation
vials, fractions that resulted in between 4% and 25% recovery were
transferred into 125 mL Erlenmeyer Flasks and fractions that
resulted in over 25% recovery were transferred into 250 mL
Erlenmeyer Flasks. To each vessel with collected material, a
calculated prorated volume of 0.1 N HCl (mass recovered on
sieve]/[mass of manipulated material]*240 mL) was added. The sieve
fraction solutions were then extracted overnight for a minimum of
15 hours at room temperature with agitation at 150 RPM following
which, aliquots of the samples were prepared for LC-MS/MS analysis.
The procedure was repeated in triplicate and the results averaged
to show an average 98.8% weight recovery. The results per sieve
fraction are shown in Table 19, below.
TABLE-US-00022 TABLE 19 Summary of results per sieve fraction
Average Average % Average % Sieve % Particle esketamine esketamine
fraction Size Distribution recovery uniformity >1000 .mu.m 0.3
0.1 0.8 500-1000 .mu.m 5.4 9.7 7.4 212-500 .mu.m 31.9 62.4 8.0
106-212 .mu.m 26.7 18.9 3.0 75-106 .mu.m 24.3 5.2 0.9 <75 .mu.m
(pan) 11.4 1.8 0.7
[0313] The preceding results demonstrate that the esketamine was
not concentrated in any particular fraction of particle sizes, and
in all fractions, the amount of esketamine was less than 10% and
the amount of excipients greater than 90%. Therefore, physical
manipulation is not expected to allow for the isolation of
esketamine by an abuser, and an abuser would likely be required to
insufflate the entire 1000 mg of powder, including 960 mg of
excipients, in order to attempt to administer the 40 mg of
esketamine from any given tablet.
EXAMPLE 9
Heat Pretreatment
[0314] A series of pretreatments were performed on esketamine HCl
tablets according to the present disclosure to evaluate whether
heat results in greater API recoveries when extracted in small
volumes of extraction media. Crushed 40 mg tablets of esketamine
HCl of example 3 were heated in an oven at various temperatures
(200.degree. C.-300.degree. C.) until they were visibly browned,
visibly charred, or significantly charred. The time required to
achieve the desired visual outcome was recorded and samples of the
solution's viscosity was also measured using a Cambridge VL3000
viscometer. The samples were then transferred to labeled 20 ml
scintillation vials, 20 ml of LC-MS water added and then assayed by
LC-MS. The results are shown in Table 20.
TABLE-US-00023 TABLE 20 Results of heat pretreatment per visual
endpoint Visible browning Visible charring Significant charring
Heating % esketamine Heating % esketamine Heating % esketamine
Temperature time/m:s recovery time/m:s recovery time/m:s recovery
200.degree. C. 5.00 9.7 12.00 1.3 20.00 0.0 250.degree. C. 1.40
23.0 2.00 12.0 3.40 7.2 290.degree. C. 1.30 21.0 2.10 7.4 2.32 0.9
300.degree. C. 1.20 19.2 2.00 9.3 2.20 0.0
[0315] Based on this preliminary analysis, samples of material heat
treated at 250.degree. C. were then transferred into both labeled
20 ml scintillation vials or 60 ml glass sample jars and 20 ml of
either water or 0.1 N HCl added. The 20 ml solutions were extracted
for 1 hour at room temperature with an agitation of 150RPM and
assayed by LC-MS. The 60 ml jars were extracted overnight and
assayed by LC-MS at both 1 and 18 hours. As a comparator,
extraction and LC-MS were also performed on non-heat-treated
tablets. The results are shown in Table 21, below:
TABLE-US-00024 TABLE 21 Results of % esketamine recovery No Over
pre- treatment treatment 1 hr extraction 20 ml vial LC-MS water
17.6 13.6 0.1N HCl 32.4 21.7 1 hr extraction 60 ml jar LC-MS water
57.7 28.6 0.1N HCl 57.7 46.2 18 hr extraction 60 ml jar LC-MS water
60.8 41.3 0.1N HCl 61.9 46.2
Direct comparison of verification experiments between
oven-heat-treated and non-heat-treated crushed tablets showed lower
average esketamine % recoveries from oven heat pre-treated extracts
in all cases indicating that oven heat pre-treatment of crushed
tablets likely would not enhance API recovery.
EXAMPLE 10
Simulated In Vitro Nasal Diffusion/Release
[0316] A vertical diffusion cell (VDC, or Franz cell) apparatus was
used to evaluate the capability of tablets to subside esketamine
absorption across a membrane simulating nasal diffusion. The VDC
used a 33 mm diameter 12-14 kD dialysis disc as its membrane and
the analysis was performed using either 46.1 mg pure esketamine HCl
powder (40 mg base equivalent), 161.42 mg/ml esketamine HCl (140
mg/ml esketamine base equivalent) in pH 4.5 citrate buffer, crushed
40 mg tablets of Example 3 or crushed 40 mg tablets of example 3 in
4 ml of pH 4.5 citrate buffer, with the experiments each performed
in triplicate. With each VDC in a circulating water bath set at
37.degree. C., phosphate buffer at a pH of 6.4 was added to fill
each VDC receptor chamber, the membrane slid across its rim to seal
the chamber, the donor chamber attached and the VDC sealed by a
clamp. Stirring of the phosphate buffer at 600RPM was then begun.
After equilibration of the apparatus at 37.degree. C. for a minimum
of 15 minutes, the esketamine was deposited evenly, via the donor
chamber, onto the membrane. Apart from the concentrated solution
where 200 .mu.l was deposited, the equivalent of 40 mg of
esketamine base was deposited on each membrane. At 10, 30 and 60
minutes, 150 .mu.l of extract was removed from the receiving
chamber and replaced by phosphate buffer at a pH of 6.4. The
extracted aliquots were then assayed for esketamine by LC-MS. The
results of the assay are shown in Table 22, below.
TABLE-US-00025 TABLE 22 Percentage esketamine recovery 10 minutes
30 minutes 60 minutes Esketamine HCl powder 45.1 75.9 79.2
Concentrated solution 23.3 51.3 71.8 Crushed tablet 0.7 1.0 2.0
Pre-wet crushed tablet 1.1 2.3 3.3
The results indicate that there is likely no significant esketamine
diffusion from crushed tablets across a nasal membrane, in contrast
to either pure esketamine powder or concentrated esketamine
solution.
* * * * *