Title: Effervescent drug delivery system for oral administration
United States Patent: 6,350,470
Inventors: Pather; S. Indiran (Plymouth, MN); Robinson; Joseph R. (Madison, WI); Eichman; Jonathan D. (Ann Arbor, MI); Khankari; Rajendra K. (Maple Grove, MN); Hontz; John (Plymouth, MN); Gupte; Sangeeta V. (Maple Grove, MN)Assignee: Cima Labs Inc. (Minneapolis, MN)
Appl. No.: 302105Filed: April 29, 1999
The pharmaceutical compositions of the present invention comprise orally administerable dosage forms that use effervescence as a penetration enhancer for drugs known, or suspected, of having poor bioavailability. Effervescence can occur in the stomach, once the tablet or other dosage form is ingested. In addition to effervescence in the stomach, or as alternative technique, by the use of appropriate coatings and other techniques, the effervescence can occur in other parts of the gastrointestinal tract, including, but not limited to, the esophagus, duodenum, and colon. The site of effervescence and drug release is chosen to correspond with the segment of the gastrointestinal tract displaying maximal absorption of the formulated drug, or to gain some other therapeutic advantage.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The pharmaceutical compositions of the present invention
comprise orally administerable medicaments in combination with an
effervescent as a penetration enhancer for influencing absorption of a
drug in the gastrointestinal tract. Effervescence leads to an increase in
the rate and/or the extent of absorption of the drugs that are known or
suspected of having poor bioavailability. It is believed that such
increase can rise from one or all of the following mechanisms:
1. reducing the thickness and/or the viscosity of the mucus layer which is
present adjacent to the gastrointestinal mucosa;
2. alteration of the tight junctions between cells, thus promoting
absorption through the paracellular route;
3. inducing a change in the cell membrane structure, thus promoting
transcellular absorption;
4. increasing the hydrophobic environment within the cellular membrane.
The present dosage forms include an amount of effervescent agent effective
to aid in penetration of the drug in the gastrointestinal tract. The
amount of effervescent employed must not merely permit rapid dispersion of
the medicament in the gastrointestinal tract, but must aid in penetration
of the drug across the gastrointestinal mucosa. The formulations of the
present invention may be distinguished from other effervescent formulation
that are enteric coated on the basis of the amount of effervescent
material that they contain. Prior formulations contain approximately half
to a quarter as much bicarbonate as drug on a weight basis (together with
a proportionate amount of acid). In these cases, the small amount of
effervescent couple serves only to rapidly disintegrate the tablet.
The dosage forms of the present invention should preferably contain at
least twice as much sodium bicarbonate (or an equivalent amount of other
base) as drug (on a weight basis) together with the proportionate amount
of an appropriate acid for generating the effervescent reaction. More
preferably the present dosage forms should contain at least three times as
much sodium bicarbonate as drug (on a weight basis) together with the
proportionate amount of an appropriate acid. These high concentrations of
effervescent couple are needed to generate effervescence in sufficient
amounts to promote permeability and absorption of the drug.
Preferably, the effervescent is provided in an amount of between about 5%
and about 95% by weight, based on the weight of the finished tablet, and
more preferably in an amount of between about 30 to about 60%. However,
the amount of effervescent agent must be optimized for each specific drug.
The term "effervescent penetration enhancer" includes compounds
which evolve gas. The preferred effervescent penetration enhancers evolve
gas by means of a chemical reaction which takes place upon exposure of the
effervescent penetration enhancer to water and other fluids. Such
water-activated materials must be kept in a generally anhydrous state and
with little or no absorbed moisture or in a stable hydrated form, since
exposure to water will prematurely disintegrate the tablet. The acid
sources may be any which are safe for human consumption and may generally
include food acids, acid and hydrite antacids such as, for example,
citric, tartaric, amalic, fumeric, adipic, and succinics. Carbonate
sources include dry solid carbonate and bicarbonate salt such as,
preferably, sodium bicarbonate, sodium carbonate, potassium bicarbonate
and potassium carbonate, magnesium carbonate and the like.
The effervescent penetration enhancers of the present invention is not
limited to those which are based upon a reaction which forms carbon
dioxide. Reactants which evolve oxygen or other gases and which are safe
for human consumption are also considered within the scope of the present
invention.
The present dosage forms may also include in amounts additional to that
required for effervescence a pH adjusting substance. For drugs that are
weekly acidic or weakly basic, the pH of the aqueous environment can
influence the relative concentrations of the ionized and the unionized
forms of the drug present in solution, according to the Henderson-Hasselbach
equation. Th pH of solutions in which an effervescent couple with
equimolar amounts of base and acid has dissolved is slightly acidic due to
the evolution of CO2. While it is impractical and may not be
desirable to change the pH of the contents of the small intestine, it is,
nevertheless, possible to alter the pH of the local environment
(intestinal contents in immediate contact with the tablet and any drug
that may have dissolved from it). This is achieved by incorporating in the
tablet certain pH adjusting substances. Thus, the relative proportions of
the ionized and unionized forms of the drug may be controlled.
In this way the system can be optimized for each specific drug under
consideration: if the drug is known, or suspected, to be absorbed through
the cell membrane (transcellular absorption), it would be most appropriate
to alter the pH of the local environment to a level that favors the
unionized form of the drug. Conversely, if the ionized form is more
readily dissolved the local environment should favor ionization. Thus, for
fentanyl, as a nonlimiting example, the pH is adjusted to neutral (or
slightly higher) since the pKa is 7.3. At this pH, the aqueous solubility
of this poorly water-soluble drug is not compromised unduly, yet allowing
a sufficient concentration of the drug to be present in the unionized
form. This facilitates the permeation enhancement brought about by
effervescence. In the case of prochlorperazine (pKa=8.1), a slightly
higher pH is required.
Suitable pH adjusting substance for use in the present invention include
any weak acid or weak base (in amounts additional to that required for
effervescence) or, preferably, any buffer system that is not harmful to
the gastrointestinal mucosa. These include, but are not limited to, any of
the acids or bases previously mentioned as the effervescent components,
sodium carbonate, potassium carbonate, potassium carbonate, disodium
hydrogen phosphate, sodium dihydrogen phosphate, and the equivalent
potassium salts.
The active agents suitable for use in the present invention preferably
includes any drug that displays poor bioavailability, slow absorption or
long tmax. These active ingredients include small molecule drugs,
nutritional supplements (such as vitamins and minerals), proteins and
peptides and other substances of biological origin. Examples of such drugs
include, but are not limited to, the following:
Drug Bioavailability (%)
Acyclovir 15-30
Auranofin 15-25
Bretylium 23+9
Cyclosporine 23+7
Cytarabine 20
Doxepin 27+1O
Doxorubicin 5
Hydralazine 16-35
Ketamine 20+7
Labetalol 18+5
Mercaptopurine 12+7
Methyldopa 25+16
Nalbuphine 25+16
Naloxone 2
Pentoxifylline 19+13
Pyridostigmine 14+3
Terbutaline 14+2
Verapamil 22+8
Riboflavin 11
Atenolol 50
Pharmaceutical ingredients suitable for use in the present dosage forms
may include, without limitation, analgesics, anti-inflammatories,
antipyretics, antibiotics, antimicrobials, laxatives, anorexics,
antihistamines, antiasthmatics, antidiuretics, antiflatuents, antimigraine
agents, antispasmodics, sedatives, antihyperactives, antihypertensives,
tranquilizers, decongestants, beta blockers; peptides, proteins,
oligonucleotides and other substances of biological origin, and
combinations thereof. Also encompassed by the terms "active
ingredient(s)", "pharmaceutical ingredient(s)" and
"active agents" are the drugs and pharmaceutically active
ingredients described in Mantelle, U.S. Pat. No. 5,234,957, in columns 18
through 21. That text of Mantelle is hereby incorporated by reference.
Alternatively or additionally, the active ingredient can include drugs and
other pharmaceutical ingredients, vitamins, minerals and dietary
supplements as the same are defined in U.S. Pat. No. 5,178,878, the
disclosure of which is also incorporated by reference herein.The dosage forms preferably contain materials that aid in releasing the drug in a specific section of the gastrointestinal tract, thus promoting site-specific delivery. There are various mechanisms by which such materials promote site-specific delivery and this invention is not limited to any one mechanism. For example, the material may be metabolized by enzymes present in a specific part of the gastrointestinal tract, thus releasing the drug in that section.
The materials used to promote site-specific absorption may preferably be included as coatings and/or as matrix materials. If a coating is used, it may be applied to the entire dosage form or to the individual particles of which it consists. Coating materials may be used to prevent the release of the active agent before the dosage form reaches the site of more efficient absorption.
The coating can also be used in conjunction with an effervescence to cause the effervescence to occur at specific areas of the gastrointestinal tract. Nonlimiting examples or coatings used in the present invention include: cellulose derivatives including cellulose acetate phthalate (CAP); shellac and certain materials sold under the trademark Eudragit.TM. (various grades may be used in specific combinations). Hydroxypropylmethyl cellulose phthallate in a grade that dissolves at pH 5 is the preferred coating material.
Precoating materials may also be used in the present invention. Nonlimiting examples include cellulose derivatives such as methylcellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose or combinations and certain materials sold under the trademark Eudragit.TM. (various grades which may be combined). Hydroxypropylmethyl cellulose phthallate in a grade that dissolves at pH 5 is the preferred coating material.
Other materials may be used to aid in site specific delivery, and include, for example, sugars, polysaccharides, starches, polymers, etc. These compounds may be included as coatings or as matrix materials and aid in releasing the drug in specific sections of the gastrointestinal tract, thus promoting site-specific delivery.
Other ingredients or techniques may preferably be used with the present dosage forms to enhance the absorption of the pharmaceutical ingredient, to improve the disintegration profile, and/or to improve the organoleptic properties of the material and the like. These include, but are not limited to, the use of additional chemical penetration enhancers, which are referred to herein as noneffervescent penetration enhancers; absorption of the drug onto fine particles to promote absorption by specialized cells within the gastrointestinal tract (such as the M cells of Peyer's patches); ion pairing or complexation; and the use of lipid and/or surfactant drug carriers. The selected enhancement technique is preferably related to the route of drug absorption, i.e., paracellular or transcellular.
A bioadhesive polymer may preferably be included in the drug delivery device to increase the contact time between the dosage form and the mucosa of the most efficiently absorbing section of the gastrointestinal tract. See Jonathan D. Eichman, "Mechanastic Studies on Effervescent-Induced Permeability Enhancement," University of Wisconsin-Madison (1997), hereby incorporated by reference. Nonlimiting examples of known bioadhesives used in the present invention include: carbopol (various grades), sodium carboxy methylcellulose, methylcellulose, polycarbophil (Noveon AA-1), hydroxypropyl methylcellulose, hydroxypropyl cellulose, sodium alginate, and sodium hyaluronate.
Disintegration agents may also be employed to aid in dispersion of the drug in the gastrointestinal tract. Disintegration agents include any pharmaceutically acceptable effervescent agent. In addition to the effervescence-producing disintegration agents, a dosage form according to the present invention may include suitable noneffervescent disintegration agents. Nonlimiting examples of disintegration agents include: microcrystalline cellulose, croscarmelose sodium, crospovidone, starches and modified starches.
Apart from the effervescent material within the tablet, some additional effervescent components or, alternatively, only sodium bicarbonate (or other alkaline substance) may be present in the coating around the dosage form. The purpose of the latter effervescent/alkaline material is to react within the stomach contents and promote faster stomach emptying.
The drug delivery device may be in the form of a tablet, granules, pellets or other multiparticulates, capsules that can contain the drug in the form of minitablets, beads, or a powder, or any other suitable dosage form.
If tablets are used, they may be matrix tablets; layered tablets in which the various components are separated in different layers to optimize their benefits; or other specialized forms of tablets, including nonconventional shapes and geometric arrangements. One example of a nonconventional shape is a flat-faced tablet with a biconcave central zone, as depicted in FIG. 1. The outer, thicker part of the tablet may contain the mucoadhesive material while the inner, thinner segment may contain the drug and effervescent components. This arrangement allows drug release to a segment of the gastrointestinal mucosa in close proximity to the point at which the tablet is attached to the mucosa.
The drug and/or the effervescent material could be present in a sustained release matrix. The whole tablet may consist of this matrix or the matrix may be confined to one, or more, layers of a multilayered tablet. FIG. 2 depicts a multilayered tablet with a central layer containing the drug and optional effervescent material; and two mucoadhesive layers. The tablet would adhere to the mucosa irrespective of its spatial orientation within the intestine.
FIGS. 3 and 4 depict the effervescent layer external to the mucoadhesive layer of each dosage form. FIG. 3 depicts a multilayered tablet in which a central core is completely surrounded by each subsequent layer. Such a tablet may be prepared by a compression coating technique. A similar physical arrangement of layers can also be achieved in a spheroid or pellet which may be prepared by extrusion and spheronization, layering, coating or any combination of these techniques. (See FIG. 4.) The effervescence will cause a thinning of the mucus layer from the gastrointestinal segment, thus facilitating adhesive of the dosage form to the cellular surface rather than to the mucus layer. This arrangement promotes better absorption of the drug.
Tablets can be manufactured by wet granulation, dry granulation, direct compression or any other tablet manufacturing technique. The tablet may be a layered tablet consisting of a layer of the active ingredients set forth above in layers of diverse compositions. In accordance with the present invention, the tablet size is preferably up to about 3/4". In accordance with the present invention, the multiparticulate size is preferably up to about 3 mm. In accordance with the present invention, the tablet hardness is preferably between about 5N and 100N.
Excipient fillers can be used in connection with the present invention to facilitate tableting. Nonlimiting examples of fillers include: mannitol, dextrose, lactose, sucrose, and calcium carbonate.
Pellets or other multiparticulates may be manufactured by granulation, layering techniques, extrusion and spheronization or other pellet manufacturing methods. The multiparticulates are then coated with an enteric coating material as described for tablets. The coating is preferably done in a fluid bed coater. The preferred, but nonlimiting, coating material is hydroxypropylmethyl cellulose in a grade that dissolves at pH 5. The multiparticulates are then packed into capsules.
The granules may be made by a wet granulation process or a dry granulation process. When wet granulation is used, isopropyl alcohol, ethyl alcohol or other nonaqueous granulating agent is used. Low moisture content grades of these organic solvents are used.
Dry granulation may be achieved through slugging or chilsonation. Layering may be done in a fluid bed apparatus or coating pan. Nonaqueous binders are used to aid the adherence of the added material (drug, effervescent penetration enhancer and excipients) to the starting material. Nonlimiting examples of the starting material or cores are nonpareils (sucrose) or microcrystalline cellulose seeds.
The preferred technique for the manufacture of multiparticulates is extrusion and spheronization. The beads contain the drug, effervescent couple (as previously described), a fine particle diluent which also aids in the formation of the beads (examples are lactose and mannitol) and a spheronization aid such as microcrystalline cellulose. The preferred grade of the latter is Avicel RC 591 which contains sodium carboxymethyl cellulose as an additional ingredient. For this formulation, a nonaqueous solvent is used. Nonlimiting examples of nonaqueous solvents are isopropanol and ethanol. Low moisture content grades are used.
The alternate (and preferred) formulation is to manufacture two populations of beads, one containing the acid component and the other the alkaline component of the effervescent couple. Each population of beads contains similar drug concentrations and can be manufactured using water. Care should be taken to ensure that each population of beads has a similar size range and a similar density. Equal densities may be achieved by the incorporation of a nontoxic material of high density to the population of beads that would, otherwise, have had a lower density. A nonlimiting example of such a material is barium sulfate. Equivalence of size and density facilitates the achievement of similar emptying rates of the beads from the stomach once the dosage forms are consumed by the subject. When the beads come into contact with the intestinal fluids, the coating dissolves and the close proximity of the beads to each other allows the effervescent reaction to occur in situ.
The coating applied to the dosage forms of the present invention must be performed with precision to avoid pinhole faults since water penetration through such faults leads to rapid and premature disintegration of the tablet. Such coating can be performed by one skilled in the art who, additionally, takes precautions to limit abrasion and chipping of the partially formed coat during the coating process. A fluid bed coater, pan coater or other coating apparatus may preferably be used.
Claim 1 of 59 Claims
We claim:
1. A dosage form for delivery of a therapeutically effective amount of a
drug to a target area in the gastrointestinal tract of a mammal;
comprising:
(a) a therapeutically effective amount of a drug;
(b) at least one effervescent penetration enhancer; wherein said at least
one effervescent penetration enhancer is present in an amount sufficient
to increase the penetration of said drug across said target area of said
gastrointestinal tract to permit delivery of a therapeutically effective
amount of said drug;
(c) a pH adjusting substance comprising an acid or a base; and
(d) an enteric coating maintained over said drug, said at least one
effervescent penetration enhancer and said pH adjusting substance; wherein
said enteric coating prevents the release of said drug, said at least one
effervescent penetration enhancer and said pH adjusting substance until a
time at which said dosage form reaches said target area in said
gastrointestinal tract.
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