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  Pharmaceutical Patents  

 

Title:  Reconstitutable parenteral composition
United States Patent: 
7,695,736
Issued: 
April 13, 2010

Inventors:
 Kararli; Tugrul T. (Skokie, IL), Nema; Sandeep (Grayslake, IL), Karim; Aziz (Skokie, IL)
Assignee:
  Pfizer Inc. (New York, NY)
Appl. No.:
 10/113,281
Filed:
 April 1, 2002


 

Training Courses --Pharm/Biotech/etc.


Abstract

A pharmaceutical composition comprises, in powder form, (a) at least one water-soluble therapeutic agent selected from selective COX-2 inhibitory drugs and prodrugs and salts thereof, for example parecoxib sodium, in a therapeutically effective total amount constituting about 30% to about 90% by weight, (b) a parenterally acceptable buffering agent in an amount of about 5% to about 60% by weight, and optionally (c) other parenterally acceptable excipient ingredients in a total amount not greater than about 10% by weight, of the composition. The composition is reconstitutable in a parenterally acceptable solvent liquid to form an injectable solution. A lyophilization process is provided for preparation of such a composition.

Description of the Invention

SUMMARY OF THE INVENTION

There is now provided, in one embodiment, a pharmaceutical composition comprising, in powder form, (a) at least one water-soluble therapeutic agent selected from selective COX-2 inhibitory drugs and prodrugs and salts thereof, in a therapeutically effective total amount constituting about 30% to about 90% by weight, (b) a parenterally acceptable buffering agent in an amount of about 5% to about 60% by weight, and optionally (c) other parenterally acceptable excipient ingredients in a total amount not greater than about 10% by weight, of the composition. The composition is reconstitutable in a parenterally acceptable solvent liquid, preferably an aqueous liquid, to form an injectable solution.

The composition described above can be prepared by a process comprising a step of lyophilization of an aqueous solution comprising the therapeutic agent, the buffering agent and optionally other excipient ingredients to form a readily reconstitutable powder; such a process represents a further embodiment of the present invention.

A still further embodiment of the invention is an injectable solution prepared by reconstitution of the composition.

A still further embodiment of the invention is an article of manufacture comprising a sealed vial having contained therewithin a unit dosage amount of the composition in a sterile condition.

A still further embodiment of the invention is a method of treating or preventing a COX-2 mediated disease or disorder in a subject, the method comprising (a) reconstituting a unit dosage amount of the composition in a physiologically acceptable volume of a parenterally acceptable solvent liquid to form an injectable solution, and (b) injecting the solution parenterally into the subject.

In all of the above embodiments, an especially preferred therapeutic agent is a water-soluble salt of parecoxib. It is surprisingly found that parecoxib, upon parenteral administration, exhibits through conversion to valdecoxib substantially equal anti-inflammatory and analgesic effect at equal dose to valdecoxib itself. Thus, according to a yet further embodiment of the invention, there is provided a method of treating or preventing a COX-2 mediated disease or disorder in a subject, the method comprising parenterally administering parecoxib or a salt thereof to the subject at a parecoxib dosage equal in molar amount to a therapeutically effective dosage of valdecoxib.

A yet further embodiment of the invention is an article of manufacture comprising a sealed vial having contained therewithin a sterile parenterally deliverable composition that comprises parecoxib or a salt thereof in a parecoxib dosage amount equal to a therapeutically effective dosage of valdecoxib.

DETAILED DESCRIPTION OF THE INVENTION

A pharmaceutical composition of the present invention comprises as the therapeutic agent: (a) a water-soluble selective COX-2 inhibitory drug; (b) a water-soluble salt of a selective COX-2 inhibitory drug, whether or not such drug is itself water-soluble; (c) a water-soluble prodrug of a selective COX-2 inhibitory drug, whether or not such drug is itself water-soluble; or (d) a water-soluble salt of a prodrug of a selective COX-2 inhibitory drug, whether or not such prodrug is itself water-soluble.

More than one such therapeutic agent can be present, but in general it is preferred to include only one such selective COX-2 inhibitory drug or prodrug or salt thereof in the composition. A composition comprising a prodrug of a selective COX-2 inhibitory drug or a salt of such drug or prodrug may contain a small quantity of the drug itself, for example if the prodrug or salt readily converts to the drug during manufacture, storage, handling or use.

The term "water-soluble" as applied to a therapeutic agent herein means that the agent, in an amount that is therapeutically effective in a subject, is soluble in water at 20-25.degree. C. and at a parenterally acceptable pH, the water being in a volume less than a maximum volume acceptable for parenteral administration of a single dose to the subject. Preferred therapeutic agents have a solubility in water at 20.degree. C. and pH 7.4 of greater than about 0.1 mg/ml. More preferred therapeutic agents have a solubility in water at 20.degree. C. and pH 7.4 of greater than about 0.5 mg/ml.

A selective COX-2 inhibitory drug useful herein, or to which a prodrug or salt useful herein is converted in vivo, exhibits selective inhibition of COX-2 relative to COX-1 with a selectivity factor of at least 50, preferably at least 100. Such drugs include without limitation compounds disclosed in the patents and publications listed below, each of which is individually incorporated herein by reference.

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A preferred selective COX-2 inhibitory drug useful herein, or to which a prodrug or salt useful herein is converted in vivo, is a compound of formula (IV) -- see Original Patent.

Compositions of the invention are especially useful for water-soluble salts, prodrugs and salts of prodrugs of selective COX-2 inhibitory drugs having the formula (V) -- see Original Patent.

Illustratively, compositions of the invention are suitable for water-soluble salts, prodrugs and salts of prodrugs of celecoxib, deracoxib, valdecoxib, rofecoxib, etoricoxib, 2-(3,5-difluorophenyl)-3-[4-(methylsulfonyl)phenyl]-2-cyclopenten-1-one and 2-(3,4-difluorophenyl)-4-(3-hydroxy-3-methyl-1-butoxy)-5-[4-(methylsu- lfonyl)phenyl]-3-(2H)-pyridazinone, most particularly valdecoxib. A particularly useful prodrug of valdecoxib for use in compositions of the invention is parecoxib, more particularly a water-soluble salt thereof, for example parecoxib sodium.

Parecoxib used in compositions and methods of the invention can illustratively be prepared in the manner set forth in above-cited U.S. Pat. No. 5,932,598.

Compositions of the invention are also useful for compounds having the formula (VI) -- see Original Patent.

A particularly useful compound of formula (VI) is (S)-6,8-dichloro-2-(trifluoromethyl)-2H-1-benzopyran-3-carboxylic acid, particularly in the form of a water-soluble salt thereof, for example the sodium salt. This compound can illustratively be prepared in the manner set forth in above-cited U.S. Pat. No. 6,034,256.

One or more therapeutic agents selected from those disclosed hereinabove are present in a reconstitutable powder composition of the invention in a total amount of about 30% to about 90%, preferably about 40% to about 85%, and more preferably about 50% to about 80%, by weight of the composition.

The buffering agent, which is present in an amount of about 5% to about 60%, preferably about 10% to about 60%, and more preferably about 20% to about 50%, by weight of the composition, is typically the predominant excipient ingredient. In one embodiment of the invention, the reconstitutable powder composition consists essentially of the therapeutic agent and the buffering agent.

The buffering agent is selected to provide a pH of the composition, upon reconstitution in a physiologically acceptable volume of a parenterally acceptable solvent liquid, that (a) is parenterally acceptable, (b) is consistent with the therapeutic agent being entirely in solution in the solvent liquid, and (c) provides a medium wherein the therapeutic agent exhibits acceptable chemical stability for at least about one hour following reconstitution. Suitable buffering agents can illustratively be selected from sodium and potassium phosphates, sodium and potassium citrates, mono-, di- and triethanolamines, 2-amino-2-(hydroxymethyl)-1,3-propanediol (tromethamine), etc. and mixtures thereof. Preferred buffering agents are dibasic sodium and potassium phosphates and tromethamine. An especially preferred buffering agent is dibasic sodium phosphate, for example dibasic sodium phosphate anhydrous, heptahydrate, dodecahydrate, etc.

In one embodiment, the pH of the composition upon reconstitution is about 7 to about 9, preferably about 7.5 to about 8.5, for example about 8. If desired, pH can be adjusted by including in the composition, in addition to the buffering agent, a small amount of an acid, for example phosphoric acid, and/or a base, for example sodium hydroxide.

Excipients other than the buffering agent, if present, constitute not more than about 10%, preferably not more than about 5%, by weight of the composition prior to reconstitution. The term "excipient" herein embraces all non-therapeutically active components of the composition except for water. In one embodiment of the invention, no excipients other than the buffering agent are substantially present.

Surprisingly, it has been found important to include in the composition no more than about 10% by weight, preferably no more than about 5% by weight, and most preferably substantially no amount, of ingredients commonly used as bulking agents in reconstitutable parenteral formulations, other than buffering agents. In particular, the widely used bulking agent mannitol is preferably excluded from the composition, or if included, is present at no more than about 10%, preferably no more than about 5%, by weight of the composition. According to the present invention, it is believed that by minimizing the amount of, or excluding altogether, such bulking agents, especially mannitol, as components of the composition, acceptable chemical stability of the therapeutic agent can be assured.

Optionally, one or more preservatives can be included in the composition at up to about 0.5% by weight. Suitable illustrative preservatives include methylparaben, propylparaben, phenol and benzyl alcohol.

A reconstitutable powder composition of the invention preferably contains less than about 5%, more preferably less than about 2%, and most preferably less than about 1%, by weight of water. Typically the moisture content is about 0.5% to about 1% by weight. It is especially important to keep the amount of water to such a low level where the therapeutic agent has a tendency to degrade or convert to a less soluble form in presence of water. Powder compositions of the invention exhibit acceptable chemical stability of the therapeutic agent for at least about 30 days, preferably at least about 6 months, most preferably at least about 2 years, when stored at room temperature (about 20-25.degree. C.) in a sealed vial.

"Acceptable chemical stability" herein means that the composition, following the defined time period (e.g., about 30 days, about 6 months or about 2 years), passes a standard test for chemical purity of the therapeutic agent, for example as may be required for approval by a regulatory authority. An example of such a test is the "5% total, 1% single impurity rule", whereby a preparation of a candidate drug must contain not more than 5% total impurities, and not more than 1% of any single impurity.

Where the therapeutic agent is parecoxib, for example in the form of parecoxib sodium, partial conversion to valdecoxib can occur in a composition over a period of time. As valdecoxib is itself therapeutically active as a selective COX-2 inhibitory drug (indeed the therapeutic efficacy of parecoxib is dependent upon conversion in the body to valdecoxib), such conversion does not result in a loss of therapeutic effect. However, as valdecoxib has extremely low solubility in water, it is desirable to minimize such conversion prior to reconstitution, so that complete dissolution of the therapeutic agent is assured. The presence of particulates, such as would result from the presence of significant quantities of valdecoxib, is generally undesirable in a solution intended for parenteral administration.

It is surprisingly found that conversion of parecoxib to valdecoxib in a reconstitutable powder composition can be greatly reduced by reduction or, preferably, elimination from the composition of bulking agents such as mannitol. This is illustrated in Examples 1 and 2 hereinbelow. Compositions of the invention, having no more than 10% by weight of excipients other than buffering agents, exhibit a very high degree of chemical stability of parecoxib, as shown in Example 1, whereas compositions having higher levels of excipients other than buffering agents exhibit a greater degree of conversion of parecoxib to valdecoxib, as shown in Example 2.

An injectable solution composition prepared by reconstituting a powder composition as herein provided in a parenterally acceptable solvent, preferably an aqueous solvent, is a further embodiment of the present invention. In such a solution composition the therapeutic agent can have limited chemical stability, in which case it is preferred to reconstitute the composition within a short period of time, for example within about one hour, before administration. In other cases the therapeutic agent can exhibit a relatively high degree of chemical stability in solution, and in such cases it is not critical to administer within a short period of time after reconstitution.

Where the therapeutic agent is parecoxib, for example in the form of parecoxib sodium, partial conversion to highly insoluble valdecoxib can occur in aqueous solution over a period of time, resulting in formation of solid particulates. As indicated above, the presence of solid particulates is generally undesirable in injectable formulations; thus in the particular case of parecoxib compositions of the invention, injectable solutions are preferably administered within a short period of time, for example within about one hour, following reconstitution.

Rate of conversion of parecoxib to valdecoxib in an aqueous medium can be greatly reduced by maintaining the medium at a pH of about 7 or higher. Furthermore, aqueous solubility of parecoxib sodium itself is strongly affected by pH. For example, equilibrium solubility at 20.degree. C. rises from 1.0 mg/ml at pH 7.3 to 18 mg/ml at pH 7.8 and to 220 mg/ml at pH 8.2. Supersaturated solutions of parecoxib sodium can also be prepared at much higher concentrations. A preferred pH range providing physiological acceptability, good short-term chemical stability and good solubility of parecoxib sodium is about 7.5 to about 8.5, more preferably about 7.8 to about 8.2, for example about 8.0.

Any known parenterally acceptable solvent liquid can be used to reconstitute a powder composition of the invention. Water for injection can be suitable, but will generally provide a hypotonic solution. Accordingly, it is generally preferred to use an aqueous liquid containing a solute such as dextrose or sodium chloride. Illustratively, 0.9% sodium chloride injection USP, bacteriostatic 0.9% sodium chloride injection USP, 5% dextrose injection USP, and 5% dextrose and 0.45% sodium chloride injection USP are suitable. Lactated Ringer's injection USP is less suitable, at least where the therapeutic agent is parecoxib sodium, because of a tendency to form crystals.

A suitable volume of the solvent liquid for reconstitution depends on the age and body weight of the subject, the solubility and dosage amount of the therapeutic agent and other factors, but is generally about 0.25 ml to about 5 ml, preferably about 0.5 ml to about 2 ml. For example, in the case of parecoxib sodium, a 20 mg dose can generally be conveniently reconstituted in about 1 ml of any of the above solvent liquids, while for a 40 mg dose a 2 ml volume of the solvent liquid is generally suitable.

A powder composition of the invention preferably has sufficient porosity to permit rapid dissolution of the therapeutic agent upon reconstitution in the solvent liquid. A high degree of porosity is obtainable by using a process to prepare the powder as described hereinbelow. Such a process is a further embodiment of the present invention and is described herein with particular reference to parecoxib sodium and dibasic sodium phosphate heptahydrate; however, it will be understood that the process can be readily adapted to other therapeutic agents and/or other buffering agents in accordance with the invention.

In this process, parecoxib sodium and dibasic sodium phosphate heptahydrate as buffering agent are dissolved in water to form an aqueous solution. Preferably water for injection is used as the solvent. Parecoxib sodium and the buffering agent are present in the solution at concentrations relative to each other consistent with the desired relative concentrations of these ingredients in the final composition. Absolute concentrations of these ingredients are not critical; however, in the interest of process efficiency it is generally preferred that the concentration of parecoxib sodium be as high as can be conveniently prepared without risking exceeding the limit of solubility. Other formulation ingredients can be added in this step if desired. Order of addition is not critical but it is strongly preferred to add the parecoxib sodium last to ensure rapid and complete dissolution.

The solution is optionally but preferably sterilized, for example by passing through one or more sterilizing filters, and is then metered into one or more vials. Each vial receives a measured volume of solution having a desired unit dosage amount of parecoxib sodium. Lyophilization stoppers having an opening to allow sublimation to occur are placed on the vials. Preferably the vials and stoppers are sterile and filling is conducted under aseptic conditions.

The stoppered vials are then placed in a lyophilization chamber and the contents of the vials lyophilized, preferably in a three-phase cycle.

In a first phase of the lyophilization cycle, the solution in each vial is frozen to a temperature below the glass transition temperature of the solution. For compositions of the invention comprising parecoxib sodium and dibasic sodium phosphate, the glass transition temperature is about -20.degree. C. Glass transition temperature can be measured by any technique known in the art, for example by use of a freeze-drying microscope or by electrical resistance measurement. A suitable temperature for this freezing phase is typically about -30.degree. C. to about -60.degree. C., for example about -40.degree. C. to about -50.degree. C. Temperature is gradually lowered from room temperature to the desired freezing temperature, typically over a period of about 1 to about 5 hours, more typically about 2 to about 4 hours. The temperature is then held at the freezing temperature, typically for a period of about 0.5 to about 24 hours, more typically about 0.75 to about 3 hours.

In the freezing phase of a preferred lyophilization process, temperature is first lowered from room temperature to about -20.degree. C. fairly rapidly, e.g., over a period of about 0.25 to about 1 hour, more preferably about 0.5 to about 0.75 hour. Temperature is then lowered more gradually from about -20.degree. C. to about -30.degree. C., e.g., over a period of about 1 to about 4 hours, more preferably about 1.5 to about 3 hours. Without being bound by theory, it is believed that this gradual lowering of temperature ensures that the solution is completely frozen. Temperature is then lowered fairly rapidly from about -30.degree. C. to the final freezing temperature, preferably about -40.degree. C., e.g., over a period of about 0.1 to about 1 hour, more preferably about 0.25 to about 0.5 hour. It has been found that a stepwise freezing phase as described above tends to provide a final lyophilized product that appears solid with no cracking.

In a second phase of the lyophilization cycle, freeze-drying is effected by drawing a vacuum in the lyophilization chamber. This phase is described herein as the "primary drying" phase. A vacuum of about 25 to about 500 .mu.m Hg (about 25 to about 500 millitorr), preferably about 50 to about 300 .mu.m Hg, is generally suitable. During the primary drying phase, temperature is gradually raised, optionally in stages separated by periods when the temperature is held constant. Preferably the vacuum is maintained with a nitrogen sweep. Ice sublimates from the frozen solution during this phase, forming a partially dried cake.

In the primary drying phase of a preferred lyophilization process, temperature is first raised from the freezing temperature, e.g., about -40.degree. C., to about 0.degree. C. over a period of about 1 to about 5 hours, preferably about 2 to about 4 hours, and is then held at about 0.degree. C. for a prolonged period, for example about 6 to about 12 hours, preferably about 8 to about 10 hours. Preferably a vacuum of about 150 to about 300 .mu.m Hg is used during the primary drying phase.

In a third phase of the lyophilization cycle, drying is completed under vacuum. This phase is described herein as the "secondary drying" phase. Again a vacuum of about 25 to about 500 .mu.m Hg, preferably about 50 to about 300 .mu.m Hg, is generally suitable, preferably maintained with a nitrogen sweep. Temperature is raised during the secondary drying phase, preferably to a level above room temperature, for example about 40.degree. C., to drive off remaining moisture and provide a powder having a moisture content of less than about 5%, preferably less than about 2%, more preferably less than about 1%, by weight.

In the secondary drying phase of a preferred lyophilization process, temperature is first raised from about 0.degree. C. to about 40.degree. C. over a period of about 1 to about 4 hours, preferably about 1.5 to about 3 hours, and is then held at about 40.degree. C. for about 3 to about 12 hours, preferably about 4 to about 8 hours. Preferably a vacuum of about 150 to about 300 .mu.m Hg is used during the secondary drying phase. Optionally during the last part of the secondary drying phase, while temperature is being held at about 40.degree. C., the vacuum is lowered to about 25 to about 75 .mu.m Hg.

The overall lyophilization cycle time is typically about 18 to about 36 hours. Extending the cycle time is generally not deleterious to quality of the finished product but increases process cost. The best combination of product quality and process economics can be found by routine testing based on the information presented herein, and will vary depending on several factors, including the particular lyophilization equipment used, the precise composition and concentration of ingredients in the solution being lyophilized, the therapeutic agent and buffering agent selected, etc. In general, however, a cycle time of about 18 to about 24 hours will be found suitable. In the case of parecoxib sodium compositions having dibasic sodium phosphate as the buffering agent, it has been found that shortening cycle time substantially below about 18 hours, for example to 16.5 hours, leads to increased incidence of collapse of the finished product, which in turn is not conducive to the desired rapid dissolution upon reconstitution.

On completion of the lyophilization cycle, the vacuum is released and temperature is permitted to return to room temperature. The vials are then capped and sealed to prevent reabsorption of moisture from the atmosphere and to maintain sterility.

An article of manufacture comprising a sealed vial, preferably a glass vial, having enclosed therewithin a powder composition as herein provided in a unit dosage amount and in a sterile condition, is a further embodiment of the present invention. In a particular embodiment, such an article of manufacture is provided, prepared by a process as described above. The vial preferably has a capacity sufficient to enable reconstitution of the composition in situ. Generally a capacity of about 1 ml to about 10 ml, preferably about 2 ml to about 5 ml, will be found convenient.

The term "vial" herein is used to denote any small container, having a closure, that is suitable for packaging a unit dosage amount of a reconstitutable powder, preferably in a sterile condition. It will be understood that equivalent forms of packaging, such as an ampoule, a disposable syringe and a syringe cartridge, are encompassed by this embodiment of the invention.

Optionally the vial can comprise two compartments, one to contain the reconstitutable powder and one to contain a solvent liquid in an amount sufficient to dissolve the powder. In such a vial the two compartments are interconnected by an aperture wherein a stopper can be engaged to prevent contact of the powder and the solvent liquid until the vial is ready for use. In use, the liquid is brought into contact with the powder by disengagement or puncture of the stopper by any suitable means, for example a device such as a plunger that exerts pressure or drives a needle through the stopper. Examples of such multi-compartment vials include a dual-chamber cartridge for a syringe and a dual-chamber vial such as that available under the trademark Act-O-Vial.RTM. of Pharmacia Corporation.

A unit dosage amount of a powder composition of the invention, suitable for preparation and or placement in a vial to form an article of manufacture of the invention, is an amount that comprises sufficient of the therapeutic agent to provide a therapeutic benefit upon parenteral administration to a subject having a COX-2 mediated condition or disorder. For example, in the case of a parecoxib sodium composition of the invention, a suitable unit dosage amount is generally one containing about 1 mg to about 200 mg, preferably about 5 mg to about 120 mg, and more preferably about 10 mg to about 100 mg, for example about 20 mg, about 40 mg or about 80 mg, parecoxib. Where the therapeutic agent is other than parecoxib, a suitable unit dosage amount is one that is therapeutically equivalent to parecoxib at the dosage ranges indicated above.

Compositions of the invention are useful in treatment and prevention of a very wide range of disorders mediated by COX-2, including but not restricted to disorders characterized by inflammation, pain and/or fever. Such compositions are especially useful as anti-inflammatory agents, such as in treatment of arthritis, with the additional benefit of having significantly less harmful side effects than compositions of conventional NSAIDs that lack selectivity for COX-2 over COX-1. In particular, compositions of the invention have reduced potential for gastrointestinal toxicity and gastrointestinal irritation, including upper gastrointestinal ulceration and bleeding, by comparison with compositions of conventional NSAIDs. Thus compositions of the invention are particularly useful as an alternative to conventional NSAIDs where such NSAIDs are contraindicated, for example in patients with peptic ulcers, gastritis, regional enteritis, ulcerative colitis, diverticulitis or with a recurrent history of gastrointestinal lesions; gastrointestinal bleeding, coagulation disorders including anemia such as hypoprothrombinemia, hemophilia or other bleeding problems; kidney disease; or in patients prior to surgery or patients taking anticoagulants.

Contemplated compositions are useful to treat a variety of arthritic disorders, including but not limited to rheumatoid arthritis, spondyloarthropathies, gouty arthritis, osteoarthritis, systemic lupus erythematosus and juvenile arthritis.

Such compositions are useful in treatment of asthma, bronchitis, menstrual cramps, preterm labor, tendinitis, bursitis, allergic neuritis, cytomegalovirus infection, apoptosis including HIV-induced apoptosis, lumbago, liver disease including hepatitis, skin-related conditions such as psoriasis, eczema, acne, burns, dermatitis and ultraviolet radiation damage including sunburn, and post-operative inflammation including that following ophthalmic surgery such as cataract surgery or refractive surgery.

Such compositions are useful to treat gastrointestinal conditions such as inflammatory bowel disease, Crohn's disease, gastritis, irritable bowel syndrome and ulcerative colitis.

Such compositions are useful in treating inflammation in such diseases as migraine headaches, periarteritis nodosa, thyroiditis, aplastic anemia, Hodgkin's disease, sclerodoma, rheumatic fever, type I diabetes, neuromuscular junction disease including myasthenia gravis, white matter disease including multiple sclerosis, sarcoidosis, nephrotic syndrome, Behcet's syndrome, polymyositis, gingivitis, nephritis, hypersensitivity, swelling occurring after injury including brain edema, myocardial ischemia, and the like.

Such compositions are useful in treatment of ophthalmic disorders, including without limitation inflammatory disorders such as endophthalmitis, episcleritis, retinitis, iriditis, cyclitis, choroiditis, keratitis, conjunctivitis and blepharitis, inflammatory disorders of more than one part of the eye, e.g., retinochoroiditis, iridocyclitis, iridocyclochoroiditis (also known as uveitis), keratoconjunctivitis, blepharoconjunctivitis, etc.; other COX-2 mediated retinopathies including diabetic retinopathy; ocular photophobia; acute trauma of any tissue of the eye including postsurgical trauma, e.g., following cataract or corneal transplant surgery; postsurgical ocular inflammation; intraoperative miosis; corneal graft rejection; ocular, for example retinal, neovascularization including that following injury or infection; macular degeneration; cystoid macular edema; retrolental fibroplasia; neovascular glaucoma; and ocular pain.

Such compositions are useful in treatment of pulmonary inflammation, such as that associated with viral infections and cystic fibrosis, and in bone resorption such as that associated with osteoporosis.

Such compositions are useful for treatment of certain central nervous system disorders, such as cortical dementias including Alzheimer's disease, neurodegeneration, and central nervous system damage resulting from stroke, ischemia and trauma. The term "treatment" in the present context includes partial or total inhibition of dementias, including Alzheimer's disease, vascular dementia, multi-infarct dementia, pre-senile dementia, alcoholic dementia and senile dementia.

Such compositions are useful in treatment of allergic rhinitis, respiratory distress syndrome, endotoxin shock syndrome and liver disease.

Such compositions are useful in treatment of pain, including but not limited to postoperative pain, dental pain, muscular pain, and pain resulting from cancer. For example, such compositions are useful for relief of pain, fever and inflammation in a variety of conditions including rheumatic fever, influenza and other viral infections including common cold, low back and neck pain, dysmenorrhea, headache, toothache, sprains and strains, myositis, neuralgia, synovitis, arthritis, including rheumatoid arthritis, degenerative joint diseases (osteoarthritis), gout and ankylosing spondylitis, bursitis, burns, and trauma following surgical and dental procedures.

Such compositions are useful for treating and preventing inflammation-related cardiovascular disorders, including vascular diseases, coronary artery disease, aneurysm, vascular rejection, arteriosclerosis, atherosclerosis including cardiac transplant atherosclerosis, myocardial infarction, embolism, stroke, thrombosis including venous thrombosis, angina including unstable angina, coronary plaque inflammation, bacterial-induced inflammation including Chlamydia-induced inflammation, viral induced inflammation, and inflammation associated with surgical procedures such as vascular grafting including coronary artery bypass surgery, revascularization procedures including angioplasty, stent placement, endarterectomy, or other invasive procedures involving arteries, veins and capillaries.

Such compositions are useful in treatment of angiogenesis-related disorders in a subject, for example to inhibit tumor angiogenesis. Such compositions are useful in treatment of neoplasia, including metastasis; ophthalmological conditions such as corneal graft rejection, ocular neovascularization, retinal neovascularization including neovascularization following injury or infection, diabetic retinopathy, macular degeneration, retrolental fibroplasia and neovascular glaucoma; ulcerative diseases such as gastric ulcer; pathological, but non-malignant, conditions such as hemangiomas, including infantile hemangiomas, angiofibroma of the nasopharynx and avascular necrosis of bone; and disorders of the female reproductive system such as endometriosis.

Such compositions are useful in prevention and treatment of benign and malignant tumors and neoplasia including cancer, such as colorectal cancer, brain cancer, bone cancer, epithelial cell-derived neoplasia (epithelial carcinoma) such as basal cell carcinoma, adenocarcinoma, gastrointestinal cancer such as lip cancer, mouth cancer, esophageal cancer, small bowel cancer, stomach cancer, colon cancer, liver cancer, bladder cancer, pancreas cancer, ovary cancer, cervical cancer, lung cancer, breast cancer, skin cancer such as squamous cell and basal cell cancers, prostate cancer, renal cell carcinoma, and other known cancers that effect epithelial cells throughout the body. Neoplasias for which compositions of the invention are contemplated to be particularly useful are gastrointestinal cancer, Barrett's esophagus, liver cancer, bladder cancer, pancreatic cancer, ovarian cancer, prostate cancer, cervical cancer, lung cancer, breast cancer and skin cancer. Such compositions can also be used to treat fibrosis that occurs with radiation therapy. Such compositions can be used to treat subjects having adenomatous polyps, including those with familial adenomatous polyposis (FAP). Additionally, such compositions can be used to prevent polyps from forming in subjects at risk of FAP.

Such compositions inhibit prostanoid-induced smooth muscle contraction by inhibiting synthesis of contractile prostanoids and hence can be of use in treatment of dysmenorrhea, premature labor, asthma and eosinophil-related disorders. They also can be of use for decreasing bone loss particularly in postmenopausal women (i.e., treatment of osteoporosis), and for treatment of glaucoma.

Preferred uses for compositions of the invention are for treatment of rheumatoid arthritis and osteoarthritis, for pain management generally (particularly post-oral surgery pain, post-general surgery pain, post-orthopedic surgery pain, and acute flares of osteoarthritis), for treatment of Alzheimer's disease, and for colon cancer chemoprevention.

Besides being useful for human treatment, compositions of the invention are useful for veterinary treatment of companion animals, exotic animals, farm animals, and the like, particularly mammals. More particularly, compositions of the invention are useful for treatment of COX-2 mediated disorders in horses, dogs and cats.

The present invention is further directed to a therapeutic method of treating a condition or disorder where treatment with a COX-2 inhibitory drug is indicated, the method comprising parenteral administration of a reconstituted composition of the invention to a subject in need thereof. The dosage regimen to prevent, give relief from, or ameliorate the condition or disorder preferably corresponds to once-a-day or twice-a-day treatment, but can be modified in accordance with a variety of factors. These include the type, age, weight, sex, diet and medical condition of the subject and the nature and severity of the disorder. Thus, the dosage regimen actually employed can vary widely and can therefore deviate from the preferred dosage regimens set forth above.

Initial treatment can begin with a dose regimen as indicated above. Treatment is generally continued as necessary over a period of several weeks to several months or years until the condition or disorder has been controlled or eliminated. Subjects undergoing treatment with a reconstituted composition of the invention can be routinely monitored by any of the methods well known in the art to determine effectiveness of therapy. Continuous analysis of data from such monitoring permits modification of the treatment regimen during therapy so that optimally effective doses are administered at any point in time, and so that the duration of treatment can be determined. In this way, the treatment regimen and dosing schedule can be rationally modified over the course of therapy so that the lowest amount of the composition exhibiting satisfactory effectiveness is administered, and so that administration is continued only for so long as is necessary to successfully treat the condition or disorder.

The term "parenteral administration" herein encompasses injection and/or infusion of a composition into or through the skin of a subject, and includes intradermal, subcutaneous, intramuscular, intravenous, intramedullary, intra-articular, intrasynovial, intraspinal, intrathecal and intracardiac administration. Any known device useful for parenteral injection or infusion of drugs can be used to effect such administration.

It has been found that parecoxib, when administered parenterally to a human subject, is rapidly and completely converted to valdecoxib. Surprisingly, therefore, even where rapid onset of therapeutic effect is desired, a therapeutically effective dose of parecoxib, for example in the form of parecoxib sodium, is one that is equal to a therapeutically effective dose of valdecoxib administered orally. The term "equal" in this context means equal in molar amount or in absolute amount (i.e., in weight). Based on molecular weights, complete conversion of 1 mg parecoxib produces about 0.85 mg valdecoxib. For practical purposes, no great error arises from considering 1 mg parecoxib to be equivalent to 1 mg valdecoxib.

Thus according to an embodiment of the present invention, a method is provided for treatment of a COX-2 mediated disorder in a human subject comprising parenterally administering parecoxib or a salt thereof to the subject at a parecoxib dosage equal to a therapeutically effective dosage of valdecoxib. Preferably, the parecoxib or salt thereof, for example the sodium salt, is administered in a daily dosage amount of about 1 mg to about 200 mg. More preferred daily dosage amounts are about 5 mg to about 120 mg, more preferably about 10 mg to about 100 mg, for example about 20 mg, about 40 mg or about 80 mg, parecoxib.

In an especially surprising finding, illustrated in FIG. 1 (see Original Patent), so rapid and complete is the conversion of parecoxib to valdecoxib that parenteral, for example intravenous, administration of parecoxib to a human subject provides a significantly earlier peak of blood plasma concentration of valdecoxib than does oral administration of valdecoxib itself at equal dose in immediate release form.

In a further embodiment of the invention, an article of manufacture is provided comprising a sealed vial, preferably a glass vial, containing a sterile parenterally deliverable composition that comprises parecoxib or a salt thereof in a parecoxib dosage amount equal to a therapeutically effective dosage of valdecoxib. Preferably the dosage amount of parecoxib is about 1 mg to about 200 mg, more preferably about 5 mg to about 120 mg, and most preferably about 10 mg to about 100 mg, for example about 20 mg, about 40 mg or about 80 mg. Preferably the parecoxib is present as parecoxib sodium. Optionally the vial is a multicompartment vial as hereinabove described.

Therapeutic methods of the present invention further include combination therapies of parecoxib or a composition of the invention with one or more drugs selected from opioids and other analgesics, including narcotic analgesics, Mu receptor antagonists, Kappa receptor antagonists, non-narcotic (i.e. non-addictive) analgesics, monoamine uptake inhibitors, adenosine regulating agents, cannabinoid derivatives, Substance P antagonists, neurokinin-1 receptor antagonists and sodium channel blockers, among others. Preferred combination therapies comprise use of a composition of the invention with one or more compounds selected from aceclofenac, acemetacin, e-acetamidocaproic acid, acetaminophen, acetaminosalol, acetanilide, acetylsalicylic acid (aspirin), S-adenosylmethionine, alclofenac, alfentanil, allylprodine, alminoprofen, aloxiprin, alphaprodine, aluminum bis(acetylsalicylate), amfenac, aminochlorthenoxazin, 3-amino-4-hydroxybutyric acid, 2-amino-4-picoline, aminopropylon, aminopyrine, amixetrine, ammonium salicylate, ampiroxicam, amtolmetin guacil, anileridine, antipyrine, antipyrine salicylate, antrafenine, apazone, bendazac, benorylate, benoxaprofen, benzpiperylon, benzydamine, benzylmorphine, bermoprofen, bezitramide, .alpha.-bisabolol, bromfenac, p-bromoacetanilide, 5-bromosalicylic acid acetate, bromosaligenin, bucetin, bucloxic acid, bucolome, bufexamac, bumadizon, buprenorphine, butacetin, butibufen, butophanol, calcium acetylsalicylate, carbamazepine, carbiphene, carprofen, carsalam, chlorobutanol, chlorthenoxazin, choline salicylate, cinchophen, cinmetacin, ciramadol, clidanac, clometacin, clonitazene, clonixin, clopirac, clove, codeine, codeine methyl bromide, codeine phosphate, codeine sulfate, cropropamide, crotethamide, desomorphine, dexoxadrol, dextromoramide, dezocine, diampromide, diclofenac sodium, difenamizole, difenpiramide, diflunisal, dihydrocodeine, dihydrocodeinone enol acetate, dihydromorphine, dihydroxyaluminum acetylsalicylate, dimenoxadol, dimepheptanol, dimethylthiambutene, dioxaphetyl butyrate, dipipanone, diprocetyl, dipyrone, ditazol, droxicam, emorfazone, enfenamic acid, epirizole, eptazocine, etersalate, ethenzamide, ethoheptazine, ethoxazene, ethylmethylthiambutene, ethylmorphine, etodolac, etofenamate, etonitazene, eugenol, felbinac, fenbufen, fenclozic acid, fendosal, fenoprofen, fentanyl, fentiazac, fepradinol, feprazone, floctafenine, flufenamic acid, flunoxaprofen, fluoresone, flupirtine, fluproquazone, flurbiprofen, fosfosal, gentisic acid, glafenine, glucametacin, glycol salicylate, guaiazulene, hydrocodone, hydromorphone, hydroxypethidine, ibufenac, ibuprofen, ibuproxam, imidazole salicylate, indomethacin, indoprofen, isofezolac, isoladol, isomethadone, isonixin, isoxepac, isoxicam, ketobemidone, ketoprofen, ketorolac, p-lactophenetide, lefetamine, levorphanol, lofentanil, lonazolac, lornoxicam, loxoprofen, lysine acetylsalicylate, magnesium acetylsalicylate, meclofenamic acid, mefenamic acid, meperidine, meptazinol, mesalamine, metazocine, methadone hydrochloride, methotrimeprazine, metiazinic acid, metofoline, metopon, mofebutazone, mofezolac, morazone, morphine, morphine hydrochloride, morphine sulfate, morpholine salicylate, myrophine, nabumetone, nalbuphine, 1-naphthyl salicylate, naproxen, narceine, nefopam, nicomorphine, nifenazone, niflumic acid, nimesulide, 5'-nitro-2'-propoxyacetanilide, norlevorphanol, normethadone, normorphine, norpipanone, olsalazine, opium, oxaceprol, oxametacine, oxaprozin, oxycodone, oxymorphone, oxyphenbutazone, papaveretum, paranyline, parsalmide, pentazocine, perisoxal, phenacetin, phenadoxone, phenazocine, phenazopyridine hydrochloride, phenocoll, phenoperidine, phenopyrazone, phenyl acetylsalicylate, phenylbutazone, phenyl salicylate, phenyramidol, piketoprofen, piminodine, pipebuzone, piperylone, piprofen, pirazolac, piritramide, piroxicam, pranoprofen, proglumetacin, proheptazine, promedol, propacetamol, propiram, propoxyphene, propyphenazone, proquazone, protizinic acid, ramifenazone, remifentanil, rimazolium metilsulfate, salacetamide, salicin, salicylamide, salicylamide o-acetic acid, salicylsulfuric acid, salsalte, salverine, simetride, sodium salicylate, sufentanil, sulfasalazine, sulindac, superoxide dismutase, suprofen, suxibuzone, talniflumate, tenidap, tenoxicam, terofenamate, tetrandrine, thiazolinobutazone, tiaprofenic acid, tiaramide, tilidine, tinoridine, tolfenamic acid, tolmetin, tramadol, tropesin, viminol, xenbucin, ximoprofen, zaltoprofen and zomepirac (see The Merck Index, 12th Edition, Therapeutic Category and Biological Activity Index, ed. S. Budavari (1996), pp. Ther-2 to Ther-3 and Ther-12 (Analgesic (Dental), Analgesic (Narcotic), Analgesic (Non-narcotic), Anti-inflammatory (Nonsteroidal)).

Particularly preferred combination therapies comprise use of parecoxib or a composition of the invention with an opioid compound, more particularly where the opioid compound is codeine, meperidine, morphine or a derivative thereof.

The drug being used in combination therapy with parecoxib or a composition of the invention can be administered by any route, including parenterally, orally, topically, etc.
 

Claim 1 of 34 Claims

1. A pharmaceutical composition comprising, in powder form: (a) parecoxib, or a salt thereof, in a therapeutically effective total amount constituting about 30% to about 90% by weight of the composition; (b) a parenterally acceptable buffering agent in an amount of about 10% to about 60% by weight of the composition; and (c) said parecoxib and buffering agent present in an amount from about 90% to about 100% by weight of the composition said composition being reconstitutable in a parenterally acceptable solvent liquid to form an injectable solution.

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