|Title:||Posaconazole intravenous solution formulations stabilized by substituted .beta.-cyclodextrin|
|Abstract:||The present invention relates to aqueous solutions useful as pharmaceutical compositions of posaconazole for intravenous administration. These compositions include a solubilizing agent, such as a modified .beta.-cyclodextrin in an acidified solution, which can also include a chelating agent such as disodium edetate (EDTA). In clinical trials, a 200 mg posaconazole dose of the selected composition was found to achieve acceptable pharmacokinetic properties.|
|Inventor(s):||Heimbecher; Susan K. (Morris Plains, NJ), Monteith; David (Pittstown, NJ), Pipkin; James D. (Lawrence, KS)|
|Assignee:||Merck Sharp & Dohme Corp. (Rahway, NJ)|
1. A pharmaceutical composition for intravenous administration comprising: posaconazole, or a pharmaceutically acceptable salt thereof; and a modified .beta.-cyclodextrin
which comprises sulfobutylether-.beta.-cyclodextrin having a degree of substitution of 6.5 and a molecular weight of 2163 g/mole; in aqueous solution, wherein the pH of said composition is between about 2.0 and about 3.5, wherein the concentration of
said posaconazole, or pharmaceutically acceptable salt thereof, is between about 14 and about 22 mg/mL, and the concentration of said modified .beta.-cyclodextrin is between about 350 and about 450 mg/mL.
2. The composition according to claim 1, further comprising a chelating agent.
3. The composition according to claim 2, wherein said pharmaceutical composition comprises posaconazole free base, said chelating agent comprises EDTA, and wherein said pH is between about 2.3 and about 3.0.
4. The composition according to claim 3, wherein the concentration of said EDTA is between about 0.1 and about 0.3 mg/mL.
5. The composition according to claim 3, wherein the concentration of said posaconazole free base is about 18 mg/mL, the concentration of said sulfobutylether-.beta.-cyclodextrin is about 400 mg/mL, and the concentration of said EDTA is about 0.2 mg/mL.
6. The composition according to claim 1, wherein administration of a dose of said composition that delivers 200 mg of posaconazole to a patient results in a C.sub.max of between about 1176 and about 18375 ng/ml, and an AUC.sub.iast of between about 21,600 and about 33,750 hr*ng/ml.
7. The composition according to claim 1, wherein administration of a dose of said composition that delivers 200 mg of posaconazole to a patient results in a C.sub.max of about 1470 ng/ml and an AUC.sub.last of about 27,000 hr*ng/ml.
8. A pharmaceutical composition comprising components and the quantities of each as follows: TABLE-US-00014 Components Quantity Posaconazole about 18 mg/mL sulfobutylether-.beta.-cyclodextrin about 400 mg/mL (185 mM) sodium salt, molecular weight 2163 g/mole (degree of substitution = 6.5), solubility > 800 mg/mL in water Disodium Edetate (EDTA) about 0.2 mg/mL 1N Hydrochloric Acid sufficient quantity to adjust to pH of about 2.6 1N Sodium Hydroxide sufficient quantity to adjust to pH of about 2.6 Water q.s. ad 1 mL.
9. A method of treating an infection in an animal in need thereof which comprises administering to said animal an effective amount of the pharmaceutical composition of claim 1.
10. The method of claim 9 where said infection is caused by a fungus or a parasite.
11. The method of claim 9 wherein said infection is one or more selected from the group consisting of: oropharyngeal or esophageal candidiasis; refractory oropharyngeal and esophageal candidiasis; invasive aspergillosis, candidiasis, fusarriosis, scedosporiosis, infections due to dimorphic fungi, zygomycosis, and invasive infections due to rare molds and yeasts; invasive mycoses in patients who are refractory to, or intolerant of, other therapies; Candidiasis, invasive mold infections in patients who have undergone intensive chemotherapy and/or radiation therapy for hematologic malignancies, bone marrow or peripheral stem cell transplant conditioning regimes, and patients receiving combination immunosuppressive therapy for the treatment of acute or chronic graft-versus-host disease; Chagas disease; and Leishmaniasis.
12. A pharmaceutical composition according to claim 1, wherein after said composition has been injected into an infusion bag, the composition and the infusate have been admixed, and the resulting admixture has been allowed to stand for up to 24 hours, no posaconazole precipitate is visible.
13. A method of treating an infection in an animal in need thereof which comprises administering to said animal the composition of claim 1 in an amount sufficient to deliver a dose of between about 180 and about 220 mg posaconazole to said animal.
14. A method of treating an infection in an animal in need thereof which comprises administering to said animal the composition of claim 1 in an amount sufficient to deliver a dose of about 200 mg posaconazole to said animal.
15. The method according to claim 13 wherein said administration occurs once per day.
16. The method according to claim 13 wherein said administration occurs twice per day.
17. The method of claim 9 further comprising administering a second active ingredient selected from one or more of the group consisting of antifungals, antibacterials, antivirals, steroids, nonsteroidal anti-inflammatory drugs, chemotherapeutics and anti-emetics.
18. The method of claim 9 wherein said antifungals are selected from the group consisting of azoles, echinocandin, allylamine, polyene, flucytosine, benzoic acid, ciclopirox, 1,3-dihydro-5-fluoro-1-hydroxy-2,1-benzoxaborate, tolnaftate, undecyclenic acid, griseofulvin and haloprogin.
19. A kit comprising: a small, breakable container; an infusion bag; and the composition of claim 1, wherein said container contains the composition of claim 1, and said infusion bag contains a diluent selected from the group consisting of normal saline solution and 5% dextrose solution, and wherein said small, breakable container is placed directly inside said infusion bag suitably to allow said composition to be diluted by breaking said small, breakable container directly inside diluent in said infusion bag.
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