ES2539904T3 - Formulaciones orales de agonistas opioides resistentes a manipulaciones indebidas - Google Patents

Formulaciones orales de agonistas opioides resistentes a manipulaciones indebidas Download PDF

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ES2539904T3
ES2539904T3 ES12167170.5T ES12167170T ES2539904T3 ES 2539904 T3 ES2539904 T3 ES 2539904T3 ES 12167170 T ES12167170 T ES 12167170T ES 2539904 T3 ES2539904 T3 ES 2539904T3
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opioid
antagonist
dosage form
opioid antagonist
naltrexone
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Benjamin Oshlack
Curtis Wright
David J. Haddox
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Euro Celtique SA
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Euro Celtique SA
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    • A61K9/5084—Mixtures of one or more drugs in different galenical forms, at least one of which being granules, microcapsules or (coated) microparticles according to A61K9/16 or A61K9/50, e.g. for obtaining a specific release pattern or for combining different drugs
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Abstract

Composición de antagonista opioide que comprende un antagonista opioide dispersado en una matriz obtenida por extrusión de masas fundidas, en la que la matriz comprende uno o más de un material hidrófobo farmacéuticamente aceptable y convierte el antagonista en sustancialmente no liberable cuando la forma de dosificación se administra intacta, de tal manera que la relación de la cantidad de antagonista liberada desde dicha forma de dosificación después de la manipulación indebida, con respecto a la cantidad de dicho antagonista liberada desde dicha forma de dosificación intacta es aproximadamente 4:1 ó mayor, basándose en la disolución in-vitro a 1 hora de dicha forma de dosificación en 900 ml de Fluido Gástrico Simulado usando un aparato USP Tipo II (de paletas) a 75 rpm y a 37 grados C.

Description

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60 EP 2517710
E12167170
18-06-2015
[0051] La expresión “manipulación indebida” significa cualquier manipulación por medios mecánicos, térmicos y/o químicos que cambia las propiedades físicas de la forma de dosificación, por ejemplo, con el fin de liberar el agonista opioide para una liberación inmediata si el mismo se encuentra en forma de liberación sostenida, o para conseguir que el agonista opioide esté disponible para un uso inapropiado tal como su administración por una vía alternativa, por ejemplo, parenteralmente. La manipulación indebida puede ser, por ejemplo, por medio de machacadura, corte, trituración, masticación, disolución en un disolvente, calentamiento (por ejemplo, mayor que aproximadamente 45 ºC), o cualquier combinación de los mismos.
[0052] La expresión “que bloquea por lo menos parcialmente el efecto opioide” se define a efectos de la presente invención de modo que significa que el antagonista opioide bloquea por lo menos significativamente el efecto eufórico del agonista opioide, reduciendo de este modo el potencial de abuso del agonista opioide en la forma de dosificación.
[0053] En ciertas realizaciones preferidas de la presente invención, la forma sustancialmente no liberable del antagonista opioide comprende partículas de antagonista opioide en un recubrimiento que evita sustancialmente la liberación del antagonista. En realizaciones preferidas, el recubrimiento comprende uno o más de material hidrófobo farmacéuticamente aceptable. El recubrimiento es preferentemente impermeable al antagonista opioide contenido en el mismo y es insoluble en el sistema gastrointestinal, evitando sustancialmente de este modo la liberación del antagonista opioide cuando la forma de dosificación se administra oralmente según se desee.
[0054] Por consiguiente, cuando la forma de dosificación oral no se manipula indebidamente para comprometer la integridad del recubrimiento, el antagonista opioide contenido en la misma no se liberará sustancialmente durante su primera hora de tránsito a través del sistema gastrointestinal, y por lo tanto no estaría disponible para su absorción. En ciertas realizaciones preferidas de la presente invención, el material hidrófobo comprende un polímero de celulosa o un polímero acrílico que es insoluble en los fluidos gastrointestinales e impermeable al antagonista opioide.
[0055] El término “partículas” de antagonista opioide, tal como se usa en el presente documento, se refiere a gránulos, esferoides, perlas o pellets que comprenden el antagonista opioide. En ciertas realizaciones preferidas, las partículas de antagonista opioide tienen un diámetro de entre aproximadamente 0,2 y aproximadamente 2 mm, más preferentemente un diámetro de entre aproximadamente 0,5 y aproximadamente 2 mm.
[0056] En ciertas realizaciones de la presente invención, la forma de dosificación oral comprende además un antagonista opioide en una forma liberable y por lo tanto tiene la capacidad de ser liberado desde la forma de dosificación oral cuando se administra oralmente, siendo la relación del agonista opioide con respecto a la forma liberable del antagonista opioide tal que la forma de dosificación, cuando se administra oralmente, es analgésicamente eficaz. Por ejemplo, cuando el antagonista opioide se recubre con un recubrimiento que evita sustancialmente su liberación, y a continuación se mezcla con un agonista opioide y se prensa para obtener comprimidos, ciertas cantidades del recubrimiento se podrían agrietar, dejando así al descubierto el antagonista opioide para ser liberado tras la administración oral.
[0057] Preferentemente, el agonista opioide útil para la presente invención se puede seleccionar del grupo consistente en morfina, hidromorfona, hidrocodona, oxicodona, codeína, levorfanol, meperidina, metadona y mezclas de los mismos. Ejemplos preferidos del antagonista opioide útil para la presente invención incluyen naltrexona, naloxona, nalmefeno, ciclazacina, levalorfano, sales farmacéuticamente aceptables de los mismos y mezclas de los mismos.
[0058] En ciertas realizaciones de la presente invención, la relación del agonista opioide y el antagonista opioide, presente en una forma sustancialmente no liberable, está entre aproximadamente 1:1 y aproximadamente 50:1 en peso, preferentemente entre aproximadamente 1:1 y aproximadamente 20:1 en peso o entre 15:1 y aproximadamente 30:1. La relación en peso del agonista opioide con respecto al antagonista opioide, según se usa en la presente solicitud, se refiere al peso de los ingredientes activos. De este modo, por ejemplo, el peso del antagonista opioide excluye el peso del recubrimiento o matriz que convierte al antagonista opioide en sustancialmente no liberable, u otros posibles excipientes asociados a las partículas antagonistas. En ciertas realizaciones preferidas, la relación está entre aproximadamente 1:1 y aproximadamente 10:1 en peso. Puesto que el antagonista opioide está en una forma sustancialmente no liberable, la cantidad de dicho antagonista dentro de la forma de dosificación se puede hacer variar más ampliamente que las formas de dosificación combinadas de agonista/antagonista opioides en las que ambos están disponibles para la liberación al producirse la administración, en la medida en la que la formulación no depende del metabolismo diferencial o del aclaramiento hepático para un funcionamiento correcto. Por razones de seguridad, la cantidad del antagonista opioide presente en una forma sustancialmente no liberable se selecciona de manera que no sea perjudicial para humanos incluso si la misma se liberara completamente por manipulación indebida de la forma de dosificación.
[0059] En ciertas realizaciones preferidas de la presente invención, el agonista opioide comprende hidrocodona, oxicodona o sales farmacéuticamente aceptables de las mismas y el antagonista opioide, presente en una forma sustancialmente no liberable, comprende naloxona, naltrexona o sales farmacéuticamente aceptables de las mismas.
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ciclazacina, levalorfano, y mezclas de los mismos. En ciertas realizaciones preferidas, el antagonista opioide es naloxona o naltrexona. En ciertas realizaciones, la cantidad del antagonista opioide, presente en una forma sustancialmente no liberable, puede estar aproximadamente entre 10 ng y 275 mg.
[0095] La naloxona es un antagonista opioide que está prácticamente desprovisto de efectos agonistas. Dosis subcutáneas de hasta 12 mg de naloxona producen efectos subjetivos no discernibles, y 24 mg de naloxona provocan solamente una ligera somnolencia. Dosis pequeñas (entre 0,4 y 0,8 mg) de naloxona proporcionada intramuscular o intravenosamente en el ser humano evitan o invierten puntualmente los efectos de un agonista opioide de tipo morfina. Se ha publicado que un mg de naloxona intravenosamente bloquea completamente el efecto de 25 mg de heroína. Los efectos de la naloxona se observan casi inmediatamente después de la administración intravenosa. El fármaco se absorbe después de su administración oral, aunque se ha publicado que se metaboliza en una forma inactiva rápidamente en su primer paso a través del hígado de tal manera que se ha publicado que tiene una potencia significativamente menor que cuando se administra parenteralmente. Se ha publicado que la dosificación oral de más de 1 g se metaboliza casi completamente en menos de 24 horas. Se ha publicado que se absorbe el 25 % de naloxona administrada sublingualmente. Weinberg, et al., Sublingual Absorption of selected Opioid Analgesics, Clin Pharmacol Ther. (1988); 44:335-340.
[0096] Otros antagonistas opioides, por ejemplo, ciclazocina y naltrexona, que presentan ambas, sustituciones de ciclopropilmetilo en el nitrógeno, conservan mucha de su eficacia por la vía oral y sus duraciones de acción son mucho más prolongadas, aproximándose a 24 horas después de dosis orales.
[0097] En el tratamiento de pacientes que han sido previamente adictos a opioides, la naltrexona se ha usado en grandes dosis orales (por encima de 100 mg) para evitar efectos euforizantes de agonistas opioides. Se ha publicado que la naltrexona ejerce una acción de bloqueo fuerte preferencial contra sitios mu con respecto a delta. La naltrexona se conoce como un congénere sintético de la oximorfona sin propiedades agonistas opioides, y difiere en cuanto a estructura con respecto a la oximorfona en la sustitución del grupo metilo situado en el átomo de nitrógeno de la oximorfona por un grupo ciclopropilmetilo. La sal clorhidrato de naltrexona es soluble en agua hasta aproximadamente 100 mg/cc. Las propiedades farmacológicas y farmacocinéticas de la naltrexona se han evaluado en múltiples estudios animales y clínicos. Véase, por ejemplo, Gonzalez JP, et al. Naltrexone: A review of its Pharmacodynamic and Pharmacokinetic Properties and Therapeutic Efficacy in the Management of Opioid Dependence. Drugs 1988; 35:192213, incorporada por la presente a título de referencia. Tras su administración oral, la naltrexona es absorbida rápidamente (en 1 hora) y presenta una biodisponibilidad oral comprendida entre el 5 y el 40 %. La unión a proteínas de la naltrexona es aproximadamente del 21 % y el volumen de distribución tras una administración de una sola dosis es 16,1 L/kg.
[0098] La naltrexona está disponible comercialmente en forma de comprimidos (Revia®, DuPont) para el tratamiento de la dependencia alcohólica y para el bloqueo de opioides administrados exógenamente. Véase, por ejemplo, Revia (comprimidos de clorhidrato de naltrexona). Physician’s Desk Reference 51ª ed., Montvale, NJ. “Medical Economics” 1997; 51:957-959. Una dosificación de 50 mg de Revia® bloquea los efectos farmacológicos de 25 mg de heroína administrada por IV durante hasta 24 horas.
[0099] Se sabe que cuando se administra conjuntamente con morfina, heroína u otros opioides de forma crónica, la naltrexona bloquea el desarrollo de dependencia física con respecto a opioides. Se cree que el método mediante el cual la naltrexona bloquea los efectos de la heroína es mediante unión competitiva en los receptores opioides. La naltrexona se ha usado para tratar la adicción a narcóticos mediante el bloqueo completo de los efectos de opioides. Se ha observado que el uso más satisfactorio de la naltrexona para una adicción a los narcóticos es con adictos a narcóticos que tienen un buen pronóstico, como parte de un programa integral ocupacional o de rehabilitación que conlleve un control de la conducta u otros métodos mejoradores del cumplimiento. Para el tratamiento de la dependencia de los narcóticos con naltrexona, es deseable que el paciente esté sin opioides durante por lo menos entre 7 y 10 días. La dosificación inicial de naltrexona con dichos fines ha sido típicamente de forma aproximada 25 mg, y si no se produce ningún signo de síndrome de abstinencia, la dosificación se puede aumentar a 50 mg por día. Se considera que una dosificación diaria de 50 mg produce un bloqueo clínico adecuado de las acciones de opioides administrados parenteralmente. La naltrexona se ha usado también para el tratamiento de alcoholismo como un complemento con métodos sociales y sicoterapéuticos.
[0100] En ciertas realizaciones de la presente invención, la relación del agonista opioide con respecto a la forma sustancialmente no liberable de un antagonista opioide en la forma de dosificación oral es tal que el efecto del agonista opioide se ve por lo menos parcialmente bloqueado cuando la forma de dosificación es masticada, machacada o disuelta en un disolvente y calentada, y se administra oral, intranasal, parenteral o sublingualmente. Puesto que la forma de dosificación oral de la presente invención, cuando se administra correctamente tal como se pretende, no liberaría sustancialmente el antagonista opioide, la cantidad de dicho antagonista se puede hacer variar más ampliamente que si el antagonista opioide está disponible para ser liberado al sistema gastrointestinal al producirse la administración oral. Por razones de seguridad, la cantidad del antagonista presente en una forma sustancialmente no liberable no debería ser perjudicial para seres humanos incluso si se liberara en su totalidad. La relación del agonista opioide particular con
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un aumento de peso de entre aproximadamente el 2 y aproximadamente el 25 % del sustrato de manera que se obtenga un perfil deseado de liberación sostenida. Se describen recubrimientos obtenidos a partir de dispersiones acuosas de forma detallada, por ejemplo, en las patentes U.S. n.º 5.273.760 y 5.286.493, cedidas al cesionario de la presente invención e incorporadas por la presente a título de referencia.
[0133] Otros ejemplos de formulaciones y recubrimientos de liberación sostenida que se pueden usar según la presente invención incluyen las patentes U.S. del cesionario n.º 5.324.351; 5.356.467 y 5.472.712, incorporadas por la presente a título de referencia en su totalidad.
Polímeros de alquilcelulosa
[0134] Los materiales y polímeros celulósicos, incluyendo alquilcelulosas, proporcionan materiales hidrófobos muy adecuados para el recubrimiento de las perlas según la invención. Simplemente a título de ejemplo, un polímero alquilcelulósico preferido es la etilcelulosa, aunque los expertos apreciarán que se pueden utilizar fácilmente otros polímeros de celulosa y/o alquilcelulosa, de forma individual o en cualquier combinación, como un todo o como parte de un recubrimiento hidrófobo según la invención.
[0135] Una dispersión acuosa comercialmente disponible de etilcelulosa es el Aquacoat® (FMC Corp., Philadelphia, Pennsylvania, U.S.A.). El Aquacoat® se prepara disolviendo la etilcelulosa en un disolvente orgánico inmiscible en agua y a continuación emulsificando el mismo en agua en presencia de un surfactante y un estabilizador. Después de la homogeneización para generar gotitas submicrónicas, el disolvente orgánico se evapora al vacío para formar un pseudolátex. El plastificante no se incorpora en el pseudolátex durante la fase de fabricación. De este modo, antes de usar el mismo como recubrimiento, es necesario mezclar íntimamente el Aquacoat® con un plastificante adecuado antes de su uso.
[0136] Otra dispersión acuosa de etilcelulosa está disponible comercialmente como Surelease® (Colorcon, Inc., West Point, Pennsylvania, U.S.A.). Este producto se prepara incorporando plastificante en la dispersión durante el proceso de fabricación. Se prepara una masa fundida en caliente de un polímero, un plastificante (sebacato de dibutilo), y un estabilizador (ácido oleico) en forma de una mezcla homogénea, la cual a continuación se diluye con una solución alcalina para obtener una dispersión acuosa que se puede aplicar directamente sobre sustratos.
Polímeros acrílicos
[0137] En otras realizaciones preferidas de la presente invención, el material hidrófobo que comprende el recubrimiento de liberación controlada es un polímero acrílico farmacéuticamente aceptable, que incluye, aunque sin limitarse a los mismos, copolímeros de ácido acrílico y ácido metacrílico, copolímeros de metacrilato de metilo, metacrilatos de etoxietilo, metacrilato de cianoetilo, poli(ácido acrílico), poli(ácido metacrílico), copolímero de alquilamida ácido metacrílico, poli(metacrilato de metilo), polimetacrilato, copolímero de poli(metacrilato de metilo), poliacrilamida, copolímero de metacrilato de aminoalquilo, poli(anhídrido de ácido metacrílico), y copolímeros de metacrilato de glicidilo.
[0138] En ciertas realizaciones preferidas, el polímero acrílico está compuesto por uno o más copolímeros de metacrilato y amonio. Los copolímeros de metacrilato y amonio son bien conocidos en la técnica, y se describen en NF XVII como copolímeros totalmente polimerizados de ésteres de ácido acrílico y metacrílico con un bajo contenido de grupos amónicos cuaternarios.
[0139] Para obtener un perfil de disolución deseable, puede que sea necesario incorporar dos o más copolímeros de metacrilato y amonio que tengan propiedades físicas diferentes, tales como relaciones molares diferentes de los grupos amónicos cuaternarios con respecto a los ésteres (met)acrílicos neutros.
[0140] Ciertos polímeros del tipo éster de ácido metacrílico son útiles para preparar recubrimientos dependientes del pH que se pueden usar según la presente invención. Por ejemplo, existe una familia de copolímeros sintetizados a partir de metacrilato de dietilaminoetilo y otros ésteres metacrílicos neutros, conocidos también como copolímero de ácido metacrílico o metacrilatos poliméricos, disponibles comercialmente como Eudragit® en Röhm Tech, Inc. Existen varios tipos diferentes de Eudragit®. Por ejemplo, Eudragit® E es un ejemplo de un copolímero de ácido metacrílico que se hincha y se disuelve en medios ácidos. Eudragit® L es un copolímero de ácido metacrílico que no se hincha con aproximadamente un pH < 5,7 y que es soluble con aproximadamente un pH > 6. Eudragit® S no se hincha con aproximadamente un pH < 6,5 y es soluble con aproximadamente un pH > 7. Eudragit® RL y Eudragit® RS son hinchables en agua, y la cantidad de agua absorbida por estos polímeros depende del pH, aunque las formas de dosificación recubiertas con Eudragit® RL y RS son independientes del pH.
[0141] En ciertas realizaciones preferidas, el recubrimiento acrílico comprende una mezcla de dos lacas de resina acrílica disponibles comercialmente en Rohm Pharma con los nombres comerciales Eudragit® RL30D y Eudragit® RS30D, respectivamente. Eudragit® RL30D y Eudragit® RS30D son copolímeros de ésteres acrílicos y metacrílicos con un bajo contenido de grupos amónicos cuaternarios, siendo la relación molar de los grupos amónicos con respecto a los
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