US20040214849A1 - Parenteral administration of 6-hydroxy-oxymorphone for use as an analgesic - Google Patents

Parenteral administration of 6-hydroxy-oxymorphone for use as an analgesic Download PDF

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US20040214849A1
US20040214849A1 US10/189,653 US18965302A US2004214849A1 US 20040214849 A1 US20040214849 A1 US 20040214849A1 US 18965302 A US18965302 A US 18965302A US 2004214849 A1 US2004214849 A1 US 2004214849A1
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oxymorphone
hydroxy
hydroxy oxymorphone
pharmaceutical composition
blood plasma
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Huai-Hung Kao
Richard Smith-Carliss
Troy McCall
David Lee
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Endo Pharmaceuticals Inc
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Endo Pharmaceuticals Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/02—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
    • A61K47/38—Cellulose; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2009—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2013—Organic compounds, e.g. phospholipids, fats
    • A61K9/2018—Sugars, or sugar alcohols, e.g. lactose, mannitol; Derivatives thereof, e.g. polysorbates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2022—Organic macromolecular compounds
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2022—Organic macromolecular compounds
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A61K9/2054—Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/20—Pills, tablets, discs, rods
    • A61K9/2072—Pills, tablets, discs, rods characterised by shape, structure or size; Tablets with holes, special break lines or identification marks; Partially coated tablets; Disintegrating flat shaped forms
    • A61K9/2086—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat
    • A61K9/209—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat containing drug in at least two layers or in the core and in at least one outer layer
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]

Definitions

  • the invention relates to methods for alleviating pain. More particularly, the invention relates to methods for alleviating pain by administering 6-hydroxy oxymorphone. Most particularly, the invention relates to methods of inducing analgesia by increasing blood plasma levels of 6-hydroxy oxymorphone.
  • the present invention provides methods for treating pain by administration of a pharmaceutical composition comprising 6-hydroxy oxymorphone in an amount sufficient to induce analgesia.
  • the pharmaceutical composition is administered parenterally, preferably by injection and intravenous drip.
  • blood plasma levels of 6-hydroxy oxymorphone are raised to at least approximately 0.05 ng/mL.
  • Methods for administering compositions comprising 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia are also provided.
  • FIG. 1 is a phannacokinetic profile for 6-hydroxy oxymorphone with PID scores.
  • FIG. 2 is a pharmacokinetic profile for oxymorphone with PID scores.
  • FIG. 3 is a pharmacokinetic profile for 6-hydroxy oxymorphone with categorical pain scores.
  • FIG. 4 is a pharmacokinetic profile for oxymorphone with categorical pain scores.
  • compositions containing 6-hydroxy oxymorphone as an active ingredient.
  • the composition comprising 6-hydroxy oxymorphone alone (excepting, of course, carriers, diluents, and other excipients),
  • 6-hydorxy oxymorphone may be combined with other opioids or other pharmaceutical agents.
  • compositions comprising both 6-hydroxy oxymorphone and its parent, oxymorphone.
  • FIGS. 1-4 show graphical representation of the data combining the two studies such that the effect of blood plasma levels on pain can be evaluated.
  • Oxymorphone levels peak within 2 hours, fall slightly, and plateau. Interestingly, the level spikes again at 4-6 hours from administration. After this time, oxymorphone levels again drop and eventually fall to levels near the earlier plateau.
  • 6-hydroxy oxymorphone blood plasma levels peak within 2 hours after administration. After the initial peak, however, a more or less steady decline in the 6-hydroxy oxymorphone's plasma levels is observed.
  • 6-hydroxy oxymorphone ensures immediate release into the blood stream and the quickest route to pain relief. Administration of a composition containing 6-hydroxy oxymorphone by injection, IV drip, or other means is most effective. Regardless of the actual route of administration, an amount of 6-hydroxy oxymorphone sufficient to induce analgesia will be supplied. Blood plasma levels of 6-hydroxy oxymorphone must be raised to levels sufficient to induce the desired level of analgesia.
  • the amount administered will be dependent upon normal criteria such as patient weight, intensity of pain, and other factors. Based on the pharmacokinetic studies blood plasma levels around at least 0.05 ng/mL will provide some analgesia. The upper plasma level limit will be ultimately established by safety concerns. Over-dosing of any opioid, including 6-hydroxy oxymorphone, can lead to respiratory failure and other undesirable side effects, and can even result in death. Preferably, the blood plasma level of 6-hydroxy oxymorphone will be raised to at least 0.075 ng/mL. Subsequent doses may be required to maintain these blood levels.
  • the preferred administration is of 6-hydroxy oxymorphone with appropriate carriers and excipients as will be readily apparent to those skilled in the art.
  • the resulting blood plasma in these preferred administrations will therefore be substantially free of oxymorphone.

Abstract

In a method of treating pain a patient is administered a pharmaceutical composition of 6-hydroxy oxymorphone in an amount sufficient to induce analgesia. In one embodiment, the pharmaceutical composition is administered parenterally, preferably by injection and intravenous drip. To achieve the desired analgesic effect, blood plasma levels of 6-hydroxy oxymorphone are raised to at least approximately 0.05 ng/mL. Most preferably blood plasma levels of 6-hydroxy oxymorphone range at least 0.075 ng/mL during treatment. Administration of compositions containing 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia is also contemplated.

Description

  • This application relates to Provisional Application Serial No. 60/303,357 filed Jul. 6, 2001, Provisional Application Serial No. 60/329,432 filed Oct. 15, 2001, Provisional Application Serial No. 60/329,445 filed Oct. 15, 2001, and Provisional Application Serial No. 60/329,444 filed Oct. 15, 2001.[0001]
    • BACKGROUND
  • Field of Invention [0002]
  • The invention relates to methods for alleviating pain. More particularly, the invention relates to methods for alleviating pain by administering 6-hydroxy oxymorphone. Most particularly, the invention relates to methods of inducing analgesia by increasing blood plasma levels of 6-hydroxy oxymorphone. [0003]
    • SUMMARY OF THE INVENTION
  • The present invention provides methods for treating pain by administration of a pharmaceutical composition comprising 6-hydroxy oxymorphone in an amount sufficient to induce analgesia. In one embodiment, the pharmaceutical composition is administered parenterally, preferably by injection and intravenous drip. To achieve the desired analgesic effect, blood plasma levels of 6-hydroxy oxymorphone are raised to at least approximately 0.05 ng/mL. Methods for administering compositions comprising 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia are also provided.[0004]
    • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 is a phannacokinetic profile for 6-hydroxy oxymorphone with PID scores. [0005]
  • FIG. 2 is a pharmacokinetic profile for oxymorphone with PID scores. [0006]
  • FIG. 3 is a pharmacokinetic profile for 6-hydroxy oxymorphone with categorical pain scores. [0007]
  • FIG. 4 is a pharmacokinetic profile for oxymorphone with categorical pain scores.[0008]
    • DETAILED DESCRIPTION
  • The methods described herein provide for the direct administration of a pharmaceutical composition containing 6-hydroxy oxymorphone as an active ingredient. In a preferred embodiment the composition comprising 6-hydroxy oxymorphone alone (excepting, of course, carriers, diluents, and other excipients), In other embodiments, 6-hydorxy oxymorphone may be combined with other opioids or other pharmaceutical agents. For example compositions comprising both 6-hydroxy oxymorphone and its parent, oxymorphone. [0009]
  • In separate studies, blood plasma levels and indications of pain relief were recorded over a 12 hour period. FIGS. 1-4 show graphical representation of the data combining the two studies such that the effect of blood plasma levels on pain can be evaluated. [0010]
  • The administration of oxymorphone yields blood plasma levels of oxymorphone and one of its metabolites, 6-hydroxy oxymorphone. Oxymorphone levels peak within 2 hours, fall slightly, and plateau. Interestingly, the level spikes again at 4-6 hours from administration. After this time, oxymorphone levels again drop and eventually fall to levels near the earlier plateau. [0011]
  • Like oxymorphone, 6-hydroxy oxymorphone blood plasma levels peak within 2 hours after administration. After the initial peak, however, a more or less steady decline in the 6-hydroxy oxymorphone's plasma levels is observed. [0012]
  • Comparing these levels to the pain profiles, a correlation between the 6-hydroxy oxymorphone blood plasma levels and pain relief can be seen. The pain levels nearly mirror the 6-hydroxy oxymorphone levels, with substantial rises in relief near the spikes associated with oxymorphone blood levels. Thus, pain relief can be achieved through administration of 6-hydroxy oxymorphone alone. [0013]
  • In addition to the pharmacokinetic studies, binding studies have been conducted to compare the binding affinity of 6-hydroxy oxymorphone to that of oxymorphone. The results are reported in TABLE 1. These results clearly indicate that 6-hydroxy oxymorphone has great binding affinity for the δ, κ, and μ receptor cites, comparable to the binding affinity of its parent. The inventors believe that by virtue of this binding affinity, 6-hydroxy oxymorphone has similar analgesic effects to its parent, oxymorphone. [0014]
    TABLE 1
    ASSAY REPORT
    6-HYDROXY
    OXYMORPHONE OXYMORPHONE
    10 nm 10 μm 10 nm 10 μm
    1.0 E−8 1.0 E−5 1.0 E−8 1.0 E−5
    Opiate, Delta 1 −4.12% 90.48% −18.26% 89.03%
    Opiate, Delta 2 7.19% 55.45% 7.76% 72.74%
    (Human
    Recombinant)
    Opiate, 2.45% 62.47% 10.35% 89.41%
    Kappa
    (Human
    Recombinant)
    Opiate, Mu 63.16% 99.91% 85.42% 100.39%
    (Human
    Recombinant)
  • Accordingly, methods of administering the metabolite, 6-hydroxy oxymorphone, directly have been developed. It is believed that the β isomer has greater efficacy in the treatment of pain, but this disclosure is not limited to use of that isomer alone. Pharmaceutical compositions containing either 6-α-hydroxy oxymorphone, 6-β-hydroxy oxymorphone, or mixtures thereof can be used in the invention. [0015]
  • Parenteral administration of 6-hydroxy oxymorphone ensures immediate release into the blood stream and the quickest route to pain relief. Administration of a composition containing 6-hydroxy oxymorphone by injection, IV drip, or other means is most effective. Regardless of the actual route of administration, an amount of 6-hydroxy oxymorphone sufficient to induce analgesia will be supplied. Blood plasma levels of 6-hydroxy oxymorphone must be raised to levels sufficient to induce the desired level of analgesia. [0016]
  • The amount administered will be dependent upon normal criteria such as patient weight, intensity of pain, and other factors. Based on the pharmacokinetic studies blood plasma levels around at least 0.05 ng/mL will provide some analgesia. The upper plasma level limit will be ultimately established by safety concerns. Over-dosing of any opioid, including 6-hydroxy oxymorphone, can lead to respiratory failure and other undesirable side effects, and can even result in death. Preferably, the blood plasma level of 6-hydroxy oxymorphone will be raised to at least 0.075 ng/mL. Subsequent doses may be required to maintain these blood levels. [0017]
  • The preferred administration is of 6-hydroxy oxymorphone with appropriate carriers and excipients as will be readily apparent to those skilled in the art. The resulting blood plasma in these preferred administrations will therefore be substantially free of oxymorphone. [0018]
  • The above description encompasses some preferred embodiments of the invention. This disclosure is merely illustrative in nature and is not intended to limit the following claims. [0019]

Claims (7)

1. A method of treating pain comprising:
administering parenterally to a patient a pharmaceutical composition comprising 6-hydroxy oxymorphone in an amount sufficient to induce analgesia.
2. The method of claim 1 wherein said pharmaceutical composition is administered by injection or IV drip.
3. The method of claim 1 wherein said administration is sufficient to raise blood plasma levels of 6-hydroxy oxymorphone to at least about 0.05 ng/nL.
4. The method of claim 1 wherein said administration is sufficient to raise blood plasma levels of 6-hydroxy oxymorphone to at least about 0.075 ng/mL.
5. A method of treating pain comprising about parenterally administering to a patient a pharmaceutical composition comprising 6-hydroxy oxymorphone, and one or more carriers, diluents, and excipients in an amount sufficient to induce analgesia.
6. A pharmaceutical composition comprising 6-hydroxy oxymorphone in a pharmaceutically acceptable formulation for parenteral delivery to animals.
7. A method of treating pain comprising:
parenterally administering to a patient a pharmaceutical composition comprising 6-hydroxy oxymorphone and oxymorphone in an amount sufficient to induce analgesia.
US10/189,653 2001-07-06 2002-07-03 Parenteral administration of 6-hydroxy-oxymorphone for use as an analgesic Abandoned US20040214849A1 (en)

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US30335701P 2001-07-06 2001-07-06
US32943201P 2001-10-15 2001-10-15
US32944501P 2001-10-15 2001-10-15
US32944401P 2001-10-15 2001-10-15
US10/189,653 US20040214849A1 (en) 2001-07-06 2002-07-03 Parenteral administration of 6-hydroxy-oxymorphone for use as an analgesic

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US10/190,192 Expired - Lifetime US9820982B2 (en) 2001-07-06 2002-07-03 Oxymorphone controlled release formulations
US10/189,897 Abandoned US20030130297A1 (en) 2001-07-06 2002-07-03 Oral administration of 6-hydroxy-oxymorphone for use as an analgesic
US10/189,653 Abandoned US20040214849A1 (en) 2001-07-06 2002-07-03 Parenteral administration of 6-hydroxy-oxymorphone for use as an analgesic
US11/425,966 Abandoned US20070098792A1 (en) 2001-07-06 2006-06-22 Oxymorphone controlled release formulations
US11/426,170 Abandoned US20070098793A1 (en) 2001-07-06 2006-06-23 Oxymorphone controlled release formulations
US11/680,432 Active 2026-03-08 US8309122B2 (en) 2001-07-06 2007-02-28 Oxymorphone controlled release formulations
US12/167,859 Abandoned US20080262013A1 (en) 2001-07-06 2008-07-03 Oxymorphone controlled release formulations
US12/426,112 Abandoned US20090192183A1 (en) 2001-07-06 2009-04-17 Oxymorphone Controlled Release Formulations
US13/908,328 Abandoned US20140134250A1 (en) 2001-07-06 2013-06-03 Oxymorphone controlled release formulations
US14/492,701 Abandoned US20150011577A1 (en) 2001-07-06 2014-09-22 Oxymorphone controlled release formulations
US14/798,619 Abandoned US20160136152A1 (en) 2001-07-06 2015-07-14 Oxymorphone controlled release compositions
US16/049,390 Abandoned US20180338967A1 (en) 2001-07-06 2018-07-30 Oxymorphone controlled release compositions
US17/035,453 Abandoned US20210008063A1 (en) 2001-07-06 2020-09-28 Oxymorphone controlled release compositions

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US10/190,192 Expired - Lifetime US9820982B2 (en) 2001-07-06 2002-07-03 Oxymorphone controlled release formulations
US10/189,897 Abandoned US20030130297A1 (en) 2001-07-06 2002-07-03 Oral administration of 6-hydroxy-oxymorphone for use as an analgesic

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US11/425,966 Abandoned US20070098792A1 (en) 2001-07-06 2006-06-22 Oxymorphone controlled release formulations
US11/426,170 Abandoned US20070098793A1 (en) 2001-07-06 2006-06-23 Oxymorphone controlled release formulations
US11/680,432 Active 2026-03-08 US8309122B2 (en) 2001-07-06 2007-02-28 Oxymorphone controlled release formulations
US12/167,859 Abandoned US20080262013A1 (en) 2001-07-06 2008-07-03 Oxymorphone controlled release formulations
US12/426,112 Abandoned US20090192183A1 (en) 2001-07-06 2009-04-17 Oxymorphone Controlled Release Formulations
US13/908,328 Abandoned US20140134250A1 (en) 2001-07-06 2013-06-03 Oxymorphone controlled release formulations
US14/492,701 Abandoned US20150011577A1 (en) 2001-07-06 2014-09-22 Oxymorphone controlled release formulations
US14/798,619 Abandoned US20160136152A1 (en) 2001-07-06 2015-07-14 Oxymorphone controlled release compositions
US16/049,390 Abandoned US20180338967A1 (en) 2001-07-06 2018-07-30 Oxymorphone controlled release compositions
US17/035,453 Abandoned US20210008063A1 (en) 2001-07-06 2020-09-28 Oxymorphone controlled release compositions

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EP (4) EP1414458B1 (en)
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AU (3) AU2002320309B2 (en)
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