# Patent

## Title
Solid oral dosage form containing an enhancer

## Abstract

The invention relates to a pharmaceutical composition and oral dosage forms comprising a bisphosphonate in combination with an enhancer to enhance intestinal delivery of the bisphosphonate to the underlying circulation. Preferably, the enhancer is a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms, and the solid oral dosage form is a controlled release dosage form such as a delayed release dosage form.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a divisional of U.S. patent application Ser. No. 11/733,007, filed on Apr. 9, 2007, issued on Apr. 27, 2010 as U.S. Pat. No. 7,704,977, which claims priority to U.S. Provisional Application No. 60/791,231, filed Apr. 7, 2006, the contents of which are fully incorporated herein by reference.


FIELD OF THE INVENTION
The present invention relates to a compositions and solid oral dosage forms containing an enhancer. In particular the invention relates to compositions and solid oral dosage forms comprising a pharmaceutically active ingredient in combination with an enhancer which enhances the bioavailability and/or the absorption of the active ingredient.
BACKGROUND OF THE INVENTION
The epithelial cells lining the lumenal side of the gastrointestinal tract (GIT) can be a major barrier to drug delivery via oral administration. However, there are four recognized transport pathways which can be exploited to facilitate drug delivery and transport: the transcellular, paracellular, carrier-mediated and transcytotic transport pathways. The ability of a drug, such as a conventional drug, a peptide, a protein, a macromolecule or a nano- or microparticulate system, to “interact” with one or more of these transport pathways may result in increased delivery of that drug from the GIT to the underlying circulation.
Certain drugs utilize transport systems for nutrients which are located in the apical cell membranes (carrier mediated route). Macromolecules may also be transported across the cells in endocytosed vesicles (transcytosis route). However, many drugs are transported across the intestinal epithelium by passive diffusion either through cells (transcellular route) or between cells (paracellular). Most orally administered drugs are absorbed by passive transport. Drugs which are lipophilic permeate the epithelium by the transcellular route whereas drugs that are hydrophilic are restricted to the paracellular route.
Paracellular pathways occupy less than 0.1% of the total surface area of the intestinal epithelium. Further, tight junctions, which form a continuous belt around the apical part of the cells, restrict permeation between the cells by creating a seal between adjacent cells. Thus, oral absorption of hydrophilic drugs such as peptides can be severely restricted. Other barriers to absorption of drugs may include hydrolyzing enzymes in the lumen brush border or in the intestinal epithelial cells, the existence of the aqueous boundary layer on the surface of the epithelial membrane which may provide an additional diffusion barrier, the mucus layer associated with the aqueous boundary layer and the acid microclimate which creates a proton gradient across the apical membrane. Absorption, and ultimately bioavailability, of a drug may also be reduced by other processes such as P-glycoprotein regulated transport of the drug back into the gut lumen and cytochrome P450 metabolism. The presence of food and/or beverages can also interfere with absorption and bioavailability.
Bisphosphonates are a family of drugs used to prevent and treat bone fractures, osteoporosis, Paget's disease, metastatic bone cancer, and other bone diseases with high bone resorption. Bisphosphonates bind to bone hydroxyapatite and slow down bone-eroding cells known as osteoclasts. This effect allows the bone-building cells known as osteoblasts to work more effectively.
Some of the limitations with conventional bisphosphonates include irritation of the upper GIT, such as esophageal ulcers, and low bioavailability. As a result, conventional bisphosphonates require a specific dosing regimen so that the patient can absorb some of the drug properly and avoid side effects. Because foods, beverages, medications and calcium interfere with absorption, conventional bisphosphonates must be administered on an empty stomach and, depending on the particular bisphosphonate, must wait from 30 minutes to two hours before consuming any food, beverages (other than water), medications or calcium supplements. As esophageal ulcers are a known side effect, dosing regimens for conventional bisphosphonates specify that patients consume an entire glass of water with the dosage form and avoid assuming a horizontal orientation, such as by lying down, within 30 to 60 minutes after administration.
The specific characteristics of alendronate served to exemplify the members of the class of bisphosphonates and the issues associated with them. Alendronate is a white, crystalline, odorless, non-hygroscopic bisphosphonate prepared by chemical synthesis. Alendronate monosodium trihydrate has a molecular weight of 325.1. Alendronate is approved in the U.S. for the prevention and treatment of osteoporosis in men and postmenopausal women, and for the treatment of Paget's disease of bone and glucocorticoid induced osteoporosis in both sexes. Like other bisphosphonates, alendronate binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts. Alendronate reduces bone turnover in human and animal models and decreases activation frequency, reducing bone resorption in both cortical and trabecular bone and ultimately increasing bone density and strength.
The oral bioavailability of alendronate is very low and independent of the dose (5-80 mg), averaging 0.76% in women and 0.59% in men. Presystemic metabolism does not occur. Following oral administration of conventional forms of alendronate, 40% of the dose absorbed is excreted in the urine within 8 hours and a further 5% is excreted over the next 64 hours. Sixty to seventy per cent of the absorption occurs within 1 hour of dosing. Bioavailability is markedly reduced by coincident consumption of food (85%-90%) and even consumption of coffee or orange juice will impair absorption by as much as 60% or more. Coincident medication will also reduce absorption, as any calcium-containing compounds and multivalent cations will bind to the bisphosphonate. Elevation of gastric pH above 6 is associated with a twofold increase in alendronate absorption. Alendronate is not metabolized and is excreted unchanged with renal clearance comparable to the glomerular filtration rate.
Bisphosphonate compositions and oral dosage forms with improved systemic bioavailability which are not subject to the dosing restrictions of conventional bisphosphonates would represent a considerable benefit for patients. As a result, new strategies for delivering drugs across the GIT cell layers are needed, particularly for bisphosphonates.
Numerous potential absorption enhancers have been identified. For instance, medium chain glycerides have demonstrated the ability to enhance the absorption of hydrophilic drugs across the intestinal mucosa (Pharm. Res. (1994), 11, 1148-54). However, the importance of chain length and/or composition is unclear and therefore their mechanism of action remains largely unknown. Sodium caprate has been reported to enhance intestinal and colonic drug absorption by the paracellular route (Pharm. Res. (1993) 10, 857-864; Pharm. Res. (1988), 5, 341-346). U.S. Pat. No. 4,656,161 (BASF AG) discloses a process for increasing the enteral absorbability of heparin and heparinoids by adding non-ionic surfactants such as those that can be prepared by reacting ethylene oxide with a fatty acid, a fatty alcohol, an alkylphenol or a sorbitan or glycerol fatty acid ester.
U.S. Pat. No. 5,229,130 (Cygnus Therapeutics Systems) discloses a composition which increases the permeability of skin to a transdermally administered pharmacologically active agent formulated with one or more vegetable oils as skin permeation enhancers. Dermal penetration is also known to be enhanced by a range of sodium carboxylates [Int. J. of Pharmaceutics (1994), 108, 141-148]. Additionally, the use of essential oils to enhance bioavailability is known (U.S. Pat. No. 5,66,386 AvMax Inc. and others). It is taught that the essential oils act to reduce either, or both, cytochrome P450 metabolism and P-glycoprotein regulated transport of the drug out of the blood stream back into the gut.
Often, however, the enhancement of drug absorption correlates with damage to the intestinal wall. Consequently, limitations to the widespread use of GIT enhancers are frequently determined by their potential toxicities and side effects. Additionally and especially with respect to peptide, protein or macromolecular drugs, the “interaction” of the GIT enhancer with one of the transport pathways should be transient or reversible, such as a transient interaction with or opening of tight junctions so as to enhance transport via the paracellular route.
As mentioned above, numerous potential enhancers are known. However, this has not led to a corresponding number of products incorporating enhancers. One such product currently approved for use in Sweden and Japan is the DoktacillinTM. suppository [Lindmark et al. Pharmaceutical Research (1997), 14, 930-935]. The suppository comprises ampicillin and the medium chain fatty acid, sodium caprate (C10).
Provision of a solid oral dosage form which would facilitate the administration of a drug together with an enhancer is desirable. The advantages of solid oral dosage forms over other dosage forms include ease of manufacture, the ability to formulate different controlled release and extended release formulations and ease of administration. Administration of drugs in solution form does not readily facilitate control of the profile of drug concentration in the bloodstream. Solid oral dosage forms, on the other hand, are versatile and may be modified, for example, to maximize the extent and duration of drug release and to release a drug according to a therapeutically desirable release profile. There may also be advantages relating to convenience of administration increasing patient compliance and to cost of manufacture associated with solid oral dosage forms.
SUMMARY OF THE INVENTION
According to one aspect of the present invention, the compositions and dosage forms made therefrom of the present invention comprise a drug and an enhancer to promote absorption of the bisphosphonate at the GIT cell lining wherein the enhancer is a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms; with the provisos that (i) where the enhancer is an ester of a medium chain fatty acid, said chain length of from 6 to 20 carbon atoms relates to the chain length of the carboxylate moiety, and (ii) where the enhancer is an ether of a medium chain fatty acid, at least one alkoxy group has a carbon chain length of from 6 to 20 carbon atoms, and wherein the enhancer and the composition are solids at room temperature.
According to another aspect of the present invention, the compositions and dosage forms made therefrom comprise a drug and an enhancer to promote absorption of the bisphosphonate at the GIT cell lining, wherein the only enhancer present in the composition is a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms.
In embodiments in which the drug comprises a bisphosphonate, the drug may be selected from the group that includes the free acids forms and biologically acceptable salts of alendronate, clodronate, etidronate, incadronate, ibandronate, minodronate, neridronate, olpadronate, pamidronate, risedronate, tiludronate, zoledronate and derivatives thereof. The bisphosphonate dosage form may be an enteric coated instant release solid oral dosage form which provides improved oral bioavailability and minimizes the risk of local irritation of the upper GIT. In one embodiment, the bisphosphonate is zoledronic acid.
The dosage forms can be a tablet, a multiparticulate or a capsule. The multiparticulate can be in the form of a tablet or contained in a capsule. The tablet can be a single or multilayer tablet having compressed multiparticulate in one, all or none of the layers. Preferably, the dosage form is a controlled release dosage form. More preferably, it is a delayed release dosage form. The dosage form can be coated with a polymer, preferably a rate-controlling or a delayed release polymer. The polymer can also be compressed with the enhancer and drug to form a matrix dosage form such as a controlled release matrix dosage form. A polymer coating can then be applied to the matrix dosage form.
Other embodiments of the invention include the process of making the dosage forms, and methods for the treatment of a medical condition by administering the dosage forms to a patient and use of a drug and enhancer in the manufacture of a medicament.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows the effect of the sodium salts of C8, C10, C12, C14, C18 and C18:2 with 3H-TRH on TEER (Ωcm2) in Caco-2 monolayers at time 0 and at 30 min. intervals up to 2 hours as described in Example 1.
FIG. 2 shows the effect of the sodium salts of C8, C10, C12, C14, C18 and C18:2 on Papp for 3H-TRE transport in Caco-2 monolayers as described in Example 1.
FIG. 3 shows the serum TRH concentration-time profiles following interduodenal bolus dose of 500 μg TRH with NaC8 or NaC10 (35 mg) enhancer present according to the closed loop rat model described in Example 1.
FIG. 4 shows the serum TRH concentration-time profiles following interduodenal bolus dose of 1000 μg TRH with NaC8 or NaC10 (35 mg) enhancer present according to the closed loop rat model described in Example 1.
FIG. 5 shows the APTT response over a period of 4 hours following administration of USP heparin (1000 IU) with different sodium caprate (C10) levels (10 and 35 mg) according to the closed loop rat model described in Example 2.
FIG. 6 shows the anti-factor Xa response over a period of 5 hours following administration of USP heparin (1000 IU) in the presence of different sodium caprylate (C8) levels (10 mg and 35 mg) according to the closed loop rat model described in Example 2.
FIG. 7 shows the anti-factor Xa response over a period of five hours following administration of USP heparin (1000 IU) in the presence of different sodium caprate (C10) levels (10 mg and 35 mg) according to the closed loop rat model described in Example 2.
FIG. 8 shows the mean anti-factor Xa response in dogs over a period of time up to 8 hours following administration of: a) s.c. USP heparin solution (5000 IU); b) oral uncoated instant release tablet formulation containing USP heparin (90000 IU) and NaC10; c) oral uncoated instant release tablet formulation containing USP heparin (90000 IU) and NaC8; and d) oral uncoated sustained release tablet formulation containing USP heparin (90000 IU) and sodium caprate prepared according to the invention as described in Example 2.
FIG. 9 shows the anti-factor Xa response over a period of three hours following intraduodenal administration to rats of phosphate buffered saline solutions of parnaparin sodium (low molecular weight heparin (LMWH)) (1000 IU), in the presence of 35 mg of different enhancers such as sodium caprylate (C8), sodium nonanoate (C9), sodium caprate (C10), sodium undecanoate (C11), sodium laurate (C12) and different 50:50 binary mixtures of enhancers, to rats (n=8) in an open loop model. The reference product comprised administering 250 IU parnaparin sodium subcutaneously. The control solution comprised administering a solution containing 1000 IU parnaparin sodium without any enhancer intraduodenally.
FIG. 10 shows the mean plasma levels of leuprolide over a period of eight hours following intraduodenal administration of solutions of leuprolide (20 mg) containing different levels of sodium caprate (0.0 g (control), 0.55 g, 1.1 g) to dogs.
FIG. 11 shows the mean anti-factor Xa response in dogs over a period of eight hours following oral administration of parnaparin sodium (90,000 IU) in the presence of 550 mg sodium caprate, as both a solution (10 ml) and an instant release tablet dosage form.
FIG. 12 shows the mean anti-factor Xa response in humans over a period of 24 hours following oral administration of parnaparin sodium (90,000 IU) in the presence of sodium caprate, as both a solution (240 ml) and an instant release tablet dosage form
FIG. 13 shows the mean anti-factor Xa response in humans over a period of 24 hours following intrajejunal administration of 15 ml solutions containing different doses parnaparin sodium (20,000 IU, 45,000 IU, 90,000 IU) in the presence of different doses of sodium caprate (0.55 g, 1.1 g, 1.65 g)
FIG. 14 shows the mean anti-factor Xa response in dogs over a period of 8 hours following oral administration of 45,000 IU parnaparin sodium as: (a) instant release capsules containing 0.55 g sodium caprate, (b) Eudragit L coated rapidly disintegrating tablets containing 0.55 g sodium caprate and (c) Eudragit L coated rapidly disintegrating tablets without enhancer.
FIG. 15 shows the mean anti-factor Xa response in dogs over a period of 8 hours following co-administration of 45,000 IU LMWH and 0.55 g sodium caprate orally, intrajejunally and intracolonically compared to subcutaneous administration.
FIG. 16 shows the non-dose normalized amount of alendronate excreted in the urine over a period of 36 hours following oral administration of alendronate (17.5 mg) with different amounts of sodium caprate (0.5 g and 0.25 g) in the fasted and fed states compared with the mean plasma levels of Fosamax® (35 mg) in the fasted state.
FIG. 17 shows the mean cumulative amount of zoledronic acid excreted in the urine over a period of 48 hours following oral administration of zoledronic acid in 10 mg and 20 mg tablets compared with the amount excreted following intravenous injection of zoledronic acid (1 mg) made from Zometa® liquid concentrate



DETAILED DESCRIPTION OF THE INVENTION
As used in this specification and appended claims, the singular forms “a”, “an” and “the” include plural referents unless the content clearly dictates otherwise. Thus, for example, reference to “an enhancer” includes a mixture of two or more enhancers, reference to “a drug” includes a mixture of two or more drugs, and the like.
As used herein, the term “drug” includes any drug, including conventional drugs and analogs thereof, appropriate for administration via the oral route to an animal including a human. The term “drug” also explicitly includes those entities that are poorly absorbed via the oral route including hydrophilic or macromolecular drugs such as peptides, proteins, oligosaccharides, polysaccharides or hormones including, but not limited to, insulin, calcitonin, calcitonin gene regulating protein, atrial natriuretic protein, colony stimulating factor, betaseron, erythropoietin (EPO), interferons, somatropin, somatotropin, somatostatin, insulin-like growth factor (somatomedins), luteinizing hormone releasing hormone (LHRH), tissue plasminogen activator (TPA), thyrotropin releasing hormone (TRH), growth hormone releasing hormone (GHRH), antidiuretic hormone (ADH) or vasopressin and analogues thereof such as for example desmopressin, parathyroid hormone (PTH), oxytocin, estradiol, growth hormones, leuprolide acetate, goserelin acetate, naferelin, buserelin, factor VIII, interleukins such as interleukin-2, and analogues thereof and anti-coagulant agents such as heparin, heparinoids, low molecular weight heparin, hirudin and analogues thereof, bisphosphonates including alendronate, clodronate, etidronate, incadronate, ibandronate, minodronate, neridronate, olpadronate, pamidronate, risedronate, tiludronate and zoledronate, pentassacharides including anti-coagulant pentassacharides, antigens, adjuvants and the like. In those embodiments in which the drug is a bisphosphonate, the drug is selected from the group consisting of alendronate, clodronate, etidronate, incadronate, ibandronate, minodronate, neridronate, olpadronate, pamidronate, risedronate, tiludronate and zoledronate. As used herein, the terms “drug” and “bisphosphonate” include all forms thereof including optically pure enantiomers or mixtures, racemic or otherwise, of enantiomers as well as derivative forms such as, for example, salts, acids, esters and the like. The drug may be provided in any suitable phase state including as a solid, liquid, solution, suspension and the like. When provided in solid particulate form, the particles may be of any suitable size or morphology and may assume one or more crystalline, semi-crystalline and/or amorphous forms.
The drug can be included in nano- or microparticulate drug delivery systems in which the drug is, or is entrapped within, encapsulated by, attached to, or otherwise associated with, a nano- or microparticle.
As used herein, a “therapeutically effective amount of a drug” refers to an amount of drug that elicits a therapeutically useful response in treating an existing medical and/or preventing or delaying the onset of a medical condition from occurring in an animal, preferably a mammal, most preferably a human.
As used herein, the term “enhancer” refers to a compound (or mixture of compounds) which is capable of enhancing the transport of a drug, particularly a hydrophilic and/or macromolecular drug across the GIT in an animal such as a human, wherein the enhancer is a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms; with the provisos that (i) where the enhancer is an ester of a medium chain fatty acid, said chain length of from 6 to 20 carbon atoms relates to the chain length of the carboxylate moiety, and (ii) where the enhancer is an ether of a medium chain fatty acid, at least one alkoxy group has a carbon chain length of from 6 to 20 carbon atoms. Preferably, the enhancer is a sodium salt of a medium chain fatty acid. Most preferably, the enhancer is sodium caprate. In one embodiment, the enhancer is a solid at room temperature.
As used herein, the term “medium chain fatty acid derivative” includes fatty acid salts, esters, ethers, acid halides, amides, anhydrides, carboxylate esters, nitriles, as well as glycerides such as mono-, di- or tri-glycerides. The carbon chain may be characterized by various degrees of saturation. In other words, the carbon chain may be, for example, fully saturated or partially unsaturated (i.e. containing one or more carbon-carbon multiple bonds). The term “medium chain fatty acid derivative” is meant to encompass also medium chain fatty acids wherein the end of the carbon chain opposite the acid group (or derivative) is also functionalized with one of the above mentioned moieties (i.e., an ester, ether, acid halide, amide, anhydride, carboxylate esters, nitrile, or glyceride moiety). Such difunctional fatty acid derivatives thus include for example diacids and diesters (the functional moieties being of the same kind) and also difunctional compounds comprising different functional moieties, such as amino acids and amino acid derivatives, for example a medium chain fatty acid or an ester or a salt thereof comprising an amide moiety at the opposite end of the fatty acid carbon chain to the acid or ester or salt thereof.
As used herein, a “therapeutically effective amount of an enhancer” refers to an amount of enhancer that enhances intestinal delivery of the drug to the underlying circulation and allows for the uptake of a therapeutically effective amount of the drug via oral administration. It has been shown that the effectiveness of an enhancer in enhancing the gastrointestinal delivery of poorly permeable drugs is dependent on the site of administration (see Examples 6, 7 and 12), the site of optimum delivery being dependent on the drug and enhancer.
The enhancer of the present invention interacts in a transient and reversible manner with the GIT cell lining increasing permeability and facilitating the absorption of otherwise poorly permeable molecules. Preferred enhancers include (i) medium chain fatty acids and their salts, (1) medium chain fatty acid esters of glycerol and propylene glycol, and (iii) bile salts. In one embodiment, the enhancer is a medium chain fatty acid salt, ester, ether or other derivative of a medium chain fatty acid which is, preferably, solid at room temperature and which has a carbon chain length of from 8 to 14 carbon atoms; with the provisos that (i) where the enhancer is an ester of a medium chain fatty acid, said chain length of from 8 to 14 carbon atoms relates to the chain length of the carboxylate moiety, and (ii) where the enhancer is an ether of a medium chain fatty acid, at least one alkoxy group has a carbon chain length of from 8 to 14 carbon atoms. In another embodiment, the enhancer is a sodium salt of a medium chain fatty acid, the medium chain fatty acid having a carbon chain length of from 8 to 14 carbon atoms; the sodium salt being solid at room temperature. In a further embodiment, the enhancer is sodium caprylate, sodium caprate or sodium laurate. The drug and enhancer can be present in a ratio of from 1:100000 to 10:1 (drug:enhancer) preferably, from 1:1000 to 10:1.
As used herein, the term “rate controlling polymer material” includes hydrophilic polymers, hydrophobic polymers and mixtures of hydrophilic and/or hydrophobic polymers that are capable of controlling or retarding the release of the drug compound from a solid oral dosage form of the present invention. Suitable rate controlling polymer materials include those selected from the group consisting of hydroxyalkyl cellulose such as hydroxypropyl cellulose and hydroxypropyl methyl cellulose; poly(ethylene)oxide; alkyl cellulose such as ethyl cellulose and methyl cellulose; carboxymethyl cellulose, hydrophilic cellulose derivatives; polyethylene glycol; polyvinylpyrrolidone; cellulose acetate; cellulose acetate butyrate; cellulose acetate phthalate; cellulose acetate trimellitate; polyvinyl acetate phthalate; hydroxypropylmethyl cellulose phthalate; hydroxypropylmethyl cellulose acetate succinate; polyvinyl acetaldiethylamino acetate; poly(alkylmethacrylate) and poly(vinyl acetate). Other suitable hydrophobic polymers include polymers and/or copolymers derived from acrylic or methacrylic acid and their respective esters, zein, waxes, shellac and hydrogenated vegetable oils.
Particularly useful in the practice of the present invention are poly acrylic acid, poly acrylate, poly methacrylic acid and poly methacrylate polymers such as those sold under the Eudragit® trade name (Rohm GmbH, Darmstadt, Germany) specifically Eudragit® L, Eudragit® S, Eudragit® RL, Eudragit® RS coating materials and mixtures thereof. Some of these polymers can be used as delayed release polymers to control the site where the drug is released. They include polymethacrylate polymers such as those sold under the Eudragit® trade name (Rohm GmbH, Darmstadt, Germany) specifically Eudragit® L, Eudragit® S, Eudragit® RL, Eudragit® RS coating materials and mixtures thereof.
A solid oral dosage form according to the present invention may be a tablet, a multiparticulate, or a capsule. A preferred solid oral dosage form is a delayed release dosage form which minimizes the release of drug and enhancer in the stomach, and hence the dilution of the local enhancer concentration therein, and releases the drug and enhancer in the intestine. A particularly preferred solid oral dosage form is a delayed release rapid onset dosage form. Such a dosage form minimizes the release of drug and enhancer in the stomach, and hence the dilution of the local enhancer concentration therein, but releases the drug and enhancer rapidly once the appropriate site in the intestine has been reached, maximizing the delivery of the poorly permeable drug by maximizing the local concentration of drug and enhancer at the site of absorption.
As used herein, the term “tablet” includes, but is not limited to, immediate release (IR) tablets, sustained release (SR) tablets, matrix tablets, multilayer tablets, multilayer matrix tablets, extended release tablets, delayed release tablets and pulsed release tablets any or all of which may optionally be coated with one or more coating materials, including polymer coating materials, such as enteric coatings, rate-controlling coatings, semi-permeable coatings and the like. The term “tablet” also includes osmotic delivery systems in which a drug compound is combined with an osmagent (and optionally other excipients) and coated with a semi-permeable membrane, the semi-permeable membrane defining an orifice through which the drug compound may be released. Tablet solid oral dosage forms particularly useful in the practice of the invention include those selected from the group consisting of IR tablets, SR tablets, coated IR tablets, matrix tablets, coated matrix tablets, multilayer tablets, coated multilayer tablets, multilayer matrix tablets and coated multilayer matrix tablets. A preferred tablet dosage form is an enteric coated tablet dosage form. A particularly preferred tablet dosage form is an enteric coated rapid onset tablet dosage form.
As used herein, the term “capsule” includes instant release capsules, sustained release capsules, coated instant release capsules, coated sustained release capsules, delayed release capsules and coated delayed release capsules. In one embodiment, the capsule dosage form is an enteric coated capsule dosage form. In another embodiment, the capsule dosage form is an enteric coated rapid onset capsule dosage form.
The term “multiparticulate” as used herein means a plurality of discrete particles, pellets, mini-tablets and mixtures or combinations thereof. If the oral form is a multiparticulate capsule, hard or soft gelatin capsules can suitably be used to contain the multiparticulate. Alternatively a sachet can suitably be used to contain the multiparticulate. The multiparticulate may be coated with a layer containing rate controlling polymer material. The multiparticulate oral dosage form may comprise a blend of two or more populations of particles, pellets, or mini-tablets having different in vitro and/or in vivo release characteristics. For example, a multiparticulate oral dosage form may comprise a blend of an instant release component and a delayed release component contained in a suitable capsule. In one embodiment, the multiparticulate dosage form comprises a capsule containing delayed release rapid onset minitablets. In another embodiment, the multiparticulate dosage form comprises a delayed release capsule comprising instant release minitablets. In a further embodiment, the multiparticulate dosage form comprises a capsule comprising delayed release granules. In yet another embodiment, the multiparticulate dosage form comprises a delayed release capsule comprising instant release granules.
In another embodiment, the multiparticulate together with one or more auxiliary excipient materials may be compressed into tablet form such as a single layer or multilayer tablet. Typically, a multilayer tablet may comprise two layers containing the same or different levels of the same active ingredient having the same or different release characteristics. Alternatively, a multilayer tablet may contain different active ingredient in each layer. Such a tablet, either single layered or multilayered, can optionally be coated with a controlled release polymer so as to provide additional controlled release properties.
A number of embodiments of the invention will now be described. In each case the drug may be present in any amount which is sufficient to elicit a therapeutic effect. As will be appreciated by those skilled in the art, the actual amount of drug compound used will depend on, among other things, the potency of the drug, the specifics of the patient and the therapeutic purpose for which the drug is being used. The amount of drug compound may suitably be in the range of from about 0.5 μg to about 1000 mg. The enhancer is suitably present in any amount sufficient to allow for uptake of therapeutically effective amounts of the drug via oral administration. In one embodiment, the drug and the enhancer are present in a ratio of from 1:100000 to 10:1 (drug:enhancer). In another embodiment, the ratio of drug to enhancer is from 1:1000 to 10:1. The actual ratio of drug to enhancer used will depend on, among other things, the potency of the particular drug and the enhancing activity of the particular enhancer.
In one embodiment, there is provided a pharmaceutical composition and a solid oral dosage form made therefrom comprising a bisphosphonate and, as an enhancer to promote absorption of the bisphosphonate at the GIT cell lining, a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms, wherein the enhancer and the composition are solids at room temperature.
In another embodiment, there is provided a pharmaceutical composition and an oral dosage form made therefrom comprising a bisphosphonate and, as an enhancer to promote absorption of the bisphosphonate at the GIT cell lining, wherein the only enhancer present in the composition is a medium chain fatty acid or a medium chain fatty acid derivative having a carbon chain length of from 6 to 20 carbon atoms.
In a further embodiment, there is provided a multilayer tablet comprising a composition of the present invention. Typically such a multilayer tablet may comprise a first layer containing a drug and an enhancer in an instant release form and a second layer containing a drug and an enhancer in a modified release form. As used herein, the term “modified release” includes sustained, delayed, or otherwise controlled release of a drug upon administration to a patient. In an alternative embodiment, a multilayer tablet may comprise a first layer containing a drug and a second layer containing an enhancer. Each layer may independently comprise further excipients chosen to modify the release of the drug or the enhancer. Thus the drug and the enhancer may be released from the respective first and second layers at rates which are the same or different. Alternatively, each layer of the multilayer tablet may comprise both drug and enhancer in the same or different amounts.
In yet another embodiment, there is provided a multiparticulate comprising a composition of the present invention. The multiparticulate may comprise particles, pellets mini-tablets or combinations thereof, and the drug and the enhancer may be contained in the same or different populations of particles, pellets or mini-tablets making up the multiparticulate. In multiparticulate embodiments, sachets and capsules such as hard or soft gelatin capsules can suitably be used to contain the multiparticulate. A multiparticulate dosage form may comprise a blend of two or more populations of particles, pellets or mini-tablets having different in vitro and/or in vivo release characteristics. For example, a multiparticulate dosage form may comprise a blend of an immediate release component and a delayed release component contained in a suitable capsule.
In the case of any of the above-mentioned embodiments, a controlled release coating may be applied to the final dosage form (capsule, tablet, multilayer tablet etc.). The controlled release coating may typically comprise a rate controlling polymer material as defined above. The dissolution characteristics of such a coating material may be pH dependent or independent of pH.
The various embodiments of the solid oral dosage forms of the invention may further comprise auxiliary excipient materials such as, for example, diluents, lubricants, disintegrants, plasticizers, anti-tack agents, opacifying agents, pigments, flavorings and the like. As will be appreciated by those skilled in the art, the exact choice of excipients and their relative amounts will depend to some extent on the final dosage form.
Suitable diluents include for example pharmaceutically acceptable inert fillers such as microcrystalline cellulose, lactose, dibasic calcium phosphate, saccharides, and/or mixtures of any of the foregoing. Examples of diluents include microcrystalline cellulose such as that sold under the Avicel trademark (FMC Corp., Philadelphia, Pa.) for example AvicelTM pH101, AvicelTM pH102 and AvicelTM pH112; lactose such as lactose monohydrate, lactose anhydrous and Pharmatose DCL21; dibasic calcium phosphate such as Emeompress® (JRS Pharma, Patterson, N.Y.); mannitol; starch; sorbitol; sucrose; and glucose.
Suitable lubricants, including agents that act on the flowability of the powder to be compressed are, for example, colloidal silicon dioxide such as AerosilTM 200; talc; stearic acid, magnesium stearate, and calcium stearate.
Suitable disintegrants include for example lightly cross-linked polyvinyl pyrrolidone, corn starch, potato starch, maize starch and modified starches, croscarmellose sodium, cross-povidone, sodium starch glycolate and combinations and mixtures thereof.
Example 1
TRH Containing Tablets
(a) Caco-2 Monolayers.
Cell Culture: Caco-2 cells were cultured in Dulbecco's Modified Eagles Medium (DMEM) 4.5 g/L glucose supplemented with 1% (v/v) non-essential amino acids; 10% fetal calf serum and 1% penicillin/streptomycin. The cells were cultured at 37° C. and 5% CO2 in 95% humidity. The cells were grown and expanded in standard tissue culture flasks and were passaged once they attained 100% confluence. The Caco-2 cells were then seeded on polycarbonate filter inserts (Costar; 12 mm diameter, 0.4 μm pore size) at a density of 5×105 cells/cm2 and incubated in six well culture plates with a medium change every second day. Confluent monolayers between day 20 and day 30 seeding on filters and at passages 30-40 were used throughout these studies.
Transepithelial Transport Studies: The effects of sodium salts of various MCFAs on the transport of 3H-TRH (apical to basolateral flux) was examined as follows: 15.0 μCi/ml (0.2 μM) 33H-TRH was added apically at time zero for TRH flux experiments. The transport experiments were performed in Hank's Balanced Salt Solution (HBSS) containing 25 mM N-[2-hydroxyethyl]-piperazine-N′-[2-ethanesulfonic acid] (HEPES) buffer, pH 7.4 at 37° C. Due to variations in solubilities, various concentrations of the different MCFA sodium salts and various apical buffers were used as shown in Table 1. In all cases the basolateral chamber contained regular HBSS+HEPES.







TABLE 1







Concentrations and buffers used for various MCFA sodium salts











MCFA salt*
Conc. (mM)
Buffer






NaC8: 0
0.32
HBSS + HEPES



NaC10: 0
0.40
Ca2+ free HBSS



NaC12: 0
3.77
PBS**



NaC14: 0
1.44
PBS**



NaC18: 0
0.16
HBSS + HEPES



NaC18: 2
0.16
HBSS + HEPES





*In the nomenclature CX: Y for a MCFA salt, X indicates the length of the carbon chain and Y indicates the position of unsaturation, if any.


**PBS—phosphate buffer solution.






After removing the cell culture medium, the monolayers were placed in wells containing prewarmed HBSS (37° C.); 1 ml apically and 2 ml basolaterally. Monolayers were incubated at 37° C. for 30 mins. Then at time zero, apical HBSS was replaced with the relevant apical test solution containing the radiolabelled compounds with and without the enhancer compound. Transepithelial electrical resistance (TEER) of the monolayer was measured at time zero and at 30 min intervals up to 120 min using a Millicell ERS chopstix apparatus (Millipore (U.K.) Ltd., Hertfordshire, UK) with Evom to monitor the integrity of the monolayer. The plates were placed on an orbital shaker in an incubator (37° C.). Transport across the monolayers was followed by basolateral sampling (1 ml) at 30 min. intervals up to 120 mins. At each 30 min. interval each insert was transferred to a new well containing 2 ml fresh prewarmed HBSS. Apical stock radioactivity was determined by taking 10 μl samples at t=0 and t=120 mins. Scintillation fluid (10 ml) was added to each sample and the disintegrations per min. of each sample were determined in a Wallac System 1409 scintillation counter. Mean values for 3H-TRH concentrations were calculated for the apical and basolateral solutions at each time point. The apparent permeability coefficients were calculated using the method described by Artursson (Artursson P., J. Pharm. Sci. 79:476-482 (1990)).
FIG. 1 shows the effect of C8, C10, C12, C14, C18 and C18:2 sodium salts with 3H-TRH on TEER (Ωcm2) in Caco-2 monolayers over 2 hours. The data for the C8, C10, C14 and C18 indicate minimal reduction in TEER compared to the control. While the data for C12 indicates some cell damage (reduction in TEER), this reduction is probably a result of the higher concentration of enhancer used in this.
FIG. 2 shows the effect of C8, C10, C12, C14, C18 and C18:2 sodium salts on Papp for 3H-TRH across in Caco-2 monolayers. Compared to the control, the sodium salts of C8, C10, C12 and C14 showed considerable increases in the permeability constant, Papp, at the concentrations used. It is noted that the high Papp value observed for the C12 salt may be indicative of cell damage at this high enhancer concentration.
Mitochondrial Toxicity Assay: Mitochondrial dehydrogenase (MDH) activity was assessed as a marker of cell viability using a method based on the color change of tetrazolium salt in the presence MDH. Cells were harvested, counted and seeded on 96 well plates at an approximate density of 106 cells/ml (100 μl of cell suspension per well). The cells were then incubated at 37° C. for 24 hours in humidified atmosphere, 5% CO2. A number of wells were treated with each MCFA sodium salt solution at the concentrations shown in Table 1 and the plate was incubated for 2 hours. After incubation 10 μl of MTT labeling reagent was added to each well for 4 hours. Solubilization buffer (100 μl; see Table 1) was added to each well and the plate was incubated for a further 24 hours. Absorbance at 570 nm of each sample was measured using a spectrophotometer (Dynatech MR7000).
(b) In Vivo Administration (Closed Loop Rat Model).
In vivo rat closed loop studies were modified from the methods of Doluisio et al. (Doluisio J. T., et al: Journal of Pharmaceutical Science (1969), 58, 1196-1200) and Brayden et al. (Brayden D.: Drug Delivery Pharmaceutical News (1997) 4(1)). Male Wistar rats (weight range 250 g-350 g) were anaesthetized with ketamine hydrochloride/acepromazine. A mid-line incision was made in the abdomen and a segment of the duodenum (7-9 cm of tissue) was isolated about 5 cm distal from the pyloric sphincter, taking care to avoid damage to surrounding blood vessels. The sample solutions (PBS containing C8 or C10 (35 mg) and TRH (500 μg and 1000 μg)) and control (PBS containing TRH only (500 μg and 1000 μg)) warmed to 37° C. were administered directly into the lumen of the duodenal segment using a 26 G needle. All intraduodenal dose volumes (for samples and control) were 1 ml/kg. The proximal end of the segment was ligated and the loop was sprayed with isotonic saline (37° C.) to provide moisture and then replaced in the abdominal cavity avoiding distension. The incision was closed with surgical clips. A group of animals were administered TRH in PBS (100 μg in 0.2 ml) by subcutaneous injection as a reference.
FIG. 3 shows the serum TRH concentration-time profiles following interduodenal bolus dose of 500 μg TRH with NaC8 or NaC10 (35 mg) enhancer present, according to the closed loop rat model. FIG. 4 shows the serum TRH concentration-time profiles following interduodenal bolus dose of 1000 μg TRH with NaC8 or NaC10 (35 mg) enhancer present, according to the closed loop rat model. From FIGS. 3 and 4 it can be seen that the presence of the enhancer in each case significantly increases the serum levels of TRH over the control TRH solution indicating increased absorption of the drug in the presence of the enhancer.
(c) Tableting.
Having established the enhancing effect of NaC8 and NaC10 on TRH in solution, immediate release (IR) and sustained release (SR) TRH tablets and the like may be prepared. IR and SR formulations are detailed in Tables 2 and 3 below.







TABLE 2







THR IR tablet formulation details (all amounts in wt. %)


















Silica



Micro.



TRH
NaC8
NaC10
Dioxide
Mg Stearate
Lactose
Disintegrant
Cellulose
PVP





0.64
70.36
—
0.5
0.5
20
8
—
—


1.27
69.73
—
0.5
0.5
20
8
—
—


1.23
—
67.64
0.5
0.5
20
8
—
2.13


2.42
—
66.45
0.5
0.5
—
8
20
2.13


2.42
—
66.45
0.5
0.5
20
8
—
2.13
















TABLE 3







THR SR tablet formulation details (all amounts in wt. %)















Silica
Mg

Micro.



TRH
NaC10
Dioxide
Stearate
HPMC(a)
Cellulose
PVP





1.41
77.59
0.5
0.5
20
—
—


1.05
57.95
0.5
0.5
20
20
—


2.68
73.94
0.5
0.5
20
—
2.37









Example 2
Heparin Containing Tablets
(a) Closed-Loop Rat Segment.
The procedure carried out in Example 1(a) above was repeated using USP heparin in place of TRH and dosing intraileally rather than intraduodenally. A mid-line incision was made in the abdomen and the distal end of the ileum located (about 10 cm proximal to the ileo-caecal junction). 7-9 cm of tissue was isolated and the distal end ligated, taking care to avoid damage to surrounding blood vessels. Heparin absorption as indicated by activated prothrombin time (APTT) response was measured by placing a drop of whole blood (freshly sampled from the tail artery) on the test cartridge of Biotrack 512 coagulation monitor. APTT measurements were taken at various time points. FIG. 5 shows the APTT response of USP heparin (1000 iu) at different sodium caprate (C10) levels (10 and 35 mg). Using APTT response as an indicator of heparin absorption into the bloodstream, it is clear that there is a significant increase in absorption in the presence of sodium caprate compared to the control heparin solution containing no enhancer.
Citrated blood samples were centrifuged at 3000 rpm for 15 mins. to obtain plasma for anti-factor Xa analysis. FIG. 6 shows the anti-factor Xa response of USP heparin (1000 iu) in the presence of sodium caprylate (C8, 10 mg and 35 mg). FIG. 7 shows the anti-factor Xa response of USP heparin (1000 iu) in the presence of sodium caprate (C10, 10 mg and 35 mg). The control in each case is a solution of the same heparin concentration containing no enhancer. The significant increase in anti-factor Xa activity observed for NaC8 (at 35 mg dose) and NaC10 (at both 10 mg and 35 mg doses) is indicative of the increase in heparin absorption relative to the control heparin solution.
(b) Tableting.
(i) IR Tablets.
Instant release (IR) tablets containing heparin sodium USP (197.25 IU/mg, supplied by Scientific Protein Labs., Waunkee, Wis.) and an enhancer (sodium caprylate, NaC8; sodium caprate, NaC10, supplied by Napp Technologies, New Jersey) were prepared according to the formulae detailed in Table 4 by direct compression of the blend using a Manesty (E) single tablet press. The blend was prepared as follows: heparin, the enhancer and tablet excipients (excluding where applicable colloidal silica dioxide and magnesium stearate) were weighed out into a container. The colloidal silica dioxide, when present, was sieved through a 425 μm sieve into the container, after which the mixture was blended for four minutes before adding the magnesium stearate and blending for a further one minute.







TABLE 4







Formulation data for IR tablets containing heparin and enhancer


(all amounts in wt. %)















Batch



Silica
Magnesium





No.
NaC8
NaC10
Heparin
dioxide
stearate
Mannitol
Disintegrant(a)
PVP(b)


















1
65.7 
—
13.3
0.5
0.5
20.0
—
—


2
62.2 
—
16.8
0.5
0.5
20.0
—
—


3
57.49
—
21.91
0.1
0.5
20.0
—
—


4
75.66
—
15.34
0.5
0.5
—
8.0
—


5
—
62.0 
37.5
0.5
—
—
—
—


6
—
49.43
30.07
0.5
—
20.0
—
—


7
—
31.29
25.94
0.5
0.5
40.0
—
1.77





“—” indicates “not applicable”


(a)Disintegrant used was sodium starch glycolate;


(b)PVP = polyvinyl pyrrolidone






The potency of tablets prepared above was tested using a heparin assay based on the azure dye determination of heparin. The sample to be assayed was added to an Azure A dye solution and the heparin content was calculated from the absorbance of the sample solution at 626 nm. Tablet data and potency values for selected batches detailed in Table 4 are given in Table 5.
Dissolution profiles for IR tablets according to this Example in phosphate buffer at pH 7.4 were determined by heparin assay, sampling at various time points.
Heparin/sodium caprylate: Tablets from batches 1 and 2 gave rapid release yielding 100% of the drug compound at 15 minutes. Tablets from batch 4 also gave rapid release yielding 100% release at 30 minutes.
Heparin/sodium caprate: Tablets from batches 5 and 6 gave rapid release 100% of the drug compound at 15 minutes.







TABLE 5







Tablet data and potency values for IR heparin tablets


















Actual





Tablet

Disinte-
heparin
Potency


Batch

Weight
Hardness
gration
Potency
As % of


No.
Enhancer
(mg)
(N)
Time(s)
(mg/g)
label
















1
NaC8
431 ± 5
85 ± 4
—
145.675
109


2
NaC8
 414 ± 14
82 ± 9
—
175.79
105


3
NaC8
650 ± 4
 71 ± 12
552
166.4
119


4
NaC8
377 ± 2
 58 ± 10
—
168.04
110


5
NaC10
 408 ± 21
79 ± 7
—
394.47
105


6
NaC10
490 ± 6
124 ± 10
—
323.33
108


7
NaC10
 584 ± 12
 69 ± 22
485
143.0
102









(ii) SR Tablets.
Using the same procedure as used in (i) above, sustained release (SR) tablets were prepared according to the formulae shown in Table 6. The potency of controlled release tablets was determined using the same procedure as in (i) above. Tablet details and potency for selected batches are shown in Table 7. Dissolution profiles for SR tablets according this Example were determined by heparin assay at pH 7.4, sampling at various time points.
Heparin/sodium caprylate: Dissolution data for batches 8, 9 and 11 are shown in Table 8. From this data it can be seen that heparin/sodium caprylate SR tablets with 15% Methocel K100LV with and without 5% sodium starch glycolate (batches 8 & 9) gave a sustained release with 100% release occurring between 3 and 4 hours. Batch 11 sustaining 10% mannitol gave a faster release.
Heparin/sodium caprate: Dissolution data for batches 13 and 14 are shown in Table 8. From this data it can be seen that heparin/sodium caprate SR tablets with 20% Methocel K100LV (batch 13) gave a sustained release of the drug compound over a six hour period. Where Methocel K15M (batch 14) was used in place of Methocel K100LV release of the drug compound was incomplete after 8 hours.







TABLE 6







Formulation data for SR tablets containing heparin and enhancer


(all amounts in wt. %)

















Batch



Silica
Mg.



Micro



No.
NaC8
NaC10
Heparin
dioxide
stearate
HPMC(a)
Disintegrant(b)
Mannitol
cellulose
PVP




















8
69.84
—
14.16
0.5
0.5
15
—
—
—
—


9
65.68
—
13.32
0.5
0.5
15
5.0
—
—
—


10
65.68
—
13.32
0.5
0.5
12
8.0
—
—
—


11
65.68
—
13.32
0.5
0.5
10.0
—
10.0
—
—


12
53.77
—
20.48
—
1.0
14.85
—
—
9.9
—


13
—
56.2
23.3
0.5
—
20.0
—
—
—
—


14
—
56.2
23.3
0.5
—
20.0*
—
—
—
—


15
—
 41.63
34.52
0.5
1.0
20.0
—
—
—
2.35





“—” indicates “not applicable”;


(a)Hydroxypropylmethyl cellulose: Methocel K100LV in each case except “*” in which Methocel K15M was employed;


(b)Disintegrant used was sodium starch glycolate;


(c) PVP = polyvinyl pyrrolidone;













TABLE 7







Table data and Potency values for SR heparin tablets

















Actual







Heparin


Batch

Tablet
Hardness
Disintegration
potency


No.
Enhancer
Weight (mg)
(N)
Time (s)
(mg/g)















8
NaC8
397 ± 5
52 ± 11
—
—


9
NaC8
 436 ± 11
40 ± 10
—
140.08


10
NaC8
384 ± 4
42 ± 12
—
—


11
NaC8
400 ± 8
72 ± 16
—
129.79


12
NaC8
683 ± 9
84 ± 17
3318
147.10


13
NaC10
 491 ± 14
69 ± 7 
—
—


14
NaC10
 456 ± 13
47 ± 4 
—
—


15
NaC10
 470 ± 29
—
2982
148.20
















TABLE 8







Dissolution data for selected batches of SR tablets









% Release (as of label)












Time
Batch 8
Batch 9
Batch 11
Batch 13
Batch 14


(min)
(NaC8)
(NaC8)
(NaC8)
(NaC10)
(NaC10)















0
0
0
0
0
0


15
22.9
21.2
45.3
18.8
5.7


30
37.3
30.8
72.3
45.0
11.6


60
57.8
54.5
101.9
44.8
11.2


120
92.2
90.8
109.4
65.2
20.0


240
109.5
105.8
96.4
83.1
33.9


360
—
—
—
90.3
66.0


480
—
—
—
102.7
82.8









(iii) Enteric Coated Tablets.
Tablets from batches 7 and 15 were enterically coated with a coating solution as detailed in Table 9. Tablets were coated with 5% w/w coating solution using a side vented coating pan (Freund Hi-Coater). Disintegration testing was carried out in a VanKel disintegration tester VK100E4635. Disintegration medium was initially simulated gastric fluid pH1.2 for one hour and then phosphate buffer pH7. The disintegration time recorded was the time from introduction into phosphate buffer pH7.4 to complete disintegration. The disintegration time for enterically coated tablets from batch 7 was 34 min. 24 sec, while for enteric coated tablets from batch 15 the disintegration time was 93 min. 40 sec.







TABLE 9







Enteric coating solution










Component
Amount (wt. %)













Eudragit ® 12.5
49.86



Diethylphthlate
1.26



Isopropyl alcohol
43.33



Talc
2.46



Water
3.06









(c) Dog Study.
Tablets from batches 3, 7 and 15 in Tables 5 and 6 above were dosed orally to groups of five dogs in a single dose crossover study. Each group was dosed with (1) orally administered uncoated IR tablets containing 90000 IU heparin and 550 mg NaC10 enhancer (batch 7); (2) orally administered uncoated IR tablets containing 90000 IU heparin and 550 mg NaC8 enhancer (batch 3); (3) orally administered uncoated SR tablets containing 90000 IU heparin and 550 mg NaC10 enhancer (batch 15) and (4) s.c. administered heparin solution (5000 IU, control). Blood samples for anti-factor Xa analysis were collected from the jugular vein at various time points. Clinical assessment of all animals pre- and post-treatment indicated no adverse effects on the test subjects. FIG. 8 shows the mean anti-factor Xa response for each treatment, together with the s.c. heparin solution reference. The data in FIG. 8 shows an increase in the plasma anti-factor Xa activity for all of the formulations according to the invention. This result indicates the successful delivery of bioactive heparin using both NaC8 and NaC10 enhancers. Using IR formulations and an equivalent dose of heparin, a larger anti-factor Xa response was observed with the NaC10 enhancer, in spite of the lower dose of NaC10 relative to NaC8 administered (NaC10 dose was half that of NaC8). The anti-factor Xa response can be sustained over longer time profiles relative to IR formulations by the use of SR tablets.
Example 3
Effect of Enhancers on the Systemic Availability of Low Molecular Weight Heparin (LMWH) After Intraduodenal Administration in Rats
Male Wistar rats (250 g-350 g) were anaesthetized with a mixture of ketamine hydrochloride (80 mg/kg) and acepromazine maleate (3 mg/kg) given by intra-muscular injection. The animals were also administered with halothane gas as required. A midline incision was made in the abdomen and the duodenum was isolated.
The test solutions, comprising parnaparin sodium (LMWH) (Opocrin SBA, Modena, Italy) with or without enhancer reconstituted in phosphate buffered saline (pH 7.4), were administered (1 ml/kg) via a cannula inserted into the intestine approximately 10-12 cm from the pyloris. The intestine was kept moist with saline during this procedure. Following drug administration, the intestinal segment was carefully replaced into the abdomen and the incision was closed using surgical clips. The parenteral reference solution (0.2 ml) was administered subcutaneously into a fold in the back of the neck.
Blood samples were taken from a tail artery at various intervals and plasma anti-factor Xa activity was determined. FIG. 9 shows the mean anti-factor Xa response over a period of 3 hours following intraduodenal administration to rats of phosphate buffered saline solutions of parnaparin sodium (LMWH) (1000 IU), in the presence of 35 mg of different enhancers [sodium caprylate (C8), sodium nonanoate (C9), sodium caprate (C10), sodium undecanoate (C11), sodium laurate (C12)] and different 50:50 binary mixtures of enhancers, to rats (n=8) in an open loop model. The reference product comprised administering 250 IU parnaparin sodium subcutaneously. The control solution comprised administering a solution containing 1000 IU parnaparin sodium without any enhancer intraduodenally.
FIG. 9 shows that the systemic delivery of LMWH in the absence of enhancer is relatively poor after intraduodenal administration to rats; however, the co-administration of the sodium salts of medium chain fatty acids significantly enhanced the systemic delivery of LMWH from the rat intestine
Example 4
Effect of Enhancers on the Systemic Availability of Leuprolide After Intraduodenal Administration in Dogs
Beagle dogs (10-15 Kg) were sedated with medetomidine (80 μg/kg) and an endoscope was inserted via the mouth, esophagus and stomach into the duodenum. The test solutions (10 ml), comprising leuprolide acetate (Mallinckrodt Inc, St. Louis, Mo.) with or without enhancer reconstituted in deionized water were administered intraduodenally via the endoscope. Following removal of the endoscope, sedation was reversed using atipamezole (400 μg/kg). The parenteral reference solutions comprising 1 mg Leuprolide reconstituted in 0.5 ml sterile water were administered intravenously and subcutaneously respectively.
Blood samples were taken from the jugular vein at various intervals and plasma leuprolide levels were determined. The resulting mean plasma leuprolide levels are shown in FIG. 10. The results show that, although the systemic delivery of leuprolide when administered intraduodenally without enhancer is negligible, coadministration with enhancer resulted in a considerable enhancer dose dependent enhancement in the systemic delivery of leuprolide; a mean % relative bioavailability of 8% observed for at the upper dose of enhancer.
Example 5
Effect of Enhancers on the Systemic Availability of LMWH After Oral Administration in Dogs
(a) Granulate Manufacture
A 200 g blend containing parnaparin sodium (47.1%), sodium caprate (26.2%), mannitol (16.7%) and ExplotabTM (Roquette Freres, Lestrem, France) (10.0%) was granulated in a Kenwood Chef mixer using water as the granulating solvent. The resulting granulates were tray dried in an oven at 67-68° C. and size reduced through 1.25 mm, 0.8 mm and 0.5 mm screens respectively in an oscillating granulator. The actual potency of the resulting granulate was determined as 101.1% of the label claim.
(b) 30,000 IU LMWH/183 mg Sodium Caprate Instant Release Tablet Manufacture
The granulate described above was bag blended with 0.5% magnesium stearate for 5 minutes. The resulting blend was tableted using 13 mm round concave tooling on a Riva Piccalo tablet press to a target tablet content of 30,000 IU parnaparin sodium and 183 mg sodium caprate. The tablets had a mean tablet hardness of 108 N and a mean tablet weight of 675 mg. The actual LMWH content of the tablets was determined as 95.6% of label claim.
Disintegration testing was carried out on the tablets. One tablet was placed in each of the six tubes of the disintegration basket. The disintegration apparatus was operated at 29-30 cycles per minute using de-ionized water at 37° C. Tablet disintegration was complete in 550 seconds.
(c) 90,000 IU LMWH/0.55 g Sodium Caprate Solution Manufacture
90,000 IU parnaparin sodium and 0.55 g sodium caprate were individually weighed into glass bottles and the resulting powder mixture was reconstituted with 10 ml water.
(d) Dog Biostudy Evaluation
90,000 IU parnaparin sodium and 550 mg sodium caprate was administered as both a solution dosage form (equivalent to 10 ml of the above solution composition) and a fast disintegrating tablet dosage form (equivalent to 3 tablets of the above tablet composition) in a single dose, non randomized, cross-over study in a group of six female beagle dogs (9.5-14.4 Kg) with a seven day washout between treatments. A subcutaneous injection containing 5000 IU parnaparin sodium was used as the reference.
Blood samples were taken from the jugular vein at various intervals and anti-factor Xa activity was determined. Data was adjusted for baseline anti-factor Xa activity. The resulting mean plasma anti-factor Xa levels are summarized in FIG. 11. Both the tablet and solution dosage forms showed good responses when compared with the subcutaneous reference leg. The mean delivery, as determined by plasma antifactor Xa levels, of parnaparin sodium from the solid dosage form was considerably greater than that from the corresponding solution dosage form.
Example 6
Effect of Enhancers on the Systemic Availability of LMWH After Oral Administration in Humans
(a) Granulate Manufacture
Parnaparin sodium (61.05%), sodium caprate (33.95%) and polyvinyl pyrrolidone (Kollidon 30, BASF AG, Ludwigshafen, Germany) (5.0%) were mixed for 5 minutes in a Gral 10 prior to the addition of water, which was then gradually added, with mixing, using a peristaltic pump until all the material was apparently granulated.
The resultant granulates were tray dried in an oven at either 50° C. for 24 hours. The dried granules were milled through a 30 mesh screen using a Fitzmill M5A
(b) 45,000 IU LMWH/275 mg Sodium Caprate Instant Release Tablet Manufacture
The parnaparin sodium/sodium caprate/polyvinyl pyrrolidone granulate (78.3%) was blended for 5 minutes with mannitol (16.6%), Explotab (5.0%) and magnesium stearate (1.0%) in a 10 liter V Cone blender. The potency of the resulting blend (480.41 mg/g) was 100.5% of the label claim. The blend was tableted using 13 mm round normal concave tooling on the Piccola 10 station press in automatic mode to a target content of 45,000 IU LMWH and 275 mg sodium caprate. The resulting instant release tablets had a mean tablet weight of 1027 mg, a mean tablet hardness of 108 N and a potency of 97% label claim. The tablets showed a disintegration time of up to 850 seconds and 100% dissolution into pH 1.2 buffer in 30 minutes.
(c) 90,000 IU LMWH/550 mg Sodium Caprate Solution Manufacture
Two instant tablets, each containing 45,000 IU LMWH and 275 mg sodium caprate, were reconstituted in 30 ml water.
(d) Human Biostudy Evaluation
90,000 IU LMWH and 550 mg sodium caprate was orally administered to 12 healthy human volunteers as both a solution dosage form (equivalent to 30 ml of the above solution dosage form) and as a solid dosage form (equivalent to 2 tablets of the above composition) in an open label, three treatment, three period study with a seven day washout between each dose; Treatments A (Instant Release Tablets) and B (Oral Solution) were crossed over in a randomized manner whereas Treatment C (6,400 IU FluxumTM SC (Hoechst Marion Roussel), a commercially available injectable LMWH product) was administered to the same subjects as a single block.
Blood samples were taken at various intervals and anti-factor Xa activity was determined. The resulting mean anti-factor Xa levels are shown in FIG. 12. Treatments A and B exhibited unexpectedly low responses when compared with the subcutaneous reference treatment. However it should be noted that the mean delivery of LMWH, as measured by plasma anti-factor Xa levels, was considerably higher from the solid dosage form than that from the corresponding solution dosage form for which a mean % bioavailability of only 0.9% was observed.
Example 7
Effect of Enhancers on the Systemic Availability of LMWH After Intrajejunal Administration in Humans
(a) Solution Manufacture
The following LMWH/sodium caprate combinations were made with 15 ml deionized water:
(i) 20,000 IU LMWH, 0.55 g Sodium Caprate;
(ii) 20,000 IU LMWH, 1.1 g Sodium Caprate;
(iii) 45,000 IU LMWH, 0.55 g Sodium Caprate;
(iv) 45,000 IU LMWH, 1.1 g Sodium Caprate;
(v) 45,000 IU LMWH, 1.65 g Sodium Caprate.
(b) Human Biostudy Evaluation
15 ml of each of the above solutions was administered intrajejunally via a nasojejunal intubation in an open label, six treatment period crossover study in up to 11 healthy human volunteers. 3,200 IU FluxumTM SC was included in the study as a subcutaneous reference. Blood samples were taken at various intervals and anti-factor Xa activity was determined. The resulting mean anti-factor Xa levels are shown in FIG. 13.
It should be noted that the mean % relative bioavailability for each treatment in the current study was considerably higher than the mean % bioavailability observed for the solution dosage form in Example 6; mean % bioavailabilities ranging from 5% to 9% were observed for the treatments in the current study suggesting that the preferred LMWH oral dosage form containing sodium caprate should be designed to minimize release of drug and enhancer in the stomach and maximize the release of drug and enhancer in the small intestine.
Example 8
Manufacture of Delayed Release Tablet Dosage Form Containing LMWH and Enhancer
(a) LMWH/Sodium Caprate Granulate Manufacture
A 500 g batch of parnaparin sodium:sodium caprate (0.92:1) was granulated in a Gral 10 using a 50% aqueous solution of Kollidon 30 as the granulating solvent. The resulting granulate was dried for 60 minutes in a Niro Aeromatic Fluidized Bed Drier at a final product temperature of 25° C. The dried granulate was milled through a 30 mesh screen in a Fitzmill M5A. The potency of the resulting dried granulate was determined as 114.8% of the label claim.
(b) 22,500 IU LMWH/275 mg Sodium Caprate Instant Release Tablet Manufacture
The above granulate (77.5%) was added to mannitol (16%), PolyplasdoneTM XL (ISP, Wayne, N.J.) (5%) and AerosilTM (1%) (Degussa, Rheinfeiden, Germany) in a 10 IV coned blender and blended for 10 minutes. Magnesium stearate (0.5%) was added to the resulting blend and blending was continued for a further 3 minutes. The resulting blend was tableted on Piccola tablet press using 13 mm round normal concave tooling to a mean tablet weight of 772 mg and a mean tablet hardness of 140 N.
The actual potency of the resulting tablets was determined as 24,017 IU LMWH per tablet.
(c) 22,500 IU LMWH/275 mg Sodium Caprate Delayed Release Tablet Manufacture
The above tablets were coated with a coating solution containing Eudragit L 12.5 (50%), isopropyl alcohol (44.45%), dibutyl sebecate (3%), talc (1.3%), water (1.25%) in a Hi-Coater to a final % weight gain of 5.66%.
The resulting enteric coated tablets remained intact after 1 hour disintegration testing in pH 1.2 solution; complete disintegration was observed in pH 6.2 medium after 32-33 minutes.
Example 9
Manufacture of Instant Release Capsule Dosage Form Containing LMWH and Enhancer
(a) 22,500 IU LMW 275 mg Sodium Caprate Instant Release Capsule Manufacture
The granulate from the previous example, part a, was hand filled into Size 00 hard gelatin capsules to a target fill weight equivalent to the granulate content of the tablets in the previous example.
Example 10
Manufacture of Delayed Release Tablet Dosage Form Containing LMWH Without Enhancer
(a) LMWH Granulate Manufacture
A 500 g batch of parnaparin sodium: AvicelTM pH 101 (0.92:1) (FMC, Little Island, Co. Cork, Ireland) was granulated in a Gral 10 using a 50% aqueous solution of Kollidon 30 as the granulating solvent. The resulting granulate was dried for 60 minutes in a Niro Aeromatic Fluidized Bed Drier at an exhaust temperature of 38° C. The dried granulate was milled through a 30 mesh screen in a Fitzmill M5A. The potency of the resulting dried granulate was determined as 106.5% of the label claim.
(b) 22,500 IU LMWH Instant Release Tablet Manufacture
The above granulate (77.5%) was added to mannitol (21%) and Aerosil (1%) in a 25 L V-cone blender and blended for 10 minutes. Magnesium stearate (0.5%) was added to the resulting blend and blending was continued for a further 1 minute.
The resulting blend was tableted on Piccola tablet press using 13 mm round normal concave tooling to a mean tablet weight of 671 mg and a mean tablet hardness of 144 N.
The actual potency of the resulting tablets was determined as 21,651 IU LMWH per tablet.
(c) 22,500 IU LMWH Delayed Release Tablet Manufacture
The above tablets were coated with a coating solution containing Eudragit L 12.5 (50%), isopropyl alcohol (44.45%), dibutyl sebecate (3%), talc (1.3%) and water (1.25%) in a Hi-Coater to a final % weight gain of 4.26%.
The resulting enteric coated tablets remained intact after 1 hour disintegration testing in pH 1.2 solution; complete disintegration was observed in pH 6.2 medium in 22 minutes.
Example 11
Effect of Controlled Release Dosage Form Containing Enhancer on the Systemic Availability of LMWH After Oral Administration in Dogs
(a) Dog Study Evaluation
45,000 IU LMWH was administered to 8 beagle dogs (10.5-13.6 Kg), in an open label, non randomized crossed over block design, as (a) an instant release capsule dosage form containing 550 mg sodium caprate (equivalent to 2 capsules manufactured according to Example 9) (b) a delayed release tablet dosage containing 550 mg sodium caprate (equivalent to two tablets manufactured according to Example 8) and (c) a delayed release tablet dosage not containing any enhancer (equivalent to 2 tablets manufactured according to Example 10). 3,200 IU FluxumTM SC was included in the study as a subcutaneous reference.
Blood samples were taken from the jugular vein at various intervals and anti-factor Xa activity was determined. The mean anti-factor Xa levels are shown in FIG. 14.
It should be noted that in the absence of sodium caprate, the systemic delivery of LMWH was minimal from the delayed release solid dosage form without enhancer. In contrast, a good anti-factor Xa response was observed after administration of the delayed release LMWH solid dosage form containing sodium caprate. The mean anti-factor Xa response from the delayed release dosage form containing sodium caprate was considerably higher than that from the instant release dosage form containing the same level of drug and enhancer.
Example 12
Effect of the Site of Administration on the Systemic Availability of LMWH in Dogs After Co-Administration with Enhancer
Four beagle dogs (10-15 Kg) were surgically fitted with catheters to the jejunum and colon respectively. The test solutions (10 ml) comprising LMWH with sodium caprate reconstituted in deionized water were administered to the dogs either orally or via the intra-intestinal catheters. 3,200 IU FluxumTM SC was included in the study as a subcutaneous reference.
Blood samples were taken from the brachial vein at various intervals and anti-factor Xa activity was determined. The resulting mean anti-factor Xa levels are shown in FIG. 15. The results show that the intestinal absorption of LMWH in the presence of enhancer is considerably higher than absorption from the stomach.
Example 13
Leuprolide Containing Tablets
Following the same type of approach as used in Examples 1 and 2, leuprolide-containing IR tablets may be prepared according to the formulations detailed in Table 10.







TABLE 10







IR Formulations containing Leuprolide


(all amounts in wt. %)















Silica
Magnesium


Microcrystalline


Leuprolide
NaC10
Dioxide
Stearate
Lactose
Disintegrant
Cellulose
















0.05
68.82
0.5
0.5
20
8
—


.013
70.87
0.5
0.5
—
8
20


0.13
68.75
0.5
0.5
20
8
—









Example 14
Intrajejunal Administration of Alendronate
A study was conducted as an open labeled, randomized, 7 treatment, 6 period study with IJ or PO administrations and at least a 48-hour washout period between each dose. Nineteen (19) healthy male subjects were enrolled into the study and the 15 subjects who were dosed at least once were included in the pharmacokinetic analysis. Pharmacokinetic analysis was based on urinary excretion of alendronate. Table 11 shows the treatments, cumulative amount, and % of administered dose excreted in the urine (based on the cumulative amount) in this study.







TABLE 11







Mean PK Parameters (Mean ± SD - CV %)










Administered dose
Cumulative


Treatment
excreted in the urine (%)
Amount (mg)





10 mg Fosamax ®
0.61 ± 1.11
0.06 ± 0.11


(CV %)
181.3 
181.3 


10 mg Alendronate +
3.77 ± 3.16
0.38 ± 0.32


0.25 g C10 (IJ)




(CV %)
83.9
83.9


10 mg Alendronate +
6.64 ± 4.97
0.66 ± 0.50


0.50 g C10 (IJ)




(CV %)
74.9
74.9


10 mg Alendronate +
7.66 ± 3.72
0.77 ± 0.37


0.75 g C10 (IJ)




(CV %)
48.6
48.6


70 mg Alendronate +
10.47 ± 3.63 
7.33 ± 2.54


0.75 g C10 (IJ)




(CV %)
34.7
34.7









As shown by these data, the gastrointestinal absorption of alendronate was significantly enhanced when administered as an intrajejunal bolus solution with sodium caprate, compared to the current commercially available uncoated instant release Fosamax® reference tablet.
Example 15
Intrajejunal and Oral Administration of Alendronate
In an open label, partially randomized, 3 treatment, 3 period study with at least a 48 hour washout between each dose, twelve (12) male subjects were dosed at least once during the course of the study and were included in the pharmacokinetic analysis. The following treatments were administered in this study:







TABLE 12







Mean PK Parameters (Mean ± SD - CV %)









Treatments











Trt A
Trt B




17.5 mg Alendronate +
17.5 mg Alendronate +
Trt C



0.5 g C10
1.1 g C10
35 mg Fosamax ®


PK
(IJ Infusion over 25 min)
(IJ Infusion over 25 min)
(PO)


Parameters
n12
n12
n12





Relative Bioavailability (%)
3376.78 ± 5362.54
2664.30 ± 2183.57
—


(CV %)
158.8 
82.0
—


Cumulative Amount (mg)
0.89 ± 0.71
1.20 ± 0.74
0.21 ± 0.31


(CV %)
80.0
61.5
149.4


Administered Dose
5.08 ± 4.07
6.88 ± 4.23
0.59 ± 0.88


excreted in the urine (%)





(CV %)
80.0
61.5
149.4









As shown by these data, the systemic absorption of alendronate was considerably enhanced after co-administration, as an aqueous intrajejunal infusion (over 25 minutes), with sodium caprate. This finding indicates that an enteric coated instant release oral dosage form of alendronate and sodium caprate (C10), with enhanced oral absorption of alendronate, as compared to the currently commercially available dosage form, should be advantageous.
Example 16
Oral Administration of Alendronate
A study was conducted to compare the relative bioavailability of alendronate administered as solid oral dosage forms containing an absorption enhancer, with an oral dose of the commercially available reference dosage form Fosamax®. This study was conducted as an open label, partially randomized, single dose, S treatment, S period study with at least a 48 hour washout between each dose. Sixteen (16) healthy volunteers (13 male and 3 female subjects between 20 and 34 years old and weighing between 64.1 and 81.5 kg) were enrolled and completed all 5 treatments as set forth in Table 13 below.










TABLE 13





Treatment
n
Route
Treatment







Trt A
16
PO
35 mg of Fosamax ®





administered as 1 tablet with 250 mL tap water - Fasted


Trt B
16
PO
17.5 mg Alendronate and 0.5 g C10





administered as 2 tablets with 250 mL tap water - Fasted





(8.75 mg Alendronate and 0.25 g C10 per tablet)





HPMC P-55/Opadry coated alendronate/C10 tablets


Trt C
16
PO
17.5 mg Alendronate and 0.5 g 010





administered as 2 tablets with 250 mL tap water - Fed





(High Fat)





(8.75 mg Alendronate and 0.25 g C10 per tablet)





HPMC P-55/Opadry coated alendronate/C10 tablets


Trt D
16
PO
17.5 mg Alendronate and 0.25 g C10





administered as 2 tablets with 250 mL tap water - Fasted





(8.75 mg Alendronate and 0.125 g C10 per tablet)





HPMC P-55/Opadry coated alendronate/C10 tablets


Trt E
16
PO
17.5 mg Alendronate and 0.25 g C10





administered as 1 tablet with 250 mL tap water - Fasted





(17.5 mg Alendronate and 0.25 g C10 per tablet)





HPMC P-55/Opadry coated alendronate/C10 tablets









Human urine samples were collected across a 36-hour sampling period and analyzed by HPLC with fluorescence detection (assay range: 2 to 2000 ng/mL). The mean % of administered dose excreted in the urine (based on the cumulative amount) for the test treatments, were as follows:









TABLE 14







% of Administered Dose




Excreted in the Urine



Treatment ID
(CV %)








Trt A
0.3 ± 0.1 (33.6)



Trt B
1.5 ± 0.6 (40.5)



Trt C
0.2 ± 0.2 (109.8)



Trt D
1.6 ± 1.7 (106.8)



Trt E
1.2 ± 0.9 (79.0)









Paired t-test analysis was conducted comparing the % Dose Excreted of the test prototypes versus % Dose Excreted for Fosamax®.










TABLE 15





Treatment
Trt A
Significance
P-Value


















Trt B
S
Higher
<0.001




Significance level less than the 0.1%



Trt C
S
Lower
0.037




Significance level 5%



Trt D
S
Lower
0.006




Significance level 1%



Trt E
S
Lower
0.001




Significance level 1%





S = Statistically significant






A statistically significant increase in the % of the administered dose of alendronate excreted in the urine was observed for the test prototypes administered fasted (dosed as 1 or 2 tablets) compared to that observed for the reference product, Fosamax®. A statistically significant decrease in the percent of the administered dose of alendronate excreted was observed for the test prototype administered fed (Trt C—sig. at 5%) as compared to that observed for Fosamax®. The cumulative amount of administered dose recovered in the urine for the test administrations was 4.6-6.4-fold greater than that observed for Fosamax®.
Increasing the amount of C10 co-administered with alendronate from 0.25 g to 0.5 g did not change the % of administered dose recovered in the urine (1.6±1.7% and 1.5±0.6% respectively). The administration of 17.5 mg alendronate with 0.25 g C10 as 2 tablets (Trt D) resulted in a higher % of administered dose recovered of alendronate (1.6±1.7%) than when administered as 1 tablet according to Trt E (1.2±0.9%). When 17.5 mg alendronate and 0.5 g C10 was administered as 2 tablets in the fed state (Trt C), 0.2±0.2% of alendronate was determined in the urine.
It should be noted that the published literature states that the bioavailability of Fosamax® is negligible when alendronate is administered with or up to 2 hours after a standard breakfast.
Example 17
Bioavailability Study of Oral Dosage Forms of Zoledronic Acid
A single dose, crossover study was performed to compare the bioavailability of zoledronic acid in an oral dosage form of the present invention with the currently marketed form of zoledronic acid that is provided as a liquid concentrate for intravenous infusion under the name Zometa® by Novartis. The oral dosage form under consideration was an enterically coated tablet containing sodium caprate and either 10 mg or 20 mg of zoledronic acid formed in accordance with the methods of Examples 6, 8 and 13. The liquid concentrate was administered as an intravenous infusion containing 1 mg zoledronic acid.
All available data from the 12 subjects who completed the study were used in the pharmacokinetic analyses. (There were no data for Subject 1 for the reference product.) All pharmacokinetic calculations were performed using SAS (PC version 6.12). The zoledronic acid level for each urine collection for each subject in each period was reported by the analytical laboratory in terms of both the concentration (ng/mL) and the total amount excreted (ng). Any sample with a reported concentration value less than the assay limit of quantitation was set to a zero amount excreted for use in the pharmacokinetic analyses.
The reported amount of zoledronic acid excreted in nanograms (g×10−9) was converted to milligrams (g×10−3) by multiplying each reported value by 10−6 prior to pharmacokinetic analyses. This was done to simplify the statistical output and to express the total amount excreted in the same units (mg) as the administered doses. The amounts excreted over the hourly intervals 0-12, 12-24, 24-36 and 36-48 for each subject in each period were incrementally summed to obtain the cumulative amounts excreted over the hourly intervals 0-12, 0-24, 0-36 and 0-48.
Statistical analyses were performed using the General Linear Models (GLM) procedure of the SAS statistical program (PC version 6.12). The cumulative amounts of zoledronic acid excreted, and the natural log transformed (ln-transformed) cumulative amounts of zoledronic acid excreted, were evaluated by analysis of variance. Hypothesis testing for treatment effects in the analysis was conducted at α=0.05.
Pair-wise comparisons of interest were between the 10 mg tablet and the injection, the 20 mg tablet and the injection, and between the 10 mg and 20 mg tablets. The statistical model used in the analyses contained terms for subject and treatment effects. F-ratios for testing the equivalence of treatment effects were constructed using the mean square error term for the effect as the numerator and the mean square error term from the analysis of variance as the denominator.
In addition to the hypothesis tests, confidence intervals (90%) for the pair-wise treatment comparisons were calculated by the t-test approach (2, 1-sided) at α=0.10 overall, α=0.05 each side:

Interval Lower Limit=(XT−XR)−Se*tα/2 

Interval Upper Limit=(XT−XR)+Se*tα/2 

Where

    
    
        XT is the least-squares mean for the test treatment and XR is the least-squares mean for the reference treatment. In the comparison between the two tablets of the present invention, XT is the least-squares mean for the 20 mg tablet of the present invention and XR is the least-squares mean for the 10 mg tablet of the present invention.
        Se is the standard error of the estimated difference between means from the SAS estimate statement.
        
            tα/2 is the critical value from the t-distribution with degrees of freedom that of the error term in the statistical analysis at the α=0.10 level.
        
        
    
    


For ln-transformed data the interval was calculated from the results for the transformed values and then exponentiated to convert to the non-transformed scale:

Interval Limit=e(ln-transformed interval limit) 

The confidence interval was computed for the “true” mean treatment differences, expressed as a percent of the reference mean (non-transformed results), and for the true geometric mean ratio (ln-transformed results). Similarly, the exponentiated test and reference least squares means from ln-transformed results provided an estimate of the geometric means for these treatments.
Statistical analyses were performed on the results in order to compare the 10 mg tablets, the 20 mg tablets, and the 1 mg Zometa® injection when each was administered following an overnight fast. Tables 16-18 below summarize the results of the pair-wise treatment comparisons of the urinary excretion of zoledronic acid. FIG. 17 shows the mean cumulative excretion for the three treatments. No statistically significant differences were detected with regard to mean cumulative urinary excretion. The 10 mg and 20 mg tablets had a mean 48-hour urinary excretion approximately equal to 0.5 mg. The 1 mg Zometa® injection treatment has a similar mean amount excreted over this time. For all three dosage forms, most of the zoledronic acid excretion (85% to 87%) occurred within the first 12 hours after administration.
A summary of the statistical comparisons of urinary excretion of zoledronic acid following administration of a single 10 mg tablet dose and a 1 mg injection to 12 fasted, postmenopausal females is presented below in Table 16.










TABLE 16







Excretion
Least-Squares

90% Confidence


Interval
Means (mg)1

Interval4













(hrs)
10 mg
Zometa
Ratio2
CV %3
Lower
Upper





0-12
0.459
0.465
0.987
—
0.669
1.306


0-24
0.492
0.499
0.984
—
0.662
1.307


0-36
0.511
0.521
0.982
—
0.658
1.305


0-48
0.525
0.538
0.976
—
0.653
1.299







Ln-Transformed Results:













0-12
0.429
0.408
1.052
50.8
0.743
1.490


0-24
0.462
0.439
1.052
50.9
0.742
1.490


0-36
0.480
0.458
1.049
51.2
0.739
1.489


0-48
0.492
0.473
1.041
51.6
0.731
1.481





1Least-squares geometric means for ln-transformed data.


2Ratio calculated as the 10 mg least-squares mean divided by the Zometa least-squares mean. None of the comparisons was detected as statistically significant by ANOVA (α = 0.05).


3Estimated intra-subject coefficient of variation. CV % = 100 * SQRT(eMSE− 1), where MSE is the mean square error term from the ANOVA.


4Confidence interval on the ratio.






Comparison between 20 mg tablets and Zometa® injection 1 mg
A summary of the statistical comparisons of zoledronic acid urinary excretion following administration of a single 20 mg tablet dose and a 1 mg injection to 12 fasted, postmenopausal females is presented below in Table 17.










TABLE 17







Excretion
Least-Squares

90% Confidence


Interval
Means (mg)1

Interval4













(hrs)
20 mg
Zometa
Ratio2
CV %3
Lower
Upper





0-12
0.378
0.465
0.813
—
0.495
1.132


0-24
0.411
0.499
0.824
—
0.501
1.146


0-36
0.431
0.521
0.827
—
0.504
1.151


0-48
0.446
0.538
0.830
—
0.507
1.153







Ln-Transformed Results:













0-12
0.349
0.408
0.856
50.8
0.604
1.212


0-24
0.378
0.439
0.861
50.9
0.608
1.220


0-36
0.395
0.458
0.863
51.2
0.608
1.225


0-48
0.408
0.473
0.865
51.6
0.608
1.230





1Least-squares geometric means for ln-transformed data.


2Ratio calculated as the 20 mg least-squares mean divided by the Zometa least-squares mean. None of the comparisons was detected as statistically significant by ANOVA (α = 0.05).


3Estimated intra-subject coefficient of variation, CV % = 100 * SQRT(eMSE− 1), where MSE is the mean square error term from the ANOVA.


4Confidence interval on the ratio.






Comparison between 20 mg and 10 mg tablets
A summary of the statistical comparisons of zoledronic acid urinary excretion following administration of single 10 mg and 20 mg tablet doses to 12 fasted, postmenopausal females is presented in Table 18.










TABLE 18







Excretion
Least-Squares

90% Confidence


Interval
Means (mg)1

Interval4













(hrs)
20 mg
10 mg
Ratio2
CV %3
Lower
Upper





0-12
0.378
0.459
0.824
—
0.512
1.136


0-24
0.411
0.492
0.837
—
0.520
1.153


0-36
0.431
0.511
0.843
—
0.524
1.162


0-48
0.446
0.525
0.851
—
0.530
1.171







Ln-Transformed Results:













0-12
0.349
0.429
0.813
50.8
0.581
1.139


0-24
0.378
0.462
0.819
50.9
0.584
1.147


0-36
0.395
0.480
0.822
51.2
0.586
1.154


0-48
0.408
0.492
0.831
51.6
0.591
1.169





1Least-squares geometric means for ln-transformed data.


2Ratio calculated as the 20 mg least-squares mean divided by the 10 mg least-squares mean. None of the comparisons was detected as statistically significant by ANOVA (α = 0.05).


3Estimated intra-subject coefficient of variation, CV % = 100 * SQRT(eMSE− 1), where MSE is the mean square error term from the ANOVA.


4Confidence interval on the ratio.






Example 18
Bioavailability Study of Oral Dosage Forms of Alendronate
This study was an open label, 4 treatments, 4 periods, randomized crossover study with at least a 7 day washout between each dose. The objective of this study was to determine the pharmacokinetics and bioavailability of dosage forms of alendronate sodium of the present invention following administration of single doses to postmenopausal women under fed and fasted conditions to determine the appropriate dose for osteoporosis use, and the extent to which such dosage forms overcome the morning dosing rituals associated with Fosamax® tablets marketed by Merck & Co., Inc.
A total of 17 subjects were enrolled and were dosed on at least 1 occasion and 16 subjects completed the study and received at least three treatments. The treatments administered in this study were as follows:

    
    
        Trt A Fosamax® 35 mg tablet dosed according to package insert (after an overnight fast, subject remained upright for 4 hours after dosing)
        Trt B 6 mg tablet dosed according to Fosamax® dosing regimen (after an overnight fast, subject remained upright for 4 hours after dosing)
        Trt C 6 mg tablet dosed at 10.30 PM following a 6 PM meal (fasting from 6.30 PM until breakfast; subject laid down for at least 2 hours after dosing)
        Trt D 6 mg tablet dosed in the AM with the standard FDA high fat breakfast (subject remained upright for 4 hours after dosing)
    
    


Alendronate was measured in urine samples by a validated HPLC with fluorescence detection method. The limit of quantitation of the alendronate urinary assay was 2 ng/mL (assay range 2-500 ng/nL). Urine samples were collected prior to dosing, and 0-12, 12-24, 24-36 and 36-48 hours post-dosing.
Based on the definitive data analysis, the administration of 6 mg dosed PM after a 4 hr fast (Trt C) or dosed AM, after a 10 hr fast (Trt B) resulted in a 15.4 and 11.8 fold increase respectively in the bioavailability of alendronate compared to the reference tablet, 35 mg Fosamax® (Trt A). The administration of 6 mg dosed AM, fed (Trt D) resulted in a 2.8 fold increase in the bioavailability of alendronate compared to the reference tablet, 35 mg Fosamax® (Trt A). The highest relative bioavailability of alendronate compared to the administration of 6 mg dosed AM, after a 10 hr fast (Trt B) was Trt C (dosed PM, after a 4 hr fast) 127±104%, Trt D (dosed AM, fed) 20±35%, and then Trt A (Fosamax® dosed AM, after a 10 hr fast) 10±5%.
Based on previous data, an enhancer-containing tablet containing 5.65 mg alendronate is equivalent to a 35 mg Fosamax® tablet which, for purposes of this study, was rounded to 6 mg. The objective of this study was to compare the enhancer-containing alendronate tablet to Fosamax® in a single dose, four-way crossover bioavailability study in up to 16 postmenopausal females. There was at least a 7 day washout between each treatment period.
The method used was a HPLC with fluorescence detection in accordance with the test method. The method is based on the co-precipitation of the alendronate with calcium phosphates. The primary amino group of the molecule is then derivatized with 2,3-naphthalene dicarboxyaldehyde and (NDA)-N-acetyl-D-penicillamine (NAP) to form the fluorescent derivative. Gradient HPLC is then performed on the derivatized molecule and detection is at λ's Excitation: 420 nm, Emission: 490 nm. The limit of quantitation of the alendronate urinary assay was 2 ng/mL (assay range 2-500 ng/mL).
The pharmacokinetic parameters were calculated using WinNonlinTM, Version 4.0.1 (Pharsight Corporation, USA). The following parameters were derived from the urine concentration data for alendronate using non-compartmental methods:

    
    
        The cumulative amount excreted at each time point (Aet) and the total amount excreted (AeT).
        The excretion rate at each time point (Aet/t), the overall excretion rate (AeT/T), the maximum excretion rate observed (max rate) and the last measurable rate (rate last).
        Relative bioavailability (F %) of test treatments compared to the reference treatment was calculated on an individual subject basis (the dose adjusted amount of alendronate excreted in the test by each individual subject divided by the dose adjusted amount of alendronate excreted in the reference by the same subject),
    
    






  =
  
    
      
        Dose
        ⁢
        
          
        
        ⁢
        adjusted
        ⁢
        
          
        
        ⁢
        cumulative
        ⁢
        
          
        
        ⁢
        amount
        ⁢
        
          
            
          
          ⁢
          
            
          
        
        ⁢
        excreted
        ⁢
        
          
        
        ⁢
        
          (
          test
          )
        
      
      
        Dose
        ⁢
        
          
        
        ⁢
        adjusted
        ⁢
        
          
        
        ⁢
        cumulative
        ⁢
        
          
            
          
          ⁢
          
            
          
        
        ⁢
        amount
        ⁢
        
          
        
        ⁢
        
          excreted
          ⁢
          
            
              
            
            ⁢
            
              
            
          
          (
          ref
          )
        
      
    
    ×
    100
    ⁢
    %
  




Relative bioavailability was calculated using Treatment A (Fosamax® 35 mg dosed AM, after 10 hr fast) or Treatment B (6 mg dosed AM, after a 10 hr fast) as the reference treatment. As Subject 08 did not receive an administration of the reference (Treatment A), the mean cumulative amount excreted for the Treatment A population was used as the reference value to calculate the relative bioavailability for this individual. The mean of these calculated values are presented as the mean relative bioavailability.
Before a formal analysis, the pharmacokinetic data was subjected to a data review. This included checks for missing data and outliers. Subject number 12 did not complete the study because she voluntarily withdrew consent and was replaced by Subject number 17; consequently Subject number 12 was not included in the pharmacokinetic analysis. Subject 8 was not dosed during Treatment Period Two (Treatment A) but was included in the pharmacokinetic analysis and the mean cumulative amount excreted for the Treatment A population was used as the reference value to calculate the relative bioavailability for this individual.
A total of 17 female subjects were enrolled in this study and dosed at least once during the course of the study. Fifteen subjects completed the study and received all 4 treatments. One subject (Subject 12) withdrew consent for the study after dosing in Treatment Period One (Treatment A) and one subject (Subject 8) was not dosed during Treatment Period Two (Treatment A) due to a family emergency but was granted permission from the Sponsor to come back and finish the other periods of the study. One volunteer, Subject 6, did not absorb any appreciable amount of alendronate when she took the Fosamax® tablet. She was classified as a non-responder, because her lack of ability to absorb alendronate from a Fosamax® tablet would not allow her to be treated as a patient. It should be noted that when she received the enhanced tablet dosed in the same manner, she absorbed a normal amount of alendronate. Therefore, the enhanced tablet of the present invention may be appropriate for treating such non-responders.
The descriptive statistics were calculated based on the complete dataset and the dataset with Subject S06 (non-responder on Fosamax®) omitted. The following results are based on the definitive dataset, i.e Subject S06 (non-responder on the reference treatment) omitted from the descriptive statistics.
The rank order of bioavailability of alendronate from enhancer-containing alendronate tablet formulations compared to the reference tablet, Fosamax® (Trt A), are as follows: Trt C (dosed PM, after a 4 hr fast) 1536±1554%, Trt B (dosed AM, after a 10 hr fast) 1180±536%, and then Trt D (dosed AM, fed) 283±559%.
The highest relative bioavailability of alendronate compared to enhancer-containing alendronate tablet formulations dosed AM, after a 10 hr fast (Trt B) was Trt C (dosed PM, after a 4 hr fast) 127±104%, Trt D (dosed AM, fed) 20±35%, and then Trt A (Fosamax® dosed AM, after a 10 hr fast) 10±5%.
The highest total cumulative amount of alendronate excreted in the urine following administration was Trt C (dosed PM, after a 4 hr fast) 220±163 μg, Trt B (dosed AM, after a 10 hr fast) 203±87 μg, and then Trt D (dosed AM, fed) 33±54 μg, compared to the reference tablet, Fosamax®, 113±55 μg.
The fastest overall alendronate excretion rate determined following administration was Trt C (dosed PM, after a 4 hr fast) 5.2±3.9 μg/hr, Trt B (dosed AM, after a 10 hr fast) 4.8±2.1 μg/hr, and then Trt D (dosed AM, fed) 0.8±1.3 μg/hr compared to the reference tablet, Fosamax®, 2.7±1.3 μg/hr.
The overall percent of alendronate recovered from each of the administrations ranged was highest following administration of Trt C (dosed PM, after a 4 hr fast) 3.7±2.7%, Trt B (dosed AM, after a 10 hr fast) 3.4±1.5%, and then Trt D (dosed AM, fed) 0.6±0.9%, compared to the reference tablet, Fosamax®, 0.3±0.2%.
These results demonstrate not only the superior bioavailability of the alendronate tablet formulations of the present invention as compared with existing dosage forms of alendronate, but also a greater flexibility in the conditions under which administration of alendronate can occur without loss of bioavailability. Dosing regimens for traditional bisphosphonate formulations require: (1) morning administration; (2) in a fasted state; and (3) the avoidance of all food, beverages and other medications for up to 2 hours after administration. By contrast, the enhancer-containing alendronate tablet formulations of the present invention allow administration not only in accordance with the dosing regimen of traditional bisphosphonate formulations, but also at times of day other than the morning, after less than overnight fasting times, and without regard to any subsequent delay in the consumption of food and/or beverages. The enhancer-containing alendronate tablet formulations of the present invention also provide bioavailability levels equivalent to substantially higher doses of alendronate in existing dosage forms. This enhancement in bioavailability exhibited by the dosage forms of the present invention permits the use of lower doses of bisphosphonates in achieving equivalent bioavailability, or equivalent doses in achieving greater bioavailability.
The compositions and dosage forms of the present invention also include the use of enhancers other than the medium chain fatty acids and medium chain fatty acid derivatives described above. Absorption enhancers such as fatty acids other than medium chain fatty acids; ionic, non-ionic and lipophilic surfactants; fatty alcohols; bile salts and bile acids; micelles; chelators and the like may be used to increase the bioavailability and permit dosing at times other than in the morning upon arising from sleep or within two hours of consuming food, beverages (other than water), calcium supplements and/or medications.
Nonionic surfactants considered within the scope of the invention include alkylglucosides; alkylmaltosides; alkylthioglucosides; lauryl macrogolglycerides; polyoxyalkylene ethers; polyoxyalkylene alkyl ethers; polyoxyalkylene alkylphenols; polyoxyalkylene alkyl phenol fatty acid esters; polyethylene glycol glycerol fatty acid esters; polyglycerol fatty acid esters; polyoxyalkylene sorbitan fatty acid esters; sorbitan fatty acid esters; hydrophilic transesterification products of a polyol with at least one member of the group consisting of glycerides, vegetable oils, hydrogenated vegetable oils, fatty acids, and sterols; polyoxyethylene sterols, derivatives, and analogues thereof; polyoxyethylated vitamins and derivatives thereof; polyoxyethylene-polyoxypropylene block copolymers, PEG-10 laurate, PEG-12 laurate, PEG-20 laurate, PEG-32 laurate, PEG-32 dilaurate, PEG-12 oleate, PEG-15 oleate, PEG-20 oleate, PEG-20 dioleate, PEG-32 oleate, PEG-200 oleate, PEG-400 oleate, PEG-15 stearate, PEG-32 distearate, PEG-40 stearate, PEG-100 stearate, PEG-20 dilaurate, PEG-25 glyceryl trioleate, PEG-32 dioleate, PEG-20 glyceryl laurate, PEG-30 glyceryl laurate, PEG-20 glyceryl stearate, PEG-20 glyceryl oleate, PEG-30 glyceryl oleate, PEG-30 glyceryl laurate, PEG-40 glyceryl laurate, PEG-40 palm kernel oil, PEG-50 hydrogenated castor oil, PEG-40 castor oil, PEG-35 castor oil, PEG-60 castor oil, PEG-40 hydrogenated castor oil, PEG-60 hydrogenated castor oil, PEG-60 corn oil, PEG-6 caprate/caprylate glycerides, PEG-8 caprate/caprylate glycerides, polyglyceryl-10 laurate, PEG-30 cholesterol, PEG-25 phyto sterol, PEG-30 soya sterol, PEG-20 trioleate, PEG-40 sorbitan oleate, PEG-80 sorbitan laurate, polysorbates including polysorbate 20, polysorbate 40, polysorbate 60, polysorbate 65, polysorbate 80, polysorbate 85, POE-9 lauryl ether, POE-23 lauryl ether, POE-10 oleyl ether, POE-20 oleyl ether, POE-20 stearyl ether, tocopheryl PEG-100 succinate, PEG-24 cholesterol, polyglyceryl-10 oleate, sucrose monostearate, sucrose monolaurate, sucrose monopalmitate, PEG 10-100 nonyl phenol series, PEG 15-100 octyl phenol series, and poloxamers.
Ionic surfactants considered within the scope of the invention include alkylammonium salts; fusidic acid salts; fatty acid derivatives of amino acids, oligopeptides, and polypeptides; glyceride derivatives of amino acids, oligopeptides, and polypeptides; lecithins and hydrogenated lecithins; lysolecithins and hydrogenated lysolecithins; phospholipids and derivatives thereof, lysophospholipids and derivatives thereof; camitine fatty acid ester salts; salts of alkylsulfates; fatty acid salts; sodium docusate; acyl lactylates; mono- and di-acetylated tartaric acid esters of mono- and di-glycerides; succinylated mono- and di-glycerides; citric acid esters of mono- and di-glycerides; sodium laurylsulfate; and quaternary ammonium compounds.
Lipophilic surfactants considered within the scope of the invention include fatty alcohols; glycerol fatty acid esters; acetylated glycerol fatty acid esters; lower alcohol fatty acids esters; propylene glycol fatty acid esters; sorbitan fatty acid esters; polyethylene glycol sorbitan fatty acid esters; sterols and sterol derivatives; polyoxyethylated sterols and sterol derivatives; polyethylene glycol alkyl ethers; sugar esters; sugar ethers; lactic acid derivatives of mono- and di-glycerides; hydrophobic transesterification products of a polyol with at least one member of the group consisting of glycerides, vegetable oils, hydrogenated vegetable oils, fatty acids and sterols; oil-soluble vitamins/vitamin derivatives; and mixtures thereof. Within this group, preferred lipophilic surfactants include glycerol fatty acid esters, propylene glycol fatty acid esters, and mixtures thereof, or are hydrophobic transesterification products of a polyol with at least one member of the group consisting of vegetable oils, hydrogenated vegetable oils, and triglycerides.
Bile salts and acids considered within the scope of the invention include dihydroxy bile salts such as sodium deoxycholate, trihydroxy bile salts such as sodium cholate, cholic acid, deoxycholic acid, lithocholic acid, chenodeoxycholic acid (also referred to as “chenodiol” or “chenic acid”), ursodeoxycholic acid, taurocholic acid, taurodeoxycholic acid, taurolithocholic acid, taurochenodeoxycholic acid, tauroursodeoxycholic acid, glycocholic acid, glycodeoxycholic acid, glycolithocholic acid, glycochenodeoxycholic acid, and glycoursodeoxycholic acid.
Solubilizers considered within the scope of the invention include alcohols and polyols such as ethanol, isopropanol, butanol, benzyl alcohol, ethylene glycol, propylene glycol, butanediols and isomers thereof, glycerol, pentaerythritol, sorbitol, mannitol, transcutol, dimethyl isosorbide, polyethylene glycol, polypropylene glycol, polyvinylalcohol, hydroxypropyl methylcellulose and other cellulose derivatives, mono-, di- and trigycerides of medium chain fatty acids and derivatives thereof; glycerides cyclodextrins and cyclodextrin derivatives; ethers of polyethylene glycols having an average molecular weight of about 200 to about 6000, such as tetrahydrofurfuryl alcohol PEG ether or methoxy PEG; amides and other nitrogen-containing compounds such as 2-pyrrolidone, 2-piperidone, ε-caprolactam, N-alkylpyrrolidone, N-hydroxyalkylpyrrolidone, N-alkylpiperidone, N-alkylcaprolactam, dimethylacetamide and polyvinylpyrrolidone; esters such as ethyl propionate, tributylcitrate, acetyl triethylcitrate, acetyl tributyl citrate, triethylcitrate, ethyl oleate, ethyl caprylate, ethyl butyrate, triacetin, propylene glycol monoacetate, propylene glycol diacetate, .epsilon.-caprolactone and isomers thereof, .delta.-valerolactone and isomers thereof, .beta.-butyrolactone and isomers thereof; and other solubilizers known in the art, such as dimethyl acetamide, dimethyl isosorbide, N-methyl pyrrolidones, monooctanoin, diethylene glycol monoethyl ether, and water.
Still other suitable surfactants will be apparent to those skilled in the art, and/or are described in the pertinent texts and literature.
The present invention is not to be limited in scope by the specific embodiments described herein. Indeed, various modifications of the invention in addition to those described herein will become apparent to those skilled in the art from the foregoing description and accompanying figures. Such modifications are intended to fall within the scope of the appended claims.

## Claims

1. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition which is effective in delivering a therapeutically effective amount of a bisphosphonate and an enhancer to an intestine, said composition comprising a bisphosphonate and an enhancer wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature.

2. The method of claim 1, wherein the medical condition is osteoporosis.

3. The method of claim 1, wherein the medical condition is metastatic bone cancer.

4. The method of claim 1, wherein the medical condition is rheumatoid arthritis.

5. The method of claim 1, wherein the medical condition is a bone fracture.

6. The method of claim 1, wherein the administration step occurs within thirty minutes prior to the patient consuming food, medications, or beverages other than water.

7. The method of claim 1, wherein the administration step occurs at a time of day other than the morning.

8. The method of claim 1, wherein the administration step occurs in the evening.

9. The method of claim 1, wherein the administration occurs within 30 minutes prior to the patient lying down.

10. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition which is effective in delivering therapeutically effective amounts of a bisphosphonate and an enhancer, wherein the enhancer: (1) comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms; (2) is the only enhancer present in the composition; and (3) enhances intestinal delivery of the bisphosphonate to the underlying circulation.

11. The method of claim 10, wherein the administration step occurs within thirty minutes prior to the patient consuming food, medications, or beverages other than water.

12. The method of claim 10, wherein the administration step occurs at a time of day other than the morning.

13. The method of claim 10, wherein the administration occurs within 30 minutes prior to the patient lying down.

14. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition comprising a bisphosphonate and an enhancer, wherein the enhancer enhances intestinal delivery of the bisphosphonate to the underlying circulation, wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature, and wherein the composition delivers a therapeutically effective amount of the bisphosphonate when administered to a patient within thirty minutes prior to the patient consuming food, medications, or beverages other than water.

15. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition comprising a bisphosphonate and an enhancer, wherein the enhancer enhances intestinal delivery of the bisphosphonate to the underlying circulation, wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature, and wherein the composition delivers a therapeutically effective amount of the bisphosphonate when administered to a patient at a time of day other than the morning.

16. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition comprising a bisphosphonate and an enhancer, wherein the enhancer enhances intestinal delivery of the bisphosphonate to the underlying circulation, wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature, and wherein the composition delivers a therapeutically effective amount of the bisphosphonate when administered to a patient within 30 minutes prior to the patient lying down.

17. A method for treating or delaying the onset of a medical condition responsive to bisphosphonates comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition comprising a bisphosphonate and an enhancer, wherein the enhancer enhances intestinal delivery of the bisphosphonate to the underlying circulation, wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature, and wherein the composition delivers a therapeutically effective amount of the bisphosphonate when administered to a patient within six hours after consuming food, medications, or beverages other than water.

18. A method for treating or delaying the onset of osteoporosis comprising the step of administering orally to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition which is effective in delivering a therapeutically effective amount of a drug and an enhancer-to an intestine, said composition comprising a bisphosphonate and an enhancer wherein the enhancer comprises a salt of a medium chain fatty acid having a carbon chain length of from 8 to 12 carbon atoms and is solid at room temperature, wherein the administration step occurs weekly.

19. The method of claim 1, wherein about 1 mg to about 20 mg bisphosphonate is orally administered.

20. The method of claim 1, wherein about 2 mg to about 7 mg bisphosphonate is orally administered.

21. The method of claim 17, wherein about 1 mg to about 100 mg bisphosphonate is orally administered.

22. The method of claim 17, wherein about 1 mg to about 50 mg bisphosphonate is orally administered.

23. The method of claim 1, wherein the enhancer is a sodium salt of a medium chain fatty acid.

24. The method of claim 23, wherein the enhancer is selected from the group consisting of sodium caprylate, sodium caprate and sodium laurate.

25. The method of claim 24, wherein the absorption enhancer is sodium caprate.

26. The method of claim 10, wherein the enhancer is a sodium salt of a medium chain fatty acid.

27. The method of claim 26, wherein the enhancer is selected from the group consisting of sodium caprylate, sodium caprate and sodium laurate.

28. The method of claim 27, wherein the absorption enhancer is sodium caprate.

29. The method of claim 18, wherein the enhancer is a sodium salt of a medium chain fatty acid.

30. The method of claim 29, wherein the enhancer is selected from the group consisting of sodium caprylate, sodium caprate and sodium laurate.

31. The method of claim 30, wherein the absorption enhancer is sodium caprate.