PENTAMIDINE SOLUTIONS

Abstract: The invention provides a stabilised aqueous solution of a water soluble pentamidine salt comprising an acetate buffer, and having a total acetate concentration of 0.01-­ 0.06M, and a pH of 4.0-5.0 at room temperature.

Description: This invention relates to a stabilised aqueous solution of a pentamidine salt, for example the isethionate, which is particularly suitable for use in a nebuliser, and a process for its production. Pentamidine [1,5-bis(4-amidinophenoxy)pentane] is a trypanocidal compound which is particularly active against Leishmaniasis. It unfortunately suffers from a large number of side-effects and has now been substantially displaced by other drugs. However, it is also active against pneumocystis carinii pneumonia (PCP) - one of the commonest, lethal, opportunistic infections suffered by AIDS patents - having utility as both a curative and prophylactic agent. Due to the instability of aqueous pentamidine solutions, the material is normally supplied in the form of its isethionate (2-hydroxyethanesulphonate), as a powdered material to be reconstituted with water immediately prior to administration by injection or infusion. This means that the patient still suffers from the side effects. Although these are more acceptable in the treatment of a potentially lethal infection, it is nevertheless desirable to overcome them if at all possible. With this in mind it is clearly advantageous to administer the drug directly to the site of infection, i.e. to the lungs. Therefore pentamidine isethionate is now used in solution in nebulisers for administration by inhalation. Not only does this result in direct treatment of the infected site, but also absorption from the lungs is relatively limited, so that the side effects are substantially reduced. Because of the abovementioned instability in solution it is still necessary to supply the material in the form of an ampouled solid, which is dissolved in water before use. This is a relatively troublesome process and involves the use of needles and syringes (clearly undesirable for many AIDS patients). It would therefore be highly desirable to produce pentamidine in a stabilised solution form, which can be placed directly into a nebuliser when required for use. It has been found that pentamidine is more stable in acidic than in alkaline aqueous media. However the production of usable solutions appeared to be impossible as heretofore pentamidine has been found to be insoluble in, or precipitated or salted out by, buffer solutions which are also pharmaceutically and pharmacologically acceptable at concentrations normally used. This was not unexpected in view of the known difficulty of solubilising pentamidine and the need to use unusual anions such as isethionate when a water soluble form of pentamidine was required. We have, however, found that the use of a dilute acetate buffer does allow the formation of a stabilised solution of water soluble pentamidine salts, such as the mesylate (methanesulphonate), gluconate, lactate or isethionate. The present invention accordingly provides an aqueous solution of a water soluble pentamidine salt, e.g. the mesylate, gluconate, lactate or, preferably, isethionate comprising an acetate buffer, and having a total acetate concentration of 0.01-0.06M, preferably 0.02M, and a pH of 4.0-5.0 at room temperature, the solution preferably being sterile. The preferred pH is about 4.6. The solution can be made up by mixing preformed solutions or by direct dissolution of the solid in the buffer and can be sterilised by, for example, filtration through a bacteria-retaining filter. The buffer is of conventional form, comprising an aqueous solution of acetic acid and a pharmaceutically acceptable acetate salt, e.g. an alkali metal, such as sodium or potassium, acetate or ammonium acetate in the correct proportions for the establishment of the required pH. Sodium acetate is preferred. Typically the buffer has an initial pH of 4.6 to 5.0 and is 0.1 M in acetate and when the solution is made up this is diluted by a factor of 2 to 10, preferably about 5, to give the final acetate concentration. The water soluble pentamidine salts used in the invention preferably have a solubility greater than 40mg/ml in water at ambient temperature. The maximum pentamidine salt, e.g. isethionate, concentration achievable in compositions according to the invention varies depending upon the acetate concentration used. In 0.04M acetate, the maximum concentration of pentamidine salt, e.g. isethionate, is 6% w/v, whereas when the acetate concentration is reduced to 0.02M, then up to a 10% w/v loading of pentamidine salt, e.g. isethionate, (equivalent to its saturation solubility in water) can be reached. The pentamidine salt concentration will generally be from 1% w/v to 10% w/v and preferably from 1.2% w/v to 6% w/v. As the solution is intended for pulmonary administration it is desirable to make it isotonic in order to avoid bronchoconstriction. It is also believed that isotonicity limits droplet size alteration during nebulisation and this would clearly be of assistance in controlling the administration. Normal tonicity adjusting agents such as sodium chloride are unsuitable, just as most ionic species cannot be used in the stabilising buffer. We have however found that non-ionic tonicity adjusting agents, such as sugars and sugar alcohols can be used and it is particularly preferred to use dextrose, glucose, sorbitol, mannitol or xylitol. The invention also provides the application of an aqueous solution according to the invention to the preparation of an aerosol useful by inhalation for the treatment of Pneumocystis carinii pneumoniae. In prophylactic treatment typical dosages vary from 30mg to 600mg of pentamidine isethionate and the frequency of administration from monthly to thrice weekly (although on occasion only a single dose is given). The preferred dose is 300mg of pentamidine isethionate every four weeks or 150mg every fortnight. In the treatment of an existing infection typical dosages vary from 300mg to 1000mg of pentamidine isethionate and the frequency of administration from thrice weekly to daily, typically for up to three weeks or until the infection is successfully treated. The preferred dosage is 600mg daily. If a water soluble salt other than the isethionate is used, the amount administered should be such as to provide an equivalent amount of the pentamidine base. It will be understood that the foregoing doses are typical or preferred. As the administration of pentamidine by inhalation is known, suitable doses for individual patients will be known to, or readily determinable by, those skilled in the art. The invention also provides an aqueous solution of a water soluble pentamidine salt, e.g. the mesylate, gluconate, lactate or, preferably, isethionate comprising an acetate buffer, and having a total acetate concentration of 0.01-0.06M, preferably 0.02M, and a pH of 4.0-5.0, preferably 4.6, at room temperature, and preferably being sterile, for use as a medicament in the treatment of pneumocystis carinii pneumonia as hereinbefore described. The following Examples illustrate the invention. In storage stability tests the relative humidity, unless otherwise specified, is ambient relative humidity. EXAMPLE 1 A solution was made up from:- This was filled through a 0.45µm filter into sterile ampoules and had an initial pH of 4.57 and an initial measured pentamidine isethionate content of 55.3 mg/ml. The following stability data were obtained: EXAMPLE 2 In a similar manner to that of Example 1, a solution was made up from:- This was sterilised by being passed through a 0.22µm filter and filled into sterile vials. EXAMPLE 3 A solution was made up consisting of:- The pH of this solution was 4.60. 5 ml samples of this solution [nominal content of pentamidine isethionate of 300mg (58mg/ml - measured initial content 58.0 mg/ml)] were stored in low density polyethylene bottles and glass vials. The following stability data were obtained: EXAMPLE 4 A solution was made up consisting of:- The solution pH was again 4.60. 5ml samples of this solution [nominal content of pentamidine isethionate of 600mg (12 mg/ml - measured initial content 11.8mg/ml)] were placed in low density polyethylene bottles and glass vials. The following stability data were obtained: COMPARISON EXAMPLE 1 A mixture was made up consisting of:- This resulted in an immediate precipitate. The pH of the mixture was 5.86 COMPARISON EXAMPLE 2 A mixture was made up consisting of:- A heavy precipitate formed and it was impossible to measure the pH of the mixture. COMPARISON EXAMPLE 3 A mixture was made up consisting of:- This was compared with a solution according to the invention, consisting of:- (which had an initial pH of 4.31) in an accelerated stability test. After 84 hours at 60°C the comparison solution showed 2.1% decomposition and a pH of 6.3, whereas the solution according to the invention showed only 0.2% decomposition and a pH of 4.17.

Claims: Claims for the following Contracting States : AT, BE, CH, LI, DE, DK, FR, GB, IT, LU, NL, SE An aqueous solution of a water soluble pentamidine salt comprising an acetate buffer, and having a total acetate concentration of 0.01-0.06M, and a pH of 4.0-5.0 at room temperature. A solution according to Claim 1 in which the water soluble pentamidine salt is the mesylate, gluconate, lactate or isethionate. A solution according to Claim 1 in which the water soluble pentamidine salt is the isethionate. A solution according to any one of the preceding claims in which the total acetate concentration is 0.02M. A solution according to any one of the preceding claims in which the pH is about 4.6. A solution according to any one of the preceding claims which is sterile. A solution according to any one of the preceding claims in which the buffer comprises an aqueous solution of acetic acid and an alkali metal acetate or ammonium acetate. A solution according to any one of the preceding claims in which the buffer comprises an aqueous solution of acetic acid and sodium acetate. A solution according to any one of the preceding claims in which the pentamidine salt concentration is from 1% w/v to 10% w/v. A solution according to any one of the preceding claims in which the pentamidine salt concentration is from 1.2% w/v to 6% w/v. A solution according to any one of the preceding claims which is isotonic. A solution according to claim 11 which comprises, as a non-ionic tonicity adjusting agent, a sugar or sugar alcohol. A solution according to Claim 12 in which the sugar or sugar alcohol is dextrose, glucose; sorbitol, mannitol or xylitol. Application of an aqueous solution according to any one of claims 1-13 to the preparation of an aerosol composition useful by inhalation for the treatment of a human suffering from, or susceptible to, Pneumocystis carinii pneumoniae. Claims for the following Contracting States : GR, ES A process for the preparation of an aqueous solution of a water soluble pentamidine salt comprising an acetate buffer, and having a total acetate concentration of 0.01-0.06M, and a pH of 4.0-5.0 at room temperature which process comprises formulating as an aqueous solution the pentamidine salt, and an acetate buffer or, as the components of the buffer, acetic acid and an acetate. A process according to Claim 1 in which the water soluble pentamidine salt is the mesylate, gluconate, lactate or isethionate. A process according to Claim 1 in which the water soluble pentamidine salt is the isethionate. A process according to any one of the preceding claims in which the total acetate concentration in the aqueous solution is 0.02M. A process according to any one of the preceding claims in which the pH of the aqueous solution is about 4.6. A process according to any one of the preceding claims in which the aqueous solution is sterile. A process according to any one of the preceding claims in which the buffer comprises an aqueous solution of acetic acid and an alkali metal acetate or ammonium acetate. A process according to any one of the preceding claims in which the buffer comprises an aqueous solution of acetic acid and sodium acetate. A process according to any one of the preceding claims in which the pentamidine salt concentration is from 1% w/v to 10% w/v. A process according to any one of the preceding claims in which the pentamidine salt concentration is from 1.2% w/v to 6% w/v. A process according to any one of the preceding claims in which the aqueous solution is isotonic. A process according to claim 11 in which the aqueous solution comprises, as a non-ionic tonicity adjusting agent, a sugar or sugar alcohol. A process according to Claim 12 in which the sugar or sugar alcohol is dextrose, glucose, sorbitol, mannitol or xylitol. A process for the preparation of an aerosol comprising a water soluble pentamidine salt which comprises nebulising an aqueous solution of a water soluble pentamidine salt comprising an acetate buffer, and having a total acetate concentration of 0.01-0.06M and a pH of 4.0-5.0 at room temperature.

Inventors: LORD, JOHN DAVID
Applicants: RHONE-POULENC SANTE
Application year: 1990
Main classification: A61K31
IPC codes: A61K31, C07C43, C07C31, A61K9, A61P33, A61K47