IMPROVED METHOD TO ADMINISTER DRUGS BY IONTOPHORESIS

Abstract: A method for the improved transdermal delivery of ionic drugs by electrotransport is provided, wherein certain fatty acids are applied to the body surface which enhance the penetration of the drugs therethrough.

Description: IMPROVED METHOD TO ADMINISTER DRUGS BY IONTOPHORESIS Background of the Invention Iontophoresis is a method for introducing ionic substances into the body. The method utilizes direct elec¬ trical current to drive ionized substances, such as drugs, through the intact skin or other body surfaces . This has proven to be very useful in numerous medical applications . U.S. Patent Nos . 3,991,755 issued to Jack A. Vernon et al. and 4,141,359 issued to Stephen C. Jacobsen et al . disclose examples of iontophoretic devices and some applications of the devices. The iontophoretic process has been found to be useful in the- administration of lidocaine hydrochloride, lin, dexamethasone sodium phosphate and many other " drug ' s ." Perhaps the best known use of iontophoresis is that . of diagnosing cystic fibrosiε by using pilocarpine nitrate iontophoresis. The pilocarpine nitrate stimulates sweat production and the sweat is collected and analyzed for its chloride content to detect the presence of the disease. In iontophoretic devices, two electrodes are used. One electrode, called the active electrode, is the elec- -trode at which the ionic -substance- is driven into the -body. The other electrode, called the indifferent or ground electrode, serves to close the electrical circuit through the body. It will be appreciated by those skilled in the art that the active electrode must hold, contain, or other- wise have available to it a source of the ionic substance. Thus, the active electrode is generally-relatively complex compared to the indifferent electrode. As in the case of methods which attempt to accom¬ plish the passive diffusion of drugs across the skin, the stratum corneum presents the primary barrier to effective drug administration by iontophoresis. This is primarily due to the non-conductive lipids present in this layer, SUBSTITUTESHEET which present a barrier to ionized drugs. This is a parti¬ cularly serious problem when the transdermal delivery of the ionic form of highly ionized, fat-insoluble (hydro¬ philic) drugs is attempted. The use of chemical agents as "penetration enhan¬ cers" to improve both passive drug delivery and ionto¬ phoresis has been disclosed. Penetration enhancers can disrupt the lipid domain of the stratum corneum, thus lowering the resistance of the skin to ion flow. For example, R. M. Gale et al. (U.S. Patent No. 4,645,502) disclose a device for passive transdermal drug delivery which internally mixes an ionized drug with a penetration enhancer such as an aikyi-substituted sulfoxide, polyoxy- ethylene glycol esters of fatty acids, and n-methyl pyr- rolidone. Certain fatty acids have also been used as penetration enhancers for passive transdermal drug delivery. For example, G. M. Golden et al. ' , in J. Pharm. Sci. , 76 , 25 (1987) reported that, of a series of octa- decenoic acids, only cis-9- and cis-11-octadecenoic acid achieved significant enhancement of salicylic acid through porcine stratum corneum. In addition, B. J. Aungst, Pharm. Res . , • 5, 244 (1989) summarizes studies indicating that the "kinked structure (the kink due to the cis double bond)" of oleic acid creates gaps in the packed lipid structure of the normal stratum corneum, thus reducing diffusional resistance. For a review of the use of fatty acids as penetration enhancers in passive transdermal therapeutic systems, see K. A. "Walters, in Transdermal Drug Delivery, J. Hadgraft et al., eds. , Marcel Decker (1989). Theratech, Inc. (published European Patent Application No. 267,617) discloses "penetrating topical compositions" based on the use of a pharmaceutically active agent dissolved in, or admixed with, a binary mixture of oleic acid and ethanol. Up to 50% water can also be included in the compositions, e.g., when they are formulated as gels. SUBSTITUTESHEET However, a need exists for effective penetration enhancers for the iontophoretic delivery of ionic hydro¬ philic drugs. Summary of the Invention The present invention provides an improved method for transdermal delivery of an ionic, hydrophilic drug com¬ prising applying an effective penetration-enhancing amount of a fatty acid selected from the group consisting of oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof, ' to the body surface prior to, or preferably simultaneously with, elec¬ trotransport of the drug through said surface, preferably by iontophoresis. The body surface is preferably the intact skin or mucosal membranes of a mammal, but the term "body" also includes plants and the bodies of other animals. Most preferably, both the drug, or drugs, and the fatty acid or fatty acid mixture, are applied as an aqueous solution or dispersion, which can contain an organic co- solvent for the fatty acid. Preferred co-solvents include ethanol, propylene glycol, liquid polyethylene glycols, " acetone, tetr hydrofurfuryl alcohol, 1-pyrrolidone, 1- methyl-2-pyrrolidone, N,N-dimethylformamide and the like, with ethanol being most preferred. The aqueous solution of the fatty acid penetration enhancer and the ionic, hydrophilic drug can be directly contacted with the skin of the mammalian recipient, e.g., a human patient. Alternatively, the aqueous solution of the enhancer and the drug can be pre-gelled, or combined with a polar organic polymer to form an adhesive body. Gels useful for drug matrices for transdermal drug delivery are disclosed in R. M. Gale et al. (U.S. Patent No. 4,645,502) . Polar adhesive compositions useful as iontophoretic drug delivery reservoirs as disclosed in Spevak et al . (U.S. Patent No. 4,820,263) . SUBSTITUTE SHEET During iontophoresis, application of an electrical current to these "aqueous media" (solutions, gels or adhe- sives) will cause charged drugs to migrate through the skin of the recipient at a rate that is substantially increased over that observed in the absence of the present fatty acid enhancers. For example, a 0.5% solution of oleic acid in 67:33 ethanol water resulted in a greater than four-fold enhancement of the steady state delivery rate of oxymor- phone or hydromorphone hydrochloride through pig skin, in the model system described in detail hereinbelow. The present method also encompasses (a) applying the ririi tn the skin in combination with the fatty acid enhancer, prior to iontophoresis; and (b) applying the fatty acid iontophoretically to the skin, prior to ionto- phoresis of the drug, through the same area of the ski . Although the present invention is exemplified in terms of iontophoresis, it is expected that the present fatty acid and fatty acid salt enhancers will also improve the transdermal delivery or transport of drugs which is accomplished by other methods of electrotransport, and such methods are also within the scope of the present invention. The term "electrotransport" refers to methods for trans¬ dermal delivery of drugs, whether charged or uncharged, by means of an applied electromotive force to electrolyte- containing reservoir. The particular drug being delivered may be charged or uncharged, depending upon the particular method chosen. When the drug delivered is uncharged, it may be considered delivered by means of electro-osmosis techniques or other electrokinetic phenomenon such as -electrohydrokinesis , electro-convection or' electrically- induced osmosis. In general, these latter processes for the electrokinetic delivery of uncharged species into a tissue result from the migration of solvent, in which the SUBSTITUTESHEET uncharged species is dissolved, as a result of the applica¬ tion of electromotive force to the electrolyte reservoir. Of course, during the process, some transport of charged species will take place as well. Brief Description of the Drawings Figure 1 is a diagrammatic illustration showing an exemplary iontophoretic system. Figure 2 is a sectional diagrammatic view of a pair of electrodes applied to the body, illustrating the iontophoretic process. Figure 3 is a sectional -view of the iontophoretic diffusion cell according to a preferred embodiment of the invention. Detailed Description of the Invention Drugs The specific drugs used are not critical to the _ present method and as used herein, the term "drug" is to be construed in its broadest sense as a material which is intended to produce some beneficial effect on the organism to" which it is applied. -Preferably,- the- drug used in the present method is hydrophilic and ionizable in an aqueous solvent system. As used herein, a drug in its acid or basic form is considered to ' be hydrophilic, if the solubil¬ ity of the drug in mineral oil is less than about 100 μg/g. Most preferably, the drug is highly ionized in an aqueous solvent. A drug is considered to be "highly ionized" when the percent ionization of the drug in an aqueous drug reservoir is at least about 95%. This occurs when the pK of the drug differs from the pH of the reservoir by an absolute value of at least 1.3. The pKα of a drug is the pH of an aqueous solution in which 50% of the drug is in the ionized salt form and 50% is in the unionized base or SUBSTITUTESHEET acid form. Since physiological pH of the skin is in the range of approximately 5.5-7.2, the pKα for the most pre¬ ferred drugs according to this invention is lower than about 4.2 for acidic drugs and for basic drugs, higher than 8.5 Representative drugs meeting these criteria include, without limitation, acidic drugs such as the sodium or other salts of indo ethacin, acetazolamide, methazolamide, and acetylsalisylic acid, for example, and salts or acid salts of basic drugs such as naltrexone-HCl, naloxone-HCl, -nalbuphine-HCl, oxymorphone-HCl, hydromorphone-HCl, phenyl- ephrine-HCl, chlorphenitra ine-maleate, phenylpropanol- amine-HCl, clonidine- HCl, " dextro ethophan-HBr, atropine sulfate, fentanyl citrate, apomorphine sulfate, proprano- lol-HCl, lidocaine- HCl, tetracycline-HCl, oxytetracycline- -HCl, tetracaine-HCl, dibucaine-HCl, terbutaline sulfate, and bromphentramine maleate, for example. When the drug is in the form of an acid salt, such as the salt of a basic drug and a pharmaceutically acceptable acid, ' the drug ions are positively charged, and will generally be delivered from the anode. The concentration of the drugs in the aqueous media which are- employed as the iontophoretic -delivery reservoirs, can be varied widely, and will depend to some extent on the rate of delivery through the skin, and on the known effective plasma levels or target tissue levels . Therefore, the appropriate concentration can be preselected by comparing the enhanced rate of delivery attained by the present method, using model systems such as those exempli¬ fied hereinbelow, with known in vivo levels which can be attained by iontophoresis without the use of the fatty acid enhancers . Fatty Acid Penetration Enhancers The fatty acids useful as penetration enhancers in the present iontophoretic method are selected from the SUBSTITUTESHEET group consisting of oleic acid (cis-9-octadecenoic acid) , lauric acid (dodecanoic acid), capric acid (decanoic acid) and caprylic acid (octanoic acid) . These materials are commercially available, e.g., from Aldrich Chemical Co., Milwaukee, WI . Physiologically acceptable salts of these acids, such as alkali metal salts, can also be employed. However, such salts are not preferred for use in the present method. For example, when 1% of sodium oleate was added to the drug in an ethanol-water mixture, an about two-fold enhancement of drug delivery was obtained. The use of fatty acid salts can permit lower amounts of organic solvents to be used in the aqueous media. The total concentration of the fatty acid in the aqueous media which are employed as the iontophoretic delivery reservoirs can also be varied widely. For ' ' example, it is dependent on its solubility in the organic solvent-water mixture used to prepare the medium, given the need to maintain the salt of the hydrophilic 'drug in solu¬ tion, and recognizing that these fatty acids are essentialy water-insoluble. Preferred concentrations are about 0.05- 15 wt-%, most preferably about 0.1-10 wt-% of the aqueous medium, e.g., of an aqueous solution comprising about 10-85 vol-% ethanol, ethanol-propylene glycol, or other organic co-solvent. Iontophoretic Drug Delivery The present method can be adapted for use with any of the apparatuses employed for iontophoretic drug delivery. For exemplary purposes herein, an iontophoretic system is illustrated in diagrammatic form in Figure 1. The system includes current source 10 which is electrically coupled through leads 12 and 14 to electrodes 16 and 18, respectively. For purposes of illustration, electrode 16 is labeled the "active" electrode while electrode 18 is labeled the "indifferent electrode," although the positions SUBSTITUTESHEET may be reversed. It is also possible that in some embodi¬ ments of electrodes according to the invention that an electrode that is active when the current is flowing in one direction in the system will become an indifferent elec- trode when the current is flowing the opposite direction in the system. Both electrodes can be "active" electrodes, e.g., when delivery of the drug is by electro-osmosis. Leads 12 and 14 may be wires or they may be any other means for electrically coupling the current source 10 and the electrodes 16 and 18. Figure 2 shows a sectional view of a pair of electrodes 20 and 30, placed upon body 40 to illustrate the iontophoretic process. Electrode 20 comprises a reservoir element (22) which can hold a solution or a gel in direct or indirect contact with the body, or which- can. be composed of an adhesive material and a backing sheet (26) . A posi¬ tively charged ionic substance 24(-) is dissolved in the solution, or dispersed throughout the gel or- the adhesive layer, preferably in admixture with the penetration enhan- cer (25)(«). The positively charged ionic substance (24) in reservoir element 22 of electrode 20 is the drug which is to be -introduced -into the body. Electrodes 20 and 30 may be coupled to a current source, such as 10, through leads, such as 12 and 14 (not shown in Figure 2) . The current source 10 may also include a source of electrical pulses, which may be of a type suitable for either nerve or muscle stimulation. The polarity of the current produced by current source 10 may also be reversed by a polarity control (not shown) , so that either positively charged ionic substances or negatively charged ionic substances, or both, in alter¬ nation, can be delivered from electrode 20. For example, a negatively charged penetration agent could be delivered to the skin, followed by a positively charged ionic drug, and SUBSTITUTE SHEET these steps could be repeated, as desired, to maintain the enhanced delivery rate of the drug. See U.S. Patent No. 4,406,658. The leads 12 and 14 may be attached to elec¬ trodes 20 and 30 in any conventional manner. When a current is generated by a current source, such as 10, and applied to electrodes 20 and 30 in place upon body 40, a current will flow through body 40 in the direction shown at arrow 45. The current will cause positively charged ionic substance 24 to be driven out of electrode 20 into body 40. A wide variety of active electrodes have been disclosed in the prior art, which can be used for the co- delivery of the present penetration enhancers and the ionically charged drug, so long as they can be admi-xe ' d in the reservoir element 22. Inasmuch as the extent of ionized drug migration is a function of the current flow, the rate of iontophore¬ sis increases with a corresponding increase in current. Limitations as to the amount of current are based primarily on considerations of patient safety. Currents of from about 0.10 mA to about 2-5 mA can be used in the present method. Preferred current densities are about 10-500 Vernon (U.S. Patent No. 3,991,755) discloses several examples of active electrodes. In one example, the electrode comprises a stainless steel wire housed in a plastic sheath which is shaped to safely fit within the ear canal together with a liquid solution which can contain the ionized drug and could contain the present penetration enhancer. The liquid is poured into the ear canal so that it contacts the inner ear and the wire through an opening in the sheath. In another example, the electrode wire housed in a plastic sheath having an opening is placed in a wad of absorbent material which could hold the liquid con¬ taining the ionic drug and the penetration enhancer. SUBSTITUTESHEET U.S. Patent No. 4,141,359 also discloses several embodiments of an active electrode. All of the embodiments include a receptacle for holding either a conducting gel in which the ionic drug and a penetration enhancer can be dissolved, or for holding a sponge which is saturated with the conductive gel in which the ionic drug and the penetra¬ tion enhancer can be dissolved. The conducting gel drug/- enhancer solution communicates with the body tissue through a hole in the receptacle. The receptacle is held in con- tact with the skin by an adhesive pad surrounding the receptacle or a strap attached to the pad. In other embod¬ iments of the prior art, the hole in the receptacle is covered with a membrane and the ionic subtance is driven through the membrane by the electric current. An active electrode can be formed by a gauze pad soaked in the solution containing the ionic drug and the enhancer superimposed by several layers of paper towels moistened with tap water and a section of block tin or aluminum foil placed over the moistened towel with the tin or foil connected to the iontophoretic current generator by means of a wire and alligator clip is disclosed in Acetic Acid Iontophoresis for Calcium Deposits , by Joseph Kahn in Physical Therapy. Vol. 57, No. 6, June, 1977 (pp. 658-659) Spevak et al. (U.S. Patent No. 4,820,263) dis- closed an active electrode which consists essentially of an element composed of an adhesive material mixed with the ionic drug and the penetration enhancer and includes a means for electrically coupling the element to an electri¬ cal device. Preferably, the adhesive material is a non- ionic, polar material. Webster (U.S. Patent No. 4,383,529) and Ariura et al. (U.S. Patent No. 4,474,570) disclose active electrodes wherein the drug is contained in a hydro¬ philic polymer/gel. Although the present penetration enhancers are preferably co-delivered with the ionic drug, the present SUBSTITUTESHEET method also encompasses pretreating the skin with the enhancer. Pretreatment of the skin with an effective amount of the enhancer can be accomplished by (a) passive delivery of enhancer by application of the enhancer to the skin in a suitable carrier vehicle, e.g., as a salve or ointment; (b) passive delivery of an effective amount of the enhancer in combination with an adhesive layer which can first make contact with the skin, and which can, at the side distal from the skin, be in contact with the drug reservoir; and (c) iontophoretic delivery of the enhancer from an appropriate vehicle prior to the iontophoretic delivery of the drug to ' the 'same area of skin. The invention will be further described by 'refer¬ ence to the following detailed examples, wherein vertical ' glass diffusion cells were used. The flow-through diffu¬ sion cell (Figure 3) consisted of a donor compartment and a receptor compartment. This cell exposed 5 cm 2 of the skin to donor solution, which filled about 75% of the cell volume. A support for the skin exposed 3.26 cm 2 of the membrane to the receptor solution and was placed between the two compartments . Either pig skin or human cadaver skin was used; It was placed in the-cell dermal- side down. The donor compartment was then positioned over the skin and the cell assembly was clamped together. A volume of 7 ml of donor solution was used in each donor compartment. The receptor compartment contained a small mag¬ netic stirring bar which allowed the contents of the recep¬ tor compartment (about 8.5 ml) to be mixed as receptor solution continuously flowed through the cell as indicated. The receptor compartment was surrounded by a water jacket which was maintained at 37 " c by circulating warm water therethrough as indicated. The receptor solution com¬ pletely filled the receptor compartment. A silver/silver chloride cathode was placed in the receptor compartment. The silver wire of the electrode was SUBSTITUTESHEET threaded out via the inlet port and emerged through sili- cone tubing. A silver mesh anode was placed in the donor compartment. The silver mesh anode was suspended over the skin by threading the stem of the electrode through the donor cell cover. The anode and cathode wires were con¬ nected to one channel of the power source. A nine-cell flow-through drug delivery system was designed to screen drug candidates for iontophoresis. By selecting various system parameters, each of the nine cells could represent a unique experiment, but generally, each experiment was run in replicates of three or six cells. A multichannel peristaltic pump having multiple cassettes and variable pump speeds was fitted with a specially-made nine- port glass manifold. A nine-cell magnetic stirring console- was modified to hold the diffusion cells. Samples were collected using a fraction collector fitted with a nine- port gantry. A heated, circulating water bath maintained the diffusion cells at 37 * C. The power source provided nine channels of constant DC current which could be indi- vidually adjusted up to 2.0 milliamps (mA) of current. The flow of receptor solution could be followed through 'the system-. Receptor solution flowed from a -reser¬ voir into the pump manifold and through the nine ports, each of which fed into a length of silicone rubber pump tubing (1/16" ID x 1/32" wall). One length of tubing was placed in each pump cassette and receptor solution was pumped at a rate of 3 ml/hr through the inlet port of the receptor compartment of the diffusion cell. There, the receptor solution collected any drug which had been delivered iontophoretically into the receptor compartment. Each of the nine lengths of outlet tubing was held in position over a test tube by a gantry which was mounted to the fraction collector. Receptor solution from each cell was automatically collected in a separate tube for two-hour intervals for the duration of the 66-hour test. The SUBSTITUTESHEET samples were then analyzed for drug content by high- performance liquid chromatography (HPLC) . The iontophoretic drug delivery tests employed two types of skin, dermato ed pig skin and human skin. Pig skin was harvested at a thickness of approximately 0.6 mm using a Padgett dermatome. Human cadaver skin was har¬ vested from the abdominal region at a thickness of approxi¬ mately 0.3 mm. All skin was stored frozen. The receptor solution, 0.1 M NaCl (5.84 mg/ml), was prepared in deionized water (DI W) . Donor solutions were prepared with model drugs (©) at a concentration of 0.1 M in deionized water: oxymorphone hydrochloride was made up to 33.78 mg/ml, and hydromorphone hydrochloride (Dilaudid), was made up to 32.18 mg/ml. The two drugs were used interchangeably since they are similar chemically and previous work has shown equivalent delivery results . The solvent, ethanol (reagent grade) , was purchased from Fisher; propylene glycol, 99%, was purchased from Aldrich Chemical Company. For enhancer studies, the free acid form of the fatty acid (•») was first dissolved in the appropriate amount of ethanol which was then mixed together with the aqueous drug solution such that the final drug content was 0.1 M. Oleic acid (cis-9-octadecenoic acid), 99÷% was obtained from Aldrich ' Chemical Company. Caprylic acid (n- octanoic acid) 99+%; capric acid (n-decanoic acid) 99-100% and lauric acid (dodecanoic acid) 99-100% were obtained from Sigma Chemical Company, St. Louis, MO. Each experiment consisted of three phases totaling 66 hours. Several schemes are summarized on Table 1 and Table 6. SUBSTITUTESHEET 14 Table 1. Duration Phase (hrs) Donor Solution Current 18 0.1 M drug in DI W Off 24 same Off 24 same 18 0.1 M drug in DI W Off 24 same On 24 same Off 18 0.1 M drug in DI W Of 24 0.1 M drug * + enhancer On in solvent mixture III 24 same Off Phase I was usually an 18-hour passive (no current) phase. Since drug delivery rates were normally low during this phase, it was used to screen out damaged skin. Generally, the phase I donor solution was an aqueous drug solution, but where the phase I solution included an enhancer, a higher passive drug delivery rate was expected. Phase II represented the iontophoretic portion of the test and current and resistance measurements across the skin were recorded periodically. Most of the phase II receptor -samples were analyzed -for drug content- so that a delivery profile could be plotted. During iontophoresis, the drug concentration in the receptor compartment increased during the first 6-10 hours and then leveled off; this plateau represented steady state delivery rates . Steady state delivery rates were computed for each cell by knowing the sample concentrations and the volumes collected at each steady state time point. The exact flow rate for each time interval was determined by weighing the sample vials . After measuring the drug concentrations in each vial, the rate of drug delivery was calculated by multiply¬ ing the drug concentration by the flow rate (i.e., μg/ml x l/hr = μg/hr) . After computing steady state delivery rates with and without enhancers, an enhancement factor was SUBSTITUTE SHEET calculated as the ratio of average steady state delivery rate in the presence and absence of enhancer. During phase III, current was turned off and delivery was allowed to continue for a period of 24 hours. A comparison of delivery rates obtained during phases I and III was used as an indicator of skin damage brought about by the experimental treatment in phase II. Receptor samples were covered, kept in the dark and refrigerated until they were analyzed for drug by HPLC. The HPLC analysis was performed using a Hewlett Packard 1090A liquid chromatograph equipped with a diode array detector set to 280 n . ' A DuPont 5 μm, C 18 (150 x 4.6 mm) column was used. The mobile phase was 59% 0.005 M hep- tanesulfonic acid, 40% methanol and 1% acetic acid; the flow rate was 1 ml/minute. The injection volume was 10 μl . A standard curve was prepared up to a drug concentration of 1800 mg/ml as the free base equivalent. Example 1 - Comparison of Fatty Acid Enhancers Delivery of hydro orphone hydrochloride (HM-HC1) or oxymorphone hydrochloride (Oxy-HCl) across human skin or pig skin, was significantly enhanced by the application -of iontophoresis. A typical iontophoretic steady state delivery rate of about 1200 μg/hr was achieved using a current of 1 mA without the addition of a fatty acid. Further enhancement of this delivery rate was obtained using any of the four fatty acid enhancers, as shown in Table 2. SUBSTITUTESHEET Table 2 σ- Ethanol :water (voltvol) 17 This data shows about a five-fold enhancement in delivery rate when 0.5% oleic acid and ethanol/water (E/W) was present in the donor solution. The other three enhan¬ cers showed about a four-fold enhancement when 10% fatty acid was used in E/W mixtures. Enhancement was not due to the ethanol alone, since the steady state delivery rate of 1202 ± 134 μg/hr for E/W (67/33) compares closely with the rate of 1236 ± 152 μg/hr for the 100% water control. The data also shows no additional enhancement by 1% oleic acid beyond that achieved at the 0.5% level. Example 2. Effect of Varying Enhancer Concentration ' Enhancement with oleic acid was observed £t co - . centrations lower than 0.5% although no enhancement was seen at the lowest concentration tested, 0.025%. These tests were done using pig skin, oxymorphone-HCl and 1 mA of current. Results are shown in Table 3. Table 3. Oleic Acid Steady State Delivery Enhance- Conc(mq/ml) (%) E/W Rate ± sd (μg/hr) ment Factor 0 1.3 1.9 3.2 4.2 4.5 4.7 The two identical tests with 0.25% oleic acid (shown in Table 3) were done on different days and show fair agreement, considering the large standard deviations observed in these tests . SUBSTITUTESHEET 18 Example 3. Effect of Current Variation In vitro testing showed that enhancement was also observed across a range of lower currents (0.25 to 1.0 mA) , using two lower concentrations of oleic acid, 0.2% in 56/44 (E/W) and 0.5% in 62/38 (E/W) with pig skin. The enhanced steady state delivery rates are shown in Table . Tests with enhancer may be compared to the control delivery rate with no oleic acid and using human skin. Tests summarized in Table 4 were done using oxymorphone in the donor com¬ partment. SUBSTITUTESHEET Table 4. Steady State Delivery Rate ± sd (μq/hr) Enhancer (oleic acid) Current (roΛ) 0 mg/ml (control) 2 mg/ml (0.2%) 5 mg/ml (0.5%) 27 25 1280 ± 221 1734 ± 102 0.25 228 55 2204 ± 140 2032 91 0.50 542 ± 62 2597 ± 338 3699 ± 222 0.75 910 ± 117 3476 ± 4G5 4583 ± 304 1.0 1024 ± 276 3806 ± 512 • 5597 ± 433 Example 4. Effect of Solvent Variation A higher concentration of oleic acid (5.0%) was used in two different propylene glycol/ethanol/water (PG/E/W) mixtures. These experiments were carried out in an attempt to lower the percent of ethanol used as a vehicle for fatty acids. High ethanol concentrations in transdermal products can cause unacceptable levels of skin irritation. PG was therefore added as a co-solvent with lower concentrations of ethanol. The control solution contained no oleic acid. The steady state delivery rates are shown in Table 5. SUBSTITUTESHEET Table Steady State Delivery Enhancement Oleic Acid (m /ml) (%) Solvent Rate ± sd (μq/hr) Factor The steady state rate for the controls shows no enhancement from the propylene glycol alone as a solvent, and perhaps a decrease in delivery. Although there was enhancement using PG/E/W mixtures with oleic acid, enhance¬ ment was not greater than that which was seen using only 0.5% oleic acid and E/W, 67/33. Also, the solvent mixture with the higher concentration of PG (65%) showed less enhancement than the other solvent mixture having 35% PG. These tests show that propylene glycol along with lower amounts of ethanol results in a significant enhance¬ ment of delivery. However, no additional enhancement was seen using the higher concentration of oleic acid. Example 5. Pretreatment with Fatty Acid Several tests were done in which oleic acid was present during phase I, which then was considered a pre¬ treatment phase. All tests employed 10 mg/ml (1%) oleic acid and pig skin. Schemes for these tests are shown in Table 6. SUBSTITUTESHEET Table 6. Current Phase Duration (hrs) Donor Solution ( mh ) 18 0.1 M HM.HC1 + enhancer Off 24 same On 24 same Off 18 0.1 M HM.HC1 + enhancer Off 24 same Off + enhancer On 24 0.1 M HM.HCl in DI W On 24 same Off The test represented by scheme A contained enhancer in all phases . Results from the iontophoretic phase showed that steady state was achieved about four hours earlier than in cells without oleic acid in phase I (see scheme for Enhancer Studies in Table 1) . The steady state delivery rates were 5344 ± 541 μg/hr and 5205 ± 499 μg/hr, respectively. Although these rates were essentially the same, the total drug delivery was higher in pretreated cells due to earlier attainment of steady state. Another test was done in which the enhancer and drug were present- in the phase I solution, but no enhancer was present when the phase II current was applied according to scheme B. Results showed that by the end of phase I, delivery reached approximately 1800 μg/hr due to the pre- sence of 1% oleic acid in the donor solution. The steady state (phase II) delivery rate was 2163 ± 354 μg/hr. Therefore, delivery was at an intermediate level; greater than that from controls with current and no enhancer (1235 ± 151 μg/hr) but less than iontophoretic delivery with 1% enhancer (5205 ± 498 μg/hr). One additional test was done in which a current was- applied to an oleic acid/NaCl mixture -in E/W (67/33) during phase I. The purpose of the salt was to provide ions for conductivity. According to scheme C, drug but no enhancer was present in the second phase. The steady state delivery rate was 2164 ± 551 μg/hr, the same as for the previous test. Total delivery was greater in the previous test due to the already-high delivery at the onset of iontophoresis. Thus, the effect of pretreatment on steady state, but not total delivery, was the same whether pre¬ treatment included enhancer and drug in the passive mode, (Scheme B) , or enhancer but no drug in the phase I ionto¬ phoretic mode (Scheme C) . SUBSTITUTE SHEET Example 6. Voltage Variations Typically, ' the voltage begins to drop when current is applied during phase II, and may continue to fall until about midway through phase II. Some typical changes in voltages are shown in Table 7 , along with times at which voltages reached their minimum value. Oxymorphone HCl and pig skin were used in these tests . Table 7. Enhancer Current (mA) % Drop in Voltage 0.2% Oleic acid 0 71 (in 66 hrε) 0.5% Oleic acid 0 74 (in 66 hrs) 0 1 22 (in 8 hrs w/current) 0.25% Oleic acid 1 42 (in 8 hrs w/current) 0.50% Oleic acid 1 52 (in 8 hrs w/current) All of the art cited herein is incorporated by reference herein. The invention has been described w'th reference to various specific and preferred embodiments and techniques. However, it should be understood that many variations and modifications may be made while remaining within the spirit and ' scope ' of the invention. SUBSTITUTESHEET

Claims: Claims : 1. The use of a fatty acid or a physiologically acceptable salt thereof for the manufacture of a composition for use in a method of electrotransported drug delivery through a body surface. 2. Use as claimed in claim 1 of a C 8 . 18 fatty acid or a physiologically acceptable salt thereof. 3. Use as claimed in claim 2 of a fatty acid or salt selected from oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof. 4. Use as claimed in any one of claims l to 3 for the manufacture of an aqueous composition containing an ionic hydrophilic drug and a said fatty acid or salt there and, optionally, an organic co-solvent. 5. Use as claimed in claim 4 for the manufacture of a said composition in solid or gel-like form. 6. Use as claimed in any one of claims l to 5 for the manufacture of a aqueous composition comprising a drug, a said fatty acid or salt thereof and a co-solvent selected from ethanol, propylene glycol, liquid polyethylene glycols, acetone, 1-pyrrolidone, tetrahydrofurfury1 alcohol, l- methyl-2-pyrrolidone and N,N-dimethylformamide. 7. A pharmaceutical composition for drug delivery by electrotransport through a body surface comprising an aqueous solution or dispersion containing an ionic hydrophilic drug, a fatty acid or a physiologically acceptable salt thereof and, optionally, an organic co- solvent. SUBSTITUTESHEET 8. A composition as claimed in claim 7 wherein said fatty acid or salt is a C 8 . 18 fatty acid or salt thereof. 9. A composition as claimed in claim 8 wherein the fatty acid or salt is selected from oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof. 10. A composition as claimed in either of claims 7 and 8 wherein said drug is an acid- or base-addition salt. 11. A composition as claimed in claim 9 wherein said addition salt has a pK χ of less than 4.2 or greater than 8.5. 12. A composition as claimed in any one of claims 7 to 10 containing an organic co-solvent selected from ethanol, propylene glycol, liquid polyethylene glycols, acetone, 1- pyrrolidone, tetrahydrofurfuryl alcohol, l-methyl-2- pyrrolidone and N,N-dimeth lformamide. 13. A composition as claimed in any one of claims 7 to 11 further containing a gelling agent or polar organic polymer. 14. A composition as claimed in any one of claims 7 to 12 absorbed within a substrate support. 15. An iontophoresis composition as claimed in any one of claims 7 to 13 further comprising an electrode member disposed in electrical contract with said aqueous solution or dispersion. 16. An electrotransport drug delivery reservoir comprising: a reservoir portion containing an ionic SUBSTITUTESHEET hydrophilic drug in aqueous solution or dispersion together with a fatty acid or a physiologically acceptable salt thereof and optionally together with an organic co-solvent; and a body surface contacting portion which is in electrical contact with said reservoir portion and which comprises a said fatty acid or salt and, optionally, an adhesive. 17. An electrotransport drug reservoir as claimed in claim 15 wherein the fatty acid or salt is selected from oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof. 18. A reservoir as claimed in claim 15 further comprising electrode means in electrical contact with said reservoir portion. 19. An electrotransport drug delivery kit comprising: a first composition adapted for topical or electrotransport administration to a body surface and comprising a fatty acid or a physiologically acceptable salt thereof; and a second composition adapted for electrotransported administration through a body surface and comprising in aqueous solution or dispersion an ionic hydrophilic drug, optionally together with an acid or salt thereof and optionally together with an acid or salt thereof and optionally together with an organic co-solvent; said first and second compositions being for sequential administration to the same body surface. 20. An electrotransport drug delivery kit as claimed in claim 17 wherein the fatty acid or salt is selected from oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof. 21. A method for delivering a drug by electrotransport through a body surface comprising: SUBSTITUTE SHEET a) applying to an area of the body surface a fatty acid selected from oleic acid, lauric acid, capric acid, caprylic acid and the physiologically acceptable salts thereof, in an amount effective to enhance the rate of penetration of said drug through said body surface during electrotransport; and b) delivering the drug by electrotransport through the same area of the body surface. 22. A method as claimed in claim 18 wherein said body surface is selected from intact skin and mucosal membranes. 23. A method as claimed in either of claims- 18 and ' 19 wherein said drug is in the form of drug ions which are delivered through the body surface by iontophoresis. 24. A method as claimed in any one of claims 18 to 20 wherein steps (a) and (b) are performed simultaneously whereby said drug is delivered in the presence of said fatty acid or salt thereof. 25. A method as claimed in any one of claims 18 to 21 wherein said fatty acid or salt thereof is applied by electrotransport in step (a) . 26. A method as claimed in any one of claims 18 to 22 wherein said drug is also applied to said body surface in step (a) . 27. A method as claimed in any one of claims 18 to 23 wherein said fatty acid or salt thereof is also applied by electrotransport in step (b) . SUBSTITUTESHEET 28. A method as claimed in any one of claims 18 to 24 wherein said drug and said fatty acid or salt thereof are in an aqueous medium. 29. A method as claimed in claim 25 wherein said aqueous medium comprises a solution of the drug and said fatty acid or salt thereof. 30. A method as claimed in either of claims 25 and 26 wherein said aqueous medium contains an organic solvent in an amount effective to dissolve an effective amount of said fatty acid. 31. A method as claimed in claim 27 wherein said organic solvent is selected from ethanol, propylene glycol, liquid polyethylene glycols, acetone, 1-pyrrolidone, tetrahydrofurfuryl alcohol, l-methyl-2-pyr»olidone and N,N- dimethyIformamide. 32. A method as claimed in claim 28 wherein said organic solvent is ethanol. 33. Pharmaceutical compositions comprising fatty acids or salts thereof substantially as herein disclosed in any of the Examples. SUBSTITUTE SHEET

Inventors: PADMANABHAN RAMA V, SUNRAM JOAN M, PADMANABHAN, RAMA, V., SUNRAM, JOAN, M.
Applicants: MEDTRONIC INC, MEDTRONIC, INC.
Application year: 1991
Main classification: A61K47
IPC codes: A61K9, A61K47