COMBINATION INJECTION PREPARATION

Abstract: The invention belonging to the field of clinical pharmacology is based on a combination of a glucocorticoid and an antiinflammatory analgesic to be administered as a targeted drug in the form of an injection. The preparation exhibits a surprisingly rapid, effective and long-acting effect on musculoskeletal soft tissue disorders without side effects.

Description: Combination injection preparation The object of the present invention is a new injection preparation comprising, in combination, a glucocorticoid and a NSAID antiinflammatory analgesic (non-steroidal antiinflammatory drug) as well as the use of these active agents for the preparation of such an injection prepara¬ tion to be injected intralesionally directly into the site of pain or inflammation, for the treatment of pain and inflammatory conditions associated with musculo- skeletal soft tissue disorders. Numerous medical treatment methods have been tested for the treatment of musculoskeletal soft tissue disorders, such as cortisone injections administered to the site of pain, and orally administered antiinflammatory anal¬ gesics. They are used in our country and elsewhere rela¬ tively widely without reliable scientific evidence. Cor¬ tisone injections have, however, their well-known adverse effects and often repeated injections are not recommen¬ ded. Nearly all orally administered antiinflammatory analgesics have side effects on the gastro-intestinal tract. As they, in addition, are distributed into the in¬ terstitial fluid of the whole body, the drug concentra- tions in the tissue after oral administration remain re¬ latively small, and the benefit reached by them is often questionable. As the orally administered antiinflammatory analgesics have the aforementioned adverse effects and deficiencies, there are injection formulations of these drugs which have been administered parenterally intramuscularly to a patient, not, however, directly into the site of inflammation and pain. Also when using intramuscularly administered antiinflammatory analgesics, the drug concentrations in the tissue remain relatively small. According to the invention it has now surprisingly been discovered that very good treatment results are reached in the treatment of musculoskeletal soft tissue disor¬ ders, such as epicondylitis (usually tennis elbow) by injecting an antiinflammatory analgesic and a glucocorti- coid as a combination preparation directly into the site of pain. By means of injectable antiinflammatory anal¬ gesics administered intralesionally into the site of pain, high concentrations of the drug are reached in the tissue, which are even a thousand times higher as compa- red to a treatment with orally or intramuscularly or int¬ ravenously administered drug. Although the effect of a drug usually increases in relation to the logarithmic increase of the drug concentration or dosage, the thou- sendfold levels reached by the intralesional injection treatment also multiply the local effect without in¬ creasing the side effects of the drugs. The object of the invention is thus an injection prepara¬ tion which contains - a glucocorticoid - a non-steroidal antiinflammatory analgesic (NSAID) - a carrier suitable for injection purposes, and optionally other pharmacologically acceptable adjuvants and/or additives. The object of the invention is also the use of a non-ste¬ roidal antiinflammatory analgesic in combination with a glucocorticoid for the preparation of an injection preparation to be injected intralesionally directly into the site of pain, for the treatment of pain and inflamma¬ tory conditions associated with musculoskeletal soft tis¬ sue disorders. By combining a non-steroidal antiinflamma¬ tory analgesic and a glucocorticoid, drugs having diffe- rent mechanisms of action can be combined in order to reach the most optimal effect of relief of inflammation and pain. It is also possible to use a combination of two or more antiinflammatory analgesics or a combination of two or more glucocorticoid compounds. The antiinflammatory analgesic to be used according to the invention is preferably selected from the following groups: phenyl acetic acid or phenyl propionic acid derivatives such as ketoprofen, ibuprofen, naproxen, alclofenac, diclofenac, fenoprofen, tolmetin, suprofen, ketorolac, pyrazolone derivatives, such as phenylbutazone, oxyphen- butazone, metamizo1, salicylic acid derivatives, such as salicylic acid, sali¬ cylic acid amide, acetylsalicylic acid, indole derivatives, such as indomethacin, sulindac, anthranilic acids and its analogues, such as flufenamic acid, mefenamic acid, niflu ic acid, tolfenamic acid, oxicams, such as piroxicam, tenoxicam, lefetamine, nabumetone. According to one embodiment of the invention the an¬ tiinflammatory analgesic is ketoprofen, diclofenac, or indomethacin. The glucocorticoid used in the invention is selected e.g. from the following group of compounds: cortisone, hydro- cortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, betamethasone, dexamethasone. According to the invention, the active agents are injec¬ ted into the site of pain of a patient in an amount suf¬ ficient to achieve the desired treatment result. This amount depends, of course, on both the condition of the patient and the pharmaceutical agents to be used, and this amount can be determined by a person skilled in the art. The amount of antiinflammatory analgesic typically used is in the range of 1 to 1000 mg/single injection dose. As an example it can be mentioned that when using ketoprofen, the dosage used varies from 10 to 100 mg/single injection dose, and from 1 to 100 mg/single injection dose when using diclofenac. The amount of the corticoid type compound also depends both on the condition of the patient and the drug to be used, and it can also be determined by a person skilled in the art. The amount can thus vary in the range of 1 to 100 mg/single injection dose, depending on the drug. The injection frequence to be used according to the in¬ vention depends naturally on the condition of the patient and the dosage level used. We have, as appears later, treated severe epicondylitis and other musculoskeletal soft tissue disorders by injecting two single injections at an interval of a week, and thereby reached good re¬ sults. The object of the invention is also an injection prepara¬ tion which contains a corticoid in combination with a non-steroidal antiinflammatory analgesic in a carrier suitable for injection, whereby suitable adjuvants and/or additives are added, when necessary or desired. The amount of the active agents in the injection prepara¬ tion according to the invention can vary within relative¬ ly large ranges depending on the drug and the other addi¬ tives. An appropriate amount of each of the active agents is generally in the range of 0.1 to 5 % by weight, depen¬ ding on the drug and the formulation. The carrier is preferably sterile water or a physiologi¬ cal (0.9%) sodium chloride solution suitable for injecti- on. Also other pharmaceutically acceptable organic sol¬ vents suitable for injection purposes, and mixtures the¬ reof with water, may come into question. In the preparation according to the invention adjuvants and additives known per se can be used. Such agents are e.g. preservative agents, buffers and other agents sui¬ table for adjusting the pH-value, agents for adjusting the osmotic pressure, viscosity adjustment agents, solu¬ bility improving agents, stabilizing agents, surface- active agents and anesthetics. The selection of the type and the amount of carrier and other adjuvants and additi¬ ves can be done by a person skilled in the art. As suitable preservative agents benzalkonium chloride, benzyl alcohol, thiomersal, chlorhexidine and comparable agents, or mixtures thereof, can be mentioned. As suitable buffers e.g. phosphate buffers, citrate buf¬ fers, and borate buffers come into question. For adjus¬ ting the pH-value, conventional pH adjustment agents, such as inorganic and organic bases and acids, can be used. As bases e.g. sodium hydroxide, amines, e.g. al- canol amines or amino acids, e.g. arginine or lysine, come into question. As an acid, e.g. hydrochloric acid is useful. For adjusting the osmotic pressure, agents well- known for this purpose, such as sodium chloride, glyce¬ rol, mannitol, sorbitol, lactose, sodium borate or cor- responding agents, can be used. When desired, also viscosity adjustment agents, typically various cellulose derivatives, such as sodium carboxy¬ methyl cellulose, can be used in the preparation. In some cases it can be preferable to add solubility enhancing agents or stabilizing agents, e.g. polyvinylpyrrolidone of which various qualities are commercially available e.g. under the name Kollidon. According to one advantageous embodiment of the invention an injection solution ready for use is prepared from a so-called pre-preparation or pre-pack, "kit". The pre- pack can contain e.g. two separate components, i.e. a component containing a glucocorticoid, and a component containing an antiinflammatory analgesic, as well as means for combining the active agents to form a prepara- tion designed to be injected, which preparation contains a pharmacologically acceptable carrier suitable for in¬ jecting and optionally further additives and adjuvants. Preferably, both the component containing the glucocorti¬ coid and the component containing the antiinflammatory analgesic are in injectable form, each of them containing a pharmacologically acceptable carrier suitable for in¬ jection purposes, and optionally further adjuvants and/or additives. The components can advantageously be joined in a triple ampule, which additionally contains a suitable anesthetic for preventing possible smarting, such as li- docaine or bupivacaine, in combination with adrenaline when necessary, if there are no contraindications for the use of adrenaline. The anesthetic is given prior to the administration of the actual drugs. At the moment of use, the active agents of the components can be joined in an appropriate manner, e.g. by joining the contents of the ampules, e.g. by drawing the injection solution con¬ tained in each of the ampules into the same syringe, whe¬ rein they are mixed together. By this arrangement, any preservation problems caused by the possible incompatibi¬ lity of the drugs are avoided. The following examples illustrate the invention. Example 1 The following injection solution compositions 1 and 2 are prepared separately. 1. ketoprofen 5 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s. ad pH 6.5 water, aq. ad. inj. ad 1 ml 2. betamethasone acetate 3 mg betamethasone disodium phosphate (respond betamethasone) 3 mg disodium phosphate anhydride 7.1 mg sodium dihydrogen phosphate monohydrate 3.4 mg sodium edetate 0.1 mg benzalkonium chloride 0.2 mg water, aq. ad. inj. ad 1 ml Two ml of the solution having the above composition 1 is used as the injection solution of the antiinflammatory analgesic and one ml of the solution having the above composition 2 is used as the corticoid solution. These solutions are mixed together by drawing them in succession into a syringe prior to injecting. Example 2 Analogously to Example 1, an injection solution is prepa- red from the injection solutions having the following compositions 1 and 2. ketoprofen 50 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s. ad pH 6.5 water, aq. ad. inj. ad. 1 ml 2. methylprednisolone acetate 40 mg macrogol 4000 29 mg sodium chloride 8.7 mg myristyl-7-picoline chloride 0.19 mg water, aq. ad. inj. ad. 1 ml Example 3 Analogously to Example 1, an injection solution is prepa¬ red from the injection solutions having the following compositions 1 and 2. 1. ketoprofen 50 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s. ad pH 6.5 water, aq. ad. inj. ad 1 ml 2. methylprednisolone acetate 40 mg macrogol 3000 30 mg sodium chloride 5 mg Kollidon PF 12 14 mg Polysorb 80 2 mg benzyl alcohol 10 mg water, aq. ad. inj. ad 1 ml Example 4 Analogously to Example 1, an injection solution is prepa- redd from the injection solutions having the following compositions 1 and 2. 1. ketoprofen 50 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s. ad pH 6.5 water, aq. ad. inj. ad 1 ml 2. methylprednisolone sodium succinate respond methylprednisolone 40 mg lactose, anh. 25 mg sodium dihydrogen phosphate monohydrate 1.8 mg sodium phosph. sice. 17.5 mg benzyl alcohol 9 mg water, aq. ad. inj. ad 1 ml Example 5 Analogously to Example 1, an injection solution is prepa- red from the injection solutions having the following compositions 1 and 2. 1. ketoprofen 50 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s.ad pH 6.5 water, aq. ad. inj. ad 1 ml 2. triamcinolone acetonide 50 mg sodium carboxymethylcellulose 7.5 mg sodium chloride 6.6 mg Polysorb 80 0.4 mg benzyl alcohol 15 mg water, aq. ad. inj. ad 1 ml Example 6 Analogously to Example 1, an injection solution is prepa¬ red from the injection solutions having the following compositions 1 and 2. 1. ketoprofen 50 mg arginine 36 mg benzyl alcohol 25 mg citric acid monohydrate q.s ad pH 6.5 water, aq. ad. inj. ad 1 ml 2. triamcinolone hexacetonide 20 mg benzyl alcohol 9 mg Polysorb 80 4 mg sorbitol 450 mg sodium hydroxide/hydrochlorid acid ad pH 5.8/6.5 water, aq. ad. inj. ad 1 ml Example 7 Analogously to Example 1, an injection solution is prepa- red from the injection solutions having the following compositions 1 and 2. 1. diclofenac sodium 25 mg mannitol 6 mg sodium pyrosulfis. 0.67 mg benzyl alcohol 40 mg propylene glycol 200 mg sodium hydroxide ad pH 8.0 water, aq. ad. inj. ad 1 ml 2. methylprednisolone acetate 40 mg macrogol 4000 29 mg sodium chloride 8.7 mg myristyl-γ-picoline chloride 0.19 mg water, aq. ad. inj. ad 1 ml As the injection solution of the antiinflammatory anal¬ gesic, 3 ml of the solution having the above composition 1 is used, and as the corticoid solution, 1 ml of the solution having the above composition 2 is used. These solutions are mixed together by drawing them in succession into a syringe prior to injecting. Example 8 Analogously to Example 1, an injection solution is prepa¬ red by combining the following compositions 1 and 2. 1. indomethacin sodium respond indomethacin 50 mg monosodium phosphate 27.1 mg sodium hydroxide 12 mg water, aq. ad. inj. ad 10 ml 2. methylprednisolone acetate 40 mg macrogol 3000 30 mg sodium chloride 5 mg Kollidon PF 12 14 mg polysorbate 80 2 mg benzyl alcohol 10 mg water, aq. ad. inj. ad 1 ml As the injection solution of the antiinflammatory anal- gesic, 3 ml of the solution having the above composition 1 is used, and as the corticoid solution, 1 ml of the solution having the above composition 2 is used. These compositions are mixed together by drawing them in suc¬ cession into a syringe prior to injecting. Combination preparations can be prepared by analogously using other, above mentioned NSAIDs. Test report We have treated patients by administering combination injections of a glucocorticoid compound and an antiin- flammatory analgesic as "a targeted means" directly into the site of pain. There are no published studies of such an alternative for the treatment of epicondylitis or a corresponding disease, nor is such a treatment disclosed in any textbook in the art. We have used an anesthetic- cortisone-ketoprofen combination preparation in the treatment of epicondylitis and comparable conditions of musculoskeletal soft tissue disorders. We have treated various musculoskeletal disorders with the combination preparation, i.a. rotator cuff tendinitis of the shoulder joint, bursitis, peritendinitis, tendovaginitis and in¬ sertion tendinitis, post-traumatic soft tissue disorders and distended joints. Other indications are pain condi¬ tions in the neck and the back as well as joint disor¬ ders. Among the diseases treated there have been sixteen patients with chronic tennis elbow, whose disease had lasted from two months to one year. All treated patients recovered completely or nearly completely after two in¬ jections of the combination (given at one-week intervals) within two to three weeks. The effect has lasted at least for three months from the first injection given. The ef¬ fect has been very surprising, as chronic tennis elbow, for the treatment of which we mainly used the preparati¬ on, has generally been considered as a condition, which is hardly cured by drug treatment. As an anesthetic we have used bupivacaine administered prior to the com¬ bination preparation; in this case, the antiinflammatory analgesic used, ketoprofen, causes hardly any smarting. Ketoprofen has not been expected to have any local side effects, and no side effects occurred from the treatment with our injections. The pharmaceutical used by us affects the symptoms of the disease rapidly (approximately within 24 hours) , the ef¬ fect is long-acting or permanent. Compared to the orally administered antiinflammatory analgesics, the rapidity, the efficiency and the duration of the effect of the drug used by us are essentially better. In the following we have used ketoprofen and diclofenac as the antiinflammatory analgesic. As the active agent of the glucocorticoid preparation we have used beta ethaso- ne, methylprednisolone and triamcinolone. Patient examples: The patients treated by us included, among others, six- teen patients with chronic tennis elbow, whose disease had lasted from two months to one year. All treated pa¬ tients have recovered completely or nearly completely after two combination preparation injections (injected at one-week interval) within two to three weeks. The effect has lasted at least for three months from the first in¬ jection given. injections slight pain and no symptoms, minor clinical no clinical findings findings 6. 49 y.F bursitis diclofenac + slight pain and nearly symptomless betamethasone minor clinical minor clinical injections findings findings * Two combination preparation injections (injected at an interval of one week) In the following some additional examples of the patients: patients disease, medical treatment* treatment result treatment result duration after 1 week after 2 weeks 1. 49 y.M painful tennis elbow, ketoprofen + slight pain and no symptoms 6 months betamethasone minor clinical no clinical findings injections findings 43 y. M painful ketoprofen + no visit at the no symptoms, tennis betamethasone doctor and no clinical findings elbow, injections no therapy 3 months t 3. 46 y.F painful ketoprofen + slight pain and no symptoms, tennis betamethasone minor clinical no clinical elbow, injections findings findings 8 months 4. 38 y.M tendinitis ketoprofen + slight pain, no symptoms of the betamethasone minor clinical shoulder, injections findings 9 months 5. 40 y.F bursitis ketoprofen + betamethasone

Claims: Claims 1. Injection preparation, characterized in that it con¬ tains - one or more glucocorticoids, - one or more non-steroidal antiinflammatory anal¬ gesics, - a pharmacologically acceptable carrier suitable for injection purposes, as well as optionally further, pharmacologically accep¬ table adjuvants and/or additives. 2. The preparation according to claim 1, characterized in that the glucocorticoid is selected from the group con- sisting of cortisone, hydrocortisone, prednisone, pred- nisolone, betamethasone, dexamethasone, methylprednisolo¬ ne, and triamcinolone. 3. The preparation according to claim 1 or 2, characteri- zed in that the antiinflammatory analgesic or a com¬ bination of the antiinflammatory analgesics are selected from the group consisting of the following compounds: phenyl acetic acid or phenyl propionic acid derivatives, such as ketoprofen, ibuprofen, naproxen, alclofenac, di- clofenac, fenoprofen, tol etin, suprofen, ketorolac, pyrazolone derivatives, such as phenylbutazone, oxyphen- butazone, metamizol, salicylic acid derivatives, such as salicylic acid, sali¬ cylic acid amide, acetylsalicylic acid, indole derivatives, such as indomethacin, sulindac, anthranilic acids and its analogs, such as flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid, oxicams, such as piroxicam, tenoxicam, lefetamine, nabumetone. 4. The preparation according to any of the claims 1-3, characterized in that the carrier is water or an aqueous organic solvent. 5. The preparation according to any of the claims 1-4, characterized in that it is intended for intralesional use. 6. Pre-preparation or pre-pack, characterized in that it contains a) a component containing a glucocorticoid b) a component containing a non-steroidal anti¬ inflammatory analgesic, and c) means for combining the glucocorticoid and the antiinflammatory analgesic to a preparation intended to be injected, which contains, in addition to the active agents, a pharmacologically acceptable carrier suitable for injecting and optionally further adjuvants and/or additives. 7. The pre-preparation according to claim 6, characteri- zed in that the glucocorticoid and the antiinflammatory analgesic are each separately in injection form, each of them containing a pharmacologically acceptable carrier suitable for injection purposes and optionally further adjuvants and/or additives. 8. The pre-preparation according to claim 6 or 7, charac¬ terized in that the glucocorticoid is selected from the group consisting of cortisone, hydrocortisone, predniso¬ ne, prednisolone, betamethasone, dexamethasone, methyl- prednisolone, and triamcinolone. 9. The pre-preparation according to any of the claims 6-8, characterized in that the antiinflammatory analgesic is selected from the group consisting of the following compounds: phenyl acetic acid or phenyl propionic acid derivatives, such as ketoprofen, ibuprofen, naproxen, alclofenac, di- clofenac, fenoprofen, tolmetin, suprofen, ketorolac, pyrazolone derivatives, such as phenylbutazone, oxyphen- butazone, metamizol, salicylic acid derivatives, such as salicylic acid, sali- cylic acid amide, acetylsalicylic acid, indole derivatives, such as indomethacin, sulindac, anthranilic acids and its analogs, such as flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid, oxicams, such as piroxica , tenoxicam, lefetamine, nabumetone. 10. The pre-preparation according to any of the claims 6-9, characterized in that the carrier is water or an aqueous organic solvent. 11. The pre-preparation according to any of the claims 6-10, characterized in that it contains also a component containing an anesthetic and, when necessary, adrenaline. 12. The use of a glucocorticoid and a non-steroidal an¬ tiinflammatory analgesic in combination for the prepara¬ tion of an injection preparation according to any of the claims 1-4, intended for the treatment of pain and in- flammmatory conditions associated with musculoskeletal soft tissue disorders. 13. The use according to claim 12 for preparing a prepa¬ ration to be be injected intralesionally directly into the site of pain. 14. The use of a glucocorticoid and a non-steroidal antiinflammatory analgesic as separate injection com¬ ponents containing a pharmacologically acceptable carrier suitable for injection purposes and optionally further adjuvants and/or additives, in a pre-pack intended for the treatment of musculoskeletal soft tissue disorders based on the combined effect of the active agents. 15. The use according to claim 14 for the intralesional treatment of musculoskeletal soft tissue disorders. 16. The use according to any of the claims 12-15 for the preparation of an injection preparation intended for the treatment of epicondylitis, tendinitis of the shoulder and bursitis. AMENDED CLAIMS [received by the International Bureau on 9 June 1997 (09.06.97); original claims 1-16 replaced by new claims 1-11 (3 pages)] 1. The use of - one or more glucocorticoids, - one or more non-steroidal antiinflammatory analgesics, - a pharmacologically acceptable carrier suita¬ ble for injection purposes, as well as optionally further, pharmacologically accep- table adjuvants and/or additives for the preparation of an injection preparation intended for the intralesional treatment of epicondylitis, tendinitis of the shoulder and bursitis. 2. The use according to claim 1, characterized in that the glucocorticoid is selected from the group consisting of cortisone, hydrocortisone, prednisone, prednisolone, betamethasone, dexamethasone, methylprednisolone, and triamcinolone. 3. The use according to claim 1 or 2, characterized in that the antiinflammatory analgesic or a combination of the antiinflammatory analgesics are selected from the group consisting of the following compounds: phenyl acetic acid or phenyl propionic acid derivatives, such as ketoprofen, ibuprofen, naproxen, alclofenac, di¬ clofenac, fenoprofen, tolmetin, suprofen, ketorolac, pyrazolone derivatives, such as phenylbutazone, oxyphen- butazone, metamizol, salicylic acid derivatives, such as salicylic acid, sali¬ cylic acid amide, acetylsalicylic acid, indole derivatives, such as indomethacin, sulindac, anthranilic acids and its analogs, such as flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid, oxicams, such as piroxicam, tenoxicam, lefetamine, nabumetone. 4. The use according to any of the claims 1-3, characte¬ rized in that the carrier is water or an aqueous organic solvent. 5. The use of a glucocorticoid and a non-steroidal antiinflammatory analgesic as separate injection com¬ ponents containing a pharmacologically acceptable carrier suitable for injection purposes and optionally further adjuvants and/or additives, in a pre-pack intended for the intralesional treatment of epicondylitis, tendinitis of the shoulder and bursitis. 6. The use according to claim 5, characterized in that the pre-pack also contains means for combining the gluco- corticoid and the antiinflammatory analgesic to a prepa¬ ration intended to be injected. 7. The use according to claim 5 or 6, characterized in that the glucocorticoid and the antiinflammatory anal- gesic are each separately in injection form, each of them containing a pharmacologically acceptable carrier suita¬ ble for injection purposes and optionally further adju¬ vants and/or additives. 8. The use according to claim 5, 6 or 7, characterized in that the glucocorticoid is selected from the group con¬ sisting of cortisone, hydrocortisone, prednisone, pred¬ nisolone, betamethasone, dexamethasone, methylprednisolo¬ ne, and triamcinolone. 9. The use according to any of the claims 5-8, characte¬ rized in that the antiinflammatory analgesic is selected from the group consisting of the following compounds: phenyl acetic acid or phenyl propionic acid derivatives, such as ketoprofen, ibuprofen, naproxen, alclofenac, di¬ clofenac, fenoprofen, tolmetin, suprofen, ketorolac, pyrazolone derivatives, such as phenylbutazone, oxyphen- butazone, metamizol, salicylic acid derivatives, such as salicylic acid, sali¬ cylic acid amide, acetylsalicylic acid, indole derivatives, such as indomethacin, sulindac, anthranilic acids and its analogs, such as flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid, oxicams, such as piroxica , tenoxicam, lefetamine, nabumetone. 10. The use according to any of the claims 5-9, characte- rized in that the carrier is water or an aqueous organic solvent. 11. The use according to any of the claims 5-10, charac- terized in that it contains also a component containing an anesthetic and, when necessary, adrenaline.

Inventors: MALMIVAARA ANTTI, TOLONEN JORMA, MALMIVAARA, ANTTI, TOLONEN, JORMA
Applicants: MALMIVAARA ANTTI, SUPRAKORT OY, TOLONEN JORMA, MALMIVAARA, ANTTI, TOLONEN, JORMA
Application year: 1997
Main classification: A61K9
IPC codes: A61K9, A61K31, A61K45, A61P19, A61P29