Abstract:
The invention relates to a solid oral pharmaceutical composition combining ketorolac and B-complex consisting of inter alia thiamin, pyridoxine and cyanocobalamin (vitamins B1, B6 and B12 respectively) and/or the pharmaceutically acceptable salts thereof, as well as pharmaceutically acceptable excipients and/or vehicles. The invention also relates to the method for producing the composition and to the use of said composition having a synergistic therapeutic activity, indicated for the treatment of moderate to severe pain or neuralgias in different locations.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention refers to a solid oral pharmaceutical composition comprising the combination of ketorolac and B-complex comprising, inter alia thiamin, pyridoxine and cyanocobalamin (vitamins B1, B6 and B12, respectively) and/or the pharmaceutically acceptable salts thereof, as well as pharmaceutically acceptable vehicles and/or excipients; the manufacturing process of said composition and the use of said composition having a synergistic therapeutic activity, indicated for the treatment of moderate to severe pain or neuralgias in different locations. 
       BACKGROUND OF THE INVENTION 
       [0002]    The treatment of inflammatory-originated pain requires the use of different strategies, such as the use of non-steroidal anti-inflammatory agents (NSAIDs). However, depending on the pain extent, the use of NSAIDs alone will not provide a satisfactory pain control, and, furthermore, major adverse events could appear with the chronic use of said agents, namely gastric damage, gastric ulcers (Gambero et al., 2005). 
         [0003]    For the present invention, a stable, effective, oral formulation was developed, having less adverse side effects, wherein an analgesic (ketorolac) known for its therapeutic efficacy and B-complex comprising thiamine (vitamin B1), pyridoxine (vitamin B6) and/or cyanocobalamin (vitamin B12), coexists. Due to physicochemical interactions occurring among active drugs of the present invention, it is difficult to create a pharmaceutical compound by simple association of active drugs. 
         [0004]    Ketorolac tromethamine, (+−)-5(benzoyl)-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid tris (hydroxymethyl)methylamine is a highly water-soluble, non-steroidal, anti-inflammatory analgesic (NSAID), having a pH from neutral to slightly basic of 9.0, and melting point from 160 to 161° C. 
         [0005]    Ketorolac acts on the cyclooxigenase II enzyme, which mediates in the painful inflammatory process, having a plasmatic mean life from 4 to 6 hours. More than 99% is bound to proteins and about 90% is excreted without any change in urine, the remaining is excreted in the feces. 
         [0006]    Clinical studies have demonstrated that Ketorolac is a powerful and effective analgesic (similar to an opiate type analgesic), useful in the treatment of moderate to severe pain. 
         [0007]    In addition to its analgesic effect, it is a moderate antipyretic and, compared to opioid analgesics, it does not produce adverse effects such as: nausea, vomit, sedation or tolerance. Ketorolac is an analgesic with peripheral action that does not interfere with opiate binding and does not exacerbate sedation or respiratory depression associated with the use thereof. 
         [0008]    Usual oral ketorolac doses are from 10 mg to 30 mg, three to four times a day, said dose may increase depending on the pharmaceutical form, severity and kind of pain. 
         [0009]    B-complex vitamins are used in the present composition, these can be hydrosoluble and liposoluble, having a pH between 3.0 and 5.0; they are highly photosensitive and, in general, sensitive to the surrounding environment. Vitamins B1, B6, and/or B12, which are hydrosoluble vitamins, are used in the present invention, with the use thereof not limiting the use of other vitamins within the B-complex. 
         [0010]    Thiamine (vitamin B1) is part of a coenzyme, which participates in metabolic reactions of lipids and carbohydrates; it normalizes nervous, cardiovascular and digestive system functions. 
         [0011]    Pyridoxine (vitamin B6) promotes metabolism of lipids and proteins into amino acids, and stimulates the fagocitary activity of white blood cells. 
         [0012]    Cyanocobalamin (vitamin B12) helps in nucleic acid formation, contributes to the normal functioning of red blood cells and helps in maintaining a well functioning state of nervous cells. 
         [0013]    B-complex (vitamins B1, B6 and/or B12) has multiple therapeutic applications such as: vitamin deficiencies, in a pre- or post-operatory state, neuritis, polyneuritis, chronic diarrhea, polyneuropathies and Wernicke encephalopathy, among other theurapeutic activities. 
         [0014]    Due to ketorolac and B-complex vitamins properties, when combined in a pharmaceutical oral composition, incompatibility problems arise because chemical reactions that promote degradation of the active agents ketorolac and B-complex vitamins take place, causing non-conformity of the formulation regarding stability requirements and, consequently, of the desired therapeutic effect. 
         [0015]    It was confirmed experimentally, in the present invention, that the combination of ketorolac with B-complex vitamins, leads to the modification of ketorolac physical and chemical properties. In particular, when combined with pyridoxine (vitamin B6), a mayor formulation instability occurs, with said vitamin being mostly responsible for ketorolac degradation in the pharmaceutical combination. 
         [0016]    Coexistence of ketorolac and B-complex vitamins in the same dose unit by simple association is not possible, since degradation can take place due to particular physicochemical properties of the active ingredients. 
         [0017]    Currently, a known therapy used in pain treatment in the immediate post-operatory state is the use of analgesics in combination with opioids, as described in the patent document No. PA/a/2002/010828. The document refers to a pharmaceutical composition in capsule form, comprising the association of a non-steroid anti-inflammatory analgesic (NSAID), ketorolac, with an opiate, tramadol, used in pain treatment. 
         [0018]    The disadvantage of the above composition relates to adverse side effects of the opiate tramadol, wherein the restriction of opioids usage is associated with side effects, being primarily the following: itch, nausea, vomit, urinary retention, constipation, paralytic ileum, potential respiratory depression, sedation, tolerance, anxiety, abstinence syndrome and/or respiratory depression. 
         [0019]    Combinations of analgesics with pyridoxine (vitamin B6) exist in the state of the art, as described in the patent document WO/1999/053928. Said document discloses a method for alleviating inflammatory conditions in patients suffering from hypertension and being treated with an NSAID. The related composition comprises administering NSAID and vitamin B6, jointly or separately; specifically, combinations of diclofenac, indomethacin and acetyl salicilate with vitamin B6 are recited. It is worth mentioning that, although ketorolac is cited in said document in a general form, there is no experimental evidence in said document WO/1999/053929 about the combination of ketorolac and vitamin B6. 
         [0020]    On the other hand, U.S. Pat. No. 4,564,614 refers to an anti-inflammatory pharmaceutical composition useful in the treatment of gastric ailments or gastric ulcers. Said composition envisions the direct binding of piroxicam and pyridoxine (vitamin B6) in an oral tablet formulation. Unlike the present invention, therapeutic indication is different, as well as the physicochemical properties of the NSAID used. Therefore, said background does not contemplate possible interactions between an NSAID and any B-complex vitamins. 
         [0021]    Patent document PA/a/2006/004020 refers to ketorolac and B-complex pharmaceutical compositions having therapeutic activity in the treatment of moderate to severe pain, and to the process for obtaining said compositions. Said invention discloses an injectable formulation and its process of manufacture, as well as a pharmaceutical formulation in capsules containing coated microspheres, wherein the objective was to keep vitamin B12 protected and isolated from physicochemical interactions with the rest of the active ingredients in the formulation, the reason being that said vitamin is less stable and is present in lesser amounts in said formulation. 
         [0022]    Unlike the patent document PA/a/2006/004020, the present invention refers only to ketorolac and B-complex oral compositions wherein coexistence of ketorolac tromethamine and B-complex is achieved in the same dose unit. Active substances are contained in individual and separated compartments, using a reduced amount of excipients, which improves operation time and costs; stability is reached without the use of any protection system by means of buffers or antioxidants (such as citric acid) typically employed in pharmaceutical formulations. In the present invention vitamin B6 is applied as part of the outer layer. 
         [0023]    Currently, there are formulations of pharmaceutical combinations comprising an NSAID (diclofenac, meloxicam or ketoprofen) and B-complex (vitamin B1, B6, and B12) or, an NSAID like ketorolac in combination with the tramadol opiate; side effects of different kind and severity may appear regarding these formulations. 
         [0024]    Diclofenac formulations indicated for a short-term pain treatment, once in the organism, show the effect of the first step of the metabolic absorption, which leads to reaching the maximum plasma concentration in a longer period of time than ketorolac, which does not show the effect of said first metabolic step and it is absorbed immediately. 
         [0025]    The ketoprofen and B-complex oral formulation is administered from 200 mg to 300 mg per day, the half-life of ketoprofen being from about 1 to 3 hours. When administered with meals, absorption becomes slower, resulting in a delay and reduction of the concentration peak (Cmax). Administration of ketoprofen and B-complex at the usual doses as mentioned above may lead to cefalea, confusion, cutaneous rash, nausea, vomit, and gastric irritation, and may occasionally cause Stevens-Johnson syndrome. 
         [0026]    In the case of the meloxicam and B-complex oral formulation, its main therapeutic effect is as an anti-inflammatory, having a therapeutic indication different from the therapeutic indication of the present invention. 
         [0027]    On the other hand, when following a pain treatment regime with NSAIDs, close supervision is recommended for those patients suffering from gastrointestinal disorders or those having a history suggesting presence of gastric or intestinal ulcer; less frequently, the following might appear: Stevens-Johnson syndrome, Lyell syndrome, erythroderma (exfoliative dermatitis), alopecia, photosensitive reactions, purpura, and in some cases allergic reactions. 
         [0028]    In the case of pain treatment with an NSAID combined with an opiate analgesic such as tramadol, its use is more delicate, since its extended use can cause gastric injury, somnolence, headache, nausea, tolerance, anxiety, withdrawal effect, respiratory disorders, sedation, confusion, and even resistance and tolerance may appear. 
         [0029]    For the above reasons, it is convenient to have a pharmaceutical formulation which addresses moderate to severe pain ailment without causing adverse side effects commonly related to NSAIDs. By using a lower dose of ketorolac than what is typically used, the ketorolac and B-complex oral formulation of the present invention is intended to relieve both moderate to severe pain and neuralgia in different locations, with less risk of suffering from side effects. 
         [0030]    Unlike diclofenac, ketoprofen, tramadol formulations and combinations thereof with B-complex, the present invention, given its synergistic effect and by the use of a dose of ketorolac which is lower than the common therapeutic dose thereof, does not cause the adverse side effects commonly associated with these compositions; further, it should be noted that treatment periods may be increased when necessary, resulting in a greater effect or keeping the analgesic therapeutic effect against moderate to severe pain and neuralgias in different sites. 
         [0031]    In the present invention, coexistence of active ingredients in the same unit dose is obtained by successfully isolating the active ingredients from direct contact in separate compartments. For the composition of the present invention we identified that vitamin B6 in presence of ketorolac shows a higher oxidation reaction, therefore we developed a separate compartment system preventing formation of this kind of interactions. 
         [0032]    One design of the tablet composition comprises the isolation, in a first compartment, of ketorolac, vitamin B1, vitamin B12, compressibility vehicle, diluent binder, antistatic agent, lubricant, plasticizer, and a disintegrant. A coating or isolating layer, corresponding to a second compartment, is added to the first one, said layer comprising a protective coating polymer. Then, pyridoxine and a binding polymer are added in order to form a third compartment. Finally, a final coating can optionally be added, using a polymer for final coating and finishing, said polymer confers color and gloss, as well as protection against potential photolysis and/or hydrolysis. 
         [0033]    A preferred embodiment of the present invention uses 5 mg or less of the typical ketorolac dosage (10 mg), so it is less likely that the formulation of the present invention could cause adverse side effects compared to currently existing conventional formulations that contain an NSAID. 
         [0034]    The present formulation provides an easier administration in persons who do not wish or cannot get a treatment via parenteral administration, such as post-operatory patients, seniors or the like, since it is a small tablet of no more than one half centimeter in diameter. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0035]    The attached figures show drug behavior. 
           [0036]      FIG. 1  shows the timing of the analog visual scale (AVS) after administering diclofenac-vitamins B (black circles) and ketorolac-vitamins B (white circles) every eight hours. 
           [0037]      FIG. 2  shows the timing of the first eight hours of the analog visual scale (AVS) in patients who received diclofenac-vitamins B (black circles) and ketorolac-vitamins B (white circles). 
           [0038]      FIG. 3  shows the Area Under the Curve (AUC) of a 24-hour timing of the analog visual scale. Data are expressed as average ±standard error. 
           [0039]      FIG. 4  shows the Area Under the Curve (AUC) of an 8-hour timing plot of the analog visual scale. Data are expressed as average ±standard error. 
       
    
    
     DESCRIPTION OF THE INVENTION 
       [0040]    The challenge faced by the development of the present invention is the obtention of a stable, safe, oral pharmaceutical composition having therapeutic efficacy, in a single dose unit comprising drugs physically and chemically incompatible one to another such as ketorolac and B-complex, with associated reduced operating times and excipient use. 
         [0041]    Ketorolac monodrug oral formulations and formulations containing B-complex exist, so it could be thought that it is possible to perform a composition by simply mixing these compositions. However, this is not possible, because a plurality of physical and chemical interactions exist, which would take place if these active ingredients were contained together. 
         [0042]    Ketorolac, due to its physical and chemical properties, has higher solution stability in basic medium, in a pH range between 7.0 and 9.5. B-complex shows a higher stability in an acid pH range between 3.0 and 5.0. These drug properties difficult the manufacturing process of the pharmaceutical composition when trying not to affect the stability of each drug. By simple combination of ketorolac-B-complex in a solution, evident physical instability and active drug degradation occur, as well as turbidity, precipitate formation and an acid pH between 3.5 and 5.0, which is an unfavorable pH for ketorolac stability. 
         [0043]    In the present invention, coexistence of active ingredients in the same dose unit is obtained by successfully isolating the active ingredients avoiding direct contact, by including them in separate compartments. These formulations can be present in tablets or coated cores. 
         [0044]    A design of the composition as tablets comprises isolation of ketorolac, vitamin B1, vitamin B12, compressibility vehicle, diluent binder, antistatic agent, lubricant, plasticizer, and a disintegrant, in a first compartment. A coating or isolating layer comprising a protective coating polymer corresponding to the second compartment, is added to the first one. Then, pyridoxine and a binding polymer are added to form a third compartment. Finally, a final covering may be optionally added, comprising a polymer for final coating and finishing, said polymer confers color and gloss, as well as protection against potential photolysis and/or hydrolysis. 
         [0045]    One of the main uses of polymeric excipients in solid pharmaceutical formulations is to provide protection to said formulations during other manufacturing processes (e.g. coatings or compression) or against external factors such as, without limitation, humidity and light. In the present invention, however, it is worth mentioning that this formulation uses a polymeric coating or layer containing the active ingredient, vitamin B6, which is an uncommon process. 
         [0046]    One way to reduce processing timing is by the inclusion of the active ingredient along with the polymer. However, application of the coating polymer with amounts of active ingredient (vitamin B6) jointly, may cause problems during processing, such as not complying with dosage uniformity. This technical difficulty represented a major challenge to the present invention, which was solved, and the formation of an homogenous film was obtained, achieving thereby the goal of containing vitamin B6 and conferring protection to the tablet. 
         [0047]    Therefore, during the development of the pharmaceutical composition of the present invention, several technical problems were solved in order to obtain a stable and safe composition, by shielding active agents with polymeric excipients and by protecting said formulation against light intensity and the surrounding environment in general. 
       Formulations 
       [0048]    Because oral formulation is among the most widely accepted formulations due to its comfortable administration and ease of transportation, the composition of the present invention can be provided in the form of tablets. 
         [0049]    The formulation and manufacturing process thereof is disclosed below, said formulation comprising ketorolac and B-complex active ingredients and/or pharmaceutically acceptable salts thereof, and, in addition, pharmaceutically acceptable vehicles or excipients. Weight amounts of active ingredients, vehicles and/or excipients, can be used within the ranges recited in the description of formulation compounds. 
       Example 1 
     Oral Formulation in Pellet, Tablet 
       [0050]    Description of formulation compounds: 
         [0051]    Active Ingredients, as disclosed or pharmaceutically acceptable salts thereof:
       Ketorolac tromethamine, which can be comprised from 2 mg to 40 mg per dose unit and/or from 0.2% to 6.0% by weight of the composition.   Thiamine hydrochloride or mononitrate (vitamin B1), which can be comprised from 15 mg to 250 mg per dose unit and/or from 2.5% to 60.0% by weight of the composition.   Pyridoxine hydrochloride (vitamin B6), which can be comprised from 15 mg to 250 mg per dose unit and/or from 2.5% to 60.0 by weight of the composition.   Cyanocobalamin (vitamin B12), which can be comprised from 0.1 mg to 10 mg per dose unit and/or from 0.05% to 1.5% by weight of the composition.       
 
         [0056]    Pharmaceutically acceptable excipients and/or vehicles:
       Compressibility vehicle: its role is as a base for active ingredients and other components of the formulation. It can be selected from: microcrystalline cellulose, lactose, starch, a mixture thereof, or another equivalent excipient, with microcrystalline cellulose being preferred. Compressibility vehicle can be present from 90.0 mg to 120 mg per unit dose and/or from 15.0% to 60.0% by weight of the composition.   Diluent binder: it is used as a carrier for the active ingredients and other components of the formulation; it can be selected from: lactose, dextrose, sucrose, mannitol, with lactose being the preferred base. The excipient can be present from 50 mg to 90 mg per dose unit and/or from 5.0% to 60.0% by weight of the composition.   Antistatic agent: allows for electrostatic charge suppression and helps in the flowability of the formulation during the manufacturing process, it can be selected from silicon dioxide, talc, a mixture thereof, or another equivalent excipient, with silicon dioxide being the preferred antistatic agent. The antistatic agent can be present from 0.5 mg to 3.0 mg per unit dose and/or from 0.002% to 1.0% by weight of the composition.   Disintegrant: Helps in the expansion of the pharmaceutical form when being in contact with water, allowing for the compressed pellet disintegration once it enters the organism; it can be selected from sodium croscarmellose, sodium starch glycolate, mixtures thereof, or another equivalent excipient, with sodium croscarmellose being the preferred disintegrant. The disintegrant can be present from 2.0 mg to 6.0 mg per dose unit and/or from 0.5% to 2.5% by weight of the composition.   Lubricant: it is selected from magnesium stearate, magnesium phosphate, stearic acid, glyceryl stearate, polyethylene glycol, sodium stearyl fumarate, talc, a mixture thereof, or another equivalent excipient, with magnesium stearate being preferred. The lubricant can be present from 3.0 mg to 5.0 mg per unit dose and/or from 0.5% to 2.5% by weight of the composition.   Plasticizer: it is incorporated as a fragility reducer as well as a modifier of both film plasticity and elasticity; it is selected from polyethylene glycol, propylene glycol, among other glycol derivatives; with propylene glycol being the preferred plasticizer. The plasticizer can be present from 1.5 mg to 3.5 mg per unit dose and/or from 0.2% to 11.5% by weight of the composition.   Ligand binder polymer: helps in the adhesion and cohesion of the components of the formulation, it is selected from polyvynilpyrrolidone, hydroxypropyl cellulose, hypromellose, a mixture thereof, or another equivalent excipient, with hypromellose being the preferred ligand binder polymer. The polymer can be present in said formulation from 25.0 mg to 45.0 mg per dose unit and/or from 5.0% to 40.0% by weight of the composition.   Coating polymer: provides protection to the compressed pellet, improves handling and stability strength while in storage; it is selected from methacrylate copolymer derivatives (Opadry), hydroxypropylmethyl cellulose, polyvinylpyrrolidone or another equivalent excipient; with Opadry being the preferred coating polymer. The polymer can be present from 10.0 mg to 16.0 mg per unit dose and/or from 1.5% to 7.5% by weight of the composition.   Coating and finishing polymer: improves appearance and is formulation-distinctive, and besides providing good appearance, it masks taste or unpleasant odors; it can be selected from celullose derivatives and methacrylates (Opaglos), polyvynilpyrrolidone, polyvinyl alcohol, hydroxypropylmethyl cellulose, polyethylene glycol or another equivalent excipient; with either polyethylene glycol or Opaglos being the preferred coating and finishing polymers. The polymer can be present from 1.0 mg to 3.0 mg per unit dose and/or from 0.5% to 7.5% by weight of the composition.       
 
         [0066]    The following table shows the general formula, without limiting the formulation; it is possible to make the composition by varying compound amounts within useful permissible range limits. 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 GENERAL FORMULATION OF COMPRESSED PELLETS, TABLETS 
               
             
          
           
               
                   
                 Permisible limits of use 
               
               
                 Ingredients 
                 milligrams/unit dose 
               
               
                   
               
               
                 Ketorolac tromethamine 
                  2-40 
               
               
                 Thiamine hydrochloride 
                  15-250 
               
               
                 Pyridoxine hydrochloride 
                  15-250 
               
               
                 Cyanocobalamin 
                 0.1-10  
               
               
                 Compressibility vehicle 
                  90-300 
               
               
                 Diluent binder 
                 50.0-90.0 
               
               
                 Disintegrant 
                  2-15 
               
               
                 Antistatic agent 
                  0.5-10.0 
               
               
                 Lubricant 
                 2.5-7.5 
               
               
                 Ligand binder polymer 
                 25-65 
               
               
                 Plasticizer 
                 1.5-7.5 
               
               
                 Coating polymer 
                 10-20 
               
               
                 Coating and finishing polymer 
                 1.0-3.0 
               
               
                 Purified water* 
                 Cbp 
               
               
                 Total 
                 aprox. 340-1000 mg 
               
               
                   
               
               
                 *It evaporates during processing 
               
             
          
         
       
     
         [0067]    The following example shows the object of the invention as tablets, however without limiting the invention. 
         [0000]    
       
         
               
             
               
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 ORAL FORMULATION OF COMPRESSED PELLETS, TABLETS 
               
             
          
           
               
                   
                 Miligrams/unit dose 
               
             
          
           
               
                 Ingredients 
                 Formulation 1 
                 Formulation 2 
                 Formulation 3 
               
               
                   
               
             
          
           
               
                 Ketorolac 
                 2 
                 5.0 
                 40 
               
               
                 tromethamine 
                   
                   
                   
               
               
                 Thiamine 
                 15 
                 50.0 
                 250 
               
               
                 hydrochloride 
                   
                   
                   
               
               
                 Pyridoxine 
                 15 
                 50.0 
                 250 
               
               
                 hydrochloride 
                   
                   
                   
               
               
                 Cyanocobalamin 
                 0.1 
                 1.0 
                 10 
               
               
                 Compressibility 
                 300 
                 110.4 
                 90 
               
               
                 vehicle 
                   
                   
                   
               
               
                 Diluent binder 
                 90 
                 73 
                 50 
               
               
                 Disintegrant 
                 15 
                 4.3 
                 2 
               
               
                 Antistatic agent 
                 10 
                 1.5 
                 0.5 
               
               
                 Lubricant 
                 7.5 
                 4.3 
                 2.5 
               
               
                 Ligand binder 
                 65 
                 35.7 
                 25 
               
               
                 polymer 
                   
                   
                   
               
               
                 Plasticizer 
                 7.5 
                 2.3 
                 1.5 
               
               
                 Coating polymer 
                 20 
                 13.0 
                 10 
               
               
                 Coating and 
                 3.0 
                 2.1 
                 1.0 
               
               
                 finishing polymer 
                   
                   
                   
               
               
                 Purified water* 
                 cbp 
                 cbp 
                 cbp 
               
               
                 Total 
                 aprox. 440 mg 
                 aprox. 440 mg 
                 aprox. 1000 mg 
               
               
                   
               
               
                 *It evaporates during processing 
               
             
          
         
       
     
         [0068]    A preparation method of said composition is described below. The following example shows the object of the invention by means of the tablet formulation, however it does not limit the invention to this specific example. 
         [0069]    1. Weighing of formulation components. 
         [0070]    2. Mixing the compressibility vehicle: 110.4 mg microcrystalline cellulose; active ingredients: 5.0 mg ketorolac, 50.0 mg thiamine, 50.0 mg cyanocobalamin; antistatic agent: 1.5 mg silicon dioxide; diluent binder: 73.0 lactose; lubricant: 4.3 mg magnesium stearate, disintegrant: 4.3 mg sodium croscarmellose; and plasticizer: 2.3 mg propylene glycol. 
         [0071]    3. Compressing the mixture obtained from step 2. 
         [0072]    4. Coating the compressed mixture with 34.6 mg hypromellose. 
         [0073]    5. Separately, dissolving the active ingredient, 50 mg pyridoxine, in water. 
         [0074]    6. Applying the solution from step 5 to the compressed mixture from step 4. 
         [0075]    7. Applying to the compressed mixture of step 6, a coating comprising the coating polymer, preferable Opadry, 13.0 mg. 
         [0076]    8. Optionally, applying to the tablet obtained from step 7, a solution comprising polymer and finisher, preferably 2.1 mg polyethylene glycol or 2.1 mg Opaglos. 
         [0077]    9. Conditioning the tablet. 
         [0078]    The formulations in coated compressed tablet forms were evaluated in stability studies in order to demonstrate that said formulations are robust and can keep their stability. 
         [0079]    Chart 1. Stability study for oral compositions in compressed pellets, tablets. These tablets were prepared according to the preferred form of formulation 2 of table 2. 
         [0080]    The evaluated parameters were formulation appearance, worthiness and stability. 
         [0081]    Stability Study Results 
         [0000]    
       
         
               
               
               
             
               
               
               
               
               
             
           
               
                   
               
               
                   
                 Initial Time 
                 Final Time 
               
             
          
           
               
                   
                 Formulation by  
                 Formulation 
                 Formulation by  
                 Formulation 
               
               
                 Parameter  
                 simple association 
                 according to the  
                 simple association 
                 according to the  
               
               
                 to be evaluated 
                 of active agents 
                 present invention 
                 of active agents 
                 present invention 
               
               
                   
               
               
                 Appearance 
                 Excellent 
                 Excellent 
                 Non-Satisfactory 
                 Excellent 
               
               
                 Worthiness 
                 96.0 % 
                 96.7 % 
                 59.3 % 
                 93.0 % 
               
               
                 Stability 
                 98.0 % 
                 99.2 % 
                 62.3 % 
                 94.0 % 
               
               
                   
               
             
          
         
       
     
         [0082]    Wherein, excellent, satisfactory and non-satisfactory mean: 
         [0083]    Excellent: Full integrity of the tablet (circular), with an even coating or layer, tablet shows homogeneous color. 
         [0084]    Satisfactory: Full integrity of the tablet (circular), with an even coating or layer, tablet shows opaque or non-homogeneous color. 
         [0085]    Non-satisfactory: Porous tablet, cracked coating or layer, tablet shows non-homogeneous color. 
         [0086]    According to the results obtained, the present invention formulations prove being stable and robust against environment conditions, indicating that they are safe for administration and effective in their therapeutic activity. 
         [0087]    On the other hand, a comparative clinical study of the present invention formulation against a commercial diclofenac plus B-complex formulation was carried out in patients suffering from knee or hip arthrosis grade III and IV, before they were submitted to replacement surgery. 
         [0088]    The analgesic effect of ketorolac-vitamins against diclofenac-vitamins B was compared in patients with chronic pain caused by the degenerative joint disease. This study was applied to persons within 40 and 60 years old, men or women, having pain greater than or equal to 5 according to the visual analog scale (1-10), patients were not taking any drugs that could interfere with the pharmacokinetics or efficacy of active ingredients included in the formulations of the present study, they were hospitalized as candidates scheduled for surgery. 
         [0089]    The studied formulations were: Diclofenac in combination with vitamins B1, B6 and B12 of 50 mg, 50 mg, 50 mg and 0.25 mg (Dolo-Neurobion®); and ketorolac in combination with B1, B6 and B12 of 5 mg, 50 mg, 50 mg, and 1 mg. 
         [0090]    The study was carried out according to a parallel experimental design. Two groups of 10 patients each were formed. Patients were given ketorolac-vitamins B or diclofenac-vitamins B every 8 hours per day, and pain was recorded according to the analog visual scale. 
         [0091]    Group 1 received a formulation containing diclofenac and B-complex (commercial formulation), while Group 2 received a formulation comprising 5 mg ketorolac, 50 mg thiamine, 50 mg pyridoxine and 1 mg cianoconalamin. It should be noted that the diclofenac and B-complex formulation used in this study contains 5 mg ketorolac which is half the typical dose used in oral commercial ketorolac formulations of 10 mg per unit dose. 
         [0092]    Timing plots of the effect were obtained and the Area Under the Curve of said effect was calculated. 
         [0093]    The treatment designation was made randomly and a formulation was administered every 8 hours. Pain was evaluated by means of a 10 cm analog visual scale before administering said formulations and at 0.5, 1, 2, 4, 6, 8, 12, 16, and 24 hours after drug administration. At the end of the study patients were surveyed about the overall evaluation of pain relief associated with the pain at the time they were admitted in the study. 
         [0094]      FIG. 1  shows the timing plot of the analog visual scale in 10 patients who received treatment with diclofenac-vitamins B every 8 hours (black circles) and 10 patients who received ketorolac-vitamins B every 8 hours (white circles). Data are expressed as average ±standard error. 
         [0095]    It can be seen that, in average, patients start with a pain between 8 and 9 (indicating severe pain). Under these conditions, it was observed that both treatments were able to produce a similar analgesic effect; no significant difference was encountered among these treatments. 
         [0096]      FIG. 2  shows the first eight hours of the timing plot for the analog visual scale in patients having received diclofenac-vitamins B (black circles) and ketorolac-vitamin B (white circles). A similar behavior can be observed from both treatments, with a small tendency of ketorolac-vitamins B to produce a higher effect. The area under the curve (AUC) was plotted up to 24 hours ( FIG. 3 ) and up to 8 hours ( FIG. 4 ). In both cases, it was observed that ketorolac-vitamins B (Column A) produced a slightly higher effect in relation to diclofenac-vitamins B (Column B), most of all, at 24 hours. On the other hand, it was observed that 80% of the patients treated with the ketorolac-vitamins B combination reported full relief and 20% moderate relief; while in the case of the diclofenac-vitamins B treatment, 50% of the patients reported full relief and 50% moderate relief. 
         [0097]    In this study, the ketorolac-vitamins B combination was evaluated regarding whether it is at least as effective as the diclofenac-vitamins B combination in a similar dosage scheme. 
         [0098]    It is important to consider that in a typical treatment with ketorolac as a monodrug, dosage is 10 mg every 6 hours, in the present study a ketorolac-B complex combination was used wherein ketorolac is present as a 5 mg dose and administered every 8 hours. Less than half the daily ketorolac dose was administered, which will result in a reduced incidence of adverse effects. 
         [0099]    Based on the clinical study results, it can be concluded that the combination of ketorolac and vitamins B is a good option in pain treatment and it is perfectly justified. 
         [0100]    According to the foregoing, the present invention discloses pharmaceutical compositions indicated in the prevention and treatment of pain from moderate to severe, said compositions can be administered in a same dose unit. 
         [0101]    Formulations presented in this invention are physicochemically stable as well as therapeutically effective, this was achieved by developing compositions that prevent direct contact between the active ingredients, which are incompatible one another, contained in separate compartments in order to avoid physicochemical interactions. 
         [0102]    In formulating said compositions in separate compartments, wherein both active ingredients and excipients are added independently and in separately, a non-oxidative balance is obtained, preventing degrading interactions that otherwise would appear between active ingredients. 
         [0103]    The obtained formulations do not limit the content of active ingredients to the exemplary formulations described herein, since these formulations could vary in ketorolac and B complex content. That is to say, ketorolac can be present in 5 mg, 10 mg, 15 mg, 30 mg, and up to 40 mg per unite dose. B-complex can be present from 25 mg, 50 mg, 100 mg, 150 mg, and up to 250 mg thiamine; 25 mg, 50 mg, 100 mg, 150 mg, and up to 250 mg pyridoxine; and 1 mg, 2 mg, 5 mg, and 10 mg cyanocobalamin. 
         [0104]    A preferred formulation, without limiting the scope of the present invention, contains 5.0 mg ketorolac, 50.0 mg vitamin B1, 50 mg vitamin B6 and 1.0 mg vitamin B12. 
         [0105]    The formulations of the present invention provide for a better control of the plasmatic level of drugs, by being evenly distributed within the gastrointestinal tract since they are readily dissolved and have immediate release, resulting in less bioavailability variations, and providing better control both in the administration regime and therapeutic monitoring. 
         [0106]    Compared to existing products of NSAIDs alone, combinations of NSAID with B-complex and opiate with B-complex, the present invention can provide a remarkable reduction in adverse side effects; this is obtained by using a low ketorolac dosage, without compromising the therapeutic effect, and because ketorolac acts synergistically with B-complex in pain treatment. 
         [0107]    The present invention embodied as tablets, does not limit its presentation, and can be applied to other pharmaceutical forms such as: microspheres in capsules, microcapsules, or other spherical or non-spherical particulate systems, and other solid pharmaceutical forms as compressed pellets. 
         [0108]    In the case of microencapsulated formulations, the cited excipients used in tablets are mostly employed in addition or instead of: inert cores, antioxidant sequestrants and antioxidants, without limiting the use thereof. 
         [0000]    
       
         
               
             
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Oral Formulation of capsules with microspheres 
               
             
          
           
               
                   
                   
                 Range of use 
               
               
                   
                 Ingredients 
                 milligrams/unit dose 
               
               
                   
                   
               
               
                   
                 Ketorolac tromethamine 
                  2-40 
               
               
                   
                 Thiamine hydrochloride 
                  15-250 
               
               
                   
                 Pyridoxine hydrochloride 
                  15-250 
               
               
                   
                 Cyanocobalamin 
                 0.1-10  
               
               
                   
                 Inert cores 
                 160-400 
               
               
                   
                 Coating polymer 
                 10-20 
               
               
                   
                 Antioxidant sequestrant 
                 0.02-0.5  
               
               
                   
                 Ligand binder polymer 
                 0.02-0.5  
               
               
                   
                 Antioxidant 
                 0.001-0.5  
               
               
                   
                 Coating and finishing polymer 
                 10-20 
               
               
                   
                 Purified water* 
                 cbp 
               
               
                   
                 Total 
               
               
                   
                   
               
             
          
         
       
     
         [0109]    By virtue of the foregoing, the present invention provides oral pharmaceutical compositions comprising ketorolac and B-complex in a single dose unit, without compromising their release, the compositions are useful in the treatment of moderate to severe pain, while reducing incidence and severity of adverse side effects. 
         [0110]    The invention has been sufficiently disclosed so that a person with ordinary skill in the art can reproduce and obtain the results as recited in the present disclosure. Nonetheless, any person skilled in the art of the present invention may be able to make modifications thereto, which changes are not described specifically in the present invention. However, if application of said modifications in a given composition requires the subject matter as claimed in the following claims, said compositions should be considered as being within the scope of the present invention.