Abstract:
The invention provides novel compositions of water-insoluble corticosteroid drug in combination with antimicrobial agents and very low concentrations of polymers and surfactants for topical, otic and ophthalmic treatment. The invention provides stable aqueous suspension where the ingredients remain in such a state so as to allow for immediate re-suspension, when desired, even after extended periods of settling. The invention provides also a method for treating inflammation with low systemic absorption and side-effects of the corticosteroid.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     Typically topical, otic, or ophthalmic products containing water insoluble steroid(s) alone or in combination with antimicrobial agent(s) are very greasy because of mineral oil or petrolatum present in the suspension. Such products are very hard to instill and spread into the ear canal or skin folds, especially on haired areas. In the case of otic application, the “oily residue” stays in the ear canal after application for prolonged periods of time, which is not desirable.  
         [0002]     There are some aqueous suspensions (for example, Lotemax Suspension, for ophthalmic use) or oil-in-water lotion products for topical use. However, many of these products still leave non-drug residues because of high concentrations of suspending agents (0.2% w/w for example), surfactants (2-5% w/w) and/or oily components (2-10% w/w) which may cause harmful effects. The ideal topical, otic, or ophthalmic formulation should be low in residues, isotonic, aqueous based, and physically and chemically stable.  
         [0003]     In U.S. Pat. No. 5,540,930, the non-ionic polymer concentration in its steroid composition is about 0.2-2% w/w and the claimed molar concentration range for the steroid:non-ionic-polymer:surfactant is between about 1:20:1 and about 1:0.01:0.5. U.S. Pat. No. 5,540,930 indicates that the polymer used in the formulation has to be non-ionic.  
         [0004]     A reduction in amount of polymer and surfactant used in a steroid composition should be beneficial to the biological membrane. Thus, there exists a need for aqueous suspensions of water insoluble corticosteroids, which are free of problems of prior art formulations which can be easily applied.  
       SUMMARY OF THE INVENTION  
       [0005]     The present invention provides formulations having very low concentrations of non-ionic polymers and very low concentrations of surfactants. The present invention also provides formulations having ionic polymers and very low concentrations of surfactants. It is surprisingly found that at the low concentrations of non-ionic polymers (e.g., 0.005% to 0.2% w/w), the re-suspension of the drug substance is better than the formulation comprising conventional concentrations (i.e., 0.2˜2% w/w) of non-ionic polymers. The following table shows molar ratios of steroid, polymers, and surfactant that can be used in this invention. These molar ratios of non-ionic polymer and surfactant range from about 1.7 to more than 1300 fold below the limits of U.S. Pat. No. 5,540,930,  
                                                                                                         U.S. Pat. No. 5,540,930           MW   % w/w   mM   Molar ratio   Molar Ratio Lower limit                                    Etiprednol   485.41   0.2   4.120228    1   1       Dicloacetate       Methocel ®   86,000   0.005-0.2   0.005814-0.0232558    0.000141-0.0056443   0.01       F4M       Merquat ®   1,600,000   0.005-2     0.000313-0.0125     0.0000076-0.003034    Doesn&#39;t have non-       550 (9%                   ionic polymers.       solid)       Tyloxapol   5,000   0.005-0.3   0.01-0.2    0.0024271-0.0485410   0.5       Loteprednol   466.96   0.2   4.2830221   1   1       etabonate       Methocel ®   86,000   0.005-0.2   0.005814-0.0232558    0.000141-0.0056443   0.01       F4M       Merquat ®   1,600,000   0.005-2     0.000313-0.0125     0.0000076-0.003034    Doesn&#39;t have non-       550 (9%                   ionic polymers.       solid)       Tyloxapol   5,000   0.005-0.3   0.01-0.2    0.0024271-0.0485410   0.5                  
 
         [0006]     In addition to the unexpected improvements in physical properties, the use of low concentrations of surfactant and non-ionic polymer also surprisingly improves the pharmacological profile when compared to the formulation of drug suspended in mineral oil or without polymer. This second unexpected result is the reduction in systemic absorption of steroid, which is highly desirable given the side effects of steroidal drugs. Furthermore, contrary to U.S. Pat. No. 5,540,930, which is limited to non-ionic polymer only, however, we have also discovered that ionic polymers (e.g., Merquat® 550 and/or Xanthan gum) also work well in the present steroidal formulations.  
         [0007]     Thus, surprisingly, we have found that by reducing the concentration of surfactant (e.g., Tyloxapol) from the prior art teaching of 0.3-2% w/w to 0.005-0.3% w/w and by either adding an ionic polymer or a low concentration, 0.005-0.2% w/w, of non-ionic polymer, the systemic absorption and as a consequence, the systemic (side) effect of anti-inflammatory corticosteroids, could be reduced by approximately 60%.  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0008]     A soft steroid antimicrobial combination topical and/or otic formulation has broad application for inflammatory conditions complicated by secondary bacterial and/or fungal infections. In fact, most ear and skin infections in companion animals are precipitated by an inflammatory process.  
         [0009]     Examples of cutaneous and otic inflammatory diseases include but are not limited to: 
        Parasites such as  Otodectes cynotis, Demodex  spp.,  Sarcoptes scabiei, Notoedres cati, Cheyletiella  spp.,  Ctenocephalides felis       Foreign bodies such as plant awns     Hypersensitivity and allergic diseases such as atopic dermatitis and otitis, food related dermatitis and otitis, contact allergic and irritant cutaneous and otic reactions, feline eosinophilic dermatitis     Autoimmune diseases such as pemphigus foliaceus, pemphigus erythematosus, pemphigus vulgaris, pemphigus vegitans, discoid lupus erythematosus, cutaneous vasculitis, bullous pemphigoid, and mucous membrane pemphigoid        
 
         [0014]     Bacterial and fungal infections may present secondary to the above inflammatory diseases or as primary infections. Common canine and feline cutaneous and/or otic pathogens include but are not limited to: 
         Staphylococcus intermedius        Staphylococcus aureus        Staphylococcus schleiferi        Pseudomonas aeruginosa        Streptococcus  spp.      Proteus mirabilis        Escherichia coli        Corynebacterium  spp.      Enterococcus  spp.      Malassezia pachydermatis        Candida  spp.        
 
         [0026]     Systemic side effects are a limiting factor in the long-term use of anti-inflammatory corticosteroids. These side effects are well documented and include 
        suppression of the adreno-pituitary axis resulting in Cushing-syndrome,     immunosuppression by a reduction in cell-mediated immunity and decreased antibody production, thus, increasing the risk of infections,     retention of sodium and water and hence edema,     urinary potassium increase, which leads to hypokalemia and metabolic alkalosis,     hyperglycemia,     delay in wound healing,     altered calcium metabolism with prolonged treatment, resulting in osteoporosis and bone fractures,     reduction in GI motility, thinning of the gastric mucosa, and reduced mucus production, thus resulting in gastrointestinal ulceration.        
 
         [0035]     Therefore, a significant reduction in systemic absorption of steroid from formulation, which results in a safer long-term use of corticosteroids is highly desirable.  
         [0036]     Some of the materials and their sources that can be used in the current inventions are listed below. The first table lists examples of water insoluble corticosteroids and anti-microbial agents that can be combined with the steroids. More than one steroid or more than one anti-microbial can be used in the present invention.  
                                       Drug substance   Manufacturer   Address                   Hydrocortisone Acetate micronized   Shandong   China           Xinhua       Hydrocortisone Acetate micronized   Roussel Uclaf   Paris, France       Betamethasone dipropionate   Sicor   Via       micronized       Terrazzano,               Italy       Betamethasone dipropionate   Pfizer   Kalamazoo, MI       Micronized       Betamethasone Valerate, Micronized   Pfizer   Kalamazoo, MI       Triamcinolone acetonide, Micronized   Pfizer   Kalamazoo, MI       Clotrimazole micronized   Erregierre,   Sovere, Italy           S.p.A.       Polymyxin B sulfate   Alphrama APS   Copenhagen,               Denmark                  
 
         [0037]    
       
         
               
               
               
               
             
           
               
                   
               
               
                   
               
               
                 Generic name 
                 Trade Name 
                 Manufacturer 
                 Address 
               
               
                   
               
             
             
               
                 Hydroxypropylcellulose 
                 Klucel GF Pharm 
                 Hercules 
                 Wilmington DE 
               
               
                 HydroxyETHYLcellulose 
                 Natrosol 250HHX 
                 Hercules 
                 Wilmington DE 
               
               
                 HydroxyETHYLcellulose 
                 Natrosol 250H 
                 Hercules 
                 Wilmington DE 
               
               
                 Hydroxypropylmethylcellulose 
                 Methocel ® F4M Prem 
                 Dow Chem 
                 Midland Michigan 
               
               
                 Hydroxypropylmethylcellulose 
                 Methocel ® K4M Prem 
                 Dow Chem 
                 Midland Michigan 
               
               
                 Polyvinyl alcohol 
                 Celvol V540 
                 Celanese 
                 Dallas, Tx 
               
               
                 Polyethylene glycol 
                 Polyox WSR N60K NF 
                 Dow Chem 
                 Midland Michigan 
               
               
                 Xanthan gum 
                 Kaltrol CGF 
                 Kelco Biopolymers 
                 Chicago, IL 
               
               
                 Polyquaternium 7 series 
                 Merquat ® 550 (9% solid) 
                 Nalco 
                 Naperville, IL 
               
               
                 Tyloxapol 
                 Tyloxapol, USP 
                 Ruger Chemical Co. 
                 Irvington, NJ 
               
               
                   
               
             
          
         
       
     
         [0038]     Additional surfactants include, but are not limited to, polysorbate 80, TWEEN 80 (ICI America Inc., Wilmington, Del.), PLURONIC F-68 (from BASF, Ludwigshafen, Germany) and poloxamer surfactants. Additional non-ionic polymers include, but are not limited to dextrans and other hydroxypropylmethylcelluloses, hydroxyethylcelluloses, hydroxypropylcelluloses, polyvinyl alcohols, and polyethylene glycols not listed above. Additional ionic polymers include, but are not limited to other xanthan gums and other highly charged cationic homo- or co-polymers (e.g., other copolymer of diallyl dimethyl ammonium chloride and acrylamide) not listed above.  
         [0039]     The amount of surfactant present can range from 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, to 0.3% w/w, with other ranges and examples including (a) 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, to &lt;0.3% w/w, (b) 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, to 0.05% w/w, and (c) 0.01% w/w. When no ionic polymer is present in the formulation, then the amount of surfactant present is preferably &lt;0.3% w/w. The amount of non-ionic polymer present can range from 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.11, 0.12, 0.13, 0.14, 0.15, 0.16, 0.17, 0.18, 0.19, to 0.20% w/w with other ranges and examples including (a) 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.11, 0.12, 0.13, 0.14, 0.15, 0.16, 0.17, 0.18, 0.19, to &lt;0.20% w/w, (b) 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, to 0.05% w/w, and (c) 0.01% w/w. When no ionic polymer is present in the formulation, then the amount of non-ionic polymer present is preferably &lt;0.2% w/w. The amount of ionic polymer is not specifically limited, but can range from 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, to 2.0% w/w with other ranges and examples including (a) 0.005, 0.006, 0.007, 0.008, 0.009, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, to 1.0% w/w, (b) 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, to 0.50, % w/w, (c) 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.11, to 0.12% w/w, (d) 0.12% w/w and (e) 0.01% w/w. Both a non-ionic and ionic polymer can be present in the present invention.  
         [0040]     The molar ratio of water insoluble corticosteroid, polymer (e.g., non-ionic polymer), and surfactant can be between about 1:0.000001:0.001 to about 1:0.01:0.49. Another example of this molar ratio is between about 1:0.0014:0.002 to about 1:0.006:0.15. These ratios are typically used when a non-ionic polymer is present, but can also apply when an ionic polymer is present.  
         [0041]     Pharmaceutically acceptable excipients, as used herein, include anything that one of ordinary skill in the art would add to a composition in order to aid in its manufacture, stability, marketing, etc. Examples of excipients include, but are not limited to, preservatives (e.g., EDTA salts), glycerin, mineral oil, additional surfactants (e.g., Brij® 72 and Brij® 721), base (e.g., sodium hydroxide), acid (e.g., hydrochloric acid), methyl paraben, and water.  
         [0042]     As an example, the present invention includes oil/lotion based suspensions. This type of suspension includes an oil (e.g., mineral oil) and a second surfactant capable of emulsifying the oil. The second surfactant can be two (or more) surfactants. Surfactants capable of emulsifying oil in pharmaceutical compositions are well known. Examples of surfactant pairs include, but are not limited to Brij® 72/Brij® 721, Brij® 78/Arlacel SM  60, Brij® 72/Brij® 78, and Brij® 52/Brij® 58 (Brij® surfactants are etherified polyethylene glycols, which are available from Uniqema) (Arlacel™ 60 is a sorbitan stearate surfactant available from Uniqema). The amount of second surfactant present can be from about 0.1 to 2% w/w. This amount includes the total amount of second surfactant, if the second surfactant is a pair (or more). The molar ratio of second surfactant to corticosteroid can be about 1:1.2 to 1:10 and 1:7 to 1:9. This ratio includes the total amount of second surfactant, if the second surfactant is a pair (or more).  
       EXAMPLES  
       [0043]     Formulations in this invention include the following.  
                                                                                                                   ED-Poly-B-Clo Otic suspension                1578-   1578-   1578-   1578-   1578-   1578-   1578-           57A   64   89T   90B   90D   90E   90F       Ingredients   % w/w   % w/w   % w/w   % w/w   % w/w   % w/w   % w/w                    Etiprednol   0.2   0.2   0.2   0.2   0.2   0.2   0.2       dicloacetate       Polymyxin B   0.125   0.125   0.125   0.125   0.125   0.125   0.125       sulfate 10,000 U/g       Clotrimazole   1   1   1   1   1   1   1       Micronized       Tyloxapol   0.300   0.300   0.01   0.01   0.01   0.01   0.01       Methocel ® K4M   0.2   —   —   0.01   —   —   0.01       Methocel ® F4M   —   —   —   —   0.01   —   —       Merquat ® 550   —   2   0.556   —   —   0.278   0.01       Methylparaben   —   0.18   0.18   0.18   0.18   0.18   0.18       EDTA disodium   0.100   0.1   0.1   0.1   0.1   0.1   0.1       salts       Glycerin   2.50   2.50   2.50   2.50   2.50   2.50   2.50       NaOH pH 5.0-5.5   QS   QS   QS   QS   QS   QS   QS       Purified water   95.775   93.595   95.33   95.775   95.775   95.61   95.775       Total   100   100   100   100   100   100   100                  
 
         [0044]     The following procedures can be used to manufacture the formulations of the present invention. The non-ionic polymer, Methocel® F4M, is used as a non-limiting example. 
        1. Heat the purified water to 57-85° C., dissolve disodium edentate and tyloxapol first, then dissolve methylparaben. Disperse the Methocel® F4M and then cool to about 30° C. (Methocel® does not dissolve in hot water, so first disperse it in hot water and upon cooling, the Methocel® solution will become clear.)     2. Add glycerin to the vehicle in Step 1 and mix to dissolve.     3. For active drug substances, dissolve the water soluble drug substance (Polymyxin B sulfate in this example) in the vehicle first.     4. Add and disperse the water insoluble clotrimazole and etiprednol dicloacetate. High shear mixer would facilitate the dispersion for better uniformity.     5. Adjust the pH and QS to the final proper weight.        
 
         [0050]     Formulation 1578-90D (Methocel® F4M 0.01%, tyloxapol 0.01%) can be re-suspended easily when compared to formulation 1578-57A, which comprises higher concentration of non-ionic polymer (0.2%) and surfactant (0.3%). It takes about 25˜30 vigorous shakes to suspend the drug substances in formulation 1578-57A. It takes only about 4 shakes for formulation 1578-90D. As non-ionic polymer concentration increases, it becomes harder to re-suspend the water insoluble corticosteroid.  
         [0051]     The following additional formulations demonstrated the applicability of this type of formulation to other steroids (hydrocortisone acetate, betamethasone dipropionate, betamethasone valerate, triamcinolone acetonide) as well as polymer (Klucel, Natrosol, Methocel®, polyethylene glycol, polyvinyl alcohol, xanthan gum) combinations,  
                                                                                                             Steroid-antimicrobial suspensions                        2170-96-   2170-96-           2170-90   2170-93-3   TRM10   TRM17       Ingredients   % w/w   % w/w   % w/w   % w/w               Hydrocortisone Acetate, Microniced   1.12   —   —   —       Etiprednol dicloacetate Micronized   —   0.1   —   —       Triamcinolone acetonide Micronized   —   —   0.1   0.1       Clotrimazole Micronized   1.00   1.00   1.00   1.00       Tyloxapol   0.010   0.01   0.01   0.01       Hydroxypropyl methylcellulose   0.010   —   0.01   —       (Methocel ® F4M)       Hydroxypropyl cellulose, Klucel GF   —   0.01   —   —       Polyethylene glycol, Polyox WSR N60K   —   —   —   0.01       Methylparaben   0.18   0.18   0.18   0.18       EDTA disodium Salts   0.100   0.1   0.1   0.1       Glycerin   2.50   2.50   2.50   2.50       NaOH pH 5.0-5.5   QS   QS   QS   QS       Purified Water   95.775   95.775   95.775   95.775       Total   100   100   100   100                        Steroid-antimicrobial suspensions                2170-96-   2170-96-   2170-96-   2170-96-   2170-96-           BD5   BD-15   BV4   BV15   BV20       Ingredients   % w/w   % w/w   % w/w   % w/w   % w/w               Betamethasone dipropionate,   0.10   0.10   —   —   —       Micronized       Btamethasone valerate, Micronize   —       0.10   0.10   0.10       Clotrimazole Micronized   1.00   1.00   1.00   1.00   1.00       Tyloxapol   0.01   0.01   0.01   0.01   0.01       Hydroxyethylcellulose, Natrosol   0.01   —   —   —   —       250H       Hydroxyethylcellulose,   —   —   0.01   —   —       Natrosol 250HHX       Polyvinal alcohol   —   0.01   —   0.01—   —       (Celvol V540)       Xanthan gum (Kaltrol)   —   —   —   —   0.01       Methylparaben   0.18   0.18   0.18   0.18   0.18       EDTA disodium Salts   0.10   0.1   0.1   0.1   0.1       Glycerin   2.50   2.50   2.50   2.50   2.50       Purified Water   95.775   95.775   95.775   95.775   95.775       Total   100   100   100   100   100                  
 
         [0052]     The formulation with low concentration of surfactant (for example Tyloxapol at 0.01%) and non-ionic polymer (for example Methocel® F4M at 0.01% w/w) also reduced the systemic absorption of anti-inflammatory corticosteroids when applied topically. This was demonstrated in a validated mouse model as follows.  
         [0053]     In the following experiment, the irritant, croton oil, was applied to one earlobe of the mice in the untreated control group and to both earlobes of the mice in the treatment groups to induce inflammation. The control group was left untreated after induction of inflammation. In the treatment group, the anti-inflammatory treatment was applied to one ear, one hour after croton oil application; the opposite ear was left untreated. Assessment of the reduction in ear-weight and ear-thickness on the non-treated earlobe was performed 3 hours after treatment application. Since the measurement is performed on the untreated ear, the reduction of ear weight or thickness is due to the drug that reached the untreated ear from systemic circulation after absorption of drug at the area of treatment. Results showed statistical significance (p&lt;0.05) when the aqueous formulation with low concentration of surfactant and non-ionic polymer (Formulation 2170-79 &amp; 2170-64) was compared to pure mineral oil formulation or aqueous formulation with no polymer (Formulation 2170-20).  
         [0054]     Systemic effect of aqueous suspension and oil suspension on the opposite non-treated ear,  
                                                                                         Ear weight (mg) mean +/− sd            N = 20   N = 20   N = 20       Untreated control   Betamethasone 0.1% in   Betamethasone 0.1% in       group   aqueous formulation   pure mineral oil* group           2170-64* group       47.53 +/− 5.66   40.18 +/− 4.29 a     34.93 +/− 3.09 a,b              Reduction in   (40.18-47.53)/(34.93-47.53) × 100 = 58%       systemic effect=            Ear thickness (×10 −2  mm)) mean +/− sd            N = 20   N = 20   N = 20       Untreated control   Betamethasone 0.1% in   Betamethasone 0.1% in       group   aqueous formulation   pure mineral oil* group           2170-64* group       36.4 +/− 4.85   28.95 +/− 3.97 a     24.92 +/− 2.20 a,b              Reduction in   (28.95-36.4)/(24.92-36.4) × 100 = 65%       systemic effect=                  
 
         [0055]     Systemic effect of two aqueous suspensions on the opposite non-treated ear,  
                                                                                         Ear weight (mg) mean +/− sd            N = 40   N = 20   N = 20       Untreated control   Etiprednol dicloacetate   Etiprednol dicloacetate       group   0.2% in aqueous   0.2% in aqueous           suspension 2170-79*   suspension 2170-20*           with 0.01% polymer   with. no polymer       46.51 +/− 4.77   39.34 +/− 6.27 a     35.75 +/− 3.27 a,b              Reduction in   (39.34-46.51)/(35.75-46.51) × 100 = 67%       systemic effect            Ear thickness (×10 −2  mm)) mean +/− sd            N = 40   N = 20   N = 20       Untreated control   Etiprednol dicloacetate   Etiprednol dicloacetate       group   0.2% in aqueous   0.2% in aqueous           suspension 2170-79*   suspension 2170-20*           with 0.01% polymer   with. no polymer       34.58 +/− 4.58   28.60 +/− 3.95 a     25.40 +/− 3.23 a,b              Reduction in   (28.60-34.58)/(25.40-34.58)_× 100 = 65%       systemic effect                 *See below for formulation.            ANOVA (p &lt; 0.05; Two-sides)              a Statistically significant when compared to the untreated control group              b Statistically significant when compared to the formulation 2170-64 or 2170-79             
 
         [0056]    
       
         
               
               
             
               
               
               
               
               
             
           
               
                   
                   
               
               
                   
                   
               
               
                   
                 ED-Otic suspension 
               
             
          
           
               
                   
                 2170-20 
                 2170-79 
                 2170-64 with 
                 Betamethasone 
               
               
                   
                 series 
                 series 
                 betamethasone 
                 in mineral oil 
               
               
                 Ingredients 
                 % w/w 
                 % w/w 
                 % w/w 
                 % w/w 
               
               
                   
               
               
                 Etiprednol 
                 0.2-0.8 
                 0.05-0.2 
                 — 
                 — 
               
               
                 dicloacetate 
               
               
                 Betamethasone 
                 — 
                 — 
                 0.1 
                 0.1 
               
               
                 Tyloxapol 
                 0.300 
                 0.01 
                 0.01 
                 — 
               
               
                 Methocel ® F4M 
                 — 
                 0.01 
                 0.01 
                 — 
               
               
                 Methylparaben 
                 0.18 
                 0.18 
                 0.18 
                 — 
               
               
                 EDTA disodium 
                 0.050 
                 0.1 
                 0.1 
                 — 
               
               
                 Salts 
               
               
                 Glycerin 
                 2.500 
                 2.50 
                 2.50 
                 — 
               
               
                 Mineral oil 
                 — 
                 — 
                 — 
                 QS 
               
               
                 NaOH pH 5.0-5.5 
                 QS 
                 QS 
                 QS 
                 — 
               
               
                 Purified Water 
                 95.775 
                 95.775 
                 95.775 
                 — 
               
               
                 Total 
                 100 
                 100 
                 100 
                 100 
               
               
                   
               
             
          
         
       
     
         [0057]     When comparing re-suspensions of (1) an aqueous based suspension and (2) an oil/lotion based suspension, it was found that the better choice was the oil/lotion based suspension. Surprisingly, the suspension in oil/lotion improved upon aging as it stayed suspended for a longer period than the non-lotion suspension (i.e., no mineral oil or Brij® surfactants). Oil/lotion based suspension have an oil (e.g., mineral) that is suspended by the presence of a surfactant (e.g., Brij® 72 and 721). The surfactant of the oil/lotion based suspension is in addition to the first surfactant discussed previously. An example of an oil/lotion formulation is shown below.  
                                                           Oil/lotion based suspension                Ingredient   % w/w                            Etidprednol dicloacetate, micronized   0.2           Clotrimazole, micronized   1           Polymyxin B sulfate USP   0.1375           Tyloxapol USP   0.01           disodium Edetate, USP   0.1           Glycerine USP   2.5           Hypromellose USP 2906 (Methocel ® F4M)   0.01           Merquat ® 550 9%   0.12           Light mineral oil   2           Brij ® 72 (Polyethylene Glycol 2 Sterayl ether)*   0.45           Brij ® 721 (Polyethylene Glycol 21 Sterayl ether)*   0.55           Sodium hydroxide NF   0.001           Sodium hydroxide NF adjust pH to 5.0˜5.5   QS           Hydrochloric acid, adjust pH to 5.0˜5.5   QS           Purified water USP, QS   QS                         *Brij ® 72 and Brij ® 721 are surfactants the act in combination as the second surfactants of the present invention.