Patent Description:
Vials are one of the most widely used containers for drug and vaccine storage. A vial-based storage container system typically consists of a vial, an elastomeric stopper and a crimp seal or stopper retainer. A drug vial for an injectable fluid consists of cylindrical vial made of glass or plastic, an elastomeric stopper and Cap/Seal. The Cap/Seal consists of a plastic lid and an aluminum crimp. Drug is filled into the vial in an automated filling line under aseptic conditions. This is then sealed with an elastomeric stopper. The stopper is then secured with a Cap/Seal using a crimping step. The drug vial has completed the fill finish process and is sent to the use site after labeling and enclosed in a secondary package (e.g., a box). When the user receives the vial, they remove the plastic lid and use an alcohol swab to sanitize the exposed portion of the stopper. In the case where the injection needle is same as the transfer needle, the needle is attached the syringe and inserted into the septum. The vial is inverted and the drug is drawn into the syringe by pulling the plunger rod of the syringe. The volume of drug drawn is conventionally higher than the volume of drug intended for injection into the patient. The initial stroke draws air into the syringe; the volume is this air corresponds to the dead space in the transfer needle and the syringe. This air is followed by drug drawn from the vial with the syringe and drawn needle oriented upwards. The vial is then detached, the user advances the plunger rod until the air is purged and a drop(s) is(are) visible - this is needle priming. The user then further advances the plunger rod until the stopper aligns with the dose reference marking corresponding to the intended dose volume; markings are printed on the external surface of the syringe barrel. In applications where injection and transfer needle are different, the aforementioned priming step is preceded by a step to substitute the transfer needle with the injection needle. In a setup involving a conventional vial adapter, the vial adapter substitutes the aforementioned transfer needle.

The dimensions and materials of these vials and associated components typically confirm to an industry standard such as ISO <NUM>. Conformance to this standard ensures compatibility for integration with equipment for filling the injectable substance, stoppering and its eventual storage in the a vial. Depending on the number of doses that can be drawn from a vial, vials can either be a single dose vials (SDV) or multi-dose vials (MDV). MDVs contain two or more doses.

Dead space in a syringe or needle is the volume in the syringe and needle, where typically the drug product remains undelivered at the end of injection. The volume of drug filled in a vial is usually determined as the sum total of indicated dose volume, dead space in syringe, dead space in the injection needle and dead space in any drug transfer devices (e.g., filter needle, connectors, vial adaptors, etc.) employed. In the case of MDVs, the effect of dead space is multiplied by a factor equal to or greater than the number of doses intended to be contained within the vial. The volume of drug (or vaccine) that is not injected but provided in the drug vial is called "overfill" volume. The overfill is small relative to dose volume for injections greater than <NUM> microliters (<NUM> milliliter). For small dose volumes, however, the overfill can be significant relative to the volume of the dose. In the example of a drug Luxturna, only on the order of <NUM>% of the drug filled in the vial is ultimately injected into the patient. That is, on the order of <NUM>% of the vial fill volume is wasted. This waste occurs at the point of drug administration.

There is tremendous effort and expenses involved filling and finishing of sterile pharmaceutical drugs; this includes materials, facility, energy, storage, etc. Minimizing overfill, and hence waste, can result in significant cost savings. Minimizing overfill waste can be important in relation to injectable agents used as emergency countermeasures such as pandemic vaccines and therapeutics. Minimizing vaccine waste at the point of use during a pandemic can help inoculate population faster in order to control pandemic spread. Given the amount of energy involved in the manufacture, storage and supply of a drug/vaccine, minimizing waste at point of injection is also a sustainability imperative. The bottom-line is that overfill equals waste; the overfill volume is never injected into a patient.

Unfortunately, overfill requirements have also been encoded into industry standards that prescribe the total volume of drug to be filled in a vial including the overfill. One such industry standard is "USP (US Pharmacopeia) General Chapter <<NUM>> Pharmaceutical Dosage Forms". Compliance to this standard in some instances can also be part of a recommendation by regulatory agencies. This USP standard prescribes the volume of injectable substance (drug or vaccine) to be filled to be stored in a vial; this filled volume is always greater than the indicated dose volume. Most regulatory agencies require that overfill ensures that a complete dose is always delivered. Summarized in below, is the overfill volume corresponding to indicated dose volume as prescribed by USP <<NUM>>.

For a microliter volume drugs (for example, drugs injected into the eye), the overfill volume is disproportionately larger than the indicated injection volume. Based on published regulatory filings, similar information for a drug injected in the eye, with an indicated dose volume of <NUM> is also included. Based on the USP<<NUM>>, the overfill volume as a proportion of indicated dose shows an increasing trend as the indicated dose volume gets smaller - i.e., smaller the dose volume, greater is the amount of drug wasted to account for dead space.

This overfill volume is simply an accommodation for anticipated dead space in the preparation and injection of the indicated volume. The overfill as a percentage of the intended dose volume increases with decreasing dose volume. This percentage increase is greater if the injectable formulation is viscous compared to a lower (waterlike) viscosity formulation having the same indicated dose volume.

Extrapolating for multiple doses based on the above, each intended injection volume to be drawn from a multidose vial (such as vaccines), an overfill corresponding to each dose intended to be delivered from the multi dose vial has to accounted for during manufacturing. In some instances, the overfill in the case of multidose vials can exceed or equal volume corresponding to a full indicated dose. In instances where drugs are expensive or in short supply, the ability to minimize overfill requirement and/or to minimize impact of dead space in delivery systems may have tremendous utility.

Need to overfill a drug in a vial has significant operational and cost implications for pharmaceutical companies. The bottom line is that drug overfill is drug that is wasted or unused and yet travels through the entire supply chain continuum. There are significant overheads involved in the procurement, manufacture and supply of drugs, and yet at the end of the day the drug overfill volume goes undelivered to the patient.

Thus, injectable therapeutics filled in vials have certain inherent waste using devices and techniques in the prior art and current practice at time of this disclosure. This waste is magnified when the injection volumes are less than <NUM> milliliter. For multi dose vials waste is cumulative to the point where this cumulative waste may be greater than a dose or multiple doses. Minimizing or eliminating this waste can have a significant impact on access, cost of care, and increasing utilization efficiencies at point of care. This waste is mostly to counteract the presence of dead space in the syringe, injection conduit (needle, catheter, other) and transfer needle/device. More the number of components in the drug administration continuum, greater is the dead-space and associated waste. In addition, the amount of dead space is not same from one injection device manufacturer to another. This uncertainty further requires pharmaceutical manufacturers to overfill as a contingency for an injection component having the highest dead space.

During manufacture of injectable drugs, there is usually a fixed total starting amount (volume) of drug, which is then allocated into multiple vials by filling equipment. The total number of vials from this total starting amount typically constitutes as one drug production batch. Need for overfill volume limits the drug product yield from a production batch. By decreasing the amount of overfill required, the fixed overheads costs are amortized over increased number of drug product, reducing the overhead costs per unit of manufactured drug product. Significant costs are involved in the manufacture of injectable pharmaceutical agents. These costs are more acute for injectable drugs to be investigated during clinical trials. With ever-increasing costs of injectable drugs and expensive drugs in the development pipeline, it is essential to identify means to efficiently use and distribute such drugs.

The prior art includes vial adapters that claim to reduce the amount of overfill necessary in a vial and to enable the user to draw and inject an accurate dose. These vial adapters have a spike feature to puncture the vial septum creating a conduit to draw. However, these vial adapters can be employed only for single-dose vials. Vial adapters in the prior art cannot be used with a multi dose vial, especially when there are time gaps between one dose and another drawn dose. Another disadvantage is that the conventional vial adapter from the prior art has to be packaged and shipped separately increasing packaging footprint and increasing shipping costs. The vial adapters in the prior art also require sterilization, and must be supplied to the end user in a sterile form.

<CIT> discloses a syringe filling aid including a body having a bottle holding means at one end and a portion at the other end that engages the hilt of a syringe supported with the syringe needle in the bottle. A plunger stop assembly is adjustably fixable to the body to limit movement of the plunger to a predetermined dose setting.

<CIT> discloses an alignment guide including an inner tube concentrically disposed inside a tubular housing, adapted to provide perpendicular puncturing of a serum bottle septum by the needle of a syringe. A first end of the inner tube receives a hypodermic syringe; the second end mounts to a fluid-containing bottle.

<CIT> discloses a one-piece needle guide and bottle holder, a syringe being received in a syringe-guide portion and the bottle being received in a bottle-guide portion, the syringe needle extending through a needle-guide channel between the syringe-guide and bottle-guide portions.

<CIT> discloses an angled needle guide that includes a base from which a housing for a fluid container extends at an angle, and a syringe holder is coupled.

Accordingly, there is a need for an arrangement wherein a complete dose may be delivered while minimizing or eliminating overfill that would be acceptable from a regulatory standpoint.

The present invention provides a vial adapter for use with an injector and a vial containing an injectable fluid, as set out in claim <NUM>. Also disclosed is a method of transferring a target volume of a fluid from a vial as set out in claim <NUM> and a method of transfer of a target fluid volume as set out in claim <NUM>. This disclosure in one aspect is directed to a vial adapter for use with an injector and a vial containing an injectable fluid, the vial including a stopper and a stopper retainer, the injector including a barrel and a needle. The vial adapter includes a vial retainer, a spacing disc, and a spacing arm. The vial retainer includes a generally cylindrical structure having a central opening. The vial retainer is sized to receive at least a portion of the vial, the stopper and the stopper retainer. The spacing disc includes a needle insertion port. The needle insertion port is sized to permit the passage of the needle and not to allow the passage of the barrel. The spacing arm is attached to the vial retainer and the spacing disc. The spacing arm is sized to space the spacing disc a predetermined distance from the vial retainer. When the needle of the injector is inserted through the needle insertion port and into the stopper, a distance that the needle may extend through the stopper is limited by contact of the injector with the spacing disc.

In another aspect, this disclosure is directed to a method of administering a single dose of an injectable fluid to a target. The method includes transferring a single dose of the injectable fluid to an injector, the injector having dead space containing dead space air, vertically orienting the injector over a target, inserting an injection needle of the injector into the target while maintaining the injector in a vertical orientation, administering the injectable fluid to the target, and removing the injection needle from the target while maintaining the dead space air within the injector.

In yet another aspect, this disclosure is directed to a method of transfer and administration of injectable fluid wherein, transfer from a vial into an injector involves injection of air from the injector into the vial approximately equal to intended dose volume followed by an injector draw stroke exactly equal to the intended dose volume, followed by administration of injectable fluid such that volume of air substantially equal to dead space of the injector is retained in the injector at the end of delivery of injectable fluid.

Shown in <FIG> are components of a vial consisting of vial <NUM>, which typically is made of glass or a polymer, such as cyclic olefin polymer or the like. An injectable drug is contained in it. The vial <NUM> is closed using an elastomeric stopper <NUM>. The elastomeric stopper <NUM> is then secured to the vial <NUM> using a crimp or stopper retainer <NUM>, which is usually made out of aluminum. Stopper retainer <NUM> is deformed radially inwards under the rim <NUM> of the vial <NUM> slightly compressing and securing the stopper <NUM>. Stopper retainer <NUM> has a circular hole <NUM> covered by a lid or cap <NUM>. Prior to use, the user removes cap <NUM> to expose septum portion <NUM> of the stopper <NUM>.

<FIG> is a sectional view of a syringe <NUM> and transfer needle <NUM> engaged with a vial <NUM> for use in drawing an injectable fluid <NUM> from the vial <NUM>. With the transfer needle <NUM> extending through the hole <NUM> of the stopper retainer <NUM> and piercing through the elastomeric stopper <NUM>, withdrawing the plunger rod <NUM> of the syringe <NUM> transfers injectable fluid <NUM> from the vial <NUM> into the syringe <NUM>. A plunger stopper <NUM> is typically connected to the plunger rod <NUM> and helps create a seal within the barrel of the syringe <NUM>. When needle <NUM> is inserted into the vial <NUM>, the vial septum <NUM> seals around the needle <NUM>. When the plunger rod <NUM> is withdrawn, it pulls the plunger seal <NUM> with it, creating negative pressure relative to the inside of the vial <NUM>. This pressure differential drives flow of injectable fluid <NUM> from the vial <NUM> into the syringe <NUM> as long as the tip of the transfer needle <NUM> as shown in <FIG> is fully submerged in the injectable fluid <NUM>.

If the tip of transfer needle <NUM> is not submerged in the injectable fluid <NUM>, however, as shown in <FIG>, then negative pressure created by the withdrawal of plunger rod <NUM> results in transfer of air instead of injectable fluid from the vial <NUM> into the syringe <NUM>. This may result in insufficient volume of injectable fluid <NUM> to be administered to the patient and/or leaves behind and wastes some of the injectable fluid <NUM> in the vial <NUM>. Ideally, the user should be able to position deterministically the tip of the transfer needle <NUM> just past vial stopper <NUM>. However, since this location is not visible to within the vial <NUM>, elastomeric stopper <NUM> and the stopper retainer <NUM>, the tip of the transfer needle <NUM> cannot be easily visualized. This is one source of injectable fluid waste.

In accordance with the invention, there is provided a vial adapter to facilitate deterministically placing a transfer needle into a vial. Turning first to <FIG>, there is illustrated a vial adapter <NUM> for placement of the transfer needle into a vial <NUM>. Unlike vial adapters from the prior art, the disclosed vial adapter does not include a vial septum piercing component. The vial septum is pierced by transfer needle attached to a syringe in case of the disclosed invention.

Shown in <FIG>, the vial adapter <NUM> comprises, first, a spacing disc <NUM>, second, a spacing arm <NUM> and third, a vial retainer <NUM>. In at least one embodiment, the vial retainer <NUM> is a generally cylindrical structure and includes a radial insertion port <NUM> for transverse vial insertion (see also <FIG>) and an axial insertion port for axial vial insertion defined by the generally annular structure of the vial retainer <NUM> (see also <FIG>). The spacing disc <NUM> is spaced from the vial retainer <NUM> by the spacing arm <NUM>, and includes a transfer needle insertion port <NUM>. Shown in <FIG> is the vial adapter <NUM> attached to a vial <NUM>.

The needle insertion port <NUM> may be of any appropriate design that permits the passage of a transfer needle. In <FIG>, for example, the needle insertion port <NUM>' includes an annular aperture. In <FIG>, however, the needle insertion port <NUM> includes an annular aperture as well as an elongated slot extending to the aperture.

<FIG> illustrate how the disclosed vial adapter <NUM> is attached to a vial <NUM> filled with injectable fluid <NUM>. A transverse or radial technique <NUM> involves insertion of vial <NUM> via the radial insertion port <NUM> (see <FIG>). An axial technique <NUM> involves insertion of the vial <NUM> through the axial insertion port at the bottom of the vial adapter <NUM>, moving the vial <NUM> in a direction toward the spacing disc <NUM>.

In <FIG> are different views of vial adapter <NUM> to illustrate different elements of the device to describe their utility. This embodiment, the radial insertion port <NUM> referenced earlier is framed by side flaps <NUM> and top flaps <NUM>. When the vial is inserted radially, the side flaps <NUM> flex out radially to accommodate the larger diameter of the vial stopper retainer and resiliently relax once the vial is coaxial with the vial adapter <NUM> thereby also radially retaining it. Additional radial retention features may be circularly arranged except for the radial insertion port <NUM>. The vial can also be pulled out radially through the radial insertion port allowing for storage after a single use or to reuse with another vial. The side flaps <NUM> similarly radially flex out to facilitate removal of the vial. This reusability feature is important from a sustainability standpoint, but also in instances where rapid scale up is necessary.

The vial adapter <NUM> further includes features to retain the vial axially within the vial retainer <NUM>. For example, the vial retainer <NUM> and/or the spacing arm <NUM> may include structures that engage along surfaces of the stopper retainer <NUM> of the vial. In the illustrated embodiment, axial retention of a vial is accomplished by radially arranged axial retention features <NUM> that may be disposed along a lower edge of the stopper retainer <NUM>, and an opposing axial retention feature <NUM> and the top flaps <NUM> that may be disposed along an upper surface or edge of the stopper retainer <NUM>. The radial location of the radially arranged axial retention features <NUM> are such that they are equal or slightly less than the radius of the neck <NUM> (shown in <FIG>) portion of the vial, but less than both the radii of barrel <NUM> and rim <NUM> (both also in <FIG>) of the vial. These axial retention features radial contact the portion under the neck <NUM> (see <FIG>) of the vial. The axial distance between a flat on retention feature <NUM>, which faces the axial vial insertion port side and tip of the radially arranged axial retention features <NUM>, is equal to or slightly less than sum of height of vial rim <NUM>, stopper retainer <NUM> thickness and thickness of portion of vial stopper <NUM> resting on the top of rim <NUM> (see <FIG>). All radial retention features have thickness such that they can flex radially or axially to accommodate oversized dimension of feature they are constraining. Top flaps <NUM> also axially constrain the vial in the same direction as retention feature <NUM>.

Top flaps <NUM> also provide additional stability during operation of the device, especially when the transfer needle is being inserted through needle insertion port <NUM>' of the spacing disk <NUM>. Needle insertion port <NUM>' shown in <FIG> is an annular aperture, that is, the needle insertion port <NUM>' is framed completely by the spacing disk <NUM>. There could optionally be a cut out or channel extending from the aperture, as shown in needle insertion port <NUM> in <FIG>. The angle of the axis of the cross section of vial retainer portion of the device and spacing arm <NUM> dictates the angle of insertion of the needle into the vial. Illustrated here is a coaxial insertion (<NUM> degree angle) - i.e., the transfer needle and vial are coaxial.

<FIG> show various steps to use the vial adapter <NUM> to draw injectable fluid <NUM> from vial <NUM> using a syringe <NUM> and transfer needle <NUM>. The steps of use illustrate the inventive method of injectable fluid transfer and subsequent administration with maximized efficiency and minimized waste of injectable fluid. While this inventive method ideally may or may not be used in conjunction with the vial adapter <NUM>.

<FIG> shows a syringe <NUM> with attached needle <NUM> where the plunger seal <NUM> is drawn by an amount <NUM> corresponding to the intended injection volume. The corresponding axial distance traversed by the plunger rod <NUM> is the "draw stroke". Air <NUM> is now adjacent to the plunger seal <NUM>. The transfer needle <NUM> is inserted through the needle insertion port <NUM> towards the vial <NUM>.

Referring to <FIG>, once the needle <NUM> is bottomed out, i.e., the base of the needle <NUM> is seated against the spacing disc, the tip of the needle <NUM> is inside the vial <NUM> past its septum. In this way, the axial location of the needle tip is determined by the vial adapter <NUM>. The user then depresses plunger rod <NUM> to inject air <NUM> inside the vial <NUM>. Transferring drug from a vial to a syringe involves subtracting of volume from the vial, which results in negative pressure in the vial and increasing resistance to transferring injectable fluid out of the vial. Pressurizing the vial is best practice and optional; this is not possible in some types of syringes such as auto disable syringes used for immunization in low- and middle-income countries. The volume of air to pressurize the vial may typically be <NUM>-<NUM>% lower than the intended volume to be transferred out of the vial in some scenarios.

<FIG> shows the plunger seal <NUM> at the end of dose position <NUM> with air <NUM> transferred to the inside of the vial <NUM>. While in the same axial position relative to each other, the orientation is inverted as shown in <FIG>, such that the injectable fluid <NUM> is now adjacent to the needle tip, which is still embedded in and has pierced the vial septum. In <FIG>, plunger rod <NUM> is drawn by a axial distance equal to the draw stroke <NUM>, which corresponds to a volume equal to the intended injection volume. This results in transfer of injectable fluid <NUM> from the vial <NUM> into the syringe <NUM>. Expected volume of injectable fluid <NUM> transferred into the syringe <NUM> is equal to the intended injection volume; some portion of this is in the transfer needle <NUM>. In some cases where the volume of injectable fluid (incompressible component) is so large that very little air compressible component) is contained in the vial, the draw stroke <NUM> imparted by the user may be larger than the intended dose volume to provide sufficient negative pressure to drive flow of intended volume from vial <NUM> into the syringe <NUM>. The increase stroke can be determined based on vial capacity, vial fill volume and intended injection volume.

<FIG> shows detachment of the injection needle <NUM> from the vial <NUM> and the attached device <NUM>. Visible within the syringe is injectable fluid <NUM> and air <NUM>. The orientation prior to detachment could be inverted relative to what is illustrated in <FIG>.

Shown in <FIG>, the air <NUM> in the syringe <NUM> is manipulated such that the air is proximal to the plunger seal <NUM>. The volume of this air is equivalent to the cumulative dead space of the syringe <NUM> and transfer needle <NUM>. Illustrated here is the transfer needle <NUM> is also the injection needle. The needle is inserted, preferably vertically, into the administration site and the plunger rod <NUM> is depressed until the plunger seal <NUM> is aligned with end of dose position <NUM> (usually the "<NUM>" mark on the syringe). This is shown in <FIG> and results in injection of injectable fluid <NUM> having volume equal to the intended dose volume. When the needle is inserted vertically, the air <NUM> corresponding to the dead space is almost entirely retained in the syringe <NUM> and needle <NUM>, thereby counteracting the effect of dead space that results in waste of drug. The orientation of administration is such that the air <NUM> always remains proximal to the plunger seal <NUM>.

In some applications, it is possible that the injection needle (or injection conduit such as a catheter, injection port, etc.) is different than the transfer needle. In this case, the volume corresponding to the draw stroke illustrated in <FIG> is the sum of intended dose volume and dead space of the transfer needle <NUM>. The injection step of <FIG> is preceded by substitution of transfer needle with the injection conduit. The injection stroke is immediately preceded by a prime stroke equal to the dead space of the injection conduit. If the dead space of the injection conduit is greater than dead space of the transfer needle, the draw stroke illustrated in <FIG> is the sum of intended dose volume and the dead space of the injection conduit.

In some instances where bubbles form in the formulation because of the presence of surfactants and other surface tension decreasing excipients, the draw stroke can be slightly larger (<NUM>-<NUM>%) than the volumes corresponding to the aforementioned draw strokes in different scenarios. This allows the dead space of the syringe and the needle to act as a bubble trap and minimize the amount of time a physician needs to spend to get rid of the bubble.

In case of the where drug is prefilled in the syringe, steps illustrated in <FIG> would be applicable with possibility of a prime stroke as described above.

This disclosure further envisions an embodiment where the total draw stroke volume is greater than the sum of the primed volume and the intended dose volume. In some applications, when the dead space of the delivery conduit is much larger than the dead space of the transfer needle or the syringe or the intended injection volume, the transfer of injectable fluid from a vial to a syringe is preceded by transfer of air into syringe. In this case the total air in the syringe prior to injectable fluid transfer from a vial is greater than the dead space of the syringe.

In applications where the injectable fluid has very high viscosity (~<NUM> to <NUM> times more viscous than water), it would be challenging to create sufficient differential pressure to facilitate flow of the injectable fluid from the vial to the syringe. In such applications it is envisioned that step of pressurizing the vial <NUM> (shown in <FIG>) is performed by a large volume pressurizing syringe (such as VacLok® Syringe from Merit Medical) and needle different from the syringe <NUM> and needle <NUM> used to administer the injectable fluid. This VacLok® Syringe can help inject <NUM>-<NUM> times the intended injection volume. When removed, a large positive pressure is created inside the vial with injectable fluid at the end of step corresponding to <FIG>. the VacLok® Syringe is replaced by the syringe <NUM> having needle <NUM>. When the needle <NUM> is inserted into the vial in orientation and configuration depicted in <FIG>, the high pressure in the vial helps provide the necessary pressure differential for the viscous injectable fluid to transfer from the vial <NUM> into the syringe <NUM>. Subsequent steps can be same as that illustrated in <FIG>.

In some applications, it may be beneficial to package and transport the vial adapter along with the drug vial to ensure that the device is always and readily available for use. Vials constructed using glass can shatter and be damaged during packaging or transport. It would be beneficial to shield the fragile vial from impact. The vial adaptor device disclosed here had three modules - Spacing disc, Spacing Arm and Vial retainer. The three were rigidly connected to each other in the embodiment described thus far.

Shown in <FIG> is a vial adaptor <NUM> (Embodiment <NUM>) equivalent to previously described vial adapter <NUM> (Embodiment <NUM>) in terms of function for transferring injectable fluid from a vial to a syringe. Vial adapter <NUM> has equivalent spacing disc <NUM>, spacing arm <NUM> and vial retainer <NUM>. In order to add more functionality, the vial adapter <NUM> includes one or more flexible living hinges, allowing the vial adapter <NUM> to be more compactly stored, for example. In the illustrated embodiment, the spacing disc <NUM> is connected to spacing arm <NUM> with a flexible living hinge <NUM>, and spacing arm <NUM> is connected to vial retainer <NUM> with flexible living hinge <NUM>. The term "living hinge" may refer to, for example, a thinned, flexible portion which allows the adjacent structures to pivot relative to one another. The flexible living hinges <NUM>, <NUM> of this embodiment enable the adjacent portions of the structure to pivot up to <NUM> degrees relative to one another, changing the angle between the portions of the structure that the living hinge connects. The configuration shown in <FIG> is equivalent to use for transferring injectable fluid from vial <NUM> as described for Embodiment <NUM>. The user has the option after one withdrawal to disengage the spacing disc <NUM> from the spacing arm <NUM> while still connected by a living hinge <NUM>. The user can concurrently or successively disengage spacing arm <NUM> from vial retainer <NUM> while still connected by living hinge <NUM>. Shown in <FIG>, the angle between the spacing disc <NUM> and spacing arm <NUM> is <NUM> degrees different than same in <FIG>. The spacing disc <NUM> snaps into flaps <NUM> on vial retainer <NUM>. Also, in <FIG> the angle between the spacing arm and vial retainer is <NUM> degrees different than same in <FIG>. This functionality enables compact storage (and transportation) of the vial adaptor <NUM> and the vial <NUM> together, as visually illustrated in <FIG>.

<FIG> illustrates how spacing disc <NUM> and spacing arm <NUM> may interlock to provide a sturdy, static structure despite a flexible hinge connecting portions of the vial adapter <NUM>. More in this embodiment, tab <NUM> of the spacing disc <NUM> is interlock in an interference fit in the gap between rigid posts <NUM> of the spacing arm <NUM>, providing a fixed structure between the spacing arm <NUM> and the spacing disk <NUM>. Illustrated also is how tab <NUM> on the spacing arm <NUM> interferes with posts <NUM> on the vial retainer <NUM> (see <FIG>). The posts <NUM> flex out slightly when the tab <NUM> is inserted prior to device operation and when the user detaching the interlocks prior to storage. Also shown are axial retention feature <NUM> on the spacing arm <NUM> and axial retention features <NUM> on the vial retainer <NUM>. The vial is axially constrained between <NUM> and <NUM>. Radial constraint to the vial is provided by flaps <NUM>. In the storage/transport configuration (shown <FIG>), the part <NUM> of the spacing disc <NUM> interlock with tab <NUM> on each of the flaps <NUM>.

Turning to <FIG>, in some applications, the amount of injectable fluid in a vial is too low for the vial to be inverted when transferring from a vial to a syringe <NUM> using a needle <NUM>. The amount of the injectable fluid is also too low for the base <NUM> of vial <NUM> to be placed flat on a surface because doing so will result in an injectable fluid liquid column of very low height. This low height will make it extremely difficult to transfer injection fluid. One method that has been employed (shown in <FIG> is part of instructions for drawing Beovu®) involved tilting the vial <NUM> such that the edge between the cylindrical part and the base <NUM> creates a well as shown in <FIG>. This well makes it easier for the needle tip to be submerged under the injectable fluid contained in the vial <NUM>.

The burden is on the user to maintain the right angle of tilt of the vial and positioning the needle tip at the precise location of the deepest point of the injectable fluid well at the said angle.

According to another aspect of this disclosure, a vial adapter <NUM> that may be utilized to positioning of a vial <NUM> to facilitate access to such small volumes of injectable fluid <NUM> remaining in the bottom of a vial <NUM>. Shown in <FIG>, as well as <FIG>, is an embodiment (embodiment <NUM>) of a vial adapter <NUM> that is axially applied to a vial <NUM> containing injectable fluid <NUM>. The vial adapter <NUM> helps control the angle of transfer needle (not shown in <FIG>) relative to the axis of the vial <NUM>, and guide the needle tip to the bottom of injectable fluid well.

<FIG> provide different views of the vial adaptor <NUM>, <FIG> illustrating the vial adapter <NUM> attached to a vial <NUM>. In order to orient the vial <NUM> for a specific angle of the insertion of the needle (not illustrated), the vial adapter <NUM> includes a vial retainer <NUM> from which a support structure extends for supporting the vial <NUM> and vial adapter <NUM> at an angle less than <NUM>° on a surface. In the illustrated embodiment, the support structure is in the form of a plurality of legs <NUM> extending from the vial retainer <NUM>. In this way, the vial <NUM> within the vial retainer <NUM> is supported on a surface at a specified angle by the legs <NUM>. While the illustrated vial adapter <NUM> includes three legs <NUM>, those of skill in the art will appreciate that the vial adapter <NUM> may include an alternative number of legs, such as four, or the support structure may be a single angled leg or wedge.

The vial is radially constrained by vial retainer <NUM> of the adapter device <NUM>, the vial retainer <NUM> presenting a generally cylindrical structure. The vial <NUM> may be axially retained within the vial retainer <NUM> by and between axial retention features <NUM> and <NUM>. The vial may be inserted from the side shown in <FIG>.

The vial adapter <NUM> may further provide guidance for insertion of a transfer needle (not illustrate) into the vial <NUM> in an optimal position for removal of injectable fluid <NUM> from the lowermost portion of the vial <NUM>. A guide for a needle is provided by needle guide features <NUM>; these needle guide features <NUM> help direct the user to orient the needle towards the vial septum <NUM>. The needle guide features <NUM> may be in the form one or more structures disposed with an upper surface disposed at an angle that is complimentary to and dependent upon, the angle at which the legs <NUM> dispose the vial <NUM>, and the size of the vial <NUM> itself. In this way, the needle guided by the needle guide features <NUM> will pierce the vial septum <NUM> and end of the needle will be disposed in the lowermost portion of the positioned vial <NUM>.

<FIG> show different stages of operation to transfer injectable fluid <NUM> from vial <NUM> into syringe <NUM> using a needle <NUM> using this this embodiment of the vial adapter device <NUM>. Shown in <FIG> is vial <NUM> with injectable fluid <NUM> incorporated into vial adapter <NUM> and placed on a flat surface <NUM>. A syringe <NUM> with attached transfer needle <NUM> is guided at a specific range of angles determined by vial adapter <NUM>. Shown in <FIG> is that the needle <NUM> is further guided by the cylindrical wall of vial <NUM> directing its tip to the bottom of the injectable fluid <NUM> well at the intersection of the base and cylindrical portion of the vial. The plunger rod <NUM> is withdrawn to transfer the injectable fluid <NUM> from the vial <NUM> into syringe <NUM> (see <FIG>).

Once the injectable fluid <NUM> is transferred into the syringe the inventive method disclosed herein or a conventional method may be employed to administer the injectable fluid <NUM>.

The disclosed invention covers a device for pre-deterministic placement of the needle tip, methods to counteract the effect of dead space in injection systems and/or combinations thereof.

The disclosed invention describes methods to minimize the impact of dead space inherent in the transfer and injection of injectable therapies. In applications where the injection needle is also used to transfer drug from the vial, the disclosed inventive approach minimizes the impact of dead space to fill volumes by prescribing methods where air occupying the dead spaces at the outset is not substituted by liquid drug. The user can axially translate the plunger rod in the non-needle direction (this is the "draw stroke") corresponding to exactly the intended injection dose volume. This transfers drug from the vial corresponding to the intended dose volume into the needle and syringe. The liquid level in the syringe would be lower than marking corresponding to the amount of the intended dose by an amount equal to the dead space. When the needle is oriented down (typical injection direction, the space between the liquid level and the plunger stopper is air. When the injection needle is inserted into the injection site and the plunger is depressed until its bottomed out, the volume dispensed is equal to the volume transferred from the vial, which in turn is equal to the intended dose volume. Barring negligible inefficiencies and for formulations involving viscosities similar to water, the overfill requirement attributable to syringe and injection needle dead space can potentially be reduced to almost "zero". Any inefficiency in the disclosed method is marginal relative to the state of the art. This benefit is multiplied in case of a multi dose vial.

As volume is subtracted from the vial, negative pressure is created in the vial which can impact the efficiency of the proposed approach. This is truer in case of large volume of drug transfer relative to the total vial fill volume. This issue is less applicable when the volume of drug transfer is small relative to the total vial fill volume. This behavior is consistent with Boyle's Law. In order to mitigate effects of negative pressure, two approaches are envisioned. First approach is to use a needle to vent and equilibrate the pressure. The venting needle may have a filter to exclude ambient particulates or microorganisms. The second approach involves drawing air (filtered or ambient) into the syringe prior to insertion of the needle into the stopper. Once the needle tip is in the vial, the aforementioned air is injected into the vial, pressurizing the drug chamber in the vial. The volume of air injection should be close to the volume of drug to be drawn from the vial. This innovative approach would mitigate the aforementioned negative pressure challenge.

Disclosed invention also includes a vial adapter that can be used with a multi dose vial (MDV) or a single dose vial (SDV). The vial adapter for use with a multi dose vial provides several benefits. The method disclosed above to mitigate challenges with dead space can be limited with a multi dose vial in the last few doses to be drawn from the vial. Success with the proposed method is predicated on ability to draw liquid drug only during the draw step. Since visualization of the liquid level is challenging when the total or remaining volume in the vial is below the line of sight obscured by the stopper and the stopper retainer. Here, fidelity of proposed method is contingent on precise and stable positioning of the needle tip within the vial (just past the stopper); this is facilitated by the disclosed vial adapter. The vial adapter enables use of conventional draw orientation independent of vial fill volume. Unlike conventional vial adapters in the prior art that include a spike to penetrate the vial stopper, the vial adapter disclosed here does not breach the drug chamber and hence can remain attached to the vial prior to receipt by the intended end user. The disclosed adapter has a hinge feature to enable sanitizing steps between use similar to that employed to sanitize the stopper between uses. The hinge feature also allows for the vial adapter to be attached to the vial even without removing the plastic lid. The ratchet features on the vial adapter ensure secure axial positioning of the vial adapter for optimal performance.

The disclosed invention covers various embodiments of a vial adapter that connect to an injectable fluid vial. Also disclosed are methods of injectable fluid transfer from a vial using a transfer needle and subsequent injection of the injectable fluid through a delivery conduit. In some applications, the transfer needle and the delivery conduit may be the same.

Hence, an innovation such as the one disclosed here, that can help deliver a complete dose and minimize (or eliminate) overfill should be acceptable from a regulatory standpoint.

For the purposes of this disclosure, the term "substantially" is to be interpreted as +/- <NUM>% where applicable.

The use of the terms "a" and "an" and "the" and "at least one" and similar referents in the context of describing the invention, as defined by the claims, are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context.

Claim 1:
A vial adapter (<NUM>) for use with an injector (<NUM>) and a vial (<NUM>, <NUM>, <NUM>) containing an injectable fluid (<NUM>, <NUM>), the vial (<NUM>, <NUM>, <NUM>) including a stopper (<NUM>) and a stopper retainer (<NUM>), the injector (<NUM>) including a barrel and a needle (<NUM>), the vial adapter (<NUM>, <NUM>, <NUM>) comprising:
a vial retainer (<NUM>), the vial retainer (<NUM>) having a generally cylindrical structure having a central opening and being sized to receive at least a portion of the vial (<NUM>, <NUM>, <NUM>), the stopper (<NUM>) and the stopper retainer (<NUM>),
characterized by a spacing disc (<NUM>) the spacing disc (<NUM>) including a needle insertion port (<NUM>, <NUM>'), the needle insertion port (<NUM>, <NUM>') being sized to permit the passage of the needle (<NUM>) and not to allow the passage of the barrel,
a spacing arm (<NUM>) attached to the vial retainer (<NUM>) and the spacing disc (<NUM>), the spacing arm (<NUM>) being sized to space the spacing disc (<NUM>) a predetermined distance from the vial retainer (<NUM>), and
at least one hinge (<NUM>, <NUM>) disposed between the spacing arm (<NUM>) and at least one of the spacing disc (<NUM>) and the vial retainer (<NUM>),
wherein when the needle (<NUM>) of the injector (<NUM>) is inserted through the needle insertion port (<NUM>, <NUM>') and into the stopper (<NUM>), a distance that the needle (<NUM>) may extend through the stopper (<NUM>) is limited by contact of the injector (<NUM>) with the spacing disc (<NUM>).