PHARMACEUTICAL COMPOSITION
FIELD OF INVENTION:
The present invention relates to pharmaceutical compositions for inhalation. There is also
provided a process for preparing the compositions and use thereof in the treatment and / or
prevention of respiratory, inflammatory or obstructive airway disease.
BACKGROUND OF INVENTION:
Asthma is a major cause of chronic morbidity and mortality, with an estimated 300 million
affected individuals worldwide and 2, 50,000 annual deaths attributed to the disease. People
of all ages in most countries are affected by this chronic disease.
Asthma is a chronic inflammatory disorder of the airways associated with airway hyper
responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness,
and coughing. An increased inflammatory response is a major part of the pathophysiology of
acute asthma, and regular preventive treatment is important.
Chronic obstructive pulmonary disease (COPD) is a severe respiratory condition that is
increasing in prevalence worldwide. In India, the estimated prevalence is about 12.36 million.
It is currently the fourth leading cause of death in the UK & US, and predicted to rank third
in the global impact of disease by the year 2020.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state
characterized by air flow limitation that is not fully reversible. The airflow obstruction is
usually progressive and associated with an abnormal inflammatory response of the lungs to
noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects
the lungs it also produces significant systemic consequences. COPD is associated with mucus
hyper secretion, emphysema, bronchiolitis.
Therapy for the treatment and/or prevention of asthma and chronic obstructive pulmonary
disease (COPD) currently includes the use of bronchodilators such as beta2-agonists,
anticholinergics and steroids.
More specifically asthma, COPD and other related disorders have been known to be treated
with beta -agonist as they provide a bronchodilator effect, resulting in relief from the
symptoms of breathlessness. Beta -agonists can be short acting for immediate relief, or long
acting for long term prevention of asthma symptoms.
Long acting -agonists improve lung function, reduce symptoms and protect against
exercise-induced dyspnea in patients with asthma and COPD. Long acting 2-agonists induce
bronchodilation by causing prolonged relaxation of airway smooth muscle. In addition to
prolonged bronchodilation, long acting 2-agonists (LABAs) exert other effects such as
inhibition of airway smooth-muscle cell proliferation and inflammatory mediator release, as
well as non smooth-muscle effects, such as stimulation of mucociliary transport,
cytoprotection of the respiratory mucosa and attenuation of neutrophil recruitment and
activation.
Further use of a long acting 2-agonist reduces the frequency of drug administration.
Currently available long acting beta2-agonists (LABAs) include salmeterol and formoterol.
Even though it is known that beta2-agonists provide a symptomatic relief in
bronchoconstriction, another component of asthma, which is inflammation, requires separate
treatment such as steroid. Most of the inhaled corticosteroids need to be administered in
multiple dosage regimens.
Corticosteroids exhibit inhibitory effects on inflammatory cells and inflammatory mediators
involved in the pathogenesis of respiratory disorders. Treatment with a
corticosteroid/glucocorticoid is considered one of the most potent and effective therapies
currently available for persistent asthma.
However, a considerable proportion of patients treated with inhaled corticosteroids (ICS)
have been found to remain symptomatic, despite the use of low to moderate doses of inhaled
corticosteroids (ICS).
Also, use of these corticosteroids, especially in children, has been limited due to their
potential side effects. In children and teenagers, these medicines can prohibit or slow down
growth and may affect the function of adrenal glands. Another possible problem in children
is that these corticosteroids may cause infections such as chickenpox and measles.
Other side effects with the use of corticosteroids are that they cause suppression of the
Hypothalamic-Pituitary-Adrenal (HPA) axis, produces adverse effects on the bone growth in
children and on the bone density in the elderly, ocular complications (cataract formation and
glaucoma) and skin atrophy. In elderly people, corticosteroids may seem to increase the risk
of high blood pressure and bone diseases. Bone associated diseases by using corticosteroids
are especially more likely to occur in elderly females.
Thus the therapeutic options in the treatment of asthma chronic obstructive pulmonary
disease (COPD) which are not adequately controlled by the use of low to moderate doses of
ICS are either to increase the dose of the inhaled corticosteroid (ICS) or to combine the
therapy of an inhaled corticosteroid (ICS) with bronchodilators such as beta2-agonists and/or
anticholinergics.
Currently available corticosteroids include beclomethasone, budesonide, fluticasone,
mometasone, ciclesonide and triamcinolone.
Anticholinergic agents also act as bronchodilators and are potential alternatives to beta
agonists. However, anticholinergics can also be administered along with beta2-agonists
(LABAs) for the management of asthma. Anticholinergics act by competing with
acetylcholine for the receptor sites at vagus nerve or nerve-muscle junctions. This prevents
the transmission of reflexes that are induced by asthma stimuli.
The use of anticholinergics provides an advantage in elderly patients as the responsiveness of
2-agonists declines with old age. Further it would be advantageous to use in patients who
are intolerant to the use of beta2-agonists.
Further, anticholinergics can also be used in patients suffering from nocturnal asthma,
chronic asthma with concurrent fixed way obstruction, intrinsic asthma and also in patients
with asthma of longer duration.
Although a combination therapy of a bronchodilator with an inhaled corticosteroid improves
pulmonary efficiency, reduces inflammatory response and provides symptomatic relief as
compared to higher doses of inhaled corticosteroid alone in patients affected by respiratory
disorders such as asthma, the selection of a specific bronchodilator and inhaled corticosteroid
can also play a very important role in formulation of fixed dose combinations.
Additionally it simplifies the therapy, reduces the cost and also provides control of
respiratory disorders. Reducing the dose frequency to the minimum is an important step in
simplifying asthma management for improving patient adherence to the therapy.
Currently, there are several approved combinations of long-acting beta agonist (LABA) and
inhaled corticosteroid (ICS). Some of these approved combinations for the treatment of
asthma and chronic obstructive pulmonary disease (COPD) are salmeterol / fluticasone
propionate (Advair diskus, Advair HFA), and formoterol fumarate dehydrate / budesonide
(Symbicort).
Most of the available combinations of a long-acting beta agonist (LABA) with inhaled
corticosteroid (ICS) have to be administered twice daily.
Even from the patient compliance point of view, the treatment calls for the patient to comply
with different dosage regimens, different frequencies of administration, etc.
Efforts to improve compliance have been aimed at by, simplifying the medication packaging,
providing effective medication reminders, improving patient education, and limiting the
number of medications prescribed simultaneously.
US7008951 discloses a pharmaceutical composition comprising indacaterol and a
corticosteroid for simultaneous, sequential or separate administration in the treatment of
inflammatory or obstructive airway diseases and in a ratio of 100:1 to 1:300.
US7622483 discloses a combination comprising indacaterol and a steroid.
US6800643 discloses a medicament comprising separately or together indacaterol and a
corticosteroid in a ratio from 100:1 to 1:300.
US7622484 discloses a composition in inhalable form comprising indacaterol and
mometasone furoate for simultaneous administration in the treatment of inflammatory or
obstructive airway diseases and in a ratio of 3:1 to 1:7.
US6030604 discloses a dry powder composition comprising glucocorticoids and beta-2
agonist.
WOO178745 discloses compositions containing a combination of formoterol and fluticasone
propionate.
US7 172752 discloses inhalation particles comprising a combination of a beta2-agonist and a
glucocorticosteroid in a predetermined and constant ratio.
WO020831 3 discloses pharmaceutical compositions comprising formoterol and a steroidal
anti-inflammatory agent in a pharmacologically suitable fluid.
WO2004028545 discloses a combination of a long-acting beta2-agonist and a
glucocorticosteroid in the treatment of fibrotic diseases.
US2005053553 discloses methods for administration by inhalation of a metered dry powder
having combined doses of formoterol and fluticasone.
US2005042174 discloses a combination comprising indacaterol and of doses of a beta2-
agonist, an anticholinergic agent and an anti-inflammatory steroid.
US2009088408 discloses pharmaceutical compositions of anticholinergics, corticosteroids
and betamimetics and their use in the treatment of respiratory diseases.
WO2006 105401 discloses anticholinergic in combination with a corticosteroid, and a long
acting beta agonist, for simultaneous or sequential administration in the prevention or
treatment of a respiratory, inflammatory or obstructive airway disease.
Further selecting a combination of a long-acting beta2 agonist (LABA) and an inhaled
corticosteroid (ICS) is critical since both drugs should be capable of being administered once
daily. A treatment method where a long-acting beta2 agonist (LABA) is required to be
administered once daily and an inhaled corticosteroid (ICS) is required to be administered
twice daily or vice versa will not be useful since the purpose of once a day treatment is
defeated.
However, none of the above prior art specifically discloses the combination of indacaterol
with fluticasone furoate, formoterol with fluticasone furoate or indacaterol with ciclesonide
and indacaterol with fluticasone furoate and tiotropium. Moreover, none of these prior arts
mention or disclose that the combination of indacaterol and fluticasone furoate, formoterol
with fluticasone furoate or indacaterol with ciclesonide and indacaterol with fluticasone
furoate and tiotropium can be administered once daily for the prevention or treatment of
respiratory, inflammatory or obstructive airway disease.
Hence, there still remains a need to formulate a pharmaceutical composition which simplifies
the dosage regimen by administering a once a day composition for the treatment of these
respiratory disorders.
OBJECT OF THE INVENTION:
The object of the present invention is to provide a pharmaceutical composition comprising
one or more bronchodilators and one or more inhaled corticosteroid (ICS) for administration
in the prevention or treatment of respiratory, inflammatory or obstructive airway disease.
Another object of the present invention is to provide a pharmaceutical composition
comprising one or more bronchodilators and one or more inhaled corticosteroid (ICS) for
once daily administration for the prevention or treatment of respiratory, inflammatory or
obstructive airway disease.
Yet another object of the present invention is to provide a process for preparing the
pharmaceutical composition comprising one or more bronchodilators and one or more
inhaled corticosteroid (ICS) for administration in the prevention or treatment of respiratory,
inflammatory or obstructive airway disease.
A further object of the present invention is to provide a method for prophylaxis or treatment
of asthma, COPD or related a respiratory disorder which comprises administering a
pharmaceutical composition comprising one or more bronchodilators and one or more
inhaled corticosteroid (ICS).
SUMMARY OF THE INVENTION:
According to a first aspect of the present invention, there is provided a pharmaceutical
composition comprising one or more bronchodilators and one or more inhaled corticosteroid
(ICS).
Preferably the composition further comprises one or more anticholinergics.
According to a second aspect of the present invention, there is provided a pharmaceutical
composition comprising indacaterol and fluticasone, especially an ester of fluticasone., in
particular fluticasone furoate.
According to a third aspect of the present invention, there is provided a pharmaceutical
composition comprising formoterol and fluticasone, especially an ester of fluticasone., in
particular fluticasone furoate.
According to a fourth aspect of the present invention, there is provided a pharmaceutical
composition comprising indacaterol and ciclesonide.
According to a fifth aspect of the present invention, there is provided a pharmaceutical
composition comprising indacaterol, tiotropium and fluticasone, especially an ester of
fluticasone, in particular fluticasone furoate.
According to a sixth aspect of the present invention, there is provided a process for preparing
the pharmaceutical compositions described above.
According to a seventh aspect of the present invention, there is provided a method for
prophylaxis or treatment of asthma, COPD or a related respiratory disorder which comprises
administering a pharmaceutical compositions described above.
According to a eighth aspect of the present invention there is provided the use of the
pharmaceutical compositions described above in treating disorders or conditions that respond
to, or are prevented, ameliorated or eliminated by, the administration of a long-acting beta
agonist (LABA) and inhaled corticosteroid (ICS).
DETAILED DESCRIPTION OF THE INVENTION:
Drug therapy with a bronchodilator (such as a long-acting beta agonist (LABA)) and inhaled
corticosteroid (ICS) has been recommended for the prevention or treatment of respiratory,
inflammatory or obstructive airway disease such as asthma and chronic obstructive
pulmonary disease (COPD).
Further there is a need to formulate a composition which can be administered once daily for
the prevention of conditions that respond to, or are prevented, ameliorated or eliminated by,
the administration of a bronchodilator (such as a long-acting beta agonist (LABA)) and
inhaled corticosteroid (ICS).
Bronchodilators used according to the present invention may be beta-agonists and/or
anticholinergics. According to the present invention, beta agonists may comprise, one or
more, short acting beta agonist, long acting beta agonist or ultra long acting beta agonist. In a
preferred embodiment of the present invention beta agonists comprise indacaterol or
formoterol.
Specific preferred pharmaceutical compositions according to the invention include:
- A corticosteroid comprising fluticasone (especially fluticasone furoate) in combination with
a beta2-agonist comprising formoterol.
- A corticosteroid consisting of fluticasone (especially fluticasone furoate) in combination
with a beta2-agonist consisting of formoterol.
- A corticosteroid comprising fluticasone (especially fluticasone furoate) in combination with
a beta2-agonist comprising indacaterol.
- A corticosteroid consisting of fluticasone (especially fluticasone furoate) in combination
with a beta2-agonist consisting of indacaterol.
- A corticosteroid comprising fluticasone (especially fluticasone furoate) in combination with
a beta2-agonist comprising indacaterol and an anti-cholinergic comprising tiotropium.
- A corticosteroid consisting of fluticasone (especially fluticasone furoate) in combination
with a beta2-agonist consisting of indacaterol and an anti-cholinergic consisting of
tiotropium.
- A corticosteroid comprising ciclesonide in combination with a beta2-agonist comprising
indacaterol.
- A corticosteroid consisting of ciclesonide in combination with a beta2-agonist consisting of
indacaterol.
In an embodiment, the indacaterol is provided as the maleate.
In the above compositions, the fluticasone may be provided as the ester of fluticasone, in
particular the furoate or the valerate or propionate.
The invention also encompasses methods of preparing the pharmaceutical compositions
according to the invention and their use in respiratory, inflammatory or obstructive airway
diseases.
It has been surprisingly found that indacaterol in combination with fluticasone furoate
provides relief from respiratory disorders, while simultaneously reducing the frequency of
dosage administration.
The present invention provides a novel combination for inhalation comprising indacaterol in
combination with fluticasone (especially fluticasone furoate) for the prevention or treatment
of respiratory, inflammatory or obstructive airway disease while simultaneously reducing the
frequency of dosage administration.
Indacaterol is chemically known as (i?)-5-[2-[(5,6-Diethyl-2,3-dihydro-l H-inden-2-
yl)amino]-l-hydroxyethyI]-8-hydroxyquinolin-2(l H)-one is a ultra long acting beta2-agonist.
Further more indacaterol exhibits a longer duration of action.
In this specification, the terms "indacaterol", "fluticasone", "ciclesonide" and "tiotropium are
used in broad sense to include not only "indacaterol" and "fluticasone" per se but also any
pharmaceutically acceptable salts, pharmaceutically acceptable solvates, pharmaceutically
acceptable hydrates, pharmaceutically acceptable enantiomers, pharmaceutically acceptable
derivatives, pharmaceutically acceptable polymorphs, pharmaceutically acceptable prodrugs,
etc.
Fluticasone is currently available as a furoate salt and propionate salt. Fluticasone furoate is a
novel corticosteroid which substantially overcomes the potential side effects that are
generally produced by the use of conventional corticosteroids. Moreover fluticasone furoate
exhibits a 1.7 times higher binding affinity for the human glucocorticoid receptor as
compared to that of fluticasone propionate.
Fluticasone furoate has a longer duration of action with an elimination half life of 15.1 hrs.
Indacaterol and formoterol have a longer duration of action of about more than 24 hrs and
exhibits a faster onset of action.
We prefer that the fluticasone is provided in the form of the furoate. Fluticasone furoate is a
synthetic fluorinated corticosteroid that has been developed as an intranasal treatment for
patients with symptoms of rhinitis and has an enhanced affinity towards the glucocorticoid
receptor.
Further, fluticasone furoate has greater potency than other clinically used corticosteroids such
as mometasone furoate, budesonide, fluticasone propionate, ciclesonide for the
glucocorticoid receptor and against the proinflammatory transcription factors nuclear factor
KB (NF-KB), activation protein- 1, and tumor necrosis factor- induced interleukin-8 cytokine
production.
Fluticasone (especially fluticasone furoate) and indacaterol mainly act on two different
components of asthma exhibiting a complimentary action. Chronic inflammation which is
commonly associated with asthma is managed by fluticasone (especially fluticasone furoate)
while other aspects of asthma, such as abnormalities in bronchial smooth muscle are
improved, by indacaterol
Hence, the combination of fluticasone (especially fluticasone furoate) with indacaterol
provides a novel combination which has the convenience of once daily administration for
patients of asthma and COPD.
5 Further a rapid onset of the effect of the combination due to indacaterol may increase the
patient's confidence in the treatment and subsequently improve compliance to therapy.
Thus the present invention provides a pharmaceutical composition comprising indacaterol
and fluticasone (especially fluticasone furoate), preferably for once daily administration.
10
According to another embodiment the present invention provides a pharmaceutical
composition comprising indacaterol and fluticasone propionate, preferably for twice daily
administration.
15 According to another embodiment the present invention provides a pharmaceutical
composition comprising indacaterol and an ester of fluticasone, preferably for once daily
administration.
Further, combination of fluticasone (especially fluticasone furoate) and indacaterol exhibits a
20 synergistic activity, in which fluticasone furoate helps in increasing the activity of
indacaterol; at the same time indacaterol helps in improving the efficacy of fluticasone
furoate.
According to the present invention, indacaterol may be present in the in the amount of about
25 20mcg to 1200mcg.
According to the present invention, an ester of fluticasone may be present in the in the
amount of about 0.5 meg to 800mcg.
30 According to another embodiment of the present invention the pharmaceutical composition
may comprise indacaterol and fluticasone (especially fluticasone furoate) with one or more
pharmaceutically acceptable excipients.
It has been surprisingly found that formoterol in combination with fluticasone (especially
fluticasone furoate) provides relief form respiratory disorders, while simultaneously reducing
the frequency of dosage administration.
The present invention provides a novel combination for inhalation comprising formoterol in
combination with fluticasone (especially fluticasone furoate) for the prevention or treatment
of respiratory, inflammatory or obstructive airway disease while simultaneously reducing the
frequency of dosage administration.
Formoterol is chemically known as (±)-2-hydroxy-5-[(lRS)-l-hydroxy-2-[[(lRS)-2-(4-
methoxyphenyl)-lmethylethyl]-amino] ethyl] formanilide fumarate dihydrate is a selective
long acting beta2-agonist. Formoterol exhibits a quick onset of action within 1-3 minutes
which helps to achieve an immediate therapeutic response. Further more formoterol exhibits
a longer duration of action.
Fluticasone (especially fluticasone furoate) and formoterol mainly act on two different
components of asthma exhibiting a complimentary action. Chronic inflammation which is
commonly associated with asthma is managed by fluticasone (especially fluticasone furoate)
while other aspects of asthma, such as abnormalities in bronchial smooth muscle are
improved, by formoterol.
Hence, the combination of fluticasone (especially fluticasone furoate) with formoterol
provides a novel combination which has the convenience of once daily administration for
patients of asthma and COPD.
Thus the present invention provides a pharmaceutical composition comprising formoterol and
fluticasone (especially fluticasone furoate), preferably for once daily administration.
According to another embodiment the present invention provides a pharmaceutical
composition comprising formoterol and fluticasone propionate, preferably for twice daily
administration.
According to yet another embodiment the present invention provides a pharmaceutical
composition comprising formoterol and an ester of fluticasone, preferably for once daily
administration.
Further a rapid onset of the effect of the combination due to formoterol may increase the
patient's confidence in the treatment and subsequently improve compliance to therapy.
Further, the combination of fluticasone (especially fluticasone furcate) and formoterol
exhibits a synergistic activity, in which fluticasone (especially fluticasone furoate) helps in
increasing the activity of formoterol; at the same time formoterol helps in improving the
efficacy of fluticasone (especially fluticasone furoate).
According to the present invention, formoterol may be present in the in the amount of about
0.5mcg to 40mcg.
According to the present invention, an ester of fluticasone may be present in the in the
amount of about 0.5 meg to 800mcg.
According to another embodiment of the present invention the pharmaceutical composition
may comprise formoterol and fluticasone (especially fluticasone furoate) with one or more
pharmaceutically acceptable excipients.
It has been surprisingly found that indacaterol in combination with ciclesonide provides relief
form respiratory disorders, while simultaneously reducing the frequency of dosage
administration.
The present invention also provides a novel combination for inhalation comprising
indacaterol in combination with ciclesonide for the prevention or treatment of respiratory,
inflammatory or obstructive airway disease while simultaneously reducing the frequency of
dosage administration.
Ciclesonide, a non halogenated corticosteroid is a prodrug which is hydrolysed enzymatically
by esterases in the lungs to form its active metabolite desisobutyryl ciclesonide which
exhibits pronounced anti-inflammatory activity. Further ciclesonide has negligible systemic
effects and therefore exhibits a better safety profile.
Ciclesonide exhibits a longer duration of action due to its lipophilic nature and lipid
conjugation property. Indacaterol has a longer duration of action of about more than 24 hrs
and exhibits a faster onset of action.
Ciclesonide and indacaterol mainly act on two different components of asthma exhibiting a
complimentary action. Chronic inflammation which is commonly associated with asthma is
managed by ciclesonide while other aspects of asthma, such as abnormalities in bronchial
smooth muscle are improved, by indacaterol.
Further a rapid onset of effect of the combination due to indacaterol may increase in patient's
confidence in the treatment and subsequently improve compliance to therapy.
Hence, the combination of ciclesonide with indacaterol provides a novel combination which
has the convenience of once daily administration for patients of asthma and COPD.
Thus the present invention provides a pharmaceutical composition comprising indacaterol
and ciclesonide, preferably for once daily administration.
Further, combination of ciclesonide and indacaterol exhibits a synergistic activity, in which
ciclesonide helps in increasing the activity of indacaterol; at the same time indacaterol helps
in improving the efficacy of ciclesonide.
According to the present invention, indacaterol may be present in the in the amount of about
20mcg to 1200mcg.
According to the present invention, ciclesonide may be present in the in the amount of about
20mcg to 800mcg.
According to another embodiment of the present invention the pharmaceutical composition
may comprise indacaterol and ciclesonide with one or more pharmaceutically acceptable
excipients.
As discussed above, the selection of a specific 2-agonist, anticholinergic agent and inhaled
corticosteroid (ICS) plays a very important role in formulation of fixed dose combinations.
We have also found that a combination therapy of fluticasone (especially fluticasone furoate),
indacaterol and tiotropium is effective for the prevention or treatment of respiratory, treating
inflammatory and/or obstructive airway disease such as diseases of the respiratory tract,
particularly asthma and or chronic obstructive pulmonary disease (COPD).
Furthermore, the combination of fluticasone (especially fluticasone furoate), indacaterol and
tiotropium provides a rapid onset of action and improved control of obstructive or
inflammatory airway diseases, or reduction in the exacerbations of the diseases.
Another advantage of the combination is that the invention facilitates the treatment of an
obstructive and inflammatory airway disease with a single medicament.
Further this combination therapy provides for administration of the said combination therapy
by use of a single inhaler for patients who currently have to make use of multiple inhalers.
This is particularly advantageous when using fluticasone furoate, which can be administered
once daily along with tiotropium as compared to fluticasone propionate which is to be
administered twice daily. This is particularly important in case of elderly patients who may
get confused between the inhalers and who also suffer from several other medical conditions
such as heart disease, arthritis etc. and are receiving multiple other medications.
Thus the present invention provides a pharmaceutical composition comprising fluticasone
furoate, indacaterol and tiotropium for once daily administration.
According to another embodiment the present invention provides a pharmaceutical
composition comprising fluticasone furoate, indacaterol and tiotropium for twice daily
administration.
According to yet another embodiment the present invention provides a pharmaceutical
composition comprising esters of fluticasone, indacaterol and tiotropium for once daily
administration.
Chronic inflammation which is commonly associated with asthma is managed by fluticasone.
The anticholinergic used according to the present invention may be tiotropium. In an
embodiment, the tiotropium is tiotropium bromide, especially tiotropium bromide
monohydrate.
Tiotropium bromide is an anticholinergic bronchodilator that antagonises muscarinic Ml, M2
and M3 receptors. Tiotropium, is chemically described as (la, 2fi, 4 , 5a, 7B)-7-[(Hydroxydi-
2-thienylacetyl) oxy]-9, 9-dimethyl-3-oxa-9-azoniatricyclo [3.3.1.02'4] nonane bromide
monohydrate. Tiotropium has a longer duration of action of up to 32 hours. Also tiotropium
exhibits an improvement in dyspnea and ceases the need for rescue therapy.
Tiotropium in combination with pulmonary rehabilitation (PR) associated with an increased
exercise endurance time produces clinically meaningful improvements in dyspnea and health
status as compared to pulmonary rehabilitation (PR alone in COPD patients.
Further, tiotropium is more potent than ipratropium in the treatment of patients with COPD in
terms of the effect of lung function, dyspnea, exacerbation rates and health status.
The present invention provides a pharmaceutical composition comprising fluticasone furoate,
tiotropium and indacaterol.
According to the present invention, the ester of fluticasone may be present in the in the
amount of about 0.5 meg to 800mcg.
According to another the present invention, tiotropium may be present in the in the amount of
about 2.25mcg to 30mcg.
According to the present invention, indacaterol may be present in the in the amount of about
20mcg to 1200mcg.
According to one embodiment of the present invention the pharmaceutical composition may
comprise indacaterol and fluticasone furoate, indacaterol and tiotropium with one or more
pharmaceutically acceptable excipients.
The pharmaceutical compositions of the present invention may be administered by any
suitable methods used for delivery of the drugs to the respiratory tract. The composition of
the present invention may thus be administered as metered dose inhalers (MDI), dry powder
inhalers (DPI), nebuliser, nasal spray, nasal drops, insufflation powders.
The various dosage forms according to the present invention may comprise one or more
pharmaceutically acceptable carriers/excipients suitable for formulating the same.
The metered dose inhalers, according to the present invention may comprise one or more
pharmaceutically acceptable excipients such as but not limited to HFC/HFA propellants, cosolvents,
bulking agents, non volatile component, buffers/pH adjusting agents, surface active
agents, preservatives, complexing agents, or combinations thereof.
Propellants are those which, when mixed with the cosolvent(s), form a homogeneous
propellant system in which a therapeutically effective amount of the medicament can be
dissolved. The HFC/HFA propellant must be toxicologically safe and must have a vapor
pressure which is suitable to enable the medicament to be administered via a pressurized
MDI.
According to the present invention the HFC/HFA propellants may comprise, one or more of
1,1,1,2-tetrafluoroethane (HFA-134(a)) and 1,1,1,2,3,3,3,-heptafluoropropane (HFA-227),
difluoromethane (HFC-32), 1,1,1-trifluoroethane (HFC-143(a)), 1,1,2,2-tetrafluoroethane
(HFC- 134), and 1,1-difluoroethane (HFC- 152a) and such other propellants which may be
known to the person having a skill in the art.
Co-solvent is any solvent which is miscible in the formulation in the amount desired and
which, when added provides a formulation in which the medicament can be dissolved. The
function of the cosolvent is to increase the solubility of the medicament and the excipients in
the formulation.
According to the present invention the co-solvent may comprise one or more of, C2- C
aliphatic alcohols, such as but not limited to ethyl alcohol and isopropyl alcohol; glycols such
as but not limited to propylene glycol, polyethylene glycols, polypropylene glycols, glycol
ethers, and block copolymers of oxyethylene and oxypropylene; and other substances, such
as but not limited to glycerol, polyoxyethylene alcohols, and polyoxyethylene fatty acid
esters; hydrocarbons such as but not limited to n-propane, n-butane, isobutane, n-pentane,
iso-pentane, neo-pentane, and n-hexane; and ethers such as but not limited to diethyl ether.
Suitable surfactants may be employed in the aerosol solution composition meant for
administration through metered dose inhalers of the present invention which may serve to
stabilize the solution formulation and improve the performance of valve systems of the
metered dose inhaler.
According to the present invention the surfactant may comprise one or more ionic and/or
non-ionic surfactant, but not limited to, salts of stearic acids such as magnesium stearate or
esters such, as ascorbyl palmitate, isopropyl myristate and tocopherol esters oleic acid,
sorbitan trioleate, lecithin, isopropylmyristate, tyloxapol, polyvinylpyrrolidone, polysorbates
such as polysorbate 80, Polysorbate 20, Polysorbate 40, vitamin E-TPGS, and macrogol
hydroxystearates such as macrogol- 15-hydroxystearate, acetylated monoglycerides like
Myvacet 9-45 and Myvacet 9-08, Polyoxyethylene ethers, ethyloleate, glyceryl trioleate,
glyceryl monolaurate, glyceryl monooleate, glyceryl monosterate, glyceryl monoricinoleate,
cetylalcohol, sterylalcohol, cetylpyridinium chloride, block polymers, natural oils, polyvinyl
pyrrolidone, sorbitan fatty acid esters such as sorbitan trioleate, polyethoxylated sorbitan
fatty acid esters (for example polyethoxylated sorbitan trioleate), sorbimacrogol oleate,
synthetic amphotensides (tritons), ethylene oxide ethers of octylphenolformaldehyde
condensation products, phosphatides such as lecithin, polyethoxylated fats, polyethoxylated
oleotriglycerides and polyethoxylated fatty alcohols.
The surfactants may also be selected from the vast class known in the art like oils such as, but
not limited to, corn oil, olive oil, cottonseed oil and sunflower seed oil, mineral oils like
liquid paraffin, oleic acid and also phospholipids such as lecithin, or sorbitan fatty acid esters
like sorbitan trioleate or Tween 20, Tween 60, Tween 80, PEG - 25 Glyceryl trioleate, PVP,
citric acid, PFDA (per fluoro-n-decanoic acid).
Non- volatile component is all the suspended or dissolved constituents that would be left after
evaporation of the solvent.
According to the present invention, the non-volatile component may comprise one or more of
monosaccharides such as but not limited to glucose, arabinose; disaccharides such as but not
limited to lactose, maltose; oligosaccharides and polysaccharides such as but not limited to
dextrans; polyalcohol such as but not limited to glycerol, sorbitol, mannitol, xylitol; salts
such as but not limited to potassium chloride, magnesium chloride, magnesium sulphate,
sodium chloride, sodium citrate, sodium phosphate, sodium hydrogen phosphate, sodium
hydrogen carbonate, potassium citrate, potassium phosphate, potassium hydrogen phosphate,
potassium hydrogen carbonate, calcium carbonate and calcium chloride.
Suitable bulking agents may be employed in metered dose inhalation composition of the
present invention.
According to the present invention, the bulking agent may comprise one or more of
saccharides, including monosaccharides, disaccharides, polysaccharides and sugar alcohols
such as arabinose, glucose, fructose, ribose, mannose, sucrose, terhalose, lactose, maltose,
starches, dextran or mannitol.
Suitable buffers or pH adjusting agents may be employed in the metered dose inhalation
composition of the present invention.
According to the present invention, the buffer or the pH adjusting agent may comprise one or
more of organic or inorganic acids such as, but not limited to, citric acid, ascorbic acid,
hydrochloric acid, sulfuric acid, nitric acid, or phosphoric acid.
Suitable preservatives may be employed in the aerosol solution composition of the present
invention to protect the formulation from contamination with pathogenic bacteria.
According to the present invention, the preservative may comprise one or more of
benzalkonium chloride, benzoic acid, benzoates such as sodium benzoate and such other
preservatives which may be known to the person skilled in the art.
Suitable complexing agents may be employed in the aerosol solution composition of the
present invention which is capable of forming complex bonds.
According to the present invention, the complexing agent may comprise one or more of but
not limited to sodium EDTA or disodium EDTA.
The pharmaceutical composition of the present invention may be administered by a dry
powder inhaler (DPI).
The pharmaceutically acceptable excipients suitable for dry powder inhalation according to
the present invention may be selected from suitable carriers which may comprise one or more
of, but not limited to sugars such as glucose, saccharose, lactose and fructose, starches or
starch derivatives, oligosaccharides such as dextrins, cyclodextrins and their derivatives,
polyvinylpyrrolidone, alginic acid, tylose, silicic acid, cellulose, cellulose derivatives (for
example cellulose ether), sugar alcohols such as mannitol or sorbitol, calcium carbonate,
calcium phosphate, etc. lactose, lactitol, dextrates, dextrose, maltodextrin, saccharides
including monosaccharides, disaccharides, polysaccharides; sugar alcohols such as arabinose,
ribose, mannose, sucrose, trehalose, maltose, dextran.
The pharmaceutical composition of the present invention may be administered by
nebulization.
Nebulisation therapy has an advantage over other inhalation therapy, since it is easy to use
and does not require co-ordination or much effort .It also works much more rapidly than
medicines taken by mouth.
For nebulisers, the composition according to the present invention may comprise suitable
excipients such as tonicity agents, pH regulators, chelating agents, tonicity adjusting agents,
surfactants, buffer agents in a suitable vehicle.
Isotonicity-adjusting agents, which may be used, may comprise one or more of, but not
limited to, sodium chloride, potassium chloride, zinc chloride, calcium chloride and mixtures
thereof. Other isotonicity-adjusting agents may also include, but are not limited to, mannitol,
glycerol, and dextrose and mixtures thereof.
The pH may be adjusted by the addition of pharmacologically acceptable acids.
Pharmacologically acceptable inorganic acids or organic acids may be used for this purpose.
Examples of preferred inorganic acids which may be used include one or more of, but not
limited to, hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid and phosphoric
acid or combinations thereof. Examples of particularly suitable organic acids which may be
used include one or more of, but not limited to, ascorbic acid, citric acid, malic acid, tartaric
acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and propionic acid or
combinations thereof. Examples of preferred bases which may be used include one or more
of, but not limited to, aqueous ammonia solution, ammonium carbonate, sodium borate,
sodium carbonate, and sodium hydroxide or combinations thereof.
Complexing/chelating agents according to the present invention may comprise one or more
of, but not limited to, editic acid (EDTA) or one of the known salts thereof, e.g. sodium
EDTA or disodium EDTA dihydrate (sodium edetate) or combinations thereof
Suitable surfactants or wetting agents may also be used in the pharmaceutical compositions
of the present invention. According to the present invention, surfactant may comprise one or
more, but not limited to Polysorbates such as uch as polysorbate 20, polysorbate 40,
polysorbate 60, polysorbate 80, polysorbate 65, polysorbate 85, sorbitan fatty acid esters such
as Span 20, Span 40, Span 60 Span 80, Span 120; sodium lauryl sulfate; polyethoxylated
castor oil; polyethoxylated hydrogenated castor oil, sodium dodecyl sulfate (sodium lauryl
sulfate), Lauryl dimethyl amine oxide, Docusate sodium, Cetyl trimethyl ammonium bromide
(CTAB) Polyethoxylated alcohols, Polyoxyethylene sorbitan, Octoxynol, N, Ndimethyldodecylamine-
N-oxide, Hexadecyltrimethylammonium bromide, Polyoxyl 10
lauryl ether, Brij, Bile salts (sodium deoxycholate, sodium cholate), Polyoxyl castor oil,
Nonylphenol ethoxylate, Cyclodextrins, Lecithin, Methylbenzethonium chloride.
Carboxylates, Sulphonates, Petroleum sulphonates, alkylbenzenesulphonates,
Naphthalenesulphonates, Olefin sulphonates, Alkyl sulphates, Sulphates, Sulphated natural
oils & fats, Sulphated esters, Sulphated alkanolamides, Alkylphenols, ethoxylated &
sulphated, Ethoxylated aliphatic alcohol, polyoxyethylene surfactants, carboxylic esters
Polyethylene glycol esters, Anhydrosorbitol ester & it's ethoxylated derivatives, Glycol
esters of fatty acids, Carboxylic amides, Monoalkanolamine condensates, Polyoxyethylene
fatty acid amides, Quaternary ammonium salts, Amines with amide linkages,
Polyoxyethylene alkyl & alicyclic amines, N,N,N,N tetrakis substituted ethylenediamines 2-
alkyl 1- hydroxyethyl 2-imidazolines, N -coco 3-aminopropionic acid/ sodium salt, N-tallow
3 -iminodipropionate disodium salt, N-carboxymethyl n dimethyl n-9 octadecenyl
ammonium hydroxide, n-cocoamidethyl n-hydroxyethylglycine sodium salt etc.
According to the present invention, the buffer agents may comprise one or more of organic or
inorganic acids such as but not limited to citric acid/sodium hydrogensulphate borate buffer,
phosphates (sodium hydrogen orthophosphate, disodium hydrogenphosphate), trometamol,
acetate buffer, citrate buffer, sodium citrate dehydrate, citric acid monohydrate, sodium
dihydrogen phosphate dehydrate, anhydrous disodium hydrogen phosphate or equivalent
conventional buffers.
Anti-microbial preservative agent may be added for multi-dose packages.
The composition according to the present invention may be provided in suitable containers
with suitable means enabling the application of the contained formulation to the respiratory
tract.
The powder for inhalation intended for administration through DPI may either be
encapsulated in capsules of gelatin or HPMC or in blisters or alternatively, the dry powder
may be contained as a reservoir either in a single dose or multi-dose dry powder inhalation
device.
Alternatively, the powder for inhalation intended to be used for DPI may be suspended in a
suitable liquid vehicle and packed in an aerosol container along with suitable propellants or
mixtures thereof.
Further, the powder for inhalation intended to be used for DPI may also be dispersed in a
suitable gas stream to form an aerosol composition.
The MDI composition according to the present invention may be packed in plain aluminium
cans or SS (stainless steel) cans. Some aerosol drugs tend to adhere to the inner surfaces, i.e.,
walls of the cans and valves, of the MDI. This can lead to the patient getting significantly less
than the prescribed amount of the active agent upon each activation of the MDI. Coating the
inner surface of the container with a suitable polymer can reduce this adhesion problem.
Suitable coatings include fluorocarbon copolymers such as FEP-PES (fluorinated ethylene
propylene and polyethersulphone) and PFA-PES (perfluoroalkoxyalkane and
polyethersulphone), epoxy and ethylene. Alternatively, the inner surfaces of the cans may be
anodized, plasma treated or plasma coated.
It may be well acknowledged to a person skilled in the art that the said pharmaceutical
composition, according to the present invention, may further comprise one or more active(s)
selected from anticholinergics, antihistamines, antiallergics or leukotriene antagonist or their
pharmaceutically acceptable salts, solvates, tautomers, derivatives, enantiomers, isomers,
hydrates, prodrugs or polymorphs thereof.
The present invention also provides a process to manufacture the compositions according to
the present invention.
The present invention provides a process of preparing a metered dose inhalation composition
which process comprises admixing of a pharmaceutically acceptable carrier or excipient with
the actives and the propellant and providing the composition in precrimped cans.
The present invention provides a process of preparing a dry powder inhalation composition
which process comprises admixing of a pharmaceutically acceptable carrier or excipient with
the actives and providing the composition to be administered through dry powder inhaler.
The present invention also provides a process of preparing an inhalation solution/suspension
repulse which process comprises dissolving/dispersing the drugs, optionally chelating agents,
osmotic agents and any other suitable ingredients in the vehicle and adjusting the pH using a
suitable pH adjusting agent.
The present invention also provides a method for the treatment in a mammal, such as a
human, for treating chronic obstructive pulmonary disease and asthma, which method
comprises administration of a therapeutically effective amount of a pharmaceutical
composition according to the present invention. The method of treatment may be
characterized in that the pharmaceutical compositions according to the present invention are
administered once a day in therapeutically effective amounts.
The present invention provides a pharmaceutical composition comprising one or more
bronchodilators (such as a long-acting beta agonist (LABA)) and an inhaled corticosteroid
(ICS) for use in treating disorders or conditions that respond to, or are prevented, ameliorated
or eliminated by, the administration of one or more bronchodilators (such as a long-acting
beta agonist (LABA)) and inhaled corticosteroid (ICS).
The following examples are for the purpose of illustration of the invention only and are not
intended in any way to limit the scope of the present invention.
Example 1
Sr. No. Ingredients Qty / Spray
1. Indacaterol 50 meg
2. Fluticasone furoate 100 meg
3. HFA227 q.s.
Process:
1) Indacaterol and Fluticasone furoate were homogenized with a part quantity of HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 2
Process:
1) Indacaterol and Fluticasone furoate were homogenized with lactose and a part quantity of
HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 3
Sr. No. Ingredients Qty / Spray
1. Indacaterol 50 meg
2. Fluticasone Furoate 100 meg
3. PEG400/1000 0.3% of total
formulation
4. PVP K 25 0.001% of total
formulation
HFA227 q.s.
Process:
1) PVP was dissolved in PEG and part quantity of HFA
2) The solution obtained in Step 1 was transferred to a mixing vessel.
3) Indacaterol and Fluticasone furcate were homogenized with a part quantity of HFA.
4) The suspension obtained in step 3 was transferred to the mixing vessel where remaining
quantity of HFA was added.
5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 4
Process:
1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
2) Indacaterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 5
1. Indacaterol 50 meg
2. Fluticasone Furoate 100 meg
3. Ethanol 15-20% of total
formulation
4. HCL ( 0.08N) pH 2.5-3.5
5. HFA134a q.s.
Process:
1) Required quantity of HC1 was added to ethanol.
2) Indacaterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 6
Process:
1) Required quantity of citric acid was added to ethanol.
2) Indacaterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 7
Sr. No. Ingredients Qty / unit (mg)
1. Indacaterol Maleate 0.194
2. Fluticasone Furoate 0.100
3. Lactose monohydrate IP/Ph.Eur/NF 24.7060
Total 25.000
Process:
1) Indacaterol and Fluticasone furoate were sifted with a part quantity of lactose.
2) The cosift of step 1was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 8
Process:
1) Indacaterol and Fluticasone furoate were sifted with a part quantity of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 9
Sr. No. Ingredients Qty / unit (mg)
1. Indacaterol Maleate 0.194
2. Fluticasone Furoate 0.400
3. Lactose monohydrate IP/Ph.Eur/NF 24.4060
Total 25.0000
Process:
1) Indacaterol and Fluticasone furoate were sifted with a part quantity of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 10
Process:
1) Formoterol and Fluticasone furoate were homogenized with a part quantity of HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 11
Process:
1) Formoterol and Fluticasone furoate were homogenized with lactose and a part quantity of
HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 12
Process:
1) PVP was dissolved in PEG and part quantity of HFA
2) The solution obtained in Step 1 was transferred to a mixing vessel.
3) Formoterol and Fluticasone furoate were homogenized with a part quantity of HFA.
4) The suspension obtained in step 3 was transferred to the mixing vessel where remaining
quantity of HFA was added.
5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 13
Sr. No. Ingredients Qty / Spray
1. Formoterol 6 meg
2. Fluticasone Furoate 100 meg
3. Ethanol 15-20% of total
formulation
4. Glycerol 1% of total
formulation
5. HCL ( 0.08N) pH 2.5 - 3.5
6. HFA134a HFA134A q.s.
Process:
1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
2) Formoterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 14
Process:
1) Required quantity of HC1 was added to ethanol.
2) Formoterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 15
Sr. No. Ingredients Qty / Spray
1. Formoterol 6 meg
2. Fluticasone Furoate 100 meg
3. Ethanol 15-20% of total
formulation
4. Citric acid pH 3 - 4
5. HFA134a/HFA134A q.s.
Process:
1) Required quantity of citric acid was added to ethanol.
2) Formoterol and Fluticasone furoate were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 16
Process:
1) Sifted lactose was co-sifted with formoterol and fluticasone furoate.
2) The mixture obtained in step (1) was blended.
Example 17
Process:
1) Sifted lactose was co-sifted with formoterol and fluticasone furoate.
2) The mixture obtained in step (1) was blended.
Example 18
Process:
1) Sifted lactose was co-sifted with formoterol and fluticasone furoate.
2) The mixture obtained in step (1) was blended.
Example 19
Process:
1) Indacaterol and Ciclesonide were homogenized with a part quantity of HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 20
Sr. No. Ingredients Qty / Spray
1. Indacaterol 50 meg
2. Ciclesonide 100 meg
3. Lactose 100% of the drug
4. HFA227 q.s.
Process:
1) Indacaterol and Ciclesonide were homogenized with lactose and a part quantity of HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 21
Process:
1) PVP was dissolved in PEG and part quantity of HFA
2) The solution obtained in Step 1 was transferred to a mixing vessel.
3) Indacaterol and Ciclesonide were homogenized with a part quantity of HFA.
4) The suspension obtained in step 3 was transferred to the mixing vessel where remaining
quantity of HFA was added.
5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 22
Sr. No. Ingredients Qty / Spray
1. Indacaterol 50 meg
2. Ciclesonide 100 meg
3. Ethanol 15-20% of total
formulation
4. Glycerol 1% of total
formulation
5. HCL ( 0.08N) pH 2.5 -3.5
6. HFA134a q.s.
Process:
1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
2) Indacaterol and Ciclesonide were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 23
Process:
1) Required quantity of HC1 was added to ethanol.
2) Indacaterol and Ciclesonide were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 24
Sr. No. Ingredients Qty / Spray
1. Indacaterol 50 meg
2. Ciclesonide 100 meg
3. Ethanol 15-20% of total
formulation
4. Citric acid pH 3 - 4
5. HFA134a q.s.
Process:
1) Required quantity of citric acid was added to ethanol.
2) Indacaterol and Ciclesonide were dissolved in the solution obtained in step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 25
Process:
1) Indacaterol and Ciclesonide were sifted with a part quantity of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 26
Sr. No. Ingredients Qty / unit (mg)
1. Indacaterol Maleate 0.194
2. Ciclesonide 0.200
3. Lactose monohydrate IP/Ph.Eur/NF 24.606
Total 25.000
Process:
1) Indacaterol and Ciclesonide were sifted with a part quantity of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 27
Process:
1) Indacaterol and Ciclesonide were sifted with a part quantity of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 28
Sr. No. Ingredients Qty / unit (mg)
1. Tiotropium bromide monohydrate 0.0225
2. Fluticasone Furoate 0.100
3. Indacaterol Maleate 0.194
4. Lactose monohydrate IP/Ph.Eur/NF 24.6835
Total 25.000
Process:
1) Fluticasone furoate, Indacaterol and Tiotropium bromide were sifted with a part quantity
of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 29
Process:
1) Fluticasone furoate, Indacaterol and Tiotropium bromide were sifted with a part quantity
of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 30
Process:
1) Fluticasone furoate, Indacaterol and Tiotropium bromide were sifted with a part quantity
of lactose.
2) The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
3) The blend of step 2 was then filled in capsules.
Example 31
Process:
1) Fluticasone furoate, Indacaterol and Tiotropium were homogenized with part quantity of
HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 32
Process:
1) Fluticasone furoate, Indacaterol and Tiotropium were homogenized with lactose and part
quantity of HFA.
2) The suspension obtained in step 1 was transferred to the mixing vessel where remaining
quantity of HFA was added.
3) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 33
Process:
1) PVP was dissolved in PEG and part quantity of HFA134A or HFA227.
2) The solution obtained in Step 1was transferred to a mixing vessel.
3) Fluticasone furoate, Indacaterol and Tiotropium were homogenized with a part quantity of
HFA.
4) The suspension obtained in step 3 was transferred to the mixing vessel where remaining
quantity of HFA was added.
5) The resulting total suspension was mixed, recirculated and filled in into pre-crimped
aluminum cans.
Example 34
Sr. No. Ingredients Qty /Spray
1. Fluticasone Furoate 50 meg
2. Tiotropium 9 meg
3. Indacaterol 50 meg
4. Ethanol 15-20% of total
formulation
5. Glycerol 1% of total
formulation
6. HCL ( 0.08N) pH 2.5 - 3.5
7. HFA134a q.s.
Process:
1) Glycerol was dissolved in ethanol and required quantity of HC1 was added.
2) Fluticasone furoate, Indacaterol and Tiotropium were dissolved in the solution obtained in
step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 35
Process:
1) Required quantity of HC1 was added to ethanol.
2) Fluticasone furoate, Indacaterol and Tiotropium were dissolved in the solution obtained in
step 1.
3) The resulting solution was transferred to the mixing vessel where HFA was added.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 36
Process:
1) Citric acid anhydrous and glycerol were dissolved in ethanol.
2) Fluticasone furoate, Indacaterol and Tiotropium were dissolved in the solution obtained in
step (l).
3) The solution obtained in step (2) was transferred to the main mixing vessel where it was
mixed with entire quantity of HFA134a.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 37
Sr. No. Ingredients Qty /Spray
1. Fluticasone Furoate 50 meg
2. Tiotropium 9 meg
3. Indacaterol 50 meg
4. Ethanol 15-20% of total
formulation
5. Citric acid anhydrous pH 2.5 - 3.5
HFA134a q.s.
Process:
1) Citric acid anhydrous was dissolved in ethanol.
2) Fluticasone furoate, Indacaterol and Tiotropium were dissolved in the solution obtained in
step (l).
3) The solution obtained in step (2) was transferred to the main mixing vessel where it was
mixed with entire quantity of HFA134a.
4) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 38
Process:
1) Lecithin was dissolved in ethanol.
2) Tiotropium and Indacaterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
3) Fluticasone furoate was homogenized with lecithin and ethanol.
4) The suspension obtained instep (3) was transferred to the main mixing vessel where the
remaining quantity of HFA was added.
5) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 39
Sr. No. Ingredients Qty /Spray
1. Fluticasone Furoate 50 meg
2. Tiotropium 9 meg
3. Indacaterol 50 meg
4. Ethanol 1-2% of total
formulation
5. Oleic acid 0.02 - 5% of the
API
6. HFA 134a or HFA227 q.s.
Process:
1) Oleic acid was dissolved in ethanol.
2) Tiotropium and Indacaterol were homogenized with part quantity of HFA and transferred
to the mixing vessel.
3) Fluticasone furoate was homogenized with oleic acid and ethanol.
4) The suspension obtained instep (3) was transferred to the main mixing vessel where the
remaining quantity of HFA was added.
5) The resulting suspension was mixed, recirculated and filled in into pre-crimped aluminum
cans.
Example 40
Sr.No. Ingredients Qty (%w/v)
1. Formoterol Fumarate 0.001
2. Fluticasone Furoate 0.025
3. Polysorbate 80 0.02
4. Sodium Chloride 0.80
5. Disodium Edetate 0.01
6. Citric acid monohydrate 0.12
7. Sodium Citrate Dihydrate 0.40
8. Sodium Hydroxide q.s. to pH 5.3
( 1 % w/v solution)
9. Water For Injection q.s. to 100 ml
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
and Formoterol Fumarate were dissolved in WFI and filtered through sterilizing grade filter
to obtain the main bulk.
2) Fluticasone Furoate, Polysorbate 80 & WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 41
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
and Formoterol Fumarate were dissolved in WFI and filtered through sterilizing grade filter
to obtain the main bulk.
2) Fluticasone Furoate, Polysorbate 80 & WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 42
Process:
1) Sodium chloride, Disodium Edetate, Sodium Dihydrogen Phosphate Dihydrate,
Anhydrous Disodium Hydrogen Phosphate & Tiotropium Bromide were dissolved in WFI
and filtered through sterilizing grade filter to obtain the main bulk.
2) Fluticasone Furoate, Indacaterol and Polysorbate 80 and WFI were colleted in a pressure
vessel and subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 43
Sr. Ingredients Qty (%w/v)
No.
1. Tiotropium Bromide 0.001
2. Indacaterol 0.05
3. Fluticasone Furoate 0.10
4. Polysorbate 80 0.02
5. Sodium Chloride 0.90
6. Sodium Dihydrogen Phosphate 0.94
Dihydrate
7. Anhydrous Disodium Hydrogen 0.175
Phosphate
8. Disodium Edetate 0.01
9. Water For Injection q.s. to 100 ml
Process:
1) Sodium chloride, Disodium Edetate, Sodium Dihydrogen Phosphate Dihydrate,
Anhydrous Disodium Hydrogen Phosphate & Tiotropium Bromide were dissolved in WFI
and filtered through sterilizing grade filter to obtain the main bulk.
2) Fluticasone Furoate, Indacaterol, Polysorbate 80 and WFI were colleted in a pressure
vessel and subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 44
Sr.No. Ingredients Qty (%w/v)
1. Indacaterol 0.025
2. Ciclesonide 0.025
3. Polysorbate 80 0.02
4. Sodium Chloride 0.80
5. Disodium Edetate 0.01
5. Citric Acid Monohydrate 0.12
6. Sodium Citrate Dihydrate 0.40
7. Sodium Hydroxide ( 1 % w/v solution / q.s. to pH
Hydrochloric acid
( 1N Solution)
8. Water For Injection q.s. to 100 ml
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
were dissolved in WFI and filtered through sterilizing grade filter to obtain the main bulk.
2) Indacaterol, Ciclesonide, Polysorbate 80 and WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 45
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
were dissolved in WFI and filtered through sterilizing grade filter to obtain the main bulk.
2) Indacaterol, Ciclesonide, Polysorbate 80 and WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 46
Process:
1) Sodium chloride, Disodium Edetate, Sodium Dihydrogen Phosphate Dihydrate,
Anhydrous Disodium Hydrogen Phosphate were dissolved in WFI and filtered through
sterilizing grade filter to obtain the main bulk.
2) Indacaterol, Fluticasone furoate, Polysorbate 80 and WFI were colleted in a pressure
vessel and subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 47
Sr.No. Ingredients Qty (%w/v)
1. Indacaterol 0.05
2. Fluticasone Furoate 0.10
3. Polysorbate 80 0.02
4. Sodium Chloride 0.90
5. Sodium Dihydrogen Phosphate 0.94
Dihydrate
6. Anhydrous Disodium Hydrogen 0.175
Phosphate
7. Disodium Edetate 0.01
8. Water For Injection q.s. to 100 ml
Process:
1) Sodium chloride, Disodium Edetate, Sodium Dihydrogen Phosphate Dihydrate,
Anhydrous Disodium Hydrogen Phosphate were dissolved in WFI and filtered through
sterilizing grade filter to obtain the main bulk.
2) Indacaterol, Fluticasone furoate, Polysorbate 80 and WFI were colleted in a pressure
vessel and subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 47
Sr.No. Ingredients Qty (% /v)
1. Formoterol Fumarate 0.001
2. Fluticasone Propionate 0.025
3. Polysorbate 80 0.02
4. Sodium Chloride 0.80
5. Disodium Edetate 0.01
6. Citric acid monohydrate 0.12
7. Sodium Citrate Dihydrate 0.40
8. Sodium Hydroxide q.s. to pH 5.3
( 1 % w/v solution)
9. Water For Injection q.s. to 100 ml
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
and Formoterol Fumarate were dissolved in WFI and filtered through sterilizing grade filter
to obtain the main bulk.
2) Fluticasone propionate, Polysorbate 80 and WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
Example 48
Process:
1) Sodium chloride, Disodium Edetate, Citric acid Monohydrate, Sodium Citrate dihydrate
and Formoterol Fumarate were dissolved in WFI and filtered through sterilizing grade filter
to obtain the main bulk.
2) Fluticasone propionate, Polysorbate 80 and WFI were colleted in a pressure vessel and
subjected to sterilization by autoclave to obtain slurry.
3) The slurry obtained in step (2) was added to the main bulk obtained in step (1).
4) Weight was made up with WFI and filled in 2.0ml in LDPE form fill seal ampoules.
It will be readily apparent to one skilled in the art that varying substitutions and
modifications may be made to the invention disclosed herein without departing from the
spirit of the invention. Thus, it should be understood that although the present invention has
been specifically disclosed by the preferred embodiments and optional features, modification
and variation of the concepts herein disclosed may be resorted to by those skilled in the art,
and such modifications and variations are considered to be falling within the scope of the
invention.
It is to be understood that the phraseology and terminology used herein is for the purpose of
description and should not be regarded as limiting. The use of "including," "comprising," or
"having" and variations thereof herein is meant to encompass the items listed thereafter and
equivalents thereof as well as additional items.
It must be noted that, as used in this specification and the appended claims, the singular
forms "a," "an" and "the" include plural references unless the context clearly dictates
otherwise. Thus, for example, reference to "an excipient" includes a single excipient as well
as two or more different excipients, and the like.
CLAIMS:
1. A pharmaceutical composition comprising a beta2-agonist selected from indacaterol
and formoterol in combination with a corticosteroid selected from fluticasone and
ciclesonide, and, optionally, one or more pharmaceutically acceptable excipients.
2. A pharmaceutical composition according to claim 1, wherein the beta2-agonist is
formoterol.
3. A pharmaceutical composition according to claim 1 or 2, wherein the formoterol is
present in an amount ranging from 0.5-40mcg.
4. A pharmaceutical composition according to claim 1, wherein the corticosteroid is
fluticasone.
5. A pharmaceutical composition according to claim 1 or 4, wherein the fluticasone is
present in an amount ranging from 0.5-800mcg.
6. A pharmaceutical composition according to claim 1, 4 or 5, wherein the fluticasone is
in the form of an ester of fluticasone.
7. A pharmaceutical composition according to claim 1, wherein the beta2-agonist is
indacaterol.
8. A pharmaceutical composition according to claim 1 or 7, wherein indacaterol in an
amount ranging from 20-1200mcg.
9. A pharmaceutical composition according to claim 1, wherein the corticosteroid is
ciclesonide.
10. A pharmaceutical composition according to claim 1 or 9, wherein ciclesonide in an
amount ranging from 20-800mcg.
11. A pharmaceutical composition according to any one of the preceding claims, wherein
the fluticasone is in the form of fluticasone furoate.
1 . A pharmaceutical composition according to any one of the preceding claims, wherein
the indacaterol is in the form of indacaterol maleate.
13. A pharmaceutical composition according to any of the preceding claims comprising
indacaterol and fluticasone furoate.
14. A pharmaceutical composition according to any of the preceding claims comprising
formoterol and fluticasone furoate.
15. A pharmaceutical composition according to any of the preceding claims comprising
indacaterol and ciclesonide.
16. A pharmaceutical composition comprising a beta2-agonist selected from indacaterol
and formoterol in combination with a corticosteroid and one or more anticholinergics,
optionally with one or more pharmaceutically acceptable excipients.
17. A pharmaceutical composition according to claim 16, wherein the corticosteroid is
selected from fluticasone, ciclesonide.
18. A pharmaceutical composition according to claim 16, wherein the anticholinergic is
tiotropium.
19. A pharmaceutical composition according to claim 18, wherein the tiotropium is
present in an amount ranging from 2.25-30mcg.
20. A pharmaceutical composition according to claim 16, 17, 18 or 19, wherein the
anticholinergic is tiotropium bromide.
21. A pharmaceutical composition according to any of the preceding claims, comprising
indacaterol, fluticasone furoate and tiotropium.
5 22. A pharmaceutical composition according to any one of the preceding claims wherein
pharmaceutical composition along with any excipients are formulated in a single
pharmaceutical composition
23. A pharmaceutical composition according to any one of the preceding claims,
10 formulated as an inhalation composition.
24. A pharmaceutical composition according to any one of claims 1 to 22, formulated for
use in a metered dose inhaler.
15 25. A pharmaceutical composition according to claim 23 or 24, further comprising a
propellant.
26. A pharmaceutical composition according to claim 23, 24 or 25, further comprising an
excipient selected from a cosolvent, an antioxidant, a surfactant, a bulking agent and a
20 lubricant.
27. A pharmaceutical composition according to any one of claims 1 to 22, formulated for
use as a dry powder inhalation formulation.
25 28. A pharmaceutical composition according to claim 27, further comprising at least one
finely divided pharmaceutically acceptable carrier suitable for use in dry powder inhalation
formulations.
29. A pharmaceutical composition according to claim 26, wherein said carrier includes a
30 saccharide and/or a sugar alcohol.
30. A pharmaceutical composition according to any one of claims 1 to 22, formulated for
use as an inhalation solution/suspension.
31. A pharmaceutical composition according to claim 30, further comprising an excipient
selected from a wetting agent, osmotic agent, a pH regulator, a buffering agent and a
complexing agent, provided in a pharmaceutically acceptable vehicle.
32. A pharmaceutical composition according to any one of the preceding claims for once
daily administration.
33. A pharmaceutical composition according to any one of claims 1 to 3 1 for twice daily
administration.
34. A process for manufacturing a pharmaceutical composition according to any one of
claims 1 to 22 comprising combining indacaterol or formoterol with a corticosteroid selected
from fluticasone or ciclesonide, and, optionally, one or more pharmaceutically acceptable
excipients.
35. A process for manufacturing a pharmaceutical composition according to any one of
claims 1 to 22 comprising combining indacaterol or formoterol with a corticosteroid selected
from fluticasone or ciclesonide, and anticholinergic tiotropium, optionally, one or more
pharmaceutically acceptable excipients.
36. The use of indacaterol or formoterol in combination fluticasone or ciclesonide in the
manufacture of a medicament for the prophylaxis or treatment of a respiratory, inflammatory
or obstructive airway disease.
37. The use of indacaterol or formoterol and a corticosteroid selected from fluticasone or
ciclesonide and anticholinergic tiotropium, in the manufacture of a medicament for the
prophylaxis or treatment of a respiratory, inflammatory or obstructive airway disease.
38. The use of indacaterol in combination fluticasone or ciclesonide in the manufacture of
a medicament for the prophylaxis or treatment of a respiratory, inflammatory or obstructive
airway disease.
5 39. The use of indacaterol in combination fluticasone and tiotropium in the manufacture
of a medicament for the prophylaxis or treatment of a respiratory, inflammatory or
obstructive airway disease.
40. The use of formoterol in combination fluticasone in the manufacture of a medicament
10 for the prophylaxis or treatment of a respiratory, inflammatory or obstructive airway disease.
4 1. The use according to claim 36, 37, 38, 39 or 40, wherein the fluticasone is provided in
the form of fluticasone furoate.
15 42. The use according to claim 36, 37, 38, 39, 40 or 41, wherein said medicament is for
once daily administration.
43. The use according to any one of claims 34 to 42, wherein the disease is COPD or
asthma.
20
44. A method of prophylaxis or treatment of a respiratory, inflammatory or obstructive
airway disease, comprising administering a therapeutically effective amount of a
pharmaceutical composition according to any one of claims 1 to 33 to a patient in need
thereof.
25
45. A method according to claim 44, wherein said pharmaceutical composition is
administered once daily.
46. A method according to claim 44, wherein said pharmaceutical composition is
30 administered twice daily
A method according to claim 44, 45 or 46, wherein the disease is COPD or asthma.
48. A pharmaceutical composition substantially as herein described with reference to the
examples.
49. A process for making a pharmaceutical composition substantially as herein described
with reference to the examples.