WO2001035927A2 - Topical application of muscarinic analgesic drugs such as neostigmine - Google Patents
Topical application of muscarinic analgesic drugs such as neostigmine Download PDFInfo
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- WO2001035927A2 WO2001035927A2 PCT/US2000/031416 US0031416W WO0135927A2 WO 2001035927 A2 WO2001035927 A2 WO 2001035927A2 US 0031416 W US0031416 W US 0031416W WO 0135927 A2 WO0135927 A2 WO 0135927A2
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- skin
- neostigmine
- pain
- analgesic agent
- analgesic
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0014—Skin, i.e. galenical aspects of topical compositions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
- A61K31/27—Esters, e.g. nitroglycerine, selenocyanates of carbamic or thiocarbamic acids, meprobamate, carbachol, neostigmine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
- A61K47/24—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing atoms other than carbon, hydrogen, oxygen, halogen, nitrogen or sulfur, e.g. cyclomethicone or phospholipids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/70—Web, sheet or filament bases ; Films; Fibres of the matrix type containing drug
- A61K9/7007—Drug-containing films, membranes or sheets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
- A61P25/04—Centrally acting analgesics, e.g. opioids
Definitions
- Morphine is the prototype of the class of opioid analgesic drugs which exert their effects by activating opioid receptors within the brain.
- morphine is referred to individually in this application, this reference is meant to encompass other opioid drugs and is not meant to be morphine exclusively.
- narcotics have been used since the 18th century in the forms of oral or injectable morphine or opium in order to accomplish pain relief. Morphine is considered to be unsurpassed as an analgesic for severe pain.
- morphine and other opioid drugs have a number of severe side effects which hamper their wide spread use and acceptance by both physicians and patients. These side effects include: addiction, nausea, inhibition of breathing, somnolence and dysphoria, all of which are mediated by morphine's action within the brain. It is still the current belief that narcotics ingested or injected will cross to the blood stream and from there go to the brain where there are morphine receptors . At that time, the narcotics are believed to attach to these morphine receptors and create a dullness of the pain but with all of the side effects described above. Of course, the worst potential effect is the addiction that can occur if the morphine is used beyond a few days or weeks on a continuous basis.
- the intraspinal method of treating pain has been extensively developed but, as more extensive use was made of this technique, a number of serious problems developed.
- the first problem is that the intraspinal method of treatment requires a spinal tap which of course necessitates the use of a needle to the spinal cord.
- the second problem results from the first in that if it is necessary to use the intraspinal method over a period of time, such as two or three weeks, medication must be injected into the spine for this period of time and the continuous needle sticks into the spine has potential hazards.
- intraspinal application of narcotics is still used to alleviate pain after surgery, this technique has the limitations with the potential for addiction as described above.
- the intraspinal technique of administering narcotics creates difficulty with male patients and especially with elderly male patients in that there can be problems with urination and with consequent problems of urine retention.
- this intraspinal technique produces a significant itching problem as a side effect.
- Engl. J. Med. 325: 1123-1126 (1991) also reported the analgesic effect of intraarticular morphine after arthroscopic knee surgery . These results were reviewed in Stein, C , Peripheral mechanisms of opioid analgesia. Anesth. Analg. 76: 182-191 (1993), and in Stein, C , Lehrgerger, K. , Yassouridis, A. , Khoury, G. : Opioids as novel intraarticular agents in arthritis. In: Progress in Pain
- peripheral opioid receptors endorphins, the body's own pain killers
- endorphins the endorphins
- the endorphins can produce intrinsic analgesia within peripheral tissues both in animals and in humans (Stein (1993), ibid.).
- the peripheral opioid effects were more pronounced in inflamed than in non- inflamed tissues.
- 5,589,480 discloses a method and preparation for a topical application of an opioid drug, such as morphine, for a direct activation of the peripheral opioid receptors on the surface of inflamed skin, without any substantial transdermal or transmucosal systemic delivery of the opioid.
- an opioid drug such as morphine
- the inflammatory process in peripheral tissue is associated with an increase in sensitivity to the antino- ciceptive effects of opioid agents, perhaps by activation of opioid receptors located on primary afferent neurons. This may occur by one or more means, e.g. , de novo synthesis of opioid receptors which increases the number of receptors; axonal transport of pre-existing receptors to peripheral nerve terminals increasing their concentration and thus sensitivity; some other means of activation of pre-existing neuronal opioid receptors by the inflammatory process. See, e.g. , Stein, C , Peripheral and non-neuronal opioid effects. Curr. Opin. Anaesth. 7:347-351 (1994).
- inflamed skin is generally more permeable to topically-administered agents, because the inflammatory process destroys Schwann cells in the epidermis, leading to further exposure of the nerve terminals; inflammation also causes edema, which results in loss of integrity of the epidermis, making the nerve terminals more accessible to topical agents.
- topical analgesia could be induced in non-inflamed skin or mucosa, at least without effecting systemic transdermal or transmucosal delivery as well.
- topical opioid analgesia induced in inflamed skin or mucosal tissue, without effecting syste-mic delivery of the opioid agents.
- the analgesic effect was thus potentiated by topically administering to a patient in need of such treatment a topically effective amount of an analgesic agent, which amount is systemically ineffective for induction of analgesia, admixed with a skin- or mucosa-specific penetration enhancer, such as, e.g. , lecithin, and a pharmaceutical- ly acceptable excipient for topical administration, preferably whereby effective analgesia in the non-inflamed skin or mucosal tissue is induced in the substantial absence of transdermal or transmucosal delivery of the opioid analgesic agent to the systemic circulation.
- a skin- or mucosa-specific penetration enhancer such as, e.g. , lecithin
- Neostigmine is an acetylcholinesterase inhibitor; it was postulated to in-duce analgesia by a variety of pathways, presumably via induction of peripheral cholinerigic antinociception by elevating endogenous acetylcholine available to peripheral muscarinic receptors.
- Systemic administration of neostigmine through the spinal or epidural route of administration has been shown to have dose-related side effects similar to opioids, such as nasuea, vomiting and pruritus.
- This invention provides a method of inducing analgesia in intact, inflamed or non- inflamed skin or mucosal tissue, comprising topically administering to a patient in need of such treatment a topically effective amount of an analgesic agent which affects peripheral muscarinic receptors, which amount is systemically ineffective for induction of analgesia, optionally admixed with a skin- or mucosa-specific penetration enhancer, e.g.
- a further object of the invention is to provide a pharmaceutical composition comprising an admixture of an analgesic agent which affects peripheral muscarinic receptors, and optionally, a skin- or mucosa-specific penetration enhancer, e.g.
- a unit dosage amount of the admixture contains a systemically ineffective amount of the analgesic agent and, optionally, an effective amount of a skin-specific penetration enhancer, such as, e.g. , lecithin, and neither the optional skin-specific penetration enhancer nor the excipient substantially enhances transdermal or transmucosal transmission of the analgesic agent into the central nervous system, with the proviso that, when the admixture is a liquid, it further comprises a component that is pharmaceutically unacceptable for parenteral administration.
- a skin-specific penetration enhancer such as, e.g. , lecithin
- a still further object of the invention is to provide a pharmaceutical compo- sition comprising an admixture of an analgesic agent which affects peripheral muscarinic receptors, a skin-specific penetration enhancer, such as, e.g. , lecithin, and a pharmaceutically acceptable excipient for topical administration to inflamed skin or mucosal tissue, wherein a unit dosage amount of the admixture contains a systemically ineffective amount of the analgesic agent and, optionally, an effective amount of a skin- or mucosa-specific penetration enhancer, such as, e.g.
- the admixture is a liquid, it further comprises a com- pon-ent that is pharmaceutically unacceptable for parenteral administration.
- compositions, and method of use thereof can further comprise an externally-applied wound dressing, or the like, for placing on the exterior of the body to facilitate intimate contact with an area to be treated.
- Figure 1 illustrates a method and apparatus of the present invention and specifically shows a patient 10 receiving a topical application of an analgesic agent which affects muscarinic receptors, such as neostigmine, optionally admixed with a skin penetration enhancer, using a spray 12.
- an analgesic agent which affects muscarinic receptors, such as neostigmine, optionally admixed with a skin penetration enhancer, using a spray 12.
- a small quantity of the neo-stigmine solution is then sprayed onto a painful area 14 on a patient 10 to provide the particular pain relief described above.
- neostigmine and 2700 mg of lecithin may be diluted in 120 cc of saline to form the spray 12.
- the neostigmine/lecithin is initially provided as a solution of 16.8 mg/cc, whereby the final spray solution contains 2 mg in a total of 120 cc.
- the final concentration of neostigmine in the spray is .0168 mg/cc.
- the specific application may result in approximately .1 mg of neostigmine in solution to cover approximately a 6 x 6 square inch area.
- Figure 2 illustrates the same patient 10 with a painful area 14 with an analgesic agent which affects muscarinic receptors, such as neostigmine, optionally admixed with lecithin, and applied topically in either a gel or a cream.
- an analgesic agent which affects muscarinic receptors, such as neostigmine, optionally admixed with lecithin, and applied topically in either a gel or a cream.
- neostigmine and 2700 mg of lecithin may be mixed with 120 cc of a topical gel.
- the neostigmine/lecithin is initially provided in solution as .0168 mg/cc and with the resultant mixture 16 comprising 2 mg of neostigmine in a total of 120 cc.
- the resultant set or cream is applied to the painful area 14 whereby .1 mg of neostigmine covers an area of approximately 6 x 6 square inches.
- Patent 5,589,480 demonstrated that extremely small systemically inactive doses of both conventional opioid drugs such as morphine, as well as other opioid agents, can produce potent analgesic effects after local application to inflamed skin in peripheral tissue. Unexpectedly, similar effects are found for topical treatment of inflammatory pain with analgesic agents which bind to muscarinic receptors as well.
- analgesic agents which bind to muscarinic receptors in intact, non- inflamed skin in a patient suffering from non-inflammatory skin pain such as peripheral neuropathy is potentiated by the use of skin-specific penetration enhancers, which are added to the topical formulation, whereby even pain arising in non- inflamed skin can be successfully treated with topical, local analgesic agents which affect peripheral muscarinic receptors in the absence of delivery of clinically effective central nervous system levels.
- these skin penetration enhancers surprisingly improve the effectiveness of local analgesic agents which affects peripheral muscarinic receptors in the treatment of pain in inflamed skin or mucosal tiss ⁇ e without the concomitant delivery of substantial amounts of the analgesic agent into the central nervous system.
- the analgesic effect is thus potentiated by topically administering to a patient in need of such treatment a topically effective amount of an analgesic agent, which amount is systemically ineffective for induction of analgesia, admixed with a skin- or mucosa-specific penetration enhancer, such as, e.g.
- a skin-specific penetration enhancer an agent which enhances the penetration of an analgesic agent which affects peripheral muscarinic receptors through the uppermost layers of non-inflamed skin to the skin layers in which the peripheral nerves are located that are involved in the painful condition, e.g.
- inflammatory conditions such as burns, herpetic lesions, acne, as well as peripheral nerves that are indirectly involved in the painful conditions, e.g. , wherein an inflammatory disease or condition causes inflammation and pain in the surrounding dermal tissues, e.g., muscle injuries, fractures, arthritis, etc. ; as well as non-inflammatory conditions such as diabetic peripheral neuropathy or post-herpetic neuralgia; without substantial transmission or delivery to the CNS.
- the skin-specificity of the penetration enhancer will be determined by its concentration; e.g., at a concentration of 22 % , lecithin has been shown to be an excellent vehicle for enhancing transdermal delivery to the systemic circulation, whereas it has been shown that at a concentration of 3-6% in non-inflamed skin, lecithin potentiates the passage of analgesics, e.g. , morphine sulfate, across the epidermis into the dermis, yet very little, if any, of the active agent is carried beyond those two layers into the bloodstream.
- analgesics e.g. , morphine sulfate
- lecithin can enhance transport of morphine sulfate across the epidermis and into the dermis in inflamed skin, without transport of substantial amounts into the systemic circulation. Similar optimization can be routinely determined by the skilled worker for analgesic agents which affect peripheral muscarinic receptors, e.g. , a concentration of 3 -6% lecithin for enhancing transport of neostigmine across the epidermis and into the dermis without transport of substantial amounts into the CNS.
- the invention has been tested on a number of patients, and the results are set forth in the Examples.
- patients for whom various types of non-inflamed skin conditions, both acute and chronic, were causing intense pain which was not sufficiently alleviated by systemic administration of opioids were treated topically with various formulations of neostigmine, even without skin penetration enhancers.
- the results were accomplished with the use of only 0.05 or 0.1 mg of the analgesic agent which affects peripheral muscarinic receptors, such as neostigmine, diluted to be sprayed or applied to a relatively large area of skin such as six inches square and without any side effects such as nausea, vomiting or itching.
- the agent may be applied using a variety of different topical formulations such as gels, creams, etc.
- the topical application will reduce pain in lesions such as diabetic neuralgia and post-herpetic neuralgia, e.g. , after herpes zoster (shingles) flare-ups.
- Other types of pain treatable by the methods and compositions disclosed herein include pain associated with damage to peripheral nerves resulting from chemotherapy treatment for a variety of diseases, including cancer and AIDS.
- Vincristine chemotherapy can result in peripheral neuropathy not associated with an inflammatory process.
- the main advantage of the method and pharmaceutical preparations disclosed herein is the excellent pain relief without the typical side effects associated with systemically-effective amounts of oral or injectable drugs which function in the central nervous system. The potential for the present mvention is widespread and the topical application opens up a whole new use of muscarinic receptor-active agents without the prior associated problems.
- analgesic agent used in the topical application of the present invention is typically a small fraction of the typical dosage used in other methods of treatment using these agents, e.g. , intravenous administration for the reversal of muscle relaxant, e.g. , curare, paralysis during surgery.
- analgesic drugs may be used to interact with the peripheral muscarinic receptors which are present in peripheral tissues in various areas of the body and the invention is not to be limited specifically to neostigmine.
- Suitable analgesic agents include compounds which have an analgesic effect through binding to any muscarinic receptor, whereby antinociceptive properties of the agent are functional at the site of pain, as well as agents which enhance the antinociceptive properties of other agents which bind to muscarinic receptors. These include, e.g. , the muscarinic receptor agonists (e.g.
- analgesic agents present invention can be used in conjunction with topically applied opioid analgesic agents, e.g. , in accordance with the invention described in US 5,589,480.
- analgesic agents include, but are not limited to morphine, cyclazocine, piperidine, piperazine, pyrrolidine, morphiceptin, meperidine, trifluadom, benzeneacetamine, diacylacetamide, benzomorphan, alka- loids, peptides, phenantrene and pharmaceutically acceptable salts, prodrugs or derivatives thereof.
- compounds contemplated by as suitable in the present invention include, but are not limited to morphine, heroin, hydromor- phone, oxymorphone, levophanol, methadone, meperidine, fentanyl, codeine, hy- drocodone, oxycodone, propoxyphene, buprenorphine, butorphanol, pentazocine and nalbuphine.
- pharmaceutically acceptable salts, prodrugs and derivatives refers to derivatives of the opioid analgesic compounds that are modified by, e.g.
- analgesically active parent com- pound examples include but are not limited to mineral or organic salts of acidic residues such as amines, alkali or organic salts of acidic residues such as carboxylic acids, acetate, formate, sulfate, tartrate and benzoate derivatives, etc.
- Suitable opioid analgesic agents including those specifically mentioned above, are also described in Goodman and Gilman, ibid, chapter 28, pp. 521-555.
- active agents may be included in the pharmaceutical composition, e.g., topically-effective anaesthetics such as xylocaine, cocaine, lidocaine, benzocaine, etc. , which may provide a more immediate, if less effective in the long run, level of pain relief until the analgesic agent becomes fully effective.
- active agents which may be present in the pharmaceutical preparations include, e.g. , antibiotics, and especially those agents which themselves cause pain when applied to the inflamed site due to their inherent properties, e.g. , pH.
- Still other agents can also be administered, preferably topically, to potentiate the effects of the topically-administered analgesic agents.
- dextromethorphan a non-addictive opioid compound
- parenteral administration is also effective, to enhance the effectiveness of the topically administered analgesic agent.
- dextromethorphan has previously unappreciated analgesic properties in peripheral nerves.
- Suitable concentrations of dextromethorphan are routinely ascertainable by the skilled worker, and include the normal therapeutic amounts administered parenterally for conventional purposes, e.g., as a cough suppressant, or less, and routinely determinable amounts for topical administration; for example, 1 g of dextromethorphan can be added to a composition of Example 1 to provide additional relief from pain.
- a preferred criterion for selecting a suitable topical excipient is that, while it enhances percutaneous delivery of the analgesic agent into the skin or mucous membrane, it does not enhance delivery of the analgesic agent through the skin or mucosa into the systemic circulation, e.g.
- the amount and rate of transmission and thus the difference between pro-viding transdermal or transmucosal delivery and not doing so will lie in the selection of the amount of enhancer used, the intactness of the skin, the type of skin or mucosal tissue which is being treated, the nature of the analgesic agent, etc.
- these are routinely determinable parameters which can be optimized for a particular condition by one of ordinary skill in the art.
- penetration enhancers include penetration enhancers, prodrugs, superfluous vehicles, iontophorosis, phono- phoresis and thermophoresis.
- penetration enhancers are preferred.
- Ideal penetration enhancers have no irritancy or toxicity to the skin, as well as high enhancing effects.
- Enhancers themselves should be physiochemically stable and not have pharmacologic effects and preferably should not have smell, color or taste.
- the stratum corneum provides the principal barrier to the percutaneous pene-tration of topically applied substances. It is the most superficial, cutaneous layer, the horny layer, which consists of flat, scalelike "squames " ' made up of the fibrous protein keratin.
- the squames are continually being replaced from below by epider-mal cells that die in the process of manufacturing keratin. It is unlikely that the emulsified fat on the skin surface greatly affects permeability. However, vehicles can control, to a great extent, the rate of penetration of drugs that are applied to the skin. The intercellular lipids may be important for the permeability barrier in skin. It is known that some combinations of enhancers are synergistic in action, as with ethanol as a vehicle for the potent enhancer laurocapram. Some combinations are not synergistic; for instance, (N) decylmethylsulfoxide lowers the zeta potential of the skin; thus, enhancement due to conduction flow (iontophoresis) is minimized. In any case, optimization of suitable transdermal or transmucosal enhancing prepar- ations for a given use is routine for one of ordinary skill in the art.
- suitable topical transdermal or transmucosal enhancing agents can be routinely selected for a particular use by those skilled in the art. and especially with reference to one of many standard texts in the art, such as Remington's Pharmaceutical Sciences, Vol. 18, Mack Publishing Co. , Easton, PA (1990), in particular Chapter 87.
- suitable enhancers for transdermal absorption include ethanol, propylene glycol, water, sodium oleate, leucinic acid, oleic acid, capric acid, sodium caprate, lauric acid, sodium laurate, neodecanoic acid, dodecyl-amine, cetryl lactate, myristyl lactate, lauryl lactate, methyl laurate, phenyl ethanol, hexa- methylene lauramide, urea and derivatives, dodecyl N, N-dimethylamino acetate, hydroxy ethyl lactamide, phyophatidylcholine, sefsol-318 (a medium chain glycer- ide), isopropyl myristate, isopropyl palmitate, several surfactants, including poly- oxyethylene (10) lauryl ether (Brij 361 R), diethyleneglycol lauryl ether (PEG-2-L), laurocapram (Azone),
- decylmethylsulfoxide enhances primarily polar or ionic molecules (soluble in ethanol), acetone, polyethylene glycol 100-400 MW, dimethylacetamide, dimethylforamide, dimethylisosorbide, sodium bicarbonate, various N 7 . 16 -alkanes, mentane, menthone, menthol, terpinene, D-terpinene, dipen- tene, N-nonalol and limonene.
- medical dressings which comprise an analgesic agent which affects peripheral muscarinic receptors, and pharmaceutical compositions thereof.
- analgesic agent which affects peripheral muscarinic receptors
- pharmaceutical compositions thereof pharmaceutical compositions thereof.
- medical dressing it is meant, e.g. , any article which is placed on the exterior of the body and facilitates intimate contact with a target area to be treated, such as a source of severe pain, wounds, surgical wounds, burns, cuts, abrasions, incisions, ulcers, infected wounds or burns, superficial surgical sites, such as after the removal of a skin cancer lesion, or a wart, and the like.
- a device for topical or external application comprises a medical dressing and agent or pharmaceutical composition in accordance with the present invention.
- Medical dressings in accordance with the present invention include, but are not limited to, bandages, surgical dressings, gauzes, and sterile adhesive strips, surgical gauzes, dressing combines, laparotomy sponges, sanitary napkins, eye pads, gauze roller bandages, muslin bandage rolls, woven elastic bandages, crepe bandages, conforming bandages, high-bulk bandages, triangular bandages, orthopedic bandages, stockinette bandages, cast bandages, adhesive tapes, adhesive strips, cotton balls, pads, sponges, and combinations thereof. See, e.g., Remington's Pharmaceutical Sciences, Eighteenth Edition, Chapter 105, "Surgical Supplies," 1990.
- Such medical dressings can comprise any effective material, including, e.g.
- a dressing can comprise an agent or pharmaceutical composition in accordance with the present invention in any manner which is effective for it to treat the target area.
- the agent and compositions thereof can be associated with the dressing in various ways, including, but not limited to, impregnated, absorbed, adsorbed, ionically applied, etc., in the dressing material.
- a method of inducing analgesia comprising delivering for a period of time via an externally-applied wound dressing, a therapeutically-effective amount of an muscarinic analgesic, wherein delivering the muscarinic analgesic is ineffective for production of centrally-located muscarinic receptors.
- Sulfoxides e.g. , dimethyl sulfoxide [DMSO], N-decylmethylsulfoxide
- Alcohols e.g. , ethanol
- Esters e.g. , isopropyl palmitate, isopropyl myristate
- topical excipient as a vehicle for the analgesic agent, while routine, is an important aspect of the claimed invention.
- the most important criterion for selecting a suitable topical excipient is that it does not enhance delivery of the analgesic agent to the systemic circulation or to the central nervous system by substantial transdermal or transmucosal transmission.
- the topical excipient not have substantial occlusive properties, which enhance percutaneous transmission of the analgesic agent through the skin or mucosa into the systemic circulation.
- occlusive vehicles include hydrocarbon bases such as white petrolatum (e.g. , Vaseline); anhydrous absorption bases such as hydrophilic petrolatum and anhydrous lanolin (e.g. , Aquaphor); and water-in-oil emulsion bases such as lanolin and cold cream.
- vehicles which are substantially nonocclusive and generally include those which are water-soluble, such as oil-in-water emulsion bases (creams or hydrophilic ointments) and water-soluble bases such as polyethylene glycol-based vehicles and aqueous solutions gelled with various agents such as methylcellulose, hydroxy ethyl cellulose, and hydroxypropyl methylcellulose (e.g. , K-Y Gel).
- water-soluble bases such as oil-in-water emulsion bases (creams or hydrophilic ointments) and water-soluble bases such as polyethylene glycol-based vehicles and aqueous solutions gelled with various agents such as methylcellulose, hydroxy ethyl cellulose, and hydroxypropyl methylcellulose (e.g. , K-Y Gel).
- Suitable topical excipients and vehicles can be routinely selected for a particular use by those skilled in the art, and especially with reference to one of many standard texts in the art, such as Remington's Pharmaceutical Sciences, Vol. 18, Mack
- additives for enhancing the adherent properties of the pharmaceutical preparation to various special skin areas, e.g. , the axillar, plantar and palmar skin, and mucosal tissues, e.g. , in the mouth, on the throat, on the genitalia, particularly the external female genitalia, can be similarly routinely selected and the preparation adapted to such use by one of ordinary skill in the art.
- tissue comprising a superficial epithelial membrane which is lubricated by mucus. This includes, inter alia, the lining of the mouth, throat, nose, tympanic membrane, external female genitalia, vagina, urethra, rectum and anus. It does not include the conjunctiva of the eye.
- peripheral muscarinic receptors in the skin or mucosal tissue, but not sufficient to activate central nervous system muscarinic receptors
- analgesic action of the analgesic agent is mediated through interaction with peripheral muscarinic receptors, e.g. , and not through interaction with CNS receptors. See, e.g. , Stein (1993), supra, which sets forth criteria for evaluating peripheral opioid receptor antinociception, as an example for such evaluation.
- substantially absence of or “does not enhance” transdermal or transmucosal delivery of the analgesic agent is meant that upon the induction of analgesia, less than 25 % , preferably less than 10% , more preferably less than 5 % , still more preferably less than 1 % and most preferably none of the analgesic agent has passed through the stratum corneum into the systemic circulation. In particular, an insufficient amount for induction of systemic analgesia is delivered to the systemic circulation.
- the patient is a 71 year old female with a history of acute herpes attack.
- the lesion was at the level of the cervical area in the back of the neck and encompassing the back of the head and the neck.
- the patient was treated with anti-viral medications, with Vicodin (hydrocodone) with Motrin, without any relief of the pain.
- Vicodin hydrocodone
- Motrin Motrin
- the patient was unable to sleep because every time she turned in bed, the back of her head touched the pillow and the Patient woke up.
- the patient was then given topical neostigmine as a mixture of 500 meg of neostigmine in 30 cc of K-Y Gel.
- the patient is a 31-year-old female with painful cold sores in the mouth, and she had been treated with the usual anti-viral medication without much relief.
- the patient was offered with topical 30 cc of K-Y Gel with 500 meg of neostigmine which was used in an amount to cover the area of irritation. The patient stated that within 15 min. The pain was less, and that by the next day she had full relief of her pain. She only had to use it about three times that day.
- the patient is a 71-year-old male with a history of gout. He was referred to the pain clinic because of acute exacerbation of the gout in his big toe, and the patient was unable to control his pain with the usual oral pain medication he had been receiving and the gout medication he was taking.
- the patient was provided with 30 cc of K-Y Gel with 500 meg of neostigmine, and directed to cover the area of pain with the medication, and to repeat every three to four hours as needed. The patient stated that by the next morning his pain was fully gone, and he did not need any of the other pain medications.
- Example 4 Broken Wrist
- the patient is a 70-year-old male with a broken wrist, who was complaining of severe pain with swelling and redness of the wrist.
- the patient was being taken to the operating room for closed reduction of the fracture.
- the patient was supplied with 500 meg neostigmine in 30 cc K-Y Gel and directed to apply the mixture to his wrist himself, so he did not hurt from the application.
- the patient started feeling a difference in his pain and was able to mobilized his hand better than before, and within the next half hour the patient had no pain at all.
- the arm was immobilized, and he had some pain on mobilization of the wrist.
- the patient is a 58-year-old woman with a fractured clavicle, painful with breathing, and not responsive to the oral anti- inflammatory he was taking.
- the patient was given 30 cc of K-Y Gel, 500 meg of neostigmine, and was direct to apply it over his clavicle every three to four hours. After four hours, the patient called back stating that his pain started to disappear within the half hour and within the hour after the application the pain was significantly less than before, and he was very excited about it as he was able to stop all his anti- inflammatory medications, which were causing him a lot of gastrointestinal side-effects.
- Example 6 Sprained Ankle A 45-year-old woman with a sprained ankle, who was in severe pain, unresponsive to the oral anti-inflammatory he was receiving, and the hot and cold packs applied to his ankle.
- the patient was provided with 30 cc of K-Y Gel and 500 meg of neostigmine, and was directed to use it every three to four hours. After a half hour of using it, the pain started subsiding, and after three applications, the patient was definitely in significantly less pain than before. The patient was excited about this, as it was providing him with much more relief than the other treatment he had received thus far.
- the patient is a 50-year-old- female with severe pain in her hand, resulting from a second degree burn of her hand.
- the patient has blisters and was unable to mobilize the fingers because of pain.
- She was provided with 30 cc of K-Y Gel and 500 meg of neostigmine, and was directed to use it every three to four hours.
- the patient applied the cream on her burn, and within 10-15 mins the patient started seeing a change in the quality of her pain, and within the next few hours, the pain had significantly subsided.
- An exemplary composition according to the invention comprises: Neostigmine: 500 meg
- a second exemplary composition according to the invention comprises:
- Neostigmine 500 meg
- Polyethylene glycol to wet
- Soya lecithin 2700 mg (4.5 ml)
- the patient is a 58 year old woman with severe pain in his knee. He underwent arthroscopic surgery of the knee, but the pain stayed the same. The patient was referred for further treatment and the patient was given topical neostigmine to apply on his knee on his follow-up visit, and he was provided with 120 cc of K-Y jelly with 2 mg of neostigmine mixed together. The patient was instructed to cover the area of pain every three to four hours. The patient was using approximately 2 to 3 cc of the mixture and was applying the mixture every three to four hours. At the follow-up visit, the patient stated that he had excellent relief of his pain which was lasting for close to three to four hours. The patient states that because of the use of this cream, he did not need to use any further oral medication to control his pain. He even stopped his anti- inflammatories.
- the patient is an 81 year old female with severe shingles on her chest. She has used oral narcotics and antiviral medication without success.
- the patient was referred to the clinic about two weeks after the onset of the pain and was complaining of severe pain unrelieved with any kind of treatment.
- the patient was given 120 cc of K-Y jelly with 2 mg of neostigmine mixed together and instructed to use enough to cover the area of pain and to repeat it every three to four hours if needed.
- the next day the patient called stating that it is the best relief that she ever had, that the pain had gone away and she does not need to use any other sort of pain medication and she uses close to 4 to
- the patient is a 45 year old female with severe low back pain. She had two back surgeries to relieve her pain without success. She was maintained on oral nar- cotics and she was using approximately 10 tablets of pain medication daily. The patient was contemplating undergoing a third surgery to control her pain. The patient was provided with 120 cc of K-Y jelly with 2 mg of neostigmine to be applied every three to four hours as needed. On her first follow-up visit, the patient stated it was the best relief she ever had. She stated that the pain goes away within five to ten minutes after applying the topical neostigmine and said the relief will last three to four hours. Her intake of pain medications dropped by almost half, and now she is contemplating not undergoing any further surgery because of the pain relief she is getting with the cream.
- a 43 year old female with arthritis of the hands was unable to extend her fingers because of pain.
- the patient was supplied with 120 cc of K-Y jelly with 2 mg of neostigmine and was instructed to use it every three to four hours as needed.
- the patient stated that she used about 2-3 cc per treatment which was enough to cover her hand and fingers and after using it, within a few minutes, she was able to extend her hands fully and the pain had completely disappeared.
- the horse was unresponsive to the usual anti-inflammatories. Because of pain, the horse was unable to be saddled and because of his pain, he would be unable to make any turns or twists.
- the horse trainer was provided with 120 of K-Y jelly with 2 mg of neostigmine and started to use it every three to four hours. Ten minutes after using it the first time, the horse was walking as if nothing were wrong with him and was able to be saddled and taken on a ride for a couple of hours.
- the preceding examples can be repeated with similar success by substituting the generically or specifically described reactants and/or operating conditions of this invention for those used in the preceding examples.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU14904/01A AU1490401A (en) | 1999-11-16 | 2000-11-16 | Topical application of muscarinic analgesic drugs such as neostigmine |
PCT/US2000/031416 WO2001035927A2 (en) | 2000-11-16 | 2000-11-16 | Topical application of muscarinic analgesic drugs such as neostigmine |
EP00977235A EP1406604A2 (en) | 1999-11-16 | 2000-11-16 | Topical application of muscarinic analgesic drugs such as neostigmine |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/US2000/031416 WO2001035927A2 (en) | 2000-11-16 | 2000-11-16 | Topical application of muscarinic analgesic drugs such as neostigmine |
Publications (2)
Publication Number | Publication Date |
---|---|
WO2001035927A2 true WO2001035927A2 (en) | 2001-05-25 |
WO2001035927A3 WO2001035927A3 (en) | 2002-01-10 |
Family
ID=21741999
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2000/031416 WO2001035927A2 (en) | 1999-11-16 | 2000-11-16 | Topical application of muscarinic analgesic drugs such as neostigmine |
Country Status (3)
Country | Link |
---|---|
EP (1) | EP1406604A2 (en) |
AU (1) | AU1490401A (en) |
WO (1) | WO2001035927A2 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
AT500143A1 (en) * | 2004-04-22 | 2005-11-15 | Sanochemia Pharmazeutika Ag | CHOLINESTERASE INHIBITORS IN LIPOSOMES AND THEIR PREPARATION AND USE |
EP3413888A4 (en) * | 2016-02-12 | 2020-01-15 | United States Government as Represented by The Department of Veterans Affairs | Bowel care using iontophoresis |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6011022A (en) * | 1998-03-03 | 2000-01-04 | El Khoury; George F. | Topical application of muscarinic analgesic drugs such as neostigmine |
WO2000027381A2 (en) * | 1998-11-09 | 2000-05-18 | El Khoury George F | Topical application of muscarinic agents such as neostigmine for treatment of acne and other inflammatory conditions |
-
2000
- 2000-11-16 EP EP00977235A patent/EP1406604A2/en not_active Withdrawn
- 2000-11-16 WO PCT/US2000/031416 patent/WO2001035927A2/en active Application Filing
- 2000-11-16 AU AU14904/01A patent/AU1490401A/en not_active Abandoned
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6011022A (en) * | 1998-03-03 | 2000-01-04 | El Khoury; George F. | Topical application of muscarinic analgesic drugs such as neostigmine |
WO2000027381A2 (en) * | 1998-11-09 | 2000-05-18 | El Khoury George F | Topical application of muscarinic agents such as neostigmine for treatment of acne and other inflammatory conditions |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
AT500143A1 (en) * | 2004-04-22 | 2005-11-15 | Sanochemia Pharmazeutika Ag | CHOLINESTERASE INHIBITORS IN LIPOSOMES AND THEIR PREPARATION AND USE |
EP3413888A4 (en) * | 2016-02-12 | 2020-01-15 | United States Government as Represented by The Department of Veterans Affairs | Bowel care using iontophoresis |
EP4230202A1 (en) * | 2016-02-12 | 2023-08-23 | The United States Government Represented by the Department of Veterans Affairs | Bowel care using iontophoresis |
Also Published As
Publication number | Publication date |
---|---|
AU1490401A (en) | 2001-05-30 |
EP1406604A2 (en) | 2004-04-14 |
WO2001035927A3 (en) | 2002-01-10 |
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