HK1238130A1 - Oral administration of unstable or poorly-absorbed drugs - Google Patents

Abstract

The disclosure relates to a dosage forms and combinations of dosage forms useful for effective oral administration of drugs which are otherwise unsuitable for oral administration, owing to acid- and/or protease-mediated degradation. The dosage forms include a self-microemulsifying drug delivery system (SMEDDS) with which the drug is combined and an antacid. When co-administered to a mammal, the dosage form(s) can prevent drug degradation by the strong acid and digestive enzymes normally present in the gastric environment, and can improve water-soluble drug absorption in gastrointestinal (GI) tract. The dosage forms can be used to effectively administer insulin by an oral route, for example, such as in the form of a powder that can be stored for long periods and reconstituted with water or another fluid shortly before administration.

Description

Oral administration of unstable or poorly soluble drugs

Technical Field

The present invention relates to the field of oral administration of drugs, such as human insulin, which are unstable or poorly soluble in the gastrointestinal tract.

Background

Many drug failures are due to instability in the gastrointestinal tract and low permeability to the gastrointestinal surface of oral administration. Protein digestive enzymes such as pepsin and strong acid further cause instability of peptide and protein drugs in the stomach, and further inhibit the stability and curative effect of the drugs. In addition, drugs with low lipophilicity and/or high molecular weight are not generally readily absorbed through the mucosal layers of the gastrointestinal tract.

Many strategies have been reported to improve the stability and bioavailability of orally administered active agents. In particular, the drug is placed in a carrier, such as a liposome, micelle, nanoparticle, water-in-oil (w/o) or water-in-oil-in-water emulsion (w/o/w) or microemulsion, or enteric capsule, to protect the active compound from exposure to adverse chemical environments (e.g., low ph or digestive enzymes). This method has its disadvantages such as low drug stability, low drug loading, inefficiency, complex processing requirements and high cost.

U.S. Pat. No. 6,191,105 discloses the preparation of water-in-oil (w/o) emulsion insulin formulations. Water-in-oil emulsions can be unstable due to phase changes upon oral administration and direct exposure of the drug to the harsh gastrointestinal environment.

U.S. Pat. No. 6,277,413 discloses water-in-oil-in-water (w/o/w) type emulsions in which a water-soluble drug is contained in an internal aqueous phase. This emulsion showed low drug loading.

U.S. patent No. 5,552,156 discloses the use of liposomes and micelles as drug carriers. The preparation of such formulations is complex and expensive.

Australian patent No. 2004305395 discloses nanoparticles for oral administration and preparation of water-soluble drugs. The preparation of the combination involves freeze-drying the nanoparticles, which increases the preparation cost.

U.S. patent application No. 13/561,105 discloses enteric capsules containing cationic nanoparticles to avoid acidic degradation of active substances such as insulin. The disclosed capsule has a complex manufacturing method, including freeze-drying and preparation of enteric-coated capsules.

U.S. patent application Ser. No. 13/521,377 discloses compositions for oral administration of insulin peptides using a spontaneous microemulsion delivery system (SMEDDS) for enteric soft capsules. Insulin peptide is prepared into a spontaneous microemulsion drug delivery system, and the acidic environment in the stomach is still unstable (degraded or inactivated). To overcome the instability problem, insulin peptides in spontaneous microemulsion delivery systems are placed in enteric carriers to avoid active compound cleavage or other degradation in the stomach. Enteric carriers, however, produce an undesirable delay in onset of action when administered orally. In addition, the gastric emptying time varies from person to person, which affects the release and absorption time of insulin preparations through the intestinal tract. This variable will lead to wide variations in insulin absorption, which may lead to uncontrolled blood glucose levels.

Spontaneous microemulsion delivery systems have limitations in liquid dosage forms, such as excipient capsule incompatibility (see, for example, Mu et al, 2013, int.j.pharm.453(1):215-224and kallikuta et al, 2012, powd. technol.221: 375-382).

U.S. patent application publication No. 2011/0293714 discloses a composition comprising a polar organic solvent and a lipophilic component for oral administration of derivatized insulin peptides. The composition is administered at a high oral dose (840IU/kg) to lower blood glucose.

U.S. patent application publication No. 2009/0176691 discloses a single phase formulation comprising a buffer and a free protein active agent. The monophasic formulation is administered orally and, following oral administration, is combined with a buffering agent to buffer the pH of the stomach and/or intestine to a pH in the range of 4-8.

At least some of the technologies described by others have resulted in compositions that affect absorption of drugs, such as insulin, after oral administration (see, for example, Wong,2010, j. drug target.18(2): 79-92; Arbit et al, 2009, Diabetes sci. technol.3(3):562-567). However, the applicant believes that there is currently no oral formulation that exhibits a rapid onset of action, high bioavailability, or optionally a short-term effect and is particularly useful for drugs such as insulin. Traditional oral insulin formulations are reported to have slow onset of action (over 1.5 hours) and longer duration of action (over 5 hours). It would be advantageous for physicians and patients to have a fast onset (onset within 15 minutes) and a short duration (less than 5 hours) of action of drugs such as insulin in a convenient oral administration to provide effective glycemic control.

The compositions described herein overcome some of the disadvantages of previous compositions and provide fast-acting, short-acting pharmaceutical compositions even for oral administration of drugs that may be unstable or poorly bioavailable using conventional formulations.

Disclosure of Invention

A dosage form for oral administration of a hydrophilic pharmaceutical dosage form to the blood of a mammal is disclosed. The dosage form comprises an antacid in the form of a pill sufficient to raise the gastric pH of the mammal to at least about 3 (more preferably at least about 3.4) upon ingestion of the dosage form (e.g., the pill neutralizes 1-7 milliequivalents of gastric acid). The dosage form also comprises a therapeutically effective amount of a substantially homogeneous combination of the drug and a surfactant system. The surfactant system comprises a nonionic surfactant.

The nature and amount of the surfactant system are selected to be sufficient to induce spontaneous emulsification upon contact between the combination and the aqueous medium under conditions of moderate mechanical agitation, such as occurs in the stomach of a mammal, or in a container (e.g., a cup) wherein the combination is agitated with a small amount of aqueous medium in rotation prior to administration. For example, the nature and amount of the selected surfactant system is selected to induce spontaneous emulsification upon contact between the mixture and a 9-fold excess of distilled water under the conditions of mechanical agitation characteristics of the mammal's stomach. (selection of precise objective criteria is not necessary; for example, the surfactant system may be selected to be sufficient to induce spontaneous emulsification upon contact with 4 or 2 fold excess distilled water or USP simulated gastric fluid). The identity and amount of the surfactant system is selected such that the average droplet size of the emulsion formed upon contact between the combination and the aqueous medium is no greater than about 2000 nm (or less, preferably no greater than about 800,500 or 300 nm).

In such dosage forms, the pills may be contained in a substantially homogeneous combination. Alternatively, the pills and mixtures may be present in different parts of the dosage form, for example in different solids, powders, or liquids.

The dosage forms can be used for administration of a variety of hydrophilic drugs, including those that are not normally bioavailable when administered orally. Examples of the drugs include insulin peptides (e.g., human therapeutic insulin such as isolated or synthesized human insulin peptides), growth hormone, gentamycin, gemcitabine, penicillin, and vancomycin.

The dosage form is provided in the form of a kit comprising the dosage form and an aqueous medium in amounts sufficient to dissolve or suspend the pellets of the antacid and to emulsify the mixture. Alternatively, a kit is provided comprising a bolus of the first dosage antacid and a second dosage comprising a substantially homogeneous combination of the drug and the surfactant system.

Further disclosed is a method for orally administering a hydrophilic drug to the blood of a mammal. The method comprises combining a therapeutically effective amount of the drug with the described surfactant system, mixing the combination, the aqueous medium and the antacid pill sufficient to raise the gastric pH of the mammal to about at least 3 to produce an emulsified mixture; and subsequently orally administering said emulsified mixture to said mammal.

In an alternative method, the drug and surfactant system are combined to produce a conjugate, the antacid pill is orally administered to the mammal, and the oral administration of the conjugate to the mammal is in time to the administration of the pill such that the gastric pH of the mammal is maintained at least about 3 when the conjugate is administered.

Drawings

FIG. 1 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin to 3.78% (w/v) aqueous sodium bicarbonate (NaHCO) as a percentage of the initial blood glucose value₃) (filled circles), in aqueous phosphate solution (open circles), or in aqueous sodium bicarbonate solution (final concentration of 3.78%; triangle) of formulation 1. The data shown are the mean and standard deviation of a group of eight mice each.

Figure 2 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin suspended in sodium bicarbonate solution at various final concentrations, as a percentage value of the initial blood glucose value. The final concentration of sodium bicarbonate solution was: 0.90% (filled circle), 1.80% (open circle), 2.70% (triangle) and 3.78% (open triangle). The data shown are the mean and standard deviation of a group of eight mice each.

Figure 3 is a graph of blood glucose levels over time for dogs administered 150IU/kg insulin orally to formulation 1 suspended in aqueous sodium bicarbonate (final concentration 3.78%; open circles) or for untreated control dogs (closed circles), as a percentage of the initial blood glucose value. The data shown are the mean and standard deviation of a group of two migu dogs.

Figure 4 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin in formulation 2 suspended in aqueous sodium bicarbonate (final concentration of 3.78%), calculated as a percentage value of the initial blood glucose value. The data shown are the mean and standard deviation of a group of eight mice each.

Figure 5 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin of formulation 3 suspended in aqueous sodium bicarbonate (final concentration of 3.78%), calculated as a percentage value of the initial blood glucose value. The data shown are the mean and standard deviation of a group of eight mice each.

FIG. 6, consisting of FIGS. 6A and 6B, is a set of graphs of blood glucose levels over time, calculated as percentage values of the starting blood glucose value (FIG. 6A), and a graph of plasma insulin concentration over time (FIG. 6B), for normal Wistar rats orally administered 200IU/kg insulin in formulation 4 suspended in 3.00% aqueous sodium bicarbonate. The data shown are the mean and standard deviation of a group of three rats. The comparative data also show that rats are orally administered free insulin suspended in 3% aqueous sodium bicarbonate.

Figures 7 and 8 are graphs of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 50IU/kg insulin at formulation 5 including 8% sodium bicarbonate (figure 7) or 50IU/kg insulin at formulation 6 including 2.1% sodium bicarbonate and 0.9% magnesium hydroxide (figure 8), as a percentage value of the starting blood glucose value.

FIG. 9, consisting of FIGS. 9A and 9B, is a set of graphs of blood glucose levels over time for streptozotocin-induced diabetic Wistar rats, calculated as a percentage of the initial blood glucose value (FIG. 9A), and a graph of plasma insulin concentration over time (FIG. 9B), orally administered 200IU/kg insulin from formulation 4. The data shown are the mean and standard deviation of a group of three rats.

Figure 10 is a graph of the percentage of initial blood glucose values calculated over time as blood glucose levels and which is a suspension of streptozotocin-induced diabetic Wistar rats orally administered 200IU/kg insulin with the insulin being distributed in water at formulation 7.

Figure 11 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin in suspension after formulation 8 was distributed in water, calculated as a percentage of the initial glycemic value.

Figure 12 is a graph of blood glucose levels over time for streptozotocin-induced diabetic Wistar rats administered orally 116IU/kg insulin in formulation 9, calculated as a percentage of the initial glycemic value. The data shown are the mean and standard deviation of a group of five rats.

Figure 13 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg insulin in 3.78% (w/v) aqueous sodium bicarbonate solution, either freshly prepared (filled squares) or stored at 5 degrees celsius for three months (filled circles) prior to administration, as a percentage value of the starting blood glucose value.

Figure 14 is a graph of blood glucose levels over time for streptozotocin-induced diabetic mice orally administered 200IU/kg free insulin solution (filled squares) or the rapid acting oral formulation insulin described in the examples herein (filled circles) as a percentage of the initial blood glucose value.

FIG. 15 is a graph of plasma insulin concentrations over time for a miglu dog orally administered 25IU/kg insulin in formulation 8 and Subcutaneously (SC) injected 0.5IU/kg free insulin. The data shown are the mean and standard deviation of a group of three experimental dogs.

Detailed Description

Disclosed are oral formulations and dosage forms for drugs, particularly hydrophilic drugs, that are poorly soluble in acidic solutions, are susceptible to pepsin or other pepsin/peptidase, exhibit low gastrointestinal penetration, exhibit undesirable delayed onset (on-of-action), exhibit undesirable long-lasting (on-of-action), or combinations thereof (collectively, "intragastric non-acting drugs"). The oral preparation comprises: i) a self (micro) emulsifying drug delivery system (SMEDDS) comprising the drug, and ii) an antacid pill sufficient to raise the ph of the stomach to about at least 3, and most preferably 3.4 or higher, upon oral administration of the formulation to a subject (e.g., a human or other mammal).

Spontaneous microemulsion drug delivery systems (SMEDDS) technology is known and known (see, for example, Khan et al 2012, j. pharmacy alt. med.1: 13-19; U.S. patent application publication No. 2003/0022944; U.S. patent application publication No. 2010/0273730). Spontaneous microemulsion delivery systems are isotropic mixtures (isotropic mixtures) of one or more relatively hydrophobic solvents, one or more surfactants, and a drug, which exhibit the ability to form tiny microemulsions (e.g., micelles, liposomes) upon gentle agitation upon dilution (e.g., contact) with an aqueous solution. The enhancement of bioavailability (bioavailability) of hydrophobic or hydrophilic drugs by incorporation of these drugs into SMEDDS formulations has been described by others. However, when administered orally, the mere incorporation of drugs that exhibit undesirable bioavailability or pharmacokinetics into SMEDDS often still does not provide sufficient bioavailability or pharmacokinetics for pharmaceutical purposes. Particularly drugs that are sensitive (i.e., degraded, cleaved, or inactivated) to the acidic environment of the stomach or to the action of one or more proteases or peptidases (e.g., pepsin) normally present in the stomach.

The formulations disclosed herein include a SMEDDS composition containing a drug and an antacid pill. The two components may be co-orally administered to a mammalian subject (or orally administered to a subject at a time sufficiently close that the antacid effect of the antacid pill overlaps the period of time during which the drug-containing SMEDDS composition is present in the stomach) to effectively deliver the drug across the gastrointestinal barrier while reducing or eliminating degradation of the drug by gastric acid and/or enzymes.

Dosage forms are disclosed which comprise a medicament, preferably a hydrophilic medicament, for oral administration to a mammal, such as a human, which is difficult to absorb from the stomach, such as by oral administration to the mammal in a simple, rapid-release dosage form, such as a pill, capsule, granule, or solution. The dosage form comprises an antacid pill sufficient to raise the gastric pH of the animal to at least about 3 upon ingestion of the dosage form. The dosage form also comprises (whether as an additional part of a single dosage form, or as a component of a multi-piece dosage form) i) a therapeutically effective amount of the drug ii) a polyol solvent, as appropriate, and iii) a surfactant comprising a combination of nonionic surfactants. The composition is "substantially homogeneous" when intimately mixed or associated such that the composition is a homogeneous composition in appearance to the ordinary pharmaceutical practitioner (i.e., the composition, even if it includes visibly discernible components, is intended to be uniformly distributed throughout the composition). The nature and amount of the drug, any polyol solvent and surfactant may be selected so that the combination will spontaneously emulsify when contacted with an aqueous solution under mild mechanical agitation. Thus, for example, when the combination is spun with water (or other aqueous liquid, such as a beverage) in a cup prior to oral administration, or when the combination is contacted with the aqueous contents of the stomach, the combination emulsifies and produces an emulsion comprising the drug in the gastrointestinal tract of the mammal. Since the antacid pill reduces acidity in the stomach and thus pepsin activity, the stability of the drug in the emulsion will be improved, and the uptake of the drug by the mammal (i.e., into the mammal's bloodstream) will also be improved.

The formulations described herein protect against degradation of the drug in the presence of strong acids and digestive enzymes normally found in the gastric environment of mammals. The above preparation also improves the absorption of the drug in the gastrointestinal tract (GI tract). These formulations can increase the rate of absorption of the drug and optionally limit the drug's duration of use (e.g., by including a limited amount of antacid). In the context of certain pharmaceutical applications, such as insulin, a rapid initial effect (e.g., within 15-30 minutes after administration of insulin) and a relatively short duration of action (e.g., within less than 5 hours, preferably less than about 4 hours after administration of insulin, falling to a maximum activity of 25%) are desirable. Thus, for example, the oral administration of formulations containing insulin as set forth herein may mimic the characteristics of a subcutaneous injection of insulin during its relatively direct and short-acting period. In other embodiments, the drug is contained in a composition whereby the drug is released for an extended period of time (e.g., 0-24 hours, e.g., by selection of the components of the formulation whereby the drug is slowly delivered to the gastrointestinal fluids).

The ingredients and methods of the above-described compositions set forth herein are described in more detail below.

The compositions described herein are for oral administration of drugs that are normally poorly absorbed by the gastrointestinal tract (GI tract), and have two main components that can be combined into a single dosage form, packaged as a two or more component kit, or provided separately to a physician or patient for combined use. The two main components of the above composition are a "SMEDDS composition" (i.e., microemulsion concentrate and drug optionally homogeneous), and an antacid pill. The bolus of antacid is administered to a mammalian patient (e.g., human) to increase the pH of the stomach (and any other part of the gastrointestinal tract). The SMEDDS composition contains a drug and, upon contact with an aqueous medium, spontaneously emulsifies to yield droplets (e.g., micelles) that contain or contain the drug and facilitate the delivery of the drug along the GI tract through a cellular layer (e.g., the stomach or small intestine epithelium). Drug delivery through these cell layers can enter the systemic blood circulation (systemic blood circulation) and be delivered throughout the body.

The components of the SMEDDS composition and antacid pill can be administered to a subject as a dosage form. By way of example, the components may be administered in the form of a dosage form comprising a liquid in which both components are suspended or dissolved, two components which have been mixed and are in a single-powder form, or an adsorbent (e.g., a poorly soluble mineral powder such as silica particles) on which either or both components are adsorbed. Alternatively, the two components may be administered in the form of a single dosage form, with the two components being present in separate locations (e.g., a bi-layer tablet or multi-compartment capsule, the two components may be present in separate compartments). Alternatively, the two components may be administered in separate dosage forms, so long as the SMEDDS composition is administered during the period of time in which the antacid pill raises the gastric pH to about at least 3. Compositions in liquid form are prepared prior to oral administration or compositions in powder form may be advantageously administered to patients who have difficulty swallowing tablets or capsules.

SMEDDS compositions

An important part of the compositions and methods described herein relates to a drug-containing composition that spontaneously emulsifies upon contact with water or an aqueous medium to form droplets containing the drug. Because the present disclosure is directed primarily to enhancing the delivery of intragastric non-functional drugs (e.g., as compared to hydrophilic drugs), e.g., polypeptides (e.g., human therapeutic insulin), the droplets formed are preferably micelles that contain the drug or a portion thereof (fraction). The micelles are suspended in an aqueous medium and the suspension is administered to a subject. Alternatively, micelles may be formed in the gastrointestinal tract (GI tract) by administration of the SMEDDS composition, optionally (e.g., when the stomach contains a relatively small amount of liquid) with sufficient water-soluble liquid (e.g., a bolus of antacid dissolved in water) to promote emulsification in the stomach. In the gastrointestinal tract of the subject, the micelles facilitate the delivery of the drug through the gastrointestinal tract cell layers (GI cells), and more preferably into the blood of the subject, whereby the drug may be carried in the blood to a desired point of action (e.g., within the blood, or thus to a body location remote from the gastrointestinal tract).

The SMEDDS composition is a combination of a therapeutically effective amount of a drug and a surfactant system for administration. The drug may be dissolved or suspended in an aqueous liquid, a polyol solution, or both, prior to combining the drug and surfactant system. For example, the drug and surfactant system may be combined in a powder (e.g., anhydrous or aqueous powder) form. The surfactant system comprises a non-ionic surfactant. The nature and amount of the surfactant system is selected so that the SMEDDS composition spontaneously emulsifies upon contact with an aqueous medium under conditions of mild mechanical agitation, such as: after combining with this medium, the SMEDDS composition is gently swirled in a container (e.g., a glass or unit dose cup). In one embodiment, the SMEDDS composition is kept discrete (e.g., a powder or granular form of the composition in a capsule, and the capsule is swallowed whole and then dissolved in the gastrointestinal tract) until or after the subject swallows, and the SMEDDS composition emulsifies in the gastrointestinal tract of the subject (e.g., a powder or granular form of the composition in a capsule, which is swallowed whole and then dissolved in the stomach or small intestine) when the SMEDDS composition contacts the liquid therein. The timing of the binding of the drug and surfactant system is not critical. The drug and surfactant system can be mixed (e.g., homogenous) with stability approval; alternatively, the drug and surfactant system may be combined immediately prior to combining the two with the antacid (e.g., by mixing a powder form drug and a liquid surfactant system), or combined simultaneously with combining the two with the antacid.

The SMEDDS composition can also include a polyol solvent, such as glycerol, propylene glycol or polyethylene glycol (or other polyether compounds), which is liquid in its pure state (purestate), at 20 degrees celsius, and at one atmosphere. For example, the polyol solvent may function to assist in binding the drug to the surfactant system, to coat the bound drug/polyol/surfactant system onto an adsorbent (adsorbant), or to dissolve the drug in an aqueous medium. The amount of polyol included in the SMEDDS composition is not critical and can be readily determined empirically by one skilled in the art based on the intended use of the polyol. For example, the SMEDDS composition can include from about 0 to 80% by weight of the polyol prior to mixing with the aqueous medium. In formulations that include human insulin as the drug, desirably, the SMEDDS composition includes at least about 40% by weight.

An important feature of SMEDDS compositions is that at least some droplets are formed upon contact between the composition and an aqueous medium, the droplets having a size suitable for passage through or across the cell layer of the gastrointestinal tract. The droplets should have a size (i.e., diameter) of no greater than about 500 nanometers, preferably no greater than about 300 nanometers, and preferably the droplets have a size of at least about 10 nanometers. Droplet size formation is determined by the composition of the SMEDDS composition, which is primarily determined by the surfactant system.

The formulation of spontaneous emulsion compositions is known in the art (see, e.g., Khan et al 2012, j. pharmaceutical alt. med.1: 13-19; U.S. patent application publication No. 2003/0022944; U.S. patent application publication No. 2010/0273730; and others). The preparation of a spontaneous emulsion composition having a selected droplet size distribution is itself a matter of routine experimentation with regard to the reconstitution combinations and proportions of ingredients, e.g., the identity and concentration of the surfactant used. Some degree of empirical testing is routinely performed for selecting the identity and concentration of the components used.

The SMEDDS compositions can be prepared, packaged, and/or administered to a subject, are substantially homogeneous compositions, can be substantially homogeneous single phase liquids, substantially homogeneous powders or granules (e.g., loose powders, compressed into tablets, or contained within capsules), or substantially homogeneous emulsions (e.g., w/o emulsions or w/o/w emulsions). When in the form of an emulsion, the SMEDDS composition preferably comprises the drug described above in the dispersed phase of the emulsion (i.e., in the aqueous phase of the w/o emulsion). In one embodiment, the SMEDDS composition is prepared, encapsulated and/or administered in the form of a powder or granular mixture (optionally including antacid pellets) that is intended to be mixed with water or other water-soluble liquid (to facilitate emulsification of the SMEDDS composition) shortly (within 24 hours, optimally within 2 hours) or immediately prior to oral administration.

The SMEDDS compositions can be used to enhance drug delivery across the stomach and intestinal membranes, such as through tight junctions (tig junctions) known to exist between intestinal epithelial cells. The compositions may be used to enhance delivery of substantially hydrophilic/hydrophobic drugs, but the disclosure is particularly directed to drugs that are relatively hydrophilic, which are generally affected by gastric acid and enzymes contained in the aqueous medium of mammalian gastric solutions. Examples of drugs include insulin peptide, growth hormone, erythropoietin, antibodies (e.g., monoclonal antibodies), antibody fragments, gentamicin, gemcitabine, penicillin, and vancomycin.

Insulin peptides represent a particularly important class of drugs, which are known to be susceptible to degradation and/or inactivation in gastric fluid. The family of gastric proteases, commonly referred to as pepsin (pepsin), is known to cleave insulin peptides at specific sites in the acidic (ph <3.4) environment normally present in the stomach of mammals. Pepsin has maximum activity at a ph of about 2.0, but is substantially inactivated at a ph of 6.5 or higher. Thus, antacid pellets may be selected to produce a gastric pH greater than about 3, preferably greater than 3.4, and more preferably even higher (with negligible additional benefit in inducing gastric pH to greater than 6.5). Insulin peptides are also known to undergo deamination (deamination) in an acidic environment. Cleaved and/or deaminated insulin peptides exhibit poor pharmaceutical activity compared to intact insulin peptides, which may indicate the ineffectiveness of insulin for treating insulin response disorders (e.g., diabetes) when administered orally. The compositions described herein protect insulin (and other drugs) from inactivation by gastric acid and proteases, and also promote insulin transport through gastrointestinal membranes (GI membranes). The compositions and methods described herein are particularly useful in enhancing the bioavailability of insulin peptides when administered orally.

Many insulin peptides are known, and the terms used herein refer to naturally occurring forms of insulin (e.g., normal and unmodified human insulin) and synthetic insulin and insulin-like peptides (e.g., produced by modifying naturally occurring insulin or via non-biosynthetic pathways). The exact nature of the insulin peptide is not important. More preferably, the insulin peptide is a human therapeutic insulin that induces one or more physiological effects in a human to which it is administered that are similar or identical to the physiological effects induced by naturally occurring forms of insulin injected, such as intravenous (intravenous), intramuscular (intramuscular) or subcutaneous (subcutaneous) injections.

The amount of drug and any polyhydric alcohol or water solvent incorporated into the SMEDDS composition is not critical so long as the SMEDDS retains its ability to spontaneously emulsify upon contact with excess water soluble liquid. When a unit dose of the SMEDDS composition is administered to a subject, the SMEDDS composition should contain at least a sufficient amount of the drug to have the desired effect on the subject. The aqueous solution should be selected to be compatible with the drug (i.e., not cause significant degradation or inactivation) during the period between manufacture and administration of the SMEDDS composition and under the conditions of intended storage. During manufacture, a suitable amount of aqueous solution can improve the handling (processability) of the SMEDDS composition and typically does not exceed about 30% (w/w) of the SMEDDS composition, and preferably, it comprises 20%, 10% (w/w) or less of the SMEDDS composition. SMEDDS compositions can be manufactured in large quantities and distributed in aliquots into unit dosage forms suitable for administration to individual subjects; in this case, a plurality of SMEDDS compositions will include multiples of the effective dose of the drug, and each unit dosage form will contain a single effective dose. For example, a large quantity of the SMEDDS composition can be prepared and packaged into a single compartment of one of a plurality of dual-compartment individual dosage forms (e.g., capsules).

SMEDDS compositions can include a polyol solvent, such as one or more of glycerol (glycerol), propylene glycol (propylene glycol), and polyethylene glycol (PEG). Other similar compounds (e.g., other polyethers) may also be used. The polyol solvent may facilitate dissolution or suspension of the drug (e.g., insulin) in other components of the SMEDDS composition, thereby enhancing the drug-uptake inducing effect (drug-uptake-inducing effect) of the SMEDDS composition. When a polyol solvent is included in the SMEDDS composition, the SMEDDS composition preferably includes at least about 5% (weight percent, w/w) polyol solvent, and preferably no greater than about 50% (weight percent, w/w). In some SMEDDS compositions, the polyol content of the composition suitably ranges from about 20-30% (weight percent, w/w) of the composition.

The SMEDDS composition includes a surfactant system, which, together with the drug and any included water-soluble or polyol solvent, yields a SMEDDS composition that spontaneously emulsifies upon contact with an aqueous medium. The exact degree or speed of emulsification is not required, but preferably the entire SMEDDS composition is substantially emulsified within 1 hour after combining with more than 9 times distilled water under gentle stirring at 20 degrees celsius (i.e., 9 parts water, 1 part SMEDDS composition are stirred with a stir bar in a temperature controlled beaker with 10 revolutions for 1 minute). The above-mentioned surfactantThe system includes at least one nonionic surfactant, and preferably at least one surfactant selected from the group consisting of a polyglycolyzed glyceride having at least one acyl moiety and a propylene glycol fatty acid ester. As used herein, a polyglycolyzed glyceride (polyglyceride) refers to a mixture of monoglycerides (monoglycerides), diglycerides (diglycerides), and triglycerides (triglycerides), with mono and/or di-fatty acid esters of polyethylene glycol having a Hydrophilic Lipophilic Balance (HLB) value between 4and 19 inclusive. The acyl moiety is a linear-or branched-chain alkane or alkene (preferably, no more than two alkyl groups bonded) compound containing from 8 to 18 carbon atoms. Preferably, the acyl moiety comprises-CO- (CH)₂)₇CH₃、–CO–(CH₂)₉CH₃、–CO–(CH₂)₁₁CH₃、–CO–(CH₂)₁₃CH₃,–CO–(CH₂)₇–CH＝CH–(CH₂)₇CH₃and-CO- (CH)₂)₇–CH＝CH–CH₂–CH＝CH–(CH₂)₄CH₃. Examples of polyglycolyzed glycerides include oleoyl polyoxylglycerides (oleoyl polyoxylglycerides), such as oleoyl polyoxy-6-glyceridesM-1944CS), linoleoyl polyoxylglycerides (linoleoyl polyoxylglycerides), e.g. linoleoyl polyoxy-6 glyceridesM-2125CS), caprylic/capric polyoxylglycerides (caproyl polyoxylglycerides) (polyethylene glycol-6 caprylic/capric glycerides, e.g. caprylic/capric glycerides767) Caprylic capric polyoxy-8 glycerides (e.g.,) Lauroyl polyoxylglycerides (lauroyl polyoxylglycerides) ((44/14) and mixtures thereof.

The propylene glycol esters of fatty acids as used herein refer to mixtures of mono-and diesters of propylene glycol of saturated or unsaturated fatty acids, preferably derived from edible oils and fats, which may result from the direct esterification of propylene glycol and fatty acids or by the transesterification of propylene glycol and oil (or fat). When prepared by transesterification, the product may contain residual mono-and diglycerides and glycerol, which may be followed by molecular distillation to separate the monoesters. Examples of propylene glycol esters of fatty acids include propylene glycol caprylate (propylene glycol monolaurate), propylene glycol dilaurate (propylene glycol dilaurate), propylene glycol monolaurate (propylene glycol monolaurate), propylene glycol dicaprylate (propylene glycol dicaprylyl acetate), propylene glycol laurate (propylene glycol monolaurate), propylene glycol caprylate (propylene glycol caprylate).

The surfactant system may further comprise an additional surfactant (or more than one) selected from the group consisting of polysorbates, polyglycol ether copolymers (poloxamers), polyoxyethylene castor oil derivatives (polyoxyethylene castor oil derivatives), polyoxyethylene alkyl ethers (polyoxyethylene alkyl ethers), sorbitan fatty acid esters (sorbitan fatty acid esters), glycerol monooleate (glycerol monooleate), glycerol monolinoleate (glycerol monolinoleate), medium-chain triglycerides (medium-chain triglycerides), polyglycerol oleates (glycerol oleates), lauroyl polyoxylglycerides (stearoyl polyoxylglycerides), and combinations thereof.

The formulation of self-emulsifying compositions is known in the art and involves the selection of the identity and concentration of the surfactant contained in the composition. The identity and concentration of the surfactant is not critical to the surfactant system, and in addition, the surfactant is selected to provide the SMEDDS composition with the ability to spontaneously emulsify upon contact with an aqueous medium (optionally with gentle agitation). Preferably, the surfactant system forms about 5-90% (weight percent, w/w), more preferably at least about 20%, at least about 30%, at least about 40%, at least about 50%, and more preferably at least about 60% (e.g., 20-70%, 40-70%, or 50-70% (weight percent, w/w)) of the SMEDDS composition. As is known in the art, combinations of surfactants are suitable for use in providing spontaneous emulsification capability to drug-containing formulations, and such combinations are suitable for use in the surfactant systems described herein. Combinations of surfactants may be selected, for example, with reference to their hydrophilic-lipophilic balance (HLB) value (see U.S. patent Application Publication nos.2003/0022944 and 2010/0273730(u.s. patent Application Publication nos.2003/0022944 and 2010/0273730)). When the hydrophilic-lipophilic balance (HLB) is used to select a surfactant system, an HLB ranging from about 8 to 19 is considered suitable for use in the compositions described herein.

SMEDDS compositions can be prepared by mixing the ingredients in any order and are effective to yield a composition that spontaneously emulsifies upon contact with an aqueous medium. In one suitable method, the drug is dissolved or suspended in an aqueous solution, and this solution/suspension is then mixed with a polyol solvent to form a substantially homogeneous single phase mixture. The surfactant of the surfactant system is added (either separately or prior to mixing of the surfactants) to the mixture. Depending on the surfactant system selected, gentle stirring, shaking or other agitation may yield a second substantially homogeneous single phase mixture (e.g., if less or no aqueous or polyol solvent is included) or a multiphase mixture, such as a w/o emulsion (w/o emulsion) or w/o/w emulsion (w/o/w emulsion) (particularly if relatively large amounts of water soluble solvent are included).

The SMEDDS composition can be combined with an adsorbent (adsorbent). The adsorbents are solid compositions, most often used in the form of fine powders, which are mainly used as excipients (excipients) to facilitate the handling of the composition of the pharmaceutical composition described herein. Since the adsorbent tends to be a free flowing powder or other easily handled material, which may bind, absorb, dry or adhere a component on or in the adsorbent, facilitates handling of the material. The use of adsorbents is known in the pharmaceutical art. Examples of suitable adsorbents include silicon dioxide (e.g., silicon dioxide powders such as fumed silica) and other mineral powders that are substantially insoluble in water, cellulose (e.g., microcrystalline cellulose), and starch.

For example, the SMEDDS composition (including the drug) can be cured on microcrystalline cellulose particles (e.g., by contacting the particles with the SMEDDS composition, which includes a volatile solvent followed by volatilization of some or all of the solvent), and the particles coated with the SMEDDS composition can be combined with a powdered antacid to produce a dosage form. Alternatively, the antacid may be cured on the particles (e.g., as an outer layer). Alternatively, the SMEDDS composition (not yet containing the drug) can be coated onto the granules, and then both the powdered drug and the powdered antacid can be mixed with the granules. Those skilled in the art will recognize that many known adsorbents and compatible forms of the other components of the pharmaceutical compositions described may be utilized without departing from the subject matter described herein.

The SMEDDS composition can be stored (preferably at a controlled temperature, e.g., less than 20 degrees celsius, and preferably at a temperature above the freezing point of any aqueous phase present therein, e.g., 4-5 degrees celsius) as a substantially homogeneous combination (emulsified or not) or it can be combined with an aqueous medium (e.g., water or an aqueous solution/suspension of an antacid) to form an emulsion prior to storage. Under various conditions, dry or low humidity compositions are known to exhibit better storage properties. The dosage form, in which one or more of the components are present as a dry powder (e.g., coated or adhered to an adsorbent), may thus ensure more stringent storage conditions, such as long term storage at a controlled temperature (e.g., less than 30 degrees celsius and greater than zero degrees celsius).

The SMEDDS composition can be administered directly to the subject (i.e., such that it will spontaneously emulsify upon contact with the gastric juices of the subject) or it can be contacted with an aqueous medium (e.g., a glass of water that has been dissolved in the antacid, or a flavored beverage) prior to administration to the subject (i.e., such that the SMEDDS composition will emulsify, in whole or in part, in the aqueous medium prior to its administration to the subject).

Antacid pill

The compositions and methods described herein relate to one or more antacid pills sufficient to raise the gastric pH of the mammal receiving the administration to about at least 3 when the pill is administered orally (i.e., preferably no later than 3-5 minutes later). The type of antacid is not critical, and suitable examples include sodium bicarbonate (sodium bicarbonate), magnesium hydroxide (magnesium hydroxide), calcium carbonate (calcium carbonate), and aluminum hydroxide (aluminum hydroxide). For example, other suitable antacids are described in U.S. patent application publication No. 2014/0127296 (U.S. patent application publication No. 2014/0127296). In other embodiments, the antacid is provided in a form that is a single pill and is not released upon oral administration, but is released over a long period of time (e.g., 2-24 hours) after oral administration. The preparation of long-term release antacids is known.

It is within the understanding of one of ordinary skill in the art to select an appropriate antacid (or multiple antacids in a mixture) and appropriate amounts thereof to achieve a gastric acid base number of not less than about 3, preferably not less than 3.4, and to take into account the amount of acid expected to be present in the stomach of the subject. For example, a normal and fasted person typically expects about 1-7 milliequivalents (mEq) of stomach acid in his/her stomach. One skilled in the art can calculate the amount of antacid needed to achieve the desired pH in the stomach of the individual over the desired period of time.

The type of antacid packaged and/or administered to a subject is not critical. The liquid is relatively bulky and presents packaging or storage difficulties, but it is relatively simple to administer. Solids are smaller and generally shelf stable, but require hydration and dissolution in the patient prior to or after administration.

The amount of antacid pill affects the period of time that the pH of the stomach is raised to 3 or above. In general, a greater amount of antacid may result in a somewhat longer duration of action, at least to the point. Where a relatively short duration of action is desired for the drug, inclusion of only sufficient antacid in the dosage form to elevate gastric pH over the desired period may provide for a limited duration of action of the drug by allowing the pH elevation of gastric secretion over the antacid to degrade or inactivate the drug.

If it is desired to prolong the protection of the drug from gastric acid, a pharmaceutical preparation effective in reducing gastric acid secretion may be administered with (or over an overlapping period of time with) the composition described herein.

Dosage forms

The exact form or nature of the dosage form within the composition that is administered to a subject is not critical herein. Any of a variety of known dosage forms may be used, including: tablets, capsules, liquid carriers, and multi-layered and/or multi-compartmentalized dosage forms. Other contemplated dosage forms include: powders, granules, and dosage cups with or additional solid materials contained therein, each of which may be used in combination with an aqueous liquid prior to administration in order to emulsify, suspend, or dissolve the antacid composition, or both. Importantly, the drug is released from the dosage form comprising the SMEDDS composition over a period of time and which overlaps with the time the antacid pill raises the gastric ph to above about 3.

In one embodiment, the compositions described herein are packaged as powdered unit dosage forms, wherein the unit dosage form of a solid SMEDDS composition (e.g., a powdered SMEDDS composition, or an adsorbent having an SMEDDS composition adsorbed or subsequently dried thereon) is combined with a unit dosage form of a drug (in solid form) and an antacid (also in solid form). The solid components of the dosage form are combined with a separate aqueous liquid (provided by the individual or contained separately within the solid dosage form) to form a dispersion, emulsion or (preferably) nanoemulsion suspended in the aqueous liquid prior to administration of the suspension to a patient.

In another embodiment, the compositions described herein are packaged as unit dosage forms, wherein a unit dose of the SMEDDS composition is emulsified by contacting an aqueous medium in which antacid pills have been dissolved; the emulsions are administered to a subject orally (e.g., by pouring or stuffing the contents of a unit dosage form into the mouth of a subject, or by swallowing the entire dosage form, e.g., in the form of a capsule).

In another embodiment, the composition is for use by a physician and/or patient in the form of a kit comprising unit doses of antacid (e.g., as tablets or solutions) separately packaged from unit doses of the SMEDDS composition (e.g., in capsules); the entire dosage form is administered by administering a unit dose of the antacid and a unit dose of the SMEDDS composition to the patient.

In another embodiment, the unit dose of antacid and unit dose of the SMEDDS composition are packaged into separate compartments or layers of a single dosage form (e.g., a multi-compartment container, a coated or bi-layer tablet, or a coated or multi-compartment capsule), such that ingestion of the entire dosage form by a subject results in release of the antacid pill from the compartment of the dosage form (i.e., thereby raising the gastric pH to greater than 3), and release of the SMEDDS composition from the compartment of the dosage form (resulting in release or formation of a drug-containing emulsion within the gastrointestinal tract).

In another embodiment, the drug and antacid are combined and prepared in the form of a tablet or powder and provided to the patient with a SMEDDS composition that has been combined with an aqueous liquid (i.e., such that it is in the form of a suspended nano-or micro-emulsion). In this embodiment, the dosage form is administered to the patient by combining (or allowing the patient to combine) the tablet or powder with a suspoemulsion (for dissolving or suspending therein the drug and antacid), and administering the resulting liquid to the patient.

In another embodiment, the dosage form may be a capsule comprising the SMEDDS composition and coated with a rapidly dissolving antacid pill. The dosage form may be placed in a glass of water to form an antacid solution (optionally with flavoring) and this solution may be used as a vehicle to facilitate swallowing of the capsule by the subject or as a vehicle for dissolving the capsule therein (thereby forming a drug-containing emulsion in the vehicle) which is then administered to the subject.

The exemplary embodiments set forth herein are not intended to be limiting. Any dosage form or method for orally administering both compositions to substantially the same subject may be used. However, administration of the SMEDDS composition should be completed in a period of time whereby contact of the SMEDDS composition with the gastric juice occurs when the gastric juice has been raised above about 3 by administration of the antacid pill.

Use of the composition

The compositions described herein are useful for oral administration of a drug that is not functional in the stomach (i.e., a poorly available drug in the stomach, such as a hydrophilic drug) to the blood of a mammal. To accomplish this, a therapeutically effective amount of the drug is dissolved or suspended in water or an aqueous solution. The dissolved or suspended drug is combined with the surfactant system described herein and, optionally, a polyol solvent. These components are gently mixed to form a substantially homogeneous SMEDDS composition, which can be a substantially single phase liquid, a water-in-oil emulsion (w/o emulsion) (hydrophilic drug tends to concentrate in the aqueous phase) or a water-in-oil-in-water emulsion (w/o/w emulsion) (hydrophilic drug tends to concentrate in one or more aqueous phases). In another embodiment, the drug is combined with a surfactant system, an adsorbent to form a mixture of solid forms (e.g., solid particles or powders) which are mixed with an aqueous liquid (e.g., water or a suspension of antacid pellets) prior to administration.

As described herein, the selection of the type and amount of drug, any water-soluble solvent, any polyol solvent, and surfactant system results in spontaneous emulsification of the SMEDDS composition under mild mechanical agitation while in contact with an aqueous medium. The SMEDDS composition is contacted with an aqueous medium to produce an emulsion (or to dilute an emulsion already present in the SMEDDS composition), and the emulsion is optionally stored at a reducing temperature (preferably above the freezing point of the aqueous phase of the emulsion). The resulting emulsion can be administered orally to a mammal and can be administered in conjunction with (i.e., shortly before, shortly after, or simultaneously with) antacid pills sufficient to raise the gastric pH of the mammal to about at least 3 (and preferably above 3.4).

Optionally, by administering a dosage form to the subject which directly releases the SMEDDS composition into the stomach, an emulsion can be formed in the stomach of the subject. If the dosage form is not already in the form of an emulsion, the SMEDDS composition can spontaneously form an emulsion in the gastric fluid of the subject. Along with the simultaneous intake of water by the dosage form, the likelihood that the stomach contents of the individual contain sufficient water to form an emulsion is increased.

The SMEDDS composition is orally administered to the mammal in a time equivalent to the administration of the pill such that the gastric pH of the mammal is maintained at least about 3 while the emulsion formed from the SMEDDS composition resides in the stomach of the mammal.

Treatment of diabetes and other diseases is by administration of insulin peptides to a subject and the compositions and methods described herein are believed to be particularly useful for such diseases. Effective acute treatment of insulin response disorders may require a rapid onset of action after administration of an insulin peptide, and it is desirable that the duration of action of the insulin peptide does not last for more than a few hours. For the above reasons, injectable compositions of insulin peptides are commonly used because insulin peptides tend to be poorly bioavailable (if at all) when administered by other routes (e.g., orally). As indicated in the discussion and examples herein, insulin peptides can be administered orally via one of the formulations described herein, can exert a very rapid (less than 30 minutes) onset of action, and the duration of action lasts 2-4 hours. For these reasons, the formulations described herein may be used to deliver insulin peptides on a routine basis, or to deliver insulin to an individual in need of insulin therapy in an acute, on-demand manner. The ability of an individual to ingest the formulation orally, rather than by injection, may also improve the comfort and ease of administration, encouraging patients to follow prescribed dosing rules or emergency instructions (emergency instructions).

Examples

The disclosure is described in the following examples. These examples are for illustrative purposes only and the present application is not limited to these examples but, on the contrary, encompasses all variations and all modifications that come within the teachings provided herein.

Example 1

Preparation

In this embodiment, a formulation comprising insulin is described.

Formulations 1, 2 and 3 were each prepared as follows.

Unmodified human insulin (28.8IU/mg) was weighed into a 7 ml vial and the indicated amount of 0.05N HCl was added to the vial to dissolve the insulin. Polyol solvent (propylene glycol, glycerol, and/or PEG 400) was added to the vial and the contents gently stirred to mix the ingredients. The three surfactants were then added to the vial and the contents were gently stirred until a clear mixture formed. Prior to administration, the clear mixture was suspended in about 160-230 microliters of 3.78% (w/w) sodium bicarbonate solution (ten-fold dilution) and allowed to emulsify.

This formulation, designated formulation 1, had the following ingredients:

this formulation, designated formulation 2, had the following composition:

this formulation, designated formulation 3, had the following composition:

Labrasol^TMis a trademark of Gattefose, Inc. in the United states, which is a PEG-8 caprylic/capric glyceride having the general formula R- (CH)₂-CH₂O)₈A mixture of-R, wherein each-R is-CO- (CH)₂)₆-CH₃or-CO- (CH)₂)₈-CH₃。Lauroglycol^TMFCC is a trademark of Gattefose, Inc. in the United states, which is monopropylene glycol monolaurate (C)₁₅H₃₀O₃)。Tween^TM80 is a trademark of Saifusi chemical company, which is a mixture of polyoxyethylene (20) sorbitan monooleate. Softigen^TM767 it is Sasol Olefins&Trademarks of the company Surfactants GmbH, PEG-6 caprylic/capric glycerides with a general formula R- (CH)₂-CH₂O)₆A mixture of-R, wherein each-R is-CO- (CH)₂)₆-CH₃or-CO- (CH)₂)₈-CH₃。Cremophor^TMRH40 is a trademark of BASF group and is a hydrogenated fatty castor oil surfactant. Cremophor^TMThe major component of RH40 is glycerol polyethylene glycol hydroxystearic acid, which constitutes the hydrophobic part of the product with glycerol polyethylene glycol ester of fatty acid. The hydrophobic moiety comprises polyethylene glycol and glycerol glycolate, having formula C₅₇H₁₁₀O₉(CH₂CH₂O)_n。Labrafil^TM1944CS is a trademark of Gattefosse, USA, and has the general structure HO- (CH)₂-CH₂O)₆-CO-(CH₂)₇-CH＝CH-(CH₂)₇-CH₃。

The surfactant considered acceptable but not used in these experiments comprised Labrafil^TMM-2125CS, a trademark of Gattefosse, USA, having the general structure HO- (CH)₂-CH₂O)₆-CO-(CH₂)₇-CH＝CH-CH₂-CH＝CH-(CH₂)₄-CH₃And Gelucire 44/41 is a trademark of Gattefose, USA, and has the general formula R- (CH)₂-CH₂O)₃₂-R, wherein-R is-CO- (CH)₂)₁₀-CH₃or-CO- (CH)₂)₁₂-CH₃。

Preparation 4 was prepared by mixing 8 mg of unmodified human insulin, 300mg of sodium bicarbonate, 100 mg of glycerol, and 600 mg of Labrasol in a 20 ml beaker^TM. Thereafter, 8992 mg of water were added to the beaker and the mixed ingredients were gently stirred until a nanoemulsion formed.

This formulation, designated formulation 4, had the following composition:

composition (I)	Amount (mg)	Fractional% (w/w)
			Insulin	8	0.08
Sodium bicarbonate	300	3
			Glycerol	100	1
Labrasol	600	6
			Water (W)	8992	89.92
Total of	10000	100.0

Formulation 5 was prepared as follows. Combine and mix 8 mg of insulin, 800 mg of sodium bicarbonate, 100 mg of glycerol, and 600 mg of Labrasol in a 20 ml beaker^TM. After 8492 mg of water was added to the beaker, the mixed contents were gently stirred until a nanoemulsion formed.

This formulation, designated formulation 5, had the following composition:

composition (I)	Amount (mg)	Fractional% (w/w)
			Insulin	8	0.08
Sodium bicarbonate	800	8
			Glycerol	100	1
Labrasol	600	6
			Water (W)	8492	84.92
Total of	10000	100.0

Formulation 6 was prepared as follows. Combine and mix 8 mg of insulin, 210 mg of sodium bicarbonate, 90 mg of magnesium hydroxide, 100 mg of glycerol, and 600 mg of Labrasol in a 20 ml beaker^TM. Thereafter, 8992 mg of water were added to the beaker and the mixed ingredients were gently stirred until a nanoemulsion formed.

This formulation, designated formulation 6, had the following composition:

composition (I)	Amount (mg)	Fractional% (w/w)
			Insulin	8	0.08
Sodium bicarbonate	210	2.1
			Magnesium hydroxide	90	0.9
Glycerol	100	1
			Labrasol	600	6
Water (W)	8992	89.92
			Total of	10000	100.0

Formulation 7 (powder, suspension in powder)Then for oral administration) is prepared by adding Labrasol dropwise^TMTo Aerosil contained in a mortar^TM200. After addition, the mixture was homogenized using a corresponding pestle to ensure uniform distribution. Thereafter, insulin and sodium bicarbonate powder are added to Labrasol^TM–Aerosil^TM200 and mixing the resulting composition. The resulting powder was passed through a 16 mesh screen (1.19 mm nominal mesh), dried at ambient temperature and stored for later use. Thereafter, 1.158 g of the stock powder was mixed with 9 ml of water before administration to yield a water-based dispersion.

This formulation, designated formulation 7, had the following composition:

preparation of formulation 8 (powder, for oral administration after powder suspension) by dropwise addition of liquidTo be loaded in mortarUS2 (a granular magnesium aluminium silicate product sold by fuji chemical industries, having an average particle size of about 60-120 microns). After addition, the mixture was homogenized using a corresponding pestle to ensure uniform distribution. Then adding insulin and sodium bicarbonate powder into Labrasol-US2 mixtures and mixing the resulting combination. The resulting powder was passed through a 16 mesh screen, dried at ambient room temperature and stored for subsequent use. Thereafter, 1.108 grams of the powder was mixed with 9 milliliters of water prior to administration to yield a water-based dispersion.

This formulation, designated formulation 8, had the following composition:

formulation 9 (two-part formulation), prepared as follows:

and part A comprises:

composition (I)	Weight (D)
		Mannitol	277.5 mg
Povidone K-30	7.5 mg
		Sodium bicarbonate	300mg of
Insulin	8 mg of

Part a (granules) was prepared in a wet granulation mode in which all part a ingredients were weighed and passed through a #20 sieve. Insulin was dissolved in 0.05N ordinary HCl and placed in a mortar containing the other part A ingredients. After the insulin was added, the mixture was homogenized by pounding 100 times with a pestle to ensure uniform distribution of the formulation and the granules were dried using a fluidized bed dryer at 25 ℃ for 30 minutes. The dried granules were passed through a 16 mesh screen and stored at 4 degrees celsius for later use.

Component B

Preparation of part B is thatAnd glycerol, then suspending these ingredients in water to form a dispersion.

Formulation 9 is prepared by combining part a and part B shortly before oral administration (e.g., within 2 hours before oral administration).

Example 2

Droplet size

The advantage of the present formulation is that insulin is contained in the water soluble core of the droplets (which may contain micelles and/or liposomes) which spontaneously forms (optionally upon gentle agitation) when the formulation is contacted with water or an aqueous solvent. Since the size of the droplets affects their ability to cross the gastrointestinal surface (and thus the rate and extent of bioavailability of the drug contained in the liposomes), the size of the droplets formed when the formulation is self-emulsified is analyzed here.

In the respective samples, a part of each of the formulations 1, 2, 3, and 4 was gently mixed with 500 parts of distilled water under stirring, and a dispersion or emulsion was formed. The size of the droplets formed was measured using a Zetasizer Nano ZS interfacial potential analyzer (Malvern instruments). The same instrument was used to measure the polydispersity index (PDI) of these emulsions. The calculated polydispersity index parameters are defined in ISO Standard documents 13321: 1996E and ISO 22412: 2008. One part of formulation 1 was mixed with 500 parts of 0.1N HCl or Phosphate Buffered Saline (PBS), indicating that the droplet size would not typically be greater than about 2000 nm, and that the droplet size of the other formulations described herein would typically be no greater than about 800 nm.

The results of these experiments are as follows.

The mean droplet size of formulation 1 in 0.1 normality (N) HCl was 1822 nm. Formulation 1 in standard phosphate buffer had an average droplet size of 873 nm.

Example 3

Acid neutralization study

Formulation 1 was diluted 10-fold with 4.2% (w/w) sodium bicarbonate solution (i.e., one part formulation 1 was mixed with 9 parts sodium bicarbonate solution; final concentration 3.78%). The diluted mixture had a pH of 8.2. The pH of 0.1N HCl was 1.2.

4.0 ml of 0.1N HCl was mixed with a selected amount of the diluted composition, and the pH of the resulting mixed solution was measured. When HCl was combined with 1.0 ml of the diluted composition, the resulting ph was 5.64. When HCl was mixed with 1.5 ml of the diluted composition, the resulting ph was 6.27. When HCl was mixed with 2.0 ml of the diluted composition, the resulting ph was 6.48. This result shows the acid neutralization effect of the formulation/antacid combination described herein. The skilled artisan will be able to select an appropriate amount of antacid to neutralize the predicted amount of gastric acid in humans and other subjects (e.g., to raise the pH to at least 3, to at least 3.4, or other desired pH).

Example 4

Protease research

Pepsin is a digestive protease in the stomach and has significant proteolytic activity (including insulin inactivating activity) at ph values between 1 and 3. The following experiment was conducted to investigate the pH effect of insulin in pepsin-mediated inactivation of insulin contained in the insulin-loaded formulations described herein.

Separately, 1 ml of formulation 1 and 9 ml of phosphate buffer were added to form a dispersion or emulsion (the accuracy of the mixture is not critical, hereinafter "emulsion"). The pH of the emulsion was 6.9. This emulsion was then mixed with 0.5 ml of artificial gastric juice (1 g of sodium chloride, 3.5 ml of 37% hydrogen chloride in 500 ml of water) containing 1650 units of pepsin at a pH of 1.4 or 3.4 (pH adjusted to 0.1 normal (N) sodium hydroxide). The mixture was mixed and incubated at 37 degrees celsius. After 5, 30, or 90 minutes, the incubation of the whole mixture with 0.1N NaOH was stopped (changing the pH to the range of 6-6.5 and thus halting pepsin action).

Pepsin-mediated cleavage of each insulin aliquot was performed using high performance liquid chromatography to detect the expected insulin cleavage products. Incubation at ph 1.4 for 5, 30 or 90 minutes in aliquots revealed no intact insulin observed, indicating that insulin produces rapid protease cleavage. In aliquots incubated at pH 3.4 for 30 and 90 minutes (the entire insulin incubated at pH 3.4 for only 5 minutes was not evaluated), essentially all of the insulin remained intact, indicating that a pH of 3.4 was sufficient to inactivate pepsin to maintain the uncleaved form of insulin during this period. These results also indicate that raising the gastric pH of the subject to 3.4 (or at least to 3.0) allows the present formulation to remain intact in the stomach through orally administered insulin.

Example 5

In vitro intestinal permeability study

The experiments described in this example show that insulin can be transported across a Caco-2 cell monolayer, known as a layer of similar intestinal epithelial cells arranged as the small intestine. These experiments indicate that the formulations described herein have the ability to pass hydrophilic drugs, such as insulin, across the intestinal wall.

In an incubator, Caco-2 cell lines were cultured at 37 ± 2 ℃ in Minimal Essential Medium (MEM) containing eagle's salt (eagles @) and 1-glutaminic acid supplemented with 15% fetal bovine serum, 1% non-essential amino acids, 1% antibiotic-antifungal drugs, and in an atmosphere containing 5% carbon dioxide to mimic intestinal wall cells. Cell monolayers exhibited transcellular epithelial resistance values (TEER) of greater than 300 ohms/square cm 21-28 days post-propagation for use in this study.

At time zero, the culture medium on the surface of the cell monolayer was replaced with 0.5 ml of a solution containing one of formulations 1, 2, and 3, or insulin not mixed to the SMEDDS-containing formulation. The solution was diluted ten-fold with culture medium (i.e., one portion of insulin-containing solution and nine times the buffer) prior to application to the cell monolayer. After 30 minutes following the above displacement, the insulin content on the basal side (basal face) of the cell monolayer was analyzed by High Performance Liquid Chromatography (HPLC). The permeability coefficient (Papp) is calculated by the following equation: papp ═ d (dQ/dt)/(C)₀× area) where dQ/dt is the linear occurrence rate (linear expected rate) obtained from a data plot of the amount of substrate transmitted versus time (measured in micrograms/second), C₀Is a measure of the initial concentration (measured in micrograms/ml) at the administration end (donor component), and the "area" is the membrane surface area of the cell monolayer.

after 30 minutes incubation, no free insulin (i.e., insulin not bound to the composition containing SMEDDS) was detected to be transported across the monolayer the permeability coefficient (Papp) value was determined as 12 × 10 for diluted formulation 1 applied to the monolayer^-6centimeter/second, a diluted formulation 2 applied to the monolayer is 16 x 10^-6cm/s, 9X 10 of the diluted formulation 3 applied to the monolayer^-6Centimeter per second.

These results show that insulin lines diluted with the SMEDDS formulations described herein and administered to a cultured Caco-2 cell monolayer significantly increased insulin transport across the cell monolayer. Since the Caco-2 cell monolayer forms tight junctions (light junctions) and is considered to be a suitable model for the intestinal absorptive cell layers (enterocyte cells) lining the small intestine, the results of these experiments suggest that the dosage forms described herein have the ability to transport hydrophilic drugs (e.g., insulin) across the intestinal lining.

Example 6

In Vivo Hypoglycemic studies (In Vivo hyperglycemic Study) utilize insulin-containing SMEDDS In combination with antacids after oral administration to diabetic mice, normal rats and healthy laboratory dogs.

Male mice (eight weeks old, approximately 20 grams in weight) at C57BL/6JNarl (national institute of laboratory) were treated with two tail vein injections of Streptozotocin (STZ) (first: 75mg/kg, second: 150mg/kg) to induce diabetes. It was confirmed that the mice had induced diabetes by measuring the blood glucose concentration of a blood sample taken from the tail vein. Mice with blood glucose levels above 300mg/dL were considered to be confirmed to induce diabetes, and mice with such blood glucose levels ("streptozotocin-induced diabetes mice") were used in the experiments described in this example.

A total of three groups of mice with streptozotocin-induced diabetes (i.e., 24 mice) were orally administered by tube feeding with 200IU/kg of insulin. The first group received each unmodified insulin, suspended in about 160-230 microliters (depending on the animal body weight) of a 3.78% (w/w) sodium bicarbonate antacid solution. The second group each received only formulation 1 form of insulin suspended in about 160-230 microliters of Phosphate Buffered Saline (PBS). The third group received insulin as formulation 1, and the insulin in the form of formulation 1 was suspended in about 160-230 microliters of a 3.78% (w/w) sodium bicarbonate antacid solution (i.e., 10-fold dilution of formulation 1). The ph is expected to increase above 3.4 (i.e. within 0-3 minutes) after tube feeding of the first and third groups, whereas the ph is expected to not change significantly after tube feeding of the second group.

Blood samples were drawn from mice after each tube feeding and the blood glucose levels of these samples were determined. These blood glucose level measurements are illustrated in figure 1.

The third group of streptozotocin-induced diabetic mice (formulation 1 insulin administered with an antacid) exhibited a substantial drop in blood glucose levels 15 minutes after oral tube feeding and lasted for no more than about 4 hours. During the first 15 minutes after administration, blood glucose levels decreased by about 10% compared to the initial time. Streptozotocin induced blood glucose levels in diabetic mice without significant change in the first group (free insulin) + antacid) and the second group (formulation 1 insulin without antacid) for the remainder of the study.

50. Approximately proportional dose responses were observed in the streptozotocin-induced diabetic mouse group with 100, and 200IU/kg insulin administered orally as formulation 4and formulation 4 diluted with 3% sodium bicarbonate as described herein. Of these mice, those receiving 50IU/kg insulin showed a maximum decrease in blood glucose levels 30 minutes after administration of about 11% compared to the initial levels; those receiving 100IU/kg of insulin showed about a 25% maximum decrease in blood glucose levels after administration; those receiving 200IU/kg insulin showed a maximum drop in blood glucose level of about 45% after administration.

Similar results were also observed in mice with diabetes induced by streptozotocin administered orally in a tube with a 10-fold dilution of formulation 2 in 3.78% sodium bicarbonate, as shown in figure 4(200IU/kg of insulin). Similar results were observed when 50IU/kg insulin was orally administered to streptozotocin-induced diabetic mice in the form of formulation 5 in combination with 8% sodium bicarbonate (see fig. 7) or formulation 6 containing 2.1% sodium bicarbonate and 0.9% magnesium hydroxide (see fig. 8). A reduction in blood glucose levels was also observed, although relatively minor, in the formulation 3 (10-fold dilution in 3.78% sodium bicarbonate) when 200IU/kg insulin in the form of formulation 3 was orally administered to streptozotocin-induced diabetic mice. On the other hand, the oral administration of 200IU/kg of insulin in the form of formulation 4 to streptozotocin-induced diabetic Wistar rats resulted in a similar condition of reduced blood glucose levels observed (see fig. 9A) with elevated blood insulin levels (see fig. 9B).

Formulations 7 and 8 were also effective in rapidly lowering blood glucose levels in streptozotocin-induced diabetic Wistar rats or streptozotocin-induced diabetic mice after administration, as shown in fig. 10 and 11. In addition, administration of streptozotocin induced insulin (116IU/kg) preparation 9 in diabetic Wistar rats, inducing an increase in blood insulin concentration (see fig. 12), meaning that insulin was efficiently absorbed by the preparation.

The results of experiments with compositions with different sodium bicarbonate content orally administered tube-fed streptozotocin-induced diabetic mice are shown in figure 2. The difference in blood glucose levels achieved with the composition having a sodium bicarbonate concentration in the range of 1.80-3.78% (w/w) was not significant, and some slight difference in blood glucose levels was observed when the sodium bicarbonate concentration was reduced to 0.90% (w/w). These results indicate that the amount of antacid after oral administration is sufficient to immediately suppress gastric acidity to a value of 3.4 (or at least to about 3), contributing to the bioavailability of insulin administered via the oral route. Reducing the pill dose of antacids administered with insulin limits the overall bioavailability and shortens the duration of action of insulin. Thus, the use of different amounts of antacid in the formulation allows for titration (or adjustment) of the duration of action of the insulin.

As shown in fig. 13, the efficacy of streptozotocin-induced diabetes mice administered formulation 1 orally in combination with an antacid was unchanged as the composition was stored at 5 degrees celsius three months prior to administration (compared to the composition just prepared). These data indicate that the compositions described herein are suitable for storage.

Similar results were observed when unmodified insulin (150IU/kg) formulation 1 was orally tube-fed to healthy miglu dogs (beagle dogs) at 10-fold dilution in 3.78% sodium bicarbonate (50 ml total), as shown in figure 3. In figure 3, it is shown that insulin action rapidly occurs and blood glucose levels are reduced in treated miglu dogs (shown as open circles) 15 minutes after administration compared to untreated miglu dogs (shown as filled circles). The duration of action on dogs (no more than 1 hour) was shorter than on mice, probably because dogs produced much more gastric acid than mice.

Similar results were obtained in mice and dogs when normal Wistar rats were administered with 3% sodium bicarbonate (2.5-3.3 ml total) unmodified insulin (200IU/kg) formulation 4, as illustrated in figure 6A. Figure 6B shows the measured insulin levels in these rats, confirmed hypoglycemic effects due to elevated blood insulin levels.

Two insulin preparations, one of which was administered to migu dogs to measure blood insulin concentrations. The first formulation was formulation 8, which was administered via the oral route after suspension in liquid, as described in this specification, in an amount of 25IU per kg. The second formulation was normal insulin administered as a subcutaneous injection at 0.5IU of suspension per kg. Blood samples were taken from dogs receiving the formulation at time 0 (i.e., immediately prior to administration) and at 15, 30, 60, 90, 120, 150, 180, and 240 minutes after administration. The results of these studies are shown in FIG. 15.

In summary, the data presented in this example show that the insulin preparation and antacid pill compositions comprising the SMEDDS composition are sufficient to raise the gastric pH to above 3, such that the insulin is rapidly (i.e., within 15-30 minutes or less) available to the mammalian subject and results in an insulin action period of about 2-4 hours. These data show that the formulation is effective for administration of hydrophilic drugs sensitive to the acidic and/or proteolytic environment of the stomach, and that the formulation has to be selected to produce a fast onset and limited duration of action.

Example 7

A short acting oral insulin preparation is developed by using a nanoemulsion solution containing unmodified insulin (normal insulin). Short-acting oral insulin formulations begin to produce physiological effects within 15 minutes after oral administration, and the highest blood insulin levels occur at minute 30. The duration of action is less than 3 hours. In addition, the glycemic response of oral insulin preparations is proportional to the administered agent. Stability studies have shown that the potency and pharmacological effects of this insulin preparation are stable after storage at 5 ℃ for three months.

Insulin is usually administered parenterally due to degradation of proteins in the gastrointestinal tract and low permeability. Injections are often painful and result in low compliance by the patient. The oral route of administration of the drug is a comfortable and convenient route of administration, relative to the inconvenience and discomfort of injection administration. Many strategies such as liposomes, nanoparticles, nanoemulsions or enteric capsules have been reported to improve oral administration of insulin. At least some of these platforms provide for efficient absorption of insulin. (Wong,2010, J.DrugTarget.18(2): 79-92; Arbit et al, 2009, J.diabetes Sci.technol.3(3):562-567). However, this oral formulation is not fast acting and short lived.

Existing experimental oral insulin formulations have a slow onset time (over 1.5 hours) and a long duration of action (over 5 hours). The oral administration of insulin, which is fast acting (takes effect within 15 minutes) and short acting time (less than 5 hours), has similar effects as the intravenous administration of insulin, and will provide better metabolic control (Mannucci et al, 2009, Diabetes obes. metab.11(1): 53-59). This is because administration of insulin at the appropriate time will result in the corresponding absorption of carbohydrates after meals. Thus, the experiment described in this example is aimed at developing a fast acting short acting oral insulin formulation for oral administration that provides better metabolic control in patients with diabetes.

A short acting oral dosage form comprising normal (i.e., unmodified) insulin ("insulin preparation") was used in the studies described in this example. In vivo hypoglycemic studies (hypoglycemia study) were conducted to study streptozotocin-induced diabetes (200IU/kg) and healthy laboratory dogs (150IU/kg) fed free insulin (free insulin) and insulin formulations via oral tubes. The use of streptozotocin in a ratio (doses of 50, 100, and 200IU/kg) to induce a glycemic response in diabetic mice was also studied.

The stability of short-acting oral insulin formulations was also studied in this study. Insulin preparation samples were stored in sealed glass and screw-top tubes at 5 ℃ for three months. The remaining drug in the formulation was analyzed and the in vivo efficacy was also evaluated by administering the insulin formulation to streptozotocin-induced diabetic mice and measuring blood glucose with a blood glucose meter.

The results obtained from these studies are now set forth herein.

Streptozotocin induced blood glucose levels in diabetic mice following oral administration of 200IU/kg free insulin solution (free insulin) and short acting oral formulations are shown in FIG. 14. After oral tube feeding of the insulin formulation, the maximum decrease in initial blood glucose value was observed at 0.5 hours (about 45%). The duration of action is less than 3 hours. Blood glucose levels did not differ significantly at any time point by oral tube feeding of a solution of free insulin (free insulin solution).

Blood glucose reduction in healthy test dogs administered short-acting oral formulation insulin is shown in figure 3. Short-acting oral insulin formulations resulted in an average decrease in blood glucose levels (about 25%) 0.5 hours after administration compared to the control group. This finding is similar to the observation for hyperglycemic mice.

The following table shows the proportional doses of insulin short-acting oral dosage forms (50, 100, and 200IU/kg doses) in response to glycemic kinetics. At 0.5 hours post-dosing, the mean blood glucose reduction exhibited a linear dose-response relationship.

Dosage (IU/kg)	Maximal reduction in blood glucose (% of initial)
		50	11
100	25
		200	45

The in vivo efficacy of insulin preparations stored at 5 degrees celsius for three months was evaluated and indicated that 101.1 ± 0.16% of the insulin remained intact and available (data not shown). The in vivo (in vivo) efficacy of insulin formulations administered to diabetic mice via oral tube feeding was evaluated (results are shown in figure 13). The hypoglycemic condition was not significantly different between the use of the just prepared formulation and the insulin formulation stored for three months. This result confirms the in vitro (in vitro) efficacy of insulin formulations stored at 5 degrees celsius for at least three months.

The information in this example indicates that the fast acting, short acting oral insulin formulations described in this example ("insulin formulations") exhibit dose ratios with 50, 100 and 200IU/kg of insulin. In vitro and in vivo studies have shown that insulin formulations stored at 5 degrees celsius for three months do not significantly lose potency and biological efficacy.

Each patent, patent application, and publication cited herein is hereby incorporated by reference.

While the present disclosure is directed to particular embodiments, other embodiments and variations may be devised and will be apparent to those skilled in the art without departing from the true spirit and scope of the invention described herein. Additional claims encompass all embodiments and equivalents thereof.

Claims (29)

1. A dosage form for oral administration of a gastric-inactive drug to the blood of a mammal, the dosage form comprising:

an antacid in the form of a pill sufficient to raise the gastric pH of said mammal to about at least 3 when said dosage form is ingested; and

a therapeutically effective amount of a substantially homogeneous combination of said drug and a surfactant system comprising a non-ionic surfactant, said surfactant system being of a nature and in an amount sufficient to induce spontaneous emulsification upon contact between said combination and an aqueous medium under conditions of mild mechanical agitation.

2. The dosage form of claim 1, wherein the surfactant system is of a nature and in an amount sufficient to induce spontaneous emulsification upon contact between the composition and a 2-fold, 4-fold or 9-fold excess of distilled water under conditions of mechanical agitation characteristics of the stomach of said mammal.

3. The dosage form of claim 1, wherein the substantially homogeneous combination comprises the pill.

4. The dosage form of claim 1, wherein said pill is sufficient to raise the gastric pH of said mammal to about at least 3.4 upon ingestion of said dosage form.

5. The dosage form of claim 1, wherein the substantially homogeneous composition is in the form of a first solid and the pellet is in the form of a second solid.

6. The dosage form of claim 5, wherein the first and second solids are present in different portions of the dosage form.

7. The dosage form of claim 6, wherein the first solid is contained within the first solid.

8. The dosage form of claim 1, wherein the identity and amount of the surfactant system are selected such that the average droplet size of the emulsion formed upon contact between the combination and the aqueous medium is no greater than about 2000 nm.

9. The dosage form of claim 8, wherein the average droplet size is not greater than about 800 nanometers.

10. The dosage form of claim 1, wherein the drug is selected from the group consisting of insulin peptides, growth hormones, erythropoietin, monoclonal antibodies, antibody fragments, gentamicin, gemcitabine, penicillins, and vancomycin.

11. The dosage form of claim 10, wherein the drug is selected from the group consisting of human therapeutic insulin.

12. The dosage form of claim 11, wherein the drug is human insulin peptide.

13. The dosage form of claim 11, wherein the drug is a hydrophilic drug.

14. The dosage form of claim 1, wherein the surfactant system comprises at least one surfactant selected from the group consisting of a polyglycolyzed glyceride having at least one acyl moiety and a propylene glycol fatty acid ester.

15. The dosage form of claim 1, wherein the substantially homogeneous combination further comprises a polyol solvent.

16. The dosage form of claim 15, wherein the polyol solvent is selected from the group consisting of glycerol, propylene glycol, and polyethylene glycol, which is liquid at 20 ℃ (celsius).

17. The dosage form of claim 1, wherein upon ingestion of the dosage form, the bolus of antacid is sufficient to raise the gastric pH of the animal to at least about 3.

18. The dosage form of claim 1, wherein the antacid is selected from the group consisting of sodium bicarbonate, magnesium hydroxide, calcium carbonate, aluminum hydroxide, and combinations thereof.

19. The dosage form of claim 1, wherein the bolus of antacid is sufficient to neutralize at least about 1 milliequivalent (milliequivalent) of gastric acid.

20. A kit comprising the dosage form of claim 1 and a portion of the aqueous medium in an amount sufficient to dissolve or suspend the pellet of antacid, and emulsifying the mixture.

21. A set of reagents, comprising:

a first dosage form comprising a bolus of an antacid sufficient to raise the gastric pH of said mammal to at least about 3 upon ingestion of said first dosage form; and

a second dosage form comprising a substantially homogeneous combination of a therapeutically effective amount of a drug that is not effective in the stomach and a surfactant system comprising a nonionic surfactant, said surfactant system being of a nature and in an amount sufficient to induce spontaneous emulsification upon contact between said second dosage form and an aqueous medium under mild mechanical agitation.

22. A method for orally administering an intragastric, non-functional drug to the blood of a mammal, the method comprising:

combining a therapeutically effective amount of the drug with a surfactant system comprising a nonionic surfactant, the identity and amount of the surfactant system being selected such that the combination spontaneously emulsifies upon contact with an aqueous medium under mild mechanical agitation, into a substantially homogeneous combination;

mixing the combination, the aqueous medium and the antacid pill sufficient to raise the gastric pH of the mammal to at least about 3 to produce an emulsified mixture; and

followed by orally administering the emulsified mixture to the mammal.

23. The method of claim 22, wherein the drug is selected from the group consisting of insulin peptides, growth hormones, erythropoietin, monoclonal antibodies, antibody fragments, gentamicin, a selective injection, penicillin and vancomycin.

24. The method of claim 22, wherein the drug is selected from the group consisting of human therapeutic insulin.

25. The method of claim 22, wherein the drug is human insulin peptide.

26. A method for orally administering an intragastric, non-functional drug to the blood of a mammal, the method comprising:

combining a therapeutically effective amount of the drug with a surfactant system comprising a nonionic surfactant in a substantially homogeneous combination, the identity and amount of the surfactant system being selected such that the combination spontaneously emulsifies upon contact with an aqueous medium under mild mechanical agitation;

orally administering to said mammal a bolus of an antacid sufficient to raise the gastric pH of said mammal to about at least 3; and

oral administration of the combination to the mammal is in time to administration of the pill such that the gastric pH of the mammal is maintained at least about 3 when the combination is administered.

27. The method of claim 26, wherein the drug is selected from the group consisting of insulin peptides, growth hormones, erythropoietin, monoclonal antibodies, antibody fragments, gentamicin, a selective injection, penicillin and vancomycin.

28. The method of claim 26, wherein the drug is selected from the group consisting of human therapeutic insulin.

29. The method of claim 26, wherein the drug is human insulin peptide.