WO2012011882A1

WO2012011882A1 - A combination of atorvastatin and aspirin to be used in the treatment of cardiovascular diseases

Info

Publication number: WO2012011882A1
Application number: PCT/TR2011/000162
Authority: WO
Inventors: Mahmut Bilgic
Original assignee: Individual
Current assignee: Individual
Priority date: 2010-06-30
Filing date: 2011-06-29
Publication date: 2012-01-26
Anticipated expiration: 2012-12-30
Also published as: TR201005325A2; WO2012002919A1; WO2012002920A1; EP2588103A1; EP2588102A1

Abstract

The present invention relates to pharmaceutical compositions comprising aspirin and atorvastatin and/or their pharmaceutically acceptable salts, hydrates, enantiomers, racemates, organic salts, inorganic salts, esters, polymorphs, crystal forms and amorphous forms and/or combinations thereof in order to be used in the treatment and prophylaxis of cardiovascular diseases.

Description

A COMBINATION OF ATORVASTATIN AND ASPIRIN TO BE USED IN THE TREATMENT OF CARDIOVASCULAR DISEASES

The Prior Art

Cardiovascular disease is one of the leading causes of death in the world and one of the most significant factors for these diseases is total/high density lipoprotein (HDL) cholesterol level. However, recent developments have indicated that only taking the cholesterol level under control is not sufficient for cardiovascular treatment. In line with this need, researchers have found that use of some active agents in combination provides a more effective treatment method. In the prior art, it is disclosed that cardiovascular diseases such as atherosclerosis, heart attack, angina pectoris arise from increase in lipid levels in blood; however, another factor called "thrombosis" plays an important role in nervous system diseases accompanying these such as stroke, paralysis. Thrombosis means obstruction of blood vessels in consequence of formation of a blood clot in the blood vessels. This obstruction may occur in any part of the body. Due to the obstruction, blood flow through the target organ gets slower and it may completely stop in advanced stages. Rarely, this clot obstructs brain vessels and causes brain hemorrhage or obstruction of heart veins, in other terms coronary infarction. Formation of thrombosis in brain or blood veins going to the brain generally leads to fatal results.

To this respect, it is important to eliminate thrombosis and the factors leading to thrombosis as well as lowering cholesterol level in blood in the effective treatment of cardiac diseases.

One of the drugs commonly used in the treatment and prevention of thrombosis is aspirin. Although aspirin, chemical name of which is 2-(acetyloxy)benzoic acid, has been used as an analgesic and antipyretic drug for more than 100 years, it has been pointed out in recent years that use of aspirin in low doses reduces platelet formation and therefore prevents thrombosis. It is known that use of 20-40 mg aspirin once a day prevents formation of thrombosis. This anti-platelet effect of aspirin enables it to take part in the treatment and prevention of most cardiac diseases.

Atorvastatin is a hypolipidemic drug used as a HMG-CoA reductase enzyme inhibitor as the other statins. Distinctly from other drugs in this group, it is the only drug having the indication of lowering both the increased LDL cholesterol and triglyceride levels in patients with hypercholesterolemia. In various publications, it is suggested that atorvastatin is more effective than other HMG CoA reductase enzyme inhibitors when used in recommended doses:

- Nawrocki JW, Weiss SR, Davidson MH et al. Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-

CoA reductase inhibitor. Arterioscler Thromb Vase Biol 1995 ; 15: 678-82.

Bakker- Arkema RG, Davidson MH, Goldstein RJ et al. Efficacy and safety of a new HMG-CoA Reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia. JAMA 1996; 257: 128-33.

Atorvastatin lowers LDL cholesterol levels by 60%; when administered in low doses, such as 2.5 mg/day, it displays activity at recommended routine level of other HMG CoA reductase enzyme inhibitors. While atorvastatin lowers the triglyceride levels in patients with hypercholesterolemia by 45%, it may raise HDL cholesterol level at 12%. It was disclosed in the tricentric double-blind study conducted with patients having hypercholesterolemia that atorvastatin lowers total cholesterol, LDL cholesterol, apolipoprotein B and triglyceride levels compared with lolvastatin, pravastatin and simvastatin.

It is well known that aspirin use reduces the risk of contracting cardiovascular diseases such as myocardial infarction and similarly, statin group active agents are effective in prevention and treatment of cardiovascular, cerebrovascular diseases {Ridker PM, Cushman M, Stampfer MJ et al. Inflammation, aspirin, and the risk of cardiovaskuler disease apparently healthy in men. N eng j Med 1997; 336:973-9).

Use of aspirin and statin group active agents in combination is known to decrease mortality rates of cardiovascular diseases. Hennekens et. al. attested that aspirin reduces the risk of contracting cardiovascular diseases by 24% averagely in comparison with statin treatment only. In parallel with this, statin treatment alone reduces the same risk by 13% in comparison with aspirin treatment (Hennekens CH, Sacks FM, Tonkin A, Jukema JW, Byington RP, Pitt B, Berry DA, Berry SM, Ford NF, Walker AJ, Natarajan K, Sheng-Lin C, Fiedorek FT, Belder R: Additive benefits of pravastatin and aspirin to decrease risks of cardiovascular disease: randomized and observational comparisons of secondary prevention trials and their meta- analyses. Arch Intern Med 164:40-44, 2004).

However, many problems are encountered when aspirin and statin group active agents are formulated together, the most important ones of which are low bioavailability and chemical degradation. As it is known, aspirin is an active agent with weak acidic features while most of the statins are basic active agents used in their salt forms. Therefore, formulation of the two active agents together causes the statins to be degraded and their bioavailability to decrease.

Another problem encountered in development of combined formulations comprising aspirin and atorvastatin is low water solubility of atorvastatin. Low water solubility of this active agent impedes preparation of formulations with high bioavailability. The purpose of the present invention is to provide a combined pharmaceutical formulation which comprises the active agents aspirin and atorvastatin together as a solution to these problems existing in the prior art.

In said pharmaceutical formulation, aspirin and atorvastatin are prepared in separate unit dosage forms independently and then combined in a compact dosage form. Detailed Description of the Invention

The present invention relates to pharmaceutical dosage forms comprising effective amounts of atorvastatin and aspirin and/or their pharmaceutically acceptable salts, hydrates, solvates, esters, amorphous or crystalline forms and/or mixtures thereof; dosage forms comprising said active agents and preparation of said dosage forms so as to be used in the treatment/prophylaxis of cardiovascular diseases.

The term "cardiovascular diseases" used here refers to hypercholesterolemia, atherosclerosis, coronary and cerebral diseases, for instance myocardial infarction, secondary myocardial infarction, myocardial ischemia, angina pectoris, congestive heart diseases, cerebral infarction, cerebral thrombosis, cerebral ischemia and temporary ischemic attacks. In the formulations of the present invention, the active agents are formulated as separate unit dosage forms and the unit dosage forms prepared are presented as combined in a single, compact dosage form. With this new dosage form developed in scope of the present invention, chemical degradation resulting from formulation of aspirin and atorvastatin together has be minimized; therefore formulations with longer shelf life have been produced.

On the other hand, preparation of the active agents as unit dosage forms of different physical and contents has enabled to solve the problems of the active agents effectively such as low solubility, chemical degradation; and efficiency of the treatment is improved this way. At the same time, adaptation of the patients to the treatment is enhanced by combining the active agents in a compact unit dosage form, for instance in a capsule.

Unit dosage forms developed in scope of the present invention can be in the form of granule, powder, pellet, tablet, mini tablet, micro tablet, capsule, micro capsule and/or combinations thereof.

However, the inventors have found that the combined product having the highest bioavailability is obtained by producing the unit dosage forms in tablet and powder form and then combining them in a compact dosage form.

The combined dosage form of the present invention is composed of powder unit dosage form comprising an effective amount of atorvastatin calcium and tablet dosage form comprising an effective amount of aspirin. Said tablet and powder formulations have similar content as unit dosage forms such as capsule, tablet dosage forms known in the prior art.

Tablet formulations of the present invention comprise effective amounts of aspirin, at least one pharmaceutically acceptable filling material, binder, disintegrant, coating material and optionally at least one other excipient; powder formulations, on the other hand, comprise effective amounts of atorvastatin calcium, at least one pharmaceutically acceptable filling material, binder, disintegrant, diluent, surfactant, buffer substance and optionally at least one other excipient.

The amount of aspirin used in the formulations of the present invention is in the range of 1 - 500 mg, preferably in the range of 1-300 mg, more preferably in the range of 1-150 mg per unit dosage form. The amount of atorvastatin used in the formulations of the present invention is in the range of 1-200 mg, preferably in the range of 1-150 mg, more preferably in the range of 1-100 mg per unit dosage form.

Pharmaceutically acceptable excipients used in the formulations of the present invention are selected from binders, disintegrants, viscosity enhancing components, filling materials, drying agents, lubricants, buffer substances, diluents, binders, glidants, surfactants, coating agents designed so as to provide various release characteristics, anti-adhesive agents, solvents, sweeteners or combinations thereof.

The binders used in the formulations of the present invention comprise one or more components selected from a group comprising potato, wheat or corn starch; microcrystalline cellulose, for instance Avicel®, Filtrak®, Heweten® or Pharmacel®; hydroxypropyl cellulose, hydroxyethyl cellulose; hydroxypropylmethyl cellulose, for instance hydroxypropylmethyl cellulose-type 2910 USP; hypromellose and polyvinylpyrrolidone, for instance Povidone® 30(BASF), lactose, guar gum, pectin, gelatin, sodium alginate. The disintegrant used in the formulations of the present invention enables the dosage form to disperse in water easily and rapidly, and it is significant from this aspect. The disintegrants can be selected from a group comprising polymers having high dispersing characteristics such as cross-linked hydroxypropyl cellulose, polyvinylpyrrolidone, high molecular weight polymers, microcrystalline cellulose, sodium starch glycolate, croscarmellose sodium, povidone; the products known under the trademarks Crospovidone®, Polyplasdone® or colloidal silicon dioxide, alginic acid, sodium alginate, corn starch.

The filling agents used in the formulations of the present invention comprise one or more components selected from the group comprising lactose, sugar, starch, modified starch, corn starch, mannitol, sorbitol, inorganic salts, microcrystalline cellulose, cellulose, calcium sulfate, xylitol and lactitol and/or pharmaceutically acceptable hydrates thereof.

Atorvastatin formulations of the present invention comprises at least 60%, preferably in the range of 60-95%, more preferably in the range of 70-95% lactose and/or a pharmaceutically acceptable hydrate thereof, for instance its monohydrate form or anhydrate, by weight as the filling material. Particularly preferred filling agent is lactose anhydrate.

The diluents used in the formulations of the present invention comprise one or more components selected from a group comprising alkali metal carbonates, cellulose derivatives (microcrystalline cellulose, cellulose acetate, etc.), dextrin, fructose, dextrose, glyceryl palmitostearate, lactitol, lactose, direct compression lactose, maltose, mannitol, simethicone, sorbitol, starch, talc, xylitol and/or hydrates thereof and/or derivatives thereof.

The surfactants used in the formulations of the present invention are selected from a group comprising hydroxypropyl methyl cellulose, hydroxypropyl cellulose, polyvinylpyrrolidone, vinyl acetate, sodium lauryl sulfate, dioctyl sulfosuccinate, gelatin, casein, lecithin, dextran, sorbitan esters, polyoxy ethylene alkyl ethers, polyethylene glycols, polyethylene stearates, collodial silicon dioxide, phosphates, carboxymethyl cellulose calcium, carboxy methyl cellulose sodium, triethanolamine, polyvinyl alcohol, hydroxy propyl methyl cellulose phthalate or combinations thereof.

Atorvastatin formulations of the present invention comprise at least one pharmaceutically acceptable surfactant. The amount of the surfactant in the formulations is in the range of 1 - 10%, preferably in the range of 1-5% in proportion to the weight of unit dosage form.

The surfactant preferred is sodium lauryl sulfate. The buffer substances of the present invention are either water-soluble or water-insoluble and selected from a group comprising meglumine, tromethamol, sodium bicarbonate, sodium carbonate, sodium citrate, calcium gluconate, disodium hydrogen phosphate, dipotassium hydrogen phosphate, tripotassium phosphate, sodium tartrate, sodium acetate, calcium glycerophosphate, tromethamine, magnesium oxide, magnesium hydroxide, aluminum hydroxide, dihydroxy aluminum, sodium carbonate, calcium carbonate, aluminum carbonate, dihydroxy aluminum amino acetate, diethanolamine, triethanolamine, N-methyl-glucamine, glucosamine, ethylenediamine, triethyleneamine, isopropylamine, di-isopropyl amine or combinations thereof.

Atorvastatin formulations of the present invention comprise at least one pharmaceutically acceptable buffer substance. The buffer substance preferred is calcium carbonate and its amount in the formulations is in the range of 1-20%, preferably in the range of 1-10% in proportion to the weight of unit dosage form.

The inventors, as a result of development studies they conducted in scope of the present invention, have found that amount of surfactant and buffer substance in the powder formulations comprising atorvastatin calcium causes a significant change in solubility of the final product. According to this, the highest solubility has been ensured when the ratio of the surfactant to the buffer substance is in the range of 0.1 to 10, preferably in the range of 0.1 to 5, more preferably in the range of 0.5 to 5.

Solvents used in preparation of the formulations of the present invention comprise one or more components selected from a group comprising ethanol, methanol, water, toluene, benzene, acetone, methyl acetate, tetrahydrofurane, heptanes, hexane, acetonitrile, alcohol and/or alcohol mixtures.

The lubricants used in the present invention comprise one or more components selected from a group comprising metallic stearates (such as magnesium stearate, calcium stearate, aluminum stearate), fatty acid esters (such as sodium stearyl fumarate), fatty acids (such as stearic acid), fatty alcohol, glyceryl behenate, mineral oil, paraffins, hydrogenated vegetable oil, leucine, polyethylene glycols (PEG), metallic lauryl sulfate (such as sodium lauryl sulfate, magnesium lauryl sulfate), sodium chloride, sodium benzoate, sodium acetate, talc, siliconized talc and/or hydrates thereof.

The formulations according to the present invention can optionally be formulated so as to provide different release characteristics. Release rate determinant polymers that can be used in the formulations in order to provide the required release characteristics can be pH-dependant polymers, non pH-dependant polymers, swellable polymers, non-swellable polymers, hydrophilic polymers, hydrophobic polymers and/or one or more hydrophobic substances; ionic polymers such as sodium alginate, carbomer, calcium carboxy methyl cellulose or carboxy methyl cellulose; non-ionic polymers such as hydroxy propyl methyl cellulose; natural or/synthetic polysaccharides such as alkyl celluloses, hydroxyl alkyl celluloses, cellulose ethers, nitrocellulose, dextrin, agar, carrageenan, pectin, starch and starch derivatives or mixtures thereof; cellulosic polymers; methacrylate polymers, methacrylate copolymers, polyvinylpyrrolidone, polyvinylpyrrolidone-polyvinyl acetate copolymer, ethyl cellulose, cellulose acetate, cellulose propionate (high, medium and low molecular weight), cellulose acetate propionate, cellulose acetate butyrate, cellulose acetate phthalate, cellulose triacetate, polyvinyl acetate, polyvinyl chloride.

In these dosage forms according to the present invention can optionally be coated with coatings such as protective coating, enteric coating, film coating. The film coating material of the present invention is composed of the following components and/or combinations thereof: lactose, hydroxypropyl methyl cellulose, hydroxypropyl cellulose, triacetine, hydroxypropyl methyl cellulose phthalate, hydroxypropyl methyl cellulose acetate phthalate, polyvinyl acetate phthalate, diethyl phthalate, sugar derivatives, polyvinyl derivatives, waxes, fats and gelatins, triethyl citrate, glyceride, titanium oxide, talc, sodium alginate, stearic acid, lecithin. Aspirin formulations of the present invention can optionally be formulated as enterically coated. Enteric coating does not dissolve in acidic environment; it is generally dissolved between 5 to 7.5 of pH. Enterically coated dosage forms passes from the stomach to the intestines without being dissolved; they are dissolved and release the active agent there. Thus, stomach problems which may result from acidic chemical structure of aspirin in long term uses are impeded.

The enteric coating materials used here can be selected from methacrylic copolymers, for instance methacrylic acid/methyl methacrylate, methacrylic acid/ethyl acrylate copolymers, methacrylic acid/methyl acrylate/methyl methacrylate copolymers, shellac, hydroxypropyl methylcellulose phthalate, hydroxyl propyl methyl cellulose acetate succinate, hydroxypropyl methyl cellulose trimellitate, cellulose acetate phthalates, polyvinyl acetate phthalates or combinations thereof. The enteric coating material is preferably in the range of 1-30% of the total weight of the unit dose.

In the event that unit dosage forms comprising aspirin formulations are enterically coated, said unit dosage forms can optionally be coated with a sub-coating before the enteric coating. The sub-coating materials are selected from a group comprising lactose, microcrystalline cellulose hydroxypropyl methyl cellulose, starch, calcium phosphate, calcium carbonate, talc, lecithin, titanium dioxide, croscarmellose sodium, crospovidone or combinations thereof.

The sub-coating is preferably in the range of 0.1 -20% of total weight of the unit dosage form.

The formulations of the present invention can be prepared by any one of dry blending, wet granulation, dry granulation methods in the prior art.

Powder formulations of atorvastatin of the present invention are preferably prepared by dry blending method. According to said method; an effective amount of atorvastatin, at least one pharmaceutically acceptable disintegrant, filling material, surfactant and buffer material are sieved and blended dryly. At least one pharmaceutically acceptable lubricant is added into the mixture and it is mixed again and then the powder formulation is finalized. One feature of this method proposed for production of said powder formulations is that atorvastatin calcium, the buffer substance and the surfactant are blended without bringing them into contact with water.

Tablet formulations of aspirin of the present invention are preferably produced by wet granulation method. According to this production method, an effective amount of aspirin, at least one pharmaceutically acceptable binder and at least one other excipient are mixed and the mixture is treated with the lubricant. The final mixture obtained is compressed in tablet form. The tablets are optionally coated first with a sub-coating, then with the enteric coating.

Powder formulations of atorvastatin and tablet formulations of aspirin obtained this way are presented as combined in a compact dosage form, preferably in a gelatin capsule.

Examples belonging to the formulations of the present invention are given below. Formulations of the present invention are not limited to these examples.

EXAMPLES Example 1.

Claims

1. A pharmaceutically acceptable capsule formulation characterized in that said capsule comprises atorvastatin formulation in powder form and aspirin formulation in tablet form.

2. The atorvastatin formulation in powder form according to claim 1 characterized in that said formulation comprises an effective amount of atorvastatin calcium, at least one pharmaceutically acceptable filling material, a binder, a disintegrant, a diluent, a surfactant, a buffer substance and optionally at least one other excipient.

3. The atorvastatin formulation in powder form according to claim 2 characterized in that said formulation comprises a surfactant in the range of 1-10 % by weight.

4. The formulation of atorvastatin in powder form according to claim 3 characterized in that said formulation comprises a surfactant in the range of 1-5 % by weight.

5. The atorvastatin formulation in powder form according to claims 3-4 characterized in that the surfactant used in the formulations is selected from a group comprising hydroxypropyl methyl cellulose, hydroxypropyl cellulose, polyvinylpyrrolidone, vinyl acetate, sodium lauryl sulfate, dioctyl sulfosuccinate, gelatin, casein, lecithin, dextran, sorbitan esters, polyoxy ethylene alkyl ethers, polyethylene glycols, polyethylene stearates, collodial silicon dioxide, phosphates, carboxymethyl cellulose calcium, carboxy methyl cellulose sodium, triethanolamine, polyvinyl alcohol, hydroxy propyl methyl cellulose phthalate or combinations thereof.

6. The atorvastatin formulation in powder form according to claims 3-5 characterized in that the surfactant used in the formulations is sodium lauryl sulfate.

7. The powder formulation according to claim 2 characterized in that said formulation comprises a buffer substance in the range of 1 -20% by weight.

8. The atorvastatin formulation in powder form according to claim 7 characterized in that said formulation comprises a buffer substance in the range of 1-10% by weight.

9. The atorvastatin formulation in powder form according to claim 8 characterized in that the buffer substance used in the formulations is selected from a group comprising meglumine, tromethamol, sodium bicarbonate, sodium carbonate, sodium citrate, calcium gluconate, disodium hydrogen phosphate, dipotassium hydrogen phosphate, tripotassium phosphate, sodium tartrate, sodium acetate, calcium glycerophosphate, tromethamine, magnesium oxide, magnesium hydroxide, aluminum hydroxide, dihydroxy aluminum, sodium carbonate, calcium carbonate, aluminum carbonate, dihydroxy aluminum amino acetate, diethanolamine, triethanolamine, N-methyl- glucamine, glucosamine, ethylenediamine, triethyleneamine, isopropylamine, di- isopropyl amine or combinations thereof.

10. The atorvastatin formulation in powder form according to claim 9 characterized in that the buffer substance used in the formulations is calcium carbonate.

11. The atorvastatin formulation in powder form according to claim 2-10 characterized in that the ratio of the surfactant to the buffer substance used in the formulations is in the range of 0.1-10%.

12. The atorvastatin formulation in powder form according to claim 11 characterized in that the ratio of the surfactant to the buffer substance used in the formulations is in the range of 0.1-5%.

13. The atorvastatin formulation in powder form according to claim 12 characterized in that the ratio of the surfactant to the buffer substance used in the formulations is in the range of 0.5-5%.

14. The atorvastatin formulation in powder form according to claim 2 characterized in that said formulation comprises at least 60% filling material by weight.

15. The atorvastatin formulation in powder form according to claim 14 characterized in that said formulation comprises a filling material in the range of 60-95% by weight.

16. The atorvastatin formulation in powder form according to claim 15 characterized in that said formulation comprises a filling material in the range of 70-95% by weight.

17. The aspirin formulation in tablet form according to claim 1 characterized in that said formulation comprises an effective amount of aspirin, at least one pharmaceutically acceptable filling material, binder, disintegrant, coating material and optionally at least one other excipient.

18. The formulation according to claim 17 characterized in that the formulation in tablet form is optionally coated with a sub-coating and then an enteric coating on the sub- coat.

1 . The method for preparation of a capsule formulation according to claim 1 characterized in that said method is composed of preparation of atorvastatin formulations in powder form by dry blending method; preparation of aspirin formulations in tablet form by wet granulation method.

20. The method for preparation of a capsule formulation according to claim 19 characterized in that atorvastatin formulations in powder form are prepared by sieving and blending an effective amount of atorvastatin calcium, at least one pharmaceutically acceptable disintegrant, filling material, surfactant and buffer substance dryly; adding at least one pharmaceutically acceptable lubricant into the mixture and mixing it again; and then finalizing the powder formulation.

21. The method for preparation of a capsule formulation according to claim 19 characterized in that aspirin formulations in tablet form are prepared by mixing an effective amount of aspirin, at least one binder and at least one other excipient; treating the mixture with the lubricant; compressing the final mixture in tablet form; and coating the tablets optionally with a sub-coating first and then with an enteric coating.