Topical formulations of Flucytosine
The invention relates to topical formulations of flucytosine which demonstrate a clear advantage over currently available therapeutic regimens for the treatment and maintenance of fungal infections, particularly vulvovaginal candidiasis. The invention provides compositions which solve the long-standing need for antimicrobial agents which treat effectively resistant strains of Candida spp., especially C. albicans, C. glabrata , and C. tropicalis , and which pose limited risk of side effects, adverse reactions, or the development of resistant pathogens. The invention provides novel topical formulations of flucytosine designed to allow the active drug to act at the local application area, but which inhibit or moderate transdermal or transmucosal absorption of the drug, thus limiting systemic exposure.
1. A topical composition for exterior treatment of vulvovaginal candidiasis comprised of flucytosine, a carrier, and poly(lactic acid),
wherein the flucytosine is selected from the group consisting of flucytosine, a flucytosine salt or a mixture thereof and is capable of forming ionized flucytosine;
wherein the poly(lactic acid) reduces permeation of flucytosine across skin and mucosal membrane;
wherein the carrier comprises a pH modulator suitable to establish a pH of the composition of between about 1 to about 5 to control the ratio of ionized flucytosine to unionized flucytosine within the composition and
wherein the topical composition is configured to minimize systemic absorption of the ionized flucytosine in the treatment environment.
2. The topical composition of claim 1 further comprising one or more additional agents selected from the group consisting of antimicrobial agents, dermal absorption modulators, hydrophilicity modulators, preservatives, buffers, carriers, and emulsifying agents.
3. The topical composition of claim 2 further comprising one or more preservatives selected from the group consisting of chloro-m-cresol, citric acid, disodium edetate, ethoxylated alcohol, glycerin, 1,2,6-hexanetriol, methylparaben, parabens, potassium sorbate, propyl gallate, propylene glycol, propylparaben, sodium bisulfite, sodium citrate, butylparaben, sodium metabisulfite, sorbic acid, tannic acid, zinc stearate, butylated hydroxytoluene, butylated hydroxyanisole, benzoic acid, salicylic acid, propylparaben, dichlorobenzyl alcohol, formaldehyde, alpha-tocopherol, sodium ascorbate, ascorbic acid, ascorbyl palmitate phenol, m-cresol, bisphenol, cetrimide, benzalkonium chloride, sorbic acid, polyquaternum-1, chlorobutanol, chlorhexidine, DOWICIL® 200 (Quaternium-15, Dow Chemical Co., Midland, MI), GLYDANT® (dimethylol- 25,5-dimethylhydantoin, Lonza, Inc, Fairlawn, NJ), GERMAL 115(imidazolidylurea, Sutton Laboratories, Chatham, NJ), GERMAL II (diazolidinylurea, Sutton Laboratories, Chatham, NJ), sodium hydroxymethylglycinate, BUSAN 1504 (dimethhydroxymethyl pyrazole, Buckman Labs, Memphis, TN), phenoxyethanol, and benzoyl peroxide.
4. The topical composition of claim 1 wherein the carrier is selected from the group consisting of cold cream (USP), hydrophilic ointment (USP), and an emulsion of mineral oil and purified water, wherein the emulsion is oil-in-water with a ratio of oil to water about 1-15 to 99-85 or water-in-oil with a ratio of water to oil about 1-15 to 99-85.
5. The topical composition of claim 2 wherein one or more emulsifying agents are selected from the group consisting of polyoxyethylene oleyl ether, PEG-40 stearate, ceteareth-12, ceteareth-20, ceteareth-30, LANETTE® 0 (Cetearyl Alcohol, Henkel), glyceryl monostearate, PEG-100 stearate, methyl myristate, isopropyl myristate, glyceryl stearate, steareth-2 and steareth-20, dimethicone copolyol, Polysorbate 20 (Tween 20), Polysorbate 40 (Tween 40), Polysorbate 60 (Tween 60), Polysorbate 80 (Tween 80), lauramide DEA, cocamide DEA, and cocamide MEA, Phospholipid PTC, alginate, carrageenan, Glucate DO, methylcellulose, polyvinyl alcohol, Cocamidopropyl phosphatidyl PG-dimonium chloride, PEMULEN TR 1, PEMULEN TR 2, CARBOPOL 1342, CARBOPOL 1382, Carbomer 1342, Carbomer 934, Carbomer 934P, Carbomer 940, Carbomer 941, Carbomer 974P, Carbomer 980, and Carbomer 981.
6. The topical composition of claim 4 wherein the carrier further comprises one or more components selected from the group consisting of glycerin, glycerol, propylene glycol, hexylene glycol, gelatin, urea, stearate NF, polysorbate 60, polyglyceryl-3-oleate, sorbitol solution (USP), microcrystalline wax, white petrolatum, xanthen gum, PEG 20 Cetostearyl Ether, cetostearyl alcohol, PEG, cyclomethicone, demethiconol, dimethicone copolyol, hydroxyoctacosanyl hydroxy stearate, methoxy PEG-22/dodecylglycol copolymer, prop-2-enoic acid, docusate sodium, trolamine NF, 2-methylbutanoic acid, poyoxomer 407, triolein, and egg yolk phospholipids.
7. The topical composition of claim 2 wherein the pH of composition is between about 3.5 to about 4.5.
8. The topical composition of claim 7 wherein the flucytosine comprises from about 0.3% to about 20% (wt. % to wt. %).
9. The topical composition of claim 7 wherein the poly(lactic acid) comprises from about 10% to about 20% (wt. % to wt. %) of the composition.
10. The topical composition of claim 2 wherein the flucytosine and poly(lactic acid) form aggregation complexes.
11. A therapeutically effective dosage of the topical composition of claim 1 , wherein the dosage comprises about 0.3 g to about 2 g of flucytosine.