Nasal drug products and methods of their use
Drug products adapted for nasal delivery, comprising a pre-primed device filled with a pharmaceutical composition comprising an opioid receptor antagonist, are provided. Methods of treating opioid overdose or its symptoms with the inventive drug products are also provided.
1. A method of treating opioid overdose in a subject in need thereof, the method comprising:
delivering a spray from a pre-primed device into a nostril of a patient whose bloodstream contains an opioid of Formula (I),
wherein A is aryl or heteroaryl optionally substituted with halo, C 1 -C 3 alkyl, or C 1 -C 3 alkoxy,
wherein X is C 1 -C 3 alkyl or hydroxyethyl, optionally substituted with —COOCH 3 , aryl, or heteroaryl optionally substituted with both C 1 -C 3 alkyl and ═O,
wherein Y is C 1 -C 4 alkyl, C 2 -C 3 alkenyl, C 1 -C 3 alkoxy, C 1 -C 3 alkoxyalkyl, cycloalkyl, or heteroaryl,
wherein R 1 and R 2 are each independently selected from the group consisting of hydrogen (—H), phenyl, C 1 -C 3 alkyl, C 2 -C 3 alkenyl, C 1 -C 3 alkoxyalkyl, or C 1 -C 3 alkoxy, and —COOCH 3 ,
wherein n is 1, 2, or 3,
wherein the device is adapted for nasal delivery, and
wherein the spray delivers a 25-200 μL spray of a pharmaceutical solution comprising between about 4 mg and about 10 mg naloxone hydrochloride or a hydrate thereof, an isotonicity agent, and between about 0.005% and about 0.015% (w/v) of benzalkonium chloride.
2. The method of claim 1 , wherein the opioid of Formula (I) is selected from the group consisting of fentanyl, 2,5-dimethylfentanyl, 3-allylfentanyl, 3-methylbutyrfentanyl, 3-methylfentanyl, 3-methylthiofentanyl, 4-fluorobutyrfentanyl, p-chloroisobutyrfentanyl, p-fluoroisobutyrfentanyl, 4-fluorofentanyl, 4-phenylfentanyl, 4-methoxybutyrfentanyl, acrylfentanyl, α-methylacetylfentanyl, α-methylbutyrfentanyl, α-methylfentanyl, α-methylthiofentanyl, acetylfentanyl, alfentanyl, benzylfentanyl, β-hydroxyfentanyl, β-hydroxythiofentanyl, methylfentanyl, butyrfentanyl, brifentanyl, carfentanyl, cyclopentylfentanyl, isobutyrfentanyl, furanylfentanyl, furanylethylfentanyl, lofentanyl, N-methylcarfentanyl, methoxyacetylfentanyl, mirfentanyl, ocfentanyl, ohmefentanyl, R-30490, remifentanil, sufentanyl, thenylfentanyl, thiofentanyl, trefentanyl, and valerylfentanyl.
3. The method of claim 1 , wherein the spray is delivered as a round plume with an ovality ratio less than about 1.5 when measured at 3 cm.
4. The method of claim 3 , wherein the isotonicity agent is present in an amount between about 0.2% and about 1.2% (w/v).
5. The method of claim 4 , wherein the pharmaceutical solution further comprises between about 0.1% and about 0.5% (w/v) of a stabilizing agent and an amount of an acid sufficient to achieve a pH between about 3.5 and about 5.5.
6. The method of claim 5 , wherein:
the isotonicity agent is sodium chloride;
the stabilizing agent is disodium edetate; and
the acid is hydrochloric acid.
7. The method of claim 6 , wherein the pharmaceutical solution comprises:
about 4.4% (w/v) naloxone hydrochloride dihydrate;
about 0.74% (w/v) sodium chloride;
about 0.01% (w/v) benzalkonium chloride; and
about 0.2% (w/v) disodium edetate.
8. The method of claim 7 , wherein the device has a single reservoir containing approximately 125 μL of the pharmaceutical solution.
9. The method of claim 8 , wherein approximately 100 μL of the pharmaceutical solution is delivered by one actuation of the device.
10. The method of claim 9 , wherein the device comprises a reservoir, a piston, and a swirl chamber.
11. The method of claim 4 , further comprising storing the device for about twelve months or less at 25° C. and 60% relative humidity prior to actuating the device, wherein the device retains at least about 100% of initial naloxone hydrochloride content at actuation.
12. The method of claim 1 , wherein the patient experiences a geometric mean naloxone C max not less than about 3 ng/mL following a single spray.
13. The method of claim 12 , wherein the patient experiences a plasma naloxone concentration such that the geometric mean of area under a plasma concentration versus time curve (AUC 0-∞ ) is not less than about 8 hr*ng/mL when time is extrapolated to infinity.
14. The method of claim 12 , wherein the plasma concentration versus time curve of said naloxone hydrochloride in said patient has a T max of between about 20 and about 30 minutes.
15. The method of claim 1 , wherein the patient has consumed the fentanyl by touching the fentanyl with an unprotected area of the patient's skin.
16. The method of claim 1 , wherein less than about 10% of said pharmaceutical composition leaves the nasal cavity via drainage into the nasopharynx or externally.
17. The method of claim 16 , wherein less than about 5% of said pharmaceutical composition leaves the nasal cavity via drainage into the nasopharynx or externally.
18. The method of claim 1 , wherein the patient exhibits one or more symptoms chosen from: respiratory depression, central nervous system depression, cardiovascular depression, altered level consciousness, miotic pupils, hypoxemia, acute lung injury, aspiration pneumonia, sedation, hypotension, unresponsiveness to stimulus, unconsciousness, stopped breathing; erratic or stopped pulse, choking or gurgling sounds, blue or purple fingernails or lips, slack or limp muscle tone, contracted pupils, and vomiting.
19. The method of claim 1 , wherein the patient whose bloodstream simultaneously contains a second opioid drug in addition to the opioid of formula (I).
20. The method of claim 19 , wherein the second opioid drug is heroin.
21. The method of claim 3 , wherein pharmaceutical solution comprises:
about 4.4 mg naloxone hydrochloride dihydrate;
about 0.74 mg NaCl;
about 0.01 mg benzalkonium chloride;
about 0.2 mg disodium edetate; and
an amount of hydrochloric acid sufficient to achieve a pH of 3.5-5.5.
22. The method of claim 3 , wherein the ovality ratio is less than about 1.3 when measured at 3 cm.
23. The method of claim 3 , wherein the ovality ratio is less than about 1.2 when measured at 3 cm.
24. The method of claim 3 , wherein the ovality ratio is less than about 1.1 when measured at 3 cm.
25. The method of claim 1 , wherein the spray delivers about 4 mg naloxone.
26. The method of claim 25 , wherein the spray delivers about 100 μL of the pharmaceutical solution comprising: about 4% (w/v) naloxone hydrochloride; about 0.74% (w/v) sodium chloride; about 0.01% (w/v) benzalkonium chloride; and about 0.1% (w/v) disodium edetate.
27. The method of claim 1 , wherein the spray delivers about 5 mg naloxone.
28. The method of claim 1 , wherein the spray delivers about 6 mg naloxone.
29. The method of claim 1 , wherein the spray delivers about 7 mg naloxone.
30. The method of claim 1 , wherein the spray delivers about 8 mg naloxone.
31. The method of claim 1 , wherein the spray delivers about 9 mg naloxone.
32. The method of claim 1 , wherein the spray delivers about 10 mg naloxone.
33. The method of claim 1 , wherein delivery time is less than about 25 seconds.
34. The method of claim 33 , wherein delivery time is less than about 20 seconds.