Injectable neurosteroid formulations containing nanoparticles
The disclosure provides an injectable neurosteroid nanoparticle formulation comprising nanoparticles having a D50 of less than 2000 nm the nanoparticles comprising a neurosteroid of Formula I, where the variables R 1 -R 9 and X are defined herein and at least one surface stabilizer. The surface stabilizer can be a polymeric surface stabilizer such as hydroxyethyl starch, dextran, or povidone. The injectable neurosteroid nanoparticle formulation can be an intravenous formulation. The disclosure also provides a lyophilized powder of the injectable neurosteroid nanoparticle formulation that can be reconstituted in an aqueous solution prior to administration. The disclosure provides injectable neurosteroid nanoparticle formulations and dry powders of such formulations that have been sterilized by ebeam irradiation. The disclosure provides a method of treating a patient having a seizure disorder, stroke, or traumatic brain injury, comprising administering an effective amount of the injectable neurosteroid nanoparticle formulation. The disclosure also provides combination methods in which the injectable neurosteroid nanoparticle formulation is a first active agent that is administered in combination with at least one additional active agent.
1. An injectable neurosteroid formulation comprising stable particle size nanoparticles having a D50 of less than 2000 nm, the nanoparticles comprising
a) a neurosteroid selected from ganaxolone and allopregnanolone;
b) hydroxyethyl starch, wherein the (wt:wt) ratio of the neurosteroid to the hydroxyethyl starch is about 4:1 to about 0.5:1; and
c) an ionic surfactant selected from sodium cholate, sodium deoxycholate, and sodium cholesterol sulfate, and a mixture of any of the foregoing.
2. The injectable neurosteroid formulation of claim 1 ,
comprising nanoparticles having a D50 of less than 500 nm;
wherein the formulation is an intravenous formulation; and
the neurosteroid is ganaxolone.
3. The injectable neurosteroid formulation of claim 2 , wherein the formulation additionally comprises an antifoaming agent.
4. The injectable neurosteroid formulation of claim 2 , wherein the surfactant is sodium deoxycholate.
5. The injectable neurosteroid formulation of claim 2 additionally comprising a cryoprotectant, wherein the cryoprotectant is sucrose, dextrose, lactose, D-sorbitol, or a mixture of any of the foregoing.
6. The injectable neurosteroid formulation of claim 2 additionally comprising one or more of the following
(a) 0.5% to 1.5% sodium chloride (weight percent);
(b) a buffer; and
(c) a preservative, wherein the preservative is benzyl alcohol, chlorbutanol, 2-ethoxyethanol, parabens (including methyl, ethyl, propyl, butyl, and combinations), benzoic acid, sorbic acid, chlorhexidene, phenol, 3-cresol, thimerosal; a phenylmercurate salt, or a mixture of any of the foregoing.
7. The injectable neurosteroid formulation of claim 1 , wherein
the (wt:wt) ratio of the neurosteroid to the hydroxyethyl starch is about 4:1 to about 1:1; and the ionic surfactant is sodium deoxycholate and the ratio of neurosteroid to sodium deoxycholate (w:w) is about 10:1.5 to about 10:0.1.
8. The formulation of claim 7 , wherein the formulation is in the form of a lyophilized powder.
9. The formulation of claim 2 , wherein the formulation is an aqueous suspension and the neurosteroid concentration is about 0.1 mg/mL to about 300 mg/mL.
10. The injectable neurosteroid formulation of claim 1 , wherein the formulation is an aqueous ganaxolone formulation comprising
(a) nanoparticles having a D50 of less than 500 nm; the nanoparticles comprising ganaxolone, wherein the weight percent of the ganaxolone is 1 to 10%;
(b) hydroxyethyl starch, wherein the weight percent of the hydroxyethyl starch is 2 to 20%; and
(c) sodium deoxycholate, wherein the weight percent of the sodium deoxycholate is 0.1% to 2.0%; and
(d) an antifoaming agent.
11. The injectable neurosteroid formulation of claim 1 wherein the formulation is an aqueous formulation comprising
(a) nanoparticles having a D50 of less than 500 nm, the nanoparticles comprising ganaxolone, wherein the weight percent of the ganaxolone is about 5%;
(b) hydroxyethyl starch 130/0.4, wherein the weight percent of the hydroxyethyl starch is about 5% to about 10%;
(c) sodium deoxycholate, wherein the weight percent of the sodium deoxycholate is about 0.75%; and optionally
(d) simethicone, wherein the weight percent of simethicone is 0.009%.
12. A method for sterilizing the injectable neurosteroid nanoparticle formulation of claim 2 , comprising subjecting the formulation to ebeam radiation, wherein the method produces a sterilized neurosteroid nanoparticle formulation containing a degradant concentration of not more than 0.2% w/w of neurosteroid.
13. The injectable neurosteroid formulation of claim 2 , wherein the formulation has been sterilized by ebeam irradiation and wherein the formulation contains a degradant concentration of not more than 0.2% w/w of the neurosteroid.
14. The injectable neurosteroid formulation of claim 13 , wherein the ebeam irradiation is a cumulative dose of about 25 kGray.
15. A method of treating a patient having a seizure disorder, stroke, or traumatic brain injury, the method comprising administering intravenously a therapeutically effective amount of the injectable neurosteroid formulation of claim 2 .
16. The method of claim 13 , wherein the seizure disorder is status epilepticus, refractory status epilepticus, super refractory status epilepticus, or PCDH19 female pediatric epilepsy.
17. The method of claim 15 wherein the dosage of ganaxolone administered is from about 1 mg/kg to about 200 mg/kg.
18. The method of claim 15 comprising administering a single bolus dose of the formulation to the patient; wherein the single bolus dose provides a sufficient amount of ganaxolone to provide a plasma C max of ganaxolone of at least 1000 ng/mL in the patient.
19. The method of claim 15 comprising administering multiple bolus doses of the ganaxolone formulation to the patient, wherein the multiple bolus doses are given over 1 to 10 days at intervals of 1 to 24 hours, wherein each bolus dose provides a sufficient amount of ganaxolone to produce a plasma C max of ganaxolone of at least 1000 ng/mL in the patient.
20. The method of claim 15 comprising administering an intravenous infusion of the ganaxolone formulation to the patient, with or without an initial bolus dose, for 1 to 10 consecutive days at a rate of 1 to 10 mg/kg/hr without an initial bolus dose.
21. The method of claim 20 comprising
administering an initial bolus dose of from about 1 mg/kg to about 20 mg/kg ganaxolone, followed within 24 hours by administration of an intravenous infusion of the ganaxolone formulation for 1 to 10 consecutive days at a rate of 1 to 10 mg/kg/hr; sufficient amount of ganaxolone to provide an initial plasma C max of ganaxolone of at least 1000 ng/mL in the patient and the concentration of ganaxolone in the patient's plasma does not fall below 25% of the initial C max until after the infusion is concluded.
22. The method any one of claim 15 wherein
the injectable ganaxolone formulation is a first active agent and is administered concurrently or sequentially with at least one additional active agent; and
the at least one additional active agent is an anticonvulsant or anesthetic/sedative.