PHARMACEUTICAL COMPOSITIONS AND METHODS FOR ANESTHESIOLOGICAL APPLICATIONS
Pharmaceutical compositions and methods for inducing conscious sedation using such compositions are described, the compositions including a benzodiazepine-based compound, an NMDA antagonist, and optionally a β-blocker, antiemetic, an NSAID, and/or an antihistamine medication. Compositions may be incorporated into vehicles for extended release. Methods for fabricating the compositions and using them for anesthesiological applications are also described.
1 . A pharmaceutical composition, comprising a therapeutically effective quantity of a pharmaceutical formulation incorporated into a vehicle, wherein the pharmaceutical composition comprises:
(a) a therapeutically effective quantity of a first pharmaceutically active compound selected from the group consisting of midazolam, diazepam, lorazepam, flunitrazepam, alprazolam, chlordiazepoxide, clonazepam and clorazepate, and pharmaceutically acceptable salts, hydrates, solvates or N-oxides thereof, optionally in combination with a non-benzodiazepine compound selected from the group consisting of eszopiclone, ramelteon, zolpidem, and zaleplon;
(b) a therapeutically effective quantity of a second pharmaceutically active compound selected from the group consisting of ketamine, dextrorphan, etomidate, methadone, memantine, amantadine, dextromethorphan, and pharmaceutically acceptable salts, hydrates, solvates or N-oxides thereof; and
(c) optionally, a pharmaceutically acceptable excipient,
wherein the vehicle is configured to provide extended release of the pharmaceutical formulation and is selected from the group consisting of extended release capsules ensconcing the pharmaceutical formulation and a matrix polymer structure holding the pharmaceutical formulation that is embedded into the matrix.
2 . The pharmaceutical composition of claim 1 , wherein the pharmaceutical formulation further comprises a therapeutically effective quantity of a third pharmaceutically active compound selected from the group consisting of β-blockers, antiemetic medicaments, NSAIDs, antihistamines, α-2-adrenergic agonists, pain relievers and combinations thereof, or pharmaceutically acceptable salts, hydrates, solvates or N-oxides thereof.
3 . The pharmaceutical composition of claim 2 , wherein the β-blocker, the α-2-adrenergic agonist or the pain reliever is selected from the group consisting of metoprolol, propranolol, acebutolol, nadolol, atenolol, betaxolol, esmolol, bisoprolol fumarate, carvedilol, nebivolol, penbutolol, timolol, sotalol, dexmedetomidine hydrochloride, and acetaminophen.
4 . The pharmaceutical composition of claim 2 , wherein the antiemetic medicament is selected from the group consisting of ondansetron, dolasetron, granisetron, palonosetron, promethazine, imenhydrinate, and meclizine.
5 . The pharmaceutical composition of claim 2 , wherein the NSAID is selected from the group consisting of bromfenac, ketorolac, etodolac, sulindac, diclofenac, aceclofenac, nepafenac, tolmetin, indomethacin, nabumetone, ketoprofen, dexketoprofen, ibuprofen, flurbiprofen, dexibuprofen, fenoprofen, loxoprofen, oxaprozin, naproxen, aspirin, salicylic acid, diflunisal, salsalate, mefenamic acid, meclofenamic acid, flufenamic acid, tolfenamic acid, meloxicam, piroxicam, ternoxicam, droxicam, lornoxicam, isoxicam, celecoxib, rofecoxib, valdecoxib, parecoxib, lumiracoxib, etoricoxib, firocoxib, nimesulide, clonixin, and licofelone.
6 . The pharmaceutical composition of claim 2 , wherein the antihistamine is selected from the group consisting of hydroxyzine pamoate, hydroxyzine hydrochloride, diphenhydramine hydrochloride, meclizine, chlorpheniramine, clemastine, promethazine, and prochlorperazine.
7 . The pharmaceutical composition of claim 2 , wherein the pharmaceutical formulation further comprises a therapeutically effective quantity of a receptor antagonist to benzodiazepines.
8 . The pharmaceutical composition of claim 7 , wherein the receptor antagonist is flumazenil.
9 . The pharmaceutical composition of claim 2 , wherein the first pharmaceutically active compound is midazolam, the second pharmaceutically active compound is ketamine and the third pharmaceutically active compound is metoprolol, wherein the midazolam:ketamine:metoprolol ratio is between about 1:2:1 and about 1:10:1 by mass.
10 . The pharmaceutical composition of claim 2 , wherein the first pharmaceutically active compound is midazolam, the second pharmaceutically active compound is ketamine and the third pharmaceutically active compound is ondansetron, wherein the midazolam:ketamine:ondansetron ratio is about 3:25:2 by mass.
11 . The pharmaceutical composition of claim 1 , wherein the vehicle is configured to allow the release of the pharmaceutical formulation in a period of time between about 12 hours and about 20 hours.
12 . The pharmaceutical composition of claim 1 , wherein the vehicle comprises a polymer selected from the group consisting of esters of cellulose, poly(lactic-co-glycolic acid), polylactic acid, polyglycolide, dextrin, polyacetals, poly(N-(2-hydroxypropyl)methacrylamide), polycaprolactone, and poly-3-hydroxybutyrate.
13 . The pharmaceutical composition of claim 12 , wherein the esters of cellulose are selected from the group consisting of methyl cellulose and hydroxypropyl methyl cellulose.
14 . The pharmaceutical composition of claim 1 , wherein the excipient is selected from the group consisting of gelatin, sodium saccharin, stevioside, peppermint oil, cherry flavor, lemon oil, raspberry flavor and combinations thereof.
15 . A method for providing extended release of the pharmaceutical formulation of claim 1 to a patient in need thereof, the method comprising:
(a) preparing the pharmaceutical formulation;
(b) incorporating the pharmaceutical formulation into the vehicle; and
(c) orally administering the pharmaceutical formulation incorporated into the vehicle to a patient in need thereof,
thereby providing for extended release of the pharmaceutical formulation.