Packaged, sealed container system for stable storage of an oxygen sensitive pharmaceutical formulation

1. A packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation, the packaged, sealed container system comprising:

a primary container comprising a ready-to-use, stable norepinephrine formulation therein, the ready-to-use, stable norepinephrine formulation comprising:

0.015 mg/ml to about 0.035 mg/ml norepinephrine;

dextrose; and

a pH between 3.4 and 4.0;

wherein the ready-to-use, stable norepinephrine formulation is free of an antioxidant;

a secondary container comprising a first flexible sheet comprising a coextruded film including a metal foil, an opposing second flexible sheet layer which is colored to protect the ready-to-use, stable norepinephrine formulation from light, and a seal disposed along a common peripheral edge of the first and second flexible sheet layers, wherein the primary container is disposed between and enclosed by the first and second flexible sheet layers of the secondary container; and

an oxygen scavenger disposed between and enclosed by the first and second flexible sheet layers of the secondary container, the oxygen scavenger being in fluid communication with the contents of the primary container,

wherein the primary container is a multi-layer bag comprising a third flexible sheet layer of low-density polyethylene, an opposing fourth flexible sheet layer of polypropylene, a middle polyamide layer, and a primary container seal disposed along a common peripheral edge of the third and fourth flexible sheet layers; and

wherein the ready-to-use, stable norepinephrine formulation does not comprise sodium chloride,

wherein the norepinephrine is in the form of norepinephrine bitartrate monohydrate,

wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.5 ppm after storage for at least 150 days at 25° C., and

wherein the ready-to-use, stable norepinephrine formulation retains at least about 90% of an initial activity as measured by an initial and a final amount of R-norepinephrine present in the formulation after storage for at least 120 days at 25° C.

2. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the primary container has a single port, the single port comprising an administration port for delivering the ready-to-use, stable norepinephrine formulation to a patient.

3. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the third or the fourth flexible sheets are coextruded film laminates comprising a polypropylene layer.

4. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 3 , wherein the coextruded film laminates further comprise a polyamide layer.

5. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the metal foil of the coextruded film is an aluminum foil.

6. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the opposing second flexible sheet layer comprises a transparent coextruded film configured to allow visual inspection into the secondary container.

7. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the opposing second flexible sheet layer is amber colored.

8. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the second flexible sheet layer has a water transmission rate less than 3.0 g/m 2 /day.

9. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the oxygen scavenger comprises iron powder, iron oxide powder, or a mixture thereof.

10. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the concentration of norepinephrine is between about 0.015 mg/ml and about 0.020 mg/ml.

11. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the concentration of norepinephrine is between about 0.030 mg/ml and about 0.035 mg/ml.

12. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the pH is between about 3.5 and about 3.9.

13. The packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 , wherein the pH is between about 3.6 and about 3.8.

14. A method of treating hypotension in a subject, the method comprising:

opening the packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation according to claim 1 ; and

administering to a subject a therapeutically effective amount of the ready-to-use, stable norepinephrine formulation,

wherein the subject is in need of treatment for hypotension.

15. The method of claim 14 wherein the subject has a condition selected from one or more of pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions.

16. The method of claim 14 wherein the subject has a condition selected from one or more of cardiac arrest and profound hypotension.

17. The packaged, sealed container system according to claim 1 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.1 ppm after storage for at least 150 days at 25° C.

18. The packaged, sealed container system according to claim 1 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.5 ppm after storage for at least 180 days at 25° C.

19. The packaged, sealed container system according to claim 1 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.1 ppm after storage for at least 180 days at 25° C.

20. A packaged, sealed container system for stable storage of a ready-to-use, stable norepinephrine formulation, the packaged, sealed container system comprising:

a primary container comprising a ready-to-use, stable norepinephrine formulation therein, wherein the primary container is a multi-layer bag comprising a third flexible sheet layer of low-density polyethylene, an opposing fourth flexible sheet layer of polypropylene, a middle polyamide layer, and a primary container seal disposed along a common peripheral edge of the third and fourth flexible sheet layers;

a secondary container comprising a first flexible sheet layer comprising a coextruded film including a metal foil, an opposing second flexible sheet layer which is colored to protect the ready-to-use, stable norepinephrine formulation from light, and a seal disposed along a common peripheral edge of the first and second flexible sheet layers, wherein the primary container is disposed between and enclosed by the first and second flexible sheet layers of the secondary container; and

an oxygen scavenger disposed between and enclosed by the first and second flexible sheet layers of the secondary container, the oxygen scavenger being in fluid communication with the contents of the primary container,

wherein the ready-to-use, stable norepinephrine formulation consists essentially of 0.015 mg/ml to about 0.035 mg/ml norepinephrine;

dextrose;

water; and

optionally, hydrochloric acid and/or sodium hydroxide as pH adjusters,

wherein the ready-to-use, stable norepinephrine formulation has a pH between 3.4 and 4.0, and has a dissolved oxygen level of less than 0.5 ppm after storage for at least 150 days at 25° C.,

wherein the ready-to-use, stable norepinephrine formulation retains at least about 90% of an initial activity as measured by an initial and a final amount of R-norepinephrine present in the formulation after storage for at least 120 days at 25° C., and

wherein the norepinephrine is in the form of norepinephrine bitartrate monohydrate.

21. The packaged, sealed container system according to claim 20 , wherein the norepinephrine is present at a concentration of 0.015 mg/ml to 0.020 mg/ml or 0.030 to 0.035 mg/ml.

22. The packaged, sealed container system according to claim 20 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.1 ppm after storage for at least 150 days at 25° C.

23. The packaged, sealed container system according to claim 20 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.5 ppm or less than 0.1 ppm after storage for at least 180 days at 25° C.

24. A packaged, sealed container system comprising:

a ready-to-use, stable norepinephrine formulation consisting of 0.015 mg/ml to 0.035 mg/ml norepinephrine and dextrose, wherein the ready-to-use, stable norepinephrine formulation has a pH of 3.4-4.0 and has a dissolved oxygen level of less than 0.5 ppm after storage for at least 150 days at 25° C., wherein the ready-to-use, stable norepinephrine formulation retains at least about 90% of an initial activity as measured by an initial and a final amount of R-norepinephrine present in the formulation after storage for at least 120 days at 25° C., and wherein the norepinephrine is in the form of norepinephrine bitartrate monohydrate;

a primary container comprising the ready-to-use, stable norepinephrine formulation therein, wherein the primary container is a multilayer bag comprising third flexible sheet layer of low-density polyethylene, an opposing fourth flexible sheet of polypropylene, a polyamide middle layer, and a primary container seal disposed along a common peripheral edge of the third and fourth flexible sheet layers;

a secondary container comprising a first flexible sheet layer comprising a coextruded film including a metal foil, an opposing second flexible sheet layer which is colored to protect the ready-to-use, stable norepinephrine formulation from light, and a seal disposed along a common peripheral edge of the first and second flexible sheet layers, wherein the primary container is disposed between and enclosed by the first and second flexible sheet layers of the secondary container; and

an oxygen scavenger disposed between and enclosed by the first and second flexible sheet layers of the secondary container, the oxygen scavenger being in fluid communication with the contents of the primary container.

25. The packaged, sealed container system according to claim 24 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.1 ppm after storage for at least 150 days at 25° C.

26. The packaged, sealed container system according to claim 24 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.5 ppm or less than 0.1 ppm after storage for at least 180 days at 25° C.

27. A packaged, sealed container system comprising:

a ready-to-use, stable norepinephrine formulation consisting of 0.015 mg/ml to 0.035 mg/ml norepinephrine, dextrose, and hydrochloric acid and/or sodium hydroxide as pH adjusters, wherein the ready-to-use, stable norepinephrine formulation has a pH of 3.4-4.0 and has a dissolved oxygen level of less than 0.5 ppm after storage for at least 150 days at 25° C., and wherein the norepinephrine is in the form of norepinephrine bitartrate monohydrate, and wherein the ready-to-use, stable norepinephrine formulation retains at least about 90% of an initial activity as measured by an initial and a final amount of R-norepinephrine present in the formulation after storage for at least 120 days at 25° C.;

a primary container comprising the ready-to-use, stable norepinephrine formulation therein, wherein the primary container is a multi-layer bag comprising a third flexible sheet layer of low-density polyethylene, an opposing fourth flexible sheet layer of polypropylene, a middle polyamide layer, and a primary container seal disposed along a common peripheral edge of the third and fourth flexible sheet layers;

a secondary container comprising a first flexible sheet layer comprising a coextruded film including a metal foil, an opposing second flexible sheet layer which is colored to protect the ready-to-use, stable norepinephrine formulation from light, and a seal disposed along a common peripheral edge of the first and second flexible sheet layers, wherein the primary container is disposed between and enclosed by the first and second flexible sheet layers of the secondary container; and

an oxygen scavenger disposed between and enclosed by the first and second flexible sheet layers of the secondary container, the oxygen scavenger being in fluid communication with the contents of the primary container.

28. The packaged, sealed container system according to claim 27 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.1 ppm after storage for at least 150 days at 25° C.

29. The packaged, sealed container system according to claim 27 , wherein the ready-to-use, stable norepinephrine formulation has a dissolved oxygen level of less than 0.5 ppm or less than 0.1 ppm after storage for at least 180 days at 25° C.

30. The packaged, sealed container system according to claim 27 , wherein the formulation consists of 0.015 mg/ml to 0.020 mg/ml or 0.030 to 0.035 mg/ml norepinephrine.