Bupivacaine multivesicular liposome formulations and uses thereof
Some embodiments of the present application are related to multivesicular liposome formulations comprising high concentration of bupivacaine for the purpose of preventing, treating or ameliorating pain, for example, post-surgical pain for an extended period of time. Processes of making and administering bupivacaine encapsulated multivesicular liposome formulations (BUP-MVLs) and their uses as medicaments are also provided.
1. A composition of bupivacaine encapsulated multivesicular liposomes (MVLs), comprising:
bupivacaine residing inside a plurality of internal aqueous chambers of the MVLs separated by lipid membranes, wherein the lipid membranes comprise DPPG or a salt thereof, DEPC, cholesterol, and a triglyceride selected from the group consisting of triolein, tricaprylin, and combinations thereof; and
an aqueous medium in which the bupivacaine encapsulated MVLs are suspended, wherein the aqueous medium comprises at least one buffering agent in a concentration from about 1 mM to about 50 mM, and wherein the osmolality of the aqueous medium is from about 320 mOsm/kg to about 360 mOsm/kg;
wherein the bupivacaine concentration in the composition is from about 18 mg/mL to about 40 mg/mL, and
wherein the plurality of internal aqueous chambers of the MVLs comprises one or more pH modifying agents, and has a pH from about 3.0 to about 6.6.
2. The composition of claim 1 , wherein the bupivacaine concentration in the composition is about 20 mg/mL.
3. The composition of claim 1 , wherein the composition comprises less than about 2% by weight of unencapsulated bupivacaine.
4. The composition of claim 1 , wherein the lipid membrane comprises DPPG, DEPC, cholesterol, tricaprylin, and triolein.
5. The composition of claim 1 , wherein the one or more pH modifying agents is selected from the group consisting of organic acids, organic bases, inorganic acids, and inorganic bases, and combinations thereof.
6. The composition of claim 5 , wherein the one or more pH modifying agents comprises phosphoric acid.
7. The composition of claim 1 , wherein the plurality of internal aqueous chambers of the MVLs has a pH from about 3.5 to about 6.6.
8. The composition of claim 1 , wherein the percent packed particle volume (% PPV) of the bupivacaine encapsulated multivesicular liposomes in the composition is about 35% to 80%.
9. The composition of claim 1 , wherein the at least one buffering agent comprises sodium phosphate.
10. The composition of claim 9 , wherein the concentration of sodium phosphate in the composition is from about 5 mM to about 20 mM.
11. The composition of claim 1 , wherein the pH of the aqueous medium is from about 6.5 to about 7.5.
12. The composition of claim 3 , wherein the increase of unencapsulated bupivacaine in the composition is less than about 5% by weight after the composition is stored at 5° C. for six months.
13. The composition of claim 1 , wherein the bupivacaine is in the form of bupivacaine phosphate.
14. A method of treating or ameliorating pain in a subject in need thereof, comprising administering a composition of claim 1 to the subject.
15. The method of claim 14 , wherein the administration is selected from the group consisting of infiltration, subcutaneous injection, tissue injection, intramuscular injection, spinal injection, intraocular injection, epidural injection, subarachnoid injection, sacroiliac joints injection, intrathecal injection, caudal injection, intraotic injection, and perineural injection, and combinations thereof.
16. The method of claim 14 , wherein the administration is via local infiltration to a surgical site.
17. The method of claim 14 , wherein the administration is via nerve block.
18. The method of claim 17 , wherein the administration is via interscalene brachial plexus nerve block, femoral nerve block, sciatic nerve block, or ganglion block.
19. The method of claim 14 , wherein the pain is post-surgical pain or chronic pain.
20. The method of claim 19 , wherein the chronic pain comprises myofascial pain syndromes, complex regional pain syndromes, or radicular back pain.
21. The method of claim 14 , wherein the Tmax of bupivacaine is from about 6 hours to about 96 hours.
22. The method of claim 14 , wherein the percent AUC (0-24 hours) of bupivacaine is from about 4% to about 25%, from about 6% to about 20%, or from about 8% to about 15%.
23. The method of claim 14 , wherein the total percent AUC is above 90% from 192 hours to about 216 hours post administration.
24. The method of claim 14 , wherein the Cmax of bupivacaine is from about 40 ng/ml to about 100 ng/ml.
25. The method of claim 14 , wherein the administration provides a sustained release of bupivacaine for about 5 to 15 days.
26. A process for preparing bupivacaine encapsulated multivesicular liposomes (MVLs), comprising:
mixing a first aqueous solution comprising one or more pH modifying agents with a lipid solution comprising at least one organic solvent, DPPG or a salt thereof, DEPC, cholesterol, and a triglyceride selected from the group consisting of triolein, tricaprylin, and combinations thereof to form a first water-in-oil emulsion, wherein at least one of the first aqueous solution and the lipid solution comprises bupivacaine;
combining the first water-in-oil emulsion with a second aqueous solution to form a second emulsion; and
substantially removing the organic solvent from the second emulsion to form a first aqueous suspension of bupivacaine encapsulated MVLs; and
exchanging the aqueous supernatant of the first aqueous suspension with a third aqueous solution one or more times to provide a final aqueous suspension of bupivacaine encapsulated MVLs, wherein the bupivacaine concentration in the final aqueous suspension is from about 18 mg/mL to about 40 mg/mL, and wherein the final aqueous suspension comprises at least one buffering agent in a concentration from about 1 mM to about 50 mM; and wherein the osmolality of the final aqueous suspension is from about 320 mOsm/kg to about 360 mOsm/kg.
27. The process of claim 26 , wherein the bupivacaine concentration in the final aqueous suspension is about 20 mg/mL.
28. The process of claim 26 , wherein the one or more pH modifying agents in the first aqueous solution comprises phosphoric acid.
29. The process of claim 28 , wherein the molar ratio of bupivacaine to phosphoric acid in the first aqueous solution is from about 1:1.2 to about 1:2.
30. The process of claim 26 , wherein the second aqueous solution comprises lysine and dextrose, and the second aqueous solution has the osmolality from about 210 mOsm/kg to about 285 mOsm/kg.
31. The process of claim 26 , wherein the lipid solution comprises DPPG or a salt thereof, DEPC, cholesterol, tricaprylin, and triolein.
32. The process of claim 31 , wherein the mass ratio of tricaprylin to triolein is from about 3:1 to about 25:1.
33. The composition of claim 4 , wherein the mass ratio of tricaprylin to triolein is from about 3:1 to about 25:1.
34. A composition of bupivacaine encapsulated multivesicular liposomes (MVLs), comprising:
bupivacaine residing inside a plurality of internal aqueous chambers of the MVLs separated by lipid membranes, wherein the lipid membranes comprise DPPG or a salt thereof, DEPC, cholesterol, tricaprylin and triolein; and
an aqueous medium in which the bupivacaine encapsulated MVLs are suspended, wherein the aqueous medium comprises one or more buffering agents in a concentration from about 5 mM to about 20 mM, wherein the osmolality of the aqueous medium is from about 320 mOsm/kg to about 360 mOsm/kg, and the pH of the aqueous medium is from about 6.5 to about 7.5;
wherein the bupivacaine concentration in the composition is about 20 mg/mL;
wherein the plurality of internal aqueous chambers of the MVLs comprises phosphoric acid as a pH modifying agent, and has a pH from about 3.5 to about 6.6; and
wherein the mass ratio of tricaprylin to triolein in the composition is about 5:1 to about 15:1.
35. The composition of claim 34 , wherein the aqueous medium comprises about 10 mM sodium phosphate.
36. The composition of claim 35 , wherein the osmolality of the aqueous medium is about 330 mOsm/kg.
37. The composition of claim 34 , wherein the concentration of DEPC in the composition is from about 8 mg/mL to 12 mg/ml;
the concentration of DPPG or a salt thereof in the composition is from about 0.7 mg/mL to about 1.5 mg/ml;
the concentration of cholesterol in the composition is from about 4 mg/mL to about 7 mg/mL;
the concentration of tricaprylin in the composition is from about 2 mg/mL to about 5 mg/mL; and
the concentration of triolein in the composition is about 0.3 mg/mL to about 1.0 mg/mL.
38. A method of treating or ameliorating pain in a subject in need thereof, comprising administering a composition of claim 34 to the subject by a single injection, and wherein the administration provides a sustained release of bupivacaine for 5 to 15 days.