Milrinone controlled-release formulation
The present invention relates to oral controlled-release formulations of 5-(pyridinyl)-2(1H)-pyridinone compounds and their use in the treatment of a subject with heart failure, a stage, class or manifestation of heart failure, or at risk of developing or exhibiting symptoms of heart failure. The formulations of the invention release the compounds in the range of between 0.1 μg/kg body weight/minute and 20 μg/kg body weight/minute.
1. A method for treating a subject exhibiting symptoms of heart failure or pulmonary hypertension, said method comprising administering to the subject an oral controlled-release formulation comprising:
(i) a core comprising:
(a) milrinone, or a pharmaceutically acceptable salt thereof;
(b) hydroxyproplmethylcellulose having a viscosity of 80,000 to 120,000 cps;
(c) hydroxypropylmethylcellulose having a viscosity of about 50 cps; and
(d) at least one pharmaceutically acceptable excipient;
(ii) a sustained-release coating; and
(iii) an enteric coating;
wherein the hydroxypropylmethylcellulose (80,000 to 120,000 cps) and the hydroxypropylmethylcellulose (about 50 cps) are in a ratio of about 1.5:1 to 1:1.5, and the ratio of milrinone, or a pharmaceutically acceptable salt thereof, to total hydroxypropylmethylcellulose is about 1:3 to 1:5, and
wherein the formulation exhibits zero order release of about 100% of milrinone, or a pharmaceutically acceptable salt thereof, over about 12 hours at pH 6.8.
2. The method according to claim 1 , wherein the formulation delivers milrinone, or a pharmaceutically acceptable salt thereof, to the blood stream at a rate of from about 0.375 μg/kg body weight/minute to about 0.75 μg/kg body weight/minute.
3. The method according to claim 1 , wherein the subject is a human.
4. The method according to claim 1 , further comprising the administration of a medicament selected from an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, a beta blocker, a neurohormonal modulating agent, a diuretic, a phosphodiesterase inhibitor and an endothelin antagonist.
5. The method according to claim 1 , further comprising the step of monitoring plasma concentrations of milrinone, or a pharmaceutically acceptable salt thereof, and if the subject's milrinone plasma concentration is not in the range of 100 to 400 ng/mL, then adjusting the dosage to achieve a plasma concentration in the range of 100 to 400 ng/mL.
6. The method according to claim 1 , wherein the formulation delivers milrinone, or a pharmaceutically acceptable salt thereof, to the blood stream at a rate of from about 0.1 μg/kg body weight/minute to about 1.0 μg/kg body weight/minute.
7. The method of claim 1 , further comprising the step of monitoring plasma concentrations of milrinone, or a pharmaceutically acceptable salt thereof, and if necessary, adjusting the dosage to achieve a plasma concentration in the range of 100 to 400 ng/mL.
8. The method of claim 1 , wherein milrinone, or a pharmaceutically acceptable salt thereof, is present in an amount of 10-30% w/w of the core.
9. The method of claim 1 , wherein the ratio of hydroxypropylmethylcellulose (80,000 to 120,000 cps) to hydroxypropylmethylcellulose (50 cps) is about 1:1.
10. The method of claim 1 , wherein the ratio of milrinone, or a pharmaceutically acceptable salt thereof, to total hydroxypropylmethylcellulose is about 1:3.
11. The method of claim 1 , wherein the hydroxypropylmethylcellulose (80,000 to 120,000 cps) is present in an amount of 20-40% w/w of the core.
12. The method of claim 1 , wherein the hydroxypropylmethylcellulose (about 50 cps) is present in an amount of 20-40% w/w of the core.
13. The method of claim 1 , wherein the at least one pharmaceutically acceptable excipient is a binder, a lubricant, or a mixture thereof.
14. The method of claim 10 , wherein the binder is microcrystalline cellulose.
15. The method of claim 10 , wherein the binder is present in an amount of 16-30% w/w of the core.
16. The method of claim 1 , wherein the sustained-release coating comprises a cellulose derivative or a copolymer of acrylic acid, methacrylic acid and/or their esters.
17. The method of claim 16 , wherein the cellulose derivative is ethylcellulose.
18. The method of claim 16 , wherein the sustained-release coating further comprises a low viscosity hydroxypropylmethylcellulose.
19. The method of claim 1 , wherein the sustained-release coating comprises a copolymer of acrylic acid, acrylic ester, methacrylic acid, methacrylic ester or mixtures thereof, optionally with a methacrylic ester with quaternary ammonium groups.
20. The method of claim 1 , wherein the formulation comprises more than one sustained-release coating.
21. The method of claim 1 , further comprising one or more of a seal coating, a buffer coating, and an enteric coating.
22. The method of claim 1 , wherein the enteric coating comprises Eudragit.
23. The method of claim 22 , wherein the enteric coating comprises 25% Eudragit.
24. The method of claim 22 , wherein the enteric coating comprises 30% Eudragit.