Pharmaceutical composition and methods for peptide treatment

1. A method for treating a patient with a peptide, peptidomimetic, or a protein, said method comprising administering nasally to a patient in need of peptide treatment, peptidomimetic treatment, or protein treatment, a pharmaceutical composition in the form of a liquid emulsion suitable for delivery to a mucous membrane comprising: a macrocyclic permeation enhancer, a liquid carrier, an emulsifying agent consisting of one or more surfactants, and a therapeutically effective amount of a pharmaceutically active agent other than insulin selected from the group consisting of peptides, peptidomimetics, and proteins; wherein said macrocylic permeation enhancer is a Hsieh enhancer; said Hsieh enhancer having the following structure:

wherein X and Y are oxygen, sulfur or an imino group of the structure

or ═N—R with the proviso that when Y is the imino group of the structure ═N—R, X is an imino group of the structure

and when Y is sulfur, X is sulfur or an imino group of the structure

A is a group having the structure

wherein X and Y are defined above, m and n are integers having a value from 1 to 20 and the sum of m+n is not greater than 25, p is an integer having a value of 0 or 1, q is an integer having a value of 0 or 1, r is an integer having a value of 0 or 1, and each of R, R 1 , R 2 , R 3 , R 4 , R 5 and R 6 is independently hydrogen or an alkyl group having from 1 to 6 carbon atoms which may be straight chained or branched provided that only one of R 1 to R 6 can be an alkyl group, with the proviso that when p, q and r have a value of 0 and Y is oxygen, m+n is at least 11, and with the further proviso that when X is an imino group, q is equal to 1, Y is oxygen, and p and r are 0, then m+n is at least 11.

2. The method of claim 1 , wherein said Hsieh enhancer is selected from the group consisting of 3-methylcyclopentadecanone, 9-cycloheptadecen-1-one, cyclohexadecanone, cyclopentadecanone, oxacyclohexadecan-2-one and mixtures thereof.

3. The method of claim 2 , wherein said Hsieh enhancer is oxacyclohexadecan-2-one.

4. The method of claim 1 , wherein said pharmaceutical composition further comprises a crystallization inhibitor.

5. The method of claim 1 , wherein said one or more surfactants is a non-ionic surfactant or a combination of non-ionic surfactants.

6. The method of claim 5 , wherein said non-ionic surfactant or combination of non-ionic surfactants has an HLB of from about 7 to about 14.

7. The method of claim 1 , wherein said one or more surfactants is selected from the group consisting of an anionic surfactant and a cationic surfactant.

8. The method of claim 1 , wherein the one or more surfactants has carbon-carbon bonds that are fully saturated.

9. The method of claim 1 , wherein the emulsion is in the form of an emulsified nasal spray.

10. The method of claim 1 , wherein the liquid carrier is water.

11. A method for treating a patient with a peptide or a protein, said method comprising administering nasally to a patient in need of peptide treatment or protein treatment, a pharmaceutical composition in the form of a liquid emulsion suitable for delivery to a mucous membrane comprising: a macrocyclic permeation enhancer, a liquid carrier, an emulsifying agent consisting of one or more surfactants, and a therapeutically effective amount of a pharmaceutically active agent other than insulin selected from the group consisting of peptides, and proteins; wherein said macrocylic permeation enhancer is a Hsieh enhancer; said Hsieh enhancer having the following structure:

wherein X and Y are oxygen, sulfur or an imino group of the structure

or ═N—R with the proviso that when Y is the imino group of the structure ═N—R, X is an imino group of the structure

and when Y is sulfur, X is sulfur or an imino group of the structure

A is a group having the structure

wherein X and Y are defined above, m and n are integers having a value from 1 to 20 and the sum of m+n is not greater than 25, p is an integer having a value of 0 or 1, q is an integer having a value of 0 or 1, r is an integer having a value of 0 or 1, and each of R, R 1 , R 2 , R 3 , R 4 , R 5 and R 6 is independently hydrogen or an alkyl group having from 1 to 6 carbon atoms which may be straight chained or branched provided that only one of R 1 to R 6 can be an alkyl group, with the proviso that when p, q and r have a value of 0 and Y is oxygen, m+n is at least 11, and with the further proviso that when X is an imino group, q is equal to 1, Y is oxygen, and p and r are 0, then m+n is at least 11.

12. The method of claim 11 , wherein said Hsieh enhancer is selected from the group consisting of 3-methylcyclopentadecanone, 9-cycloheptadecen-1-one, cyclohexadecanone, cyclopentadecanone, oxacyclohexadecan-2-one and mixtures thereof.

13. The method of claim 12 , wherein said Hsieh enhancer is oxacyclohexadecan-2-one.

14. The method of claim 11 , wherein said pharmaceutical composition further comprises a crystallization inhibitor.

15. The method of claim 11 , wherein said one or more surfactants is a non-ionic surfactant or a combination of non-ionic surfactants.

16. The method of claim 15 , wherein said non-ionic surfactant or combination of non-ionic surfactants has an HLB of from about 7 to about 14.

17. The method of claim 11 , wherein said one or more surfactants is selected from the group consisting of an anionic surfactant and a cationic surfactant.

18. The method of claim 11 , wherein the one or more surfactants has carbon-carbon bonds that are fully saturated.

19. The method of claim 11 , wherein the emulsion is in the form of an emulsified nasal spray.

20. The method of claim 11 , wherein the liquid carrier is water.