TRANSDERMAL PATCH AND METHOD FOR DELIVERY OF VITAMIN B ₁₂

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001 ] This application claims priority to U.S. Provisional Application No. 60/895,571, filed March 19, 2007, the entirety of which is herehy incorporated by reference herein.

STATEMENT REGARDING FEDERALLY-SPONSORED RESEARCH OR

DEVELOPMENT [0002] Not applicable.

FIELD OF THE INVENTION

[0003] This invention relates generally to compositions, devices and methods for administering vitamin B ₁₂ to human and non-human subjects. More particularly, the invention is directed to shelf-stable vitamin B^-containing transdermal delivery patches and methods of their preparation and use.

BACKGROUND OF THE INVENTION

[0004] Vitamin B ₁₂ is the largest and most complex of all the vitamins. It is unique among vitamins in that it contains a metal ion, cobalt. For this reason cobalamin is the term used to refer to compounds having B ₁₂ activity. Methylcobalamin and 5-deoxyadenosyl cobalamin are the forms of vitamin B| ₂ used in the human body. The form of cobalamin used in most supplements, cyanocobalamin, is readily converted to 5-deoxyadenosylcobalamin and methylcobalamin.

[0005] Vitamin B ₎₂ deficiency is estimated to affect 10%-15% of individuals over the age of 60. Absorption of vitamin Bu from food requires normal function of the stomach, pancreas, and small intestine. Stomach acid and enzymes free vitamin B ₁₂ from food, allowing it to bind to other proteins, known as R proteins. In the alkaline environment at the surface of intestinal villi crypts, R proteins are degraded by pancreatic enzymes, freeing vitamin B) ₂ to bind to intrinsic factor (IF), a protein secreted by specialized cells in the stomach. Receptors on the surface of the small intestine take up the IF-Bi? complex only in the presence of calcium, which is also supplied by the pancreas. Vitamin Bj ₂ can also be absorbed by passive diffusion in the digestive

tract, but this process is very inefficient, allowing only about 1% absorption of a vitamin B J 2 dose.

[0006] The most common causes of vitamin Bn deficiency are 1) an autoimmune condition known as pernicious anemia and 2) food-bound vitamin B ₁₂ malabsorption. Although both causes become more common with age, they are two separate conditions. [0007] Pernicious anemia has been estimated to be present in approximately 2% of individuals over 60. Although anemia is often a symptom, the condition is actually the end stage of an autoimmune inflammation of the stomach, resulting in destruction of stomach cells by one's own antibodies. Progressive destruction of the cells that line the stomach cause decreased secretion of acid and enzymes required to release food bound vitamin B ₁₂ . Antibodies to IF bind to IF preventing formation of the IF-B ₁₂ complex, further inhibiting vitamin B ₁₂ absorption. If the body's vitamin Bi ₂ stores are adequate prior to the onset of pernicious anemia, it may take years for symptoms of deficiency to develop. About 20% of the relatives of pernicious anemia patients also have pernicious anemia, suggesting a genetic predisposition. Treatment of pernicious anemia generally requires injections of vitamin Bi ₂ , bypassing intestinal absorption. High-dose oral supplementation is another treatment option, because consuming 1,000 meg (1 mg)/day of vitamin B ₁₂ orally should result in the absorption of about 10 meg/day (about 1%) by passive diffusion.

[0008] Food-bound vitamin Bi ₂ malabsorption is defined as an impaired ability to absorb food or protein-bound vitamin B ₁₂ , although the free form is fully absorbable. In the elderly, food-bound vitamin B| ₂ malabsorption is thought to result mainly from atrophic gastritis, a chronic inflammation of the lining of the stomach, which ultimately results in the loss of glands in the stomach (atrophy) and decreased stomach acid production. Because stomach acid is required for the release of vitamin Bi ₂ from the proteins in food, vitamin Bi ₂ absorption is diminished. Decreased stomach acid production also provides an environment more conducive to the overgrowth of anaerobic bacteria in the stomach, interfering further with vitamin B ₁₂ absorption. Because vitamin Bi ₂ in supplements is not bound to protein, and because IF is still available, the absorption of supplemental vitamin B ₁₂ is not reduced as it is in pernicious anemia. Thus, individuals with food-bound vitamin B ₎₂ malabsorption do not have an increased requirement for vitamin Bi ₂ ; they simply need it in the form of a supplement rather than from food.

[0009] Other causes of deficiency include surgical resection of the stomach or portions of the small intestine where receptors for the IF-Bn complex are located. Conditions affecting the small intestine, such as malabsorption syndromes (celiac disease and tropical sprue), may also result in vitamin B| ₂ deficiency. Because the pancreas provides critical enzymes as well as calcium required for vitamin B ₁₂ absorption, pancreatic insufficiency may contribute to B 12 deficiency. Since vitamin B ₁₂ is found only in foods of animal origin, a strict vegetarian (vegan) diet has resulted in cases of vitamin B ₁₂ deficiency. In alcoholics, vitamin Bi ₂ intake and absorption are reduced, while elimination is increased. Individuals with acquired immunodeficiency syndrome (AIDS) appear to be at increased risk of deficiency, possibly related to a failure of the IF-B ₁₂ receptor to take up the IF-B ₁₂ complex.

[0010] The neurological symptoms of vitamin Bi ₂ deficiency include numbness and tingling of the arms and more commonly the legs, difficulty walking, memory loss, disorientation, and dementia, with or without mood changes. Although the progression of neurologic complications is generally gradual, they are not always reversible with treatment of vitamin B ₁₂ deficiency, especially if they have been present for a long time. Neurologic complications are not always associated with megaloblastic anemia, and are the only clinical symptom of vitamin Bi ₂ deficiency in about 25% of cases. Although vitamin Bn deficiency is known to damage the myelin sheath covering cranial, spinal, and peripheral nerves, the biochemical processes leading to neurological damage in Bi ₂ deficiency are not well understood. [001 1 ] A case-control study compared prediagnostic levels of serum folate, vitamin B^, and vitamin Bi ₂ in 195 women later diagnosed with breast cancer and 195 age-matched women who were not diagnosed with breast cancer. Among women who were postmenopausal at the time of blood donation, the association between blood levels of vitamin Bj ₂ and breast cancer suggested a threshold effect. The risk of breast cancer was more than doubled in those women with serum vitamin Bi ₂ levels in the lowest quintile (1/5) compared to those women in the four highest quintiles The investigators found no relationship between breast cancer and serum levels of vitamin B ₆ , folate, or homocysteine.

[0012] Neural tube defects (NTD) may result in anencephaly or spina bifida, devastating and sometimes fatal birth defects The defects occur between the 21st and 27th days after conception, a time when many women do not realize they are pregnant. Randomized controlled trials have demonstrated 60% to 100% reductions in NTD cases when women consumed folic

acid supplements in addition to a vaπed diet during the month before and the month after conception Increasing evidence indicates that the homocysteine-loweπng effect of folic acid plays a critical role in loweπng the risk of NTD Homocysteine may accumulate in the blood when there is inadequate folate and/or vitamin B ₁₂ for effective functioning of the methionine synthase enzyme Deci eased vitamin B ₁₂ levels in the blood and amniotic fluid of pregnant women have been associated with an increased risk of NTD, suggesting that adequate vitamin B ₁₂ intake in addition to folic acid may be beneficial in the prevention of NTD [0011] Individuals with Alzheimer's disease often have low blood levels of vitamin Bi ₂

One study found lower vitamin Bi ₂ levels in the cerebrospinal fluid of patients with Alzheimer's disease than in patients with other types of dementia, though blood levels of vitamin Bn did not differ The reason for the association of low vitamin B ₁₂ status with Alzheimer's disease is not clear Measures of general nutritional status indicated that the association of increased homocysteine levels and diminished vitamin B ₁₂ status with Alzheimer's disease was not due to dementia related malnutrition

[0014] Observational studies have found a significant number of patients hospitalized for depression to be deficient in vitamin Bi ₂ The reasons for the relationship between vitamin B ₁₂ deficiency and depression are not clear Vitamin B ₁₂ and folate are required for the synthesis of S-adenosylmethiomne, a methyl group donor essential for the metabolism of neurotransmitters, whose bioa\ ailabihty has been related to depression It therefore appears beneficial to screen for vitamin B, ₂ deficiency as part of a medical evaluation for depression.

[0015] A number of drugs reduce the absorption of vitamin B ₁₂ . Proton pump inhibitors

(c g., omeprazole and lansoprazole), used for therapy of Zollinger-Elhson syndrome and gastroesophageal reflux disease (GERD), markedly decrease stomach acid secretion required for the release of vitamin B] ₂ from food but not supplements Long-term use of proton pump inhibitors has been found to decrease blood vitamin Bi ₂ levels Individuals taking drugs that inhibit gastric acid secretion should consider taking vitamin B ₁₂ in the form of a supplement, because gastric acid is not required for its absorption Other drugs found to inhibit the absorption of vitamin B ₁₂ from food include cholestyramine (a bile acid-binding resin used in the treatment of high cholesterol), chloramphenicol, neomycin (antibiotics), and colchicine (anti-gout). Metformin, a medication for individuals with type 2 (non-insulin dependent) diabetes, decreases vitamin B ₁₂ absorption by tying up free calcium required for absorption of the IF- Bi ₂ complex.

[0016] Vitamin B ₁₂ is present in animal products such as meat, poultry, fish (including shellfish), and to a lesser extent milk, but it is not generally present in plant products or yeast. However, only bacteria can synthesize vitamin B ₁₂ . Those vegetarians who eat no animal products need supplemental vitamin B ₁₂ to meet their requirements. Also, individuals over the age of 50 should obtain their vitamin B ₁₂ in supplements because of the increased likelihood of food-bound vitamin B ₁₂ malabsorption.

[0017] No toxic or adverse effects have been associated with large intakes of vitamin B ₁₂ from food or supplements in healthy people. While the Recommended Dietary Allowance (RDA) of vitamin B ₁₂ is 2.4 meg/day for an adult aged 19-50 years, doses as high as 1 mg (1000 meg) daily by mouth or 1 mg monthly by intramuscular (IM) injection have been used to treat pernicious anemia, without significant side effects. Because of the low toxicity of vitamin B ₁₂ , no tolerable upper intake level (UL) was set by the Food and Nutrition Board in 1998 when the RDA was revised. In fact, certain studies have indicated intake of vitamin Bn well above RDA helps to repair DNA damage caused by ageing, degenerative diseases, and diseases of development.

[0018] It can be appreciated from the foregoing that various internal and external factors may result in an individual experiencing a vitamin B ₁₂ deficiency. In terms of providing vitamin B| ₂ as an ingestable supplement, cyanocobalamin is the principal form of vitamin B ₁₂ used but methylcobalamin is also available. Cyanocobalalmin is available by prescription in an injectable form and as a nasal gel for the treatment of, e.g., pernicious anemia. Over the counter ingestable preparations containing cyanocobalamin often include multivitamin, vitamin B-complex, and vitamin B ₁ 2 supplements.

[0019] It is clear that the present administration methods, in particular those using intravenous and nasal routes, make compliance difficult for any type of subject and particularly difficult for disabled, elderly and juvenile subjects. Accordingly, it is desirable in the medical field to provide a means for the simple and reliable administration of vitamin B _t2 at appropriate dosages, over extended periods of time. One such alternative means may be administration via the transdermal route.

[0020] Transdermal patches have been described extensively in the art to deliver drugs and agents other than vitamin Bi ₂ through intact skin. For example, such devices include, but are not limited to, those described in U.S. Pat. Nos. 3,170,795; 3,598,122, 3,598,123; 3,731,683;

3,742,951 3,814,097, 3,921 ,636, 3,972,995, 3,993,072, 3,993,073, 3,996,934, 4,031,894, 4 060,084 4,069,307, 4,077,407, 4,201,21 1 , 4,230,105, 4,286,592, 4,292,299, 4,292,303, 4,314,557, 4,379,454, and 4,568,343, each of which is hereby incorporated by reference in its entirety

[0021 ] Transdermal delivery offers several advantages as compared to oral delivery and injection, including, but not limited to 1) avoidance of hepatic first pass metabolism, 2) discontinuing administration easily accomplished by patch removal, 3) improved patient compliance, and 4) maintenance of constant active agent level in blood for longer peπods of time As specifically compared to oral delivery, transdermal delivery decreases the necessary dose to be administered

[0022] The major obstacle to transdermal delivery is the excellent barrier characteristics exhibited by skin Several routes through the skin have been identified The transappendageal route transports substances through sweat glands and hair follicles with their sebaceous glands This route is considered of minor importance due to the very limited area (less than 0 1% of total skin surface) However, large compounds can theoretically be delivered by this route The transepidermal route consists of transport via diffusion through the cellular layer that includes the stratum corneum (consisting of lipids), viable epidermis (90% water held together by tonofϊbπls), and dermis (loose connective tissue composed of fibrous protein embedded in an amorphous ground substance)

[0023] Increased penetration of the skin barrier is achieved by use of physical methods, biological methods, and chemical penetration enhancers Physical methods include iontophoresis, sonophoresis, thermal energy, and stripping of the stratum corneum The biological approach utilizes a therapeutically inactive prodrug that is transported through the skin barrier by physiological mechanisms with the prodrug then being metabolized to produce the therapeutically active drug Chemical penetration enhancers reversibly decrease the barrier allowing drug permeation

[0024] Ideal enhancers are generally non-toxic, pharmacologically inert, nonallergenic, predictable with immediate effect, amendable to full barrier recovery after removal, compatible with a drug and adjuvants, and cosmetically acceptable Penetration enhancers can be classified broadly as fatty acids, fatty alcohols, terpenes, sulfoxides, anionic surfactants, cationic surfactants, nonionic surfactants, zwitteπonic surfactants, polyols, amides, ureas, lactam, and

sugars The actual mechanism of action by a penetration enhancer may be one or more of the following 1 ) disruption of the ordered structure of stratum corneum lipids, 2) interaction with intracellular protein, or 3) improved partitioning of the drug, co-enhancer or solvent into the stratum corneum It has been found that enhancer mixtures can be more efficient by acting together on one or more of these mechanisms to facilitate permeation

[0025] Dimethyl sulfoxide (DMSO) was recognized over 40 years ago for its ability to open the skin Hundreds of formulations have since been investigated as potential penetration enhancers Unfortunately, no reliable means for predicting permeability efficacy yet exist although simple guidelines have been proposed

[0026] It has been demonstrated that macromolecules (1-10 kDa) are able to pass through the skin when mixtures of penetration enhancers are applied In particular, a mixture of sodium dodecyl sulfate and phenyl piperazine increased skin permeability up to 100-fold for macromolecular drugs including heparin, leutinizing hormone releasing hormone and oligonucleotides

[0027] Unfortunately, vitamin B ₁₂ administration by the transdermal route was previously to be problematic due to the large size of the vitamin B ₁₂ molecule Cyanocobalamin has a standard molecular weight of 1355 This is considered a large molecule that the skin barrier normally blocks It is generally understood that molecules of molecular weights of 350 or lower are free to penetrate the dermis Accordingly, the large molecular size was commonly believed to result in low skin permeation rates and, consequently, sub-optimal vitamin B _]2 dosages imparting no or negligible health benefits to a subject In addition, cyanocobalamin is sensitive to ultraviolet radiation due to its inherent organometallic character, so it requires stabilization in order to provide a product with practical shelf-life To be particularly useful as an over the counter product, any transdermal device for vitamin B ₁₂ delivery would therefore need to overcome issues related to at least skin permeation efficiency and shelf life stability

SUMMARY OF THE INVENTION

[0028] The present invention is directed to transdermal delivery patches for administering vitamin Bi ₂ and related methods of use and manufacture that overcome the technical drawbacks mentioned above In particular, the present invention provides shelf stable

transdermal delivery patches for administering vitamin B ₁₂ which impart the respective molecule in an amount sufficient for release at a skin permeation rate sufficient to achieve a health benefit in a subject.

[0029] In a first aspect, the present invention provides a shelf stable transdermal delivery patch for administering vitamin Bn to a subject. Such a delivery patch includes: (a) a backing layer; (b) a skin contact adhesive layer adjacent to the backing layer, the skin contact adhesive layer including: (i) a polymeric adhesive; (ii) vitamin B ₁₂ ; (iii) a penetration enhancer effective to enhance transdermal uptake of vitamin B ₁₂ by the subject; and (iv) a vitamin B ₁₂ stabilizer to stabilize the vitamin B ₁₂ contained within the adhesive layer; and (c) a removable impermeable layer overlaying the skin contact adhesive layer, the removable impermeable layer preventing vitamin B ₁₂ release from the skin contact adhesive layer prior to use.

[0030] Polymeric adhesives useful in the adhesive layer of transdermal patches of the invention include, but are not limited to, polyacrylate polymers, rubber-based adhesives, and polysiloxanes adhesives. Acrylic co-polymer is a preferred polymeric adhesive, particularly when provided in the adhesive layer at about 40 wt % to about 95 wt %, most preferably at about 82 wt %.

[0031] The transdermal delivery patch of the invention contains vitamin Bi ₂ , preferably at about 0.1 wt % to about 25 wt % of the skin contact adhesive layer's dry weight, most preferably at 4.0 wt %. Transdermal deliver patches further contain penetration enhancers, most preferably as a combination of: (a) nienthone at about 1.3 wt % to about 12.0 wt %; and (b) propylene glycol at about 0.8 wt % to about 12 wt %, based on the skin contact adhesive layer's dry weight. Other alternative penetration enhancers include, but are not limited to, nicotinates, fatty acids, fatty alcohols, terpenes, polyols and combinations thereof.

[0032] Delivery patches according to the invention have an adhesive layer that, in addition, includes a vitamin B) ₂ stabilizer such as, e.g., ascorbic acid, phosphoric acid, panthenoic acid, butylated hydroxytoluene, edetic acid, nicotinic acid, sodium selenite, and combinations thereof. Sodium selenite is a preferred stabilizer, most preferably when provided at about 0.01 wt % to about 1.2 wt % of the adhesive layer's dry weight. In general, such stabilizers function as anti-oxidants which prevent oxidative degradation of the vitamin B ₁₂

[0033] A most preferred composition for use in transdermal delivery contains acrylic copolymei at about 82 wt %, vitamin B, ₂ at about 4 0 wt %, menthone at about 5 0 wt %, propylene glycol at about 3 5 wt %, and sodium selenite at about 0 2 wt %

[0034] In a second aspect, the present invention encompasses a method of transdermally administering vitamin B ₁₂ to a subject Such a method includes steps of contacting a subject's skin with a composition including (a) a polymeric adhesive, (b) vitamin B12, (c) a penetration enhancer effective to enhance transdermal uptake of the vitamin B ₁₂ by the subject, and (d) a vitamin B ₁₂ stabilizer to stabilize the vitamin Bn contained within the composition [0035] The composition is preferably provided in the form of a shelf stable transdermal delivery patch as descπbed and claimed herein A subject may be any animal, most preferably, a human

[0036] In yet another aspect, the invention is directed to a shelf stable composition useful for the transdermal delivery of vitamin Bu to a subject Such a composition is useful in the prepaiation of transdermal delivery patches according to the invention Although transdermal patches may be manufactured by vaπous methods, a preferred method is a roller-coating process Such a process includes steps of roller-coating a composition compπsing (1) vitamin B ₁₂ at about 0 1 wt % to about 15 wt %, (11) sodium selenite at about 0 01 wt % to about 1 0 wt %, (ni) menthone at about 0 8 wt % to 12 wt %, (iv) propylene glycol at about 0 5 wt % to about 12 wt %, (v) nonionic surfactant at about 0 1 % to about 1 0 wt %, (vi) polyurethane polymer associative thickener at about 0 6 wt % to about 6 wt %, (vii) added water at about 0 3 wt % to about 50 wt %, and (vni) acrylic co-polymer at about 40 0 wt % to about 97 6 wt %, onto an impermeable release layer to form a skin contact adhesive layer adjacent to the release layer Water is then evaporated from the composition by heating the composition itself to a temperature no greater than about 215 degrees F, preferably no more than 200 degrees F A backing layer is then laminated to the skin contact adhesive layer and the resulting multilayered product is cut into a pre-selected shape and size thereby providing a shelf stable transdermal delivery patch [0037] Other objects, features and advantages of the present invention will become apparent after review of the specification, claims and drawings

BRIEF DESCRIPTION OF THE DRAWING

[0038] Fig 1 shows a transdermal patch having an impermeable backing layer 12, skin contact adhesive layer 14 containing vitamin Bi ₂ , and a removable impermeable layer 16

DETAILED DESCRIPTION OF THE INVENTION

[0039] Before the present compositions, devices and methods for achieving specified vitamin B^ transdermal delivery are disclosed and described, it is to be understood that this invention is not limited to the particular process steps and materials disclosed herein, but is extended to equivalents thereof as would be recognized by those ordinarily skilled in the relevant arts It should also be understood that terminology employed herein is used for the purpose of describing particular embodiments only and is not intended to be limiting

A Definitions

[0040] In describing and claiming the present invention, the following terminology will be used The singular forms "a" "an," and, "the" include plural referents unless the context clearly dictates otherwise Thus, for example, relerence to "a vitamin B _[2 molecule" includes reference to one or more of such molecules, and reference to "a fatty acid" includes reference to a mixture of two or more of such fatty acids

[0041] As used herein, the term "vitamin Bi ₂ " refers to the water soluble vitamin cyanocobdlamm which is an organometallic compound with a tπvalent cobalt ion bound inside a corπn ring Vitamin Bn is important in animals for, generally, maintaining healthy metabolism regulation, red blood cell production, and healthy central nervous system maintenance Vitamin B i ₂ useful in the present invention may be found in or deπved from any synthetic or natural source, and the term "vitamin Bi ₂ " shall refer to the analogues, derivatives, salts, and prodrugs, of vitamin B) ₂ , as well as mixtures thereof Further, vitamin Bn analogues, deπvatives, salts, and prodrugs may be obtained by synthesis, extraction as a natural product from one or more bactena, animal or plant species, or by partial extraction and further synthesis Methylcobalamin and 5-deoxyadenosyl cobalamin are the forms of vitamin B _i2 used in the human body The form of cobalamin used in most supplements, cyanocobalamin, is readily converted by the body to 5- deoxyadenosyl and methylcobalamin

[0042] As used herein, "vitamin B _n delivery composition," "vitamin Bi ₂ transdermal delivery patch," "transdermal delivery composition," "transdermal delivery formulation," or "transdermal formulation" refer to any vitamin Bn containing device, system, product, chemical combination, or mechanism capable of being applied to, or against the skin, to effect transdermal delivery, of vitamin B ₁₂ .

[0043] The term "subject" refers to an animal, most preferably a human, that derives a health benefit from the administration of vitamin B) ₂ .

[0044] As used herein, the term "skin" refers to any membrane of the animal body, preferably human body, to which a chemical formulation or composition may be applied including the external skin of the body, the mucosa membranes of the nasal, oral, vaginal, and rectal cavities.

[0045] As used herein, the term "transdermal" or "percutaneous" delivery means delivery of a substance or agent, by passage into and through the skin. Hence the terms "transdermal" and "transmucosal" are used interchangeably unless specifically stated otherwise. Likewise, the terms "skin", "derma", "epidermis", "mucosa", and the like shall also be used interchangeably unless specifically stated otherwise.

[0046] As used herein, the terms "enhancement", "penetration enhancement", or

"permeation enhancement" refer to an increase in the permeability of the skin, to a delivery substance or agent, so as to increase the rate at which the delivery substance permeates through the skin. "Permeation enhancer", "enhancer", "penetration enhancer", or similar terms refer to a material, or materials that achieve or facilitate such permeation enhancement, and an "effective amount" of an enhancer means an amount effective to enhance penetration through the skin, of vitamin B12, to a selected degree. Accordingly, the terms "skin permeation rate" and "transdermal permeation rate" refer to the rate at which the delivery substance, in this case vitamin B 12, permeates through the skin. An in-depth overview of penetration enhancers is presented by Kanikkannan et ai, (Current Medicinal Chemistry, 1999 Volume 6, No 7). An index of permeation enhancers is also disclosed by Osborne et ai, (Pharmaceutical Technology, June 1998), both of which are incorporated by reference herein. Enhanced permeation as affected through the use of such enhancers can be observed, for example, by measuring the rate of diffusion of the delivery substance through animal or human skin using a diffusion cell

apparatus Such a diffusion cell is descπbed by Merritt et al , (J Controlled Released, 61 1984), incorporated herein by reference

[0047] By the term "skin contact adhesive layer" is meant a pre-determined amount of vitamin Bi ₂ dissolved or suspended in a polymenc carrier or phase, in one aspect a pressure- sensitn e adhesive, that can also contain other ingredients, and in which a permeation enhancer, stabilizer and other positive health benefit promoting substances are also dissolved or suspended This definition is meant to include embodiments \λ herein such polymeric phase is used within an overlay adhesive to form an adhesive patch with a reservoir The transdermal patches descπbed and claimed herein are passive diffusion patches \ "passive diffusion patch" as used herein is a transdermal patch which is arranged to deliver the vitamin B ₁₂ across the skin by passive diffusion rather than utilizing an electric field

[0048] A patch system according to the invention comprises an adhesive layer having a film backing laminated onto the distal surface thereof and, before transdermal application, an impermeable telease liner on the proximal surface of the adhesive The film backing protects the polymeric phase of the patch and, in certain embodiments, totally prevents release of the delivery substance and/or enhancer to the environment While an impermeable (1 e , occlusive) backing is preferred, a non-occlusive backing layer may be utilized so long as packaging of the patch is fully occlusive to prevent loss of adhesive layer components to the environment The release liner functions similarly to the impermeable backing, but is removed from the patch prior to application of the patch to the skin as defined above Patches are known in the art of transdermal delivery to routinely contain such backing and release liner components, and patches according to the present invention should be considered to comprise such backing and release liner or their functional equivalents An adhesive layer therefore includes a unit dosage form, or type of formulation, which includes a predetermined amount of vitamin B ₁₂ , permeation enhancer, stabilizer, as well as other optional ingredients, such as good health-imparting ingredients, in a polymenc carrier

[0049] The term "shelf stable", when used in the context of transdermal devices and compositions descπbed and claimed herein, refers to the ability of those materials to withstand long term storage and, upon use, deliver an amount of vitamin B ₁₂ sufficient for release at a skin permeation rate sufficient to achieve a health benefit in a subject Devices and compositions according to the invention shall preferably have a shelf life of at least 24 months under transport

and storage conditions regularly imposed on vitamin supplements by manufacturers, earners, retailers, and providers of such products

[0050] As used herein, "inert carrier" refers to a polymeric carrier, or other carrier vehicle into which vitamin Bn may be admixed in order to form a transdermal delivery formulation Inert earners must generally be pharmaceutically acceptable, in that they are suitable for administration to the skin without causing significant instances of adverse results Further, inert carriers must not react with the active substance to substantially degrade it, or otherwise form impurities, which may be delivered to the skin.

[0051 ] Concentrations, amounts, solubilities, and other numerical data may be presented herein in a range format It is to be understood that such range format is used merely for convenience and brevity and should be interpreted flexibly to include not only the numeπcal values explicitly recited as the limits of the range, but also to include all the individual numerical values or sub-ranges encompassed within that range as if each numerical value and sub-range is explicitly recited For example, a concentration range of 0 5 to 400 ng/ml should be interpreted to include not only the explicitly recited concentration limits, but also to include individual concentrations within that range, as well as sub-ranges This interpretation should apply regardless of the breadth of the range or the characteristic being described All weight percentages (wt %s) are based on a dry weight of the descπbed composition, unless explicitly noted otherwise

B The Invention

[0052] A transdermal delivery device, also referred to herein as a transdermal patch, suitable for use for delivery of vitamin B] ₂ is now described. FIG 1 illustrates transdermal patch 10, and a basic embodiment of the present invention Patch 10 includes an impermeable backing layer 12 and a skin contact adhesive layer 14 which serves both as a reservoir for vitamin B ₁₂ and as a means of attaching the device to the skin of a subject Adhesive layer 14 includes, in addition to vitamin Bi ₂ , a permeation enhancer, and a vitamin Bi ₂ stabilizer The adhesive layer's surface is a vitamin B ₁₂ permeable contact surface and is adapted to be placed against the patient's skin Patch 10 further includes a removable impermeable layer 16, also referred to in the art as a release liner or removable peel strip, covering the adhesive layer's surface during storage and prior to use to prevent vitamin Bn release from adhesive layer 14

[0053] In a preferred embodiment, backing layer 12 functions as an occlusive layer that prevents loss of vitamin Bu, enhancers and stabilizers present in the adhesive layer to the environment. Materials suitable for use as the backing layer are known to those of skill in the art. The backing layer is preferably opaque to protect components of the matrix patch from degradation caused by exposure to ultraviolet light, particularly the organometallic vitamin Bn molecule. Further, the backing should be capable of binding to and supporting the adhesive layer, yet should be pliable to accommodate the movements of a person using the patch. It is also preferable for manufacturing purposes that the backing layer be mechanically strong enough to form a support onto which the vitamin B^-enhancer-stabilizer loaded adhesive can be brought into contact with the subject's skin.

[0054] Many polymers are useful for making backing layers, such as polyvinylchloride, polyvinyhdene chloride, polyolefins, polyethylene, polypropylene, polyurethane, and polyesters. Exemplary backing material are polyester or aluminized polyester, such as the Scotchpak (registered trademark) medical films available from 3M Corporation (St. Paul, MN) In addition to these materials, polyamides, metal vapor deposited films or sheets thereof, rubber sheets, films, expanded synthetic resin sheets, unwoven fabrics, fabrics, knitted fabrics, papers, and foils may also be used. The materials may be laminated, pigmented or metalized. The preferred backing material is VOLARA (registered trademark) closed-cell polyethylene EVA copolymer 1/32" thick foam manufactured by Sekisui Voltek (Lawrence, MA) This material is available in a range of standard colors as well as custom matched colors. Thickness is a desirable feature of the patch making it easier to manipulate by subjects with arthritic fingers. [0055] Although backing layers may be prepared directly from raw materials, they may also be obtained as films from commercial sources For instances, 3M Corporation, St. Paul MN; Dow Chemicals, Midland, MI; Avery Specialty Tape Division, Painsville, OH; and A. F. Packaging, Winston-Salem, NC, all supply commercially available films which can be used for backing layers. One type of backing layer which is commercially available from 3M Corporation is the Scotch Pak 1000 (registered trademark). The backing layer may be made from Scotch Pak 1006 or 1009 (registered trademarks), which are skin colored aluminized polyester films of 50 microns in thickness Another type of backing layer is 3M- 1012 which is a transparent polyester film laminate Each of these commercially available backing layers is sold by 3M Corporation.

[0056] Adhesive layer 14 m this embodiment serves both as a reservoir for vitamin B 12 and as contact surface for placement against a subject's skin The vitamin B12 is dispersed in the adhesive layer As used herein, the term "dispersed" refers to the distribution of vitamin B12 throughout the adhesive layer

[0057] Adhesive layer 14 shown in Fig 1 may be prepared by mixing together a solution of the polymeric adhesive (or, equivalently, adhesive polymer), which can be purchased commercially or prepared by dissolving the adhesive solid in a suitable solvent, with a solution of vitamin B ₁₂ dissolved or evenly dispersed in selected enhancers and stabilizers The mixture may be poured into a mold or cast alone or on the desired backing material The casting is then left for the solvent to evaporate at room temperature or in an oven at a slightly elevated temperature After solvent evaporation, the adhesive matrix takes the form of an adhesive polymer film typically having a thickness in the range of about 6 to 100 microns Alternatively, a B ₁₂ solution can be incubated with a precast adhesive laminate to allow the vitamin Bi ₂ to diffuse into the adhesive layer

[0058] The amount of vitamin B) ₂ loaded into the adhesive layer can be varied by varying the concentration of vitamin B ₁₂ in the casting mixture and the thickness of the adhesive layer The amount of vitamin B ₁₂ in the adhesive layer of a given patch area should be sufficient to provide for at least 8 hours of treatment, more preferably 24 hours of treatment and most preferably for 48 hours of treatment However, longer treatment times may certainly be utilized to optimize efficiency of vitamin delivery In certain embodiments, the adhesive layer is formulated to allow the patch to detach from the subject in a predetermined amount of time, such as two days from application to detachment This prompts the user to apply a new patch and also encourages the user to rotate the skin area directly within patch contact As can be appreciated, the amount of vitamin B ₁₂ present in the patch depends on several factors, such as the desired time frame for release of the vitamin, the particular components provided with the vitamin B ₁₂ , and the permeability of the adhesive layer In a preferred embodiment, the vitamin Bi ₂ is present in the adhesive layer at about 0 1 wt percent to about 25 wt percent, more preferably at about 1 wt percent to about 8 wt percent, and most preferably at about 4 wt percent Vitamin Bi ₂ suitable for use in the present invention is available from Charles Bowman & Co (Holland, MI) [0059] The transdermal device includes an enhancer effective to increase the skin permeation rate of vitamin B| ₂ to the skin Such enhancers are necessary to overcome the low

skin permeation rate of vitamin B ₁₂ , when administered alone Enhancers useful in the present invention include nicotinates, fatty acids, fatty alcohols, terpenes, polyols and combinations thereof, with a combination of menthone and propylene glycol being most preferred [0060] Various stabilizers, alternatively referred to as preservatives, are used to stabilize the vitamin B ₁₂ contained within the transdermal patch The type of stabilizer selected will depend on the type of components used within the vitamin Bi ₂ composition as well as the other materials of the patch Suitable stabilizers include, ascorbic acid, phosphoric acid, panthenoic acid, butj lated hydroxytoluene, edetic acid, nicotinic acid, sodium selenite, and combinations thereof Sodium selenite is the preferred vitamin B ₁₂ stabilizer in formulations according to the invention Stabilizers may further include, but are not limited to, alcohols, e g , ethanol or isopropanol quaternary ammonium surfactants, as well as many other preservative compounds known in the art The United States Pharmacopeia XXI 1985 includes a section which describes paiameters for selecting compounds useful in enhancing the stability of various drugs (pp 1345- 1347) Other factors, such as pH and ionic strength of the solution, also influence the stability of the compounds within the adhesive layer

[0061 ] The adhesive used in an adhesive type patch can be selected from a variety of adhesives available commercially and known to those in the art For example, common adhesives are those based on poly isobutylene, acrylic, and silicone The adhesive selected will depend in part on the enhancer or enhancers chosen and the amount of vitamin, enhancer and stabilizer loaded into the adhesive layer The adhesive must retain its adhesive properties in the presence of these additives, and provide anchorage to the backing film, tack for good instantaneous adhesion to the skin, good adhesion throughout the treatment peπod and clean removal from the skin after treatment Some preferred adhesives include those available from Dow Coming Corporation, Air Products Corporation, Cytek Surface Specialties and from National Starch and Chemical Company

[0062] A wide range of adhesives useful in connection with transdermal patches will be known to those skilled in the art of transdermal drug delivery In one aspect of the invention, acceptable adhesives may include polyacrylate polymers, rubber-based adhesives, and polysiloxanes adhesives These types of materials, as well as others, are descπbed by Van Norstrand (The Handbook of Pressure Sensitive Adhesive Technology Second Edition 1989), which is hereby incorporated by reference

[0063] In one aspect, polyacrylate polymers can be any of the homopolymers, copolymers, terpolymers, and the like of vaπous acrylic acids In another aspect of the invention, the acrylate polymers may be a combination of one or more monomers of acrylic acids and other copolymeπzable monomers

[0064] Acrylate polymers may also include copolymers of alkyl acrylates and/or methacrylates, and/or copolymeπzable secondary monomers or monomers with functional groups The adhesive material may be an acrylic adhesive including at least one polymer selected from homopolymers of acrylic esters, copolymers of two or more types of acrylic ester units and copolymers of acrylic esters and other functional monomers Acrylic esters include, but are not limited to butyl (meth)acrylate, pentyl (meth)acrylate, hexyl (meth)acrylate, heptyl (meth)acrylate, octy (meth)acrylate, nonyl (meth) acrylate, decyl (meth)acrylate, etc Functional monomers include, but are not limited to, monomers containing a hydroxyl group, such as hydroxyethyl (meth)acrylate, hydroxypropyl (meth)acrylate, etc , monomers containing a carboxyl group, such as carboxyl methacrylate, etc and monomers containing an amide group such as methacrylamide, dimetheylmethacrylamide, etc

[0065] Specific examples of acrylate monomers, which are suitable for use with the present invention include, but are not limited to methacrylic acid, butyl acrylate, butyl methacrylate, hexyl acrylate, hexyl methacrylate, 2-ethylbutyl acrylate, 2-ethylbutyl methacrylate, isooctyl acrylate, isooctyl methacrylate, 2-ethylhexyl acrylate, 2-ethylhexyl methacrylate, decyl acrylate, decyl methacrylate, dodecyl acrylate, dodecylmethacrylate, tπdecyl acrylate, tπdecyl methacrylate, and mixtures thereof

[0066] Specific examples of functional monomers which are copolymeπzable with the above-recited alkyl acrylates or methacrylates, which can also be used include, but are not limited to acrylic acid, methacrylic acid, maleic acid, maleic anhydride, hydroxyethyl acrylate, hydroxypropyl acrylate, acrylamide, dimethylacrylamide, acrylonitπle, dimethylaminoethyl acrylate, dimethylaminoethyl methacrylate, tert-butylaminoethyl acrylate, tert-butylaminoethyl methacrylate, methoxethyl acrylate, methoxyethyl methacrylate, and mixtures thereof [0067] Further details and examples of acrylic adhesives which are suitable for use in the present invention are set forth in Satas (The Handbook of Pressure-sensitive Adhesive Technology 2nd Ed Pp 396-456 1989), which is incorporated herein by reference in its entirety

[0068] Examples of suitable acrylic adhestves which are commercially available include polyacrylate adhesives sold under the trademarks DUROTAK (registered trademark) by National Starch and Chemical Corporation, Bπdgewater, NJ, as well as GELVA-MULTIPOLYMER SOLUTION (registered trademark) by Cytek Surface Specialties, Smyrna, GA Other examples of adhesives, and adhesive formulations, which can be used in connection with the present invention are disclosed in U S Pat No 5,656,286, which is incorporated herein by reference in its entirety

[0069] In one aspect, utilizing a mixture of two or more acrylic polymers may facilitate sustained release of vitamin Bi ₂ Many vaπations and combinations of acrylics may be employed to achieve the desired increase in release duration Examples of such combinations may be found in U S Pat No 6,024,976, which is incorporated herein by reference in its entirety Other examples of such acrylic combinations will be readily recognized by those skilled in the art [0070] Specific examples of suitable rubber-based pressure sensitive adhesives include, but are not limited to hydrocarbon polymers, such as natural and synthetic polyisoprenes, polybutylenes and polyisobutylene (PIB), styrene/butadiene polymers, styrene-isoprene-styrene block copolymers, hydrocarbon polymers such as butyl rubber, halogen-containing polymers such as polyacrylic nitπle, polytetrafluoroethylene, polyvinyl chloπde, polyvinyhdene chloride, and polychlorodiene, and polysiloxanes, and other copolymers thereof

[0071 ] Specific examples of suitable polysiloxanes include but are not limited to silicone pressure sensitive adhesives, which are a based on two major components a polymer, or gum, and a tackifying resin The polysiloxane adhesive may be prepared by cross-linking the gum, typically a high molecular weight polydiorganosiloxane with the resin to produce a three- dimensional silicate structure via a condensation reaction in an appropriate organic solvent Various aspects of formulating polysiloxane adhesives are known in the art Suitable silicone pressure-sensitive adhesives are commercially available and include the silicone adhesives sold under the trademark BIO-PSA (registered trademark) Dow Corning Corporation, Medical Products, Midland, MI

[0072] The adhesive layer can further comprise vaπous additives in addition to the vitamin, permeation enhancer and stabilizer that are the fundamental components of the adhesive patch formulation These additives are generally those pharmaceutically acceptable ingredients that are known in the art of transdermal substance delivery and, more particularly, in the art of

transdermal substance delivery. However, such additive ingredients must not materially alter the basic and novel characteπstics of the patch. For example, suitable diluents can include mineral oil, low molecular weight polymers, plasticizers, and the like. Many transdermal delivery substance formulations have a tendency to irritate the skin after prolonged exposure thereto, thus addition of a skin irritation reducing agent aids may be desirable.

[0073] In order to enhance the ability of the adhesive layer to attach to the skin, it may optionally contain a tackifier. Tack can be controlled by combining adhesives of varying hardnesses (glass temperature or T _g ). Tackifier is a polymer which is insoluble in water and composed of a monomer which contains partly or wholly a (meth)acrylic alkyl ester. Such types of polymers include, but are not limited to, acrylic, N-butyl-methacrylic copolymer (Primal N580NF, sold by Japan Acrylic Chemical Company, Ltd.), acrylic methyl, acrylic 2-ethylhexyl copolymer (Nikasol TS-6520, sold by Nippon Carbide Industπes Company, Ltd.), polyacrylic acid (Jurymer AC-IOLPH, sold by Nihon Junyaku Company, Ltd.), methacrylic copolymer L (Plastoid L50, sold by Rohm Pharma GmbH), and aminoalkylmethacrylate copolymer E (Plastoid E35L, Plastoid E35M, Plastoid E35H, all sold by Rohm Pharma GmbH). [0074] In a preferred embodiment, the adhesive layer is formed from a shelf stable composition having the following formulation: (a) vitamin Bn at about 4 wt %; (b) sodium selenite at about 0.2 wt %; (c) menthone at about 5 wt %; (d) propylene glycol at about 3.5 wt %; (e) noniomc surfactant at about 1 wt % (f) polyurethane polymer associative thickener at about 2 wt %; and (g) acrylic co-polymer at about 82.3 wt %.

[0075] Referring again to Fig. 1, transdermal patch 10 includes a release liner 16 which is positioned adjacent to the surface of adhesive layer 14 and which is removed prior to application of the transdermal patch to the skin. Liner 16, which is used to cover the adhesive backing during storage to prevent a evaporative loss of the vitamin composition and shield the same from ultraviolet light damage during storage, may be made from any impermeable film. It may be made from the same impermeable material as the backing layer or it may also be a metal foil, Mylar (registered trademark) polyethylene terephthalate, siliconized polyester, fumed silica in silicone rubber, polytretrafluoroethylene, cellophane, siliconized paper, alumimzed paper, polyvinyl chloπde film, composite foils or films containing polyester such as polyester terephthalate, polyester or aluminized polyester, polytetrafluoroethylene, polyether block amide copolymers, polyethylene methyl methacrylate block copolymers, polyurethanes, polyvinylidene

chloride, nylon, silicone elastomers, rubber-based polyisobutylene, styrene, styrene-butadiene, and styrene-isoprene copolymers, polyethylene, and polypropylene. A thickness of about 0.0005 to about 0.01 inch is preferred. The preferred release liner is about 0.004 inch siliconized opaque polyester.

[0076] A preferred method of manufacturing a shelf stable transdermal delivery patch according to the invention is via a roller-coating process. In general, this process includes roller- coating a vitamin Bi ₂ containing composition onto an impermeable release liner layer to form a skin contact adhesive layer adjacent to the release liner layer. Water contained within the composition is then evaporated by heating the composition to a temperature no greater than about 215 degrees F for a predetermined amount of time. A backing layer is then laminated to the skin contact adhesive layer, thus transferring the adhesive layer to the backing layer and the resulting multilayered product is cut into a pre-selected shape and size thereby providing a suitable transdermal delivery patch.

[0077] U.S. Pat. No. 5,466,465 describes the use of a visible indicator for which changes in color indicate the status of the active agent within the patch. As adapted by routine experimentation for the present use, the indicator may display one color when the patch contains a significant amount of vitamin Bi ₂ , but as the amount is depleted, the color changes to indicate that depletion. The use of the visual indicator can be of help to the subject to determine whether it is necessary to apply an additional patch. The entire contents of U.S. Pat. No. 5,466,465 are incorporated herein by reference.

[0078] The transdermal patch may be of any shape, such as oblong, square, round, rectangular, etc. The transdermal patch may also have a variety of sizes. The total surface area in general may range from 1-400 cm ² . The actual surface area will depend upon a number of factors, including the amount of vitamin Bn to be delivered over a specified period of time, and the presence of permeation enhancers as well as the type of adhesive layer. Preferred patch size is about 2 cm .

[0079] U.S. Pat. No. 5,473,966 describes a method for sizing transdermal patches. The method is useful for reducing the size of the patch, and thus the amount of active ingredient within the patch which will be administered. By routine optimization, the method can be used to customize patches for release profiles of vitamin Bn over specific periods of time. For instance, if a subject were using a 50 cm patch and desired to use one third less active agent, it would be

possible to reduce the patch area to 33 cm ² following such a method, or using any such method known in the art.

[0080] The patches are generally stored in pouches which will prevent contamination and prevent damage associated with environmental conditions such as light and dryness. Foil pouches are particularly useful. Many types of storage pouches are commercially available, such as those available from Lithotype Company (San Francisco, CA; polyethylene, surlyn), James River Corporation (San Leandro, CA; polypropylene metalized film), Ivers-Lee, a division of Becton-Dickinson (West Caldwell, NJ; 305 W, 406), Jefferson Smurfet (Alton, IL.; acrylonitrile butadiene copolymer film laminate).

[0081 ] The effect of the transdermal patches taught and claimed herein can be assessed using qualitative measures reported by the subject wearing the patch. That is, the patient may decide whether the patch has beneficial effects during wear and for a defined period of time after wearing the patch. These types of qualitative assessment tests have been used successfully to evaluate many types of treatments for chronic illnesses as well as addictions. The simplest form of qualitative analysis involves the use of a vitamin Bu patch for some experimental subjects and placebos for others. Each subject determines whether the treatment improved, worsened or made no change in pre-selected health categories.

[0082] The following examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way. Indeed, various modifications of the invention in addition to those shown and described herein will become apparent to those skilled in the art from the foregoing description and the following examples and fall within the scope of the appended claims.

C. Examples

[0083] Example 1. Transdermal Delivery Patch for Vitamin Bi ₂

[0084] The present example describes the preferred embodiment for the manufacture and formulation of a transdermal patch according to the invention. For aesthetic and consumer ease- of-use, polyethylene foam (1/32" thick) [available under the tradename VOLARA from Voltek] was selected as the fabric-style impermeable backing layer. White silicone-treated-polyester, about 4 mil thick, gives the liner enough stiffness to be easily handled by an arthritic subject.

[0085] An emulsion based adhesive was chosen to ease the incorporation of vitamin Bn although solvent based adhesives (such as polyisobutylene, polydimethylsiloxane, or acrylate copolymers) could have been chosen Other key considerations included controlling skin irritation levels of the adhesive including modifiers, proper anchorage of the adhesive to the backing, sufficient skin tackiness to adhere for up to 24 hours yet release without damaging the skin, and wet adhesive characteristics that allow roller coating

[0086] Acrylic co-polymer [Flexbond AV 190 adhesive by Air Products] was chosen as a low skin irritation pressure sensitive adhesive (PSA) that bonds better with polyethylene, has a low tendency to re-emulsify by extended contact with skin moisture, and it's capacity for high solids loading Although the preferred formulation did not include a tackifier, tackiness of the finished adhesive may be controlled by addition of another acrylic copolymer (including those with amino or carboxyl groups) and/or adding tackifers (rosin esters, hydrogenated rosins, dipropylene glycol dibenzoate, and/or mixed hydrocarbons), most preferably the acrylic copolymer [Flexbond 150 adhesive by Air Products]

[0087] Permeation enhancers identified as useful for this product included nicotinates

(methyl and benzyl), fatty acids (oleic acid, undecanioic acid, lauπc acid), fatty alcohols (octanol and nonanol), terpenes (menthol, hmonene, and menthone), and polyols (polyethylene glycol, propylene glycol, and glycerol) In an early trial, a binary enhancer system of methylnicotinate and propylene glycol was used but the inventor observed that the methylnicotinate crystallized after about 3-4 months in the patch This crystallization resulted in areas of high concentrations of methylnicotinate that could potentially cause severe skin irritation after several hours of wear Substituting benzylmcotinate resulted in the same severe and unacceptable skin irritation However the inventor subsequently found menthone to be an excellent permeation enhancer in conjunction with propylene glycol

[0088] Stabilizers for vitamin Bi ₂ included ascorbic acid (plus related mineral ascorbates and fatty acid esters), phosphoric acid, panthenoic acid (plus related alcohols and/or salts), butylated hydroxytoluene (BHT), edetic acid (EDTA), nicotinic acid (plus niacinamide), and sodium selenite Although sodium selenite is used in the exiting product, inclusion of a form of nicotinic acid has potential benefits beyond stabilization and may extend the benefits of the overall product, the inclusion of vitamins B ₃ and Be are believed to act as anti-oxidant stabilizers of vitamin Bi ₂

[0089] To achieve controlled coating thicknesses using a roller-coater method on sihcone-trcdted Mylar, the wet adhesive required thickening using either polyvinyl alcohol, polyethylene oxide polymers, and/or an associative thickener The polyurethane polymer associative thickener [Rheolate 288 (rheologic additive) by Elementis Specialties] was found to be most effective Addition of a nonionic surfactant [Surfynol 420, a surfactant by Air Products] provided effective wetting of the Mylar duπng coating. Table 1 below provides ranges of formulation components (both wet and dry wt %s) for a preferred polymeric adhesive composition according to the invention

Table 1

Minimum Maximum

Wet Dry Wet Dry

Cyanocobalarmn 0 1% 0.1% 15 0% 25 0%

Sodium Selemte 0 01% 0 01% 1 0% 1.2%

Menthone 0.8% 1 3% 12 0% 12 0%

Propylene glycol 0.5% 0 8% 12.0% 12 0%

Nonionic surfactant 0 1% 0.2% 1.0% 1 0%

Thickener 0.6% 1.0% 6.0% 8 0%

Added W atcr 0 3% 0.0% 50 0% 0 0%

Acrylic emulsion adhesive 40 0% 40 0% 97 6% 95 0%

[0090] The formulation for a particularly pieferred polymeric adhesive composition is shown below in Table 2

Table 2

Wet Dry

Basis Basis

Cyanocobalamin 2 2% 4 0%

Sodium Selenite 0 1% 0 2%

Menthone 2 7% 5 0%

Propylene glycol 1 9% 3 5%

Nonionic surfactant 0 5% 1 0%

Polyurethane associative thickener 1 1% 2 0%

Added Water 10 9% 0 0%

Aciyhc copolymer adhesive 80 5% 84 3%

[0091 ] The coating process incorporated rollers to pick up wet adhesive and apply a controlled thickness of 0 002 inches to the sihcone-treated side of the Mylar The wet adhesive on the Mylar was then transported to a forced air oven operating at 300 degrees Fahrenheit where the water was evaporated from the adhesive without raising the product temperature (i e , web temperature) above 215 degrees Fahrenheit Upon exiting the oven, polyethylene foam that that had been recently corona discharge treated (to raise surface energy to at least 40 dynes) was laminated to the adhesive The patches were then cut into pre-selected shape and size, preferably 5/8" diameter circles

[0092] It should be noted that the above descπption, attached figure and their descnptions are intended to be illustrative and not limiting of this invention Many themes and vaπations of this invention will be suggested to one skilled in this and, in light of the disclosure All such themes and vaπations are within the contemplation hereof For instance, while this invention has been described in conjunction with the vaπous exemplary embodiments outlined above, vaπous alternatives, modifications, vaπations, improvements, and/or substantial

equivalent, whether known or that rare or may be presently unforeseen, may become apparent to those having at least ordinary skill in the art Various changes may be made without departing from the spirit and scope of the invention Therefore, the invention is intended to embrace all known or later-developed alternatives, modifications, vaπations, improvements, and/or substantial equivalents of these exemplary embodiments