A pharmaceutical composition comprising 3-beta-hydroxy-5-alpha-pregnan-20-one with improved storage and solubility properties

Technical field

[0001 ] The present invention relates generally to an improved formulation of 3- beta-hydroxy-5-alpha-pregnan-20-one.

Background art

[0002] 3-beta-hydroxy-5-alpha-pregnan-20-one is a steroid in the pregnane family and a modulator of GABA _A -receptor activity which is indicated for the treatment of sex/stress steroid induced disorders conditions (W099/45931 ). 3-beta-hydroxy-5- alpha-pregnan-20-one is poorly soluble in many therapeutically acceptable solvents, which makes it difficult to administer the compound to a patient.

[0003] In animal studies, 3-beta-hydroxy-5-alpha-pregnan-20-one has been intravenously administered to rats in a formulation containing cyclodextrin

(W099/45931 ).

[0004] Grant et al (JPET 326:354-362, 2008) has administered 3-beta-hydroxy-5- alpha-pregnan-20-one to monkeys by using a formulation with hydroxypropyl β- cyclodextrin.

[0005] Formulations with cyclodextrins are not suitable for administration to human patients. One reason for this is, because 3-beta-hydroxy-5-alpha-pregnan-20- one is poorly soluble, the formulation results in a large therapeutic volume that can only be administered intravenously.

[0006] Since 3-beta-hydroxy-5-alpha-pregnan-20-one is poorly soluble in water there is still no pharmaceutically acceptable formulation for this compound. Definitions

[0007] As used in the present application, the following terms have the specified meanings unless otherwise specified.

[0008] By "acylglycerol" is meant all types and combinations of fatty acids esterified to glycerol.

[0009] By "medium-chain acylglycerol" is meant a mixture of acylglycerols where the total combined percentage of octanoic (caprylic) acid and decanoic (capric) acid is at least 95%.

[0001 0] By "solid fat content" is meant the percentage of solid as determined by pulse NMR (nuclear magnetic resonance).

[0001 1 ] "Room temperature" denotes a temperature of between 1 8°C and 25°C.

[0001 2] "UC l 01 0"denotes 3-beta-hydroxy-5-alpha-pregnan-20-one.

[0001 3] "Sterol or ester thereof" denotes steroids with at least one hydroxyl group and esters of said steroids where at least one hydroxyl group has been used for the synthesis of an ester.

[0001 4] Steroids, such as sterols, are usually described by the number of carbon atoms in the compound. Thus, for example, cholesterol is a C27 sterol, which indicates that the compound consists of 27 carbon atoms.

[0001 5] Unless stated otherwise, concentrations are stated as mg/g, that is, mg per gram of pharmaceutical composition. Brief description of figures

[0001 6] Figure 1 shows mean plasma concentrations of 3-beta-hydroxy-5-alpha- pregnan-20-one (ng/mL) in rabbits following subcutaneous administration of 3-beta- hydroxy-5-alpha-pregnan-20-one in sesame oil with cholesterol (1 : 1 ) in two doses: 1 mg/kg (squares) and 5 mg/kg (circles).

[0001 7] Figure 2 shows 3-beta-hydroxy-5-alpha-pregnan-20-one concentration in filtrate (0.2 μιτι) from a suspension of 3-beta-hydroxy-5-alpha-pregnan-20-one in relation to cholesterol:3-beta-hydroxy-5-alpha-pregnan-20-one ratio.

[0001 8] Figure 3a, 3b, 4a and 4b show photographs of suspensions of 3-beta- hy d roxy-5 -alpha-pregnan-20-one.

Summary of invention

[0001 9] An object of the present invention is to provide an improved formulation of 3-beta-hydroxy-5-alpha-pregnan-20-one in a pharmaceutically acceptable carrier.

[00020] Another object of the present invention is to provide a formulation of 3- beta-hydroxy-5-alpha-pregnan-20-one with enhanced storage properties.

[00021 ] Yet another object is to provide a formulation of 3-beta-hydroxy-5-alpha- pregnan-20-one with improved pharmacokinetics.

[00022] Yet another object of the present invention is to provide a formulation of 3- beta-hydroxy-5-alpha-pregnan-20-one with increased solubility in a pharmacologically acceptable carrier.

[00023] These and other objects are met by a first general aspect of the present invention which provides a pharmaceutical formulation comprising 3-beta-hydroxy-5- alpha-pregnan-20-one, at least one sterol or an ester thereof and a mixture of acylglycerols with a solid fat content of less than about 25% at 25°C and about 0% at [00024] In a second general aspect of the present invention there is provided methods for preparing a pharmaceutical composition.

[00025] In a third general aspect of the present invention there is provided a pharmaceutical composition obtainable according to a method according to the invention.

[00026] In a fourth general aspect of the present invention there is provided use of a pharmaceutical composition for the treatment of conditions of the central nervous system.

Detailed description

[00027] The inventors have found that the addition of a sterol surprisingly increases the solubility and improves the pharmacokinetics of 3-beta-hydroxy-5-alpha- pregnan-20-one in acylglycerols.

[00028] Generally, the pharmaceutical composition comprises 3-beta-hydroxy-5- alpha-pregnan-20-one, at least one sterol or an ester thereof and a mixture of acylglycerols with a solid fat content of less than about 25% at 25°C and about 0% at 37°C.

[00029] In particular a sterol with a hydroxyl group bound to the third carbon atom of the sterol structure is useful in the invention. The sterol may be cholesterol or beta-sitosterol, but also other sterols such as stigmasterol, brassicasterol or avenasterol may be used. In particular, cholesterol may be used.

[00030] In addition, cholesteryl esters can be used. Examples of such esters are sodium cholesteryl sulphate, cholesteryl bensoate, cholesteryl acetate, cholesteryl caprylate, cholesteryl decanoate, cholestyl palmitate, cholesteryl oleate and cholesteryl stearate. [00031 ] The sterol or ester thereof can be a C I 8-C30 sterol or an ester thereof, a C21 -C27 sterol or an ester thereof, or a C27-C29 sterol or ester thereof.

[00032] The pharmaceutical composition can, in a first embodiment, be such that 3-beta-hydroxy-5-alpha-pregnan-20-one is essentially dissolved in the composition. Thus 3-beta-hydroxy-5-alpha-pregnan-20-one can be dissolved or essentially dissolved according to this embodiment of the invention.

[00033] The weight ratio of sterol (or ester thereof) to 3-beta-hydroxy-5-alpha- pregnan-20-one can, in this embodiment, be in the range of about 1 : 1 0 to 1 0: 1 . The sterol or ester thereof may be added in an amount that is similar to the amount of 3- beta-hydroxy-5-alpha-pregnan-20-one by weight. Because 3-beta-hydroxy-5-alpha- pregnan-20-one and a sterol have similar molecular weights this results in almost equimolar amounts of 3-beta-hydroxy-5-alpha-pregnan-20-one to sterol.

[00034] Thus, the weight ratio of sterol to 3-beta-hydroxy-5-alpha-pregnan-20-one can be in the range of from 1 :5 to 5: 1 . In particular, the weight ratio of sterol to 3- beta-hydroxy-5-alpha pregnan-20-one can be from 1 :3 to 3: 1 .

[00035] Suitable concentrations of 3-beta-hydroxy-5-alpha pregnan-20-one are between 0.1 mg/g and 75 mg/g. The concentration of 3-beta-hydroxy-5-alpha pregnan-20-one can also be between 1 mg/g and 50 mg/g, between 5 mg/g and 30 mg/g or between 1 0 mg/g and 25 mg/g.

[00036] Alternatively, in a second embodiment, the pharmaceutical composition comprises a suspension of 3-beta-hydroxy-5-alpha-pregnan-20-one. In this case the pharmaceutical composition will comprise 3-beta-hydroxy-5-alpha-pregnan-20-one in particles as well as 3-beta-hydroxy-5-alpha-pregnan-20-one dissolved in the

composition. The sterol increases the soluble fraction of 3-beta-hydroxy-5-alpha- pregnan-20-one in such a suspension compared to a suspension without a sterol. One advantage with a suspension is that the formulation can contain a high concentration of 3-beta-hydroxy-5-alpha-pregnan-20-one. An additional advantage with a composition that comprises a suspension is that it results in slow release of 3-beta- hy d roxy-5 -alpha-pregnan-20-one.

[00037] When the pharmaceutical composition comprises a suspension, the particles are preferably of a range of sizes that is not engulfed by macrophages.

Macrophages do primarily engulf particles of a size that is 2-3 micrometer (Champion et al, Pharm Res 2008; 25(8): 1 81 5-1 821 ).

[00038] In this second embodiment, the weight ratio of sterol (or ester thereof) to 3- beta-hydroxy-5-alpha pregnan-20-one can be in the range of about 1 : 1 0 to 1 0: 1 . The weight ratio of sterol to 3-beta-hydroxy-5alpha pregnan-20-one can be in the range of from 1 :5 to 5: 1 . In particular, the weight ratio of sterol to 3-beta-hydroxy-5-alpha- pregnan-20-one can be from 1 :4 to 3: 1 or from 1 :3 to 3: 1 .

[00039] Suitable concentrations of 3-beta-hydroxy-5-alpha-pregnan-20-one are, in this second embodiment, between 0.1 mg/g and 750 mg/g. The concentration of 3- beta-hydroxy-5-alpha-pregnan-20-one can also be between 1 mg/g and 300 mg/g, between 1 mg/g and 1 00 mg/g, between 1 mg/g and 50 mg/g, between 5 mg/g and 30 mg/g or between 1 0 mg/g and 25 mg/g.

[00040] The following applies to the invention in general.

[00041 ] Generally, the mixture of acylglycerols is characterized in that it has a solid fat content of less than about 25% at 25°C and about 0% at 37°C. Thus, the solid fat content is, for practical purposes, 0% at 37°C. The solid fat content is at most 0.01 % at 37°C.

[00042] The mixture of acylglycerols can be a vegetable oil. Thus, it can be a vegetable oil selected from the group consisting of sesame oil, peanut oil, olive oil, and castor oil, or mixtures thereof. [00043] In particular the mixture of acylglycerols can be a medium-chain

acylglycerol, that is, a mixture of acylglycerols wherein the total combined percentage of fatty acids with 8 carbon atoms (octanoic acid) and 1 0 carbon atoms (decanoic acid) is at least 95%. The medium-chain acylglycerol can be various mixtures of monoacylglycerols, diacylglycerols and triacylglycerols.

[00044] The medium-chain acylglycerol can consist of from about 50% to about 65% of monoacylglycerols, about 25% to about 35% of diacylglycerols, less than about 5% of triacylglycerols and less than about 2.5% of glycerol. An example of such a medium chain acylglycerol is Akoline MCM.

[00045] The medium-chain acylglycerol can be such that it comprises at least about 95% triacylglycerols. Akomed R MCT is an example of such a medium-chain

acylglycerol.

[00046] The mixture of acylglycerols can comprise a mixture of a vegetable oil and a medium-chain acylglycerol. The mixture of acylglycerols can comprises a mixture of castor oil and a medium-chain acylglycerol where castor oil is present in an amount of between 40% and 60% by weight. The mixture of acylglycerols can consist of about 48% by weight of castor oil and about 52% by weight of a medium-chain

acylglycerol. In particular the mixture of acylglycerols can consist of about 48% by weight castor oil and about 52% by weight of a medium-chain acylglycerol.

[00047] The pharmaceutical composition may comprise additional excipients known to a person skilled in the art such as antioxidants, preservatives, surfactants, coloring, flavoring, or thickening agents.

[00048] The pharmaceutical composition can be administered to the patient by different means. Thus, it may be administered orally, parenterally or topically. Thus, the pharmacological composition may be administered subcutaneously, intramuscularly, intravenously, nasally, transdermally or vaginally. [00049] In a second general aspect of the present invention there is provided methods for preparing a pharmaceutical composition of 3-beta-hydroxy-5-alpha- pregnan-20-one.

[00050] One method, in which 3-beta-hydroxy-5-alpha-pregnan-20-one is dissolved or essentially dissolved in the composition, comprises the steps of a) dissolving 3-beta- hydroxy-5-alpha-pregnan-20-one in ethanol, b) adding a mixture of acylglycerols with a solid fat content of less than about 25% at 25°C and about 0% at 37°C and a sterol or ester thereof, c) mixing until a homogeneous liquid is obtained and d) evaporating the ethanol.

[00051 ] When the mixture of acylglycerol is a solid or a semi-solid at room temperature, such as a medium-chain acylglycerol, the method may comprise a further step, which is the melting of the medium-chain acylglycerol before mixing it with the ethanol-drug preparation. The melting step enables the homogeneous mixing of this type of acylglycerol with other components. Once melted and mixed with the other components, the preparation remains in a liquid state for at least the time periods indicated in Table 1 .

[00052] When the formulation comprises a suspension, the formulation is advantageously prepared according to a method that comprises the following steps: 1 ) dissolving or suspending the sterol or ester thereof in the mixture of acylglycerols, 2) suspending 3-beta-hydroxy-5-alpha-pregnan-20-one in the acylglycerol-sterol mixture, 3) gently mixing. Surprisingly, this procedure leads to suspended particles comprising 3-beta-hydroxy-5-alpha-pregnan-20-one of smaller size.

[00053] In a third general aspect of the present invention there is provided pharmaceutical compositions obtainable by the methods according to the second aspect of the invention. [00054] In a fourth general aspect of the present invention there is provided the use of the pharmaceutical composition according to the invention for the treatment or prevention of conditions of the central nervous system.

[00055] The pharmaceutical composition can be used to treat or prevent conditions of the central nervous system. Examples of such conditions that can be treated are epilepsy, menstruation cycle dependant epilepsy, depression, stress related

depression, migraine, tiredness and in particular stress related tiredness, premenstrual syndrome, premenstrual dysphoric disorder, menstrual cycle linked mood changes, stress related memory changes, menstrual cycle linked memory changes, Alzheimer's dementia, menstrual cycle linked difficulties in concentration, menstrual cycle linked sleep disorders and tiredness, substance abuse, menstrual cycle linked alcoholism, or combinations thereof.

[00056] In particular the pharmaceutical composition can be used to treat steroid induced mood disorders, in particular premenstrual dysphoric disorder.

[00057] The pharmaceutical composition can also be used for treating or preventing side effects of oral contraceptives and postmenopausal therapy.

[00058] The pharmaceutical composition can also be used for control or termination of steroid-induced anesthesia.

Examples

[00059] The invention will now be described with non-limiting examples.

[00060] In order to find a pharmaceutical composition comprising 3-beta-hydroxy- 5-alpha-pregnan-20-one, several different vehicles and combinations of vehicles were evaluated. 3-beta-hydroxy-5-alpha-pregnan-20-one was dissolved in various vehicles and was evaluated by eye for physical stability at room temperature over time. A formulation that did not undergo any visible changes in appearance and remained clear on storage in room temperature without signs of haziness, precipitation, sedimentation, phase separation into two or more liquid phases or change of colour, within 30 days was considered as "stable".

[00061 ] In addition, the particle size and solubility of 3-beta-hydroxy-5-alpha- pregnan-20-one in formulations comprising a suspension of 3-beta-hydroxy-5-alpha- pregnan-20-one were evaluated.

General procedure for examples 1 -49

[00062] The following procedure was adopted for the preparation of 3-beta- hydroxy-5-alpha-pregnan-20-one-containing formulations.

[00063] The desired amount of 3-beta-hydroxy-5-alpha-pregnan-20-one and sterol (for example cholesterol) was weighed in a 1 00 ml or 250 ml round-bottomed flask. To every gram of the mixture of 3-beta-hydroxy-5-alpha-pregnan-20-one and sterol a volume of about 30 ml of absolute ethanol was added. The mixture was treated in an ultrasonication bath (not exceeding 50°C) until a clear liquid was obtained. This was normally accomplished within 1 0 minutes. The additional lipid ingredients indicated in the "Vehicle" column in Table 1 was then added up to 20 g. The resulting mixture was gently shaken by hand until a clear, homogeneous liquid was obtained. When the lipid was a solid at room temperature it was melted in the warm ultrasonication bath to a liquid form before addition.

[00064] Compounds from the following suppliers were used (product numbers within brackets): Cholesterol from Sigma (C8503), olive oil and peanut oil from

Apoteket, Sweden (26 36 1 6 and 26 66 01 , respectively), sesame oil from Fluka (85067), and castor oil from Sigma (259853). Akomed R medium-chain triacylglycerol (MCT) and Akoline medium-chain monoacylglycerol (MCM) were both from

AarhusKarlshamns Sweden AB, Karlshamn, Sweden. [00065] The alcohol was evaporated from the liquid on a rotary evaporator at a pressure of about 25 mbar and a temperature of about 40°C until the weight of the flask was essentially constant. The remaining ethanol content was essentially less than

1 %. The aim was to obtain a liquid with the appearance of clear oil at room

temperature. The oily liquid was then transferred to clear glass vials and stored at room temperature until evaluation.

[00066] The samples were evaluated by observing the samples in the glass vials and recording signs of haziness, precipitation, sedimentation, phase separation into two or more liquid phases, or change of colour after 1 or 2 days after preparation and after 30 days after preparation. In some cases, other time intervals were used

(indicated in Table 1 ). Where indicated, the entire sample was placed in a refrigerator (2-8°C) to provoke precipitation.

Example 1

[00067] 3-beta-hydroxy-5-alpha-pregnan-20-one (UC I OI O) (5 mg/g) and peanut oil was mixed into an emulsion with ethanol as described above in the concentrations shown in Table 1 , and the ethanol was evaporated. The final weight of the

preparation was 20 g. The mixture then had the form of an oily liquid. After one day when the sample was evaluated there were signs of precipitation. At 30 days the precipitate has formed a bottom sediment. Thus, the formulation was not stable.

Example 2

[00068] Example 2 was carried out essentially as Example 1 with the difference that cholesterol (5.5 mg/g) was added. When the sample was evaluated after one day the appearance of the sample had not changed. It was still unchanged after 30 days and after four months. After five months there was a slight precipitation. Example

2 compared with Example 1 shows how the addition of 5.5 mg/g cholesterol to a solution of 5 mg/g 3-beta-hydroxy-5-alpha-pregnan-20-one in peanut oil substantially increases the solubility so that, instead of precipitating, no precipitation occurred and the sample was stable for four months. However, a slight sedimentation occurred after 5 months.

Examples 3 to 49

[00069] Examples 3 to 49 were carried out essentially as described above with the variations with regard to 3-beta-hydroxy-5-alpha-pregnan-20-one concentration, acylglycerol mixture used, sterol used and sterol concentration that are shown in Table 1 .

[00070] The data from examples 1 to 49 is presented in Table 1 . The effect of addition of cholesterol is, for example, evident in examples 8 and 1 2, where the addition of cholesterol (1 0 mg/g) substantially increased solubility so that the sample did not precipitate but instead was stable for 1 2 months.

[00071 ] In Table 1 , "Weighed amount of UC I OI O (mg/g)" is the amount of 3- beta-hydroxy-5-alpha-pregnan-20-one per gram of final total composition including sterol (when a sterol is present). "Vehicle" denotes the carrier being tested. The amount of sterol is stated as "mg/g", that is, the weight of sterol per weight of final total composition, including 3-beta-hydroxy-5-alpha-pregnan-20-one. "Appearance at preparation" describes the change of appearance of the mixture during preparation; usually the preparation is initially an emulsion or a solution whereas it has an oily appearance after evaporation of the ethanol; "Unchanged" denotes a sample that was stable and where thus 3-beta-hydroxy-5-alpha-pregnan-20-one remained in solution, without visible signs of haziness, precipitation, sedimentation, phase separation into two or more liquid phases or change of colour. This is also indicated by an asterisk (*) in the table. Table 1 bx Batch Weighed Vehicle Appearance at Appearance after Appearance after Comments am name amount of preparation 1 -2 days or other 30 days or other

pie UC l Ol O time period that time period that is

(mg/g) is indicated indicated

1 ACA09 5 Peanut oil Emulsion to oil Signs of Bottom sediment

0630-1 precipitation

2 ACA09 5 Peanut oil Emulsion to oil Unchanged Slight sedimentation

0629-6

+ cholesterol (5,5 * after 5 months

mg/g)

3 ACA09 10 Peanut oil Emulsion to Precipitation in

0629-4 suspension almost the entire

sample volume

4 ACA09 10 Peanut oil Emulsion to oil Bottom sediment

0629-3 (precipitation

+ cholesterol (10

after a few

mg/g) hours)

5 ACA09 20 Peanut oil Emulsion to oil Bottom sediment

0629-5 (precipitation

+ cholesterol (20

after a few

mg/g) hours)

6 ACA09 10 Olive oil Emulsion to oil Bottom sediment

0629-8

+ cholesterol (10

mg/g)

7 ACA09 3 Sesame oil Emulsion to oil Unchanged Slight sedimentation

0709-2 after 1 3 months

+ cholesterol (3 *

mg/g)

8 ACA09 5 Sesame oil Emulsion to oil Precipitation Bottom sediment

0702-2

9 ACA09 5 Sesame oil Emulsion to oil Unchanged Precipitation of

0822-B crystals after 2

+ cholesterol (2,5 *

months

mg/g)

10 ACA09 5 Sesame oil Emulsion to oil Unchanged A few particles on the

0702-1 bottom

+ cholesterol (5 *

mg/g)

1 1 ACA09 5 Sesame oil Emulsion to oil Unchanged Precipitation of

0822-A crystals after 2

+ cholesterol (5 *

months

mg/g)

1 2 ACA09 5 Sesame oil Emulsion to oil Unchanged Unchanged after 1 2

0822-C

+ cholesterol ( 10 * months

*

mg/g) bx Batch Weighed Vehicle Appearance at Appearance after Appearance after Comments am name amount of preparation 1 -2 days or other 30 days or other

pie UC l Ol O time period that time period that is

(mg/g) is indicated indicated

1 3 ACA09 10 Sesame oil Emulsion to oil Precipitation of

0822-E crystals

+ cholesterol (5

mg/g)

14 ACA09 10 Sesame oil Emulsion to oil Precipitation of

0822-D crystals

+ cholesterol (10

mg/g)

15 ACA09 1 1 Sesame oil Emulsion to oil Precipitation of

0822-F crystals

+ cholesterol (20

mg/g)

16 ACA09 10 Sesame oil Emulsion to oil Unchanged Crystals on the

0716-7 bottom an on the

+ β-sitosterol (1 0 *

walls of the vial

mg/g)

17 ACA09 10 Akomed R MCT Solution to oil Precipitation of

1024-1 crystals within an

hour

1 8 ACA09 10 Akomed R MCT Solution to oil Slight precipitation

1024-2 of crystals on the

+ cholesterol (10

bottom after 2

mg/g) days

19 ACA09 15 Akomed R MCT Solution to oil Slight precipitation

1025-1 of crystals on the

+ cholesterol (15

bottom after 24

mg/g) hours

20 ACA09 10 50 % Akomed R Solution to oil Unchanged Unchanged after 10

1024-3 MCT, 50 % Akoline * months

MCM *

21 ACA09 10 50 % Akomed R Solution to oil Unchanged Unchanged after 10

1024-4 MCT, 50 % Akoline * months

MCM *

+ cholesterol (10

mg/g)

22 ACA09 15 50 % Akomed R Solution to oil Slight precipitation

1025-2 MCT, 50 % Akoline of crystals on the

MCM bottom after 1

week

23 ACA09 15 50 % Akomed R Solution to oil Unchanged Unchanged after 10

1025-3 MCT, 50 % Akoline * months

MCM *

+ cholesterol (15

mg/g) bx Batch Weighed Vehicle Appearance at Appearance after Appearance after Comments am name amount of preparation 1 -2 days or other 30 days or other

pie UC l Ol O time period that time period that is

(mg/g) is indicated indicated

24 ACA09 20 50 % Akomed R Solution to oil Slight precipitation

1026-1 MCT, 50 % Akoline of crystals on the

MCM bottom after 24

hours

25 ACA09 20 50 % Akomed R Solution to oil Unchanged Very slight

1026-2 MCT, 50 % Akoline * precipitation after

MCM 2.5 months

+ cholesterol (20

mg/g)

26 ACA09 25 50 % Akomed R Solution to oil Slight precipitation

1 1 01 -1 MCT, 50 % Akoline of crystals on the

MCM bottom after 3

days

+ cholesterol (25

mg/g)

27 ACA09 30 50 % Akomed R Solution to oil First sign of

1 1 02-1 MCT, 50 % Akoline precipitation after

MCM 2 days

+ cholesterol (30

mg/g)

28 ACA09 15 Castor oil Solution to oil Slight precipitation

1025-4 of crystals on the

bottom after 26

days

29 ACA09 20 Castor oil Solution to oil Slight precipitation

1026-3 of crystals on the

bottom after 3

days

30 ACA09 20 Castor oil Solution to oil Unchanged Unchanged after 1 0

1 1 01 -2 months

+ cholesterol (20 *

*

mg/g)

31 ACA09 25 Castor oil Solution to oil Unchanged Unchanged after 1 Unchanged 1 1 09-1 * month, very slight after 1 week

+ cholesterol (25

precipitation after 2 refrigerated mg/g) months *

32 ACA09 30 Castor oil Solution to oil Slight precipitation Small crystals 1 1 09-2 of crystals on the on the

+ cholesterol (31

bottom after 8 bottom after mg/g) days 1 week refrigerated - unchanged after 2 days

* bx Batch Weighed Vehicle Appearance at Appearance after Appearance after Comments am name amount of preparation 1 -2 days or other 30 days or other

pie UC l Ol O time period that time period that is

(mg/g) is Indicated indicated

33 ACA09 40 Akoline MCM Solution to oil Massive

1 1 22-1 precipitation

within an hour

34 ACA09 40 Akoline MCM Solution to oil Unchanged after Precipitation after 1

1 1 22-2 24 hours week

+ cholesterol (40

*

mg/g)

35 ACA09 25 50 % Castor oil , 50 Solution to oil Unchanged Unchanged after 1 0 After 1 week 1 1 01 -4 % Akoline MCM * months refrigerated, ntire

+ cholesterol (25 * the e

sample was mg/g) solidified,

Slight precipitation after melting

36 ACA09 30 50 % Castor oil , 50 Solution to oil Unchanged Unchanged after 1 After 1 week 1 1 02-2 % Akoline MCM * month, very slight refrigerated, precipitation after the entire

+ cholesterol (30

approx 2 months sample was mg/g) solidified,

Slight precipitation after melting

37 ACA09 34 48 % Castor oil , 52 Solution to oil Unchanged after Precipitation in entire Unchanged 1 1 08-1 % Akoline MCM 15 days sample after 1 month after 1 week

+ cholesterol (34 * refrigerated mg/g)

38 ACA09 38 50 % Castor oil , 50 Solution to oil Slight precipitation Small crystals 1 1 08-2 % Akoline MCM of crystals on the on the bottom after 9 bottom after

+ cholesterol (38

days 1 week mg/g) refrigerated

- unchanged after 2 days

39 ACA09 40 50 % Castor oil , 50 Solution to oil Massive

1 1 20-3 % Akoline MCM precipitation after

24 hours

+ cholesterol (20

mg/g)

40 ACA09 40 50 % Castor oil , 50 Solution to oil Massive

1 1 20-1 % Akoline MCM precipitation after

24 hours

+ cholesterol (40

mg/g) bx Batch Weighed Vehicle Appearance at Appearance after Appearance after Comments am name amount of preparation 1 -2 days or other 30 days or other

pie UC l Ol O time period that time period that is

(mg/g) is indicated indicated

41 ACA09 40 47.3 % Castor oil , Solution to oil Unchanged after Starts to precipitate

1 1 22-3 47.3 % Akoline 24 hours

MCM, 5.4 % benzyl *

alcohol

+ cholesterol (40

mg/g)

42 ACA09 40 50 % Castor oil , 50 Solution to oil Very slight

1 1 20-2 % Akoline MCM precipitation of

crystal sin the

+ cholesterol (60

entire sample after

mg/g) 24 h

43 ACA09 45 45 % Castor oil , 55 Solution to oil Slight precipitation Crystals on 1 1 08-3 % Akoline MCM of crystals on the the bottom bottom after 9 after 1 week

+ cholesterol (45

days refrigerated mg/g)

44 ACA09 45 50 % Castor oil , 50 Solution to oil Slight precipitation

1 1 21 -1 % Akoline MCM of crystal sin the

entire sample after

+ cholesterol (67.5

24 h

mg/g)

45 ACA09 50 50 % Castor oil , 50 Solution to oil Very slight

1 1 21 -2 % Akoline MCM precipitations of

crystal sin the

+ cholesterol (75

entire sample after

mg/g) 24 h

46 ACA09 5 Olive oil Emulsion to oil Unchanged after Crystals at the bottom

1 216-2 4 days, first signs after 9 months

of precipitation

after 5 days

47 ACA09 5 Olive oil Emulsion to oil Unchanged after Unchanged after 8

1 216-1 3 weeks * months

+ cholesterol (10

mg/g)

48 ACA09 7,5 Olive oil Emulsion to oil Precipitation after

1 221 -2 approx. 1 hour

49 ACA09 7,5 Olive oil Emulsion to oil Unchanged after Crystals at the bottom

1 221 -1 1 day, very slight after 8 months

+ cholesterol (7.5

precipitation after

mg/g) 1 week Examples 50-75

[00072] Examples 50 to 75 were carried out essentially as examples 1 -49.

Akoline Medium-Chain Monoglyceride (MCM) (Batch 81 92270 and 821 8940) and Akomed R Medium-Chain Triglyceride (MCT) (Batch 4765) were obtained from AarhusKarlshamns Sweden AB, Karlshamn, Sweden. Absolute ethanol (>99%) was obtained from VWR International.

[00073] The procedure for making and evaluating lipid-based formulations was as follows: The batch sizes were either 20 g or 1 00 g of final formulation. The desired amounts of 3-beta-hydroxy-5-alpha-pregnan-20-one and cholesterol were weighed in a round-bottomed flask, 250 or 1 000 ml depending on the batch size.

[00074] To every gram of 3-beta-hydroxy-5-alpha-pregnan-20-one and cholesterol mixture a volume of about 1 5 to 30 ml of absolute ethanol was added. The smaller volume of alcohol per gram of solute was used when preparing the largest batch size of 1 00 g of final formulation. The mixture was treated in an ultrasonication bath (not exceeding 55°C) until a clear solution was obtained. This was normally accomplished within a few minutes. The glycerides were then added and the resulting mixture was treated in the ultrasonication bath for a few seconds until a clear, homogeneous liquid was obtained. The alcohol was evaporated from the liquid on a rotary evaporator at a pressure of about 20 mbar and a temperature of about 40°C until weight of the flask was more or less constant. Normally, the remaining ethanol content was 0.5% (w/w) or less. The evaporation time was 0.5-1 .5 h, depending on the batch size. The aim was to obtain a practically uncolored liquid with the appearance of a clear oil at room temperature. The liquid was transferred to clear glass vials, which were stored at room temperature until evaluation. Some selected formulations were portioned and stored at 2-8°C for limited period of time.

[00075] The evaluation comprised observation of the physical stability at room temperature over time. The samples were observed for haziness, precipitation of particles, aggregates or crystals, and subsequent sedimentation and/or phase separation into two or more liquid phases, and/or change of colour.

[00076] It was possible to dissolve up to 25 mg of 3-beta-hydroxy-5-alpha-pregnan- 20-one per gram of final formulation based on 50% MCT and 50% MCM (examples 68 and 69) without any noticeable change in appearance when stored at room temperature for more than 1 month. One of the samples (example 69) also withstood storage at 2-8°C and repeated temperature cycling.

[00077] In order to check the robustness and reproducibility of the formulations and the procedure for the preparation thereof, a scaling up of the batch size from 20 g to 1 00 g of final formulation was performed. The compositions corresponding to examples 60 and 69 were selected for this procedure. From the behavior during preparation and the initial observations of the resulting formulations (examples 74 and 75) it can be concluded that the adopted procedure is both robust and reproducible for making up to 1 00 g of formulation.

Table 2

Example 76

[00078] The objective of the study was to investigate the comparative

pharmacokinetics in plasma of a 3-beta-hydroxy-5-alpha-pregnan-20-one formulation comprising sesame oil and cholesterol following subcutaneous administration to New Zealand White rabbits. Two groups of three female rabbits each received single doses 1 mg/kg (formulation as in example 7) or 5 mg/kg (formulation as in example 1 0). Following subcutaneous injection into the dorsal neck region of the animals, blood samples were taken at 0.25, 0.5, 1 , 2, 4, 6, 8, 1 2 and 24 hours post dose.

Concentrations of 3-beta-hydroxy-5-alpha-pregnan-20-one in plasma were measured by a validated LC -MS/MS method. Data are presented in Figure 1 , and show mean plasma concentration (ng/mL) of 3-beta-hydroxy-5-alpha-pregnan-20-one for the two doses: 1 mg/kg (squares) and 5 mg/kg (circles). Example 77

[00079] Suspensions of 3-beta-hydroxy-5-alpha-pregnan-20-one were prepared for investigation of solubility as follows: cholesterol was first dissolved at room temperature in sesame oil at 1 0 and 20 mg/ml, respectively. Suspensions of 3-beta-hydroxy-5- alpha-pregnan-20-one in sesame oil with different amounts of cholesterol were prepared on a magnetic stirrer at about 500 rpm using a conventional Teflon coated stir bar, at room temperature for several days, with occasional cycling to 2-8°C. At this time, the particles have become substantially smaller. Thereafter, samples of the respective suspensions were filtered through a 0.2 μιτι filter and analyzed with regard to concentration of 3-beta-hydroxy-5-alpha-pregnan-20-one. The results are presented in Table 3 and Figure 2 where it can be seen that increasing the amounts of cholesterol increases the soluble fraction of 3-beta-hydroxy-5-alpha-pregnan-20-one. Figure 2 shows data for a 3-beta-hydroxy-5-alpha-pregnan-20-one concentration of 1 0 mg/g. Figure 3a and 3b show microscopy pictures taken at 5x enlargement of suspensions with a 3-beta-hydroxy-5-alpha-pregnan-20-one concentration of 1 0 mg/g and a cholesterol:3-beta-hydroxy-5-alpha-pregnan-20-one ratio of 1 : 1 immediately upon mixing (3a) and after several days of stirring (3b).

Table 3

Example 78

[00080] Micronized 3-beta-hydroxy-5-alpha-pregnan-20-one (1 0 mg/g) with a mean particle size of 6 micrometer was suspended in sesame oil with cholesterol (20 mg/g) and stirred as in example 77. Photos were taken immediately upon suspension (Fig 4a) and after 1 9 hours of stirring (Fig 4b).

Conclusion

[00081 ] It has been shown that the presence of a sterol such as cholesterol improves the possibilities to formulate 3-beta-hydroxy-5-alpha-pregnan-20-one in a pharmaceutical composition comprising acylglycerols, either as an oily solution or an oily suspension.