Title of Invention	A CONTROLLED RELEASE PHARMACEUTICAL COMPOSITION AND A PROCESS FOR PREPARING THE SAME
Abstract	A three-drug antiretrovial pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The composition provides desired dosages of the actives lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof, and the immediate release formulation including atleast one selective Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI), preferably nevirapine or a pharmaceutically acceptable derivative thereof alongwith pharmaceutically acceptable excipients. The once daily composition would favour patient compliance and effective treatment. A method of reducing the pill burden in a patient suffering from HIV infection and /or Acquired Immunodeffieciency Syndrome by administering a once daily dose of the three-drug antiretroviral pharmaceutical composition.

Title of Invention

A CONTROLLED RELEASE PHARMACEUTICAL COMPOSITION AND A PROCESS FOR PREPARING THE SAME

Abstract

A three-drug antiretrovial pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The composition provides desired dosages of the actives lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof, and the immediate release formulation including atleast one selective Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI), preferably nevirapine or a pharmaceutically acceptable derivative thereof alongwith pharmaceutically acceptable excipients. The once daily composition would favour patient compliance and effective treatment. A method of reducing the pill burden in a patient suffering from HIV infection and /or Acquired Immunodeffieciency Syndrome by administering a once daily dose of the three-drug antiretroviral pharmaceutical composition.

Full Text	FORM2 THE PATENTS ACT, 1970 (39 of 1970) & The Patents Rules, 2003 COMPLETE SPECIFICATION (See section 10; rule 13) 1. Title of the invention. - A CONTROLLED RELEASE PHARMACEUTICAL COMPOSITION AND A PROCESS FOR PREPARING THE SAME. 2. Applicant (a) NAME : (b) NATIONALITY (c) ADDRESS : LUPIN LIMITED An Indian Company 159, C.S.T. Road, Kalina, Santacruz (East), Mumbai - 400 098, Maharashtra, India. 3. PREAMBLE TO THE DESCRIPTION The following specification particularly describes the nature of the invention and the manner in which it is to be performed. FIELD OF THE INVENTION The present invention relates to antiretroviral pharmaceutical composition. The invention particularly relates to an antiretroviral pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The invention also relates to the process for manufacture of such once daily antiretroviral pharmaceutical composition. BACKGROUND OF THE INVENTION Acquired Immune Deficiency Syndrome (AIDS) which is caused by the human immunodeficiency virus (HIV) is one of the few diseases for which mankind is struggling to find a cure. In the last several years many antiretroviral agents have been discovered that have since been used to treat AIDS. The drugs that are currently approved for anti-HIV therapy are broadly classified into three categories, namely: 1. Nucleoside Reverse Transcriptase Inhibitors (NRTI), which include lamivudine, zidovudine, didanosine, abacavir, stavudine, and zalcitabine. 2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI), which include nevirapine, efavirenz, and delavirdine. 3. Protease Inhibitors (PI), which include indinavir, ritonavir, nelfinavir, saquinavir and amprenavir. For successful treatment of any disease caused by a microorganism the drug used in the therapy should eliminate the causative organism completely without allowing them to undergo mutation. Mutation may lead to resistant strains that can make treatment more difficult. This development of resistant strains is usually observed when a single agent or drugs belonging to a single category are solely used in the treatment. For most 2 diseases caused by microorganisms, it has been found that combining two or more drugs, preferably from different classes have resulted in a greater success rate. Drugs for the treatment of highly active antiretroviral therapy were initially prescribed as a loose combination of two or three drugs. This was rationalised to fixed dose combinations to be administered twice daily. In our co-pending application number PCT/IN02/00110 we have described a formulation, which further reduced the pill burden to once a day. However to date there are no reports of once a day formulation comprising a three drug combination. There are three known alternative regimens as follows: 1) 3 NRTIs 2) 2 NRTIs + 1 NNRTI 3) 2 NRTIs+1 PI Nucleoside-based reverse transcriptase inhibitors (NRTIs) were the first drugs to be given as antiretroviral agents, and they remain the backbone of therapy against HIV infection and acquired immuno deficiency syndrome (AIDS). Although various therapy regimens have been tried as indicated above, it has been reported that drug combination comprising three NRTIs is not as effective as other combinations. The combination of two NRTIs, lamivudine and zidovudine which form the backbone of therapy with one NNRTI such as Nevaripine or Efavirenz is ideal. The serum half-life of Lamivudine is about 3 to 6 hours while that of Zidovudine is 1.1 hours. Nevaripine has a long half-life of more than 25 hours and is currently given as 200 mg twice daily. Efavirenz is approved for a dosing of 600 mg once daily. We propose to use 400 mg Nevaripine to be given as a fixed dose combination with lamivudine and zidovudine once daily. In case of Efavirenz the amount of efavirenz or pharmaceutically acceptable derivative thereof is 600-800mg preferably. Multi-drug therapy in case of antiretrovirals has the advantage that drugs have different mechanisms of action and act at different stages of the viral life cycle and they may 3 exhibit a synergistic effect on such use. However, this kind of therapy results in the patient having to take multiple pills several times a day and this is known to cause problems of compliance in following the therapy regimen. Several attempts have been made to reduce the pill burden in order to enhance patient compliance. Lamivudine 150mg and zidovudine 300mg are NRTIs that are to be given twice daily. A fixed dose combination of lamivudine 150mg and zidovudine 300mg (COMBIVIR) has been developed which has reduced the pill load for this combination to two. Similarly, a three drug fixed dose combination of lamivudine 150 mg, zidovudine 300 mg and abacavir 300 mg (TRIZIVIR) has also been developed. However, there are reports of toxicity related to abacavir. Further, the frequency of dosing for both two and three drug combination is still twice daily. United States Patent No. 6,113,920 discloses a pharmaceutical composition comprising two active pharmaceutical ingredients namely lamivudine and zidovudine and a pharmaceutically acceptable glidant ingredient, selected from a group of colloidal silicon dioxide, microcrystalline cellulose, metallic stearates, calcium carbonate and combinations thereof, in the form of a film coated tablet. The composition contains lamivudine in an amount from 15 to 1500 mg per tablet and zidovudine in an amount from 30 to 1000 mg per tablet. This combination is given twice daily. United States Patent No. 4,917,900 discloses a pharmaceutical formulation for oral administration in which discrete units comprising zidovudine are provided with a controlled release coating consisting of alkyl esters of acrylic and methacrylic acids and ethylcellulose in a weight ratio of 1:3 to 3:1. These spheroids contain at least 80% of zidovudine and microcrystalline cellulose and mannitol as the core-forming agent. As discussed above, while a two drug combination product may reduce the pill burden to half, it still has to be given twice daily and when coupled with a third drug, the pill burden is substantially increased. 4 OBJECTS OF THE INVENTION It is thus the basic object of the present invention to provide for a three-drug antiretroviral pharmaceutical composition, which would reduce the pill load and frequency of drug administration thereby favouring patient compliance and effective treatment. Another object is to provide a fixed dose combination of lamivudine, zidovudine and atleast one NNRTI drug suitable for once daily administration, which would reduce the pill burden to one and the frequency to once daily. Yet further object of the present invention is directed to the development of a three drug fixed dose combination comprising essentially the antiretroviral drugs lamivudine, zidovudine, and at least one NNRTI drug preferably selected from nevirapine and efavirenz suitable for once daily dosing wherein lamivudine and zidovudine would have a controlled release while nevirapine/ efavirenz will be immediately released. Yet another object of the present invention is related to a method of increasing the in vivo half life of Lamivudine and Zidovudine while not affecting the half life of Nevirapine or Efavirenz and thus reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component Yet further object is directed to provide a process for preparing an antiretroviral pharmaceutical composition as above which would reduce the pill load and frequency of drug administration thereby favouring patient compliance and effective treatment. SUMMARY OF THE INVENTION Thus according to the present invention there is provided an antiretroviral pharmaceutical composition comprising a selective combination of i. a controlled release formulation comprising : 5 a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutically acceptable gums or mixtures thereof and d. a pharmaceutically acceptable calcium salt. ii. an immediate release formulation comprising at least one selective non-nucleoside reverse transcriptase inhibitors (NNRTI) drug or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. In accordance with another aspect of the present invention there is provided a process for the preparation of a pharmaceutical composition comprising (i) mixing together active ingredients selected from amongst lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant to provide a controlled release formulation (ii) providing an immediate release formulation obtained of at least one NNRTI or pharmaceutically acceptable derivatives thereof blended with pharmaceutically acceptable excipients and (iii) obtaining a composition therefrom by compressing the resulting blends into bilayered tablets, or by applying the said immediate release formulation as an outer coat over the core of the said controlled release formulation DETAILED DESCRD7TION OF THE INVENTION The pharmaceutical composition is preferably in the form of a bilayered tablet with the controlled release comprising one layer and the immediate release comprising the second layer. Alternatively the controlled release component may be in the form of a core and the second immediate release layer may be coated on top of the core. 6 The controlled release layer of the pharmaceutical composition comprises lamivudine and zidovudine or their pharmaceutically acceptable derivatives along with a mixture of hydrophilic polymers selected from the group consisting of cellulose ethers, polyuronic acids, pharmaceutically acceptable gums, or mixtures thereof. In addition, this layer also comprises a pharmaceutically acceptable calcium salt and optionally one or more water-soluble or water dispersible pharmaceutically acceptable excipients. The cellulose ether used in accordance with the present invention is selected from amongst those commonly known in the art such as hydroxypropyl cellulose, hydoxypropyl methylcellulose, carboxy methylcellulose, sodium carboxymethylcellulose, ethyl cellulose, methyl cellulose, hydroxy ethyl cellulose and the like. It is present in an amount from about 2% to about 12% by weight of the controlled release layer and preferably in an amount from about 3% to about 8% by weight of the controlled release layer. The polyuronic acid used in accordance with the present invention is selected from amongst alginic acid, sodium alginate, calcium alginate, sodium calcium alginate, potassium alginate, ammonium alginate, magnesium alginate and the like. It is present in an amount from about 0.5% to about 10% by weight of the controlled release layer and preferably in an amount from about 1% to about 6% by weight of the controlled release layer. The pharmaceutically acceptable gum used in the composition of the invention is selected from amongst those commonly known in the art such as guar gum, xanthan gum, gum karaya, tragacanth gum, gum acacia and the like. It is present in an amount from about 0.1% to about 10% by weight of the controlled release layer and preferably in an amount from about 0.5% to about 6% by weight of the controlled release layer. Calcium salts when used along with certain polymers, especially the alginates, have been known to stabilize the matrix. In accordance with this, in a preferred embodiment, 7 the said controlled release layer of the composition also contains a pharmaceutically acceptable calcium salt. The calcium salt is selected from the group consisting of calcium sulphate, calcium phosphate, calcium carbonate and calcium chloride. It is present in an amount from about 0.1% to about 2.5% by weight of the controlled release layer preferably from about 0.1% to about 2% by weight of the controlled release layer. The controlled release layer of the composition may further contain one or more pharmaceutically acceptable other excipients selected from amongst water-soluble and/or water dispersible diluents and lubricants. The water dispersible or water soluble diluent selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. They are present from about 1% to about 28% by weight of the controlled release layer. When the diluent is microcrystalline cellulose, it is present in an amount from about 5% to about 20% by weight of the controlled release layer. When the diluent is dicalcium phosphate, it is present in an amount from about 1% to about 5% by weight of the controlled release layer. The immediate release layer comprises at least one NNRTI selected from amongst nevirapine and efavirenz or their pharmaceutically acceptable derivatives The immediate release layer may further comprise pharmaceutically acceptable excipients selected from the group consisting of diluents, binders, disintegrants, lubricants, coloring agents and the like. The diluent is selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. The 8 diluent is present in an amount from about 2% to about 15% by weight of the immediate release layer. The binder is selected from amongst carboxymethylcellulose sodium, povidone, pregelatinised starch, gelatin, and the like. The binder is present in an amount from r about 1% to about 10% by weight of the immediate release layer. The disintegrant is selected from amongst crospovidone, sodium starch glycolate, pregelatinised starch, carboxymethylcellulose sodium, croscarmellose sodium, starch and the like. It is present in an amount from about 0.5% to about 15% by weight of the immediate release layer. Each layer may also contain lubricants selected from amongst those commonly known in the art such as magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like. It is present in an amount from about 0.1% to about 3% by weight of each layer. The pharmaceutical compositions according to the invention may be prepared by procedures well known to those skilled in the art. According to a convenient method for the preparation of the granular blend for each layer, all the active ingredients along with the necessary excipients are mixed together and then compacted. The compacted mass is then comminuted to obtain the granules. Alternatively, the granules may also be prepared by the process of wet granulation using a suitable granulating agent. The final granular blend of the two layers are either compressed into bilayered tablets on a compression machine suitable for such purpose or the controlled release layer may be present as a core and the immediate release layer is present as a coat around the core. The tablets so obtained may be further coated using a water-soluble polymer. The above-mentioned process results in a pharmaceutical composition that contains three antiretroviral agents in one tablet suitable for once daily administration. The effective therapeutic dose of the active that can be administered include a combination 9 of 300 mg of lamivudine, 600 mg of zidovudine and 400 mg of nevirapine/ 600 mg of efavirenz. The composition of the invention and its advantages are explained hereunder in greater detail in relation to non-limiting examples hereunder: Example 1 Ingredients Weight (mg/tab) Controlled Release Layer Lamivudine 300.0 Zidovudine 600.0 Microcrystalline Cellulose 187.0 Hydroxypropyl methylcellulose 62.5 Sodium alginate 31.25 Guar gum 12.5 Calcium sulphate 3.75 Dicalcium phosphate 40.0 Magnesium Stearate 13.0 Immediate Release Layer Nevirapine 400.0 Powdered Cellulose 52.5 Povidone K30 20.0 Sodium starch glycolate 15.0 Magnesium stearate 3.75 Sodium starch glycolate 5.0 Colloidal silicon dioxide 2.5 Magnesium stearate 1.25 Controlled release layer blend: Lamivudine, zidovudine, hydrophilic polymers, calcium sulphate, dicalcium phosphate, and microcrystalline cellulose were screened through 30 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The sized granules were blended with fines and lubricated. 10 Immediate release layer blend: Nevirapine, cellulose, povidone and a first portion of sodium starch glycolate were screened through 40 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The granules were mixed with a second portion of sodium starch glycolate, colloidal silicon dioxide and lubricated. Bilayered tablets: Both the above blends were compressed into bilayered tablets using a bilayered tablet compression machine. Drug Release: The tablets were tested for release of all three actives using USP Type 1 Dissolution apparatus at an RPM of 100 and with 900ml of 0. IN HCL for the first 2 hrs and pH 6.8 Phosphate buffer afterwards. Time % Drug released Lamivudine Zidovudine Nevirapine 1 hr 29.1 17.1 87.1 2hrs 42.7 25.9 4hrs 55.5 42.3 8hrs 70.4 67.6 10 hrs 79.4 80.1 12hrs 85.3 88.2 11 Example 2 Ingredients Weight (mg/tab) Controlled Release Layer Lamivudine 300.0 Zidovudine 600.0 Microcrystalline Cellulose 187.0 Hydroxypropyl methylcellulose 62.5 Sodium alginate 31.25 Guar gum 12.5 Calcium sulphate 3.75 Dicalcium phosphate 40.0 Magnesium Stearate 13.0 Immediate Release Layer Nevirapine 400.0 Powdered Cellulose 35.0 Povidone K30 20.0 Crospovidone 15.0 Sodium starch glycolate 20.0 Sunset Yellow FCF 2.5 Magnesium stearate 5.0 Colloidal silicon dioxide 2.5 The manufacturing procedure of Example 1 was followed. 12 The release of the drugs was obtained as follows: Time % Drug released Lamivudine Zidovudine Nevirapine 1 hr - - 94.2 2hrs 47.0 26.8 4hrs 61.7 43.0 8hrs 71.3 64.8 10 hrs 79.1 75.4 12hrs 86.6 76.7 14hrs 90.5 89.2 Example 3 Ingredients Weight (mg/tab) Controlled Release layer Lamivudine 300.0 Zidovudine 600.0 Microcrystalline Cellulose 187.0 Hydroxypropyl methylcellulose 62.5 Sodium alginate 31.25 Guar gum 12.5 Calcium sulphate 3.75 Dicalcium phosphate 40.0 Magnesium Stearate 13.0 Immediate Release layer Nevirapine 400.0 Powdered Cellulose 42.5 Povidone K30 10.0. Crospovidone 20.0 Sodium starch glycolate 15.0 Magnesium stearate 3.75 Sodium starch glycolate 5.0 13 Colloidal silicon dioxide 2.5 Magnesium stearate 1.25 The manufacturing procedure of Example 1 was followed The release obtained of the drugs is as follows: Time % Drug released Lamivudine Zidovudine Nevirapine L hr 33.8 21.3 97.1 2hrs 50.5 31.0 4hrs 67.8 49.5 8hrs 79.2 74.0 10 hrs 86.2 83.7 12hrs 90.6 90.1 Example 4 Ingredients Weight (mg/tab) Core Lamivudine 300.0 Zidovudine 600.0 Microcrystalline Cellulose 187.0 Hydroxypropyl methylcellulose 62.5 Sodium alginate 31.25 Guar gum 12.5 Calcium sulphate 3.75 Dicalcium phosphate 40.0 Magnesium Stearate 13.0 Coat Nevirapine 400.0 14 Powdered Cellulose 32.5 Povidone K30 20.0 Crospovidone 20.0 Sodium starch glycolate 15.0 Magnesium stearate 3.75 Sodium starch glycolate 5.0 Colloidal silicon dioxide 2.5 Magnesium stearate 1.25 Sunset Yellow FCF 2.5 Core: Lamivudine, zidovudine, hydrophilic polymers, calcium sulphate, dicalcium phosphate, and microcrystalline cellulose were screened through 30 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The sized granules were blended with fines, lubricated and compressed into a tablet. Coat: Nevirapine, cellulose, povidone and a first portion of sodium starch glycollate were screened through 40 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The granules were mixed with a second portion of sodium starch glycolate, colloidal silicon dioxide, lubricated and compression coated over the core tablet. The release obtained of the drugs is as follows: Time % Drug released Lamivudine Zidovudine Nevirapine 1 hr 37.4 22.8 80.8 2hrs 54.1 32.1 4hrs 66.5 47.5 8hrs 82.5 76.8 10 hrs 92 87.3 12hrs 97.3 93.7 15 A single dose fed study was conducted using the tablets of Example 1 against a commercially available immediate release combination of the three drugs. The results of the study are tabulated in Table 1. Test: Lamivudine 300 mg (as ER) + Zidovudine 600mg (as ER) + Nevirapine 400mg (OD) tablets Reference: Lamivudine 150 mg +Zidovudine 300 mg + Nevirapine 200 mg (IR/BD) tablets Lamivudine Zidovudine Nevirapine Lamivudine Zidovudine Nevirapine Cmax(mcg/ml) 1.79 1.54 5.17 1.51 1.49 2.88 AUC(O-1) (mcg.hr/ml) 12.18 7.45 36.37 5.84 3.12 18.55 T1/2 (hr) 5.67 2.74 29.34 2.98 0.72 17.82 The results indicate that the composition of the present invention achieves a Cmax of Lamivudine and Zidovudine, which is equivalent to that obtained when the same drugs are administered in immediate release form. However, the invention also succeeds in increasing the AUCo-t values and the half lives of all the drugs in vivo. It is thus apparent from the above exemplary illustrations that the pharmaceutical composition of the invention serves as a three-drug antiretroviral combination for once daily dosage for a combination treatment especially of NRTIs and NNRTIs. The once daily dosage form of the invention is simple and cost-effective and would serve in reducing the pill burden and frequency of administration and favour patient compliance with the desired drug regime for effective treatment. 16 WE CLAIM: 1. An antiretroviral pharmaceutical composition comprising a selective combination of i. a controlled release formulation comprising : a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutically acceptable gums or mixtures thereof and d. a pharmaceutically acceptable calcium salt. ii. an immediate release formulation comprising atleast one selective Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) drug or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. 2. An antiretroviral pharmaceutical composition as claimed in claim 1 wherein said NNRTI drug is selected from nevirapine, and efavirenz. 3. An antiretroviral pharmaceutical composition as claimed in claim 1 which is in the form of two separate layers of said controlled release and the immediate release formulation 4. An antiretroviral pharmaceutical composition as claimed in claim 1 which is in the form of a core of said controlled release formulation and an outer coat of the immediate release formulation. 5. An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a bilayer selective combination of i. a first layer of controlled release formulation comprising : a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and 17 c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutical^ acceptable gums or mixtures thereof and d. a pharmaceutical^ acceptable calcium salt. a second layer of an immediate release formulation wherein said NNRTI is nevirapine or a pharmaceutical^ acceptable derivative thereof along with pharmaceutically acceptable excipients. An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a selective combination of a core having a controlled release formulation comprising: a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutically acceptable gums or mixtures thereof and d. a pharmaceutically acceptable calcium salt. an outer coat of an immediate release formulation wherein said NNRTI is nevirapine or a pharmaceutically acceptable derivative thereof and pharmaceutically acceptable excipients. An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a selective bilayer combination of i. a first layer of a controlled release formulation comprising : a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutically acceptable gums or mixtures thereof and d. a pharmaceutically acceptable calcium salt. 18 ii. a second layer of an immediate release formulation wherein said NNRTI is efavirenz or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a selective combination of a core of controlled release formulation comprising : a. lamivudine or a pharmaceutically acceptable derivative thereof, b. zidovudine or a pharmaceutically acceptable derivative thereof, and c. a mixture of hydrophilic polymers, said polymers being selected from the group consisting of cellulose ethers, polyuronic acids and pharmaceutically acceptable gums or mixtures thereof and d. a pharmaceutically acceptable calcium salt. an outer coat of an immediate release formulation wherein said NNRTI is efavirenz or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. The composition as claimed in anyone of claims 1 to 8 wherein the amount of lamivudine or pharmaceutically acceptable derivative thereof is from about 50 mg to about 500 mg. The composition as claimed in claim 9 wherein the amount of lamivudine or pharmaceutically acceptable derivative thereof is about 300 mg. The composition as claimed in anyone of claims 1 to 8 wherein the amount of zidovudine or pharmaceutically acceptable derivative thereof is from about 100 mg to about 1000 mg. The composition as claimed in claim 11 wherein the amount of zidovudine or pharmaceutically acceptable derivative thereof is 600 mg. 19 13. The composition as claimed in anyone of claims 1 to 12 wherein the amount of nevirapine /efavirenz or pharmaceutically acceptable derivative thereof is from about 100 mg to about 1000 mg. 14. The composition as claimed in claim 13 wherein the amount of nevirapine or pharmaceutically acceptable derivative thereof is about 400 mg. 15. The composition as claimed in claim 13 wherein the amount of efavirenz or pharmaceutically acceptable derivative thereof is about 600 mg. 16. A composition as claimed in anyone of claims 1 to 15 wherein the cellulose ether is selected from amongst hydroxypropyl cellulose, hydoxypropyl methylcellulose, carboxy methylcellulose, sodium carboxymethylcellulose, ethyl cellulose, methyl cellulose, hydroxy ethyl cellulose and the like. 17. A composition as claimed in claim 16 wherein the cellulose ether is hydroxypropyl methylcellulose and is present in an amount from about 2% to about 12% by weight of the controlled release formulation. 18. A composition as claimed in claim 17 wherein the cellulose ether is hydroxypropyl methylcellulose and is present in an amount from about 3% to about 8% by weight of the controlled release formulation. 19. A composition as claimed in anyone of claims 1 to 18 wherein the polyuronic acid is selected from amongst alginic acid, sodium alginate, calcium alginate, sodium calcium alginate, potassium alginate, ammonium alginate, magnesium alginate and the like. 20. A composition as claimed in claim 19 wherein the polyuronic acid is sodium alginate and is present in an amount from about 0.5% to about 10% by weight of the controlled release formulation. 20 21. A composition as claimed in claim 20 wherein the polyuronic acid is sodium alginate and is present in an amount from about 1% to about 6% by weight of the controlled release formulation. 22. A composition as claimed in anyone of claims 1 to 21 wherein the pharmaceutically acceptable gum is selected from amongst guar gum, xanthan gum, gum karaya, tragacanth gum, gum acacia and the like. 23. A composition as claimed in claim 22 wherein the pharmaceutically acceptable gum is guar gum and is present in an amount from about 0.1% to about 10% by weight of the controlled release formulation. 24. A composition as claimed in claim 23 wherein the pharmaceutically acceptable gum is guar gum and is present in an amount from about 0.5% to about 6% by weight of the controlled release formulation. 25. The composition as claimed in anyone of claims 1 to 24 wherein the pharmaceutically acceptable calcium salt is selected from the group consisting of calcium sulphate, calcium phosphate, calcium carbonate and calcium chloride. 26. A composition as claimed in claim 25 wherein the pharmaceutically acceptable calcium salt is calcium sulphate and is present in an amount from about 0.1% to about 2.5% by weight of the controlled release formulation. 27. A composition as claimed in claim 26 wherein the pharmaceutically acceptable calcium salt is calcium sulphate and is present in an amount from about 0.1% to about 2% by weight of the controlled release formulation. 28. The composition as claimed in anyone of claims 1 to 27 wherein the controlled release formulation further comprises at least one water dispersible or water soluble diluent selected from amongst microcrystalline cellulose, dicalcium 21 phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. 29. The composition as claimed in claim 28 wherein the diluent is present from about 1% to about 28% by weight of the controlled release formulation 30. The composition as claimed in claim 29 wherein the diluent is microcrystalline cellulose. 31. The composition as claimed in claim 30 wherein the amount of microcrystalline cellulose is from about 5% to about 20% by weight. 32. The composition as claimed in claim 29 wherein the diluent is dicalcium phosphate. 33. The composition as claimed in claim 32 wherein the amount of dicalcium phosphate is from about 1% to about 5% by weight. 34. The composition as claimed in anyone of claims 1 to 33 wherein the controlled release formulation further comprises at least one lubricant selected from amongst magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like. 35. The composition as claimed in claim 34 wherein the lubricant is present from about 0.1% -3% by weight. 36. The composition as claimed in anyone of claims 1 to 35 wherein the immediate release formulation comprises from about 10% to about 95% by weight of nevirapine or a pharmaceutical^ acceptable derivative thereof along with one or more pharmaceutical^ acceptable excipients selected from amongst diluents, binders, disintegrants, lubricants, coloring agents and the like. 22 37. A composition as claimed in claim 36 wherein the diluent is selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. 38. A composition as claimed in claim 37 wherein the diluent is powdered cellulose and is present in an amount from about 2% to about 15% by weight of the immediate release formulation 39. A composition as claimed in claim 36 wherein the binder is selected from amongst carboxymethylcellulose sodium, povidone, pregelatinised starch, gelatin or mixtures thereof. 40. A composition as claimed in claim 39 wherein the binder is present in an amount from about 1% to about 10% by weight of the immediate release formulation 41. A composition as claimed in claim 36 wherein the disintegrant is selected from amongst crospovidone, sodium starch glycolate, pregelatinised starch, carboxymethylcellulose sodium, croscarmellose sodium, starch and mixtures thereof. 42. A composition as claimed in claim 41 wherein the disintegrant is present in an amount from about 0.5% to about 15% by weight of the immediate release formulation. 43. The composition as claimed in claim 36 wherein the lubricant is selected from amongst magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like. 44. The composition as claimed in claim 43 wherein the lubricant is present from about 0.1% -3% by weight. 23 45. A process for the preparation of an antiretroviral pharmaceutical composition comprising (i) providing a controlled release formulation by mixing together active ingredients selected from amongst lamivudine, zidovudine or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant, (ii) blending an immediate release formulation obtained of at least the NNRTI is blended with pharmaceutically acceptable excipients and (iii) obtaining the composition therefrom by compressing the resulting blends into bilayered tablets. 46. A process for the preparation of an antiretroviral pharmaceutical composition comprising (i) providing a core of said controlled release formulation by mixing together active ingredients selected from amongst lamivudine, zidovudine or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant, (ii) providing an outer coat of an immediate release formulation obtained of at least the NNRTI selected from Nevirapine, and Efavirenz blended with pharmaceutically acceptable excipients and (iii) obtaining the composition therefrom by applying the said outer coat over the said core by compression coating. 47. A process as described in claim 45 or 46 wherein each blend is dry granulated prior to compression. 48. A process as described in claim 45 or 46 wherein each blend is wet granulated prior to compression. 49. A method of reducing the pill burden in a patient suffering from HIV infection and /or Acquired Immunodeffieciency Syndrome by administering a three drug antiretroviral pharmaceutical composition which comprises of a combination of 24 lamivudine and zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component. 50. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodeficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a Cmax of about 1.2 to 2.0 meg / ml for Lamivudine, about 1.0 to 2.0 meg / ml for Zidovudine and about 4.5 to 5.5 meg /ml for Nevirapine. 51. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a AUCo-t of about 8 to 14 mcg.hr / ml for Lamivudine, about 5 to9 mcg.hr / ml for Zidovudine and about 32 to 40 mcg.hr / ml for Nevirapine. 52. A method of increasing the in vivo half life of Lamivudine and Zidovudine while not affecting the half life of Nevirapine and thus reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component. 53. The method of Claim 51 wherein the composition upon administration to the said patient provides a t1/2 of about 5 hrs for Lamivudine, about 2 hrs for Zidovudine and about 29 hrs for Nevirapine. 54. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug 25 antiretrovirai composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a Cmax of the said drugs in the controlled release component which is substantially similar to that provided by immediate release compositions of the said drugs when taken simultaneously, sequentially or concurrently. Dated this 22nd day of April 2006 OfS.MAJUMOARaCO. (Applicants Agent) 26 ABSTRACT A CONTROLLED RELEASE PHARMACEUTICAL COMPOSITION AND A PROCESS FOR PREPARING THE SAME A three-drug antiretrovial pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The composition provides desired dosages of the actives lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof, and the immediate release formulation including atleast one selective Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI), preferably nevirapine or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. The once daily composition would favour patient compliance and effective treatment. A method of reducing the pill burden in a patient suffering from HIV infection and /or Acquired Immunodeffieciency Syndrome by administering a once daily dose of the three-drug antiretroviral pharmaceutical composition. 27

Full Text

FORM2
THE PATENTS ACT, 1970
(39 of 1970)
&
The Patents Rules, 2003
COMPLETE SPECIFICATION
(See section 10; rule 13)
1. Title of the invention. - A CONTROLLED RELEASE PHARMACEUTICAL
COMPOSITION AND A PROCESS FOR PREPARING THE SAME.

2. Applicant
(a) NAME :
(b) NATIONALITY
(c) ADDRESS :

LUPIN LIMITED
An Indian Company
159, C.S.T. Road, Kalina, Santacruz (East), Mumbai - 400 098, Maharashtra, India.

3. PREAMBLE TO THE DESCRIPTION
The following specification particularly describes the nature of the invention and the manner in which it is to be performed.

FIELD OF THE INVENTION
The present invention relates to antiretroviral pharmaceutical composition. The invention particularly relates to an antiretroviral pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The invention also relates to the process for manufacture of such once daily antiretroviral pharmaceutical composition.
BACKGROUND OF THE INVENTION
Acquired Immune Deficiency Syndrome (AIDS) which is caused by the human immunodeficiency virus (HIV) is one of the few diseases for which mankind is struggling to find a cure.
In the last several years many antiretroviral agents have been discovered that have since been used to treat AIDS. The drugs that are currently approved for anti-HIV therapy are broadly classified into three categories, namely:
1. Nucleoside Reverse Transcriptase Inhibitors (NRTI), which include lamivudine, zidovudine, didanosine, abacavir, stavudine, and zalcitabine.
2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI), which include nevirapine, efavirenz, and delavirdine.
3. Protease Inhibitors (PI), which include indinavir, ritonavir, nelfinavir, saquinavir and amprenavir.
For successful treatment of any disease caused by a microorganism the drug used in the therapy should eliminate the causative organism completely without allowing them to undergo mutation. Mutation may lead to resistant strains that can make treatment more difficult. This development of resistant strains is usually observed when a single agent or drugs belonging to a single category are solely used in the treatment. For most
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diseases caused by microorganisms, it has been found that combining two or more drugs, preferably from different classes have resulted in a greater success rate.
Drugs for the treatment of highly active antiretroviral therapy were initially prescribed as a loose combination of two or three drugs. This was rationalised to fixed dose combinations to be administered twice daily. In our co-pending application number PCT/IN02/00110 we have described a formulation, which further reduced the pill burden to once a day. However to date there are no reports of once a day formulation comprising a three drug combination.
There are three known alternative regimens as follows:
1) 3 NRTIs
2) 2 NRTIs + 1 NNRTI
3) 2 NRTIs+1 PI
Nucleoside-based reverse transcriptase inhibitors (NRTIs) were the first drugs to be given as antiretroviral agents, and they remain the backbone of therapy against HIV infection and acquired immuno deficiency syndrome (AIDS).
Although various therapy regimens have been tried as indicated above, it has been reported that drug combination comprising three NRTIs is not as effective as other combinations. The combination of two NRTIs, lamivudine and zidovudine which form the backbone of therapy with one NNRTI such as Nevaripine or Efavirenz is ideal. The serum half-life of Lamivudine is about 3 to 6 hours while that of Zidovudine is 1.1 hours. Nevaripine has a long half-life of more than 25 hours and is currently given as 200 mg twice daily. Efavirenz is approved for a dosing of 600 mg once daily.
We propose to use 400 mg Nevaripine to be given as a fixed dose combination with lamivudine and zidovudine once daily. In case of Efavirenz the amount of efavirenz or pharmaceutically acceptable derivative thereof is 600-800mg preferably.
Multi-drug therapy in case of antiretrovirals has the advantage that drugs have different mechanisms of action and act at different stages of the viral life cycle and they may
3

exhibit a synergistic effect on such use. However, this kind of therapy results in the patient having to take multiple pills several times a day and this is known to cause problems of compliance in following the therapy regimen. Several attempts have been made to reduce the pill burden in order to enhance patient compliance.
Lamivudine 150mg and zidovudine 300mg are NRTIs that are to be given twice daily. A fixed dose combination of lamivudine 150mg and zidovudine 300mg (COMBIVIR) has been developed which has reduced the pill load for this combination to two. Similarly, a three drug fixed dose combination of lamivudine 150 mg, zidovudine 300 mg and abacavir 300 mg (TRIZIVIR) has also been developed. However, there are reports of toxicity related to abacavir. Further, the frequency of dosing for both two and three drug combination is still twice daily.
United States Patent No. 6,113,920 discloses a pharmaceutical composition comprising two active pharmaceutical ingredients namely lamivudine and zidovudine and a pharmaceutically acceptable glidant ingredient, selected from a group of colloidal silicon dioxide, microcrystalline cellulose, metallic stearates, calcium carbonate and combinations thereof, in the form of a film coated tablet. The composition contains lamivudine in an amount from 15 to 1500 mg per tablet and zidovudine in an amount from 30 to 1000 mg per tablet. This combination is given twice daily.
United States Patent No. 4,917,900 discloses a pharmaceutical formulation for oral administration in which discrete units comprising zidovudine are provided with a controlled release coating consisting of alkyl esters of acrylic and methacrylic acids and ethylcellulose in a weight ratio of 1:3 to 3:1. These spheroids contain at least 80% of zidovudine and microcrystalline cellulose and mannitol as the core-forming agent.
As discussed above, while a two drug combination product may reduce the pill burden to half, it still has to be given twice daily and when coupled with a third drug, the pill burden is substantially increased.
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OBJECTS OF THE INVENTION
It is thus the basic object of the present invention to provide for a three-drug antiretroviral pharmaceutical composition, which would reduce the pill load and frequency of drug administration thereby favouring patient compliance and effective treatment.
Another object is to provide a fixed dose combination of lamivudine, zidovudine and atleast one NNRTI drug suitable for once daily administration, which would reduce the pill burden to one and the frequency to once daily.
Yet further object of the present invention is directed to the development of a three drug fixed dose combination comprising essentially the antiretroviral drugs lamivudine, zidovudine, and at least one NNRTI drug preferably selected from nevirapine and efavirenz suitable for once daily dosing wherein lamivudine and zidovudine would have a controlled release while nevirapine/ efavirenz will be immediately released.
Yet another object of the present invention is related to a method of increasing the in vivo half life of Lamivudine and Zidovudine while not affecting the half life of Nevirapine or Efavirenz and thus reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component
Yet further object is directed to provide a process for preparing an antiretroviral pharmaceutical composition as above which would reduce the pill load and frequency of drug administration thereby favouring patient compliance and effective treatment.
SUMMARY OF THE INVENTION
Thus according to the present invention there is provided an antiretroviral pharmaceutical composition comprising a selective combination of i. a controlled release formulation comprising :
5

a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof, and
c. a mixture of hydrophilic polymers, said polymers being selected from the
group consisting of cellulose ethers, polyuronic acids and pharmaceutically
acceptable gums or mixtures thereof and
d. a pharmaceutically acceptable calcium salt.
ii. an immediate release formulation comprising at least one selective non-nucleoside reverse transcriptase inhibitors (NNRTI) drug or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients.
In accordance with another aspect of the present invention there is provided a process for the preparation of a pharmaceutical composition comprising
(i) mixing together active ingredients selected from amongst lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant to provide a controlled release formulation (ii) providing an immediate release formulation obtained of at least one NNRTI or pharmaceutically acceptable derivatives thereof blended with pharmaceutically acceptable excipients and
(iii) obtaining a composition therefrom by compressing the resulting blends into bilayered tablets, or by applying the said immediate release formulation as an outer coat over the core of the said controlled release formulation
DETAILED DESCRD7TION OF THE INVENTION
The pharmaceutical composition is preferably in the form of a bilayered tablet with the controlled release comprising one layer and the immediate release comprising the second layer. Alternatively the controlled release component may be in the form of a core and the second immediate release layer may be coated on top of the core.
6

The controlled release layer of the pharmaceutical composition comprises lamivudine and zidovudine or their pharmaceutically acceptable derivatives along with a mixture of hydrophilic polymers selected from the group consisting of cellulose ethers, polyuronic acids, pharmaceutically acceptable gums, or mixtures thereof.
In addition, this layer also comprises a pharmaceutically acceptable calcium salt and optionally one or more water-soluble or water dispersible pharmaceutically acceptable excipients.
The cellulose ether used in accordance with the present invention is selected from
amongst those commonly known in the art such as hydroxypropyl cellulose,
hydoxypropyl methylcellulose, carboxy methylcellulose, sodium
carboxymethylcellulose, ethyl cellulose, methyl cellulose, hydroxy ethyl cellulose and the like. It is present in an amount from about 2% to about 12% by weight of the controlled release layer and preferably in an amount from about 3% to about 8% by weight of the controlled release layer.
The polyuronic acid used in accordance with the present invention is selected from amongst alginic acid, sodium alginate, calcium alginate, sodium calcium alginate, potassium alginate, ammonium alginate, magnesium alginate and the like. It is present in an amount from about 0.5% to about 10% by weight of the controlled release layer and preferably in an amount from about 1% to about 6% by weight of the controlled release layer.
The pharmaceutically acceptable gum used in the composition of the invention is selected from amongst those commonly known in the art such as guar gum, xanthan gum, gum karaya, tragacanth gum, gum acacia and the like. It is present in an amount from about 0.1% to about 10% by weight of the controlled release layer and preferably in an amount from about 0.5% to about 6% by weight of the controlled release layer.
Calcium salts when used along with certain polymers, especially the alginates, have been known to stabilize the matrix. In accordance with this, in a preferred embodiment,
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the said controlled release layer of the composition also contains a pharmaceutically acceptable calcium salt.
The calcium salt is selected from the group consisting of calcium sulphate, calcium phosphate, calcium carbonate and calcium chloride. It is present in an amount from about 0.1% to about 2.5% by weight of the controlled release layer preferably from about 0.1% to about 2% by weight of the controlled release layer.
The controlled release layer of the composition may further contain one or more pharmaceutically acceptable other excipients selected from amongst water-soluble and/or water dispersible diluents and lubricants.
The water dispersible or water soluble diluent selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. They are present from about 1% to about 28% by weight of the controlled release layer.
When the diluent is microcrystalline cellulose, it is present in an amount from about 5% to about 20% by weight of the controlled release layer.
When the diluent is dicalcium phosphate, it is present in an amount from about 1% to about 5% by weight of the controlled release layer.
The immediate release layer comprises at least one NNRTI selected from amongst nevirapine and efavirenz or their pharmaceutically acceptable derivatives
The immediate release layer may further comprise pharmaceutically acceptable excipients selected from the group consisting of diluents, binders, disintegrants, lubricants, coloring agents and the like.
The diluent is selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like. The
8

diluent is present in an amount from about 2% to about 15% by weight of the immediate release layer.
The binder is selected from amongst carboxymethylcellulose sodium, povidone, pregelatinised starch, gelatin, and the like. The binder is present in an amount from
r
about 1% to about 10% by weight of the immediate release layer.
The disintegrant is selected from amongst crospovidone, sodium starch glycolate, pregelatinised starch, carboxymethylcellulose sodium, croscarmellose sodium, starch and the like. It is present in an amount from about 0.5% to about 15% by weight of the immediate release layer.
Each layer may also contain lubricants selected from amongst those commonly known in the art such as magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like. It is present in an amount from about 0.1% to about 3% by weight of each layer.
The pharmaceutical compositions according to the invention may be prepared by procedures well known to those skilled in the art. According to a convenient method for the preparation of the granular blend for each layer, all the active ingredients along with the necessary excipients are mixed together and then compacted. The compacted mass is then comminuted to obtain the granules. Alternatively, the granules may also be prepared by the process of wet granulation using a suitable granulating agent.
The final granular blend of the two layers are either compressed into bilayered tablets on a compression machine suitable for such purpose or the controlled release layer may be present as a core and the immediate release layer is present as a coat around the core. The tablets so obtained may be further coated using a water-soluble polymer.
The above-mentioned process results in a pharmaceutical composition that contains three antiretroviral agents in one tablet suitable for once daily administration. The effective therapeutic dose of the active that can be administered include a combination
9

of 300 mg of lamivudine, 600 mg of zidovudine and 400 mg of nevirapine/ 600 mg of
efavirenz.
The composition of the invention and its advantages are explained hereunder in greater
detail in relation to non-limiting examples hereunder:
Example 1

Ingredients Weight (mg/tab)
Controlled Release Layer
Lamivudine 300.0
Zidovudine 600.0
Microcrystalline Cellulose 187.0
Hydroxypropyl methylcellulose 62.5
Sodium alginate 31.25
Guar gum 12.5
Calcium sulphate 3.75
Dicalcium phosphate 40.0
Magnesium Stearate 13.0
Immediate Release Layer
Nevirapine 400.0
Powdered Cellulose 52.5
Povidone K30 20.0
Sodium starch glycolate 15.0
Magnesium stearate 3.75
Sodium starch glycolate 5.0
Colloidal silicon dioxide 2.5
Magnesium stearate 1.25
Controlled release layer blend: Lamivudine, zidovudine, hydrophilic polymers, calcium sulphate, dicalcium phosphate, and microcrystalline cellulose were screened through 30 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The sized granules were blended with fines and lubricated.
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Immediate release layer blend: Nevirapine, cellulose, povidone and a first portion of sodium starch glycolate were screened through 40 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The granules were mixed with a second portion of sodium starch glycolate, colloidal silicon dioxide and lubricated.
Bilayered tablets: Both the above blends were compressed into bilayered tablets using a bilayered tablet compression machine.
Drug Release: The tablets were tested for release of all three actives using USP Type 1 Dissolution apparatus at an RPM of 100 and with 900ml of 0. IN HCL for the first 2 hrs and pH 6.8 Phosphate buffer afterwards.

Time % Drug released
Lamivudine Zidovudine Nevirapine
1 hr 29.1 17.1 87.1
2hrs 42.7 25.9
4hrs 55.5 42.3
8hrs 70.4 67.6
10 hrs 79.4 80.1
12hrs 85.3 88.2
11

Example 2

Ingredients Weight (mg/tab)
Controlled Release Layer
Lamivudine 300.0
Zidovudine 600.0
Microcrystalline Cellulose 187.0
Hydroxypropyl methylcellulose 62.5
Sodium alginate 31.25
Guar gum 12.5
Calcium sulphate 3.75
Dicalcium phosphate 40.0
Magnesium Stearate 13.0
Immediate Release Layer
Nevirapine 400.0
Powdered Cellulose 35.0
Povidone K30 20.0
Crospovidone 15.0
Sodium starch glycolate 20.0
Sunset Yellow FCF 2.5
Magnesium stearate 5.0
Colloidal silicon dioxide 2.5
The manufacturing procedure of Example 1 was followed.
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The release of the drugs was obtained as follows:

Time % Drug released
Lamivudine Zidovudine Nevirapine
1 hr - - 94.2
2hrs 47.0 26.8
4hrs 61.7 43.0
8hrs 71.3 64.8
10 hrs 79.1 75.4
12hrs 86.6 76.7
14hrs 90.5 89.2
Example 3

Ingredients Weight (mg/tab)
Controlled Release layer
Lamivudine 300.0
Zidovudine 600.0
Microcrystalline Cellulose 187.0
Hydroxypropyl methylcellulose 62.5
Sodium alginate 31.25
Guar gum 12.5
Calcium sulphate 3.75
Dicalcium phosphate 40.0
Magnesium Stearate 13.0
Immediate Release layer
Nevirapine 400.0
Powdered Cellulose 42.5
Povidone K30 10.0.
Crospovidone 20.0
Sodium starch glycolate 15.0
Magnesium stearate 3.75
Sodium starch glycolate 5.0
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Colloidal silicon dioxide 2.5
Magnesium stearate 1.25
The manufacturing procedure of Example 1 was followed The release obtained of the drugs is as follows:

Time % Drug released
Lamivudine Zidovudine Nevirapine
L hr 33.8 21.3 97.1
2hrs 50.5 31.0
4hrs 67.8 49.5
8hrs 79.2 74.0
10 hrs 86.2 83.7
12hrs 90.6 90.1
Example 4

Ingredients Weight (mg/tab)
Core
Lamivudine 300.0
Zidovudine 600.0
Microcrystalline Cellulose 187.0
Hydroxypropyl methylcellulose 62.5
Sodium alginate 31.25
Guar gum 12.5
Calcium sulphate 3.75
Dicalcium phosphate 40.0
Magnesium Stearate 13.0
Coat
Nevirapine 400.0
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Powdered Cellulose 32.5
Povidone K30 20.0
Crospovidone 20.0
Sodium starch glycolate 15.0
Magnesium stearate 3.75
Sodium starch glycolate 5.0
Colloidal silicon dioxide 2.5
Magnesium stearate 1.25
Sunset Yellow FCF 2.5
Core: Lamivudine, zidovudine, hydrophilic polymers, calcium sulphate, dicalcium phosphate, and microcrystalline cellulose were screened through 30 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The sized granules were blended with fines, lubricated and compressed into a tablet.
Coat: Nevirapine, cellulose, povidone and a first portion of sodium starch glycollate were screened through 40 no. mesh and mixed with magnesium stearate. The blend was compacted and the slugs obtained were milled to form granules. The granules were mixed with a second portion of sodium starch glycolate, colloidal silicon dioxide, lubricated and compression coated over the core tablet.
The release obtained of the drugs is as follows:

Time % Drug released
Lamivudine Zidovudine Nevirapine
1 hr 37.4 22.8 80.8
2hrs 54.1 32.1
4hrs 66.5 47.5
8hrs 82.5 76.8
10 hrs 92 87.3
12hrs 97.3 93.7
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A single dose fed study was conducted using the tablets of Example 1 against a commercially available immediate release combination of the three drugs. The results of the study are tabulated in Table 1.

Test: Lamivudine 300 mg (as ER) + Zidovudine 600mg (as ER) + Nevirapine 400mg (OD) tablets Reference: Lamivudine 150 mg +Zidovudine 300 mg + Nevirapine 200 mg (IR/BD) tablets
Lamivudine Zidovudine Nevirapine Lamivudine Zidovudine Nevirapine
Cmax(mcg/ml) 1.79 1.54 5.17 1.51 1.49 2.88
AUC(O-1) (mcg.hr/ml) 12.18 7.45 36.37 5.84 3.12 18.55
T1/2 (hr) 5.67 2.74 29.34 2.98 0.72 17.82
The results indicate that the composition of the present invention achieves a Cmax of Lamivudine and Zidovudine, which is equivalent to that obtained when the same drugs are administered in immediate release form. However, the invention also succeeds in increasing the AUCo-t values and the half lives of all the drugs in vivo.
It is thus apparent from the above exemplary illustrations that the pharmaceutical composition of the invention serves as a three-drug antiretroviral combination for once daily dosage for a combination treatment especially of NRTIs and NNRTIs. The once daily dosage form of the invention is simple and cost-effective and would serve in reducing the pill burden and frequency of administration and favour patient compliance with the desired drug regime for effective treatment.
16

WE CLAIM:
1. An antiretroviral pharmaceutical composition comprising a selective
combination of
i. a controlled release formulation comprising :
a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof, and
c. a mixture of hydrophilic polymers, said polymers being selected from the
group consisting of cellulose ethers, polyuronic acids and
pharmaceutically acceptable gums or mixtures thereof and
d. a pharmaceutically acceptable calcium salt.
ii. an immediate release formulation comprising atleast one selective Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) drug or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients.
2. An antiretroviral pharmaceutical composition as claimed in claim 1 wherein said NNRTI drug is selected from nevirapine, and efavirenz.
3. An antiretroviral pharmaceutical composition as claimed in claim 1 which is in the form of two separate layers of said controlled release and the immediate release formulation
4. An antiretroviral pharmaceutical composition as claimed in claim 1 which is in the form of a core of said controlled release formulation and an outer coat of the immediate release formulation.
5. An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a bilayer selective combination of
i. a first layer of controlled release formulation comprising :
a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof, and
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c. a mixture of hydrophilic polymers, said polymers being selected from
the group consisting of cellulose ethers, polyuronic acids and
pharmaceutical^ acceptable gums or mixtures thereof and
d. a pharmaceutical^ acceptable calcium salt.
a second layer of an immediate release formulation wherein said NNRTI is nevirapine or a pharmaceutical^ acceptable derivative thereof along with pharmaceutically acceptable excipients.
An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a selective combination of
a core having a controlled release formulation comprising:
a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof, and
c. a mixture of hydrophilic polymers, said polymers being selected from
the group consisting of cellulose ethers, polyuronic acids and
pharmaceutically acceptable gums or mixtures thereof and
d. a pharmaceutically acceptable calcium salt.
an outer coat of an immediate release formulation wherein said NNRTI is nevirapine or a pharmaceutically acceptable derivative thereof and pharmaceutically acceptable excipients.
An antiretroviral pharmaceutical composition as claimed in claim 1 comprising
a selective bilayer combination of
i. a first layer of a controlled release formulation comprising :
a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof,
and
c. a mixture of hydrophilic polymers, said polymers being selected
from the group consisting of cellulose ethers, polyuronic acids and
pharmaceutically acceptable gums or mixtures thereof and
d. a pharmaceutically acceptable calcium salt.
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ii. a second layer of an immediate release formulation wherein said NNRTI is efavirenz or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients.
An antiretroviral pharmaceutical composition as claimed in claim 1 comprising a selective combination of
a core of controlled release formulation comprising :
a. lamivudine or a pharmaceutically acceptable derivative thereof,
b. zidovudine or a pharmaceutically acceptable derivative thereof, and
c. a mixture of hydrophilic polymers, said polymers being selected from
the group consisting of cellulose ethers, polyuronic acids and
pharmaceutically acceptable gums or mixtures thereof and
d. a pharmaceutically acceptable calcium salt.
an outer coat of an immediate release formulation wherein said NNRTI is efavirenz or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients.
The composition as claimed in anyone of claims 1 to 8 wherein the amount of lamivudine or pharmaceutically acceptable derivative thereof is from about 50 mg to about 500 mg.
The composition as claimed in claim 9 wherein the amount of lamivudine or pharmaceutically acceptable derivative thereof is about 300 mg.
The composition as claimed in anyone of claims 1 to 8 wherein the amount of zidovudine or pharmaceutically acceptable derivative thereof is from about 100 mg to about 1000 mg.
The composition as claimed in claim 11 wherein the amount of zidovudine or pharmaceutically acceptable derivative thereof is 600 mg.
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13. The composition as claimed in anyone of claims 1 to 12 wherein the amount of nevirapine /efavirenz or pharmaceutically acceptable derivative thereof is from about 100 mg to about 1000 mg.
14. The composition as claimed in claim 13 wherein the amount of nevirapine or pharmaceutically acceptable derivative thereof is about 400 mg.
15. The composition as claimed in claim 13 wherein the amount of efavirenz or pharmaceutically acceptable derivative thereof is about 600 mg.

16. A composition as claimed in anyone of claims 1 to 15 wherein the cellulose ether is selected from amongst hydroxypropyl cellulose, hydoxypropyl methylcellulose, carboxy methylcellulose, sodium carboxymethylcellulose, ethyl cellulose, methyl cellulose, hydroxy ethyl cellulose and the like.
17. A composition as claimed in claim 16 wherein the cellulose ether is hydroxypropyl methylcellulose and is present in an amount from about 2% to about 12% by weight of the controlled release formulation.
18. A composition as claimed in claim 17 wherein the cellulose ether is hydroxypropyl methylcellulose and is present in an amount from about 3% to about 8% by weight of the controlled release formulation.
19. A composition as claimed in anyone of claims 1 to 18 wherein the polyuronic acid is selected from amongst alginic acid, sodium alginate, calcium alginate, sodium calcium alginate, potassium alginate, ammonium alginate, magnesium alginate and the like.
20. A composition as claimed in claim 19 wherein the polyuronic acid is sodium alginate and is present in an amount from about 0.5% to about 10% by weight of the controlled release formulation.
20

21. A composition as claimed in claim 20 wherein the polyuronic acid is sodium alginate and is present in an amount from about 1% to about 6% by weight of the controlled release formulation.
22. A composition as claimed in anyone of claims 1 to 21 wherein the pharmaceutically acceptable gum is selected from amongst guar gum, xanthan gum, gum karaya, tragacanth gum, gum acacia and the like.
23. A composition as claimed in claim 22 wherein the pharmaceutically acceptable gum is guar gum and is present in an amount from about 0.1% to about 10% by weight of the controlled release formulation.
24. A composition as claimed in claim 23 wherein the pharmaceutically acceptable gum is guar gum and is present in an amount from about 0.5% to about 6% by weight of the controlled release formulation.
25. The composition as claimed in anyone of claims 1 to 24 wherein the pharmaceutically acceptable calcium salt is selected from the group consisting of calcium sulphate, calcium phosphate, calcium carbonate and calcium chloride.
26. A composition as claimed in claim 25 wherein the pharmaceutically acceptable calcium salt is calcium sulphate and is present in an amount from about 0.1% to about 2.5% by weight of the controlled release formulation.
27. A composition as claimed in claim 26 wherein the pharmaceutically acceptable calcium salt is calcium sulphate and is present in an amount from about 0.1% to about 2% by weight of the controlled release formulation.
28. The composition as claimed in anyone of claims 1 to 27 wherein the controlled release formulation further comprises at least one water dispersible or water soluble diluent selected from amongst microcrystalline cellulose, dicalcium
21

phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like.
29. The composition as claimed in claim 28 wherein the diluent is present from about 1% to about 28% by weight of the controlled release formulation
30. The composition as claimed in claim 29 wherein the diluent is microcrystalline cellulose.
31. The composition as claimed in claim 30 wherein the amount of microcrystalline cellulose is from about 5% to about 20% by weight.
32. The composition as claimed in claim 29 wherein the diluent is dicalcium phosphate.
33. The composition as claimed in claim 32 wherein the amount of dicalcium phosphate is from about 1% to about 5% by weight.
34. The composition as claimed in anyone of claims 1 to 33 wherein the controlled release formulation further comprises at least one lubricant selected from amongst magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like.
35. The composition as claimed in claim 34 wherein the lubricant is present from about 0.1% -3% by weight.
36. The composition as claimed in anyone of claims 1 to 35 wherein the immediate release formulation comprises from about 10% to about 95% by weight of nevirapine or a pharmaceutical^ acceptable derivative thereof along with one or more pharmaceutical^ acceptable excipients selected from amongst diluents, binders, disintegrants, lubricants, coloring agents and the like.
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37. A composition as claimed in claim 36 wherein the diluent is selected from amongst microcrystalline cellulose, dicalcium phosphate, calcium carbonate, lactose, powdered cellulose, starch, mannitol and the like.
38. A composition as claimed in claim 37 wherein the diluent is powdered cellulose and is present in an amount from about 2% to about 15% by weight of the immediate release formulation
39. A composition as claimed in claim 36 wherein the binder is selected from amongst carboxymethylcellulose sodium, povidone, pregelatinised starch, gelatin or mixtures thereof.
40. A composition as claimed in claim 39 wherein the binder is present in an amount from about 1% to about 10% by weight of the immediate release formulation
41. A composition as claimed in claim 36 wherein the disintegrant is selected from amongst crospovidone, sodium starch glycolate, pregelatinised starch, carboxymethylcellulose sodium, croscarmellose sodium, starch and mixtures thereof.
42. A composition as claimed in claim 41 wherein the disintegrant is present in an amount from about 0.5% to about 15% by weight of the immediate release formulation.
43. The composition as claimed in claim 36 wherein the lubricant is selected from amongst magnesium stearate, calcium stearate, stearic acid, silicon dioxide, talc and the like.
44. The composition as claimed in claim 43 wherein the lubricant is present from about 0.1% -3% by weight.
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45. A process for the preparation of an antiretroviral pharmaceutical composition comprising (i) providing a controlled release formulation by mixing together active ingredients selected from amongst lamivudine, zidovudine or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant, (ii) blending an immediate release formulation obtained of at least the NNRTI is blended with pharmaceutically acceptable excipients and (iii) obtaining the composition therefrom by compressing the resulting blends into bilayered tablets.
46. A process for the preparation of an antiretroviral pharmaceutical composition comprising (i) providing a core of said controlled release formulation by mixing together active ingredients selected from amongst lamivudine, zidovudine or mixtures thereof with hydrophilic polymers selected from amongst cellulose ethers, polyuronic acids, pharmaceutically acceptable gums or mixtures thereof, and with a pharmaceutically acceptable calcium salt, optionally a diluent and a lubricant, (ii) providing an outer coat of an immediate release formulation obtained of at least the NNRTI selected from Nevirapine, and Efavirenz blended with pharmaceutically acceptable excipients and (iii) obtaining the composition therefrom by applying the said outer coat over the said core by compression coating.
47. A process as described in claim 45 or 46 wherein each blend is dry granulated prior to compression.
48. A process as described in claim 45 or 46 wherein each blend is wet granulated
prior to compression.
49. A method of reducing the pill burden in a patient suffering from HIV infection
and /or Acquired Immunodeffieciency Syndrome by administering a three drug
antiretroviral pharmaceutical composition which comprises of a combination of
24

lamivudine and zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component.
50. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodeficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a Cmax of about 1.2 to 2.0 meg / ml for Lamivudine, about 1.0 to 2.0 meg / ml for Zidovudine and about 4.5 to 5.5 meg /ml for Nevirapine.
51. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a AUCo-t of about 8 to 14 mcg.hr / ml for Lamivudine, about 5 to9 mcg.hr / ml for Zidovudine and about 32 to 40 mcg.hr / ml for Nevirapine.
52. A method of increasing the in vivo half life of Lamivudine and Zidovudine while not affecting the half life of Nevirapine and thus reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug antiretroviral composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component.
53. The method of Claim 51 wherein the composition upon administration to the said patient provides a t1/2 of about 5 hrs for Lamivudine, about 2 hrs for Zidovudine and about 29 hrs for Nevirapine.
54. A method of reducing the pill burden in a patient suffering from HIV infection and / or Acquired Immunodefficiency Syndrome by administering a three drug
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antiretrovirai composition which comprises of Lamivudine and Zidovudine as a controlled release component and nevirapine or efavirenz as an immediate release component wherein the composition upon administration to the said patient provides a Cmax of the said drugs in the controlled release component which is substantially similar to that provided by immediate release compositions of the said drugs when taken simultaneously, sequentially or concurrently.
Dated this 22nd day of April 2006

OfS.MAJUMOARaCO.
(Applicants Agent)
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ABSTRACT
A CONTROLLED RELEASE PHARMACEUTICAL COMPOSITION AND A PROCESS FOR PREPARING THE SAME
A three-drug antiretrovial pharmaceutical composition having a selective combination of a controlled release active formulation and an immediate release active formulation for once daily administration. The composition provides desired dosages of the actives lamivudine, zidovudine or pharmaceutically acceptable derivatives thereof, and the immediate release formulation including atleast one selective Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI), preferably nevirapine or a pharmaceutically acceptable derivative thereof along with pharmaceutically acceptable excipients. The once daily composition would favour patient compliance and effective treatment. A method of reducing the pill burden in a patient suffering from HIV infection and /or Acquired Immunodeffieciency Syndrome by administering a once daily dose of the three-drug antiretroviral pharmaceutical composition.
27

Documents:

485-mumnp-2006-abstarct.pdf

485-mumnp-2006-abstract(27-2-2008).doc

485-mumnp-2006-abstract(27-2-2008).pdf

485-mumnp-2006-abstract.doc

485-mumnp-2006-cancelled pages(27-2-2008).pdf

485-mumnp-2006-claims(granted)-(27-2-2008).doc

485-mumnp-2006-claims(granted)-(27-2-2008).pdf

485-mumnp-2006-claims.pdf

485-mumnp-2006-correspondance-other.pdf

485-mumnp-2006-correspondance-received.pdf

485-MUMNP-2006-CORRESPONDENCE 9-7-2008.pdf

485-MUMNP-2006-CORRESPONDENCE(25-08-2008).pdf

485-mumnp-2006-correspondence(27-2-2008).pdf

485-MUMNP-2006-CORRESPONDENCE(6-8-2008).pdf

485-mumnp-2006-correspondence(ipo)-(27-2-2007).pdf

485-mumnp-2006-description (complete).pdf

485-mumnp-2006-form 1(25-4-2006).pdf

485-mumnp-2006-form 18(22-8-2006).pdf

485-mumnp-2006-form 2(granted)-(27-2-2008).doc

485-mumnp-2006-form 2(granted)-(27-2-2008).pdf

485-mumnp-2006-form 3(25-4-2006).pdf

485-mumnp-2006-form 5(25-4-2006).pdf

485-mumnp-2006-form-1.pdf

485-mumnp-2006-form-2.doc

485-mumnp-2006-form-2.pdf

485-mumnp-2006-form-26.pdf

485-mumnp-2006-form-3.pdf

485-mumnp-2006-form-5.pdf

485-mumnp-2006-power of attorney(14-3-2006).pdf

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Patent Number

222088

Indian Patent Application Number

485/MUMNP/2006

PG Journal Number

39/2008

Publication Date

26-Sep-2008

Grant Date

18-Jul-2008

Date of Filing

25-Apr-2006

Name of Patentee

LUPIN LIMITED

Applicant Address

159, CST ROAD, KALINA, SANTACRUZ (EAST), MUMBAI 400 098

Inventors:

#	Inventor's Name	Inventor's Address
1	SEN HIMADRI	LUPIN RESEARCH PARK, 46/47A, NANDE VILLAGE, TALUKA MULSHI, PUNE 411 042
2	JAYANTHI, Suryakumar	Lupin Research Park, 46/47A, Nande Village, Taluki Mulshi, Pune - 411 042, State of Maharashtra, India.
3	RAGHAVAN, Vineeth	Lupin Research Park, 46/47A, Nande Village, Taluka Mulshi, Pune - 411 042, State of Mahatrashtra, India
4	ARRA, Ganga, Srinivas	Lupin Research Park, 46/47A, Nande Village, Taluka Mulshi, Pune - 411 042, State of Mahatrashtra, India

PCT International Classification Number

A61K31/70 A61K31/495

PCT International Application Number

PCT/IN2004/000306

PCT International Filing date

2004-09-29

PCT Conventions:

#	PCT Application Number	Date of Convention	Priority Country
1	417/MUM/2003	2003-10-01	India