Solubilizing Excipients in Oral and Injectable Formulations-REVIEW-VERY IMPORTANT
Solubilizing Excipients in Oral and Injectable Formulations-REVIEW-VERY IMPORTANT
Solubilizing Excipients in Oral and Injectable Formulations-REVIEW-VERY IMPORTANT
Review Article
INTRODUCTION
The excipients used to solubilize drugs in oral and injectable dosage forms include pH modifiers, water-soluble organic solvents, surfactants, water-insoluble organic solvents,
medium-chain triglycerides, long-chain triglycerides, cyclodextrins, and phospholipids. This review focuses on the solubilizing excipients in commercially available pharmaceutical
solution formulations. The published information on oral formulations includes only the list of excipients (13), whereas
the published information on injectable formulations includes
the exact amounts of the excipients (210). Two key aspects
of any successful solution formulation are solubility and stability. The solvent system chosen must also be able to solubilize the drug at the desired concentration and must provide
1
an environment where the drug has sufficient chemical stability. Sufficient stability is normally defined as <510% degradation over 2 years under the specified storage conditions,
but the topic of stability (11) is beyond the scope of this
review.
THEORY
Solubility at constant temperature and pressure involves
the free energy of the solid (GsolidT, P) and the free energy of
the molecules in solution (GsolutionT, P). The free energy of
a specific solid is fixed (i.e., a property of that solid), but the
free energy of the molecules in solution is a function of the
solvent and the solution concentration (N). When the solution free energy is less than the solid free energy, molecules
will dissolve from the solid until the free energy of the molecules in solution equals the free energy of the solid. At saturation equilibrium solubility, the free energy of the solid
equals the free energy of the molecules in solution, Eq. (1).
GsolidT,P = GsolutionT,P Nsaturation
[1]
201
202
Strickley
[2]
[3]
Excipients that solubilize a molecule via specific interactions such as complexation interact with the molecule in a
noncovalent manner that lowers the chemical potential of the
molecules in solution. These noncovalent bulk and specific
solubility-enhancing interactions are the basis of the phenomenon that like dissolves like and include van der Waals
forces, hydrogen bonding, dipoledipole and iondipole interactions, and in certain cases favorable electromagnetic interactions.
If the molecule is ionizable, then pH adjustment can be
used to increase water solubility because the ionized molecular species has higher water solubility than its neutral species.
Equations (4) and (5) show that the total solubility, ST, is a
function of the intrinsic solubility, So, and the difference between the molecules pKa and the solution pH. The intrinsic
solubility is the solubility of the neutral molecular species.
Weak acids can be solubilized at pHs above their acidic pKa,
and weak bases can be solubilized at pHs below their basic
pKa. For every pH unit away from the pKa, the weak acid/
base solubility increases 10-fold. Thus, solubility enhancements of >1000-fold above the intrinsic solubility can be
achieved as long as the formulation pH is at least 3 U away
from the pKa. Adjusting solution pH is the simplest and most
common method to increase water solubility in injectable
products (510), but is not a major focus of this review because the excipients used to alter the solution pH are commonly used buffers (58).
For a weak acid
ST = So (1 + 10pH-pKa)
[4]
ST = So (1 + 10
[5]
pKa-pH
Cosolvents are mixtures of miscible solvents and are often used to solubilize water-insoluble drugs. Molecules with
no ionizable group(s) cannot be solubilized by pH adjustment, and thus a cosolvent approach is often used. Solubility
typically increases logarithmically with a linear increase in the
fraction of organic solvent(s) as illustrated in Eq. (6). If the
cosolvent is composed of one organic solvent and water (i.e.,
a binary mixture), the solubility can be empirically described
as in Eq. (6) by assuming that the total free energy of the
system is equal to the sum of the free energy of the individual
components (12),
log Sm = flog Sc + (1 f)log Sw
[6]
[7]
[8]
where
and acw and acc are the activity coefficients of the molecule in
water and solvent, respectively. The parameter, , which is
slope of the plot of log Sm vs. f, can be used as a measure of
the solubilization potential of a given cosolvent.
If the cosolvent mixture contains more than two organic
solvents (i.e., a ternary or higher cosolvent mixture such as a
microemulsion) the total drug solubility can be approximated
by a summation of solubilization potentials as in Eqs. (9)
and (10):
log (SmSw) =
log Sm = log Sw
(f )
+ (f )
i i
i i
[9]
[10]
[11]
[12]
ORAL FORMULATIONS
The vast majority of commercially available oral formulations are solid dosage forms such as tablets or capsules, but
there are many solubilized oral formulations such as oral solutions, syrups, elixirs, or solutions filled into soft or hard
capsules. The reasons for pursuing a solubilized oral formulation include enhancing the oral bioavailability of a poorly
water-soluble molecule, a measurable formulation for dose
modification, a formulation for patients who cannot swallow
tablets or capsules, or a solution for a sore throat/cold remedy. Table I is a list of selected, commercially available solubilized oral formulations arranged alphabetically by drug
203
Table I. List of Selected Commercially Available Solubilized Formulations for Oral Administration
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Water
solubility
Commercial oral
formulation
Amprenavir/
Agenerase/
Glaxo SmithKline/
HIV
36 g/ml
(34)
Bexarotene/
Targretin/
Ligand/
Antineoplastic
Insoluble in
water (2)
Calcitrol/
Rocaltrol/
Roche/
Calcium regulator
Relatively
insoluble
in water
(2)
Clofazimine/
Lamprene/
Geigy (1960)/
Antileprosy
Virtually
insoluble
in water
(3)
Cyclosporin A/
I. Neoral/
Novartis/
Immunosuppressant,
prophylaxis for organ
transplant rejection
Slightly
soluble in
water (23)
Excipients
1. TPGS (280 mg in
the 150 mg capsule)
PEG 400 (247, 740
mg)
Propylene glycol
(19, 57 mg)
2. TPGS (12%)
PEG 400 (17%)
Propylene glycol
(55%)
Sodium chloride
Sodium citrate
Citric acid
Flavors/sweeteners
PEG 400
Polysorbate 20
Povidone
BHA
1. Ethanol 11.9%
Corn oil-mono-di-triglycerides
Polyoxyl 40 hydrogenated castor oil (Cremophor RH 40)
Glycerol
Propylene glycol
dl--tocopherol
2. Ethanol 11.9%
Corn oil-mono-ditriglycerides
Polyoxyl 40 hydrogenated castor oil (Cremophor RH 40)
dl--tocopherol
Propylene glycol
204
Strickley
Table I. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Water
solubility
Commercial oral
formulation
1. Soft gelatin capsule
25, 50, 100 mg
2. Oral solution 100
mg/ml
Oral bioavailability
is <1089% (2)
Cyclosporin A/
II. Sandimmune/
Novartis/
Immunosuppressant,
prophylaxis for organ
transplant rejection
Cyclosporin A/
III. Gengraf/
Abbott/
Immunosuppressant,
prophylaxis for organ
transplant rejection
Excipients
1. Ethanol 12.7%
Corn oil
Glycerol
Polyoxyethylated
glycerides (Labrafil M-2125CS)
2. Ethanol 12.5%
Olive oil
Polyoxyethylated
oleic glycerides
(Labrafil
M-1944CS)
Further dilute with
milk, chocolate
milk, or orange
juice before use.
Ethanol 12.8%
Polyethylene glycol
Polyoxyl 35 castor
oil (Cremophor
EL)
Polysorbate 80
Propylene glycol
Sorbitan monooleate
Digoxin/Lanoxin/
Glaxo SmithKline/
Treatment of mild to
moderate heart failure
Practically
insoluble
in water (2)
1. PEG 400
Ethanol 8%
Propylene glycol
2. Ethanol 10%
Methyl paraben
0.1%
Citric acid
Flavor
Propylene glycol
Sodium phosphate
Sucrose
Doxercalciferol/
Hectorol/
Bone Care/
Management of secondary
hyperparathyroidism
associated with
chronic renal dialysis
Relatively
insoluble
in water (2)
BHA
Ethanol
Fractionated triglyceride of coconut oil (medium-chain triglyceride)
Dronabinol/
Marinol/
Roxane and Unimed/
Anorexia or nausea
Insoluble in
water, is an
oil at room
temperature. (2)
Sesame oil
205
Table I. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Water
solubility
Commercial oral
formulation
Excipients
Dutasteride/
Avodart/
Glaxo SmithKline/
Treatment of benign
prostrate hyperplasia
Insoluble
1. Soft gelatin
in water
capsule
(Ref. 3,
0.5 mg
product
Oral bioavailabilinsert, www.
ity is 4094%
rxlist.com)
(2)
Etoposide/
VePesid/
Bristol-Myers-Squibb/
Antineoplastic
Sparingly
soluble
in water (2)
Citric acid
Glycerin
Water
PEG 400
Beeswax
BHA
EDTA
Hydrogenated
soybean oil
flakes
Hydrogenated
vegetable oils
Soybean oil
Oral solution
10 mg/ml
pH2
Water
HP--CD 40%
Propylene glycol
2.5%
Sodium saccharin
Sorbitol
Flavors
Isotretinoin/
Accutane/
Roche/
Antiachne
Itraconazole/
Sporanox/
Ortho Biotech and
Janssen/
Antifungal
Lopinavir and
Ritonavir/
Kaletra/
Abbott/
HIV
Insoluble
in water (2)
1. Soft gelatin
capsule
133.3 mg lopinavir and 33.3 mg
ritonavir
2. Oral solution
80 mg/ml lopinavir and 20 mg/
ml ritonavir
1. Oleic acid
Polyoxyl 35 castor
oil (Cremophor
EL)
Propylene glycol
2. Alcohol (42.2%
v/v)
Glycerin
Polyoxyl 40 hydrogenated castor oil (Cremophor RH 40)
Propylene glycol
Sodium chloride
Sodium citrate/
citric acid
Water
Flavors/sweeteners
206
Strickley
Table I. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Water
solubility
Commercial oral
formulation
Excipients
Loratadine Claratin/
Schering/
Relief of allergies
Not soluble
in water (2)
Syrup
1 mg/ml
pH 2.53.1
Citric acid
EDTA
Flavor
Glycerin
Propylene glycol
Sodium benzoate
Sugar
Water
Nifedipine/
Procardia/
Pfizer/
Antianginal
Practically
insoluble
in water (2)
Glycerin
Peppermint oil
PEG 400
Sodium saccharin
Nimodipine/
Nimotop/
Bayer/
Vasodilator
Practically
insoluble
in water (2)
Glycerin
Peppermint oil
PEG 400
Phenobarbital/
Donnatal/
A.H. Robbins/
Anticonvulsant and
sedative
1 mg/ml
Elixir
3.5 mg/ml
Ethanol 23%
Glucose
Sodium saccharin
Water
Progesterone/
Prometrium/
Solvay/
Hormone
Practically
insoluble
in water (2)
Peanut oil
Risperidone/
Resperdal/
Janssen/
Antipsychotic
Practically
insoluble
in water,
free soluble
in 0.1 N HCl
(2)
Oral solution
1 mg/ml
Tartaric acid
Benzoic acid
Sodium hydroxide
Water
Ritonavir/
Norvir/
Abbott/
HIV
1. Soft gelatin
capsule 100 mg
2. Oral solution
80 mg/ml
1. BHT
Ethanol
Oleic acid
Polyoxyl 35 castor oil (Cremophor EL)
2. Ethanol
Water
Polyoxyl 35 castor oil (Cremophor EL)
Propylene glycol
Citric acid
Flavors/sweetener/dye
207
Table I. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Water
solubility
Commercial oral
formulation
Excipients
Saquinavir/
Fortovase/
Roche/
HIV (protease
inhibitor)
Insoluble in
aqueous
medium
(2)
Medium-chain
mono- and diglycerides
Povidone
dl--tocopherol
Sirolimus/
Rapamune/
Wyeth-Ayerst/
Immunosuppressant
Insoluble in
water (2)
Oral solution 1
mg/ml
Bioavailability
14% (2)
Phosal 50 PG
(Phosphatidylcholine
Propylene glycol
Mono- and
diglycerides
Ethanol 1.52.5%
Soy fatty acids
Ascorbyl
palmitate)
Polysorbate 80
Beeswax
BHA
EDTA
Hydrogenated
soybean oil flakes
Hydrogenated
vegetable oils
Soybean oil
Capsule 250 mg
Corn oil
Tretinoin/
Vesanoid/
Roche/
Antineoplastic
Valproic acid/
Depakene/
Abbott/
Antiepileptic
name and also shows a drugs chemical structure, water solubility, the marketed formulation, and the list of excipients.
Most solubilized oral formulations are either filled into
gelatin capsules that range in size from 0.195.0 ml (15) or are
oral solutions or elixirs that are usually intended for patients
who cannot swallow a tablet or capsule, such as pediatric and
elderly patients, or are used in dose-reduction regimens.
Gelatin capsules dissolve in water, thus only the minimal
amount of water is used in order to dissolve water-soluble
excipients such as sweeteners and/or buffers. In addition, ethanol is typically minimized in soft gelatin capsule formulations
because ethanol can diffuse through soft gelatin films (15).
Recently, there has been interest in polymer-based capsules, such as hydroxypropy lmethylcellulose (16,17) or polyvinylalcohol hard capsules (18,19), in order to avoid animalderived components and to accommodate some religious and
dietary considerations. Commercially available health products have used hydroxypropyl methylcellulose capsules since
1997, such as some of the products from Arkopharma in
France (20). Injection-molded polyvinylalcohol hard capsules
offer the advantages of controlled release, the ability to laser
seal the cap and body, and close control of the size, shape, and
dimensions of the capsule (19). To date, there appears to be
no commercially available pharmaceutical products that use
Slightly soluble
in water (1.3
mg/ml) (2)
208
ter-soluble antineoplastic agent (2), is solubilized in a cosolvent mixture of PEG 400, glycerin, citric acid, and water in 50
mg VePesid soft gelatin capsules, and the oral bioavailability
is 2575% (21). The cardiotonics, nifedipine and nimodipine,
are practically insoluble in water (2) and are solubilized in a
cosolvent mixture of glycerin, peppermint oil, and PEG 400 in
1030 mg Procardia and Nimotop soft gelatin capsules, respectively. Nifedipine is fully absorbed from Procardia, and
the oral bioavailability is proportional to dose over 1030 mg
(21). The oral bioavailability of nimodipine from Nimotop is
13% due to first-pass metabolism (21). Digoxin is solubilized
in a cosolvent mixture of propylene glycol, PEG 400, and 8%
ethanol in 200-g soft gelatin capsules. The oral bioavailability of digoxin from the solid tablets is 6080%, but increases
to 90100% from the solubilized oral dosage form along with
higher peak serum concentrations (21).
Oral solution and elixir formulations can be simple or
they can be quite complex, involving many types of excipients
including water-soluble organic solvents, water-insoluble organic solvents, surfactants, buffers, sugars, flavors, sweeteners, aromatics, dyes, and with/without water. Organic cosolvents are normally used to solubilize poorly water-soluble
drugs to the desired concentration in oral solutions. The exact
amount of solvent is usually not reported, but in those formulations where the amount is reported, the maximum
amount of solvent used is up to 55% propylene glycol (the
higher percentages are contraindicated in children younger
than 4 years of age), up to 17% PEG 400, and up to 42%
ethanol. Most over-the-counter oral solution formulations
contain polyethylene glycol, propylene glycol, and/or glycerin
whereas a few products contain polysorbate 20 and/or poloxamer 407 (i.e., Good Sense antihistamine liquid medication, childrens Benadryl, Cepacol sore throat, and childrens
Sudafed).
Ritonavir, an HIV protease inhibitor with peptide-like
structure, has an intrinsic water solubility of 1.0 g/ml and
two weakly basic thiazole groups with pKas of 1.8 and 2.6 (22)
(too low for pH adjustment) and is solubilized in a cosolvent
mixture of propylene glycol, ethanol, water, the surfactant
Cremophor EL, and peppermint oil to 80 mg/ml in the Norvir
oral solution. A similar cosolvent mixture of propylene glycol,
42% ethanol, water, glycerin, the surfactant Cremophor RH
40, and peppermint oil is used to cosolubilize ritonavir to 20
mg/ml and lopinavir, a non-ionizable water-insoluble HIV
protease inhibitor, to 80 mg/ml in the Kaletra oral solution.
Sirolimus is a non-ionizable and water-insoluble immunosuppressant, but is solubilized to 1 mg/ml in a solution that
is entirely organic. Sirolimus is solubilized in the Rapamune
oral solution using the surfactant polysorbate 80 and a proprietary solution, Phosal 50 PG, which is composed of phosphatidylcholine, propylene glycol, mono- and diglycerides,
1.52.5% ethanol, soy fatty acids, and ascorbyl palmitate. The
oral bioavailability of sirolimus after administration of the
Rapamune oral solution is approximately 14% and is increased to approximately 20% when given with a high fat diet
(2). Rapamune is also available in tablets that have solid
nanoparticles of sirolimus, from which the oral bioavailability
is 27% higher than with the oral solution (2).
Elixirs are sweetened hydroalcoholic oral solutions that
are specially formulated for oral use in infants and children.
Digoxin, a non-ionizable cardiotonic glycoside, is practically
insoluble in water and is solubilized in propylene glycol, 10%
Strickley
ethanol, flavor, sweetener, preservative, and buffers to 50 g/
ml in Lanoxin Elixir Pediatric from which the oral bioavailability is 7085% (21). Phenobarbital, an anticonvulsant and
sedative with an intrinsic water solubility of 1 mg/ml (23), is
solubilized in water, 23% ethanol, glucose, sodium saccharin,
and flavors to 3.5 mg/ml in Donnatal Elixir.
Water-Insoluble Organic Solvents in Oral Formulations
The water-insoluble solvents used in commercially available solubilized oral formulations include the long-chain triglycerides peanut oil, corn oil, soybean oil, sesame oil, olive
oil, peppermint oil, hydrogenated vegetable oils, hydrogenated soybean oil, and the medium-chain triglycerides derived
from coconut oil and palm seed. Other water-insoluble solvents include beeswax, dl--tocopherol (Vitamin E), and
oleic acid. Most oily oral formulations are filled into soft gelatin capsules, but some are oral solutions.
Progesterone is a water-insoluble steroid and is solubilized in peanut oil in 100 mg Prometrium soft gelatin capsules.
Dronabinol, also known as -9-tetrahydrocannabinol, a natural component of cannabis used in the treatment of nausea or
vomiting associated with cancer chemotherapy and also as an
appetite stimulant to treat AIDS wasting syndrome, is a yellowish oil at room temperature that is solubilized by sesame
oil in 2.5, 5, and 10 mg Marinol soft gelatin capsules. Dronabinol is almost completely absorbed (9095%), but the oral
bioavailability is 1020% due to first-pass hepatic metabolism
and high lipid solubility (21). Calcitrol, used in the treatment
of hypocalcemia, is non-ionizable and water-insoluble, but is
solubilized in a fractionated triglyceride of coconut oil in 0.25
and 0.5 g Rocaltrol soft gelatin capsules. Calcitrol is also
formulated in a fractionated triglyceride of palm seed oil in
the 1 g/ml Rocaltrol oral solution. Doxercalciferol is similar
to calcitrol in chemical structure, clinical application, and formulation, and is solubilized in a fractionated medium-chain
triglyceride of coconut oil and ethanol in 2.5 g Hectorol soft
gelatin capsules. Valproic acid, an anticonvulsant with an intrinsic water solubility of 1.3 mg/ml (2), is solubilized in corn
oil in 250 mg Depakene soft gelatin capsules.
A mixture of water-insoluble solvents, such as beeswax
and a vegetable oil, can be used to solubilize lipophilic drugs.
Tretinoin, a water-insoluble antineoplastic agent, is solubilized in a combination of beeswax, soybean oil, hydrogenated
vegetable oils, and hydrogenated soybean oil in 10 mg Vesanoid soft gelatin capsules. Isotretinoin, an antiacne drug, is an
isomer of tretinoin and is solubilized in the same solvent mixture in 10, 20, and 40 mg Accutane soft gelatin capsules. Clofazimine, a water-insoluble antileprosy agent, is solubilized in
beeswax, plant oils, and propylene glycol in 50 mg Lamprene
soft gelatin capsules.
Vitamin E is the common name for d--tocopherol and is
an oily liquid at room temperature and is also an antioxidant.
The water-insoluble HIV protease inhibitor, saquinavir, is
solubilized by a mixture of Vitamin E and medium-chain
mono- and diglycerides in 200 mg Fortovase soft gelatin capsules. The oral bioavailability of saquinavir is increased by
approximately 3-fold (range, 2.1- to 5.3-fold) after administering the solubilized Fortovase formulation compared to the
solid dosage form Invarase (2,24). The absolute oral bioavailability of saquinavir from Fortovase formulation has not
been reported, but from Invarase saquinavirs oral bioavail-
209
Table II. Solubilizing Excipients Used in Commercially Available Solubilized Oral and Injectable Formulations
Water-soluble
Dimethylacetamide (DMA)
Dimethyl sulfoxide (DMSO)
Ethanol
Glycerin
N-methyl-2-pyrrolidone (NMP)
PEG 300
PEG 400
Poloxamer 407
Propylene glycol
Hydroxypropyl--cyclodextrin
Sulfobutylether--cyclodextrin
(Captisol)
-cyclodextrin
Phospholipids
Hydrogenated soy
phosphatidylcholine (HSPC)
Distearoylphosphatidylglycerol
(DSPG)
L--dimyristoylphosphatidylcholine (DMPC)
L--dimyristoylphosphatidylglycerol (DMPG)
Water-insoluble
Surfactants
Beeswax
Oleic acid
Soy fatty acids
d--tocopherol (Vitamin E)
Corn oil mono-di-tridiglycerides
Medium chain (C8/C10) mono- and
diglycerides
Long-chain triglycerides
Castor oil
Corn oil
Cottonseed oil
Olive oil
Peanut oil
Peppermint oil
Safflower oil
Sesame oil
Soybean oil
Hydrogenated soybean oil
Hydrogenated vegetable oils
Medium-chain triglycerides
Caprylic/capric triglycerides
derived from coconut oil or
palm see oil
210
Strickley
Table III. Chemical Structures of Selected Solubilizing Excipients
Excipient name and/or
common name(s)
Chemical structure
Poly(ethyleneoxide)/
poly-(propyleneoxide/
poly(ethyleneoxide) triblock
copolymers (Poloxamers, Pluronics)
Poloxamer 407 (Pluronic F-127) has 200
residues of ethylene oxide and 65
residues of propylene oxide and a
molecular weight of 12,500 Da
Mono- and di-fatty acid esters of PEG
300
Example: Polyoxyl oleate (polyethylene
glycol monooleate)
R C7C17, oleate
R C7C17, oleate
211
Chemical structure
Medium-chain triglycerides
(Caprylic and capric triglycerides)
Labrafac
Miglyol 810, 812
Crodamol GTCC-PN
Softison 378 (x 10)
Long-chain monoglycerides
Glyceryl monooleate (Peceol)
Glyceryl monolinoleate (Maisine)
Phospholipids
Example
R
R
DSPG
C18
Glycerol
DMPC
C14
Choline
DMPG
C14
Glycerol
gylation of corn oil and consists of mono-, di-, and triglycerides and mono- and di-fatty acid esters of PEG 300, with the
main fatty acid being linoleic acid. Labrafil M-1944CS and
Labrafil M-2125CS are liquids at 4045C. Gelucire 44/14
(melting point 44C and HLB value of 14) is obtained by the
212
Strickley
Table III. Continued
Excipient name and/or
common name(s)
Chemical structure
Hydroxypropyl--cyclodextrin,
** average degree of substitution:
4 (Encapsin)
8 (Molecusol)
OH
|
R H or CH2CHCH3
Sulfobutylether--cyclodextrin,
average degree of substitution: 6.5
MW 2163, Captisol
R H or CH2CH2CH2CH2SO3Na
* Solutol HS 15 is 70% lipophilic consisting of polyglycol mono- and diesters of 12-hydroxystearic acid and 30% hydrophilic consisting of
polyethylene glycol. Solutol HS 15 is synthesized by reacting 12-hydroxystearic acid with 15 moles of ethylene oxide.
Cremophors are complex mixtures of various hydrophobic and hydrophilic components. Cremophor EL is obtained by reacting 35 moles of
ethyleneoxide with 1 mole of castor oil and comprises about 83% hydrophobic constituents of which the main component is glycerol
polyethylene glycol ricinoleate. Cremophor RH 40 is obtained by reacting 40 moles of ethyleneoxide with 1 mole of hydrogenated castor oil
and comprises about 75% hydrophobic constituents of which the main component is glycerol polyethylene glycol 12-hydroxystearare.
Labrasol is a mixture of mono-, di-, and triglycerides and mono- and di-fatty acid esters of PEG 400. Labrasol is synthesized by an alcoholysis/
esterification reaction using medium-chain triglycerides from coconut oil and PEG 400, and the main fatty acid is caprylic/capric acids.
Labrafil M-1944 CS is a mixture of mono-, di-, and triglycerides and mono- and di-fatty acid esters of PEG 300. Labrafil M-1944 CS is
synthesized by an alcoholysis/esterification reaction using apricot kernel oil and PEG 300, and the main fatty acid is oleic acid (5880%).
Labrafil M-2125 CS is a mixture of mono-, di-, and triglycerides and mono- and di-fatty acid esters of PEG 300. Labrafil M-2125 CS is
synthesized by an alcoholysis/esterification reaction using corn oil and PEG 300, and the main fatty acid is linoleic acid (5065%).
Gelucire 44/14 is a mixture of mono-, di-, and triglycerides and mono- and di-fatty acid esters of PEG 1500. Gelucire 44/14 is synthesized by
an alcoholysis/esterification reaction using palm kernel oil and PEG 1500, and the main fatty acid is lauric acid.
It is unclear as to which of the three hydroxyls (primary 6 or the secondary 2 or 3) substitution occurs.
213
trates, as the polar solvent is ethanol and not water. Upon
contact with aqueous media, such as gastrointestinal fluids, a
nonaqueous microemulsion spontaneously forms a fine dispersion or aqueous microemulsion.
Cyclosporin A is a sparingly water-soluble lipophilic cyclic peptide with a molecular weight of 1201 Da used in preventing rejection of transplanted kidneys, livers, and hearts
and is commercially available in multiple solubilized oral formulations. Cyclosporin A was originally formulated as Sandimmune in 25, 50, and 100 mg soft gelatin capsules as well as
a 100 mg/ml oral solution. The Sandimmune soft gelatin capsules contain cyclosporin A dissolved in 12.7% ethanol, corn
oil, glycerol, and Labrafil M-2125CS whereas the oral solution
contains 12.5% ethanol, olive oil, and Labrafil M-1944CS.
The absolute oral bioavailability of cyclosporin A as Sandimmune is erratic and is <10% in liver transplant patients and as
high as 89% in some renal transplant patients (2). To improve
the oral bioavailability, cyclosporin A was reformulated as a
microemulsion and solubilized in 11.9% ethanol, corn oilmono-di-triglycerides, polyoxyl 40 hydrogenated castor oil
(Cremophor RH 40), and propylene glycol in 25 or 100 mg
Neoral soft gelatin capsules as well as a 100 mg/ml oral solution. After oral administration of Neoral, the cyclosporin A
area under the curve of the plasma concentration vs. time
profile is 2050% higher than with Sandimmune (2). Also, the
peak plasma concentrations of cyclosporin A are 40106%
higher after oral administration of Neoral compared to Sandimmune. The Gengraf cyclosporin A formulation is a hard
gelatin capsule (no oral solution) containing 25 or 50 mg of
cyclosporin A dissolved in 12.8% ethanol, polyethylene glycol, polyoxyl 35 castor oil (cremophor EL), polysorbate 80,
propylene glycol, and sorbitan monooleate and forms an
aqueous dispersion in an aqueous environment (2). Gengraf
and Neoral are bioequivalent with virtually identical pharmacokinetics. Another cyclosporin A soft gelatin capsule contains Labrasol (Table III) as the solubilizing excipient and is
a product of Sidmak Laboratories.
Acids (pH Adjustment) in Oral Formulations
A drug with a basic functional group may be solubilized
in acidic solutions at pH values below the drugs pKa. The pH
of acidic oral aqueous solution is usually controlled by the salt
form used or by hydrochloric acid, tartaric acid, benzoic acid,
or citric acid. For example, risperidone is a tertiary amine
antipsychotic that is practically insoluble at neutral pH and is
solubilized in water, tartaric acid, and benzoic acid to 1 mg/ml
in the Resperdal oral solution (2). Loratadine is widely used
in the treatment of allergies and is a pyridine analog that is
not soluble in neutral pH water, but is solubilized by citric
acid at pH 2.53.1 and a cosolvent mixture of water, glycerin,
and propylene glycol to 1 mg/ml in Claritin syrup.
Cyclodextrin Complexation in Oral Formulations
Cyclodextrins are cyclic (-1,4)-linked oligosaccharides
of -D-glucopyranose containing a relatively hydrophobic
central cavity and a hydrophilic outer surface (36). Cyclodextrins are designated , , or corresponding to 6, 7, or 8
glucopyranose units, with cavity diameters of 4.75.3, 6.06.5,
and 7.58.3 , respectively (37). The central cavity is lined
with methylene groups (CH2) and ethereal oxygens of the
glucopyranose units, and is estimated to have a polarity simi-
214
lar to that of aqueous ethanolic solutions (36). Cyclodextrins
can increase the equilibrium solubility of some hydrophobic
molecules by forming a noncovalent inclusion complex if the
molecule, or a portion of the molecule (i.e., nonpolar sidechain or an aromatic or heterocyclic ring) is of the appropriate size to fit inside the central cavity.
In recent years, there has been a tremendous amount of
research and development devoted to cyclodextrin-based
drug delivery (13,3640) which has resulted in several commercial oral and injectable cyclodextrin-based products
throughout the world. Therefore, it is now very clear that
certain cyclodextrin excipients, when matched with their appropriate routes of delivery, are safe, effective, and acceptable for human in vivo use. There are at least 21 commercial
cyclodextrin-based pharmaceutical products of which 11 are
marketed in Europe, 9 in Japan, and 6 in the United States
with more cyclodextrin-based products awaiting regulatory
approval (38). Most of the commercial cyclodextrin-based
products are for oral administration as tablets, capsules, oral
solutions, or a gargling solution. There are also two suppositories, one eye drop, and one ointment along with various
injectable products. All of the solid cyclodextrin-based formulations use either - or -cyclodextrin. The -form is the
most commonly used, but its solubility in water is limited to
18 mg/ml. However, covalent modifications can dramatically
improve the water solubility and safety of cyclodextrins (39).
The two most common and preferred water-soluble -cyclodextrin derivatives are hydroxypropyl--cyclodextrin and sulfobutylether--cyclodextrin, which have an average degree of
substitution of 48 surface modifications per -cyclodextrin
molecule (Table III). Itraconazole, a weakly basic (pKa 3.7)
water-insoluble antifungal drug, is solubilized to 10 mg/ml
using a combination of 40% hydroxypropyl--cyclodextrin
(i.e., 400 mg/ml) in water and pH adjustment to 2 in Sporanox oral solution. The relative oral bioavailability of itraconazole from the oral solution is 149% 68% compared to
capsules (21) from which the oral bioavailability is 55% (21).
Therefore, the oral bioavailability of itraconazole from the
oral solution can be estimated to be 4582%.
INJECTABLE FORMULATIONS
The solubilization techniques for injectable formulations
are similar to those in oral formulations and include pH adjustment, mixed aqueous/organic cosolvents, organic solvent
mixtures, cyclodextrin complexation, emulsion, liposomes,
polymeric gels, and combinations of techniques (5,6,8,41).
This section focuses on solution injectable formulations for
intravenous bolus, intravenous infusion, intramuscular, subcutaneous, and local administration. Tables IV and V are
selected listings of aqueous and nonaqueous, commercially
available injectable solution formulations.
Buffers, pH Adjustment in Injectable Formulations
A drug molecule that is ionizable can often be solubilized
to the desired concentration by pH adjustment if the drugs
pKa is sufficiently away from the formulation pH value. The
acceptable range is pH 212 for intravenous and intramuscular administration, but subcutaneously the range is reduced to
pH 2.79.0 as the rate of in vivo dilution is significantly reduced resulting in more potential for irritation at the injection
site. The solution pH is controlled by either the salt form of
Strickley
the drug, strong acids/bases such as hydrochloric acid or sodium hydroxide, or a buffer such as glycine, citrate, acetate,
histidine, phosphate, tris(hydroxymethyl)aminomethane
(TRIS), or carbonate in which case the buffer concentration
must be high enough to maintain the desired pH (58) but
must be balanced by in vivo tolerability considerations (42).
Mixed Organic/Aqueous Injectable Formulations
The combination of an aqueous solution and a watersoluble organic solvent/surfactant (i.e., a cosolvent) is often
used in injectable formulations when pH adjustment alone is
insufficient in achieving the desired solution concentration
(12,43). The water-soluble organic solvents and surfactants
used in commercially available injectable formulations are
listed in Table VI and include propylene glycol, ethanol, polyethylene glycol 300, polyethylene glycol 400, glycerin, dimethylacetamide (DMA), N-methyl-2-pyrrolidone (NMP; Pharmasolve), dimethylsulfoxide (DMSO), Solutol HS 15, Cremophor EL, Cremophor RH 60, and polysorbate 80. Many
cosolvent formulations are marketed using rather high concentrations of organic solvent and are usually but not always
diluted prior to injection.
Limitations in using organic solvents in injectable products include possible precipitation, pain (44), inflammation,
and hemolysis upon injection. The in vivo compatibility of
organic solvents administered by intravenous (4550), intramuscular (5153), and subcutaneous (54) injection has been
studied by various researchers. Intravenous compatibility can
be predicted in vitro by measuring the percentage solvent
concentration that induces hemolysis in 50% of healthy red
blood cells, LD50. A higher LD50 implies a more compatible
solvent. Using this hemolysis method, the following LD50s
were measured: 37% DMA, 30% PEG 400, 21% ethanol,
10% (ethanol/propylene glycol, 10/40), 5.7% propylene glycol, and 5.1% DMSO (45). These findings are consistent with
other research (49) that showed propylene glycol produced a
large hemolytic response both in vivo and in vitro, but the
hemolysis could be reduced by either a tonicifying agent or
PEG 400. Therefore, although propylene glycol is the most
common organic solvent in injectable formulations, it is
clearly not as biocompatible as PEG 400, ethanol, or DMA.
For intravenous bolus injection, the amount of organic
solvent administered is up to 68% propylene glycol (phenobarbitol), 50% PEG 300 (methocarbamil), 20% ethanol (paricalcitrol), 15% glycerin (dihydroergotamine), and 9% PEG
400 (lorazepam). For intravenous infusion, the amount of organic solvent administered is up to 25% polysorbate 80 (docetaxel), 15% glycerin (dihydroergotamine), 10% Cremophor
EL (paclitaxel), 13% ethanol (docetaxel), and 6% propylene
glycol (melphalan). The intramuscular route has similar in
vivo constraints to the intravenous route, but can tolerate as
much as 100% organic solvent and is usually limited to less
than 5 ml per injection site. The subcutaneous route has the
most constraints when using cosolvent due to the reduced
volume flow away from the injection site compared to intravenous and intramuscular. As a result, only a few cosolvent
products are administered subcutaneously, and the amount of
organic solvent is limited to 6% ethanol and 15% glycerin
(dihydroergotamine) or 7% polyoxyethylated fatty acid
(phtyonadione, vitamin K1), and the volume is typically 12
ml. However, 0.250.50 ml of a solution containing 5566%
215
Table IV. List of Selected Commercially Available Aqueous-Based Solubilized Injectable Formulations
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Formulation
Preparation
Administration
Solubilization
technique
Alprostadil (PGE1)/
Edex/
Schwarz/
Erectile dysfunction
Intracavernous
Cyclodextrin
complexation
12:1 mole ratio
CD:drug
Amiodarone HCl/
Cordarone/
Wyeth-Ayerst/
Antiarrhythmic,
antianginal
Solution 50 mg/ml,
Polysorbate 80
at 10%,
Benzyl alcohol 2%
pH 4.1
IV infusion
Weak base
pH < pKa,
and
cosolvent,
micelles
Amphotericin B/
Ambisome/
Gilead/
Antifungal
Liposome
Amphotericin B/
Abelcet/
Elan/
Antifungal
Solution
5 mg/ml
DMPC 3.4 mg/ml,
DMPG 1.5 mg/ml,
Sodium chloride
9 mg/ml
pH 57
Dilute to 12
mg/ml with
D5W
IV infusion
Lipid complex
Calcitriol/
Calcijex/
Abbott/
Management of
hypocalcemia in
patientsundergoing
chronic renal dialysis
Solution
12 g/ml,
Polysorbate 20 at
4 mg/ml,
Sodium ascorbate
10 mg/ml,
Sodium chloride
1.5 mg/ml,
EDTA 1.1 mg/ml,
Sodium phosphates
9.2 mg/ml,
pH 6.58.0
None
IV bolus
Micelles
Carmustine/
BiCNU/
Bristol-Myers-Squibb/
Antineoplastic
Lyophilized solid
100 mg
pH 56
Reconstitute
with 3 ml of
ethanol, then
further dilute
with 27 ml
WFI
IV infusion
Ethanol
Chlordiazepoxide HCl/
Librium/
ICN/
Tranquilizer
Powder 100 mg
supplied diluent:
Propylene glycol
20%
Tween 80 at 4%,
Benzyl alcohol
1.5%,
Maleic acid 1.6%
pH 3
Reconstitute
IM/Slow IV
with supplied
bolus over
diluent to 50
1 min
mg/ml for IM.
Reconstitute
with saline or
WFI to 20
mg/ml for IV
bolus
Dilute with
D5W to <2
mg/ml
Weak base
pH < pKa,
and
cosolvent
216
Strickley
Table IV. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Formulation
Preparation
Administration
Solubilization
technique
Diazepam/
Valium/
Roche/
Management of
anxiety disorders,
skeletal muscle
relaxant
Solution 5 mg/ml
Propylene glycol
40%,
Ethyl alcohol
10%,
Benzyl alcohol
1.5%,
Sodium benzoate
5%,
Benzoic acid
pH 67
None
IM/IV IV
through
running IV
tube
Digoxin/
Lanoxin/
Glaxo SmithKline/
Cardiotonic
Solution
0.25 mg/ml
Propylene glycol
40%,
Ethyl alcohol
10%,
Sodium phosphate,
0.17%
Citric acid 0.08%
pH of 6.8 to 7.2
None or can be
diluted 4-fold
with WFI,
slaine or
D5W, but
must be used
immediately
due to
precipitation
IV over 15
Cosolvent
minutes/
rarely IM due
to pain with
IM ingection
Dihydroergotamine
mesylate
D.H.E 45
Novartis
Migraine
headaches
Solution 1 mg/ml
Glycerin 15%,
Ethyl alcohol
6.1%,
pH 3.6
None
IV bolus/
IM/
SC
Weak base pH
< pKa, and
cosolvent
Doxercalciferol/
Hectorol/
Bone care,
management of
secondary hyperparathyroidism
associated with
chronic renal
dialysis
Solution 2 g/ml
Polysorbate 80
at 4 mg/ml,
Sodium chloride
1.5 mg/ml,
Sodium ascorbate
10 mg/ml,
Sodium phosphates
dibasic 9.4 mg/ml,
Disodium EDTA
1.1 mg/ml
None
IV bolus
Micelles
Fenoldopam mesylate/
Corlopam/
Abbott/
Antihypertensive
Solution 10 mg/ml
Dilute with
IV infusion
Propylene glycol
saline or D5W
50%,
to 0.04 mg/ml
Sodium metabisulfite
1 mg/ml,
Citric acid
3.4 mg/ml,
Sodium citrate
0.61 mg/ml
pH 3
Weak base pH
< pKa and
cosolvent
Itraconazole/
Sporanox/
Ortho Biotech
and Janssen/
Antifungal
Solution 10 mg/ml
Hydroxypropyl-cyclodextrin 40%,
Propylene glycol
2.5%,
pH 4.5
Cyclodextrin
complexation
Dilute with
saline to 5
mg/ml
IV infusion
Cosolvent
217
Chemical structure
Administration
Solubilization
technique
Formulation
Preparation
Melphalan HCl/
Alkeran/
Glaxo SmithKline/
Antineoplastic,
alkylating agent
Lyophilized powder
50 mg
Povidone 20 mg.
Provided 10 ml
diluent:
Water 35%,
Propylene glycol
60%,
Ethyl alcohol 5%,
Sodium citrate
0.2 g
pH 6.57.0
Reconstitute
vigorously
with provided
diluent to 5.0
mg/ml, then
further dilute
with saline to
0.45 mg/ml
IV infusion
over 1520
minutes
Cosolvent
Methocarbamil/
Robaxin/
A.H. Robbins/
Skeletal muscle
relaxant
Solution
100 mg/ml,
PEG 300 50%,
pH 45
None for IM or
IV bolus. For
IV infusion
dilute with
250 ml saline
or D5W
IM/IV bolus/
IV infusion
Cosolvent
Oxytetracycline/
Terramycin/
Pfizer/
Antibiotic
Solution
50125 mg/ml,
Lidocaine
20 mg/ml,
Propylene glycol
6775%,
Monothioglycerol
10 mg/ml,
Magnesium chloride
2560 mg/ml,
Ethanolamine
1742 mg/ml,
Citric acid
10 mg/ml,
Propyl gallate
0.2 mg/ml
pH 3
None
IM
Weak base pH
< pKa and
cosolvent
Paricalcitol/
Zemplar/
Abbott/
Treatment of
secondary
hyperparathyroidism
associated with
chronic failure
Solution
0.005 mg/ml
Propylene glycol
30%,
Ethyl alcohol 20%
None
IV bolus
Cosolvent
Pentobarbital sodium/
Nembutal/
Abbott/
Anticonvulsant,
sedative, hypnotic,
anesthetic
Solution
50 mg/ml,
Propylene glycol
40%,
Ethyl alcohol 10%
pH 9.5
None or dilute
with saline,
D5W or
lactated
Ringers
IM/slow IV
bolus
Weak acid pH
> pKa and
cosolvent
218
Strickley
Table IV. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Formulation
Preparation
Administration
Solubilization
technique
Phenytoin sodium/
Dilantin/
Elkins-Sinn/
Anticonvulsant
Solution
50 mg/ml
Propylene glycol
40%,
Ethyl alcohol
10%
pH 1012.3
None
IM/IV bolus
Weak acid
pH > pKa
and
cosolvent
Phytonadione
(Vitamin K1)
AquaMEPHYTON/
Merck/
Vitamin K deficiency
Aqueous
dispersion
210 mg/ml
Polyoxyethylated
fatty acid
70 mg/ml,
Dextrose
37 mg/ml,
Benzyl alcohol
0.9%,
pH 3.57
SC/IM/IV
bolus/
IV infusion
Aqueous
dispersion
Propofol/
Diprivan 1%/
AstraZeneca/
Anesthetic, sedative
Emulsion,
10 mg/ml
Soybean oil
100 mg/ml,
Glycerol
22.5 mg/ml,
Egg lecithin
12 mg/ml,
EDTA
None
(shake well)
IV bolus/IV
infusion
Emulsion
Voriconazole/
Vfend/
Pfizer/
Antifungal
Lyophilized
powder
200 mg
Sulfobutylether-cyclodextrin
3200 mg
Reconstitute
with water to
10 mg/ml.
Dilute with
saline, D5W
or lactated
Ringers to
5 mg/ml
IV infusion
Cyclodextrin
complexation
Ziprasidone mesylate/
Geodon/
Pfizer/
Antipsychotic
Lyophilized
powder
24 mg
Sulfobutylether-cyclodextrin
350 mg
Reconstitute.
with 1.2 ml
water to 20
mg/ml.
IM
Cyclodextrin
complexation
N-methyl-2-pyrrolidone (leuprolide acetate in Eligard) is injected subcutaneously in which there is a transient slight
warm or burning sensation, but of no real concern (55,56).
Propylene glycol is the most common organic solvent in
commercially available injectable formulations. Fenoldopam
mesylate, a sparingly water-soluble rapid-acting vasodilator
antihypertensive, is solubilized in Corlopam to 10 mg/ml in a
citric acid pH 3.4 buffer with 50% propylene glycol which is
diluted at least 50-fold with saline or dextrose 5% prior to IV
infusion (2). Oxytertacycline, a tertiary amine antibiotic, has
solubility at pH 2 of 4.6 mg/ml (23) and is solubilized in
219
Chemical structure
Formulation
Preparation
Administration
Cyclosporin/
Sandimmune/
Novartis/
Immunosuppressant
50 mg/ml
Cremophor EL 65%,
Ethyl alcohol 35%,
blanketed with
nitrogen
IV infusion
over 26 h
Docetaxel/
Taxotere/
Rhone-Poulenc Rorer/
Antineoplastic
40 mg/ml
Polysorbate 80
IV infusion
over 1 h
Etoposide/
VePesid/
Bristol-Myers-Squibb/
Antineoplastic
20 mg/ml
PEG 300 at 60%,
Ethyl alcohol 30%,
Tween 80 at 8.0%,
Benzyl alcohol 3.0%,
Citric acid 2 mg/ml
pH 34
IV infusion
over 3060
min
Fulvestrant/
Faslodex/
AstraZeneca/
Antineoplastic
50 mg/ml
Ethyl alcohol
Benzyl alcohol
Benzyl benzoate
Castor Oil
None
IM
Haloperidol Decanoate/
Haldol Decanoate/
Ortho-McNeil/
Antipsychotic
50100 mg/ml
Sesame Oil
Benzyl alcohol 1.2%
None
IM
220
Strickley
Table V. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Formulation
Preparation
Administration
Leuprolide acetate
I) Eligard/
Atrix
Laboratories/
Prostate cancer
1. Connect the
two syringes
then mix the
contents of the
two syringes.
1. SC
Controlled
release over 1
month (7.5
mg), 3 months
(22.5 mg), or
4 months (30
mg)
II. Viadur/
Bayer
2. 72 mg in
Dimethyl sulfoxide
(DMSO) using
DUROS
technology
2. Surgical
implant of an
osmotically
driven pump
of 4 mm by 45
mm.
2. SC implant
Controlled
release over
12 months
Lorazepam/
Ativan/
Wyeth-Ayerst/
Anxiolytic,
sedation
24 mg/ml
PEG 400 at 18%, in
Propylene glycol,
Benzyl alcohol 2%
IM/IV bolus at
2 mg/min
Paclitaxel/
Taxol/
Bristol-Myers
Squibb/
Antineoplastic
Solution 6 mg/ml
Cremophor EL
51%,
Ethyl alcohol 49%
(v/v)
Dilute with
saline, D5W,
or lactated
Ringers to
0.31.2 mg/ml.
IV infusion
Tacrolimus/
Prograf/
Fujisawa/
Immunosuppressant
5 mg/ml
Cremophor RH 60
20%,
Ethyl alcohol 80%
Dilute 250- or
1000-fold into
saline or D5W
to 0.0040.02
mg/ml
IV infusion
Teniposide/
Vumon/
Bristol-Myers
Squibb/
Antineoplastic
50 mg/ml
Cremophor EL 50%,
Ethyl alcohol 42%,
Dimethylacetamide
6%,
Benzyl alcohol
30 mg/ml
pH 5 (maleic acid)
Dilute with
saline or D5W
to 0.11 mg/ml
IV infusion over
3060 min
221
Table V. Continued
Molecule/
Trade Name/
Company/
Indication
Chemical structure
Formulation
Preparation
Administration
Testosterone Enanthate/
Delatestryl/
BTG/
Hormone
200 mg/ml
Sesame oil, chlorobutanol
5 mg/mL
None
IM
Testosterone Cypionate
50 mg
Estradiol Cypionate
2 mg
Cotton seed oil
874 ml
Chlorobutanol 5.4 mg
None
IM
Valrubicin/
Valstar Medeva/
Antineoplastic
40 mg/ml Cremophor
EL 50%,
Ethyl alcohol 50%
Dilute with
saline to 10.6
mg/ml
Intravesical
instillation in
the urinary
bladder
222
Strickley
Table VI. List of Water-Soluble Solvents and Surfactants in Commercially Available Injectable Formulations
Solvent
Cremophor EL
% in Marketed
formulation
Cremophor RH 60
Dimethylacetamide (DMA)
Ethanol
1165
50
20
6
580
Glycerin
1532
N-methyl-2-pyrrolidone
(Pharmasolve)
PEG 300
PEG 400
Polysorbate 80
(Tween 80)
%
Administered
Route of
administration*
Selected examples
10
18
0.08
3
6
10
10
20
15
2.5
100
100
50
18
9
4
12
0.4
2
80
68
6
IV infusion
Intravesical
IV infusion
IV infusion
SC
IM
IV infusion
IV bolus
IM, SC, IV
IV infusion
Subgingival
SC
IM, IV bolus
IM
IV bolus
IM
IM
IV bolus
IV infusion
IM
IV bolus
IV infusion
IV
IV
IV
Paclitaxel
Valrubicin
Tacrolimus
Teniposide
Dihydroergotamine
Phenytoin
Paclitaxel
Paricalcitol
Dihydroergotamine
Idarubicin
Doxycycline
Leuprolide
Methocarbamil
Lorazepam
Lorazepam
Chlordiazepoxide
Vitamin A
Amiodarone
Docetaxel
Lorazepam
Phenobarbital
Medroxyprogesterone
Diclofenac
Propanidid
Vitamin K1
100 (diluent)
100
60
1867
0.075100
1080
Solutol HS 15
50
7
50
7
223
Oil
Castor oil
Cottonseed oil
% Administered
Mixture of castor oil/
ethanol/benzyl alcohol
100
Medium chain
triglycerides
Sesame oil
1020%
Soybean oil
10%
1020%
510%
Safflower oil
100
Route of
administration
Selected example
IM
Fulverstrat
IM
Testosterone cypionate
Estradiol cypionate
Lipofundin MCT 10%
Lipofundin MCT 20%
Haloperidol decanoate
Testosterone
Propofol
Intralipid, Liposyn III
Liposyn II
IV infusion
IM
IV bolus
IV infusion
IV infusion
224
g/ml and injected intracavernously. Itraconazole is waterinsoluble and is solubilized in Sporanox to 10 mg/ml in an
aqueous pH 4.5 solution with 40% hydroxypropyl-cyclodextrin and is administered by intravenous infusion after
a 2-fold dilution with saline. Hydroxypropyl--cyclodextrin is
also used to solubilize mitomycin in the generic product Mitozytrex (MitroExtra) (3).
The newest cyclodextrin to be commonly used is sulfobutylether--cyclodextrin (Captisol, www.cydexinc.com,
Overland Park, KS, USA, Table III). Captisol is very safe
(37,62), chemically stable, water-soluble, and is an excellent
solubilizing drug delivery technology for molecules in which it
forms an inclusion complex. An aqueous solution with 12%
w/v Captisol is isotonic, but formulations can contain as much
as 30% w/v Captisol. Ziprasidone mesylate, a rapid-acting
antipsychotic, a weak base with a pKa of 6.5 and an intrinsic
water solubility of 0.3 g/ml, is solubilized in Geodon to 20
mg/ml with 29% w/v Captisol and is administered by intramuscular injection. Ziprasidone mesylate and Captisol form a
1:1 complex in which the benzisothiazole group of ziprasidone
is positioned within the cavity of a Captisol molecule (63).
Geodon injectable formulation was initially approved in 2000
in Sweden (64,65). Voriconazole is a weakly basic triazole
antifungal that is solubilized in Vfend to 10 mg/ml with 16%
w/v Captisol and is administered by IV injection after a further 2-fold dilution with IV fluids (2).
Aqueous Dispersion Injectable Formulation
Phytonadione (Vitamin K1) is a non-ionizable waterinsoluble viscous liquid used in Vitamin K deficiency, is solubilized in AquaMEPHYTON to 2 or 10 mg/mL in an aqueous
dispersion with 7% polyoxyethylated fatty acid derivative, 37
mg/mL dextrose, and 0.9% benzyl alcohol at pH 3.57, and is
administered undiluted by subcutaneous or intramuscular injection. If IV administration is unavoidable, the rate of injection should not exceed 1 mg per minute.
Liposome Injectable Formulations
Liposomes are closed spherical vesicles composed of
outer lipid bilayer membranes and an inner aqueous core
and with an overall diameter of <100 m. Depending on
the level of hydrophobicity, moderately hydrophobic drugs
can be solubilized by liposomes if the drug becomes encapsulated or intercalated within the liposome. Hydrophobic drugs can also be solubilized by liposomes if the drug
molecule becomes an integral part of the lipid bilayer
membrane, and in this case, the hydrophobic drug is dissolved
in the lipid portion of the lipid bilayer. Water-soluble molecules reside within the aqueous inner core and are released
either as the liposome is eroded in vivo or by leakage. Liposomal formulations provide several therapeutic advantages
over the native drug formulations, including improved
pharmacokinetics (increased in vivo half-life of the drug), enhanced efficacy, and reduced toxicity. Liposomes preferentially bind to target cells such as fungal and tumor cells
as opposed to mammalian host cells, thus higher drug exposure to the target cells improves efficacy, and the limited
exposure to host cells decreases the toxicity. A typical liposome formulation contains water with phospholipid at 520
Strickley
mg/ml, an isotonicifier, a pH 58 buffer, and with or without
cholesterol. Liposomes are injected either by IV infusion or
intrathecally.
There are currently at least four commercially available
liposomal products for injection: amphotericin B (Table IV),
cytarabine, daunorubicin, and doxorubicin. Of these, only
amphotericin B is solubilized by liposomal encapsulation; the
other three drugs are water-soluble and are liposomal formulated for pharmacokinetic reasons. Amphotericin B, an antifungal, contains both a primary amine and a carboxylic acid
group, but the water solubility of the anion (pH 11) or cation
(pH 2) is only 0.1 mg/ml (23). Amphotericin B is solubilized
to 5 mg/ml by liposomal intercalation and becomes an integral
part of the lipid-bilayer membrane. The commercially available Amphotericin B liposomal product, Ambisome, is a lyophilized cake that is reconstituted with water to a 4 mg/ml
translucent liposomal suspension containing 18 mg/ml HSPC
(hydrogenated soy phosphatidylcholine), 7 mg/ml DSPG
(distearoylphosphatidylglycerol), 4 mg/ml cholesterol, 0.05
mg/ml -tocopherol, 75 mg/ml sucrose, and 2 mg/ml disodium
succinate buffer (pH 56). The reconstituted Ambisome is
then filtered through a provided 5-m filter and diluted with
dextrose 5% to 1 mg/ml and administered by IV infusion.
Another amphotericin B product, Abelcet, is a lipid complex
that is an opaque suspension at 5 mg/ml with 3.4 mg/ml
DMPC ( L --dimyristoylphosphatidylcholine), 1.5 mg/ml
DMPG ( L --dimyristoylphosphatidylglycerol), 9 mg/ml
sodium chloride, and buffered to a pH of 57. Abelcet is
diluted with dextrose 5% to 12 mg/ml and administered by
IV infusion. The amphotericin B lipid-based products have an
in vivo elimination half-life of 100-173 h (2). However, the
liposomal Ambisome has significantly lower incidence of
nephrotoxicity and infusion-related reactions compared to
the lipid complex Abelcet which allows for higher doses of
amphotericin B when using Ambisome. Thus, liposomal encapsulation of amphotericin B not only increases its solubility,
but also decreases its toxicity and also increases the in vivo
half-life.
Organic Solvents in Controlled Release and
Other Applications
N-Methyl-2-Pyrrolidone in a Polymeric Gel: Subcutaneous
or Local Injection
N-methyl-2-pyrrolidone (NMP, Pharmasolve) is a very
strong solubilizing agent and is currently in only a few commercially available pharmaceutical products. Leuprolide acetate is used in the treatment of prostate cancer and is solubilized in a solution composed of 5566% NMP and 3445%
poly(DL-lactide-co-glycolide) in an in situ controlled release
gel, Eligard, that is injected subcutaneously as a liquid. Upon
administration of 0.250.50 ml of the liquid formulation, the
NMP diffuses away from the injection site leaving a polymeric
gel that provides a depot of drug that is released over 1 to 6
months as the gel erodes or dissolves. Eligard 7.5 mg and
Eligard 22.5 mg have been commercially available since 2002
and are 1-month and 3-month controlled release products,
respectively. Eligard 7.5 mg delivers 7.5 mg of leuprolide acetate dissolved in 160 mg of NMP with 82.5 mg of poly(DLlactide-co-glycolide) as a 50:50 molar ratio. Eligard 30 mg is a
4-month controlled release product and was approved by the
225
salt form of the drug can have an impact on the solubility but
is not included in this discussion.
Intravenous Injection
The ideal immediate-release injectable formulation is
aqueous and isotonic with physiological fluids such as saline,
dextrose 5%, or lactated Ringers and with pH 7. If the drug
is not soluble in neutral pH water, the next choice is to increase solubility by changes in solution pH and/or the addition of a water-soluble organic solvent (i.e., a cosolvent).
Knowledge of the drugs pKa(s) is very useful, for only ionizable drugs can be solubilized by pH modification. Bolus
intravenous formulations can range in pH from 212, but infusion formulations are normally limited to pH 210. If the
drug is not solubilized sufficiently by pH modification, the
next choice is to increase solubility by using a water-soluble
organic solvent. The organic solvents in bolus intravenous
formulations include ethanol, glycerin, PEG 300, PEG 400,
and propylene glycol with the upper amount being 20% for
ethanol and 50% for the others. The organic solvents in
intravenous infusion formulations include DMA, ethanol,
glycerin, PEG 300, PEG 400, and propylene glycol with the
upper amount being 3% for DMA, 15% for glycerol, and
10% for the others. The combination of both pH modification and cosolvent can be a very powerful solubilization strategy and is quite useful in the preclinical setting when one does
not have much time/resources to develop an optimized formulation (43).
If the drug is not solubilized by aqueous pH-modification
or in cosolvents, the next choice is to increase aqueous solubility by complexation. The preferred complexing agents are
cyclodextrins and their derivatives, and typically only those
drugs with an aromatic ring or a nonpolar side chain are
solubilized by cyclodextrin complexation. If complexation
alone is insufficient, then a combination of complexation and
pH modification (66) or/and cosolvent may be used.
If the drug is not solubilized by pH modification, cosolvents, complexation, or combinations of these, the drug is
considered challenging. Surfactants are used to solubilize
some of the most water-insoluble drugs, and the formulations
are usually concentrated drug solutions in a completely organic solvent(s) that is diluted prior to intravenous administration, such as those listed in Table II. The surfactants for
intravenous infusion formulations include Cremophor EL,
Cremophor RH 60, and polysorbate 80. The solubilizing solvent is typically a mixture of surfactant and solvent(s) such as
cremophor/ethanol, cremophor/ethanol/DMA or polysorbate
80/PEG 300/ethanol, but neat surfactant may also be used
such as polysorbate 80 to solubilize docetaxel. The upper limit
administered in vivo is <10% for the cremophors and up to
25% polysorbate 80.
Drugs that are not soluble by cosolvents, pH modification, or complexation but are soluble in oils can be formulated
for intravenous administration by employing an oil-in-water
emulsion. Emulsion typically contain 1020% oil and an oilsoluble drug partitions into the oil phase. This formulation
strategy is rarely used for a commercial product. However,
emulsions can be useful in the preclinical setting where an
extemporaneous emulsion is prepared by slowly adding a concentrated solution of drug in an organic solvent to an emulsion with constant stirring (14).
226
Strickley
Table VIII. Flow Chart of Suggested Order of Solubilization Approaches for Injectable and Oral Liquid Formulations
Injectable
Intravenous
Subcutaneous
Oral
Intramuscular
Liposome formulations can be used as a means to solubilize some drugs for intravenous administration, but this
solubilization strategy is complex and liposomes are normally
not used for solubility enhancement but for pharmacokinetic
purposes.
Water-insoluble drugs that are not solubilized by any of
the above techniques or combinations of techniques are considered quite challenging. In these cases, because the equilibrium solubility is below the target formulation concentration, a supersaturated solution may be achievable in which
case the drug stays in solution for a long enough period of
time for handling and dosing. The typical approach is to dissolve the drug in a preconcentrated organic solution with/
without surfactant and slowly add this solution to an aqueous-
Solution
based injectable solution. To achieve supersaturation, the final injected formulation usually, but not always, contains a
surfactant(s) that is either initially in the concentrated drug
solution or in the diluent. This technique can be difficult to
commercialize due to complexity. However, this supersaturation technique is very useful in formulating water-insoluble
drugs, and many parameters can be varied such as the preconcentrate drug concentration, preconcentrate solvent(s),
diluent composition, and the mode of mixing the preconcentrate and the diluent. A novel example of combining pHmodification, cyclodextrin complexation, supersaturation, as
well as in situ chemical conversion in an intravenous formulation is the water-insoluble campothecin analog, DB-67,
which was not solubilized by any of the usual techniques (67).
227
solubility and/or oral bioavailability is still not sufficient, the
next level of complexity is a self-emulsifying drug delivery
system that contains a polar solvent, an oil, a surfactant, and
a cosurfactant.
Oral Solutions
Measurable solution formulations for oral dosing include
pediatric/elderly formulations, dose reduction compared to
the available solid oral dosage form(s), and cold remedies.
The development of pediatric formulations is beyond the
scope of this review, but can also include suspensions, powders, and other formulation types as well as the very important aspect of taste-masking. The requirements of a successful
oral solution are not only oral bioavailability, but also acceptable chemical stability and physical properties as well as acceptable taste.
Oral solution formulations can be either aqueous, aqueous/organic, or entirely organic. Therefore, all of the excipients discussed in this review, oral and injectable, can be used
in an oral dose solution. If solubility and oral bioavailability
are sufficient in an aqueous or aqueous/organic solvent, then
an aqueous-based solution formulation may be desirable. If
water solubility is limited and oral bioavailability from a solid
oral dosage form is low, then an organic solventbased solution formulation may be needed.
FUTURE TRENDS AND PROSPECTS
Even though there are many available excipients to increase the solubility of poorly water-soluble drugs, there is
still a need for more acceptable excipients and also to better
understand how these excipients actually perform in vivo.
The recent approval of products with new excipients such
as the complexing agent sulfobutylether--cyclodextrin, the
organic solvent NMP, and the surfactant TPGS are encouraging examples of emerging solubilizing excipients in parenteral (68) and oral medications. As more water-insoluble
drugs are discovered through modern screening techniques,
the need for significant formulation efforts in both preclinical
and clinical development will increase.
The use of polymer-based capsules, such as hydroxypropyl methylcellulose or polyvinylalcohol hard capsules, within
the pharmaceutical industry is likely to begin soon. Polymerbased capsules offer the advantages of potential controlled
release as well as the intriguing potential to control closely the
size, shape, and dimensions of the capsule. Enteric coating of
soft gelatin (69) and HPMC capsules (17) also offers the possibility of intestinal targeting.
It would be beneficial to the formulation scientist to have
more water-soluble organic solvents as potential vehicles. The
currently used, preferred choices of propylene glycol, ethanol,
and polyethylene glycols suffer from lack of solubilizing powers in many instances. The water-soluble solvent NMP will
likely be used more frequently because it has excellent solubilizing powder and is low viscosity, which is of practical importance in using fine-gauge needles or microcatheters.
DMSO was recently added to the monograph of pharmaceutical excipients and may be used more often. Other solvents
have been considered, such as dimethyl isosorbide (70), glycofurol, Solketal, glycerol formal, acetone, tertrahydrofurfuryl alcohol, diglyme, and ethyl lactate, but are used mainly in
228
the preclinical setting (71) or in veterinary products. The solvent Transcutol is purified diethylene glycol monoethyl ether
and is a powerful solubilizer that is used in some European
products such as the oral drops Lysanxia and the oral solutions Pilosuryl and Urosiphon as well as in some veterinary
injectable products such as Tolfedine and Vitamin E (72).
As more water-insoluble drugs are discovered, the need
for lipid-based formulations or colloidal carriers such as solid
lipid nanoparticles will increase for both oral and injectable
formulations (73,74). Oral formulations of long-chain and medium-chain triglycerides will likely be used more often in all
phases of development: preclincal, clinical, and commercial.
Shorter chain triglycerides such as triacetin and tributyrin can
solubilize many drugs and could potentially be used more.
Lipids can be transported in vivo via the lymphatic system,
and research to understand the contribution of lymphatic
transport to oral bioavailability is ongoing (75,76).
Surfactants are quite useful excipients when used correctly, but are often the last resort if simpler organic solvents and pH changes are insufficient. The commonly used
surfactants cremophors, polysorbates, Labrafils, TPGS, and
Span 20 are proven useful but with limitations. Other surfactants that are currently used less commonly such as Solutol
HS-15 (77) and the Gellucires and Labrasols can solubilize
many drugs and will likely be used more frequently. The Gellucires and Labrasol are similar to the Labrafils and are welldefined mixtures of mono-, di-, and triglycerides and monoand di-fatty acid esters of polyethyleneglycol with fatty acid
compositions of C12 (Gellucire 44/14), C16-C18 (Gellucire 50/
13), and C8C10 (Labrasol). The use of surfactants could benefit from a better understanding of supersaturation phenomenon and its practical applications. Surfactants have also been
shown to improve the oral absorption of highly polar and
water-soluble macromolecules such as vancomycin (78).
Controlled release systems that are solvent-based will
hopefully expand in their commercial success. The SABER
delivery system, developed by Southern Biosystems, Inc. (79)
and Durect Corporation, Cupertino, CA, USA (80), uses the
water-insoluble, highly viscous, liquid sucrose acetate isobutyrate (SAIB) that is dissolved in low-viscous solvent such as
NMP, ethanol, benzyl benzoate, or Miglyol 810 (mediumchain caprylic/capric triglyceride) along with the active ingredient. Upon subcutaneous or intramuscular injection, the
SAIB forms an adhesive, biocompatible, and biodegradable
depot that releases the entrapped active ingredient over a
tailored time period of a few day to 3 months or more after a
single injection. The SABER delivery system is undergoing
clinical evaluation and can also be applied to oral, dermal,
and other routes of administration.
Understanding how excipients perform in vivo is a key
aspect of their ultimate success. Certain excipients are not
inert but are functional excipients and can alter metabolism and/or transport activities. For example, a Pluronic block
copolymer is undergoing Phase II clinical evaluation for its
ability to modify cellular distribution by inhibition of the P-gp
drug efflux transport system and is a functional excipient in a
formulation with doxorubicin to increase distribution to solid
tumors (81). Understanding how excipients improve oral bioavailability will depend partially on determining how excipients perturb physiological functions including passive diffusion and transport systems such as P-gp (82,83). Understanding how excipients affect the passive and lymphatic
Strickley
absorption of poorly water-soluble drugs will assist in designing better oral formulations. The ability of scientists to determine whether improved in vivo performance is due to
solubility enhancement alone or in combination with physiological perturbations will allow for a more mechanistic understanding of formulation and excipient function(s).
CONCLUSIONS
Drug delivery has matured in the last few decades and is
now recognized as an integral part of drug discovery and
development (8486), with current emphasis on designing favorable physicochemical properties into new chemical entities
(8789) and identifying the most favorable salt form (90).
However, the trend to discover and develop small molecule
therapeutics that bind to a chosen enzyme has resulted in
more lipophilic, hydrophobic, and water-insoluble new drug
candidates. Therefore, formulation development/optimization, drug solubilization, and drug delivery will continue to be
areas of active research and development, with encouragement by current and future commercial successes.
ACKNOWLEDGMENTS
The author thanks Richard Dunn of Atrix Laboratories,
Inc., Gerold L Mosher, Diane O, Thompson, and Karl W.
Strohmeier of CyDex, Inc., Jennifer Lee and Peter Cade of
Croda, Inc., Carey M. Boyum of Lipscomb Chemical Company, Inc. (Long Beach, CA, USA, representing Gattefosse,
Inc., Cedex, France), Barbara A. Pagliocca of Sasol North
America, Inc. (Westwood, NJ, USA), and Brendan OLeary
of BASF, Inc., for information on their specialty solubilizing
excipients and drug delivery systems. The author also thanks
Tamara L. Smith of Shionogi Qualicaps, Inc. (Whitsett, NC,
USA), for information on hydroxypropyl methylcellulose
capsules and Missy Lowery of Capsugel (Greenwood, SC,
USA, a division of Pfizer, Inc.) for information on DBcaps
capsules for double-blinded clinical trials. The author also
thanks Terry Dahl, Reza Oliyai, and Taiyin Yang of Gilead
Sciences, Inc., and Ngoc-Anh T. Nguyen for their careful review of this manuscript, support, encouragement, and helpful
suggestions.
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