中文摘要:盐酸纳美芬(nalmefene hydrochloride)为特异性阿片受体拮抗剂。该药在临床上广泛应用于麻醉剂过量、酒精中毒、休克、阿片药物中毒和呼吸抑制等的治疗,疗效确切,副作用少。目前,国内外应用于临床的盐酸纳美芬制剂仅有注射液,盐酸纳美芬片剂尚处于三期临床研究阶段。注射液给药需要特定环境,且病人须忍受一定痛苦,而片剂起效较慢,同时不适用于急症的治疗。因此,本文以盐酸纳美芬为模型药物,设计了药物的鼻腔递送系统,从而能够迅速起效,起到抢救阿片中毒和酒精中毒的目的。本文从制剂学、毒性、药动学、药效学等方面对盐酸纳美芬鼻腔喷雾剂进行了较为系统而深入的研究。
在盐酸纳美芬的处方前研究中,首先建立了精密、灵敏、专属性强的盐酸纳美芬HPLC测定方法,进而从稳定性和油水分配系数两个方面进行了与制剂学研究密切相关的处方前研究。在药物的稳定性实验中,分别考察了溶液pH值、离子强度和HP-β-CD对药物稳定性的影响。pH值考察结果表明,盐酸纳美芬的稳定性具有pH依耐性,随着溶液pH值的增大,盐酸纳美芬的稳定性下降,根据实验结果初步确定了盐酸纳美芬鼻腔喷雾剂的pH值范围;离子强度考察结果显示,60℃的恒温条件下放置5天后,各样品的浓度没有明显的变化,表明离子强度对盐酸纳美芬的稳定性没有明显的影响;HP-β-CD考察结果表明,HP-β-CD在特定条件下对盐酸纳美芬具有一定的保护作用。盐酸纳美芬的油水分配系数测定结果表明,盐酸纳美芬的油水分配系数存在pH依耐性,其油水分配系数随着溶液pH值增加而增加。当pH<6时,药物主要以离子形态存在,分布在水相中。最后,在本章中还对盐酸纳美芬在羊鼻黏膜不同部位的透过性进行了考察,从而为后续的药物体外透过性实验模型的建立提供了依据。
第二章中对盐酸纳美芬鼻腔给药系统进行了设计和深入地研究。首先,根据第一章的研究结果,以离体羊中鼻甲黏膜为体外模型,对HP-β-CD、DM-β-CD、α-CD、SEM-β-CD进行了筛选,结果表明HP-β-CD促渗作用最好。在此基础上,考察了HP-β-CD在1%,3%和5%浓度下对药物的促渗作用,结果表明随着浓度的升高其促渗作用增大。由于盐酸纳美芬鼻腔喷雾剂为多次给药的制剂,故本文参照文献报道对喷雾剂的抑菌剂进行了筛选,最终选择三氯叔丁醇作为抑菌剂。在后续的大鼠鼻腔在体灌流实验中,考察了药物浓度和药物溶液的pH值对盐酸纳美芬吸收速率的影响,揭示了在体条件下盐酸纳美芬的吸收规律。最后,初步确定了制剂的处方及工艺,并考察了两种给药装置的性能,确定了盐酸纳美芬鼻腔喷雾剂所采用的给药装置,并在此基础上完成了制剂的质量研究和稳定性试验。
在第三章对制剂毒性的研究中,采用多个鼻黏膜毒性评价试验,逐步深入的研究了药物、辅料及最终制剂对鼻黏膜的毒性。首先,采用离体蟾蜍上颚黏膜对纤毛毒性的影响因素进行了考察,结果表明制剂的渗透压、溶液pH值、药物浓度、HP-β-CD和辅料溶液均对鼻腔纤毛持续摆动时间均有影响,同时发现HP-β-CD与三氯叔丁醇之间存在相互作用。在对HP-β-CD与三氯叔丁醇之间相互作用的进一步研究中发现,HP-β-CD对三氯叔丁醇引起的鼻腔毒性具有保护作用,但同时也会对三氯叔丁醇的抑菌活性产生一定影响。在本实验的浓度范围内,随着三氯叔丁醇溶液中HP-β-CD增加,抑菌活性有一定下降,但当HP-β-CD的浓度低于3%时,对抑菌作用没有明显影响。其次,采用了在体蟾蜍上颚黏膜法考察了制剂的在体毒性。最后,为了更为准确地评价制剂的毒性,采用鼻腔局部刺激性试验考察了盐酸纳美芬鼻腔喷雾剂的鼻黏膜刺激性及给药后病理变化。根据以上毒性研究的结果,确定了盐酸纳美芬鼻腔喷雾剂的毒性影响因素,并表明该制剂安全,对鼻黏膜无毒无刺激性。
第四章主要对盐酸纳美芬不同给药途径的药物动力学进行了研究。首先建立了适合的测定盐酸纳美芬家兔血浆中药物浓度的HPLC方法,随后,对三种不同给药途径(静注、肌注和鼻腔喷雾)给药后家兔的血药浓度进行了测定,并对其体内药动学过程进行了分析,比较了三种给药途径的达峰时间和生物利用度,结果表明鼻腔给药生物利用度较高,且起效迅速。此外,本章对盐酸纳美芬抗酒精中毒的药效进行了研究。完成了盐酸纳美芬抗酒精中毒的药效学研究,将肌注途径和鼻腔给药途径的药效进行了比较,并对了高、中、低三个不同浓度的盐酸纳美芬鼻腔给药后抗酒精中毒的药效作用进行了评价。
关键词:盐酸纳美芬,鼻腔给药,阿片受体拮抗剂,抗酒精中毒,鼻黏膜毒性,药动学,药效学
Abstract :Nalmefene hydrochloride (NMF) is a selective narcotic antagonist. It has been widely applied in clinic treatment of anaethetic and alcoholism, shock, opioid detoxification and so on. It was considered to be effective while has few side effects. Presently, the available dosage form of NMF is injection which is mainly used in domestic and aboard clinical treatment, while NMF tablet is undergoing the clinical phase Ⅲ at present. Intravenous administration of NMF needs special environment and the patients have to suffer from the injury of injection. Tablet takes on action slowly so it is not suitable for emergency use. In this paper, NMF is chosen as a model drug to develop a nasal drug delivery system which aiming to take on action quickly and to rescue opioid overdose and alcoholism. In this paper, the pharmaceutics, toxicity, pharmacokinetics and pharmacodynamics aspects of NMF nasal delivery system were studied.
In the beginning of pre-formulation study, a sensitive and precise HPLC method with high selectivity for NMF determination was established, and then the stability and octanol-water partition coefficient were studied which were related to formulation research. In the stability study of NMF solution, the effect of solution pH value, ionic strength and HP-β-CD were investigated. The study on the effect of pH value indicated that NMF’s stability depended on the pH value of the solution, and the stability of NMF declined with the increasing of pH value. The study on the effect of ionic strength of the solution showed that the NMF concentration of samples didn’t change under 60℃ after five days, which meant that the ionic strength had little relation to the stability of NMF. The study on HP-β-CD indicated that HP-β-CD can affect the stability of NMF under certain conditions. The octanol-water partition coefficient study showed that the octanol-water partition coefficient of NMF was depending on the pH value of solution and increased with the pH value increases. When the pH value of the solution was less then 6, NMF was mainly ionic and distribute in the water phase. Finally, the drug permeability across different regions of the ovine nasal mucosa was investigated, thus established the foundation for the permeability study in vitro.
In chapter two, the NMF nasal delivery system was developed and studied. Firstly, based on the findings we got in chapter one, middle turbinate mucosa was chosen as the in vitro penetration model for the screening of absorption enhancers. The model mentioned above was employed to screening a enhancer within HP-β-CD、DM-β-CD、α-CD and SEM-β-CD. As a result, HP-β-CD showed the highest enhancing ability. Then the enhancement of HP-β-CD under concentrations of 1%, 3%, 5% were studied, and the enhancement was found to be increasing with concentration of HP-β-CD. Since the package of NMF nasal spay was multi-doses, chlorbutanol was selected as the bacterial inhibitor according to the references. The effect of drug concentration and solution pH value on the NMF nasal absorption was carried out by employing in situ recirculation method, furthermore, the NMF nasal absorption kinetics was also evaluated. It implied that the octanol-water partition coefficient had correlation to the nasal absorption of NMF. Based on former studies, the preliminary formulation was presented, and the quality of two sprayers was studied. One of the sprayers was chosen for the package of NMF nasal spray, and then the quality evaluation and stability test were performed.
In chapter three, the toxicity of dosage was researched extensively. Firstly, the isolated toad palate was employed as experiment model to investigate the influencing factors on ciliotoxicity, it was found that osmotic pressure, pH value, HP-β-CD and excipient solution had effect on the lasting time of ciliary movement, and the cilia from the toxicity of chlorbutanol could be protected by HP-β-CD. The protecting mechanism of HP-β-CD was investigated and the effect of HP-β-CD on the bacteriostatic action of chlorbutanol was also discussed. The bacteriostatic action of chlorbutanol solution decreased with the increasing concentration of HP-β-CD, but when the concentration of HP-β-CD was below 3%, it had little effect on the bacteriostatic action. Furthermore,the in situ toad palate and nasal local irritation test, which are more similar to in vivo situation, were used to investigate the toxicity of NMF nasal spray. In this chapter, several toxicity tests were performed for deeply investigating the toxicity of model drug, excipients and formulation. According to the results of toxicity research, the influencing factors of the toxicity of NMF nasal spray were determined and the final formulation was found to be safe and had no toxicity.
In chapter four, the pharmacokinetics of NMF after administered through different routes (i.e. intravenous, intramuscular and nasal delivery) were studied. HPLC method for determining the concentration of NMF in rabbit plasm was established. The Cmax and bioavailability of three routes were compared, and it was found that NMF nasal delivery had relative high bioavailability and would take action quickly. Besides this, the pharmacodynamics of NMF for antialcoholism was discussed. The pharmacodynamics study was accomplished to compare the intramuscular route with nasal route, and the effect of NMF solutions with three different concentrations i.n. were evaluated in the test.
Keywords: nalmefene hydrochloride, nasal delivery, opioid antagonist, antialcoholism, nasal mucosa toxicity, pharmacokinetics, pharmacodynamics
前 言
1 鼻腔给药系统概述
1.1 鼻腔给药的历史
鼻腔给药在我国已有悠久的历史,汉代张仲景的《伤寒杂病论》就有“韭捣叶,灌鼻中”治疗卒死的记载。明代李时珍编著的《本草纲目》中记载了以巴豆油纸拈,燃烟治疗中风等疾病。也有古代北美印第安人通过鼻腔吸入一种树叶粉末治疗头痛的记载。在过去,鼻腔给药主要作为治疗鼻炎和鼻塞的手段,进入上世纪70年代,鼻腔给药作为全身给药的途径得到了科学界的认可,1976年,Dyke率先报道了10%的盐酸可待因经鼻吸收的研究,随后鼻内给药逐渐成为研究的热点。1984年,在美国新泽西州新布步瑞克召开了“全身给药的鼻黏膜给药制剂”的专题研讨会。近年来,在制剂学方面,鼻腔给药已由传统的滴鼻剂发展出多种新剂型,如气雾剂、喷雾剂、粉雾剂、凝胶剂、微球、脂质体以及乳剂。而在药物方面也由单一的化学药物,转向多肽药物、蛋白药物以及疫苗的研究,鼻腔给药已成为注射给药特别是多肽和蛋白类药物的可能的替代途径[3, 4]。