USPatent applicationPatented

Ophthalmic composition comprising rebamipide and method for preparing the same

Granted 16 Feb 2021 · 4 office actions

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Abstract

An ophthalmic composition is provided that includes rebamipide and a method for preparing the same. The ophthalmic composition of maintains its transparency for a long time even in a physiologically neutral to weakly basic pH range that does not injure the cornea and conjunctiva of a patient suffering from dry eye and has improved stability so as not to be re-dispersed.

Description

5 parts
›TECHNICAL FIELD

The present disclosure relates to an ophthalmic composition comprising rebamipide, which maintains its transparency, has excellent stability, and is easy to prepare, and a method for preparing the same.

›BACKGROUND ART

Rebamipide [2-(4-chlorobenzoylamino)-3-(2-quinolon-4-yl)propionic acid] is a quinolone derivative represented by the following formula I.

Rebamipide is known to increase gastric mucin to have anti-inflammatory and antiulcer actions on the digestive tract and thus has been used as an oral therapeutic agent for gastric ulcer since 1990. Moreover, the effects of rebamipide on an increase of goblet cell density in eyes, an increase of mucin in eyes, and an increase of lacrimal fluid have been proven, and thus rebamipide has been developed and sold as a therapeutic agent for dry eye syndrome in the form of an ophthalmic solution in Japan.

However, rebamipide has low solubility in a pH range where it is applicable to the eye, which makes it difficult to maintain a stable and transparent aqueous solution during long-term storage and to manufacture in the form of a transparent ophthalmic solution, and thus is available in the form of an ophthalmic suspension. Moreover, in the commercially available ophthalmic suspensions, the drug is dispersed as particles, which causes a feeling of irritation in the eye as well as local pain. Research aimed at developing a transparent ophthalmic solution comprising rebamipide has continued to progress; however, it is believed that it is difficult to develop an aqueous preparation comprising rebamipide so far, and the products developed so far are in the form of an ophthalmic suspension.

International Patent Publication No. WO 97/013515 discloses an aqueous suspension containing rebamipide. However, this suspension may form a flocculated suspension when standing for a long time. Therefore, the suspension needs to be shaken well to disperse the flocculated suspension. Moreover, the above suspension is a white suspension and thus may obscure the view.

International Patent Publication No. WO 2008/050896 discloses a rebamipide-containing aqueous suspension with improved suspensibility which can keep the dispersed fine-particle state of rebamipide stable without having the fine particle agglutinated, compared to the aqueous suspension of the above-mentioned International Patent Publication No. WO 97/013515. However, this suspension may also form a precipitate when standing for a long time and is a white suspension that obscures the view.

International Patent Publication No. WO 2006/052018 discloses an aqueous suspension containing crystalline rebamipide which has improved transparency, compared to the above-mentioned two aqueous suspensions. However, this invention requires expensive equipment such as a high-pressure homogenizer, a colloid mill, an ultrasonic device, etc. during manufacturing, the manufacturing process is very difficult and complicated, and the manufacturing time is long, resulting in high manufacturing costs. Moreover, it also has the problem that it forms a precipitate when standing for a long time.

International Patent Publication No. WO 2009/154304 and International Patent Publication No. WO 2014/051163 disclose transparent rebamipide ophthalmic compositions. However, these ophthalmic solutions have a high pH of 8 or higher and are not suitable for a patient suffering from an injury in cornea and conjunctiva such as dry eye.

Moreover, International Patent Publication No. WO 2008/074853 discloses a composition which uses a viscosity enhancer and a buffer to maintain the stability of an aqueous solution comprising rebamipide. However, this composition also has the problem that it forms a precipitate when standing for a long time.

Therefore, it is necessary to develop a pharmaceutical composition comprising rebamipide, which maintains its transparency for a long time even in a physiologically neutral to weakly basic pH range (below 8) that does not injure the cornea and conjunctiva of a patient suffering from dry eye, and which has improved stability so as not to be re-dispersed.

›DISCLOSURE OF INVENTION · 1 of 2

Technical Problem

An object of the present disclosure is to provide an ophthalmic composition comprising rebamipide, which is transparent in a pH range of 7 to 8. More specifically, an object of the present disclosure is to provide an ophthalmic composition comprising rebamipide, which maintains its transparency for a long time even in a physiologically neutral to weakly basic pH range that does not injure the cornea and conjunctiva of a patient suffering from dry eye, and which has improved stability so as not to be re-dispersed.

Moreover, another object of the present disclosure is to provide a method for preparing an ophthalmic composition of the present disclosure in a simple manner without any complicated process.

Solution to Problem

In order to accomplish the objects of the present disclosure, the present disclosure provides a novel ophthalmic composition comprising rebamipide and a method for preparing the same, which will be described in detail below.

Ophthalmic Composition Comprising Rebamipide

The ophthalmic composition of the present disclosure comprises (1) rebamipide, (2) an anti-recrystallizing agent selected from the group consisting of a cyclodextrin derivative, an amino acid, and mixtures thereof, and (3) a buffering agent.

Rebamipide may be prepared directly by a conventionally known method or commercially available.

In the present disclosure, the concentration of rebamipide may be 0.1 to 1.5 w/v %, preferably 0.2 to 1.0 w/v %.

The anti-recrystallizing agent used in the present disclosure is an additive to prevent a solution, which is sufficiently transparent but is present in a supersaturated state, from failing to maintain a transparent appearance without any precipitate being formed during long-term storage. The anti-recrystallizing agent that can be used in the present disclosure includes a cyclodextrin derivative and/or an amino acid.

Examples of the cyclodextrin derivative used as the anti-recrystallizing agent in the present disclosure include alpha-, beta-, and gamma-cyclodextrin, and substituted derivatives thereof such as dimethyl-, hydroxyethyl-, hydroxypropyl-, or sulfobutylether-beta-cyclodextrin. Hydroxypropylbetadex may preferably be used. Moreover, the concentration of the cyclodextrin derivative may preferably be 1.0 to 10.0 w/v %.

The amino acid that is another anti-recrystallizing agent of the present disclosure may comprise at least one selected from the group consisting of basic amino acids such as arginine, lysine, histidine, etc. and neutral amino acids such as glycine, alanine, valine, etc. Moreover, the concentration of the amino acid may preferably be 0.1 to 5.0 w/v %.

In the present disclosure, the buffering agent may comprise at least one selected from the group consisting of borate, phosphate, tromethamine, and mixtures thereof. Borate may preferably be used as the buffering agent. Moreover, the concentration of the buffering agent may preferably be 0.05 to 2.0 w/v %.

Moreover, the ophthalmic composition of the present disclosure may further comprise at least one additive selected from the group consisting of a thickener, a solubilizing agent, an isotonic agent, and a pH adjusting agent.

The thickener is an additive that extends the amount of time a drug stays in the body during clinical application and may comprise at least one selected from the group consisting of polyvinylpyrrolidone, hydroxypropylmethylcellulose, and polyvinyl alcohol, but not limited thereto. Polyvinylpyrrolidone may preferably be used.

The solubilizing agent is an additive to increase the solubility of a drug and may comprise at least one selected from the group consisting of polyoxyl 35 hydrogenated castor oil, poloxamer, and polysorbate.

The isotonic agent may be added in an amount that makes the osmotic pressure of the ophthalmic solution similar to that of tears and may comprise chlorides, saccharides, propylene glycol, and glycerin.

The pH adjusting agent is an additive to adjust the pH in a range that is applicable to the body (eye) and does not injure the cornea and conjunctiva and may comprise inorganic acids or organic acids. An inorganic acid such as phosphoric acid or phosphate may preferably be used.

The ophthalmic composition of the present disclosure may preferably have a pH of 7 to 8, which is in a physiologically neutral to weakly basic range that does not injure the cornea and conjunctiva of a patient suffering from dry eye.

Moreover, the ophthalmic composition of the present disclosure has excellent transparency in the above pH range (pH 7 to 8), maintains its transparency even after standing for a long time, and has improved stability so as not to be re-dispersed.

According to a preferred embodiment of the present disclosure, the ophthalmic composition of the present disclosure is a solution formulation, rather than the existing aqueous suspension. The ophthalmic composition of the present disclosure has solved the problem that it is difficult to manufacture in the form of a solution due to low solubility and, at the same time, has ensured the excellent transparency and stability. Therefore, the ophthalmic composition of the present disclosure may be very useful as an ophthalmic solution to patients suffering from dry eye.

Method for Preparing Ophthalmic Composition Comprising Rebamipide

The method for preparing an ophthalmic composition of the present disclosure comprises: a first step (S-1) of obtaining a solution by dissolving rebamipide in a buffer solution; a second step (S-2) of adding and dissolving an anti-recrystallizing agent selected from the group consisting of a cyclodextrin derivative, an amino acid, and mixtures thereof in the solution obtained in the first step; and a third step (S-3) of filtering the solution obtained in the second step through a sterile filter.

Moreover, the second step may further comprise, after dissolving the anti-recrystallizing agent, the step of adding and dissolving at least one additive selected from the group consisting of a thickener, a solubilizing agent, an isotonic agent, and a pH adjusting agent.

›DISCLOSURE OF INVENTION · 2 of 2

Specifically, a buffer solution of a suitable concentration is prepared by adding a buffering agent, and then rebamipide is added and dissolved in the buffer solution while stirring. The pH adjusting agent may be added as necessary, and the anti-recrystallizing agent is added and dissolved in the transparent rebamipide solution while stirring. The thickener, the solubilizing agent, the pH adjusting agent, and the isotonic agent may be added in appropriate concentrations according to circumstances. Moreover, all of these processes are achieved by simple stirring, and filtration is performed using a 0.22 μm sterile filter to achieve sterilization.

The manufacturing method of the present disclosure uses the anti-recrystallizing agent of rebamipide, such as the cyclodextrin derivative and/or amino acid, and the buffering agent to sufficiently maintain the transparency and prevent the formation of a precipitate layer even during long-term storage and can manufacture the ophthalmic composition comprising rebamipide by simple stirring without the use of expensive equipment.

Pharmaceutical Composition, and Method of Preventing or Treating Dry Eye Syndrome

The present disclosure provides a pharmaceutical composition comprising the ophthalmic composition of the present disclosure.

The present disclosure also provides a pharmaceutical composition for treating dry eye syndrome comprising the ophthalmic composition of the present disclosure.

The present disclosure also provides a method of treating dry eye syndrome comprising an administration of the ophthalmic composition of the present disclosure to patients.

Advantageous Effects of Invention

The ophthalmic composition of the present disclosure is prepared by mixing an anti-recrystallizing agent with a composition comprising rebamipide and a buffer solution, and thus it is possible to improve the transparency of the ophthalmic composition and maintain its transparency without aggregation or precipitation of dissolved particles even during long-term storage.

Moreover, according to the present disclosure, it is possible to manufacture a transparent rebamipide ophthalmic solution by simple stirring without requiring complicated manufacturing processes such as high-pressure homogenization, ultrasonic dispersion, etc. by selecting a buffering agent suitable for the composition and adjusting the concentration of the buffer solution. Furthermore, it is possible to remove bacteria only by filtration using a 0.22 μm sterile filter, resulting in reduced manufacturing costs.

›MODE FOR THE INVENTION

Hereinafter, Examples and Experimental Examples of the present disclosure will be described below for better understanding of the present disclosure, but the scope of the present disclosure is not limited by the Examples and Experimental Examples.

Examples 1 to 13 and Comparative Examples 1 to 5

According to the composition and ratio of components shown in the following tables 1 and 2, to purified water of appropriate volume, a buffering agent was added while stirring. To the buffer solution while stirring, rebamipide was added and dissolved, and then hydroxypropylbetadex was added thereto. After the rebamipide and hydroxypropylbetadex were completely dissolved, a pH adjusting agent and an isotonic agent were added to adjust the pH level and the osmotic pressure. The resulting rebamipide solution was filtered using a 0.22 μm sterile filter to prepare colorless transparent ophthalmic compositions of Examples 1 to 13.

According to the composition and ratio of components shown in the following tables 1 and 2, compositions of Comparative Examples 1 to 5 were prepared by the same preparation method described in Examples 1 to 13, except for the process of adding hydroxypropylbetadex.

Examples 14 to 21

Compositions of Examples 14 to 21 were prepared by the same preparation method described in Examples 1 to 13, except for varying the composition and ratio of amino acids as shown in the following table 3.

Examples 22 to 29

Compositions of Examples 22 to 29 were prepared by the same preparation method described in Examples 1 to 13, except for varying the ratio of the thickener that can be further added to the ophthalmic composition comprising the anti-recrystallizing agent and the buffering agent as shown in the following table 4.

Examples 30 to 34

Compositions of Examples 30 to 34 were prepared by the same preparation method described in Examples 1 to 13, except for varying the ratio of the solubilizing agent that can be further added to the composition comprising the anti-recrystallizing agent and the buffering agent as shown in the following table 5.

Experimental Example 1

In order to evaluate the transparency and stability depending on the presence or absence of the anti-recrystallizing agent, the compositions prepared in Examples 1 to 13 and Comparative Examples 1 to 5 were stored at room temperature and under refrigeration, and then the presence or absence of crystal precipitation over time was determined and shown in the following tables 6 to 9.

The transparency of the compositions was observed with the naked eye using a tester for the Insoluble Particulate Matter Test for Ophthalmic Solutions of the Korean Pharmacopoeia.

As shown in tables 6 to 9, the ophthalmic compositions of Examples 1 to 13 comprising the cyclodextrin derivative (hydroxypropylbetadex) that is an anti-recrystallizing agent were colorless and transparent even after standing for a long time, while precipitates were formed that does not comprise the anti-recrystallizing agent in the compositions of Comparative Examples 1 to 5 after 2 weeks.

Experimental Example 2

In order to determine the availability of amino acids as an anti-recrystallizing agent, the compositions prepared in Examples 14 to 21 were stored at room temperature and under refrigeration, and then the presence or absence of crystal precipitation over time was determined by the same method as Experimental Example 1 and shown in the following tables 10 and 11.

As a result of the experiment, the ophthalmic compositions of Examples 14 to 21 further comprising the amino acid also maintained the transparency (colorlessness) without any precipitate being formed.

Experimental Example 3

In order to determine the effect of the addition of thickener, the compositions prepared in Examples 22 to 29 were stored at room temperature and under refrigeration, and then the presence or absence of crystal precipitation over time was determined by the same method as Experimental Example 1 and shown in the following tables 12 and 13.

As a result of the experiment, it was observed that the compositions further comprising the thickener also maintained the transparency (colorlessness) and stability during the observation period.

Experimental Example 4

In order to determine the effect of the addition of solubilizing agent, the compositions prepared in Examples 30 to 34 were stored at room temperature and under refrigeration, and then the presence or absence of crystal precipitation over time was determined by the same method as Experimental Example 1 and shown in the following tables 14 and 15.

As a result of the experiment, it was observed that the compositions further comprising the solubilizing agent also maintained the transparency (colorlessness) and stability during the observation period.

›Tables in the description — 15
TABLE 1 — Compositions I according to the composition of the buffering agent and hydroxypropylbetadex Comparative
ExamplesExamples
Components123456123
Rebamipide (mg)500500500500500500500500500
Hydroxypropyl-101010555———
betadex (g)
Sodium borate (g)0.95——0.95——0.95——
Sodium phosphate (g)—0.75——0.75——0.75—
Tromethamine (g)——0.75——0.75——0.75
Sodium chloride orq.sq.sq.sq.sq.sq.sq.sq.sq.s
glycerin
Phosphoric acidq.sq.sq.sq.sq.sq.sq.sq.sq.s
Purified waterq.sq.sq.sq.sq.sq.sq.sq.sq.s
Total Volume (mL)100
pHabout 7.8
TABLE 2 — Compositions II according to the composition of the buffering agent and hydroxypropylbetadex Comparative
ExamplesExamples
Components7891011121345
Rebamipide (mg)500500500500500500500500500
hydroxypropyl-222551010——
betadex (g)
Sodium borate (g)0.950.500.100.500.100.500.100.500.10
Sodium chloride orq.sq.sq.sq.sq.sq.sq.sq.sq.s
glycerin
Phosphoric acidq.sq.sq.sq.sq.sq.sq.sq.sq.s
Purified waterq.sq.sq.sq.sq.sq.sq.sq.sq.s
Total Volume (mL)100
pHabout 7.8
TABLE 3 — Composition according to the composition and ratio of amino acids Examples
Components1415161718192021
Rebamipide500500500500500500500500
(mg)
Arginine (g)2.0—1.0——0.2——
Lysine (g)—2.0—1.0——0.2—
Glycine (g)————0.5—0.2
Sodium borate0.500.50.500.500.500.750.750.75
(g)
Sodium chlorideq.sq.sq.sq.sq.sq.sq.sq.s
or glycerin
Phosphateq.sq.sq.sq.s————
Phosphoric acid————q.sq.sq.sq.s
Purified waterq.sq.sq.sq.sq.sq.sq.sq.s
Total volume100
(mL)
pHabout 7.8
TABLE 4 — Composition according to the ratio of thickeners Examples
Components2223242526272829
Rebamipide (mg)500500500500500500500500
Hydroxypropyl-5—5555——
betadex (g)
Arginine (g)—11—0.2—1—
Lysine (g)———1—0.2—1
Sodium borate (g)0.500.500.500.500.750.750.500.50
Polyvinyl-555555——
pyrrolidone (g)
Hydroxypropyl-——————0.50.5
methyl cellulose
Sodium chlorideq.sq.sq.sq.sq.sq.sq.sq.s
or glycerin
Phosphoric acidq.sq.sq.sq.sq.sq.sq.sq.s
Purified waterq.sq.sq.sq.sq.sq.sq.sq.s
Total volume (mL)100
pHabout 7.8
TABLE 5 — Compositions according to the ratio of solubilizing agents Examples
Components3031323334
Rebamipide (mg)500500500500500
Hydroxypropylbetadex22222
(g)
Arginine (g)—0.2—0.2—
Lysine (g)——0.2—0.2
Polyvinylpyrrolidone22222
(g)
Sodium borate (g)0.950.950.950.950.95
Polyoxyl 350.50.50.5——
hydrogenated
castor oil (g)
Poloxamer (g)———0.10.1
Sodium chlorideq.sq.sq.sq.sq.s
Phosphoric acidq.sq.sq.sq.sq.s
Purified waterq.sq.sq.sq.sq.s
Total volume (mL)100
pHabout 7.8
TABLE 6 — Evaluation of Stability at Room Temperature of Examples 1 to 13 During
Preparation1 Week2 Weeks
Examples1TransparentTransparentTransparent
liquidliquidliquid
2TransparentTransparentTransparent
liquidliquidliquid
3TransparentTransparentTransparent
liquidliquidliquid
4TransparentTransparentTransparent
liquidliquidliquid
5TransparentTransparentTransparent
liquidliquidliquid
6TransparentTransparentTransparent
liquidliquidliquid
7TransparentTransparentTransparent
liquidliquidliquid
8TransparentTransparentTransparent
liquidliquidliquid
9TransparentTransparentTransparent
liquidliquidliquid
10TransparentTransparentTransparent
liquidliquidliquid
11TransparentTransparentTransparent
liquidliquidliquid
12TransparentTransparentTransparent
liquidliquidliquid
13TransparentTransparentTransparent
liquidliquidliquid
TABLE 7 — Evaluation of Stability at Room Temperature of Comparative Examples 1 to 5 During
preparation1 Week2 Weeks
Comparative1TransparentTransparentPrecipitate
Examplesliquidliquidformed
2TransparentTransparentPrecipitate
liquidliquidformed
3TransparentTransparentPrecipitate
liquidliquidformed
4TransparentTransparentPrecipitate
liquidliquidformed
5TransparentTransparentPrecipitate
liquidliquidformed
TABLE 8 — Evaluation of Stability under Refrigeration of Examples 1 to 13 During
preparation1 Week2 Weeks
Examples1TransparentTransparentTransparent
liquidliquidliquid
2TransparentTransparentTransparent
liquidliquidliquid
3TransparentTransparentTransparent
liquidliquidliquid
4TransparentTransparentTransparent
liquidliquidliquid
5TransparentTransparentTransparent
liquidliquidliquid
6TransparentTransparentTransparent
liquidliquidliquid
7TransparentTransparentTransparent
liquidliquidliquid
8TransparentTransparentTransparent
liquidliquidliquid
9TransparentTransparentTransparent
liquidliquidliquid
10TransparentTransparentTransparent
liquidliquidliquid
11TransparentTransparentTransparent
liquidliquidliquid
12TransparentTransparentTransparent
liquidliquidliquid
13TransparentTransparentTransparent
liquidliquidliquid
TABLE 9 — Evaluation of Stability under Refrigeration of Comparative Examples 1 to 3 During
preparation1 Week2 Weeks
Comparative1TransparentTransparentPrecipitate
Examplesliquidliquidformed
2TransparentTransparentPrecipitate
liquidliquidformed
3TransparentTransparentPrecipitate
liquidliquidformed
TABLE 10 — Evaluation of Stability at Room Temperature of Examples 14 to 21
RoomDuring
Temperaturepreparation1 Day2 Weeks4 Weeks
Examples14TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
15TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
16TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
17TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
18TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
19TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
20TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
21TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
TABLE 11 — Evaluation of Stability under Refrigeration of Examples 14 to 21
RoomDuring
Temperaturepreparation1 Week2 Weeks4 Weeks
Examples14TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
15TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
16TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
17TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
18TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
19TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
20TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
21TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
TABLE 12 — Evaluation of Stability at Room Temperature of Examples 22 to 29 During
preparation1 Week2 Weeks4 Weeks
Examples22TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
23TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
24TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
25TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
26TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
27TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
28TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
29TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
TABLE 13 — Evaluation of Stability under Refrigeration of Examples 22 to 29 During
preparation1 Week2 Weeks4 Weeks
Examples22TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
23TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
24TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
25TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
26TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
27TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
28TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
29TransparentTransparentTransparentTransparent
liquidliquidliquidliquid
TABLE 14 — Evaluation of Stability at Room Temperature of Examples 30 to 34 During
preparation1 Week2 Weeks
Examples30TransparentTransparentTransparent
liquidliquidliquid
31TransparentTransparentTransparent
liquidliquidliquid
32TransparentTransparentTransparent
liquidliquidliquid
33TransparentTransparentTransparent
liquidliquidliquid
34TransparentTransparentTransparent
liquidliquidliquid
TABLE 15 — Evaluation of Stability under Refrigeration of Examples 30 to 34 During
preparation1 Week2 Weeks
Examples30TransparentTransparentTransparent
liquidliquidliquid
31TransparentTransparentTransparent
liquidliquidliquid
32TransparentTransparentTransparent
liquidliquidliquid
33TransparentTransparentTransparent
liquidliquidliquid
34TransparentTransparentTransparent
liquidliquidliquid

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13 codes
IPC · International Patent Classification
Section A — Human necessities
  • A61K9/48
  • A61K31/4704
  • A61K47/10
  • A61K47/40
  • A61K47/44
  • A61K47/02
  • A61K47/32
  • A61K47/18
  • A61K9/08
  • A61K9/00
  • A61K47/22
  • A61K47/38
  • A61K47/34

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