Inflammation-preventing pharmaceutical composition of oral administration
This is a division of application Ser. No. 104,449, filed Dec. 17, 1979. 
    
    
     BACKGROUND OF THE PRESENT INVENTION 
     A great number of substances for the effective treatment of inflammatory illnesses, for example rheumatism, have been known for a long time. Since the inflammations are often chronic, the treatment with such inflammation-preventing active substances will usually extend over a long period of time. The non-steroidal antiphlogistic substances used for such continuous treatments very often have undesirable side effects on the digestive tract, such as, for example, in the form of gastro-intestinal bleeding and stomach ulcers as described by Y. H. Lee et al. in &#34;Arch.int. Pharmacodyn.&#34; 197, 370-377 (1971) and by K. D. Rainsford in &#34;Agents and Actions&#34; 1977 7(5/6), 573-77, as well as by A. R. Cooke in &#34;Drugs&#34; 1976, vol. 11, pages 36 to 44. 
     Many attempts have been made to moderate the side effects of these effective non-steroidal antiphlogistic substances by the admixture of an additional active substance. All mixtures of this type have the disadvantage that the additional substance might cause an ulcer on its own, or might even influence adversely the effectiveness of the primary non-steroidal antiphlogistic substance. 
     Attempts have been made, for example, to admix anticholinergic substances or pepsin inhibitors with the antiphlogistic substances (Y. H. Lee et al., &#34;Arch.int.Pharmacodyn,&#34; 191, 370-377 (1971)). The firm of Richter Gedeon (DE-OS No. 25 24 902) proposed the admixture of salicylic acid salts with the antiphlogistic substances. However, salicylic acid salts have analgetic and antiphlogistic properties of their own and can cause strong side effects such as nausea and vomiting as well as damage of the mucous membrane of the stomach with the possibility of bleeding if administered over longer periods of time as reported by E. Mutschler in &#34;Arzneimittelwirkungen,&#34; Wissenschaftliche Verlagsgesellschaft 1970, pages 76, 77. 
     The Sumitomo Chemical Co. Ltd. has proposed the combination of non-steroidal antiphlogistic substances with quinazolines (see DE-OS No. 26 27 914) with the purpose of preventing the formation of peptic ulcers within the area of the digestive tract. However, these quinazolines are substances with an analgetic and antiphlogistic effect of their own. U.S. Pat. No. 3,993,767 describes mixtures of non-steroidal antiphlogistic substances with metaxalon. However, the metaxalon has a muscle-relaxing effect. See the Merck Index, Ninth edition 1976, page 772. 
     OBJECTS AND SUMMARY OF THE INVENTION 
     It is therefore the object of he present invention to develope an inflammation-preventing medicine which will substantially improve the poor compatibility of non-steroidal antiphlogistic substances without adversely influencing the inflammation-preventing effect of these active substances. 
     It has been found that serious side effects on the digestive tract such as damage to the mucous membrane or gastric ulcer formation by non-steroidal antiphlogistic substances can be prevented if these substances are combined in a suitable manner with phospholipids. The medicinal compositions of the present invention will therefore contain these antiphlogistic substances in conjunction with phospholipids. The phospholipids have the advantage over the previously described substances in that they are body-inherent, can be readily broken down within the body, do not promote any side effects (even if administered continuously (see J. Weihrauch, U.S. Dept. of Agriculture, quoted in National Enquirer of June 6, 1978, page 33)) and do not possess any analgetic or antiphlogistic effect of their own. The admixture of phospholipids with non-steroidal antiphlogistic substances substantially lowers the degree of side effects while the analgetic and antiphlogistic properties remain intact. 
     DETAILED DESCRIPTION OF THE PRESENT INVENTION 
     Natural as well as synthetic phospholipids can be used in the preparations of the present invention. Natural phospholipids (of plant or animal origin) such as phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, sphingomyeline, cephaline, lysolecithin, phosphatidylglycol, cardiolipin, and plasmalogens (which can all be obtained, for example, from the soya bean or egg) and mixtures of these phospholipids are suitable for use in the present invention. Commercially available phosphatidylcholines or phosphatidylcholine-mixtures include Phospholipon® 100, Phospholipon® 100 H, Phospholipon® 80 and Phospholipon® 45. Usable synthetic phosphatides include, for example, ditetradecanoylphosphatidylcholine, dihexadecanoylphosphatidylcholine, dioleylphosphatidylcholine or dilinolyphosphatidylcholine and especially dipalmitoylphosphatidylcholine. 
     The following substances are especially suitable non-steroidal antiphlogistic substances for use in the combination proposed by the invention: 
     Pyrazolones and especially 
     phenylbutazone (4-butyl-1,2-diphenylpyrazolidine-3,5-dion), and 
     oxyphenbutazone (4-butyl-2-(4-hydroxyphenyl)-1-p-phenylpyrazolidine-3,5-dion); 
     Salicylic acid derivatives such as salicylic acid 
     salicylic acid amide, 
     acetyl-salicylic acid, 
     benorilate (4-acetamidophenyl-o-acetylsalicylate), and 
     diflunisal (5-(2,4-difluorophenyl)-salicylic acid); 
     Indoles, especially indometacine and its analogs such as 
     indometacine (1-(p-chlorobenzyl)-5-methoxy-2-methylindole acetic acid), 
     glucametacine (1-(p-chlorobenzoyl-5-methoxy-2-methylindole-3-yl acetic acid glucose amide), 
     acemetacine (1-(p-chlorobenzoyl)-5-methoxy-3-methylindole-3-acetic acid-glycolic acid-ester), and 
     sulindac (5-fluor-2-methyl-1-p-(methylsulphenyl)-benzylidene-indene-3-acetic acid); 
     Phenyl acetic acid or phenyl propionic acid derivatives such as 
     ibuprofen (2-(4-isobutylphenyl)-propinic acid); 
     naproxen (2-(6-methoxy-2-naphthtyl)-propinic acid), 
     alclofenac (4-allyloxy-3-chlorophenyl-acetic acid), ketoprofen (2-(3-benzylphenyl)benzoic acid), 
     diclofenac (2-(2,6-dichlorophenylamino)-phenylacetic acid), 
     fenoprofen (2-(3-phenyloxyphenyl)-acetic acid), 
     tolmetin (1-methyl-5-(p-toluyl)-pyrrole-2-yl-acetic acid), 
     flurbiprofen (2-(2-fluorobiphenyl-4-ye-propionic acid), and 
     suprofen (p-2-thenoyl-hydratropic acid) phenyl-proprionic acid); 
     Anthranilic acids and their nitrogen analogs such as flufenamino acid (N-(m-trifluoromethylphenyl)-anthranilic acid), 
     mefenamino acid (N-(2,3-dimethylphenyl)-anthranilic acid), and 
     niflumin acid (2-(3-trifluoromethylaminolino)-nicotinic acid). 
     The novel mixture of the present invention comprising non-steroidal antiphlogistic substances and phospholipid is particularly suitable for oral application where the molar ratio of antiphlogistic substance to phospholipid ranges from about 1:0.1 to about 1:20, and preferably from about 1:0.5 to about 1:2. 
     The mixture can be prepared by dissolving the antiphlogistic substance and the phospholipid in a suitable organic solvent such as methanol, ethanol or chloroform and by subsequently separating the solvent from the mixture by distillation. The antiphlogistic substance can also be dissolved in water at a suitable pH with the phospholipid being stirred into the solution. The emulsion or solution so obtained is then freed of water by lyophilic treatment, with a loose powder being obtained thereby. 
     The mixtures prepared in this manner can be further processed into medicines of the various standard forms of application such as, for example, in the form of pills, filled into a capsule or dispensed in the form of a granulate, a powder or a suspension. The medicine can further contain the usual quantities of carrier materials and/or diluents as well as auxiliary substances such as starch, gelatine, agar, sugar, carboxy-methylcellulose, polyvinylalcohol, magnesium stearate, sodium alginate and the like. 
     The advantageous effectiveness of the novel medicines proposed by the invention is demonstrated by several pharmacological tests which are listed below. The development of the ulcer was determined in accordance with 
     B. J. R. Whittle, &#34;Brit.J.Pharmakol.&#34; 55, 242-243 (1975), 
     L. Mariani, &#34;Eur.J.Toxicol. Environ.&#34; 8, 335-339 (1975), and 
     R. Menguy &amp; L. Desbaillets, &#34;Proc.Soc.exp.Bio.&#34; 125, 1108. 
     Ten male and ten female Wistar-rats (120 to 150 grams, in weight) which have not fed for 16 hours, were used for these tests. The bleeding stomach ulcer was provoked by oral application of the active substance. After 3.5 hours, the animals are killed and the stomach extracted, opened along the wide curvature and stretched onto a &#34;Styropor&#34; plate. The mean ulcer factor of the test and of the control group are determined. The variation is weighted in percentages as prevention of the ulcer formation. 
     Reference substances: 
     
         ______________________________________                                    
chloropromazine                                                           
             oral ED50 = 104.82 mg kg/KGW                                 
atropinesulphate                                                          
             oral ED50 = 17.06 mg kg/KGW                                  
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     The results of the tests are tabulated below in Tables I to VI: 
     
                                           TABLE I                                 
__________________________________________________________________________
Influence of Phospholipon®  100 Upon Ulcer Development                
Oral Application of Acetyl-Salicylic Acid                                 
(Molar Ratio of Acetyl-Salicylic Acid: Phospholipon = 2:1)                
                            Variation of the Mean                         
                            Ulcer Factor:                                 
                    Acetyl-Salicylic                                      
                            Acetyl-Salicylic Acid                         
Dosage    Acetyl-Salicylic                                                
                    Acid With p.sup.+                                     
                            With p.sup.+ Versus                           
                                       Incidence of                       
(mg/kg KGW)                                                               
        n Acid Ulcer Index.sup.a                                          
                    Ulcer Index.sup.a                                     
                            Without p.sup.+  (%)                          
                                       Ulcers (%)                         
                                              p-Value                     
__________________________________________________________________________
200     10                                                                
          1.20 ± 0.20                                                  
                    0.30 ± 0.09                                        
                            -83.33     70 resp. 20                        
                                              0.001                       
400     10                                                                
          1.10 ± 0.50                                                  
                    0.70 ± 0.06                                        
                            -36.36     50 resp. 70                        
                                              0.10-0.01                   
800     10                                                                
          1.20 ± 0.20                                                  
                    0.70 ± 0.06                                        
                            -41.67     80 resp. 70                        
                                               0.01-0.001                 
__________________________________________________________________________
 p.sup.+ = Phospholipon®  100 (92% Phosphatidylcholin, 4%             
 Lysophosphatidylcholin, 3% Neutrallipide, 1% water).                     
  .sup.a - x ± s- .sub.x                                               
 
    
     
                                           TABLE II                                
__________________________________________________________________________
Influence Upon Ulcer Development By Phospholipon®  100 With           
Oral Application of Phenylbutazone                                        
(Molar Ratio of Phenylbutazone:Phospholipon = 2:1)                        
                             Variation of Mean                            
                             Ulcer Factor:                                
                             Phenylbutazone                               
Dosage    Phenylbutazone                                                  
                  Phenylbutazone                                          
                             With p.sup.+ Versus                          
                                      Incidence of                        
(mg/kg KGW)                                                               
        n Ulcer Index.sup.a                                               
                  With p.sup.+  Ulcer Index.sup.a                         
                             Without p.sup.+  (%)                         
                                      Ulcers (%)                          
                                             p-Value                      
__________________________________________________________________________
25      10                                                                
          0.70 ± 0.05                                                  
                  0.30 ± 0.04                                          
                             -57.14    70 resp. 30                        
                                             0.02-0.01                    
50      10                                                                
          1.60 ± 0.42                                                  
                  0.90 ± 0.42                                          
                             -43.75    60 resp. 40                        
                                             0.01-0.001                   
100     10                                                                
          1.80 ± 0.84                                                  
                  1.20 ± 0.84                                          
                             -33.33   100 resp. 90                        
                                             0.02-0.01                    
200     10                                                                
          1.90 ± 0.66                                                  
                  1.20 ± 0.96                                          
                             - 36.84  80     0.01-0.001                   
__________________________________________________________________________
 p.sup.+ = Phospholipon®  100 (as previously defined)                 
  .sup.a - x ± s- .sub.x                                               
 
    
     
                                           TABLE III                               
__________________________________________________________________________
Influence Upon Ulcer Development By Phospholipon®  100                
With Oral Application of Indometacine                                     
(Molar Ratio Indometacine:Phospholipon = 1:2)                             
                            Variation of Mean                             
                            Ulcer Factor:                                 
                            Indometacine                                  
Dosage    Indometacine                                                    
                 Indometacine                                             
                            With p.sup.+  and                             
                                     Incidence of                         
(mg/kg KGW)                                                               
        n Ulcer Index.sup.a                                               
                 With p.sup.+ Ulcer Index.sup.a                           
                            Without (%)                                   
                                     Ulcers (%)                           
                                            p-Value                       
__________________________________________________________________________
 5      10                                                                
          1.20 ± 0.30                                                  
                 0.20 ± 0.31                                           
                            -83.33    70 resp. 20                         
                                            0.02-0.01                     
10      10                                                                
          1.90 ± 0.90                                                  
                 0.40 ± 0.07                                           
                            -78.95    90 resp. 40                         
                                            0.001                         
20      10                                                                
          1.50 ± 0.40                                                  
                 0.50 ± 0.08                                           
                            -66.67   100 resp. 50                         
                                            0.001                         
__________________________________________________________________________
 p.sup.+ = Phospholipon®  100 (as previously defined)                 
  .sup.a - x ± s- .sub.x                                               
 
    
     
                                           TABLE IV                                
__________________________________________________________________________
Influence Upon Ulcer Development By Phospholipon®  45                 
of a Rat With Oral Application of Indometacine                            
(Molar Ratio of Indometacine:Phospholipon = 1:2)                          
                           Variation of Mean                              
                           Ulcer Factor:                                  
                           Indometacine                                   
Dosage    Indometacine                                                    
                 Indometacine With                                        
                           With p.sup.+ and                               
                                    Incidence of                          
(mg/kg KGW)                                                               
        n Ulcer Index.sup.a                                               
                 Phospholipon®  45.sup.a                              
                           Without (%)                                    
                                    Ulcers (%)                            
                                           p-Value                        
__________________________________________________________________________
 5      10                                                                
          2.10 ± 0.36                                                  
                 1.20 ± 0.29                                           
                           -42.85    80 resp. 90                          
                                           0.1-0.05                       
10      10                                                                
          2.20 ± 0.42                                                  
                 1.80 ± 0.25                                           
                           -18.18    90    0.5-0.4                        
20      10                                                                
          2.30 ± 0.47                                                  
                 2.00 ± 0.36                                           
                           -13.04   100    0.5                            
30      10                                                                
          2.70 ± 0.30                                                  
                 2.40 ± 0.30                                           
                           -11.11    80 resp. 100                         
                                           0.5-0.4                        
__________________________________________________________________________
 p.sup.+ = Phospholipon®  45 (45% Phosphatidylcholine, 25%            
 Phosphatidylethanolamine, 12% Phosphatidylinositol, 10% Sterine, 4%      
 Lysophosphatidylcholine and Lysophosphatidylcholinethanolamine, 3%       
 Neutrallipide, 1% water)                                                 
  .sup.a - x ± s-  .sub.x                                              
 
    
     
                                           TABLE V                                 
__________________________________________________________________________
Influence Upon Ulcer Development By Phospholipon®  100                
With Oral Application of Indometacine                                     
Dosage One cc per mg/kg of Body Weight (KGW)                              
Proportion of              Variation of Mean Ulcer Factor:                
Indometacine:                                                             
          Indometacine                                                    
                 Indometacine With                                        
                           Indometacine With p.sup.+ Versus               
Phospholipon®  100                                                    
          Ulcer Index.sup.a                                               
                 p.sup.+ Ulcer Index.sup.a                                
                           Without p.sup.+ (%)                            
__________________________________________________________________________
1:0       2.60 ± 0.22                                                  
                 --        ±0                                          
1:0.1     --     1.70 ± 0.21                                           
                           -34.62                                         
1:2.0     --     0.40 ± 0.07                                           
                           -78.95                                         
1:10.0    --     1.60 ± 0.16                                           
                           -38.46                                         
__________________________________________________________________________
 p.sup.+ = Phospholipon®  100 (as previously defined)                 
  .sup.a - x ± s- .sub.x                                               
 
    
     
                                           TABLE VI                                
__________________________________________________________________________
Influence Upon Ulcer Development By Phospholipon®  100                
of a Rat With Oral Application of Ibuprofen                               
(Molar Ratio Ibuprofen:Phospholipon = 1:1)                                
                              Variation of Mean                           
                              Ulcer Factor:                               
                              Ibuprofen With p.sup.+                      
Dosage    Ibuprofen                                                       
                 Ibuprofen Ulcer Index.sup.a                              
                              and       Incidence of                      
(mg/kg KGW)                                                               
        n Ulcer Index.sup.a                                               
                 With Phospholipon®  100                              
                              Without p.sup.+  (%)                        
                                        Ulcers (%)                        
                                               p-Value                    
__________________________________________________________________________
 5      10                                                                
          0.20 ± 0.13                                                  
                 0.20 ± 0.13                                           
                              ±0     20     0.5                        
10      10                                                                
          0.30 ± 0.15                                                  
                 0.20 ± 0.13                                           
                              -33.30    20 resp. 30                       
                                               0.5                        
20      10                                                                
          0.50 ± 0.22                                                  
                 0.40 ± 0.16                                           
                              -20.00    40 resp. 50                       
                                               0.5                        
30      10                                                                
          0.71 ± 0.30                                                  
                 0.50 ± 0.22                                           
                              -28.57    50 resp. 70                       
                                               0.5                        
__________________________________________________________________________
 p.sup.+ = Phospholipon®  100 (as previously defined)                 
  .sup.a - x ± s- .sub.x                                               
 
    
     The antiphlogistic effectiveness was determined in accordance with the rat-paw-oedema test proposed by Hillebrecht (J. Hillebrecht, &#34;Arzneimittelforschung,&#34; 4, 607 (1954). 
     On one hind paw of each rat (weight 200 to 250 grams) an oedema was caused to develop by the &#34;subplantane&#34; application of carragenin (0.5% in a 0.9% NaCl solution) in the amount of 0.1 ml solution per paw. 
     After the application of the test substance, its volume not to exceed 10 ml per kg of body weight, the volume of the paw is determined in an overflow (&#34;Ueberlauf&#34;). After three hours the final value is ascertained. The test is carried out for every dosage by using 10 test and 10 control animals of one sex and repeated with the identical number of animals of the other sex. For the purpose of evaluation, the prevention of the oedema is expressed in percentages relative to the control group. 
     Reference substances: 
     
         ______________________________________                                    
Hydrocortisoneacetate                                                     
              oral ED50 = 19.00 mg/kg/KGW                                 
phenylbutazone                                                            
              oral ED50 = 100.00 mg/kg/KGW                                
indometacine  oral ED50 = 7.24 mg/kg/KGW                                  
______________________________________                                    
 
    
     The results of these tests are listed below in Tables VII and VIII: 
     
                       TABLE VII                                                   
______________________________________                                    
Comparison of the Effectiveness of Indometacine                           
and an Indometacine-Phospholipon®  100 Mixture                        
Applied to Rat-Paw Oedema                                                 
Indometacine                                                              
         Phospholipon®  100                                           
                       Prevention of                                      
                                  Number of                               
(mg/kg p.o.)                                                              
         mg/kg p.o.    Oedema (%) Animals                                 
______________________________________                                    
3.16     --            -47.3      12                                      
10       --            -37.8      12                                      
3.16     7.1           -39.3      12                                      
10       22.4          -35.7      12                                      
--       100           -4.1       18                                      
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                       TABLE VIII                                                  
______________________________________                                    
Comparison of the Effectiveness of Indometacine                           
and Indometacine-Phospholipon®  100 Mixtures                          
Applied to Rat Paw Oedema (Dosage 10.0 mg/kg                              
KGW, 12 Animals)                                                          
Time:                                                                     
Hours                                                                     
Elapsed                                                                   
After                                                                     
Application         Indometacine-Phospholipon®  100                   
of Active           Molar Ratios                                          
Substance                                                                 
         Indometacine                                                     
                    1:0.1     1:1    1:10                                 
______________________________________                                    
3        32         33        55     32                                   
4        40         28        41     45                                   
5        28         24        26     24                                   
6        27         24        32     38                                   
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     The invention is additionally illustrated in connection with the following Examples which are to be considered as illustrative of the present invention. It should be understood, however, that the invention is not limited to the specific details of the Examples. 
     EXAMPLE 1 
     4.2 Grams of phenylbutazone (13.6 mMol) are suspended in 75 ml of water and admixed with 13.5 ml of 1 n caustic soda solution. Into the clear solution so obtained there are stirred 5.45 gram (7.8 mMol) of Phospholipon® 100. The emulsion so obtained is treated lyophilically. The crystals produced are mixed with suitable additives, pressed into pills or filled into capsules. 
     EXAMPLE 2 
     1.5 Grams (4.2 mMol) of indometacine are processed in a manner similar to that set forth in Example 1 to form a mixture with 4.1 of 1 n caustic soda solution, 40 ml of water and 3.35 gram (4.2 mMol) of Phospholipon® 45 and then treated lyophilically. 
     EXAMPLE 3 
     1.88 Grams (10 mMol) of acetyl-salicyclic acid, 10 ml of 1 n caustic soda solution, 25 ml of water and 4 grams (5 mMol) of Phospholipon® 100 are processed into a mixture and are then treated lyophilicaly. 
     EXAMPLE 4 
     Similar to Example 1, 1.88 grams (10 mMol) of acetyl-salicyclic acid, 1.46 grams of DL-lysine, 30 ml of water and 1.6 grams (2 mMol) of Phospholipon® 100 are processed into a mixture and then treated lyophilically. 
     EXAMPLE 5 
     1.43 Grams (4 mMol) of indometacine and 3.2 grams (4 mMol) of Phospholipon® 100 are dissolved in 50 ml of heated ethanol. The ethanol is then separated by distillation. The remaining substance is mixed with suitable additives pressed into pills or filled into capsules. 
     EXAMPLE 6 
     Acetyl-salicyclic acid pills: 
     
         ______________________________________                                    
acetyl-salicylic acid                                                     
                    216 mg                                                
Phospholipon®  100                                                    
                    400 mg                                                
aerosil              50 mg                                                
Na--carboxymethylcellulose                                                
                     16 mg                                                
Cuttina H®       12 mg                                                
microcrystalline cellulose                                                
                    150 mg                                                
______________________________________                                    
 
    
     The substances listed above are mixed, pressed and the items so pressed are coated in a manner known per se with 20 mg of hydroxypropylmethylcellulosephthalate in a coating drum. 
     EXAMPLE 7 
     Acetyl-salicylic acid capsules: 
     
         ______________________________________                                    
acetyl-salicylic acid                                                     
                    108 mg                                                
Phospholipon®  80                                                     
                    200 mg                                                
talcum               3 mg                                                 
magnesiumstearate    3 mg                                                 
microcrystalline cellulose                                                
                    100 mg                                                
aerosil              25 mg                                                
______________________________________                                    
 
    
     The substances listed above are granulated and filled into capsules (500 mg hard-gelatin capsules). 
     In the case of the Examples 8-13, pills and capsules are manufactured in a manner similar to the Examples 1, 2 and 3 but employing other non-steroid, inflammation-preventing substances. 
     EXAMPLE 8 
     An indometacine pill is produced from: 
     30 mg of indometacine and 
     130 mg of Phospholipon® 100 
     EXAMPLE 9 
     An indometacine pill is produced from: 
     30 mg of indometacine and 
     70 mg of Phospholipon® 100H 
     EXAMPLE 10 
     Indometacine capsules are produced containing: 
     30 mg of indometacine 
     130 mg of Phospholipon® 100 
     EXAMPLE 11 
     Phenylbutazone pills are produced containing: 
     105 mg of phenylbutazone 
     140 mg of Phospholipon® 100 
     EXAMPLE 12 
     Ibuprofen pills are produced containing: 
     100 mg of ibuprofen 
     210 mg of Phospholipon® 100 
     EXAMPLE 13 
     Acetyl-salicylic acid pills are produced containing: 
     220 mg of acetyl-salicylic acid 
     80 mg of dipalmitoylphosphatidylcholine 
     All the preparations of Examples 8-13 show an improvement in compatibility and prevented side effects which normally are occurring in connection with the active substances involved. 
     The principles, preferred embodiments and modes of operation of the present invention have been described in the foregoing specification. The invention which is intended to be protected herein, however, is not to be construed as limited to the particular forms disclosed, since these are to be regarded as illustrative rather than restrictive. Variations and changes may be made by those skilled in the art without departing from the spirit of the invention.