Water-soluble composition for forming an aqueous isotonic nitroglycerine solution and the nitroglycerine solution formed
The invention relates to a preparation that can be dissolved in water to form an approximately isotonic nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution, and to an approximately isotonic aqueous nitroglycerine solution having a content of approximately 1 mg of nitroglycerine/ml of solution. 
     It should be possible to manufacture the approximately isotonic nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution from the preparation according to the invention by dissolving the preparation in water. This nitroglycerine solution could be used for infusions. The concentration of 1 mg of nitroglycerine/1 ml of solution would offer the user a simple basis for calculating amounts infused and further dilutions. Further advantages would be that patients would be subjected to relatively small infusion volumes and that, in the case of intensive treatment, infusion piston pumps would rarely need to be changed. 
     
                                           TABLE 1                                 
__________________________________________________________________________
Known nitroglycerine solutions                                            
           Solvent                                                        
                       After dilution                                     
                       with water to                                      
   Nitroglycerine      1 mg nitro-                                        
   concentration       glycerine/ml                                       
No.                                                                       
   (mg/ml)             solution                                           
                               Remarks                                    
                                    Literature                            
__________________________________________________________________________
1  1       approx. 100% ethanol                                           
                         --    a,b  Rote Liste 1980                       
2  5       approx. 100% ethanol                                           
                       20% ethanol +                                      
                               a,b  &#34;                                     
                       80% water                                          
3  5       approx. 100% ethanol                                           
                       20% ethanol +                                      
                               a,b  &#34;                                     
                       80% water                                          
4  3.1     1,2-propylene glycol +                                         
                         ?     a,b  &#34;                                     
           (unspecified)                                                  
           ethanol                                                        
5  0.63    1,2-propylene glycol +                                         
                       impossible                                         
                               c    &#34;                                     
           (unspecified)                                                  
           ethanol                                                        
6  ?       approx. 100% ethanol                                           
                               a,b  Trissel, &#34;Handbook                    
                                    of Injectable D ugs&#34;                  
                                    2nd Edition, 1980                     
7  0.15    water       impossible                                         
                               c    Trissel, &#34;Handbook                    
                                    of Injectable D ugs&#34;                  
                                    2nd Edition, 1980                     
8  10      approx. 100% ethanol                                           
                       10% ethanol +                                      
                               a,b,d                                      
                                    Gstirner, &#34;Grund-                     
                                    stoffe und Verfahren                  
                                    der Arzneibereitung&#34; P.               
                                    387, Stuttgart 1960                   
9  10      90% ethanol +                                                  
                       9% ethanol +                                       
                               a,b,d                                      
                                    Martindale                            
           10% water   91% water    p. 1646, London                       
10 10      approx. 100% ethanol                                           
                       10% ethanol +                                      
                               a,b,d                                      
                                    Dean and Baun,                        
                       90% water    Am. J. Hospital                       
                                    Pharm. 32 (1975)                      
                                    1036                                  
11 0.4     4% ethanol +                                                   
                       --      c    Dean and Baun,                        
           96% water                Am. J. Hospital                       
                                    Pharm. 32 (1975)                      
                                    1036                                  
__________________________________________________________________________
 Remarks:                                                                 
 a: toxicologically undesirable; see, for example, Kuhn and Loogen,       
 Internist, 19 (1978) 97-106                                              
 b: Not isotonic; an isotonic solution contains only 1.28% ethanol or 2.0%
 propylene glycol                                                         
 c: concentration too low                                                 
 d: Risk of nitroglycerine precipitation                                  
 
    
     
                                           TABLE 2                                 
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Dissolution of tablets (NG = Nitroglycerine)                              
                    NG   NG total                                         
   Tablets          concen-                                               
                         amount                                           
   (mg NG/                                                                
          Solution  tration                                               
                         (mg)/                                            
No.                                                                       
   tablet)                                                                
          solution medium                                                 
                    (mg/ml)                                               
                         mixture                                          
                              Remarks  Literature                         
__________________________________________________________________________
1  0.6    water     0.15 ?    c        Flaherty et al.,                   
                                       Circulation, 51                    
                                       (1975) 132                         
2  0.4     0.9% NaCl +                                                    
                    0.4  8    c        Kaplan et al.,                     
          99.1% water                  Anesthesiology,                    
                                       45 (1976) 14                       
3  0.6    water     1    ?    hypertonic                                  
                                       Cottrell and                       
                              approx. 17%                                 
                                       Turndorf, Am.                      
                              solids in case                              
                                       Heart J., 96                       
                              of 100 mg                                   
                                       (1978) 550                         
                              tablet                                      
4         water     0.4  ?    c        Sturek et al.,                     
5          5% dextrose +                                                  
                    0.4  ?    c        Am. J. Hosp.                       
   0.4    95% water                    Pharm., 35                         
6          0.9% NaCl +                                                    
                    0.4  ?    c        (1978) 537                         
          99.1% water                                                     
7  0.4     0.9% NaCl +                                                    
                    0.08 87.2 c        McNiff et al.,                     
          99.1% water                  Am. J. Hosp.                       
                                       Pharm. 36                          
                                       (1979) 173                         
8  0.4    (a)  0.9% NaCl +                                                
                    0.03 8    c                                           
          99.1% water +                                                   
          (b)  5% dextrose +                                              
          95% water                                                       
          (a):(b) = 10:240                                                
          or 20:230                                                       
9  0.4     0.9% NaCl +                                                    
                    1    40   hypertonic                                  
                                       Swerling,                          
          99.1% water         approx. 25%                                 
                                       Hosp. Pharm.,                      
                              solids in case                              
                                       14 (1979)                          
                              of 100 mg                                   
                                       420                                
                              tablet                                      
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                                           TABLE 3                                 
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Dissolution of adsorbate (NG = Nitroglycerine)                            
            Solution                                                      
                   Solvent                                                
            NG            after dilution                                  
   Lactose adsorbate                                                      
            concentra-    with water to                                   
No.                                                                       
   (% NG)   tion (mg/ml)  1 mg NG/ml                                      
                                   Remarks                                
                                        Literature                        
__________________________________________________________________________
1  10       10     100% ethanol                                           
                          10% ethanol +                                   
                                   a,b,c of                               
                                        Fung and                          
                          90% water                                       
                                   Table 1                                
                                        Rhodes. Am.                       
                                        J. Hosp.                          
                                        Pharm., 32                        
                                        (1975) 139                        
2  10       10     100% ethanol                                           
                          10% ethanol +                                   
                                   a,b,c of                               
                                        Ward et al.,                      
                          90% water                                       
                                   Table 1                                
                                        Drug Intell.                      
                                        Clin. Pharm.,                     
                                        13 (1979) 14                      
3  10       0.4     0.9% NaCl +                                           
                          impossible    McNiff et al.,                    
                   99.1% water          Am. J. Hosp.                      
                                        Pharm., 36                        
                                        (1979) 173                        
__________________________________________________________________________
 
    
     As can be seen from Table 1, nitroglycerine solutions are already known. These known nitroglycerine solutions have, however, a nitroglycerine concentration of less than 1 mg/ml or have (optionally after dilution to a nitroglycerine concentration of 1 mg/ml) a toxicologically undesirably high content of organic solvent and a hypertonic value. In this connection, reference is made to Kuhn and Loogen, &#34;Die Wirkung von Alkohol auf das Herz einschliesslich der Alkoholcardiomyopathie&#34;, Internist 19 (1978) 97-106. Diluting solutions having a nitroglycerine concentration of 10 mg/ml at least, may lead to a dangerous nitroglycerine precipitation; see Martindale, &#34;The Extra Pharmacopoeia&#34;, 27th Edition, p. 1647, London. On the danger of nitroglycerine droplet formation, see also Kutkiewicz and Kowalski, Chem. Abs., 74 (1971) 170, reference 128 368 w. 
     As shown in Table 2, nitroglycerine solutions have also already been manufactured by dissolving tablets. The nitroglycerine solutions obtained however also have a nitroglycerine concentration of less than 1 mg/ml or (as a consequence of the high ratio of bulk material:nitroglycerine) a hypertonic value. A known adsorbate of 10% nitroglycerine on lactose has a relatively favourable ratio of bulk material:nitroglycerine (Table 3). In that case, however, the following is to be noted. It is not by chance that Fung and Rhodes and also Ward et al propose the extraction of the adsorbate with ethanol in order to manufacture solutions from which nitroglycerine concentrations of 1 mg/ml can be obtained. Indeed, nitroglycerine has a low saturation concentration in water, in solubilisers customarily used for parenteral administration and in aqueous solutions containing such solubilisers, ethanol still proving to be best; see Table 4. 
     
                       TABLE 4                                                     
______________________________________                                    
Saturation concentration of nitroglycerine                                
            Saturation                                                    
            concentration                                                 
            of nitrogly-                                                  
Solvent     cerine (mg/ml) Literature                                     
______________________________________                                    
water        1.73          Ullman, vol. 16,                               
                           p.70, 1965                                     
water +     4.5            Gstirner, p. 955,                              
5% Tween 20                1960                                           
water +     6.4            Gstirner, p. 955,                              
10% Tween 20               1960                                           
ethanol     540            Ullmann, vol. 16,                              
                           p.70, 1965.                                    
1,2-propylene glycol                                                      
            approx. 80       --                                           
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     If nitroglycerine is introduced into water on a water-soluble solid carrier, the water-soluble carrier dissolves, and a high local nitroglycerine concentration which is above its saturation concentration occurs. The nitroglycerine collects in droplets or drops with the result that there is a danger of an explosion while the nitroglycerine drops are slowly dissolving in the supernatent solution (Comparison Example 1). It is therefore not possible to use this procedure for the manufacture of nitroglycerine solutions on an industrial scale. 
     Despite the poor solubility of nitroglycerine in solubiliers customarily used for parenteral administration and in aqueous solutions containing such solubilisers, surprisingly it has now been found that, according to the invention, it is possible to provide a preparation that can be dissolved in water to form an approximately isotonic nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution without the separation of nitroglycerine droplets, by providing a small amount of a solubiliser customarily used for parenteral administration in conjunction with a solid nitroglycerine carrier. 
     According to the invention, therefore, there is provided a preparation that can be dissolved in water to form an approximately isotonic nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution, which comprises 
     (a) nitroglycerine, 
     (b) a solubiliser customarily used for parenteral administration, and 
     (c) as a solid nitroglycerine carrier, a substance which is customarily used in isotonic basic solutions and renders them isotonic 
     having a weight ratio of nitroglycerine:solubiliser of from 0.1:1 to 10:1, 
     and having an amount of carrier which supplements the total amount of all the substances in an amount of preparation containing approximately 0.1 g of nitroglycerine to the equivalent corresponding to approximately 0.90 g of sodium chloride for isotonicity. 
     The amount of carrier therefore supplements the total amount of all the substances in an amount of preparation containing 0.1 g of nitroglycerine to the isotonicity equivalent corresponding to approximately 0.90 g of sodium chloride. 
     The isotonicity equivalent ensures that when an amount of preparation containing approximately 0.1 g of nitroglycerine is dissolved to form an aqueous solution having a content of approximately 1 mg of nitroglycerine/ml of solution, an approximately isotonic nitroglycerine solution is obtained. For the manufacture of isotonic solutions, it is customary in the field of medicaments to express the amount of individual constituents of a medicament in sodium chloride equvalents; see, for example, Gstirner, &#34;Grundstoffe und Verfahren der Arzneibereitung&#34;, Stuttgart 1960, p. 204, Table 24. 
     In respect of the value of 0.1 g of nitroglycerine, values that exceed or fall short of that value by up to 10%, preferably up to 5%, and especially up to 2%, are tolerated according to the invention. In respect of the isotonicity equivalent corresponding to 0.90 g of sodium chloride, deviations that are within the range of from 0.60 to 1.50 g of sodium chloride or that lead to a depression of the freezing point within the range of from 0.51° to 0.63° C. when an amount of preparation according to the invention having a content of approximately 0.1 g of nitroglycerine is dissolved to form an approximately isotonic aqueous nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution are tolerated according to the invention. In respect of a concentration of 1 mg of nitroglycerine/ml of solution, concentrations that exceed or fall short of that concentration by up to 10%, preferably by up to 5%, and especially up to 2%, are also tolerated according to the invention. 
     In the case of special embodiments, the weight ratio of nitroglycerine:solubiliser may be from 0.2:1 to 5:1, preferably from 0.3:1 to 3:1, and especially from 0.5:1 to 2:1. 
     With regard to solubilisation, reference is made, in general, to the following literature, the disclosures of which are incorporated herein: Rohdewald, &#34;Grundlagen der Losungsvermittlung&#34;, Pharm. Z., No. 19 (1971) 673-680; Anschel, &#34;Losungsmittel und Losungsvermittler&#34;, Pharm. Ind., 27 (1965) 781-787; Fiedler, &#34;Lexikon der Hilfsstoffe fur Pharmazie, Kosmetik und angrenzende Gebiete&#34;, pages 341  and 342 etc., Aulendorf 1971; Sucker et al., &#34;Pharmazeutische Technologie&#34;, pages 283 etc., 551 etc., and 556 etc., Stuttgart 1978; Gstirner, &#34;Einfuhrung in die Verfahrenstechnik der Arzneiformung,&#34; p. 271 etc. Stuttgart 1973; and Bohme et al., &#34;Europaisches Arzneibuch&#34;, vol. 3, Kommentar, pages 657 etc., Stuttgart 1979. 
     It is surprising that, preferably, a liquid solubiliser can be used without clumping of a finely particulate preparation according to the invention and loss of its pourability. Molecularly disperse solubilisers can be selected from the following groups: 
     (a) monovalent and polyvalent, lower and higher alcohols, such as 
     1,2-propanediol, 
     1,3-butanediol, and glycerine, 
     (b) lower and higher ether alcohols, such as 
     1,2-propylene glycol-1-n-propyl ether (Soluphor CE 5149), 
     1,2-butylene glycol-1-methyl ether (Soluphor CE 5151), 
     tetraethylene glycol (Tetraglycol or Glucofurol), and polyethylene glycol (average molecular weight, for example, from 200 to 600), 
     (c) lower and higher ethers, such as 
     isopropylpropylene glycol ether, 
     diethylene glycol dimethyl ether, and 
     tetrahydrofurfuryl methyl ether, 
     (d) esters of monovalent or polyvalent organic acids, 
     such as 
     ethyl lactate, 
     glycol monoacetate, 
     glycol diacetate, 
     glycol monopropionate, 
     glycol dipropionate, and 
     propylene glycol propionate, 
     (e) monovalent or polyvalent organic acids, such as lactic acid, 
     (f) amides of organic acids, such as 
     dimethylformamide, 
     dimethylacetamide, 
     N-(β-hydroxyethyl)lactamide, and 
     N,N-dimethylmethoxyacetamide, 
     (g) acetals and ketals, such as 
     isopropylidene glycerol (glycerol dimethyl ketal), and glycerine formal, 
     (h) urea and derivatives thereof, such as 
     urethane, for example ethylurethane, and 
     tetraethylurea, and 
     (i) sulphones, such as 
     tetrahydrothiophene-1,1-dioxide (Sulfolan). 
     In addition, colloidally disperse solubilisers selected from the following group can be used: 
     cellulose derivatives, for example carboxymethylcellulose 
     (cellulose glycolate), 
     Pluronic, 
     Tetronic and 
     castor oil/ethylene oxide condensates (Cremophor). 
     There come into consideration as nitroglycerine carriers solid substances that are customarily used for the manufacture of basic infusion solutions or isotonic basic solutions. Examples of solutions of that type are 0.9% strength sodium chloride solution, 5% strength glucose solution, Ringer&#39;s solution, Ringer&#39;s lactate solution and solutions of full electrolytes and mixtures thereof. Examples of nitroglycerine carriers are especially sodium chloride, mannitol, sorbitol, glucose, lactose and levulose and mixtures thereof; see Ahnefeld and Schmitz, &#34;Systematisierung von Infusionslosungen und Grundlagen der Infusionstherapie&#34;, Karger-Verlag 1980. 
     The preparation according to the invention can be manufactured, for example, by mixing the nitroglycerine, solubiliser and nitroglycerine carrier in a volatile solvent and subsequently evaporating off the solvent. 
     The composition of the preparation according to the invention ensures that it can be dissolved at a temperature of up to 100° C., especially up to 70° C., on an industrial scale, without precipitation of nitroglycerine, to form an approximately isotonic aqueous nitroglycerine solution having a concentration of approximately 1 mg of nitroglycerine/ml of solution. 
     The solution according to the invention is ready for use and does not require to be diluted further. In this manner, the danger of contamination during dilution and also possible incompatibility between active substance and infusion solution are avoided; see Ahnefeld and Schmitz, 
     loc. cit., p. 67 and 73. From a toxicological point of view, the complete lack of ethanol in the solution according to the invention is especially advantageous. 
     The invention is explained in detail below by means of examples and a comparison example. 
    
    
     EXAMPLES 1 TO 4 AND COMPARISON EXAMPLE 1 
     In each case, a mixture of 0.5 g of nitroglycerine, optionally 0.5 g of solubiliser, and anhydrous glucose to 25 g was prepared. 2.5 g of each mixture were stirred into 50 ml of water in each case. When a solubiliser was present, nitroglycerine precipitation no longer occurred at an elevated temperature, from approximately 60° C. Details are given in the following Table 5. 
     
                       TABLE 5                                                     
______________________________________                                    
                   x = nitroglycerine                                     
                   precipitation (forma-                                  
                   tion of droplets) at                                   
       Solubiliser   24° C.                                        
                             60° C.                                
                                     70° C.                        
______________________________________                                    
Example 1                                                                 
         1,2-propylene glycol                                             
                         x       x     --                                 
2        polyethylene glycol                                              
                         x       x     --                                 
         (--M 300)                                                        
3        N,N--dimethylacetamide                                           
                         x       x     --                                 
4        1,2-propylene glycol-1-                                          
                         x       x     --                                 
         n-propylether                                                    
Comparison                                                                
         omitted         x       x     x                                  
Example 1                                                                 
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     EXAMPLE 5 
     (a) Subject to the safety regulations of the explosives industry, 1.6 kg of nitroglycerine were dissolved in from 8 to 10 liters of ether and 1.6 kg of 1,2-propylene glycol were mixed therewith. The solution was then homogeneously mixed with 76.8 kg of glucose in a mixer with the admission of air until the ether had evaporated. 
     (b) 11.550 kg of the preparation according to (a), added in portions, were dissolved, with stirring, in water previously heated to 70° C., in a boiler. After the solution had cooled, the remainder of, in total, 220 liters of water was added. This solution could then be filled into 10 ml ampoules or 50 ml bottles having pierceable caps.