Division of Biopharmaceutics and Pharmacokinetics Department of Pharmacy

University of Helsinki

Development of Multiple-Unit Oral Formulations for Colon-Specific

Drug Delivery Using Enteric Polymers and Organic Acids as Excipients

Pirjo Nykänen

Academic Dissertation To be presented, with the permission of the Faculty

of Science of the University of Helsinki, for public criticism in Auditorium 1041 at Viikki Biocentre (Viikinkaari 5),

on October 4th, 2003, at 12 noon.

Helsinki 2003

Supervisor Professor Martti Marvola Division of Biopharmaceutics and Pharmacokinetics Department of Pharmacy University of Helsinki Finland

Reviewers Professor Kristiina Järvinen Department of Pharmaceutics Faculty of Pharmacy University of Kuopio Finland Docent Sari Eerikäinen Ranua Pharmacy Ranua Finland

Opponent

Docent Juhani Posti Schering Oy Turku Finland

© Pirjo Nykänen ISBN 952-10-1045-2 ISBN 952-10-1046-0 (PDF) ISSN 1239-9469 Yliopistopaino Helsinki 2003 Finland

i

Contents

ABSTRACT iii

LIST OF ORIGINAL PUBLICATIONS iv

1. INTRODUCTION 1

2. REVIEW OF LITERATURE 2

2.1. Colon-specific drug delivery systems 2

2.1.1. Drug release based on variation of pH 2

2.1.2. Drug release based on gastrointestinal transit time 4

2.1.3. Drug release based on the presence of colonic microflora 6

2.1.4. Pressure-controlled drug-delivery systems 9

2.1.5. Conclusions concerning colon-specific drug-delivery methods 10

2.2. In vitro and in vivo evaluation of colon-specific drug-delivery

systems 12

3. AIM OF STUDY 15

4. MATERIALS AND METHODS 18

4.1. Model drugs (I–IV) 18

4.2. Enteric polymers (I–IV) 18

4.3. Pharmaceutical additives (I–IV) 19

4.4. Preparation and enteric coating of matrix granules (I–IV) 19

4.5. Detection of release of drug from granules (I) 21

4.6. Preparation and enteric coating of tablets (III–IV) 21

4.7. Dissolution tests (I–IV) 22

4.8. Bioavailability studies (I–IV) 23

4.9. Plasma assay (I–IV) 24

4.10. Pharmacokinetic parameters (I–IV) 25

4.11. In vitro/in vivo correlation (II, IV) 25

ii

5. RESULTS AND DISCUSSION 27

5.1. Effect of grade of enteric polymer and thickness of enteric

coating on dissolution and absorption of ibuprofen and furosemide

from enteric granules (I) 27

5.1.1. Uncoated matrix granules 27

5.1.2. Enteric-coated matrix granules 28

5.1.3. Thickness of enteric coating 30

5.2. Effect of incorporation of an organic acid on dissolution and

absorption of ibuprofen (II–IV) 30

5.2.1. Effect of incorporation of an organic acid in granules on

dissolution and absorption of ibuprofen from matrix granules (II) 31

5.2.2. Effect of amount and location of citric acid on dissolution

and absorption of ibuprofen from tablets (III–IV) 33

5.3. In vitro/in vivo correlations (II, IV) 37

6. CONCLUSIONS 40

ACKNOWLEDGEMENTS 42

REFERENCES 44

ORIGINAL PUBLICATIONS I–IV

iii

Abstract

The colon is a site where both local and systemic delivery of drugs can take place. Local delivery could, for example, allow topical treatment of inflammatory bowel disease. Treatment could be made more effective if it were possible for drugs to be targeted directly on the colon. Systemic side effects could also be reduced. Colon-specific systems might also allow oral administration of peptide and protein drugs, which are normally inactivated in the upper parts of the gastrointestinal tract. Colon-specific systems could also be used in diseases that have diurnal rhythms.

The aim of the work reported here was to develop a multiple-unit colon-specific formulation for administration by mouth, using enteric polymers as the relevant excipients. It was aimed to prepare a formulation that allows drug absorption after a lag time of about 4 hours. The idea was that the enteric polymers would prevent drug release and absorption in the upper gastrointestinal tract. Use of organic acids as additional excipients might further delay drug dissolution and absorption.

Initially, enteric-coated matrix granules were made using Eudragit™ S100 to form matrices in granules and Aqoat™ AS-HF to provide an enteric coating. Citric acid, tartaric acid or succinic acid were incorporated in the granules to regulate pH. Enteric-coated matrix tablets were then made from the enteric-coated granules. Citric acid was used as a pH-regulating additive in both the granule cores and the tablet matrix. Ibuprofen and furosemide were used as model drugs. Drug dissolution was studied in vitro, at different pH levels. In vitro gradient dissolution studies were carried out in relation to some formulations. Drug absorption was studied in healthy volunteers by means of bioavailability tests.

It was concluded that drug release and absorption can be targeted on the colon when enteric polymers and citric acid were used as excipients in multiple-unit tablets. Lag times of 2–4 hours in relation to commencement of drug absorption were noted when different amounts of citric acid were included in the tablet matrix and granules. It was found to be very important to include citric acid in the tablet matrix when preparing colon-specific formulations. Percentages of citric acid of between 10 and 15 are likely to be appropriate for colon-specific formulations with lag times of 3–4 hours. Inclusion of citric acid in granules is unnecessary. Citric acid in granules can retard drug release excessively.

Correlations between in vitro and in vivo findings were poor. It is therefore important to conduct bioavailability tests at all stages of the process of development of new controlled-release dosage forms. Modifying circumstances during an in vitro gradient dissolution study may allow establishment of level-A in vitro/in vivo correlations.

iv

List of original publications

This dissertation is based on the following publications. The studies are referred to in the text by the Roman numerals I–IV. Some unpublished results are also presented.

I Marvola M., Nykänen P., Rautio S., Isonen N. and Autere A-M.

1999. Enteric polymers as binders and coating materials in multiple-unit site-specific drug delivery systems. Eur. J. Pharm. Sci. 7, 259–267.

II Nykänen P., Krogars K., Säkkinen M., Heinämäki J., Jűrjenson H.,

Veski P. and Marvola M. 1999. Organic acids as excipients in matrix granules for colon-specific drug delivery. Int. J. Pharm. 184, 251–261.

III Nykänen P., Lempää S., Aaltonen M-L, Jűrjenson H., Veski P. and

Marvola M. 2001. Citric acid as excipient in multiple-unit enteric-coated tablets for targeting drugs on the colon. Int. J. Pharm. 229, 155–162.

IV Nykänen P., Sten T., Jűrjenson H., Veski P. and Marvola M. 2003.

Citric acid as a pH-regulating additive in granules and in the tablet matrix in enteric-coated formulations for colon-specific drug delivery. Accepted for publication in Die Pharmazie.

1

1. Introduction

During the last decade there has been interest in developing site-specific formulations for targeting drug delivery to the colon. The colon is a site where both local and systemic drug delivery can take place (Bussemeier et al. 2001). A local means of drug delivery could allow topical treatment of inflammatory bowel disease, e.g. ulcerative colitis or Crohn’s disease. Such inflammatory conditions are usually treated with glucocorticoids and sulphasalazine (Friend 1991, Watts and Illum 1997). Treatment might be more effective if the drug substances were targeted directly on the site of action in the colon. Lower doses might be adequate and, if so, systemic side effects might be reduced. A number of other serious diseases of the colon, e.g. colorectal cancer, might also be capable of being treated more effectively if drugs were targeted on the colon.

Site-specific means of drug delivery could also allow oral administration of peptide and protein drugs, which normally become inactivated in the upper parts of the gastrointestinal tract (Watts and Illum 1997, Yang et al. 2002). Vaccines, insulin and growth hormone are examples of candidates. However, the permeability of the epithelium of the colon to peptide and protein drugs is fairly poor, and bioavailabilities are usually very low.

Colon-specific systems could also be used in conditions in which a diurnal rhythm is evident, e.g. asthma, rheumatic disease, ulcer disease and ischaemic heart disease (Yang et al. 2002). The incidence of asthmatic attacks is, for example, greatest during the early hours of the morning. Because dosage forms remain longer in the large intestine than in the small intestine, colon-specific formulations could be used to prolong drug delivery.

2

2. Review of literature

2.1. Colon-specific drug delivery systems

Rectal administration offers the shortest route to targeting drugs on the colon. However, reaching the proximal part of the colon via rectal administration is difficult. Rectal administration can also be uncomfortable for the patient, and compliance may be less than optimal (Watts and Illum 1997).

There are several ways in which drugs can be targeted on the colon when they are given by mouth (Ashford and Fell 1993, Watts and Illum 1992, Yang et al. 2002). In time-dependent formulations the drug concerned is released during the period of gastrointestinal transit time. Release from formulations that contain pH-dependent polymers takes place on the basis that pH is higher in the terminal ileum and colon than in the upper parts of the gastrointestinal tract. The colon is also home to large numbers of bacteria of many kinds. Prodrugs and dosage forms from which drug release is triggered by the action of colonic bacterial enzymes have therefore been devised.

2.1.1. Drug release based on variation of pH

In the stomach pH ranges between 1 and 2 during fasting but increases after eating (Rubinstein 1995, Wilson et al. 1989b). The pH is about 6.5 in the proximal small intestine and about 7.5 in the distal small intestine (Evans et al. 1988). From the ileum to the colon pH declines significantly. It is about 6.4 in the caecum. However, pH values as low as 5.7 have been measured in the ascending colon in healthy volunteers (Bussemer et al. 2001). The pH in the transverse colon is 6.6, in the descending colon 7.0.

Use of pH-dependent polymers is based on these differences in pH levels. The polymers described as pH-dependent in colon specific drug delivery are insoluble at low pH levels but become increasingly soluble as pH rises (Ashford and Fell 1993). There are various problems with this approach, however. The pH in the gastrointestinal tract varies between and within individuals (Friend 1991, Ashford and Fell 1993, Kinget et al. 1998).

3

It is affected by diet and disease, for example (Rubinstein 1995). During acute stage of inflammatory bowel disease colonic pH has been has been found to be significantly lower than normal (Leopold and Eikener 2000). In ulcerative colitis pH values between 2.3 and 4.7 have been measured in the proximal parts of the colon (Fallingborg et al. 1989). Although a pH-dependent polymer can protect a formulation in the stomach and proximal small intestine, it may start to dissolve even in the lower small intestine, and the site-specificity of formulations can be poor (Fukui et al. 2001). Contrariwise, failure of enteric-coated dosage forms, especially single-unit dosage forms, because of lack of disintegration has been reported (Bussemer et al. 2001). The decline in pH from the end of the small intestine to the colon can also result in problems. Lengthy lag times at the ileo-caecal junction or rapid transit through the ascending colon can also result in poor site-specificity of enteric-coated single-unit formulations (Ashford et al. 1993a)

Eudragit™ products are pH-dependent methacrylic acid polymers containing carboxyl groups. The number of esterified carboxyl groups affects the pH level at which dissolution takes place. Eudragit™ S is soluble above pH 7 and Eudragit™ L above pH 6. Eudragit™ S coatings protect well against drug liberation in the upper parts of the gastrointestinal tract and have been used in preparing colon-specific formulations (Dew et al. 1982, Ashford et al. 1993a, Zahirul et al. 1999). When sites of disintegration of Eudragit™ S-coated single-unit tablets were investigated using a gamma camera they were found to lie between the ileum and splenic flexure. Site-specificity of Eudragit S formulations, both single- and multiple-unit, is usually poor (Ashford et al. 1993a).

Eudragit™ S coatings have been used to target the anti-inflammatory drug 5-aminosalicylic acid (5-ASA) in single-unit formulations on the large intestine (Dew et al. 1982, Kinget et al. 1998). Eudragit™ L coatings have been used in single-unit tablets to target 5-ASA on the colon in patients with ulcerative colitis or Crohn’s disease (Hardy et al. 1987).

The polypeptide hormone vasopressin and insulin have been administered to rats orally in Eudragit™ S-coated single-unit capsules (Touitou and Rubinstein 1986, Rao and Ritchel 1992). Eudragit™ S-coated insulin capsules have also been administered orally to hyperglycaemic beagle dogs (Hosny et al. 2002). In the latter study it was concluded that

4

plasma glucose levels were lowered gradually and reproducibly but that delivery by means of the oral route was not bioequivalent to delivery by means of parenteral route (SC).

Eudragit™ S has been used in combination with another methacrylic acid copolymer, Eudragit™ L100-55, in colon-targeted systems to regulate drug delivery (Khan et al. 1999). Dissolution studies showed that drug release profiles from enteric-coated single-unit tablets could be altered in vitro by changing the ratios of the polymers, in the pH range 5.5 to 7.0.

Hydroxypropylmethylcellulose acetate succinate (HPMCAS) has been included in outer layers of single-unit press-coated tablets with a view to preventing drug release in the stomach and small intestine (Fukui et al. 2001). In vitro dissolution studies suggested that such tablets could be useful as colon-specific formulations. No in vivo studies were undertaken.

2.1.2. Drug release based on gastrointestinal transit time

The time of transit through the small intestine is independent of formulation. It has been found that both large single-unit formulations and small multiple-unit formulations take three to four hours to pass through the small intestine (Davis et al. 1986, Parker et al. 1988, Wilson et al. 1989a, Adkin et al. 1993). Transit time through the small intestine is unaffected by particle size or density, or by the composition of meals.

Because the time taken by formulations to leave the stomach varies greatly the time of arrival of a formulation in the colon cannot be accurately predicted. However, the effects of variation in gastric residence time can be minimized by using systems that are protected in the stomach, and drug release can be targeted on the colon by means of formulations that release the drug they contain a certain time after gastric emptying. Such formulations pass through the stomach and small intestine and drug is then released at the end of the small intestine or beginning of the colon (Kinget et al. 1998). Accordingly, formulations that depend for drug release on time of transit through the small intestine also usually depend for drug release on changes in pH in the gastrointestinal tract. Transit times through the colon that are faster than normal have been observed in patients with irritable bowel syndrome, diarrhoea and ulcerative colitis. Systems that depend on

5

gastrointestinal transit time for drug release are therefore not ideal for drug delivery in the colon for treatment of colon-related disease (Yang et al. 2002).

Combinations of hydrophilic (hydroxypropylmethylcellulose, HPMC) and hydrophobic polymers have been used as coatings for tablets that release drug from a core after a lag time (Pozzi et al. 1994). When the in vivo behaviour of such tablets was studied scintigraphically it was found that disintegration occurred in the proximal colon after about 5.5 hours (range 5 to 6.5 hours). Lag time could be adjusted by changing the thickness of the polymer layer. HPMC and hydroxypropylcellulose (HPC) have been used as swellable polymers in delayed release formulations (Gazzaniga et al. 1994a, b, Vandelli et al. 1996). In such formulations enteric polymers can also be used as coatings to protect the formulation in the stomach. Using gammascintigraphy, Sangalli et al. (2001) investigated the in vivo behaviour of tablets with a drug-containing core coated with hydrophilic HPMC and an enteric polymer (Eudragit™ L30D). The lag-time in relation to absorption was found to be 7.3 ± 1.2 hours when the thickness of the polymer layer was greatest. The formulation disintegrated in the colon in all six volunteer subjects.

Time-controlled formulations have also been prepared using water-insoluble ethylcellulose and swellable polymer (HPC) (Hata et al. 1994, Takaya et al. 1995). Each of the formulations consisted of a core, drug, swelling agent and a water-insoluble membrane. The swelling agent HPC absorbed liquid and the ethylcellulose coat disintegrated as the core swelled. A lag time of 4.0 ± 0.5 hours in relation to absorption was found for this formulation in a human bioavailability study, and it was not influenced by food.

A drug delivery system (Pulsincap™), from which there is rapid drug release after a lag-time, has been developed to allow release of drug in the large intestine (Wilding et al. 1991). The system involves an insoluble capsule body with a hydrogel plug. The plug is ejected from the capsule when it has swelled after a particular lag-time. A release profile is characterized by a period during which here is no release followed by rapid and complete drug release. Release using this system was found to be reproducible in vitro and in vivo. When gastrointestinal transit of the formulations was followed by means of gammascintigraphy it was found in

6

six of the eight subjects that the device reached the colon before drug was released (Wilding et al. 1992). The formulation had been administered with the subjects in a fasting state. Effects of food and gastric retention time were not investigated. In later scintigraphic studies it was found that the site of release of drug in the gastrointestinal tract varied. In one subject the formulation even remained in the stomach for a long time, and drug was also released in the stomach (Stevens et al. 2002).

A formulation that involves a plug that erodes rather than a hydrogel plug has also been developed (Krögel and Bodmeier 1998). The aim of the studies descibed was to simplify the Pulsincap™ technology and develop a chronopharmaceutical formulation (Ross et al. 2000).

2.1.3. Drug release based on the presence of colonic microflora

Both anaerobic and aerobic micro-organisms inhabit the human gastrointestinal tract (Rubinstein 1990, Watts and Illum 1997, Kinget et al. 1998). In the small intestine the microflora is mainly aerobic, but in the large intestine it is anaerobic. About 400 bacterial species have been found in the colon, and some fungi. Most bacteria inhabit in the proximal areas of the large intestine, where energy sources are greatest (Watts and Illum 1997). Carbohydrates arriving from the small intestine form the main source of nourishment for bacteria in the colon. The carbohydrates are split into short-chain fatty acids, carbon dioxide and other products by the enzymes glycosidase and polysaccharidase. Protease activity in the colon can result in cleavage of proteins and peptides. In the proximal colon the pH is lower than at the end of the small bowel because of the presence of short-chain fatty acids and other fermentation products. Diet can affect colonic pH (Rubinstein 1990, Watts and Illum 1997, Kinget et al. 1998).

The presence of colonic microflora has formed a basis for development of colon-specific drug delivery systems. Interest has focused primarily on azo reduction and hydrolysis of glycoside bonds. However, the colonic microflora varies substantially between and within individuals, reflecting diet, age and disease. Such variations need to be taken into account in developing colon-specific formulations depending on the presence of colonic microflora. There is also significant proteolytic activity in the colon,

7

although this is 20 to 60 times less than in the small bowel (Rubinstein et al. 1993, Watts and Illum 1997). Even when proteolytic activity is relatively low a drug may remain much longer in the colon than in the small intestine, with the result that it is exposed longer to proteolytic activity (Bussemer et al. 2001).

Prodrugs have been used in targeting drugs on the large intestine. Sulphasalazine, used in the treatment of ulcerative colitis and Crohn’s disease, is a colon-specific prodrug (Friend 1991, Watts and Illum 1997, Kinget et al. 1998). In the colon sulphasalazine is split by bacterial azo-reduction into 5-ASA and sulphapyridine (Klotz 1985). Sulphapyridine can cause side effects, and other carriers for delivery of 5-ASA to the colon have therefore also been investigated. Olsalatzine consists of two molecules of 5-ASA linked by an azo-bond. Ipsalatsine and balsalatsine are other 5-ASA containing prodrugs (Friend 1991). Polymers and polyamides containing azo groups have been used to convey 5-ASA to the large intestine (Schacht et al. 1996). Azo polymers have been used as colon-specific film coatings (Saffran et al. 1986, Van den Mooter et al. 1992). Colon targeting by means of azo polymers is associated with many problems (Van den Mooter et al. 1997). Microbial degradation of azo polymers is usually slow, and drug delivery can be incomplete and irregular. Not enough is yet known about the safety of azo polymers. In vivo absorption studies with azo polymers have mostly been carried out using rats. No results of studies in human beings are available. Although the gastrointestinal microflora of rats and humans differ, results of in vivo experiments with rats can give some indications regarding biodegradation of azo polymers (Van den Mooter 1992).

Hydrogels containing azo-aromatic cross-links have been investigated in connection with site-specific drug delivery of peptide and protein drugs (Brønstedt and Kopeček 1992, Kopeček et al. 1992). In the low pH range of the stomach the gels have a low equilibrium degree of swelling and the drug is protected against digestion by enzymes, but at high pH levels they swell. So in the stomach a drug will be protected, but released in the colon, where cross-links become degraded.

The colonic microflora produces a wide range of glycosidases capable of hydrolysing glycosides and polysaccharides (Friend and Tozer 1992). Glycosides of glucocorticosteroids have been synthesized, and tested in

8

rodents. The problem in these studies was that some drug was hydrolysed even in the small intestine. However, in rodent bacterial glycosidase activity in the small intestine is some 100 times greater than in human beings. It is likely that drug delivery in man would be more predictable than in rodents. Glucuronides, which are less subject to hydrolysis in the small intestine than glycosides, have also been used as drug carriers (Friend 1995).

An extensive range of drug delivery systems based on polysaccharides has been investigated. The advantage of these materials is that most are easily available. Disadvantages are that most of polysaccharides are hydrophilic and gel forming (Watts and Illum 1997). In preparing dosage forms from polysaccharides it is necessary to ensure that no drug is released until it reaches the colon.

Amylose has been used in coatings of colon-specific formulations (Milojevic et al. 1996a, b). Amylose, a major component of starch, swells too much on its own, but amylose-ethylcellulose coatings have been investigated in connection with targeting of drug release on the colon. From the results of in vitro studies it was concluded that amylose-ethylcellulose coatings could be suitable for colon-specific formulations.

Pectin is a polysaccharide, found in the cell walls of plants. It is totally degraded by colonic bacteria but is not digested in the upper gastrointestinal tract (Ashford et al. 1994, Rubinstein et al. 1993). One disadvantage of pectin is its solubility. This can however be adjusted by changing its degree of methoxylation, or by preparing calcium pectinate (Rubinstein et al. 1993, Ashford et al. 1994). The film-coating properties of pectin have been improved through use of ethylcellulose (Wakerly et al. 1996). Pectin has also been used with chitosan (Munjeri et al. 1997) and HMPC (Turkoglu et al. 1999). It has been shown in studies in which gamma camera was used that pectin-coated tablets disintegrate in the colon during transit (Ashford et al. 1994).

Cross-linked guar gum has been used as a drug carrier in matrix tablets (Gliko-Kabir et al. 1998, Rama Prasad et al. 1998). It was concluded that guar gum is suitable for preparation of colon-specific formulations and is particularly suitable as a carrier of drugs that are not very soluble in water. However, the guar gum formulations mentioned have only formed the subjects of in vitro dissolution studies and in vivo evaluation in rats.

9

Dextran ester prodrugs have been investigated as means of transporting drugs to the colon (Harboe et al. 1989, McLeod et al. 1993). When the bioavailability of naproxen after administration of dextran-naproxen prodrug was assessed in pigs, lag times of two to three hours were observed. Dextran esters of fatty acids have been used to form colon-specific film coatings (Bauer and Kesselhut 1995). The suitability of such formulations for colon-specific drug delivery in human being remains to be demonstrated in volunteers.

Chitosan is a high-molecular-weight polysaccharide that is degraded by colonic microflora (Tozaki et al. 1997). Insulin and 5-ASA have been administered to rats in enteric-coated chitosan capsules. A multiple-unit formulation containing chitosan and drug has also been prepared (Lorenzo-Lamosa et al. 1998). This formulation depended for drug delivery on both variations in gastrointestinal pH and the presence of colonic microflora.

2.1.4. Pressure-controlled drug-delivery systems

As a result of peristalsis, higher pressures are encountered in the colon than in the small intestine. Takaya et al. (1995) have developed pressure-controlled colon-delivery capsules prepared using an ethylcellulose, which is insoluble in water. In such systems drug release occurs following disintegration of a water-insoluble polymer capsule as a result of pressure in the lumen of the colon. The thickness of the ethylcellulose membrane is the most important factor for disintegration of the formulation (Muraoka et al. 1998, Jeong et al. 2001). The system also appeared to depend on capsule size. When salivary secretion of caffeine after oral administration of pressure-controlled capsules was studied in human volunteers, a correlation was found between ethylcellulose membrane thickness and the time of first appearance of caffeine in the saliva (Muraoka et al. 1998).

Because of reabsorption of water from the colon, the viscosity of luminal content is higher in the colon than in the small intestine. It has therefore been concluded that drug dissolution in the colon could present a problem in relation to colon-specific oral drug delivery systems (Takaya et al. 1998). In pressure-controlled ethylcellulose single-unit capsules the drug is in a liquid. Lag times of three to five hours in relation to drug absorption were noted when pressure-controlled capsules were administered to human

10

subjects (Hu et al. 2000). It was concluded that the capsules disintegrated in the colon because of increases in pressure. It was also concluded that the formulation studied was advantageous in that the drug release mechanism is independent of pH (Hu et al. 1999). The site at which the formulations disintegrated was not demonstrated in the studies mentioned above. The mechanism of disintegration was also not clarified. As discussed above, ethylcellulose coatings have also been used in connection with time-controlled drug delivery. Disintegration of the formulation can therefore also occur some time after administration, even in the small intestine.

2.1.5. Conclusions concerning colon-specific drug-delivery methods

During the last decade many investigations have been carried out with the aim of discovering an ideal formulation for colon-specific drug delivery. Many approaches have been demonstrated. All have some disadvantages (Table 1).

The microflora of the colon can split polymers. However, such enzymatic degradation is usually excessively slow. The bioavailabilities of drugs from such formulations can be low. In addition, little is known about the safety of the polymers and few have been accepted for use in relation to medicines. Most studies relating to biodegradable polymers have been carried out only in vitro or in laboratory animals.

Time-controlled formulations have also been investigated and developed in connection with targeting of drug delivery on the colon. Formulations of this kind need to be manufactured in such a way that they remain intact in the stomach, in the presence or absence of food. Manufacture of such formulations on an industrial scale is often complicated and expensive.

Formulations involving enteric polymers that react to changes in gastrointestinal pH have been extensively used in connection with colon-specific drug delivery. Enteric polymers have been shown to be safe, and have been accepted for use in drug products. The enteric polymers that have been used are soluble above pH 6 to 7. The pH at the end of the small intestine is about 7.5. It is therefore obvious that drug release from enteric-coated formulations can begin from the end of the small intestine. pH levels

11

Table 1. Advantages and disadvantages of various oral colon-specific drug delivery methods.

Method Advantages Disadvantages References

Time-dependent systems

Small intestine transit time fairly consistenta

Substantial variation in gastric retention timesb

Transit through the colon more rapid than normal in patients with colon diseasec

Davis et al. 1986a

Yang et al. 2002b,c

Ashford and Fell 1993b

Watts and Illum 1997b

pH-dependent systems

Formulation well protected in the stomachd

pH levels in the small intestine and colon vary between and within individualse

pH levels in the end of small intestine and caecum are similarf

Poor site specificityg

Friend 1991d

Ashford and Fell 1993 d,e

Kinget et al. 1998 d,e,f

Yang et al. 2002 e,f

Ashford et al. 1993b g

Microflora-activated systems

Good site-specificity with prodrugs and polysaccharidesh

Diet and disease can affect colonic microflorai

Enzymatic degradation may be excessively slowj

Few have been accepted for use in relation to medicinesk

Rubinstein et al. 1997 h,i

Yang et al. 2002 j

12

also decline from the ileum to the colon. If an enteric-coated formulation is still intact after passage through the small intestine there may be a significant delay in relation to drug release in the colon, where the pH value is lower. Rapid drug release in the ascending colon is however usually required when colon-specific formulations are used, e.g. in treating colon disease. It is advantageous if drug release from a formulation can begin immediately after it enters the colon, even though drug release may subsequently be retarded.

It may be concluded that no ideal formulation for colon-specific drug deliver yet exists. Drug release from an ideal formulation should begin in the ascending colon, at a predetermined rate. The manufacturing process for the formulation should also be simple and not too expensive.

2.2. In vitro and in vivo evaluation of colon-specific drug-delivery systems

In vitro dissolution testing is important in the development of solid dosage forms. The method used should simulate the environment to which the dosage form being developed will be exposed in the gastrointestinal tract. In the United States Pharmacopoeia (USP) dissolution procedures are described for conventional oral formulations, and for extended-release and delayed-release formulations (USP 23). In the case of enteric-coated formulations the test for ”delayed-release articles” should be used. However, controlled-release formulations used for colon-specific drug delivery are usually complex, and the dissolution methods described in the USP cannot wholly mimic in vivo conditions such as those relating to pH, bacterial environment and mixing forces (Yang et al. 2002).

The conventional method involving dissolution in various buffers is useful for assessing the ability of an enteric-coating to prevent drug release in the stomach and small intestine. Dissolution studies of this kind can be used in relation to both time-release systems and formulations with enteric-coatings.

Dissolution tests relating to colon-specific drug delivery systems may be carried out using the conventional basket method. Parallel dissolution studies in different buffers may be undertaken to characterize the behaviour of formulations at different pH levels. Rudolph et al. (2001) carried out

13

dissolution tests of a colon-specific formulation in various media simulating pH conditions at various locations in the gastrointestinal tract. The media chosen were, for example, pH 1.2 to simulate gastric fluid, pH 6.8 to simulate the jejunal region of the small intestine, and pH 7.2 to simulate the ileal segment.

Consecutive dissolution tests in different buffers for different periods of time best simulate the transit of a formulation through the gastrointestinal tract. In gradient dissolution studies a particular formulation unit is exposed to buffers representing successive conditions in the gastrointestinal tract. Enteric-coated capsules for colon-specific drug delivery have been investigated in a gradient dissolution study in three buffers. The capsules were tested for two hours at pH 1.2, then one hour at pH 6.8, and finally at pH 7.4 (Cole et al. 2002). The relationship between percentage of drug released in vitro and percentage of drug absorbed in vivo was observed when pulsatile-release tablets were tested in vitro for two hours at pH 1.2 followed by a dissolution study at pH 6.8 (Fan et al. 2001).

Fukui et al. (2000) kept enteric-coated tablets in a buffer at pH 1.2 for 16 hours. A dissolution study was then carried out at pH 6.8. It was concluded that the dissolution profiles of formulations that had not been kept in buffer at pH 1.2 did not differ markedly from dissolution profiles of formulations that had been kept in buffer at pH 1.2. Exposure to acid in the stomach should therefore not affect the dissolution properties of such formulations in the lower gastrointestinal tract. On the basis of these findings it is obvious that sufficient information regarding dissolution properties of formulations can often be obtained using parallel dissolution tests. Gradient dissolution tests are usually unnecessary.

To allow the performance of colon-specific delivery systems containing biodegradable polymers to be assessed, the contents of animal caecum have been used in dissolution studies (Yang et al. 2002). Such studies provide no information about the physical and chemical functionality of a system.

In vivo bioavailability tests in human beings are important in developing controlled-release drug delivery systems. From of the results of bioavailability tests, sites of drug liberation in vivo can be determined, if the formulation has been administered to the subjects in the fasting state. However, it is impossible to predict times of arrival of formulations in the colon accurately, because gastric emptying times vary so greatly. In recent

14

years gammascintigraphy has become the most popular means of investigating the gastrointestinal performance of pharmaceutical dosage forms, especially site-specific dosage forms (Wilding et al. 1991). By means of gammascintigraphic imaging, information can, for example, be obtained regarding time of arrival of a colon-specific drug delivery system in the colon, times of transit through the stomach and small intestine, and disintegration. Information about the spreading or dispersion of a formulation and the site at which release from it takes place can also be obtained (Hebden et al. 1999). Gammascintigraphic studies can also provide information about regional permeability in the colon. Information about gastrointestinal transit and the release behaviour of dosage forms can be obtained by combining pharmacokinetic studies and gammascintigraphic studies (pharmacoscintigraphy). Good correlations between appearance of a drug in plasma and observed disintegration times have been recorded.

When gammascintigraphy was used to investigate the suitability of an Eudragit™ S-coated tablet for drug delivery to the colon results of the study were found to be in accordance with results of in vitro dissolution studies (Ashford et al. 1993a). Gammascintigraphy has also been used to determine gastrointestinal transit times and sites of disintegration of calcium pectinate tablets intended to allow colon-specific drug delivery (Adkin et al. 1997). Although the tablets disintegrated completely in the colon it was concluded that gammascintigraphy did not allow exact information about the mechanism of disintegration to be obtained.

Many pharmacoscintigraphic studies have been reported. Stevens et al. (2002) used gammascintigraphy to identify the site of release from a Pulsincap™ formulation, intended to release drug after a five-hour lag time. Plasma concentrations of the model drug were also followed. A good correlation was found between release times determined scintigraphically and pharmacokinetic profiles. A correlation between pharmacokinetic and gammascintigraphic data was also found when times and anatomical locations of break-up of colon-specific formulation were determined by Sangalli et al. (2001).

15

3. Aim of study

As discussed earlier enteric polymers have been widely used to form films in connection with formulations intended to target drug delivery on the colon. Site-specificity of such formulations has, however, usually been poor. In the present study it was therefore decided to determine whether better formulations for colon-specific drug delivery could be prepared using enteric polymers to form matrices as well as films. Most formulations previously studied have been single-unit formulations. A secondary aim of the work described here was therefore also to evaluate whether multiple-unit colon-specific formulations has advantages.

In our work we also tried to improve site-specificity in relation to the colon through use of organic acids as excipients. Incorporation of organic acids was intended to delay dissolution of enteric polymers by keeping the pH level within formulations low, even where the pH in the gastrointestinal tract exceeded 7. It was hoped that it would be possible to prevent drug liberation and absorption in the terminal ileum and defer commencement of drug absorption until the proximal colon was reached.

In the dosage forms studied enteric polymers were used at three stages (Fig. 1). Firstly, we prepared matrix granules in which enteric polymers were used as both binders and film coatings. Enteric-coated multiple-unit tablets were then prepared, using the granules just mentioned and various excipients. Organic acids were used as excipients in both the granules and tablet matrices with the aim of delaying disintegration of the formulations and drug liberation. The granules that make up the individual units in multiple-unit systems of the kind we studied can become widely disseminated over the surface of the colon, an advantage in formulations intended to act locally in the colon, i.e. to be colon-specific.

Ibuprofen and furosemide were used as model drugs because they are absorbed at different sites in the human gastrointestinal tract. Ibuprofen is well absorbed throughout the latter (Wilson et al. 1989a). In contrast, furosemide is well absorbed only in the stomach and at the beginning of the small intestine (Ritschell et al. 1991). Its absorption in the colon is negligible and it is therefore suitable for use as an unabsorbed model drug.

16

The elimination half-life of each model drug is brief, about 2 hours (Ritschell 1992). In studies of effects of formulation on drug absorption a brief elimination half-life is beneficial. At the outset of the study five enteric polymers (Eudragit™ S, Eudragit™ L, Aqoat™ AS-HF, Aqoat™ AS-MF, Aquateric™), dissolving at different pH levels, were used to modify drug delivery. Succinic acid, tartaric acid and citric acid were used as pH-regulating additives.

Dissolution studies at different pH levels were conducted throughout the study. Conclusions were drawn primarily from results of in vivo bioavailability tests with ibuprofen. One of the most important pharmacokinetic parameters calculated was lag time in relation to commencement of drug absorption. For a colon-specific formulation the lag time should be 4–5 hours with subjects in the fasted state. Amounts of drug liberated and absorbed were calculated from area under concentration time curve (AUC) values. Determination of tmax (time to peak concentration) and Cmax (maximum plasma concentration) values allowed evaluation of whether absorption of ibuprofen was delayed or retarded.

The type of formulation we studied has not been described before. Although the formulations are moderately complex, their manufacture is easy, and might also be undertaken on an industrial scale.

Figure 1. Structure of multiple-unit colon-specific tablet developed.

FILM COATING - enteric polymer FILM COATING

- enteric polymer

TABLET MATRIX - microcrystalline cellulose - organic acid

GRANULE CORE - model drug - organic acid - enteric polymer - diluent

17

In detail, the aims of the study described here were as set out below:

The primary aim was to prepare matrix granules incorporating model drugs and diluents, using enteric polymers as binders, and to determine whether drug dissolution and commencement of drug absorption can be influenced in this way. The variables studied were the model drug, the dissolution pH of the enteric polymer and the nature of the diluent (I). Secondarily it was determined whether drug dissolution and absorption could be further delayed through use of various enteric polymers to form films in matrix granules. The effect of the thickness of enteric coating was in particular investigated (I). In a third phase of the study an organic acid was incorporated in uncoated and enteric-coated granules to determine whether disintegration of the granules and, consequently, drug liberation could be delayed by doing so. The variables studied during that phase were the nature and amount of organic acid (II). Enteric-coated multiple-unit tablets were then prepared from the enteric-coated granules that gave the best results. The effect of inclusion of organic acid in the tablet matrix was also investigated. It was assumed that drug release from multiple-unit formulations containing two types of enteric coating and an organic acid as excipient might be sufficiently delayed for drug delivery to be colon-specific. The optimal distribution of the organic acid between the granules and the tablet matrix was determined (III, IV). In vitro/in vivo correlations between dissolution and bioavailability parameters were determined, to see whether the in vivo behaviour of formulations might be predictable from results of dissolution studies. If so, it might be possible to reduce numbers of bioavailability studies in healthy volunteers, and accelerate the drug-development process.

18

4. Materials and methods

4.1. Model drugs (I–IV)

Ibuprofen (Ph. Eur.) was used as a model drug in matrix granules and in multiple-unit tablets (I–IV). Furosemide (Ph. Eur.) was used as a model drug in matrix granules (I).

Ibuprofen (2-(-4-isobutylphenyl)-propionic acid) is almost insoluble in water. Its pKa is 5.3 (Herzfeldt and Kümmel 1983). Ibuprofen is well absorbed throughout the gastrointestinal tract and is therefore suitable as a model drug in relation to study of colon-specific formulations (Wilson et al. 1989a). The elimination half-life of ibuprofen is about 2 hours. Therapeutic concentrations in plasma range from 5 to 50 mg/l (Ritschell 1992). Ibuprofen has anti-inflammatory, antipyretic and analgesic properties.

Furosemide (4-chloro-N-furfuryl-5-sulfamoylanthranilic acid) is almost insoluble in water. Its pKa is 3.9. Furosemide is well absorbed in the stomach (Ritschell et al. 1991). Small amounts can be absorbed in the small intestine. Absorption in the large intestine is negligible. It is therefore suitable for use as an unabsorbed model drug in studying colon-specific formulations. The elimination half-life of furosemide is 1.5 hours. Therapeutic concentrations in plasma range from 0.1 to 0.3 mg/l (Ritschell 1992). Furosemide is a potent diuretic. It acts primarily by inhibiting electrolyte absorption in the loop of Henle.

4.2. Enteric polymers (I–IV)

The enteric polymers used were the methacrylate copolymers Eudragit™ S and Eudragit™ L (Röhm Pharma, Germany), the hydroxypropyl methylcellulose acetate succinates, Aqoat™ AS-HF and Aqoat™ AS-MF (Shin-Etsu Chemical Co., Japan) and cellulose acetate phthalate Aquateric™ (FMC Corporation, USA). The enteric polymers used dissolve around or below pH 7 (Peeters and Kinget 1993, Bauer and Kesselhut 1995), cellulose acetate phthalate at pH 6.2, Eudragit™ L at pH 6 and Eudragit™ S and Aqoat™ AS-HF at pH 7.

19

4.3. Pharmaceutical additives (I–IV)

Calcium phosphate (CaHPO4·2H20), lactose (Ph. Eur), mannitol (Ph. Eur.) and microcrystalline cellulose (Avicel™ PH 102) were also incorporated in the granules. Succinic acid (Ph. Eur.), tartaric acid (Ph. Eur.) or citric acid (monohydrate, Ph. Eur.) were used in granules to adjust the pH of their microenvironments. Citric acid was also used as a pH-regulating additive in tablets.

Microcrystalline cellulose (Emcocel™ LP200, Penwest Pharmaceuticals, USA), magnesium stearate (Ph. Eur.) and talc (Ph. Eur.) were also incorporated in the tablets.

Triethylcitrate (Ph. Eur.), diethylphthalate (Ph. Eur.), talc, magnesium stearate and polysorbate 80 (Ph. Eur.) were incorporated in the coating solution, which was prepared using demineralized water.

4.4. Preparation and enteric coating of matrix granules (I–IV)

During the first phase of the study granules were made mechanically. Details of the process are given in publication I.

Granules containing organic acids were prepared manually (II–IV). A 20% solution in ethanol (Oy Primalco Ab, Finland) of methacrylate polymer (Eudragit™ S) was prepared. The Eudragit™ S was mixed slowly into the ethanol and the solution was stirred magnetically for 2 hours. Dry substances were sieved through a 1.18-mm sieve. Ibuprofen was mixed with the various combinations of diluents. Powder masses (each weighing approximately 200 g) were moistened with binder solution in a mortar and sieved manually through a 2.0-mm sieve. The granules were dried overnight at room temperature. The fraction 1.18–1.68 mm was separated by sieving. The percentage of enteric polymer in the dried granules was 10. The compositions of the granules containing organic acids are shown in Table 2.

During the first phase of the study granules were coated using the enteric polymers hydroxypropylmethylcellulose acetate succinate (Aqoat™ AS-HF) or cellulose acetate phthalate (Aquateric™). These polymers are soluble in water and can be used in water-based film coatings. Details of the coating process are given in publication I.

20

Aqoat™ AS-HF was chosen to film-coat the matrix granules containing organic acids on the basis of the results of the first phase of the study. Enteric matrix granules containing organic acids were coated using a fluidized-bed coater (Aeromatic Strea-1, Aeromatic AG, Switzerland) (II–IV). The coating solution contained 10% Aqoat™ AS-HF as film former, 3.5% triethylcitrate as plasticizer, 3% magnesium stearate as lubricant and 83.5% demineralized water. Triethylcitrate was added to cold water and the solution was stirred magnetically for half an hour. The enteric-coating polymer was dispersed throughout the solution and magnesium stearate was then added. The coating solution was passed through a 0.3-mm sieve, and kept in an ice bath.

Table 2. Compositions (%) of matrix granules containing organic acids.

Ingredients

Ibuprofen 60 60 60 60 60 60 60 60 60 60 60 60 60

Calcium phosphate

30 20 10 - 20 10 - 27.5 25 22.5 20 10 -

Succinic acid (II) - 10 20 30 - - - - - - - - -

Tartaric acid (II) - - - - 10 20 30 - - - - - -

Citric acid (II–IV)

- - - - - - - 2.5 5 7.5 10 20 30

Eudragit™ S 100 10 10 10 10 10 10 10 10 10 10 10 10 10

Granules were preheated for 5 minutes at an outlet temperature of 40ºC ± 5ºC and an air-flow rate of 40 m3/h. The air-flow rate used during coating was 70 m3/h, the outlet temperature 40ºC ± 5ºC and the spraying pressure 1 bar. The spraying rate was 5 g/min. Coating was continued until a theoretical weight increase of 20% had been achieved. Granules were dried after coating at the same temperature for 5 minutes, and then overnight at room temperature.

21

4.5. Detection of release of drug from granules (I)

Release rates of ibuprofen and furosemide from uncoated and enteric-coated granules containing no organic acid were detected via the gradual increase in pH of the dissolution medium. Details are given in publication I.

4.6. Preparation and enteric coating of tablets (III–IV)

Five granule formulations were used in the tablets (Table 3). Twelve tablet formulations were prepared (Table 4). The amount of the model drug ibuprofen in each case was 100 mg. Masses were prepared just before tableting. Coated granules, microcrystalline cellulose and citric acid (if used) were mixed in a Turbula mixer (W. A. Bachofen, Switzerland) for 5 minutes. Magnesium stearate and talc were added and mixing continued for an additional 2 minutes. Tablets were compressed using concave 11-mm punches in a Korch EK-0 single-punch press (Erweka Apparatebau GmbH, Germany). The weight of each tablet was 412 mg. Compression forces were adjusted so that the hardness of tablets was 60–70 N, measured using a Schleuniger 2-E/205 tablet-hardness tester (Dr. K. Schleuniger and Co., Switzerland).

Table 3. Compositions of cores of Aqoat™ AS-HF –enteric-coated matrix granules used in the tablets (%).

Code

Ingredients 0 2.5 5 7.5 10

Ibuprofen 60 60 60 60 60

Calcium phosphate

30 27.5 25 22.5 20

Citric acid 0 2.5 5 7.5 10

Eudragit™ S 100 10 10 10 10 10

22

Aqoat™ AS-HF was used as the enteric coating for the tablets because it is soluble above pH 7. It was also found to be suitable as an enteric coating for the matrix granules used in the tablets. Tablets were enteric-coated using a fludized-bed coater mentioned above except that the air-flow rate was 100 m3/h. One hundred to 200 g of tablets were coated in each case. Coating was continued until a theoretical weight increase of 12% had been achieved.

Table 4. Compositions of uncoated tablets (%).

Code*

Ingredients 0-0

0-5

0-10

0-11

.7

0-13

.3

0-15

2.5-

10

5-10

7.5-

10

10-0

10-5

10-1

0

Granule 0 48.5 48.5 48.5 48.5 48.5 48.5 - - - - - -

Granule 2.5 - - - - - - 48.5 - - - - -

Granule 5 - - - - - - - 48.5 - - - -

Granule 7.5 - - - - - - - - 48.5 - - -

Granule 10 - - - - - - - - - 48.5 48.5 48.5

Emcocel™ LP200 49.5 44.5 39.5 37.8 36.2 34.5 39.5 39.5 39.5 49.5 44.5 39.5

Citric acid - 5 10 11.7 13.3 15 10 10 10 - 5 10

Magnesium stearate

1 1 1 1 1 1 1 1 1 1 1 1

Talc 1 1 1 1 1 1 1 1 1 1 1 1

*A code system was developed to make it easier to process the results. The first number in the code indicates whether granules were of code 0, 2.5, 5, 7.5 or 10, as shown in Table 3. The second number indicates the amount of citric acid in the tablet matrix.

4.7. Dissolution tests (I–IV)

Drug release from formulations was studied using the basket method described in USP 23 (apparatus: Sotax AT7, Sotax AG, Switzerland (I) or Dissolutest 07, Prolabo, France (II-IV)). When drug release from granules was studied, the amount of drug in each basket was 18 mg. When drug

23

release from tablets was studied, one tablet was placed in each basket. The dissolution media (at 37 ± 0.5ºC, volume 500 ml (II, III) or 900 ml (I, IV)) were phosphate buffers (USP 23) at pH 7.4, 6.8 and 5.8 (II–IV) or 5.0 (I). The speed of rotation was 100 min-1. The dissolution apparatus was connected to a flow-through spectrophotometer (Ultrospect II, LKB Biochrom Ltd., UK) via a peristaltic pump. Absorbances were recorded automatically at 221 nm (ibuprofen) or 274 nm (furosemide). Absorbances were monitored by a computer running tablet-dissolution software (TDS™, LKB Biochrom Ltd., UK)

Time points at which 50% of drug had been released (t50% values) were calculated for the formulations from the results of the dissolution studies. Statistics relating to the t50% values were analysed using Student’s t-test relating to independent groups.

In vitro release data were fitted to zero-order kinetics, first-order kinetics and a square-root of time equation using the Minsq™ program (MicroMath, USA).

A gradient-dissolution study was performed using two enteric-coated tablet formulations containing 2.5% citric acid in the granules and 10% citric acid in the tablet matrix, or no citric acid in the granules and 15% citric acid in the tablet matrix (IV). Tablets were kept in 4 ml of 0.1 N hydrochloric acid (pH 1.2) for two hours. A dissolution study was then carried out in phosphate buffer at pH 6.8 for one hour. Testing in phosphate buffer at pH 7.4 followed. The dissolution apparatus and method were otherwise as described above.

4.8. Bioavailability studies (I–IV)

Thirteen groups of healthy volunteers of both sexes participated in randomized cross-over single-dose studies carried out in accordance with the recommendations of the Declaration of Helsinki (World Medical Assembly 1964) as revised in Edinburgh (2000). The ages of the volunteers ranged from 20 to 46 years, their weights from 43 to 87 kg. Before the studies each participant was examined physically and underwent routine haematological testing (Hb, ESR, S-Alat, S-Alat, S-GT, S-Drea). An electrocardiogram (ECG) was also obtained. The volunteers were informed about possible risks and adverse effects of taking the drugs, and written

24

consent was obtained from each. The experiments were carried out in the Medical Department of Orion-Pharma (I, Orion Corporation, Finland) or in the University of Tartu (II–IV). The study protocols had been approved by the Ethical Committee of Orion-Pharma (I) or the Ethical Committee of the University Hospital of Tartu (II–IV).

Necessary amounts of each granule formulation studied were dispensed into hard gelatine capsules (size 0, Capsugel AG, Switzerland). The amount of ibuprofen in each capsule was 150 mg (I, II), the amount of furosemide 60 mg. The amount of ibuprofen in each tablet was 100 mg (II, IV). One bioavailability study with furosemide formulations was undertaken using a commercial prolonged-release product for reference purposes (Lasix Retard™ 60 mg, Hoechst, Germany) (I). One furosemide capsule, two ibuprofen capsules or three ibuprofen tablets were administered to each subject with 200 ml of water following overnight fasting for at least 10 hours. In one study the effect of food on bioavailability of furosemide was tested (I). A standard breakfast was served just before drug administration. In all of the experiments a standard lunch was served 4 hours after drug administration. The washout period between successive administrations of drugs was at least one week. Blood samples (10 ml) were collected from a forearm vein into heparinized tubes. Plasma was separated after collection and stored at -20°C until analysed.

4.9. Plasma assay (I–IV)

Ibuprofen plasma concentrations were determined by means of high-performance liquid chromatography (HPLC) using the method described by Avgerinos and Hutt (1986) with slight modifications. Plasma (300 µl or 500 µl) was measured into two test tubes. Methanol (HPLC grade, Rathburn, Scotland) was added (600 µl or 1 ml). The contents of the test tubes were mixed for 1 minute and centrifuged for 10 minutes at 4000 min-1.Supernatants (120 µl) were measured into HPLC tubes.

The HPLC system was equipped with a Waters Model 501 piston pump (USA), a Waters Model 700 or 717 Intelligent Sample Processor, a Waters Model 484 or 486 Tunable Absorbance Detector operated at 222 nm and a Waters Millenium (II–IV) or Maxima 820 (I) workstation. Sample separation was carried out on a µBondapak (Waters, USA) C18 reverse-

25

phase silica column (3.9 x 300 mm, particle size 10 µm). The isocratic mobile phase was acetonitrile and 0.1 sodium acetate (35:65), the pH of which had been adjusted to 6.2 with glacial acetic acid. The flow rate was 2 ml min-1. The standard curve was found to be linear (r2 > 0.996) over the concentration ranges 0.5–40 mg/l (I, II) and 0.3–30 mg/l (III, IV). Accuracy, precision, limit of quantitation, specificity and reproducibility were investigated as recommended by Shah et al. (1992).

Furosemide plasma concentrations were determined by means of HPLC using the method described by Beerman (1982). Details of the process and equipment are given in publication I.

4.10. Pharmacokinetic parameters (I–IV)

Pharmacokinetic parameters assessed, using the Siphar™ pharmacokinetic data analysis program (Simed, France), were lag time in commencement of drug absorption (tlag), time to peak concentration (tmax), maximum plasma concentration (Cmax), area under the concentration time curve (AUC0-

8/12/14/24/∞), mean residence time (MRT) (I, II), apparent elimination half-life (t1/2) (I, II) and absorption rate constant (ka) (I). The rate of absoption was also evaluated by means of the ratio Cmax/AUC. AUC and MRT values were calculated using the trapezoidal method without logarithmic transformation. The method of Wagner and Nelson was used to calculate the times at which 10 and 90% had been absorbed (t10 % and t90%, I, II). Statistical analyses were carried out using Student`s paired t-test, the t-test for independent groups and the Wilcoxon or Mann-Whitney nonparametric test (for tmax values).

4.11. In vitro/in vivo correlation (II, IV)

Level-A in vitro/in vivo correlation was investigated using enteric-coated matrix granules containing 10% citric acid, 10% succinic acid, 30% succinic acid or no organic acid in the granule cores (II). Cumulative dissolution curves for each formulation at pH 6.8 were used as the in vitro parameter. For each volunteer the in vivo concentration versus time curve was used to calculate cumulative amounts absorbed at each time, using the method of Wagner-Nelson. Mean cumulative amounts of each formulation absorbed were then calculated.

26

In vitro/in vivo correlations were assessed by superimposing the in vitro release curve on the mean cumulative amount absorbed curve for each formulation, using the same set of coordinates. Correlation between mean values was assessed using the equation of Brocmeier et al. (1983) as modified by Luckow (1994), with slight alternations (Equation 1.)

In the following equation t´= time in vivo, t = time in vitro, a = lag time in vivo, b = scale factor and c = shape factor (I).

t´= a + btc (1)

Level-A in vitro/in vivo correlation was also investigated using two enteric-coated matrix tablets containing no citric acid in the granules and 15% citric acid in the tablet matrix, and 2.5% citric acid in the granules and 10% citric acid in the tablet matrix (IV). Cumulative dissolution curves from the gradient-dissolution study were used as the in vitro parameter. For both formulations mean in vivo concentration-versus-time curves and the method of Wagner-Nelson were used to calculate cumulative amounts absorbed at each time during the 24-hours of bioavailability testing. In vitro/in vivo correlations were investigated by superimposing curves.

Level-C in vitro/in vivo correlation was investigated using time at which 50% of the drug had dissolved (t50%) and lag time in dissolution as the in vitro parameters and lag time in absorption (tlag) as the in vivo parameter. The in vitro parameter used was plotted against the in vivo parameter and regression lines were calculated. Correlations were investigated at both pH 6.8 and 7.4.

27

5. Results and discussion

5.1. Effect of grade of enteric polymer and thickness of enteric coating on dissolution and absorption of ibuprofen and furosemide from enteric granules (I) 5.1.1. Uncoated matrix granules

The nature of the enteric polymer used in making matrix granules had no marked effect on absorption of drug when the granules were uncoated. There was no lag time in relation to absorption of ibuprofen or furosemide when either Eudragit™ S or Eudragit ™ L was employed in making matrix granules (I, Fig. 1 and 2). The pH at which disintegration took place was 6.8 for Eudragit™ S and 6.0 for Eudragit™ L (I, Table 1). These results are similar to earlier findings (Spitael and Kinget 1979). In the fasting state, the pH in the stomach has been reported to range from 1 to 2 (Wilson et al. 1989b). The enteric polymers mentioned above are insoluble in this pH range. Because there was no lag time before absorption of the model drugs, the latter must have diffused from the matrices. Absorption began in the stomach, even though neither model drug is highly soluble in acidic environments. Because of the diffusion of the model drugs from the matrix granules, the different pH level at which the enteric polymers disintegrate had no effect on commencement of absorption.

Peak plasma concentrations (tmax) of ibuprofen occurred about 4.5 hours after administration when either enteric polymer was used to form a matrix (Table 5). Values for t1/2 were about 2.4 hours. With conventional formulation tmax has been reported to be 1.8 hours and t1/2 2.6 hours (Halsas et al. 1998). However, mean residence times in the study reported here were 3 hours longer than those following administration of pure ibuprofen in immediate-release capsules. It is therefore obvious that the uncoated ibuprofen formulations in the study described here behaved as slow-release formulations. Such behaviour was also seen with furosemide in uncoated matrix granules when these were compared with a commercial prolonged-release formulation (I, Table 3). Because drug release from the uncoated

28

formulations was immediate they were unsuitable in themselves for colon-specific drug delivery. However, formulations of this kind could be used as simple slow-release formulations, e.g. for furosemide.

5.1.2. Enteric-coated matrix granules

In vitro release of ibuprofen was faster from Aquateric™-coated matrix granules than from Aqoat™ AS-HF-coated matrix granules, when Aqoat™ AS-HF or Eudragit™ S had been used to form the matrices (I, Fig. 3). This was especially evident at pH 6.8. Values for t50% at pH 6.8 for Aquateric™- and Aqoat™ AS-HF-coated granules were 1 hour and 3–4 hours, respectively. At pH 7.4 release of the model drug was also faster from Aquateric™-coated granules than from Aqoat™ AS-HF-coated granules. The pH levels at which Aquateric™- and Aqoat™ AS-HF-coated granules disintegrated were about 5.8 and 6.7, respectively (I, Table 1). It is therefore obvious that Aquateric™ does not protect granule cores for as long as Aqoat™ AS-HF, at the pH levels concerned. The results of the dissolution studies show that the nature of the enteric polymer used for film-coating matrix granules is more important in relation to drug release than the nature of the enteric polymer used to form the granule matrix. Drug release can be adjusted by altering the enteric polymer used for granule coating. Use of an enteric polymer for coating can prevent release of a drug. Once an enteric coating has dissolved, drug release from a matrix can begin, even though the matrix itself has not completely dissolved.

Absorption of ibuprofen took place more slowly from Aqoat™ AS-HF-coated granules than from Aquateric™-coated granules (I, Fig. 4). The lag time in relation to commencement of absorption was also greatest for Aqoat™ AS-HF-coated formulations (Table 5). It has been shown that the pH level at the beginning of the small intestine is about 6.6 (Evans et al. 1988). It is therefore obvious that dissolution of Aquateric™ can commence as soon as granules coated with it have passed from the stomach to the small intestine. In the fasting state, the gastric emptying time for small particles such as granules, is usually brief (about an hour) (Hunter et al. 1982, 1983, Davis et al. 1986). From lag times relating to absorption it can also be concluded that granules coated with Aquateric™ are protected only in the stomach but that coating with Aqoat™ AS-HF can delay drug release a little

29

longer (Table 5). From the results of bioavailability testing it can also be concluded that the nature of the enteric polymer used for coating granules is more significant in relation to drug absorption than the nature of the polymer used to form granule matrices. When Aqoat™ AS-HF was used as film-coating the bioavailability of ibuprofen was very similar for matrix granules made with Aqoat™ AS-HF or Eudragit™ S (I, Table 4). The pH levels at which matrices made from the two substances disintegrate are very similar (I, Table 1).

Table 5. Pharmacokinetic parameters of ibuprofen from uncoated and enteric-coated matrix granules (single-dose 300 mg, means ± SDs).

Polymer in matrix*

L S S S AS-HF AS-HF

Polymer in coating - -A

S-H

F

Aqu

ater

ic

AS-

HF

Aqu

ater

ic

Parameter

tlag (h) 0.44 ± 0.16

0.32 ± 0.13

1.50 ± 0.41

0.59 ± 0.40

1.90 ± 1.20

0.86 ± 0.62

tmax (h) 4.33 ± 0.52

4.67 ± 0.52

5.00 ± 0.62

4.20 ± 0.40

4.80 ± 0.80

4.50 ± 1.00

Cmax (mg/l) 16.6 ± 3.4

14.7 ± 2.0

10.5 ± 1.6

16.6 ± 3.0

9.2 ± 3.0

9.5 ± 1.1

AUC 0-∞ (mg l-1h) 89.6 ± 10.7

88.1 ± 17.3

99.2 ± 33.1

101.0 ± 14.1

78.7 ± 20.1

82.4 ± 12.8

t1/2 (h) 2.37 ± 0.47

2.33 ± 0.41

- - - -

MRT (h) 6.10 ± 0.40

5.90 ± 0.30

10.70 ± 3.90

6.80 ± 0.70

10.00 ± 1.80

9.40 ± 1.70

* L = Eudragit™ L, S = Eudragit™ S, AS-HF = Aqoat™ AS-HF

It was obvious that enteric-coated granules that also contain enteric polymers in their matrices can prevent drug liberation in the stomach. However, drug release from such formulations begins even in the small

30

intestine. The enteric polymers used for film-coating can start to dissolve in the small intestine, where the pH level exceeds 6.7. If colon-specific formulations are to be developed, longer lag times (3-4 hours) in relation to release are required.

5.1.3. Thickness of enteric coating

When the thickness of enteric coating with Aqoat™ AS-HF was increased, the rate of dissolution of the ibuprofen was reduced, especially at pH levels 6.8 and 7.4 (I, Fig. 5). Very little drug was released at pH 5.0. In the case of enteric coating with Eudragit™ S the rate of release of the model drug was also reduced and the lag time in relation to commencement of dissolution increased with the thickness of the enteric coating (Ashford et al. 1993b). It has previously been reported that the disintegration rate of enteric-coated (Eudragit S and Eudragit L) tablets depends on coat thickness and that disintegration time was greatest when coating thickness was highest (Khan et al. 1999).

With uncoated granules there was minimal lag time in relation to commencement of drug absorption. When the granules were enteric-coated using Aqoat™ AS-HF the lag time in relation to absorption was about 1.5–2 hours (Table 5). There was no further increase in retardation of absorption of the model drug once the theoretical weight increase resulting from enteric-coating exceeded 20% (I, Fig. 6). It was therefore concluded that a theoretical weight increase of 20% resulting from enteric coating might be appropriate. It was also concluded that a colon-specific formulation could not be prepared simply by increasing the thickness of enteric coating of matrix granules.

5.2. Effect of incorporation of an organic acid on dissolution and absorption of ibuprofen (II–IV)

Following investigation of enteric-coated matrix granules that included enteric polymers in the granules it was concluded that neither drug dissolution nor absorption were sufficiently delayed if the aim was to develop a colon-specific formulation. It was felt it might be possible to delay drug dissolution and absorption further by addition of an organic acid

31

to formulations. An organic acid in matrix granules could regulate pH locally and retard dissolution of enteric polymers in granule cores and their enteric coatings. Through incorporating of an organic acid, drug release might be displaced from the end of the small intestine to the colon, and prevented in the terminal small intestine, where pH levels are higher than in the caecum. In this way it might be also possible to improve site specificities of formulations incorporating enteric polymers.

Organic acids have been used to promote dissolution. They have been employed in Eudragit™ RS-film-coated multiple-unit formulations to modify drug release (Narisawa et al. 1994, 1996, 1997). In that study the aim was to increase the rate of drug release by increasing osmotic pressures within the formulations. It was concluded that rapid drug release after lengthy lag times could be achieved by means of such formulations. Organic acids have also been used in a capsule system involving an acid-soluble layer, a hydrophilic layer and an enteric-coated layer. The system is both pH-sensitive and time-dependent (Ishibashi et al. 1998a, b). In it, the pH inside the capsule decreases as the organic acid dissolves. The acid-soluble polymeric layer then dissolves in the acidic fluid.

5.2.1.Effect of incorporation of an organic acid in granules on dissolution and absorption of ibuprofen from matrix granules (II)

The dissolution rate of ibuprofen from uncoated matrix granules decreased when an organic acid was included in the granules. The effect was greatest when citric acid or succinic acid was used (II, Fig. 1 and 3). The drug release rate at pH 6.8 declined gradually as the amount of succinic acid increased. At pH 5.8, inclusion of just 10% succinic acid retarded drug release. Increasing the percentage of succinic acid above 10, did not reduce release rate further at pH 5.8. In contrast, no significant reduction in release rate was observed at pH 7.4 until the percentage of succinic acid was 30. Ibuprofen and Eudragit™ S are poorly soluble in acid. It is therefore obvious that addition of even a small amount of an organic acid can retard drug dissolution at pH 5.8. Dissolution takes place faster at 7.4 and more succinic acid is needed to retard drug dissolution. The results with citric acid were similar to those with succinic acid. When tartaric acid was included in

32

uncoated granules drug release was retarded but the effect was less marked than with succinic acid or citric acid (II, Fig. 2). The solubility of tartaric acid in aqueous solutions is good. Its pKa (2.93) is lower than the pKa-values for citric acid (3.13) and succinic acid (4.10). It has been found that an organic acid with high solubility can easily diffuse from matrices and that it has little buffering effect (Gabr 1992).

With uncoated granules the percentage of citric acid needed to decrease drug dissolution rate at pH 6.8 was 20. With enteric-coated granules the percentage needed to decrease drug dissolution rate at 6.8 was 10 (II, Fig. 4). The buffering effect of citric acid in enteric-coated granules was greater and persisted longer than that in uncoated matrix granules. It was therefore obvious that dissolution of citric acid took place faster from uncoated than from coated granules. A short lag time in relation to commencement of drug dissolution at pH 6.8 was also observed when an organic acid was included in Aqoat™ AS-HF-coated granules. The presence of an organic acid in the granule core delayed dissolution of the enteric coating.

Although incorporation of organic acids could retard drug dissolution from both uncoated and enteric-coated granules no effects were evident in bioavailability tests (II, Fig. 5 and 6). Drug absorption from uncoated granules containing succinic acid was similar to that from uncoated granules containing no organic acid (II, Fig. 5).

The lag time in relation to commencement of drug absorption tended to increase when matrix granules containing organic acids were enteric coated (II, Table 1 and 2). However, differences were not statistically significant. Even though the granules were enteric-coated the inclusion of an organic acid had no marked effect on drug absorption. The situation in the human gastrointestinal tract differs from that in vitro. Mixing forces in the gastrointestinal tract are more powerful than those during dissolution studies. The organic acids used are water-soluble, which may have had an effect on granule disintegration.

33

5.2.2. Effect of amount and location of citric acid on dissolution and absorption of ibuprofen from tablets (III–IV)

It was concluded that drug liberation could not be targeted solely on the colon by means of enteric-coated matrix granules containing organic acids. It was therefore decided to make multiple-unit tablets from such granules, and to investigate the effect of formulation on drug dissolution and absorption.

The effect of varying the amount of citric acid in granules of enteric-coated matrix tablets was investigated. Percentages of citric acid ranging from 0 to 10 (0.0, 2.5, 5.0, 7.5, 10.0) were incorporated in granules, with the percentage of citric acid in the tablet matrix remaining at 10. Formulations containing percentages of 0 and 10 citric acid in granules and no citric acid in the tablet matrix were also studied.

When uncoated matrix tablets were studied in different phosphate buffers dissolution of ibuprofen was found to be gradually retarded as the amount of citric acid in the granules increased (III, Fig. 1). Lag times in relation to commencement of drug dissolution of about 30 minutes were observed at pH 6.8 once the percentage of citric acid in the granules exceeded 5, even though the tablets were uncoated. At pH 7.4 lag times of similar magnitudes were observed when the percentage of citric acid exceeded 7.5.

The effects of citric acid in the granules on release rate of ibuprofen were similar in enteric-coated tablets and uncoated tablets. Drug release from enteric-coated tablets was gradually retarded and delayed as the amount of citric acid in the granules increased, at pH 6.8 and 7.4 (III, Fig. 2). At pH 5.8 drug release rates were very low; only about 5% of ibuprofen had dissolved after 8 hours, from all formulations. Lag times in relation to commencement of drug dissolution increased as the amount of citric acid in granules increased (Table 6).

The effect of incorporation of citric acid in the tablet matrix was investigated by varying its percentage from 0 to 15, with no citric acid in the matrix granule cores. Formulations containing 10% citric acid in the matrix granule cores and 0, 5 or 10% citric acid in the tablet matrices were also studied. Drug dissolution from uncoated tablets in phosphate buffers at pH 6.8 and 7.4 was retarded when 5% citric acid was included in the tablet matrix (III, Fig. 1). Drug dissolution rate did not decline further when the

34

percentage of acid exceeded 5%. This finding was expected because uncoated tablets disintegrate rapidly and the pH-regulating effect of citric acid in the matrix of an uncoated tablet is therefore weak.

Table 6. Lag times (hours) in relation to commencement of drug dissolution (pH 6.8, means) and absorption (means ±SDs) in enteric-coated tablet.

Formulations containing different amounts of citric acid in the tablet matrix

0-0* 0-5 0-10 0-11.7 0-13.3 0-15 10-0 10-5 10-10

Lag time

in vitro

0.02 0.13 0.37 1.33 0.72 1.10 0.48 0.45 1.78

Lag time

in vivo

0.54 ± 0.30

- 1.00 ± 0.87

1.75 ± 0.71

2.00 ± 1.85

4.00 ± 1.85

0.72 ± 0.30

- 3.63 ± 2.74

Formulations containing different amounts of citric acid in the granules

0-0 10-0 0-10 2.5-10 5-10 7.5-10 10-10

Lag time

in vitro

0.02 0.48 0.37 0.82 1.22 0.93 1.78

Lag time

in vivo

0.54 ± 0.30

0.72 ± 0.30

1.00 ± 0.87

5.13 ± 2.32

- - 3.63 ± 2.74

* First value = amount of citric acid in granules (%), second value = amount of citric acid in tablet matrix (%).

Release of ibuprofen from enteric-coated tablets at pH 6.8 and 7.4 was gradually retarded as the percentage of citric acid in the tablet matrix increased from 0 to 11.7 (IV, Fig. 2). Lag times in relation to commencement of drug dissolution at pH 6.8 increased correspondingly (Table 6). Increasing the percentage of citric acid in the tablet matrix above 11.7 did not reduce the release rate further (IV, Fig.2). It was concluded that when the percentage of citric acid in a tablet matrix exceeded 11.7 degradation of the tablet matrix might be promoted.

On the basis of the results of the gradient-dissolution study, formulations of these kinds are well protected in acidic environments (IV, Fig. 3). Drug release was also delayed at pH 6.8.

35

From the results of the in vitro dissolution studies it was concluded that incorporation of citric acid in granule cores can retard drug dissolution. It was also concluded that when the amount of citric acid in granule cores was increased lag times usually increased (Table 6). However, findings were different when the effects of incorporation of citric acid in the tablet matrix were investigated. Citric acid, which is water-soluble, could accelerate degradation of the formulation when present in certain amounts. It was also noted that the drug release rate was lower from an enteric-coated formulation containing 10% citric acid in the granule cores than from a formulation containing 10% citric acid in the tablet matrix (III, Fig. 2). Inclusion of citric acid in granules can decrease rate of dissolution for longer than inclusion of citric acid in the tablet matrix.

The effects of inclusion of citric acid in granule cores on the bioavailability of ibuprofen was investigated using formulations containing 0, 2.5 and 10% citric acid the in granules and 10% citric acid in the tablet matrix, in two separate studies. Bioavailabilities from formulations containing 0 or 10% citric acid in the granules and no citric acid in the tablet matrix were also determined. Drug absorption was delayed when citric acid was included in the granule cores (Fig. 2). The effect on drug absorption of

Figure 2. Bioavailability of ibuprofen (300 mg) from enteric-coated multiple unit tablets containing 10% citric acid in the granules and no citric acid (�), 2.5% citric acid in the tablet matrix (�) or 10% (�) citric acid in the tablet matrix. Means ± SEMs, n=8.

0

2

4

6

8

10

0 6 12 18 24

time (h)

conc

entra

tion

(mg/

l)

36

inclusion of citric acid in the granule cores was especially great when citric acid had also been incorporated in the tablet matrix. Lag time in relation to commencement of drug absorption was increased and drug absorption was retarded as the percentage of citric acid in the granule cores increased from 0 to 10 (Table 6).

The effect of location of citric acid in the tablet matrix on the bioavailability of ibuprofen was investigated using formulations containing 0, 10, 11.7, 13.3 and 15% citric acid in the tablet matrix and no citric acid in the granules (Fig. 3). A lag time in relation to commencement of drug absorption was observed when the citric acid content of the tablet matrix equalled or exceeded 10% (Table 6). Lag times also increased as the amount of citric acid was increased (Fig. 3). Drug absorption rate was so slow that peak plasma concentrations were not achieved during the 24 hours of bioavailability testing when the amount of citric acid in the tablet matrix was over 10%.

Figure 3. Bioavailability of ibuprofen (300 mg) from enteric-coated multiple-unit tablets containing no citric acid (x), and 10% (�), 11.7% (�), 13.3% (�) or 15% (�) citric acid in the tablet matrix and no citric acid in the granules. Means ± SEMs, n = 8.

As previously mentioned, the time of transit through the small intestine is 3–4 hours, regardless of formulation (Washington et al. 2001). The gastric

0

2

4

6

8

10

0 6 12 18 24

time (h)

conc

entra

tion

(mg/

l)

37

emptying time for large single units is 1–2 hours in the fasting state. It is therefore obvious that the lag time in relation to commencement of drug absorption for a formulation that is intended to be colon-specific should be 4–6 hours. From the results of the in vivo bioavailability tests it was concluded that it is important to incorporate citric acid into the tablet matrix itself if lag times exceeding 4 hours are required (Table 6). Incorporating of citric acid in a tablet matrix can prevent dissolution of the enteric coating of a tablet. It was concluded that incorporation of between 10% and 15% citric acid in a tablet matrix would be appropriate for preparation of colon-specific formulations. With such formulations, fairly rapid absorption after lengthy lag times would be achievable. Inclusion of citric acid in granule cores allows adjustment of the rate of drug absorption, following a lag time. It is important for the percentage of citric acid in the granule cores to be fairly low, below 10. It may be even unnecessary to include citric acid in the granule cores.

5.3. In vitro/in vivo correlations (II, IV)

No level-A in vitro/in vivo correlation relating to enteric-coated matrix granules was observed when in vitro dissolution curves and in vivo cumulative absorption curves were superimposed (II, Fig. 7). The enteric polymers used dissolve relatively fast at pH 6.8. Drug absorption in vivo took place more slowly than drug release in vitro at pH 6.8 because the pH at the stomach during fasting is 1–2. Within this pH range dissolution of the enteric polymers was negligible, as would have been expected. Level-A in vitro/in vivo correlations could be established through use of the equation of Brockmeier and Luckow (II, Fig. 8). The correlations were formulation-specific.

Level-A in vitro/in vivo correlations relating to two enteric-coated tablet formulations are shown in Figure 4. Times relating to in vivo results were divided by 3. The in vitro dissolution curve and the in vivo cumulative absorption curve profiles are similar for the tablet containing 15% citric acid in the tablet matrix and no citric acid in granules but the lag times are different. A level-A in vitro/in vivo correlation might be capable of being established if the circumstances of the in vitro gradient dissolution study were modified. However, the correlation is always formulation-specific.

38

Level-C in vitro/in vivo correlations were studied in enteric-coated matrix tablets containing different amounts of citric acid in the tablet matrices or granule cores (Fig. 5). Correlation between the in vitro and in vivo parameters was poor. Neither the in vitro t50% value nor the in vitro lag time would have allowed prediction of the in vivo lag time. As discussed above, the rate of drug release did not decrease further when tablets contained more than 11.7% citric acid in the tablet matrix. However absorption of drug from tablets of the kinds described became delayed as the amount of citric acid was gradually increased.

Figure 4. Level-A in vitro/in vivo correlations for enteric-coated multiple-unit tablets containing 2.5% citric acid in the granules and 10% citric acid in the tablet matrix (�, �), and no citric acid in the granules and 15% citric acid in the tablet matrix (�, �). In vitro result = open symbol, in vivo result = closed symbol. In vivo times were divided by 3.

0

20

40

60

80

100

0 2 4 6 8

time in vitro / time in vivo/3 (h)

rele

ased

/abs

orbe

d(%

)

0

20

40

60

80

100

0 2 4 6 8

time in vitro / time in vivo/3 (h)

rele

ased

/abs

orbe

d(%

)

39

pH 6.8y = 0.76x + 2.71

R2 = 0.6163

pH 7.4y = 0.27x + 1.40

R2 = 0.23340

1

2

3

4

5

6

0 1 2 3 4 5 6

tlag in vivo (h)

t50%

invi

tro(h

)

Figure 5. Level-C in vitro/in vivo correlations relating to enteric-coated multiple-unit tablets containing different percentages (0, 10, 11.7, 13.3, 15) of citric acid in the tablet matrix and no citric acid in the granules (top) or containing various percentages of citric acid in the granules (0, 2.5, 10) and 10% citric acid in the tablet matrix (bottom). Tlag relating to absorption was used as the in vivo parameter and tlag relating to dissolution or the t50%-value was used as the in vitro parameter. Dissolution media pH values were; 6.8 (�, line) and 7.4 (�, broken line).

pH 7.4y = 0.18x + 0.50

R2 = 0.3298

pH 6.8 y = 0.28x + 0.18

R2 = 0.4865

0

1

2

0 1 2 3 4 5 6

tlag in vivo (h)

tlag

invi

tro(h

)

pH 6.8y = 0.40x + 3.60

R2 = 0.5528

pH 7.4y = 0.11x + 1.49

R2 = 0.09330

1

2

3

4

5

6

0 1 2 3 4 5 6

tlag in vivo (h)

t50%

invi

tro(h

)

pH 6.8y = 0.16x + 0.48

R2 = 0.2087

pH 7.4y = 0.02x + 0.59

R2 = 0.09160

1

2

0 1 2 3 4 5 6

tlag in vivo (h)

tlag

invi

tro(h

)

40

6. Conclusions

The main objective in relation to this study was development of an oral multiple-unit colon-specific formulation. The intention was to prepare a formulation, using enteric polymers as excipients that allowed drug liberation and absorption after a lag time of about 4–5 hours in the fasting state. The formulation developed also had to prevent drug liberation at the stomach.

It was found that enteric-coated matrix granules that also contained enteric polymers as matrix formers are not appropriate for use in preparing colon-specific formulations. Drug liberation in the stomach can be prevented by enteric coating but after gastric emptying drug release occurred too rapidly, in the small intestine. The pH at which the enteric polymer used for coating of the granules dissolved affected the lag time in relation to commencement of drug absorption. Through inclusion of an organic acid in the granules drug dissolution can be modified in vitro. However, preparation of colon-specific formulations through use of enteric-coated matrix granules that contained an organic acid as excipients proved impossible.

Drug release and absorption can be targeted on the colon through use of enteric polymers and citric acid as excipients in multiple-unit tablets. Lag times of some 2–4 hours in relation to commencement absorption of ibuprofen can be achieved by incorporation of different amounts of citric acid in the tablet matrix and the granules. It is important to include citric acid in the tablet matrix itself if lengthy lag times are required. Percentages of citric acid of between 10 and 15 would be appropriate for colon-specific formulations. Drug release takes place after a lag time especially once the percentage of citric acid in the tablet matrix exceeds 10. Citric acid can be incorporated in the granules to adjust drug release after the lag time. It may be unnecessary to include citric acid in granule cores if citric acid has been incorporated in the tablet matrix.

This kind of multiple-unit tablet developed is more likely than granules to remain entire in the upper gastrointestinal tract. Accordingly, drug liberation is also more likely to be prevented. If citric acid is incorporated in

41

the tablet matrix the tablet is likely to remain entire for longer. In this way drug release at the end of the small intestine might be prevented even though pH levels exceed 7. In the colon the formulation can disintegrate into granules. These can then distribute themselves throughout the colon.

It was concluded that in vitro/in vivo correlation relating to the kinds of tablets studied was poor. It is therefore important to undertake bioavailability testing at all stages of development. For colon-specific formulations it might be possible to establish a level-A in vitro/in vivo correlation by adjustment of the circumstances relating to the in vitro gradient dissolution study.

42

Acknowledgements

The work described was carried out in the Division of Biopharmaceutics and Pharmacokinetics, Department of Pharmacy, University of Helsinki. I am most grateful to Professor Martti Marvola for suggesting the topic of the studies. His support, patience and ideas made completion of this study possible. I also thank Professor Jouko Yliruusi for providing excellent tableting and film-coating facilities. I am grateful to Docent Jyrki Heinämäki for excellent guidance regarding use of the film-coating equipment. Professor Peep Veski, head of the Department of Pharmacy, University of Tartu, is thanked for his cooperation.

The reviewers of the thesis, Professor Kristiina Järvinen and Docent Sari Eerikäinen are sincerely thanked for their constructive criticisms, and suggestions for its improvement.

Particular thanks are due to Erja Piitulainen B.Sc.(Pharm.), Susanna Oravisto B.Sc.(Pharm.), Karin Krogars M.Sc.(Pharm.), Mia Säkkinen Lic.Sc.(Pharm.), Minna-Liisa Aaltonen M.Sc.(Pharm.), Susanna Lempää M.Sc.(Pharm.) and Taina Sten M.Sc.(Pharm.) for their excellent technical assistance and friendship. I am most grateful to all of my colleagues in the Division of Biopharmaceutics and Pharmacokinetics for their friendship, support and fruitful discussions. Finally, my warmest thanks go to my dear husband Eerik for his love, humour and never-ending optimism. I also thank our little son Henri for being my sunshine and for sharing my interest in writing and reading. His “help” while I was writing always delighted me.

43

Financial support from the Finnish Cultural Foundation and the Pharmacal Research Foundation, Finland, is gratefully acknowledged.

Pirjo Nykänen Helsinki, August 2003

44

References

Adkin D. A., Davis S. S., Sparrow R. A. and Wilding I. R. 1993. Colonic transit of different sized tablets in healthy subjects. J. Controlled Release, 23, 147-156.

Adkin D. A., Kenyon C.J., Lerner E. I., Landau I., Strauss E., Caron D., Penhasi A., Rubinstein A. and Wilding I.R. 1997. The use of scintigraphy to provide ”proof of concept” for novel polysaccharide preprations designed for colonic drug delivery. Pharm. Res., 14, 103-107.

Ashford M. and Fell J. T. 1993a. Colonic delivery of drugs. Current status on targeted drug delivery to the gastrointestinal tract. Short Hills (NJ). Capsugel, Symposia Series, 133-142.

Asford M., Fell J. T., Attwood D., Sharma H. and Woodhead P. J. 1993a. An in vivo investigation into the suitability of pH-dependent polymers for colonic targeting. Int. J. Pharm., 95, 193-199.

Asford M., Fell J. T., Attwood D. and Woodhead P. J. 1993b. An in vitro investigation into the suitability of pH-dependent polymers for colonic targeting. Int. J. Pharm., 91, 241-245.

Asford M., Fell J. T., Attwood D., Sharma H. and Woodhead P. J. 1994. Studies on pectin formulations for colonic drug delivery. J. Conrolled Release, 30, 225-232.

Avgerinos A. and Hutt A. 1986. High-performance liquid chromatographic determination of ibuprofen in human plasma and urine by direct injection. J. Chromatogr., 380, 468-471.

Bauer K. H. and Kesselhut J. F. 1995. Novel pharmaceutical excipients for colon targeting. S.T.P. Pharma Sci., 5, 54-59.

Beerman B. 1982. Kinetics and dynamics of furosemide and slow-acting furosemide. Clin. Pharmacol. Ther., 32, 584-591.

Brønstedt H. and Kopeček J. 1992. Hydrogels for site-specific drug delivery to the colon: in vitro and in vivo degradation. Pharm. Res., 9, 1540-1545.

Brockmeier D., Voegele D. and von Hattingberg H. M. 1983. In vitro-in vivo correlation, a time scaling problem? Arzneim. Forsch./Drug Res., 33, 598-601.

Bussemer T., Otto I. and Bodmeier R. 2001. Pulsatile drug-delivery systems. Crit. Rev. Ther. Drug Carrier Syst., 18, 433-458.

Cole E., Scott R., Connor A., Wilding I., Petereit H-U., Schminke C., Beckert T. and Cadé D. 2002. Enteric coated HPMC capsules designed to achieve intestinal targeting. Int. J. Pharm., 231, 83-95.

Davis S. S., Hardy J. G. and Fara J. W. 1986. Transit of pharmaceutical dosage forms through the small intestine. Gut, 27, 886-892.

Dew M. J., Hughes P. J., Lee M. G., Evans B. K. and Rhodes J. 1982. An oral preparation to release drugs in the human colon. Br. J. Clin. Pharmac., 14, 405-408.

Evans D. F., Pye G., Bramley R., Clark A. G., Dyson T. J. and Hardcastle J. D. 1988. Measurement of gastrointestinal pH profiles in normal ambulant human subjects. Gut, 29, 1035-1041.

45

Fan T., Wei S., Yan W., Chen D. and Li J. 2001. An investigation of pulsatile release tablets with ethylcellulose and Eudragit L as film coating materials and cross-linked polyvinylpyrrolidone in the core tablets. J. Controlled Release, 77, 245-251.

Fallingborg J., Christensen L.A., Ingeman-Nielsen M., Jacobsen B.A., Abildgaard K. and Rasmussen H.H., 1989. pH-profile and regional transit times of the normal gut measured by a radiotelemetry device. Aliment. Pharmacol. Ther., 3, 605-613.

Friend D. R. 1991. Colon-specific drug delivery. Adv. Drug Deliv. Rev., 7, 149-199.

Friend D. R. 1995. Glycoside prodrugs: novel pharmacotherapy for colonic diseases. S.T.P. Pharma Sci., 5, 70-76.

Friend D. R. and Tozer T. N. 1992. Drug glycosides in oral colon-specific drug delivery. J. Controlled Release, 19, 109-120.

Fukui E., Miyamura N. and Kobayashi M. 2001. An in vitro investigation of the suitability of press-coated tablets with hydroxypropylmethylcellulose acetate succinate (HPMCAS) and hydrophobic additives in the outer shell for colon targeting. J. Controlled Release, 70, 97-107.

Fukui E., Miyamura N., Uemura K. and Kobayashi M. 2000. Preparation of enteric-coated timed-release press-coated tablets and evaluation of their function by in vitro and in vivo tests for colon targeting. Int. J. Pharm., 204, 7-15.

Gabr K. E. 1992. Effect of organic acids on the release patterns of weakly basic drugs from inert sustained release matrix tablets. Eur. J. Pharm. Biopharm., 38, 199-202.

Gazzaniga A., Iamartino P., Maffione G. and Sangalli M. E. 1994a. Oral delayed-release system for colonic specific delivery. Int. J. Pharm., 108, 77-83.

Gazzaniga A., Sangalli M. E. and Giordano F. 1994b. Oral chronotopic drug delivery systems: achievement of time and/or site specificity. Eur. J. Pharm. Biopharm., 40, 246-250.

Gliko-Kabir I., Yagen B., Penhasi A. and Rubinstein A. 1998. Low swelling, crosslinked guar and its potential use as colon-specific drug carrier. Pharm. Res., 15, 1019-1025.

Gupta V., Beckert T. and Price J. 2001. A novel pH- and time-based multi-unit potential colonic drug delivery system. I. Development. Int. J. Pharm., 213, 83-91.

Halsas M., Hietala J., Veski P., Jürjenson H. and Marvola M. 1998. Morning vs. evening dosing of ibuprofen in two different oral drug formulations. Proceedings of 2nd World Meeting on Pharma-ceutics, Biopharmaceutics and Pharmaceutical Technology, Paris 25.-28.5. 1998, 1197-1198.

Harboe E., Larsen C., Johansen M. and Olesen P. 1989. Macromolecular prodrugs. XIV. Absorption characteristics of naproxen after oral administration of a dextran T-70-naproxen ester prodrug in pigs. Int. J. Pharm., 53, 157-165.

Hardy J. G., Healey J. N. C. and Reynolds J. R. 1987. Evaluation of an enteric-coated delayed-release 5-aminosalicylic acid tablet in patients with inflammatory bowel disease. Aliment. Pharmacol. Ther., 1, 273-280.

Hata T., Shimazaki Y., Kagayama A., Tamura S. and Ueda S. 1994. Development of a novel drug delivery system, time-controlled explosion system (TES). Part 5. Animal pharmacodynamic and human bioavailability study. Int. J. Pharm., 110, 1-7.

46

Hebden J.M., Perkins A.C. and Spiller R.C. 1999. Scintigraphic study of colonic release and absorption. In: Perkins, A. C. and Frier, M. (ed.). Nuclear Medicine in Pharmaceutical Research. Taylor and Francis. London. pp.101-112.

Herzfeldt C.D. and Kümmel R. 1983. Dissociation constants, solubilities and dissolution rates of some selected nonsteroidal anti-inflammatories. Drug Dev. Ind. Pharm., 9,767-793.

Hosny E., Al-Shora H. and Elmazar M. 2002. Oral delivery of insulin from enteric-coated capsules containing salicylate: effect on relative hypoglycemia of diabetic beagle dogs. Int. J. Pharm., 237, 71-76.

Hu Z., Kimura G., Ito Y., Mawatari S., Shimokawa T., Yoshikawa H., Uoshikawa Y. and Takada K. 1999. Technology to obtain sustained release characteristics of drugs after delivered to the colon. J. Drug Target., 6, 439-448.

Hu Z., Mawatari S., Shimokawa T., Kimura G., Yoshikawa Y., Shibata N. and Takada K. 2000. Colon delivery efficiencies of intestinal pressure-contolled colon delivery capsules prepared by a coating machine in human subjects. J. Pharm. Pharmacol., 52, 1187-1193.

Hunter E., Fell J. T. and Sharma H. 1982. The gastric emptying of pellets contained in hard gelatin capsules. Drug Dev. Ind. Pharm., 8, 751-757.

Hunter E., Fell J. T. and Sharma H. 1983. The gastric emptying of hard gelatin capsules. Int. J. Pharm. 17, 59-64.

Ishibashi T., Hatano H., Kobayashi M., Mizone M. and Yoshino M. 1998a. Design and evaluation of a new capsule-type dosage form for colon-targeted delivery of drugs. Int. J. Pharm., 168, 31-40.

Ishibashi T., Pitcairn G., Yoshino H., Mizobe M. and Wilding I. 1998b. Scintigraphic evaluation of a new capsule-type colon specific drug delivery system in healthy volunteers. J. Pharm. Sci., 87, 531-535.

Jeong Y-I., Ohno T., Hu Z., Yoshikawa Y., Shibata N., Nagata S. and Takada K. 2001. Evaluation of an intestinal pressure-controlled colon delivery capsules prepared by a dipping method. J. Controlled Release, 71, 175-182.

Khan M., Prebeg Ž. and Kurjakovič N. 1999. A pH-dependent colon targeted oral drug delivery system using methacrylic acid copolymers. I. Manipulation of drug release using Eudragit™ L100-55 and Eudragit™ S100 combinations. J. Controlled Release, 58, 215-222.

Kinget R., Kalala W., Vervoort L. and van den Mooter G. 1998. Colonic drug delivery. J. Drug Target., 6, 129-149.

Klotz U. 1985. Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalisylic acid. Clin. Pharmacokinet., 10, 285-302.

Kopeček J., Kopečeková P., BrØndstedt H., Rathi R., Řihová B., Yeh P.-Y. and Ikesue K. 1992. Polymers for colon-specific drug delivery. J. Controlled Release, 19, 121-130.

Krögel I. and Bodmeier R. 1998. Pulsatile drug release from an insoluble capsule body controlled by an erodible plug. Pharm. Res., 15, 474-481.

Leopold C. and Eikeler D. 2000. Basic coating polymers for the colon-specific drug delivery in inflammatory bowel disease. Drug Dev. Ind. Pharm., 26, 1239-1246.

47

Lorenzo-Lamosa M., Remuñán-López C., Vila-Jato J. and Alonso M. 1998. Design of microencapsulated chitosan microspheres for colonic drug delivery. J. Controlled Release, 52, 109-118.

Luckow V. 1994. In vitro/in vivo correlation in custom tailoring of sustained release drug formulations. Bulletin Technique Gattefosse, 86, Saint Priest (France), 33-41.

McLeod A., Friend D. and Tozer T. 1993. Synthesis and chemical stability of glucocorticoid-dextran esters: potential prodrugs for colon-specific delivery. Int. J. Pharm., 92, 105-114.

Milojevic S., Newton J., Gummings J., Gibson G., Botnam L., Ring S., Stockham M. and Allwood C. 1996a. Amylose as a coating for drug delivery to the colon: Preparation and in vitro evaluation using 5-aminosalicylic acid pellets. J. Controlled Release, 38, 75-84.

Milojevic S., Newton J., Gummings J., Gibson G., Botnam L., Ring S., Stockham M. and Allwood C. 1996b. Amylose as a coating for drug delivery to the colon: Preparation and in vitro evaluation using glucose pellets. J. Controlled Release, 38, 85-94.

Munjeri O., Collett J. H. and Fell J. T. 1997. Hydrogel beads based on amidated pectins for colon-specific drug delivery: the role of chitosan in modifying drug release. J. Controlled Release, 46, 273-278.

Muraoka M., Hu Z., Shimokawa T., Sekino S., Kurogoshi R., Kuboi Y., YoshikawaY. and Takada K. 1998. Evaluation of intestinal pressure-controlled colon delivery capsule containing caffeine as a model drug in human volunteers. J. Controlled Release, 52, 119-129.

Narisawa S., Nagata M., Danyoshi C., Yoshino H., Murata K., Hirakawa Y. and Noda K. 1994. An organic acid-induced sigmoidal release system for oral controlled-release preparations. Pharm. Res., 11, 111-116.

Narisawa S., Nagata M., Hirakawa Y., Kobayashi M. and Yoshino H. 1996. An organic acid- induced sigmoidal release system for oral controlled-release preparations. 2. Permeability enhancement of Eudragit RS coating led by the physicochemical interactions with organic acid. J. Pharm. Sci., 85, 184-188.

Narisawa S., Nagata M., Hirakawa Y., Kobayashi M. and Yoshino H. 1997. An organic acid- induced sigmoidal release system for oral controlled-release preparations. 3. Elucidation of the anomalous drug release behaviour through osmotic pumping mechanism. Int. J. Pharm., 148, 85-91.

Parker G., Wilson C. G. and Hardy J. G. 1988. The effect of capsule size and density on transit through the proximal colon. J. Pharm. Pharmacol., 40, 376-377.

Peeters R. and Kinget R., 1993. Film-forming polymers for colonic drug delivery: I. Synthesis and physical and chemical properties of methyl derivatives of Eudragit S. Int. J. Pharm., 94, 125-134.

Pozzi F., Furlani P., Gazzanica A., Davis S.S. and Wilding I.R. 1994. The time clock system: A new oral dosage form for fast and complete release of drug after a predetermined lag time. J. Controlled Release, 31, 99-108.

Rama Prasad Y. V., Krishnaiah Y. S. R. and Satyanarayana S. 1998. In vitro evaluation of guar gum as a carrier for colon-specific drug delivery. J. Controlled Release, 51, 281-287.

Rao S. S. and Ritschel W. A. 1992. Development and in vitro / in vivo evaluation of a colonic release capsule of vasopressin. Int. J. Pharm., 86, 35-41.

48

Rittschell W. A. 1992. Handbook of Basic Pharmacokinetics. 4th ed., Drug Intelligence Publications, Hamilton Press, Illinois.

Ritschell W. A., Menon A. and Sakr A. 1991. Biopharmaceutic evaluation of furosemide as a potential candidate for a modified release peroral dosage form. Meth. Find Exp. Clin. Pharmacol., 13, 629-636.

Ross A., Macrae R., Walther M. and Stevens H. 2000. Chronopharmaceutical drug delivery from a pulsatile capsule device based on programmable erosion. J. Pharm. Pharmacol., 52, 903-909.

Rubinstein A. 1990. Microbially controlled drug delivery to the colon. Bioph. Drug Dispos., 11, 465-475.

Rubinstein A. 1995. Approaches and opportunities in colon-specific drug delivery. Crit. Rev. Ther. Drug Carrier Syst., 12, 101–149.

Rubinstein A., Radai R., Ezra M., Pathak S. and Rokem S. 1993. In vitro evaluation of calcium pectinate: A potential colon-specific drug delivery carrier. Pharm. Res., 10, 258-263.

Rudolph M., Klein S., Beckert T., Petereit H-U. and Dressman J. 2001. A new 5-aminosalicylic acid multi-unit dosage form for the therapy of ulcerative colitis. Eur. J. Pharm. Biopharm., 51, 183-190.

Saffran M., Sudesh Kumar G., Savariar C., Burnham J., Williams F. and Neckers D. 1986. A new approach to the oral administration of insulin and other peptide drugs. Science, 233, 1081-1084.

Sangalli M.E., Maroni A., Zema L., Busetti C., Giordano F. and Gazzanica A. 2001. In vitro and in vivo evaluation of an oral system for time and/or site-specific drug delivery. J. Controlled Release, 73, 103-110.

Schacht E., Gevaert A., Kenawy E. R., Molly K., Verstraete W., Adriaensens P., Carleer R. and Gelan J. 1996. Polymers for colon specific drug delivery. J. Controlled Release, 39, 327-338.

Spitael J. and Kinget R. 1979. Solubility and dissolution rate of enteric polymers. Acta Pharm. Technol., 7, 163-168.

Stevens H., Wilson C., Welling P., Bakhshaee M., Binns J., Perkins A., Frier M., Blackshaw E., Frame M., Nichols D., Humphrey M. and Wicks S. 2002. Evaluation of Pulsincap™ to provide regional delivery of dofetilide to the human GI tract. Int. J. Pharm., 236, 27-34.

Takaya T., Ikeda C., Imagawa N., Niwa K. and Takada K. 1995. Development of a colon delivery capsule and the pharmacological activity of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in beagle dogs. J. Pharm. Pharmacol., 47, 474-478.

Takaya T., Niwa K., Muraoka M., Ogita I., Nagai N., Yano R., Kimura G., Yoshikawa Y., Yoshikawa H. and Takada K. 1998. Importance of dissolution process on systemic availability of drugs delivered by colon delivery system. J. Controlled Release, 50, 111-122.

Touitou E. and Rubinstein A. 1986. Targeted enteral delivery of insulin to rats. Int. J. Pharm., 30, 95-99.

Tozaki H., Komoike J., Tada C., Maruyama T., Terabe A., Suzuki T., Yamamoto A. and Muranishi S. 1997. Chitosan capsules for colon-specific drug delivery: Improvement of insulin absorption from the rat colon. J. Pharm. Sci., 86, 1016-1021.

Turkoglu M., Takka S., Baran H. and Sakr A. 1999. Pectin-hydroxypropylmethylcellulose drug delivery system for colon targeting. Pharm. Ind., 61, 662-665.

49

USP 23, The United States Pharmacopeia, 1994. United States Pharmacopeial Convention, Inc., Rockville, MD.

Wakerly Z., Fell J. T., Attwood D. and Parkins D. 1996. Pectin/Ethylcellulose film coating formulations for colonic drug delivery. Pharm. Res., 13, 1210-1212.

Vandelli M. A., Leo E. Forni F. and Bernabei M. T. 1996. In vitro evaluation of a potential colonic delivery system that releases drug after a controllable lag-time. Eur. J. Pharm. Biopharm., 43, 148-151.

Van den Mooter G., Maris B., Samyn C., Augustijns P. and Kinget R. 1997. Use of azo polymers for colon-specific drug delivery. J. Pharm. Sci., 86, 1321-1327.

Van den Mooter G., Samyn C. and Kinget R. 1992. Azo polymers for colon-specific delivery. Int. J. Pharm., 87, 37-46.

Washington N., Washington C. and Wilson C. 2001. Physiological Pharmaceutics. Taylor and Francis. London.

Watts P. and Illum L. 1997. Colonic drug delivery. Drug Dev. Ind. Pharm., 23, 893-913.

Wilding I., Coupe A. and Davis S. 1991. The role of γ-scintigraphy in oral drug delivery. Adv. Drug Del. Rev. 7, 87-117.

Wilding I. R., Davis S. S., Bakhshaee M., Stevens H. N. E., Sparrow R. A. and Brennan J. 1992. Gastrointestinal transit and systemic absorption of captopril from a pulsed-release formulation. Pharm. Res., 9, 654-657.

Wilson C. G., Washington N., Greaves J. L., Kamali F., Rees J. A., Sempik A. K. and Lampard J. F. 1989a. Bimodal release of ibuprofen in a sustained-release formulation: a scintigraphic and pharmacokinetic open study in healthy volunteers under different conditions of food intake. Int. J. Pharm., 50, 155-161.

Wilson C. G., Washington C. and Washington N. 1989b. The stomach: its role in oral drug delivery. In; Wilson, C. G. and Washington, N. (ed) Physiological Pharmaceutics. Ellis Horwood Limited, Chichester. pp. 47-70.

Yang L., Chu J. and Fix J. 2002. Colon-specific drug delivery: new approaches and in vitro/in vivo evaluation. Int. J. Pharm., 235, 1-15.

Zahirul M., Khan I., Prebeg Ž. and Kurjaković N. 1999. A pH-dependent colon targeted oral drug delivery system using methacrylic acid copolymers. I. Manipulation of drug release using Eudragit™ L100-55 and Eudragit™ S 100 combinations. J. Controlled Release, 58, 215-222.