AU1045695A - Use of lobeline for the treatment of nicotine withdrawal - Google Patents

Use of lobeline for the treatment of nicotine withdrawal

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Publication number
AU1045695A
AU1045695A AU10456/95A AU1045695A AU1045695A AU 1045695 A AU1045695 A AU 1045695A AU 10456/95 A AU10456/95 A AU 10456/95A AU 1045695 A AU1045695 A AU 1045695A AU 1045695 A AU1045695 A AU 1045695A
Authority
AU
Australia
Prior art keywords
lobeline
nicotine
subject
sublingual
dosage form
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
AU10456/95A
Inventor
Rajinder P. S Matharu
Indu A Muni
B. Ram Murty
Mahendra K Pandya
F. Howard Schneider
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
DynaGen Inc
Original Assignee
DynaGen Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US08/145,203 external-priority patent/US5414005A/en
Application filed by DynaGen Inc filed Critical DynaGen Inc
Publication of AU1045695A publication Critical patent/AU1045695A/en
Abandoned legal-status Critical Current

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    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/52—Use of compounds or compositions for colorimetric, spectrophotometric or fluorometric investigation, e.g. use of reagent paper and including single- and multilayer analytical elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4425—Pyridinium derivatives, e.g. pralidoxime, pyridostigmine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
    • A61K31/4545—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring hetero atom, e.g. pipamperone, anabasine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/455—Nicotinic acids, e.g. niacin; Derivatives thereof, e.g. esters, amides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/465—Nicotine; Derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence

Description

USE OF LOBELINE FOR THE TREATMENT OF NICOTINE WITHDRAWAL
Field of the Invention The present invention features methods and articles of manufacture for the administration of lobeline to humans for the purpose of reducing symptoms of tobacco or nicotine withdrawal and as an aid in smoking cessation.
Background of the Invention
Greater understanding of the adverse health effects of tobacco consumption and associated nicotine intake has led to a marked increase in research on the nature of nicotine addiction and its treatment. Addiction to nicotine, as described in past U.S. Surgeon General's reports on smoking, is widespread, with over 50 million smokers in the United States alone. Addiction to nicotine is a major barrier to an individual's ability to successfully and permanently stop smoking.
As with other addictions, addiction to nicotine encompasses two key components. One component is a physiological addiction to nicotine itself. The physiological addiction is mediated through adaptive changes in specific brain nicotine receptors that lead to typical withdrawal symptoms upon abstaining from nicotine. A second component is a complex behavioral component. The behavior component is linked to learned internal cues associated with various positive or negative emotional feelings tied to tobacco smoking or abstinence.
The physiological addiction to nicotine is significant. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) lists the officially recognized diagnostic criteria for nicotine withdrawal as the presence of at least four of the following signs: (1) craving for nicotine; (2) irritability, frustration, anger; (3) anxiety; (4) difficulty concentrating; (5) restlessness; (6) decreased heart rate; and (7) increased appetite or weight gain.
Differing approaches to smoking cessation attempt to address the physiological addition and the behavior component. The approaches range from stopping "cold turkey," hypnosis, electroshock, acupuncture, behavioral counseling, to various forms of therapeutic support. Nicotine replacement therapies such as chewing gum and transdermal patches, in conjunction with behavioral counselling, are now commonly used to treat nicotine withdrawal and as an aid to smoking cessation. However, long-term success through the use of nicotine replacement is low. In general, 25% or less of the individuals attempting to stop nicotine use are abstaining 12 months after treatment. •
There is a great need for treatment systems which promote permanent smoking cessation. There also is a need for products that provide temporary relief of tobacco/nicotine withdrawal symptoms for individuals who use tobacco products, when such use is temporarily interrupted.
Individuals who use tobacco, and do not intend to stop such use, must often refrain from such use for extended periods of time. Airline personnel and passengers, hospital workers and patients, individuals working in chemical plants or with flammable materials and the like may need to temporarily curtail the use of tobacco products. The occurrence of nicotine withdrawal is also frequently associated with reduction in task performance efficiency. Prevention of nicotine withdrawal may alleviate or prevent such reductions in task performance.
Individuals who have stopped tobacco use and are past acute withdrawal symptoms often have acute nicotine cravings. A reduction in nicotine craving is useful for such individuals encountering situations that increase their urge to use tobacco. Such relief may increase the individual's ability to maintain abstinence from tobacco use.
Lobeline is the principal alkaloid obtained from the dried leaves and tops of Lobelia inflata, an annual plant of the Lobeliaceae family. Lobeline is a substituted piperidine compound that produces several physiological effects, some of which are similar to those produced by nicotine. It is believed that the pharmacological actions of lobeline are produced by its ability to bind to nicotine receptors in the brain and elsewhere in the body. Lobeline'ε potency in causing peripheral pharmacological effects, such as increases in blood pressure and heart rate, is significantly less than that of nicotine.
Lobeline has been proposed as a substitute for nicotine, to reduce dependence on nicotine anc reduce the use of tobacco products. Although use of lobeline as a smoking cessation aid has been studied since at least the 1930 's, its efficacy has been a matter of dispute.
Typical over-the-counter (OTC) products providing lobeline comprise icoban™, Bantron™, CigArrest™, NicFit™ and Smoker's Choice™. All lobeline containing smoking cessation products sold in recent years have been non-prescription OTC products. The FDA reports that there is no compelling proof that OTC smoking cessation aids are effective and has taken the unusual step of declaring all such OTC products mislabeled in order to remove such products from the market. Most of the OTC products administered lobeline orally for absorption in the gastrointestinal tract. The directions with such products recommend a daily dose of up to 6 milligrams. Antacids are incorporated in some of the products to overcome gastrointestinal discomfort, a side-effect similar to that caused by nicotine. Higher oral doses may not be feasible because of the concomitant gastric upset.
Although there have been reports of using lobeline in oral formulations at doses in excess of 10 mg/day, nausea and even vomiting have been associated with such doses. A further problem with such oral dose regimens is that self-administration of as many as 18 tablets per day has been required. Patients may consider such a dosing regimen as intrusive, and such dosing regimen does not permit the physician to carefully control the administration of the drug or monitor patient compliance.
Lobeline is poorly absorbed from the gastrointestinal tract. Subjects desiring to substitute lobeline for nicotine are unable to take effective quantities of lobeline orally, due to adverse gastrointestinal effects. The oral products may not produce effective blood or tissue levels.
One product presently available, Smoker's Lozenges, contains lobeline in a candy lozenge. The lozenge is intended to dissolve slowly in the mouth to release lobeline. A second product, Smoker's Gum, contains lobeline in a gum base. The gum is intended to release lobeline slowly as the gum is chewed. The instructions with these products do not instruct users to retain the dissolved candy or gum fluids in the oral cavity. The normal reflex would urge users to swallow, severely limiting any buccal absorption of lobeline. Absorption of swallowed lobeline from the gastrointestinal tract may not avoid first pass metabolism by the liver.
These OTC products, as with other lobeline OTC products, have been subjected to FDA action questioning the efficacy of the formulation. It was believed that effective doses of lobeline could not be obtained without an invasive dosage form, such as injection. The present invention is directed methods and articles of manufacture for delivering an effective amount of lobeline to the sublingual mucosa. The methods and articles of manufacture of the present invention provides relief from acute nicotine withdrawal, in a manner previously believed unattainable in a non-invasive dosage form. Such relief from acute nicotine withdrawal is directly applicable to individuals wanting to (1) temporarily abstain from smoking or otherwise using nicotine without suffering the full extent of nicotine withdrawal symptoms, or (2) cease using nicotine-containing products.
Summary of the Invention
The present invention features methods and articles of manufacture for the treatmen" of nicotine withdrawal symptoms. One method of the _ resent invention comprises administering to a subject an effective amount of lobeline or a lobeline analog to the sublingual mucosa prior to or during a period in which the subject is experiencing nicotine withdrawal symptoms. The lobeline is absorbed through the sublingual mucosa to alleviate the subject's desire for nicotine.
The term "nicotine" refers to the active ingredient of tobacco products. Nicotine has the formula represented below:
Lobeline refers to: 2-_6-(β-hydroxyphenethyl)-l- methyl-2-piperidyl acetophenone. Lobeline is represented by the formula below.
The term "lobeline" as used herein includes lobeline free base and its various salts. Functional groups may be added or deleted from the formula above, while retaining the physiological activity of lobeline. Such alterations and deviations are encompassed within the term "lobeline analogs.
The term "administering" means applying as a remedy, such as by the placement of a drug in a manner in which such drug would be received and be effective in carrying out its intended purpose.
An "effective amount" is an amount of a drug which, if administered to a subject will cause a desired therapeutic effect.
The term "sublingual" refers to the area of the oral cavity below the tongue. The term "nasal" refers to the air passages extending from the nose to the lungs. The term "mucosa" refers to a mucous membrane.
The term "subject" refers to an individual who is to be treated.
As used herein, long-term or sustained action refers to an action or duration of greater than 12 hours. As used herein, "short-term" means within a five minute period of time.
Preferably lobeline is administered as a soluble salt. Soluble salts of lobeline comprise hydrochloride, sulfate or pal oate salts. A preferred soluble salt comprises the hydrochloride or the sulfate salt which are more soluble than the palmoate. Most preferably, the soluble salt is the sulfate salt.
Preferably, lobeline is administered in an amount equivalent to 0.6 to 15 mg of lobeline free base and, more preferably, 2.5 to 15 mg 1-lobeline sulfate. A particularly preferred amount is 5.0 to 10.0 mg lobeline sulfate. This amount of lobeline provides an effective level of lobeline through the sublingual mucosa to alleviate nicotine withdrawal symptoms.
Preferably the nicotine substitute is administered as a soluble salt. In the case of lobeline, soluble salts of lobeline comprise hydrochloride, sulfate or palmoate salts. A preferred soluble salt comprises the hydrochloride or the sulfate salt which are more soluble than the palmoate. Most preferably, the soluble salt is the sulfate salt.
Preferably, the nicotine substitute is administered having an equivalent of 0.6 to 7.5 mg of lobeline free base. This amount of the nicotine substitute provides *n effective level of drug through the sublingual or nasal mucosa or pulmonary tissues to alleviate nicotine withdrawal symptoms.
Preferably, the nicotine substitute is administered to provide 30 to 140 mg lobeline free base per day in divided doses. A more preferred range is 50 to 100 mg and, even more preferred, 60 to 80 mg.
Preferably, the nicotine substitute is administered up to 18 times per day and more preferably, 6 to 9 times per day, or upon the subject's perception of smoking withdrawal symptoms.
One embodiment of the present method features lobeline administered as a sublingual tablet. As used herein, the term "tablet" refers to pharmaceutical dosage forms prepared by compressing or molding. Sublingual tablets are small and flat, for placement under the tongue and designed for rapid, almost instantaneous disintegration and release of drug to the sublingual mucosa. As used herein, the term "tablet" specifically excludes gums and lozenge dosage forms.
The term "disintegration" means to break apart; and, as used herein, specifically excludes breaking apart as a result of chewing, sucking and grinding in the oral cavity.
Preferably, the sublingual tablets of the present invention disintegrate, to release lobeline for rapid absorption by the mucosa, within five minutes and, more preferably, within a two minute period of time. The tablets generally comprise disintegrants to provide the rapid breaking up of the tablets. Lobeline released rapidly to the sublingual mucosa is absorbed and transported to active sites in the brain, mimicking the rapidly increasing nicotine blood levels individuals experience when smoking. Thus, embodiments of the present method are ideally suited for treating acute nicotine withdrawal. Embodiments are also ideally suited to treat transient cravings for nicotine often experienced by smokers treated with long acting nicotine replacement therapy.
Sublingual administration of lobeline avoids first pass metabolism by the liver. Thus, lobeline absorbed by the mucosa is most effective in addressing withdrawal symptoms.
Preferably the tablet comprises a taste masking flavoring, such as peppermint, spearmint and the like to improve user acceptance.
One embodiment of the present invention features, as an article of manufacture, a dosage form for treating nicotine withdrawal symptoms comprising an effective amount of lobeline or lobeline analogs for application to the sublingual mucosa. The lobeline is absorbed through the mucosa to alleviate nicotine withdrawal symptoms. The term "dosage form" refers to a pharmaceutical preparation for administering drug to a subject.
Preferably, the dosage form administers the equivalent of 0.6 to 15 mg of lobeline free base per dose and, more preferably, 2.5 to 15 mg lobeline sulfate. A particularly preferred amount is 5.0 to 10.0 mg lobeline sulfide.
Preferably, the lobeline is held in the dosage form as _. soluble salt. Preferred pharmaceutically acceptable salts comprise hydrochloride and sulfide sal_.s.
A preferred dosage form is a sublingual tablet. Preferably, the sublingual tablet disintegrates and releases lobeline to the sublingual mucosa within a five minute period of time and most preferably within two minutes.
Embodiments of the present invention feature administering lobeline for acute nicotine replacement therapy. Embodiments of the present invention are ideally suited for co-therapy with long-acting, sustained release drug formulations. One embodiment of the present invention features a method of treating nicotine withdrawal symptoms comprising the steps of administering to a subject an effective amount of nicotine or lobeline by a sustained release drug formulation prior to or during a period in which the subject is experiencing nicotine withdrawal symptoms. The nicotine or lobeline released from the sustained release drug formulation provides a base level of nicotine or lobeline to substantially alleviate the subject's desire for nicotine. The method further comprises the step of administering to the subject an effective amount of lobeline to the sublingual mucosa prior to or during a period in which the subject is experiencing acute nicotine withdrawal symptoms. The lobeline absorbed through the sublingual mucosa alleviates the subject's short-term or immediate desire for nicotine in situations in which the withdrawal symptoms may be more intense. The sustained release delivery system drug formulation may comprise a transdermal patch, or injectable of biodegradable polymers carrying lobeline for sustained release for subcutaneous, intramuscular or intradermal administration.
Other features and advantages of the present invention will be apparent from the following description which depict or describe preferred embodiments of the present invention and the principles thereof and what is now considered to be the best mode to apply these principles.
Brief Description of the Drawings Fig. 1 depicts graphically tobacco withdrawal symptoms index scores averaged for each individual plotted against the amount of lobeline sulfate administered per day; and
Fig. 2 graphically depicts the* reduction of nicotine withdrawal symptoms as a function of compliance with a therapeutic regimen comprising the method of the present invention.
Detailed Description of the Invention The present invention is described in detail as methods and articles of manufacture for the treatment of nicotine withdrawal symptoms. One method of the present invention comprises the step of administering to a subject an effective amount of lobeline or lobeline analog to the sublingual mucosa prior to or during the period in which the subject is experiencing nicotine withdrawal symptoms. The lobeline or lobeline analog is absorbed through the sublingual mucosa to alleviate the subject's desire for nicotine.
The present invention features the administration of lobeline through rapid release dosage forms such as sublingual tablets. Embodiments of the present invention are wel"1 suited for a wide variety of situations wlr 'ch may give ris<_ to tobacco or nicotine witndrawal symptoms. For those active tobacco users who want to stop permanently, the present method and articles of manufacture allow for the immediate dosing of the subject, on an individual need basis. Coupled with appropriate behavior modification counselling, the present method and articles of manufacture can be an important part of a smoking cessation program.
For subjects who need to abstain from tobacco and nicotine, due to hospitalization or other medical necessities, embodiments of the present invention provide for a su table nicotine replacement. Smokeless administration of nicotine by patches and the like is not suitable for many hospitalized patients due to its effects on heart rate and blood pressure. Lobeline has little effect on blood pressure and heart rate. Moreover, individuals who want to abstain from nicotine for a short time nay resume their tobacco use upon release from the hospital without any concern regarding the lingering effects of administration with long-acting nicotine or nicotine substitutes.
In situations which require individuals to abstain from smoking due to restrictions encountered in every day situations, such individuals are able to alleviate nicotine withdrawal symptoms with a rapid acting nicotine substitute. For example, airline personnel and passengers are often unable to utilize tobacco products during flight. Embodiments of the present invention feature the administration of lobeline in a fast acting form with no lingering effects which would be expected in long-acting patches or other sustained delivery forms. Thus, individuals upon the completion of the period of time in which they are unable to utilize tobacco products, may resume their customary usage of tobacco products. Embodiments of the present method and articles of manufacture have application in situations in which former users of tobacco products may need temporary relief from tobacco withdrawal symptoms due to environmental factors that may initiate a specific craving for nicotine. Such individuals may have completed a smoking cessation program, and/or may also be utilizing a sustained action nicotine or nicotine substitute drug formulation and encounter unexpected cravings or desires for nicotine products. Embodiments of the present invention feature the administration of lobeline in rapid acting dosage forms to alleviate acute nicotine craving.
Such a broad spectrum of applications is not found in other nicotine withdrawal remedies. The administration of lobeline in a non-invasive drug formulation which is effective is surprising and unexpected.
Administration to the sublingual mucosa avoids first pass metabolism and allows the lobeline to be received at nicotine receptor sites in the brain to alleviate nicotine withdrawal symptoms.
Other features and advantages of the present invention are disclosed in the following examples which exemplify preferred embodiments of the present invention.
EXAMPLE I Sublingual Tablets
Sublingual tablets are made in accordance with the formulation set forth in Table I. Lobeline Sulfate Mannitol, USP (DC grade) Microcryst, Cellulose Sodium Starch Glycolate NF Sodium Saccharin, USP Asparta e (Neutrasweet) Flavor S.D. Peppermint, FC Magnasweet MM 188M Vanilla flavor #800 Prosweet #560 (mm54) Chocolate Flavor #682 DSC Yellow #10, Aluminum L Magnesium stearate, NF Aerosil 200
TOTAL 80-85 mg
The formulation set forth in Table I represents a preferred sublingual tablet formula. Individuals skilled in the art will recognize that modifications to the formulation can be readily made.
The preferred formulation features a tablet with 5-10.0 mg lobeline sulfate and, most preferably, 7.5 mg lobeline sulfate. However, dosage can be varied to provide 0.6 mg or smaller and as much as 15.0 mg or more. However, lobeline amounts in less than 0.6 mg may require the administration of more than one tablet to obtain the desired effect. Higher doses could, however, be required for individuals highly addicted to nicotine. Lobeline, expressed as free base, amounts greater than 7.5 mg per dose are generally not required to produce the desired effect. In the above formulation, mannitol, sodium saccharine, aspartame, prosweet, chocolate flavor, peppermint, magnasweet and vanilla are flavoring agents which are capable of masking the bitter taste of lobeline. The flavoring agents may be deleted without sacrificing efficacy. However, patient compliance may be more difficult. Flavorings may be altered to suit individual needs and tastes.
D&C yellow is used as a colorant. The colorant may be readily deleted or substituted with other dyes.
Magnesium stearate and Aerosil-200 are lubricants to release the tablet from press equipment. These ingredients may be substituted or deleted entirely depending on the manufacturing process.
Microcrystalline cellulose, mannitol and sodium starch glycolate provide the tablet core. The cellulose and starch facilitate binding the core ingredients and facilitate tablet disintegration in the presence of moisture. The relative amounts of these ingredients may be altered to adjust the disintegration rate of the tablet. Other disintegrants may comprise starches, clays, celluloses, alginε, gums and crosslinked polymers.
Quantities of all ingredients are weighed and all the ingredients, other than mannitol and Avicel, are passed through a 80 mesh stainless steel sieve. The materials are blended in a suitably sized polyethylene bag for about five minutes and transferred to suitable blender, such as a PK Blender. The required quantities of mannitol and Avicel are passed through a 40 mesh stainless steel sieve and added to the PK Blender with the other ingredients. The mixture is blended in the PK Blender for 10 minutes and unloaded. A sample of the blend is subjected to inspection for potency and other quality determining criteria. The bulk density is determined on the blend using bulk density apparatus set for 100 taps. The tablet press is set for the designated punches and the blend is compressed at 80 mg tablet weight.
Tablets are administered by placing a single tablet under the tongue. The tablet is allowed to disintegrate and release lobeline. The tablets described in this example disintegrate within seconds of being placed under the tongue. The lobeline is absorbed by the sublingual mucosa.
EXAMPLE II This example features the use of 2.5 mg lobeline sulfate sublingual tablets.
Experience of JG
JG is a 54 year old male who has smoked 1 to 1-1/2 packs of cigarettes per day for 40 years. He wants to quite smokmg and has tried unsuccessfully to quit one time in the past.
J.G. was given 12 2.5 mg lobeline-SL tablets to evaluate as aids in smoking cessation. On the morning of day number one he self-administered two tablets εublingually. One hour later he self-administered one tablet and then took one more approximately three hours later. He smoked five cigarettes over the course of day number one.
One the second day JG took two tablets, one in the morning and one in the early afternoon. He smoked only two cigarettes that day.
On the third day JG took one-half of a tablet at three separates times, spr ~ evenly throughout each day. He smoked only two cigarettes that day.
On the fourth day, JG took one-half of a tablet at two separate times, one in the morning and one in the afternoon. He smoked only two cigarettes on that day.
On the fifth day, JG took one-half of a tablet in the morning. He smoked only one cigarette that day. JG continued taking one-half of a tablet daily until the supply was exhausted. During this time he smoked only one or two cigarettes each day.
When asked the reason he reduced hiε smoking level, he replied that he had much less desire to smoke and the cigarettes tasted bad when he did εmoke.
Experience of SG
SG is a 44-year old male who has εmoked 1 to 1-1/2 packε of cigarettes per day for 15 years. He wants to quit smoking and has tried to quit ten times in the past, although unsuccessful in each case. He recently obtained a supply of nicotine transder al patches to uεe in a εmoking cessation program. However, he did not use them since he believes he would not be able to refrain___from smoking and would, therefore, εmoke cigarettes-^vfiile using the patch and suffer the detrimental conεequences of exposure to excess nicotine.
SG was given eight 2.5 mg lobeline-SL tablets to evaluate as an aid for smoking cessation. On the morning of day number one he self-adminiεtered two tablets sublingually. Two and one-half hours later he εelf-adminiεtered a third tablet and then a fourth tablet approximately three hourε later. He εmoked only two cigarettes on day one, compared to the 20 to 30 he would have normally smoked.
On the second day, SG took the remaining four tablets periodically throughout the day and smoked four cigarettes.
When asked why he smoked fewer than his usual number of cigarettes, he responded that he just did not have the urge to smoke. Three weeks after this two-day evaluation SG was εmoking only 7 or 8 cigarettes per day.
EXAMPLE III Thiε example deεcribes the use of lobeline sublingual tablets of varying strength. Sublingual tablets were prepared in accordance with Example _.. These εublingual tabletε comprised 2.5 mg 1-lobeline sulfate, 5.0 mg 1-lobeline sulfate, 7.5 mg 1-lobeline sulfate. A placebo sublingual tablet was formed incorporating an inert material. These tabletε were administered to 22 subjects who regularly smoked nicotine cigaretteε. The εtrength and number of tabletε adminiεtered per day determined the total daily doεe.
The subjects spent two nights in the clinic and abstained from smoking over the full time. Subjects entered the clinic at noon on Day 1 and immediately ceased tobacco consumption. At 7:00 a.m. the next morning they started taking either placebo or 1-lobeline sulfate sublingual tablets, which they continued to take periodically over the next 16 hourε, the total amount taken being dependent on the doεe group to which they belonged and. the εtrength of tablet.
Tobacco Withdrawal Syndrome Index (TWSI) scores were taken periodically throughout the day. The TWSI is a system for evaluating symptomε of tobacco εmoking withdrawal on a 0-4 εcale. The componentε of TWSI which were evaluated compriεed anxiety, anger, craving for a cigarette, restlessness and difficulty concentrating. The TWSI scores were obtained in three separate 42-44 hour sessions, one in each of three consecutive weeks. The amount of lobeline sulfate administered sublingually per day was plotted against the Tobacco Withdrawal Syndrome Index (TWSI) score averaged for each subject. In Figure 3, "P" is used to indicate the use of placebo sublingual tablets containing no lobeline. The line marked with "2" indicates the response to the use of 2.5 mg L-lobeline sulfate sublingual tablets. The line marked "5" indicates the responεe to 5.0 mg L-lobeline sulfate sublingual tablets. And, the line marked "7" indicates the response to 7.5 mg L-lobeline sulfate sublingual tablets. These results suggest a marked reduction in nicotine withdrawal symptoms with increasing doses of L-lobeline sulfate. These results suggest that an effective amount is approximately 30-90 mg L-lobeline εulfate adminiεtered εublingually per day.
EXAMPLE IV
Thiε example deεcribeε a εtudy involving the uεe of lobeline sulfate sublingual tablets with 156 smokers.
These smokers were randomly divided into four groups . One group received 30 mg l-lobeline εulfate/per day administered as 5 mg l-lobeline sulfate sublingual tablets 6 times per day. A second group received 45 mg l-lobeline εulfate/per day adminiεtered aε 5 mg l-lobeline sulfate sublingual tablets nine timeε a day. A third group received 67.5 mg l-lobeline εulfate/per day administered aε 7.5 mg l-lobeline εulfate εublingual tabletε 9 times per day. A fourth group received a placebo adminiεtered nine times per day. Each individual of each group received brief (5 to 10 minutes) once a week behavioral counseling.
Lobeline tablets were made in accordance with Example I. The lobeline sulfate tablets were formulated to maεk the taεte of lobeline. The placebo tabletε were formulated to imitate the flavor of lobeline tablets.
The results of the study suggeεt that lobeline, adminiεtered εublingually, in rapid diεintegrating tabletε, can be adminiεtered safely with no clinically significant adverse effects . The resultε of the εtudy εuggeεt that lobeline, administered sublingually, in rapid diεintegrating tabletε is effective to alleviate tobacco withdrawal symptoms and reduce the number of cigarettes smoked per day. Results of the study with respect to smoking activity are summarized in Table 1 below:
Table 1
NicErase^-SLPHASE2.b: SMOKINGAfHTTVTTY
Consistent with FDA guidelines, treatment efficacy was evaluated during weeks 3-6 of the study. The results of the low and medium doses of lobeline are not as clear as the high dose due to the small enrollment number of this study. The low and medium doses may also be less than optimal for a percentage of the population. The low and medium dose results are, therefore, more variable. However, these reεultε do suggest that lobeline administered sublingually is more effective than a placebo. The reεultε suggesting a reduction of cigarettes smoked, from well over 200, down to one to 13, with respect high doεeε of lobeline, is striking. Results of the study with respect to abstinence rates are summarized in Table 2 below:
Table 2
NicErase^-SL PHASE 7_h: ABSTTNENCE RATES
Smoking activity, expressed either as the number of cigarettes smoked or as total abstinence from smoking, was clearly reduced for those subjects who complied with therapy to an extent of taking at least 77% of their recommended doses. With respect to Table 2, within those individuals who were identified as 100% compliant, there is one individual who received high dose lobeline and who smoked one cigar and as a result is identified as a failure. This individual apparently did not understand that he was not allowed to smoke a cigar and still be considered abstinent from smoking. However, had this individual not smoked that one cigar, the efficacy of high dose lobeline would be even higher at 66%. The results of the low and medium doses of lobeline are variable due to the small enrollment numbers. The results at the lower doses may also be more variable because such dose may be less than optimal for part of the population. These results are striking in demonstrating a high level of efficacy in promoting abstinence.
The resultε with reεpect to smoking withdrawal scores, for the high dose lobeline group compared to placebo is set forth in Figure 2.
The difference between the placebo and the lobeline group became greater aε compliance to therapy increaεed, again indicating that lobeline reduceε tobacco withdrawal symptoms. The resultε of Figure 1 are εtriking in demonεtrating a reduction in smoking withdrawal symptomε.
Thus, while preferred embodiments of the present invention have been described, the present invention is capable of variation and modification and, therefore, the present invention should not be limited to the precise details set forth, but should include εuch changes and alterations as fall within the purview of the following claims.
What iε claimed iε:

Claims (17)

1. A method of treating nicotine withdrawal symptoms, comprising:
(a) administering to a εubject an effective amount of lobeline or lobeline analog to the εublingual mucosa, prior to or during a period in which the subject is experiencing nicotine withdrawal symptomε, said lobeline absorbed through the sublingual mucosa to alleviate the subject 'ε desire for nicotine.
2. The method of claim l wherein the equivalent of 0.6 to 15 mg lobeline free base is adminiεtered per doεe.
3. The method of claim 1 wherein the lobeline or lobeline analog iε l-lobeline sulfate. •
4. The method of claim 3 wherein the l-lobeline sulfate is present in an amount of 2.5 to 15 mg.
5. The method of claim 2 wherein said lobeline is administered as a soluble salt.
6. The method of claim 5 wherein said salt is a sulfate or hydrochloride salt.
7. The method of claim 1 wherein said lobeline is administered as a sublingual tablet.
8. The method of claim 1 wherein said lobeline is available for abεorption within a five-minute period.
9. The method of claim 1 wherein said lobeline is available for absorption within a two-minute period.
10. As an article of manufacture, a dosage form for treating nicotine withdrawal symptoms comprising: an effective amount of lobeline or lobeline analog held in a sublingual tablet for application to the sublingual mucosa, said tablet releasing εaid lobeline or lobeline analog upon disintegration of the tablet and said lobeline or lobeline analog being absorbed through the mucosa to alleviate nicotine withdrawal symptomε.
11. The dosage form of claim 10 wherein said sublingual tablet disintegrate: vithin a five-minute period.
12. The dosage form of claim 10 wherein said sublingual tablet disintegrates within a two-minute period.
13. The dosage form of claim 10 wherein said effective amount is the equivalent of 0.6 to 15 mg of lobeline free base per dose.
14. The dosage form of claim 10 wherein the lobeline or lobeline analog is l-lobeline εulfate.
15. The doεage form of claim 14 wherein the l-lobeline εulfate is in an amount of 2.5 to 15 mg.
16. The dosage form of claim 8 wherein said lobeline or lobeline analog is a soluble salt.
17. A method of treating nicotine withdrawal symptoms, comprising:
(a) administering to a subject an effective amount of nicotine or lobeline by a sustained release dosage form prior to or during a period in which the subject is experiencing nicotine withdrawal symptoms, said nicotine or lobeline releaεed from said sustained release dosage form providing a base level of nicotine or lobeline to alleviate the subject's long term desire for nicotine; and
(b) administering to a subject an effective amount of lobeline to the sublingual mucosa, prior to or during a period in which the subject is experiencing nicotine withdrawal symptoms, said lobeline absorbed through the sublingual mucosa to alleviate the subject's acute desire for nicotine.
AU10456/95A 1993-10-28 1994-10-28 Use of lobeline for the treatment of nicotine withdrawal Abandoned AU1045695A (en)

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US4665069A (en) * 1985-04-02 1987-05-12 Barnett Rosenberg Analgesic composition and method of relieving pain
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