MXPA03003751A

MXPA03003751A - Novel medicament compositions based on anticholinergics and corticosteroids.

Info

Publication number: MXPA03003751A
Application number: MXPA03003751A
Authority: MX
Inventors: Michel Pairet
Original assignee: Boehringer Ingelheim Pharma
Priority date: 2000-10-31
Filing date: 2001-10-23
Publication date: 2004-10-15
Also published as: WO2002036106A2; AU2002210575A1; EP1333830A2; CA2733294C; CA2436540C; CA2733294A1; CA2436540A1; PE20020576A1; UY26992A1; JP2004512359A; WO2002036106A3

Abstract

The invention relates to novel medicament compositions based on anticholinergics and corticosteroids, a method for the production thereof and the use thereof for treating respiratory conditions.

Description

NEW COMPOSITIONS OF MEDICINES ON THE BASE OF ANTICOLINERGIC AND CORTICOESTEROID AGENTS DESCRIPTION OF THE INVENTION The present invention relates to new compositions of drugs based on anticholinergic agents and corticosteroids, to processes for their preparation, as well as to their use in the therapy of diseases of the respiratory tract. The present invention relates to new compositions of medicaments based on anticholinergic agents and corticosteroids, to processes for their preparation, as well as to their use in the therapy of diseases of the respiratory tract. Surprisingly, it was found that an unexpected advantageous therapeutic effect, particularly a synergistic effect, can be observed in the treatment of inflammatory or obstructive diseases of the respiratory tract, when one or more anticholinergic agents are used in common with one or more corticosteroids. Because of this synergistic effect, the combinations of medicaments according to the invention can be used with a lower dosage than that which occurs in the case of monotherapy, otherwise usual, with the individual compounds. This can reduce unwanted side effects KEF: 145810, as they may appear for example when performing the application of corticosteroids. The effects mentioned above are observed both when applying simultaneously in a single formulation of active substances and also in the case of successive application of both active substances in separate formulations. According to the invention, the simultaneous application of both constituents of active substances in a single formulation is preferred. Within the context of the present invention, anticholinergic agents 1 are understood as meaning the salts which are preferably selected from the group consisting of tiotropium salts, oxitropium salts and ipratropium salts, with tiotropium salts being particularly preferred in this context. In the salts mentioned above, the cations of tiotropium, oxitropium and ipratropium represent the pharmacologically active constituents. Within the framework of the present patent application, an explicit reference to the preceding cations may be recognized by the use of the designation 1. However, a reference to compounds 1 includes, of course, a reference to the constituents 1 '(tiotropium , oxitropium or ipratropium). Within the salts 1 that can be used within the framework of the present invention are to be understood the compounds that together with tiotropium, oxitropium or ipratropium, contain as ion of opposite sign (anion) that of chloride, bromide, iodide, sulfate, methane -sulfonate or para-toluene sulfonate. Within the framework of the present invention, among all the salts 1, those of methanesulfonate, chloride, bromide or iodide are preferred, with special relevance to methane sulfonate or bromide. Of outstanding importance according to the invention are the salts 1 which are selected from the group consisting of tiotropium bromide, oxitropium bromide and ipratropium bromide. Tiotropium bromide is especially preferred. Within the framework of the present invention, corticosteroids (hereinafter referred to as 2) are understood as the compounds, which are selected from the group consisting of flunisolide, beclomethasone, triamcinolone, budesonide, fluticasone, mometasone, ciclesonide, rofleponide, GW215864, KSR 592, ST-126 and dexamethasone. Preferred is compound 2 selected from the group consisting of flunisolide, beclomethasone, triamcinolone, budesonide, fluticasone, mometasone, ciclesonide and dexamethasone. Particularly preferably, compound 2 is selected from among, budesonide, fluticasone, mometasone, ciclesonide. Eventually, within the framework of the present patent application, instead of the denomination of corticosteroids 2, only the name of spheroids 2 is also used.

A reference to steroids 2 includes within the framework of the present invention a reference to salts or 2 'derivatives, which can be formed by steroids. Possible salts or derivatives 2 are mentioned, for example: sodium salts, sulfobenzoates, phosphates, isonicotinates, acetates, propionates, dihydrogen phosphates, palmitates, pivalates or furoates. Optionally, the compounds of Formula 2 can also be present in the form of hydrates. The application of the drug combinations according to the invention based on 1 and 2 is preferably carried out by inhalation route. In this case, powders suitable for inhalation can be used, which are applied packed in appropriate capsules (inhalets) by corresponding powder inhalers. Alternatively, an inhalation application can also be carried out by administering suitable aerosols for inhalation, containing as a propellant gas for example HFA134a, HFA227 or a mixture thereof. The application by inhalation can also be carried out by appropriate solutions of the combination of drugs consisting of 1 and 2. An aspect of the present invention relates correspondingly to a medicament, which contains the combination of 1 and 2.

Another aspect of the present invention relates to a medicament, which contains one or more salts 1 and one or more compounds 2, optionally in the form of their solvates or hydrates. In these cases, the active substances can be contained either in common in a single form of presentation or in two separate forms of presentation. Preferred according to the invention are medicaments containing the active substances 1 and 2 in a single form of presentation.

Another aspect of the present invention relates to a medicament, which together with therapeutically active amounts of 1 and 2 contains a pharmaceutically compatible auxiliary substance. Another aspect of the present invention relates to a medicament which together with therapeutically active amounts of 1 and 2 does not contain any pharmaceutically compatible auxiliary substance. The present invention further relates to the use of 1 and 2 for the preparation of a medicament containing therapeutically active amounts of 1 and 2 intended for the treatment of inflammatory or obstructive diseases of the respiratory tract, particularly asthma or chronic obstructive pulmonary diseases. (COPD), by simultaneous or successive application. In addition, the drug combinations according to the invention may find use for the preparation of a medicament for treating cystic fibrosis or allergic alveolitis (Farmers Lung = farmer's lung) by simultaneous or successive application. An application of the combinations of active substances according to the invention is not carried out only in the case that a treatment with steroids is contraindicated from a therapeutic point of view. The present invention has as its mission also the simultaneous or successive use of therapeutically active doses of the combination of drugs preceding 1 and 2 for treating inflammatory or obstructive airways diseases, particularly asthma or chronic obstructive pulmonary disease (COPD ), provided that with a steroid treatment it is not contraindicated from the therapeutic point of view, by simultaneous or successive application. The present invention also aims at the simultaneous or successive use of therapeutically active doses of the combination of the above drugs 1 and 2, for example for the treatment of cystic fibrosis or allergic alveolitis. { Farmers Lung). In the combinations of active substances 1 and 2 according to the invention, the constituents 1 and 2 can be contained in the form of their enantiomers, mixtures of the enantiomers or in the forms of the racemates. The relationships, in which the two substances 1 and 2 can be used in the combinations of active substances according to the invention, are variable. The active substances 1 and 2 can optionally be present in the form of solvates or hydrates. Depending on the choice of the compounds !, and 2, the weight ratios, which can be used within the framework of the present invention, vary because of the different molecular weight of the different compounds as well as because of their different intensity of effect . As a rule, combinations of medicaments according to the invention can contain compounds 1 and 2 in weight ratios which are in a range from 1: 300 to 50: 1, preferably 1: 250 to 40: 1. In especially preferred drug combinations, which contain the tiotropium salt as compound 1 and a compound selected from the group consisting of, budesonide, fluticasone, mometasone and ciclesonide as steroid 2_, the weight ratios of 1 and 2 are located at especially preferred mode in a range, wherein tiotropium 1 / and steroid 2 are contained in ratios from 1: 150 to 30: 1 and even more preferably from 1:50 to 20: 1. For example, and without limiting the scope of the invention, the preferred combinations of 1 and 2 according to the invention can be contained, based on tiotropium 1__ and steroid 2 in the following weight ratios: 1:50; 1:49; 1:48; 1:47; 1:46; 1:45; 1:44; 1:43; 1:42; 1:41; 1:40; 1:39; 1:38; 1:37; 1:36; 1:35; 1:34; 1:33; 1:32; 1: 31; 1: 30; 1:29; 1:28; 1:27; 1:26; 1:25; 1:24; 1:23; 1:22; 1:21; 1:20; 1:19; 1:18; 1:17; 1:16; 1:15; 1:14; 1:13; 1:12; 1:11: 1:10; 1: 9; 1: 8; 1: 7; 1: 6; 1: 5; 1: 4; 1: 3; 1: 2; eleven; twenty-one; 3: 1; 4: 1; 5: 1; 6: 1; 7: 1; 8: 1; 9: 1; 10: 1; 11: 1; 12: 1; 13: 1; 14: 1; 15: 1; 16: 1; 17: 1; 18: 1; 19: 1; 20: 1. The application of the medicaments according to the invention, which contain the combinations of 1 and 2, is usually carried out in such a way that 1 and 2 are contained in common in dosages of 0.01 to 10,000 ccg, preferably 0.1 to 2,000 ocg, more preferably from 1 to 1,000 ocg, still more preferably from 5 to 500 ocg, preferably according to the invention from 10 to 300 ocg, most preferably from 20 to 200 mg, for each administration in a single time. For example, the combinations according to the invention of 1 and 2 contain such a quantity of the tiotropium α and the steroid and 2 that the total dosage for each administration at one time amounts to approximately 20 ccg, 25 ocg, 30 ocg, ocg, 45 ccg, 50 ccg, 55 ccg, 60 ccg, 65 ccg, 70 ccg, 75 ccg, 75 ccg, 80 ccg, 85 ccg, 90 ccg, 95 ccg, 120 ccg, 125 ccg, 130 ccg, 135 ccg, 140 ccg, 140 ccg, 150 ccg, 150 ccg, 150 ccg, 150 ccg, 150 ccg, 180 ccg, 180 ccg, 180 ccg, 180 ccg, 185 ccg, 195 ccg, 205 ccg, 205 ccg, 205 ccg, 205 ccg , 210 oc, 215 oc, 220 oc, 225 oc, 230 oc, 235 oc, 240 ccg, 245 oc, 250 oc, 255 oc, 260 cc, 265 oc, 270 oc, 275, or similar. In these dosing ranges, the active substances 1__ and 2_ can be contained in the weight ratios described above. For example, and without limiting to them the extension of the invention, the combinations according to the invention of 1 and 2 may contain such a quantity of tiotropium 3 and spheroid 2_, that for each administration in a single time 5 ocg of 1 are applied. / and 25 ocg of 2.5 ocg of 1_ and 50 ocg of 2.5 ocg of and 100 ccg of 2.5 ccg of G and 125 ocg of 2.5 ccg of 1 'and 200 ocg of 2.5 xg of ] and 250 ocg of 2, 10 ccg of G and 25 ccg of 2, 10 ocg of and 50 ocg of 2, 10 xg of 3 / and 100 ocg of 2, 10 ocg of and 125 ccg of 2, 10 ocg of and 200 ccg of 2, 10 ccg of 3 and 250 ccg of 2, 18 ocg of 1 / and 25 ccg of 2, 18 ccg of 1 / and 50 ccg of 2, 18 ocg of 1 / and 100 ocg of 2, 18 ocg of 1 / and 125 ccg of 2, 18 ocg of 1¿_ and 200 ccg of 2, 18 ocg of G and 250 ocg of 2, 20 ccg of G_ and 25 ocg of 2, 20 ocg of G and 50 ccg of 2 , 20 ccg of r and 100 ocg of 2, 20 ocg of 1 / and 125 ccg of 2, 20 ccg of l_ and 200 ocg of 2, 20 ocg of 1 / and 250 ccg of 2, 36 ocg of 3 / and 25 ocg of 2, 36 ocg of 1 / and 50 ocg of 2, 36 ocg of 1 / and 100 ocg of 2, 36 ocg of and 125 ccg of 2, 36 ccg of 1 / and 200 ccg of 2, 36 ccg of 1 _ and 250 ccg of 2, 40 ocg of 1 and 25 ccg of 2, 40 ccg of] and 50 og of 2, 40 xg of 1 / and 100 ocg of 2, 40 ocg of 1 'and 125 ocg of 2, 40 ocg of 1. Y 200 ^ 9 of i. ° 40 K < 3 of ¿1 and 250 ccg of 2_. If, as a preferred combination according to the invention of 1 and 2, the combination of active substances in which 1 means tiotropium bromide is used, the amounts of active substances 1 / and 2 applied per administration at one time, mentioned above in a way for example, correspond to the following amounts of 1 and 2 applied for each administration at a time: 6 ocg of l_ and 25 ocg of 2, 6 ocg of V¡_ and 50 ccg of 2, 6 ocg of 1 ^ and 100 ocg of 2, 6 ocg of β and 125 ocg of 2, 6 ocg of 1 'and 200 ocg of 2, 6 «g of 1 and 250 ocg of 2, 12 < xg of G and 25 mg of 2, 12 ccg of r and 50 ocg of 2, 12 ccg of 1 / and 100 ocg of 2, 12 ccg of 1 'and 125 ocg of 2, 12 ocg of l_ and 200 ocg of 2, 12 ocg of 3 / and 250 ocg of 2, 21.7 ocg of r and 25 ccg of 2, 21.7 ccg of G and 50 ccg of 2, 21.7 ocg of 2¿_ and 100 ocg of 2, 21, 7 ocg of and 125 ocg of 2, 21.7 ocg of and 200 ocg of 2, 21.7 ccg of G and 250 ocg of 2, 24.1 ocg of 1 / and 25 ccg of 2, 24.1 ccg of r and 50 ccg of 2, 24.1 ccg of 1_ and 100 ocg of 2, 24.1 ccg of and 125 ccg of 2, 24.1 ccg of 1_ and 200 ccg of 2, 24.1 ccg of 1¿_ and 250 ocg of 2, 24.1 ccg of 1¿_ and 25 ccg of 2, 24.1 ccg of 1 / and 50 ocg of 2, 24.1 ocg of 1 'and 100 ocg of 2, 24.1 ocg of 1 'and 125 ccg of 2, 24.1 ocg of P and 200 ocg of 2, 24.1 ocg of 1 / and 250 ocg of 2, 43.3 ocg of ~ _ and 25 ocg of 2, 43.3 ocg of 3 and 50 ocg of 2, 43.3 ocg of 1_ and 100 ocg of 2, 43.3 ccg of P and 125 ocg of 2, 43.3 ocg of P and 200 ccg of 2, 43.3 ocg of 2_ and 250 ccg of 2, 48.1 ocg of ± ¡and 25 ocg of 2, 48.1 ocg of 3 / and 50 ocg of 2, 48.1 ocg of 3 and 100 ocg of 2, 48.1 ocg of G and 125 ccg of 2, 48.1 ocg of 1¿_ and 200 ocg of 2 or 48.1 ccg of 1 / and 250 ocg of 2. If as a preferred combination according to The combination of active substances in which 1 means tiotropium bromide monohydrate is used for the invention of 1 and 2, the amounts of active substances and 2 applied per administration at one time, mentioned above by way of example, correspond to the following amounts of 1 and 2 applied for each administration in a single time: 6.2 ocg of and 25 xg of 2, 6.2 ocg of l _ and 50 ocg of 2, 6.2 ocg of 1 / and 100 ocg of 2, 6.2 ccg of and 125 ccg of 2, 6.2 ocg of and 200 ocg of 2, 6.2 ocg of 1_ and 250 ocg of 2, 12.5 ocg of 1 / and 25 ccg of 2, 12.5 xg of 1 and 50 ocg of 2, 12, 5 ocg of l / _ and 100 ocg of 2, 12.5 ocg of 1_ and 125 ocg of 2, 12.5 ccg of 1 'and 200 ocg of 2, 12.5 ocg of 1 / and 250 ccg of 2, 22.5 ocg of 1 / and 25 og of 2, 22.5 ccg of 1 and 50 ocg of 2, 22.5 ocg of 3 / and 100 ccg of 2, 22.5 ocg of _ and 125 ocg of 2, 22.5 ccg of 0 and 200 ccg of 2, 22.5 ccg of r and 250 ocg of 2.25 ccg of 1 and 25 ccg of 2.25 ocg of \ and 50 ocg of 2.25 ccg of 1¿_ And 100 85 of 2, 25 ocg of 1 'and 125 ocg of 2, 25 «g of G and 200 ocg of 2, 25 ccg of 1' and 250 ocg of 2, 45 xg of 1 / and 25 ocg of 2, 45 cg of 1 and 50 mg of 2, 45 cc of 3 and 100 cc of 2.45 cc of G_ and 125 g of 2, 45 cc of c and 200 cc of 2, 50 cc of 3 and 100 cc of 2 , 50 ocg of lj_ and 125 ocg of 2, 50 ocg of 1 ^ and 200 ocg of 2, 50 ocg of l_ and 250 ocg of 2, 50 ocg of G and 25 ocg of 2, 50 ocg of 1 / and 50 ocg of 2, 50 ocg of and 100 ocg of 2, 50 ocg of 1 and 125 ccg of 2, 50 ocg of and 200 ocg of 2 or 50 ocg of l_ and 250. ocg of 2. The application of the combinations of active substances 1 and 2 according to the invention are preferably carried out by inhalation route. For this, constituents 1 and 2 have to be made available in inhalable forms of presentation. As dosable aerosols with a content of propellant gas and solutions for inhalation according to the invention, which contain the combination of active substances 1 and 2, they can consist only of the said active substances or of a mixture of the said active substances with physiologically auxiliary substances. compatible Within the scope of the present invention, concentrates or sterile inhalation solutions, ready for use, are also encompassed by the concept of inhalation solutions free of propellant gas. The forms of presentation according to the invention may contain the combination of active substances 1 and 2 or in common in a presentation form or in two separate presentation forms. These forms of presentation, which can be used within the framework of the present invention, are described in detail in the following part of the specification. A) Powders for inhalation containing the combinations of active substances 1 and 2 according to the invention: The inhalable powders according to the invention can contain active substances 1 and 2 either alone or in mixture with suitable physiologically acceptable auxiliary substances. If the active substances 1 and 2 are contained in a mixture with physiologically acceptable auxiliary substances, the following physiologically acceptable auxiliary substances can be used for the production of these inhalable powders according to the invention: monosaccharides (for example glucose or arabinose), disaccharides (for example lactose, sucrose, maltose), oligo-and poly-saccharides (for example dextrans), polyalcohols (for example sorbitol, mannitol, xylitol), salts (for example sodium chloride, calcium carbonate) or mixtures of these auxiliary substances with each other. Preferably, mono- or di-saccharides are used, with the use of lactose or glucose being preferred, particularly, but not exclusively, in the form of their hydrates. As particularly preferred in the sense of the invention, lactose is used as the auxiliary substance, most preferably lactose monohydrate. The auxiliaries have, within the framework of the inhalable powders according to the invention, a maximum average particle size of up to 250 ocm, preferably between 10 and 150 ocm, particularly preferably between 15 and 80 [deg.] Cm. If necessary, it may be desirable to add finer fractions of excipients with an average particle size of 1 to 9 ocm to the excipients mentioned above. The finer auxiliary substances mentioned lastly are also selected from the abovementioned group of auxiliary substances that can be used. Finally, for the production of the inhalable powders according to the invention, the micronized active substances (shredded to micrometer size) 1 and 2, preferably with an average particle size of 0.5 to 0.5, can be added to the mixture of auxiliaries. 10 ocm, more preferably from 1 to 5 ocm. The processes for the production of the powders for inhalation according to the invention, by grinding and comminution to micrometer size as well as by final mixing of the constituents, are known from the state of the art. The inhalable powders according to the invention can be made available either in the form of a single mixture of powders, containing either 1 or 2 or in the form of separate inhalation powders, containing only 1 and 2, respectively. The inhalable powders according to the invention can be applied by inhalers known from the state of the art. The powders for inhalation according to the invention, which together with 1 and 2 also contain a physiologically harmless auxiliary substance, can be applied, for example, by means of inhalers which dose an individual dose from a reserve charge by means of a measuring chamber, such as is described in U.S. Pat. US 4570630 a, or through other device arrangements, such as are described in German patent application DE 36 25 685 A. Preferably, the inhalation powders according to the invention are applied, which together with 1 and 2 contain a physiologically safe auxiliary substance, however, packaged in capsules (to give the so-called inhalants), which are used in inhalers as described, for example, in WO 94/28958. An especially preferred inhaler for the administration of the combination of medicaments according to the invention in inhalets can be taken from Figure 1.

This inhaler (called Handihaler) for the inhalation of drugs in the form of powders from capsules, is characterized by a housing 1, which contains two windows2, a cover 3, in which there are holes for the air intake and which it is provided with a sieve 5 fixed on a sieve housing 4, an inhalation chamber 6 joined to the cover 3, next to which a trigger 8 provided with two sharpened needles 7, movable against a spring 8, is provided. as an embocadural2 hingedly connected through an axis 10 to the housing 1, the cover 3 and a cap 11. If the inhalation powders according to the invention are packaged in capsules (inhalets) in the direction of administration in capsules (Invention) preferred, mentioned above, charged amounts of 1 to 30 mg, preferably 3 to 20 mg, more preferably 5 to 10 mg of a powder for inhalation per capsule are recommended. These contain according to the invention either in common or in each case the dosages already mentioned above for 1 and 2 for each administration at one time. Sprays for inhalation with a content of propellant gas, containing the combinations of active substances 1 and 2 according to the invention: Sprays for inhalation with a content of propellant gas, according to the invention, can contain dissolved components 1 and 2 or in dispersed form in the propellant gas. In this case, the 1 and 2 can be contained in separate presentation forms or in a common presentation form, 1 and 2 being able to be contained or both dissolved, both dispersed or in each case only one component dissolved and the other dispersed. . The propellant gases, which can be used for the production of aerosols for inhalation according to the invention, are known from the prior art. Suitable propellant gases are selected from the group consisting of hydrocarbons such as n-propane, n-butane or isobutane and halogenated hydrocarbons such as fluorinated derivatives of methane, ethane, propane, butane, cyclopropane or cyclobutane. The aforementioned propellant gases can then be used alone or in mixtures thereof. Especially preferred propellant gases are allogenated derivatives of alkanes, selected from TG134a and TG227. Of the aforementioned halogenated hydrocarbons, TG134a (1,1,1,2-tetrafluoroethane) and TG227 (1,1,1,2,3,3,3-heptafluoro-propane) and mixtures thereof are preferred according to the invention. they. Inhalation aerosols with a propellant gas content according to the invention can also contain other constituents such as co-solvents, stabilizers, surfactants (with surface activity), antioxidants, lubricating agents as well as agents for adjusting the pH value . All these constituents are known in the state of the art.

The aerosols for inhalation with a content of propellant gas, according to the invention, can contain up to 5% by weight of the active substances 1 and / or 2. The aerosols according to the invention contain, for example, from 0.002 to 5% by weight, from 0.01 to 3% by weight, from 0.015 to 2% by weight, from 0.1 to 2% by weight, from 0.5 aw% by weight or from 0.5 to 1% by weight of the active substances 1 and / or 2. If the active substances 1 and / or 2 are present in dispersed form, the particles of active substances preferably have an average particle size of up to 10 ocm, more preferably from 0.1 to 5 ocm, particularly preferably from 1 to 5 ocm.

The aerosols for inhalation with a content of propellant gas, according to the invention mentioned above, can be applied by inhalers known in the state of the art (MDI's = metered dose inhalers). Correspondingly, an additional aspect of the present invention relates to medicaments in the form of aerosols with a content of propellant gas, as described above, in connection with one or several inhalers that are suitable for the administration of these aerosols. In addition, the present invention relates to inhalers, which are characterized in that they contain aerosols with a content of propellant gas, according to the invention, which have previously been described. The present invention also relates to cartridges which, equipped with an appropriate valve, can be used in a suitable inhaler, and which contain one of the aerosols for inhalation with a content of propellant gas, according to the invention, mentioned above. Suitable cartridges and methods for packaging these cartridges with aerosols for inhalation with a content of propellant gas, according to the invention, are known from the state of the art.

C) Solutions or suspensions for gas-free inhalation | propellant, containing the combinations of active substances 1 and 2 according to the invention: Particularly preferably, the application of the combination of active substances, according to the invention, is carried out in accordance with the invention. . form of solutions for inhalation and suspensions for inhalation free of propellant gas. Suitable solvents are aqueous or alcoholic solutions, preferably ethanolic. The solvent can be exclusively water or it is a mixture of water and ethanol. The relative proportion of ethanol to water is not limited, but preferably the maximum limit is up to 70 volume percent, particularly up to 60 volume percent and particularly preferably up to 30 volume percent . The remaining percent volume is completed by water. The solutions or suspensions containing 1 and 2, separately or in common, are adjusted with appropriate acids to a pH value of 2 to 7, preferably 2 to 5. For the adjustment of this pH value acids can be used. which are selected from inorganic or organic acids. Examples of especially suitable inorganic acids are hydrochloric acid, hydrobromic acid, nitric acid, sulfuric acid and / or phosphoric acid. Examples of particularly suitable organic acids are: ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and / or propionic acid and others. Preferred inorganic acids are hydrochloric acid and sulfuric acid. It is also possible to use acids that already form a salt by adding acid with one of the active substances. Among the organic acids, ascorbic acid, fumaric acid and citric acid are preferred. It is also possible to use mixtures of the aforementioned acids, particularly in the case of acids, which, together with their acidification properties, also have other properties, for example as flavoring substances, antioxidants or complexing agents, such as, for example, citric acid or ascorbic acid. According to the invention, hydrochloric acid is particularly preferably used to adjust the pH value. According to the invention, in the present formulation, the addition of aditinic acid (EDTA) or one of the known salts thereof, the sodium edetate, as a stabilizer or complexing agent can be dispensed with. Other embodiments contain this or these compound (s). In one preferred embodiment, the content, based on sodium edatate, is below 100 mg / 100 ml, preferably below 50 mg / ml, particularly preferably below 20 mg / ml. my . In general, solutions for inhalation in which the content of sodium edetate is located at 0 to 10 mg / 100 ml are preferred. To the solutions for inhalation free of propellant gas, according to the invention, co-solvents and / or other auxiliary substances can be added. Preferred co-solvents are those containing hydroxyl groups or other polar groups, for example alcohols - in particular isopropyl alcohol, glycols - in particular propylene glycol, polyethylene glycol, propylene glycol, glycol ethers, glycerol, polyoxyethylene alcohols polyoxyethylene fatty acid esters. The term "auxiliary and additive substances" is understood in this context as any pharmacologically compatible substance, which is not an active substance, but which can be formulated together with the active substance (s) in the pharmacologically appropriate solvent, in order to improve the qualitative properties of the formulation of active sustainability. Preferably, these substances do not develop any undesired pharmacological effect, or in the context with the intended therapy, no undesired pharmacological effect worthy of mention or at least any undesired pharmacological effect. The additive and auxiliary substances include, for example, surface-active substances, such as for example soy lecithin, oleic acid, sorbitan esters, such as polysorbates, poly (vinyl pyrrolidone), other stabilizers, antioxidant complexing compounds and / or preservatives, which guarantee or prolong the duration of use of the finished formulation of medicaments, flavoring substances, vitamins and / or other additive substances known from the state of the art. The additive substances also include pharmacologically harmless salts, such as, for example, sodium chloride as isotonxa agents. Preferred auxiliary substances include antioxidants, such as, for example, ascorbic acid, provided that it has not already been used for adjusting the pH value, vitamin A, vitamin E, tocopherols and similar vitamins or provitamins present in the organism. human . Conservation substances may be used to protect the formulation from germ contamination. Suitable preservatives are those known from the prior art, in particular cetylpyridinium chloride, benzalkonium chloride or benzoic acid, or benzoates such as sodium benzoate in the concentration known from the prior art. The above-mentioned preservatives are preferably contained in concentrations of up to 50 mg / 100 ml, particularly preferably between 5 and 20 mg / 100 ml. Preferred formulations contain, in addition to the solvent, water and the combination of active substances 1 and 2, still only benzalkonium chloride and sodium edetate. In another preferred embodiment, sodium edetate is dispensed with. For the application of inhalation solutions, free of propellant gas, according to the invention, inhalers are especially suitable which can nebulize a small amount of a liquid formulation in the therapeutically necessary dosage within a few seconds in an appropriate aerosol for an inhalation therapy. Within the framework of the present invention, nebulizers are preferred in which an amount of less than 100 ocm, preferably less than 50 ccm, more preferably between 10 and 30 ccm of active substance can be nebulized preferably with a stroke for forming an aerosol with an average particle size of less than 20 ocm, preferably less than 10 ccm, such that the inhalable proportion of the aerosol already corresponds to the therapeutically active amount. A device of this type for the administration without propellant gas of a metered amount of a liquid medicament intended for application by inhalation is described in detail, for example, in international patent application WO 91/14468 as well as in WO 97/12687 (there particularly in Figures 6a and 6b). The nebulizer devices (devices) described therein are also known by the name Respimat®. This nebulizer (Respimat®) can be used advantageously for the generation of inhalable aerosols according to the invention containing the combination of active substances 1 and 2 ^. Due to its cylindrical shape and a manageable size from less than 9 to 15 cm in length and 2 to 4 cm in width, this device can be carried by the patient at any time. The nebulizer projects a defined volume of drug formulation through the application of high pressures through small nozzles, so that inhalable aerosols result. Essentially, the preferred atomizer consists of a housing top part, a pump housing, a nozzle, a locking tensioning mechanism, a spring housing and a reserve container, characterized by • a pump housing, which is fixed to the upper part of the housing, and that one of its ends bears a nozzle body with the nozzle or the nozzle arrangement, • a hollow piston with a valve body, • a PTO flange, on which the hollow piston is fixed, and which is located on the upper part of the housing, • a locking tensioner mechanism, which is located in the upper part of the housing, a spring housing which is inside it, which is supported so as to be able to rotate in the upper part of the housing by means of a rotation support • a lower housing part, which is fitted on the spring housing in the axial direction.

The hollow plunger with valve body corresponds to a device disclosed in WO 97/12687. It partially penetrates the cylinder of the pump housing and is arranged axially displaceable in the cylinder. Particularly reference is made to Figures 1-4- in particular to Figure 3 - and to the corresponding parts of the specification. The hollow piston with valve body exerts on its high pressure side, at the time of release of the spring, a pressure of 5 to 60 MPa (approximately 50 to 600 bar), preferably 10 to 60 MPa (approximately from 100 to 600 bar) on the fluid, which is the measured solution of active substances. In this case volumes of 10 to 50 microlites are preferred, volumes of 10 to 20 microlites are especially preferred; a volume of 15 microlites per bolus is very particularly preferred. The valve body is preferably positioned adjacent the end of the hollow piston, which faces the body of the nozzle. The nozzle in the nozzle body is preferably microstructured, ie a micrometric technique is produced. Mx-structured nozzle bodies are disclosed, for example, in WO 94/07607; to this document is hereby referenced in its contents, particularly reference is made to Figure 1 disclosed therein and to its description. The body of the nozzle consists, for example, of two plates firmly connected to each other on the basis of glass and / or silicon, of which at least one plate has one or more micro-structured channels, which join the input side in the nozzle with the exit side from the nozzle. On the outlet side from the nozzle is located at least one circular or non-circular hole with a depth of 2 to 10 micrometers and a width of 5 to 15 micrometers, the depth preferably being 4.5 to 6.5 micrometers and the length from 7 to 9 micrometers. In the case of several nozzle orifices, with two of them being preferred, the directions of the jets of the nozzles in the nozzle body can run parallel to each other or are inclined with respect to each other direction to the respective nozzle orifice. In the case of a nozzle body with at least two nozzle orifices on the outlet side, the directions of the jets may be inclined with respect to each other at an angle of 20 degrees to 160 degrees, an angle of 60 to 150 degrees, and one of 80 to 100 ° is particularly preferred. The nozzle orifices are preferably arranged at a distance of 10 to 200 micrometers, more preferably at a distance of 10 to 100 micrometers, particularly preferably from 30 to 70 micrometers. The most preferred are 50 microns. The directions of the jets correspond to each other correspondingly in the vicinity of the nozzle orifices. The liquid drug preparation impinges on the nozzle body with an inlet pressure of up to 600 bar, preferably 200 to 300 bar, and is sprayed through the nozzle orifices to form an inhalable aerosol. Preferred particle sizes or droplets of the aerosol are located at up to 20 micrometers, preferably between 3 and 10 micrometers. The locking tensioning mechanism contains a spring, preferably a helical cylindrical compression spring, as an accumulator store for mechanical energy. The spring acts on the PTO flange as a jump piece, whose movement is determined by the position of a blocking member. The path of the PTO flange is limited precisely by one upper and one lower stop. The spring is preferably tensioned by a transmission that multiplies the force, for example helical displaceable gear, through an external torque, which when rotating the upper part of the housing is generated against the spring housing in the lower part of the housing. In this case, the upper part of the housing and the PTO flange contain a transmission of wedges of one or multiple steps. The locking member with intercalatable locking surfaces is arranged in an annular shape around the PTO flange. This consists, for example, of a ring itself deformable elastically radially based on a synthetic material or a metal. The ring is arranged in a plane perpendicular to the axis of the atomizer. After the spring has been tensioned, the locking surfaces of the locking member move in the path of the PTO flange and prevent the spring from coming off. The locking member is released by a key. The release key is attached or engaged with the locking member. To release the locking tension member, the release key moves parallel to the plane of the ring and preferably preferably into the atomizer; in such a case, the deformable ring deforms in the plane of the ring. Constructive details of the locking tensioning mechanism are described in WO 97/20590. The lower part of the housing moves in the axial direction through the spring housing and covers the support, the propulsion of the spindle and the reservoir for the fluid. When the atomizer is actuated, the upper part of the housing is rotated with respect to the lower part of the housing, whereby the lower part of the housing carries the spring housing with it. In such a case, the spring is jointly compressed and tensioned through the helical displaceable gear, and the locking mechanism automatically latches. The angle of rotation is preferably a fraction of a whole number of 360 degrees, for example 180 degrees. At the same time that the spring is tensioned, the PTO part in the upper part of the housing is displaced by a previously established path, the hollow piston is pushed back inside the cylinder in the pump housing, thereby a partial amount of the fluid is drawn from the reservoir into the high-pressure space in front of the nozzle. A number of interchangeable reservoir containers containing the fluid to be atomized can optionally be introduced and used in the atomizer. The reservoir contains the aqueous aerosol composition according to the invention. The atomization process is initiated by lightly pressing the release key. In this case, the locking mechanism leaves the path for the PTO part free. The tensioned spring moves the plunger into the cylinder of the pump housing. The fluid leaves the nozzle of the atomizer in an atomized form. Additional construction details are disclosed in PCT patent applications WO 97/12683 and WO 97/20590, which are hereby referenced in their contents. The component parts of the atomizer (nebulizer) are made of an appropriate material in a way corresponding to its function. The atomizer housing and - whenever the function permits - other parts are also preferably made of a synthetic material, for example by the injection molding process. For physiological purposes, physiologically innocuous materials are used.

In Figures 2a / b appended to this patent application, which are identical to Figures 6a / b of WO 97/12687, the nebulizer (Respimat) is described, with which aqueous compositions of aerosols can be safely inhaled. according to the invention. Figure 2a shows a longitudinal section through the atomizer when the spring is tensioned, and figure 2b shows a longitudinal section through the atomizer when the spring is de-stressed. The upper part (51) of the housing contains the housing (52) of the pump, next to which end the frame (53) for the atomizer's workpiece is placed. In the frame are the nozzle body (54) and a filter (55). The hollow piston (57), fixed on the PTO flange (56) of the locking tensioning mechanism, partially penetrates the cylinder of the pump housing. At its end, the hollow plunger supports the valve body (58). The hollow piston is sealed by the seal (59). Inside the upper part of the housing is the stop (60), on which the power take-off flange rests when the spring is released. Next to the PTO flange is the stop (61), on which the PTO flange rests when the spring is released. After the spring has been tensioned, the blocking member (62) moves between the stop (61) and a support (63) located on the upper part of the housing. The release key (64) is in communication with the blocking member. The upper part of the housing ends in the mouth (65) and is closed with the protective cap (66) fitted on top of it. The spring housing (67), provided with a compression spring (68), is supported so as to be able to rotate in the upper part of the housing by means of the elastic jump appendages (69) and the rotation support. The lower part (70) of the housing travels through the spring housing. Inside the spring housing is the exchangeable reservoir (71) for the fluid (72) to be atomized. The reservoir is closed with the cap (73) through which the hollow piston enters the reservoir and is immersed with its end in the fluid (reservoir of active substance solution). The spindle (74) for the mechanical counter mechanism is located on the wrapping surface of the spring housing. Next to the end of the spindle, which is oriented towards the upper part of the housing, is the drive pinion (75). The slide (76) sits on the spindle.

The nebulizer described above is suitable for nebulizing the aerosol compositions according to the invention to give an aerosol suitable for inhalation. If the formulation according to the invention is nebulized by the technique described above (with the Respimat®), the spread mass should correspond to at least 97%, preferably in at least 98% of all the operations of the inhaler (strokes ) at a defined amount with a tolerance range of at most 25% preferably 20% of this amount. Preferably, 5 to 30 mg of the formulation are spread as a defined mass, preferably 5 to 20 mg, for each stroke. However, the formulation according to the invention can also be nebulized by means of other inhalers other than those described above, for example, jet-stream inhalers or other stationary nebulizers. Correspondingly, a further aspect of the present invention relates to medicaments in the form of solutions or suspensions for inhalation free of propellant gas as described above, in conjunction with a device suitable for the administration of these formulations, preferably in conjunction with the Respimat. ®. Preferably, the present invention relates to solutions or suspensions for inhalation free of propellant gas, which are characterized by the combination of active substances 1 and 2 according to the invention in conjunction with the device known by the name Respimat®. Furthermore, the present invention relates to the aforementioned inhalation devices, preferably Respimat®, which are characterized in that they contain the solutions or suspensions for inhalation free of propellant gas according to the invention, described above. The solutions or suspensions for inhalation free of propellant gas, according to the invention, together with the preceding solutions and suspensions, intended for application in the Respimat®, can also be presented in the form of concentrates or sterile solutions or suspensions for inhalation, ready for use. Concentrates can be generated from the concentrates, for example by adding isotonic solutions of sodium chloride, ready-for-use formulations can be applied by stationary or transportable nebulizers that are powered by energy, which generate inhalable aerosols by ultrasound or compressed air according to the Venturi principle or other principles. Correspondingly, a further aspect of the present invention relates to medicaments in the form of solutions or suspensions for inhalation, free of propellant gas, as described above, which are presented in the form of concentrates or sterile formulations ready for use, in linkage with an appropriate device for the administration of these solutions, characterized in that in the case of this device is a stationary or tansportable nebulizer that works powered by energy, which generates aerosols inhaled by ultrasound or compressed air according to the Venturi principle u other principles The following examples serve to provide a broader explanation of the present invention, without however limiting the extension of the invention to the following embodiments, given by way of example. Starting materials Tiotropium bromide: Tiotropium bromide, used in the following formulation examples, can be obtained as described in the European patent application EP 418 716 A1. For the production of the inhalation powders according to the invention, it may also employ a crystalline tiotropium bromide monohydrate. This crystalline tiotropium bromide monohydrate is obtainable according to the procedure described below.

In a suitable reaction vessel, 15.0 kg of tiotropium bromide are incorporated in 25.7 kg of water. The mixture is heated to 80-90 ° C and stirred at a constant temperature until a clear solution results. Active carbon (0.8 kg), moistened with water, is suspended in 4.4 kg of water, this mixture is introduced into the solution containing tiotropium bromide and subsequently rinsed with 4.3 kg of water. The mixture thus obtained is stirred at 80-90 ° C for at least 15 min and then filtered through a hot filter in a previously heated apparatus at a shell temperature of 70 ° C. The filter is subsequently rinsed with 8.6 kg of water. The contents of the apparatus are cooled to 3-5 ° C for 20 minutes until reaching a temperature of 20-25 ° C. Upon cooling with cold water, the apparatus is further cooled to 10-15 ° C and the crystallization is completed by further stirring for at least one hour. The crystallized material is isolated through a dryer with suction filter, the isolated crystalline slurry is washed with 9 1 of cold water (at 10-15 ° C) and cold acetone (at 10-15 ° C). The obtained crystals are dried at 25 ° C for 2 hours in a stream of nitrogen. Yield: 13.4 kg of tiotropium bromide monohydrate (86% of theory). The crystalline tiotropium bromide monohydrate thus obtained is minced to a micrometer size according to known methods to make available the active substance in the form of the average particle size corresponding to the specifications according to the invention. Formulation examples Powders for inhalation: 1) Constituents ° cg per capsule Tiotropium bromide 21.7 Budesonide 200 Lactose 4,778, 3 Sum 5,000 2) constituents ocg per capsule tiotropium bromide 21,7 Fluticasone Propinate 125 Lactose 4,853, 3 Sum 5,000 3) Constituents ocg per capsule Tiotropium bromide x ¾0 22.5 Raometasone furoate 250 Lactose 4,727, 5 Sum 5,000 4) B) Aerosols for inhalation containing propellant gas: Suspended aerosol Constituents% by weight Tiotropium bromide 0.029 Budesonide 0.4 Soybean lecithin 0.2 TG 134a: TG 227 = 2: 3 Up to 100 2) Suspension aerosol: Constituents% by weight Totropium bromide 0.029 Fluticasone Propinato 0.3 Isopropyl Myristate 0.1 TG 227 Up to 100 3) Suspension aerosol: Constituents% by weight Totropium bromide 0.029 Mometasone furoate 0.6 Isopropyl myristate 0.1 TG 227 Up to 100 Aerosol in suspension It is noted that in relation to this date, the best method known to the applicant to carry out the aforementioned invention, is the conventional one for the manufacture of the objects or products to which it refers.

Claims

CLAIMS Having described the invention as above, it claims as property that contained in the following claims: 1. Medicament, characterized by a certain content of one or more anticholinergic agents in combination with one or several steroids, optionally in the form of their enantiomers, mixtures of the enantiomers or in the form of the racemates, optionally in the form of the solvates or hydrates as well as possibly in common with a pharmaceutically compatible auxiliary substance. 2. The medication according to claim 1, characterized in that the active substance 1 and 2 are contained either in common in a single presentation form or in two separate depression forms. Medicament according to one of claims 1 or 2, characterized in that the active substance 1 is selected from the group consisting of tiotropium salts, oxitropium salts or ipratropium salts, preferably tiotropium salts. Medicament according to one of claims 1 to 3, characterized in that the active substance 1 is contained in the form of the chloride, bromide, iodide, methane sulphonate, sulfate or para-toluene sulfonate, preferably in the form of the bromide. Medicament according to one of claims 1 to 4, characterized in that the active substance 2_ is selected from the group consisting of flunisolide, beclomethasone, triamcinolone, budesonide, fluticasone, mometasone, ciclesonide, rofleponide, GW 215864, KSR 592, ST-126 and dexamethasone. 6. Medicament according to one of claims 1 to 5, characterized in that the active substance 2 is selected from the group consisting of flunisolide, beclomethasone, triamcinolone, budesonide, fluticasone, mometasone, ciclesonide and dexamethasone. Medicament according to Claims 1 to 6, characterized in that the weight ratios of 1 to 2_ are in a range from 1: 300 to 50: 1, preferably from 1: 250 to 40: 1. 8. Medicament according to claims 1 to 7, characterized in that a one-time application corresponds to a dosage of the combination of active substances 1 and 2 from 0.01 to 10,000 ccg, preferably from 0.1 to 2,000 ccg. Medicament according to one of claims 1 to 8, characterized in that it is in the form of a presentation form suitable for inhalation. 10. Medicament according to claim 9, characterized in that it is a form of presentation selected from the group of powders for inhalation, aerosols dosable with a content of propellant gas and solutions or suspensions for inhalation, free of propellant gas. 11. Medicament according to claim 10, characterized in that it is a powder for inhalation containing the active substances 1 and 2 in mixture with physiologically acceptable auxiliary substances, selected from the group consisting of monosaccharides, disaccharides, oligo- and poly-saccharides , plialcohols, salts or mixtures of these substances help each other. 12. Powder for inhalation according to claim 11, characterized in that the auxiliary substance has a maximum average particle size of up to 250 ccm, preferably between 10 and 150 or more. 13. Capsules characterized by a certain content of a powder for inhalation according to claim 11 or 12. 14. Drug according to claim 10, characterized in that it is a powder for inhalation, which as constituents contains only the active substances 1 and 2. Medicament according to claim 10, characterized in that it is an aerosol for inhalation with a content of propellant gas, containing the active substances 1 and 2 in dispersed or dissolved form. Aerosol for inhalation with a content of propellant gas according to claim 15, characterized in that as a propellant gas it contains hydrocarbons such as fluorinated methane derivatives, ethane, propane, butane, cyclopropane or cyclobutane. Inhalation aerosol with a propellant gas content according to claim 16, characterized in that the propellant gas consists of TG134a, TG227 or a mixture thereof. 18. Aerosol for inhalation with a content of propellant gas according to claims 15, 16 or 17, characterized in that it optionally contains one or more additional constituents selected from the group consisting of co-solvents, stabilizers, surfactants (with surface activity) ), antioxidants, lubricating agents and agents for adjusting the pH value. Aerosol for inhalation with a content of propellant gas according to one of claims 15 to 18, characterized in that it can contain up to 5% by weight of the active substances 1 and / or 2. 20. Drug according to claim 10 , characterized in that it is a solution or suspension for inhalation, free of propellant gas, containing as solvent water, ethanol or a mixture of water and ethanol. 21. Solution or suspension for inhalation according to claim 20, characterized in that the pH value is 2-7, preferably 2-5. 22. Solution or suspension for inhalation according to claim 21, characterized in that the pH is adjusted by means of an acid selected from the group consisting of hydrochloric acid, hydrobromic acid, nitric acid, sulfuric acid, ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and propionic acid or mixtures thereof. 23. Solution or suspension for inhalation according to one of claims 20 to 22, characterized in that it optionally contains other co-solvents and / or other auxiliary substances. 24. Solution or suspension for inhalation according to one of claim 23, characterized in that as co-solvents contain constituents, which contain hydroxyl groups or other polar groups, for example alcohols- in particular isopropyl alcohol, glycols- in particular propylene glycol, polyethylene glycol, polypropylene glycol, glycol ethers, glycerol, polyoxyethylene alcohols and polyoxyethylene fatty acid esters. 25. Solution or suspension for inhalation according to one of claims 23 or 24, characterized in that as auxiliary substances it contains surfactants, stabilizers, complexing compounds, antioxidants and / or preservatives, flavoring substances, pharmacologically harmless salts and / or vitamins. 26. Solution or suspension for inhalation according to claim 25, characterized in that, as a complexing agent, it contains edinic acid, preferably sodium edetate. 27. Solution or suspension for inhalation according to claim 25 or 26, characterized in that as antioxidant agents it contains compounds selected from the group consisting of ascorbic acid, vitamin A, vitamin E and tocopherols. 28. Solution or suspension for inhalation according to claims 25, 26 or 27, characterized in that as preservative contains compounds selected from cetyl-pyridinium chloride, benzalkonium chloride, benzoic acid and benzoates. 29. Solution or suspension for inhalation according to one of claims 23 or 26, characterized by addition to active substances 1 and 2 and the solvent also contains only benzalkonium chloride and sodium edetate. Solution or suspension for inhalation according to one of claims 23 to 28, characterized by together with the active substances 1 and 2_ and the solvent also contains only benzalkonium chloride. 31. Solution or suspension for inhalation according to one of claims 20 or 30, characterized in that it is a concentrate or a solution or suspension for sterile inhalation, lends for use. 32. The use of a capsule according to claim 13 in an inhaler, preferably in a "Handihaler". The use of a solution for inhalation according to one of claims 20 to 30 for nebulization in an inhaler according to WO 91/14468 or in an inhaler as described in Figures 6a and 6b of WO 97 / 12687 34. The use of a solution for inhalation according to claim 31 for the nebulization in a stationary or transportable nebulizer, which operates powered by energy, which generates inhalable aerosols by ultrasound or compressed air according to the Venturi principle or other principles. 35. The use of a composition according to one of claims 1 to 31 for the preparation of a medicament for the treatment of inflammatory or obstructive diseases of the respiratory tract.