US 20140178492A1 (19) United States (12) Patent Application Publication (10) Pub. N0.: US 2014/0178492 A1 HALOW (43) Pub. Date: Jun. 26, 2014

(54) BOWEL CLEANSING COMPOSITION (52) U.S. Cl. CPC ...... A61K33/42 (2013.01); A61K 31/08 (71) Applicant: GEORGE M. HALOW, EL PASO, TX (201301) (Us) USPC ...... 424/606

(72) Inventor: GEORGE M. HALOW, EL PASO, TX (Us) (57) ABSTRACT (21) APP1~ NO-3 13/7241931 The invention provides compositions for rapid bowel cleans (22) Filed_ Dec 21 2012 ing comprising a water-soluble mixture of polyethylene gly ' ' ’ col and sodium phosphate(s). The compositions are particu Publication Classi?cation larly useful for preparing the bowel prior to surgery or diagnostic procedures such as colonoscopies. The invention (51) Int. Cl. further comprises methods for cleansing the bowel using A61K 33/42 (2006.01) these compositions, and bowels cleansing kits comprising A61K 31/08 (2006.01) these compositions. Patent Application Publication Jun. 26, 2014 US 2014/0178492 A1

Transversel Normal Sigmoidl FIG.1 FIG.2

X Transversel Ulcerated mucosa Descendingl Normal FlG.3 FIG.4

Transverse! Normal Transversel Normal FIG.5 FIG.6 US 2014/0178492 A1 Jun. 26, 2014

BOWEL CLEANSING COMPOSITION attendant nausea. Further, although these purgatives normally include electrolytes to counterbalance electrolyte loss during [0001] This application is a continuing application from treatment, symptoms of electrolyte imbalance are, notwith US. application Ser. No. 10/194,251, which is incorporated standing, often experienced by the patient. herein by reference. SUMMARY OF THE INVENTION BACKGROUND OF THE INVENTION [0010] The inventions accordingly provide dry bowel [0002] 1. Field of the Invention cleansing compositions for oral administration comprising [0003] The invention relates to compositions for rapid polyethylene glycol; dibasic sodium phosphate; and, option bowel cleansing which are particularly useful for preparing ally, monobasic sodium phosphate; which are dissolved in an the bowel prior to surgery or diagnostic procedures such as aqueous carrier prior to use. For added potency in certain colonoscopies. clinical applications a bowel stimulant such as biscodyl; or [0004] 2. Background Information other agent known for its laxative properties may be taken in [0005] Gastrointestinal agents for regulating bowel move conjunction with the administration of these compositions as ment can conveniently be placed into two categories: laxa appropriate. tives and bowel cleansers. Laxatives are formulated for long [0011] The inventions further provide methods for the term use, with the intention of eliminating constipation and short-term use of the compositions as cathartics in emergency obtaining a regular bowel function. Many laxatives work by situations or in severe constipation, or as bowel preparations stimulating bowel motility (peristalsis) in various ways, as by prior to surgery, bowel examinations, childbirth, or similar distending the gut with bulking or osmotic agents, or by occasions. directly stimulating the bowel nerves or muscles with stimu [0012] The compositions demonstrate signi?cantly lant laxatives. Other laxatives function as stool softeners or improved patient compliance and very good ef?cacy. lubricants. The various types of laxatives are often combined in attempts to maximize e?icacy or to reduce side effects of BRIEF DESCRIPTION OF THE DRAWINGS the agents. [0006] Bowel cleansers, also called purgatives, cathartics, [0013] FIGS. 1-6 are video photographs taken during and lavages, are formulated for rapid emptying of the bowel colonoscopy of six different patients, illustrating clean-out of and are intended for short-term use only. They are commonly various sections of their colons using a bowel prep according used as “bowel preps” for emptying the bowel prior to sur to the invention. gery, childbirth, or diagnostic procedures, and usually com prise an osmotic or stimulant laxative administered by either DETAILED DESCRIPTION OF THE PREFERRED oral or anal route. While purgatives formulated for patient use EMBODIMENT as enemas are often prescribed before examinations, they are [0014] Polyethylene glycols useful in the composition of awkward to handle and are frequently not properly adminis the invention broadly comprise any food-grade or pharma tered, so orally-administered preparations are generally pre ceutical-grade PEG. Currently preferred for convenience of ferred. However, the orally-administered compositions for use in preparing and using the composition of the invention rapid bowel cleansing in common use also have disadvan are polymers having molecular weights above about 900 tages which discourage patient compliance. which are solid at room temperature and soluble in or mis [0007] The most commonly prescribed oral bowel preps cible with water. Polymers having average molecular weights today for bowel examination comprise sodium phosphate between about 3000 and 8000 are exemplary; PEG 4000, compositions in varying proportions of mono-and dibasic which is nearly odorless and tasteless and widely available in species, and polyethylene glycol (PEG) in combination with USP grade, or PEG 3350, are very suitable. A proprietary electrolytes. laxative, MiraLax® (Braintree Laboratories, supra), is a use [0008] Sodium phosphate is a saline osmotic laxative, sold, ful source of PEG 3350 powder readily soluble in water. for example, as Fleet Phospho-Soda® (C.B. Fleet Co., Other suitable PEG powders are commercially available, as Lynchburg, Va.), which contains both monobasic and dibasic from the Spectrum Chemical Mfg. Company, Gardena, Calif. uncoated sodium phosphate powders. It is also sold as V151 Non-powdered PEG should be comminuted to a particle size colTM, which comprises mono- and dibasic sodium phos that is readily soluble in water before use. phates in tablet form. This laxative, when formulated and [0015] The sodium phosphate powder according to the used as a bowel cleanser, is associated with nausea, vomiting, invention comprises a pharmaceutical-grade (USP) free ?ow and symptoms of electrolyte imbalance; the product also has ing powder of anhydrous dibasic sodium phosphate an unpleasant taste. As a result, patient compliance is dif?cult (N a2HPO4, disodium phosphate), optionally in combination to obtain, particularly when the cleanser is supplemented with monobasic sodium phosphate monohydrate with, for example, another saline agent such as a magnesium (NaH2PO4~HZO monosodium phosphate), or anhydrous, salt, or a bowel stimulant such as bisacodyl. such as conventionally used in saline laxatives, for example, [0009] While PEG is known for its successful use as a the powders described in the Fleet Phospho-Soda® compo long-term osmotic laxative in combination with dietary ?ber sition discussed supra. The phosphate powder provides the (as described in US. Pat. No. 5,710,183, issued Jan. 20, 1998 compositions of the invention with a saline osmotic effect to Halow, and incorporated herein by reference), PEG purga which complements the effect of the PEG component and is tives such as Colyte® (Braintree Laboratories, Braintree, used in amounts which provide the desired osmolarity for this Mass.) have poor patient compliance. They have an unpleas purpose, as known in the art. ant taste, and the amount and frequency of ?uid the patent is [0016] To administer, the phosphate and PEG powders are required to drink, typically 8 ?uid ounces every ten minutes simply dissolved by mixing into any desired aqueous carrier, over several hours, frequently cause severe bloating and such as water or juice. US 2014/0178492 A1 Jun. 26, 2014

[0017] PEG and phosphate powder are combined in [0022] For added potency in certain clinical applications, amounts which provide a composition that will preferably the compositions may be taken in conjunction with a bowel evacuate the bowel in the course of a few (3-4) hours. Typi stimulant such as bisacodyl, generally available over-the cally, a dry prep composition according to the invention will counter as Dulcolax®, BiscoLax®, or other proprietary prod contain about 60 to 80% by weight PEG and 20 to 40% by uct. For use with the present invention, bisacodyl should not weight of phosphate; the term “phosphate” herein refers to be taken in powder form to avoid neutralization with stomach either disodium phosphate alone, or disodium phosphate in acids. Enterin-coated 10 milligram tablets once or twice a day combination with monosodium phosphate. In typical are suitable. embodiments, the amount of PEG in a composition according [0023] The compositions may include, or be taken in con to the invention will be about 70 to 80% by weight, and 20 to junction with, conventional additives such as ?avoring or 30% by weight sodium phosphate, based on the total amount coloring agents. While not presently recommended, an herbal of PEG and phosphate; the combined PEG and phosphate bowel stimulant such as Cascara sagrada may also be should make up no less than about 80% by weight of a included in or taken in conjunction with the inventive com composition containing additives for optimum results. Com positions. Additionally, psyllium or other ?ber commonly positions containing about 75 to 80% by weight PEG and 20 used as a stool-bulking agent may be optionally added to or to 25% by weight phosphate are particularly contemplated. taken with the compositions, both for its laxative properties Generally, at least a major amount (greater than about 50% by and its potential ability to counteract any adverse effects of weight) of the phosphate present is disodium phosphate; if the other components. monosodium phosphate is included in the composition, it should usually make up less than one-half, and preferably less EXAMPLES than one-quarter, of the phosphate content of the composi tion. Methods and Materials: [0018] To formulate a convenient single dosage drink, a dry [0024] Patients were prepared for colonoscopy with a dry prep composition containing from about 45 to 70 grams pow prep composition of 60 grams PEG powder and 18 grams dered PEG and 10 to 30 grams phosphate powder, preferably disodium phosphate powder per dose. about 55 to 65 grams PEG and 15 to 25 grams phosphate [0025] Each patent was given two single-dose packets for powder, is dissolved or suspended in an aqueous liquid of self-administration on the day preceding the colonoscopy, choice, such as water, tea, or juice. In an exemplary drink with instructions to dissolve each dose in water and drink the formulation, a single dose dry prep composition containing ?rst dose at 10 am. and the second at 4 pm. For each patient, from about 58 to 63 gram PEG and from about 15 to 20 grams a clear liquid diet was prescribed for that day. A ?avor packet phosphate powder, for example, 60 grams powdered PEG and containing powdered Crystal Light® Ice Tea was provided 18 grams sodium phosphate powder, preferably disodium for use as desired with the prep to encourage drinking. phosphate powder, is dissolved in about 1 to 1.5 quarts of water or other aqueous liquid, for oral ingestion. Alternately, Results: the compositions can be dissolved in a smaller portion of water, such as eight ?uid ounces, and the remainder of the [0026] The results reported here are representative of those liquid taken in conjunction with this solution. The amount of obtained in the experimental group. water or other aqueous medium in which the dry prep com position is dissolved or which is taken with the dry prep Patient #1 : composition is not critical; however, for optimum bowel [0027] This is a 61 year-old female with weight loss and cleansing, at least about a pint should be used, and preferably decrease in appetite. She underwent a clear liquid diet the day at least a quart, depending upon the patient’s total liquid before with bowel prep taken at 10 am. and at 4 pm. Good intake during the treatment. prep and adequate view of the colon was veri?ed by multiple [0019] In another embodiment of the invention, lower photographs during colonoscopy. She had no complaints of molecular weight PEG polymers such as PEG 400 which are cramping or complaints of nausea. Mild dislike of taste. liquid at room temperature may be used as a base, and the [0028] View of transverse colon, FIG. 1. phosphate powder dissolved or dispersed therein; the solution may then be diluted to taste with the desired aqueous liquid. Patient #2: [0020] The single dosage drinks so prepared are taken from twice per day to four times per day on the day preceding the [0029] This is an 86 year-old female with a history of ane colonoscopy or other procedure, depending upon the degree mia who underwent bowel prep, taking it twice the day before of clean-out required and the presence of complicating bowel examination with a clear liquid diet. There was adequate clean out and a good view of the entire colon with no abnor conditions such as constipation. malities found in the colon. [0021] Typically, in an average patient, twice per day for [0030] View of sigmoid colon, FIG. 2. one day will provide the desired result. If, for example, the patient has failed a standard prep, a two day prep is recom Patient #3: mended. Preferably, the patient is restricted to a clear liquid diet while on the regimen, i.e., a diet of liquids containing no [0031] This is a 62 year-old male with hemorrhoidal bleed signi?cant solid material. Suitable clear liquids include apple and diarrhea undergoing colonoscopy. Bowel prep at 10 am. juice, tea, plain Jello®, 7-Up®, Sprite®, and chicken or beef and 4 pm. and a clear liquid diet were prescribed. He had no broth. If the patient receives a suf?cient amount of liquids complaints of nausea, vomiting, or discomfort. No com containing sodium and potassium ions to satisfy hunger, no plaints of taste abnormalities. He was given ?avor packet to supplemental electrolytes need be used with the PEG/phos use as needed. phate compositions. [0032] View of transverse colon, FIG. 3. US 2014/0178492 A1 Jun. 26, 2014

Patient #4: am. and 4 pm. on the day before the exam, with a clear liquid diet. The bowel prep was good, with adequate view of colon. [0033] This is a 74 year-old male with a history of colon No complaints. polyps for surveillance colonoscopy, underwent bowel prep [0038] View of transverse colon, FIG. 6. and clean out the day before using the dry prop at 10 am. and [0039] Although the invention has been described with ref 4 pm. with one Dulcolax 10 milligram tablet. Adequate clean erence to speci?c embodiments, this description is not meant out showing diverticulosis at the sigmoid colon. Mild rectal to be construed in a limited sense. Various modi?cations of irritation and in?ammation with a good view of the entire the disclosed embodiments, as well as alternative embodi colon veri?ed by video photographs taken during colonos ments of the inventions will become apparent to persons copy. Tolerance of the prep and slight complaint about taste, skilled in the art upon the reference to the description of the but no cramping sensation. No nausea and vomiting that he invention. It is, therefore, contemplated that the appended has had with other preps. claims will cover such modi?cations that fall within the scope [0034] View of descending colon, FIG. 4. of the invention. I claim: 1. A single dosage of a dry bowel cleansing composition Patient #5: comprising from about 12.5% to about 40% of a water soluble [0035] This is a 50 year-old female with a ?rst degree sodium phosphate powder and from about 60% to about relative with colon cancer who underwent surveillance 87.5% of a water soluble PEG powder, wherein the compo colonoscopy. Took the bowel prep at 10 am. and 4 p.m.; some sition contains no additional electrolytes. stool found in the sigmoid colon. There was no liquid, able to 2. The single dosage of a dry bowel cleansing composition suction out completely and got a good visualization of the as de?ned in Claim I wherein the amount of water soluble entire colon veri?ed by video photographs during the phosphate powder ranges from about 19.23% to about colonoscopy with the patient having no complaints of product 25.64% and the amount of water soluble PEG powder ranges from about 74.35% to about 87.17%. tolerance. No nausea and no vomiting with diarrhea, and no crampy sensation. 3. The dry bowel cleansing composition of claim 1, wherein said water soluble sodium phosphate powder is diba [0036] View of transverse colon, FIG. 5. s1c. 4. The dry bowel cleansing composition of claim 2, Patient #6: wherein said water soluble sodium phosphate powder is diba [0037] This is a 50 year-old female who presented with s1c. diarrhea for colonoscopy. The bowel prep was taken at 10