Improved bromocriptine formulations

Abstract

The present disclosure describes pharmaceutical formulations of bromocriptine and methods of manufacturing and using such formulations. The formulations are useful for treating physiological disorders including improving glycemic control in the treatment of type 2 diabetes. Also disclosed is synthesis of bromocriptine citrate, and compositions and dosage forms containing bromocriptine citrate.

Description

CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 IlVIPR()VED BR(Jl\ / lOCRIPTINE P()Rl\'IULATIONS TECHNICAL FIELD This invention relates to pharmaceutical formulations and methods of their manufacture and use, and more particularly to formulations of bromocriptine that are useful for treating 5 metabolic or physiological disorders, including type 2 diabetes mellitus (T2DJ\ / I) and also to synthesis of bromocriptine citrate, and to compositions and dosage fom1s containing bromocriptine citrate that provide increased stability and water solubility compared to prior art bromocriptine dosage fom1s. The present invention also relates to synthesis of bromocriptine citrate, and to compositions and dosage forms containing bromocriptine citrate that provide 1 o increased heat and humidity stability and water solubility and water stability compared to prior art bromocriptine dosage fonns. In another aspect, the invention relates to methods for using these compositions and dosage fom1s for the treatment of metabolic disorders including type 2 diabetes mellitus (T2DM). 15 20 BACKGROUND Bromocriptine ((5 'a)-2-bromo-l 2'-hydroxy-2'-( l-methylethyl)-5 '-(2-methylpropyi)ergotaman- 3 ',6', 18-trione, CAS Registry No. 25614-03-3) is an ergot alkaloid which is a potent dopamine D2 receptor agonist The compound has the following formula: Solid oral dosage forms of bromocriptine are available as bromocriptine mesylate ((S'o,)- 2-bromo-12'-hydroxy-2'-(l-methylethyl)-5 '-(2-methylpropyl)-ergotaman-3 ',6', 18-trione 1 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 monomethanesulfonate salt, CAS Registry No. 22260-51-1) in a pharmaceutical formulation (e.g., a tablet) containing up to 2.5 mg bromocriptine or in capsule form containing 5 mg bromocriptine. This dosage form of bromocriptine is useful in the treatment of certain hyperprolactinemia-associated dysfunctions and acromegaly, in the prevention of physiological 5 lactation, and in the treatment of Parkinson's disease and prevention of tolerance to Levodopa therapy for Parkinson's disease. In clinic.:al trials, adverse effects included nausea, headache, dizziness, fatigue, lightheadedness, vomiting, abdominal cramps, nasal congestion, constipation, diarrhea, and drowsiness. When bromocriptine is used as described above at appropriate doses, prolactin is reduced to low levels throughout a 24 hour period. CYCLOSETC!i\ a phamiaceutical 1 o formulation of bromocriptine mesylate providing a 0.8 mg dose of bromocriptine per tablet, is FDA-approved for once-daily administration to improve glycemic control in adults with type 2 diabetes mellitus, at a dose of 2-6 tablets (1.6 to 4.8 mg total dose). US patents 8,741,918 and 9,41,005 disclose compositions for parenteral administration using dopamine agonists such as bromocriptine, that are useful for treating metabolic-related conditions such as type 2 diabetes. 15 Bromocriptine, especially the bromocriptine mesylate salt, is prone to light, heat and 20 water decomposition via oxidation and isomerization to form bromocriptinine and other byproducts and to chemical degradation in acidic environments. Bromocriptine and bromocriptine mesylate are particularly susceptible to water-facilitated degradation, particularly to acidic ,vater-facilitated degradation, limiting the biological utility of the bromocriptine. U.S. Patent 4,654,345 describes a lyophilized formulation ofbromocriptine for ophthalmic administration providing reconstituted formulations with improved stability. U.S. Patent 5,066,495 describes a process for preparing bromocriptine formulations with improved stability by inclusion in an excipient or by separated granulation of excipients and mixing granulate with a mixture of the active ingredient and an excipient having low moisture 25 content. U.S. Patents 5,344,832, 5,554,623, and 5,716,957 discuss a method for modifying and regulating lipid and glucose metabolism by administering a dopamine agonist, e.g., bromocriptine, and / or a prolactin stimulator to reset hormonal timing in the neural centers of the brain to control insulin resistance, hyperinsulinemia, and hyperglycemia. 2 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 lJ.S. Patents 5,468,755, 5,756,513, and 5,866,584 discuss a method to modify and regulate lipid and carbohydrate metabolism-generally to reduce obesity, insulin resistance, hyperinsulinemia and hyperglycemia, by administration of a dopamine agonist such as bromocriptine to inhibit prolactin over a limited period at a time of day to reset normal honnonal 5 timing and control insulin resistance, hyperinsulinemia, and hyperglycemia. U.S. Patent 5,523,082 describes lyophilized formulations of bromocriptine mesylate for ophthalmic administration providing solutions with improved stability of bromocriptine in solution. U.S. Patent 5,679,685 discusses accelerated release brornocriptine mesylate formulations 1 o for regulating prolactin levels that are abnormal during particular times during the day. 15 U.S. Patent 5,814,638 discusses lyophilized bromocriptine formulations containing cyclodextrin with improved stability. U.S. Patents 9,192,576; 8,613,947; and 8,431,155 describe pharmaceutical formulations of micronized bromocriptine mesylate for oral use. SUl\11\IA.RY Bromocriptine mesylate is not stable under high heat conditions, under exposure to light, or in aqueous environments, particularly acidic aqueous environments. Moreover, bromocriptine is very poorly soluble in aqueous environments. This circumstance limits the shelf life of the compound and importantly also limits the biological utility of the compound, as biological 20 systems (e.g., plasma and cells) are largely aqueous. What is needed is a bromocriptine formulation that is both highly ,vater soluble (much more water soluble than bromocriptine mesylate) and also at the same time stable in the aqueous environment (not labile to waterfacilitated degradation). Since water destroys the bromocriptine, enhancing the stability of bromcoritpine by making it more soluble in (i.e, accessible to) water is highly counterintuitive. 25 The present invention provides for such a unique bromocriptine formulation. After substantial experimentation with various dosage regimens, and contrary to the general teaching in the art that mesylate salts confer greater water solubility relative to other salts including citrate, it is surprisingly found that bromocriptine formulated as a citrate salt (referred to as bromocriptine citrate) has a markedly increased water solubility versus bromocriptine 3 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 mesylate. l'Vforeover, bromocriptine mesylate or bromocriptine citrate in combination with certain excipients has the unique ability to markedly improve the heat stability (i.e., protect against heat degradation), aqueous / water stability (i.e., protect against the aqueous / water degradation ofbromocriptine) and aqueous / water solubility ofbromocriptine compared to the 5 mesylate salt of bromocriptine in its traditional pharmaceutical form (see Table 1) . As a result, compared to bromocriptine mesylate in its traditional pham1aceutical form (see Table 1) bromocriptine citrate, particularly in the fommlations described herein of excipients containing a short chain saccharide, fatty acid or triglyeride, and citric acid, exhibits a better shelf life (storage stability) in pharmaceutical preparations and additionally provides for longer term stability 1 o profiles (i.e., longer duration of appropriate drug activity) in pharmaceutical preparations with respect to bromocriptine dissolution, allowing for a longer storage period betw·een drug manufacture and drug administration, and / or less stringent (e.g., in terms of humidity or temperature) storage conditions. This feature allows for a more flexible (and, thus, less expensive) manufacturing process. 15 In one aspect, the present disclosure provides a pham1aceutical fommlation (e.g., a tablet) that includes bromocriptine (e.g., bromocriptine rnesylate or a different bromocriptine salt, e.g., bromocriptine citrate) and an excipient; wherein the bromocriptine is present in an amount that provides a dose of at least about 0.1 mg ofbromocriptine per pharmaceutical formulation; and wherein the excipient comprises a triglyceride. 20 In some embodiments, at least about 80~o of the acyl groups of the triglyceride are fatty acid acyl groups of C14-C26 fatty acids. In some embodiments, at least about 90% of the acyl groups of the triglyceride are fatty acid acyl groups of C 14-C26 fatty acids. In some embodiments, at least about 80° / .i of the acyl groups of the triglyceride are fatty acid acyl groups of C1G-C20 fatty acids. In some embodiments, at least about 90% of the acyl groups of the triglyceride are fatty 25 acid acyl groups of C1G-C20 fatty acids. In some embodiments, at least about 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C18 fatty acids. In some embodiments, at least about 90% of the acyl groups of the triglycetide are fatty acid acyl groups of C1s fatty acids. In some embodiments, at least about 80~'<> of the acyl groups of the triglyceride are stearoyl or 12-hydroxystearoyl groups. In some embodiments, at least about 90% of the acyl groups of the 30 triglyceride are stearoyl or 12-hydroxystearoyl groups. In some embodiments, at least about 80% 4 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 of the acyl groups of the triglyceride are saturated. In some embodiments, at least about 90% of the acyl groups of the triglyceride are saturated. In some embodiments, the excipient includes a hydrogenated vegetable oil. In some embodiments, the excipient includes hydrogenated castor oil, hydrogenated coconut oil, 5 hydrogenated cottonseed oil, hydrogenated palm oil, hydrogenated palm kernel oil, hydrogenated soybean oil or a c.:ombination thereof. In some embodiments, the excipient includes hydrogenated castor oil. In some embodiments, the excipient comprises KOLLJWAX@ HCO. 10 In some embodiments, the triglyc.:eride excipient is present in an amount from about 0.5% to about 20% by weight of the formulation. In some embodiments, an excipient is a particular saccharide (e.g., a monosaccharide, or a disaccharide, excluding lactose). In some embodiments, the excipient is extragranular. In some embodiments, the pharmaceutical formulation (e.g., a tablet) when prepared in pharmaceutical standard foil sealed plastic containers and with desiccant included is stable as in 15 the following embodiments: In some embodiments, the pharmaceutical formulation ( e.g., a tablet) is stable such that the pharmaceutical formulation contains no more than 5% total related substances (degradant) as detem1ined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical fommlation at a temperature of 25 :+, 2 °C at about 60 ± 5% relative humidity for about 18 months. In some embodiments, the pharmaceutical 20 formulation is stable such that the pharmaceutical formulation contains no more than 5(;;o total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ± 5 °C and about 60 ,J.: 5% relative humidity for about 24 months. In some embodiments, the pharmaceutical fonnulation is stable such that the phannaceutical formulation contains no more than 5% of 25 bromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °Cat about 60 :-1:-, 5% relative humidity for about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 5% of bromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm 30 following storage of the pharmaceutical formulation at a temperature of 25 :+, 5 °C and about 5 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 60 ± 5%i relative humidity for about 24 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 3% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm follovv-ing storage of the pharmaceutical formulation at a temperature of 40 :J:. 2 °C at about 70 ,J:, 5 5% relative humidity for about 6 weeks. In some embodiments, the pharmaceutical formulation (e.g., a tablet) is stable suc.:h that the phannaceutical formulation contains no more than 8% total related substances (degradant) as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 :.f:. 2 °C at about 60 :J:. 5% relative humidity 1 o for about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ,t: 5 °C and about 60 J~ 5% relative humidity 15 for about 24 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical fommlation contains no more than 8~~ of bromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative humidity for about 18 20 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmac.:eutical fommlation contains no more than 8%> of bromocriptine as determined by HPLC analysis using detection of UV abs01vtion at 300 nm following storage of the pharmaceutical fonnulation at a temperature of 25 ± 5 °C and about 60 ± 5~--o relative humidity for about 24 25 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 1'% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 ± 2 °C at about 70 ± 5~o relative humidity for 30 about 6 weeks. 6 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8(;;o total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 :+: 2 °Cat about 70 :}: 5% relative humidity for 5 about 6 months. In some aspects, the present disclosure provides a pharmac.:eutical formulation (e.g., a tablet) comprising micronized bromocriptine in an amount that provides a dose of at least about 0.1 mg ofbromocriptine per pharmaceutical formulation; wherein the pharmaceutical formulation is stable such that the phannaceutical fomrnlation contains no more than 5'% of 10 bromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical fommlation at a tt~mperature of 25 :+: 2 °Cat about 60 ± 5~o relative humidity for about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pham1aceutical formulation contains no more than 5%, total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm 15 following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 :}: 5% relative humidity for about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 5% of bromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pham1aceutical formulation at a temperature of 25 ± 2 °Cat about 20 60 ~}: 5%1 relative humidity for about 24 months. In some embodiments, the phannaceutical formulation is stable such that the pharmaceutical formulation contains no more than 5% total related substances as detem1ined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ~l: 2 °C at about 60 ± 5% relative humidity for about 24 months. In some embodiments the pharmaceutical 25 formulation is stable such that the pharmaceutical formulation contains no more than 3% of bromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm foUow'ing storage of the pharmaceutical formulation at a temperature of 25 c-1:, 2 °C at about 60 ± 5% relative humidity for about 18 months. In some embodiments, the pharmaceutical fonnulation is stable such that the phannaceutical formulation contains no more than 3% total 30 related substances as determined by HPLC analysis using detection of UV absorption at 300 nm 7 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 following storage of the pham1aceutical fommlation at a temperature of 25 ± 2 °Cat about 60 :re 5%i relative humidity for about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 3~~ of bromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm 5 following storage of the pharmaceutical formulation at a temperature of 25 c.l:: 2 °C at about 60 ± 5% relative humidity for about 24 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 3% total related substances as detem1ined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 cJ:: 2 °C at about 1 o 60 ± 5%i relative humidity for about 24 months. . In some embodiments the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8% of bromocriptinine ine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ,t: 2 °Cat about 60 :1: 5% relative humidity for 15 about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5%1 relative humidity for 20 about 18 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmac.:eutical fommlation contains no more than 8%> of bromocriptine as determined by HPLC analysis using detection of UV abs01vtion at 300 nm following storage of the pharmaceutical fonnulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for at least 24 25 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8'% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °Cat about 60 ± 5~o relative humidity for 30 about 24 months. 8 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 1 (;;o total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 :+: 2 °Cat about 70 :}: 5% relative humidity for 5 about 6 weeks. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8% total related substances as determined by FIPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 :+: 2 °Cat about 70 :}: 5% relative hurnidity for 1 o about 6 months. 15 In some embodiments of the pharmaceutical formulations described above, the bromocriptine is micronized. In some embodiments, the bromocriptine has a Dv90 of about 20 μm or lower. In some embodiments, the bromocriptine has a Dv90 of about 10 p.m or lower. In some embodiments, the bromocriptine has a Dv90 of about 5 μm or lower. In some embodiments, the bromocriptine has a Dv99 of about 20 μm or lower. In some embodiments, the bromocriptine has a Dv99 of about l O μm or lower. In some embodiments, the bromocriptine has a volume-based particle size distribution wherein not more than about 20%i of the bromocriptine has a particle size ofless than about 20 1 μrn. In some embodiments, the phannaceutical fonnulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein at least about 80% of the bromocriptine has been released at about 30 minutes. 25 In some embodiments, the phannaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle 1\.fothod at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 3 7 °C, wherein at least about 90% of the bromocriptine has been released at about 30 minutes. In some embodiments, the pharmaceutical formulation provides a dissolution profile, 30 when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric 9 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 acid at about 37 ''C, wherein at least about 95%> of the bromocriptine has been released at about 30 minutes. In some embodiments, the pharmaceutical formulation provides a dissolution profile, when tested in LISP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric 5 acid at about 37 °C, wherein at least about 90 % of the bromocriptine has been released at about 20 minutes. In some embodiments, the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle :Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein not more than about 50 i:.fo of the bromocriptine has been released at 1 o about 7 minutes. In some embodiments, the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle 1\riethod at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein not more than about 75% of the bromocriptine has been released at about 10 minutes. 15 In some embodiments, the pharmaceutical formulation provides a pharmacokinetic profile wherein the time to maximum plasma concentration (Tmax) following administration of the pharmaceutical formulations (e.g., six phannaceutica1 formulations each comprising a dose of 0.8 mg ofbromocriptine) to adult subjects is between about 30 and 60 minutes when the pharmaceutical formulations are administered under fasting conditions. 20 In some embodiments, the pharmaceutical formulation provides a pharmacokinetic 25 profile comprising) a Tmax at about 1 to about 90 minutes after administration of the parenteral dosage form; and b) a plasma drug concentration of at least 50° / o Cmax for a duration of about 90 to about 360 minutes after Tmax when said dosage fonn is administered parenterally In some embodiments, the pharmaceutical formulation comprises citric acid as an excipient. In some embodiments, the citric acid is present in an amount from about l ~o to about 7~{, by weight. In some embodiments, the pharmaceutical formulation comprises a disintegrant. In some 30 embodiments, disintegrant is present in an amount from about 5% to about 20% by weight 5 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In some embodiments, the bromocriptine is present in an amount that provides a dose of about 0.8 mg ofbromocriptine per pharmaceutical formulation. In some embodiments, the pharmaceutical formulation comprises a triglyceride or diglyceride ora phospholipid, including phosphatidylcholine. In some embodiments, the pharmaceutical formulation comprises a shmt chain saccharide exclusive of lactose. In some embodiments the shmt chain saccharide comprises mannitol In some embodiments the pham1aceutical fommlation comprises the fatty acid, stearic acid. In another aspect, the present disclosure provides a rnethod for the manufacture of a 1 o brornocriptine pharmaceutical formulation comprising blending the brornocriptine with excipients to fom1 a mixture wherein the bromocriptine is substantially evenly distributed in the mixture, and compressing the mixture to form a pharmaceutical formulation. In some embodiments, the method includes processing bromocriptine to reduce the average particle size of the bromocriptine to provide bromocriptine that has a Dv90 of about 15 20 μm or less prior to the blending. 20 In some embodiments, the method includes determining that bromocriptine has a particle size distribution equivalent to a volume-based particle size distribution with a Dv90 of about 20 ~tm or less prior to the blending, so that the bromocriptine that is blended is of determined particle size distribution. In some embodiments, the bromocriptine can have a particle size of 0.1 to 100 um diameter. In an aspect, the present disclosure provides a pharmaceutical formulation prepared according to such methods. In some embodiments the present disclosure provides a method for treating metabolic 25 disorders including T2DM in a subject in need of such treatment, the method including administering to the subject a solid dosage form such as a tablet or capsule containing bromocriptine citrate, a short chain saccharide such as mannitol and stearic acid. 11 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In another embodiment the method can include orally and / or parenterally administering the solid dosage form containing bromocriptine citrate, a short chain saccharide such as mannitol and stearic acid to the subject. The formulation can also contain citric acid. Any of the above-described methods can include the administration of between about 5 0.05 μg and about 0.5 mg / kg per day of bromocriptine citrate to the subject Oral fommlations generally contain 30-60% by weight of a short chain saccharide, while parenteral (sublingual) formulations contain 60-90% by weight of a short chain saccharide. Any of the above-described methods can further include treating the subject with one or more additional therapeutic regimens. The additional therapeutic regimens can include, e.g., 1 o administering one or more dopamine D 1 receptor agonists, al pha-1 adrenergic antagonists, alpha-2 adrenergic agonists, serotonergic inhibitors, and / or serotonin 5HT1b agonists. Alternately or in addition, the additional therapeutic regimens can include, e.g., administering one or more peripheral acting agents. In some embodiments the present disclosure provides for a formulation containing 15 micronized bromocriptine citrate, a short chain saccharide such as mannitol, a fatty acid such as stearic acid or a triglyceride, and citric acid as an excipient. 20 In some embodiments, the present disclosure provides a formulation containing between 0.1-lO~"o bromocriptine citrate, 0.1-10% citric acid, 30-90% non-lactose short chain saccharide, and 0.2-10% free fatty acid, phosphoEpid or triglyceride. In some embodiments, the present disclosure provides a formulation containing between 0.1-10% bromocriptine citrate, 0.1-10% citric acid, 60-90% non-lactose short chain saccharide, and 0.2-10% free fatty acid, phospholipid or triglyc.:eride. In another embodiment the present disclosure provides a formulation containing(by weight) between 0.l-8~0 bromocriptine citrate, 0.5-8% citric acid, 65-90%> non-lactose short 25 chain saccharide, and 0.2-5% free fatty acid, phospholipid or triglyceride. In one preferred embodiment the present disclosure provides a formulation containing(by weight) 0.1-5 % bromocriptine citrate, 0.5-5%, citric acid, 70-90% non-lactose short chain saccharide, and 0.2-3.0%> free fatty acid, phospholipid or triglyceride 12 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In some embodiments the present disclosure provides a method for treating metabolic disorders including T2DM in a subject in need of such treatment, by administering to the subject a solid dosage form such as a tablet or capsule containing (micronized) bromocriptine citrate, a short chain saccharide such as mannitol, a fatty acid such as stearic acid or a triglyceride, and 5 citric acid. In another embodiment the method can include orally and / or parenterally administering the solid dosage form containing bromocriptine citrate, a short chain saccharide such as mannitol a fatty acid such as stearic acid or a triglyceride to the subject. The formulation can also contain citric acid. 1 o The term "parenteral administration" is defined herein to mean a form of administration 15 or dosage form that provides for the absorption of a substantial amount of the drug through other than the gastric and / or intestinal mucosa of the GI tract, Any of the above-desclibed methods can include the administration of between about 0.05 p.g and about 0.5 mg / kg per day ofbromocriptine citrate to the subject. Any of the above-described methods can further include treating the subject with one or more additional therapeutic regimens. Alternately or in addition, the additional therapeutic regimens can include, e.g., administering one or more peripheral acting agents. In an aspect, the present disclosure provides a method of treatment for improving glycemic control in a type 2 diabetes patient comprising administering to the patient or providing to the patient for 20 administration one or more bromocriptine pharmaceutical formulations as described herein. In an aspect, the present disclosure provides a method of treatment for improving metabolic disorders such as glycemic control in a type 2 diabetes patient or key elements of metabolic disorders comprising manufacturing one or more bromocriptine pharmaceutical formulations according to the methods of manufacture disclosed herein and administering the 25 one or more of the pharmaceutical formulations to the patient or providing one or more of the pharmaceutical formulations to the patient for administration. In an aspect, the present disclosure provides a method of treating a metabolic disorder or key element thereof by administering the herein described bromocriptine formulations within 4 13 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 hours of waking in the morning or so as to produce a daily peak in dopamine agonist activity in the body within about 4 hours of waking in the morning. The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will 5 be apparent from the description and drawings, and from the claims. DESCRIPTION OF DRAWINGS Figure IA shows a plot of the total related substances impurity measured for bromocriptine mesylate pharmaceutical formulation formulations prepared using micronized bromocriptine mesylate and various lubricants at the beginning of an experiment to measure 1 o product stability (T=0) and following storage at 40 ± 2 °C and 75 ± 51%RH for 1, 2 or 3 months. 15 Figure l B shows a plot of the total related substances impurity measured for bromocriptine mesylate pharmaceutical formulation formulations prepared using micronized bromocriptine mesylate and various lubricants at the beginning of an experiment to measure product stability (T=0) and following storage at 30 ± 2 °C and 65 ± 5~oRH for 3 months. Figure IC shows a plot of the total related substances impurity measured for bromocriptine mesylate pharmaceutical formulation formulations prepared using micronized bromocriptine mesylate and various lubricants at the beginning of an experiment to measure product stability (T"00) and following storage at 25 ,±, 2 °C and 60 :}: 5%RH for 3 months. Figure 2 shows a plot of the effect of various additives on the degradation of 20 brornocriptine (evaluated via the formation of the browning reaction) as a fonction of time of exposure to a heated aqueous environment. 25 Figure 3 shows a typical chromatogram of a blank solution, a reference bromocriptine mesyiate solution containing 0.112 mg / ml of bromoc1iptine mesylate, and a sample solution prepared from bromocriptine mesylate pharmaceutical formulations. DETAILED DESCRIPT[ON "About" or "Approximately," as used herein, means approximately, e.g., plus or minus approximately ten percent of the indicated value. 14 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 "Particle," as used herein, refers to an aggregated physical unit of a compound (e.g., bromocriptine mesylate or a different bromocriptine salt, e.g., bromocriptine citrate), i.e., a piece or a gram. "Particle size," as used herein, refers to the average linear dimension of a particle of a 5 compound, for example the diameter of a spherical particle of a compound. "1\1icronization," as used herein, refers to a proc.:ess of reducing the average particle size of a solid material, typically to provide particles with a particle size of a few micrometers. "Micronized," as used herein, refers to a material that has been subjected to microni zation. 1 o "Short chain saccharide" as used herein refers to monosaccharides or di saccharides, (excluding lactose) including but not limited to,, mannitol, xylitol, dextrose, maltose, sucrose, galactose, fructose, and sorbi tol The term "oral dosage form" refers to a drug dosage form that provides for absorption of a substantial amount of the drug through the gastric and / or intestinal mucosa of the 1 5 gastrointestinal tract. The term "pham1aceutical formulation" refers to an oral dosage form that comprises a mixture of active substances and excipients, usually in powder form, pressed or compacted from a powder into a solid dose. "Particle size distribution," as used herein, refers to the relative proportions of particles of 20 a compound, such as bromocriptine mesylate or a different bromocriptine salt, e.g., bromocriptine citrate, having a given particle size. While the particle size of a spherical object can be unambiguously and quantitatively defined by its diameter, particles comprising an active pharmaceutical ingredient, such as bromocriptine mesylate for example, may be non-spherical and irregular in shape. There are several methods by which those of ordinary skill in the art 25 measure and express the size of non-spherical and irregular particles, such as measuring the size of such particles using laser diffractometry and expressing the size of such particles based on replacing a given particle with an imaginary sphere that has one of a number of properties of the particle. Such properties can be selected from, e.g., but are not limited to, the diameter of an imaginary sphere having the same volume of the particle being measured (volume-based particle 30 size), the diameter of an imaginary sphere having the same weight as the particle being measured 15 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 (weight-based particle size), and the diameter of an imaginary sphere having the same surface area as the particle being measured (area-based particle size). Those having ordinary skill in the art are familiar with such methods, and the manner in which the results of such methods are expressed, and such methods can be applied to the embodiments disclosed herein without undue 5 experimentation. The particle size distribution may be represented, e.g., graphically as a plot. A common type of plot is a cumulative undersize plot which represents the fraction (e.g., by number, volume or mass) of particles that are smaller than the stated particle size. The parameters Dvl0, Dv50, Dv90 and Dv99 represent the particle size at the 10%, 50~'o, 90% and 99'% points of the cumulative volume undersize particle size distribution. Thus, a 10 "DvlO" for a material represents a particle size wherein lO~o of the volume of the material consists of particles having a particle size equal to the DvlO value or smaller. A "Dv50" for a material represents a particle size wherein 50% of the volume of the material consists of particles having a particle size equal to the Dv50 value or smaller. A "Dv90" for a material represents a particle size wherein 90% of the volume of the material consists of particles having a particle 15 size equal to the Dv90 value or smaller. A "Dv99" for a material represents a particle size wherein 99% of the volume of the material consists of particles having a particle size equal to the Dv99 value or smaller. The term "span" as used herein means a measure of the width of the distribution of given particle sizes of a given compound comprising an embodiment disclosed herein. In particular, the 20 span of a given embodiment can be provided by measuring the size of the particles of a given compound using a volume-based particle size distribution method and applying the formula below, wherein Dv90, DvlO and Dv50 are as hereinbefore defined: Dv90 --- Dv 10 Dv50 Span The term "fatty acid" as used herein is a carboxylic acid with a long aliphatic chain (tail) containing from about 4 to about 26 carbon atoms. An "unsaturated" fatty acid is a fatty acid that 25 contains at least one c,,,c double bond between carbon atoms of the fatty acid aliphatic chain. A "saturated" fatty acid is a fatty acid that lacks any C=C double bonds between the carbon atoms of the aliphatic chain. 16 17 A “triglyceride” is an ester that is formally derived from glycerol and three fatty acids, i.e., a triacylglyceride wherein the acyl groups are derived fatty acids. The term “treating” or “treatment” as used herein means the treating or treatment of a disease or medical condition (such as type 2 diabetes) in a patient, such as a mammal (particularly a human) that comprises ameliorating the disease or medical 5 condition, i.e., eliminating or causing regression of the disease or medical condition in a patient, suppressing the disease or medical condition, i.e., slowing or arresting the development of the disease or medical condition in a patient; or alleviating the symptoms of the disease or medical condition in a patient. 10 The present disclosure describes improved bromocriptine formulations for improving glycemic control and treating type 2 diabetes, manufacturing methods for preparing such formulations, as well as methods of using such formulations. The formulations may contain bromocriptine (e.g., bromocriptine mesylate or a different bromocriptine salt, e.g., bromocriptine citrate) in an amount that provides a dose of at least about 0.1 mg, e.g., about 0.8 mg, of 15 bromocriptine. The bromocriptine may be present in the formulations as the sole pharmaceutically active ingredient. The bromocriptine formulations may be an oral dosage form, e.g., pharmaceutical formulations (e.g., a tablet). The bromocriptine may be substantially evenly distributed in the pharmaceutical formulations. Bromocriptine citrate can be prepared directly from the bromocriptine free base or from 20 the bromocriptine mesylate salt after desalting to the bromocriptine free base. Bromocriptine mesylate as well as the free base is commercially available from several sources (e.g., Sigma Aldrich and Euticals). In contrast to the mesylate, bromocriptine citrate is not an alkylating agent and is therefore safer for long term parenteral (e.g.sublingual)) administration. Desalting of the bromocriptine mesylate to generate the bromocriptine free base can be accomplished by any of a 25 variety of known desalting techniques. Such techniques are generally known in the art and include desalting by, e.g., gel filtration (e.g., SephadexTM (cross-linked dextran gel) filtration column), dialysis, ion exchange column purification (effecting removal of mesylate by binding to the charged column), and / or diafiltration or ultrafiltration (use of permeable membranes to separate molecules based upon size). The solvent for the desalting process can be a variety of 30 organic solvents and / or combinations of solvents, such as, e.g., methanol, ethanol, and / or CA 3079522 Date reçue / Received date 2025-03-03 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 chloroform. Also, the desalting process may additionally employ phase separation between aqueous and organic solvent phases, w-ith the salt isolated in the aqueous phase and the bromocriptine isolated in the organic phase. Additionally, the free base of bromocriptine can be generated from the mesylate salt by extraction of the mesylate from brornocriptine by dissolving 5 the bromocriptine mesylate in an organic solvent (not miscible with water) that forms a bilayer upon addition of an aqueous solution of a pH in which the mesylate migrates into the aqueous phase while the bromocriptine remains in the organic phase. The free base bromocriptine can subsequently be washed with repeated organic / aqueous separations and dried to purity. Citric acid is a tribasic compound with pKa values of 3.13, 4.76, and 6.40. As such, the 1 o bromocriptine citrate described herein may be of the mono, di, or tri citrate forms or combinations thereof. Starting with tlu.~ bromocriptine free base, the preparation of the citrate salt can be accomplished by any of the following general methods. A1ethod 1: Citric acid (about 1-3 grams) is dissolved in absolute (i.e., about 100%) 15 ethanol at room temperature in a reaction vessel, to which an ethanol solution ofbromocriptine (about 2---10 grams) is then added in an equi-mole amount to the citric acid. Citric acid may also be present in excess of the bromocriptine free base. The resulting solution is stirred for about some time, e.g., 2-24 hours at room temperature and is then evaporated under vacuum, e.g., on a rotary evaporator. The resulting semi-solid or solid product is then dissolved in, e.g., an ethanol 20 type mixture, e.g., straight ethanol or acetone-ethanol mixture (e.g., a 50:50 mixture) and subsequently dried under vacuum. Other mixtures (e.g., other organic solvent systems, e.g., methanol) and / or other mixture ratios (e.g., a 5:95, 10:90, 20:80, 25:75, 30:70, 40:60, 60:40, 70:30, 75:25, 80:20, 90: 10, or 95:5 mixture) can be used. The resulting precipitate is bromocriptine citrate. 25 Afethod 2: Citric acid (about 1-3 grams) is dissolved in methanol. Bromocriptine (about 2-10 grams) is also dissolved in methanol then added directly to the citrate citric acid solution in an equi-mole amount to the citric acid Citric acid may also be present in excess of the bromocriptine free base. The two solutions are then mixed and then stirred (about 2-24 hours at 18 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 room temperature) and then evaporated to dryness (e.g., under vacuum, e.g., using a rotary evaporator). The resulting residue is bromocriptine citrate. A1ethod 3: Citric acid (about 1-3 grams) is dissolved in butanol and bromocriptine (about 5 2---10 grams) dissolved in butanol is then added to this solution in an equi-mole amount to the citric acid (citric acid may also be present in excess of the brornocriptine free base) and stirred at room temperature for about 2---24 hours. The solvent is removed under vacuum; the resulting precipitate is brornocriptine citrate. The isolated precipitate may be re-dissolved in butanol and water to create a two phase system. The phases are separated and the organic phase is 1 o evaporated to dryness to yield purified bromocriptine citrate. A1ethod 4: Citric acid (about 1-3 grams) is dissolved in a water / ethanol solvent, to which a water / ethanol solution containing bromocriptine (about 2-10 grams) is added in an equi-mole amount to the citric acid. Citric acid may also be present in excess of the bromocriptine free 15 base. Various organic solution(s) containing bromocriptine can be used. For example, bromocriptine can be dissolved in one or more organic solvents, e.g., methanol, propanol, or butanol. The resulting solution is stirred at room temperature for about 2---24 hours; the solution is then evaporated to dryness. The dried solid can be washed in methanol and re-precipitated by evaporation to dryness. The resulting residue is bromocriptine citrate. 20 Ji.lethod 5 Citric acid (about 1-3 grams) is dissolved in any organic solvent or aqueous / organic solvent in which bromocriptine is soluble. Bromocriptine (about 2-10 grams) is dissolved in the same organic solvent or aqueous / organic solvent as the citric acid or in a solvent that is miscible with the solvent used to solvate the citric acid and then added to and mixed with 25 the citric acid / organic solution in an equi-mole amount to the citric acid. Citric acid may also be present in excess of the bromocriptine free base. The resulting solution is stirred at room temperature for about 2-24 hours. The solution is evaporated to dryness to yield bromocriptine citrate. 19 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In each of the above examples it is preferred to use the citric acid and bromocriptine solutions at near their saturation point). One or more chemical modifications generally known in the art can be made to the above- described methods to enhance or optimize the purity and / or yield of bromocriptine citrate. For example, the pH of the bromocriptine and citric acid solutions 5 may be adjusted to optimize the formation of the bromocriptine citrate. As further non -limiting examples, one or more organic solvents ( e.g., methanol, propanol, or butanol) can be used to dissolve, re-suspend, and / or re-precipitate citric acid, bromocriptine, and / or bromocriptine citrate. The pKa of bromocriptine and citric acid can be adjusted, for example, by changing the solvent used to prepare the citric acid or bromocriptine solutions. The basic fonns of citric acid 10 may also be employed in these methods (e.g. sodium citrate), though the citric acid fom1 is preferred. One or more steps in any of the above-described methods can be carried out at a different (i.e., lower or higher) temperature or pH; alternately or in addition, the temperature can be varied over time during one or more steps. The final product (i.e., bromocliptine citrate) can be re-precipitated to reduce and / or remove any impurities (such as, e.g., bromocriptine free base 15 or unassociated / unbound citric acid or water). In each method, the product can be "cleaned" (e.g., using one or more of the above-described techniques, e.g., dissolution, resuspension, and / or re-precipitation) to remove unreacted bromocriptine or citrate. Water may be removed by fractional distillation or other standard dewatering techniques known to those skilled in the art. Further, bromocriptine citrate will provide for pharmaceutical preparations with more 20 etlicient absorption across biological cellular membranes relative to bromocriptine mesylate. Still further, due to the unexpectedly improved degradation resistance of bromocriptine citrate to heat and water (e.g., in a physiological environment) and its simultaneously increased aqueous solubility (a phenomenon not predicted by the art) relative to bromocriptine mesylate, minimum and preferred dosages of bromocriptine citrate for treating vertebrates are lower than the 25 minimum and prefern~d dosages ofbromocriptine mesylate for an equivalent therapeutic effect and treatment duration. Taken together, the unanticipated advantages of bromocriptine citrate provide for a substantial improvement over the use ofbromocriptine mesylate in the current commercial bromocriptine pharmaceutical preparations (e.g., CYCLOSET@ or PARLODEL@), providing a more stable, more efficient and more biologically compatible compound, with more 30 predictable and reproducible effects, for pharmaceutical preparations of bromocriptine for the 20 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 treatment of any of a variety of medical disorders including prediabetes, obesity, insulin resistance, hyperinsulinemia, hyperglycemia and type 2 diabetes mellitus (T2DM). The enhanced properties of pharmaceutical preparations of bromocriptine citrate cannot be mimicked by the mere addition of citrate to pharmaceutical preparations of bromocriptine mesylate. Due to its 5 increased solubility in water, bromocriptine citrate will display increased absorption in vivo as compared to bromocriptine mesylate. Bromocriptine citrate may be administered, with or without a dopamine D1 receptor agonist such as SKF-38393, SKF-82958 or SKF-82957 to treat one or more of the metabolic disorders associated with MS, including, e.g., T2DM, hypertension, hypertriglyceridemia, a pro- 1 o inflammatory state, insulin resistance, fatty liver, NASH, CVD, and / or obesity-Bromocriptine citrate may further optionally be administered in conj unction with one or more of an alpha-I adrenergic antagonist, an alpha-2 adrenergic agonist, or a serotonergic inhibitor, optionally further in combination with a serotonin 5HT lb agonist. Examples of such agents are known in the art and are disclosed in, e.g, U.S. Pat. No. 5,877,183. Bromocriptine citrate may still further 15 optionally be administered in conjunction with various peripheral acting agents, e.g., HI'vfGCoA reductase inhibitors, anti-hypertensives, anti-diabetes agents including, e.g., postprandial insulin secretagogues or insulin itself, anti-inflammatory agents, and anti-coagulative agents. Examples of such agents are known in the art and are disclosed in, e.g., Int'l. Pat. App. Pub. No. \VO 2009 / 091576 A2. 20 Bromocriptine citrate is administered to the vertebrate, animal or human, preferably orally or sublingually, optionally parenterally, for the treatment of any one or more symptoms desirable of change, e.g., obesity or hyperglycemia. The solid pharmaceutical compositions of the invention should include an amount of the compound(s) of the invention effective for treatment of metabolic diseases and disorders such as, 25 but not limited to, T2DM, obesity, prediabetes, l\fotabolic Syndrome, cardiometabolic risk, hypertension, dyslipidemia, insulin resistance, hyperinsulinemia, hepatic steatosis, renal disease, cardiovascular disease, cerebrovascular disease, and peripheral vascular disease and biomarkers of impending vascular disease. The effective dosage will depend on the severity of the diseases and the activity of the particular compound(s) employed, and is thus within the ordinary skill of 30 the art to determine for any particular host mammal or other host organism. Suitable dosages of 21 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 bromocriptine citrate for a vertebrate (e.g., a human) may be, e.g., in the range of about 0.05μg to about 0.5 mg per kg B\.V, optionally in the range of about 0. 1 ~ig to about 0.3 mg per kg B\V or in one preferred embodiment between about 2μg and 0.1 mg / kg, RW per day. A suitable pharmaceutical dosage form comprising bromocriptine citrate may have a total weight of, e.g., 5 (including excipients) of between about 2.5 mg and about 2000 mg. In each of the above examples it is preferred to use the citric acid and bromocriptine solutions at near their saturation point. One or more chemical modifications generally known in the art can be made to the above- described methods to enhance or optimize the purity and / or yield of bromocriptine citrate. For example, the pH of the bromocriptine and citric acid solutions 1 o may be adjusted to optimize the fom1ation of the bromocriptine citrate. As further non -limiting examples, one or more organic solvents (e.g., methanol, propanol, or butanol) can be used to dissolve, re-suspend, and / or re-precipitate citric acid, bromocriptine, and / or bromocriptine citrate. The pKa of bromocriptine and citric acid can be adjusted, for example, by changing the solvent used to prepare the citric acid or bromocriptine solutions. The basic forms of citric acid 15 may also be employed in these methods (e.g. sodium citrate), though the citric acid fom1 is preferred. One or more steps in any of the above-described methods can be carried out at a different (i.e., lower or higher) temperature or pH; alternately or in addition, the temperature can be varied over time during one or more steps. The final product (i.e., bromocriptine citrate) can be re-precipitated to reduce and / or remove any impurities (such as, e.g., bromocriptine free base 20 or unassociated / unbound citric acid or water). In each method, the product can be "cleaned" (e.g., using one or more of the above-described techniques, e.g., dissolution, resuspension, and / or re-precipitation) to remove unreacted bromocriptine or citrate. \.Vater may be removed by fractional distillation or other standard dewatering techniques known to those skilled in the art. Further, bromocriptine citrate provides for pharmaceutical preparations with much 25 greater water solubility (about 7-fold greater) than would be expected versus bromocriptine mesylate and therefore also more efficient absorption across biological cellular membranes relative to bromocriptine mesylate. Still fbrther, due to the unexpectedly improved degradation resistance of bromocriptine citrate to water (e.g., in a physiological environment) and its simultaneously increased aqueous solubility (a phenomenon not predicted by the a1i) relative to 30 bromocriptine rnesylate, minimum and preferred dosages ofbromocriptine citrate for treating 22 23 vertebrates are lower than the minimum and preferred dosages of bromocriptine mesylate for an equivalent therapeutic effect and treatment duration. Taken together, the unanticipated advantages of bromocriptine citrate provide for a substantial improvement over the use of bromocriptine mesylate in current commercial bromocriptine pharmaceutical preparations (e.g., CYCLOSET® or PARLODEL®), providing a more stable, more efficient and 5 more biologically compatible and useful compound, with more predictable and reproducible effects, for pharmaceutical preparations of bromocriptine for the treatment of any of a variety of medical disorders including prediabetes, obesity, insulin resistance, hyperinsulinemia, hyperglycemia, cardiovascular disease, and type 2 diabetes mellitus (T2DM). Due to its increased solubility in 10 water, bromocriptine citrate displays increased absorption in vivo as compared to bromocriptine mesylate. The enhanced physical and biological properties of pharmaceutical preparations of bromocriptine citrate cannot be mimicked by the mere addition of citrate to pharmaceutical preparations of bromocriptine mesylate. Moreover, the incorporation of bromocriptine citrate into a pharmaceutical formulation that contains acidic compounds such as fatty acid combined 15 with citric acid enhances the stability of the bromocriptine which is unexpected and counterintuitive inasmuch as bromocriptine stability is hindered in an acidic environment. Substituting magnesium stearate with stearic acid surprisingly enhances the stability of the bromocriptine molecule, especially in the presence of the acid, citric acid. This stability is further enhanced by the removal or exclusion of lactose and its replacement with mannitol. 20 Additionally, the stability of the bromocriptine citrate can be further enhanced by the presence of triglyceride in the formulation without alteration of its water solubility. This is surprising in that lubricants such as triglyceride do not have a known use to enhance stability of bromocriptine and are known to be hydrophobic not hydrophilic. The resulting formulation of (i)bromocriptine citrate, (ii) a non-lactose short chain saccharide such as mannitol, (ii)stearic acid or a 25 triglyceride, and (iv) citric acid produces a unique and unexpected bromocriptine formulation that is both highly water soluble, a circumstance not true for bromocriptine or bromocriptine mesylate, and yet stable in water, an environment that normally destroys bromocriptine and bromocriptine mesylate, and such is accomplished in part by adding certain acidic excipients together with other certain excipients and a particular salt of bromocriptine. CA 3079522 Date reçue / Received date 2025-03-03 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Bromocriptine citrate may be administered, with or without a dopamine D1 receptor agonist such as SKF-38393, SKF-82958 or SKF-82957 to treat one or more of the metabolic disorders associated with l'VlS, including, e.g., T2DM, hypertension, hypertriglyceridemia, a proinflammatory state, insulin resistance, fatty liver, NASH, CVD, and / or obesity. -Bromocripti.ne 5 citrate may further optionally be administered in conjunction with one or more agents that increase central dopaminergic.: neuronal activity or decrease central noradrenergic neuronal activity. Examples of such agents are known in the art and are disclosed in, e.g., U.S. Pat. Nos. 5,877,183 and 9,655,865 Bromocriptine citrate may still further optionally be administered in conjunction with 1 o various peripheral acting agents, e.g., HMGCoA reductase inhibitors, anti-hypertensives, antidiabetes agents including, e.g., postprandial insulin secretagogues or insulin itself: antiinflammatory agents, and anti-coagulative agents. Examples of such agents are known in the art and are disclosed in, e.g., Int'l. Pat. App. Pub. No. WO 2009 / 091576 A2. Bromocriptine citrate is administered to the vertebrate animal or human, preferably orally 15 or sublingually, optionally parenterally, for the treatment of any one or more symptoms desirable of change, e.g., obesity or hyperglycemia. The solid phaimaceutical compositions of the invention should include an amount of the compound(s) of the invention effective for treatment of metabolic diseases and disorders such as, but not limited to, T2DM, obesity, prediabetes, J\!Ietabolic Syndrome, cardiometabolic risk, 20 hypertension, dyslipidemia, insulin resistance, hyperinsulinemia, hepatic steatosis, renal disease, cardiovascular disease, cerebrovascular disease, and peripheral vascular disease and biomarkers of impending vascular disease and key elements thereof such as arteriosclerosis, coronary arte1y disease, peripheral vascular disease, or cerebrovascular disease), congestive heart failure, obesity, elevated plasma norepinephrine, elevated cardiovascular-related inflammatory factors, 25 hyperlipoproteinernia, atherosclerosis, hyperphagia, hyperglycemia, hyperlipidemia, and hypertension or high blood pressure, increased plasma postprandial triglyceride or free fatty acid levels, increased cellular oxidative stress or plasma indicators thereof: increased circulating hypercoagulative state, renal disease including renal insufficiency . The effective dosage will depend on the severity of the diseases and the activity of the particular compound(s) employed, 30 and is thus \.Vt thin the ordinary skill of the art to determine for any particular host mammal or 24 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 other host organism. Suitable dosages of bromocriptine citrate for a vertebrate (e.g., a human) may be, e.g., in the range of about 0.05μg to about 0.5 mg per kg B\V, optionally in the range of about 0.1 μg to about 0.3 mg per kg BW or in one preferred embodiment between about 2μg and 0.2 mg / kg, H\V per day. A suitable pharmaceutical dosage form comprising bromocriptine citrate 5 may have a total weight of, e.g., (including excipients) of between about 2.5 mg and about 2000 mg. In one aspect, the present disclosure describes that in the preparation of bromocriptine formulations for improving glycemic control and treating type 2 diabetes, it has been discovered including certain excipients in the forrnulations rnay improve the stability of the bromocriptine. 1 o The present disclosure therefore describes bromocriptine pharmaceutical formulations with improved stability and bromocriptine pharmaceutical formulations that include an excipient that improves the stability of the bromocriptine in the formulation. The bromocriptine pharmaceutical fommlations are manufactured to have a uniform content, such that the bromocriptine is uniformly distributed within an ingredient blend that is 15 compressed to form pharmaceutical fonnulations, and eac.:h pharmaceutical formulation contains substantially the same amount ofbromocriptine and, as a result, provides substantially the same dose of bromocriptine to the patient. This property is desirable so that bromocriptine pharmaceutical formulations provide consistent efficacy, by ensuring that each pharmaceutical formulation provides an efficacious amount ofbromocriptine, but also does not provide too high 20 a dose ofbromocriptine which may lead to side effects. The mode of action involved in using bromocriptine to improve glycemic control and treating type 2 diabetes presents challenges in developing and manufacturing formulations that are suitable for this purpose. Many drugs work best when the pharmacological action of the drug (e.g., blocking a receptor or inhibiting an enzyme) is maintained throughout the period of 25 treatment "While not being limited by theory, reslllts frorn preclinical studies suggest that appropriately timed daily administration of bromocriptine in the morning normalizes aberrant hypothalamic neurotransmitter activities that induce, potentiate, and maintain the insulinresistant, glucose-intolerant state. Thus, it is believed that a formulation of bromocriptine manufactured to improve 30 glycemic control and treat type 2 diabetes should provide a consistent, rapid and substantially 25 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 complete release of the bromocriptine from the formulation to provide the optimum pharmacokinetic profile for treating diabetes. For example, while not being limited by theory, it is understood that bromocriptine for improving glycemic control should be formulated in a pharmaceutical fomrnlation that provides a dose of at least about 0.1 mg ofbromocriptine and 5 which releases at least about 80%1, or preferably at least about 90%, of the bromocriptine within about 30 minutes. Drug release can be measured, e.g., using the methods and apparatus described in the U.S. Pharmacopoeia (USP), General Chapter 711, Dissolution, 34th Edition, 2011. A suitable method for measuring release ofbromocriptine from the pharmaceutical formulations described in the present disclosure can use USP Apparatus Type 2 Paddle Method at 50 rpm in 1 o 500 ml of 0.1 N hydrochloric acid. The dissolution experiment is typically carried out at about 37 °C. A bromocriptine citrate product as described herein can be manufactured that consistently provides the specified dose and release profile, the resulting product may be less effective for improving metabolic disorders including key elements thereof including but not limited to, type 2 diabetes, prediabetes (impaired fasting glucose or impaired glucose tolerance), metabolic 15 syndrome or indices (key elements) thereof (increased waist circumference, increased fasting plasma glucose, increased fasting plasma triglycerides, decreased fasting high density lipoprotein level, increased blood pressure), insulin resistance, hyperinsulinemia, cardiovascular disease (or key elernents thereof such as arteriosclerosis, coronary artery disease, peripheral vascular disease, or cerebrovascular disease), congestive heart failure, obesity, elevated plasma 20 norepinephrine, elevated cardiovascular-related inflammatory factors, hyperlipoproteinemia, atherosclerosis, hyperphagia, hyperglycemia, hyperlipidemia, and hypertension or high blood pressure, im.:reased plasma postprandial triglyceride or free fatty acid levels, inc.:reased cellular oxidative stress or plasma indicators thereof, increased circulating hypercoagulative state, renal disease including renal insufficiency(all of which can be treated with the formulations disclosed 25 herein), In addition to providing a suitable consistent release profile, another important aspect of manufacturing a safe and effective bromocriptine formulation is that the bromocriptine in the formulation must be stable over a prolonged period so that the formulation provides a consistent therapeutic dose of bromocriptine as well as avoiding possible side effects from the presence of 26 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 bromocriptine degradation products that do not provide therapeutic benefit. The degradation of bromocriptine to bromocriptinine, with or without the concurrent formation of a browning reaction (i.e., degradation-associated browning of the white pharmaceutical formulation and / or powdered excipients), represent major degradants ofbromocriptine formulations with 5 magnesium stearate and lactose that both occur at increased levels under stress conditions (i.e., conditions with higher heat and / or humidity relative to normal bromocriptine storage conditions, e.g., a temperature of 25 :t: 2 °C and a relative humidity of about 60 :t: 5%). \Vithout wishing to be bound by theory, a possible facilitator of the browning reaction and brornocriptinine production is the interaction of bromocriptine with lactose when in the 1 o presence of an alkaline environment (e.g., an environment caused by the presence of alkaline magnesium stearate [Mg stearate] or in the presence of magnesium). Such an interaction can result in a general base-catalyzed reaction of lactose. Alternately or in addition, JVIg stearate can interact directly with bromoc1iptine (either in the presence or absence of lactose) to catalyze its isomerization to bromocriptinine. Bromocriptinine itself can also potentially participate in a 15 browning reaction with lactose. Surp1isingly, l'vfg interaction with lactose in the presence of bromocriptine can be expected to facilitate a degradative browning reaction (see Figure 2). That is to say, the magnesium and not the magnesium stearate, especially in the presence of lactose, can be particularly damaging to bromocriptine. Any or all of the above degradative reactions can be accelerated by increased heat and / or humidity, e.g., higher heat and / or humidity relative to 20 nonnal bromocriptine storage conditions. Any or all of the above reactions can be accelerated by increased pH, e.g., increased pH caused by the presence of one or more impurities in a bromocriptine formulation. As such, it is c.:ounterintuitive to add acidic compounds together in combination with bromocriptine in a pharmaceutical formulation to enhance bromocriptine stability. It is further counterintuitive to add compounds such as lubricants to enhance stability 25 ofbromocriptine that are not generally accepted as having this function. As shown in Example 4, various brornocriptine formulations were studied to investigate the effects of reducing or eliminating Mg stearate and / or lactose from the presence of brornocriptine mesylate in the browning reaction. It was found that reducing or removing Mg stearate, lactose, or both l'vig stearate and lactose from the bromocriptine mesylate formulation 30 decreased the rate of degradation of bromocriptine to bromocriptinine and the rate of fom1ation 27 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 of the browning reaction. Removing both ~lg stearate and lactose decreased the rate of formation of the browning reaction to the greatest extent (relative to removing only J\1g stearate or removing only lactose). Furthermore, Mg stearate can be replaced Vv'ith one or more acidic compounds, e.g., stearic acid, or one or more non-magnesium salt glidants (e.g., solid castor oil) 5 to decrease the rate of degradation ofbromocriptine and the rate offonnation of the browning reaction. Alternately or in addition to the above-described bromoc.:riptine formulation alterations, lactose can be replaced with mannitol and / or one or more other short chain saccharides to decrease the rate of degradation ofbromocriptine and the rate of formation of the browning reaction. Alternately or in addition, one or more acidic compounds, e.g., citric acid or stearic 1 o acid, can be added to a bromocriptine formulation of mannitol to decrease the rate of degradation ofbromocriptine and the rate of formation of the browning reaction. Again, this particular degradative reaction of bromocriptine is counterintuitively reduced by adding acids to the formulation, an interaction normally known to destroy bromocriptine. An accelerated release formulation of bromocriptine mesylate was described in U.S. 15 Patent No. 5,679,685, which discusses that accelerated release from bromocriptine mesylate formulations could be achieved by formulating bromocriptine, an antioxidant, a filler, a disintegrant, a water scavenging agent and a lubricant. In the preferred formulation, the bromocriptine formulation included bromocriptine mesylate together with citric acid, com starch, non-lactose filler, silicon dioxide and magnesium stearate. Use of an anhydrous filler is preferred 20 to minimize moisture content. Citric acid is an antioxidant. Com starch is a disintegrant. Colloidal silicone dioxide acts as a water-scavenger. Nlagnesium stearate acts as a lubricant. ·while the '685 patent describes the preparation of rapid release bromocriptine mesylate on a laboratory scale, difficulties were encountered in manufacturing such a formulation on a large scale suitable for commercial use because a high degree of variation in the dissolution and 25 rate of release ofbromocriptine mesylate from the finished drug product, and problems in achieving acceptable product uniformity were found. Additionally, this formulation displays poor long term stability in storage under standard pharmaceutical conditions (25C and 60% humidity) and worse stability at 40C and 75%RH, and is very poorly water soluble and very labile to water degradation. 28 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 It was found that that the manufacture of bromocriptine mesylate pharmaceutical formulations for improving glycemic control in patients with type 2 diabetes can be improved significantly by carefully controlling the size of the bromocriptine mesylate particles used in manufacturing the pharmaceutical formulations. By controlling the particle size, pharmaceutical 5 formulations could be manufactured which consistently provide a release profile wherein about 90% or greater of the bromocriptine mesylate has been released at about 30 minutes or even within 20 minutes thereby ensuring that the product is produced vvith a consistently acceptable potency and safety profile for improving glycemic control and treating type 2 diabetes. This is particularly useful when a manufacturing method is employed that achieves improved content 10 uniformity by employing direct transfer of the bromocriptine formulation mixture for, e.g., tableting after blending without allowing tirne for the ingredients to settle in the blended mixture. Advantages include the ability to reproducibly produce drug product with a defined drug content and drug release profile to meet quality standards mandated by drug regulatory authorities such as the Food and Drug Administration. 15 In particular, it is desirable to control the particle size of the bromocriptine used in bromocriptine pharmaceutical formulations for improving glycemic control in patients with type 2 diabetes so that the bromocriptine may have a Dv90 of about 20 μm or lower and thus the bromocriptine pharmaceutical formulations described herein can have a particular particle size distdbution. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical 20 formulations may have a Dv90 of about 20 μm or lower, about 18 ~nn or lower, about 16 ~un or lower, about 15 μm or lower, about 10 μ.m or lower, or about 5 μm or lower. In some embodiments, the bromocriptine used for manufacturing the phamrnceutical fommlations may have a Dv99 of about 15 μm or lower, about 10 μm or lower, or about 5 μm or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may 25 have a Dv50 of about 10 μm or lower, about 8 ~un or lower, about 7 ~un or lower, about 5 ~un or lower, or about 2 μm or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a Dvl 0 of about 5 μm or lower, about 3 ~un or lo\ver, or about 2 μm or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a volume-based particle size distribution such that not 29 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 more than about 40%, not more than about 20%, not more than 10%1 or not more than about 5% of the bromocriptine has a particle size of less than about 1 μm. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a particle size such that the particle size distribution has a Dv90 of about 5 20 μm or lower, a DvS0 of about 10 μm or lower and a Dvl 0 of about 5 μrn or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a particle size such that the particle size distribution has a Dv90 of about 15 μm or lower, a Dv50 of about 8 μm or lower and a Dv 10 of about 3 μm or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical fomrnlations may have a particle size 1 o such that the particle size distribution has a Dv90 of about 10 μm or lower, a Dv50 of about 5 μm or lower and a Dvl 0 of about 3 ~un or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a particle size such that the particle size distribution has a Dv90 of about 8 μm or lower, a Dv50 of about 5 μm or lower and a DvlO of about 3 μm or lower. In some embodiments, the bromocriptine used for manufacturing 15 the pharmaceutical formulations may have a particle size such that the particle size distribution has a Dv90 of about 5 i1m or lower, a Dv50 of about 3 ~1m or lower and a Dvl 0 of about 1 μ.m or lower. In some embodiments, the bromocriptine used for manufacturing the pharmaceutical formulations may have a volume-based particle size such that the particle size span is about 5 or 20 lower, about 3 or lower, about 2.5 or lower, or about 2 or lower, or about 1.5 or lower. In some embodiments the bromocriptine has a particle size diameter of 0.1 to 100 um. In one embodiment the brornocriptine has an average particle size diameter between 0.5 and 3.0 um. By using brornocriptine with controlled particle size, brnmocriptine pham1aceutical 25 formulations can be manufactured that consistently provide drug release profiles that are effective for improving glycemic control and treating type 2 diabetes. The bromocriptine pharniaceutical formulation prepared using bromocriptine having controlled particle size is fommlated to provide a dissolution profile such that, when tested in USP Apparatus Type 2 paddle method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 30 37 °C, the pharmaceutical formulation has released at least about 80%, preferably at least about 30 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 90 % of the bromocriptine at about 30 minutes. In some embodiments, the bromocriptine pharmaceutical formulation provides a dissolution profile such that the pharmaceutical formulation has released at least about 95 % of the bromocriptine at about 30 minutes. In some embodiments, the bromocriptine phamrnceutical formulation provides a dissolution profile such 5 that the pharmaceutical formulation has released at least about 80%, or at least about 90%, of the bromocriptine at about 20 minutes. Although the bromocriptine pharmaceutical formulation is formulated to provide a dissolution profile such that, when tested in USP Apparatus Type 2 paddle method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, the pharmaceutical formulation has released at least about 80%, preferably about 90%, of the 1 o bromocriptine at about 30 minutes, extremely rapid release of bromocriptine from the formulation may not be desired, since a fommlation that rt~leases bromocriptine extremely rapidly may result in an undesired spike in in vivo drug levels and may not be suitable for treating type 2 diabetes, or give rise to side-effects. Therefore, in some embodiments, the bromocriptine pharmaceutical formulation prepared using micronized bromocriptine is 15 fonnulated to provide a dissolution profile such that, when tested in USP Apparatus Type 2 paddle method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, not more than about 75%, not more than about 60%, or not more than about 50%1 of the bromocriptine has been released at about 7 minutes, and / or not more than about 90%, not more than about 85%, not more than about 80%i, or, not more than about 75~o of the bromocriptine has been released at about 10 20 minutes. The release profiles may be achieved by producing bromocriptine pharmaceutical formulations using bromocriptine having a particular particle size distribution so that the finished drug product consistently provides a dissolution profile that is suitable for treatment of type 2 diabetes. The bromocriptine pharmaceutical formulation prepared using bromocriptine having 25 controlled particle size is formulated to provide a pharmacokinetic profile wherein the time to maximum plasma concentration (Tmax) following administration of bromocriptine pharmaceutical formulations, (e.g., administration of six bromocriptine pharmaceutical formulations each providing a dose of about 0.8 mg ofbromocriptine), is between about 30 and about 60 minutes, such as about 50 minutes, e.g., about 53 minutes, when the pharmaceutical 30 formulations are administered under fasting conditions, or between about 90 and about 120 31 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 minutes, ,vhen the pharmaceutical formulations are administered under high fat fed conditions, to adult subjects. The bromocriptine pharmaceutical formulation may contain an amount of bromocriptine e.g. brornocriptine citrate that provides a dose of at least about 0.1 mg of bromocriptine per 5 pharmaceutical formulation, or, e.g., about 0.8 mg per pharmaceutical formulation. The bromocriptine pharmaceutical formulation may contain an amount ofbromocriptine that provides a dose per pharmaceutical formulation of bromocriptine of, e.g., about 0.8 mg, about 1.6 mg, about 2.4 mg, about 3.2 mg, about 4.0 mg, about 4.8 mg, about 5.6 mg, about 6.4 mg, about 7.2 mg, about 8.0 mg, about 8.8 mg, or about 9.6 mg. 10 In some embodiments, the pa11icle size may be controlled by use of micronized bromocriptine. It has been discovered that a superior bromocriptine forrnulation for improving glycemic control and treating type 2 diabetes can be prepared by using micronized bromocriptine for manufacturing bromocriptine pharmaceutical formulations. The micronized bromocriptine may have Dv99, Dv90, Dv50, Dvl0, span and other properties of the particle size distribution 15 with the values described above, including any embodiment thereof, or combination thereof. The pharmaceutical formulations manufactured using the micronized bromocriptine may have any of the dissolution profiles described above as being effective for improving glycemic control and treating type 2 diabetes, including any embodiment thereof or combination thereof. In addition, the formulation manufactured using micronized bromocriptine may provide a pharmacokinetic 20 profile as described above and may contain an amount ofbromocriptine as described above. J\1icronization provides for reduction of particle size to provide particles that are on the order of microns in diameter as measured by methods known to those of ordinary skill in the aii, such as the volume distribution method. Methods of micronizing bromocriptine to afford fonnulations disclosed herein include those that are known to those of ordinary skill in the aii 25 and include, but are not limited to, milling, grinding, and the use of supercritical fluids. For example, one method of micronization (the "rapid expansion of supercritical solutions" or RESS method), material is dissolved in supercritical fluid under high temperature and pressure and the resulting solution is expanded through a nozzle to form small particles. Micronization by jet milling is a method that can be used to produce particles in the lower 30 micrometer range, and is the preferred method for micronizing bromocriptine. In brief, the raw 32 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 material with a maximum size of about 1 to 2 mm is introduced into the milling chamber via a gas stream. 'Within the milling chamber a circular gas stream accelerates the particles which are micronized by collision with each other or Vv'ith the wall of the chamber. The ground particles are removed from the milling chamber by the gas stream, while the larger ones stay inside due to 5 centrifugal forces. In the preferred process for micronizing bromocriptine, micronization is performed using a jet mill under a nitrogen atmosphere at a controlled temperature of about O 0C. However, reducing the particle size of bromocriptine as described above also very significantly increases the instability of the bromocriptine. Consequently, new methods need to be developed that can preserve the stability of micronized bromocriptine white also making it much more 1 o water soluble, an environment that destroys bromocriptine. It has surprisingly been found that including certain excipients traditionally used as lubricants in the bromocriptine formulation can improve the stability of the pharmaceutical formulation. Moreover, it has surprisingly been found that excluding certain excipients to be used as lubricants (e.g., magnesium stearate) or as fillers / disintegrants (e.g., lactose) in the 15 bromocriptine formulation can improve the stability of the phamrnceutical-fommlation of rnicronized brornocriptine. Lubricants are agents that are added, usually in small quantities, to a pharmaceutical formulation and capsule formulations to improve certain processing characteristics. The lubricants serve to decrease friction at the interface bet\veen a pharmaceutical formulation and a die wall during fom1ation of the pham1aceutical formulation to 20 assist with, e.g., allowing the pharmaceutical formulation to be ~jected from a die and reduce wear on punches and dies. In addition, the lubricants can serve an anti-adherent role, e.g., preventing the pharmaceutical formulation from sticking to punch faces or capsule-filling equipment. Lubricants can also serve a glidant role, e.g., enhancing product flow by reducing interparticulate friction. Lubricants, pa1iicularly acidic lubricants, are not typically used to 25 reduce degradation reactions of agents such as bromocriptine. The excipients or lubricants that are effective for improving the stability of micronized bromocriptine phannaceutical formulations as described herein comprise a triglyceride or a free fatty acid. The triglycerides can have fatty acid acyl groups with from 6 to 14 carbon atoms (C6 - C14 fatty acids), 14 to 26 carbon atoms (C14-C20 fatty acids), from 14 to 24 carbon atoms (C14-C24 30 fatty acids), from 14 to 22 carbon atoms (C14-C22 fatty acids), from 14 to 20 carbon atoms (C14- 33 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 C20 fatty acids), from 14 to 18 carbon atoms (C14-Cl8 fatty acids), from 16 to 24 carbon atoms (C16-C24 fatty acids), from 16 to 22 carbon atoms (C16-C22 fatty acids), from 16 to 20 carbon atoms (C16-C20 fatty acids), from 16 to 18 carbon atoms (C16-Cl8 fatty acids), from 18 to 24 carbon atoms (C1s-C24 fatty acids), from 18 to 22 carbon atoms (Cui-C2;~ fatty acids) or from 18 5 to 20 carbon atoms (Crn-C20 fatty acids). In some embodiments, at least about 80%, at least about 85%, at least about 90%,, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C14-C26 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%, at least about 95'}"o, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl 1 o groups of C6-C14 fatty acids. In some embodiments, at least about 80%i, at least about 85~o, at least about 90~o, at least about 95~o, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C14-C24 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90'%, at least about 95'%, at least about 98~o or at least about 99° / .i of the acyl groups of the triglyceride can be fatty acid acyl groups of C14-C22 15 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%,, at least about 95%, at least about 98~'o or at least about 99c¼i of the acyl groups of the triglyceride can be fatty acid acyl groups of C14-C20 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 9Qi%, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C14-Crn fatty acids. In some 20 embodiments, at least about 80%, at least about 85~o, at least about 90%, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C16-C26 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C16-C24 fatty acids. In some embodiments, at 25 least about 80%, at least about 85%, at least about 90%i, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the tliglyceride can be fatty acid acyl groups of C16-C22 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%, at least about 95%i, at least about 98%i or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C16-C20 fatty acids. In some embodiments, at least about 80%,, at 30 least about 85%, at least about 90%, at least about 95%, at least about 98% or at least about 99% 34 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 of the acyl groups of the triglyceride can be fatty acid acyl groups of C16-Cl8 fatty acids. In some embodiments, at least about 80~1.i, at least about 85~o, at least about 90%, at least about 95%1, at !east about 98~{i or at least about 99% of the acyl groups of the triglyceride can be :fatty acid acy! groups of C1S-C26 fatty acids. In some embodirnents, at least about 80%, at least about 851%, at 5 least about 90° / il, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of Crn-C24 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of C1S-C22 fatty acids. In some embodiments, at least about 80%, at least about 85%, at least about 90<;,o, at 1 o least about 95%), at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of Crn-C20 fatty acids. In some embodiments, at least about 801%, at !east about 85~'<>, at least about 90%, at least about 95%, at least about 98~o or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of Cl8 fatty acids. In some embodiments, the acyl groups of the triglyceride can be fatty acid acyl groups of saturated fatty 15 acids. In some embodiments, at least about 80%, at least about 85%, at least about 90%, at least about 95%, at least about 98% or at least about 99% of the acyl groups of the triglyceride can be fatty acid acyl groups of saturated fatty acids. In some embodiments, at least about 80%>, at least about 85%, at least about 90~"o, at least about 95%, at least about 98%.1 or at least about 99% of the acyl groups of the triglyceride can be a stearoyl group or a 12-hydroxystearoyl group. 20 Examples of suitable excipients or lubricants include, without limitation, waxes, glycerides, vegetable oils and hydrogenated vegetable oils. Examples of vegetable oils include almond oil, apric.:ot kernel oil, canola oil, castor oil, cinnamon oil, coconut oil, mm oil, cottonseed oil, flaxseed oil, palm oil, palm kernel oil, olive oil, peanut oil, rapeseed. oil, safflower oil, soybean oil and sunflower oil and mixtures thereof. Examples of hydrogenated vegetable oils 25 include hydrogenated castor oil (castor wax), hydrogenated coconut oil, hydrogenated. cottonseed oil, hydrogenated palm oil, hydrogenated palm kernel oil, hydrogenated soybean oil and mixtures thereof Examples of suitable excipients or lubricants include, without limitation, BBS (partially hydrogenated vegetable oil); BBS-C (partially hydrogenated vegetable oil); CASTORWAX@) (hydrogenated castor oil), CASTORWAX® MP-70 (hydrogenated castor oil), 30 CASTORW AX@ lV[P-80 (hydrogenated castor oil), CENWAX@ G (hydrogenated castor oil), 35 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 CERITTM SH (hydrogenated castor oil), CUTINA ® HR (hydrogenated castor seed oil); HYDRO~~KOTE@ 112 (hydrogenated palm kernel oil); HYDRO-~KOTE'B' C (hydrogenated cottonseed oil); HYDRO·-,KOTE@ M (hydrogenated palm kernel oil); HYDRO·-,KOTE@ S (hydrogenated soybean oil); KOLLIWAX@ HCO (hydrogenated castor oil), LUBRITAB@ 5 (hydrogenated cottonseed oil, STEROTEXci'\l K (hydrogenated soybean oil and castor wax), STER.OTEX'~' (hydrogenated cottonseed oil), STEROTEXrp;, FL (hydrogenated soybean oil). The lubricant, the formulation, or both can be substantially free oflactose. The lubricant, the formulation, or both can be substantially free of magnesium. "Substantially free" in this context means magnesium ions may be present in the parts per 10 million range (preferably less than about 10 ppm) and preferably not in the parts per hundred (percentage) range. 15 The lubricant contained in the pharmaceutical formulation may comprise less than about 0.75~'<> by weight of magnesium stearate by weight compared to the total weight of the pharmaceutical formulation. The excipient or lubricant used to stabilize the formulation can be used in an amount from about 0.1 % to about 25% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 0.5% to about 5% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 1 % to about 5% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 1.5% to about 5% by weight. In some 20 embodiments, the excipient or lubricant is used in an amount from about 2% to about 5%1 by weight. In some embodiments, the excipient or lubricant is used in an amount from about 0.1 % to about 3% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 0.5% to about JC¼) by weight. In some embodiments, the excipient or lubricant is used in an amount from about 1.5% to about 3% by weight. In some embodiments, the excipient or 25 lubricant is used in an amount from about 2% to about 3% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 0.5% to about 2.5% by weight. In some embodiments, the excipient or lubricant is used in an amount from about 0.5% to about 1.5(;;o by weight. In some embodiments, the excipient or lubricant is used in an amount from about 1.5% to about 5% by weight. In some embodiments, the excipient or lubricant is used in an amount 30 of about 2% by weight. 36 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 In some embodiments, the excipient or lubricant is extragranular. The excipient or lubricant can be added after blending the remaining ingredients prior to, e.g., tableting. The present application also describes pharmaceutical formulations comprising micronized bromocriptine that include, exclude or reduce the amounts of certain excipients in the 5 pharmaceutical formulations can reduce the amount of related substances or impurities contained in the pharmaceutical formulations when they are stored under particular conditions over a period of time. In one aspect pharmaceutical formulations are provided comprising micronized bromocriptine and no magnesium stearate in the total weight of the pharmaceutical formulation. In a forther aspect pharmaceutical formulations are provided comprising micronized 1 o bromocriptine and one or more lubricants selected from stearic acid, fatty acids, and at least one triglyceride, or combinations thereof . The triglyceride can be or have any of the properties of the triglyceride-containing lubricants or excipients described above. Exemplary pha1maceutical formulations were prepared using micronized bromocriptine mesylate formulations with various lubricants (see, e.g., Example 6). The formulations had the 15 compositions shown in Table 8. Formulation A was a control that used magnesium stearate (0.76~.10 by weight) as a lubricant Formulation Bused stearic acid (2%) as a lubricant. Formulation C used sodium stearyl fomarate (2%) as a lubricant. Formulation D used hydrogenated castor oil (KOLLlWAX!:<J HCO) (2%) as a lubricant. Finally, Formulation E used magnesium stearate as a lubricant (0.44%, a reduced amount compared to Formulation A). Each 20 pharmaceutical formulation was then stored at 25 :J:. 2 °C and 60 :t, 5%RH, at 30 ,-+, 2 °C and 65 J_, 5%RH, or at 40 ±: 2 °C and 75 J:. 5%RH for up to 3 months and analyzed for related substam.:e impurities at the beginning of the experiment and at 1, 2, and / or 3 months. The results shown in Table 9 and Figures IA, 1B, and 1C indicate that the formulation using hydrogenated castor oil as a lubricant was significantly more stable, forming smaller amounts of related 25 substance impurities, than any of the other formulations. Formulations which used sodium stearyl fomarate or less than about 0.75% by weight of magnesium stearate compared to the total weight of the pharmaceutical formulation were also more stable, forming smaller amounts of related substance impurities, relative to the control Formulation A. In addition, the dissolution of Formulations A and C-E was tested both before and after storage at 25 ± 2 °C and 60 ± 5%RH 37 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 for 3 months with the results, shown in Table 10, demonstrating that the lubricants described above had no significant effect on dissolution for any of the formulations before or after storage. The formulations that include excipients or lubricants that stabilize the formulation as described above can be prepared using bromocri.ptine of controlled particle size may have Dv99, 5 Dv90, DvS0, Dv10, span and other properties of the particle size distribution with the values described above, including any embodiment thereof: or combination thereof. The bromocriptine particle size can be controlled by micronization or any of the other methods described above. The pharmaceutical formulations manufactured using the bromocriptine of controlled particle size and a diluent may have any of the dissolution profiles described above as being effective for 1 o improving metabolic disorders or key elements thereof such as dysglycemic control and type 2 diabetes, including any embodiment thereof or combination thereof In addition, the formulation manufactured using excipients or lubricants that stabilize the formulation as described above may provide a pharmacokinetic profile as described above and may contain an amount of bromocriptine as described above. 15 In another aspect, the present disclosure provides bromocriptine pharmaceutkal formulations containing micronized bromocriptine that have enhanced stability. The stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 8'% total related substances following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 18 months. In some 20 embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 8% total related substances following storage of the pharmac.:eutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 24 months. [n some embodiments, stability of the pharmaceutical fommlation can be such that the pharmaceutical formulation contains no more than 8%) total related substances following 25 storage of the phamiaceutical formulation at a temperature of 25 :t: 2 °Cat about 60 ::.t:. 5% relative humidity for about 36 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical fommlation contains no more than 8% total related substances following storage of the pham1aceutical formulation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative humidity for about 48 months. The stability of the 30 pharmaceutical formulation can be such that the pharmaceutical formulation contains no more 38 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 than 8% ofbromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 :±: 2 °C at about 60 :r: 5%1 relative humidity for about 18 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 8% of bromocriptinine following storage of the pharmaceutical 5 formulation at a temperature of 25 :1: 2 °C at about 60 c.l:: 5% relative humidity for about 24 months. In some embodiments, stability of the phannaceutical formulation can be such that the pharmaceutical formulation contains no more than 8% ofbromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 36 months. In some embodiments, stability of the pharmaceutical formulation can be 1 o such that the pharmaceutical formulation contains no more than 8% of bromocriptinine following storage of the phamiaceutical formulation at a temperature of 25 :+: 2 °Cat about 60 :f.:: 5% relative humidity for about 48 months. The stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than S~o total related substances following storage of the pharmaceutical formulation at a temperature of 25 cl: 2 °Cat about 60 :+: 5% relative 15 humidity for about 18 months. In some embodiments, stability of the pharmaceutic.:al formulation can be such that the pharmaceutical fommlation contains no more than 5% total related substances following storage of the pharmaceutical formulation at a temperature of 25 cJ, 2 °C at about 60 :+: 5% relative humidity for about 24 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation 20 contains no more than 5% total related substances follo\ving storage of the pharmaceutical formulation at a temperature of 25 ,J, 2 °Cat about 60 :+: 5% relative humidity for about 36 months. In some embodiments, stability of the pham1ac.:eutical formulation can be such that the pharmaceutical formulation contains no more than 5% total related substances following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative 25 humidity for about 48 months. The stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 5%, ofbromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 :±: 2 °Cat about 60 :r.:: 5% relative humidity for about 18 months. The stability of the pharmaceutical formulation can be such that the phannaceutical formulation contains no more than 3% ofbromocriptinine following storage 30 of the pharmaceutical formulation at a temperature of 25 cl: 2 °Cat about 60 J: 5% relative 39 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 humidity for about 18 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 5% of bromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 ,J, 2 °C at about 60 :+, 5~o relative humidity for about 24 months. In some embodiments, 5 stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 5% ofbromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 :+: 2 °Cat about 60 :t, 5% relative humidity for about 36 months. In some embodiments, stability of the pham1aceutical formulation can be such that the pharmaceutical formulation contains no more than 5%> ofbromocriptinine following storage of 1 o the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 48 months. The stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 3% total related substances following storage of the pharmaceutical fommlation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative humidity for about 18 months. In some embodiments, stability of the pharmaceutical 15 fonnulation can be such that the pharmaceutical formulation contains no more than 3% total related substances following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 24 months. 1n some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 3%> total related substances following storage of the pharmaceutical 20 formulation at a temperature of 25 :+, 2 '-'C at about 60 ,t: 5~o relative humidity for about 36 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmac.:eutical formulation contains no more than 3%> total related substances following storage of the pharmaceutical formulation at a temperature of 25 :±· 2 °Cat about 60 ,1, 5% relative humidity for about 48 months. In some embodiments, the stability of the pham1aceutical 25 formulation can be such that the pharmaceutical formulation contains no more than 3% of bromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 :+, 2 °C at about 60 :+, 5% relative humidity for about 18 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 3% ofbromocriptinine following storage of the pharmaceutical 30 formulation at a temperature of 25 ,J, 2 °Cat about 60 :t, 5% relative humidity for about 24 40 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 months. In some embodiments, stability of the pharmaceutical formulation can be such that the pharmaceutical formulation contains no more than 3(;;o ofbromocriptinine following storage of the pharmaceutical formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 36 months. In some embodiments, stability of the pharmaceutical formulation can be 5 such that the pharmaceutical formulation contains no more than 3~'o of bromocriptinine following storage of the pharmac.:eutical formulation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative humidity for about 48 months. 10 The amount of total related substances or the amount ofbromocriptine is determined by HPLC analysis using detection of UV absorption at 300 nn:L In some embodiments, the pham1aceutical fommlation is stable such that the pharmaceutical formulation contains no more than 1 % total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm follmving storage of the pharmaceutical formulation at a temperature of 40 ± 2 cc at about 70 ± 5% relative humidity for about 6 weeks. 15 In some embodiments, the pharmaceutical formulation is stable such that the 20 25 pharmaceutical formulation contains no more than 8% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 ,+: 2 cc at about 70 :r: 5% relative humidity for about 6 months. In some embodiments, the pharmaceutical formulation is stable such that the pharmaceutical formulation contains no more than 8% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 ,t.· 2 °C at about 70 :r., 5% relative humidity for at least 6 months. In some embodiments, the phannaceutical formulation is stable such that the pharmaceutical fomrnlation contains no more than 8% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 40 ± 2 °C at about 70 ± S~o relative humidity for at least 12 months. The amount of total related substances or the amount ofbromocriptine is 30 detennined by HPLC analysis using detection of UV absorption at 300 nm. 41 42 The formulations disclosed herein may also include permeation enhancing agents, bioadhesives, film forming agents, plasticizers, stabilizers, fillers and mucosal tissue irritant reducers, binders, disintegrants, lubricants 5 and fillers. Bioadhesives are included, for example, in adhesive tablets, solutions, colloidal suspensions, gels, ointments, patches, films, pastes, and lozenges. Examples of bioadhesives polymers include, without limitation, Klucel, Benecel® MP814, KollidonTM, chitosan, cellulose derivatives, CarbopolTM 934P, Carbopol 974P, 1Voveou AA-1, carbopole resins, carbomer, 10 xanthan gum, polycarbophil and polyethylene oxide combined with an inert diluent and an active ingredient, and ionic polysaccharides. Several synthetic and semi-synthetic bioadhesive polymers of different molecular weight and variations in degree of substitution include, without limitation, hydroxyethylcellulose, polyvinylalcohol, polyacrylic acid, sodium carboxymethylcellulose, polyvinylpyrrolidone, polyethylene glycols and others. Mucosal 15 adhesion of these bioadhesive formulations is based on the interpenetration of hydrated hydrocolloid chains of the bioadhesive formulation and glycoprotein chains of the oral mucosa. Examples of suitable film forming agents include, but are not limited to, hydroxypropylmethylcellulose, ethylcellulose and polymethacrylates. Examples of suitable plasticizers include, but are not limited to, polyethylene glycols of 20 different molecular weights (e.g., 200-8000 Da), plant gums, and propylene glycol and triethyl citrate. Examples of permeation enhancing agents include, without limitation, bile salts, fatty acids, fatty acid derivatives, surfactants, fatty acid esters, such as laureate, myristate and stearate monoesters of polyethylene glycol, enamine derivatives and alpha-keto aldehydes; sodium 25 cholate; sodium glycocholate; sodium deoxycholate; sodium lauryl sulfate; sodium salicylate; sodium ethylenediaminetetraacetic acid (EDTA); aprotinin; azone; sodium 5-methoxysalicylate; 1-oleylazacycloheptan-2-one; and / or silicas with a high affinity for aqueous solvents, such as the CA 3079522 Date reçue / Received date 2025-03-03 43 precipitated silica better known by the trade mark Syloid®, maltodextrins, ß-cyclodextrins, surfactants, chelators, cyclodextrins, chitosan, and lower alcohols. Examples of stabilizers include, without limitation, citric acid, ascorbic acid, oleic acid, caprylic acid, capric acid, polyvinylpyrrolidone, waxes, block co-polymers, poloxamers, Poloxamer 188 and 407, poloxamines, Poloxamine 908, polyvinyl pyrrolidone, 5 polyvinyl alcohol, gelatine, polysaccharide, hyaluronic acid, chitosan, derivatives of chitosan, polyacryl acid, derivatives of polyacryl acid, polycarbophil, cellulose derivatives, methyl cellulose, hydroxypropyl cellulose, carboxymethyl cellulose, sugar esters, saccharose monostearate, sodium citrate individually, fatty acids, fatty alcohols, alcohols, long chain fatty acid esters, long 10 chain ethers, hydrophilic derivatives of fatty acids, polyvinylethers, polyvinyl alcohols, hydrocarbons, hydrophobic polymers, moisture-absorbing polymers, and combinations thereof. Examples of anhydrous mucosal tissue irritant-reducing agent include, without limitation, plant oils like but not limited to olive oil, corn oil or mineral oil. Examples of fillers include, without limitation, microcellulose, e.g., ProSolvTM; Pharmaburst; Cab-o-silTM; and saccharides, 15 e.g., mannitol, lactose, xylitol and mixtures thereof. Examples of suitable binders include, without limitation, either individually or in combination, such binding agents as sucrose, gelatin, glucose, starch, cellulose materials, polyethylene glycols, povidone, methylcellulose, sodium carboxymethylcellulose, sodium alginate, agar, alginic acid and salts of alginic acid, calcium carrageenan, magnesium aluminum 20 silicate, polyethylene glycol, guar gum, polysaccharide acids, bentonites, polyvinylpyrrolidone (povidone), hydroxymethyl polyvinyl pyrolidone, polymethacrylates (such as EudragitTM), methylcellulose, hydroxypropyl methylcellulose (HPMC), hydroxypropyl cellulose (KlucelTM), ethyl cellulose (EthocelTM), hydroxypropylmethylcellulose, pregelatinized starch (such as NationalTM 1511 and Starch 1500), sucrose, lactose, starch paste, povidone polyethylene glycol, 25 Pullulan and corn syrup, waxes, and natural and synthetic gums, such as acacia, tragacanth, vegetable gum, castor oil, microcrystalline cellulose, dextrin, liquid glucose, guar gum, pectin, PEG, povidone, pregelatinized starch etc. CA 3079522 Date reçue / Received date 2025-03-03 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Examples of suitable disintegrants include, without limitation, Klucel, starches such as maize starch and rice starch, cross-linked N-vinyl-2-pyrrolidone (CLPVP), alginic acid or alginates, microcrystalline cellulose, hydroxypropyl cellulose and other cellulose derivatives, croscarmellose sodium, crospovidone, polacrillin potassium, starch, pregelatinized starch, 5 Pharmablast@ carboxymethyl starch (e.g. Primogel® and Explotab@ (sodium starch glyco1ate and sodium carboxymethyl starch)), sodium starch glycolate, and formaldehyde casein. Effervescent di sintegrants include without limitation, for example, starch, potassium bicarbonate, and sodium bicarbonate in combination with citric or tartaric acids. The disintegrant is present as an intra-granular disintegrant or extra-granular disintegrant. 1 o Examples of suitable lubricants include, without limitation, sodium oleate, sodium stearate, sodium stearyl fumarate, stearic acid, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride, calcium stearate or other metallic stearate, talc, waxes and glycerides, light mineral oil, PEG, glyceryl behenate, colloidal silica, hydrogenated vegetable oils, corn starch, sodium stearyl fumarate, polyethylene glycols, alkyl sulfates, sodium benzoate, and 15 sodium acetate. Examples of suitable flavoring agents include, without limitation, menthol, pepperrnint, vanilla, fruit flavorings, and sweeteners, e.g., aspartame or sodium saccharinate. The formulations disclosed herein may further include citric acid as an excipient. Citric acid as an excipient may act to improve the stability of the bromocriptine citrate in water 20 ( counter to the knmvn effect of bromocriptine to be degraded in acidic environments), and also may enhance bromocriptine solubility and absorption. Other agents used as antioxidants may include, but are not limited to, vitamins A, C, E, beta-carotene, zinc, selenium, glutathione, coenzyme Q-10 and echinacea. The citric acid or other antioxidant can be used in an amount from about 0.1 % to about 5% by weight. In some embodiments, the citric acid or other 25 antioxidant is used in an amount from about 0.5%i to about 5% by weight. In some embodiments, the citric acid or other antioxidant is used in an arnount from about 1 % to about 5~o by weight In some embodiments, the citric acid or other antioxidant is used in an amount from about 0.5% to about 3% by weight. In some embodiments, the citric acid or other antioxidant is used in an 44 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 amount from about 1 % to about 2% by weight. In some embodiments, the citric acid or other antioxidant is used in an amount of about 1.5% by weight Citric acid used in the formulations can be of a particle size such about 3% or less of said citric acid is great er than 600 μm when sieved and about 5% or greater of said citric acid is 150 μm or less when sieved. 5 The formulations disclosed herein may also include one or more (non-lactose) disintegrants. Examples of suitable disintegrants include, but are not limited to, starches such as com starch, maize starch, pregelatinized starch, rice starch, sodium starch glycolate, and sodium carboxymethyl starch, alginic acid or alginates such as sodium alginate, croscarmellose sodium, crospovidone, cross-linked N-vinyl-2-pyrrolidone (CLPVP), cellulose derivatives such as 1 o sodium carboxymethyl cellulose, calcium carboxymethyl cellulose, po1yviny1pyrrolidone, methyl cellulose, microcrystalline cellulose, and lower alkyl-substituted hydroxypropyl cellulose, formaldehyde casein, and po1acri11in potassium. Effervescent disintegrants include without limitation, for example, starch, potassium bicarbonate, and sodium bicarbonate in combination with citric or tartaric acids. The disintegrant can be used in an amount from about 2% to about 15 50% by weight. In some embodiments, the disintegrant is used in an amount from about 5% to about 20% by weight. In some embodiments, the disintegrant is used in an amount from about 5~o to about 15% by weight. In some embodiments, the disintegrant is used in an amount of about 10% by weight. The formulations disclosed herein may also include one or more diluents such as short 20 chain saccharides (e.g., monosaccharides or di saccharides, excluding lactose). Examples of such short chain saccharides include, but are not limited to,, mannitol, xylitol, dextrose, maltose, sucrose, galactose, fructose, and sorbitol . In some embodiments, the diluent is used in an amount from about 60° / o to about 90% by weight. In some embodiments, the diluent is used in an amount from about 65% to about 90~o by weight. In some embodiments, the diluent is used in an 25 amount from about 70~'o to about 90% by weight. In some embodiments, diluent is used in an amount of about 85% by ,veight. The preferred formulation excludes lactose from the formulation. In some embodiments, the pharmaceutical formulation may have a pharmacokinetic profile wherein the time to maximum plasma concentration (Tmax) following administration of 30 bromocriptine pharmaceutical formulations (e.g., six pharmaceutical formulations each 45 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 providing a dose of about 0.8 mg ofbromocriptine) is between about 30 and about 60 minutes, such as about 50 minutes, e.g., about 53 minutes, \vhen the phannaceutical formulations are administered under fasting conditions, or between about 90 and about 120 minutes, when the pharmaceutical formulations are administered under high fat fed conditions, to adult subjects. 5 The bromocriptine pharmaceutical formulations (e.g., tablets) described herein, and bromocriptine pharmaceutical formulations prepared by the methods herein, may be used to treat type 2 diabetes by improving glycemic control in an individual with type 2 diabetes. The pharmaceutical formulation may be administered within about two hours after waking in the morning with food. The initial dose may be about 0.1 mg ofbromocriptine daily, which rnay be 1 o increased weekly until a maximal tolerated daily dose of about 1.6 to about 7.2 mg is achieved. It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, can also be provided in combination in a single embodiment (while the embodiments are intended to be combined as if written in multiply dependent form). Conversely, various features of the invention which are, for brevity, described 15 in the context of a single embodiment, can also be provided separately or in any suitable subcombination. Therefore, in summary: ,r1. The present disclosure therefore provides a pharmaceutical formulation (e.g., a tablet) comprising bromocriptine (e.g., bromocriptine mesylate or a different bromocriptine salt, 20 e.g., bromocriptine citrate) and an excipient; wherein the bromocriptine is present in an amount that provides a dose of at least about 0.1 mg ofbromocriptine per pharmaceutical formulation; and wherein the excipient comprises a fatty acid or t1iglyceride. The excipient can be devoid of magnesium, magnesium stearate, and / or lactose. The excipient can include one or more nonlactose saccharides. Moreover, the present disclosure provides a pharmaceutical formulation of 25 bromocriptine that is stable to heat and humidity and that has a water solubility of at least 500 mg / ml of water and that can be stable in an aqueous environment. Specifically, the present disclosure provides a pharmaceutical formulation comprising bromocriptine citrate, a free fatty acid such as stearic acid or triglyceride, a non-lactose saccharide such as mannitol, and citric acid as an excipient. The excipient can be devoid of magnesium or magnesium stearate. More 30 specifically the present disclosure provides a pharmaceutical formulation of bromocriptine 46 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 citrate, a free fatty acid such as stearic acid or a triglyceride, a non-lactose saccharide such as mannitol, and citric acid as an excipient wherein the bromocriptine formulation to stable to heat and humidity and wherein the bromocriptine formulation has a high water solubility (e.g., at least 200 mg / Lor 500 mg / L solubility in water) and can be stable in an aqueous environment 5 (minimal degradation at 25C for 6 hours). More specifically yet, the present disclosure provides a pharmaceutkal formulation comprising bromocriptine citrate, a free fatty acid such as stearic acid or a triglyceride, a non-lactose saccharide such as mannitol, and citric acid as an excipient wherein the bromocriptine fommlation is more stable to heat and humidity and wherein the bromocriptine formulation has a much greater water solubility (e.g., at least 500 mg / Lor at least 10 200 mg / L solubility in water) and can be more stable in an aqueous environment than a traditional pharmaceutical formulation comprising bromocriptilH.~ as the mesylate salt plus lactose, magnesium stearate, and citric acid as excipients. i12. The present disclosure provides a pha1maceutical formulation as described in i-11, wherein at least about 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C6- 15 C14fattyacids. The present disclosure provides a pharmaceutical formulation as described in ,Il, wherein at least about 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C1,1-C26 fatty acids. ,[3. The present disclosure provides a pharmaceutical formulation as described in 20 paragraph ,I2, wherein at least about 90% of the acyl groups of the triglyceride are fatty acid acyl groups of C 14-C26 fatty acids. i14. The present disclosure provides a pharmaceutical formulation as described in paragraph ,r2, wherein at least about 80~'<> of the acyl groups of the triglyceride are fatty acid acyl groups of C16-C20 fatty acids. 25 ,-rs. The present disclosure provides a pharmaceutical formulation as described in paragraph i[3, wherein at least about 90% of the acyl groups of the triglyceride are fatty acid acyl groups of CH_;-C20 fatty acids. ,r6. The present disclosure provides a pharmaceutical formulation as described in paragraph i1f:4, wherein at least about 80%> of the acyl groups of the triglyceride are fatty acid acyl 30 groups of Cm fatty acids. 47 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 i[7. The present disclosure provides a pharmaceutical formulation as described in paragraph ~5, wherein at least about 90% of the acyl groups of the triglyceride are fatty acid acyl groups of Cl8 fatty acids. ,rs. The present disclosure provides a pharmaceutical formulation as described in 5 paragraph fi6, wherein at least about sm'<> of the acyl groups of the triglyceride are stearoyl or 12- hydroxystearoyl groups. i19. The present disclosure provides a pharmaceutical formulation as described in paragraph ,rs, wherein at least about 90'% of the acyl groups of the triglyceride are stearoyl or 12- hydroxystearoyl groups. 1 o ir10. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,r1 to 9, wherein at least about 80% of the acyl groups of the triglyceride are saturated. ,r11. The present disclosure provides a pharmaceutical formulation as described in paragraph ,r10, wherein at least about 90% of the acyl groups of the triglyceride are saturated. 15 4112. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ir1 to 11, wherein the excipient comprises a hydrogenated vegetable oil. i113. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,Tl to 12, \vherein the excipient comprises hydrogenated castor oil, hydrogenated coconut oil, hydrogenated cottonseed oil, hydrogenated palm oil, hydrogenated 20 palm kernel oil, hydrogenated soybean oil or a combination thereof. 25 ip4. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,Tl to 13, wherein the excipient comprises hydrogenated castor oil. iP 5. The present disclosure provides a pharmaceutical formulation as described in paragraphs ,;1 to 14, wherein the excipient comprises KOLLIWAX@ HCO. ,Tl6. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ifl to 15, wherein the excipient is present in an amount from about 0.5% to about 3% by weight of the formulation. ir17. The present disclosure provides a pharmaceutical formulation as described in any one of paragraph ,TI to 16, wherein the excipient is extragranular. 48 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 i[I 8. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,r1 to 17, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5%, total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a 5 temperature of 25 J~ 2 °Cat about 60 :t: 5% relative humidity for about 18 months. 4119. The present disclosure provides a pharmaceutical formulation as described in paragraph ifl 8, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5~o total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 1 o 25 ± 5 °C and about 60 ± 5% relative humidity for about 24 months. 4120. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs iP to l 7, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5% ofbromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 15 25 ± 2 °C at about 60 ± 5% relative humidity for about 18 months. i121. The present disclosure provides a pharmaceutical formulation as described in paragraph ir20, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5~'o ofbromocriptine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 5 °C and 20 about 60 ,J:: 51% relative humidity for about 24 months. i122. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs 411 to 17, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a 25 temperature of 25 + 2 °C at about 60 ,-1:. 5% relative humidity for about 18 months. i123. The present disclosure provides a pharmaceutical formulation as described in paragraph ,I22, v,,rherein the pharmaceutical formulation is stable such that the formulation contains no more than 3~{i total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 30 25 J_, 5 °C and about 60 :t, 5% relative humidity for about 24 months. 49 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 ~[24. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,r1 to 17, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3%, ofbromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 5 25 ,J, 2 °C at about 60 :+: 5% relative humidity for about 18 months. 4125. The present disclosure provides a pharmaceutical formulation as described in paragraph if20, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3~o ofbromocriptinine as detennined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 :r, 5 °C and 1 o about 60 ± 5% relative humidity for about 24 months. 4126. The present disclosure provides a pharmaceutical formulation comprising micronized bromocriptine (e.g., bromocriptine mesylate or a different bromocriptine salt, e.g., bromocriptine citrate); wherein the micronized bromocriptine is present in an amount that provides a dose of at least about 0.8 mg of bromocriptine per pharmaceutical formulation; and 15 the pharmaceutical formulation is stable such that the formulation contains no more than 5% of bromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 2 °Cat about 60 ± 5% relative humidity for about 18 months. ~[27. The present disclosure provides a pharmaceutical formulation as described in 20 paragraph if26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5% total related substances as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ,J.: 2 °C at about 60 :t, 5% relative humidity for about 18 months. 4128. The present disclosure provides a pharmaceutical formulation as described in 25 paragraph if26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 5%, ofbromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ,_-l: 2 °Cat about 60 ± 5% relative humidity for about 24 months. 4129. The present disclosure provides a pharmaceutical formulation as described in 30 paragraph if26, wherein the pharmaceutical formulation is stable such that the formulation 50 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 contains no more than 5% total related substances as determined by HJ>LC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 24 months. ,r30. The present disclosure provides a pharmaceutical formulation as described in 5 paragraph fi26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3% ofbromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ,±, 2 °Cat about 60 ± 5% relative humidity for about 18 months. ,r3 l. The present disclosure provides a pharmaceutical formulation as described in 1 o paragraph ,r26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3% total related substances as determined by HPLC analysis using detection ofl.JV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 2 °C at about 60 ± 5% relative humidity for about 18 months. ~[32. The present disclosure provides a pharmaceutical formulation as described in 15 paragraph f:26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3% ofbrornocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 2 °Cat about 60 :±: 5~o relative humidity for about 24 months. The present disclosure provides a pharmaceutical formulation as described in 20 paragraph f:26, wherein the pharmaceutical formulation is stable such that the formulation contains no more than 3% ofbromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the formulation at a temperature of 25 ± 2 °Cat about 60 :t: 5% relative humidity for about 24 months. 4'[34. The present disclosure provides a pharmaceutical formulation as described in any 25 one of paragraphs "ijl to 25, wherein the bromocriptine is micronized. ips. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,Il to 34, \vherein the bromocriptine has a Dv90 of about 20 μm or lower. ~[36. The present disclosure provides a pharmaceutical formulation as described in paragraph f:35, wherein the bromocriptine has a Dv90 of about 10 ~tm or lower. 51 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 i[37. The present disclosure provides a pharmaceutical formulation as described in paragraph ~35, wherein the bromocriptine has a Dv90 of about 5 μm or lower. ips. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ,Tl to 3 7, \vherein the bromocriptine has a Dv99 of about 20 μrn or lower. 5 if39. The present disclosure provides a pharmaceutical formulation as described in paragraph ~3 8, wherein the bromocriptine has a Dv99 of about 10 ~tm or lower. i140. The present disclosure provides a pharmaceutical formulation as described in paragraphs ~1 to 39, wherein the bromocriptine has a volume-based particle size distribution wherein not more than about 20% of the bromocriptine has a particle size ofless than about 10 1 μm. ,T4l. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs iP to 40, wherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein at least about 80% of the bromocriptine has been 15 released at about 30 minutes. i142. The present disclosure provides a pharmaceutical formulation as described in paragraph i[41, wherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of0.1 N hydrochloric acid at about 37 °C, wherein at least about 90% of the bromocriptine has been released at about 30 20 minutes. i143. The present disclosure provides a pharmaceutical formulation as described in paragraph ,I41, wherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein at least about 95% of the bromocriptine has been released at about 30 25 minutes. i144. The present disclosure provides a pharmaceutical formulation as described in paragraph ,I4 l, v,,rherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein at least about 90 ~·'<> of the bromocriptine has been released at about 20 30 minutes. 52 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 The present disclosure provides for stable bromocriptine formulations wherein the dissolution (as tested in Example U) of the formulation is 90% or greater within 10 minutes, 5 minutes, or 2 minutes. ~45. The present disclosure provides a pharmaceutical formulation as described in 5 paragraphs if4 l to 44, wherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein not more than about 50 % of the bromocriptine has been released at about 7 minutes. ~46. The present disclosure provides a pharmaceutical formulation as described in any 10 one of paragraphs il41 to 45, wherein the pharmaceutical formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle lVfothod at 50 rpm in 500 ml of 0.1 N hydrochloric acid at about 37 °C, wherein not more than about 75% of the brornocriptine has been released at about 10 minutes. i[47. The present disclosure provides a pharmaceutical formulation as described in any 15 one of paragraphs ,Tl to 46, wherein the pharmaceutical formulation provides a pharmacokinetic profile wherein the time to maximum plasma concentration (Tmax) following administration of six of the formulations to adult subjects is between about 30 and 60 minutes when the formulations are administered under fasting conditions. i[48. The present disclosure provides a pharmaceutical formulation as described in any 20 one of paragraphs ~1 to 47, wherein the phamiaceutical formulation provides a pharmacokinetic profile wherein the time to maximum plasma concentration (Tmax) following administration of six of the formulations to adult subjects is between about 90 and about 120 minutes, when the formulations are administered under high fat fed conditions. In another embodiment the dosage form is suitable for parenteral administration and 25 exhibits a pharmacokinetic profile with a plasma Tmax from about 1 to about 90 minutes after administration, a plasma drug concentration of at least 50% Cmax for a duration of about 90 to about 360 minutes, and a decrease in plasma level that may approximate first order elimination kinetics. 53 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 ,[49. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ~1 to 48, wherein the pharmaceutical formulation comprises citric add. iiso. The present disclosure provides a pharmaceutical formulation as described in paragraph ,I49, \vherein the citric acid is present in an amount from about Ji% to about 10% by 5 weight 4!51. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs if1 to 50, wherein the pharmaceutical formulation comprises a disintegrant. i152. The present disclosure provides a pharmaceutical formulation as described in 4"[51, wherein the disintegrant is present in an arnount from about 5% to about 90% by weight. 10 ,[53. The present disclosure provides a pharmaceutical formulation as described in any one of paragraphs ~1 to 52, wherein the bromocriptine is present in an amount that provides a dose of at least about 0.1 mg of bromocriptine per pharmaceutical formulation. i154. The present disclosure provides a method for the manufacture of a pham1aceutical formulation as described in any one of paragraphs ir1 to 53 wherein the method comprises 15 blending the bromocriptine with exc.:ipients to form a mixture wherein the bromocriptine is substantially evenly distributed in the mixture, and compressing the mixture to form a pharmaceutical formulation. ~55. The present disclosure provides a method as described in paragraph ,I54 comprising processing bromocriptine to reduce the average particle size of the bromocriptine to 20 provide bromocriptine that has a Dv90 of about 20 ~nn or less prior to the blending. i156. The present disclosure provides a method as described in paragraphs i154 or 55 comprising detem1ining that bromocriptine has a particle size distribution equivalent to a volume-based particle size distribution with a Dv90 of about 20 ~un or less prior to the blending, so that the bromocriptine that is blended is of determined particle size distribution. 25 '1157. The present disclosure provides a pharmaceutical formulation prepared by a method as described in any one of paragraphs f154 to 56. i158. The present disclosure provides a method of treatrnent for improving glycernic control in a type 2 diabetes patient comprising administering to the patient a bromocriptine pharmaceutical formulation as described in any one of paragraphs fl1 to 53 or 57. 54 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 if 59. The present disclosure provides a method of treatment for improving glycemic control in a type 2 diabetes patient comprising providing to the patient for administration a bromocriptine pham1aceutical formulation as described in any one of paragraphs ir1 to 53 or 57. ~60. The present disclosure provides a method of treatment for improving glycemic 5 control in a type 2 diabetes patient comprising preparing at least one pharmaceutical formulation by a method as described in any one of paragraphs ~54 to 56 and providing the pharmaceutical formulation for administration to the patient. ~61. The present disclosure provides a method of treatment of metabolic disorders or key elernents thereof such as for improving glycemic control in a type 2 diabetes patient 1 o comprising preparing at least one pharmaceutical formulation by a method as described in any one of paragraphs ~54 to 56 and administering the pharmaceutical formulation to the patient. 62. The present disclosure provides a solid pharmaceutical fommlation comprising bromocriptine citrate, a free fatty acid or triglyceride, a non-lactose short chain saccharide such as mannitol, and citric acid. 15 63. The present disclosure provides a method for treating metabolic disorders such as 20 25 30 type_2 diabetes_mellitus,_or_keyelements_of metabolic_disorders_by _administerin,eLto_a__patient_in nye_9 pf_;m_cl:} tr:esμI!}e_p.t__a_pharmaceutical formulation comprising bromocriptine citrate, a free fatty acid or triglyceride, a non-lactose short chain saccharide such as mannitol, and citric acid. 64. The present disclosure provides an oral pharmaceutical formulation containing between 0. 1-10% bromocriptine citrate, 0.1-10% citric acid, 30-90% non-lactose short chain saccharide, and 0.2-1 o~.{i free fatty acid, phospholipid or triglyceride 65. The present disclosure provides a parenteral pharmaceutical formulation containing between 0.1-10% bromocriptine citrate, 0.1-10% citric acid, 60-90% non-lactose short chain saccharide, and 0.2-101% free fatty acid, phospholipid or triglyceride. 55 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 ICXAl\:lPL:KS The inventor's discoveries are illustrated by the following examples, which are not intended to limit the scope of the claims. Other variations or embodiments of the invention will also be apparent to one of ordinary skill in the art from the above descriptions and the following 5 Examples. Example 1. Prer1aration of Stable, l\!Iicronized Rromocriptine Formulations. J\ / Iilling of the bromocriptine (to prepare micronized bromocriptine) was accomplished using a Fluid Energy lVIodel 00 Jet-0-Mizer jet mill. Enhanced stability of bromocriptine 1 o pharmaceutical formulations can be obtained by substituting either or both of two reactive excipients, magnesium and lactose, with alternative non-reactive lubricants and saccharides, respectively. Thus, to increase the stability of a bromocriptine pharmaceutical formulation, nonreactive alternatives to these reactive excipients were examined. 15 20 Stearic.: acid or triglyceride (as possible replacements for magnesium stearate) and rnannitol (as a possible replacement for lactose) were evaluated. Tablet formulations were prepared using these non-reactive alternatives and accelerated stability tests were performed. The compositions of the formulations produced and evaluated in this project are found in Tables 1-4, below. 350 tablets of each formulation were produced. The tablets were formulated using dry granulation and pressed using a single stage tablet press. The tablets were flat round tablets with a diameter of 6.0 mm and with an average weight of 90 mg + / -5%. % of total Excipicnt N amc wci2ht Wci2ht (mg) Excipients for 350 Tablets ii!) Bromocriptine Mesvlate 1.05 0.945 0.331 Citric Acid (Anhvdrous) 1.50 1.350 0.473 Starch 1500 10.00 9.000 3.150 Anhydrous Lactose 86.20 77.580 27.153 Fumed Silica 0.50 0.450 0.158 Magnesium Stearate 0.75 0.675 0.236 Total 100.00 90.000 31.500 56 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Table 1: Formulation Guide for VS-541?-A (Bromocriptine pharmaceutical formulations with magnesium stearate and lactose). The hardness of the formulation was about 8-10 KP. The appearance of the tablets was white in color. The disintegration time for this formulation was about 5-8 minutes. The flow property of this granulation mixture was suitable for use in a 5 gravity feed press. % of total Excinient Name weh!ht Weie:ht (me:) Exdoients for 350 Tablets(~) Bromocriptine Mesylate 1.04 0.945 0.331 Citric Acid (Anhydrous) 1,49 L350 0.473 Starch 1500 9.93 9.000 3.150 __ Anhydrous 1'vfannito1 85.56 77.580 27.153 Fumed Silica 0.50 0.450 0.158 Steaiic Acid 1.49 1.350 0.473 Total 100.00 90.675 31.736 Table 2: Formulation Guide for VS-54F-B (Bromocriptine phanmu.'.eutical formulations with stea.-ic add substituted for magnesium stearate and mannitol substituted for lactose). The hardness of the formulation \Vas about 8-10 KP. The appearance of the tablets was white in 1 o color. The disintegration time for this formulation was about 5-8 minutes. The flow properties of this granulation mixture were suitable for use in a gravity feed press. 1% of total Excinient Name weight Weie:ht (mg) Excipients for 350 Tablets (2) Bromocriptinc Mesyiatc 1,04 0.945 0.331 Citric Add (Anhydrous) 1.50 1.350 0.473 Starch l500 10.00 9.000 3 . .150 Anlwdrous Mam1itol 86.20 77.580 27.153 Fumed Silica 0.50 0.450 0.158 Castor Oil (Solid) 0.75 0.675 0.236 Total 100.00 90.000 31.500 Table 3: Formulation Guide for VS-54F-C (Brnmocriptine pharmaceutical formulations with castor oil substituted for magnesium stearate and mannitol substituted for lactose. The 15 hardness of the formulation was about 8-10 KP. The appearance of the tablets was white in color. The disintegration time for this formulation was about 5-8 minutes. The flow property of this granulation mixture was suitable for use in a gravity feed press. 57 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 % of total Exdpient Name weight Weight (mg} Excipients for 350 Tablets (!!} Bromocriptine Mesylate 1.04 0.945 0.331 Citric Acid (Anhydrous) 1.49 1.350 0.473 Starch 1500 9.93 9.000 3.150 Anhydrous 1\ / Iamritol 85.56 77.580 27.153 Fumed Silica 0.50 0.450 0.158 Stearic Add 1.49 1.350 0.473 Total 100.00 90.675 31.736 Table 4: Formulation Guide for VS-54F-B.1 (Bromocriptine pharmaceutical f"m·nmlations with stearic acid substituted for magnesium stearate and mannitol substituted for lactose). The hardness of the formulation was about 8-10 KP. The appearance of the tablets ,vas white in color. The disintegration time for this formulation was about 5-8 minutes. The flow property of 5 this granulation mixture was suitable for use in a gravity feed press. Each of the above-described formulations was prepared and tested for assay, content uniformity and for starting bromocriptinine (the main degradation product ofbromocriptine; BCI) content prior to being subjected to stress at 40°C / 75%RH. For content uniformity, three 10 tablets from each formulation were tested. The lot numbers for each of these formulations are shown below: VS-54F-A VS-54F-B 15 VS-54F-C VS-54F-B. l (Second preparation of Formulation B) Example 2. Stability and Dissolution Studies of Three Tablet Bromocriptine Formulations. Using HPLC, a calibration curve was set up to analyze each of the fommlations described in 20 Example 1. For assay and% bromocriptinine (the main degradation product ofbromocriptine; BCI) determination, one tablet was dissolved in 10 ml of0.1•% citric acid solution in a volumetric flask to give a theoretical concentration of about 0.0945 mg / ml. Based on the new information regarding sample stability and our need for a To we analyzed a tablet of each fonnulation stored at 5°C bracketed by 2 tablets that were stressed at 40°Ci751%RR. All 4 58 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 formulations were analyzed at T = 2, 4, and 6 weeks for assay and% BCI. The percent BCI was calculated based on the area of the BCI peak and the total area of the BCI and API peaks. Condition 2 weeks 4 weeks 6 weeks A40 / 75 91.9 91.5 90.4 ASC 95.0 91.8 91.6 B40 / 75 78.6 86.5 98.9 BSC 95.4 90.4 82.0 C:40 / 75 86.1 84.5 91.1 C5C 90.6 105.4 77.5 B.140 / 75 112.0 107.4 108.0 B.1. SC 11.7.6 1.02.0 1.21.7 Table 5: Bromocri11tine Assay of F'ormulations. Assays for all of the formulations over the 5 course of the stability study. Condition 2 weeks 4 weeks 6 weeks A40 / 75 0.74 1.24 2.26 ASC 0.25 0.20 0.16 B 40 / 75 0.42 0.53 0.78 BSC 0.19 0.19 0.19 C40 / 75 0.12 0.20 0.26 C5C 0.08 0.12 0.17 B.140 / 75 0.59 0.73 0.89 B.1 SC 0.24 0.24 0.24 Table 6: % Bromocriptinine in Formulations.% BCI (degradation product ofbromocriptine) for each formulation based on the area of the bromocriptine API and the BCI peaks. ·10 As expected, there was a slight increase in% BCI in all of the samples stressed at 40 / 75 over the course of the study. Formulation C (VS-54F-C) had the lowest% BCI at the start and its '?o BCI remained low throughout the entire study (i.e., Formulation C gave the best stability with regard to bromocriptine decomposition as evidenced by% BCI). Formulation B had the next lowest percent of BCI throughout the study. The highest amount of decomposition was seen in 15 Formulation A. Relative to Formulation A, Formulations Band C markedly reduced the degradation ofbromocriptine under the test conditions employed, by 63% and 88%, respectively. Each formulation was also tested for dissolution using a basket apparatus, a paddle apparatus, and a flow-through cell (Formulation C only). For the basket and paddle apparatus, 11 tablets 59 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 from each formulation were weighed and added to 1,000 ml of0.2% citric acid solution. Time points were taken at l 0, 15, 20, 25, 30, 45, and 60 minutes. The samples \Vere prepared for analysis by centrifugation and injection of the resulting mother liquors. For the flow-through cell, 1 tablet was used in 100 ml of solvent which continuously flowed through the cell. The 5 samples were prepared in the same way as for the basket and paddle apparatus. Dissolution testing of all of the tablet fommlations showed fast and high release recoveries of the API over the course of an hour. rn all cases, the release after 30 minutes was >90% theory and in many cases reached the 90th percentiles early in the sampling. 1 o It can be appreciated from a comparison of studies of degradation of bromocriptine from a formulation lacking magnesium stearate and lactose (see, e.g., Tables 5 and 6, Formulations B and Cat~ weeks at 40°C / 75%RH) versus from a formulation containing magnesium stearate and lactose that the impact to reduce degradation ofbromocriptine is much greater when both magnesium stearate and lactose are not present as constituents of the fommlation. 15 Example 3: Methods Used in Examples 1 and 2. Bromocriptine HPLC assay. HPLC Setup: Agilent 1100; Column: Waters Symmetry Shield RP18, 3.5 micron 4.6 x 150 mm; P / N 186000180 ~Mobile Phase A: 0.1 % TFA Water 20 Mobile Phase B: 0.1% TFA Acetonitrile Gradient: Time %A %B 0 80 20 5 65 35 20 60 40 21 80 20 25 80 20 :Flow: 1 ml / min; Detection UV: 300 nm; Sample Diluent: 0.1 % citric acid; Column Oven Temperature: 30°C; In.it~ction Volume: 100 μl 25 BromocriJltine ]>article Size Reduction using Jet Milling. ICxcipients: Bromocriptine Mesylate ; Equipment: Malvern Mastersizer Particle Size Analyzer (Model MS / S); Scale 0.0000 readability; Spatulas; 500 ml Amber Glass Bottle With Teflon Lined Lid; Fluid Energy 60 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Model 00 Jet-O-Mizer; Dry Compressed Air; TA Instruments Differential Scanning Calorimeter; TA Instruments Thermo Gravimetric Analyzer; Olympus Microscope. In a weighing dish 1.0 g bromocriptine was weighed to the nearest 0.000 grams. The material 5 was then loaded into the vibratory feeder. After loading the sample the compressed air line set to 100 psi was connected to the mill, then the gas inlet switc.:h to the instmment was moved to the on position. The grinding pressure was then set to 40 psi and the feeding pressure was set to 50 psi. After the pressures were set for the mill, the feeder power knob was then set to the zero position, and the current for the feeder Vv'as turned on. After the current was turned on, the power 1 o button on the feeder was turned until the desired feeding rate into the hopper was achieved this translated to a dial reading of about 1.5 from a scale of 1 to 10 (about 0.500 grams of APT / min). Grinding at this feeding pressure was continued until all of the material was fed into the mill. When all of the material (1.000 gas initially weighed) was milled, the gas was then turned off. The milled material from this run was removed from the collecting filter, then another 1.000 g 15 bromocriptine was weighed out and milling was resumed. After milling was completed, all of the milled material was placed in one 20 ml glass vial with cap. The total amount of product recovered was 1.500 grams (75% yield). The milled product was then characterized using the following methods: Microscopy, I-IPLC, and Particle Size Analysis. 20 Jvficroscopy: Approximately 2-3 mg of KPT-350 \Vas placed on a glass slide. Using a cover glass the material was carefully spread evenly on the surface of the slide. The spread material was covered with the cover glass and observations were made at 50x. Examination of these materials with polarized light revealed that the materials were crystalline in nature. No amorphous zones were observed. The un-milled material had particles that ranged in size from about 0.5-10 μm. 25 The jet milled material had an average particle size of about 0.5-3.0 μm. HPLC- HPLC analysis of un-miUed and milled material confirmed that there was no change to the chemical composition. 61 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Tableting of 1\1Iilled Bromocriptine. Chemicals: Milled Bromocriptine Mesylate (NAT) Lot#: VS-ER-001; Anhydrous Citric Acid (Fisher) Lot#: 100610; Starch 1500 (Colorcon) Lot#: IN510883; ~fannitol (SPI Pharma) Lot#: 06N129; Lactose Lactopress Anhydrous 250 (DFE Pharma); Aerosil R202 (Evonik) Lot#: 3150090932; Magnesium Stearate (Spectrum Chemicals) 5 Lot#: UL0756; Stearic Acid (Spectrum Chemicals) Lot#: TB 1349; Fully Hydrogenated Castor Oil Acid (ACl'vIB Hardesty) Lot#: 07-H-29. 10 15 Equipment: Laboratory Scale (0.000 readability); TDP 1.5 Table Top Tablet Press; 6 mm Concave round punches; 6 mm Round Dies; 50 ml Vials "With Caps; Variable Speed Roller. Procedure for blending Formulation VS-54F-A: A 50 ml round flask with cap was charged with 0.331 g bromocriptine and 0.473 g citric acid. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll ( at highest speed) for I 0 minutes. After rolling for l O minutes, blending was stopped and 3 .150 g starch 1500 was added to the blend. The mixture was then briskly shaken for a few seconds, then placed in the roller where the blend was pennitted to roll (at highest speed) for 10 minutes. 20 After rolling for IO minutes, blending was stopped and 27.153 g anhydrous lactose and 0.158 g fumed silica were added to the blend. The mixture was then briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for l O minutes. After rolling for 10 minutes, blending was stopped and 0.236 g magnesium stearate was added to 25 the blend. After the addition of the magnesium stearate, the mixture was then briskly shaken for a few seconds, then rolled at the highest speed for two minutes. After rolling for two minutes, the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDP 1.5 (about 1.5 62 5 10 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 tons of pressure). The tablet shape was a 6 mm flat round ,vith and the average weight was about 0.090+ / -5~'o grams. After completing the run hardness tests, disintegration tests, and observations were made. Procedure fo1· blending Formulation VS-54F-B: A 50 ml round flask with cap was charged with 0.331 g bromocriptine and 0.473 g citric acid. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes, blending was stopped and 3.150 g starch 1500 was added to the blend. The mixture ,vas then briskly shaken for a few seconds, then placed in the roller where the blend was pennitted to roll (at highest speed) for 10 minutes. 15 After rolling for 10 minutes, blending was stopped and 27.153 g anhydrous mannitol and 0.158 g fumed silica were added to the blend. The mixture was then briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes, blending was stopped and 0.473 g stearic acid was added to the 20 blend. After the addition of the steark acid, the mixture was briskly shaken for a few seconds, then rolled at the highest speed for two minutes. After rolling for two minutes, the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDP 1. 5 ( about 1. 5 25 tons of pressure). The tablet shape was a 6 mm flat round with and the average weight was about 0.090+ / -5% grams. After completing the run hardness tests, disintegration tests, and observations were made. 63 5 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Procedure for blending :Formulation VS-54F-C: A 50 ml round flask with cap was charged with 0.331 g bromocriptine and 0.473 g citric acid. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend ,vas permitted to roll (at highest speed) for 10 minutes. After rolling for l 0 minutes, blending was stopped and 3. I 50 g stan.:h I 500 was added to the blend. The mixture \.Vas then briskly shaken for a few seconds, then placed in the roller where the blend was pennitted to roll (at highest speed) for 10 minutes. 1 o After rolling for 10 minutes, blending was stopped and 27.153 g anhydrous mannito1 and 0.158 g fumed silica \Vere added to the blend. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes, blending was stopped and 0.236 g fully hydrogenated castor oil was 15 added to the blend. After the addition of the castor oil, the mixture was briskly shaken for a few seconds, then rolled at the highest speed for two minutes. After rolling for two minutes, the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDP 1.5 (about 1.5 20 tons of pressure). The tablet shape was a 6 mm flat round with and the average \veight was about 0.090+ / -S~'o grams. After completing the nm hardness tests, disintegration tests, and observations were made. 25 Procedure for blending Formulation VS-54F-B.1. A 50 mt round flask with cap was charged with 0.331 g bromocriptine and 0.473 g citric acid. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for l 0 minutes. 64 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 After rolling for 10 minutes, blending was stopped and 3 .150 g starch 1500 was added to the blend. The mixture \Vas briskly shaken for a fow seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. 5 After rolling for 10 minutes, blending was stopped and 27.153 g anhydrous mannitol and 0.158 g fumed silica were added to the blend. The mixture was briskly shaken for a few seconds, then placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes, blending was stopped and 0.473 g stearic add was added to the 1 o blend. After the addition of the stearic acid, the mixture was briskly shaken for a few seconds, then rolled at the highest speed for two minutes. After rolling for two minutes, the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TOP 1.5 (about 1.5 15 tons of pressure). The tablet shape was a 6 mm flat round with and the average weight was about 0.090+ / -5%, grams. After completing the run hardness tests, disintegration tests, and observations were made. 20 :Example 4. Studies on the Browning (Degradation) Reactions of Hromocriptine plus ·Magnesium Stearate, with or without Lactose. A series of reaction vessels were prepared containing various combinations of bromocriptine mesylate, Mg stearate, and / or lactose, with or without citric acid, in aqueous suspension and reacted at 60 °C for 55 hours. Additionally, samples were prepared wherein the 25 Mg stearate was replaced / substituted with stearic acid. :Mg stearate was from Sigma (MAGNESIUM STEARATE EXTRA PURE DAB, PH. E, Sigma Product Number: 26454); stearic acid was from Sigma (STEA.RIC ACID, REAGENT GRADE, 95~o, Sigma Product Number: 175366); lactose was from Sigma (LACTOSE 65 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 ANHYDROUS, PH EUR, Sigma Product Number: 17814); and citric acid ,vas from Sigma (CITRIC ACID ANHYDROUS, Sigma Product Number: 27109). Any or all of these reagents can be acquired from other sources known in the art. Reagents were weighed out as indicated in Table 7 below. 2 ml of distilled water was 5 added to the samples, which were then mixed by vortexing, placed in a reaction chamber with thermostat set at 50 °C for 24 hours, then (after 24 hours) set at 60 °C. The color change of the sample solutions / mixtures were evaluated by comparing the color of the solution with a Standardized Color Chart; the color intensities of the sample solutions / mixtures (from clear to dark brown) was graded at specified time points from time Oto time 55 hours (see Figure 2). In 1 o Figure 2, a number "0" indicates a clear solution or v,.rhite suspension; a number "40" represents the darkest solution / suspension observed. Table 7: List ofJngredients in the Formulations Tested. Bromocriptine, Citric acid, MgStearate, Stearic acid, Lactose, mg mg mg mg mg Bromocriptine (BC) alone 10 .,.,.,,,,,.,.,.,. .. , .. ,.,.,.,.,,., .,.,.,,,,.,.,.,. .. , .. ,.,.,.,.,,.,.,.,.,.,,,,.,.,.,. .. , .. ,.,.,.,.,,.,.,.,.,. BC + Mg stearate 10 7 BC+ Lactose 10 800 BC+ citric acid (CA) 10 1.4 800 BC + Mg stearate + 10 7 800 Lactose ! n"'"""n'""~""'"" n"'"""n'""~""'"""'"n'"""n'""~""'""""~' BC + Stearic acid 1.0 7 BC + Stearic acid + 1.0 7 800 Lactose BC + CA + Mg stearate 10 14 7 BC + CA+ Stearic acid 10 14 7 """""'"A""""'"""" """""'-A"""'""""""'"""""'"A"""'""""""'""" BC + CA + Mg stearate + 10 14 7 800 Lactose BC + CA+ Stearic acid + 10 1.4 7 800 Lactose 15 Thus, it was observed that: 66 5 10 15 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 l) When Mg stearate was allowed to interact ,vith bromocriptine in an aqueous environment, a browning product \Vas produced even in the absence of lactose. 2) A more intense browning reaction occurred when bromocriptine was exposed to both Mg stearate and lactose. 3) Addition of citric acid attenuated bromocriptine degradation and the browning reaction when bromoc.:riptine was exposed to Mg stearate alone, as well as when bromocriptine was exposed to both Mg stearate and lactose. 4) Substitution ofwig stearate with stearic acid attenuated bromocriptine degradation and the browning reaction when bromocriptine was not exposed to lactose, as well as when bromocriptine was exposed to lactose. 5) Addition of citric acid and substitution of Mg stearate with stearic acid attenuated bromocriptine degradation and the browning reaction by the greatest magnitude (i.e., greater than either addition of citric acid alone or substitution of Mg stearate with stearic acid alone). 6) Substitution of Mg stearate with solid castor oil attenuated bromocriptine degradation to an even greater extent than substitution of Mg stearate with stearic acid. In summary, removing Mg stearate from a bromocriptine formulation enhances its stability in terms of a browning reaction product formation, ,vhether in the presence or absence oflactose. Lactose in the presence ofl'\,1g stearate further enhances the browning reaction. 20 Importantly, it was found that of the two components ofIVIg stearate, it is the Mg, not the stearate that facilitates the browning reaction, as replacement ofl'\,1g stearate with stearic acid markedly improves bromocriptine stability. Removing Mg stearate from a brornocriptine formulation and replacing it with stearic acid or another non-magnesium salt glidant (e.g., solid castor oil) enhances the stability of the bromocriptine formulation. Removing lactose from a bromocriptine 25 formulation and replacing it with mannitol or another short chain saccharide enhances the stability of the bromocriptine formulation. The addition of citric.: acid to a bromocriptine formulation that is substantially free of magnesium and lactose can to a finite degree further reduce (i.e., protect against) any / all of these degradation reactions, but it itself is not enough to prevent them. 67 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 :KxamJlle 5. Studies on the Stability of Bromocriptine :Pharmaceutical J?ormulations Formulated with Replacement of IVfagnesium Stearate with Stearic Add or Triglyceride and with Re11lacement of Lactose with IVlannitol. To test the relative stabilities of bromocriptine pham1aceutical formulations formulated 5 with or without l'vfg stearate and lactose, several different bromocriptine formulations (e.g., tablets) were manufactured by standard mixing and tableting procedures known in the art: 10 Formulation A: Tableted bromocriptine formulation with Mg stearate and lactose 0.945 mg bromocriptine mesylate; 9.00 mg corn starch 1500; 1.350 mg anhydrous citric acid; 77.58 mg anhydrous lactose; 0.450 mg silicon dioxide; 0.675 mg magnesium stearate Fommlation B: Tableted bromocriptine formulation with Mg stearate substituted with stearic acid and lactose substituted with mannitol 0.945 rng bromocriptine mesylate; 9.00 mg corn starch 1500; 1.350 mg anhydrous citric acid; 77.58 mg anhydrous mannitol; 0.450 mg silicon dioxide; 1.350 mg stearic acid Formulation C: Tableted bromocriptine formulation with Mg stearate substituted with 15 solid castor oil and lactose substituted with mannitol. 0.945 mg bromocriptine mesylate; 9.00 mg corn starch 1500; 1.350 mg anhydrous citric acid; 77.58 mg anhydrous mannitol; 0.450 mg silicon dioxide; 0.675 mg solid castor oil The manufactured bromocriptine fomrnlations were placed into sealed containers and subsequently subjected to an environment of 40 °C and 75~.fo relative humidity for six weeks. 20 Following six weeks' exposure to this environment, the formulations were dissolved and analyzed for bromocriptinine (the major degradant ofbromocriptine) content by HPLC analysis. Relative to bromocriptine fommlation A (which contained Mg stearate and lactose), bromocriptine formulation B (with stearic acid substituted for Mg stearate and mannitol substituted for lactose) and bromocriptine formulation C (with solid castor oil substituted for Mg 25 stearate and mannitol substituted for lactose) displayed a reduction in the amount of the 68 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 bromocriptine degradation product (i.e., bromocriptinine) in the formulations of 63%, and 88%), respectively. Example 6. Preparation, Stability and Dissolution of 1',ficronized Bromocdptine IVIesylate Pharmaceutical Formulations Prepared with Various Lubricants. 5 Test pharmaceutical formulations of micronized bromocriptine mesylate (identified as Formulations A-E) were prepared using micronized bromocriptine mesylate and various lubricants. The ingredients used for each formulation are listed in Table 8 below. 10 69 ~ Table 8: Bromocriptine Mesylate Pharmaceutical Pormulations (PF') (F'ormulations A-E) Prepared Using Micronized Bromocriptine and Various Lubricants. Formulation A (.c ontrol), B C D E mg / , O' mg / g / mg / g / mg / g / mg / ai Ingredient d .... O' PF hatch PF batch PF batch PF batch PF batch I:; Bromocriptine rnesyiate 0.95 10.6 0.95 10.6 0.95 10.6 0.95 10.6 0.95 10.6 ( micronized) Com starch ~'F 9.00 99.9 9.00 99.9 9.00 99.9 9.00 99.9 9.00 100.0 Citric acid NF 1.35 15.0 l.35 15.0 1.35 15.0 1.35 15.0 1.35 15.0 Anhydrous lactose NF 77.58 861.9 76.48 849.5 76.48 849.5 76.48 849.5 77.88 865.0 10 Colloidal Si02 NF 0.45 5.0 0.45 5.0 0.45 5.0 0.45 5.0 0.45 5.0 Magnesium stearate NF 0.68 7.6 0.4 4.4 Stearic acid NF 1.8 20 Sodium stearyl L8 20 fumarate NF Hydrogenated castor oil 1.8 20 15 (KOLLIWA.X@ HCO) Total Weight 90.0 1000 90.0 1000 90.0 1000 90.0 1000 90.0 1000 ~ 0 ~ .0. . ~ ~ 0'I ~ i:.; n-= ~ 00 ~ .0. . ~ UI 0'I UI UI ~ ~ 0 ".0.. ', "u,' "" "0 "0 I .0. ..I. ..., CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 The formulations were then stored at 25 ± 2 °C and 60 ± 5%RH, at 30 ± 2 °C and 65 ,J, 5%RH or at 40 ,_i~ 2 °C and 75 :..f:. 5~c,RH for up to 3 months. The total related substances impurity in each batch of formulations was measured using an HPLC method was determined at the beginning of the experiment (T===0) and at 1, 2 andior 3 months. Since bromocriptine is light sensitive, amber glassware was used for all solution preparations. To determine the amount of related substance, at least 5 formulations were weighed to determine the average fommlation weight. An aliquot of the ground sample equivalent to 3.5 fonnulations (2.8 mg ofbromocriptine) was accurately weighed and quantitatively transferred the sample into a 25 ml volumetric flask. Aqueous methanol (1:l v / v, 15 ml) was added and the solution was sonicated for 10 minutes then diluted to 25 ml total volume and mixed well. The sample solution was then filtered and analyzed by reversed phase HPLC using a Waters 250 x 4.6 mm SLTJ\i"FIRE Cl8 column (5 ~tm pmiicle size), an isocratic mobile phase of0.l M potassium phosphate buffer (pH 7.5) / acetonitrile (1: 1 v / v), an autosampler temperature of 5 °C, an injection volume of l00μL, a :flow rate of l.5~tL / min, ambient column temperature and detection by UV absorption at 300 nm. Under these conditions, brnrnocriptine elutes in about 11- 15 minutes and the impurity brornocriptinine elutes in about 35-45 minutes (a relative retention time of about 2.6). The related substances impurity was calculated using the formulae: ?-·~ Individual Related Substance"" Ai / At X 100 % Total Impurities = L¾ Individual Related Substance wherein: A = Peak area for an individual related substance in the sample solution chromatogram At"" Total area for all peaks in the sample chromato6,ram, disregarding the void disturbance and any peaks observed in the chromatogram of the diluent. The results of the stability testing are shown in Table 9 and Figures IA, 1B, and 1C. Fi6:rure 3 shows typical chromatograms of a blank solution, a reference solution containing 0.112 mg / ml of bromocriptine mesylate, and a sample solution. 71 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Table 9: Measurement of Related Substances in Bromocriptine Mesylate Pharmaceutical Formulations (Formulations A-E) Prepared Using l\ / [icronizcd Bromocriptine Mesylate and Various Lubricants. :Formulation Conditions Related Substances(%) 'f•==0 T•==l month T==2 months T===,J months 40 °C / 75%RH 3.8 7 ., . _, 11.0 A 30 °C / 65%RH 0.4 --- --- 3.1 (control) 25 °C / 60%RH --- --- 1.6 B 40 °C / 75'%RH 0.6 3.9 5.8 Not tested 40 °C / 75%RH 2.0 3.0 4.9 C 30 °C / 65%RH 0.7 --- --- 1.6 25 °C / 60%:iRH --- --- 1.3 40 °C / 75%RH 0.4 0.5 2.5 D 30 °C / 65%,RH 0.2 --- --- 0.4 25 °C / 60%iRH --- --- 0.4 40 °C / 75%,RH 2.4 4.0 5.6 E 30 °C / 65%1RH 0.3 --- --- 1.8 25 °C / 60~'oRH --- --- 0.9 The results summarized in Table 9 are also shown in Figures lA, lB, and lC. Figure IA shows a plot of the total related substances impurity measured for bromocriptine mesylate pharmaceutical formulations (formulations A-E) prepared using micronized bromocriptine mesylate and various lubricants at the beginning of the experiment (T=0) and following storage at 40 ± 2 °C and 75 ± 5'?,oRH for 1, 2 or 3 months. Figure lB shows a plot of the total related substances impurity measured for bromocriptine mesylate pharmaceutical formulations (formulations A and C-E) prepared using micronized bromocriptine mesylate and various lubricants at the beginning of the experiment (T=0) and following storage at 30 ± 2 °C and 65 ± 5'?,,oRH for 3 months. Figure IC shows a plot of the total related substances impurity measured for bromocriptine mesylate pham1aceutical formulations (formulations A and C-E) prepared using micronized bromocriptine mesylate and various lubricants at the beginning of the experiment (T"00) and following storage at 25 :t, 2 °C and 60 :.}:. 5%RH for 3 months. 72 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 The results of this study demonstrate that substitution within the described tableted micronized bromocriptine formulation of magnesium stearate (Formulation A) with either stearic acid (Formulation B), sodium stearyl fumarate (Fommlation C), or hydrogenated castor oil(Fonnulation D) in the otherwise same micronized bromocriptine formulation (and all containing lactose and citric acid) each markedly enhanced the stability of the micronized bromocriptine to heat and humidity over the test period in the test conditions employed. In addition to testing for the presence of impurities, dissolution testing was pe1formed for formulations A and C-E at the beginning of the experiment (T===O) and following storage at 25 ± 2 °C and 60 ± 5%iRH for 3 months. The results of the dissolution testing are shown in Table 10. The samples were tested using a USP Type 2 Apparatus at 50 RPM in 500 ml ofO. l N hydrochloric acid at 37 ,tc 0.5 °C with the sample drawn at 30 minutes. The bromocriptine mesylate in the sample was quantitated by HPLC as described above. Table 10: Dissolution of Bromocriptine Mesylate Pharmaceutical Formulations (Formulations A and C-E) Prepared Using lVIicronized Bromocri11tine 1\-Iesylate and Various Lubricants after 30 min. (USP Type 2 Apparatus, 50 RPM) in 0.1 N Hydrochloric Acid at 37 ± 0.5 °C Before and After Storage at 25 ± 2 °C and 60 ± 5%RH for 3 months. Formulation T=O T=3 months A 1O4.O~o 102.3%1 C 103.6% 10O.9~'o D 103.9% 98.7% E 106.2%, 100.9~0 Example 7. Citric acid was dissolved, in separate reaction vessels, in one of either methanol, ethanol, or butanol at about 4mg per ml at room temperature Free base bromocriptine was dissolved in separate reaction vessels in either methanol, ethanol, or butanol at about 12 mg per 5-30 ml. The like organic solutions of citric acid and ofbromocriptine (i.e., ethanol --ethanol, methanol-methanol, butanol-butanol) were then mixed in an equi-mole amount of bromocriptine and citrate. The three resulting solutions were stirred for about 2- 24 hours at room temperature until the solvent evaporated to dryness. The resulting solid product in each reaction vessel contains bromocriptine citrate. 73 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Example 8: Solubilitv of bromocriptine citrate relative to bromocriptine mesylate Solid samples of equal amounts ofbromocriptine mesylate and bromocriptine citrate were added, under various pH conditions, to equal volumes of water or water / organic solutions in different vessels and the dissolution of the brnmocriptine samples (aqueous solubility) was assessed over time. Bromocriptine citrate was found to dissolve much more quickly and with significantly greater solubility (increased mg of bromocriptine dissolved per ml of water in the citrate vs mesylate salt form) compared to bromocriptine mesylate. Example 9 Citric acid was dissolved in ethanol and free base bromocriptine was dissolved in an organic solvent in separate reaction vessels. The organic.: solutions of citric acid and ofbromocriptine were then mixed in an equi-mole amount of bromocriptine and citrate. The resulting solution was stirred for about 2- 24 hours at low temperature and the solvent was evaporated to dryness. The resulting solid product contained bromocriptine citrate which was over 7-fold more water soluble at 20C than bromocriptine mesylate. Example 10. Effect of constituents on the stability and solubility of bromocriptine formulations. DitTerent pharmaceutical formulations ofbromocriptine are manufactured with varying inclusion / substitution of the constituents as described in Table 11 (below) and in the descriptions of herein versus a traditional formulation of bromocriptine mesylate as described in Table 1. The stability and solubility of the formulations are assessed versus a traditional fonnulation of bromocriptine mesylate as described in Table 1. Relative to the traditional pharmaceutical formulation described in Table 1, the pharmaceutical formulation of bromocriptine citrate, fatty acid or triglyceride, non-lactose short chain saccharide, and citric acid is found to have an improved stability to heat and humidity (tested at 40C and 75%RH) and water solubility(at 20C) versus the traditional pharmaceutical formulation ofbromocriptine mesylate and also versus any 1,2, or 3 combinations of components of the pharmaceutical formulation of bromocriptine citrate, fatty acid or triglyceride, non-lactose short chain saccharide, and citric acid. 74 -..I UI TABLE 11. EFFECT OF CONSTITUENTS ON THE STABILITY AND SOLUBILITY OF BROMOCRIPTINE FORMULATIONS FORMULATION CONSTITUENTS Relative Relative Fatty Short Citric Improvement In Heat Improvement in Water Acid Such As Chain Acid & Humidity Stability Solubility Bromocriptine Stearic Acid Saccharide Versus Versus Mesylate or Such As Traditional Traditional Or Triglyceride Mannitol Bromocriptine Bromocriptine Bromocriptine Substituted Substituted Mesylate Mesylate Citrate For Mg For Lactose Pharmaceutical Pharmaceutical Stearate Formulation* Formulation* ✓ ++2 --- ✓ + - ✓ ++ ++ Bromocriptine ✓ ✓ +++ Mesylate1 -- ✓ ✓ +++++ ++ ✓-- ✓ +++ ++ ✓ ✓ ✓ +++++++ ++ ✓ ++ ++-+ ~ 0 N ,0. . ~ ~ 0'I N ~ "'d ("') ~ r,i N ,0. . ~ UI 0'I UI UI ""' ~ 0 "0 ' ..J "u,' ""'' "0 ' "0 ' I .0. ,.I. ..J -..I O'I ✓ -t-· , / -~--~- Bromocriptine ✓ ✓' +++ Citrate1 ✓- ✓ +++++ ✓ ✓ +++ ✓ ✓ ✓ ++++++++ * Traditional pharmaceutical formulation of bromocriptine mesylate as described in Table 1 1 The bromocriptine may be micronized or not. 2 each+ represents a quantum improvement and a - represents no change_ +-1-...J... ++++++ +...L...L I I ++++++ ++++++ +++++++ ~ 0 N ,0. . ~ ~ O'I N ~ "'d ("') ~ r,i N ,0. . ~ UI O'I UI UI ""' ~ 0 "0 ' -J "u,' ""'' "0 ' "0 ' I .0. ,.I. -J 77 Example 11 Procedure For Blending Formulations VS-55F-A, B, C, D, : Formulation Guide for VS-55F-A Procedure For Blending Formulation VS-55F-A : A 50 ml round flask with cap was charged with 0.075 grams of Bromocriptine and 0.150 grams of Citric Acid. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 0.250 grams of Klucel EF Pharm, 0.350 grams of crosscarmellos, and 0.050 fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 1.725 grams of AvicelTM PH 102, and 2.350 grams of Mannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 0.050 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for two minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm convex round with an average weight of about 0.100+ / -5% grams. Excipient Name % Ratio Weight (mg) Excipients for 50 Tablets (gr.) Bromocriptine mesylate 1.50 1.500 0.075 Citric Acid (Anhydrous) 3.00 3.000 0.150 HPC Klucel EF Pharm 5.00 5.000 0.250 Avicel Ph102 34.50 34.500 1.725 Crosscarmellose Sodium 7.00 7.000 0.350 Mannitol 47.00 47.000 2.350 Fumed Silica 1.00 1.000 0.050 Stearic Acid 1.00 1.000 0.050 Total 100.00 100.000 5.000 CA 3079522 Date reçue / Received date 2025-03-03 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Formulation Guide for VS-55F-B Excipient Name % Ratio \Veight (mg)_ --~!-~ipients for 50 Tablets (gr__. )_ __ -------- Bromocriptine ]\fosylate 1.43 1.000 0.050 Citric Acid (Anhydrous) 3.00 2.100 0.105 HPC Klucel EF Pharm 5.00 3.500 0.175 Avicel Phl 02 34.57 24.200 1.210 Crosscarmellose Sodium 7.00 4.900 0.245 lVIannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure For :Blending Formulation VS-55F-B: A 50 ml round flask with cap was charged with 0.050 grams of Bromocriptine and 0.105 grams of Citric Acid. The mixture ,vas then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.175 grams of Klucel EF Pharm, 0.245 grams of crosscarmellos, and 0.035 grams of fumed silica was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.725 grams of Avicel PH 102, and 1.645 grams of mannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for five minutes. After rolling for five minutes the mixture was loaded into the foeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tollerable for the TDP 1.5 (about 1.5 Tons of pressure), The tablet shape was a 6 mm convex round with an average weight of about 0.070+ / -5% grams. Results and Observations for VS-55F-B: The hardness of the formulation was about 6.0-6.9 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 3.17-3.65 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is not within specifications. :Formulation Guide for VS-55F'-C 78 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Excipient Name % Ratio I '\Veight (mg) Excipients fo:r 50 Tablets (gr.) Bromocliptine l\!lesylate 1.43 LOOO 0.050 Citric Acid (Anhydrous) 3.00 2.100 0.105 HPC Klucel EF Pharm 3.57 2.500 0.125 A vicel Ph 102 34.57 24.200 1.210 Crosscarmellose Sodium 8.43 5.900 0.295 Mannitol 47.00 32.900 1.645 Fumed Silica LOO 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure For mending lfornmlation VS-55P-C: A 50 ml round flask with cap \Vas charged with 0.050 grams ofBromocriptine and 0.105 grams of Citric Acid. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.125 grams ofKlucel EF Phatm, 0.295 grams of crosscarmellos, and 0.035 grams of furned silica was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.210 grams of Avicel PH 102, and 1.645 grams of mannitol was added. The mixture was then briskly shaken for a few seconds then it was pla<.:ed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.035 grarns of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for five minutes. After rolling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDPl.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm convex round \Vith an average weight of about 0.070+ / -5% grams. 79 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Results and Observations for VS-54F-C: The hardness of the formulation ,vas about 7-8 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 3.17-3.83 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Formulation Guide for VS-55F-D (53F-D.l) Excipient Name %, Ratio Weight (nu?:) Excipients for 50 Tablets '2:r.) VS1001 1.50 1.500 0.075 Citric Acid (Anhvdrous) 3.00 3.000 0.150 HPC Klucel EF Phann 5.00 5.000 0.250 A vi eel Ph 102 34.50 34.500 1.725 Crosscarmellose Sodium 7.00 7.000 0.350 Sorbitol 47.00 47.000 2.350 Fumed Silica 1.00 1.000 0.050 Stearic Acid 1.00 1.000 0.050 Total 100.00 100.000 5.000 Procedure For Blending Formulation VS-55F-D: A 50 ml round flask with cap was charged with 0.075 grams ofBromocriptine and 0.150 grams of Citric Acid. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend w~as pem1itted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 0.250 grams ofKlucel EF Pharm, 0.350 grams of crosscarmellos, and 0.050 fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 1.725 grams of Avicel PH 102, and 2.350 grams of sorbitol was added. The mixture was then briskly shaken for a few seconds then it \Vas placed in the roller where the blend was permitted to roll (at highest speed) for 10 minutes. After rolling for 10 minutes blending was stopped and to the blend 0.050 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for two minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at the highest pressure tolerable for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm convex round with an average weight of about 0.100+ / -5% grams. 80 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 After completing the run hardness tests, disintegration tests, and observations were made. Results and Observations for VS-54F-B.1: The hardness of the formulation was about 16-16.5 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 8.67-9.0 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Procedure For Blending Formulations VS-56F-A, B, C, D, E, and F: Foxmu.Lati.o.n .G u.id.a. .f o. r., V.S-5.6E-il ~~~ ~ ... ·-· Excipient Name % Ratio '\Veight (mg) Excipients for 50 Tablets (!!r.) Bromocriptine 1\11esylate 1.43 1.000 0.050 Citric Acid (Anhydrous) 3.00 2.lOO 0.105 Menthol 0.50 0350 0.018 HPC Klucel EF Phann 5.00 3.500 0.175 Avicel Ph 102 34.07 23.850 1.193 Crosscannellose Sodium 7.00 4.900 0.245 I\,fannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure For Blending Formulation VS-56F-A : A 50 ml round flask with cap was charged with 0.050 grams of Bromocriptine 0.105 grams of Citric Acid, 0.018 grams of menthol, and 0.175 grams of Klucel EF Phann. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend l. 193 grams of Avicel PH 102, 0.245 grams of crosscarmellos, and 0.035 grams offomed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams of .1\,fannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. 81 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at a pressure lower than the maximum for the TDP 1.5 (about 0.75 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5% grams. After completing the nm hardness tests, disintegration tests, and observations were made Results and Observations for VS-56F-A : The hardness of the formulation was about 2.8 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 1.5 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity was within specifications. Conclusion for VS-56F-A : Formulation meets content uniformity and disintegration specifications. Tablet formulation will be evaluated for release of APL Formulation Guide for VS-56F'-B Excipient Name % Ratio Weight (mg) Excipients for 50 Tablets far.) Bromocriptine Mesylate 2.14 1.500 0.075 Citric Acid (Anhydrous) 3.00 2.100 0.105 Menthol 0.50 0.350 0.018 HPC Klucel EF Phann 5.00 3.500 0.175 Avicel Phl 02 33.36 23.350 1.168 Crosscarmellose Sodium 7.00 4.900 0.245 Mannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total l00.00 70.000 3.500 82 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Procedure For Blending Formulation VS-56F-B: A 50 ml round flask with cap was charged with 0.075 grams of Bromocriptine 0.105 grams of Citric Acid, 0.CH8 grams of menthol, and 0.175 grams ofKlucel EF Phann. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.168 grams of Avicel PH 102, 0.245 grams of crosscarmeilos, and 0.035 grams of fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams of Mannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After roiling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at a pressure lower than the maximum for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5€½) grams. After completing the run hardness tests, disintegration tests, and observations were made. Results and Observations for VS-56F-B: The hardness of the formulation was about 3.9 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 1.38 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Conclusion for VS-56F-B: Formulation meets content uniformity and disintegration specifications. Tablet formulation will be evaluated for release of APt 83 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Pornmiation Guide for VS-56:F'-C Excipient Name % Ratio I Weh?ht (mg) Excipients for 50 Tablets (gr.) VS1001 1.43 1.000 0.050 Citric Acid (Anhydrous) 3.00 2.100 0.105 :Menthol 0.50 0.350 0.018 HPC Klucel EF Pharm 5.00 3.500 0.175 Avicel Ph102 34.07 23.850 1.193 Explotab 7.00 4.900 0.245 Mannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure For Blending Formulation VS-56F-C: A 50 ml round flask with cap was charged with 0.050 grams of Bromocriptine 0.105 grams of Citric Acid, 0.018 grams of menthol, and 0.175 grams of Klucel EF Pharm. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.193 grams of Avicel PH 102, 0.245 grams of crosscam1ellos, and 0.035 grams of fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams ofMannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for five rninutes the rnixture was loaded into the foeder of the tablet press. The mixture was then pressed into tablets at a pressure lmver than the maximum for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5% grams. After completing the run hardness tests, disintegration tests, and observations were made. 84 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Results and Observations for VS-56F-C: The hardness of the formulation was about 3-3.5 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 1.33 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Conclusion for VS-56F-C: Formulation meets content uniformity and disintegration specifications . Tablet fonnulation will be evaluated for release of APL Formulation Guide for VS-56F-D Excipient Name % Ratio 'Weight (mg) Excipients for 50 Tablets (gr.) VS1001 1.43 1.000 0.050 Citric Acid (Anhydrous) 3.00 2 100 0.105 PEG 3350 0.14 0.100 0.005 HPC Klucel EF Pharm 5.00 3.500 0.175 Avicel Phl02 34.43 24.100 1.205 Explotab 7.00 4.900 0.245 l\fannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure For Blending ]formulation VS-56.F-D : A 50 ml round flask with cap was charged with 0.050 grams of Bromocriptine 0.105 grams of Citric Acid, 0.005 grams of PEG 3350, and 0.175 grams of Klucel EF Phann. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.205 grams of A vicel PH 102, 0.245 grams of crosscarmel1os, and 0.035 grams of fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams of Mannitol was added. The mixture ,vas then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.()35 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a :few seconds, then it was rolled at the highest speed for 5 minutes. 85 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 After rolling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at a pressure lower than the maximum for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5% grams. After completing the run hardness tests, disintegration tests, and observations were made. Results and Observations for VS-56F-D : The hardness of the formulation was about 3.8 KP. The appearance of the tablets were \vhite in color. The disintegration time for this formulation was about 1.08 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Conclusion for VS-56F-D: Formulation meets content uniformity and disintegration specifications. Tablet formulation will be evaluated for release of APL ]<'ormulation Guide for VS-56F-E Exdpient Name (% Ratio \\ / eight ( mg) ]~xdpients for 50 Tablets (gr.) VS1001 2.14 1.500 0.075 Citric Acid (Anhydrous) 3.00 2.100 0.105 Menthol 0.50 0.350 0.018 HPC Klucel EF Pharm 5.00 3.500 0.175 Avicel Ph102 33.36 23.350 1.168 Explotab 7.00 4.900 0.245 l'vfannitol 47.00 32.900 1.645 Fumed Silica 1.00 0.700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 Procedure :For Blending ]formulation VS-561'-E: A 50 mi round flask with cap was charged with 0.075 grams of Bromocriptine 0.105 grams of Citric Acid, 0.018 grams of menthol, and 0.175 grams of Klucel EF Pham1. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.168 grams of Avicel PH 102, 0.245 grarns of Explotab, and 0.035 grams of fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pem1itted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams ofMannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was pennitted to roll (at highest speed) for 5 minutes. 86 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at a pressure lower than the maximum for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5% grams. After completing the nm hardness tests, disintegration tests, and observations were made. Results and Observations for VS-56F-E: The hardness of the formulation was about 4.0 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 1.5 minutes. The flow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Conclusion for VS-56F-E: Formulation meets content uniformity and disintegration specifications. Tablet formulation will be evaluated for release of APL ]◄'ormulation Guide for VS-56F-F 1<:xdpient Name % Ratio \Veight (me:) ]~xdpients for 50 Tablets (gr.) VS1001 1.43 1.000 0.050 Citric Acid (Anhydrous) 3.00 2.100 0.105 Menthol 0.50 0.350 0.018 PEG3350 0.14 0.100 0.005 HPC Klucel EF Pharm 5.00 3.500 0.175 Avicel Ph102 33.93 23.750 1.188 Crosscarmellose Sodium 7.00 4.900 0.245 Mannitol 47.00 32.900 1.645 Fumed Silica LOO 0,700 0.035 Stearic Acid 1.00 0.700 0.035 Total 100.00 70.000 3.500 87 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Procedure For Blending Formulation VS-56F-F: A 50 ml round flask with cap was charged with 0.050 grams of Bromocriptine 0.105 grams of Citric Acid, 0.018 grams of menthol, 0.005 grams of PEG 3350, and 0.175 grams ofKlucel EF Pharm. The mixture was then briskly shaken for a few seconds then it was placed in the roller ,vhere the blend ,vas permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 1.188 grams of Avicel PH 102, 0,245 grams of crosscam1ellos, and 0.035 grams of fumed silica was added, The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend, and 1.645 grams ofMannitol was added. The mixture was then briskly shaken for a few seconds then it was placed in the roller where the blend was permitted to roll (at highest speed) for 5 minutes. After rolling for 5 minutes blending was stopped and to the blend 0.035 grams of stearic acid was added. After the addition of the stearic acid the mixture was then briskly shaken for a few seconds, then it was rolled at the highest speed for 5 minutes. After rolling for five minutes the mixture was loaded into the feeder of the tablet press. The mixture was then pressed into tablets at a pressure lower than the rnaximum for the TDP 1.5 (about 1.5 Tons of pressure). The tablet shape was a 6 mm flat round with an average weight of about 0.070+ / -5% grams. After completing the run hardness tests, disintegration tests, and observations were made. Results and Observations for VS-56F-F: The hardness of the formulation was about 3.8 KP. The appearance of the tablets were white in color. The disintegration time for this formulation was about 1. 5 minutes. The fiow properties of this granulation mixture was suitable for use in a gravity feed press. Content uniformity is within specifications. Conclusion for VS-56F-F: Formulation meets content uniformity and disintegration specifications. Tablet formulation will be evaluated for release of API. 88 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Example 11 Two dissolution studies were performed on the tablet formulations produced in this pr~ject as shown below (set I and 2): 1st Set ( 4 Tablets) VS-ER-NL-55F-A (1.5%, BC) VS-ER-l\.'L-55F-B (1.43% BC) VS-ER-NL-55F-C (1.43% BC) VS-ER-:i\.'L-55F-D.1 (1.5% BC) 2nd Set (6 Tablets) VS-ER-NL-56F-A (1.43% BC) VS-ER-NL-56F-B (2.14% BC) VS-ER-NL-56F-C (1.43 1% BC) VS-ER-NL-56F-D (1.43% BC) VS-ER.-NL-56F-E (2.14% BC) VS-ER-:i\.'L-56F-F (1.43% BC) HPLC 1\ / 1:ethod Description: The following describes the HPLC conditions (instrument, settings, etc.) for the analysis of the samples. Column: \Vaters Symmetry Shield RP18, 3.5 micron 4.6 x 150 mm PIN 186000180 Mobile Phase A: 0.1%)TFA Water Mobile Phase B: 0.1 ~,~ TFA Acetonitrile Gradient: Time %B 0 20 5 35 20 40 21 20 25 20 Flow: 1 ml / min Detection UV: 300nm Diluent: 0.5% Citric Acid Column Oven Temperature: 30°C. Injection Volume: 100 microliters Sample tray at 5°C. 89 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 HJ>LC Standards Preparation A primary stock solution was prepared by accurately weighing and dissolving 30 mg of BC in a 25 ml volumetric flask. (Diluent - 0.5%> citric acid) (About 1.2 mg / ml) A secondary stock solution was prepared by taking 1 ml of the primary stock and diluting to 10 mls in a volumetric flask. (About 0.12 mg / ml) Different volumes of the secondary stock solution were taken into separate 10 ml volumetric flasks to prepare the standards that were directly injected for the calibration curve. The volumes and approximate concentrations are shown below; 0.125ml '" about 0.0015 mg / ml 0.250ml '" about 0.003 mg / ml 0.500ml =0 about 0.006 mg / ml 1.000ml = about 0.012 mg / ml 1.500ml "" about 0.018 mg / ml A spreadsheet ,vas developed to plot the area vs. concentrations of the standards. The slope and intercept of this line equation was used to calculate the concentrations of each of the pull points in the dissolution runs. Dissolution l\1lethod From each of the lots described above, 11 tablets were weighed and added to 1000ml of 0.5% citric acid solution at 3 7°C. The dissolution apparatus was setup with paddles at 100 RPM. (Apparatus 2) For the I st series of experiments described above, samples were pulled at 5, 10, 15, 20, 30, 45 and 60 minutes. The pull points for the second series of experiments were more frequent and were done at earlier time points in an attempt to capture the faster drug release. These time points were as follmvs: 5, 7.5, 10, 15, 30 and 60. For each pull point, about 1 ml of the solution was sampled. The samples were centrifuged to remove any particles and the supernatant was directly injected. The solubility curves were plotted in the spreadsheet. The concentration was detem1ined using the calibration curve and the percent release determined using the total weight of the 11 tablets and the percent BC, 90 CA 03079522 2020-04-17 WO 2019 / 079623 Dissolution Test Results for 55F and 56F Series 55F Series Results: 1st Set ( 4 Tablets) VS-ER-NL-55F-A (1.5~1> BC) VS-ER-NL-55F-B (1.43% BC) VS-ER-l\.'L-55F-C (1.43% BC) VS-ER-NL-55F-D.1 (1_5<% BC) Graph 1. Calibration Curve for 55F Series Dissolution Tests 800 700 600 500 • 400 • 300 • 200 • 100 • 0 0 0.005 0.01 Concentration 0.015 0.02 y "" 40635x - 6. 193 R2 "' 0.99995 -----------------------------------------------. • Series1 •... -unear_{Series1) ___ _! Table 1: Dissolution Test Results.for i:'l-E,7R-NL-55J-i'. .. A (1.5% BC) Time Area Vial Concentration Minutes Concentration (m2) 5 616.8 0.015331526 15.33 lO 661.1 0.016421725 16.42 15 667.8 0.016586608 16.59 20 665.9 0.016539851 16.54 30 666.4 0.016552155 16.55 45 669.0 0.01661614 16.62 PCT / 0S2018 / 056554 0 / 4, Theory Release 92.38 98.95 99.94 99.66 99.74 100.12 Graph 2: Graph (if Dissolution Test Results.for VS-ER-NL-55F'-A (J.5?--f., BC) c:' 05.00 0 c:I,) .i:::: 1:--< $. 00.00 20 40 60 91 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Conclusion for VS-ER-NL-55F-A (1.5% BC): Tablet ,vill be submitted for use in animal studies. Table 2: Dissolution Test Results fh.. r VS-E'R-NL-55J,'-B fl.43% BC) ' . Time Area Vial Concentration % Theory Minutes Concentration (mg) Release 5 425.9 0.010633579 10.63 95.80 10 434.7 0.010850142 10.85 97.75 15 437.3 0.010914127 10.91 98.33 20 436.5 0.010894439 10.89 98.15 30 435.8 0.010877212 10.88 98.00 45 435.4 0.010867369 10.87 97.91 60 436.1 0.010884595 10.88 98.06 Graph 3: Graph ~ / Dissolution Test Results.for v~S-ER.. -NL-55r..' --B (1.43% BC) t' 9.00 Q Cl.I .c: e,... ~ 8.00 <:> 0 VS---ER---NL--- () 92 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / US2018 / 056554 Conclusion for VS-ER-NL-55F-B (1.43% BC): Tablet will be submitted for use in animal studies. Table 3: Dissolution Test Results for r~r;;-ER.-NL-55F-C (1.43% BC) Time Area Vial Concentration Minutes Concentration (m2:) 5 437.3 0.010914127 10.91 10 442.7 0.011047018 11.05 15 439.3 0.010963346 10.96 20 441.5 0.011017486 11.02 30 442.7 0.011047018 11.05 45 441.9 0.01102733 11.03 ' . I, . ..............T.....i.m.....e... ........................... Area. ..........................V....i..a...l.. .........................C....o...n....c..e _. n....t..r. a· tion Mmutes Concentration (m2:) 5 10 15 20 30 45 t:' 00.00 0 <:LI ..c: 1--< :":'R 389 0.009725489 9.73 579.9 0.014423436 14.42 596.5 0.014831954 14.83 603 0.014991915 14.99 608.4 0.015124806 15.12 616.2 0.01531676 15.32 VSH•ER-HNL~H ~................................... .............. .. ...... .. 1.- ' ,.... .. ... ,., ........................................................................ , ..................................... , ................................... . t"""'""'"""""'""'"""""'""'"""""'""'""""" 20 40 "'············ ................................................................................................................... ···········~---·~~--·~ -~ 93 % Theory Release 99.02 100.22 99.46 99.96 100.22 100.04 % Theory Release 59.02 87.53 90.01 90.98 91.79 92.96 CA 03079522 2020-04-17 WO 2019 / 079623 Conclusion for VS-ER-NL-55F-D (1.5% BC): Tablet performs in the same manner as in previous experiment. 56F Series Results: 2nd Set (6 Tablets) VS-ER-NL-56F-A (1.43% BC) VS-ER-NL-56F-B (2.14~1> BC) VS-ER-N1-,-56F-C (1.43%:i BC) VS-ER-NL-56F-D (1.43% BC) VS-ER-NL-56F-E (2.14~'o BC) VS-ER-N"'L-56F-F (1.43% BC) Graph 6. Calibration Curve for 56F Series Dissolution Tests 00 0 0.01 0.015 ♦ Sarias1 PCT / 0S2018 / 056554 Table 5: Dissolution Test Results for VS-ER-N1-,-56F-A (1.43% BC) Time Area Vial Concentration % Theory Minutes Concentration (mg) Release 2 395.7 0.009927212 9.93 87.29 5 429.7 0.010762121 10.76 94.63 7.5 425.4 0.010656529 10.66 93.70 lO 420 0.010523926 10.52 92.54 15 422.4 0.010582861 10.58 93.05 30 428.5 0.010732653 10.73 94.37 60 434.4 0.010877535 10.88 95.65 94 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Figure 7: Graph cf Dissolution Test Resultsfor V.S"-E'R-NL-56F-A (J.43%BC) oot i VS···ER···~~ I sL ~ ,.-................................. ,. ..................................... - I I - - - - - - - - - - - - _J Conclusion for VS-ER-NL-56P-B (2.14% BC): Tablet will be submitted for animal testing Graph 6: Dissolution Test Results fbr VS-ER-NL-56F'-B (2.14% BC; Time Area Vial Concentration % Theory Minutes Concentration (m2:) Release 2 618.1 0.0153885 15.39 92.16 5 638.4 0.01588699 15.89 95.14 7.5 643.4 0.016009771 16.01 95.88 lO 650.1 0.016174297 16.17 96.86 15 655.3 0.016301989 16.30 97.63 3n - V 665.6 0.016554917 16.55 99.14 60 671.4 0.016697343 16.70 99.99 95 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Graph 8: Graph cd'Dissolution Test Resultsfor -r:S'-ER-NL-56F-B (2.14%BC) ~ 05.00 II,) .i:::: E-< "$. 00.00 donclusion for VS-ER-NL-56f-'b (2.14~ / o BC): t ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : Tablet will be submitted for animal testing. Table 7: Dissolution TestResultsfor VS-ER-NL-56F-C (1.43% BCJ Time Area Vial Concentration Minutes Concentration (m!!\ 2 491.3 0.01227478 12.27 5 429 0.010744931 I0.74 7.5 431.2 0.010798955 10.80 10 434.2 0.010872623 I0.87 15 461.2 0.01153564 11.54 30 443.8 0.011108363 11.11 60 444.4 0.011123096 11.12 Graph 9: Graph<? / Dissolution Test Resultsfor VS-ER-NL-56F-C 43% BC:J e· 2s.oo 0 ll.l ..i:::: E- ~ 20.00 n,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn• ,❖-. 0 0 Conclusion for VS-ER-NL-56F-C (1. 43% BC): Tablet will be submitted for animal testing. 96 (¼) Theory Release 119.58 104.68 105.21 105.92 112.38 108.22 108.36 CA 03079522 2020-04-17 WO 2019 / 079623 HPLC and Dissolution Method and Test Results PCT / 0S2018 / 056554 Neo-Advent Technologies, LLC Submitted By: Dr. Kenneth Avery Experiment#: VS-ER-003.4 Table 8: Dissolution Test Results for v'.S-ER-NL-561.;'-D (1.43%BC) Time Minutes 2 5 7.5 10 15 30 60 t:' 10.00 0 <:LI .i::: E--< ~ 00.00 Area Vial Concentration 372.5 0.009357509 444.2 0.011118185 454.4 0.011368658 457.3 0.011439871 457.9 0.011454604 459.5 0.011493894 459 0.011481616 ..,:,,-:- ............. ,... .............. ,... ........... ,... ........... ,..,.. ............ ,... ........... ,... ........... ,..,.. ............ ,... ........... ,... ........... ,..,.. ............ ,... ........... ,... ........... ,..,.. .... 0 Concentration (m2) 9.36 11.12 11.37 11.44 11.45 11.49 11.48 :-...nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,nn,nn,,nn,,,) Conclusion for VS-ER-NL-561'-D (1. 43% BC): Tablet will be submitted for animal testing. Table 9: Dissolution Test Resultsfor V.S-ER-NL-56F-E (2.14%BC) Time Area Vial Concentration Minutes Concentration (mg) 2 636 0.015828055 15.83 5 671.8 0.016707166 16.Tl 7.5 679.7 0.016901159 16.90 10 683.1 0.01698465 16.98 15 688.7 0.017122164 17.12 30 694.8 0.017271957 17.27 60 698.9 0.017372637 17.37 97 % Theory Release 83.43 99.13 101.37 102.00 102. 13 102.48 102.37 % Theory Release 92.86 98.02 99.16 99.65 100.45 101.33 101.92 CA 03079522 2020-04-17 WO 2019 / 079623 PCT / 0S2018 / 056554 Graph 11: Graph ~f Dissolution Test Results for VS-ER-NL-56F-E (2.14% BC) VS···ER···NL--- 5 ::,.., r.... 05.00 0 Q,) .c: E- ~ 00.00 "' 0 10 0 Conclusion for VS-ER-NL-56F-F (2.14% BC): Tablet will be submitted for animal testing. 15 Table 10: Dissolution Test Results / cw VS-ER-NL-56F-F (J.43%BC) Time Area Vial Concentration % Theory l\'linutes Concentration (mg) Release 2 402.7 0.010099105 10.10 89.27 5 430.4 0.01077931 10.78 95.28 7.5 438.8 0.010985582 10.99 97.11 10 446.2 0.011167297 l Ll7 98.71 15 454.8 0.01137848 11.38 100.58 30 470.6 0.011766467 11. 77 104.01 60 483 0.012070964 12.07 106.70 Gmph 12: Graph cf Dissolution Test Results.for VS-ER-NL-56F-F (=1.43%BC) 20 VS---ER---NL--- 25 Conclusion for VS-ER-NL-56F-F (1.43% HC): 30 Tablet will be submitted for animal testing. 98 99 A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other embodiments are within the scope of the present disclosure. 5 *** According to certain aspects, embodiments of the present disclosure as described herein include the following items: Item 1. A pharmaceutical formulation comprising bromocriptine citrate and an excipient, wherein the excipient comprises a fatty acid or a triglyceride, a non-lactose short 10 chain saccharide, and citric acid and wherein the bromocriptine citrate is soluble in water to at least 200 mg / L at 20ºC and is present in an amount that provides a dose of at least 0.1 mg of bromocriptine. Item 2. The pharmaceutical formulation of item 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C6-C14 fatty acids. 15 Item 3. The pharmaceutical formulation of item 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C14-C26 fatty acids. Item 4. The pharmaceutical formulation of item 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C16-C20 fatty acids. Item 5. The pharmaceutical formulation of item 4, wherein at least 80% of the acyl 20 groups of the triglyceride are fatty acid acyl groups of C18 fatty acids. Item 6. The pharmaceutical formulation of item 1, wherein at least 80% of the acyl groups of the triglyceride are stearoyl or 12-hydroxystearoyl groups. Item 7. The pharmaceutical formulation of any one of items 1 to 6, wherein at least 80% of the acyl groups of the triglyceride are saturated. 25 Item 8. The pharmaceutical formulation of any one of items 1 to 7, wherein the excipient comprises a hydrogenated vegetable oil. CA 3079522 Date reçue / Received date 2025-03-03 100 Item 9. The pharmaceutical formulation of any one of items 1 to 8, wherein the excipient comprises hydrogenated castor oil, hydrogenated coconut oil, hydrogenated cottonseed oil, hydrogenated palm oil, hydrogenated palm kernel oil, hydrogenated soybean oil, or a combination thereof. Item 10. The pharmaceutical formulation of any one of items 1 5 to 9, wherein the excipient comprises hydrogenated castor oil. Item 11. The pharmaceutical formulation of any one of items 1 to 10, wherein the short chain saccharide is mannitol. Item 12. The pharmaceutical formulation of any one of items 1 to 11, wherein the 10 pharmaceutical formulation is free of magnesium or / and lactose. Item 13. The pharmaceutical formulation of any one of items 1 to 12, wherein the pharmaceutical formulation contains no more than 5% w / w of bromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25±2° C. at about 60±5% relative humidity for 15 18 months. Item 14. The pharmaceutical formulation of any one of items 1 to 13, wherein the formulation comprises a tablet or oral dosage form. Item 15. The pharmaceutical formulation of any one of items 1 to 14, wherein the formulation comprises a parenteral dosage form. 20 Item 16. The pharmaceutical formulation of any one of items 1 to 15, wherein the bromocriptine is water soluble to at least 500 mg / L, and the formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at 37 ºC, wherein at least 90 % of the bromocriptine has been released at 20 minutes. 25 Item 17. The pharmaceutical formulation of any one of items 1 to 16, wherein the formulation does not generate more than 8% w / w bromocriptine after 6 months under 40ºC and 75% RH conditions, and is more stable in an aqueous environment than bromocriptine mesylate. CA 3079522 Date reçue / Received date 2025-03-03 101 Item 18. The pharmaceutical formulation of any one of items 1 to 15, wherein the formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at 37 ºC, wherein at least 80 % of the bromocriptine has been released at 30 minutes. Item 19. Use of the pharmaceutical formulation as defined in any 5 one of items 1-18 for the treatment of metabolic disorders. Item 20. Use of the pharmaceutical formulation as defined in any one of items 1-18 for the manufacture of a medicament for the treatment of metabolic disorders Item 21. The use of item 19 or 20, wherein the pharmaceutical formulation increases 10 central nervous system dopamine activity at the time of day of its natural circadian peak in healthy individuals of the same species and sex. Item 22. The use of any one of items 19 to 21, wherein the pharmaceutical formulation increases dopamine activity within 4 hours of waking. CA 3079522 Date reçue / Received date 2025-03-03

Claims

102 WHAT IS CLAIMED IS:

1. A pharmaceutical formulation comprising bromocriptine citrate and an excipient, wherein the excipient comprises a fatty acid or a triglyceride, a nonlactose short chain saccharide, and citric acid and wherein the bromocriptine citrate is soluble in water to at least 200 mg / L at 20ºC and is present in an amount that provides a dose of at least 0.1 mg of bromocriptine.

2. The pharmaceutical formulation of claim 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C6-C14 fatty acids.

3. The pharmaceutical formulation of claim 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C14-C26 fatty acids.

4. The pharmaceutical formulation of claim 1, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C16-C20 fatty acids.

5. The pharmaceutical formulation of claim 4, wherein at least 80% of the acyl groups of the triglyceride are fatty acid acyl groups of C18 fatty acids.

6. The pharmaceutical formulation of claim 1, wherein at least 80% of the acyl groups of the triglyceride are stearoyl or 12-hydroxystearoyl groups.

7. The pharmaceutical formulation of any one of claims 1 to 6, wherein at least 80% of the acyl groups of the triglyceride are saturated.

8. The pharmaceutical formulation of any one of claims 1 to 7, wherein the excipient comprises a hydrogenated vegetable oil.

9. The pharmaceutical formulation of any one of claims 1 to 8, wherein the excipient comprises hydrogenated castor oil, hydrogenated coconut oil, hydrogenated cottonseed oil, hydrogenated palm oil, hydrogenated palm kernel oil, hydrogenated soybean oil, or a combination thereof.

10. The pharmaceutical formulation of any one of claims 1 to 9, wherein the excipient comprises hydrogenated castor oil.

11. The pharmaceutical formulation of any one of claims 1 to 10, wherein the short chain saccharide is mannitol. CA 3079522 Date reçue / Received date 2025-03-03 103 12. The pharmaceutical formulation of any one of claims 1 to 11, wherein the pharmaceutical formulation is free of magnesium or / and lactose.

13. The pharmaceutical formulation of any one of claims 1 to 12, wherein the pharmaceutical formulation contains no more than 5% w / w of bromocriptinine as determined by HPLC analysis using detection of UV absorption at 300 nm following storage of the pharmaceutical formulation at a temperature of 25±2° C. at about 60±5% relative humidity for 18 months.

14. The pharmaceutical formulation of any one of claims 1 to 13, wherein the formulation comprises a tablet or oral dosage form.

15. The pharmaceutical formulation of any one of claims 1 to 14, wherein the formulation comprises a parenteral dosage form.

16. The pharmaceutical formulation of any one of claims 1 to 15, wherein the bromocriptine is water soluble to at least 500 mg / L, and the formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at 37 ºC, wherein at least 90 % of the bromocriptine has been released at 20 minutes.

17. The pharmaceutical formulation of any one of claims 1 to 16, wherein the formulation does not generate more than 8% w / w bromocriptine after 6 months under 40ºC and 75% RH conditions, and is more stable in an aqueous environment than bromocriptine mesylate.

18. The pharmaceutical formulation of any one of claims 1 to 15, wherein the formulation provides a dissolution profile, when tested in USP Apparatus Type 2 Paddle Method at 50 rpm in 500 ml of 0.1 N hydrochloric acid at 37 ºC, wherein at least 80 % of the bromocriptine has been released at 30 minutes.

19. Use of the pharmaceutical formulation as defined in any one of claims 1-18 for the treatment of metabolic disorders.

20. Use of the pharmaceutical formulation as defined in any one of claims 1-18 for the manufacture of a medicament for the treatment of metabolic disorders CA 3079522 Date reçue / Received date 2025-03-03 104 21. The use of claim 19 or 20, wherein the pharmaceutical formulation increases central nervous system dopamine activity at the time of day of its natural circadian peak in healthy individuals of the same species and sex.

22. The use of any one of claims 19 to 21, wherein the pharmaceutical formulation increases dopamine activity within 4 hours of waking. CA 3079522 Date reçue / Received date 2025-03-03