Mifepristone: Me Pēhea te Mahi, Ngā Whakamahi, te Haumarutanga me ngā Paanga Taha

Ko te Mifepristone he rongoā whakahauhau nā te tākuta, kua nui ake te rangahau i ētahi atu rongoā katoa mō te hauora whānau, ā, kua neke atu i te 5 miriona tāngata i te US kua whakamahi mai i te whakaaetanga o te FDA i te tau 2000. Ko te whakamahi tino noa ko te whakamutu i te hapūtanga i mua i te 10 wiki (me tētahi atu rongoā), engari ka whakamahia hoki hei rongoā i te ngaronga o te hapūtanga, te mate a Cushing, me ētahi atu mate e pā ana ki ngā hōmona (kāore i te mana katoa te whakamahi).

Anei mātou e hoatu nei i tētahi tirohanga whānui mō te mahi a te mifepristone, te aha e whakamahia ai, te tikanga kua whakaaetia e te FDA, ngā pānga taha ka puta mai me tana rekoata haumarutanga i roto i ngā tau 20. Ko ēnei mōhiohio i ahu mai i ngā tapanga o te FDA, ngā rangahau kua whakaputaina, me ngā aratohu mahi mai i te Whakahaere Hauora o te Ao (WHO) me te American College of Obstetricians and Gynecologists. Kāore ēnei e tika ana hei whakakapi mō te tohutohu a tō rata.

He aha te Mifepristone?

Ko te Mifepristone he rongoā whakahauhau nā te tākuta e aukati ana i te hōmona progesterone, he mea nui ki te hapūtanga. I hangaia te rongoā ki Paranihi i te tekau tau atu i 1980 me te ingoa waehere RU-486 (ka huaina tonu te ingoa nei i ētahi tuhinga rongoā tawhito). I whakaaetia e te Tari Kai me te Rongoā o Amerika (FDA) i te tau 2000 kia whakamutua te hapūtanga ki te 49 ra, engari i whakaaetia e te FDA te rongoā kia 70 ra i te tau 2016 whai muri i te kohinga mōhiohio haumarutanga me te whai hua atu anō.

Kei roto tēnei i te Rārangi Matua o ngā Rongoā Nui a te Whakahaere Hauora o te Ao, e whakaatu ana i ngā rongoā tino nui mō tētahi pūnaha hauora matua. Ka tohua anake e ngā kaiwhakarato whaimana i te US, ā, mai i te tau 2023 ka taea te tuku i ngā whare rongoā hokohoko whaimana me ngā whare rongoā tuku maile, me ngā whare hauora hoki.

Me Pēhea te Mahi a te Mifepristone?

Ka pokanoa te Mifepristone ki ngā kaiwhiwhi progesterone, kia kore ai e taea e te progesterone te mahi hei pupuri i te hapūtanga kia piri, kia mau tonu rānei te kotinga o te kōpū. Nā tēnei ka pakaru te kotinga, ka wehe te hapūtanga i te pakitara o te kōpū. Ki te tāpiri atu i te misoprostol 24-48 haora i muri mai, ka kōpeke te kōpū ā, ka puta te hapūtanga.

Nō te rōpū rongoā e mōhiotia ana ko te antiprogestins te mifepristone, ko te progesterone receptor modulators rānei. He kaha ake te rongoā i te progesterone ki te piri ki ngā kaiwhiwhi progesterone engari kāore e whakahohe i a rātou, nā reira ka mutu te tuku karere. Koinei te kaupapa o te mahi a te mifepristone misoprostol mō te whakaheke hapūtanga mā te rongoā me te whakahaere i te ngaronga o te hapūtanga i te wāhi timatanga, e ai ki tētahi arotake o te tau 2020 i te New England Journal of Medicine.

Ka aukati hoki tēnei i ngā kaiwhiwhi progesterone ki ngā taumata teitei ake, ā, nā reira tētahi atu āhuatanga ka whakaaetia hei rongoā i te mate a Cushing, ka puta ka nui rawa te cortisol a tētahi tangata.

Ngā Whakamahi a te Mifepristone

E kotahi te whakamahi a te Mifepristone kua whakaaetia e te FDA mō te hapūtanga me tētahi mō te mate a Cushing, me ētahi atu whakamahi kāore i te mana katoa engari e tautokona ana e ngā hapori rongoā nui.

Ko te huinga o te mifepristone me te misoprostol te whakamahi tino noa mā te tawhiti. E kii ana te purongo mahi a te ACOG, ko te tikanga rite nei te rārangi tuatahi rongoā mō te ngaronga o te hapūtanga wawe, ā, ka āwhina te tinana ki te whakaoti i te ngaronga o te hapūtanga ki te kāinga hei utu mō te tikanga pokatāne.

Te Horopeta me te Tikanga o te Mifepristone

Ko te horopeta auau o te mifepristone mō te whakaheke hapūtanga mā te rongoā, mō te ngaronga rānei o te hapūtanga, he kotahi te 200 mg pire ā-waha, ka whai atu 24 ki te 48 haora i muri mai ko te misoprostol, e ai ki ngā tohutohu tuku a te FDA. Ka tangohia te misoprostol ki te kāinga, ki roto i te paparinga, ki te pakitara (kā pērā i te tohutohu a te tākuta).

Ko te wā me te horopeta o te tikanga ka whakatauhia e tō tākuta, i runga i te pakeke o te hapūtanga, te hītori hauora, me te take i tohua ai te rongoā. Ka tukua hoki e rātou he rongoā mamae me tētahi rongoā whakakore ruaki (ki te nausea) hei tango tahi me te tikanga. Kāore koe e tika kia tango i te rongoā, kia whakarereke rānei i te wā i muri i te korero ki tō tākuta, nā te mea ko te horopeta i runga i ngā mōhiohio e mōhio ana tō tākuta, pēnei i te pakeke o tō hapūtanga me te whakakore i te hapūtanga ectopic.

He tino rerekē te horopeta mō te mate a Cushing (he pire hei tango ia rā mo te roa) ā, ka tohua e tētahi endocrinologist.

Ka taea e tētahi taupānga hauora pēnei i te August AI te āwhina ki te whai i ngā tohu, ngā pānga taha, me te whakaheke toto ia rā ki te kite i ngā whakarereketanga kōaro kia mōhio ai koe ka pēhea te whakapā atu ki tō tākuta.

Ngā Paanga Taha o te Mifepristone

Ko ngā pānga taha noa o te mifepristone i te wa e whakamahia ana me te misoprostol mō te hapūtanga ko te kōmaka, te whakaheke toto mai i te pakitara, te nausea, te ruaki, te korere, te mamae o te upoko, te whawhati, te kirika, me te makariri. Ko te nuinga ka memeha i roto i te 24 haora o te tango i te misoprostol. Ko te kōmaka me te whakaheke toto te mahi a te rongoā, ehara i te tohu o ngā raruraru.

Ko te whakaheke toto nui atu i te paheketanga noa ka puta mai, ā, ko te whakaputa i ngā monamona nui tae atu ki te rahi o te rēmana ka noa i te rā tuatahi. Ko te kōmaka he maha ngā wā e kiia ana he kaha ake i te kōmaka paheketanga noa ā, ka puta mai i roto i ngā ngaru. Ko te papa whakamahana, te rongoā mamae kua tohua, me te okioki ka āwhina te nuinga o te iwi.

Ko ngā pānga taha iti ake te noa engari he nui ake te kino e hiahiatia ana he rongoā rongoā tonu:

• Te mimiti o te 2 mātāriki mātāriki matotoru ia haora mō ngā haora 2 i te rarangi

• Te kirika neke atu i te 100.4°F e mau tonu ana mō te 24 haora i muri i te misoprostol

• Te mamae puku nui kāore e whakaora i te rongoā mamae kua tohua

• Kāore he whakaheke toto i roto i te 24 haora o te tango i te misoprostol

• Ngā tohu o te mate pāwera (pūhuki, huna, uaua ki te manawa)

Ko ngā pānga taha i te wa e whakamahia ana te mifepristone ki ngā horopeta teitei ake mō te mate a Cushing he rerekē, tae atu ki te ngenge, te pāhū o te pātaihuka, te mamae hononga, te toto toto tiketike, me ngā whakarereketanga o te mahi tairoiti, koinei te take e hiahiatia ai te arokepinga endocrinology tonu.

Te Whakaaetanga a te FDA me te Hītori o te Mifepristone

Ko te rārangi whakaaetanga a te FDA mō te mifepristone e toru tekau tau te roa o te arotake haumarutanga. I whakaaetia te rongoā i te Hepetema 2000 i muri i ngā whakamātau haumanu i te US me Uropi i uru atu ki te 2,100 ngā wahine. Ko te tapanga taketake e hiahiatia ana kia tukua ki te tangata e ngā kaiwhakarato whaimana.

E toru ngā whakahoutanga nui kua whai. I te tau 2016, ka whakaroa te FDA i te wāhi whakaaetia mai i te 49 ki te 70 ra o te hapūtanga, ā, ka whakaiti i te horopeta e hiahiatia ana i runga i ngā raraunga e whakaatu ana i te kaha rite ki te iti o ngā pānga taha. I te tau 2021, ka whakakore te FDA i te whakaritenga tuku ki te tangata i te wa o te mate urutomo i muri i ngā raraunga e whakaatu ana he rite te haumarutanga o te rongoā mā te telehealth. I te Hanuere 2023, i whakaaetia e te FDA ngā whare rongoā hokohoko whaimana ki te tuku i te rongoā mō te wā tuatahi.

Ko ia whakarereketanga i whai i ngā tau o te arotake raraunga haumarutanga. Tae atu ki te tau 2022, ko te kaupapa tirotiro i muri i te hokonga a te FDA i tuhia i raro iho i te 1 i te 200,000 mate e pā ana ki te whakamahi mifepristone, he iti ake i te reiti o te maha o ngā rongoā kore-whakahauhau tae atu ki te aspirin me te acetaminophen.

Te Haumarutanga o te Mifepristone: He Aha te Korerotia e ngā Rangahau

Kua rangahaua te haumarutanga o te Mifepristone i roto i ngā tekau ma rua o ngā whakamātau nui me ngā arotake i muri i te hokonga. Ko ngā raruraru nui, kua tautuhia hei takatūnga ki te hōhipera, whakawhiti toto, te mate nui rānei, ka puta i roto i iti iho i te 1 o te 300 tangata e tango ana i te tikanga mō te hapūtanga wawe, e ai ki tētahi arotake pūnaha o te tau 2022 i te Obstetrics & Gynecology e hipoki ana i te 30,000 neke atu i te manawanui.

He torutoru ngā rōpū kāore e tika kia tango i te mifepristone, me whakamahi rānei me te aroturuki atu anō:

• Ngā tāngata whai hapūtanga ectopic kua whakapumautia, kua whakapae rānei (kāore te rongoā e rongoā i te hapūtanga ectopic, ā, ka huna pea)

• Ngā tāngata whai kore mahi tairoiti tawhito

• Ngā tāngata e tango ana i te rongoā corticosteroid mo te roa

• Ngā tāngata whai mate whakaheke toto motuhake, kei te tango rānei i te rongoā hei whakaheke toto

• Ngā tāngata whai IUD kei roto (me tango tuatahi te IUD)

• Ngā tāngata e mōhiotia ana he mate pāwera ki te mifepristone, ki te misoprostol rānei

Ko te aratohu manaaki whakaheke hapūtanga a te WHO o te tau 2022 e whakarōpū ana i te whakaheke hapūtanga mā te rongoā me te mifepristone-misoprostol hei haumaru atu i ngā tikanga pokatāne noa, tae atu ki te tangohanga niho mātauranga me te tonsillectomy.

Ahea Me Waea Atu ki Tō Kaituku Tiaki, ki te Haere rānei ki te ER

Ko te nuinga o ngā tāngata e tango mifepristone ana ka oti te tukanga mā te haumaru me te kore he whakapā atu ki te rongoā i tua atu i tō rātou arokepinga kua whakaritea. Ko ētahi tohu e hiahiatia ana he tiaki tere.

Waea atu ki tō kaituku tiaki i roto i te 24 haora ki te whai koe i:

• Kāore he whakaheke toto i roto i te 24 haora o te tango i te misoprostol

• Te whakaheke toto iti iho i te paheketanga noa (he tohu pea kua haere tonu te hapūtanga)

• Te kirika neke atu i te 100.4°F e mau tonu ana mō te 24 haora i muri i te misoprostol

• Te putanga mai o te huna i te pakitara, te piro kino

• Te whakaheke toto nui e mau tonu ana mō te 2 ra i te taumata teitei

Haere ki te ER, waea rānei ki te 911 mō:

• Te mimiti o te 2 mātāriki matotoru neke atu rānei ia haora mō ngā haora 2

• Te mamae puku nui kāore e whakaora i te rongoā kua tohua

• Te raruraru, te tino whawhati rānei

• Ngā tohu o te mate pāwera (pūhuki, huna, uaua ki te manawa)

• Te whakaheke toto nui me te mamae o te pakihiwi (he tohu pea o te hapūtanga ectopic)

Mō ngā tohu ka puta engari ehara i te tino matehoro, ka āwhina te August AI ki te kōrero mō ngā mea e pā ana ki a koe, ā, ka āwhina ki te whakatau mena ka tatari koe, ka waea atu ki tō kaituku tiaki, ka haere rānei ki te ER. Ka tiaki te kōrero kia taea ai e koe te tiritiri ki tō tākuta i muri mai.

Ngā Pātai Auau

He rite te Mifepristone ki te pire i muri i te moepuku?

Kāore. Ka whakamutu te Mifepristone i te hapūtanga wawe kua puta kē, engari ko te rongoā whakapapaherehere (Plan B, ella) ka ārai i te tīmatanga o te hapūtanga i muri i te taonga tahanga. He rerekē te mahi a ngā mea e rua ā, ka whakamahia i ngā wā rerekē. Me whai tohutohu a te Mifepristone mai i tētahi kaiwhakarato whaimana. Ko te rongoā whakapapaherehere ka riro mai i te rongoā kore-whakahauhau, ki te tohutohu rānei, i runga i te waitohu.

Ka pā te Mifepristone ki te kaha ki te whai tamariki a muri ake nei?

Kāore. E whakaatu ana ngā tau tekau o te rangahau kāore te mifepristone e pā ki te kaha ki te whai tamariki a muri ake nei, ki ngā hua o te hapūtanga a muri ake nei, ki te tuponotanga rānei o te ngaronga o te hapūtanga i ngā hapūtanga o muri. Ka taea te whai tamariki kia 8 ra i muri i te tango i te rongoā. Ki te kore koe e pai ki te hapū wawe, kōrero ki tō kaituku tiaki mō ngā kōwhiringa whakapapaherehere, ka taea te tīmata i te wā o tō arokepinga.

Kia roa te noho o te Mifepristone ki roto i te tinana?

He haurua ora (half-life) te roa o te mifepristone tata ki te 18 haora, te tikanga ka whakaputa te tinana i te haurua o te horopeta ia 18 haora. Ko te nuinga o te rongoā ka ngaro mai i tō pūnaha i roto i te 3 ki te 5 ra. Ko te hua mahi (aukati progesterone) ka roa ake te mau nā te mea ka piri kaha te rongoā ki ngā kaiwhiwhi. Ko ngā pānga taha ka memeha i roto i te 24 haora.

Ka taea te whakakore i te Mifepristone i te wa i muri i taku tango?

Kāore he tikanga pono e noho ana. Ko ētahi whare hauora e whakatairanga ana i tētahi tikanga "whakakore" e whakamahi ana i te progesterone teitei, engari e kii ana te American College of Obstetricians and Gynecologists kāore tēnei i te tautokona e te pūtaiao, ā, ko tētahi rangahau o te tau 2020 i whakamātau ai i tēnei i mutu wawe nā te raruraru haumarutanga. Ki te kāore koe i te tino mōhio mō te tango mifepristone, kōrero ki tō kaituku tiaki i mua i te horopeta tuatahi.

He rite te Mifepristone matatini ki te waitohu?

Ae. Ko te mifepristone matatini, i whakaaetia e te FDA i te tau 2019, ā, ka hokona e GenBioPro, he rite te mahi ki te waitohu Mifeprex. Ko ngā mea e rua he rite te matū kaha ki te horopeta rite, ā, ka tutuki ki ngā paerewa kounga me te whai hua rite o te FDA. Ko te mea matatini he iti ake te utu. Ko tō kaituku tiaki, ko tō whare rongoā rānei e whakatau ana ko tēhea putanga e riro ana i a koe.

Ngā Matapihi Matua

Ko te Mifepristone he rongoā whakahauhau e aukati ana i te progesterone, ko te whakamahi tino noa me te misoprostol hei whakamutu i te hapūtanga wawe, hei whakahaere rānei i te ngaronga o te hapūtanga. Kua whakaaetia e te FDA mai i te tau 2000, kua whakamahia e neke atu i te 5 miriona tāngata i te US, ā, kei te rārangi rongoā nui a te WHO. Ko te tikanga paerewa he kotahi te 200 mg horopeta ka whai atu ko te misoprostol 24 ki te 48 haora i muri mai, ka tohua e tētahi kaiwhakarato whaimana.

Ko ngā pānga taha noa (kōmaka, whakaheke toto, nausea, mamae o te upoko) ka memeha i roto i te kotahi rā. Ko ngā raruraru nui ka puta i raro iho i te 1 o te 300 take, he haumaru ake i ngā tikanga pokatāne maha. Ko te whakaheke toto nui e mimiti ana i ngā mātāriki e 2 ia haora mō te 2 haora, ko te kirika e mau tonu ana i muri i te 24 haora, ko te mamae nui rānei e hiahiatia ana he tiaki tere. Kāore te kaha ki te whai tamariki a muri ake nei e pā ana, ā, ko te mifepristone matatini he rite te mahi ki ngā putanga waitohu. Ko te ture a te kawanatanga ka pā ki te uru, nā reira ka āwhina ngā pukapuka kua whakamanatia ki te whakapūmau i ngā kōwhiringa kei tō rohe.