Mifepristone: Inoshanda Sei, Zvinoshandiswa, Kuchengetedza & Zvinokonzeresa

Mifepristone mushonga une mushonga unonyorerwa wachiremba wakadzidzirwa kupfuura chero mushonga uri wehutano hwekubereka, uye wakashandiswa nevanhu vanodarika 5 miriyoni muUS kubva pakagamuchirwa neFDA muna 2000. Kushandiswa kwayo kwakanyanya ndechekupedza pamuviri pamberi pemavhiki gumi (pamwe nemumwe mushonga), asiwo unoshandiswa kurapa pamuviri usingashande, chirwere cheCushing syndrome, nezvimwe zvirwere zvine chekuita nemahomoni (kunze kwezvasina mvumo).

Pano tiri kupa pfupiso yekuti mifepristone inoshanda sei, inoshandiswa nei, nzira yakagamuchirwa neFDA, zvinogona kuitika, uye rekodhi rayo rekuchengetedza kweanopfuura makore makumi maviri. Ruzivo urwu runobva kumakambani eFDA, zvidzidzo zvakabudiswa, uye nhungamiro kubva kuWorld Health Organisation (WHO) neAmerican College of Obstetricians and Gynecologists. Haisi chinotsiva zano rechiremba wako.

Mifepristone Ndiwoi?

Mifepristone mushonga une mushonga unonyorerwa wachiremba unobvisa purogeni, iyo inokosha panguva yekuva nepamuviri. Mushonga uyu wakagadzirwa muFrance muma1980s uchizivikanwa nezita rekodhi rekuti RU-486 (uchiri kuitwa izvi mune zvimwe zvidzidzo zvechiremba zvakaremera). US Food and Drug Administration (FDA) yakaugamechera muna 2000 kupedza pamuviri kusvika kumazuva 49, asi FDA yakagamuchira mushonga uyu kwemazuva 70 muna 2016 mushure mekunge yawana rumwe ruzivo rwekuchengetedza nekushanda.

Uri pakati pemishonga iri paWorld Health Organisation's Model List of Essential Medicines, iyo inonyora mishonga yakanyanya kukosha kuhurongwa hweutano hwekutanga. Unongopiwa nachiremba ane mvumo muUS uye kubva muna 2023 unogona kupiwa muzvitoro zvemishonga zvine mvumo uye zvinotumirwa nepositi, pamwe nezvinzvimbo zveutano.

Mifepristone Inoshanda Sei?

Mifepristone inovhiringa ma receptors eprogeni, saka purogeni haigoni kushanda kuchengetedza pamuviri wakadzika kana kuchengetedza urongwa hwechidende. Izvi zvinoita kuti urongwa huputse, uye kuti pamuviri ubve pamadziro echidende. Nekuwedzera kwe misoprostol mushure memaawa 24-48, chikamu chechidende chinobvunda uye pamuviri unobviswa.

Mifepristone inobva kumapoka emishonga anozivikanwa se antiprogestins kana progesterone receptor modulators. Mushonga uyu une simba kupfuura purogeni pakubatanidza ma receptors eprogeni asi haauashandisi, saka vanorega kutumira meseji. Ichi ndicho chikonzero chekuti mifepristone misoprostol inoshandiswa pakubvisa pamuviri nemishonga uye kutarisa pamuviri usingashande, maererano neongororo ya2020 muNew England Journal of Medicine.

Inodzivisawo ma receptors eprogeni pamadosi akakwirira, uye ndicho chikonzero nei chimwe chigadzirwa chakagamuchirwa chekurapa chirwere cheCushing syndrome, chinoitika kana munhu ane huwandu hwakawandisa hwe cortisol.

Zvinoshandiswa neMifepristone

Mifepristone ine chimwe chinhu chakagamuchirwa neFDA chepamuviri uye chimwe cheCushing syndrome, pamwe nezvimwe zvinhu zvakawanda zvakashandiswa zvine hunyanzvi zvine rutsigiro kubva kumakambani makuru echiremba.

Kubatanidzwa kwe mifepristone ne misoprostol ndiko kushandiswa kunowanzoitika zvikuru. Chinyorwa chekurapa cheACOG chinotaura kuti nzira imwe chete iyi zvakare kurapa kwekutanga kwe pamuviri usingashande, uko kunobatsira muviri kupedza pamuviri usingashande kumba panzvimbo yekuda maitiro.

Mifepristone Dosisi uye Nzira yekushandisa

Dos yakajairika ye mifepristone yekubvisa pamuviri nemishonga kana pamuviri usingashande i piritsi rimwe chete re 200 mg rinotorwa nemuromo, achiteverwa maawa 24 kusvika 48 ne misoprostol, maererano ne FDA prescribing information. Chikamu che misoprostol chinotorwa kumba, muchikona chemuromo kana kuburikidza nemukadzi (sezvo chiremba achirayira).

Nguva uye dosi zvinosarudzwa nachiremba wako, zvichienderana nedanho rekutanga, nhoroondo yehutano uye chikonzero nei mushonga wapihwa. Ivo vachakupawo mishonga yekurapa marwadzo uye anti-emetic (kudzivisa kuda kurutsa) zvekushandisa ne mishonga. Haifanirwe kutora mushonga kana kuchinja nguva pasina kutaura nachiremba wako, sezvo dosi rinoenderana neruzivo rwaunoziva nachiremba wako chete, sekunge danho rako rekutanga uye kusatadza pamuviri.

Dosi re chirwere cheCushing rwakasiyana chaizvo (piritsi rekutora zuva nezuva kwenguva refu) uye rinonyorerwa nachiremba we endocrinologist.

App yehutano yakadai se August AI inogona kubatsira kuteedzera zviratidzo, zvinokonzeresa, uye kubuda ropa zuva nezuva kuti uwane chero shanduko dzisingatarisirwi saka unoziva kana kutaura nachiremba wako.

Mifepristone Zvinokonzeresa

Zvinokonzeresa zvakajairika zve mifepristone kana zvichishandiswa ne misoprostol panguva yekuva nepamuviri zvinosanganisira marwadzo, kubuda ropa kwemukadzi, kuda kurutsa, kurutsa, manyoka, musoro, dzungu, fivha, uye kutonhora. Vazhinji vanopera mukati memaawa makumi maviri nemana mushure mekunge waitora misoprostol. Marwadzo nekubuda ropa ndiyo nzira iyo mushonga unoshanda nayo pane chiratidzo chematambudziko.

Kubuda ropa kwakanyanya kune nguva dzose kwemwedzi kunotarisirwa, uye kubuda kwezvimedu zvinosvika saizi yelimon mukati mezuva rekutanga kwakajairika. Marwadzo anowanzoonekwa seanopfuura marwadzo emwedzi uye anouya mumapiritsi. Mapepa anodziya, mishonga yekurapa marwadzo, uye zororo zvinobatsira vanhu vazhinji.

Zvinokonzeresa zvisingawanzoitiki asi zvakanyanya kuipa zvinoda kuchengetwa nachiremba nekukurumidza:

• Kunyura kwepads maviri akakora kwemaawa maviri achiteedzana

• Fivha inodarika 100.4°F inoramba iripo kwemaawa anopfuura 24 mushure me misoprostol

• Marwadzo makuru mudumbu asinga pindirwe nemishonga yakapiwa

• Hakuna kubuda ropa zvachose mukati memaawa 24 mushure me misoprostol

• Zviratidzo zvekuita allergy (machubhu, kuzvimba, kuoma kufema)

Zvinokonzeresa kana mifepristone ichishandiswa pamadosi akakwirira kwechirwere cheCushing zvakasiyana uye zvinosanganisira kuneta, potassium yakaderera, marwadzo ezvibato,BP yakakwirira, uye kuchinja kwekushanda kwethyroid, ndicho chikonzero nei kutarisa kunoenderera ku endocrinology kunodiwa.

Mifepristone FDA Mvumo uye Nhoroondo

Nhoroondo yekubvumidzwa kwe mifepristone neFDA inopa makore anopfuura makumi maviri ekutarisa kwemazveji. Mushonga uyu wakagamuchirwa muna Nyamavhuvhu 2000 mushure mezvidzidzo zvekurapa muUS neEurope zvine vakadzi vanopfuura 2,100. Chinyorwa chekutanga chaidiwa kuti chipewe nevanopa mvumo vepachikamu.

Zvidzoreso zvitatu zvakakosha zvakatevera. Muna 2016, FDA yakawedzera nguva yakabvumidzwa kubva kumazuva 49 kusvika 70 ekuberekwa uye yakadzikisa dosi raidiwa zvichibva pane data inoratidza kushanda kwakafanana nemazhinji zvisinganakiswi. Muna 2021, FDA yakabvisa zvachose zvaidiwa zvepachikamu panguva yedenda mushure mekunge data aratidza kuti kutumira ne telehealth kwakanga kwakachengetedzeka. Muna Ndira 2023, FDA yakabvumidza zvitoro zvemishonga zvine mvumo kuparadzira mushonga kekutanga.

Chikamu chekuchinja chimwe nechimwe chakateverwa nemakore eongororo yedata rekuchengetedza. Kubva muna 2022, chirongwa chekuongorora cheFDA chepashure pekugadzirwa chakanyora pasi kupfuura 1 kubva pa200,000 kufa kwakabatana nekushandiswa kwe mifepristone, izvo zviri pasi pane zvakawanda zvinoshandiswa zvisina mushonga zvinosanganisira aspirin ne acetaminophen.

Mifepristone Kuchengetedza: Zvinoratidzwa nezvidzidzo

Kuchengetedza kwe mifepristone kwadzidzirwa muzvidzidzo zvikuru zvakawanda uye zviongorori zvemashure ekugadzirwa. Matambudziko akakomba, achinzi kuiswa muchipatara, kuiswa ropa, kana chirwere chikuru, anoitika mu vanhu vashoma kupfuura 1 kubva pa300 vanotora mushonga we pamuviri mangwanani, maererano neongororo ya2022 muObstetrics & Gynecology inobata vanhu vanopfuura 30,000.

Mapoka mashoma haafanirwe kutora mifepristone, kana kuti anofanira kuishandisa nekutarisa kwakawedzerwa:

• Vanhu vane pamuviri usingatendere (mushonga haubatsire pamuviri usingatendere uye unogona kuvanza)

• Vanhu vane kusashanda kwe adrenal kwenguva refu

• Vanhu vanotora kurapa kwakagadzirwa ne corticosteroid kwenguva refu

• Vanhu vane matambudziko ekubuda ropa kana vari pakunwa anticoagulants

• Vanhu vane IUD yakaiswa (IUD inofanira kubviswa kutanga)

• Vanhu vane ruzivo rwekusashanda kwemifepristone kana misoprostol

Iyo WHO's 2022 abortion care guideline inotsanangura kubvisa pamuviri nemishonga ne mifepristone-misoprostol seyakachengetedzeka kupfuura maitiro mazhinji echiremba wekunze, anosanganisira kubviswa kwemazino ekuchenjera nekubviswa kwematombo.

Nguva yekudanaChiremba Wako kana Kuenda kuER

Vanhu vazhinji vanotora mifepristone vanopedza maitiro acho zvakachengetedzeka pasina kutaurwa nachiremba kunze kwekurapwa kwavo kwakarongwa. Zvimwe zviratidzo zvinoda kutaurirwa nekukurumidza.

Dzana chiremba wako mukati memaawa 24 kana uine:

• Hakuna kubuda ropa zvachose mukati memaawa 24 mushure me misoprostol

• Kubuda ropa kwakaderera pane kwemwedzi wakajairika (kungareva kuti pamuviri wakaramba)

• Fivha inodarika 100.4°F inoramba iripo kwemaawa anopfuura 24 mushure me misoprostol

• Kutadza kubuda mweya kunonhuwa zvisingafadzi

• Kubuda ropa kwakanyanya kunoramba kuchienderera kwemazuva anopfuura 2 panguva yakakwirira

Enda ku ER kana dana 911 kana:

• Kunyura kwepads maviri akakora kana kupfuura kweawa maviri achiteedzana

• Marwadzo makuru mudumbu asinga pindirwe nemishonga yakapiwa

• Kusanzwa kana dzungu rakanyanya

• Zviratidzo zvekuita allergy (machubhu, kuzvimba, kuoma kufema)

• Kubuda ropa kwakanyanya nekurwadziwa kwepfudzi (chiratidzo chepamuviri usingatendere)

Kune zviratidzo zvinonzwa zvisiri izvo asi hazvisi zvakanyanya njodzi, August AI inokutendera kutsanangura zvauri kuona neshoko rakajeka uye inokubatsira kuona kana uchifanira kumirira, kudana chiremba wako, kana kuenda ku ER. Inochengetedza hurukuro saka unogona kuigovana nachiremba wako gare gare.

Mibvunzo Inowanzobvunzwa

Mifepristone Yakafanana Ne piritsi re Mangwanani?

Kwete. Mifepristone inopedza pamuviri uripo mangwanani, apo kudzivirira pamuviri mushure mekusangana pabonde (Plan B, ella) kunodzivisa pamuviri kutanga mushure mekusangana pabonde risina kudzivirirwa. Vose vanoshanda nenzira dzakasiyana uye vanoshandiswa panguva dzakasiyana. Mifepristone inoda mushonga kubva kune chiremba ane mvumo. Kudzivirira pamuviri mushure mekusangana pabonde kunowanikwa zvisina mushonga kana nemushonga zvichienderana nemhando.

Mifepristone Inokanganisa sei Kurega Kubereka Mukunhu?

Kwete. Makumi emakore ezvidzidzo anoratidza kuti mifepristone haikanganisi kurega kubereka mukunhu, migumisiro yekubereka yemunguva inotevera, kana njodzi yekubvisa pamuviri mumuviri uri kuuya. Ovulation inogona kudzoka nekukurumidza sezvo maawa masere mushure mekunge waitora mushonga. Kana usingadi kuva nepamuviri zvakare nekukurumidza, taura nachiremba wako nezve nzira dzekudzivirira pamuviri, dzinogona kutanga pazuva rimwe chete nekutarisa kwako.

Mifepristone Inogara Sei Muviri?

Mifepristone ine hafu-hupenyu hwemaawa 18, zvichireva kuti muviri unobvisa hafu yemadosi ese maawa 18. Zvizhinji zvemushonga zvinobva pamuviri mukati memazuva 3 kusvika 5. Kushanda kwayo kwechiremba (kubvisa purogeni) kunoramba kune simba nekuti mushonga unobatana zvakasimba nemareceptors. Zvinokonzeresa zvinowanzopera mukati memaawa makumi maviri nemana.

Mifepristone Inogona Kubviswa Mushure Mekunge Ndayitora?

Hapana nzira yakavimbika iripo. Mamwe makiriniki anoparidza maitiro ekugadzirisa "kubvisa mimba" achishandisa purogeni yakakwirira, asi American College of Obstetricians and Gynecologists inotaura kuti izvi hazvibatsirwe nesainzi uye chidzidzo cha2020 chakachiedza chakamiswa nekukurumidza nekuda kwekunetseka kwekuchengetedza. Kana usina chokwadi nezve kutora mifepristone, taura nachiremba wako usati watora dosi rekutanga.

Mifepristone Yegeneriki Yakafanana Neiyo Yemhando?

Hongu. Mifepristone yegeneriki, yakabvumidzwa neFDA muna 2019 uye inotengeswa neGenBioPro, inoshanda zvakafanana neMifeprex yemhando. Vose vane chinhu chimwe chete chinoita mushonga padosi rimwe chete uye vanosangana neFDA mitemo yekuvimbika nekushanda kwakafanana. Yegeneriki inowanzodhura zvishoma. Chiremba wako kana pharmacy anosarudza kuti ndeupi mushonga unopiwa.

Zvinhu Zvakakosha Zvekuyeuka

Mifepristone mushonga une mushonga unonyorerwa wachiremba unobvisa purogeni, unonyanya kushandiswa ne misoprostol kupedza pamuviri mangwanani kana kurapa pamuviri usingashande. Wakagamuchirwa neFDA kubva muna 2000, wakashandiswa nevanhu vanodarika 5 miriyoni muUS, uye uri paWHO's list of essential medicines. Maitiro akajairika i dosi rimwe chete re 200 mg achiteverwa ne misoprostol maawa 24 kusvika 48 mushure mezvo, zvichinyorerwa nachiremba ane mvumo.

Zvinokonzeresa zvakajairika (marwadzo, kubuda ropa, kuda kurutsa, musoro) zvinowanzopera mukati mezuva. Matambudziko akakomba anoitika muvanhu vashoma kupfuura 1 kubva pa300, zvichiita kuti ive yakachengetedzeka kupfuura maitiro mazhinji echiremba wekunze. Kubuda ropa kwakanyanya kunonyudza ma padse maviri pamaawa maviri kwemaawa maviri, fivha inopfuura maawa makumi maviri nemana, kana marwadzo makuru anoda kuchengetwa nekukurumidza. Kurega kubereka kwemangwana hakusi kukanganiswa, uye mifepristone yegeneriki inoshanda zvakafanana nemhando dzemhando. Mutemo wehurumende unokanganisa kuwanikwa, saka ma directory akavimbiswa anobatsira kusimbisa zvinhu munzvimbo yako.