Imithi kadokotela engekho ngaphandle kwelebula: Okudingayo ukwazi

Imininingwane Yezidakamizwa

Eminyakeni edlule, lapho nganginenkinga yokuphazamiseka kwemizwelo, udokotela wami wanginika umuthi ovame ukusetshenziselwa ukwelapha isithuthwane. Ngangididekile. Kungani udokotela wami enginikeza umuthi okhonjiswe ngesimo esihluke kangaka? Ingabe bekuyindlela ejwayelekile yokunakekelwa ukuzama izidakamizwa zokusetshenziswa okusha? Ingabe ukusetshenziswa okunjalo kuphephile?

Mhlawumbe kwenzekile kuwe: Umkhuba wakho wezokwelapha uthumela incwadi ekhemisi lakho, bese ufunda ukuthi umuthi ujwayele ukusetshenziselwa ukwelapha isimo esihluke ngokuphelele kunezimpawu zakho. Lokhu kubizwa ngokuthi yi-off-label prescribing (eyaziwa nangokuthi ukunquma ukusetshenziswa okungavunyelwe). Kepha kwenziwa yini lokho ngempela kusho ukuthini?

Iyini imithi engekho ilebula?

Lapho i-Food and Drug Administration (i-FDA) ihlola umuthi omusha, inkampani eyenza imithi efuna ukuvunyelwa kufanele ithumele ubufakazi besayensi — njengemiphumela yokuhlolwa komtholampilo — ukuthi umuthi uyasebenza ekusetshenzisweni kwawo okuhlosiwe. Lapho umuthi uthola ukwamukelwa yi-FDA (ngemuva kwenqubo ende yokugunyazwa), kwenzelwa ukwelashwa lokho ikakhulukazi isimo sezokwelapha, nalokho kukhonjiswa kuphela. Noma ikuphi okunye ukusetshenziswa kwezidakamizwa kungalebula.

Ingabe ukukhushulwa kwezidakamizwa ezingekho ilebula kusemthethweni?

Lapho inkampani eyenza imithi iqala ukuthengisa umuthi, ingasho kuphela isimo umkhiqizo ovunyelwe ukuselapha. Ukumaketha okungekho kwelebula , noma ukukhangisa izidakamizwa zokusetshenziswa ezingagunyaziwe, kungashiya inkampani eyenza imithi ivulekele icala. Akukho emthethweni.

Ngabe odokotela bavunyelwe ukuthi banikeze imishanguzo engekho ilebula?

Lapho udokotela enikeza umuthi wokusetshenziswa kwezidakamizwa ezingekho kwelebula, lokho kusho ukuthi unqume umuthi ngaphandle kwezinkomba zawo ezivunyelwe. Kusemthethweni e-United States, futhi kuvamile, ukuthi odokotela banikeze amagama angekho kulebula. Eqinisweni, iziguli eziningi aziqapheli nokuthi umuthi kadokotela awela ngaphandle kokusetshenziswa kwawo okuvunyiwe.

Kwesinye isikhathi, izinkomba ze-FDA zicaciselwe imithamo noma izici zesiguli (ezinjengocansi), kunokuba kube inkinga yezokwelapha uqobo. Isibonelo esihle salokhu yiqembu leminyaka yobudala — ukuhlolwa okuningi kokuhlolwa kwemitholampilo kubantu abadala kunabancane, ngakho-ke ukubeka leyo mithi ezigulini ezisencane ngobuchwepheshe kuwela ngaphansi kwesambulela sokusetshenziswa kwelebula, noma ukusetshenziswa okungavunyelwe.

Kungani odokotela bebeka imithi ngaphandle kwelebula?

Kubalulekile ukwazi ukuthi ngenxa yokuthi ukusetshenziswa kwezidakamizwa kungalebuli, akusho ukuthi kuzoba ukwelashwa okungasebenzi. Isizathu esenza ukuthi imishanguzo kadokotela isetshenziswe kabanzi ngaphandle kwelebula iyinto esebenzayo, kusho U-Amber Cann , Pharm.D, umnikazi we Ubungqabavu beVenus . Inqubo yokuthola umuthi ngenqubo yokuhlolwa komtholampilo futhi yamukelwa yi-FDA ingathatha amashumi amabili eminyaka, futhi ibiza ngendlela emangalisayo, uyachaza. Imvamisa akukho ngaphakathi kwentshisekelo yomenzi wezidakamizwa ukufuna izinkomba ezengeziwe uma umuthi ususemakethe.

Kwesinye isikhathi, umenzi wezidakamizwa uzotshala imali enkombeni eyengeziwe, ukuze bakwazi ukumaketha lesi sidakamizwa ngaleyo nhloso, kusho uDkt Cann. Isibonelo, i-anti-depressant Paxil (i-paroxetine), ibitholakala isikhathi esithile ngaphambi kokuba umenzi, u-GlaxoSmithKline, afune izinkomba ezengeziwe zelebula kokufakwa kwephakeji kokuphazamiseka kokukhathazeka okujwayelekile kanye nokuphazamiseka okuphoqelela ngokweqile.

Lezi zibuyekezo azivamile — futhi uma zenzeka, zithatha isikhathi. Kungathatha iminyaka ngaphambi kokufakwa kophawu ngemininingwane yakamuva yomtholampilo ephakamisa ukuthi umuthi ungasebenza enkingeni ethile, kusho U-Amarish Dave , MD, udokotela wezinzwa kanye nomqondisi wezokwelapha ohlobene naye Impilo e-Illinois. Kuleyo minyaka engenelela, ukusebenzisa izidakamizwa ngaphandle kwelebula kunganikeza iziguli ukunakekelwa okuthuthukile.

Imibuzo yokubuza udokotela wakho mayelana nokusetshenziswa kwelebula kadokotela okungekho kwelebula

Uma unesifiso sokusebenzisa ukusetshenziswa kwamalebula okungekho emthethweni — noma ukwesaba ngakho — kungamalungelo akho njengesiguli ukubuza imibuzo. Ungahle ufune ukwazi:

• Ingabe imithi ayikho kwilebula yalesi simo?
• Iyini imithi evunyelwe ukwelashwa?
• Kungani udokotela wakho ekuyala?
• Ingabe umuthi uzosiphatha kanjani isimo noma izimpawu?
• Iyini imiphumela emibi?
• Ziyini izinzuzo zokwelashwa ngaphandle kwelebula?
• Ngabe umshuwalense wakho wezempilo uzoyikhokha le mithi kulesi simo?

Iningi lodokotela nosokhemisi bayakujabulela ukuxoxa ngezinkomba ezintsha nokuphepha kwezidakamizwa uma isiguli sinokukhathazeka.

Ingabe izidakamizwa ezingekho ilebula zimbozwe umshwalense kanye neMedicare?

Kungase kudingeke wenze ucwaningo ukuthola ukuthi ngabe umshwalense wakho, i-Medicare, noma iMedicaid izokhipha incwadi enelebuli engekho yini. Ukutholakala kuncike emuthini — nokuthi udokotela ukunikeze ukwelashwa ngasiphi isimo. Ukubuyiselwa kwemithi enqunyelwe ngaphandle kwelebula kwesinye isikhathi kungaba nzima, njengoba izinkampani zomshuwalense zingase zixwaye ukukhokha ngezizathu zomgunyathi. Uma lokhu kwenzeka kuwe, khuluma nomhlinzeki wakho wezokunakekelwa kwempilo noma usokhemisi mayelana neminye imishanguzo. Ungasebenzisa futhi ithuluzi lokubheka intengo le-SingleCare ukubona ukuthi ukonga kwethu kuyayishaya yini intengo yemali.

Izinzuzo zokusetshenziswa kwelebula

Ukuqamba izidakamizwa ezingekho ilebula kunikeza odokotela izindlela eziningi zokwelashwa uma umuthi owodwa ungakusebenzeli. Isebenziseka ikakhulukazi ezimweni ezingavamile ezinenketho yokwelashwa elinganiselwe. Isibonelo, i-chemotherapy ivame ukuvunyelwa kuphela uhlobo olulodwa lokwelashwa komdlavuza. Odokotela bangayisebenzisa ngaphandle kwelebula ukukhomba izinhlobo eziningi ezahlukene.

Kwesinye isikhathi ukusetshenziswa kwelebula kungakongela imali. Imvamisa umuthi ojwayelekile osetshenziswa ngaphandle kwelebula ongasebenza ngenhloso efanayo nomuthi 'ovunyelwe' ungabiza kakhulu, kusho uDkt. Dave. Ezinye izinzuzo zifaka imiphumela emibi kakhulu.

Izingozi zokusetshenziswa kwelebula engekho

Njenganoma imuphi umuthi, kungahle kube nezingozi. Ngoba ukusetshenziswa kwezidakamizwa ezingekho ilebula akubanga ngaphansi kwenqubo eqinile yokuhlolwa nokuhlolwa kwemitholampilo, njengoba kwenzelwa ukusetshenziswa okugunyaziwe, kungaba nemiphumela emibi engalindelekile. Kepha uDkt. Dave uthi, Ukusetshenziswa okuningi okungekho kwelebula kungenxa yemithi esivele inephrofayili yemiphumela emibi eyaziwayo.

Izidakamizwa ezingekho kwelebula ezidumile

Kunezimo eziningi kadokotela eziwela esigabeni esingelilebuli. Udokotela angahle anikeze ama-tricyclic antidepressants ukuthi alaphe i-ADHD, noma anikeze i-anticonvulsant, njengeTopiramate, yokudangala.

Kwezinye izimo, ukusetshenziswa okungekho kwelebula kuvame kakhulu kuba yifayela le- okuyinhloko sebenzisa. Akuzwakali ukusetshenziswa okungekho kwelebula ukuze ekugcineni kuvunyelwe i-FDA. I-Minoxidil ngumuthi wakudala owake wasetshenziselwa umfutho wegazi ophakeme, kusho uDkt Cann. Kutholakale ukuthi kube nemiphumela emibi [ngaleso sikhathi] yokukhuthaza ukukhula kwezinwele. Lowo muthi manje kakhulu akuvamile ukusetshenziswa njengomuthi wegazi ophakeme, kepha uvame ukusetshenziswa njengomkhiqizo wokukhula kwezinwele. Manje sesiyazi njengo… Rogaine.

Eminye imishanguzo abajwayele ukuyisebenzisa ngaphandle kwelebula ifaka:

Igama Lesidakamizwa	Ukusetshenziswa Okuvunyelwe	Ilebuli engekho emthethweni ye
I-Prazosin HCL	Ukwelashwa komfutho wegazi ophezulu	Amaphupho amabi / i-PTSD
clomiphene-citrate	Ukwelashwa kokuzala kwabesifazane	Ukwelashwa kokuzala kwabesilisa
Namenda	Ukwelashwa Kwezifo Ze-Alzheimer	Ukwelashwa kwe-ADHD ne-OCD kwezingane
Izinyoni	Ukwelashwa Kwegazi Eliphezulu	I-ADHD, Ukushisa Okushisayo, iTourette's Syndrome
ISeroquel	Imithi yokwelapha imishanguzo yokwelapha i-schizophrenia, i-Bipolar Disorder kanye ne-Major Depression Disorder	Ukuqwasha, Ukukhathazeka Ukukhathazeka, i-OCD, i-Psychosis evela eSifo sikaParkinson
topiramate	I-Anticonvulsant yokwelashwa kokuquleka, ukuvimbela i-migraine	Ukuphazamiseka kwemizwelo, i-PTSD, ukunciphisa umzimba
i-sildenafil citrate	Ukungasebenzi kahle kwe-Erectile (emadodeni	Isifo sowesifazane sokuvusa inkanuko
sibongile	Ukwelashwa kokuquleka	Ukuphazamiseka kweBipolar, Ukushisa Okushisayo, Neuropathy
i-propranolol	Ukwelashwa komfutho wegazi ophezulu	Ukukhathazeka kokusebenza
Tegretol	I-Anticonvulsant yokwelashwa kokuquleka	I-Bipolar Disorder, i-ADHD