Methotrexate ndi mankhwala osokoneza bongo (DMARD) omwe amagwiritsidwa ntchito pochiza matenda a nyamakazi ndi matenda ena a chifuwa. Mlingo womwe umagwiritsidwa ntchito pa nyamakazi ya nyamakazi imatengedwa kuti ndi yotsika. Mofananamo, methotrexate imagwiritsidwanso ntchito ngati mankhwala opatsirana kwambiri a khansa komanso pamatenda apamwamba kuti athetse ectopic pregnancy.
Kulankhula mwaluso, methotrexate ndi dihydrofolate reductase inhibitor yomwe imapangitsa kuti purine isayambe.
Izi zikuti, zingayambitse zovuta ku ribonucleic acid ndi deoxyribonucleic acid synthesis. Methotrexate ndi yotchedwa teratogen, yomwe imatanthawuza kuti chinthu chilichonse, thupi, kapena njira yomwe imayambitsa ziphuphu m'mimba. Methotrexate ingayambitse maonekedwe a nkhope, zopanda pake za chigaza ndi miyendo, kusowa kwa kukula, kuchepa kwachitukuko, ndi kutaya mtima.
Matenda omwe amabwera chifukwa cha fetus amachititsa kuti mankhwalawa azidera nkhawa omwe ali ndi msinkhu wobereka, omwe akukonzekera kutenga pakati, makamaka omwe amakhala ndi pakati pamene akuchitidwa ndi methotrexate.
Matenda a Fetal and Pregnancy Loss Associated with Methotrexate
Akazi ayenera kudziŵa kuti ali ndi chiopsezo cha fetal anomalies komanso kutaya mimba kumayendedwe ndi methotrexate, ngakhale kuti chiwerengero cha ana oberekera amasiye chimaonedwa kuti n'chochepa. Phunziro lachifalansa, amayi omwe ali ndi matenda akuluakulu opatsirana omwe anali ndi mankhwala ochepa a methotrexate m'zaka zitatu zoyambirira anayesedwa.
Mwa mavoti 28 omwe anafufuzidwa, kufotokoza kwa mankhwala kumatha pasanafike masabata asanu ndi atatu atsikana atsikana 26. Azimayi anayi adatayika, pamene 5 anasankha kuthetsa mimba. Analipo 19 kubadwa kwa moyo, komwe 3 kunali koyambirira. Ochita kafukufuku anapeza kuti zotsatira zawo zimagwirizana ndi lingaliro lakuti palibe chiwopsezo champhamvu choopsa cha dothi ndi mankhwala otsika a methotrexate, omwe amachititsa kuti mankhwalawa asamayambe kutenga mimba mwamsanga.
Phunziro lina linayang'ana pa mimba 8 yomwe imatulutsa mimba. Panali vuto limodzi la mazira omwe amapezeka m'matumbo. Ndilo vuto loyamba lopezeka pakati pa anthu omwe amamwa mlingo umodzi wa mlungu umodzi wa methotrexate (omwe amadziwika kuti ali ndi matenda a rheumatic). Ngakhale kuti ndi vuto limodzi, akatswiri ofufuza anapeza kuti kuganiza kuti chitetezo cha methotrexate panthawi yochepa sichitha msanga.
Nanga Bwanji Anthu?
Malingana ndi Drugs.com, mimba iyenera kupeŵa ndi mwamuna kapena mzake yemwe akuchiritsidwa ndi methotrexate. Mimba iyenera kupezeka pa nthawi ya kuchipatala komanso kwa miyezi itatu kuchokera pamene odwala amatha kuchipatala, komanso panthawi ya kuchipatala komanso osachepera kamodzi kokha pambuyo pochiza odwala.
Pali chiopsezo chodziwikiratu cha kusintha kwa umuna pakati pa amuna kutenga methotrexate, koma sikunatsimikizidwe. Komanso, malinga ndi Journal of Rheumatology , kufotokozera kwa ana aamuna pa nthawi ya kulera sikuwoneka kuti kumabweretsa nkhawa kapena nkhani za mwana.
Mfundo Yofunika Kwambiri
Palibe nthawi 100 yotetezeka yogonana ndi methotrexate. Zotsatira za methotrexate zikuwoneka zosadziwika, mbali imodzi chifukwa cha kusiyana kwa majini mu mayendedwe apadera ndi a fetus kwa poizoni.
Pambuyo poyerekeza ndi methotrexate pa 1 trimester yoyamba, mayi yemwe akufuna kupitirizabe ndi mimba ayenera kudziwa kuti pali mwayi wa 10/42 wokhala wosalongosoka mu fetus (QJM: International Journal of Medicine).
Malinga ndi Kelley's Textbook of Rheumatology , amayi akulangizidwa kuti asiye methotrexate miyezi itatu asanayambe kutenga pakati. Folic acid supplementation ayenera kupitilizidwa kudzera mimba. American College of Rheumatology imalimbikitsa kugwiritsa ntchito njira zowathandiza kulera panthawi yomwe imatenga methotrexate ndipo kwa miyezi itatu mutasiya methotrexate.
Zotsatira:
Methotrexate (Rheumatrex, Trexall). American College of Rheumatology. Michael Cannon, MD May 2012.
http://www.rheumatology.org/Practice/Clinical/Patients/Medications/Methotrexate_(Rheumatrex,_Trexall)/
Mankhwala otsika otsika kwambiri m'zaka zitatu zoyambirira za mimba: zotsatira za phunziro la mgwirizano la ku France. Lewden B et al. Journal of Rheumatology. December 2004. http://www.ncbi.nlm.nih.gov/pubmed/15570635
Methotrexate Embryopathy Pambuyo pa Kutsika kwa Mlingo Wochepa Sabata Poyambirira Kwathu. Martin MC, et al. Toxicology yobereka . October 26, 2013. http://www.ncbi.nlm.nih.gov/pubmed/24513926
Mayi okhudzidwa ndi mimba ndi mazunzo. Drugs.com.
http://www.drugs.com/pregnancy/methotrexate.html
Kuwonetsera kwa ana kwa zotsatira za Methotrexate ndi Mimba. Journal of Rheumatology. Beghin, et al. January 15, 2011.
http://www.jrheum.org/content/early/2011/01/11/jheum.100600
Zotsatira za methotrexate pa mimba, kubala ndi lactation. QJM: International Journal of Medicine. 1999.
https://academic.oup.com/qjmed/article/92/10/551/1531030/The-effects-of-methotrexate-on-pregnancy-fertility
Kelley's Textbook ya Rheumatology. Elsevier Saunders. Volume I. Mimba mu Rheumatic Diseases. Mutu 39. Tsamba 552.