Originally Posted by nashvillemidwife
I was talking about hemorrhage.
I was just trying to get at the point that the orriginal question in the thread was about just assisting in third stage...just to get the placenta out faster, not a hemorrhage situation. And it sounded like some people were using it standard for third stage, with or without hemorrhage, which to me doesn't make sense. (of course, a managed third stage doesn't make sense to me anyway without a medical indication)
|Because it's highly effective. We know it causes miscarriage in pregnancy and uterine rupture in labor so should obviously used with extreme caution, but the risk/benefit analysis in treating postpartum hemorrhage is extremely favorable.
Lots of medications are used or prescribed off-label, many of them leading to new labeling for new treatments. That's part of the process.
And I agree with this. That's how Viagra came to be...someone was trying to make a (I believe) bp drug, and said "hey, this kinda sucks for treating high bp, but MAN will it give a man an erection!" and there ya go.
But to me there is a HUGE difference in finding out a drug has a side effect that can be exploited for positive use when used off lable, and using a drug off lable that both the MAKER of the drug AND the FDA have explicitly said "DO NOT USE THIS FOR ANYTHING BUT WHAT IT IS MADE FOR." There's just a huge difference there to me. I understand that it's a lot cheeper than the alternatives, but the side effects aren't just something like priapism, which, while uncomfortable, rarely causes long term damage...and having a woman's uterus literally explode, often killing her and her baby, which happens randomly among women - VBACs and vaginal birthers, first time birthers, etc - so no way to really determine who is at risk and who isn't.
I guess I'm just trying to understand why, when there are other safer options available, anyone would support using that drug off lable for anything at all. ACOG actually sent out a letter in response to Searle's letter warning them not to use the drug for induction or third stage of labor that pretty much said "we think Searle is fearmongering and we are going to make our own rules and keep using Cytotec no matter what they or the FDA says about it." So to me, using it off lable for third stage or induction says the same thing...that the users are ignoring Searle and the FDA's warnings and taking unnecessary risks.
I'm really just trying to wrap my head around the justification here, and I feel like we are going to have to agree to disagree. To me it's an obvious answer, and to you it's an obvious answer...just different answers.