A drug for high-risk pregnant women has cost about $10 to $20 per injection. Next week, the price shoots up to $1,500 a dose, meaning the total cost during a pregnancy could be as much as $30,000
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Unfortunately, just revoking the "exclusive" part of their license to manufacture it wouldn't allow the cheap versions to reappear - compounding pharmacies are not allowed to make any product that is available commercially, with very few exceptions - if the commercial product is backordered and temporarily unavailable, or if you are making a variation for medical reasons, eg, a preservative-free version for a patient with an allergy. This has not to do with patents and licenses so much as regulations involving who is considered a manufacturer, and the legal scope of practice of small-scale compounders. Major changes to the laws that govern compounding would be required in this case. Meanwhile, the FDA takes a somewhat hostile stance toward compounding pharmacies, very aggressively going after pharmacies who, as they see it, try to circumvent their regulatory authority by making products that the FDA has not approved. For instance, breastfeeding moms used to be able to buy compounded domperidone, a harmless stomach drug which is
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So tell me... should the fact that they're making it in a base of castor oil be making me raise my eyebrows? Castor oil put me into labor twice, but I'm assuming that it works by mechanically irritating the intestine, which wouldn't apply to a shot?
Castor oil works directly in the intestine, yes, by drawing fluid in to the bowel and thus indirectly stimulating muscle contractions. That hygroscopic effect wouldn't amount to anything when injected, even if you used a comparable amount to the oral dose, which of course you wouldn't, ouch! It's generally pretty inert and not a common allergen, making it more suitable than the peanut oil base that some other progesterone preparations are made with, IMHO.
There are vaginal suppositories sometimes used instead of injections for some kinds of infertility and for preventing early first trimester miscarriage, but I'm not sure they'd have the same effectiveness for preventing pre-term labour. Until now they've been more expensive, mind you, and you have to dose them once daily or more, not weekly, so those reasons might be why the shot has been used. You'd have to ask an obstetrician for the rationale. And it might be that it hasn't been studied and no one knows whether alternate delivery methods are useful in this case or not - it's an ethically difficult area to study.
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