Jack24
06-27-2008, 12:13 AM
I'm wondering if I could ring a little more time out of my 75's before I have to go up or change to another drug. I'm on a two day rotation and about 10 hours before change time I start into withdrawal and it is not plesant. Pain control is fine, it is just the withdrawal symptoms. I've been trying to cover with Percocet 10/325 which works marginally but I have to take 5 a day. The 1st day after a new patch I don't need any Percocet all day.
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conductor
06-27-2008, 03:09 AM
Dear Jack24,
An exceptionally intelligent member of our community, Exec, has a great deal of information concerning the patch. Hopefully, she'll respond as soon as she reads your posting! Perhaps you could search some of our more recent conversations--in the last few months--about this very subject? (There's a way to search these things, but maybe you should contact one of the moderators or administrators for explicit instructions. I could give you instructions, but you would not be amused later!)
Plus, there are so many others who have tremendous amounts of knowledge about these kinds of things. We are all very fortunate to have the experiences of everyone on this forum. I count HealthBoards as one of my blessings on a regular basis because the members here have taught me a great deal--for which I am very thankful!
Sincerely,
Jon (Conductor)
An exceptionally intelligent member of our community, Exec, has a great deal of information concerning the patch. Hopefully, she'll respond as soon as she reads your posting! Perhaps you could search some of our more recent conversations--in the last few months--about this very subject? (There's a way to search these things, but maybe you should contact one of the moderators or administrators for explicit instructions. I could give you instructions, but you would not be amused later!)
Plus, there are so many others who have tremendous amounts of knowledge about these kinds of things. We are all very fortunate to have the experiences of everyone on this forum. I count HealthBoards as one of my blessings on a regular basis because the members here have taught me a great deal--for which I am very thankful!
Sincerely,
Jon (Conductor)
trowftd3
06-27-2008, 05:01 AM
Correct me if I'm wrong but, you are talking about the fentanyl patch. Right?
From what I've read here on the board there is a huge difference between generic versions of the patch. The Sandoz patch(and I think Watson makes one also) is comparable to the name brand Jannsen(sp?) but the Mylan patch is inferior.
Executor is very knowledgeable on this subject and I hope she chimes in and corrects me if necessary. I believe the delivery system is different as well as the 20% +/- issue with generics.
Which are you using? Maybe switching to the brand name could help you out, that is if you could afford it. I know the patches are very expensive.
Good luck and welcome to our little cp family.~Mush
From what I've read here on the board there is a huge difference between generic versions of the patch. The Sandoz patch(and I think Watson makes one also) is comparable to the name brand Jannsen(sp?) but the Mylan patch is inferior.
Executor is very knowledgeable on this subject and I hope she chimes in and corrects me if necessary. I believe the delivery system is different as well as the 20% +/- issue with generics.
Which are you using? Maybe switching to the brand name could help you out, that is if you could afford it. I know the patches are very expensive.
Good luck and welcome to our little cp family.~Mush
Director
06-27-2008, 08:37 PM
When I was on the Duregesic patches, I was on the 50's, then 75's and finally the 100 mcg. I too, was on a 48 hour change schedule, and although the makers say they are good for 72 hours, most people can't get anywhere close to that out of them.
First off, make sure you get the brand name (if at all possible, insurance wise), because Janssen makes a far better product than the generics. One thing I noticed while on them, after I had been on them for a while, my tolerance would start to go up and I would be ready to change prior to the 48 hour mark. I started adding the new patch at 48 hours, but left the old one on until the next day. Then when I got to 48 hours with the new one, I would do the same with the next patch.
You might give it a try, because even though it doesn't seem like it, there is still some of the medication in the old patch. I think between using Janssen Duregesic Patches and use the changing method I described, you might find you can be more comfortable and not have to go to the Percs. I hope this helps you.
First off, make sure you get the brand name (if at all possible, insurance wise), because Janssen makes a far better product than the generics. One thing I noticed while on them, after I had been on them for a while, my tolerance would start to go up and I would be ready to change prior to the 48 hour mark. I started adding the new patch at 48 hours, but left the old one on until the next day. Then when I got to 48 hours with the new one, I would do the same with the next patch.
You might give it a try, because even though it doesn't seem like it, there is still some of the medication in the old patch. I think between using Janssen Duregesic Patches and use the changing method I described, you might find you can be more comfortable and not have to go to the Percs. I hope this helps you.
Jack24
06-27-2008, 10:14 PM
Thanks for the reply. It is the Mylan brand. The only reason it is that brand is that with insurance, Mylan is $10.00 a month. Name brand is $50.00 a month. Even though that is quite a bit of difference, I'd gladly pay it. I'll try leaving the patch on longer to see if that helps. I have a feeling I better call my doc first as with my luck this would be the time they do a random drug test and my next apt is in 5 days.
I posted a while back about changing to another drug as my doc offered to change me to either morphine or methadone. I was able to get a lot of good info from this board about which would suit me the best. I'm a little reluctant to change as it took so long to get my current regimen and pain relief. It might be worth going to name brand to see if I can ring a little more time out of the patch.
I posted a while back about changing to another drug as my doc offered to change me to either morphine or methadone. I was able to get a lot of good info from this board about which would suit me the best. I'm a little reluctant to change as it took so long to get my current regimen and pain relief. It might be worth going to name brand to see if I can ring a little more time out of the patch.
Executor
06-28-2008, 01:21 AM
Thanks to all for the comments. Yes, I have done quite a bit of research in this area. I would suggest you do a search of "brand vs generic-major findings" as it was a very good thread with some excellent discussion.
There are actually TWO issues @ work here:
(1) First is the patch not working a full 72 hours. This is a fairly well known fact, regardless on whether you use brand or not. The patch was first developed for end of life cancer patients. Thus, most of the original test data was on subjects who were either bed ridden, or sedentary in nature. One's activity level and metabolism has a direct effect on the patch dispensing time. For these original patients and test data subjects, the patch did last a full 72 hours in most cases.
However, since that time, the patch has won approval for an expanded label, and it is now prescribed for a whole list of ailments. In the white paper prescribing paper (included in the box), it actually states that some patients may need more frequent dosing, or 48 hours. Non-cancer patients are much more active, younger, and their metabolism is faster.
(2) The second issue is the brand vs generics issue. In 1999, Congress approved legislation to keep drug costs from escalating out of control. They passed the Hatch-Waxman Act of 1999. If you look on the FDA site, it will even tell you that this piece of legislation is largely responsible for most of the generics today. This Act provided all sorts of provisions....One of the main ones, was to allow generics a +/- 20% window in relation to the brand. This manufacturing leeway allows companies to bring drugs to market faster and more cheaply to the consumer. At the time the Act passed, it was thought that 20% was a "close enough" figure for any given drug to be effective, or equal re: it's bioavailability. For the most part, it is.....Especially with most routine meds such as allergy meds & etc. However, IMO, it is not for pain meds. One also has to keep in mind that 20% of a bigger # is a bigger #. So, the higher the dose one is one, the more of a factor the 20% becomes. Brands are superior in this regard because not only do they carry more active ingredient, but they are more consistent in their manufacturing process. Many have complained that they can tell variation within the generic family.
Thus, you have these two issues working interchangeably in regards to your question. First, you have the patch not working a full 72....Then, you have the whole brand vs generic issue. So, if one uses a generic patch, not only is it not likely to last 72 hrs, but it's probably 20% less in potency.
It's also important to note that many believe that ALL long acting meds are subject to scrutiny.....Meaning that hardly any really last as long as they say. For example, I've tried OC, the patch, and now Avinza.....NONE of them last the full amt as prescribed.
Hope this information helps. Please let me know if I answer any further questions.
Ex
There are actually TWO issues @ work here:
(1) First is the patch not working a full 72 hours. This is a fairly well known fact, regardless on whether you use brand or not. The patch was first developed for end of life cancer patients. Thus, most of the original test data was on subjects who were either bed ridden, or sedentary in nature. One's activity level and metabolism has a direct effect on the patch dispensing time. For these original patients and test data subjects, the patch did last a full 72 hours in most cases.
However, since that time, the patch has won approval for an expanded label, and it is now prescribed for a whole list of ailments. In the white paper prescribing paper (included in the box), it actually states that some patients may need more frequent dosing, or 48 hours. Non-cancer patients are much more active, younger, and their metabolism is faster.
(2) The second issue is the brand vs generics issue. In 1999, Congress approved legislation to keep drug costs from escalating out of control. They passed the Hatch-Waxman Act of 1999. If you look on the FDA site, it will even tell you that this piece of legislation is largely responsible for most of the generics today. This Act provided all sorts of provisions....One of the main ones, was to allow generics a +/- 20% window in relation to the brand. This manufacturing leeway allows companies to bring drugs to market faster and more cheaply to the consumer. At the time the Act passed, it was thought that 20% was a "close enough" figure for any given drug to be effective, or equal re: it's bioavailability. For the most part, it is.....Especially with most routine meds such as allergy meds & etc. However, IMO, it is not for pain meds. One also has to keep in mind that 20% of a bigger # is a bigger #. So, the higher the dose one is one, the more of a factor the 20% becomes. Brands are superior in this regard because not only do they carry more active ingredient, but they are more consistent in their manufacturing process. Many have complained that they can tell variation within the generic family.
Thus, you have these two issues working interchangeably in regards to your question. First, you have the patch not working a full 72....Then, you have the whole brand vs generic issue. So, if one uses a generic patch, not only is it not likely to last 72 hrs, but it's probably 20% less in potency.
It's also important to note that many believe that ALL long acting meds are subject to scrutiny.....Meaning that hardly any really last as long as they say. For example, I've tried OC, the patch, and now Avinza.....NONE of them last the full amt as prescribed.
Hope this information helps. Please let me know if I answer any further questions.
Ex
badoldback
06-29-2008, 05:02 PM
Regarding that 20 per cent, they say it is not enough to matter but if a person was taking 100 milligrams of Oxycodone and asked for a 20 percent increase (20 milligrams) all of a sudden it's a huge hairy deal.
Executor
06-30-2008, 09:46 AM
Regarding that 20 per cent, they say it is not enough to matter but if a person was taking 100 milligrams of Oxycodone and asked for a 20 percent increase (20 milligrams) all of a sudden it's a huge hairy deal.
I couldn't agree more! That's what I've been saying all along. When they came up with this provision, they decided that 20% was within the range where the med still worked effectively. This may be the case for many meds, but NOT pain management.
If a person starts on a dose and doesn't venture from brand to brand or med to med, it's probably not a problem, because the point of reference never changes. But, for many of us, we've been on the "brand" at one point or another and that's where the problem kicks in. The 20% window is just too wide for PM.
Ex
I couldn't agree more! That's what I've been saying all along. When they came up with this provision, they decided that 20% was within the range where the med still worked effectively. This may be the case for many meds, but NOT pain management.
If a person starts on a dose and doesn't venture from brand to brand or med to med, it's probably not a problem, because the point of reference never changes. But, for many of us, we've been on the "brand" at one point or another and that's where the problem kicks in. The 20% window is just too wide for PM.
Ex
feelbad
06-30-2008, 10:54 AM
its not just PM ex,and thats the really sad part. this little "varience" still just makes me sick when you think of the huge consequences that are there for patients who take meds that require exacting doses such as epilepsy transplant,cardiac patients. they have no idea how close some people can come to actual death in these instances. its is just sick. the one huge thing i found out when i was switched to the endo brand of the OC was in the amount of pills you have to actually take per dose? wow,what an impact when you are having to take like three pills for the 60mgs you are supposed to get? this is where this really became a huge issue for me when i was on nine pills per day(20mgs),at 60-60-60. if those pills were each even down just ten percent alone that would be well over one whole entire pill of my meds for me,and believe me it showed(i spent two weeks in hell with NO real coverage with this crap). i still cannot believe with all the adverse reactions that have taken place in patients who were switched to generic from brand or even switched from one generic to another that the FDA just has not yet done something with this sick practice. my son almost lost a liver becasue of sub par prednisone that we thought was the very same as his other pred he was stabilized on. i first heard about the so called generic equivalent crap back in 2000 when this occured right from my sons tx doc. i really was shocked since all the pharms and drug co kept saying everything was the very 'same' as the brand. what a sick joke ya know?
at least the info is finally getting out there much more than before. anytime i would mention this to some pharms,they just acted like i was nuts or something ya know? there has been more than enough suffering and wasted lives becasue of this practice,hopefully something will be done to actually rectify this at least some??? we can only hope for our and our familys sake. it just 'does" matter what brand you take with just about every med out there. ya know when you really think about it,there just HAD to be a good reason why the generics were just soo much cheaper than brand,at least now we know why unfortunetly. you just don;t get somethin for nothin.
okay i will put my box away now. this is just sooo incredibly sick to do to patients,and then to have it all condoned by the governing agency who is supposed to be in OUR corner here? yikes. marcia
at least the info is finally getting out there much more than before. anytime i would mention this to some pharms,they just acted like i was nuts or something ya know? there has been more than enough suffering and wasted lives becasue of this practice,hopefully something will be done to actually rectify this at least some??? we can only hope for our and our familys sake. it just 'does" matter what brand you take with just about every med out there. ya know when you really think about it,there just HAD to be a good reason why the generics were just soo much cheaper than brand,at least now we know why unfortunetly. you just don;t get somethin for nothin.
okay i will put my box away now. this is just sooo incredibly sick to do to patients,and then to have it all condoned by the governing agency who is supposed to be in OUR corner here? yikes. marcia
Executor
07-01-2008, 12:43 AM
its not just PM ex,and thats the really sad part. this little "varience" still just makes me sick when you think of the huge consequences that are there for patients who take meds that require exacting doses such as epilepsy transplant,cardiac patients. they have no idea how close some people can come to actual death in these instances.
You are right Marcia....I was just trying not to be too outspoken. Also, I was referring to "general" meds such as allergy meds and other basics. I have heard the same thing about cardiac meds and transplant meds....That Docs say there are huge differences...I just hope and pray I don't have to find out.
I don't mean to talk out of both sides of my mouth...But, I think it's much less of an issue if your "reference point" doesn't change. For example, if your Doc scripts you Hydro 10mg....You get generic....Thus, it's really 8mg....As long as you keep taking this med from this same company, all is fine. Even increases are fine as long as you don't change brands or regimens.
Where the issue pops up, I think, is when patients go to different pharmacies and thus, get different brands (or maybe their primary pharmacy changes brands) or they use the 10mg as a base for a regimen change to a different med....Then, things get skewed. And as we've discussed, the issue is more profound @ the higher levels....20% of a bigger number is a bigger number. So, for those on high dosages, the issue can much more important.
Personally, I've experienced significant problems in changing LA meds....Changing one's "base" LA med is tough enough, without having to factor in the 20%. IMO, I think brands are far superior in a number of ways and I'm lucky that I have access to them. I realize some may not be as fortunate. But, hopefully, through our support network, some may be able to convince their Docs to write "DAW" or "brand medically necessary" to help lessen the financial impact. The brands are much more consistent and given my health situation, I need them. But everyone is different. And, some have stated that they had no problems whatsoever.
Regards,
Ex
You are right Marcia....I was just trying not to be too outspoken. Also, I was referring to "general" meds such as allergy meds and other basics. I have heard the same thing about cardiac meds and transplant meds....That Docs say there are huge differences...I just hope and pray I don't have to find out.
I don't mean to talk out of both sides of my mouth...But, I think it's much less of an issue if your "reference point" doesn't change. For example, if your Doc scripts you Hydro 10mg....You get generic....Thus, it's really 8mg....As long as you keep taking this med from this same company, all is fine. Even increases are fine as long as you don't change brands or regimens.
Where the issue pops up, I think, is when patients go to different pharmacies and thus, get different brands (or maybe their primary pharmacy changes brands) or they use the 10mg as a base for a regimen change to a different med....Then, things get skewed. And as we've discussed, the issue is more profound @ the higher levels....20% of a bigger number is a bigger number. So, for those on high dosages, the issue can much more important.
Personally, I've experienced significant problems in changing LA meds....Changing one's "base" LA med is tough enough, without having to factor in the 20%. IMO, I think brands are far superior in a number of ways and I'm lucky that I have access to them. I realize some may not be as fortunate. But, hopefully, through our support network, some may be able to convince their Docs to write "DAW" or "brand medically necessary" to help lessen the financial impact. The brands are much more consistent and given my health situation, I need them. But everyone is different. And, some have stated that they had no problems whatsoever.
Regards,
Ex
brianpain33
07-01-2008, 12:55 AM
Jack:
No one has really specifically mentioned the fact that there are SEVERAL generics of the fentanyl patch. The generics are:
1. Sandoz - the one that is most like the brand name and manufactured at the same plant as the brand. This is the one that I am on and I have had pretty good success.
2. Mylan - this is the one that tends to be the cheapest and usually the most inferior
3. Watson - this is the newest generic and not widely available
Then there is the brand name DURAGESIC. You are allowed to ask for a specific manufacturer. Of course it may have to be ordered but call your pharmacy a week ahead of time and ask if they could order the SANDOZ patch (for example). Trust me I tried the Mylan patch and then the Sandoz and noticed a big difference. I also do the overlapping thing with the patches which helps to keep your BPL(blood plasma level) at the same rate. I will usually overlap, or leave the old one on 8 hours longer than the 48 hour mark, while putting the new one on at the 48 hour mark. So I have both of them on for 8 hours and then I take the old one off.
I would give those two things a try first and see if you notice a difference.
brian
No one has really specifically mentioned the fact that there are SEVERAL generics of the fentanyl patch. The generics are:
1. Sandoz - the one that is most like the brand name and manufactured at the same plant as the brand. This is the one that I am on and I have had pretty good success.
2. Mylan - this is the one that tends to be the cheapest and usually the most inferior
3. Watson - this is the newest generic and not widely available
Then there is the brand name DURAGESIC. You are allowed to ask for a specific manufacturer. Of course it may have to be ordered but call your pharmacy a week ahead of time and ask if they could order the SANDOZ patch (for example). Trust me I tried the Mylan patch and then the Sandoz and noticed a big difference. I also do the overlapping thing with the patches which helps to keep your BPL(blood plasma level) at the same rate. I will usually overlap, or leave the old one on 8 hours longer than the 48 hour mark, while putting the new one on at the 48 hour mark. So I have both of them on for 8 hours and then I take the old one off.
I would give those two things a try first and see if you notice a difference.
brian