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Old 06-13-2009, 02:59 PM   #1
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fentanyl patch not lasting 72 hrs.. due to menopause

I've been on the fentanyl patch for about 4 years and lately it hasn't been lasting 72 hours ...by not lasting I mean its not just a decrease in pain relief i'm also starting to have withdrawal symptoms anywhere from 48 to 60 hrs after I apply a new patch.... this seems to have coincided with the onset of menopause and hot flashes I told my Dr. about it last summer ,she increased my dose but I still changed it every 72 hrs. I was fine for a while, However in that time I started getting a period again and the hot flashes stopped.

About 5 months ago my periods stopped again. the flashes started, and gradually the patch stopped lasting 72 hrs.again I've been doing ok making them last, sometimes changing it a little early but that third day is getting to be hell..Has anyone ever heard of this?

 
Old 06-13-2009, 05:19 PM   #2
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

I'm not sure how menopause would affect medication effectiveness - perhaps ask a pharmacist and your doctor if this truly is an effect (if what you are experiencing is due to menopause). And, if so, how they can help you through this. What symptoms are making you think the patch is loosing effectiveness?
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Old 06-13-2009, 06:53 PM   #3
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Quote:
Originally Posted by SpineAZ View Post
I'm not sure how menopause would affect medication effectiveness - perhaps ask a pharmacist and your doctor if this truly is an effect (if what you are experiencing is due to menopause).
I would agree that it's unlikely that menopause is the issue. Probably just a coincidence. I would suggest reading the thread titled "Missed my meds for 12 hr"....It's right below this thread. Here is a direct link:

http://www.healthboards.com/boards/showthread.php?t=697028&page=4

Please see my post on the issue....It's on page 4 of the thread. Your patch is more than likely running out of med after two days.....This is quite common.

Best of luck to you and please let me know if you have any questions as I'd be glad to help.

Regards,

Ex

Last edited by Executor; 06-13-2009 at 06:54 PM.

 
Old 06-13-2009, 07:33 PM   #4
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Hi there. I think that your situation could be both directly and indirectly due to Menopause. When you have hot flashes sometimes people's body temp rises a degree or so. I know that they say that 1-2 degree change in temp shouldn't affect the Fentanyl patches, but in my case that's not true. If I exercise lightly even, my body temp rises about a degree. My body then sucks up the drug out of the patch and it stops being effective 24 hours before I'm due to change my patch. It's crazy I know, but it happens to me all the time. My doctor has my Rx's written to change every 48 so I don't run out of meds at the end of the month, but unless I'm exercising I can usually go 72 hours till I need to change. It's all about the body temperature for me. This could be the case for you too with the hot flashes related to menopause.
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Old 06-13-2009, 07:45 PM   #5
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

noescape,
It's me again, I wanted to tell you that I had that problem from the start. At my last appt. I told my doctor that I really couldn't do much on the third day of my patch. She said, "Well, we can't have any of this "third day" stuff". So, she switched me to a 48hr schedule when she put me on the 50mcg patch. Do you think your doctor will consider changing your dosing schedule?;0)
weezi

 
Old 06-26-2009, 05:00 AM   #6
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

My last doctors visit I discussed w/ him abut my patches(75mg) not lasting to its full strength on the 3rd day and I feel so much pain that last day and wanted to see about changing it every 48 hrs. He explained to me that it is not uncommon and heard of many complain of the same issue, but unfortunately that most insurance's will not cover the medication prescribed for 48 hrs. So needless to say I left the doctors that day still dealing w/ the same issue.

I have not only dealt w/ the last day problem but in the summer w/ them not wanting to stick either...So I totally understand what you are saying. I am not sure of the menopause being to blame, but then again anything is possible....So if you find anything to back that theory please write about it because I am going through the pre stages of that myself......

Another issue I have is the patches will only stick on one part of my body, (my upper arm) and only on one arm at that, anywhere else they fall off..Has anyone dealt w/ that before as well?

 
Old 06-26-2009, 07:28 AM   #7
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Quote:
Originally Posted by dolejaly View Post
My last doctors visit I discussed w/ him abut my patches(75mg) not lasting to its full strength on the 3rd day and I feel so much pain that last day and wanted to see about changing it every 48 hrs. He explained to me that it is not uncommon and heard of many complain of the same issue, but unfortunately that most insurance's will not cover the medication prescribed for 48 hrs. So needless to say I left the doctors that day still dealing w/ the same issue.
IMO, I don't think that's acceptable. I would see if your doctor would write you two scripts for your patches... 1 - for (10) 75mcg patches and 1 - (5) 75mcg patches. Have him write on both Rx's that it is 'medically necessary' to change the patch every 48 hours. (backup on this can be found on the white insert that comes from the manufacturer and is becomming much more common) Take them both to the pharmacy the same day and ask them to run both through the insurance. The insurance shouldn't deny the full refill of a total of (15) 75mcg patches, but if for some reason they won't fill, go ahead and run the 10 through the insurance and do self pay on the other 5 if you can financially afford this.

My insurance wanted to do the same thing to me since it's generally scripted for changing every 72 hours... But we went through the manufactures insert and highlighted the portion where it says that 'some patients will need to change every 48 due to metabolism and other varibles' and sent it to my insurance company. After that, they gave me no more trouble filling the 15 patches per month.

Quote:
Originally Posted by dolejaly View Post
Another issue I have is the patches will only stick on one part of my body, (my upper arm) and only on one arm at that, anywhere else they fall off..Has anyone dealt w/ that before as well?

I had MORE trouble with what your describing than I care to even share. I was so fed up with them not sticking and falling off that I was about to give up and scrap the whole idea of using them. (Thank goodness I didn't b/c they are a lifesaver)... I too could only get them to stick on one arm and in only one place. I could put them at the very top of my upper left arm and they would stay almost through the three days (when I was on three day dosing). Couldn't get it to stick in the same spot other arm. It was crazy. So I read a bunch of stuff on here about getting patches to stick and found a great solution... Tegaderm Patches. People talk about Tegaderm, Bioclusive and Opsite Flexfit... I now have tried all three and have found Tegaderms to be the best. Bioclusive are nice, but they are a little thicker than the others and can almost pinch the skin when it bends and rolls. The Opsite was really hard for me to put on b/c it doesn't have any 'tabs' to apply it with... but there are several people on here that love it... and the best in my opinion is the Tegaderm. They come in several sizes, but I've found that the 1626W (4" x 4 3/4") patches work the best. They look huge in the package but aren't so big when you put them on. They have a nice wide 'frame' around them that you use to apply the patch and then push it all down really well. Once applied, then you can pull the 'frame' off and the patch sticks great!!!! Not only does it keep your Fentanyl patch on really well, it also waterproofs it and is sweat resistant as well. Only downside to these is that they can be expensive if you buy them through a retail store. First time, I got 4 of them from Walgreens (Nexcare Brand) and paid $13 ...($3.25 each YIKES!!!) I then went online and found several online retailers that sold them for much less expensive (about $2.10 a peice), but the best price was a great, very famous 'Online bidding' site. I was able to get 50 patches for less than $30 including shipping. I now use them EVERYTIME I put on a new patch and they DO NOT COME OFF. I too live in the south so it's always hot and humid, plus I have hyperhydrosis (excessive sweating) and they still stay on! I would give them a try!

Let us know how things work out with your doctors and if you are able to try the patches!
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Old 06-26-2009, 03:26 PM   #8
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Thank you for your advice, I will for sure speak w/ my doctor about this and also get a copy of that information from the company as well and see if that is something that will be accepted....Anything is worth a try at this point.

I had to chuckle when you said about the pain patch only sticking to your upper left arm, that is the same way w/ me as well, that is weird. I have tried the other arm, my upper back and nothing worked. It is strange because I don't understand if they stick on one arm then why won't they stick on both?...HMMMMMM.... Then after awhile my arm would break down on having to place them on the same arm and caused burning, so I tried to at least just like a inch different locating it every time and that helped just a little for a small section of my arm to heal.

I really appreciate your advice, thanks again....

I still wonder about that menopause w/ the patch as well, coincidental or really could have an affect?.....

 
Old 06-27-2009, 06:24 AM   #9
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

I have to say that I like the tegaderm patches as well. They are so convenient.

In regards to the dosing schedule and your insurance, I don't understand why there is a problem. I guess it depends on your insurance company. In my case, I went up to a 50mcg and was changed to the 48 dosing schedule. My insurance paid there portion and I just paid the difference. It was quite a bit more expensive but I am getting the Duragesic brand. I was just curious to know if your insurance company would still pay a percentage if you were changed to the 48 schedule? Can you call your insurance company to discuss your options?

Someone posted using antibacterial wipes on the spot where you are going to apply your patch. I am still wiping the spot with alcohol and cotton balls and that seems to work quite well unless I break out into a sweat. We are experiencing a major heat wave here, it's been 101 for the last two days and again today! I am going to try the wipes and will post back. Hope you guys feel better;0)
weezi

 
Old 06-27-2009, 06:52 AM   #10
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

New2CP, dolejaly and friends,
I wanted to let you know of the problem I experienced this week. When I put on a new patch I tend to leave the old one on for a while because I have been having severe joint pain since starting PT. Also, it's been so hot here that I think the medication is absorbing much quicker thus I am running out sooner. A couple of days ago the old one was coming off so I just took it off a disposed of it. Later that day I wasn't feeling well and didn't even think about the patch issue. I ended up having a severe case of diarrhea overnight. I woke up Friday morning in severe pain and that is when it dawned on me that it was probably due to the patch. I realize that I shouldn't have started this habit but I was trying to make sure I had decent pain control. On the day I changed my patch I would experience a spike in pain and some withdrawal symptoms. So I started leaving the old one on for a while until the new patch began to take effect. I finally got some relief when it was time to put the new patch on and I left the old one in place. On a positive note, this is why I haven't needed the BT meds as often. I have an appt with PM doc on 7/7/09 and will discuss this with her. Needless to say, I wouldn't be able to function without the patch. Thought I would share with you all;0)
weezi

Last edited by Weezi; 06-27-2009 at 06:55 AM. Reason: mispelling

 
Old 06-27-2009, 07:36 AM   #11
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

WEEZI......I have done something similar to that and your right it did help, but I also was Leary because I didn't want to add too much medicine in me so I didn't do it often...But I would take off my old patch and put on my new one and then take the old one and tape it to my leg and it helped for awhile. It takes me normally about 5- 6 hrs after a patch change for the pain to start to lift, so w/ the old one on w/ the new it helped quicker and would control my pain better. But, the patch on my leg never stayed on very good and would fall off after a few hours, but it would stay on long enough to help jump start the new patch.

That is one of the reasons I brought the attention to my doctor of either raising my patch from 75mg to 100 mg or altering to changing the patch every 48 hrs....But, I complain too much now of being sleepy so he felt the 100 mg would be too much and I would be more tired and of course the insurance reason was the other reason for not altering.

The days my patches are down low the pain is so unbearable that it hurts to get out of bed, it hurts to sit, stand or actually move, not to mention I have had stomach cramps also.

What makes it hard is that my patch will only stick good to my left upper arm and falls off every where else that I can't add the new one w/ out taking off the old one.

Another thing I have done that increased the medicine quicker into my system was I would go to the tanner, in which it seemed that the tanner would release my medication quicker so I wouldn't have to wait the 5-6 hrs for relief...But, it scares me to do that because of overdose. My doctor says things I have complained about are not abnormal, but yet he has gave me no suggestions on helping either. I don't want to take any extra meds beings the Fentanyl and the vicoprofen are enough and I feel blah as it is w/ no energy so I don't want to take further more and make me a zombie....I only take my muscle relaxers if it is late at night beings they make me sleepy...But, this roller coaster of pain can drive a person insane after awhile.....As we all state the patches don't take all the pain away but it will at least take enough away to live some what of a normal life....

 
Old 06-28-2009, 06:43 AM   #12
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Quote:
Originally Posted by Weezi View Post
When I put on a new patch I tend to leave the old one on for a while because I have been having severe joint pain since starting PT.

I have an appt with PM doc on 7/7/09 and will discuss this with her.
I'd be careful overlapping. The med released by the old patch is still working it's way down through the transdermal layers, after you take it off. Once you put the new patch on, it starts working it's way down through the transdermal layers as well. Meanwhile, the med released from the old patch is already in your system and that last bit of med from the old patch is still working it's way down, followed by the med from the new patch.

Conversely, if you overlap two patches, then both are releasing med at the same time, resulting in a higher blood plasma level (BPL). While this process may feel like it's jump starting the new patch, what it's really doing is putting more med in your system, so you feel better. Whenever you take your old patch off at some point, your BPL will then start to slowly decline and taper off to the one patch level. Then, if you do it again 2-3 days later (whenever you're instructed to change the patch), the process repeats all over again. The end result is up and down BPL, which is what one gets with SA meds. The primary purpose of a LA med is to stabilize one's BPL.

I'd be curious what your Doc says. The patch changing instructions aren't very clear and judging by the # of posts I've read on the subject over the years, Dr. instructions are all over the board. Hope you start to feel better.

Regards,

Ex

 
Old 06-28-2009, 05:04 PM   #13
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Re: fentanyl patch not lasting 72 hrs.. do to menopause

Thanks for your response dolejaly! I have read some of your other posts and it sounds like we have very similar problems. My pain gets so bad towards the end of a patch cycle and I end up in bed because it's so severe. I have a bad habit of trying to get everything done in a day and I always push myself to far. I have been seeing a therapist and she reminds me that I need to take breaks during the day. I know that and I try to remember but I get so anxious to get things taken care of. It really is a vicious cycle! This hot weather has made it much worse because the medicine is being absorbed faster. I really don't want to go up to the 75mcg. My doctor put me on the 50mcg and changed my dosing schedule from 72 to 48 at my last visit. My PT wants x-rays before he goes any further with my treatment. We are getting ready to move in a couple of weeks and I think my anxiety and stress are getting the best of me.

I am sorry that the patch makes you so tired. I haven't had that side effect and I can't stand to be tired. Maybe if your doctor will just change your schedule that would help. I know it helped me tremendously!

Ex, thanks for the input on the patches. I can see why I am having this rollercoaster issue now. I think I need to go back to managing only what I can get done in a day and try to keep my expectations reasonable. I know that resting really helps me feel better. I have always been a rather hyper person so I struggle with my "perfectionism"

I really appreciate you guys! I have even told my husband how much support I get from my cyber friends on the PM and CP boards, take care;0)
weezi

Last edited by Weezi; 06-28-2009 at 05:06 PM.

 
Old 06-28-2009, 06:26 PM   #14
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Re: fentanyl patch not lasting 72 hrs.. due to menopause

My patch instructions say they can only be placed on the shoulder. Guess those are the Dr. instructions. Mine would not stay on either. So, now I use COVER-ROLL. It's an adhesive gauze roll. The 2 inch roll is a perfect size for the patch. You cut it as long as you need. My primary who did not give me the patch thought I might have too much medicine being dispensed because of the cover roll but it is fine. I go to aqua therapy and the pool is 94 degrees. It doesn't loosen the patch or anything. So, using the COVER-ROLL is great for me.

I hope menopause will not throw the patch out of whack. I will be knocking on that door soon. I can see hormones throwing things out of whack. I use to take Provigil for Narcolepsy. That drug threw the Estrogen out of whack so could not use the birth control pill. So everything kind of works against each other sometimes. You never know.

 
Old 06-29-2009, 01:37 PM   #15
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Re: fentanyl patch not lasting 72 hrs.. due to menopause

I just wanted to add a couple of things. I was originally prescribed the fentanyl patch and it was for 72 hours. After a month or two on this schedule it was pretty apparent that it was lasting only for about 60 hours and then I would experience some withdrawal and an increase in pain. I called my insurance company and asked them how many I could get in one month and they told me 20 of one particular strength. I then told my doctor this and he switched me to the 48 hour cycle so I am prescribed 15 patches per month. I would definitely call your insurance company and ask them about this.

You can look in the white prescribing paper in every box of patches and it will say somewhere in there about people needing to change more frequently than every 72 hours. I might try to look for it and let you know exactly where it says this. It is not going to do you much good to increase the strength of the patch and still have it stay on the 72 hour changing schedule.

It does make sense that the patch is not lasting as long since your menopause and you are experiencing hot flashes. When you experience the hot flashes your body temperature and skin temperature increase and more of the fentanyl is drawn from the patch into your body. Then this means that the amount of fentanyl in the patch will run out sooner and NOT last the full 72 hours. I would first call your insurance company and then tell your doctor to prescribe it for every 48 hours.

I was also told by my insurance company that I could get 20 patches/month of each strength so if I was taking a 50mcg and then was increased to taking a 50mcg and a 12mcg patch I could technically get 20 of each per month maximum. It gets a little confusing but once you find out the rules by your insurance company and if they will make an exception then things are better understood.

I use the the Optisite Flexifix but have been having some issues with it not working too well with the very hot days here in Ohio with it being around 90 degrees. I put my patch on at midnight (sunday) and after I took a shower last night (sunday night) it started coming off. I had to completely remove it and put another patch on so it only stayed on 24 hours. That makes me mad so I might look into buying the Tegaderm patches.

brian

 
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