Re: Question about (duragesic)patch lasting 72 hours.
Hey Drew, I now someone that partcipated in the the non mcncer trials for duragesic, Only 6% of the participants got 72 hours of relief from the patch, If you read the package insert, IT says "Up to 72 hours ofrelief" THe 6% that it did last 72 hours for, allows them to market it this way.
As far as going to a conference, I would bet it's total BS. The manufacturer has no incentive to force people to stick to 72 hours, it woul benefit them more torecognize the need for more frequent changes in some patients and they acknowledge it in their FPR so I seriously doubt it was a Jansen conference.
Print out the full prescribing info from their web site and take it with you to the aspt. That logic simply doesn't hold tru. It's like trying make a shortt acting med last longer by increasing the dose. whether you take 5 mgs of hydro or 25 mgs of hydro, it last 4 hours tops, and yet docs continue to prescribe SA meds Q 4-6 hours. No SA med last 6 hours. MY mother had a TKR 2 weeks ago and has been having problems sleeping through the night, she wakes every 4 hours in extreme pain. This is very common for post op pain, The docs solution was to change her meds from 10mg norco to 10 mg Percocet, do ya think it's going to last any longer? Not a chance.
I'll take a look and see if I can find the clinical trial data from the study my friend particiated in. It was first aproved for cancer only and then a second trial was done for non cancer CP. The results were the same in both groups. You would simply be more doped for the same amount of time. Now if he adds say a 50 mic patch you can probably cover the gaps by using a staggered method of applying the patch so you never have a completely used patch at the end of a 72 hour cycle,
For examplke if your using the 100's and he adds 50 apply a 100 on monday and the 50 on tuesday, this way when the 100 is running out of juice you still have the 50 continuing to deliver meds, As long as you stick to a set schedule you would have a smoother serum level than you would if you simply used one patch at 72 hour intervals.
Jansen does recognize the need for adjusting the dosing interval for each individual in their prescribing info too. If increasing the dose is a problem perhaps you ask the doc to try 2 50ugh patches changed at stagered intervals to maintan a smoother serum level. I would think keeping your overall dose and side effects down is more important than forcing patients to take higher doses in the hope that it will last longer. It simply doesn't work that way.
Good luck, Dave
Here is Duragesics web site and the full prescribing info can be fond here.
The DURAGESIC® (fentanyl transdermal system)CII patch is a strong medication for moderate-to-severe chronic pain, available only by prescription, that can provide long-lasting relief from persistent pain.
Through its unique patch technology, DURAGESIC delivers fentanyl, an opioid pain medication, slowly into the body through the skin where it works to relieve pain for up to 3 days (72 hours).
This is directly from the full prescribing info.
The majority of patients are adequately maintained with DURAGESIC
administered every 72 hours.A small number of patients
may not achieve adequate analgesia using this dosing interval and may require systems to be applied every 48 hours rather
than every 72 hours.An increase in the DURAGESIC
dose should be evaluated before changing dosing intervals in order to
maintain patients on a 72-hour regimen.Dosing intervals less than every 72 hours were not studied in children and adolescents
and are not recommended.
It is interesting how the prescribing info changes over the years, Last time I read the complete ful prescribing info, no info was available on pediatric use, so they are continuing to find new approved aplications for their product. They don't say what the majority % actually is and from someone that particpated in the trials this doesn't sound like the majority, rather the minority of patients recieved 72 hours of relief. Anyway, you doc is right in one aspect, They are now suggesting increasing the dose before going to a more frequent dose. This may be due to insurance comapanies unwillingness to pay for 15 expensive patches a month versus 10.
Last edited by Shoreline; 04-14-2005 at 10:56 AM.