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Old 04-13-2005, 07:09 AM   #1
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Drewtn HB User
Question about (duragesic)patch lasting 72 hours.

My doctor seems to REALLY BELIEVE that if the patch isn’t lasting the 72 hours the dose needs to go up. I am at 100ug but am only changing every 72 hours. When I got up this morning to change it I felt like I had been hit with a ton of bricks!! I have cervicogenic headaches daily. I have been on the patch for about 6 months.

I have an appointment next week to see my doc. Is there any way I can convince him that I don’t need a dose upgrade but just need to change more often??? It makes sense to me but he says he was at a conference where they discussed this exact thing and if the dose is right it will last. I am pretty good the other two days but the day I change is VERY hard to deal with!!

I REALLY appreciate any suggestions with this. Thanks,
Drew

 
Old 04-13-2005, 05:49 PM   #2
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shaynesmom HB User
Re: Question about (duragesic)patch lasting 72 hours.

Hi:

I'm only on 25mcg...but since day 1 the patch has never lasted 72 hrs for me....it's pretty much 48 on the nose. My doc agrees that it rarely lasts 72 hrs and had no hesitation changing my px for a change every 48hrs.

Good Luck.

 
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Old 04-13-2005, 09:08 PM   #3
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Re: Question about (duragesic)patch lasting 72 hours.

Hey there,

I'm with shaynesmom, I originally started out on 25mcg then was upped to 50mcg when I said I wasn't getting any noticeable relief. My third visit after first being put on the patch I told my doc it didn't feel like I was getting the full 72 hours of relief and he wrote the script to change every 48 hours which seems to have done the trick.


Good luck, and keep at your PM doc, maybe he'll understand that your dose is so high it's affecting you, but you would do better just lowering the dose, maybe to 50 or 75 and just changing it more frequently.

Keep us posted,
tk

 
Old 04-14-2005, 08:27 AM   #4
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Re: Question about (duragesic)patch lasting 72 hours.

Thanks for the replies!! I am going to ask again next week. Hopefully he will understand that the other two days I am ok. Thanks!!

 
Old 04-14-2005, 10:09 AM   #5
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Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
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.
[url]http://www.duragesic.com/html/dur/index.jsp[/url]

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.

 
Old 04-14-2005, 11:54 AM   #6
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Re: Question about (duragesic)patch lasting 72 hours.

Thanks so much Dave!! I will print that out!!

You would think they would rather give me 15 –100’s as opposed to 20 - 50's! LOL I need to double check the limit on my insurance. I think the last time I looked there was no limit on Qty. At least now I have a few ideas on other suggestions to give him. A staggered dose would be much better too.

I really appreciate your help!
Thanks,
Drew

 
Old 04-21-2005, 06:10 AM   #7
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Re: Question about (duragesic)patch lasting 72 hours.

OMG!!! He changed me to every 48 hours!!! I am so happy!! This will make my life so much easier!!! YES!! I charted my pain over the chart that duragesic uses. I kept track of exactly when things went bad. He kept my chart and had no problem changing my meds!! I guess he wanted to get to my highest dose before doing anything about how often.

Thank you everyone so much!!! ((HUGS))

 
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