I had an interesting experience yesterday at the doctor's office and as I was doing some research, came across your boards.
I have been on the patch for a couple of months now. Initially, I was on 25mg patches (because that is how they start everyone, although I had come from another doctor and on more potent meds), of course, the 25mg alone did not do the trick and aside from the Neurontin I was taking, they increased the patch to 50mg. I can be called "Juana Q", meaning I have an HMO; my patches needed to be generic. Since the 25 mg patches, were small, I did not experience any "sticking problems", and wore two until the insurance allowed me to get my new prescription. Once I began with the 50mg generic patches, my pain increased and I noticed that the edges of the patch were not sticking or it would bubble in the middle, or whatever pattern it so desired to take. Not only was it annoying, but when I had the opportunity to "re-stick" them, the pain I experienced was still telling me that apparently the sticking problems were influencing my medication release or effectiveness for that matter.
All refills for meds at my docs office must be requested with several days in advance, so I did and yesterday, since I went for a procedure, I asked for my prescription. Keep in mind, this was the first time I was informing them of the "sticking dilemma" and the prescription had been written a couple of weeks prior. When they gave it to me, I immediately noticed it was written for 25mg! I questioned the nurse, explained that I was on 50mg and how could they lower my medication, if I had yet not improved a bit with the procedures I had done. She went to ck. with someone else, and returned saying they just wanted me to try it, but that they were writing "medically necessary" on my script so that I could get the brand and the insurance cover it. Of course I asked to speak with the Phys. Assistant. I explained my concerns:
1) How could they lower my med when I still feel no relief (I have nerve entrapment of the ilioinguinal & iliohypogastric nerves and have degenerative disk disease with two herniated disks, all of this on the same side!!!) and since the meds only take off the edge of the pain, lowering them would put me in more pain than I care to have.
2) I have come to have many of my problems due to the negligence of people that thought were Gods, meaning some doctors, I was very concerned that there was a "need" to make the procedures look good on paper, by lowering my meds, after the procedures.
3) I have been on work disability for 2 yrs, desperately need to get better so that I can at least work and try to make a living. I don't want to go in the wrong direction, my goal is to function enough to work and my situation is getting very difficult as each month passes.
4) I live almost an hour away from my doctor's office. They do not call in the patches to the pharmacy and demand they be picked up my ME. To get a 25mg RX, when I have been on 50mg, leads me to "assume" that soon I will be calling again, because I am in a lot of pain, and they will tell me they will get a new 50mg RX ready and to give them 3 days and then go drive another hour in my old stick-shift car!
Well, the answer I got was that they had been receiving a lot of complaints from patients that also experienced the "sticking problem", and that there was some evidence that the time release mechanism of the generic patch apparently was not functioning as expected, and they had decided, that perhaps, because of the sticking problem, they had found themselves having to increase the med from 25mg to 50mg, when in fact maybe if the patient wore the Duragesic brand patch, they would not require the higher dose, as they did not have the same "sticky" situation. And, if the patient did, they provided the free-sticker-for-the-sticky by just calling a 1-800!
Have you heard of anything like this? I thought that brand and generic would symbolize same med just different name? I read a lot and this is the first time I hear that a 50MG could be replaced by a 25MG because one is brand and one is not.
That is weird that they would lower your dose unless they wanted you to put 2 25mg patches on b/c they stuck better for you. Have you tried using medical tape to help hold it on? If that doesn't work a number of people use a product called Tegaderm by nextcare (3m) which you should be able to get at a drug store and if they don't have the right size the pharmacy should be able to order it for you. (I used to work in a pharmacy as a technician). If you call Jassen, the mfg, they will send you an overlay for free if you tell them you are having sticking problems. There are some more tips in some of the other forums if these don't work (incl duct tape - ouch!) or ask your pharmacist for suggestions - they can reccomend the best medical tape (they are different) or something else. Another suggestion - I have someone put it on for me (I put it on my back) and make sure you press the patch onto the skin with the palm of your hand and hold it there for at least 30 seconds, making sure it sticks well, particularly at the edges.
The generic by Sandoz is actually manufactured by Alza, which is the same company manufactures the brand name for Jassen. The Mylan generic doesn't seem to stick very well. The pharmacy can also order the Sandoz product for you even if they usually use Mylan. Brand and generic are the same thing 50mg of one is 50 mg of the other.
Also - it is against the law to call in CII (strong pain killers and some other types of medicines) medications. Some doctors will mail you the prescription a couple days in advance if you give them preaddressed self stamed envelopes, but if you do this I would still call and make sure they do it. I know it sucks, but that's the way it is.
Hope you start to get some relief soon!
Last edited by RobinD21283; 08-16-2005 at 11:11 PM.
Thank you for your valuable input! I know that it is completely irrational, to try to sell me the idea that the Brand patch, at 25mg, would be the same as having the 50mg generic. I really took it as an insult to my intelligence, but I do know, that arguing with a fool is fruitless! It is precisely why I wrote here. We as patients, have a right to question what some of these "god-wanna-be's", try to tell us.
My ex-husband is a Pharmacy Technician and because of him, I learned a lot about generics etc., that is why I was so puzzled and silently annoyed, if I must confess, that they tried to tell me this; it only makes me wonder about the other patients that take on these explanations and do not question or comment to others, as opposed to bringing it to light and hopefully, open their eyes, to the things that go on in some of these offices. To live in pain is not easy, but I surely thing that a great contributing factor to peoples dilemmas, have to do with the situations they have to deal with, such as the one I have exposed. Another reason why I am so anxious to get better, and just go on with my little simple life, earning my beans, and not having to deal as "Juana Q", with the insurance companies, or present this or that paper to my employers disability insurance, having the stress of whether or not they will send me a check at the end of the month, for me to at least pay my rent, medical and car insurance, and play musical chairs with the other bills, because the money is not enough to cover them all, and now I have not a husband, because he was unable to deal with the fact that the little hen with the golden eggs, was no longer producing the same income.
Things that make you go ...hmmmm! The good thing is that I have a lot of faith and I know in my heart that I will get better, and get to a point when I will remember all this and laugh in awe....."Gee....I am a very strong woman! To think that I went through all that....and here I am standing tall! Ha, ha....!"
I have some very interesting info on the fentanyl patch. I started on the duragesic patch in late 2001 with 25mg and gradually moved up to 100mg because of the pain I was experiencing. I was on the J & J patch until Feb 2005 when the generic patches became available. I was immediately switched to the patch manufactured by Mylan Pharmaceuticals. About two months ago I went to my Dr and told him my pain was beginning to get much worse. He decided to put me back on the orginal J&J Duragesic patch and gave me a script. After dropping it off at the pharmacy I received a call from the Pharmacist and he indicating that my co-pay would be $1300. Fortunately I was able to use the Sandoz patch and it is working fine. I found that with the Mylan patch, my body was starving for the medication. The only problem I have now is with the patch sticking when I sweat, so I went to a Medical Supply House and bought the J&J coverup dressings I used to get free when using the Duragesic patch. I hope this info is of help to other users of the patch.
Thanks! I do happen to be on the Mylan Generic, which is the "sticky that doesn't stick"! I am yet to begin "my experiment" with the brand patch, but I am very disapppointed, because I feel that they are letting me get worse (as far as pain), as opposed to helping me have less pain! Anyway, I will keep you posted.
Thanks a lot! (...and I truly hope I don't find that I have to pay a Co-pay such as yours!)
Duragesic Vs Generic/Dr. lowering dose now 
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