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Old 05-16-2008, 07:50 PM   #1
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I have a few questions about the fentanyl patch...all replies appreciated.

It is my understanding the patch is made in strengths of 12.5, 25, 50, 75 and 100 mcg's...what is the strongest dose a person can safely apply at one time? 100 mcg's?

I normally use the Sandoz brand patches but yesterday, when I dropped my script off at my pharmacy, my pharmacist told me b/c of a manufacturer shortage they were unable to get the Sandoz brand patches in stock this month. Has anyone else experienced this problem? Unfortunately, I'm stuck with the Mylan brand this month.

Thanks .

 
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Old 05-16-2008, 07:57 PM   #2
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

The limit would depend on the patient's opiate tolerance (how long they have been on opiates). I had been on 50 mcg for a long time and knew by my pain level it should go up (and my doctor wanted definitely me to rather than taking more pills)...however, I was hesitant because, as I told him, I am only 40 years old, I don't want to be 70 and be in excruciating pain because I topped out on my medicine long ago. He told me there is no limit to how much can be used, you'd just be wearing more than 1 patch.

My pharmacy has also done that, switched brands. When I first started wearing them they didn't have gel-goop in the middle of the patch it was just a clear bandage with fentanyl written across it a bunch of times. Now, I have the goop stuff.....and have actually had 2 or 3 different brands of it. For me, they all seem to work the same.
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Old 05-16-2008, 08:00 PM   #3
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

What strength are you on?

Ex

 
Old 05-16-2008, 09:21 PM   #4
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

I was on them once before and I was wearing 3-100 mcg patches at once.
It depends as someone else said what your opiate tolerance is.
I am going back on them since the Oxycontin isn't working so well, so we are trying the fentanyl patches. I am hoping that they work. We are starting at 100 mcg/hr.
Sandi

 
Old 05-16-2008, 11:17 PM   #5
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by Executor View Post
What strength are you on?

Ex

I'm on 75 mcg but in pain. My Dr said she's hesitant to increase me to the 100 mcg patch this soon (I started the patch (50 mcg) on 02.16.2008, on 03.03.2008 went to 75 mcg patch) b/c that's the limit and after the 100 mcg patch there's nowhere else to go.

 
Old 05-16-2008, 11:53 PM   #6
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

You've received some good replies re: the "max" dosage(s). Due to the lack of 25s in the market, it's put a lot of pressure on all the other strengths as Docs are moving patients to other dosages. This is the reason for your shortage. Hope the Mylans work out ok. Would love to hear your feedback.

I spoke with a representative @ Jansseen yesterday, and they've fixed the problem and will be shipping huge lots of 25s by July 16th. However, this date could change. But, it's the first time Jansssen has put a date out there. Thus, I suspect the shortages will not last much longer. It may be a tough ride for the next month for all of us patch wearers.

Re: the patch in general, here are some great threads to look at:

Another question about fentanyl patches.....Last post date 5/11

Patch availability (or lack thereof) update.....Last post date 5/7

Watson fentanyl patch? Does it work like Sandoz or Mylan?.....Last post date 5/6

Just prescribed Fentanyl Patch...A few questions......Last post date 5/6

Anybody know if Duragesic patch sticks better than Sandoz?.....Last post date 4/25



Good luck.

Ex

 
Old 05-17-2008, 12:03 PM   #7
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

I do hope the Mylan patch works out for you and you do not go through withdrawals because that has happened to alot of people. Many people do not feel as if the Mylan works as well as the other brands. I make sure that I use the Sandoz brand. My CVS store pulled the switching brand routine to Mylan and I just took my business else where. There is no way that I would try the Mylan brand EVER.

I use the 50mcg patch and have not had a problem with a shortage. I just got them filled last week (15 for the month) and they had them in stock.

Now your doctor told you that 100mcg is the highest you can go. THIS IS ABSOLUTELY NOT TRUE. The thing with LA opiod medications is that you can go as high as needed. The thing that will stop you is the reluctance of a doctor to prescribe certain dosages and your insurance company paying for them. My insurance company does not have a problem and only limits them to 15 per month which is every 48hours chaning. I was on the 25 & 12 at one time and getting 15 each without any issues. I made sure that I called my insurance company ahead of time to ask about their limitations. If you need to go up then I would suggest trying it. Are you on a 72h changing cycle or the 48hour chaning cycle. Sometimes going to the 48h chaning cycle can make a big difference. Also overlapping them when you change them can help out too. I have been doing this and it does keep the blood plasma level pretty level. Keep us posted.

brian

 
Old 05-17-2008, 07:59 PM   #8
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by brianpain33 View Post
I was on the 25 & 12 at one time and getting 15 each without any issues. I made sure that I called my insurance company ahead of time to ask about their limitations.
brian
Brian - or anyone else in the know.....I have been curious about this, if the doctor prescribes say 150 mcg and you need 2 patches (the 100 and the 50) then are you charged 2 co-pays or just 1 since it is 1 prescription?
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Old 05-17-2008, 11:40 PM   #9
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Brian ~ I apply a new patch every 72 hours, but at my next monthly appt (not until June) I plan to talk to my doctor about having me apply a new patch every 48 hours instead of every 72 hours...who knows, that may relieve a great deal of my pain by simply doing that.

I think I may have figured out why my doctor thinks, and also told me, that the 100 mcg patch is the limit. My doctor is not a PM doctor, she is my GP and I honestly don't think she knows that even though the most potent patch is the 100 mcg, she can still mix and match between the different strengths. She took over my pain mgmt after I had two aweful experiences with two different PM doctors. She did so b/c she is a caring, compassionate person. I plan to discuss this with her at my next appt so she can research it further. As I previously said, she is a very caring doctor, she would not throw in the towel if there's more she could do to help me or any of her other patients. I feel very hopeful .

I hope I don't go through w/d either while I'm using the Mylan brand. I've only used the Mylan brand 1x before...the very first time I filled a script for the patch, at CVS, nonetheless...after I tried the Mylan brand and found they didn't work very well, I spoke with my pharmacist and he agreed to keep the Sandoz brand in stock for me each month...I'm not sure what happened this month...a few days ago, when I dropped my script off, I asked if they had the Sandoz brand, 75 mcg, in stock, like I do every month, I was surprised when the pharmacist said no, they didn't have the Sandoz in stock this month b/c the manufacturer had a shortage. To be honest, I think the pharmacist was fibbing but I needed my script filled ASAP b/c I was out of patches and needed to apply a new one that day...so, that's how I got stuck with the Mylan brand this month, but that won't happen next month b/c I plan to call my pharmacy atleast a week in advance to make sure they have the Sandoz brand set aside for me...if I encounter that problem again, you better believe I will be finding a new pharmacy.

Thanks for your advice. I appreciate it.

 
Old 05-18-2008, 02:48 AM   #10
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by Executor View Post
Just one.

However, if your Doc scripts you 15 patches, pills, capsules, or whatever, and the pharmacy only has 10......And you have to get the other 5 somewhere else, or come back another day to the same pharmacy (with a second script for the balance), you get charged two co-pays.

Ex
Ex - That's good info to know (especially since when I signed my pain contract I had to name the pharmacy I would use and cannot switch the pharmacy without clearing it with the Dr. first.

However, it isn't quite what I was asking. I'll try a little harder to spit out what my brain's thinkin'! Someone had said they used three 100 mcg patches at a time, and if changed every 48 hours that would mean they needed 45 patches per month, or 9 boxes....so the doctor writes the script out for 300 mcg to change q48h.....do they pay 1 copay or 3 copays? Get what I'm trying to convey? (it is quite late/early in the morning and I may not be effectively explaining what's in my curious mind!)
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Old 05-20-2008, 10:09 PM   #11
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Executor ~ Thank you SO MUCH for all of your advice. I sincerely appreciate it.

I apologize for not replying to your post sooner than today.

I have felt terrible since I started using the Mylan brand patches, I apparently received a bad box of patches or a few bad patches, I'm not sure...I applied my first patch this past Friday, around midnight, and by Saturday afternoon I was in a lot of pain, a lot more pain than normal. I woke up Sunday and my pain level was off the charts, and to add to my misery, I have also been feeling nausea quite a bit...I know all my troubles are due to these silly Mylan brand patches...I NEVER had a problem like this with the Sandoz brand.

I see my doctor once a month for a checkup and new scripts, unless something comes up and I need to see her sooner. My next appt is scheduled for June 9th, but I think I may call her office and have my appt moved up b/c I'm in too much pain. In addition to the patch, my doctor prescribes 3 percocet's (10/325mg) per day to take as needed for B/T pain but they're only barely taking the edge off my pain.


I would try a every 48 schedule before moving up to another strength. If it's a dosing issue, you'll also run out of med on the 100 and have the same problem.

I have had many people recommend a schedule change like this, but have never had someone explain it in the same manner as you...you have made it really make sense to me, THANKS!

I will be very curious to hear your feedback. The reviews on the Mylan are very mixed. Some think they're great while others claim WD. As I posted before, I think it has to do with the -20% concept of generics. Remember the thread "Brand vs Generic"? You could do a search and find it very easily if you want to brush up on the subject of why brands are more potent.

So far, I'm not too fond of the Mylan brand...I'm sure I might give it some sympathy points once I'm not in pain and I no longer want to vomit .

I did go back and read your "Brand vs Generic" thread...It was very interesting.

I do have a question, if you don't mind. Do you think it's ever safe to use a heating pad while using the patch? I ask b/c last week my doctor recommended that I start using my heating pad again...I have a bad back, and prior to using the patch, I used a heating pad all the time. I apply the patch to my upper arms, and every 3rd day I alternate arms. My doctor said she would not recommend I use a heating pad if I was applying my patches on my back, but b/c I'm not she doesn't see the harm in it. What do you think?

Thank you!

 
Old 05-20-2008, 10:33 PM   #12
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by scrappinmaniac View Post
Executor ~ Thank you SO MUCH for all of your advice. I sincerely appreciate it.
No problem....Sorry to hear you feel so bad, but to be honest, I am not surprised.

Quote:
I have felt terrible since I started using the Mylan brand patches, I apparently received a bad box of patches or a few bad patches, I'm not sure...I applied my first patch this past Friday, around midnight, and by Saturday afternoon I was in a lot of pain, a lot more pain than normal. I woke up Sunday and my pain level was off the charts, and to add to my misery, I have also been feeling nausea quite a bit...I know all my troubles are due to these silly Mylan brand patches...I NEVER had a problem like this with the Sandoz brand.
What's happening is that you are going through WD. Additionally, your pain has returned because you aren't getting enough / any med so it's a double whammy. This is the feedback I have read over & over. In fact, my Doc forbids me from using Mylan and says that if I use it to not call him for new patches because he warned me. How about that as a statement? He said because the active ingredient, glue, and byproducts are all mixed together, that the system just doesn't work. Throw in the 20% less active ingredient, and it only makes the situation worse.


Quote:
I see my doctor once a month for a checkup and new scripts, unless something comes up and I need to see her sooner. My next appt is scheduled for June 9th, but I think I may call her office and have my appt moved up b/c I'm in too much pain.
I'd call first thing in the AM and tell the nurse you're having a very bad reaction to the med and need to be seen immediately. Beg, plead, or whatever you have to do....Don't take "NO" for an answer. WDs are VERY SERIOUS and can cause all sorts of related medical issues...High BP, stess, anxiety, you name it. Not trying to scare you, but just explain the severe situation you're in. If all else fails, go to the ER.

Quote:
In addition to the patch, my doctor prescribes 3 percocet's (10/325mg) per day to take as needed for B/T pain but they're only barely taking the edge off my pain.
You may also run out early as a result of the significant increase in pain. You will need to tell the Doc this also @ your appointment so he can make adjustments for you.

Quote:
I do have a question, if you don't mind. Do you think it's ever safe to use a heating pad while using the patch? I ask b/c last week my doctor recommended that I start using my heating pad again...I have a bad back, and prior to using the patch, I used a heating pad all the time. I apply the patch to my upper arms, and every 3rd day I alternate arms. My doctor said she would not recommend I use a heating pad if I was applying my patches on my back, but b/c I'm not she doesn't see the harm in it. What do you think?
As long as the heating pad is far away from the patch, you are fine. You're overall body temp won't raise much, if at all simply from using the heating pad. However, if there is radiant heat near your patch, that will cause the patch to dispense more med than usual. At this point, it doesn't seem like it's even working, so you should be fine....Just don't put the pad near the patch. Since the patch is on your arm and the heating pad is on your back, you should be fine. Now, a really hot bath or sauna would be a different situation because your entire body temp would raise.

PLEASE call your Doc ASAP. Good luck and God bless. I'm sooo sorry to hear this.

Ex

Last edited by Executor; 05-20-2008 at 10:36 PM.

 
Old 05-21-2008, 10:02 PM   #13
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by Executor View Post
I'd call first thing in the AM and tell the nurse you're having a very bad reaction to the med and need to be seen immediately. Beg, plead, or whatever you have to do....Don't take "NO" for an answer. WDs are VERY SERIOUS and can cause all sorts of related medical issues...High BP, stess, anxiety, you name it. Not trying to scare you, but just explain the severe situation you're in. If all else fails, go to the ER.
Ex ~ Thank you for replying so quickly.

Due to an unexpected family emergency, I was unable to call my doctor's office today to see if they could squeeze me in, so I plan to call as soon as they open in the morning. I feel confident that she'll have something available b/c Thursday is the one day of the week when her office is open late.

I'll keep you posted.

BTW, another thing I've noticed since starting the Mylan patch is how drowsy I feel all the time. I haven't felt this way since I first started using the patch....it's as if I've started using the patch for the first time again.

Thanks again .

 
Old 05-21-2008, 10:10 PM   #14
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Do you guys have locum services, which will come to your home for out of hours emergencies?

 
Old 05-21-2008, 10:13 PM   #15
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Re: I have a few questions about the fentanyl patch...all replies appreciated.

Quote:
Originally Posted by scrappinmaniac View Post
Ex ~ Thank you for replying so quickly.

BTW, another thing I've noticed since starting the Mylan patch is how drowsy I feel all the time. I haven't felt this way since I first started using the patch....it's as if I've started using the patch for the first time again.

Thanks again .
That would lead me to believe they are stronger than your previous brand. Do they feel stronger or weaker? Can you tell?

Ex

 
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