Hello all,
I read here everyday to gain knowledge on how to help my mother.
Long story short, she has battled lung cancer, osteoporosis w/compression fractures, rheumatoid arthritis she is 76. Her pain was out of control with Loratab 5-500 as many as 8 per day, she weighs 88#, we took her to the Dr and they put her in the hospital for monitoring for the patch. Which is fentanyl 25 micrograms change every 72 hours.
My question is when do the side effects of insomnia (sleeps all day) at night, wild dreams (she tells us stories that she thinks happens when it is dreams) crazy wild eyes, she fights with me, angry, agitated. I know that this is not the way my mom is but if this keeps up she is in danger of hurting herself. She fell the other day while chasing chickens, she is not eating, she
is unaware of her surroundings, so to speak. She keeps scratching her patches off. She is allowed 3 loratab for breakthrough pain and takes them way before it is time. Thank God I only give her three.
Is this normal, she has been on it sense July 29. I know it will take some time but how much time usually do these side effect subside? Sorry for the spelling
Hello....Sorry to hear about your mother. I have used the patch two different times now, and have quite a bit of experience with it. I last changed from it in the late spring due to the heat of summer and my sweating. I plan on switching back in the Fall, hopefully.
The patch is one of the strongest meds out there because it's fentanyl. It is 100 x more potent than morphine. Some of the side effects your describing are normal, especially the ones of vivid dreams, itching, and sleep patterns. In fact, these are the case with all narcotics, not just fentanyl. However, in general terms, the stronger the med, the more likely these are to occur. It takes your body a while to adjust. Although it seems like a good while to you, in reality, it hasn't. It may take her a couple weeks to a month to stabilize. The last thing that will stabilize will be her sleep patterns. Those on pain meds can often have much different sleep patterns.
The "angry, agitated" part is also somewhat normal. This may be due to the meds and or her pain. Normally, those things occur when one doesn't feel well...Many here can attest to that! Also, she may be going through a tad bit of hydrocodone withdrawal since she's been abruptly cut back from 8 per day to three. I don't care what Docs say about how pain meds are supposed to "replace" each other....They don't, in most cases. This will subside fairly quickly, however, since Lortab isn't that strong.
Re: the "itching", this is also normal....Goes for all narcotics. You may ask the Doc if you can give her some type of antihistimine on a daily basis...This will help quite a bit. Question for you...When she scratches her patch off, do you reapply it, or put a new one on? It can be tough to "re-apply"....Even with tape...I don't think they completely seal to the skin again. You may want to talk to the Doc about getting some "extras" each month, just in case.
I'm a little surprised that she is only permitted 3 per day for BT pain...I guess it's because her body weight is so low. Her Doc probably doesn't want her to OD since she's just been put on the patch. Can't argue with that. However, if her pain continues, you may need to request either more Lortabs, or a stronger BT med like Percocet. But, her body will need time to adjust first.
Hope all of this helps. Let me know if I can help further. Take care, and I hope things improve with your mom.
I know all you have said is very true, the itching especially. The first change was Saturday evening and I noticed the patch was gone, so I applied a new one (time to change anyway), yesterday I notice she was scratching in the area where the new one was, I found it when I helped her change her shirt, I reapplied it with a bandage, and rubbed her down with lotion. Would benedryl help with the itching?? I know it makes her tired but we have in the past given it to her for sleep issues. She also takes valium as many a day as she needs; I put two in her med's for afternoon and evenings. She is in no pain really she says that she has some areas that kind of feel funny. Her left lung is where the cancer was and it has filled with fluid, and is not working anymore, she is also on full time O2, so I am sure that can be some what painful on top of the compression fractures. I was also wondering about the withdrawal symptoms with the loratab although not very strong she was taking so many without relief. She is terminal and we are waiting to get out referral to hospice, but in the meantime I have come to the experts which is you.
I read all you post nearly everyday and have gained much knowledge for you. Thank you so much for replying. Please know I am praying for you all. Denise
Hi Denise, I just wanted to say welcome and to give you some of my experience with both pain meds and taking care of an elderly family member with pain issues. I myself have chronic pain, but do not use the Fent patch. But Ex already gave you excellent info about that. Just a side note. Benedryl at bed-time might help not only the itching, but to get her back on a regular schedule of sleeping at night.
I took care of both my mom and her sister for about 4 years. My mom had Alzheimer's and my aunt who was older was quite sharp mentally, but had medical issues. With both of them, the hospital and any type of narcotic medication had a tendency to make them very confused and agitated. Even my aunt, who was sharp as a tack. Put her in a hospital setting, even without pain meds and she was off her nut the entire time. Add in pain meds, and Oh boy! It is very common for the elderly to have very strong reactions to meds. (My mom was 77 and my aunt was 84 when I moved in)
We had to have sitters for both of them when they were in the hospital because they would have harmed themselves. And my husband and I ended up selling our home and moving in with them, because they could not remember when to take meds, nor were they eating properly or bathing often enough, etc. Is your mom living with you?
I just wanted to let you know that I fully understand what you are going through. If I can be of any help, at any time, please just ask. And don't forget to take care of yourself. I know it's easier said than done, but there are resources out there to help. God Bless, CMP/MM
I'm Shay. I was on the Duragesic patches for years. My highest does was 200 mcg ( I wore 2 patches of the 100 mcg dose). Even on that high of a dose of Duragesic, my pain really wasn't that well controlled. So, I switched to another medication that has worked wonders for me.
Anyway, my point I was getting to, is that I'm a bit surprised your Mother's doc put her on the Duragesic at such a low body weight. It's not recommended for anybody that weighs under 118 pounds. It evens says that in the prescribing info that comes inside of the Duragesic boxes.
That may be why she is acting a bit strange because it's such a potent med (actually, the most potent med to date) and with her extremely low body weight, she is getting quite a bit of fentanyl in her system, eventhough the dose is low.
Also, when I was on Duragesic, I did experince some of the things she is.....erractic sleep paterns, extremely vivid and wild dreams (very real in intensity) and very irratable. Although, most of the crabbiness was due to my pain and not feeling well, at all.
I just thought I would give you some feedback on my experiences with the Duragesic patch. Also, you can buy covers to put over the patch. I used Tegaderm (you can get them at any pharmacy). If your Mother is on the brand name Duragesic, she can get the Johnson & Johnson bioclusive covers for free. You would just need to contact Janseen Pharmaceuticals (the maker of Duragesic).
They will ask you a few questions like.. Have you tried other means to keep the patch on? How long have you tried any other methods? They will also ask for info about your RX and pharmacy phone number to make sure you do indeed have the brand name Duragesic. They will not send you the bioclusive covers if you are using generic forms of the Duragesic patch.
I hoped this has helped. Take care and bye for now.
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