I was recently prescribed Fentanyl 50 mcg Transdermal Patches. I also take Vicodin HP 10/660 (60 a month) for breakthrough pain. After about 3 Mylan manufactured patches, I told my doctor that I'm not getting a lot of relief from the patches. He said that he will increase my meds to 75 mcg in a few weeks. He also told me that in the mean time when it's time to change the new patch, go ahead and do it, but also leave the old patch on for about 4 hours. I fell asleep and when I woke up from my nap, I was nauseous and had a fever, I was delirious, couldn't walk, sweating like crazy and my right forearm was burning like it was on fire! The old patch was on my upper right arm. When I looked at my forearm, it had red spots and 2 blisters. One of the blisters grew into a medium-sized 2nd degree burn! I quickly ripped the old patch off, and tried to reach my doctor since it was the weekend. Has anyone who ever overlapped patches had problems? My pain was gone, but I didn't want to die in order for the pain to leave. Was this an actual overdose?
I use 2 50 patches at the same time but I change one at 1 and 1/2 days different to the other. I definitely would not leave one on for more than 72 hours. Also I would think of going to what I do rather than 75 but that is only my opinion. Now I have been taking narcotic medication for well over a year and it did take a while for me to get used to the second patch but I found that it was better than the pain coming back on the third day while only taking one patch for the three days. Some people change there patch after 48 hours because if the weather is hot or you are more active than a cancer patient that they were designed for. So it is a mater of getting the time right or the mix right if you are taking BT Meds. Personalty I only take BT's when I really have to. Even the Paracetamol or maybe Tylenol there. I take that first before any Oxycodone. That is my last resort before hospital.
So even though I take 2 50 patches they have lost some of there strength when I put the second on. You are welcome to ask me any questions and welcome here.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
Last edited by allanbruce; 04-18-2010 at 07:27 AM.
I think my Dr. wants to go up to 75mcg and titrate up if needed, plus I don't think my insurance will pay for 2 patches. So you've never had any crazy reactions when wearing more than one patch? I think I had also taken a Vicodin HP right before I put the new patch on. The last patch was put on Friday, April 16th, so I know it's time to put on a new patch (I've been in extreme pain for two days), but how long do I leave the old one on? I'm afraid of what happened last time. The Dr. wanted me to overlap the patches until we can move up to 75mcg. I will mention the two 50mcg patches and see what he says. Also, I don't know where else to put these patches. I have two burns on my forearm that are still trying to heal. When that happened, I had a patch on each arm. Any suggestions are greatly appreciated.
I have never left a patch on more than 72 Hours so if he wants you to overlap the patches just put the other patch on a little sooner even if it is 4 hours that should be ok but as I said never more than 72 hours for a patch! You are definitely not ready for two 75 patches at the same time. If you have BT meds just use them about a day before putting on the new patch even if it is from 24 hours to 8 hours before the new patch as you will have to work out when the pain is worst and how long the BT med lasts. I would use the BT me as soon as the pain got bad but it wouldn't be until the patch has been on for 36 Hours first, especially if you are on the 75 patch.
I always put the patch across my collar bone starting on one side then the other because there is room to change up to 2 spots on your shoulder either side giving you plenty of time for the skin to recover to normal before using the same placement. But if you are getting large blisters see your doctor and you may have to change to another slow release medication. There are a number of them you could try along with your BT med's.
As I have said in the past you can overlap them up to one and a half days before the 72 hours are up but if you are using BT's leave it a bit longer as they work quickly and would be to much for you so I would leave it till 48 hours or 36 hours if on the 50 patch before using BT meds. I actually got up to 75 patches changed at 48hrs but I found it was way to much for me. So I have stuck to the two 50's but if I was on one 75 patch I would need the BT's at about 2 days. I hope I have been helpful.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
Last edited by allanbruce; 04-19-2010 at 08:48 PM.
I just put on a new 50mcg patch today. I have 4 patches left before my Dr. will increase me to 75mcg. Now when I hear the word overlap, I think of putting one patch on top of another, but when my Dr. explained it to me he said leave the old patch on for a few hours and place the new patch in a DIFFERENT spot. Which is correct? I got the burns when I first started the patches, but not anymore. Maybe 50mcg was to high to start off on. It's been 2 hours since I put on the new patch, (I still have the old one on in a different spot) and I don't feel any pain relief. How long does it take for this med to enter your system? When I first started the patch it did wonders for my pain, so I know it works, just not at 50 mcgs. As far as BT meds go, sometimes I need a pill the same day as the new patch because of the pain. I used to take 4 Vicodin HP a day (120 pills) before I started the patch. Now I'm down to 2 Vicodin HP a day for BT pain, and it isn't enough because I'm in pain on the first day of the new patch. Oxycontin 40mg used to make me itch like crazy and did nothing for the pain either.
Because you are only on the 50 no doubt you would need the BT meds as well. And yes not on top of the other. You must have got a laugh. When you put these patches on they take quite a long time before they kick in. So if you are getting used to them you would be needing the BT med's as well, but when you start the 75 I would be a bit careful about when you use other med's. You probably will be needing the other for up to several hours after you put the patch on. Then you should be alright for a couple days before you need BT's. But you have to be your own judge and you will know what to do after a while as it takes a while to get used to any change in your med's. Just be careful your BT's are stronger than what I have ever been given, as they are very cautious in Australia. Most doctors won't even give you that strength. My BT's are 5mg of endone and only 20 for a month.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
I am not sure about that but, if you have not been on pain meds and have put one on it may give you a giddy feeling in the head but if someone has been on other pain killers for any period of time I don't think the 25 patch would be that strong so long as it is not on top of a lot of other medication. These patches contain fentanyl which is a very strong medication so you do need to be careful with them. But under a doctors supervision they are normally quite safe because they are sustained realise. The only way you would overdose on one would be if you chewed it up and swallowed it I believe.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
I tried that patches and they made me feel SO dizzy and SO weird that I just took that patch off and called my doctor asap and switched to something else. I am wondering if like me, you just maybe don't get along with these patches.
I also find them very dangerous. They have had problems and some people have died.
I don't know....for me, the oral meds are better BUT so many have had success with the patches, that I know they would highly disagree with me and I do understand why.
Our bodies have a wonderful way of telling us when something is wrong and we always need to listen to that. Maybe that was a "warning" (towards overdose) for you. And who knows what may of happened if you had left that patch on.
I wear 2 50mc/gr patches changing at 1 1/2 days and leaving them on for 3 days and have very good pain control with them. But when changing dose I have had nausea and dizziness so I can see how they could effect someone who is sensitive to change. But when I persevered I came good. I do need other BT meds etc to keep my pain manageable. The patch has given me best relief of anything I have tried. I agree that everyone is different. I am very disabled by my pain and sciatica so they give me a stable level of pain relief to start from then I have to manage the variations of Breakthrough pain.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
Just be careful your BT's are stronger than what I have ever been given, as they are very cautious in Australia. Most doctors won't even give you that strength. My BT's are 5mg of endone and only 20 for a month.
Allan
Hey Allan I wanted to say thanks for the fentanyl information. My doctor has prescribed them for me and I will pick them up tomorrow if I can. That means I would be starting them over the weekend. I'm sure my pharmacist will have info for me on how to start. I, too have had lower bad pain for 10 years and it is exhausting and exasperating! I am looking forward to pain relief that my Oxycodone doesn't supply. I took T3s for years, then Oxy for about the last 2 and I finally am graduating to Fentanyl 25 mcg. It is a frightening move for me. Your posts give me a heads-up on what to expect and sound like I need to be patient and persist. May the wind be always at your back. An old Irish proverb
I hope you do well on the patch as I have never looked back. I know it is a little difficult to get used to them but if you persevere it is worth the try. Also that is why your doctor starts you on 12's or 25's then 50's if you need it. Once you get to 50's and if they are helping but still running out early, as with me (because I tend to perspire a lot and stay as active as I can) , in my opinion then you may need to ask the doctor about wearing 2 x 50 rather than 75's and change them at a staggered time at 36 hours apart.
Because I don't have to worry about anyone seeing them I wear mine on my collar bone, inside my shoulder. With women I am not sure that it would be as good a spot because of the difference in clothing. You may need to try yourself for the best place for you. Other women here would know best. I hope you don't need as much as me but if you do you can always PM me and ask any questions you like. I also take paracetamol every day and spread them evenly through out the day to keep my blood levels even and so as to lessen the up's and down's. Also any chance of overdosing as this thread is about. Though you would have to take over 4000 mg to risk any over dose. I take about 3000 mg normally every day but up to 4000 and then if that is not doing it heat is my first thing then the Endone (Oxycodone) if I really need them.
I don't think anyone who seriously follow your doctors instructions would have to worry about overdose. But medication needs to be secured and kept away from children as they would be the only ones who could be at risk of overdose if they got hold of a patch in my belief.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
They also need to be kept away from our beloved pets. I just started on the Fent. Patch and although I keep my patches locked up, I do worry that the one I have on might fall off-and I will be unaware of it. Just have to be VERY careful!! ....janiee
Yes I am always conscious of the presence of the patch's on me and that I always dispose of them correctly. I live with my niece and great niece so I have a lock on my bedroom door. That is always closed when I go out. I also store them and my other medication up high in my cupboard. I am also aware that someone else may go looking for them so the door is always closed when we have visitors and I have never lost any and I am not keen on having to explain to my doctor that I lost any medication. I have all my guitars etc in there also. Now that I live here I am careful.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
I've been on fentanyl patches since Jan 2001 - began with 75's and moved up to 100's. In 09 I was able to go back down to 75's, but with recent shoulder problems and surgery, I'm back up to 100's again.
Just a few comments - with some people you need to give them a few weeks before they become fully effective at killing your pain - they do not work overnight; plus you need to give your body time to get used to their side-effects (mostly fatigue, dizzyness, etc), but you will get used to them and get past them - just give it enough time.
For some of us, we absorb the drug faster than other people. I found out that my patches lost their effectiveness after 48 hours; they did not last the stated 72 hours. So my doctor had to change my prescription to changing the patch every other day (instead of every three days). It made a big difference in pain control, I'll tell you that. BUT - there are sometimes it will last a bit more then 48 hours - only you can tell. If that happens, I'll have an extra patch that I'll store away in case of emergencies and/or accidents with a patch.
Yes, sometimes a patch will fold over and stick to itself - and that renders it USELESS! Never try to unfold a patch and use it on your skin. Why? If it's the reservoir type, you might damage it and the drug may leak onto your skin in a much higher dose - You don't want that!!! If it's the newer type, the one's with the drug impregnated into the plastic, if you unfold it, you still might cause it to give you the wrong does, or not give you any dose from that damaged area. So do like the package inserts say - if it gets folded over - discard it. That's when your extra patch, the emergency one that you saved, comes in for the rescue. And don't try crying to your Doctor that you accidentally folded one too many patches - they're not going to believe you - it's like your telling them you lost a patch or two. They're going to be suspicious. These patches are abused so much on the street that we have to really safeguard them.
That brings me to another note - buy a lock-box/safe for your narcotic painkillers. Target or Walmart sells them for lower prices. They have keys and or combination locks. Keep your medicines locked away in them. Your painkillers are too valuable to you and to theives. You don't want anyone taking your meds. They are too difficult to replace. Most doctors will want a Police Report if you say your meds were missing and/or stolen. So if you have younger family members in your house, one's who know you take narcotic medicines, by all means, LOCK THEM UP! Fentanyl Patches sell for a lot of money on the street. Plus, you don't want your younger relatives finding one and "experimenting", do you? So lock it up!!! PLEASE.....
As to where to put the patch - where ever you think it will stick the best. I put mine on my upper chest - I rotate from side to side. Also, my skin type is of the type where a lot of patches tend to not stick. Yep, many of today's patches don't stick to me. Now if you use the name brand Duragesic, you can call them up and tell them your problem. They'll ask a lot of questions, including the lot numbers etc, and they'll arrange to deliver these Bioclusive Coverings to you in the mail. These Bioclusive Coverings go over the patch and keep it stuck to your skin. For years I used them and they worked great, but once the generics became available, they wouldn't supply them for free anymore. I can still buy them - they're about $85 per box I think. So if patches don't stick to your skin, try it. Otherwise, try cleaning your skin with an Alcohol Prep pad, wait until it thoroughly dries, then put on your patch, and press down really hard for about two minutes - this works for me now (most of the time). I still have problems with the patches sticking, mostly with the reservoir types, but you do what you have to do. Some have suggested using those new skin glues just around the edge, but I haven't tried that yet (I don't wan to block any of the drug).
As to the one posted that they had leftover 25mcg patches from their deceased relative: I suggest that you give those patches to your Physician for proper disposal. I'm not going to tell you to cut them in half, because they may be the new kind, the non-reservoir kind, and cutting them will not destroy them - so the best thing you can do is do turn them over to your Doctor for disposal. He/She will know what to do with them.
Sorry for the longish post, but I've been using Fentanyl patches for over 9 years now. They have made my life livable. Without them I would be in terrible pain, I know that for a fact. Still, I hope I can go off of them someday, and this year, once my shoulder settles down I want to go back down to 75mcg again, and next year I want to target down to 50. BTW, I use Oxycodone for breakthrough pain - usually take 30-45mg in the morning, and thankfully it lasts about 12 hours. Then I take 30mg in the evening, again that lasts 12 hours, and Oxycodone kicks in in about 30 minutes (Thank God). Still, I'd rather live without it, but the Pain says otherwise.
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"It is the mark of an educated mind to be able to entertain a thought without accepting it."
Aristotle
Thankfully in Australia (as far as I know) only has one brand patch and it is called Durogesic. I have had some rashes at times but not very bad. By the time it comes around to put the new patch on that spot it has cleared up because I swap from one side to the other of my shoulders. I think it is mostly from like a heat rash. I also use clippers to cut the hair otherwise it can cause the patch to peal or just make it painful to rip them off. As I mentioned I use 2 x 50 patches and leave them on the 72 hours because I found if I change the patch at 48 hours the quantity is too much for me. I also tried one 100 patch and that was like too much for one day then good for a day then not enough for one day. So it was all over the place. So the method I use now is ideal for me. I suppose if you evened it out it would be on average 75 Mc/Gr/Hr. I also tried using two 75 patches but I found them a bit strong also.
When I say to strong for me I don't mean that I don't need that much pain relief because I do but the side effects are too much for me. I get nausea and can't eat and I throw up. I get the shacks more also. So I have found I can cope with the side effects that the two 50's leave with me.
So because the fentinyl is not enough I have to take other medications to make up for what the patch doesn't cover. I take Norgesic which is an older medication and I have to order it, but it has worked well for me. The other meds I take help as well.
I wish that I could just put the patch on and that did it all but it is not that easy. There are things like anti- inflammatorys that also make a big difference also anti-depressants. The Norgesic I take has the acetaminophen in it so I take between 2700mg and 3600mg a day. This is my only option as I can't get a script of any decent amount of Oxycodone, only enough for emergencies.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
You take that much acetaminophen? Oh please be careful with that, taking that much can ruin your liver. Don't forget to ask your Doctor to do Liver Function Tests every year to ensure your liver is working properly.
In fact all of us taking narcotic painkillers should be periodically tested to ensure our livers are functioning within normal parameters.
As for your Doctor prescribing meds for breakthrough pain, many don't like to give you a large number. Their belief is that the Fentanyl Patches should be strong enough to take care of all of our pain relief. And if it isn't, then they'll increase the dosage of the Fentanyl patch. That's what my Doctor does - he'd rather take care of the general pain then give me more Oxycodone pills.
Sometimes I understand his ideology, other times no. Why? Well, Fentanyl in higher strengths does work in making my pain issues lessen, but they also have their side effects. When the dosage is increased, I'm way more lethargic, have more nausea, makes me more constipated, and generally don't really trust my driving.
However, when I take Oxycodone, it seems to make more wide awake. That's right - it seems to awaken me from my lethargy. It also works fast. I can take my dose of Oxycodone at 6 pm and by 6:30pm I can already feel the pain going away. Also, for me it works as an anti-depressant. I guess that because the pain goes away so fast, it makes me feel better.
What it doesn't do, is make me feel high. None of the narcotic pain killers I take ever made me feel high - never. And yes, I do remember what the feeling of "getting high" was; I would sometimes smoke marijuana when I was in College back in the mid-1970's. But it's been what? Over 30 years since I last partook any type of drug like that one.
And I think this is common, those of us who really need narcotic pain killers, none of us get high from them; we only get relief from the constant, unrelentless pain that we're in. They're a Godsend to us, and without them, most of us would suffer so much, it would be unbearable.
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"It is the mark of an educated mind to be able to entertain a thought without accepting it."
Aristotle
I also have more side effects if I increase the fentinyl patch as I have tried it as most of us probably have. I got terrible nausea and constipation. The oxycodone works much better for me at times of flare ups. I do have to take the paracetamol (in the form of Norgesic) regularly or I would need the oxycodone daily and my doctors won't give me that much and also one doctor tried to get me an authority for more than 20 a month and they would not give it to me so I haven't tried since. It is the same as the patch my doctor has to ring and get an authority every month because I use 20 patch's a month in stead of one every 72 hours. I use double of the 50's in stead of one 100 patch for 3 days, that would be 10 a month. I can only get max 20 endone's a month also, if that and I have to see my specialist for them. My GP will not give me them even for emergency's. I would have to go to the hospital if it was up to him. So I get a box of 20 every couple of months just for flare ups that is about two or three times a week at least.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
Thanks again Allan . . . I slept for almost 2 weeks when first given the patch. I had to wait for a 'overnight delivery' that took 4 days. Anyway, my web search led to you and that's where I got all the info I did get. Sad, but true. The pharmacist just pushed a piece of paper at me and said all you do is put it on your hip and put the tegaderm over it - nothing more. I finally was able to stay awake today. Not sure how much pain relief I am getting - I am still taking my Oxycodone. I'm determined to give a good trial.
Quote:
Originally Posted by seniorcitizen
Hey Allan I wanted to say thanks for the fentanyl information. My doctor has prescribed them for me and I will pick them up tomorrow if I can. That means I would be starting them over the weekend. I'm sure my pharmacist will have info for me on how to start. I, too have had lower bad pain for 10 years and it is exhausting and exasperating! I am looking forward to pain relief that my Oxycodone doesn't supply. I took T3s for years, then Oxy for about the last 2 and I finally am graduating to Fentanyl 25 mcg. It is a frightening move for me. Your posts give me a heads-up on what to expect and sound like I need to be patient and persist. May the wind be always at your back. An old Irish proverb
Last edited by seniorcitizen; 09-30-2010 at 09:07 PM.
Reason: misspelled word
Yes I was very tired for a long while as well and I still find that I have to have a sleep during the day. The patch is a big step up I think but when you are searching for some thing to give you any kind of relief from the constant pain and not getting much help from the injections, I was happy to go through some trials and ups & downs to eventually have some reprieve from it all. I know this thread is about possible overdose from fentanyl so I might start a new thread seeing as I don't really have anything to add to that subject.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.
Possible Fentanyl Patch Overdose 
