Hi Candi, The 25ugh patch is the standard starting dose for most opiate naive patients. Meaning you really haven't been exposed to potent opiates previously. I checked a conversion chart made by Duragesic and it looks like they started you correctly. Hydro is roughly equivalent to morphine mg to mg. However that's a pretty wide range from 40mgs to 100mgs. If you didn't tell him you sometimes took 10 a day it makes it harder to correctly start a new med.
Because of the potency of Fentanyl, the active ingredient in the patch is measured in micro grams. The first patch is a little too soon to tell. If your not experiencing withdrawal symptoms which you would after 36 hours without hydro it just means your basically taking an equivalent dose. If the hydro wasn't cutting the pain even with 10 a day then the doc will likely increase the size of the patch at your next apt.
A month is a long time to go in between apts when initiating a new med but a couple weeks is reasonable. Calling your doc within 36 hours isn't exactly the way to fly low and under the radar of the problem patients that constantly call and are never satisfied.
Titration of a new med is never fun, No doc has a magic ball to determine what dose will provide relief. It's a matter of trial and error and often a miserable time for the patient.
If your next apt was set a month away from your first and you are still miserable after using 4-5 patches then I would call the nurses line or try to move your apt up. Did he give you anything for additional pain that the patch doesn't cover? In PM terms the additional meds are called break through meds, meaning pain that breaks through your base dose and a short acting med is used to regain control over that pain.
Ideally the doc would have advised you as far as how long to wait to see if this dose works but without that guidance 2 weeks for each new level should be plenty of time but not too much for him to expect you to endure.
Ask him at your next apt how long you should give a new dose before reporting the effectiveness. Some docs will only see you once a month due to heavy schedules but ideally he/she should be there for you if the dose isn't providing relief.
It's never a good idea to report no relief but do report honestly. If you hurt, you hurt. It's better to get the dose right from the start than to except a minimal dose for a few months and then report lack of relief. That looks like rapid tolerance rather than improper titration from the get go
Now if you were having any adverse reaction, forget about being the problem patient and report it immediately, but as far as med adjustments most docs should expect to hear from the patient after a fair trial of that particular dose has passed. I think 2 weeks is a fair amount of time but we all have different ideas of what we consider a fair amount of time.
If your miserable and can't stand it then call, If you can manage until your next apt or at least a week or two then wait so the doc knows you did give the dose a fair trial. As far as the 25 patch being equal in strength to your previous dose it is in the ballpark. You might want to keep a daily log, this way you have a record of your pain level and the duration the patch works for you. It doesn't last 72 hours for everyone.
I'm not sure if I can post a link to an equianalgesic chart, but you can find several on the net by doing a search. Remember though, the charts are just guides and shouldn't replace patient reporting. Hydro isn't usually listed but is considered equivalent to morphine 1:1. or mg to mg, Good luck, Shore
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