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Old 06-13-2012, 02:50 PM   #16
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Re: Anyone have experience with Butrans or Nucynta?

Yep They all do Teg is readily available at most pharmacies

 
Old 06-13-2012, 07:09 PM   #17
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Re: Anyone have experience with Butrans or Nucynta?

Yes the pharmacies have Tegaderms, but they are way cheaper online. I was only on Fentanyl a short time but I ordered some off of Ebay for a fraction of the cost, knowing that even if I ended up not needing them all, it was a good deal.
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Old 06-13-2012, 09:55 PM   #18
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Re: Anyone have experience with Butrans or Nucynta?

You can get the Tegaderms at the pharmacy, but go online and check the manufacturer website, some patch makers give out patch covers free.

I would stay away from dilauded/opana for bt. You don't need something that strong for bt pain, and Opana is hard as heck to get and keep in stock these days, plus it's very expensive.

Not sure who told you morphine has high euphoria rate, but I've taken it in every form available at just about every dose available and I've never had euphoria issues from morphine. Honestly if your current Norco's are working for BT with the patches, why not just stay with what you know? the other meds are all much stonger and not generally used as bt meds until you get way up the pain ladder....

Also as we've talked about, you have sleep issues...morphine can agrivate those further.

Take care,

Kat

 
Old 06-13-2012, 11:23 PM   #19
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Re: Anyone have experience with Butrans or Nucynta?

Thanks for the thoughts on the BT meds Kat!

I went by the pharmacy this evening to get some Tegaderms, and while I was there I asked a Tech I know to give me the prices of some LA and IR meds so I could compare and bring it with me to my PM to show him what is out of the park un-affordable and what is most economical. She added these all to my profile as if they were scripts, applied my discount coverage, then had it display the cash price, discounted price, and a bunch of pharmacy stuff I don't pretend to comprehend. The list is as follows...

Kadian 60 mg ER - #60 - Cash Price $907.99 - Discounr Price $$512.49
MS Contin 60 mg tabs - #60 - Cash Price $464.99 - Discount Price $125.98
BuTrans 10 mcg/h - #4 - Cash Price $287.98 - Discount Price $160.05

MSIR 30 mg Tab - #60 - Cash Price $38.99 - Discount Price $21.41
Dilauded 2 mg Tab - #60 - Cash Price $78.59 - Discount Price $19.98
Norco 10/325 Tab - #60 - Cash Price $97.49 - Discount Price $54.07

The bold items are the least expensive for their categories. There are close runners up with regard to price in both LA and BT/IR meds, so it isn't like anything is a heavy favorite. The one thing I don't really like is that Norco is the most expensive, and it would need probably 120 for adequate relief (taking two at a time as a single dose is what I have to do to get BT relief or relief in general, so for two doses a day it would be 4 a day x 30 days = 120). On the other hand CII's are a pain and Norco circumvents the issues with CII's. So I dont't know - I will discuss it all with my PM to figure out the best solution. As for insomnia and Morphine - I have been on morphine sulfate parenterally before, and it was quite calming and soothing; I actually fell asleep from the numbing (mentally) effects morphine has. I am surprised MS aggravates your insomnia, though I know we discussed that narcotics seem to paradoxically act as stimulants to both of us. Morphine is actually the only narcotic that hasn't produced stimulation or insomnia effects in me (oxycodone, hydrocodone, meperidine, buprenorphine etc all give me a paradoxical boost of energy).

I want to request some Valium 5-10 mg BiD - TiD as well (have been on it before) for insomnia, severe anxiety, and muscle spasm. Klonopin works almost as well, but hopefully I can avoid Soma (I've had terrible experiences with Soma's side effects before). MS Contin is a bit cheaper than BuTrans, and I would need a dose bump on BuTrans, but will probably stay on BuTrans. Does anyone have any suggestions on how to address the issue of the patches wearing out after 5 days instead of 7? I need to figure out how to maintain sufficient analgesia those last few days of a patch without having to use my BT meds every week to compensate for the worn out patch. The only options I can think of are to use MS Contin for those last few days each week, or switch to PO meds like MS Contin. I really don't want to have to give up the patch though... Would a PM prescribe an LA med for use to bridge the gap at the end of the patches life? Seems like thy wouldn't but I don't have enough experience to know how to read PMs.
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Old 06-14-2012, 12:35 AM   #20
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Re: Anyone have experience with Butrans or Nucynta?

Don't think your going to get him to RX 2 LA meds and a heavy duty BT like morphine or dilaudid. LA Morphine, Butrans and IR Morphine is a pretty heavy combo plus your on a higher dose of Neurontin....

Have you considered adjusted dosing for the patch. Just like some folks (moi) have to change a Fent patch at 48 hours instead of 72. Ask him if you can do 5 day doses instead of 7 day.

Your pharmacy is high on MS Contin, I get 60mg #60 at Rite Aid, and price match it to Sams and pay $74.36 each month, then get Oxycodone 10mgs #150 for $34.37.

LA Morphine is one of the worse for me, it jacks me up big time, which is why I'm typing away at 3:35 a.m. when the rest of you guys are sleeping!

Why exactly are you wanting to switch from Norco as your breakthru, is it not working, don't want the APAP, what?

Kat

 
Old 06-14-2012, 02:17 AM   #21
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Re: Anyone have experience with Butrans or Nucynta?

Quote:
Originally Posted by katlin09 View Post
Have you considered adjusted dosing for the patch. Just like some folks (moi) have to change a Fent patch at 48 hours instead of 72. Ask him if you can do 5 day doses instead of 7 day.
Why exactly are you wanting to switch from Norco as your breakthru, is it not working, don't want the APAP, what?

Kat
Will PM's allow a 5 day switch of a transdermal patch? I assumed they would consider it an attempt at violating the contract by asking permission to dose more frequently. If a PM will allow replacement of the patch every 5 days then that would be ideal to solve that problem, I just assumed that wasn't an option.

As for the Norco, 3 10/325 Norco provide modest relief from BT pain, where MSIR and Dilauded provide complete BT coverage. If I have BT pain, I want the BT pain to be as tightly controlled by the BT meds as possible, not leave significant lingering pain even after taking BT meds. And yes I don't want the APAP. Ive been on Norco 12 tabs a day for so long, and part of that time it was 5/500 tabs where I would be taking 1000 mg APAP per 10 mg hydrocodone dose. Plus, it is almost as expensive as MS Contin and Butrans at 120 tabs a month, and I really need to go with the most economical options I can. That said Norco is better than nothing, but it would be nice to only pay $20 a month for BT meds as opposed to $60-$110.

If he will allow me to rotate the patch every 5 days instead of 7, then MSIR for BT (which he has already put on the table) would only add $20 a month to my Rx fees. Still, the BuTrans will be > $100 especially if I am filling it more often than 28 days (due to rotating them every 5 days rather than 7).
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Old 06-14-2012, 07:29 AM   #22
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Re: Anyone have experience with Butrans or Nucynta?

Re: Butrans patch lasting 5 days- is this something you personally experienced? or something you have read about? I am on Butrans 10 and don't find that is the case at all. Regarding getting them wet- I was worried about that also but 4 months later I can tell you I have never had one come off due to showering.

 
Old 06-14-2012, 08:51 AM   #23
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Re: Anyone have experience with Butrans or Nucynta?

Quote:
Originally Posted by hanginin View Post
Re: Butrans patch lasting 5 days- is this something you personally experienced? or something you have read about? I am on Butrans 10 and don't find that is the case at all. Regarding getting them wet- I was worried about that also but 4 months later I can tell you I have never had one come off due to showering.
I've both read about it and also personally experienced it through a third party. A family member was apparently on Duragesic for a long while, then switched over to BuTrans when it came out due to the less frequent dosing and the fact the Duragesic was a little strong in terms of side effects. I only found out about this in the last day or two, as the family member is not close to me, but is a direct relative of my grandparents (speaking of, everyone in my family seems to live incredibly long - my grandparents are in their 80's and their parents lived to their 90's - 100's). Today in fact I suggested my grandfather, who takes Hydro/APAP 7.5/500 4-5 times a day for chronic pain and is still not sufficiently medicated, inquire about a BuTrans patch because he suffers a lot but is scared of oral pain meds. I will know for sure from my direct experience by this weekend how it turns out. If it lasts 7 days - fantastic, but the prescribing instructions even state that the first 2-3 days the peak plasma concentration is about 235 pg/ml (picograms/ml) then it slowly tapers down to about 140 pg/ml by day 5 and then by day 6-7 about only 90 pg/ml. SO that would indicate at day 5 it is only administering 60% of the initial dose, tapering down to less than 38% on day 6-7.

Here is a link to a graphic plot of Cmax/Cmin over multiple doses through time and an inferred AUC (area under curve) upon extrapolation of data.

https://docs.***********/open?id=0B9L8tHFls7ghZWIteFhZMkt3amc
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Old 06-14-2012, 02:58 PM   #24
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Re: Anyone have experience with Butrans or Nucynta?

I personally experienced the 1 yr I was on the Butrans Patch 10's that they NEVER lasted the 7 days the company claimed they would, although they worked great for my pain when 1st applied, the effect diminished around day 4 and but day 5 there was very little pain stopping effect. My BT meds were used mostly at that time

Last edited by danme; 06-14-2012 at 02:59 PM.

 
Old 06-15-2012, 10:21 AM   #25
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Re: Anyone have experience with Butrans or Nucynta?

I am more familier with the Suboxone ( same ingredient ) but it is a sublingual film taken twice a day . i started taking this medication when my month supply of pain meds were stolen FROM THE PHARMACY the day they were filled. Long story there. Anyway at first the Sub film were limited to special group of Doctors with special lisence. My PM actually prescribed me these to aleviate WD's as I had been on a pretty high dosoge of a LA med AND Ocycodone for BT pain. I LOVED IT. I didn't have the sluggish dopey feeling I get sometimes when my meds are first taken, but it didn't give me the best pain control

 
Old 06-15-2012, 10:07 PM   #26
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Re: Anyone have experience with Butrans or Nucynta?

If the patch isn't lasting as long as it is supposed to, definitely tell your doctor. See what they say to that. That way you aren't asking to be switching it more often. Some people do absorb meds faster, and often there is documentation that a good number of folks need to dose something more often than the prescribing info. Worst they can say is no, and then you need to decide whether to put up with it or ask to try a different med. Best wishes.
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Old 06-15-2012, 11:02 PM   #27
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Re: Anyone have experience with Butrans or Nucynta?

Hello Recombinant,

I currently take Nucynta 100mg tablets 3x daily (along with other pain meds).

It's working for me...

The only thing is when I wake in the morning,I am in terrible pain,until I take my regimen of meds.

Once ingested,it usually takes anywhere from 30-45 minutes to take effect.

Respectfully
Phoenix
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