I have only been on this Fentanyl patch for about 8 months now, with my dosage increasing to a 25mg patch only 2 months ago. The brand of my patch switches continuously based on what the pharmacy has in stock, and currently I am taking the "Watson" brand.
Irregardless of the brand, I have experienced (except for the very first two months I was using the patch) that they are NOT lasting the full 72 hours. Let me be clear that it is not withdrawals that I am experiencing; I know what those feel like as I had to go without the patch for a week when my first pain doctor could not prescribe me medication anymore (the government blocked him from being able to have his scripts filled by Medicare.). What I am feeling is an increase in pain after about 50 hours of patch usage that is NOT relieved by my "break-through" pain reliever, hydrocodone.
I have no real major issues with excessive sweating, etc....that might cause, for any reasons that I am aware of, the medication to release into my system at a quicker rate. But I do wonder how my high metabolism might have an effect or if there would be any other medical reason WHY it doesn't last as long as it's "supposed to" for me. I seem to be "the rare case" in all medical circles, from rare side effects to medications to extremely odd idiopathic symptoms (and I blame this on my MS.). Is there something going on with my body that can cause what I am experiencing with this medication to happen?
While looking through others' posts to try to find answers, I have found that others have also experienced this problem. One recommendation that was made is that increasing the frequency of patch applications can help, but I am concerned that this is not a possibility with my insurance coverage and strict doctor's guidelines -- I am on Medicare, and they approve certain amounts in a certain amount of time. period.
So, my question is several, I guess...... 1) What are the possible REASONS (given what I have described) that the patch isn't lasting as long as it should last? 2) What can I DO about this problem (considering my insurance and doctor scenario)? 3) Should I contact the various manufacturers and inform them of this issue? 4) Should I contact the FDA and inform them of this, as well? 5) Any other advice?????
Thank you for any assistance at all!
from, needing relief
~~~Live, Laugh & Love~~~
Last edited by adrodysee2001; 08-01-2012 at 10:39 AM.
Reason: add tags
What you are experiencing is not rare at all as many people get less than the full 72 hours...
So have you actully contacted your Dr. and talked with him about this and had him write a letter to your insurance company showing that you are in need to change them every 48 hours?
I see that you are concerned that it "may" not work doing that....but you need to go ahead with that plan first as many people are able to get the approval for this. I know quite a few people with Medicare that change every 48 hours.
There is no need to call the manufacturers or the FDA as they are not going to do anything about this because many people do get the 72 hour relief. So it's really up to each patient to work with their Dr. and insurance.
Believe me, if the manufacturers/laboratories wanted to change things, they would, because it would make them even more money to sell more patches per month. The FDA will not do a thing because they are just concerned about dangerous side effects of drugs and not going to recommend patients take "more" of a certain medication.
It's just like with Oxycontin, MSContin or any of the other long acting/time released medications...With some people it lasts the full 12 hours...and others end up getting them prescribed to take every 8 hours.
So...I would call and set up an appt. with your Dr. and speak to him about this. Usually with a letter attached supporting evidence that you need them changed sooner, many insurance companies are ok with this.
Good luck and keep us posted..
Last edited by Ilovemycutedog; 08-01-2012 at 11:11 AM.
The Following User Says Thank You to Ilovemycutedog For This Useful Post: adrodysee2001 (08-01-2012)
I do know that what's going on isn't rare....I am wondering if the REASONS could be, I guess, but I am very glad you offered some advice on how to solve this problem with the insurance company......
I hadn't spoken with my doctor about an increase in frequency...only because I had assumed that this wasn't possible. (If I try to fill my psych meds a day early I am told that the insurance company will not approve it.) But it makes since that a doctor could seek approval for that. Also, my previous pain doctor -- who I have just fired, btw -- was so strict that he was ANGRY when I went to the ER for something that he couldn't have treated anyway and that I had received pain medication at the hospital. I no longer felt comfortable telling him ANYTHING about how I was feeling and felt like I was being treated like a drug addict, so I relieved him of his duties. I will certainly be discussing this with my new doctor!!!
LOL I know you're right about not even worrying about contacting the manufacturer!!! I had to contact them when I was shorted TWO patches in a box one time, and it was an extreeeeeeeeeeemely tedious experience. And they wanted ALL KINDS of information, like did I take anything for breakthrough pain and how did that work for me? And, you are right about the FDA, too. Although I knew that FDA only dealt with bad reactions, etc....I think I was only venting and wanting answers. LOL
Anyway, no I didn't even consider that my doctor might be able to do this request to the insurance for a change in frequency, and that is wonderful news! I think I still wonder WHY this happens for people... I have always been the analytical type, but I certainly can be content with simply getting the medication to work around the clock as it's supposed to for now.
I was just thinking, too, about the Oxycontin scenario that was presented (how it won't last as log as it should for some people). And that happened to me prior to going on the Fentanyl. Only my doctor didn't try increasing the dose of that -- because it didn't last as long as it should, we ended up moving me to the Fentanyl which for the first few months did its job..... Anyway, I guess that's good to know....
If I think about other pain meds I have taken, it is usually the same way. I can have an average amount of anesthesia, but it wares off quickly and I will need more. The hydrocodone I'm on does NOT last the 6hrs I am given for it -- 3 tops. When I was benzondiazapines, I had the same issue.
I don't know if this is "tolerance" really, maybe a metabolic thing, liver thing, I don't know, but I know that's how my body works with meds, so for future reference I will be making my doctor's aware of this, too.
Maybe if my doctor had increased the frequency of the Oxycontin, I never would have needed the Fentanyl....
Hi adrodysee2001, Your really not experiencing anything unusual, I dont know anyone that gets 72 hours out of a patch and absolutely none that get 6 hours relief from vicodin in any strength. If your your looking for some explanation as to what's different about you, the answer is very little. People become tolerant to valium very rapidly, One of the first signs of increased tolerance is decreased duration, not that i can think of anyone using 25ugh patches every 72 hours. 48 to 60 hours is the norm. 3-4 hours is the norm with hydro, sometimes 4 hours is a stretch. If your doc is unwilling to work with you then he really isn't familiar with either of those meds or he doesn't believe you should be taking them. Nothing unusual with what you are experiencing.
The Following User Says Thank You to Shoreline For This Useful Post: adrodysee2001 (08-01-2012)
Thank you for your insight, Dave. I have heard so many stories of people who have similar troubles, and I have begun to think that perhaps it has got something to do with a tolerance factor. Hearing that "decreased duration" is one of the first signs is very good to know. Thank you again!
I too have Medicare and they do not have any problem with every 48 hours vs 72 hours. Most docs don't have an issue with it as like everyone has said it's a common occurance. Everyone metabolize meds differently. When I was going to my very first pain doc, his patients were enrolled in a study looking at metabolic rates and pain meds. Every month we got both a urine and blood test. I always keep my own copies of my records so I would get those as well and it always amazed me month by month with little variation on my part, how much the numbers varied.
I am sure other things play a part as well. But hopefully switching it to every 48 hours will give you better coverage.
Keep in mind the original drug study for fent patches was done with bed riden cancer patients. So very low activity and arent living a active life style. I have been on fent for 2 years now. I never got 48hrs out of a patch. So what i suggested to my pain dr was lets stagger them. So for instance when i was on 150, one day i would put a 100 on then next day a 50 then next day a 100 then next day a 50 etc. So actually each patch would stay on for 48 hrs but it kept my levels more consistant staggering them. It worked great and actually he told me awhile back patients that complain about them not lasting he know has them try it and works great for them too.
Also take in consideration the weather your living in. The med in the patch is released due to heat and then stores in fat cells and is released due to heat. Out here in AZ were its really hot during these months if iam out side for long periods of time its makes a big differnce. So you may be feeling a change due to weather. Also next the changing of brand. My experience I strongly recomend staying with one brand and also the "matrix" style not the watson reservoir style. Twice i have swithced generic brands both being matrix style and i could feel a differnce. With the hackman-waxman act of 1999 the FDA allows generic meds to vary in strength 20% plus or minus. So if your taking 50mcg and get some that are 20% less your going to feel it.I experienced this for the first time with Norco many years ago.Lately with it being so hot and being in the heat for about 3-4 hrs a night I actually had to switch my patch routine because I was getting to much released into me due to the heat. First time ive ever had that happen but also first time iam working in the heat at night while on fent. So feel free to message me or make posts on here and we all try to help each other out. What dr's read is not always the facts. The patients that use it for many years know the true facts and ive seen thats how good pain mgmt drs learn from is talking with there patients.. Feel good..
I metabolize very quickly and so my patches last only 36 hours. And I have had this problem since I first started on them. It was difficult to get my doctor to listen to me about the problem even though from the beginning I was telling her that I was fine for the first 1.5 days, but then the pain would return, and then before I got to 72 hours, the sweating and spasms would start up. It was a nasty roller coaster ride. But finally, she listened and changed the dose every 36 hours. It works fine now, except that I really just wish I didn't need the patches at all. I hate having to depend upon them to control pain. I am on medicare too. They will cover them for every 36 hours, but only if your doctor goes to the extra effort of telling them you need them that often. I don't know what causes me to metabolize them so quickly, whether it is the collagen thing, or the autonomic dysfunction, but I metabolize just about all medications too quickly, and the fentanyl is super fast.
It is absolutely a metabolism/genetic thing. All the women in my family are like this...any medication doesn't last as long as it should or we need a LOT more than we should. We've also noticed that certain meds work better than others. For example, I was given Norco (hydrocodone) 10/325's...they did nothing. Then given oxycontin....did absolutely nothing, might as well have taken sugar pills. Turned out only thing that helped my pain was Tylenol 3's (Codeine)...a much "weaker" pain med. Go figure. Anything that should last me 12 hours lasts 4 if I'm lucky. In the hospital for my last c-section, I had a wonderful Dr. who actually listened to me and I ended up being on Demoral (rarely given these days) and they left my spinal in for a few days (rare). Actually made my recovery amazing compared to my others. (I have six kids). She sent me home with oral demerol and tylenol 3's. Helped tremendously.
It gets frustrating having doctors or nurses assume that everyone responds the same to medications. I can't count the number of times I heard a nurse say in the hospital "there is NO way you got that much medicine and are still in pain". I actually had one nurse ask how I was still talking lol.
Everyone is different and everyones metabolism/chemistry is different. Dont ever be afraid to fight for what you need to be comfortable.
So what can you have high tolerance to pain medications? (metabolism).
Is there anything to do with this metabolism issue? anything to do with weight?.
Is it cause I am skinny.
As far as medications, it usually (for me anyways) end up being a dosage increase or splitting doses up. You still have to be careful to not take too much, because even though you may not feel it or it isn't taking care of the pain, it could still be too much for your body. I rarely use anything considered extended release for this reason honestly, because I have to take more than is considered safe. As far as these patches I've never used them myself, but I have read that some people have to switch them more frequently, but not need quite as high of a dose. Just needs to be discussed with the doctor.
Some doctors are comfortable with and can recognize when a patient has a higher tolerance for meds and/or metabolizes them quick. This is a good reason to see a pain specialist. Tolerance is more likely to occur quicker in younger patients as well. Besides increasing the dose, switching to an opiate you don't have as much tolerance to, or taking a break from the meds, there isn't much to do about it.
Its expected in pain management, but doctors definitely handle it differently. Some will seemingly exponentially increase the doses (which can be bad because after a period of time you will be on such a high dose that nothing works anymore, and the side effects increase), some will take you off the meds, and many are in between. A specialist can try various methods to get you pain relief while minimizing the dose you need.
Suboxone is an alternative type of pain med that is helpful for some folks, and can get around tolerance issues, but has its drawbacks as well. Some folks believe that patients on Methadone won't build tolerance as quickly (but they are often on a short acting meds as well). There are some adjunct meds and therapies that are helpful for some folks that sometimes were overlooked before starting opiates that can then be added in. Best wishes.