Hello All. I recently (July '12) Had surgery on my foot to remove a series of growths (27). It was extremely painful to say the least. I ha been on oxycodone IR 30mg for a few months to help with pain I experienced from gout and chronic ear infections. I was put on Fentanyl patches by my Doctor because I was "opiate tolerant". My pain is now completely subsided, and it is time to stop using the drug. For about 3 weeks I reached my max dose of 50 mcg/hr patches that I was to change every 48 hrs. My doctor and I decided the best thing to do was to gradually taper off to avoid w/d. I originally went down to 25 mcg patches, but experienced what I believe to be w/d symptoms. I was completely out of it, and was so tired I could barely function. Also i experienced nasua and diarrhea (sp). I was then told to go to 37 mcg (1 25 patch and 1 12). Again, my injuries have healed and I am in no pain. Since going to 37 mcg, I have been extremely lethargic, and can barely get off the couch. I can sleep fr 20+ hrs per day, and still not feel rested. I called My Dr. today and said that I wasn't having w/d symptoms, but was actually feeling "doped up" because the pain was gone and I was just feeling the effects of the medicine. he instructed me to go down to 25 mcg for now, and eventually lower to 2 and then none. I really want off of these patches ASAP. I have never been into drugs, except for occasional Marijuana use and some social drinking. I am hoping to find someone who has been where I am, and overcame their problems. Half of me wants to just rip the patch off and deal with the inevitable w/d tht I have read so much about on these forums. Have I even been on them long enough to be physically addicted (about 2 months)? I have horrible anxiety concerning my health. When taking opiates throughout my life for various ailments (never recreationally) I have discovered that I get hyper/gittery while on them and cant sleep. It's almost as if they are an "upper" to me. Is this why I'm so tired when trying to get off of them? I have a full prescription of 30mg and 10 mg Oxycodone IR left over from previous procedures I've had. Do I stop the patch and switch to the pills, and taper from there? I feel so confused and helpless. I never thought I would have an addiction problem. I never screwed around with pills my whole life, and now I feel trapped. Do I even have an issue or is it all in my head? Any advice would be a life-saver. I'm currently living in Memphis for a year while my wife finishes up her doctorate, so I don't have to worry about symptoms preventing me from going to work, etc. Thank you so much for anyone's time. I guess I'm just in need of advice/support.
Welcome! Two months is long enough to be physically dependent (get withdrawal symptoms if you stop or taper off too quickly). Psychological addiction is a separate issue, which some people can get. From what you say it seems more like anxiety over this than addiction. Sorry I haven't been in this situation. I can see where your doctor is coming from on the withdrawal vs. too much med. I'd give the 25 a try and see how you do on it. Yes you will probably have some discomfort.
If you just can't deal with the withdrawal, ask your doctor about switching to pills so you can taper more slowly. Do not switch on your own though...even if you have the pills left. Your doctor would need to give you this permission and advice you on a safe dose conversion. Some folks do find it better to taper faster if they feel they will be easier either way, but the suggested way is definitely to do a slow taper over time.
Even with the 12.5 patches, there is only so slow you can taper. Everyone deals with it differently. Often doctors underestimate withdrawal. I think there is a difference between addiction and anxiety over discontinuing the med. I would not go from 25+12.5 to none. Not sure why you are so tired when tapering down, but it is possible they have been hyping you up so much that you aren't used to normal anymore.
It will take time to adjust to each dose decrease. I'd give it as long as you can with the amount of patches you have. Going from 25 to 12.5 and 12.5 to 0 will likely be much worse than going from 37.5 to 25 (as its a larger percent). You may also want to ask your doctor about any short term medications which can make this taper easier on you...such as clonidine, an anti anxiety medication, etc. Congrats on being pain free! Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
The Following User Says Thank You to tortoisegirl For This Useful Post: HuskerZman (08-25-2012)
The 50 mcg patches being dropped down to 25 mcg. doses was probably a bit too big of a jump down for you, all at once. Since your pain levels have resolved, it is simply a matter of slowly decreasing your dosages until you are off of the fentanyl altogether. There are a couple of ways of doing this, the normal way of tapering is usually done by decreasing your total daily intake of a particular medication by somewhere between 10-25 % , and then steadily reducing each reduction by a similar amount. The problem with fentanyl is the patches only come in 12.5 mcg, 25 mcg. , 50 mcg. , etc up to 100 mcg strengths. You may want to talk to your doctor about extending your patch changes to every 3 days instead of every 48 hours, which will allow your body to become accustomed to the reduced levels over those three days, and then reducing your dosage further with each patch change until you are down to the one 12.5 mcg patch. Then you can either jump off completely or if necessary, he can covert you to oral meds ( pills) and taper you that way.
Withdrawal for some is very difficult for some and for others ( most) it is more like a case of the flu, nausea, maybe some vomiting ( not always by any stretch) , some muscle cramping and sometimes diarrehea and it is usually over within a week. Others don't experience any withdrawal symptoms at all. The drowsiness may be a side effect of the minor withdrawal symptoms or it may be that your body just needs the extra sleep . Don't believe every horror story you read about withdrawal because most of the symptoms as I said are more like the flu and can easily be managed with some over the counter remedies and maintaining fluid levels.
I would talk to your doctor and he may suggest converting to oral meds and a written tapering plan if the fentanyl patches aren't working well in the tapering plan he has you on currently.
The Following User Says Thank You to backhurtz For This Useful Post: HuskerZman (08-25-2012)
I have been able to continue on the 25mcg patches. After speaking with my doctor he would like me to wswitch down to 12 mcg patches when the 25 mcg wear off. I have continued to be extremely tired, and have started to feel kind of "unattached and depressed" and have a feeling that "something just doesn't feel right". Is this to be expected? I have also had no appetite and been losing weight (I am probably about 60 lbs or so overweight). Is this normal to lose weight rapidly (5 lbs o week or so)? I know that a lot of this has to do with my anxiety. I amprescribed xanax, and this does help. How long should I expect to feel this way?. Thanks to all for their help. Just feeling like someone is listening truely does help ease the discomfort!
Husker,yes, this is very normal for coming off a narcotic like fentanyl. Usually anxiety or like you said feeling like "something isn't right". Another option you could speak with your doc about is extending the days in which you change the patch. Instead of every 48 hours try every 72. See what the doc thinks.
Withdrawl really sucks and I hope they can taper you down so you do not really feel much of it.
If you continue to have a problem and just cannot seem to get down to a lower dose or get all the way off, ask your doc if he can refer you to a doc who does subutex or suboxone. It is both used as a pain med and a med to get people off of pain meds. You would want to be on a very quick taper like a 5 day taper down and then jump off around day 5 and you would want to start out at a very low dose like 8mg or lower. It's usually for people who have been on meds longer than you, but fent is strong and hard to get off and the sub really stops the withdrawl feelings as long as you do it the right way. So if this is something you would want to try make sure you get a doc who really knows sub and what he/she is doing.
Yes it would be normal to have withdrawal symptoms such as you describe. If you are really struggling, try to get an appointment. Make your withdrawal symptoms clear to them and ask your doctor about tapering down at a slower pace/percentage, which likely means switching to pills. The patches aren't ideal to taper from as you are having to make 50% dose reductions.
Going from 25 to 12.5 and 12.5 to 0 is going to be worse than when you went from 50 to 37.5 and 37.5 to 25. Sometimes withdrawal can sneak up on you a bit after a dose drop as well, so if you drop too quickly. You shouldn't have to suffer, but you should expect to be uncomfortable. Its good you have xanax to take.
No, even if you are overweight, rapid weight loss from lack of appetite isn't good. The symptoms will probably last for a number of days after you are able to discontinue the med, but the goal is to minimize them as much as possible. So how long are you to stay on the 25 / what do you mean by when they wear off)? Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
Tortoise, I meant run out. Sorry for the typo. He gave me enough for two weeks at 37 two weeks at 25 and two weeks at 12. He actually called today to check on progress (a relief to hear from him). I told him how it was going. He said the weightloss could also be from a recent change in diet (wife and I are trying to control our portions, and the fact I hadn't had a drink since I started my meds...I used to have four or five drinks, three or four nights a week) and my recent move down south. He also asked about caffeine intake. I had been drinking many cups of coffee and diet soda a day to help combat fatigue. He said to stick with hydrating fluids and watch the caffeine. Today I only had one diet soda and actually feel much better. Since I have more than enough 25 patches and am feeling a little better I considering dropping to 12 on Sunday. I know I may feel a little crummy, but I guess I'd rather get it over with and be closer to zero.
Thanks for all the replies. Please keep them coming. They really do seem to keep my spirits up an that's half the battle!