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    Old 12-06-2006, 02:05 PM   #1
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    how can you go off fentynal patches safely

    my husband has been on 25 mg fentynal patches for a few months. want to go off them because of the side effects he is suffering and is really bothered by what he is reading. his dr. offered him no help. told him to try skipping a day. he told her that he tried that and thoguht he would lose his mind and she said "oh well; i don't know what to tell you. this sounds dangerous to me to just stop this drug. dr. and pharmacist told him never to cut them in half even though it seems the only solution. anyone ever go off these and if so how?

     
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    Old 12-06-2006, 03:47 PM   #2
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    Re: how can you go off fentynal patches safely

    Your pharmacist is correct. Never cut them in half as you will release all the medication that is meant to be released over a period of three days, in a matter of a few hours. He could OD!!

    Your husband is not on the lowest dose, fortunately. It use to be the lowest, but they are now making a patch that is either 12.5 or 13.5 mcg. He could switch to that before going off the patch.

    When I was on them and decided to go off, I was on 100 mcg and I just had scripts from my doctor for each dose 100, 75, 50, and 25 mcg. After being on the 25's for a period of time, I just went off them. It wasn't fun or easy, but after a few days, it passed.

    His doctor could give him some different meds, like Oxycodone for instance, that would make it easier for him, but that would be up to the doc and she doesn't seem to be too eager to help

    Good luck, I hope it's not too hard for him.

    Last edited by Rrector; 12-06-2006 at 03:48 PM.

     
    Old 12-07-2006, 06:18 AM   #3
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    Re: how can you go off fentynal patches safely

    hi director-----pharmacist told him it is unsafe to cut the patches but he also said he looked it up and so did the dr. and both said they are not sold in a 12.5. now we both no different . i have a friend in CA who had the 12.5. maybe you can't get them everywhere. so we are at a stand still. the only thing he can think to do to wean himself is to cut them. have a call into his PCP in hopes of some help. he's not worried about painkillers he's worried about the withdrawal . the last time he forgot to cahnge it he was out of his mind in the middle of the night and as soon as he put a new one on was fine wtihin minutes. he's only been on the 25 mg for abut 4-5 months. we just dont' know what to do. i though maybe a benzo since they are sometimes prescribed for alcolhol and drug withdrawal might help
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    Old 12-07-2006, 09:01 AM   #4
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    Re: how can you go off fentynal patches safely

    Hi ICC, Do not cut patches in half, there is another way. I'm familiar with the name brand duragesic patches, not the generics, so I don't know if this will work with the other release systems. However this will work with duragesic or a patch that uses two 2 seperate protective covers you have to remove before applying to the skin. If you only remove half the cover on a 25 ugh patch or any size duragesic and place it on your skin and tape it down. The adhesive portion of the patch that touches the skin is the part that delivers the medecine. If only half the adhesive cover is removed and has contact with the skin, only half the dose is delivered. You will have to tape the other side of the patch down with the cover remaining on the patch so it doesn't get snagged or pulled off. By reducing the amount of transdermal material that touches the skin you reduce the amount of med that can be delivered.

    A 50 ugh patch covers twice the amount of skin and delivers twice the amount of med. It's all about reducing the amount of the adhesive portion of the patch that touches the skin. Just like appling a band aid with only half the adhesive cover removed. The band aid or patch will try to lift away from the skin with the backing still on but that can be taped down. The drug can only migrate through the portion exposed to skin, if half the patch remains covered, you won't recieve medication through the covered portion.

    Reducing a dose by half will cause some withdrawal symptoms, but if your unable to find the 12ugh patches this is an effective way to reduce the amount being delivered.

    As far as danger, people don't die from opiate withdrawal. Unless your hubby has a pre existing heart condition he's not going to develop one from going through withdrawal. It's very unpleaseant but it will get better 7-10 days.

    It really sounds criminal that this doc has absolutely no idea or is unwilling to help your husband discontinue meds, is he afraid of loosing one of his customers? There are meds like clonodine to manage BP, Benzo diazapines to manage the shakes and jitters and meds for nausea , However even with meds it may still be unpleaeant but either way it's not life threatening. This is why PM docs can discharge patients dependent on opiates without a taper plan or any support system because they know the patient isn't going to die. If there was truly a rsik of death PM docs and surgeons would refer patients to addcition speilists to cover the back side. Since the worst thing that may happen is a few days of barfing and feeling wrotten, docs aren't worried about a law suite from a patient who's only loss was some time from work and a couple of weeks feeling wrotten. Even if someone looses their job because they were going through withdrawal for 2 weeks, most likely meds were discontinued due to to non compliance and the doc is at greater risk continuing to supply opiates to a non compliant patient.

    He will be sick for a week or two and it may take several months to get back to normal sleep patterns or feel completely normal, he also may have pain issues he needs to find another way to deal with.

    A big part of withdrawal aside from shakes and the obvious sickness is increased pain and a short but severe period of deprerssion. Since the PM is unwilling to provide a taper plan or meds to ease the process, he can ask his GP to help, but GP's really have very little training in opiate dependece or withdrawal aside from the most basic information.

    There are docs that specialize in discontinuing meds and he could ask to see an addictionologist but that does create a record and could effect eligablity for life insurance and many other things that ask the question, have you ever been treated for an addiction or chemical dependence. Aside from life insurance it can effect health insurance and disability benefits in the future, so how you deal with this one time event that ispurrely physical and not true addiction where abuse is a problem is very important to remain discreet about.

    If there was any real risk to his life, I wouldn't reccomend doing anything on your own, but he will get passed the sickness, anxiety,depression, increased pain and other symptoms of withdrawal unharmed. He may feel like he's dying and some people kill themselves when they feel hopeless, but the process of withdrawal isn't life threatening to otherwise healthy people including heroin addicts. Addictcs come off Heroin cold turkey on a concrete floor in jail all the time. There are no support meds, of feel better meds, it's just a matter of getting passed those days or weeks of feeling wrotten.

    There are newer versions of opiate maint like subutex "buprenex" but again, it's a fairly new drug and usualy managed by addiction or pain specialists. The easier thing may be to find a new PM doc willing to work towards discontinuing the opiates and finding an alternative to manage his pain.

    Good luck, Dave

    PS I just checked the FDA electronic orange book, Name brand Duragesic 12 is still on the list and delivers 12.5 ug per hour. It might not be commonly stocked but likely can be ordered.

    Last edited by Shoreline; 12-07-2006 at 09:06 AM.

     
    Old 12-07-2006, 12:36 PM   #5
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    Re: how can you go off fentynal patches safely

    dave--thanks so much for the info. hubby cut one in half today and as luck has it his PCP came to the rescue. he prescribed something for him, i'm not sure what yet but told him to take the patch off tomorrow and take these pills at specific intervals. 4 the first 2 days, 3 the next two and so on. dr. told my husband to give them to me so if he is really sick and gets tempted he won't chew them like candy. that won't solve the problem. said it should take about a week and he will have some discomfort but shuld subside within 7 days. he's scared but determined to get off them. dr. also sais that he fought to have them removed from the market and they were but put back out there. what a digrace that dr.s prexcribe something knowing this info and having no way to help the person get off them. the PM dr. is a disgrace. here's hoping for the best. i'll be by his side watching him and no his determination will see him through.

     
    Old 12-07-2006, 12:37 PM   #6
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    Re: how can you go off fentynal patches safely

    Hey ICC: Go to your pharmacy and talk with the manager of the pharmacy, who does the drug ordering. Have them check and look up the 12.5 ugm patches. They should have a book (Or it might be computerized) telling them all drugs that can be ordered.

    This happened to me when I went in to fill a script for Oxycodone, 15 mgs. They told me it only came in 5 mg. Because I have been on these boards and knew that it came in 5, 15, and 30 mg, I told them they were wrong. Well, they got the book out and looked and sure enough, Roxane makes Oxycodone IR in the three doses I told them. They learned something that day and they ordered it for me and were able to fill my script the next day. Go in and tell them they're wrong and ask them to look it up for you.

     
    Old 12-07-2006, 02:06 PM   #7
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    Re: how can you go off fentynal patches safely

    hi director---my husband did exactly that. dr and pharmacist looked it up and said no. i am wondering why some can get it and other can't. i think he'll be ok with his PCP walking him through it. he prescribed something to help him through and i'll watch him. thanks for your help i'll keep you updated if this works and how uncomfortable he is.

     
    Old 12-08-2006, 10:51 PM   #8
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    Re: how can you go off fentynal patches safely

    I was on the duragesic fentanyl pain patch for a year, and safe w/d with very little symptoms is slow. I went from 100mcg/hr and stayed there for three months. I had a small w/d but it wasn't bad. Then I went down to 75mcg and stayed there until I stabilized. The down to 50mcg. I am now on a 25mcg patch plus a 12. My next cut will be at the end of January or the beginning of March. I will do away with the 12mcg and just be on the 25mg. Then next cut will be to just the 12.5mcg alone. There are fentanyl suckers also now. The help when you make your last cut. My Dr. has been great at helping me get off of them.

    There are several faster ways, but since I don't want w/d, this is best for me. There is one other option I would consider but probably never do. It goes like this.....start taking methadone tomorrow with the patches I have on for a two week period. Then take off all patches and take the methadone for one week and that's it. I'm too much of a chicken to try that one I think.

    As for the patches sticking, I have been blessed. I wear them on my upper back. My dh changes them for me every 72 hours. There has only been twice that they didn't stick the whole time. He cut a very narrow strip of tape and put it on the border of the patch. Nothing touched the patch itself. My pharmacists helped us through that.

    I will be so happy when I am off of these things. They seem to depress me. Just worrying about them staying on is enough.

    Thanks for the post. I always look for someone that is dealing with the same meds I am using. Take Care To All........SW

     
    Old 12-09-2006, 03:39 AM   #9
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    Re: how can you go off fentynal patches safely

    spirit wind---- i know how you feel. my husband will be so glad when these are out of his life totally. they have helped the pain but he hasn't felt well since bein gon them. even though he has been told by numerous people including the dr and pharmacist not to cut them he did anyway. he was very cautious and just gave it a clean cut with the backing still on. he has been on 25 mg. (the highest he's ever been on) for only 4-5 months. since putting the half on he seems to feel better and is sleeping better. he has a routine to follow staring monday when it comes off for good. percocet 4 xs a day for 2 days, 3 xs a day for 2 days and so on. i will give him a klonopin occassionally if the anxiety is really bad and will call 911 if i think he is in danger. dr. told him to give me the percocet just in case it gets bad and he is really tempted to overdo because of any withdrawal. that would defeat the purpose. wishing you the best. keep me updated on how you're doing with your cut back. it's a scary drug that from what dr. told us was removed from the market and put back on. the 12.5 are not abailable where we are. dr. and pharmacist both looked them up and said they can't get them hence having to cut a 25 mg in half.

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    Old 12-09-2006, 10:37 AM   #10
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    Re: how can you go off fentynal patches safely

    Please don't cut them in half...

    He may be getting "less" of the medicine overall, but he may be getting a DANGEROUS amount of the medicine at once.

    Please tell him to stop.

     
    Old 12-13-2006, 12:41 AM   #11
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    Re: how can you go off fentynal patches safely

    Quote:
    Originally Posted by ICC
    dave--thanks so much for the info. hubby cut one in half today and as luck has it his PCP came to the rescue. he prescribed something for him, i'm not sure what yet but told him to take the patch off tomorrow and take these pills at specific intervals. 4 the first 2 days, 3 the next two and so on. dr. told my husband to give them to me so if he is really sick and gets tempted he won't chew them like candy. that won't solve the problem. said it should take about a week and he will have some discomfort but shuld subside within 7 days. he's scared but determined to get off them. dr. also sais that he fought to have them removed from the market and they were but put back out there. what a digrace that dr.s prexcribe something knowing this info and having no way to help the person get off them. the PM dr. is a disgrace. here's hoping for the best. i'll be by his side watching him and no his determination will see him through.
    I am not sure what you have read about the patches? I have not heard anything negative about them. Can you fill me in on why you want your hubby off of them, and what you have heard that makes you so scared of the patch. I have been on it for a few months and seem to have had no problems as of yet.

     
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