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  • Fentnyl Patch Third Day Concerns

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    Old 03-29-2008, 03:03 PM   #1
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    Fentnyl Patch Third Day Concerns

    I had a little talk with my pharmacist today and asked him about my Fentanyl patch. I'm on the 3rd on, 24 hours into it today. I've noticed a difference already with the amount of pain that I have. The 1st two patches worked great. This one, however, isn't working so well. I showed him the patch and he said that it's probably from the tape I have on it to keep it from coming away from my skin. He said that the patches are made to stick well and have no worries about it coming off or showering with it on. He said the tape can cause it to not work as well as it should. So, I don't know what to make of what he said. I'm afraid that if I take the tape off, it will ruin the patch and I don't want to have to put another one on when it's not time for it. He also said that if I have any more problems with it that I can call him and he will call the drug company(Watson) and talk to them for me and possibly replace them for me. They don't carry any brand but the Watson brand because of the recall. I'm hoping it's not working as well because I cleaned a little bit this morning and did a few loads of laundry and then went shopping at Wal Mart for a few hours. That's where my pharmacy is, Wal Mart.
    If anyone that is on the patch that has had any problems with it not working like it did the 1st few times they used it, please let me know.

    Last edited by shannonjord08; 03-29-2008 at 03:05 PM.

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    Old 03-29-2008, 04:48 PM   #2
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    Re: Fentnyl Patch Third Day Concerns

    Originally Posted by shannonjord08 View Post
    he said that it's probably from the tape I have on it to keep it from coming away from my skin. He said that the patches are made to stick well and have no worries about it coming off or showering with it on. He said the tape can cause it to not work as well as it should.
    This is pretty ludicrous to me. I wear a patch cover and have done this ever since I had 2 of them come off and one time it was while I was in the shower. Trust me many, many people have to use some type of cover because the patch does not adhere very well. Plus, the consequences of what happens, if you do start having patches not sticking & coming off is not good either. Personally, I do not like the tape but it does the trick. I think having something completely covering the patch works better because it helps to push down on the patch equally and make it push against your skin better.

    You can go to CVS, Walgreens or many other places and get something called Nexcare Tegaderm cover. You simply take one of these, peel the stuff off, and place it directly over your patch. This may, and usually does, work better than using the tape. Plus, I hate trying to get the adhesive off my skin that the tape leaves behind.

    I have also tried the Band-Aid Brand x-tra tough waterproof strips ($3-4/box) and they work well. I use the Opsite Flexifix by Smith & Nephew currently. You can do a search online using that name and find plenty of places to buy them from. You could also try the Johnson & Johnson Bioclusive covers which I have heard stay extremely well but they are quite pricey just like the Tegaderm covers. But try the different options and see what works best.

    I would not go up in strength on the patches until you have been on them for at least 2 weeks. As you have seen with Moldova's thread it can have SEVERE complications. Let us know what you do.


    P.s there is a thread at the top of this message board in the pain management section concerning fentanyl patch covers

    Last edited by brianpain33; 03-29-2008 at 04:56 PM.

    Old 03-29-2008, 09:27 PM   #3
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    Re: Fentnyl Patch Third Day Concerns

    Here's some FYIs on the patch that may answer your question(s). I've read hundreds.....Literally hundreds of user experiences in an effort to learn as much as I can. Yes, Docs are the primary source of info, but I want to hear from those who use the product....Sort of like buying a new stereo or car....Great to have Consumer Rpts or whatever, but I want to hear from those who use the darn stuff. Also, I don't go by what one person says, but "trends" of many...I figure it's the best indicator...At least for me.

    Thus, I've found the following:

    (1) There seems to be a significant variation among patch locations. Those who wear it on dense parts of their bodies....Arms, shoulders, and lower back seem to have better luck. Personally, I've only used two locations....Lower back and flanks. Lower back is MUCH better. I think "fattier" parts retain more fentanyl vs. hit your blood stream and thus BPL. The flanks just don't work for me really at all. One patch I put there seemed like it didn't work at all...Maybe it was just a bad one...But, I don't use the flank anymore and am doing much better. I've also read recently where many have had great success on their thigh...I have yet to try that, but want to and will. Izzy reports that her ankle worked well.

    (2) There seems to be a significant variation in how you apply the patch. My research tells me that those who clean the area right before applying and shower, get good results. I wash my back and then immediately after the shower and drying off (maybe 5 minutes), have my spouse apply the patch. I also think a warm shower/bath raises your skin temp slightly and therefore gets the patch going.

    (3) The directions say to press firmly against the patch for 30 seconds in order to press the fentanyl against your skin. I think this is important because (A) it presses the fent against your skin and (B) sets the glue.

    (4) Make sure the patch isn't applied to any hair or old glue (from a previous patch). The hair will absorb the fent and go nowhere.

    (5) I have read where some users report that there seems to be variation in patch to patch...That they'll get a bad patch here or there. This seems very plausible to me because when I was working, I was employed by a leading fortune 5 manufacturing company and although we made great product, things do happen in the manufacturing process that is out of the companies control. Additionally, we made "offbrand" product for our competitors and while it was decent product and worked fine, it wasn't the quality of our branded product. I have to assume the same goes with drugs. You may have also seen where I've posted that the FDA only requires generics to be within 10% of the branded product. Well, that tells me right there all I need to know! So, if you can swing it, you may try the brand, or "Duragesic." Most insurance companies will pay for it if you get the Doc to write "brand medically necessary" on the script. Also, Watson is the newest player in the patch market, so I'd be a little leary myself. I use Sandoz. I've also used Duragesic and IMO, the Duragesic are better. However, they can be hard to get, especially now with the re-call. Once it is over, i will go back to the brand.

    (6) How often do you change? Most patients end up on every 48 hrs, which can make a big difference. I've also recently started the process known as "staggering", where I change a patch everyday. Has worked wonders. I like this if for nothing else, if there happens to be a bad patch, or I do too much one day and it slides some, I'm always putting new ones on.

    (7) Your activity level may have a significant impact on your patch. For example, if you're very active one day and sweat a lot, it could move some (depending on the location on your body) or the sweat from your body could be pushing out the med. Also, if you did a lot one day and got overheated, the patch could have prematurely dumped med into your system. Therefore, it wouldn't work as well later in the process.

    (8) The patch needs to be firmly against your depending on how this tape and so forth is working, it could be the problem. It's critical that once you apply it, not to move it or re-position it in anyway. The glue works great for one application, but it's not meant to be re-applied or moved. My Doc has said that taping over a patch will work, but again, it's got to be against your skin.

    (9) Lastly, I'd ask your Doc for a little extra in your script....An extra patch or two. Explain to him/her that by giving you the precise # of patches, that if something goes wrong with one, you're in trouble for those 2-3 days (depending on how often you change).

    Remember that it takes a good two weeks for your BPL to get fully elevated and stable, so hang in there. You can read all about this in the white prescribing information that comes in your box of patches. While the patch is far from perfect, so are many other LA meds. For me, I'd rather put a patch on once a day then take a pill 3-4 times a day. Additionally, fent just works better for me. I never had much success with OC.

    Hope this helps....This is about all I know....And it took me MONTHS to learn it all....You get it in one shot!


    Old 03-30-2008, 01:29 AM   #4
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    Re: Fentnyl Patch Third Day Concerns

    executor brought up some great points, i also agree though they are not suppose to varry they do.

    Recently my pharmacist stopped carrying the brand i found i do very well on.
    The one the pharmacist has now ( watson) just to me seemed filled with issues.
    I as well showed my pharmacist the difference between the two and reported to him the brand they switched to did not seem to be as effective to me.
    Oh other issue my insurance will only allow so many per month. Because of that issue at this point with the pharmacist changing of the meds i will try to go to my neruo more often. That way i am covered .
    I found with the patch the pharmacist changed too very grateful for my break through meds.
    In answer to your question after re reading i hate the watson as well, but only because it does not seem to work as well as what i use to take.
    Also had issues with opening them which i also reported.
    I am glad you reported your issues i hope more folks report things not working as well for them or the differences. Thank you and i am sorry we are both in same boat......

    Old 04-14-2008, 12:29 AM   #5
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    Re: Fentnyl Patch Third Day Concerns

    I told my PM doctor that I felt like a truck ran me over on the third day and she said she wasnt surprised and that it is called 3rd day failure. She changed me to every 48 hrs and some patches barely last the full 48 but I make due. Talk to your doc - I had no idea at the time and thought it would sound as if I was drug seeking but she understood right away and your doc will too.

    Good luck and warm hugs!!

    Liz 217

    Old 04-14-2008, 06:31 AM   #6
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    Re: Fentnyl Patch Third Day Concerns

    That's great news Liz! To your point, I'm not sure they even last 48. As a result, you may have seen a post of mine in another thread where I'm on a patch a day....Alternate every day with one patch. 30 patches per month, each one stays on for 48 hours, but apply a new one each AM. Works great.


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