HealthBoards

HealthBoards (https://www.healthboards.com/boards/)
-   Pain Management (https://www.healthboards.com/boards/pain-management/)
-   -   Fentanyl patch questions (https://www.healthboards.com/boards/pain-management/594117-fentanyl-patch-questions.html)

conductor 04-10-2008 07:01 PM

Re: Fentanyl patch questions
 
Dear Ex,

I have been reading your posts with TREMENDOUS INTEREST--concerning the manner in which you use the patch. I don't think the patches distribute their medication with fine-tuned continuity either. For years, I have used 75 mcg patches--changing them every other day. They, frankly, are not consistent. I guess that's where the Actiq (generic) saves me. But, I hate to think I am using the Actiq to correct the "distribution problem" of the patch. I don't want to detect pain the minute my patch isn't correctly distributing. The doctor who originally placed me on the patches and then on the Actiq (when it came out) was an anesthesiologist and a Pain Management Specialist. He made a great big deal out of the fact that he had received very specific training in BOTH. I don't know how true that was, but he was an excellent physician. When he decided to practice several thousand miles away, I truly cried. He had given me so much of my life back that I have to go back and remember it specifically once in a while!!

Sorry to have bored you. However, your take on the way a patch actually distributes the medication has caught my eye in a significant manner. Thank you, Ex. I enjoy reading your posts.

Sincerely,
Jon (Conductor)

P.S. I use the patch 75 mcg, changing it every 48 hours (15 patches per month). I use the generic Actiq 800 mcg, up to 3 per day--but I just get 2 boxes (of 30 lozenges) per month. If I used 3 per day, I would need 3 boxes (of 30 lozenges) per month--which would cost me the same. This is a way to hold myself off from using 3 every single day! Finally, I use generic Dilaudid (Roxane) 8 mg, 1 bottle of 100 per month. I'm allowed to use up to 120 per month if needed, but I try not to do so! These three meds have been generally the same in strength and dosage for the last 10 years!

Executor 04-10-2008 09:50 PM

Re: Fentanyl patch questions
 
Jon-

Thanks for the feedback! I have tried to become educated in the field of PM, as it really hits home for me. I also enjoy helping others, and in some small way, hope that I can help improve someone's condition by providing information for them to make their own decisions. I appreciate such kind words from a poster such as you. You are a great resource too, as I always enjoy your posts.

I too use the combination of patch and Actiq. I also use Oxyfast for BT when the Actiq isn't enough. It's my last line of defense....Knocks me down pretty good, but also the pain. With Actiq, I can still function and do things.

Are you using a generic patch, and if so, what brand? I'm starting on the brand tomorrow, so I'll let you know something if interested. I've had ups and downs with my generic patches....I swear I can tell the difference patch to patch. I'm sure my activity level (or lack thereof) is in play as well.

Thanks goodness that your new physician was/is willing to continue your treatment, especially given the potency of what you're taking. As I'm sure you're probably aware, it seems that poster after poster has a story about a change in Docs and how they get essentially "dumped." Hard to believe actually, but then again, not.

Thanks again for the feedback!;)

Ex

conductor 04-11-2008 12:37 AM

Re: Fentanyl patch questions
 
Dear Ex,

It seems that our medications are frighteningly similar! As I've probably stated far too many times for your comfort--I use the following pain medications (and for what): First of all, I have Systemic Lupus and the Lupus Anticoagulant. This is why I am on these medications, and I have been on them for many years--I'll place start year in parentheses. [B](1996) Duragesic[/B] titrated up to 75 mcg within a few months and have remained there ever since! [B](2006, I think)[/B] Went to the first of two generic forms of the patch! The first and most hateful was the [B]Mylan[/B]--no pain relief, significant withdrawal symptoms. I would have given anything to pay the Brand Name Co-Pay to obtain the relief. However, my pharmacist--a truly grand man who is earning the jewels in his crown in Heaven--quickly ordered the Sandoz brand. He pointed out that the Sandoz laboratory (for this product) had the same, exact address [B]AS THE JANSSEN BRAND NAME[/B]. According to my insurance, it didn't cost me anything different. As well, this Sandoz fentanyl patch looked surprisingly similar to the Janssen Brand Name Duragesic Patch! All of the pain relief, the manner in which I perceived it's function, etc., all seemed the same. Even the printing on the patches themselves looked very similar!! The way it all functioned--but at a much lower price than the Janssen--$10 for 15 patches, according to my plan--was almost Biblical!

[B](1998--I think) Actiq[/B] began being offered. However, I was quickly "not a valid candidate" according to my insurance company because I was not terminal. It was beyond needed to me, but it cost me nearly $900 per box per month. Dearest Ex...I had to use 2 boxes per month! My parents helped me pay for this. [B](2005--I think) Actiq[/B] went generic through the Barr Company. This way, my cost went down from $1,800 for two boxes of Actiq per month to $10.00 for two boxes of this generic Actiq per month! I have not commented a single time concerning this change. It is truly absurd. It's like adding another pay check. The packaging looks almost identical to the Brand Name Actiq. Even the printing on the lozenge itself looks the same, except that the word "ACTIQ" doesn't appear!

Now, Ex, I do not come from money. My father is a retired minister and my mother is a retired English teacher. Frankly, I'm just thankful in every way I can muster! The only way I can "get by" is that I applied for and, thankfully, receive Disability!! I have enough Medical Records to choke anyone!!

[B](1996)[/B] I was titrated up to [B]generic Dilaudid (Roxane) 8 mg.[/B] I get a bottle of between 100 and 120 per month. It just depends on my needs during each time period, and I must say that my doctor keeps very, very close records. This medication usage has been consistent ever since I was placed upon it.

While I do have some other incidental medications, these three are my main medications. I do use Fioricet and Fioricet w/Codeine for muscle tension type headaches. These medications have been used regularly ever since I was in college--around 1990!

I'm sorry to have gone on and on. Thank you for your interest. Again, please know that I am impressed with the manner in which you write. As well, I appreciate your expressions!

Thank you, Ex! Thank you for always posting what you really, really mean.

Sincerely,
Jon (Conductor)

P.S. I look forward to getting to know you through this board, my friend. Just to apologize in advance, I have been up for a long, long time--so forgive me of many terribly obnoxious grammatical errors! Usually, I try to read and re-read, which I did. I'm just not sure I caught every last thing!

Executor 04-11-2008 05:24 AM

Re: Fentanyl patch questions
 
[QUOTE=conductor;3526398]My pharmacist pointed out that the Sandoz laboratory (for this product) had the same, exact address [B]AS THE JANSSEN BRAND NAME[/B]. According to my insurance, it didn't cost me anything different. As well, this Sandoz fentanyl patch looked surprisingly similar to the Janssen Brand Name Duragesic Patch! All of the pain relief, the manner in which I perceived it's function, etc., all seemed the same. Even the printing on the patches themselves looked very similar!! [/QUOTE]

Yes, this is all very true. However, all should be careful to stop there. Just because a product is made in the same factory, on the same assembly line, by the same company, doesn't mean it's the same product. I would bet almost everything I own that when Janssen makes the Sandoz (for Sandoz), they take every advantage of the FDA laws. Why wouldn't they? Less ingredients means less cost. Additionally, they want to differentiate their brand...The one they worked so hard to develop and market. If people experience problems with the generic, they will revert to the brand in many cases....I am. You've seen my examples of my experience with a large fortune 5 manufacturing company...We made "off brand" product for our competitors all the time, and we used inferior components because we were manufacturing to a price point, not a quality standard.

[QUOTE]Actiq began being offered. However, I was quickly "not a valid candidate" according to my insurance company because I was not terminal. [/QUOTE]

I had the same problem. I was initially denied by Anthem under the premise that the product was only indicated for cancer pain and that my Doc's off label use was not covered by insurance. However, as you know, it is perfectly legal and customary for Docs to write off-label. Happens every day all day by Docs everywhere. I appealed and appealed and eventually won. My PM Doc argued heavily that the human body cannot differentiate pain, therefore it doesn't matter if one has cancer or not. If the med works, it works.

[QUOTE]The packaging looks almost identical to the Brand Name Actiq. Even the printing on the lozenge itself looks the same, except that the word "ACTIQ" doesn't appear![/QUOTE]

Yes, they are identical. Cephalon (maker of Actiq) is manufacturing the product for Barr, who is a big "generic" company. I had to move from 400s to 600s to account for the drop in generic potency. 400 x .8 = 320. Ouch!

[QUOTE]The only way I can "get by" is that I applied for and, thankfully, receive Disability!! I have enough Medical Records to choke anyone!![/QUOTE]

I receive as well, and have quite a medical history. No one is going to hire you or me on these meds. What's absurd is that I have to send in periodic reports (for my private disability insurance) and absolutely nothing has changed. I realize these organizations have rules and policies, but all they really need is a copy of my Rxs. That in itself says it all.

[QUOTE]I was titrated up to generic Dilaudid (Roxane) 8 mg. I get a bottle of between 100 and 120 per month. It just depends on my needs during each time period, and I must say that my doctor keeps very, very close records. This medication usage has been consistent ever since I was placed upon it.[/QUOTE]

I've never tried this drug. Does it work well? I use Oxyfast for BT. My Doc post dates everything and the "days" are counted to a T. In 5+ years of seeing him, I've never asked for a date change and he's never offered.

[QUOTE]While I do have some other incidental medications, these three are my main medications. I do use Fioricet and Fioricet w/Codeine for muscle tension type headaches. These medications have been used regularly ever since I was in college--around 1990![/QUOTE]

I used them way back in school as well....Almost the exact time frame as you, but they didn't work very well for me.

[QUOTE]I look forward to getting to know you through this board, my friend. [/QUOTE]

Me too. Thanks much for the post. We'll continue to learn about this complex field together.


Ex

ms_west 04-11-2008 08:09 AM

Re: Fentanyl patch questions
 
Jon and Ex -

I have to butt in this conversation and say that you both are an inspiration to me to have suffered for so many years with cp, you take large amounts of medication and yet you are there for us newbies each and every day. Thank you from the bottom of my heart.

Pepper

brianpain33 04-11-2008 03:42 PM

Re: Fentanyl patch questions
 
[QUOTE=123dietdrpepper;3526747]Jon and Ex -
you both are an inspiration to me to have suffered for so many years with cp, you take large amounts of medication and yet you are there for us newbies each and every day. Thank you from the bottom of my heart. [/QUOTE]

I have to second this notion. I know that when I first started posting I thought that I knew quite a bit and you guys really sat me down and got me to realize that I needed to "listen". I know that I have taken a huge amount of knowledge and information from you two. I wouldn't have all of the knowledge that I do and be able to help newcomers if I had not learned from you two. Thank you

brian

Executor 04-11-2008 04:45 PM

Re: Fentanyl patch questions
 
Thanks Brian.....I appreciate the nice words. To be honest, I think we all learn from each other. The key is to keep learning. I pick up bits and pieces all the time. While I have retracted some physically, I still have my mind and given my education, work experience, and background, I feel like I have something to offer to others. I'm trying to turn the negative of my condition into a positive to help others where I can.

Thanks again....

Ex

conductor 04-11-2008 05:15 PM

Re: Fentanyl patch questions
 
Dear Pepper,

You are welcome for anything and everything. Your screen name always catches my eye and guarantees a view (possibly a reply) from me! Pepper, you have a large number of replies, so please know that the knowledge, sharing, and "thank you's" go both ways! I've learned a great deal from you, too. And, I don't say these things if I don't mean them! Sincerely, Jon (Conductor)

Dear Brian,

You have regularly made me realize the need to learn. When I started following your story, I read with awe at your difficult plight! And, Brian, you never needed anyone to "set you straight" concerning the knowledge!! Sincerely, Jon (Conductor)

To Everyone,

(I don't usually like to follow this same way of answering, but I will use it for now.)

[B][U]This whole fentanyl patch use idea keeps morphing, doesn't it?[/U][/B] I see that we started years ago with just the Brand Name by Janssen. Then, it changed to having Janssen, Sandoz, and Mylan. Now, there is an additional generic brand. I don't remember the company's name, right now. Plus, people have all sorts of different ways to keep the patches on the skin! I wouldn't be surprised to see that we might need to start another thread to keep this idea going, if needed.

Sincerely,
Jon (Conductor)

P.S. This is to Ex--because she was reponding to me when she mentioned it. Anyone can answer, of course, but I address it to Ex. What is Oxyfast? Is it another form of Percocet or Oxycodone without the acetaminophen? Thanks! Jon (Conductor)

Executor 04-11-2008 06:02 PM

Re: Fentanyl patch questions
 
[QUOTE=conductor;3527444]This whole fentanyl patch use idea keeps morphing, doesn't it?[/U][/B] I see that we started years ago with just the Brand Name by Janssen. Then, it changed to having Janssen, Sandoz, and Mylan. Now, there is an additional generic brand. I don't remember the company's name, right now.[/QUOTE]

Watson

[QUOTE]This is to Ex--because she was reponding to me when she mentioned it. Anyone can answer, of course, but I address it to Ex. What is Oxyfast? Is it another form of Percocet or Oxycodone without the acetaminophen? [/QUOTE]

Oxyfast is liquid Oxycodone made by Purdue Pharma (same Manuf as OC). Another equal brand is "Roxicodone" in liquid. Each bottle is 30cc or 30 droppers. The dropper that comes with it is almost identical to baby Tylenol. The dropper has 4 lines on it....Bottom one is 5Mg, next is 10Mg, three fourths full is 15Mg, and the top line or one dropper full is 20Mg. Works within 5-10 minutes, max. What I like about it (besides working quick) is that you can titrate the dose depending on your pain. I guess you can do that with pills, but it's easier with a liquid dropper. I use two bottles per month for BT.

Ex

WPTN3 04-21-2008 07:06 PM

Re: Fentanyl patch questions
 
Hello everyone, it is a relief to find people that I can connect and relate to. Everyone in my current world has no idea what I'm going through. I am on 75mcg of fentanyl every 48hrs. I still suffer significantly, and I feel my PM doc doesn't take me seriously. I have frequent episodes of breakthrough pain. I have AIDS and my pain is mostly neuropathic. My hands hurt so badly I just want to cut them off, now my toes are starting to act how my fingers did before they got so badly. I'm only 27 and when I asked my PM doc for Breakthrough meds he told me that he was concerned about me, and that in 5 years we would have run the gammet of opiates and have run out of options, therefore he wants me to be evaluated by another pain doc who is also a psychiatrist. I don't understand if there is a stigma with the AIDS, or if the pain is considered "insignificant" compared to those with sickle cell, lupus, cancer, or other serious illnesses. But it is significant to me. I just want to someone to be considerate and take me seriously. I'm not drug seeking, but maybe that's it, maybe that's where the stigma is associated, I don't know. Can someone out there help me or give me some advice. I read you guys, and it sounds like your pain is being managed. I feel that my friends and family don't always take me seriously either, that they don't understand. I hope this new doc doesn't try to tell me it's all in my head. I just want some relief.

Sincerely,
WPTN3

brianpain33 04-21-2008 11:56 PM

Re: Fentanyl patch questions
 
[QUOTE=WPTN3;3540332]. I still suffer significantly, and I feel my PM doc doesn't take me seriously. I have frequent episodes of breakthrough pain. I have AIDS and my pain is mostly neuropathic. My hands hurt so badly I just want to cut them off, WPTN3[/QUOTE]

WPTN3:
Welcome to the boards and let me say that if your pain is mostly neuropathic in nature then the fentanyl may be of little use. Opiods/Opiates sometimes do little for neuropathic pain. Your PM doc really should be trying you on meds that usually do work specifically for neuropathic pain. The most common ones are Neurontin, Lyrica, Cymbalta, Ultram, and Topomax. Here is a complete list of meds designed for neuropathic pain. I will bold the most common ones

[B][U][SIZE="3"]Anticonvulsants[/SIZE][/U][/B] - [B]Topomax, Tegretol, Trileptal[/B], Depakote,[B] Lamictal[/B], Dilantin, Depakene, [B]Neurontin, Lyrica[/B], Gabitril,[B] Klonopin[/B](even though it's technically a benzodiazepine)

[B][U][SIZE="3"]Tricyclic Antidepressants[/SIZE][/U][/B] -[B] Elavil(amitryptiline), Pamelor(nortriptyline[/B]), desipramine, imipramine, doxepin(Sinequan), trimipramine, clomipramine

**very good at treating nerve pain & helpful with sleep so usually prescribed at night**

[B][U][SIZE="3"]SNRI Antidepressants[/SIZE][/U][/B] - [B]Cymbalta[/B], Effexor, Wellbutrin

**very effective for nerve pain & also depression that usually accompanies chronic pain, many people on these boards have success with Cymbalta**

[B][U][SIZE="3"]Atypical Antidepressants[/SIZE][/U][/B]- Trazadone, [B]Ultram(tramadol[/B]),
Ultracet, Ultram ER

**good at treating nerve pain, tramadol also has a mild opiod quality to it so IT IS A MILD NARCOTIC**

[B][U][SIZE="3"]SSRI Antidepressants[/SIZE][/U][/B]- Paxil, Prozac, Zoloft, Celexa, Luvox

[B][U][SIZE="3"]Opiod/Opiates[/SIZE][/U][/B]- hydrocodone(Vicodin, Lortab, Norco), oxycodone(Percocet, Oxycontin, Oxy IR), hydromorphone(Dilaudid), oxymorphone(Opana), methadone, fentanyl(patch, Actiq), morphine(MS Contin, Avinza, Kadian)
**can be useful for certain types of pain especially when used in combination with other non-narcotic meds**

Trust me I have been there where I really just wanted to chop my feet off. But now I am on the right set of meds, which is different for everyone. Here is what I currently take to give you an idea: Lyrica, Percocet, fentanyl patch, Trileptal. Keep posting and let us know if you find some relief.

brian

cweinbl 04-24-2008 03:01 PM

Re: Fentanyl patch questions
 
Keep shopping! Don't stop until you receive the treatment you deserve.

[QUOTE=WPTN3;3540332]Hello everyone, it is a relief to find people that I can connect and relate to. Everyone in my current world has no idea what I'm going through. I am on 75mcg of fentanyl every 48hrs. I still suffer significantly, and I feel my PM doc doesn't take me seriously. I have frequent episodes of breakthrough pain. I have AIDS and my pain is mostly neuropathic. My hands hurt so badly I just want to cut them off, now my toes are starting to act how my fingers did before they got so badly. I'm only 27 and when I asked my PM doc for Breakthrough meds he told me that he was concerned about me, and that in 5 years we would have run the gammet of opiates and have run out of options, therefore he wants me to be evaluated by another pain doc who is also a psychiatrist. I don't understand if there is a stigma with the AIDS, or if the pain is considered "insignificant" compared to those with sickle cell, lupus, cancer, or other serious illnesses. But it is significant to me. I just want to someone to be considerate and take me seriously. I'm not drug seeking, but maybe that's it, maybe that's where the stigma is associated, I don't know. Can someone out there help me or give me some advice. I read you guys, and it sounds like your pain is being managed. I feel that my friends and family don't always take me seriously either, that they don't understand. I hope this new doc doesn't try to tell me it's all in my head. I just want some relief.

Sincerely,
WPTN3[/QUOTE]

QUAYZAR 03-22-2009 07:58 PM

Re: Fentanyl patch questions
 
I had a simular problem. My doc prescribed provigil. It is normally an antinarclepsy med but it has secondary uses. Works for me. I need to mention I am not on fentanyl but 120mg morphine a day.

QUAYZAR 03-22-2009 08:08 PM

Re: Fentanyl patch questions
 
[QUOTE=QUAYZAR;3929382]I had a simular problem. My doc prescribed provigil. It is normally an antinarclepsy med but it has secondary uses. Works for me. I need to mention I am not on fentanyl but 120mg morphine a day.[/QUOTE]

LORDSETH65 01-08-2010 02:14 AM

Re: Fentanyl patch questions
 
I have been on Fentanyl for 8 years. I currently wear 2 patches at a time. I use 1: 100mcg plus 1 25mcg patch. My dr. has them prescribed for me every 2 days instead of 3 days (72hrs) because they are hard to keep on after showering, sweating etc. I also us a bit of tape around the edges. Tagaderm is the best to hold them in place but they are expensive and I find that regular medical tape works well. I broke my back 10 years ago and I have tried every pain medicine there is out there. Fentanyl works the best plus it has no acetaminophen like most pain pills. Fentanyl is actually a man made synthetic Opiate that is between 80-100 times stronger than morphine. if you have any questions I would be happy to answer them. Thanks SETH

LORDSETH65 01-08-2010 02:22 AM

Re: Fentanyl patch questions
 
Another thing to consider with the fentanyl Patch is the brand name. I have tried all 3 "different" types the "Foil" metallic backed ones. the "gel" filled ones and the ones from Mylan which is a clear patch but no "gel" resevoir. I definatley like the ones from Mylan the best by far. no chance of burns from the foil. no chance of leaks from the gel "pouch". the Mylans are by far the most reliable. I make it a point if I have to go to a new Pharmacy to ask what kind they prescribe before I ask them to fill it. I have used the Mylan brand for the past 7 years.

lacy1893 01-08-2010 02:01 PM

Re: Fentanyl patch questions
 
That is so funny...I hate Mylan. I tried it once about 8 years ago and the pain relief was much less than the gel. So, I switched back, even though I had to search for a pharmacy that carried something different.

I guess everyone responds differently to them...that is why they have different types!

LORDSETH65 01-09-2010 12:19 AM

Re: Fentanyl patch questions
 
Yeah Lacy no doubt that is funny. like you said each person responds differently. the gel worked well for me I was just afraid of the gel leaking. to me anything but the foil backed one is acceptable. thanks seth


All times are GMT -7. The time now is 09:39 AM.