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scrappinmaniac 04-06-2008 10:39 PM

Fentanyl patch questions
 
[FONT="Arial Narrow"][SIZE="3"]I started using the patch on 02.16.2008 at 50 mcg. On 03.03.2008 my doctor increased my dose to the 75 mcg patch.

My question is does anyone know when I should stop feeling so drowsy? It doesn't matter how much sleep I get at night, if I sit down for any amount of time during the day, I'm dozing off. I feel like sleep has taken over my life. My pain level is GREAT for the first time in years, so I don't want to step down on the patch or change to a different pain med.

I would appreciate any advice.

Thanks,
Scrappin'
[/SIZE][/FONT]

brianpain33 04-06-2008 11:52 PM

Re: Fentanyl patch questions
 
scrappin:
welcome to the patch club and the drowsy effect. So what would you say that your pain level is at right now on average (from 1-10)? It could be that you are getting too much pain relief and that is the reason for being too sedated. However, it causes me quite a bit of sedation as well which I HAVE TO COUNTERACT with caffeine. This means that I really, really do need caffeine to make it through the day since I have an office job and sit mostly all day. This makes things even worse since I want to nod off even more. I just put up with it and deal with it the best way possible each day even if it means drinking 3-4 cups of coffee, drinking tea, trying to drink water (since water hydrates you) and the others actually dehydrate you. It is amazing how much more alert you can be if you can actually get fully hydrated. But I tend to get into the coffee/tea habit too much. I will also tell you that I sleep at least 10 hours every day as well. I guess it depends on if you are willing to put up with it and counteract it the best way possible.

You should realize that the 75mcg patch is the equivalent of taking around 27 (5/500mg Percocets), yes that is 27/day. So if you think about it like this no wonder it makes you sedated. My doctor told me he could presribe enough narcotic to get me pain free but I would probably be completely non-functioning and drooling, past out in a corner some where. It is definitely a balancing act.

brian

Executor 04-07-2008 08:16 AM

Re: Fentanyl patch questions
 
[QUOTE=brianpain33;3520043] It is definitely a balancing act.[/QUOTE]

A very good post by Brian....Yes, there is a happy medium. In your case, since you're new to the patch, your body is still adjusting....It will get better as your body becomes accustomed to the fentanyl. I don't mean to sound insensitive, but it this is your only side effect, you're doing ok...Some others have headaches, can't keep the patches on, 3rd day issues, & etc.

Hang in there....And a little caffeine won't hurt either, as Brian said.

Ex

Moldova 04-07-2008 08:33 AM

Re: Fentanyl patch questions
 
Brian and Ex said it all, I just want to add some my thoughts.
When my PM put me on a patch, he started from 25 mcg and this made me sleepy too! Your Dr put you right the way on 50 and in short time increased it to 75...
Like Ex said, your body needs time to adjust to all this meds in your system. I consider your very lucky that only one side effect you have is sleepiness, could be worse, trust me.
Sometimes they say if you are too sleepy, it can be a sign of overdose, just check this with your DR. I am pretty sure you are OK, we all react to different meds differently, but just to be on a safe side...

And good luck to you! Take care :angel:

scrappinmaniac 04-07-2008 09:03 PM

Re: Fentanyl patch questions
 
[FONT="Arial Narrow"][SIZE="3"]Thank you for all of your replies :).

Brian - I would say my pain level is averaging about a 3-4 on a daily basis. My doctor prescribes 3 percocet's (10/325 mg) a day for breakthrough pain...on average, I might take 1 or 2 of them a day, sometimes through the week (and on day 3 of the patch, when the patch is less effective) I take all 3 of them b/c I take care of my toddler all day long on weekdays by myself so I can get pretty sore. I have become a caffeine junkie since starting the patch. My husband has introduced me to energy drinks, and some days they seem to help, but some days they don't. Since starting the patch, I have become more aware of the meds I'm prescribed that could compound my drowsiness, such as flexeril (10 mg)...I only take these meds if it's absolutely necessary in hopes of decreasing my drowsiness a bit. Before the patch, I was on oxycontin and my pain level on average was about an 8-9 on a daily basis, so like every other patch user, the patch has been a Godsend to me.

Executor - Much to my dismay, drowsiness is not the only side effect I've encountered while using the patch. Nearly 2 months after starting the patch, I'm nausea most of the time...my doctor has given me a script for phenergan but I only take it as a last resort b/c I'm a full-time mom and cannot be in bed all day long. I do remember the horror of day 3, when the fentanyl initially spikes and most patch users get really sick...unfortunately for me, I was really sick for the first week I was on the patch. I have been fortunate enough not to have had a problem so far keeping my patch on b/c I place Tegaderm over it. Tegaderm is expensive, especially the large covers, but in my opinion, they are well worth the money.

Moldova - Thank you for your input. I am so glad you are doing well. You have had a few medical scares in the last several months and each time I have lifted you up in prayer. You are living proof that God answers prayer. What pain medicine does your doctor currently have you taking?

I still do have a few questions for anyone that has used the patch longer than I have...I have been using the patch for about 2 months.

How long did it take for your body to adjust to the fentanyl patch? By "adjust" I mean, when did the side effects, such as the drowsiness and nausea, subside? Were you still experiencing these kind of side effects 2 months after you started the patch?

Thanks! I appreciate your help!

Take care everyone,
Scrappin'[/SIZE][/FONT]

conductor 04-07-2008 09:27 PM

Re: Fentanyl patch questions
 
Dear Scrappin',

You've received excellent responses from excellent members!

I have used the fentanyl patch for over a decade! I use the 75 mcg Sandoz fentanyl patch, which I change every 2 days--I get 15 patches per month. There are times when I still feel drowsy, but it is usually when I have used breakthrough medications. Particularly, I use the generic Actiq (which is an oral form of the fentanyl) and the generic Dilaudid (hydromorphone).

As far as nausea, it has been years since I have suffered from nausea due to the opiate/opioid use. I have had a few flu-like illnesses over the years and have had nausea from those enjoyable experiences. And, I fell last June 1st and cracked my skull. I was in the hospital for 12-13 days, and I've had nausea off and on due to the dizziness I sometimes get. Fortunately, this has been occurring less and less. I just wish I would get my senses of smell and taste back!

Fentanyl is certainly a potent medication, and it takes our bodies a long time to adjust. Keep us posted on your progress!

Sincerely,
Jon (Conductor)

scrappinmaniac 04-07-2008 10:04 PM

Re: Fentanyl patch questions
 
[FONT="Arial Narrow"][SIZE="3"]Hi Conductor,

Thank you so much for your response. I sincerely appreciate it!

Take care,
Scrappin'
[/SIZE][/FONT]

Executor 04-07-2008 10:10 PM

Re: Fentanyl patch questions
 
[QUOTE=scrappinmaniac;3521508] I have been fortunate enough not to have had a problem so far keeping my patch on b/c I place Tegaderm over it. Tegaderm is expensive, especially the large covers, but in my opinion, they are well worth the money. [/QUOTE]

Have you used the Tegaderms from the beginning, or did you try the patch without them? Also, have you noticed a difference in how effective the patches are since you've started covering them?

Glad you're doing better.

Ex

scrappinmaniac 04-07-2008 10:31 PM

Re: Fentanyl patch questions
 
[QUOTE=Executor;3521581]Have you used the Tegaderms from the beginning, or did you try the patch without them? Also, have you noticed a difference in how effective the patches are since you've started covering them?[/QUOTE]

[FONT="Arial Narrow"][SIZE="3"]I have always used Tegaderm to cover my patches, mainly b/c I have a young child and was terrified he would somehow come in contact with it otherwise.[/SIZE][/FONT]

Moldova 04-08-2008 10:03 AM

Re: Fentanyl patch questions
 
Scrappin',
thank you for your prayers, I really appreciate your kindness.

I will see my PM and Neurologist again this coming Thursday.
Today my PM called me and had a nice conversation about Fentanyl reaction I had and his concern about prescribing next LA meds for me.
He is definatelly sure too that I had spinal fluid leakage and wants to see all MRI and CT tests results and than only he will see what he wants to put me on. I love the fact they work together with Neurologist; 2 smart heads can make a better decision.:)
He tried to call my Pharmacy for LA Oxy until I see him, but they did not want to accept prescription over the phone. So i will wait 2 more days until I see him.
I just wish this saga with meds will come to the end for me. Not only I have to deal with meds, I have to deal with sensitivity to them and changes.
I hope something good is coming my way...

Good luck to you and best wishes!:angel:

brianpain33 04-08-2008 03:18 PM

Re: Fentanyl patch questions
 
[QUOTE=scrappinmaniac;3521508][FONT="Arial Narrow"][SIZE="3"](and on day 3 of the patch, when the patch is less effective)

so far keeping my patch on b/c I place Tegaderm over it. Tegaderm is expensive, especially the large covers, but in my opinion, they are well worth the money. [/SIZE][/FONT][/QUOTE]

Scrappin,
why are you still on the 72hr schedule when obviously you need to be on the 48hr schedule or overlapping the patches on the 3rd day. the patches are definitely not making for 3 days on you and probably you start to notice withdrawal on day 3 just like I did although you are taking 3 Percocet on the 3rd day. you really should talk to your doctor about this and going to the 48hr schedule, you would be so much happier and not need as many BT meds.

as for the tegderm covers, I used to use these as well and got tired of paying the price. I now use [B][U]opsite flexifix by smith & nephew[/U][/B]. I ordered it for $32 and started using it around christmas. I still have 1/2 a roll left so I figure it will last a total of 6 month for me. [B]YES THAT IS 6 MONTHS OF COVERS FOR $32[/B]. You will have to get these on the internet but order them, get it in 3-4 days and there you have it. they work just as well as the tegaderm covers, come in a roll and you just cut off as much adhesive cover as needed. I think they are great and you can't beat if for cost effectiveness.

brian

Executor 04-08-2008 09:24 PM

Re: Fentanyl patch questions
 
As I've mentioned in a different thread, I'm on a new schedule now where I apply a new patch every day. My new system is:

Patch 1 on day 1
Patch 2 on day 2
Replace patch 1 on day 3
Replace patch 2 on day 4
and so on......

Has been a huge improvement as my BPL is staying much higher.

Ex

brianpain33 04-09-2008 02:34 PM

Re: Fentanyl patch questions
 
[QUOTE=Executor;3523112]My new system is:

Patch 1 on day 1
Patch 2 on day 2
Replace patch 1 on day 3
Replace patch 2 on day 4
and so on......
Ex[/QUOTE]

So, how many patches does this work out to each month. I am really tired and don't want to figure out the math right now

brian

Executor 04-09-2008 07:15 PM

Re: Fentanyl patch questions
 
[QUOTE=brianpain33;3524195]So, how many patches does this work out to each month. I am really tired and don't want to figure out the math right now

brian[/QUOTE]

30. Every 72 hours is 10 per month. Every 48 hours is 15 per month. Every day is 30 per month.

Ex

scrappinmaniac 04-10-2008 01:20 PM

Re: Fentanyl patch questions
 
Moldova,

What will your doctor need to do if you did have spinal fluid leakage? I pray that's not the case b/c it's obviously not something that's suppose to happen...I do hope and pray that whatever the case may be, your doctors will be able to correct it...and yes, I do think it's WONDERFUL your doctors work together, in fact, more of us would be much better off if our doctors worked together...it seems like you have a pretty good team taking care of you and I'm glad to hear it :).

Take care and I will continue to keep you in my prayers.

Scrappin'

scrappinmaniac 04-10-2008 01:45 PM

Re: Fentanyl patch questions
 
Brian,

It has only been in the last 30 days that I have noticed my pain being worse on day 3, as well as the gel in my patch being almost completely gone. I have my monthly appt with my doctor next Wednesday, on the 16th, that's when I plan to discuss these issues with her. I have a great doctor and feel fairly certain that she'll change my meds accordingly.

Thank you for recommending the Opsite Flexifix by Smith & Nephew...I looked it up and it definately appears to be comparable to Tegaderm...minus a gazillion dollar signs :D...I'm going to order a roll and give it a try!

I appreciate your help...THANKS!

Take care,
Scrappin'

scrappinmaniac 04-10-2008 01:55 PM

Re: Fentanyl patch questions
 
[QUOTE=Executor;3523112]As I've mentioned in a different thread, I'm on a new schedule now where I apply a new patch every day. My new system is:

Patch 1 on day 1
Patch 2 on day 2
Replace patch 1 on day 3
Replace patch 2 on day 4
and so on......

Has been a huge improvement as my BPL is staying much higher.

Ex[/QUOTE]

Ex,

If you don't mind me asking, what is the strength of the patches you're using?

Thanks,
Scrappin'

Executor 04-10-2008 02:19 PM

Re: Fentanyl patch questions
 
[QUOTE=scrappinmaniac;3525688]Ex,

If you don't mind me asking, what is the strength of the patches you're using?

Thanks,
Scrappin'[/QUOTE]

Not at all....Was using 37.5 total...A 25 and a 12.5. Now, I'm using 50Mcg total...2 x 25. So, instead of a 50 every 48hrs, I'm using a 25 once a day. Works great! My Doc doesn't believe that these LA meds last as long as they advertise. Add in some individual variety, metabolism, and activity level(s), it's not surprising that patches don't last. Once a day also addresses the "won't stay applied issue."

Also, I was using generics (Sandoz) and I'm starting brand tomorrow...It's refill day and I had the pharmacy order me the brand. I will report back after a couple of days.

Ex

scrappinmaniac 04-10-2008 03:30 PM

Re: Fentanyl patch questions
 
[QUOTE=Executor;3525721]Not at all....Was using 37.5 total...A 25 and a 12.5. Now, I'm using 50Mcg total...2 x 25. So, instead of a 50 every 48hrs, I'm using a 25 once a day. Works great! My Doc doesn't believe that these LA meds last as long as they advertise. Add in some individual variety, metabolism, and activity level(s), it's not surprising that patches don't last. Once a day also addresses the "won't stay applied issue."

Also, I was using generics (Sandoz) and I'm starting brand tomorrow...It's refill day and I had the pharmacy order me the brand. I will report back after a couple of days.

Ex[/QUOTE]

Is your doctor's specialty pain mgmt? Do you still find yourself needing b/t meds? Also, have you found the side effects associated with the patch to be worse now, than they were when you were changing the patch every 48 or 72 hours?

Your doctor may be onto something here...I'm very interested to know how this works out for you, especially once you try the brand name.

Thanks,
Scrappin'

Executor 04-10-2008 07:23 PM

Re: Fentanyl patch questions
 
Hey Scrap....Yes, my PM Doc is a pain specialist. He's an anesthesiologist, and primary partner in a very large 5 Doc (and 3 PAs) PM practice. He treats many war veterans & many other complicated patients.

On this new system, I find myself needing less BT meds, although he has been gracious enough to not reduce them...yet. But, I will probably request they be reduced soon so I don't have to pay for them. My Actiq sticks are very expensive and I'd rather not purchase them if I don't have to. I have no side effects...The only thing that changed when I went to an every day schedule was feeling better. If anything, I think one would have [B]less[/B] side effects because you're never putting all 50Mcg on at once...It's spread out.

If you think about this system logically, it makes perfect sense. Under a 48 hr schedule, you apply a patch and then it delivers meds for 48 hours (or is supposed to). The problem is that I (and my Doc) don't believe that it lasts 48 hours. If one were laying in a bed under a controlled environment, it would. However, most patients are semi-active...They run errands, clean their house, do laundry, some gardening, take care of kids, or whatever. As a result, your body builds up "heat" and you sweat. Add in one's individual metabolism, and practically every patient has a different dosing schedule via the patch. When I was on a 48 hr schedule, the second half of the second day was bad...Sometimes, the second day was kinda rough.

At the end of the 48 hours, you remove the patch, and apply a new one. Well, it takes about 8-10 hours for the med to reach your system. Meanwhile, once you removed the old patch, some med was in your system that continues to be delivered. But the manufacturer reports that in just 14 hours after patch removal, you get a 50% reduction in BPL (blood plasma level). So, in just 14 hours, you lose 50% of what it took several patch applications to do (stabilize your BPL).

In theory, as one patch is applied, and the other is removed, they are to cancel each other out, but in reality, it doesn't happen. There isn't enough med from the old patch to offset this completely....Maybe some, but not all. The drug is metabolized and removed much faster than the new one hits your system. Thus, this contributes to the "ups and downs" of PM. Furthermore, if the patch doesn't last 48 hours....Say it lasts 40 or 42 hours, the problem gets even worse. Add in the huge variation in generic patches that we discussed in the other thread of brand vs generics, and the problem becomes almost uncontrollable....Different patches can vary as much as 20%.

So, applying one 25Mcg patch every day (vs a 50Mcg every other) keeps your BPL very constant. It also helps reduce the impact of any patches that may work loose, sweat off, or whatever. Because my PM Doc is an advanced specialist, I feel quite sure he is on the cutting edge of some new PM theories, so I really trust him. He has been profiled in several magazines and is supposed to be one of the better ones. I will continue to report back for more feedback if anyone would like the info.

Hope this helps explain things.:)

Ex


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