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  • "Deep Thoughts by Onyxgates" re Fentanyl Patch

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    Old 04-16-2009, 10:35 AM   #1
    onyxgates
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    "Deep Thoughts by Onyxgates" re Fentanyl Patch

    Have you all noticed the new patches that are coming out? There is one for blood pressure. It must be changed daily. Also one for Altheimzer (sp) that too must be changed daily. Yet mysteriously our fentanyl patch can last three days. Isn't that amazing!!! NOT!!!! More likely the other two conditions are more critical and more likely to cause manufacturer a class action suit so they ensure they are getting proper medication but since no one can really determine anyones pain, lets let those SOB's just suffer through three days. It's amazing and I cannot help but shake my head and wonder. Any thoughts out there????

     
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    Old 04-16-2009, 02:33 PM   #2
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    You know Onyx-
    I've never stopped to think about that. I was put on the Fentanyl patch a couple years ago and it didn't last three days. I'm so thankful that the side effects were severe enough that my doctor took me off of them.

    You brought up a good point here, and you know what? Chronic pain isn't on the list of top priorities to people unless it's the ignorant people who know nothing about true chronic pain, or the people who just assume we are addicts, or even better yet- the people who want to "wage war" on the pharmacutical companies. It's a shame plain and simple.

    All these other chronic conditions are treated respectfully and so are the unfortunate people who suffer with them, but us CP'ers? Hmmmm, we are painted to be scum of the earth and have to basically live "secret" lives for fear of being treated poorly and having our character attacked.

    Thanks for the post!

    Last edited by ozzybug; 04-16-2009 at 02:34 PM.

     
    Old 04-16-2009, 02:48 PM   #3
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    When I was first prescribed the patch I was supposed to change every 3 days. However, it did not last this long. But for me it does last 2 days and I am able to change it every 48 hours luckily. I think that for some people, especially chronically ill and bedriden, the patch does last 3 days. These are the patients that the patch was designed for in the first place. The more active you are, metabolize, sweat, get hot, the more fentanyl your body is going to absorb and the less amount of time the patch will last. Dont' forget there is also a patch for testosterone as well. I was going to try it but having to wear one patch is enough.

    brian

     
    Old 04-16-2009, 05:41 PM   #4
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    I too change the patch every 2 days. I have never thought about it like that either, although I do wear a hormone patch and I only change that every 3 and a half days.

    Melissa

     
    Old 04-16-2009, 06:07 PM   #5
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    Quote:
    Originally Posted by onyxgates View Post

    It's amazing and I cannot help but shake my head and wonder. Any thoughts out there????
    Here's the story behind the patch and why it works for some and not others. When Janssen first debuted the patch, it was intended only for people with Cancer, and specifically, end of life...Hospice & etc.

    All the test data the manufacturer collected was based on this sample group. Therefore, most of these subjects were bedridden and at the very least, lacked any real mobility. Therefore, the subject's metabolism was much slower, and they didn't sweat, or have issues with patches coming off.

    Over time, Janssen applied for a broader label (mainly back pain) and was granted such by the FDA. However, per FDA rules, you have to use the original test data when broadening a label. What's interesting is that even in the original test data, the manufacturer recommends in the white prescribing paper that some subjects may need more frequent changing. So, to me.....If that's the case with end of life subjects who are immobile, then how about today's more active person?

    Naturally, with the broader label and widespread prescribing habits, today's typical patch subject is much different than the original. Therefore, we now have sweating issues, sticking issues, faster metabolisms, and etc. Protocol calls for an initial instruction of 72 hr changing, but to increase to 48 if the patient has problem with end of patch life. Docs are very careful when initially prescribing the patch because Fentanyl is by far the strongest med out there and can kill someone if they OD, or have a bad reaction.

    Nevertheless, many people complain that the patch runs out of med around the 50-60 hour mark. Invariably, this causes "ups and downs" due to the BPL decreasing, and then increasing when a new patch is applied.

    Keeping the patch area dry and clean is critical, and there needs to be a good bond between the patch and the skin. Also, sweat can push the med back out of the pores. I found the patch to work best when applied to areas of your body that have the last amt of sweat glands....Like the outer arm (where a tattoo would be) or under your armpit about 6-8 inches down, or the flanks. The back, for example, is bad because it's riddled with sweat glands. Also, if you lay on it, this creates "heat" and the patch empties more quickly.

    When I was on the patch, my Doc had me change a patch everyday. I started on every 72....Then went to 48....And because I'm a "fast metabolizer", we went to a very creative dosing schedule. We started this way...Patch 1 went on Monday, Patch 2 (same dose as patch 1) was applied on Tuesday....Patch 1 stays applied, so at this point, I'm wearing (2) patches. On Wednesday, patch 1 was replaced with patch 3 (but patch 2 stays untouched). On Thursday, patch 2 was replaced by patch 4 (and patch 3 stays untouched). On Friday, patch 3 was replaced by patch 5....And so on. So, I wore each patch 48 hours, but was changing one of the two, and applying one every day. This kept my BPL much higher than 2 patches changed every 48 hours. Make sense? It worked great for me. The only reason I changed meds was because the patch I was using was involved in the nationwide recall and I had a very difficult time finding enough patches. One month, for example, it took me 4 different scripts, 4 different pharmacies, and 4 different co-pays, just to get my monthly requirement. Each pharmacy would have one box it seemed.

    Granted, I'm a fast metabolizer, but the point is that given my example, there is no way the patch would last 72 hours and work properly. It's a great med and a good concept, but with most patients, there needs to be some adjusting depending on the characteristics of each patient. Most on a 48hr dosing schedule find it to work well, assuming they don't switch around brands. When my PM Doc transitions patients, they keep appointments at 10-14 day intervals in order to properly monitor the patient and make changes where necessary.

    Hope this helps.

    Regards,

    Ex

     
    Old 04-17-2009, 11:19 AM   #6
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    I just thought it interesting. I am actually weaning down. I am stepping down again today. Going from 50 to 37.5. I am a little anxious. I hope I don't feel like crap again but if I do, at least I know it will only last for about a week and then I will feel better.

    I just cannot wait until I am done with this patch and will be hopefully pain free. Although this past week was hard on me. Returning to work and having to deal with the drive. Ouch!!!

    Take care all!!!

     
    Old 04-17-2009, 08:55 PM   #7
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    Re: "Deep Thoughts by Onyxgates" re Fentanyl Patch

    Best of luck to you. I'm so glad we got your Doc to finally agree to supplement with the 12.5s I hope your next transition goes well.

    Take care,

    Ex

     
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