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    Old 06-14-2009, 08:23 AM   #16
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    Re: Extremely Frustrated with my Fentanyl Patches

    Thanks again Executor, I appreciate the advice. If I originally get a good seal when I first apply and tape it down will that be sufficient going forward or do I have to maintain a good seal. When I first put them on, I get a great seal with no lifting, so If I can tape them down that way, do you think it would remain in contact with my skin even it it starts rippling and waving later?

    Also, please see the other post you replied to from me when you can. I had some weird events in the last 24 hours and wanted to get your advice. Thanks so much again!
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    Old 06-14-2009, 08:45 AM   #17
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    Re: Am So frustrated with the Fentanyl Patches Staying On!!!

    Do this: Get a bottle of nose spray. I have Nasacort because my physiatrist prescribed it for me but I think you can try an OTC one. Mark an area with a pen on your upper outer arm, near the shoulder, on your hip just below where your pants sit, your upper back, (my husband puts it on for me or I just slap it on where I can reach) or your upper buttock. These are where I have the most luck - the skin doesn't bend or fold much in those areas. Okay, spray one primer squirt in the air, then spray one spray where you have marked your patch to be. One squirt only. The drawing is to make sure it is all in the same place. Let the spray air dry. Do not touch it in any way. It can take up to 1/2 hour to dry. When completely dry put your patch on. It will stick nearly perfectly and it won't eat your skin with irritation as was the problem I have. Yes, my doctor told me this. It is a little known remedy and as all things go it may not work for everyone but it is definitely worth a try. It told this to my mom who talked to her PM doc about it and he said it was an old wives tale and to ignore it. My doctor just laughed when I told him that.
    Like I said, it's worth a try and a lot cheaper than getting more and more patches.

     
    Old 06-14-2009, 08:59 AM   #18
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    Exclamation Really Freaked Out!! Fentanyl OD or W/D, Not sure! Need Advice!!

    Hi all, I''m pretty new to this board but posted yesterday with some background on me, some minor side effects and issues I was having with patch placement. I'm sorry about the length of this post but needed to provide detail about what has happened.

    Since starting the patch 10 days ago, I've vomited one time. It was on day two and I was exercising and really exerting myself pretty hard and I started sweating a lot. I also made the mistake of drinking a glass of grapefruit juice. Neither my doctor or my pharmacist warned against eating or drinking anything with grapefruit. There also wasn't any info in my first drug info packet from the pharmacy. I also had a fairly large meal for me( I thought I vomited b/c I ate too much. I had bariatric surgery a few years ago and if I overdo it food wise, I sometimes have to throw up, but it's never involuntary. It's a very uncomfortable feeling and then I get to the bathroom and it still takes a little coaxing to actually vomit)When I talked with my doctor, she thought it was because of the grapefruit juice and the fact that I had only been on the drug one day and wasn't used to it.

    Since then, I haven't really had many serious problems. Just the usual sleepiness, euphoria and occasionally that 'high' feeling when I change my patch. What has me more than a bit worried is what has happenend in the last 24 hours or so. Yesterday was going to be my first 48 hour patch change (per my doctors instruction) since I had A LOT of housework to do. So mid-day yesterday I did my housework, starting getting flushed, really sweaty and a bit light headed (not as bad as last time though). With all the sweat, the patch fell off around 6. I finished house-cleaning, showered and rested and felt fine. I went to apply the patch to my upper right arm around 8. It would NOT stay on. I tried taping it there and it kept rippling and such. I tried then moving it to my other arm (same thing) and then my chest (same thing). At that point, I gave up on that patch thinking it might be dysfucntional. I called a girlfriend of mine who's been on Fentanyl for years and asked her advice. She told me to do something that I've read I'm not supposed to do. She told me to wipe down my arm with rubbing alcohol and then wait for a few hours to let any irritation go away and then try and apply the patch. She said she did that a lot when her patch wouldn't stay and never caused her any side effects. Well like an idiot I did it. I wiped the area down gently with alcohol (there was no irritation) and then waited 2 hours and put it on my upper arm and taped it down with first aid tape around ten last night. I was also having some breakthrough pain badly so I took a dose of Norco. The Norco kept me awake, so I didn't go to bed until 6 this morning. At 9 my dogs wanted out, so I got up to let them out and sat down to type an email when I got REALLY nauseated. I went to the restroom and then ended up vomiting twice. I have almost NO gag reflex and almost never vomit unless it's self induced (due to my bariatric surgery). There was no way I could have stopped it. It was coming up no matter what, which is Very strange for me. Scared that I was in an overdose, I took the patch off immediately. So now I'm laying on my couch not knowing what to do. The pharmacies aren't open right now so I can't call them to ask about this. Does this sound like and overdose from using the rubbing alcohol and switching to the 48 hr dosing or does it sound like a withdrawal from not having the patch on for 6 hours or so last night. It REALLY scared me. I'm afraid it was a mild overdose. Other than being really tired and sleepy (only having 3 hours of sleep and having taken my insomnia meds) I'm not having any other side effects. I don't know what to do and I'm totally freaked out about this and am really scared to go back to sleep even though I'm so tired (I usually need 8-10 hours to be functional, and I've only had 3) There's nobody here that can check on me if I do go to sleep...What do I do?? Anybody have any thoughts??? Thanks so much!

    -Totally FREAKED OUT!

     
    Old 06-14-2009, 09:01 AM   #19
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    Exclamation Fentanyl OD or W/D!!! Not sure, need advice PLEASE!!!

    Hi all, I''m pretty new to this board but posted yesterday with some background on me, some minor side effects and issues I was having with patch placement. I'm sorry about the length of this post but needed to provide detail about what has happened.

    Since starting the patch 10 days ago, I've vomited one time. It was on day two and I was exercising and really exerting myself pretty hard and I started sweating a lot. I also made the mistake of drinking a glass of grapefruit juice. Neither my doctor or my pharmacist warned against eating or drinking anything with grapefruit. There also wasn't any info in my first drug info packet from the pharmacy. I also had a fairly large meal for me( I thought I vomited b/c I ate too much. I had bariatric surgery a few years ago and if I overdo it food wise, I sometimes have to throw up, but it's never involuntary. It's a very uncomfortable feeling and then I get to the bathroom and it still takes a little coaxing to actually vomit)When I talked with my doctor, she thought it was because of the grapefruit juice and the fact that I had only been on the drug one day and wasn't used to it.

    Since then, I haven't really had many serious problems. Just the usual sleepiness, euphoria and occasionally that 'high' feeling when I change my patch. What has me more than a bit worried is what has happenend in the last 24 hours or so. Yesterday was going to be my first 48 hour patch change (per my doctors instruction) since I had A LOT of housework to do. So mid-day yesterday I did my housework, starting getting flushed, really sweaty and a bit light headed (not as bad as last time though). With all the sweat, the patch fell off around 6. I finished house-cleaning, showered and rested and felt fine. I went to apply the patch to my upper right arm around 8. It would NOT stay on. I tried taping it there and it kept rippling and such. I tried then moving it to my other arm (same thing) and then my chest (same thing). At that point, I gave up on that patch thinking it might be dysfucntional. I called a girlfriend of mine who's been on Fentanyl for years and asked her advice. She told me to do something that I've read I'm not supposed to do. She told me to wipe down my arm with rubbing alcohol and then wait for a few hours to let any irritation go away and then try and apply the patch. She said she did that a lot when her patch wouldn't stay and never caused her any side effects. Well like an idiot I did it. I wiped the area down gently with alcohol (there was no irritation) and then waited 2 hours and put it on my upper arm and taped it down with first aid tape around ten last night. I was also having some breakthrough pain badly so I took a dose of Norco. The Norco kept me awake, so I didn't go to bed until 6 this morning. At 9 my dogs wanted out, so I got up to let them out and sat down to type an email when I got REALLY nauseated. I went to the restroom and then ended up vomiting twice. I have almost NO gag reflex and almost never vomit unless it's self induced (due to my bariatric surgery). There was no way I could have stopped it. It was coming up no matter what, which is Very strange for me. Scared that I was in an overdose, I took the patch off immediately. So now I'm laying on my couch not knowing what to do. The pharmacies aren't open right now so I can't call them to ask about this. Does this sound like and overdose from using the rubbing alcohol and switching to the 48 hr dosing or does it sound like a withdrawal from not having the patch on for 6 hours or so last night. It REALLY scared me. I'm afraid it was a mild overdose. Other than being really tired and sleepy (only having 3 hours of sleep and having taken my insomnia meds) I'm not having any other side effects. I don't know what to do and I'm totally freaked out about this and am really scared to go back to sleep even though I'm so tired (I usually need 8-10 hours to be functional, and I've only had 3) There's nobody here that can check on me if I do go to sleep...What do I do?? Anybody have any thoughts??? Thanks so much!
    -Totally FREAKED OUT
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    Old 06-14-2009, 09:07 AM   #20
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    Re: Am So frustrated with the Fentanyl Patches Staying On!!!

    Hey Kathy, Thanks for the advice, I'm willing to try it as long as it's safe. The nasal spray on the skin doesn't affect the Fentanyl or the absorbsion of it? As long as there are not negative side effects and the patch remains effective, I'll try just about anything. If you get a chance, could you read my other post in chronic pain about Fentanyl OD or W/D? Thanks again for the advice. I'll give it a whirl!
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    Old 06-14-2009, 01:44 PM   #21
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    Re: Really Freaked Out!! Fentanyl OD or W/D, Not sure! Need Advice!!

    I would advise calling your doctor. I'm surprised he put you on 48 hour dosing if you were already having side effects and euphoria from 3 day dosing.

    It could be nothing, but your doctor knows better than we do. My guess is that you aren't used to the 48 hour switch. I don't think the rubbing alcohol had anything to do with it.

    If you are having problems with it falling off a lot, you can buy tegaderm patches in the drug store to put over it, and they help a lot.

    Cat

     
    Old 06-14-2009, 04:37 PM   #22
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    Re: Really Freaked Out!! Fentanyl OD or W/D, Not sure! Need Advice!!

    Hi, and welcome!
    I agree about the 48 hrs...I mean that is GREAT that your doc is letting you change that soon, but in all reality, you may want to try using them longer. I think that is why you are having all of the problems. Being alone is also really scary.
    I have been tur HELL with the patches, trust me, if you would like to send me a private message, I would be happy to help you in any way I can~
    xoxoxo,
    IZZY'SMOM

     
    Old 06-14-2009, 05:21 PM   #23
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    Re: Extremely Frustrated with my Fentanyl Patches

    I have been on the patch for seven years and at first I had the same problem. When you first put the patch on make sure you keep your flat hand on the patch for at least 30 seconds. It's the body heat from your hand that activates the glue. If you still have problems with it sticking, you can get a cover called bioclusive. I think there is also another one called tegaderm. They cover the patch completely and then some. Those should work.

    The other thing I have found is that the mylan brand sticks much better than the brand or watson or any of the ones that have a resevoir. The mylan brand has the medicine in the glue. The problem is that many people find that the mylan brand is not as good as the resevoir kind, myself included. Although I am going to get the mylan brand next month for when we go on vacation because it's smaller and I don't have to use the bioclusives.

    Hope this helps and I hope you are feeling better(I read your other post).

    Melissa

     
    Old 06-14-2009, 05:35 PM   #24
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    Re: Am So frustrated with the Fentanyl Patches Staying On!!!

    I use the tegaderm too. Got mine online cheaper. I also has weight loss surgery but no nausea from the patch except for one time when I forgot to put replacement on for hours. I do not have the problem w/ gag reflex as you describe except if something is stuck. The rippling I understand from losing all the weight. I only had problems w/ Mylan brands sticking. The gel ones stick better and work better for me. We are limited in meds we can take due to the malabsorption, so long acting meds arent an option. I cannot handle alot of heat sun exposure without getting sick. Maybe if you can get the covers to work and keep the are free of sweat. Alot have to go off them because of high activity levels but would be great if this work so you would have a long acting option. I did not know how well mine was working until I forgot it that day. Was staying with someone and new to patch, cant believe I forgot it. Got home in record timing that trip, really sick. It was well over 12 hours, not just a couple. With it being summer and hotter I may try the nasal spray as well, i have scripted ones at home.
    I used the upper buttock alot, just have to make sure not near the belt line and now watch for heat too from summer.
    Keep us posted and keep your dr in the loop on what is going on.
    Best wishes and hope you are feeling better.
    S

    Last edited by shananava; 06-14-2009 at 08:17 PM.

     
    Old 06-14-2009, 07:27 PM   #25
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    Re: Extremely Frustrated with my Fentanyl Patches

    Quote:
    Originally Posted by New To CP View Post
    Thanks again Executor, I appreciate the advice. If I originally get a good seal when I first apply and tape it down will that be sufficient going forward or do I have to maintain a good seal.
    Yes, you need a good seal throughout the entire dosing period. If it pulls away at some point, the med won't be absorbed into the skin properly. If you're having a problem with the patches becoming loose, I would either tape it down upon application, or as soon as you notice it coming loose. This is very important.

    Quote:
    Also, please see the other post you replied to from me when you can. I had some weird events in the last 24 hours and wanted to get your advice. Thanks so much again!
    Yes, I read it. I'm not sure what was going on...Hard to say with so little information. It could have been non-med related...A virus or something....Could be anything. But, I will say this.....Fentanyl is the strongest med on the market....You need to be very careful and report everything to your Dr. and most importantly....Follow his directions exactly.

    Best of luck to you.

    Regards,

    Ex

     
    Old 06-14-2009, 07:38 PM   #26
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    Re: Extremely Frustrated with my Fentanyl Patches

    I had a heck of time getting patches to stick on my arms - no matter brand they just didn't like my arms. I switched to my legs and I have had zero problems since. My legs aren't skinny and it seems to work out fine in this location. Stand facing forward, put your legs slightly apart and think of this location. I put the patch about mid-calf height, on the inside of the leg centered between the front and back of that leg. The patch is kind of more towards the front than back, but really on the inside center. I use a cover EVERY time and when I put a new patch on I flex my leg and get a good seal. I always put it on in the morning and it is before any shower. This technique works for me.

    While you wait for the tape your ordered you can buy nextcare tegaderm at any drugstore, they are expensive and not good value long term but for emergency so you don't waste anymore patches it will work. I buy very large 3M Tegaderm medical covers on the internet for a low price, kind of the same as the other stuff.

     
    Old 06-14-2009, 07:49 PM   #27
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    Re: Really Freaked Out!! Fentanyl OD or W/D, Not sure! Need Advice!!

    I am a little concerned for you. To me it sounds like you might not be that opiod tolerant and you are experiecing some side effects that most people do not feel as they switch to the fentanyl patches.

    This is a dangerous medication and it is not one that you want to be "experimenting" with. Such as wiping your arm with alcohol when it clearly says not to do these kinds of things. Do not do things friends advise you to do when using this medication other than things like putting a cover on it, or where to buy the covers etc.

    I don't remember if I read this but what dose patch did they put you on in this conversion? What type opiod medication and quantity were you taking before you started using the patch? Most people are also not switched to 48 hours dosing so quickly after just beginning use of this medication. Most doctors will take you over to it very slowly. Is this your family practice doctor or a pain management doctor giving you the patches?

    I feel everything you have described here should be immediately discussed with your physician as I believe you are showing signs of a higher risk for having a problem with this medication and they need to figure out what to do.

    Last edited by PNo; 06-14-2009 at 07:50 PM.

     
    Old 06-14-2009, 08:32 PM   #28
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    Re: New to Fenanyl, Need help with Side Effect

    Hi, New To CP . . . the rubbing alcohol may indeed have given you a mild over-dose. My husband has been on these patches for years and we have had to learn all of the possible things that go with it.

    Like you, he is on a medication to help with sleep (Trazodone) and one that is actually prescribed for him for diabetic neuropathy but is also an anti-depressant (Gabapentin/Neurontin).

    Do you also have the patch covers for the Fentanyl patch (the ones he uses are called Op-Site Grid or something like that) that are larger than the Fentanyl patch and help to keep it on?

    He finds that the best way to wear it is on one side of his chest at the top of the breast area. He alternates sides when he changes it.

    He has had that not able to catch his breath feeling before also and it seems to occur when he is in an area where it is too warm.

    When he is going to be doing a lot of work, he will go from the 72 hours to the 60 hours but never anything closer together. You may want to check with your doctor and see if the 72 hour does not work when you are exerting if the 60 hour might be better for you. I am the one that keeps track of his changing schedule and I watch for his symptoms, and have found that to be the best for him.

    Also, since you are taking Norco (my husband takes generic Percocet), you will find that it is best if you need them, to take them earlier in the day to prevent the nodding off to sleep before bed. My husband got busy with something on the computer tonight and did not take his Percocet until a couple of hours ago and slept through one of his favorite programs.

    As for nausea, my husband will get that since he has been on Fentanyl if he is exerting too much or gets too warm. They do have him taking some supplements such as calcium and fish oil, but he does not take multi-vitamins and I am not sure how those would react with you.

    I did not know about grapefruit products either. My husband cannot have them because of the cholesterol medicine he is on.

    Lindaru

     
    Old 06-14-2009, 09:42 PM   #29
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    Re: Fentanyl OD or W/D!!! Not sure, need advice PLEASE!!!

    First, I'm really sorry you're completely freaked out. I have been there before. You might look for answers in multiple places right now. However, in a situation like this, I really feel like you should get a hold of a doctor --or have a doctor "see" you. Is there a 24 hour pharmacy you might call and say you are their patient??? MY concern is that the patch is so strong and people have O.D.'ed from the misuse/improper use of the patch. I will tell what I "think." I am not a nurse or a doctor and I have no medical training. I have used the patch in the past.

    I have not noticed that alcohol, especially after several hours, causes the patch to release high amounts of fentanyl. However, if the patch insert say not to use alcohol on the spot, there must be a reason. I can recall using rubbing alcohol to clearn the area an waitng a few minutes before putting the patch on. I think that the effect alcohol could have on the patch could differ substantially according to the type of patch -- Mylan or the the gel patches.

    But, it's certainly possible that you got more. You've described several situations now where exertion caused you to get an "overdose" -- or more than the patch would deliver under "normal" circumstances. If you got some kind of overdose, I think that it initially came from all the housework. You described symptoms that indicated your were getting more medication from your patch while you exercised and while you did housework. Heat --Internal and external causes the patch to release more medication. In some cases, it releases so much more medication that people have overdosed and died. There is a case of someone who went out hiking in the summer and overdosed. There are also overdoses from using a heating pad and the patch. I had previously thought that a person would feel an overdose b/c they would feel "high" first. Apparently, feeling high is not a prerequisite for overdosing.

    So, while I don't know if the alcohol caused increased absorption after several hours, I imagine that you already had a higher level of medication in your body from doing A LOT of housework, particularly if your were moving fast and getting hot as you did it. Sometimes, these meds initially (or if the level is too high), give you a surge of energy (tho it sounds like you've been drowsy, which is often an indication that your body is trying to adjust to an amount that is a bit high - that has been my experience anyway). With the patch, it isn't a good idea to ramp up your activity level (esp. in the summer) really quickly while you're adjusting to teh med. Fentanyl is a very strong medication and it's extremely sensitive to body temperature.

    Incidently, I believe I read that the grapefruit juice can affect medications for up to 30 days. Pls. don't quote me on that -- the gp juice may or may not have raised the levels or caused you to metabolize the fentanyl more slowly, and the effect may diminish considerably after a few days (if, indeed, it had an effect). In general, it's best to avoid GP juice with most prescription meds b/c the effect is unpredictable.

    Any heat (externally or internally generated) and the patch is a bad mixture. You are going to get more medication from the patch when you are active - exercising, doing a lot of cleaning, outside in the summer sun, etc. Do not, under any circumstances, take warm/hot baths or long hot showers, lie out in the sun with the patches exposed, and be very cautious about doing exercise/housework etc. that raises your body temp, especially during this initial period of getting used to the patches. There have been cases where people have overdosed from using a heating pad or from going out in the hot summer sun and being very active. It would be good to hear from more people here who use the patch in the summertime and are active once you get through this.

    I would worry about heat a lot more than alcohol, but you shouldn't take either lightly since the patches are so strong and the potential for overdose is very serious, especially when you are starting the patches.

    My advice is see a doctor or go to the ER - fentanyl is an extremely potent drug and many people have overdosed and died during the initial titration period because they did not understand how to use the patch properly. IMHO, it's too soon for you to know how your body responds to fentanyl and you are just reaching the point where you should begin to have a steady BPL (blood plasma level) 10-14 days -- If you have been really active, your BPL may be fluctuating a lot because you will be getting more medication when you're exerting yourself/exercising/in the sun, and then a drop when you are cooler and more sedentary.

    The symptoms of overdose I'm aware of are drowsiness, possibly slowed heart rate or bp, respiratory depression-which, of course, is what kills you. I don't think you should go to sleep. If you're not willing to go to the ER or page your GP, stay up and don't stay in bed where you could simply fall asleep.

    Symptoms of withdrawal would be sweating, insomnia, increased pain, diahhrea, stomach upset, aches and pains, sniffling - flu like symptoms --watery, itchy eyes, cramps in your legs or arms or anywhere else...anxiety (I realize you're probably anxious b/c you're trying to figure this out), Look up opiate withdrawal symptoms as there are more I haven't mentioned. Headache, shaking, increased blood pressure and **heart rate, sweating, lack of appetite...vomiting. You can find a clinical opiate withdrawal scale somewhere.

    Other than what I mentioned, I do not know what the signs and symptoms of a fentanyl overdose are though I would certainly call the paramedics if you experience slowed breathing, a drop in blood pressure or heart rate. I think it may be too late at that point and would go to the ER as a precaution [Take you pain dr's card/phone #, your GP's card & phone number AND, importantly your prescriptiom for the fentanyl so they know you are legitimate. Explain your concerns calmly and without getting emotional. A docor will be able to tell if you are in a withdrawal by looking at you and taking your vital signs. Don't tell them you are overdosing - they may not hear anything else - explain that you are a chronic pain patient - don't let anyone give you anything until they understand your story and there is no confusion.

    I wish I knew what to say - I would love to reassure you, but fentanyl is a powerful medication and the consequences of an overdose (death) simply aren't worth risking. I always thought I would feel some kind of "high" before overdosing. I have since read/heard that is not the case. Extreme drowsiness is something you should watch out for.

    If I think of anything else, I'll post it. I'm sorry I can't be more helpful and tell you one way or the other, but the last thing I want to do is to steer you in the wrong direction. I think vomiting could be a sign of overdosing and a sign of withdrawal. The bottom line is that I don't know and fentanyl is way to strong to "guess" about.

    I'm very sorry you are having to go through this. My best guess is that you are not overdosing. But that's what it is --- a guess by someone who is not a doctor, not a nurse, not a medical professional of any kind and who hasn't seen you (and if I had, I couldn't say for certain if you were overdosing or not). It's your call, obviously. But I wouldn't take an unqualified stranger's guess as any indication of what you should do.

    Good luck with all. Please check in again...

    PS - if you decide to stay at home, don't go to sleep. I know you took your insomnia meds, but your drowsiness (despite the lack of sleep and meds) could be indicative of an OD. If I understand correctly, you don't have the patch on now, right? You do, however, realize that the spot where the patch was is continuing to deliver medication to your body, even if it is a lower amount than before. Again, if you stay home, I would not go to sleep since there isn't anyone to check on you.

    Last edited by krit; 06-15-2009 at 12:09 AM.

     
    Old 06-15-2009, 01:39 AM   #30
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    Re: Am So frustrated with the Fentanyl Patches Staying On!!!

    I use Durogesic patch's as that is the only one available in Aussie. I always have a shower before applying a patch or if not, I just wet the site (Just above the collar bone always) with a wet cloth, soapy or warm, swapping sides each time. I have never had a problem though I always have some clear tape handy in case. Please be careful which tape you use as some are not appropriate.
    Allan.

     
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    Tags
    chronic fatige, chronic pain, depression, fenanyl, fentanyl, fentanyl patch, fibromyalgia, norco, overdose, oxycodone, pain management, pain mangement, withdrawal



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