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  • Executor-? about fentanyl patch/"opiate tolerant"

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    Old 09-20-2009, 01:39 PM   #1
    tattoogirl
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    Executor-? about fentanyl patch/"opiate tolerant"

    Hi Ex-Thought I'd ask you about this since you seem very knowledgeable about PM:

    Didn't want to hijack someone elses post when you mentioned "opiate tolerant". You used the words "opiate tolerant", what exactly does that mean? Does it happen to everyone? I ask because my doctor mentioned putting me on the Fentanyl patch, the last few visits or so....can you become "tolerant" to this med too? I feel like this should be a last resort kinda thing. Am I right in thinking this way? My only experience with this med is when caring for my grandmother and I needed to do her patches for her. Thanks.

    Last edited by tattoogirl; 09-20-2009 at 01:39 PM.

     
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    Old 09-20-2009, 09:14 PM   #2
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    Re: Executor-? about fentanyl patch/"opiate tolerant"

    Quote:
    Originally Posted by tattoos View Post

    Hi Ex-Thought I'd ask you about this since you seem very knowledgeable about PM:

    You used the words "opiate tolerant", what exactly does that mean? Does it happen to everyone?
    "Opioid Tolerant" is a term in PM for those patients who have been on long term narcotic therapy and have built up a certain amount of overall tolerance. Fentanyl is the strongest pain med out there, so it's reserved for those who have tried other meds and either these meds aren't working that well, or the patient has built up such tolerance that they need a lot of the specific med. A good example is hydrocodone. When one first starts taking this med, one pill works wonders. But eventually, it may take many pills to do the work that one did. Thus, many move to Oxycodone in this type of situation. Fentanyl is usually reserved for those who have tried other potent meds, such as oral morphine or Oxycodone, and they have become ineffective (over time).

    More specifically, in the Duragesic prescribing white paper, there is a chart that cross references each patch strength to other meds. For example, the 25mcg patch is usually the first patch prescribed (there is a 12.5, but it's hard to find, and is used more for small increments upwards, or weaning...Not an initial dose) and the chart says it should be used when a patient is taking between 30-67mg of Oxycodone per day. You can find this prescribing white paper rather easily on the manufacturers site. The 50mcg patch is for those patients taking between 67-112 mg of Oxy per day.


    Quote:

    I ask because my doctor mentioned putting me on the Fentanyl patch, the last few visits or so....can you become "tolerant" to this med too?


    Yes, you can become "tolerant" to any pain med, including fentanyl. However, this isn't something that you should be overly worried about. "Tolerance" is widely accepted in PM and part of PM therapy. Patients need adjusted upwards from time to time to account for this concept....It is very normal.

    The good news is that in most cases, there is no ceiling....Patients who have been on narcotic therapy for a long time, can escalate to some very large doses and as long as they are monitored closely and have moved to these high levels slowly, it is relatively safe. A good PM Doc understands and embraces this concept. You'd be surprised at some of the levels of meds some patients are on.

    Please let me know if you have any further questions....I'd be happy to help anytime.

    Regards,

    Ex

     
    Old 09-21-2009, 02:43 PM   #3
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    Re: Executor-? about fentanyl patch/"opiate tolerant"

    Thanks, that is making sense to me and my particular situation. If I have anymore questions I will ask.

     
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