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  • 91yr. old using fentanyl patch-side effects question

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    Old 08-14-2011, 05:07 PM   #1
    azure7789
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    91yr. old using fentanyl patch-side effects question

    Hi--

    I am wondering if someone could help us to know what to expect with my husband's mother who is 91 and has just started the fentanyl patch.

    She is in pain due to falling and hurting her hip. Sadly, she broke this hip about 10 months ago and had surgery and hip replacement. She has had several falls since then but this last one is causing her great pain. The dr. said the x-ray doesn't clearly show a fracture--it is indeterminate.

    So she has been put on a fentanyl patch. Could anyone tell us what we should expect as side effects with the patch on a 91yr. old? Any help would be appreciated.

    She already has cognitive issues...confusion, poor memory etc. Will she likely become more confused, lethargic, depressed, lose her appetite? Fentanyl is a strong narcotic isn't it ? I worry about the side effects, but they say they must do something for her pain.

    Any thoughts?
    Thanks in advance.

     
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    Old 08-14-2011, 06:15 PM   #2
    rdyrmsg
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    Re: 91yr. old using fentanyl patch-side effects question

    My husband's aunt used such a patch for angina pain from ages 90 to 95. She learned that putting it on when she woke up (usually around 6am) and then going back to bed for an hour gave her the most relief and no (for her) side effects.

    I know that this isn't exactly the same circumstance but the age certainly is :-)

    In any case I hope the patch works for your loved one.

     
    Old 08-14-2011, 06:22 PM   #3
    rdyrmsg
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    Re: 91yr. old using fentanyl patch-side effects question

    BTW, I forgot to mention that she wore the patch on a twelve hours one, twelve hours off cycle.

     
    Old 08-14-2011, 06:24 PM   #4
    rdyrmsg
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    Re: 91yr. old using fentanyl patch-side effects question

    BTW, I forgot to mention that she wore the patch on a twelve hours on, twelve hours off cycle.

     
    Old 08-14-2011, 08:29 PM   #5
    azure7789
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    Re: 91yr. old using fentanyl patch-side effects question

    Thanks rdy--so it sounds like it worked well for your husband's aunt. My husband spoke with his mom tonight and she sounded off--cranky and out of it. But, she is in pain and that could explain it. I believe I read that it takes 5 days for the patch to kick in, though that doesn't sound right . I need to read some more.

    Thanks for your input.

     
    Old 08-14-2011, 09:44 PM   #6
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    Re: 91yr. old using fentanyl patch-side effects question

    Well first off, the Fentanyl patch is usually reserved for people who are opiate tolerant, meaning for those people that have been on narcotics for a long time. However, there are exceptions. What dose is she on? And has she ever been on narcotic meds before? Do you know if she has Osteoporosis? Many times with women of that age, they really don't fall and break their hip. What really happens is that they break their hip and then fall-just the oposite! This is because their bones are so porous and break due to this disease. Just a thought...janiee

     
    Old 08-14-2011, 09:50 PM   #7
    azure7789
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    Re: 91yr. old using fentanyl patch-side effects question

    janiee--thank you so much for responding. Yes, I also read that fentanyl should be for those who are opiate tolerant. Well....I do not think my mil is opiate tolerant. Before with her fall when her hip broke, she was given lortab. Also she was given lortab on and off through the past 10 months just for pain as needed after a few small falls. But, the lortab was never a steady thing.

    Now, they have started the fentanyl. Do you know if the lortab would be viewed as showing she is opiate tolerant? I am really quite worried for her on this med as I have read some things that spook me about it like respiratory depression with shallow breathing. That has got to be a big risk for an older frail person already with compromised health.

    I am going to find out her fentanyl dose and I guess we should find out how often the patch is reapplied.

    I am worried for my mil, and appreciate your taking the time to comment . If you have any other thoughts I would welcome them. Thank you so much.

    Yes, she has bone loss but I do not think they did a DEXA...the dr. just looking at the xray said osteopenia.

    Last edited by azure7789; 08-14-2011 at 10:57 PM.

     
    Old 08-14-2011, 10:18 PM   #8
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    Re: 91yr. old using fentanyl patch-side effects question

    azuree, Your welcome. The doctors may have thought she was opiate tolerant because of the Lortab, but I couldn't be sure. If I remember correctly, Lortab comes in different dosages as well, and we don't know what dose she was taking and how often, do we? It does seem as though you are very concerned about your MIL, and rightly so, esp. in regards to the patch. I would advise you and your husband to talk to her doctors about all of your concerns. Hope everything works out...janiee

     
    Old 08-14-2011, 10:55 PM   #9
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    Re: 91yr. old using fentanyl patch-side effects question

    I am on the patch and have been for almost 2 years. When I was put on the put on the patch I was given the lowest dose which I believe is 12.5 mcg/h hour. However, I wasn't getting great pain relief with it and my pain management Doctor adjusted it to the next dosage level, which is 25 mcg/h., I am in my forties and I have to say (even though I am opiate tolerant), I couldn't have imagined being on a higher dose. It did really affect me and for the few days I tended to sleep a lot more. Luckily, my body adjusted to the med within a few days and I haven't had to have dosage adjusted. However, I also take medication for break-through pain.

    So, given her age, I would hope they have her on a pretty low dosage so her body can adjust. And yes initially you may notice her more sleepy, etc. However, I never had any confusion from it. I know the patch isn't for everyone, but it has been a very effective LA med for me (I like the idea of it cutting down on the amount pills I have to take, even though I realize fentanyl is a strong medication), I am happy I have stayed on the low-end dosage.

    Please keep us posted on how she's doing.

    ~ Fiona Jo
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    Old 08-14-2011, 11:05 PM   #10
    azure7789
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    Re: 91yr. old using fentanyl patch-side effects question

    Thanks Fiona Jo---I am sorry to hear about your ongoing pain issues. It does sound like you have found what works for you. That is great as I have heard so many people have such issues with chronic pain management.

    About my mil....I need to have my husband get the info in the next few days as to dosage and how often a new patch is applied. I will post with the info. I just know when I have the smallest bit of a narcotic in connection with med. procedures I get totally looped , lose my appetite, etc. So, I do worry about my mil at 91 yrs. of age and such very frail health. And, she is quite small....petite and low body weight. So, I would think this must hit her hard. But, the nurse said to us that they have to treat the pain. Of course that is so. I guess there is no easy solution here.
    Azuree

     
    Old 08-15-2011, 03:31 AM   #11
    jewels416
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    Smile Re: 91yr. old using fentanyl patch-side effects question

    I am 38 years old and have been on the patch (50mcg) since July 21, 2011. I was very afraid to use it b/c of all the bad things I have read about it (I have also read good things though), still it is scary (possibility of OD, WD, etc.). The risk of OD and withdrawls is also true for ANY opiate though.

    So far, I am very satisified w/it. It is very effective for pain control without the high (which I no longer experinced with the norco anyway). If anything, there is a sedative effect. My pain is controlled way better than with the norco (I too went directly from hydrocodone to fentanyl). I have using the hydrocodone for almost 20 years though.

    I was actually terrified to make this switch but if I can keep fears of withdrawl out of it (which was causing me enormous anxiety, not to mention the initial anxiety I experienced fearing an OD), it had been a Godsend. As long as they are used as directed (I wouldn't think a woman in her 90s would misuse anyway), I don't think there is that high a risk of OD once the body has adjusted to the dosage, just watch her for signs (shallow breathing, confusion, sweating, etc.) until she has adjusted.

    In my experience, (she is geriatric though so she will probably be far more susceptible to side effects than I), it has seriously decreased my appetite, initially caused some mild itching, which has gone away now that my body has adjusted, and some insomnia perhaps, (I am a severe insomniac already though). I think my dosage at this time is exactly correct as well, I didn't vomit, become confused, sedated or have any other of the common negative side effects indicative of too high a dose.

    My biggest problem was getting to stick & say stuck. The answer is to use Tagederm or Bioclusives (which are not cheap, cause me pretty severe skin irritation, and even sores/blisters). They are clear plastic(?) adhesives that can me placed over patches, like what they would use in a hospital to keep an IV in place.

    I don't know if this is true or not but I have read that the company that makes Duragesic & Sandoz brands (same company) has a # on the box you can call & that they will send free Bioclusives. In my experience I like the Biocluisives better
    , they seem to stick better, and didn't take off any skin when I removed them (Tagederm did take off skin). . Now I have to purchase some Goo-Gone or some other form of adhesive remover though (I have adhesive rectangles all over that I cannot seem to remove).

    Also, and everyone is different, I had read horrible things about the Mylan generic patch (not as effective, people going in to WD when they used them, etc.), so when that was the only brand that my pharmacy had available, I was very unhappy and reluctant to try them. However, with the Mylan brand, my pain is controlled just as well (perhaps even better b/c they seem to release the med at a steadier, more consistant rate, and they are much smaller).

    Well, I hope that some of this will help you. Good luck to you and your loved one.

    Peace.

    ~~Jewels

     
    Old 08-15-2011, 07:04 AM   #12
    Ilovemycutedog
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    Re: 91yr. old using fentanyl patch-side effects question

    Azuree....I really implore you to find a Gerontologist or call around about PM Dr.s who specialize in Elder care and pain medicine.

    Hopefully she is only on the 12.5 mcg patch for now. Pain medicine works very differently in the elderly...Accidental overdose is unfortunately very common.

    I was caregiver to both my MIL and my Great Aunt for 10 years total between the two and now for my mom. My Great Aunt lived until 96...So I worked extremely closely with the Dr.s about any pain medicine.

    Of course it's very important that they get the appropriate care and do not suffer in any way.

    First off..

    The key is finding members of the family that live close by that can be her health care power of attorneys...This can be as many people as you want...But people who can be actively involved in her care from day to day.

    You can get this legal document online with any Legal program like Quicken. It needs to be signed by all parties, including your MIL and notarized. So I hope that she is cognitive enough to do this.

    This will allow all of you to be able to actually discuss her health care with the Dr.s Because now...under the HIPAA law...they cannot talk to you about anything detailed.

    Then you can have her medical records to discuss with a Gerontologist or PM specialist as well as check with a Pharmacy and run a check of ALL medications that she is on and looking for interactions.

    The scary part about being on too much medication...is that if she does fall and break a bone or have an internal injury...She will not feel this pain and could perish quickly.

    The dosing of Pain medication cannot be compared to that of people are age.

    Again..it's very important to find that balance between giving her appropriate relief and comfortable...but not so much to be completely out of pain...Unless you are dealing with absolute end of life care with advanced Cancer or other disease.

    I went to every single Dr. appt. talked to every single Dr. and was involved in every bit of care for my family. My Great Aunt was in an Assisted Living then moved to a Nursing Home when she developed Alzheimers... Unfortunately there are many nursing homes that do NOT properly care for our elderly..

    I just can't impress on you all how important it is to get involved in all of her care from medicine, to proper nutrition each day, to getting Physical therapy to keep her active, keeping her brain as active as possible..to getting the emotional support of love and care.

    Good luck and keep us posted..

     
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