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  • Fentanyl Patch Quantity Limit

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    Old 03-31-2012, 03:49 PM   #1
    tortoisegirl
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    Fentanyl Patch Quantity Limit

    (skip down to the * part if you just want the question lol)

    Hi there! I'm new here but definitely not new to pain. I'm pretty much at the tried everything stage for my chronic head pain. I have been on daily pain meds for a few years now, but had been seeing my primary doctor until recently. He wasn't comfortable with increasing my meds or even changing them (Methadone + Oxycodone for b/t). I guess I'm lucky to get anything though. I finally found a pain specialist willing to work with me...it was tough as I'm 26, had chronic pain since 19, and am at high doses already.

    They added a Fentanyl patch to my current meds as my biggest issue (besides really low pain relief) is that I only take the Methadone during the work day, so I don't have anything in my system when I wake up (or during the evening). I've tried spreading out the Methadone to 3-4 times a day, but then its not enough per dose, and its still worn off by the time I wake up anyways (it lasts 6 hours).

    The Fentanyl seems to be helping a little bit, but I definitely need a higher dose and a switch from 72 to 48 hour patch changing (it seems to take forever to ramp up and wears off very quickly). Hard to tell how its working though as my pain intensity drastically changes all the time.

    *question: I need an increase in the Fentanyl from the 25 mcg patch. I assume my doctor won't want to go from 25 to 50 mcg, but instead try adding a 12 mcg patch. My insurance documentation online says there is a quantity limit of 15 patches / 30 days. Does this mean I can't be prescribed more than one dosage and have it covered? *

    At least they cover the 48 hour switching. I'd call my insurance but I have never got any real answers out of them! I figured you all here would have experience with it, as I often read of two dosages being prescribed, whether its a 25+12 or a 100+50. I haven't been able to find any posts on quantity limits when it comes to two dosages. I imagine the other options are to trade some Methadone to be allowed to go up to the 50 mcg, or pay cash for the 12 mcg (not desirable).

    Comments also welcome on anything that might be helpful to me. I started with the Mallincroft and plan to try some other of the generics as well as different body placement (so far tried upper arm, lower abdomen, and high chest) to see if I can eek out any more relief. Thanks!

     
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    Old 03-31-2012, 08:54 PM   #2
    Boxerluver
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    Re: Fentanyl Patch Quantity Limit

    My thoughts are as the patch is recommended initially to be changed every 72 hours, that allowing it changed every 48 which is the 15 a month, is to make sure people do not end up taking too much of the fentanyl. As every insurance is different the only thing I can advise is your doc can call your inusurance for a pre-authorization allowing you to have the additional patches.

     
    Old 04-01-2012, 09:07 AM   #3
    tortoisegirl
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    Re: Fentanyl Patch Quantity Limit

    Thanks for the advice!

     
    Old 04-07-2012, 12:34 PM   #4
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    Re: Fentanyl Patch Quantity Limit

    I started on the 25mcg/hr, and now five years later, I'm on the 75. For me, the Mylan brand seems to have the longest life, and I can go 72 hours on a patch. The others stopped working at about 50 hours. I'd try a couple of brands before going to 50; you might get better relief from a certain brand. If that doesn't do it, then probably a 48 hour change might be the answer. Best of luck - it's something that takes time to adjust so that you get the most relief from the lowest dose possible.

     
    Old 04-08-2012, 02:07 PM   #5
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    Re: Fentanyl Patch Quantity Limit

    I actually ended up already getting switched off the patch. I see two different PAs at the clinic. The one I saw two weeks after starting the patch kinda disagreed with the one who added the patch to my meds. It was thought having Methadone and Fentanyl together was a bad idea as they are both stored in the fat?

    I wasn't so keen on it anyways since I was getting skin irritation, sweating/flushing, in general was kinda annoyed by wearing a patch (making sure it was still there and putting it in a spot that was hidden under clothing and was comfortable), and I would have needed a higher dose and increased change frequency anyways.

    I was planning to try different brands, but I haven't had a doctor willing to do a dose increase or even a med change in almost 2 years now, so I really just need to get my meds bumped up before I do the little tweaking.

    I got switched to morphine ER (still in addition to the Methadone), but I don't start it until tomorrow since I still had one more patch. We're eventually going to try to get me on about 50-50 Methadone and Morphine, dosing the morphine around the clock and the Methadone during my work day. I need a lot more pain relief at work so it doesn't make since to have a high amount in my system all the time, and I didn't want to get off the Methadone since its the most helpful (vs. supposedly equivalent amounts of other meds) and may help me from building tolerance.

    Right now I am taking a lot more Methadone than Morphine, but I think as we titrate up the Morphine we'll also titrate it up and take out some Methadone to make it a bit more even. Hoping to not be in so much screaming pain when I wake up...sucks to have no meds in your system as it takes a long time for them to catch up (second dose of the day for me). Also still need to find a new breakthrough med as the Oxycodone hasn't been consistently working, so I find myself not taking it very often since I know the less often I take it the more likely it is to work. Best wishes.

     
    Old 04-08-2012, 03:01 PM   #6
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    Re: Fentanyl Patch Quantity Limit

    That's interesting that they are putting you on two different long acting medications....That is unusual....but hope it will work for you.

    Hopefully your insurance covers this....the only concern is if you ever have to change Drs. and they go back to standard protcol which is one long acting and one breakthrough...

    Obviously I am not a Dr. not even close! LOL....So I'm only stating on what I know of PM and what I've read over the last 11 years dealing with chronic pain.

    The key is that you are working with your Drs and they seem to really want to help you get the best pain control you can...

    I use the OxyIR 5mg for my BT....I am on the MSContin as my long acting medication...It took close to a month to work out the nuisance side effects of a bit of nausea and fatigue...I find it a wonderful medication that you can't tell one bit that you take it...it's a very smooth medicine for pain control..

    I also have generic Flexeril for my muscle relaxer to take when needed. And then all the other modalities to help my pain from exercise, PT, yoga/stretching, aqua therapy, injections, TENS unit, biofeedback, acupuncture, eat all organic, stay at a healthy weight, and went to counseling after my 3rd fusion to adjust my mentality with living with chronic pain..

    Keep us posted on how the addition of the medicine goes!!

     
    Old 04-08-2012, 04:22 PM   #7
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    Re: Fentanyl Patch Quantity Limit

    Yeah I know its unusual. We just couldn't figure out any easier way to get me from Methadone twice a day (but only 5-6 hours apart) to better pain control. Even if I did take the Methadone four times a day, I'd still wake up with basically no meds in my system. So, it seemed like a good idea to add an all the time med to the long acting but not so quite long acting Methadone, since switching me completely wasn't so desirable (since I'd need more during the workday anyways, and I am on a very high dose so I'd have to taper off quite a bit first since Methadone has such a long half life).

    Nope, no problems with insurance covering more than one long acting med. I don't think they care at all how many meds I'm on...only stuff like pre-auths for certain ones, not filling too early, and quantity limits. They covered all three of these narcotic rx plus my 10 or so others!

    Yes I am very happy I found this new clinic of doctors who actually wants to do something. I have been "shopping" for a year now. My primary doctor was ok with prescribing me some narcotics (on a neurologist's suggestion since I've exhausted all other good options for my headache), but I quickly hit his dose ceiling and he wouldn't switch me or increase. He also didn't have any recommendations for a pain doctor.

    I think I went to four before finding this place which actually doesn't have an aversion to increasing my dose. Most places don't like to see someone my age (26) taking even what I was before I was seen here. Its the best option I've been given though. I don't want to be on crazy high doses (although some would say I'm there already), but I don't think aiming for 50% relief is too much to ask (especially since I got there before with meds, but became tolerant because that was a couple years ago now).

    Thankfully I've been on morphine IR before so I have no worries about starting the ER. Especially good since I'm due to take it first thing tomorrow, before going into work. Usually I start new meds on the weekend. Happy to finally be on a true long acting med (Fentanyl patch and now Morphine ER). The Methadone is the best I've tried for pain (I've actually tried every basic form of narcotic now, although not all the long acting types), but the 5-6 hour max effect isn't so great.

    I'm also on Zanaflex, doing massage, starting up exercise again (had too long of a commute for awhile), and looking for a therapist to talk through this chronic pain thing. No too many options left, but I'm slowly working through them. I have a consult for a nerve stimulator soon. It was hard to find a place which does the occipital one and adds suborbital leads for frontal headache.

    Thanks for the kind words! Best wishes.

     
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