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    Old 07-27-2012, 02:40 PM   #16
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    Re: Fentanyl Patch Questions, Doubts and Observations

    I've only had or 3 times when my patch got too muchs meds into my system, fortunately I knew what it felt like and took it off until I was all better. You can out a used patch back on, although I did need the Bioclusive to keep it on. I too found that none of the other BT's worked well.

    I am sorry you are having so many ups and downs. The heat never was an issue for me. I get high fevers, live in FL and have a hot tub and love hot baths. I usually will wait till after my bath to put a patch on and in the hot tub I don't go much above 95 degrees. If my temp goes above 102 then I also take it off. I am not advising any of that, everybody is different and the warnings are explicit.

    I think either the patch is a miracle worker or a PITA for people. If you are having that much fluctuation in your pain then it probably can't hurt to try something else.

     
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    Old 07-27-2012, 05:35 PM   #17
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    Re: Fentanyl Patch Questions, Doubts and Observations

    There are a couple of things you can do. First, Contact Mylan and they will send you - free of charge - overlays for your patches, so the patch won't fall off. You can swim with these overlays. I order them monthly, and it's free. I know some people get good results from Flonaze. For me, I use generic Benedryl (dyphenhydramine) pills. You can got the non-drowsy formulation. I haven't checked to see if Flonaze has alcohol in it, but if it does, that's probably why the patch won't stick. Any alcohol used on the patch site prior to application will weaken the adhesive.

    Also, I've dealt with overdose due to heat with respect to the patches. I'm on the same dose you are. There are many variables: weight, height, etc. I wear cotton shirts - I put the patch either on my upper chest (right and left) or on the side of my abdomen (right and left) If you wear a "breathable" shirt, it will help dissipate the heat.

    You can get the generic Benedryl at Wally World and other big box stores very inexpensively. Good luck with this.


    [QUOTE=ttomassini;5028612]
    Quote:
    Originally Posted by MESnap View Post
    Hello... I'm new to the board and have some questions about fentanyl patches.

    I'm currently using the 75 mcg dosage and receive mylan patches from the pharmacy. Prior to fentanyl I was taking opana, but an increase in my pain coupled with a change in their formulary meant I needed a change. The fentanyl has been more helpful, period, but I have some issues with the patch that contribute to an unevenness in how much it helps.

    Question one anecdote:
    My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

    After another day of feeling really sick I noticed the second patch not even close to being in full contact with the skin. It was totally stuck to my arm (as in not coming off) but it only stuck to the skin in two small areas. I touched the patch on the inside where it didn't stick to my arm and it wasn't sticky. I could actually feel the flonase product on the patch (slick and brittle). I had both wiped off the leftover product from my arm, and let it air dry before applying the patch. I took off that patch and put a new one on without using the flonase (already burns like mad) and within four hours started feeling better. I think it was withdrawal symptoms that had me so sick.

    Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

    - In response to question 1, the same thing happened to me this morning. I was prescribed 50mcg Duragesic patches and Flonase due to the red itchy welts I was getting from the patch site after 36 hours of wear, but the patch is so much more effective than OxyContin, I still choose to use them. (I am about to have a 3 level cervical fusion, with chronic nerve pain.) I picked up the Flonase from the pharmacist yesterday and put the patch on last night. I woke up this morning with bad neck pain and some nausea and digestive problems. Since I upped the dose from 37mcg to 50, this seemed odd.

    What I think happened is, I didn't wait long enough for the Flonase to dry and/or sprayed too much when I put the patch on my upper arm and put the NextCare (like Tegaderm) covering over it. So I immediately changed it. The patch smelled like Flonase. I'm pretty sure I used to much, I was just so worried about getting those welts. (which I didn't!). But the patch was useless, so I had to take 2 15mg oxycodone to make my pain manageable. Normally, with 50mcg of Fentanyl, I would only need 2-3 15mg oxycodone pills throughout the day when things are working properly (in conjunction with 100mg of Topamax (non-narcotic) for my nerve pain.

    I hope your use of patches gets sorted out, they work so well when we don't have to deal with them falling off, or allergic welts, rashes, etc. :/

    Last edited by dave490; 07-27-2012 at 05:36 PM. Reason: spelling

     
    Old 07-27-2012, 05:47 PM   #18
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    Re: Fentanyl Patch Questions, Doubts and Observations

    So, in continuation of my issue from this morning...I have been in excruciating pain all day. I put on a new 50mcg patch with Flonase (and waited for it to dry) and it seems that the new patch hasn't worked at all. I'm in so much pain it is ridiculous. The patch is also starting to come off at the edges. Has anyone experienced Flonase blocking the patch from not working at all?

    I'm about to go home and put a new patch on (this is 2 that I have wasted now) without the Flonase, in hopes that I will get some sort of relief. I have taken 6 of my 15mg oxycodone for BT throughout the day (from 9am to 5pm), but I don't want to wake up tomorrow with the inability to walk, or worse, a ride to the ER. I think the itchy welts are a lesser evil at this point.

     
    Old 07-27-2012, 06:03 PM   #19
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    Re: Fentanyl Patch Questions, Doubts and Observations

    Quote:
    Originally Posted by ttomassini View Post
    So, in continuation of my issue from this morning...I have been in excruciating pain all day. I put on a new 50mcg patch with Flonase (and waited for it to dry) and it seems that the new patch hasn't worked at all. I'm in so much pain it is ridiculous. The patch is also starting to come off at the edges. Has anyone experienced Flonase blocking the patch from not working at all?

    I'm about to go home and put a new patch on (this is 2 that I have wasted now) without the Flonase, in hopes that I will get some sort of relief. I have taken 6 of my 15mg oxycodone for BT throughout the day (from 9am to 5pm), but I don't want to wake up tomorrow with the inability to walk, or worse, a ride to the ER. I think the itchy welts are a lesser evil at this point.
    From what you're describing, it does seem like Flonase is causing problems with the adhesive, which in turn would stop the flow of medication. I would talk to your doctor on Monday and let him/her know that you've had two patches fail after applying flonase. I'd also try the generic Benedryl and see if that stops your reaction to the adhesive on the patch. Generally there are two reasons for skin reactions. Either an allergic reaction, or bacteria that's trapped under the patch. Wash the area with clear water before applying the patch and see if that helps. If you use lotion of any kind, be sure the site where you're applying the patch is free from lotions. Good luck and keep us posted.

     
    Old 07-27-2012, 09:16 PM   #20
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    Re: Fentanyl Patch Questions, Doubts and Observations

    I'm intrigued with this thread. I started the patch a few weeks ago. My skin under the entire patch and Tegaderm cover gets inflammed/itchy/red, plus at the edges of the Tegaderm gets raised and often tears through, almost like a contact rash? I asked my primary doctor for a Flonase script yesterday and sprayed some on before applying the last batch of patches, wiping it around with a kleenex and letting it dry maybe 10 minutes. It felt dry, but my skin was sticky.

    I'm still at a tapering up stage with the patch and have been having quite inconsistent relief so I can't tell if it interfered for me, but I could definitely see how it could be a barrier for the medication. I think there are a lot of variabilities in this patch. If even 20% of the patch wasn't sticking, that is 20% of your meds (as its by surface area). Seems like this is a med where they should be required to give you some extras since it is inevitable something will happen to some of them. I've had some even so far I would have replaced if I could have (missed a corner on the cover so the whole thing was waterlogged with the med dried out).

    If the patch isn't sticking to the skin in even some small area, you don't get enough med and even if you were to tape it down after, you won't get the same amount as it dries out with air contact (why you shouldn't re-apply a patch that falls off unless you have no extras). I was wary to put any sort of ointment on before hand for the same reason.

    >>Curious to hear from those who have used Flonase or similar successfully.

    I want to give these patches a good shot but I'm having nothing but trouble so far. I'm already at a supposedly equivalent/higher dose to my previous meds and they aren't working nearly as well, lots of skin irritation/welts, sweating, and they don't even last 48 hours. Seems like some of my issue with the welts is dependent on patch location. Lower abdomen is the best but I can only tolerate it all the way to one side. On my hip was the worst as it would rub on my pants. Even the side of my leg (my doctor said it was ok) was bad on one or both of the horizontal edges.

    I don't have the guts to try these without the Tegaderm covers since I don't have extras, but I'm pretty sure they make the irritation worse. I have some OpSite Flexifix too, and its the same thing). I'm pretty sure my reaction isn't allergic as 80% of it is at the edges of the covers, not under the entire patch, but I haven't tried oral benedryl. Best wishes.
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    Old 07-27-2012, 09:40 PM   #21
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    Re: Fentanyl Patch Questions, Doubts and Observations

    Thanks, will do. I think I screwed up again too! I got a facial today, and the gal put lotion on my shoulders. I was in so much pain when I got home, I swapped out my patch and put it over the lotion-y arms. I'm still not getting relief. This time I used two 25mcg from a previous RX.

    I'm taking a hot shower now. And putting a new patch on with no Flonase and I'll take a benedryl, and hopefully I'll be good to go in the morning. What a mess! Keep you posted.

     
    Old 07-28-2012, 04:39 AM   #22
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    Re: Fentanyl Patch Questions, Doubts and Observations

    I'm doing a little better with the patch, after much trial and error. First I just quit using the flonase and dealt with the patch eating my skin alive. I too get welts more on the outside of the patch, and yes, it lifts the edges off of the skin. Once I got the next script filled with 48 hours per patch, I had a little more freedom to try a couple things.

    First, the flonase has to dry for a minimum of half an hour for me, and I wipe it off after spraying it.

    Second, I have four spots on my body that work for placement: at the top of my arm at my shoulder (on each side), and by cutting the patch into two strips and laying them lengthwise along the muscle edges on each arm. (I have the mylan, not duragesic. I'm also not suggesting anyone cut the patch, bc the kind you have matters so much. It's dangerous if you have the gel patch.) Any other place, and the edges come up. I think you guys hit the nail on the head when you said the edges coming up means the patch dries out, and it has to be in full contact with your skin.

    That said, I still have problems. If I use tegaderm, it gets too hot and I get too much. Then I feel sick. If I don't use tegaderm (or something similar) the edge of my tshir can actually catch the patch and pull part of it up.

    It's a careful Balancing act I think I'm getting used to. Unfortunately dilaudid seems to be the only other narcotic that my nerve pain responds to, and it's a rough medication for me. So for now, I'm balancing. I'm sorry others are struggling with the patch, but glad we can share experiences on here. It also kind of helps to know I'm not just nuts with the up and down. I think my doctor thinks this should be the most stable med of them all and it's probably in my head.

     
    Old 07-28-2012, 12:21 PM   #23
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    Re: Fentanyl Patch Questions, Doubts and Observations

    Interesting that you say a half hour for the drying time of the Flonase. I was waiting maybe a minute or two. That must be it! And now I'm dealing with the repercussions of all the pain from the withdrawal of not having any around the clock medicine for a day.

    So - after the day from hell yesterday, I put on a 50mcg patch on freshly washed skin (upper inner bicep/tricep) with a NextCare covering (no Flonase) and took a non-drowsy Claritin. I still woke up in significant pain and only got 5 hours sleep, so I put an extra 12mcg on to try and break the pain because I do not want to take a million oxycodones like yesterday. (i've put a call in to my doc's office and will be seeing him Monday.)

     
    Old 07-28-2012, 02:09 PM   #24
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    Re: Fentanyl Patch Questions, Doubts and Observations

    Thanks for the advice on longer drying time for Flonase--I too thought once it didn't feel wet it was "dry". I'm on 100+50+50 every two days. Once I got up to this, I started doing an alternating schedule, changing a 100 on alternating days from changing two 50s. I'll mention it to my doctor, but as its not a change in dose or frequency (I started it by keeping a patch on for 3 days so I didn't even use an extra), I don't see a problem.

    They weren't lasting 48 hours so I'm hoping it helps. Still waiting for the increase from 150 to 200 to kick in. Seems to be 3-4 days for me. When changing my 100 yesterday I decided not to risk the Flonase again until I got further advice (I couldn't tell if it affected absorption on my 50s as I'm doing pretty bad lately, but I wouldn't be surprised).

    >>Anyone else absorb this med so fast they don't even last 48 hours? I get increased pain and even some withdrawal at 40-44 hours, and I change them at night so this is during the evening, where I usually have the least pain.

    For me the welts seem to have a lot to do with location. I seem to have figured out that although the leg is really good (doesn't bug me so much, and lots of area for rotating locations & for multiple patches), too high on my leg isn't good--there is too much bend/movement. I got the worst welts on the hip and very top of the leg. Also, with me wearing multiple patches, overlapping the edges of the Tegaderm covers all on one leg seems to be better. That way I only get welts on an edge on its own. With my rotation I will have to cut away the stuck together Tegaderms though to only replace half the dose every day.

    I sit a lot (like most folks) and I've also realized that even with covers, many spots of the skin will have the patch crinkle up when you are sitting...that has got to effect it some as you aren't getting that full contact.

    I agree with those who have said patches for ambulatory patients can be tough. Thankfully I've been no where near OD though...I think I'm still having some withdrawal in fact. I haven't gone out in high heat (mild summer here), but I haven't noticed any problems with hot showers or using covers. Something to definitely keep an eye on.

    ttomassini-So will you now run out very early if you can't get your doctor to do something? Sounds like you've used up quite a few patches these last couple days. I just haven't had that option, but really hope I can get some extras going forward. It can be a bad idea to increase your dose on your own, even in situations like yours (assuming your doctor didn't give you this option to go from 50 to 62.5). The conversion chart I looked at said a 12 mcg/hr patch is like 15-30 mg of oxycodone a day, so I'd be surprised if adding the extra small patch helped much...plus patch dose increases often take 12-72+ hours to kick in.

    At my current dose & schedule if I was on two 100s every two days (instead of 100+50+50) it would be 30 a month. Getting 30 patches in 28 days would be a good start for me, and seems pretty reasonable. I hate having no extras, especially as these as so easy to mess up. Usually I would have waited longer to switch to the patch to use up my bit of extra meds so then I'd have the extras of the new med, but I only do full med changes on weekends, and I couldn't wait until the next weekend.

    >>Does anyone have some data on how much of a difference various locations make?

    My best spots seem to be lower abdomen and the side of my upper leg for comfort & less welts. I wonder if I get better patch contact on the leg, or if that is outweighed by it being even further from my heart. My doctor said it worked best on the chest, but I could use it any number of places such as everywhere the manufacturer listed, plus the abdomen and upper leg.

    She didn't elaborate on how much of a difference it makes, nor can I find anything on that or why its best on the chest (per some info...other info says it doesn't make a difference, and neither does the amount of fat). I'm guessing there is a different type of tissue there that stores/releases the med better. Some claim the patches don't work on frail/skinny people as the med needs the fat. I don't have that issue though. I've even heard claims that placement on the abdomen will increase the release rate of the med. Can't find reliable data though (this is mostly from forum discussions).

    Curious how much of a difference this is. This could help me justify to myself that a dose increase is ok. Per the equivalency chart, I am well above what I was on previously, yet with less relief. I know charts are just a guide, but I'm curious if I'm not getting all the medicine or if this medication just isn't a good choice. I get the best bang for my buck on methadone, but it doesn't last long enough so I wake up in too much pain and play catch up all day. I just may have to go back to it though.

    When I started at this doctor I chose to try switching meds before just increasing the methadone dose as I was frustrated after being on it for years without my doctor allowing any changes. Also wondering if brand will make a difference for me. I have Watson and Apotex right now, but am trying to get my pharmacy to order Sandoz.

    I asked them to get me 6 boxes of 100s next week since they don't seem to stock 100s and even the other local pharmacies don't keep that amount in stock. They said they could order, but they didn't guarantee a brand at the time (I said if they couldn't get Sandoz I'd take anything but Watson...they are driving me nuts due to the crinkly noise and you feel the more on your skin). Thanks! Best wishes.
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    Old 07-28-2012, 02:58 PM   #25
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    Re: Fentanyl Patch Questions, Doubts and Observations

    Hey there, I think I'm playing catch up, I'm still hurting, but not in the "unbearable" state anymore, so that's a good thing. On Monday, my doc took me off of OxyContin (30mg 2x day) which wasn't doing the trick, I was taking 15mg oxycodone for BT 4-6 times a day, that's why we decided to go back to the patch and deal with the welts, so I have quite a few boxes of 12mcg and some 25mcg patches left, aside from my 50mcg script I just had filled, so I should be ok until I get in to see him.

    My concern is weather this is still a backlash from Friday, or is it really valid pain, as I don't want to over medicate. But, I haven't woken up in over 6 months without having to reach for oxycodone. I just wish I could wake up remotely close to pain free. I'm usually a VERY upbeat optimistic person, and this is starting to wear on me.

     
    Old 07-28-2012, 04:41 PM   #26
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    Re: Fentanyl Patch Questions, Doubts and Observations

    I sure wish I could wake up close to pain free, but I know in the near future I won't be there. I'll be happy not to be miserable. An average of 50% relief is my goal. Glad you won't run out of patches, but increasing it on your own, even short term, doesn't sound like a good idea. I haven't been in a good place with my pain for a couple years, but since we have started trying to switch my meds to something better, I've only done worse. Hang in there! If you were doing ok on the patches before the problems with absorption, I'd think you can again...it may take a few days though. Depends on the person, but I seem to be quite slow to respond to dose increases from my limited experience with these so far. My mornings are the worst too. Best wishes.

    Just had an idea for the rash at the edge of the Tegaderm covers: Since my covers are significantly larger than my patches, I peeled up the very edge of the cover where there was the rash so I could apply ointment (I have a rx steroid cream but, anything you'd use after removing the patch would work). The fentanyl patch itself appears to still have plenty of cover on it to stick. I imagine I'll just have to keep an eye on it to ensure the entire cover doesn't then decide to come off when I change clothes. I wonder if doing this proactively would be helpful? I know ointment under the patch itself would be a bad idea, but I don't see why we couldn't do the same for the very edges of the cover, provided there is area between. Or, even 1 day in is helpful so the rash isn't as bad by day 2.
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    Last edited by tortoisegirl; 07-28-2012 at 06:32 PM.

     
    Old 07-28-2012, 11:32 PM   #27
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    Re: Fentanyl Patch Questions, Doubts and Observations

    It's been 24 hours and it seems like I'm doing better. I just took my non-drowsy Claritin and so far no itching or redness on either patch. It usually becomes intolerable at 36 hours, so this is a good sign. Aside from seeing my PM doc Monday, I'm going to try to see my homeopath on Monday as well and see if there is something natural he can give me, as I would hate to have to start taking allergy meds on a daily basis. But hey, if it works, it works.

    My pain level has gone from an 8 to a 4. So I think I'm back on track and will see how things go when I wake up tomorrow. If I can stay at a 4 in the AM, then maybe an increase (with his permission of course) might do the trick.

    I've been on Fentanyl for 2 years (except Jan-this week of this year when I contracted candida), and previously, before I was out on disability, it kept me relatively pain-free to where I didn't have to take BT meds until I came home from work around 2-3pm (I worked 6hrs a day cause of the neck pain.). But lately, I just haven't found that happy place.

    Also, surgery is coming up soon....so my assumption is I would need to wean down a bit beforehand even though my PM doc said I won't because I will most likely be getting a pump since I'm getting a 3 level fusion. I think I need some clarification on that too....

    Hopefully things will progress a bit better tomorrow. I'm glad I found this message board, it's helpful to know there are others out there who have the same types of challenges that I have.

     
    Old 07-29-2012, 01:40 PM   #28
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    Re: Fentanyl Patch Questions, Doubts and Observations

    So, I'm starting to think that maybe I received a bad box of 50mcg patches. Has anyone experiened this before? I woke up again with really bad neck pain and decided to change my patch and there were no welts and I'm not sure if it's the Claritin, but since I'm in so much pain, and I'm in more pain than when I was on 37mcg. So I swapped the 50mcg out with a patch from the other box from my script and we'll see what happens.

     
    Old 07-29-2012, 02:14 PM   #29
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    Re: Fentanyl Patch Questions, Doubts and Observations

    I've heard there can be bad batches sometimes. Or, especially if you switch between two generics. However, if your levels really got low, it could take many days for them to build back up. I had a tough day yesterday with more withdrawal and pain than in previous days and figured that the Flonase was a problem. The new patches are a bit better.
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    Old 07-29-2012, 04:48 PM   #30
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    Re: Fentanyl Patch Questions, Doubts and Observations

    When I had the two patches covered in too much flonase, it took 4 days of withdrawal symptoms and an additional 4-6 days of uncontrolled pain before the patches started helping again.

    I actually need up getting IV meds at the hospital on day 6.

    My BT meds still do not help at all with the fentanyl. (Except for my super breakthrough med - dilaudid - at a high dose, which I don't use more than a couple times a week when I'm utterly falling apart from pain.)

    Which brand are you two using?

    Have you tried other long acting meds?

     
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