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Fentanyl Patch Questions, Doubts and Observations


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Old 06-21-2012, 02:30 AM   #1
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Question Fentanyl Patch Questions, Doubts and Observations

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.

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.

 
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Old 06-21-2012, 11:55 AM   #2
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Re: Fentanyl Patch Questions, Doubts and Observations

You might want to try Tegadern patches over the Fentanyl patch from coming off. I've had 7 surgeries on my left shoulder including 2 humeral head replacements from a previous gun shot injury. Had 3 MUA's (Manipulation Under Anethesia) to eliminate adhesive capulitus (frozen shoulder). I now have chronic "mechanical" pain. I was taking 15mg of MS Contin ER every 12 hrs & 10mg of Percocet every 4-6hrs. They stopped working after awhile and the PM Dr. switched me to 25mcg of Fentanyl every 72 hrs & Dilaudid 8mg every 6 hrs which works great for me except for the constipation which I take Senna for.

Good luck

Last edited by jakmak52; 06-21-2012 at 12:10 PM.

 
Old 06-22-2012, 07:25 AM   #3
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Re: Fentanyl Patch Questions, Doubts and Observations

Thanks for the suggestion. That may be the way to go.

I just wonder if the flonase could block the fentanyl from absorption if I just taped it down tight anyway? I mean if I can feel the product on the patch...?

 
Old 06-22-2012, 07:38 AM   #4
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Re: Fentanyl Patch Questions, Doubts and Observations

Quote:
Originally Posted by MESnap View Post
I think it was withdrawal symptoms that had me so sick.

Yes, it was withdrawals that was making you sick, the patch has to be completely adhesed to your skin for it to work like it's designed to.

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.

Either your Dr. will have to come up with another solution, or you can try another patch, I"ve used Watson, Sandoz, and Duragesic. You can also use Tegaderms over the patches to help them stick, some manufacturers give these out free to patch patients, if not you can get them at the pharmacy or online in bulk cheap.

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

You can request that your Pharmacist order a different brand patch, they usually have a couple of choices, he may not be able to get the specific one you want.

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

Even Fent being a continuous BPL med can still not be able to handle pain flares at times. It's important to always change your patch at the same time. Alwasy wear your patch above your breastline. Stay out of hot baths, sauna's, jacuzzi's, not too long in a hot shower, stay out of the heat outdoors for very long. Any of these conditions can and do cause your body heat to rise which causes the patch to release the medication unevenly which will effect how long it lasts.

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

You hit the nail on the head...Fentayl is pretty much the strongest "use at home" pain med. Once your on it there's isn't anything stronger to go up to, so the weaker meds aren't going to do much for your pain. That's the risk patients take when they chose to go to a Fent patch.

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.
I hope things stabilize for you and this works out. As you know Pain Management is not about relieving pain, but making it manageable so that we can live our lilves as we endure it. The Fent patches can work very well but there are a lot of variables to consider. If they don't seem to be lasting long enough or working well enough you can go to a 48 hr. dosing as opposed to the 72 hr., might be something to discuss with your Dr. on the next visit. Also when on Fent, most switch to a more powerful BT med like pure Oxycodone, the weaker ones are like taking baby aspirin at this point. Welcome to the Boards, hope we can be of some use and support to you.

Kat

 
Old 06-22-2012, 10:31 AM   #5
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Re: Fentanyl Patch Questions, Doubts and Observations

Thanks Kat. Yeah I am hoping my PM PA understands next time I explain that I'm really getting no help whatsoever from the percocet or norco. I've literally stopped even taking them, even though I'm losing my mind during the pain flares. I feel that since they do nothing, taking them is not only pointless but an irresponsible use of them.

Ive had and lived with pain since I was 10 years old. I took nothing for that pain until my late 20's, and the nerve pain started keeping me up all night, making it hard to wake up to get to work, or work after not having fallen asleep at all, etc. Concentration was part of my job and it was shot.

Now I've been on opiods for five years, a fall causing turned vertabrae and herniated discs, surgeries for stump reconstruction and neuroma removal, chronically (and severely) low magnesium... It's all gotten frustrating and feels like I'm losing control of my health situation. I don't want to be on such a strong narcotic, but I was an emotional wreck from trying to live with the pain while on opana! Not exactly a weak med.

Anyway, I can't believe how much of the nerve pain the fentanyl sometimes cuts through. it would be a shame to give it up because I cant get an antihistamine to work with it sticking so it sounds like I need to just spray, wipe and let dry and then just stick the patch on there regardless of the possible barrier with those sticker things.

One more question though - Why use it above your breastline?

Thanks, Kat

 
Old 06-27-2012, 03:11 AM   #6
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Re: Fentanyl Patch Questions, Doubts and Observations

They say that above the waistline is how you get the best absorption from the blood flow. Not to mention they want it to be applied to a location with less fat and less hair. Also flat areas where there is less movement, bending, creases, etc. I truthful never gotten a exact answer. I hear something different but I guess it all is a reason they want it above the breastline. Now I have known people to use it on their thighs, and stomach. But I am a straight by the book kind of girl. So I would tell you do as you are directed to. Also like Kat was saying talk to your doctor about changing the patch every 48 hrs. That is how I take it. It does help. Also Tagaderm is a great way to keep your patches on but I have been told that Tagaderm is not good because it covers the whole patch with no air and it can't breath and sometimes it will heat it up to where it may release more med than it should. They say the 4mm breathable tape is great that way your patch still can breath. Good luck! God Bless
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Old 06-27-2012, 01:53 PM   #7
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Re: Fentanyl Patch Questions, Doubts and Observations

Hi,

i am sorry this happenes to you, but did your PM Dr told you about precautins while on Fentanyl patch? For example about heat (like hot showers/hot bath or wrinkles on a patch and how important to watch corners of the square to be fully attached to your skin), etc.
I was on Fentanyl patch and it was OK in the beginning, but when my dose was increased I ended up in ER, very ill. I thought my head will explode, nausea, dizziness, low heart rate and passing out.
When I called my PM in the morning saying I am not well, he immideately blamed increased dose of my patch and called ER for me without waiting. He was very concern saying that out of all opiates, most death cases happen from Fentanyl side effects (we are not talking about overdosing, just about side effects and reaction). It may happen either from start (reaction to this drug) or when dose is increased. Of course it may happen if one on Fentanyl patch gets into hot tab, taking very hot shower, damaged patches, etc.
When I checked on Internet about this drug I was shocked reading statistics and how many death occurred while being on it. I am almost happy that I got reaction to it and no need to be on it anymore.

All the best; check with your DR and follow every little direction please.
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Old 06-29-2012, 02:46 PM   #8
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Re: Fentanyl Patch Questions, Doubts and Observations

I too use Flonase with my patch as I was getting those skin sores as well. I have never noticed a problem with the patch not sticking because of the Flonase, but I use Duragesic brand patches. I just make sure it has ample time to dry before putting the patch on.

I hope it works for you as youmsaidmyou would hate to have to stop taking it when it's helped with your nerve pain.

 
Old 07-01-2012, 01:50 AM   #9
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Re: Fentanyl Patch Questions, Doubts and Observations

Yes, I have been warned about heat with the patch. (great point given triple digit heat and powerloss across the board where I live.). My PA didn't tell me about skin contact concerns but I read about that on the Internet.

I've tried taping the patch down and usin the flonase. That definitely helped, but the tape made the patch a bit hotter, I think. Or I actually got full skin contact. Or both. Either way, it released more medication last time.

I guess that solved the sticking/flonase problem. As long as it doesn't release *too much* at a time. I still have problems with it wrinkling, and I'm still having giant fluctuations in pain levels.

But yet thinking back to befor switching to the patch... Well, like I said, as bad as it is, it's better.

(it's not all the meds fault though; the nerve pain itself seems to be connected to sitting. But standing is difficult and causes SI problems and lying down seriously hurts my back to the point where I have to roll out of the bed onto the floor to start gettin up...)

Thanks, all of you.

If I decide to try locations other than the arms, I'll let you know how it worked for me.

Do most of you who use the patch use an immediate release form of fentanyl for BT pain?

 
Old 07-01-2012, 08:23 AM   #10
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Re: Fentanyl Patch Questions, Doubts and Observations

I just went through a problem with my Mylan 75's releasing too much because of heat. Mylan sends me the Askina overlays to keep the patch on firmly, and I think the overlay is too much during hot weather. I was wiped out for several days thinking I was just exhausted from working long hours. Once I realized what was going on, I stopped using the overlay to help dissipate heat away from the patch. I wear mine on my chest. Females I've talked to wear theirs below a breast, and low enough that their bra doesn't cover any part of the patch. As for breakthrough pain, I use morphine tabs 15mg PRN, and that cuts the pain down to around a 4. With the patch I'm usually at about a 6, and without it, I'm off the charts. Have you tried other patches than Duragesic? I can't wear that brand, or I'll break out in rashes and sores. I think I might have an allergy to the adhesive. Mylan doesn't give me any problems.

 
Old 07-01-2012, 11:11 PM   #11
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Re: Fentanyl Patch Questions, Doubts and Observations

Mylan (75) is the type I have. And today it really released too much. (The heat, I'm sure.). I felt really sick and had to lie down. I got weak, sick at my stomach, dizzy, etc. And I wear it on my arm, on the outside, upper area.

I haven't tried the duragesic brand.

I'm fluctuating wildly from 3 to 10 - like I want to go to a hospital 10.

I think I'm going to either ask to change from fentanyl (not sure which med to try - just know opana doesn't work), or drop the dosage of fentanyl and get a stronger BT medicine. Or propose either or and?

I'm also taking 2400 mg of neurontin a day. It's pretty heavy, but the nerve pain is actually spreading. That scares the crap out of me. It was a neuroma in one spot with referred nerve pain in a second spot from a disc. Now it's in other places as well.

Last edited by MESnap; 07-01-2012 at 11:14 PM. Reason: Little more info

 
Old 07-01-2012, 11:57 PM   #12
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Re: Fentanyl Patch Questions, Doubts and Observations

At 10 I go to the ER, because there's no way I can break that at home. They give me a shot of 12mg morphine and some Visteril so I don't get nauseated. About 15 minutes after the shot I'm back down to 5. IV morphine works faster, but I don't like lying in the ER for an hour waiting for the IV to finish. Besides, after you end up with a bag of saline running in you, it seems like I have to go to the bathroom every hour to get rid of the fluid.

 
Old 07-02-2012, 07:03 PM   #13
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Re: Fentanyl Patch Questions, Doubts and Observations

Sorry you aren't getting stable relief. Were you been able to be stabilized on a different long acting med? I've had a very tough time with this...I've never got stable pain relief throughout the day as my baseline pain wildly varies (plus I absorb pain meds very fast). I end up needing to vary my dose throughout the day (more in the morning) and to have a high dose for breakthrough available.

Not too many folks actually use IR Fentanyl with the patch as Fentora, Actiq, and Onsolis are only FDA approved for cancer pain, so besides them not being appropriate for many folks on the patch, insurance will only cover them for cancer pain most of the time. Also, they are so strong and short acting they are the most high risk meds for abuse.

There is varied opinion on if its best to use the same med for breakthrough...whether you want something different to hit different receptors (and hopefully built tolerance slower as its two different meds vs. one), or you want the same one to increase the level of that med.

I'd tell your doctor this isn't working and for what reasons, and see what they suggest. It would be one thing to say that by comparison to something else, this is better/worse, but I'd never specifically ask for a med by name or suggest specific dose changes. You may want to get in ASAP if you feel the heat is causing you to get too much of the medication. The prescribing info says to contact your doctor immediately in a case such as this or when you have a fever, in which case they often suggest to take it off. I've heard of some folks even using some ice on it if needed, but definitely talk to your doctor. Best wishes.
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Old 07-02-2012, 08:29 PM   #14
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Re: Fentanyl Patch Questions, Doubts and Observations

That's excellent advise Kate. When you start asking for narcotics by name and dosage, you run the risk that you'll be viewed as nothing more than a drug-seeking-patient (DSP)
If that happens, you'll have a very difficult time getting any physician to help you adequately control your pain. Great post!

 
Old 07-27-2012, 11:27 AM   #15
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Re: Fentanyl Patch Questions, Doubts and Observations

[QUOTE=MESnap;5003425]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. :/

 
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