Discussions that mention duragesic

Pain Management board


Hey JW, Suboxone or Subutex or BUP all have clinical advantages for patients just starting opiate therapy. A combination of opiate agonist and antagonsit is believed to provide anelgesia and reduce dependence. However Suboxone is a MU receptor binder and and Kappa receptor blocker. The reason why Duragesic is difficult to transition to other opiates is because most other opiates have little effect on the Kappa receptor so most people experience differential withdrawal when switching from Duragesic to another opiate.

If your presently dependent on Duragesic, Physically that is, it will send you into immediate severe withdrawal. This is the warning I clipped for you.
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Opioid withdrawal effects:

Because it contains naloxone, SUBOXONE is highly likely to produce marked and intense withdrawal symptoms if misused parenterally by individuals dependent on opioid agonists such as heroin, morphine, or methadone. Sublingually, SUBOXONE may cause opioid withdrawal symptoms in such persons if administered before the agonist effects of the opioid have subsided................................................................................................

If your going to try Suboxone , subutex or Bup you must first completely withdrawal from all opiates to prevent intense withdrawal symptoms from imediately setting in.

The bst way to DC the patch is to decrease the size of the dosage increments. 25 ugh is a large decrease but you can limit the size of the decrease by exposing only one half of the patch to your skin. Peel off one half and apply to skin and then adhere the patch to your skin with a coverlet that Jansen makes or use tape to hold it down. because the amount absorbed is based on the amount of transdermal material exposed to the skin you can effectively cut the drops down to 12.5 increments making discontinuing Duragesic much easier. Are you planning on DCing all opiates or planning on making a switch,

Meds like subutex or suboxone have their place in first line pain treatment for people that are not already physically dependent on opiates.

What dose are you presently on and I can show you how to decrease the size of each drop in strength by half making the transition much smoother. Good luck and take care, Shore
Hey JW, YOur not actually folding the patch over, Your only removing thebacking on one side and then taping it down. It will miograte some but unless you forc the vuisable fenatanyl to the exposed side of the patch it will not migrate. This is an effective way to reduce pacth strenght. Delievery of Fentanyl is based solely on the amount of transdermal material exposed to the skin, Not on the amount of fentanyl inside the resvoir.

I'm sorry JW, As much as I post I do confuse peoples problems sometimes. If you could expalin what your pain generator is, what other meds you have tried and why you ended up on the patch and stayed on it so long with such minimal relief I may have some suggestions. Was swallowing meds a problem, there is a solution for that. Start a new thread directed to me regarding the patch and I can make some suggestions, but now is not the time for subutex. As far as switching to other meds the easiest med with th least withdrawal would be methadone, it's available in oral solution if swallowing is a problem. Meds like kadian capsules can be opened and sprinkled in apple soauce or mixed with water and delievered through a feeding tube without effecting the time release componment. I'm sure you have some options.

Do you have a problem with patches staying on and wrinkiling, Jansen can supply a large coverlet adhesive patch to place over the Duragesic patch. There are many options. Hang in there, Shore