View Full Version : Trying to move on to Fentanyl Patches
hamilw
08-19-2003, 07:01 AM
Posting for my partner....
Along with Amitryptaline, Neurontin, Valium and Baclofen, I am on Oxycontin - 40mg x 3 daily. Despite this, I am still in unbearable pain and severely constipated. The pain doctor has suggested I try Fentanyl patches, 25ug in place of my evening 40mg Oxycontin, then increasing the dose and eventually replacing all the Oxycontin.
I have only reduced the Oxycontin by 20mg and the pain has gone off the scale. I even put on a second 25ug patch at the same time but had to go back to my original Oxycontin dose.
I cant get to see the pain doctors for ages so my question is this...
Can anyone advise if it is OK to increase the Fentanyl while staying on the Oxycontin and only reducing this when I am up to it. Also, is Fentanyl much less constipating as this is my biggest problem at the moment.
Any advice would be greatly appreciated.
Thanks
I would find out why you are in so much pain.
Them pain meds got you by the butt and are taking over your life.You are taking 2 powerful drugs at one time. Duke
Richie
08-19-2003, 10:37 PM
Try Methadone, it reduced my SCI pain by about 90%. Good luck.
Rich if you dont mind me asking what is the mg you take daily. Duke
David Berg
08-20-2003, 09:50 PM
I understand that methadone works for some people where other opiods fail because it works on slightly different receptor sites. I'd say it's surely worth a try if your doctor's willing.
Richie
08-20-2003, 10:44 PM
Duke, I take 10MG - one tablet three times a day. I've tried just about everything, Methadone was the only medication that worked. It also really helps you stay painfree at night so you can sleep well.
Wise Young
08-22-2003, 03:12 AM
Will H, I don't know if you saw my review of Fentanyl patches. In general, most people say that it has less side effects. Wise.
http://carecure.rutgers.edu/spinewire/Articles/Duragesic%20folder/Duragesic.htm
Sarahsmo
08-22-2003, 01:06 PM
Richard,
Writing for partner....
can you tell me anything about taking Methadone for pain? Anything written that I can take with me to doctors?
If I bring some fact in he might be willing to help. Right now all he will give for pain is tylenol 3. He will not give me anything stronger. I have had some nerves burned about 3 yr ago which help relieve the major pain, now minor pain has replaced major pain. I have burning like holding glass in left hand and left hip pain.
any info will help
Sarah's mom
tylenol 3 is a joke!
You need to find yourself a better Doctor.
hamilw
08-22-2003, 06:46 PM
Hello Wise. A very comprehensive review. Thank you. My one worry is that if I start Fentanyl patches and increase the dose so that I can reduce the Oxycontin I could find myself stuck on high doses of both if I cant reduce the Oxycontin.
Also is it OK to be taking both at the same time?
Thanks
Tylenol is bad for the liver, taken long term. A pure opiate is better than tylenol plus an opiate, as in Tylenol 3.
I couldn't use the patch - gave me terrible headaches and nausea, and nothing counteracted those effects.
Alan
Richie
08-22-2003, 10:55 PM
Sarahsmo:
Concering more information on Methadone and SCI. On this web site -care-cure- write Methadone in FIND. You will find good information there and current clinical studies that are being done around the country to take to you doctor.
Wise Young
08-23-2003, 01:44 AM
Will H... sorry... I am not sure whether I should address Will H or partner. I am assuming that Will H is the person who is taking the Oxycontin.
The recommended approach is to give intravaneous fentanyl to get therapeutic blood levels and place an appropriate dose fentanyl patch on. The patch should maintain the therapeutic levels achieved by the intravenous dose. The patch dose is increased until adequate pain relief occurs with acceptable side-effects. It may take several days or even weeks to find that balance. In the meantime, most doctors give oral morphine or transmucosal fentanyl (lollipops) for breakthrough pain.
In my opinion, the approach that your doctor recommended suggests that he/she is not experienced with use of fentanyl patches. Replacing an evening oxycontin dose with a fentanyl patch will not work for the following reasons
1. A 25 µg/hour patch will not result in adequate fentanyl levels for 12-16 hours whereas skipping a dose of oxycontin will result a reduction in oxycontin levels below therapeutic levels within 2-3 hours. No wonder the pain went "off the scale".
2. The dose of 25 µg/hour may not sufficient for somebody who is already accomodated to 120 mg per day of oxycontin. You may need to start on a higher dose patch (50-75 µg/hour).
3. A breakthrough pain medication should be prescribed for you instead of staying on oxycontin.
You should not be using multiple patches. This is what gets people into trouble. Because each patch increases plasma levels slowly, you are initially fooled into thinking that it is okay and then get toxic levels 8-12 hours later. Please note also that the the fentanyl collects in the subcutaneous tissue and that removing the patch does not immediately stop fentanyl input. The skin depot of fentanyl continues to leak into the system for hours.
Most people who have switched to fentanyl patches say that it is less constipating. The degree of constipation depends on the amount of breakthrough oral opioids that they use. In other words, the breakthrough opioids probably contribute more to the constipation than the transdermal fentanyl.
I strongly recommend finding a doctor who is experienced with fentanyl patches and having this done properly, instead of doing it in the ad hoc manner you describe.
Wise.
Wise Young
08-23-2003, 01:54 AM
I repeat, please please find an experienced doctor to work with. What you are doing is quite dangerous and will get you into trouble. The goal is to simplify your analgesic treatment. You are already on five meds with complex drug interactions. Wise.
hamilw
09-01-2003, 01:20 AM
Thanks for this Wise. We are trying to get another appointment with the pain team and the spinal specialit to discus your comments.
Will let you know how we get on
Thanks
whiterabbit11
09-01-2003, 03:59 PM
Originally posted by Wise Young:
I repeat, please please find an experienced doctor to work with. What you are doing is quite dangerous and will get you into trouble. The goal is to simplify your analgesic treatment. You are already on five meds with complex drug interactions. Wise.
Dr. Young,
your warning not to use multiple fentanyl patches confuses me As I have a Pain specialist who has me on 2 100mcg patches every 72 hrs and at times when they don't control the pain well he has me put 2 more on after the 1st 2 are on 48-60 hrs. leaving the old ones on. He says they losemost of their potency after 48 hours and the two new don't take effect for about 12 hrs.I then take the old ones off after 72 hrs. I've never had a problem with them in 3 years of use, though I started with 50mcgs. They are much less constipating than oral opiates and don't give dry mouth. If you run out at the wrong time though it's not good.WR
Wise Young
09-02-2003, 05:08 AM
whiterabbit,
I was really referring to Will H putting on additional patches without the supervision of a doctor. The danger is of course that he can get an overdose (respiratory depression) without knowing it.
As you know, there are duragesic patches of different sizes that deliver several different doses: 25, 50, 75, 100 µg/hour. In your case, you are already well over the maximum dose patch and your pain specialist had you put on two patches. In your situation where you are getting such high doses, I think that the suggestion of putting on a new patch and leaving the old ones on so that it doesn't waste the drug is also reasonable. However, I strongly urge people not to do this on their own without doctor supervision.
I was alarmed by some of the comments that I read on this site, by how little people know or understand the drugs that they are getting. When I read the original question posted in this topic, it bothered me enough to go and write the literature review that I posted.
Wise.
Dr. Young's advice not to do anything without your doctor's okay is right on. Sure, for example, multiple fentanyl patches can be used (as are daily dosages of hundreds of milligrams of oral opiates, or thousands of mg. of neurontin), and often are, but the prescribing physician must be the person who gives the patient the okay. Meds are too risky to play around with unsupervised.
Alan