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It depends entirely on the individual. Fentanyl stays in the system for a lot longer than acute meds do, so you've got several hours to either put a new patch on or swap the old one. Ideally, you want to put a new patch on a couple of hours before the old one is supposed to expire, but it's important to note that the normally prescribed 72 hour mark doesn't apply to everyone, and isn't fixed in stone, something that a lot of pain doctors have trouble understanding.

Fentanyl transdermal patches regulate the dosage by body heat - this means if you're engaged in physical activity or anything else that raises your body temp, the dosage delivery is increased, and the expiration time is decreased. Also, a small percentage of the population (myself included) require a 48 hour change rather than 72. It's more typical of high-dose opiate patients like myself.

The problem lies in that for many years, Janssen Pharmaceuticals' literature on Duragesic had 72 hours as the effective dosage period. However, they knew that some people didn't get that much. Though they finally changed the literature about 4 years ago to say that 48-72 hours, a lot of doctors don't keep up with those kinds of minor changes, and a lot of pain patients don't understand the proper way to communicate with their pain doctors. The real problem is that if you're getting patches based on a 72 hour dosage rate, and you're falling shorter, you'll wind up having less patches for your monthly prescription. In those cases, keeping an accurate Pain Diary is essential in showing your doctor that his prescription isn't right for your particular case and needs to be adjusted. If you're a fairly new Pain Management patient, or have an idiot for a pain doctor, it can be frustrating.

Where you place the patch is important as well. I've always used my biceps in the 10 years I've been using them, since it's easy to add them and the skin doesn't flex as much as it does in other areas. Even during the times when I've had to increase to 200mcg (2x100mcg patches), I still use both arms, taking on patch off for a few hours to let the skin breathe, clean it, then put a new one on, and then do the same with the other one.

As I said, if you overlap the patches (put a new one on in a new location as the other one is about to expire) you'll have no withdrawals to deal with. It takes a couple of hours for the new patch to ramp up to full delivery, so as the old one is getting weaker the new one is slowly catching up. The result helps to keep your overall maintenance dose fairly steady.

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In a study of 7 patients given fentanyl in surgery - Fentanyl and its two metabolites (norfentanyl and despropionylfentanyl) were extracted from samples and analyzed by gas chromatography/mass spectrometry. Unchanged fentanyl was detectable in urine in all patients immediately postoperatively and in 3 of 7 patients at 24 hours. By 72 hours, fentanyl was undetectable. Norfentanyl was present in larger quantities than fentanyl immediately postoperatively and was detected in all patients at 48 hours and in 4 of 7 patients at 96 hours.


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