How do you i stop using 12mcgh duragesic patches?

Answer 1

There's a couple of ways to do it: Withdrawal assistance drugs and Incremental Dosage Reduction. You never want to just stop taking an opiate - depending on the person and dosages involved, real problems could occur if you try doing it cold turkey.

Withdrawal drugs essentially ease the withdrawal process, but they can make you sick if you take them at the wrong time. I personally don't like using them as it's just something else in your system you have to deal with at some point. But each person is different, and it really depends on how you deal with withdrawal symptoms.

It's actually easier to do an incremental dosage reduction over time. Having been dependent on opiates for many years, and having had to increase and decrease my dosages many times over that period (10 years), I've used incremental dose reduction many times to lower my dosages. Usually it takes about 4-6 weeks depending on the drug. Since I use the strongest dosages of strongest opiates, and have been using them for over 10 years, (I have major spinal problems and severe chronic pain), it takes a bit longer for me than it might for someone using less for a shorter amount of time.

In incremental dose reduction, what you do is cut the pill in half or in quarters. If you're using 2 pills per dose, just cut one down and add the 1/2 or 3/4 of one pill to the other. With patches, the trick is to use your breakthrough meds to compensate for a lower patch dose as you slowly wean yourself off Fentanyl, and then use dose reduction for pills to reduce it further. This is no easy task depending on how long you've been using patches. It took myself almost 9 months, slowly dropping from 200mcgh (2x100mcg/h patches every 48hrs) to the point where I could just use Percocet 10's, and that involved about a month of heavy withdrawals. At that point I'd been a Duragesic user for about 8 years, along with Percocet, Demerol, and MS-Contin (morphine timed-release) tabs for breakthrough.

Start by slowly increasing the time between your patch changes (e.g., 75hrs instead of 72, then increase). After you can tolerate longer and longer periods between patch applications, try taking half your normal prescribed dose in pill form (i.e., the equivalent to half a patch dose in Percocet (about 30-60mg/day), and see how you deal with the withdrawals. If it's too strong, then start with only a 1/4 reduction in dosage by cutting the pill in quarters and taking 3/4 of your normal dose. Take it for a week, then drop another 1/4. If the withdrawals are too strong still, then stay at 1/4 dose reduction for another week (2 weeks total) , then try again. When you can tolerate the withdrawal, then reduce by another 1/4, and repeat the weekly process. Keep doing it until you're completely off of the drug.

Since I'm retired on disability, I've had the luxury of being able to sedate myself heavily and remain in bed when dealing with large dosage reductions and withdrawals. Since most people don't have that available to them, it might take longer or shorter amount of time to reduce the drug to the point you can stop taking it. Most don't have the luxury of that much time off. Though as I said it took me about 9 months overall to get to the point where I could stop using patches altogether, it took about 1 month of severe withdrawals at the end to get there. 12mcg/h is frankly a pretty low dose in the scheme of patch dosages, but each person is different when it comes to withdrawals.

It also helps to take an OTC med to compensate and ease the withdrawal pain. Two of my favorites are Tylenol Rapid Release Gel-tabs, and Bayer Back and Body Aspirin. I also use them frequently when I don't feel like using any Percocet for breakthrough pain. Bayer works better for withdrawal pain though. Keep in mind though that if you're using OTC Tylenol with Percocet, you need to add the amount of Tylenol in the Percocet (second number on tablet) to overall daily amount so you don't exceed daily toxic levels. That used to be 4g/day, but they dropped it about 2 years ago to 3g/day.

Two things that will help are an anti-anxiety med, and an anti-nausea med, which you'll need toward the end. The anti-anxiety med will help get you through the heavier withdrawal periods.

You'll need to be prepared to deal with a lot of sweating and chills (it's essentially like a really bad flu, without the congestion and coughing), so keep plenty of water/gatorade on hand to replace your fluids. Dry clothes and a change of bedding should be available as well. Do anything to keep your mind off of the withdrawal pain (internet, movies, games, music), as well as the increased pain you'll feel as a result of a lower amount of opiates in your system. Initially, the withdrawal pain will be as bad or worse than your regular pain, until the point where you'll get a feel for just how bad your actual pain levels really are. At that point you'll need to decide if you can continue, or continue with opiate therapy.

It does help to sedate yourself (e.g., Flexeril, Valium) if your doctor agrees with that.

Regardless of how you do it, you should never try and reduce your dosages without your doctor's involvement. The body doesn't respond well to withdrawals, and each person's body reacts differently. You don't want to experience sudden withdrawal related problems,and your doctor can help you navigate that minefield.