Duragesic Patches

No it won't show up as morphine or hydromorphone. Its totally unrelated chemically. If there is a test category for 'opioids' this might test for fentanyl, but I believe this is fairly uncommon. If there is a test for 'fentanyl' or 'synthetic opioids' these will/may test for it, respectively.

Depending on your current opiate tolerance level, it usually takes about a week or two before you get the dosage right.

The initial opiate dose conversion charts that calculate the conversion equivalence for acute opiates (e.g., Oxycodone) to an initial patch dose are purposely skewed toward the low end for safety reasons. That's in case a new user isn't yet tolerant enough to a higher dose, as too much can cause respiratory problems (or worse). As such, for most people the initial dose is too low, and it often takes a few days to adjust the dosage to get it right.

The conversion charts are pretty close though - as long as you've got enough breakthrough meds to compensate, you'll be okay. Just make sure you've got plenty of breakthrough meds available, and track your pain throughout the initial patches so that you and your doctor can tweak the dosages to where it's effective.

There is no average dose - all fentanyl patients must first be "opiate tolerant", meaning they are already tolerant to the effects of opiate medications. Most, like myself, only start using it when other meds (Oxycodone, Morphine, etc.) aren't effective and long-term pain control is needed.

Initial dosages are based on the patient's current medication. All opiates have a morphine-equivalency rating, as does Fentanyl. The patient's current med doses are converted its morphine equivalent, adjusted for increased pain control if necessary, then matched with one of the standard Fentanyl doses available as an initial dose. Dosage adjustment goes from there.

Most initial doses are low - this is because the Morphine-Fentanyl equivalency charts are purposefully kept on the low end for patient safety considerations.

Medications like Duragesic and their generic counterparts deliver the dose transdermally, meaning that the drug is delivered through the skin membrane and thus into the bloodstream.

Duragesic patches work by containing the drug in a suspension gel, contained inside a small pouch on the patch. The bottom of the patch is made of a material that is both adhesive and similar to a porous membrane, which will release the drug into the skin when it's heated by normal body heat. The dosage is regulated over the life of the patch by body heat, which is why overheating the patch (fever, external heat sources,etc.) can significantly increase the delivery rate to the bloodstream. In those cases, even in patients who are opiate tolerant, delirium or respiratory depression can occur. In many cases, for most people who aren't tolerant to high doses (or those who abuse them), it can lead to death.

"Transdermal" means "through the skin". These cannot be injected.

It depends entirely on the situation. If you just add another patch to one that's still effective at full dosage delivery, then you're adding to the overall dosage rate and if you're not tolerant enough you can experience severe respiratory depression or death if you're not careful.

If you're referring to a patch that's in the last few hours of expiration (e.g., 64 hours of a 72 hours prescription period or 40 of a 48 hour period) then you won't feel much difference. It takes the new patch time to start delivery, and depending on how low your current patch is your overall maintenance dose is likely starting to get low anyway.

Over the years I've added a new one as my current one was winding down. This helps to keep the overall dose constant and avoid any withdrawal symptoms. But each person is different, and it's important to know the signs of higher dosages if you're not tolerant to high levels of opiates.

Most Duragesic users know what's normal and what isn't when it comes to patch use over long periods of time, so when something isn't right, it's important to take notice of your symptoms. High dosages can come from different ways other than just adding a patch - increased activity raises body heat, which in turn increases the dosage delivery rate (that's why you're not supposed to expose it to heat or direct sunlight). The first symptoms for most are drowsiness and sometimes trouble breathing, depending on how tolerant they are. Confusion and loss of cognitive ability is the most common though - imagine knowing what's happening to you, but your mind can't direct your body to help itself, and you'll get an idea.

In such cases, the 2 things to do are to immediately remove the patch(es) (make sure you don't fold them - you can re-apply later contrary to what some think), and cool yourself down externally and internally. It's important to also let family/friends know about this as well, so that they know what to do if you suddenly start acting like a wacko. My daughter has had to help me a couple of times when I've become overheated and my dosage rate increased fast (I have an extremely high opiate tolerance level, so respiratory depression doesn't happen, just increased side effects).

If you're using breakthrough meds like Percocet or Vicodin, then your overall tolerance is higher than your patch dose anyway, Just make sure that if you overlap the patches, one is expiring.

The last thing you want to do is ask up front - in today's climate, even with the medical community more aware of opiates as a viable therapy, simply asking for pain meds will likely get you tagged as a drug seeker, and it'll really hamper yourself in the long run if you've got real pain issues.

If you've got real problems, then start keeping a Pain Diary. PD's are commonly used by first-time chronic pain patients (and even short term acute pain patients) to document their pain over time, giving the doctor a visual record of your problem, especially if there's nothing evident on X-rays, MRI's, CT's, etc. Real pain and recording it is extremely difficult to fake - most doctors, and other pain patients like myself, can easily tell when someone is BS'ing about having pain bad enough to require pain meds.

You also need to show that you've tried alternate meds and therapies, which is something most patients are willing to do; they just want a quick remedy for pain. Problem is, real pain has no quick remedy.

Seeing a Pain Specialist is also preferable than a General Practitioner, since they're authorized to prescribe more pain meds than regular doctors are. Regular doctors and the groups they belong to tend to pull back from any long-term prescriptions involving pain meds that are Schedule II (Duragesic, Percocet, Morphine, etc.), and even Schedule III and IV drugs (Vicodin, Codeine mixes, etc.)

It depends on your overall condition, reason for pain, your overall tolerance level, and the length of time you've been using Fentanyl Transdermal patches of any type. However, in general, if you're up to the task, then yes, it's okay, as long as you're aware of the potential risks involved.

Fentanyl patches (either Duragesic or its generic alternatives) work by slowly releasing the drug through a transdermal membrane into the bloodstream via the skin layer. The dosage delivery is controlled by body heat, and naturally any strenuous physical activity will increase your heart rate and elevate your core body temperature. This alone increases the dosage delivery rate, and if you're not yet that tolerant to the drug or opiates in general (rare since the patches are only supposed to be prescribed to prior opiate tolerant patients), then confusion or other increased side effects can occur.

As a long time Duragesic user and chronic pain patient on opiate therapy for many years (see my bio for specifics), I've experienced this several times while doing outside work or remodeling around my home. Even though I knew what was happening, the confusion level is so much that it's difficult to get out of the situation on your own. I describe it as being stuck in a loop you can't get yourself out of. Only removing the patch (if you do it properly you can re-attach it later - see my answer on that) or cooling your body to normal will alleviate the problem. It's also important to understand that opiates are Vasodilators, meaning they open the blood vessels (that's why you feel cold when the dosage tapers off - they start constricting). Opening the blood vessels wider naturally warms your body, but again if you're tolerant to the constant dosage over time then your body is already used to it.

However, if you take simple precautions to keep yourself from getting overheated (stay hydrated and cool while working) and your overall physical condition doesn't limit you from the work (e.g., you're dealing with extreme pain but are physically able to work), and you're prepared for what can happen (my family knows what to do if they find me in such a situation, and I always have my cell with me when working) then there isn't much you can't normally do that you didn't do before.

As you become more tolerant, the depressant effects will become less. I found years ago that a cerebral stimulant will help overcome the depressant effects to the point where I feel relatively normal. Of course I don't use them often, only when I'm using higher opiate dosages to control pain.

As far as driving, it's an individual situation. Not everyone handles opiate therapy the same way, and again only tolerant individuals can deal with the depressant side effects over time. I've never had any driving restrictions, though I've always been acutely aware that in any accident it would likely be an issue. Having said that, unless I told you that I was a high level opiate patient you'd never know as I feel normal most of the time. It's really a topic for your pain specialist and yourself, but if you've already got handicap driver plates or a placard, then your doctor has already signed off on the fact that he/she believes that you're okay to drive. How responsible you are is totally up to you. I won't drive if I need to increase my normal dosages to deal with increased pain.

You should also be aware of the fact that the patches will and do slow your reaction time, so you need to be more aware of safety factors and compensate for your slower reaction than normal when working. Also, remember that opiates work by altering the brain's perception of pain, and if you over-exert yourself, you could further aggravate your condition without realizing it until the pain becomes worse. Be smart.

If you're wondering, at my highest dosages I was using 2 100mcg Duragesic patches for primary pain, Percocet 10/325's for breakthrough (120/150 per month), 100mg Demerol tabs, and 30mg MS Contin tabs for pain. My normal dosages are 1 100mcg patch and the same amount of Percocet monthly. Those have been my normal dosages for about 9 years.

a drug dealer

Normally it comes out through the body's regular excretion process - kidneys, etc. During major withdrawals though, and if your dosage is high enough, it'll sweat out through your pores.

That's not a good sign, particularly if the itching is around the patch edges, and worse if it's the entire patch area.

Itching usually indicates either an allergic reaction to the patch adhesive material, or the patch material itself. If the entire skin area under the patch is itching, you likely have an allergy to the gel or the Fentanyl itself.

The other possibility is an irritant on the skin prior to patch application. This is common if you've cleaned the area with alcohol and not rinsed it well with water, or you've used some type of other skin product before putting on the patch. Shaving the area and then immediately putting it on can cause irritation as well if it's not rinsed well.

I think you mean Fentanyl, No it's not a good idea.

See the link below.

yes, every time I am in the hospital they put new patches on me and give me 1mg dilaudid IV. and at home I wear the patch and take 2mg dilaudid by mouth.

Depends entirely on the person and how long they've been taking it. The longer it's been taken, the longer it takes to leave. In general though, if another patch isn't put on, around 2-4 days.

You can, but you won't notice any effect other than maybe feeling a bit more relaxed. Fentanyl is the strongest opiate (100x stronger than morphine), and cannabis isn't even close to affecting anyone who's using patches on a regular basis.

$100.00 per patch?

This has always been a problem for Duragesic users like myself, particularly during the Summer months. However, there are several ways you can help keep your patch(es) in place:

1. If you're using Duragesic and not the generic patches (most people like me who've used Duragesic for years can't use them), Janssen Pharmaceuticals, the maker of the patch, has a program for users of their patch to deal with the problem. Qualified individuals are sent a package of Bioclusive cover bandages to place over the existing patch. Bioclusives are transparent bandages that work like any other, but are just transparent and have different properties. The Bioclusive is large enough to fit over a single 100mcg patch and hold it in place. The information is in the Duragesic box, or you can call them directly at the number on the back of the box. The Bioclusive program is one of the menu items. Note that it is ONLY for Duragesic users; if you're using the generic patch, you're not qualified for the program.

2. Skin Prep - Skin Prep is a medical adhesive skin preparation, normally used by Colostomy patients who have much greater adhesive/adhesion requirements. Skin Prep preps the skin by adding a thin layer of a chemical that increases the adhesion of whatever it's stuck to. The key to using this though is that you must be absolutely precise in its application where the adhesive edges of the patch are to go. If careless, you can block the skin area where the patch membrane is when you apply your patch, thus preventing a full skin area for drug release.

There are 2 versions of the drug; one stings, the other is a 'non-sting" version. But the stuff works.

3. Medical/Surgical tape - You can use medical tape on the edges also. If the patch has come off, don't toss it if it's still intact and not stuck to itself. Clean the area where it was thoroughly, then put the patch back on using tape on the edges to hold it in place. Once removed from the skin, the patch adhesive is no longer strong enough to hold it in place on its own, so it needs tape or something like a Bioclusive patch to hold it. It takes a bit of time, but if you've got enough Fentanyl left in the patch, it'll start transferring within an hour or more depending on your body heat.

Having said that, at times requiring 2 100mcg patches myself every 48 hours (I'm in a small percentage of the population that only gets 48 hours out of the patch) I eventually figured out that the best way to keep them from coming off while sweating was to ensure they were put on properly in the first place. The only way to do this is to remove all skin oils from the area where the patch is going to be.

Ah, you say - but the directions say not to use alcohol for skin preparation, right? Actually, yes and no - the directions say not to use alcohol and THEN apply the patch. The reason for this is that Isopropyl Alcohol leaves a residue that can block drug release. So how do you get around this problem?

The answer is to use Isopropyl to clean the skin area, the to rinse/flush the area with water afterward to remove any residue left by the alcohol. Be sure not to use any soaps either, as they leave residue also.

Having used 1 or 2 100mcg Fentanyl patches for over 10 years now, I've always used them on my biceps, since for me they're the best place which affords the least skin flexing. Where you place your patch has a major effect on its adhesive capability as well. Any patch must be placed above the waist; many cancer patients I've known who've used them prior to passing on had them placed on the back. Anywhere you place the patch is supposed to be free of any body hair, as even small hairs can interfere with the patch. I've use mine for so long in the same place on both arms that hair doesn't grow there anymore, but when first starting I had to shave the areas where I put the patches. If you're wondering, I switch arms every time I switch change patches. You must give the area where you place your patch enough time to breathe and replenish itself.

I also offer this advice to any Fentanyl Patch user; as Schedule 2 opiate patients, all of us know the extreme restrictions placed on us by Federal Law, including the "minor problem" of only being given 30 days worth of medicine, only to lose one or more to sweating. I learned many years ago to maintain at least a 30 day emergency supply of all of my opiate medications, both primary and breakthrough (120/150 Percocet 10/325's per month). It is not easy to save up that much - if you have a good relationship with your Pain Specialist, you can always ask for extra, but be absolutely honest in why you're asking for it. Having had more bad doctors than good, it took a long time for me to find a good Pain Specialist, so be sure you've got a good one before saying anything if you should choose to try and bank extras for emergencies.

In my case, I used my breakthrough meds to substitute for my patches on those days when my pain wasn't as bad. It typically takes me a year to save that much - I've always kept my doctor informed, and he in turn has always given me a little extra in my prescription when my emergency supply ran low due to problems with my HMO or some other stupid reason. But I had the same doctor for 9 years, and I was one of his best patients. Never break the trust between you and your Pain Doctor - ever.

Those who have specific or further questions concerning patch adhesion may email me at the address at the top of my Supervisor Bio page.

133 a box of ten "generic". 5 in a box

Never, EVER, cut a fentanyl patch! The patch is designed to time release the medication through the material. If you cut the patch, the medication's release will no longer be appropriately "time-released". Technically, you are supposed to wash your hands after applying the patch as well. Fentanyl is 80 times stronger than morphine and can easily put someone into a coma or kill them if they are abused. If these patches have been prescribed for you, it is imperative to follow the instructions exactly as prescribed, and to be certain to wash your hands after applying. Cutting a patch could inadvertently release the medication in a significantly quicker manner, and cause a lot of harm. It is very dangerous.

Nothing. just a lot of water and heat. Don't use a cotton, it'l clog your pin. It's thick, so u have to heat it and mix it a lot to suck it up.

50 mg would kill you dead. No question. The correct dosage you are seeking is 50 mcg, micrograms, instead of milligrams. The difference: 50mcg = .05mg 100mcg = .1mg 1000mcg = 1mg.

It depends on how you take it. I'm finding the most common answer to state potentially up to 3 days or 72 hours but it depends on if its a patch you wear, a patch you're putting in your mouth, or a pill you're eating. WEARING A PATCH ON YOUR SKIN SHOULD BE THE LONGEST DETECTION TIME BECAUSE IT WILL STORE IN YOUR FAT. I MIGHT BE WRONG BUT I THINK ORAL OR IV WOULD BE THE SHORTEST DETECTION TIME.

ULTIMATELY, GO TO A METHADONE CLINIC OR AN NA MEETING AND GET HELP. DON'T WIND UP LIKE I WAS. I'M 2 YEARS CLEAN NEXT MONTH AND I'M HOLDING 2 PATCHES RIGHT NOW AND DEBATING A REAL QUICK RELAPSE.

When used IV, they often start with 50 MICROGRAMS of Fentanyl for pain. If needed, they go up to 100 MICROGRAMS. In contrast if they are using morphine they give 1 MILLIGRAM then go up to 2 MILLIGRAMS. 1 MG = 1000 MICROGRAMS. So doing the math, the fentanyl is 20 times more potent (50 x 20 = 1000) The main difference is fentanyl wears off in an hour whereas the morphine will last 2-4 hours. Fentanyl is used in anesthesia, for pain pumps and epidurals where you need fine control. If you overdose with Fentanyl a single dose of NARCAN to reverse usually is all you need as the Narcan lasts longer than the fentanyl. If you over dose with Morphine you might needed repeated shots of the Narcan because the Morphine lasts longer than Narcan. The biggest danger of fentanyl is powdered fentanyl can be quickly absorbed thru the lungs or skin.

Depending what type of for you take Fentanyl in, it can vary. I'm on Actiq 1600 mcg's, it has a half life of 7 hours. Multiply 7 hours by 7 half lives you come up with 49 hours. So, since you last dose of Actiq, it would take 49 hours to clear your system. Give or take a few, depends on your metabolism. If you have access to read this. just Google your questions, that's where I get my info.

can you use lidocaine patches to keep fentyanyl patches one

Fentanyl is roughly 80-100x stronger than morphine. It is often used with benzos for surgeries. It is only prescribed for home use for those who are opiate tolerant, in otherwords, those who have been taking high doses of opiates for long periods of time, due to moderate to severe chronic pain. Use by those who are not opiate tolerant is extremely dangerous, and many people have died from abusing Fentanyl, just like any drug. Fentanyl is very safe for those who use it as prescribed and for a valid purpose, but is definitely not something that should be used by someone to, 'get high'. Abuse happens with this narcotic, just like with any other drug, but the likelihood of addiction is small for those using it as prescribed.