Duragesic Patches

I currently am on fentanyl 100mcg with 4mg dilaudid and 50mg ultram. The patch and dilaudid are for my cronic back pain after major back surgery to remove 3 discs associated with spinalcerebellaratrophy also called opca. The ultram is for migraines.

The amount of time it takes for the amount of drug in the body to reduce by 50% is called the half-life. It takes approximately five to six half lives for the drug to be cleared from the body. The half-life for fentanyl patches is 9.5 to 12.4 hours. Multiply that by 6 and it could take up to 74.4 hours to clear the drug. You can do the math. Fentanyl lozenges-approx. 7 hours.

Duragesic takes a few hours to kick in and is supposed to last up to 72 hours (like how Oxycontin is supposed to last 12 hours) but most people find it lasts 36-60 hours. From my experience I've found fentanyl patches to last about 48-54 hours. In regards to drug testing, assuming it's a UA, fentanyl takes longer to clear than most opiates, it would take AT LEAST 48 hours after the removal of the patch (assuming you wore it for at least 2 days)

A standard box of 5 patches (100 micrograms NOT milligrams) costs on average around $300 US if you don't have any insurance to pay for it. That's for Duragesic - generic Fentanyl patches may be lower.

Fentanyl originally was developed as an anesthetic, and is still widely used today for surgical procedures where the patient needs to be conscious (relatively) and able to respond to commands (e.g., bronchoscopy). Fentanyl is 100 times more potent than morphine (100 micrograms of Fentanyl is equivalent to 10mg's of Morphine). Fentanyl patches (Duragesic, e.g.) use concentrated doses of Fentanyl delivered to the bloodstream transdermally over extended periods, which make them ideal for long term chronic pain patients.

minimum 50 cents micro-gram per hour 1 microgram is .001 milligrams

$85 bucks cash for a 100ng/hr patch is high price between 50-70 is reasonable. Cheaper sometimes in the midwest and out east.

Yes, my doctor just prescribed them today. I have pain on top of the foot fm big & 2nd toe to ankle (just the foot, not into ankle)- sudden electric shock raw nerve pain w/ movement- no bone issues. Not sure of exact cause, but I do have RA & that does nasty things all over the body, altho it's usually both sides & not just one. Doc said will prob have to have surgery, but we are trying the patches & orthotics 1st to see if it helps.

As to if the Lidoderm patches help, I can't answer that one yet. They were $273 a box- something to think abt depending on your insurance situation & what is causing your pain. At least discuss it w/ your doc.

No. This can cause a potentially lethal overdose. Venlafaxine is a cytochrome P450 3A4 inhibitor which is the enzyme which metabolizes fentanyl. Levels of fentanyl can reach lethal doses as a result of this combination.

The Lidocaine patch will float off your body and get sucked up in the pool's filtration system. Since these patches are pricey, you may want to time your swimming during the patch-off periods or remove the patch temporarily and replace it on the sheet of clear plastic to which it is attached when you first open it....bring the packaging with you. Skin has to be clean and dry...no chlorine or salty water residue either....before re-applying the patch again. You are not supposed to re-apply them, but it is possible...just be mindful of the "12 hours off and 12 hours on" rule. Some patients use medical tape to keep the patch securely on the skin after re-applying.

fentanyl will not show up on a standard urine drug screen. While it is an opioid analgesic of the same class of morphine, it is in a different subclass. Fentanyl is a synthetic opioid were morphine is a natural occurring opioid that is extracted from the poppy plant. The chemical structure is very different between these two substances which leads to different methods of metabolism in the body. The urine drug screen picks up the metabolites of typical drugs of abuse such as morphine or codein or hydromorphone. While the metabolites of fentanyl can not be detected in a urine drug test. Other drug screens are available for such drugs but must be specially ordered for direct suspicion of such substance abuse

Just like any opiate, you'll start feeling the withdrawal effects, but they're gradual, not like pills, happening over a couple of hours. Usually you'll start feeling cold/clammy first, then if you haven't replaced it in time, the rest of the usual withdrawal symptoms kick in.

It depends on the patient - by instruction, the patch must be applied on the upper torso or upper extremities (arms). Most people tend to put them on their back or chest, but I learned early on that for the back you need someone to change them, and the chest/stomach area has both too much hair and the skin flexes too much with activity.

As a result, for many years I've worn them on my biceps - they're flat, the patches easy to put on them with one hand, and the skin doesn't flex very much there. When using 1 100mcg patch, I just switch arms when it's time to put a new one on. When I have to increase to 2 100mcg patches, I use both arms, but take one off a few hours before the other to clean it and let the skin breathe before putting on a new one and taking the other one off. That way your dosage doesn't drop much during the process, and if you feel breakthrough you can take a Percocet or whatever your breakthrough med is to cover it.

The key to keeping a patch on (see the link to my answer on that below) is to make sure the skin is clean and there's no hair present. The literature says not to use any Isopropyl alcohol - that's because it leaves a residue. Problem is, it's difficult to remove skin oil and dirt without it. To get around the problem, clean it with Iso, then rinse the area well to make sure any residue is washed off. Dry the skin well, then apply the patch. If there's a lot of hair or micro-hairs, you might need to shave it off as well. Before you put the patch on, hold it between your hands (still attached to the backing) for about a minute to soften the adhesive. Apply it, then put your hand over it for another minute to ensure the adhesive gets a good bond to the skin. You'll find it sticks pretty well after that.

strong enought that if your arent opiate tolerant that the lowest dose of the patch will make you overdose, dont be stupid, when it says for opiate tollerent patients only it really facking means it.

No - they are 2 completely separate drugs. OxyContin is the time release version of Oxycodone, and typically lasts from 7-12 hours.

Duragesic / Fentanyl transdermal patches are timed release fentanyl over a 48-72 hour period. Its release is regulated by body heat. It is a much more reliable and steadier drug than OxyContin, in that it doesn't wear off as fast, and it lasts a lot longer.

The precursor used is N-Phenethyl-Piperidone (NPP) which can be easily synthesized from Piperidone and Phenethyl-tosylate or Phenethyl-bromide through a simple SN2 mechanism.The NPP is reacting with Aniline giving the Imine derivative which is reduced to the 4-Anilino-N-Phenethyl-Piperidine (4-ANPP). The 4-ANPP is then reacted with Propionyl Chloride giving Fentanyl which is then purified.

It's extremely common for Duragesic patients to have Hydrocodone, Oxycodone, or other acute opiate meds (Demerol, Methadone, etc.) as their breakthrough medication. Remember that patches are for primary, chronic pain; increased activity can cause the pain to increase past the point of patch effectiveness, which is termed "breakthrough pain". In those cases, an acute (short term) pain med like Vicodin or Percocet is used to deal with the short term increase.

I myself have used Percocet 10/325's for about 10 years in conjunction with my patches, about 120/month. At some point though, if breakthrough becomes constant, then it's time to re-evaluate the need for a higher dose patch or patch combination. I've had to deal with this several times over the years, and I prefer to use pills because it gives you more spot control of the pain. But for severe increases (see my bio for more), adding another patch is really the only way to go.

It is different for each person, and also dependent on how long you've been using it. Higher levels take longer for the body to remove over time. In general, you'll start feeling the withdrawals within 6 hours after total depletion of the patch contents, and really feel it at 12 - 18 hours. This does not mean that it has left your system - it means that your body's Fentanyl level is below what it has become used to and is reacting.

The longer you use Duragesic, the harder it is to end your overall dependence. As I write this, I'm in the final stages of ending my own 11 year dependence on Duragesic and Oxycodone, Demerol, and just about every other known chronic and acute pain medication. It has taken 6 months of continuous lowering of my opiate levels, and 2 hard withdrawal periods.

For those who haven't used it for very long, it is usually out of the body within 72 hours, assuming good kidney function. However, few people like myself are ever prescribed Duragesic for a short period, and if they are, it's due to a doctor's incompetence. Duragesic is intended for long-term, opiate tolerant, chronic pain patients only, and not as a short term pain medication. Fentanyl is 30 times stronger than morphine, and I can tell you it is not easy to end your dependence at all.

For those who disrespect and attempt to misuse Duragesic, it's not a problem, since most people usually kill themselves in the process, not realizing just how strong it is, and how fast it can kill you if you are not tolerant to opiates - and by opiates, I don't mean minor street drugs like Cocaine or Heroin. For true long term opiate patients, stuff like that is nothing, and it's why addicts fail to realize the dangers of Fentanyl misuse until it's too late.

to get high if you cut it open and lick it or rub it on your mouth its absorbed right away the patch is time release through the patch eight to twelve hrs so if some one is doing this its probably to get high

You can, but they are typically not prescribed together since they perform the same function - long term dosage delivery of opiate for chronic pain. They can be prescribed together when the patient is making the transition from OxyContin to Duragesic or vice-versa, but there's really no reason for it. All Duragesic patches come with information instructing the patient and doctor on the minimum starting dosage with a morphine equivalence chart that allows them to estimate your current equivalence with the drug you're using to the equivalent Duragesic dosage. Janssen Pharmaceuticals does skew the dosage estimates lower than they normally should be though for safety reasons, since all patients should start at the lowest dose and then work up to maintenance levels.

The difference is in the time factor - OxyContin has an advertised dosage time of 12 hours effective dosage, while Fentanyl patches are good for either 48 to 72 hours depending on the individual. For most people it's 72 hours, but a small percentage of the population (myself included) only gets 48 hours.

Since they're both controlled delivery drugs, Fentanyl patches are often prescribed when OxyContin tolerance has lowered to the point where the patient is only getting relief for about the same time that an acute pain medication does - just over 6 hours. Before I started using Duragesic, I was barely getting 7 hours out of OxyContin. The idea in pain management is to maintain a controlled dosage with less medication at a steady rate over long periods so that the patient doesn't have to rely on more medication to achieve the same results. Of course as tolerance increases, dosages may have to be adjusted, or increased if the pain increases. I've had to do this several times over the many years I've used Duragesic, but ultimately was able to return to my normal dosage levels after the reason for increased need was dealt with.

the fentanyl patch is a long timed system patch in which it lasts up to 72 hours per patch and dosage in your system compared to the tablet of Oxycontin in which it only lasts about 6-8 hours per pill depending on dose and your tolerance of pain medications

The peak of pain relief provided by the Fentanyl transdermal system is between 12 and 18 hours after application.

If your patch can't be reapplied (and as long as it isn't folded over on itself it can be with medical tape or a Bioclusive bandage) then yes, you apply a new patch to replace the one that came off.

Typically you won't start feeling withdrawals for several hours. If you have one of those doctors who isn't forgiving on your patch quantities, you can always use your breakthrough meds to cover the period you lost between patches.

After many years, I learned to bank extra patches to deal with such problems (try to stretch the period between patches using breakthrough meds). The key is really to make sure they stay applied - Skin Prep is a good product to help adhesion, but cleaning the skin properly is the best. Though the literature tells you not to use alcohol, what they don't want you to do is use it and then apply the patch, because Isopropyl leaves a film. You can use it as long as you rinse the area and dry it, then apply a patch.

Selecting a good spot on the body helps also. I've always avoided my torso since the skin tends to stretch more with activity, and that's the cause of most patch adhesion failures. Use the bicep of your arm - it's wide enough and flat enough, and doesn't get that much flexing during regular activity. Swap arms during your patch change.

You can't.

On first application it usually takes 24-72 hours for serum concentrations of fentanyl to reach a peak,

so it may not be until the second patch has been applied that a steady-state concentration is reached.

Break-through analgesia may be required initially. Wean other analgesics slowly after the first patch.2

The patch should be changed every 72 hours.

Duragesic patches do - you can get a $50 coupon for your prescription from the Duragesic site, and they often include them in the boxes. For me it's enough to take care of my copay.