Duragesic Patches

All Duragesic users experience withdrawals on a regular basis - it's the nature of using them. However, you can avoid the minor withdrawals if you overlap your patch changes. It takes several hours after your patch expires (or it's removed) before you really start to feel it. Initially you'll just feel cold and clammy (opiates are Vasodilators, meaning they open the blood vessels - the reason you feel cold is because the blood vessels constrict)

Duragesic takes several hours to ramp up to full dosage delivery, and the same goes for when it's running out. Eventually you'll learn when the dosage is low enough that you'll start feeling the first signs of withdrawals - not really that strong, but enough to get your attention. Severe Fentanyl withdrawal is not a good time, so never let yourself get that low on your meds. Try to stretch your patches so that you've got one or two extras at the end of the month - I've always maintained an emergency 1 month supply just in case.

The trick to avoiding the withdrawals is to know when your current patch is winding down. If you add your new patch as the other one is winding down, you'll find that your dosage level remains fairly constant, as one is ramping up to full dosage while the other one is expiring. You can always use your breakthrough meds if you need to if the expiring patch is too low.

Like any patch, you won't feel any withdrawal effects for several hours. After that, depending on your dependence level, the withdrawals will increase steadily over time. 25mcg patches aren't very strong, so you'd probably be through it within a week, depending on how long you've used them.

However, like any opiate, it's not recommended just doing it cold turkey, as the withdrawals can be pretty bad if you're not used to it (and bad enough if you are). There are many ways to ease the process, but in general you should have someone staying with you, keep hydrated (Gatorade is great), and warm (opiates dilate the blood vessels, so when the level decreases your blood vessels constrict, making you cold and clammy). Getting a doctor to prescribe an anti-anxiety and nausea med really helps. I've also used Flexeril and Naproxen to ease the discomfort, as well as just to knock me out.

One way I've done it in the past (I've had to increase/decrease my patch dosages many times over the years) is to use decreasing levels of breakthrough meds (Percocet in my case) and OTC meds (I use Tylenol ES Rapid Release geltabs, Bayer Back & Body aspirin) to help deal with the withdrawal pain.

The final key ingredient is mental distraction - Internet, or in my case, a large game and video collection. As long as you're focused on something other than your discomfort, it's a big help.

Severe withdrawals are a lot like having a really bad case of the Flu - it's uncomfortable, but unlike Flu, it won't kill you.

Yes, but it is used and prescribed with many restrictions. It is a DEA Schedule II controlled substance, and as such, restrictions are:

1. Patients can only be prescribed a 30 day supply.

2. Prescriptions must be new every month - they cannot be called in.

3. No refills are allowed.

It's the same for all Schedule II opiates, but for those of us who use them, it's an inconvenience compared to living with extreme pain on a regular basis.

I faced a similar problem in 1999, when I was using OxyContin for a year, and my doctor kept trying to get me to move to a 100mcg patch. My only regret is that I didn't listen to her and do it sooner.

I can guess your reluctance, as it's probably the same as mine was; increasing your opiate dependence. But in the long run, you actually wind up using less medication, as your stomach and kidneys can only take so much if your pain levels are high enough and the drugs you've been using are not doing the job. Remember that the stuff you've used in the past is for acute (short term) pain, not constant chronic pain, and only lasts a few hours. Duragesic is for long-term, constant chronic pain, and lasts 48-72 hours, and trust me when I say that it works. Of course you'll run into days where you'll need to use breakthrough drugs, and eventually your tolerance level will require you to increase your dosages. But the alternative is constant agony, and Duragesic at the very least gives you back some semblance of a normal life. Eventually you'll become tolerant enough that you won't even notice it. I've used up to 200mcg's (2 100mcg patches) for many years, and at my tolerance level I feel fairly normal, save for the fact that my pain isn't there.

Using patches comes with a price, and it's a quality-of-life decision not to be made lightly. None of use likes dealing with the restrictions placed on Schedule II opiates, but on the flip side none of use likes to be in constant agony either. You need to consider your long-term prognosis, and if it's going to help you live a better life, then use it. The side effects aren't much different than any other opiate, though mood swings can be more often. But if your pain level is that high, you already know that you can only keep up mental focus for so long before the pain changes your mood anyway. Duragesic at least increases the periods between those changes, and as long as your family and friends know what to expect (my wife just closes the door to whatever room I'm in), it's okay.

If you're wondering, over the years my prescriptions have been:

1 -2 100mcg patches

120/150 Percocet 10/325's per month

100mg Demerol tab

30mg MS Contin tabs

I also use 30mg Fiorinal w/Codeine for migraines (Butalbital/Aspirin/Caffeine).

yes

it s noticable within a 1/2 hour of appliying a patch.

The loly-pops are imediate

Patches are long acting and the manufacture states full effect in 17 to 24 hours. Your doctor should provide you with a "fast acting" pain medication like Percocet, to use until

the patch takes effect. The medication remains in your body for 17 to 24 hours after the patch is removed.

Technically, no.

Absolutely - in fact, you should take it off if you start feeling increased side effects. That's not uncommon if you get overheated during physical activity, or your patch is exposed to heat from another source and it increases the dosage delivery rate.

Just make sure that the edges don't get any dirt or hair on them, and you can reapply later on. If the adhesive is too weak to reattach (not uncommon) you can use a Bioclusive bandage or medical adhesive tape to reapply. It doesn't take long for the dose to start flowing again.

Of course, if you accidentally fold it over onto itself, you're screwed.

Dependence and Tolerance are the most common, but that's true with many drugs that require long term maintenance doses. I've used them for 9 years now, and I've learned how to lower my dosages if I need to after I've had to increase them. My normal dose is 100 mcg, but I do occasionally need to increase it to 200mcg.

Duragesic is well tolerated over time. Most of the time I forget I'm wearing them, and the effectiveness cannot be overstated. For long term chronic pain, there is no better drug.

If you go more than seven days without a patch, you could get pregnant. Either put the next patch on a day earlier to shorten the patch-free interval, or use a backup method of birth control for the first seven days that you use the next patch.

It MUST BE applied ABOVE THE WAISTLINE. From there, it should be in a relatively hairless area, and one that does not see a lot of skin stretching/movement.

Personally, I use both of my biceps; they're flat, smooth, have little hair, are easily accessible for swapping new patches, easy to clean, etc. Others who have needs requiring several patches at once often use their backs; the chest isn't a great area due to the amount hair.

Everyone's different, but in general it takes several hours (especially if you're already opiate tolerant by using OxyContin) for Fentanyl to achieve a dosage equivalent to what you're taking. You want to adjust your patch attachment time so that when your OxyContin dose is going down, the patch dose is ramping up.

Your doctor should have already told you this; keep in mind that initial patch doses are skewed toward the low end of the dosage chart for safety, so your initial dose might not cut it. Make sure you've got enough breakthrough meds available until you can get your patch dose correct.

No - in fact, if you're running a fever, you should remove the patch anyway. Increased body/skin temperature increases the dosage delivery rate through the skin, and if you're not careful or aware, you could easily wind up with a fentanyl overdose, or worse.

The biggest indication is you'll start feeling disoriented and confused - get the patch off and get cooled down as fast as possible if that occurs.

I have never had good luck trying to reapply Fentanyl patches. Once they are removed from my skin, I can never get the same level of adhesiveness from them. They might have been just as potent, but it was hard for me to tell because I usually would wear more than one patch at a time in conjunction with eating them (this is very dangerous and can kill). I would recommend keeping the patch on if at all possible. If it is already off, do your best to tape it back on to yourself and hope for the best.

NEVER use Fentanyl for recreational purposes. Multiple patches and/ or overdoses can KILL.

The literature for years has always recommended taking the patch off, folding it over on itself so that the adhesive sides stick to itself, then flushing down the toilet.

However, if you've got a septic system, I wouldn't recommend it as they don't break down. Personally I've always folded them over and tossed them in the trash, but I don't have small kids or have to worry about anyone nosing through my trash either. It's essentially dependent on your own situation - if you're in an environment where used patches might be abused (even small residual amounts can make non-opiate users pretty sick) then flush 'em.

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That's a tough one, and it comes down to several factors.

The bottom line is once you're at a decent tolerance level, you can drive. However, the reality is that if you're involved in an accident and you're at fault, your opiate dependence is going to be an issue. Essentially it comes down to quality of life, and making sure that whenever you drive, you're not being affected by the drug.

Most Fentanyl patients become highly tolerant after several weeks of regular use, and after that period you really don't notice any impairment - in fact, the pain you're taking the drug for is more of a driving distraction than anything else. But again, current laws are pretty anal when it comes to pain patients - most governments and law enforcement don't like to make a distinction between opiate dependence and opiate addiction, even though there is a clear line between the two.

My point is that you can, but be sure you're cognizant enough before you do to avoid any problems.

No - in fact, virtually all pain specialists/doctors who prescribe Fentanyl patches will require you to only use one pharmacy, unless otherwise agreed upon, as part of your pain management contract.

It depends totally on how long you've been using patches, but if it's even a couple of months, I wouldn't recommend it. You might make it few days, but trust me when I say it's not easy, even for someone like me who had experience increasing and decreasing my dosages several times over many years.

If you want to do it, you really need to have some type of acute meds around, though if not, you can get away with Naproxen, Tylenol (extra strength rapid release gel tabs) and Aspirin. Plan to try and sedate yourself, and have someone around to help you through it. Ask you doctor for some anti-anxiety meds to ease the shaking, and keep plenty of water/fluids around, as you'll be sweating like you won't believe. Keep some clean bedding and dry clothes around too.

It's easier if you've got Percocet (just drop the dosage in increments until you're off the patches - Percocet's easy after that). Doing it without a an opiate to help is extremely difficult, even when you're prepared and can sedate yourself.

No! You can not eat it with Fiber, with fruit, with nuts, with anything! Eating fentanyl will kill you!

Absolutely - Hydrocodone and Oxycodone are typically prescribed along with Duragesic as breakthrough pain meds.

The urine drug screen would be positive for opioids.

The lidocaine patch may have rare negative interactions with digoxin (Lanoxin) or any medications for irregular heartbeats. Some antibiotics, antidepressants, and monoamine oxidase inhibitors (MAOIs) may adversely react with the lidocaine patch

You really shouldn't - either direct heat to the patch or increasing overall body temp increases the dosage delivery rate to the bloodstream, and if you're not aware of the symptoms and how to deal with it, you can get into real trouble. You can get disoriented pretty fast, and if no one knows what's happening and how to help, it just makes things worse.

You can always take the patch off and re-attach later - see the link to my answer below on how to keep them applied. If it's not feasible, then at least be cognizant of how much time you're spending on the table and how much you're being heated. If the staff doesn't know you're wearing a patch, then tell them, but don't assume they know anything about how to deal with opiate overdoses. Most staffers these days aren't nurses, and even many RN's don't know how to recognize or deal with fentanyl overdose symptoms, particularly if they don't know you're wearing patch.

Everyone's different of course, but in general, any meds that increase metabolism or are respiratory depressants should be avoided. Usually anyone who's opiate tolerant enough to use Fentanyl patches on a regular basis isn't going to have problems with respiratory depression/arrest, but you don't want to push it if you're not sure.

Anything that increases body metabolism (e.g., Ritalin, Adderall, Phentermine, etc.) or raises body temperature should be discussed with your doctor prior to use also. Fentanyl patch doses are released transdermally through the skin, and are activated / controlled by body heat. Any increase in metabolism tends to lead to an increase in body temp, and that in turn can increase the dosage delivery rate to the point where you'll get the effects of overdose. The indications are confusion, dizziness, and a general feeling of helplessness and being "stuck in a loop" that you can't get out of.

If you start feeling that way, the 2 things you need to do are to take the patch(es) off (don't fold them - you can re-apply them later with Bioclusive bandages or medical tape on the edges), and get into a cool shower to lower your body temperature quickly. Drinking something cold to lower your core temperature helps a lot also.