Duragesic Patches

You can, but you must be aware and extremely careful that you don't become overheated (body temperature) or let a patch become exposed to sunlight. The patch dosage is regulated by body heat, and if core body temperature rises or if the patch is heated externally, the dosage delivery rate increases significantly. If you're not aware of what's happening or what to do, you can easily find yourself in a confused or delirious state, or worse if you're not that tolerant to high doses of opiates.

It's important to understand the effects to recognize the symptoms when they first occur, and to also educate family/friends on what to do if you start acting confused and it appears you're overheated. While it affects each person differently, I can only describe it as like being in a loop you're stuck in but can't get out of. You know what's happening, but your mind can't process enough to help yourself. Feeling completely helpless is a good description.

In such instances, the key is to both cool down your core body temp, and to remove the patch immediately (you can reattach it later as long as you don't fold it over on itself) to stop the dosage delivery through the skin. It takes about an hour or so before you're feeling fairly normal.

Over the years, it's happened to me several times when working around the house when it's hot during the summer, and it overtakes you pretty fast if you're not aware of what's happening. I have an extremely high opiate tolerance, so respiratory depression has never been a factor for me, but the mental confusion that comes with it is very unnerving to say the least. If it comes at a really bad time (operating equipment or driving) it can be much worse for you and others.

If you're working outside, make sure the patch is covered by clothing so it's not in direct sunlight, and that you keep well hydrated to maintain normal body temperature. Don't forget that increased activity will increase sweating, so if you've got problems keeping your patches on keep that in mind as well.

It depends on how long you've been using them, but generally if you've been using long enough to become tolerant without constant headaches and other side-effects, then it's likely your getting headaches from increased dosage regulation.

Duragesic and other Fentanyl patches are regulated by body heat; normal dosage is transferred through the skin to the bloodstream when the body's temperature is normal. However, if the patient becomes overheated (fever, sunlight exposure, increased activity) the dosage regulation increases, and so does the side-effects. Along with headaches, if the dosage gets high enough (no pun intended), you'll also feel dizzy, disoriented, and sweaty. That's why the literature specifically tells you to keep the patch from direct sunlight or heating pads.

It is not something to take lightly if this is what's happening; the easiest way to deal with it is to take the patch off (by the edges, and don't fold it - you can re-attach it later) and cool yourself off inside and out to get your temp back to normal.

If this isn't what's happening to you (you'll know if it is or isn't) then I'd suspect either another drug you're using in combination with the patch. You have to be opiate tolerant to be prescribed Fentanyl anyway, so if you've not had problems with other opiates it's unlikely the patch is the culprit. The key is whether or not your headache is constant or occasional; if it's constant, the patch could be contributing. If not, then you need to look at what you've taken prior to the headache. Keep in mind also that Fentanyl won't deal with a headache; even as high dosages as I've used, I still got serious migraines, and had to use Fiorinal w/ Codeine to deal with them (been using it for over 20 years).

On another note, there's always the possibility if you're using a generic patch that it's the patch ingredients themselves. Generics are "chemically equivalent", bu they're not always "quality equivalent" to the brand name. I've had problems in the past with both generic patches (when they first came out I had been a Duragesic patient for about 8 years) and generic Percocet as well. To this day, I always pay more for brand meds, because I know the quality and potency will be what I'm used to. For long term opiate patients, drug consistency is a bigger deal than doctors tell you.

Yes, Believe me my Probation officer would second that. Because I broke my sternum, all my ribs, collarbones, and 9 burst vertebrae and my a miracle of God cal still walk. There was nothing she could do about it given that I had a prescription. She's very open with me and told me they only recently were able to detect this drug despite being discovered in the 50's and 60's depending on who you believe (50's or 60's and which scientist discovered it. I believe the scientist that discovered it was from Germany hope this helps. And Masking agents do work at hiding it in urine tests if you go with Terminator Gold or something similar. Just follow the directions to the "T"

you don't.it should be prescribed to you in the first place..........which is acceptable on any drug test if you have chronic pain

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.

Transdermal fentanyl patches (Duragesic) are a common example of a long-acting opioid drug often used for cancer pain management.

It depends on your opiate tolerance level, but for first time users you should start feeling it around 3-6 hours after application.

A number of factors affect the dosage rate as well - adhesion to the skin, body temperature (which regulates the dose), and again, your tolerance level. Doctors typically prescribe the lowest dose first, and it's important to know that the dosage equivalence table (Fentanyl-Morphine) used to determine the initial dose is purposely skewed to the lower end for safety reasons. As such, its not uncommon for first time users to not get the desired effect on the first patch dose, and it's something you need to tell your doctor about.

Keep a record on how well (or not) it's affecting you so that you can show your doctor you need to increase if you need to.

Feels good if you've got the tolerance for it... But fentanyl in the right dose works WELL all by itself.

Not so much affected to stomach. from patch fentanyl directly goes to the blood with out stomach.

Side effects of using Fentanyl patches are pretty common. Mood swings (typical with most opiates), urination (you won't feel it until you're ready to bust), respiratory problems (if you're not tolerant to the drug - if it happens at all call your doctor immediately), euphoria for first time users (until you get used to it). 25mcg is a pretty low dose, but if you're not that tolerant, increased body heat can increase the dosage delivery to the bloodstream. In such cases it can lead to confusion - as a 200mcg patient myself, it's happened to me several times over the years. You literally feel like you're stuck in a loop you cannot get out of. If you ever feel this way, remove the patch immediately (you can put it back on - just don't let it get stuck to itself. See my answer on keeping patches applied). Opiates are Vasodilators, meaning they open the blood vessels wider. As long as your body heat is higher from exercise or moving around, the drug will continue to be delivered at a higher rate, and if you're not that tolerant it will affect you adversely. It is difficult to realize what is happening to you, harder still to do anything about it until your body heat returns to normal. You should alert family and friends about what to do if they find you in a confused state and it's apparent you're overheated. Tell them to get your patch off and get you cooled down. Fentanyl takes several hours before you'll feel any withdrawal symptoms at all, and you should be well recovered before then.

If you have specific questions about side effects you can email me at my WA email listed on my Supervisor bio page. After nearly 10 years, there aren't many side effects I haven't experienced from it.

Additionally, nausea can be a major problem. As a 300 mcg patient, I lost 40 lbs. in 3 months. Zofran helped, but Marinol worked best .

if you rub it on your gums and are not opiod tolerant; 1-2hrs maxium, re rubbing fentanyl opiod analgesic onto gums.

It depends - if you're just removing it by the edges, you're not going to get any real contact with the gel. If the patch is cut and you come into contact with it, that's a different story, but if you wash it off quickly, you'll likely not have any problems with it.

The contact issue only affects non-users if the gel comes into contact with the skin, since the gel itself contains a concentrated amount of Fentanyl within it. Used patches approaching the 72 hour mark (I used to change mine at around 68 when I was on a 3 day dose, 44 when I changed to 2 days) are already pretty depleted of the gel, but it's still good to take precautions when handling used ones.

For the newer non-gel patches, you'd need to have skin contact for at least a few minutes to get any real exposure, as the dosage delivery is generated by body heat. Even so, with or without gel I'd recommend using either your fingernails or a pair of tweezers to remove the patches by the edges, then fold it in half per the patch literature and dispose of it, you're pretty much covering yourself from exposure. The best option if you're removing old patches is to just use nitrile gloves - you can't use them for applying patches, but you can use them to remove and dispose of them. Just grab the edge, pull it off, fold it and dispose, or if just one, hold it in your gloved hand then pull the glove off over it and dispose.

Yes, fentanyl and phenergan together can act as a respiratory suppressant and may shut down your respiratory drive. I learned this after my mother who uses fentanyl for pain related to her multiple sclerosis was given phenergan for bronchitis and a few days later was found not breathing in bed.

There aren't many studies or data available on long-term Fentanyl (or opiate for that matter) patients for a variety of reasons, but in general it's because that until the last few years, opiate therapy wasn't really widely accepted, and it still hasn't been by all doctors. The other reason is that opiate patients typically tend to be terminally ill, so they're not around long enough to study the effects on. A smaller percentage of patients are long term chronic pain patients and Duragesic users like myself, but the number is growing who are being prescribed it.

Pain management hasn't really been at the forefront of medicine until the past few years. However, again it comes down to a quality of life decision - if you're in constant extreme pain 24/7/365, it doesn't make a difference what the long term effects are - I guarantee you that the short term effects of that pain will kill your spirit long before the effects of long term opiate use will.

For any long-term user of Duragesic like myself, it is fundamentally a quality of life decision to start or continue with opiate therapy. Of course there are long term physical considerations, and the normal side effects of opiates in general (mood swings, urination problems, constipation, etc.), but those can be dealt with as long as you learn how to deal with them. The reality is that if you're in enough constant extreme pain to require Duragesic use, then long term effects aren't really an issue, as the extreme pain will kill your spirit long before the effects of using opiates long term will.

If you're referring to stored patches, they can, but if stored in a cool dry place in the original packages, they can last for a very long time. They're damaged by heat, as it's body heat that regulates the flow of the drug.

I keep mine in a plastic container in a nice dark, cool room.

Duragesic and other Fentanyl patches release Fentanyl dosages transdermally (through the skin and into the bloodstream). The dosage is regulated by body heat, which is why immersing the patch in hot water, exposing it to sunlight, getting a fever, or engaging in activity that raises core body temperature, can increase the dosage delivery rate and cause problems if the patient/family/friends aren't educated on the precautions and what to do if they start feeling the effects of an increased dose.

No, Drug interaction Moderate level. Talk to your Dr. And or Pharmacist.

No - anything that insulates the patch can cause body heat to increase in the patch area, which will increase the dosage delivery rate of the patch. If you don't have a really high opiate tolerance above what your normal dosage is, an overdose is a real possibility. Even for someone with a high opiate tolerance, it's not fun - delirium/confusion is the usual result, and it's extremely disorienting, even when you know what's happening. The only way to deal with it is to remove the patch and get yourself cooled off to lower body temperature.

Just don't fold the patch - you CAN re-apply it if the edges are intact.

If you're having problems keeping it on, check out my answer on ways to keep it on at the related question link below (How do you keep Fentanyl patches applied?). There are many other ways to keep it stuck to your body.

From what i have experienced yes, now let me clarify that i was taking something akin to the patch but using intravenous which always gives a stronger feeling but 25 mgs is pretty low of methadone ( i am currently using 135mgs daily) of the syrup at a clinic but overall yes i believe that it should easily breakthrough but heed a warning if you are not a longterm user of opiates dont even touch the patch

The link to the Duragesic Conversion Tables is below.

For oral Dilaudid (hydromorphone) the equivalent dose would be between 75-80mg's.

Duragesic Transdermal patches use normal body heat to regulate the dosage over 48-72 hours. If body heat is increased, the dosage delivery rate is increased as well. This can also happen if the person exposes the patch to sunlight, or is engaged in physical activity that raises core body temperature.

Depending on the overall dependence and tolerance of the patient, the effects can be minimal or deadly. Having an extremely high tolerance to Fentanyl after many years, I've occasionally had to deal with the problem, and it's not easy. For most, respiratory depression is the first problem, but for tolerant patients, confusion and disorientation is the biggest problem. I've equated it to being stuck in a loop that you can't get yourself out of without help.

It's important to let family and friends know what to do in case you start acting this way - have them get you to remove your patch and get you cooled down immediately (shower, drinking water, etc.) to lower your body temperature. Make sure you don't fold the patch over or ruin it as it can be reapplied with tape or a Bioclusive bandage after you've recovered.

Yes

20 mg of Opana ER

i would call a poison control center...