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Duragesic Patches
Duragesic is a trade name of fentanyl transdermal therapeutic system, which is used to relieve moderate to severe pain. A patch of Duragesic may provide pain relief for 72 hours, but it may also result in some adverse drug reactions.
226 Questions
Fentanyl Death from Eating the Gel?
Duragesic and other Fentanyl patches contain Fentanyl suspended in a gel solution, which is delivered transdermally over a 2-3 day period to the patient. Since it's a timed-release drug, cutting the patch and eating the gel bypasses the timed-release function and instantly gives the person a massive dose of Fentanyl, which even for highly opiate tolerant patients like myself, can be extremely dangerous or fatal. For most who are on high doses, the effects are usually confusion or delirium; for those who aren't opiate tolerant or use drugs like Cocaine or Heroin, the effects are usually fatal, since Fentanyl is 100 times stronger than Morphine.
Fentanyl users have the drug in their systems 24/7, and as such, build up a very high tolerance to its effects. Patient who start using it have already used other opiates for some time, and already have a high tolerance before using it. Those who aren't regular users and aren't tolerant to the effects usually die of respiratory or cardiac arrest, or a combination of both. The most common cause of death though is ignorance and a lack of respect for how powerful an opiate Fentanyl is.
Why does amiodarone interact with Fentanyl?
Scientists don't yet know why. The original research was done on patients taking oral amiodarone to control abnormal heart rythms who subsequently received a fentanyl infusion during surgery. These patients had a greater risk of severe bradycardia (very low heart rate), hypotension (low blood pressure) and cardiac arrest.
Which is better for controlled pain Fentanyl Patch or Methadone?
Fentanyl patches are better for pain (chronic pain) due to the idea that the patch releases a steady stream of medicine over time whereas taking a methadone tablet what happens is that you get the first pass effect, meaning that your liver begins to detoxify the methadone right from the beginning. Also, if you forget to take the tablet exactly on schedule then you could end up chasing the pain, ie. it is much easier and takes much less drug to maintain your analgesia rather than trying to catch up after forgetting to take your tablets, even for just an hour or so.
How do you schedule the change of a Fentanyl patch every 72 hours?
First, remember that not everyone gets a full 72 hours, and the longer you use them, the less time you'll get from them. Point is, don't think that 72 hours is a hard and fast number; there are some of us who only get 48 hours. If you're getting less than 72 hours, you probably need a higher dose. If you've not been on them that long, it's important to note that the initial patch dose conversion from oral opiates is skewed to the low side for safety reasons, and most first-time patch users get a dose that's initially too low if they've been using oral opiates for a long period.
The trick is to overlap your patch replacement time; I used to use both biceps (when using 1 or 2 patches) for patch placement, as they're flat and don't flex much, making it the ideal spot. When only using 1 patch, add the new patch on your other arm (or another area above the waistline) as the old one is winding down, at around the 70 hour mark (or whenever you've determined is a good point). I used to put my new one on about 4 hours before I knew the old one would get real low.
As a result, the new patch has enough time to ramp up to full dosage delivery as the old one winds down and runs out. This way, your overall dosage remains fairly constant, and you won't experience any withdrawal symptoms.
What is the Fentanyl Transdermal patch time table for stopping use?
It depends entirely on the patient, length of use, and overall dosage of the patch. In general, the longer you've used it, the longer it will take you to wean yourself off of it, unless you're switching to an acute med of a lower strength. In those cases, the dosage equivalent of the target drug needs to be matched with the current patch dose (keeping in mind that the dosage tables for patches are conservative estimates), and then from there incrementally reduce the dose until you're completely off of it, or you're at a new maintenance level using the new drug.
I know from experience (having had to increase and decrease my dosages) that it takes longer than you might think if you've been using them for some time. After 10 years of continual use (200mcg's), last year I spent approximately 8 months dropping my dosage levels to the point where I was able to finally stop using them and continue solely on Percocet. That was accompanied by 2 major withdrawal periods; one that lasted 5 days, the other one 3 weeks. Having been through such periods several times over the years, I knew what to expect, but it still wasn't easy. The key is to do it slowly, and when you're at a mental state that you can deal with the hard withdrawal periods (something you can't avoid), hydration, sedation, and good movies, music, or games are essential in getting through it. Toward the end, an anti-anxiety med from your doctor will really help the last stages as it purges from your system.
Keeping hydrated is very important - not only does it help flush it out of your system faster, you'll be sweating buckets while freezing at the same time. Think having the flu, only 10 times worse. I always use water and Gatorade for hydration - Gatorade helps replace what your body is sweating out. You'll know the Fentanyl is coming out too - you can literally smell it as it sweats out of your pores.
As far as sedation, anything you can do to stay asleep or relaxed really helps as well. For music, my personal preference is David Gilmour's "Night to Remember" BD, recorded at the Royal Albert Hall.
It's important that you're both physically and mentally prepared for such an attempt, and that you've got time set aside to accomplish it. To say you're going to be extremely irritable and not good company is an understatement, so doing it while you've got work/school/family commitments on a regular basis isn't recommended. You need someone who can help you and knows what to expect, as your pain will of course get worse as the drug leaves your system. At some point, the withdrawal pain will go away, leaving you with a true indication of your normal pain levels.
Always have a good supply of an acute med on hand as well to help alleviate the symptoms. Percocet or Vicodin works pretty well - you can cut them in half to stretch your supply. A good anti-inflammtory (Naproxen, Bextra) as well as OTC meds (I use Bayer Back & Body Aspirin and Tylenol Rapid Release Gel Tabs) will also help you through the process.
Having said all that, I know that at some point soon I'll need to start using them again, as my pain levels are too high for just Percocet or OTC meds.
Can Fentanyl patches be taken off after three hours then reused?
Three hours is barely enough time to get the full dosage effects, and that's if you've already been using it. Patches can be reused, but only in cases where they need to be removed for emergencies, or they've come off due to adhesive failure.
It's important to understand that they're not meant to be removed, and if you need to remove a patch in so short a time, you shouldn't be using them to begin with.
What is the dosage for Fentanyl patches?
Patches come in 5 dosages:
12.5 mcg (micrograms)
25 mcg
50 mcg
75 mcg
100 mcg
Patient dosages are prescribed as a single patch dose, or if needed, a combination of doses to get the desired result. For example, my primary dose is 100mcg, but I've had to increase to 150 and 200mcg as necessary over the years. I once met a lady who had a brother that was a former cancer patient (he's since passed away) that was using 6 100mcg patches.
Is Fentanyl 100mcg hr patch similar to oxycotin 80 mg pill?
According to a well known conversion table on globalrph.com the conversion is 80mg oxycontin is equal to 41mcg of Fentanyl so you would need 2-80mg oxycotin-er and 1-20mg oxycotin-
2-80mg Oxycontin=82mcg of Fentanyl
1-20mg Oxycontin=20mcg of Fentanyl
How well does the Fentanyl patch work the first time?
It depends on your overall opiate tolerance level.
Doctors initially prescribe the patch based on a morphine-equivalency chart, which estimates the amount of initial patch dose of Fentanyl required based on your current daily dose of whatever opiate you're taking. The chart is skewed toward the low end though, for safety reasons, so most people notice that the first dosage might be too low. In such cases, it's important to have enough breakthrough meds to compensate until you get the dosage combination down until you're comfortable.
Can you use Fentanyl patches for nerve damage?
Absolutely - that and skeletal damage is why I've used it for many years.
Keep in mind that Fentanyl, like any opiate, only alters your brain's perception of the pain, so the pain will always be there. Patch therapy should only be considered when you pain is affecting your overall quality of life, and should not be made lightly.
I will say though, that in my case, the only regret I have is that I didn't listen to my Doctor and start using them sooner.
Is it safe to drink wine while on a Fentanyl patch?
It's never a good idea to drink alcohol while on any narcotics. However, one glass of wine will not kill you. The most serious side effect being respiratory suppression or god forbid respiratory cessation.
When traveling to France with Fentanyl patches what do you need for customs?
You are allowed to import medicaments in quantities corresponding to your individual needs. I would advise taking your prescription with you, and a brief note from your doctor would probably help in the extremely unlikely event of your being stopped at Customs.
Who should not used the lidocaine patch?
Lidocaine may not be suitable for persons who have had a past reaction to any local anesthetic. Patients should discuss past adverse reactions to anesthetics with their physician before using the lidocaine patch
Which manufacturing company makes the strongest Fentanyl patch?
The original company is still the best: Janssen Pharmaceuticals.
Why can't you cover a Fentanyl patch with any type of bandage?
Bandages no--Bioclusive yes(see below)
The reason is a band aid or tape does not allow air to pass through. So the skin is starved of oxygen and the medicine begins to degrade and redden the skin. You will end up with a big red welt that can take days to go away. The increased heat is negligible as far as dosage delivery.
Ortho-Janssen Pharmaceuticals (the makers of Duragesic) have long offered a large transparent bandage (Bioclusive, made by Johnson and Johnson) that fits over the 100mcg patch for those having patch adhesion problems. Bioclusive patches are provided to Duragesic patients only, but you can buy them online or through a pharmacy. They're not cheap though - about $100 per box of 50.
Are Fentanyl pills cheaper than patches?
Yes, but they don't last as long, so in the long run they're actually more expensive.
Can duragesic patches be covered with tegaderm?
Yes you can I have been using them for two years now. there a little pricy but worth it.
Can use a Fentanyl patch while using lexapro?
As a registered nurse who has been on Fentanyl dermal patches, after 2 major unsuccessful spinal fusions surgeries, I realized the scarring and normal arthritic changes over some years, can actually diminish our acute or even chronic spinal pain. That includes the radiation of pain down their spinal nerves, causing anterior (top to side) pain in your legs. Also, this can happen with upper cervical, thoracic and as in my case, thoracolumbar pain. The patches were a life saver for 20 almost 21 years. I was able to improve my exercise tolerance, increase going to family functions. Most importantly as you who are in the same boat know, there is a certain amount of guilt, when you feel, you can not make future plans, with family & friends, since one never knows, exactly how severe the pain will impede your activities of daily living. Therefore, I decided, I would with my physician's help and both our knowledge of pain management, try to totally withdraw from the application of these very expensive & sometimes, dangerous methods of chronic Opioid tolerant pain management. As a nurse, I feel compelled to make this statement. Using the Fentanyl systems of pain managment, can and have, been implicated in patients' deaths. There are many causes but the most common one believed, is due to diminished respiration, failure to breath well enough to oxygenate our bodies, improper application, duplicate application of patches if one does not write down, the placement on your body, the time and day it was applied, or by other errors. Heat increases the medication to coarse through our bodies. If you have a fever, or are too warm, pay much closer attention to your breathing. Never use alcohol to clean the patch site, again, rubbing or any alcohol, will increase the amount of drug in your system and can potentially cause, hypoventilation or complete cessation of breathing completely. This of course will be disastrous. The more senior you are the more, one needs to consider every aspect of your overall health. I'm right up there folks, in my 60's. That's why I wanted to answer this question with my own experience.
I personally am decreasing my Fentanyl patch dosage, in what I feel is a safe manor. I was able to decrease my dosage from Feb.6th through the end of March, (2 months) from 100 micrograms, down to 50mcg. During this decrease, whether from personal issues in my family, with several deaths of younger family due to accidents, or as a result of the decrease in the Fentanyl, I became morbidly depressed. Signs included, decrease in my physical activity. I needed to force myself to eat and drink properly with concomitant weight loss. I cried at the drop of a hat. I lost interest in all the hobbies I loved, and generally was sad, just not my bubbly self.
I failed to mention one very important warning whether about Lexapro or Fentanyl use, I stopped even social drinking a glass of wine, when I began applying Fentanyl and of course I still won't drink and wouldn't on Lexapro, on or off Fentanyl. There is an increase in the drugs' effects which can be severe. So please? Do not drink alcohol or mix any other psychotripic medication while on both of these meds.
Additionally it need to be mentioned: from the day I applied my first Fentanyl patch, and over the past 20+ years, I keep thorough records of my Fentanyl patches and Lexapro. It's actually a very good idea, to keep an up to date chart, (on your person) when and how much medications you've taken on a daily basis. Fentanyl in particular, can be a bit difficult to remember, the date and time you applied this patch which is either prescribed, on a 72 (3 day) basis, and lately I've read, even every 48 hours (two day period). I continually read the package inserts each time I open a new box, there have been many changes in how to apply and use them. If you're smart, you will read the package inserts and if you do not understand something written, call your pharmacist or the company's patients telephone answer line, for any questions you may have. Both of these medications can be life savers and both can be dangerous if used improperly. Get to know your meds and how they work in your body. Again, I cannot emphasize enough do not drink alcohol. If you must take a sip for a family wedding, etc., simply put a little wine on your lips, but NEVER swallow enough to alter how you feel emotionally.
I'd like to share how important age is when using either of these type of meds. I'm sharing with you, I am now 60 years old and I am extremely careful how I "chart" my medications. Or have a family member chart them for you. I feel very proud of myself, that I have successfully decreased my Fentanyl medication by half over a twp month time frame. However, once I hit the 50 mcg. level, I tried to decrease my dosage down to 25 mcg every 3 days and went into withdrawal, and major depression. I realize it's taken me a while to get to the question's point, but here is my experience:
YES, I did take and I am still am taking Lexapro 5 mg twice a day. I've been on Lexapro since February which is now three and one-half months, without any untoward or negative symptoms, in conjunction with MY Fentanyl patches. I hope you will ask your doc and remember, they are working for you! Don't feel you can't call and ask you doctor, if you have any questions such as this one: Can I SAFELY take Lexapro anti-depressant, if I am also applying a very strong Opioid analog pain patch such as Fentanyl.
Can Fentanyl patches be called in to pharmacy?
No - like all DEA Schedule II narcotics, you must have a new prescription for patches each time you require a new supply, and typically they'll only prescribe a 30 day supply, unless there's extenuating circumstances (e.g., you're going out of the county for over a month).
Schedule II prescriptions also cannot be called in to a pharmacy - the original prescription (no copies or faxes) must be presented to the pharmacy in person by the patient or authorized family member/friend before they'll fill it, per Federal law.
It usually takes a few hours before you really start feeling it depending on the size of the person, tolerance, and dosage. For most, around 3-4 hours to start feeling the clamminess start to take hold.
If you forget and start getting low on opiate level, just take your breakthrough med to compensate in the interim period it will take your new patch to ramp up to its full dosage rate.
If you're starting to feel more pain it's likely you're becoming tolerant to your current dosages or your pain is increasing as a result of further physical problems. Don't discount either possibility. If you've got a competent pain specialist, they'd know that you're either becoming more tolerant or that your pain is increasing for another reason. Doing nothing is just incompetent and irresponsible. It's important to note that many "pain clinics" aren't really pain specialists - they're just riding the pain control wave, since all they need is a certificate and not any real training in pain management. Anesthesiologists are my favorite target for bogus pain clinics - they're good at putting people to sleep, and they know the drugs, but they know little about pain control and long term effects.
If they don't believe you, I'd start looking for another pain clinic. The other thing you should be doing already is tracking your pain through a pain diary, which is considered by any decent pain clinic as valid evidence of your pain control (or lack thereof). Telling them is one thing - showing them documentation to the effect is different, since real pain isn't easily faked, either physically or by documentation. You can get some good examples at Partners against Pain - I reviewed their material for my own pain doctor some years ago, and they've got a good collection of forms. Their site is at http://www.partnersagainstpain.com/
Documenting the fact you're not getting adequate pain control is the best way to show them - never just ask for more unless you're on a level of understanding with your doctor that is one of deep trust, and that usually takes years. If they still don't get it, move on. Doctors are like barbers - they provide a service. You don't go back after getting a bad haircut do you? We're all taught from cradle to grave that doctors know everything - if you've read my supervisor bio you know that can get you killed or worse.
You should also evaluate the types of drugs you're using. If you're using OxyContin, it dosage life decreases a lot after about a year of use. For me it went from 12 hours to about 7, which is why I made the switch to Duragesic at my doctor's recommendation. If you're using acute pain meds (Vicodin, Percocet, etc.) which are only for short term pain as needed, then you might require moving to a chronic pain drug like Duragesic or OxyContin. The decision to switch shouldn't be taken lightly though, as there's a lot of restrictions that go with using either.
You would have to have a good case of why you were still in pain. Most doctors today feel the need to slightly under-prescribe due to the huge rise in abuse in prescription meds. Your doctor can do a re-eval of your injuries and decide if a higher dose or different med is appropriate. But I highly doubt you going in and simply stating you want more or a different type is going to cut it. If it does, run! They are probably not a doctor you should be seeing!
What are other potential nutritional complications after gastrojejunostomy surgical procedure?
Other potential nutritional complications with gastrojejunostomy include: steatorrhea, weight loss, vomiting, and bacterial overgrowth. This type of surgery also known as Billroth II has greater amounts of dumping syndrome associated with it than Billroth I.
Source:
Krause's Food & Nutrition Therapy by L. Kathleen Mahan
What are the doesage strengths of duragesic?
The patches come in 12 mcg/h, 25 mcg/h, 50 mcg/h, 75 mcg/h, and 100 mcg/h strengths.
The generic of Duragesic is Ratio-Fentanyl and about one-third the cost.
Why were the Fentanyl patches recalled twice than put on the market?
Duragesic patches were recalled because there were negligible tears in the patches, thus releasing more fentanyl than should have been released per hour. These patches were taken off the market, the pharmaceutical companies (including the ones that made generic patches) rectified the problem and then the patches were on the market again.
