Fentanyl Cardiovascular side effects:
Marijuana Cardiovascular side effects:
As most Duragesic/Fentanyl patch patients know, the recommended procedure is to clean the area with water and then apply the patch. However, for anyone who has used Fentanyl Generics or Duragesic, we know that's ridiculous. Skin oil, patch location and hair are the 3 biggest adhesion factors for the patch adhesive to contend with.
Having used Duragesic 100mcg patches (x2 on occasion) for 13 years, I know of 4 good ways to keep the patch stuck:
1. If you're using Duragesic, Janssen Pharmaceuticals has long had a program for its Duragesic users who have this problem. They will send out free of charge 300 Bioclusive bandages (clear adhesive bandages) that will fit over the 100mcg patch. I've used them many times and they work well. You need to call them at the 800 number on the box. Only Duragesic users are eligible; you can get them online or order them at a pharmacy, but they're not cheap, around $100 a box.
Note: It's unclear as of 2013 whether or not Janssen still runs the Bioclusive program, but it's an automatic NO if you don't ask. You can of course just by them outright, but as I said, they're not cheap.
Worst case, you can always use medical tape to tape the edges of the patch.
2. Skin Prep - Skin Prep is a product made for Colostomy patients. It applies a thin film to the skin that helps the adhesive bond strongly to the skin. The tricky part is to only apply it to the skin area where the edges of the patch are going to be, since applying it to the transdermal area will block release of the drug. It works fantastic though, and most pharmacies carry it. They make 2 types, a lower cost one that stings, and a non-stinging one for double the cost. It doesn't sting that bad compared to the pain you're already dealing with.
2013 Note: Skin Prep works well with the older style patch type that used an adhesive edge and gel pocket, but it's impractical if you're using a patch such as the new Duragesic patches that are essentially a one-piece adhesive patch. Using SP will block the release of the Fentanyl.
3. Isopropyl Alcohol - all patch literature will tell you not to use Iso to clean the skin and then put the patch on. The reason for this is that Isopropyl leaves a residue on the skin that can interfere with the drug release. However, to get around that issue, clean the area with Iso, then rinse it with water to remove any residue and then dry well before applying. Iso is the only real way to get skin oil off of the skin, which is the primary reason the patch adhesive comes unbonded from the skin.
Of course if you use Grain alcohol (purchased from a liquor store), it leaves no residue.
The other reason is that Iso can cause skin irritation if not rinsed prior to the patch being applied.
4. Location, Location, Location - SRE (Skin Real Estate) is a major factor in how well your patch stays applied. The instructions tell you not to use the patch in the same spot over and over - this is to let the skin breathe between applications. It must be applied on the upper torso in order for the heart to properly distribute the drug throughout the body. I've always applied mine to my upper biceps, as the area is flat, relatively hairless, and the skin there doesn't flex like it does on the chest or elsewhere. Normally my regular dose is 1 100mcg patch, so I just switch arms every 2 days when I change it out for a new one. However, there have been times where I've needed 2 100mcg patches, and I have used them on both arms simultaneously. In those cases, I've overlapped the application by several hours so that the skin has time to breathe before reapplying. I also will apply it vertically or horizontally so that the same area isn't always completely covered. Edge scarring on the skin from the patch will occur, but it will go away in time if you stop using them.
If you're having difficulty with the patch staying applied and the area doesn't appear to have any hair, keep in mind that the small micro-hairs that we all have can interfere with the patch adhesive. In those cases, shave the area or use a hair remover / wax to ensure there's nothing to get in the way between the patch and your skin. Make sure you rinse it well with warm water and dry it well before you apply the patch though.
I know of terminal cancer patients who have required up to 6 100mcg patches, and in those cases they were applied on the back. The problem with that is you need someone to apply it, and if you're like me, you probably like doing it in private by yourself.
In a pinch, if your patch comes off, don't toss it. It's a misconception that it cannot be reapplied and used; as long as it doesn't stick to itself, you can re-use it, but if it does, of course you're out of luck. If you're using generics, you can buy Bioclusives yourself. Alternatively, simple transparent medical tape on the patch edges will keep the patch in place or help you to re-attach it. Make sure you clean the skin before reapplying, and put it in the same place. It takes about an hour, but if there's enough adhesive and medicine left, the body heat will start the drug release again.
When applying your patch after you've prepped the area, make sure you hold it between your hands for about a minute (BEFORE you remove the backing...) to warm and soften the adhesive. After you put it on, hold your hand over it for a minute to help the adhesive stick better
One other bit of advice - all doctors are required by Federal Law to only give a month's worth of Schedule 2 opiates to any patient, making us slaves to the system, and making it a real pain if a patch comes off and cannot be reused, especially if it was just applied recently. I learned early on to build up an emergency month supply of meds that will help me in such situations, or in those rare times where you have problems with medical insurance companies or prescription supply interruptions. It takes time, but most Fentanyl patients have breakthrough meds like Percocet. Use that to help you get by and try stretching your dosage in order to bank up extras so you don't fall short if a patch does get screwed up. If you're seeing a doctor that tells you to turn in any extras, get another one. Federal Law prohibits transfer of any narcotic to anyone other than whom it was prescribed for, and I know of no such exception for doctors, even prescribing ones. I have always been up front with my doctor about my emergency supply, and over the years he's been willing to give me a bit more when it's run low.
Having used Fentanyl (Duragesic) patches for over 10 years, I can say that of course opiate dependence is the primary effect. As I write this, I am going through my second voluntary withdrawal in the past few months, the need for it no longer exists. It is not easy at all - I've been steadily dropping my dependence levels for 6 months, and from dosages of 200mcg (2 100mcg patches) and up to 150 Percocet 10's per month. To say I've been catching up on my Supervisor work here at WA is an understatement, as the mental distraction really helps.
Other than dependence and the increased tolerance level it brings, if you tolerate opiates well there aren't any real other problems I've incurred, aside from the occasional bout of constipation, but any opiate patient learns to deal with that. I will say though, that one thing that surprised me was that it was hard to realize when I fully recovered from my last spinal surgery (check my bio page for the full skinny) that the pain I was having was actually from withdrawal and not my back.
This second period is longer than the first one - previously, I was only able to go 5 days before requiring another patch, the hold was just too much. This time, I've gone over a week now and believe I've made the switch back to pills, which are much easier to get off of. I've cut down my Percocet to 5mg and 2.5's so that I can do gradual reduction.
Fentanyl in any form is a wonderful drug if you absolutely require it, but it should only be used in a Quality of Life decision. For myself, there was no other option until 3 years ago and until now. However, with it comes responsibility and essentially slavery to the drug and the system - as a Schedule 2 opiate, you're required to get new prescriptions every month, and only 30 days worth.
You can, but it depends on your overall tolerance level. For most people, drinking any alcohol won't really do much if you're already a Fentanyl patient. However, like any opiate with alcohol, it will increase the depressant effects, which can lead to respiratory failure if you're not careful.
yes you can, there is however and increased risk of CNS depression and psycho-motor impairment, so be careful and only do so if instructed to by your doctor
It depends on the person and how long patches have been used, but in general you'll start feeling withdrawals around 6-8 hours after the patch dose expires. It takes another few days before it's really out of your system. If you've been using Fentanyl for a long time, it'll take days or weeks depending on how much and how long.
a drug called naloxone
Ending Duragesic dependence is not easy, nor can it be done in a short time. Of course it totally depends on the patient's current dosage and how long they've been using it as to how long it will take to get off it it. I can tell you that after 10 years of Duragesic use (2 100mcg patches, plus 120 Percocet 10/325's per month) it took a total of 8 months to lower my dependence enough to where I could switch to Percocet and lower those amounts as well.
Keep in mind that it comes with a cost - you'll find out how much real pain you're in once your levels are low enough, and in the end it might be easier to keep using it. It'll take time, as there's a point where the withdrawal pain is strong enough you can't get a good read on your actual pain. You'll know when it's gone and your real pain is letting you know it's still there.
Even though I've not used one since August '09, my pain is still strong enough that I consider starting to use them again every day. But for me, I resigned myself to the fact years ago that I'd be an opiate patient the rest of my life. I've experienced extremely high levels of pain without the benefit of opiates in the past (hospital & doctor screwups - read my bio if you're curious) and as such my mental tolerance for pain is extremely high. But regardless of how mentally focused you are, you can't keep it up all the time - all of us who are chronic pain patients need some type of pain relief, and that's just reality. If you're at the point where your pain is low enough you can discontinue Duragesic, that's great. But be prepared for the possibility that you might not like what you find once your opiate levels are lowered to the point where your brain is really feeling your pain. Regardless, it's good to do it to better assess your actual pain level, which you can't really do while using Fentanyl.
Depending on your current dose, there's a couple of ways you can do it. You can get lower patch doses and drop your dependence that way, using your breakthrough meds to cover the withdrawals from the difference in dosage. Over the many years I've used Duragesic, I've had to increase my dosages several times from 100 to 200mcg's and then back again - I never did it by using smaller patch doses as it's easier to do it another way. But everyone's different.
First off, you need to stretch your patches to where you're getting the absolute most out of them - change them only when the current one has expired and you're already dealing with withdrawals. Use smaller doses of your breakthrough meds to help ease the pains. Eventually you'll get used to incremental lowering, and be ready to head into your first major withdrawal period. For me, it was about 5 days of major withdrawals - I used Percocet instead of Duragesic until the withdrawals were such that I had to apply a patch. After another month, I was at a point where I was able to do it again, and successfully switched back to Percocet after 3 weeks of withdrawals that weren't nearly as bad as the first period.
To say it's not easy is an understatement, but it's not impossible either. Aside from setting aside time to deal with it, the things I always recommend are:
1. Be completely prepared mentally - eventually you'll get to the point where you'll know you're ready to deal with the discomfort that's to come. Anyone who uses Fentanyl deals with withdrawals regularly - it's no different, just longer.
2. Have lots of water and Gatorade available - Staying well hydrated is essential, as you'll be sweating buckets. You can literally smell and taste the Fentanyl sweating out of your pores. Keeping your electrolytes up is essential as well.
3. Stay warm - You'll be sweating but freezing as well. The best way to describe it is like having the flu, but without the fever. I did it in the middle of Summer, and I was freezing every day.
4. Have a family member around - Trust me when I say you're not going to feel like doing much of anything besides getting up, going to the bathroom, and going back to bed for more misery. That includes making something to eat.
5. Stay sedated - Virtually every instance where I've needed to lower my dosage levels and had to deal with withdrawals for extended periods, I've asked my doctor for something or used one of my other meds to help keep me sedated. When you're sedated, the discomfort is much easier to deal with.
6. Anti-anxiety / Anti-nausea meds - Anti-anxiety meds will help with the withdrawal pain; Anti-nausea meds help when you're near the end.
7. Movies, Music, Games - Anything to distract your mind from the discomfort. Personally I use David Gilmour (Remember That Night BD Live), though gaming helps a lot as well. I also got a lot of WikiAnswers Supervisor work done on this and my other categories during that period. It doesn't really matter what it is, as long as it's a mental distraction strong enough to focus your attention away from the discomfort.
8. Breakthrough Meds - Don't even think about this unless you've got a good supply of Percocet or other meds that you can use to help lower your dependence. My normal supply/dose is 120-150 Percocet 10/325's per month. I started with 10's, then cut them in halves and quarters, taking them together to make 7.5 and then 5mg's.
9. OTC Meds - 2 OTC meds I've used for years are Bayer Back & Body Aspirin and Tylenol Extra Strength Rapid Release Gel-Tabs. Both work fast and really ease pain, enough that I've used them when I don't feel the need for a Percocet. They'll help take up the slack for the pain that your BT med can't cover so you don't have to take as much of it.
10. Doctor - Make sure your doctor knows what you're doing - most will support your efforts. But don't get discouraged if you find that your pain is still great enough you need to continue using it. Remember Duragesic use for all of us is a quality-of-life decision. Using it sucks, since none of us like being a slave to Schedule 2 opiate regulations. But being in constant agony 24/7 isn't a picnic either.
If you've got any specific questions, feel free to contact me through my WA Supervisor email address on my bio page.
two mg of versed with 50-100 mcg of fentanyl iv
Absolutely - in fact, Hydrocodone (Vicodin, etc.) and Oxycodone (Percocet, etc.) are commonly prescribed to Fentanyl patients as their breakthrough pain med.
The strongest opiate currently prescribed for humans is the Fentanyl Transdermal Patch, in 100mcg (microgram) dosages, which can be increased as necessary. Fentanyl (brand name Duragesic) is 30 times stronger than morphine. Like Oxycodone, Morphine and others in its class, it is a DEA Schedule 2 opiate, requiring monthly new prescriptions as refills aren't permitted and only a 30 day supply can be dispensed. It really puts a damper on your life, having been Duragesic user for many years.Duragesic is typically prescribed for long-term chronic pain patients who are in constant extreme pain. The most common patients who use them are terminally ill cancer patients. I know of one such person who had up to 6 100mcg patches applied - I myself have only required 2.
Absolutely not. It will cause the med to absorb to quickly and may cause death.
Yes, but only if you're positively false.
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.
Absolutely not - Fentanyl patches should always be placed above the waist, the closer to the heart the better. They should NEVER be placed below the waist, as the effectiveness is significantly reduced due to the distance from the heart.
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.
Please seek an Answer from a licensed doctor or pharmacist. Both are powerful drugs that if used (or abused) could potentially have lethal effects. Fentanyl can be especially dangerous if used improperly.
From wikipedia.com: A dosage form of fentanyl which has appeared on the streets are the fentanyl lollipops Actiq, which are sold under the street name of "percopop"; a mixture of fentanyl and heroin is known as "magic"; "china white" a form of fentanyl refers to the clandestinely produced analogue α-methylfentanyl (AMF).
Fentanyl is very strong and extremely dangerous. A patch contains 3 day's worth of medication, so if you open up the patch, you may soon be DEAD. I know this because the liquid from a single 75 MCG/hr Fentanyl patch KILLED MY BELOVED DAUGHTER on the first of June, 2011. One single patch contains A LETHAL DOSE of narcotic medicine. Please NEVER fool around with a Fentany patch. Please do not make another father cry every day, thinking of his daughter and wanting her back.
Narcan 0.4 mg; may be repeated
Don't do it, it would only be stupid to attempt this. Of course it does depend on how long afterwards you were to take the suboxone but within 36 hours and your sure to go into detox from it making u very sick and very very uncomfortable.
Approximately 0.5mg to 1.0mg per kg body-weight in opiate-naive subjects.
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