Fentanyl

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.

Yes. See the Related Link below.

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

Yes, aspirin has no known significant drug interactions with fentanyl

yes

Fentanyl is a strong analgesic; don't use this compound as a drug !

no

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.

yes

Absolutely. It takes quite a while for the stuff to completely clear out of your system.

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, Fentanyl will show up as an opiate and methadone will only show up as methadone because it is synthetic and requires its own test to detect it.

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.

72 hours for any pill or liquid drug

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.

Depending oon your tolerance to the opiod in fentanyl...if you have a strong tolerance for abuse of opiods-then nothing, maybe intoxication.

If you have an average drug tolerance for opiods- then maybe you'd be high to feel euphoric.

If you have no tolerance to oplods, chances are you'll overdose and if you do not get proper treatment...you'll die.

I started out with 1000mg of ketamine, 25 mg promethazine (phenergan) and a 180mg transdermal fentanyl patch. After tripping sack for about 5 hours in a state of wasted, immobilized confusion (Yet far far removed from the broken heart I was escaping), I had had enough, so I took some versed to pull the proverbial "E-brake". I don't remember a thing after taking that. Like a big hole in my memory.

it ether means you have been hitting the bong pipes and stuff or that test is srewed up!

It depends on the pain and the patient, but over time if you're getting better (or not sure) there comes a point where you need to lower your dose enough to get a better determination of where your actual pain levels are. The problem with patches is that the withdrawal pain can be worse than your actual pain, and while you're using patches, you can never get a good handle on where your real pain truly is at.

Lowering your dosage enough to stop using them isn't easy, and it's harder the longer you've been using them and the higher the dose. It's not impossible, but you need to be physically and mentally prepared to do it. That's a decision only the patient can make, as everyone knows when they're ready or not.