Fentanyl

There is no average dose - all fentanyl patients must first be "opiate tolerant", meaning they are already tolerant to the effects of opiate medications. Most, like myself, only start using it when other meds (Oxycodone, Morphine, etc.) aren't effective and long-term pain control is needed.

Initial dosages are based on the patient's current medication. All opiates have a morphine-equivalency rating, as does Fentanyl. The patient's current med doses are converted its morphine equivalent, adjusted for increased pain control if necessary, then matched with one of the standard Fentanyl doses available as an initial dose. Dosage adjustment goes from there.

Most initial doses are low - this is because the Morphine-Fentanyl equivalency charts are purposefully kept on the low end for patient safety considerations.

Noop.

Although they are both in the same class, Opiate, they are very different.

Codeine is roughly 1/10th the efficacy (strength) of morphine. Fentanyl is 50--100 times the efficacy (strength) of morphine.

So, Fentanyl is 500--1000 times the efficacy (or strength) as codeine.

YOU cannot use tramadol in combination with methadone. It is an opiate antagonist which if you are taking methadone can send you into instant severe withdrawl. I do not have the answer for methadone and fentanyl combination but do not use the tramadol methadone combination. If you do or have you are in for a very very scary experience. There are many pain meds you cannot mix with methadone. Take it from a life long methadone patient who has experienced what it is like to mix an opiate antagonist with methadone........Do not try it............................

"Transdermal" means "through the skin". These cannot be injected.

It depends entirely on the situation. If you just add another patch to one that's still effective at full dosage delivery, then you're adding to the overall dosage rate and if you're not tolerant enough you can experience severe respiratory depression or death if you're not careful.

If you're referring to a patch that's in the last few hours of expiration (e.g., 64 hours of a 72 hours prescription period or 40 of a 48 hour period) then you won't feel much difference. It takes the new patch time to start delivery, and depending on how low your current patch is your overall maintenance dose is likely starting to get low anyway.

Over the years I've added a new one as my current one was winding down. This helps to keep the overall dose constant and avoid any withdrawal symptoms. But each person is different, and it's important to know the signs of higher dosages if you're not tolerant to high levels of opiates.

Most Duragesic users know what's normal and what isn't when it comes to patch use over long periods of time, so when something isn't right, it's important to take notice of your symptoms. High dosages can come from different ways other than just adding a patch - increased activity raises body heat, which in turn increases the dosage delivery rate (that's why you're not supposed to expose it to heat or direct sunlight). The first symptoms for most are drowsiness and sometimes trouble breathing, depending on how tolerant they are. Confusion and loss of cognitive ability is the most common though - imagine knowing what's happening to you, but your mind can't direct your body to help itself, and you'll get an idea.

In such cases, the 2 things to do are to immediately remove the patch(es) (make sure you don't fold them - you can re-apply later contrary to what some think), and cool yourself down externally and internally. It's important to also let family/friends know about this as well, so that they know what to do if you suddenly start acting like a wacko. My daughter has had to help me a couple of times when I've become overheated and my dosage rate increased fast (I have an extremely high opiate tolerance level, so respiratory depression doesn't happen, just increased side effects).

If you're using breakthrough meds like Percocet or Vicodin, then your overall tolerance is higher than your patch dose anyway, Just make sure that if you overlap the patches, one is expiring.

It depends on your overall condition, reason for pain, your overall tolerance level, and the length of time you've been using Fentanyl Transdermal patches of any type. However, in general, if you're up to the task, then yes, it's okay, as long as you're aware of the potential risks involved.

Fentanyl patches (either Duragesic or its generic alternatives) work by slowly releasing the drug through a transdermal membrane into the bloodstream via the skin layer. The dosage delivery is controlled by body heat, and naturally any strenuous physical activity will increase your heart rate and elevate your core body temperature. This alone increases the dosage delivery rate, and if you're not yet that tolerant to the drug or opiates in general (rare since the patches are only supposed to be prescribed to prior opiate tolerant patients), then confusion or other increased side effects can occur.

As a long time Duragesic user and chronic pain patient on opiate therapy for many years (see my bio for specifics), I've experienced this several times while doing outside work or remodeling around my home. Even though I knew what was happening, the confusion level is so much that it's difficult to get out of the situation on your own. I describe it as being stuck in a loop you can't get yourself out of. Only removing the patch (if you do it properly you can re-attach it later - see my answer on that) or cooling your body to normal will alleviate the problem. It's also important to understand that opiates are Vasodilators, meaning they open the blood vessels (that's why you feel cold when the dosage tapers off - they start constricting). Opening the blood vessels wider naturally warms your body, but again if you're tolerant to the constant dosage over time then your body is already used to it.

However, if you take simple precautions to keep yourself from getting overheated (stay hydrated and cool while working) and your overall physical condition doesn't limit you from the work (e.g., you're dealing with extreme pain but are physically able to work), and you're prepared for what can happen (my family knows what to do if they find me in such a situation, and I always have my cell with me when working) then there isn't much you can't normally do that you didn't do before.

As you become more tolerant, the depressant effects will become less. I found years ago that a cerebral stimulant will help overcome the depressant effects to the point where I feel relatively normal. Of course I don't use them often, only when I'm using higher opiate dosages to control pain.

As far as driving, it's an individual situation. Not everyone handles opiate therapy the same way, and again only tolerant individuals can deal with the depressant side effects over time. I've never had any driving restrictions, though I've always been acutely aware that in any accident it would likely be an issue. Having said that, unless I told you that I was a high level opiate patient you'd never know as I feel normal most of the time. It's really a topic for your pain specialist and yourself, but if you've already got handicap driver plates or a placard, then your doctor has already signed off on the fact that he/she believes that you're okay to drive. How responsible you are is totally up to you. I won't drive if I need to increase my normal dosages to deal with increased pain.

You should also be aware of the fact that the patches will and do slow your reaction time, so you need to be more aware of safety factors and compensate for your slower reaction than normal when working. Also, remember that opiates work by altering the brain's perception of pain, and if you over-exert yourself, you could further aggravate your condition without realizing it until the pain becomes worse. Be smart.

If you're wondering, at my highest dosages I was using 2 100mcg Duragesic patches for primary pain, Percocet 10/325's for breakthrough (120/150 per month), 100mg Demerol tabs, and 30mg MS Contin tabs for pain. My normal dosages are 1 100mcg patch and the same amount of Percocet monthly. Those have been my normal dosages for about 9 years.

Yes it does. It can make you tired and docile.

You can, but you won't feel much because fentanyl is a lot stronger. The only reason you'd take it is for breakthrough pain, but realistically, it's not that strong; if the pain is breaking through what the fentanyl can't keep up with, you need Percocet or just straight Oxycodone.

YES...fentanyl is much stronger.

I have no idea. It should show up as a true positive for opioids.

a drug dealer

Normally it comes out through the body's regular excretion process - kidneys, etc. During major withdrawals though, and if your dosage is high enough, it'll sweat out through your pores.

That's not a good sign, particularly if the itching is around the patch edges, and worse if it's the entire patch area.

Itching usually indicates either an allergic reaction to the patch adhesive material, or the patch material itself. If the entire skin area under the patch is itching, you likely have an allergy to the gel or the Fentanyl itself.

The other possibility is an irritant on the skin prior to patch application. This is common if you've cleaned the area with alcohol and not rinsed it well with water, or you've used some type of other skin product before putting on the patch. Shaving the area and then immediately putting it on can cause irritation as well if it's not rinsed well.

Fentanyl is a generic drug.

scopolamine patch is applied just behind either the left or right ear. The area should be clean and hairless prior to the application, which should occur the evening before a scheduled surgery

I think you mean Fentanyl, No it's not a good idea.

See the link below.

White

yes, every time I am in the hospital they put new patches on me and give me 1mg dilaudid IV. and at home I wear the patch and take 2mg dilaudid by mouth.

Depends entirely on the person and how long they've been taking it. The longer it's been taken, the longer it takes to leave. In general though, if another patch isn't put on, around 2-4 days.

Fentanyl, like Oxycodone, does not show up on most standard urine screens for opiates due to its chemical makeup, which differ from natural opiates. However, it is detectable in urine and blood, with specialized testing using gas chromatography.

Much of the information that has been released concerning Fentanyl and Oxycodone urine testing is inaccurate - read the link below to the Mayo Clinic report which clarifies errors in the record.

You can, but you won't notice any effect other than maybe feeling a bit more relaxed. Fentanyl is the strongest opiate (100x stronger than morphine), and cannabis isn't even close to affecting anyone who's using patches on a regular basis.

Yes. You can take a needle or safety pin and insert it into one of the corners of the fentanyl patch. Then, move the needle or safety pin, left & right, to make a small slit in the patch. Remove the needle and then take a credit card or some other type of hard, firm card and slide the card across the patch, to move the gel inside the patch, towards the slit that you made with the needle. Push the gel out of the slit. Then, take a syringe that is prefilled with water, about 30-40 cc's of water and carefully remove the plunger, after shaking the water down towards the needle. Then, take the gel and carefully apply it onto the opening of the syringe. Then, dip your index finger into water, until the water is on the verge of dripping off of your finger. Put your wet finger over the opening of the syringe and over the gel. (the wet finger will prevent the gel from sticking to your finger and mix with the water in the syringe) Then, shake the syringe upside down until the gel mixes with the water. Then, put the plunger back into the syringe and push the water filled with gel, up towards the needle end, careful not to push too far up, as the water mixed gel, will come out of the needle! Then, there you go!

I recently came across a 25 mcgh/hr fentanyl transdermal patch from Mallinckrodt. I've never tried it before but this type has no gel to it. I was told to draw up 50ml of water and put the patch in a cooker. Let it sit for 15 min and beat it down with the plunger before drawing pack up. hope it works.