Opioids Fentanyl Rx - Patches - What would be a sensible instant release alternative (UK)?

[awastedlife]

So.. I'm on a 25 (was 50) mcg patch and honestly I find them a bit shitty for consistency and in reality it's basically impossible to tell how much of the dose is making it into your system after skin being potentially dirty, blocked pores and sweat. I often find that on day 2.5-3 (given that the patches are meant to last 72 hours) I get the starting symptoms of WD.

What is a sensible instant release equivalent?

I've tried zomorph capsules but honestly it made me disassociate like crazy and I really didn't like it so that's not an option.

I have a GP appointment next week and I'm considering discussing this with my GP. Having to change a patch potentially a day early on most is just going to be hugely problematic on re-ordering scripts because I'll be out by 10 days each month. I'm just not sure what to ask for or discuss with him given that morphine doesn't seem to to be an option and the initial jump was morphine to fent. I can't say I'm looking forward to the convo because it'll just come off as drug seeking so.. yeah.

Edit, I also sweat a fair bit, always have so I'm sure that's not ideal with the patches.

Appreciate any help with this.

 

[negrogesic]

So.. I'm on a 25 (was 50) mcg patch and honestly I find them a bit shitty for consistency and in reality it's basically impossible to tell how much of the dose is making it into your system after skin being potentially dirty, blocked pores and sweat. I often find that on day 2.5-3 (given that the patches are meant to last 72 hours) I get the starting symptoms of WD.

What is a sensible instant release equivalent?

I've tried zomorph capsules but honestly it made me disassociate like crazy and I really didn't like it so that's not an option.

I have a GP appointment next week and I'm considering discussing this with my GP. Having to change a patch potentially a day early on most is just going to be hugely problematic on re-ordering scripts because I'll be out by 10 days each month. I'm just not sure what to ask for or discuss with him given that morphine doesn't seem to to be an option and the initial jump was morphine to fent. I can't say I'm looking forward to the convo because it'll just come off as drug seeking so.. yeah.

Edit, I also sweat a fair bit, always have so I'm sure that's not ideal with the patches.

Appreciate any help with this.

Here is an equivalency table https://fpm.ac.uk/opioids-aware-str...cribing/dose-equivalents-and-changing-opioids (from a UK-based reference -- which might give more credence when/if you present the data to your doctor) that lists a 25mcg/hr patch at 60mg oral morphine per day. One option is oxycodone -- an equivalent amount would be 40-50mg or so. But not sure how often that is prescribed in the UK.

The easiest thing to do might be to increase the dose back to 50mcg/hr (which would probably be met with less than resistance than asking for an oxycodone prescription).