Dr switched me to Fentanyl Transdermal patch from Dilaudis and have some question...

[painenduser]

Hey guys, I hope this is the correct place to post this, if so here goes.

So some may have read my past posts, in brief, I have visceral liver pain due to hepatocellular disease. I have been bounced between dilaudid 2-4 MG Q6prn to MS Contin 30MG TID with dilaudid 2-4MG Q4 PRN. Tonight my Dr decided to try me on the Fentanyl Transdermal Patch 100mcg/hr 1 patch every 3days or every 72 hours. So my question to you guys is what should I expect from the Fentanyl from a euphoric feeling, to a feeling of being sick ect. I am told that this is a way high does by my pharmacist to start out on and he has never seen any one being started on such a high dose, however I do take up to 8MG every 4 hours of dilaudid so he said it should be a parallel switch. Does this sound about right? Is there anything you all can advise me on as far as if I should titrate up to that dose? And if after the 15 days, my main pain mgt dr does not want me to stay on it, should I titrate down? I am told that I am not to cut the patches to lower the dosage and must place the entire patch on for every 72 hours. So what in the beginning should I expect and if I am not kept on it after the 15 days and put back on just the dilaudid will there be a withdraw (physical) from the fentantyl or would the dilaudid take care of that for me. Please share with me any experience with this new (to me) opiate, thoughts, ideas, or whatever else you can share with me regarding this. I'm a little nervous having read that Fentanyl is extremely potent infact the most potent pain reliever available by law so I want to have some education from those how have used this before regardless of whether you have used it recreationally or as directed for your pain control, I just want to know more. I do NOT plan on abusing this recreationally as I do not take my pain meds for that reason, I take them to relieve my pain, but recreational users as well as those who use as directed can certainly help educated me on what I can expect and the best ways to begin my treatment and how best to stop if my pain mgt dr refuses me on a refill.

Thanks in advance guys, your insight has always been very valuable to me..

 

[Jabberwocky]

first thing that strikes me as rather shocking is that even with extensive opiate use and cross tolerance taken into account the dr started you on 100mcg/hr straight away exactly the same response as your pharmacist. it's advised right within the patches info pamphlet and website that tolerant users start on the 25mcg patches and titrate up accordingly till they meet the required dose. 100mcg/hr straight off the bat is inane and putting your life at risk. i'd be questioning your doctor about this before putting any of them on.

heres the pamphlet from jannsen cilag to check out if you've yet to do- http://www.racgp.org.au/cmi/jccdurog.pdf

 

[Addyman]

Your doctor is insane
Jesus dude

That's the equivalent of 10mg IV morphine every hour...

Remember, if you start feeling sick, go to the ER... just taking the patch off won't work because a lot of it is already in your skin waiting to be absorbed...

 

[painenduser]

Disposition, thats what I thought too, and the Dr's reasoning was as he said, he wanted to make it a parallel switch as I was on such high doses of Dilaudid. But when the pharmacist question the dosage, he said that as long as I was taking more then 8MG's of Dilaudid per day (which infact I have been taking upwards of 64MG of dilaudid a day) he told me that I should be ok and that was his only concern. So I thank you for the heads up on that, since I have never taken Fentanyl before, I dont have anything to compare it to. I will read through what you gave me the link too, however even with that, can the patch be cut to make it smaller to titrate with lower doses? When I asked the pharmacist that he told me not the patches can not be cut.

Please keep the comments coming though guys, education on this is extremely welcome and I don't want this thread to die with one post. My understanding of this drug can be the difference between living comfortable without pain, to certain death due to over dose if this is completely wrong and my Dr was wrong in the dosage, btw I did ask him if that was a high dose and he said yes and it's normally not prescribed at this level at first to titrate it up, but due to the amount of dilaudid he felt it was the right dose. Thanks!!

 

[painenduser]

Your doctor is insane
Remember, if you start feeling sick, go to the ER... just taking the patch off won't work because a lot of it is already in your skin waiting to be absorbed...

Most definitely, I planned not to start taking it until Friday as I have enough Dilaudid to cover me until then, plus I have no where to be and my folks will be home all day to watch me to make sure Im handling it OK. Any troubles and we will be ER bound. Since I know enough about this drug to know it's very potent and enough about the adverse effects of opiates due to the years on them, I wanted to make sure Im in a safe environment the day I start applying the patch. It states in the documentation that it takes 72 hours to be at peek concentration in the body so I'm not sure how long it will take before I could start to feel any reactions to it. I have heard anywhere from 1-2 hours to 8 hours to the full 3 days. Eh I dunno, again thats why I came here to ask these questions before I start on the regiment. Thanks you all have been helpful thus far!

 

[Violenza666]

Well they don't always start you on 25. If you've been using other Opiates/Opiods around the clock and they haven't been working then they'll put you on 50... 75 or even 100mcg. My friend started on 150 for his spinal stenosis. He is on 100 now because the 150 makes him "tired".. but now he'd rather be tired and have half his pain reduced than not be tired but be on a constant 7-9 on the pain scale.. sometimes 10 then he winds up in the ER...

I got rxed fent for my back and I an not a fan, it has two purposes... use when I run out of my meds for the month... avoid some pain and sickness but.. I always have a migraine when I am on it. I am just not into it. I don't want those headaches.. bah .. they're horrid.

 

[Jabberwocky]

Well they don't always start you on 25. If you've been using other Opiates/Opiods around the clock and they haven't been working then they'll put you on 50... 75 or even 100mcg. My friend started on 150 for his spinal stenosis. He is on 100 now because the 150 makes him "tired".. but now he'd rather be tired and have half his pain reduced than not be tired but be on a constant 7-9 on the pain scale.. sometimes 10 then he winds up in the ER...

hearing these kind of stories make me cringe because i've been on fentanyl for a period of time as part of my pain management regime and because it played a factor in an overdose i had. i had a reasonable opioid tolerance and was started on the 12mcg/hr patch, the lowest available and only ever worked my way up to 50mcg, settling on 37 for the most part. it's an extremely efficient pain management tool and wish i were still on it though i had problems with the patch' adhesive in summer; tried everything the doctor before i was switched to morphine. it's recommend and says right there on the website that even with long term patients with a higher tolerance to be titrated up starting at 25mcg/hr. you're friend is an exception of the rule but it still makes me uneasy reading it.

it's irresponsible, imo (of course this is circumstantial), of doctor to start patients at such high dosages of such a highly potent narcotic, almost affiliated with manslaughter if they do overdose(ok that is probably a stretch). this shit kills a lot of people.

Disposition, thats what I thought too, and the Dr's reasoning was as he said, he wanted to make it a parallel switch as I was on such high doses of Dilaudid. But when the pharmacist question the dosage, he said that as long as I was taking more then 8MG's of Dilaudid per day (which infact I have been taking upwards of 64MG of dilaudid a day) he told me that I should be ok and that was his only concern. So I thank you for the heads up on that, since I have never taken Fentanyl before, I dont have anything to compare it to. I will read through what you gave me the link too, however even with that, can the patch be cut to make it smaller to titrate with lower doses? When I asked the pharmacist that he told me not the patches can not be cut.

the patches can be cut up and used at lower dosages, yes, even though doctors never recommend this. personally i'd get back in contact with your doctor after doing a little more research on the drug yourself and be frank with him that you're not comfortable at such a starting dose if it's how you feel. it's better to be safe than sorry. i'm sure he'd be most compliant in starting a lower dose especially if you're showing concerns.

in my experience i felt the effects within 8-12 hours when starting.

 

[painenduser]

the patches can be cut up and used at lower dosages, yes, even though doctors never recommend this. personally i'd get back in contact with your doctor after doing a little more research on the drug yourself and be frank with him that you're not comfortable at such a starting dose if it's how you feel. it's better to be safe than sorry. i'm sure he'd be most compliant in starting a lower dose especially if you're showing concerns.

I will definitely contact him tomorrow to discuss the concerns you all have raised, so thanks since I was going into this blind on fent. However, being that I have already left the pharmacy I can't return what I got and medicaid isnt covering it so I am not about to go spend another $200 for a new script. What I may do is just cut them and try taking them in smaller doses. Worst case, I argue with Medicaid and get them to pay then if he writes me a script for a lower dosage, I will titrate up with that and then use the 100's when I am comfortable I have titrated up enough to take the 100's. That may be the smartest way to go about this.

PS you guys have been great and I really appreciate the feedback your all giving me. It's important to me that I get the advise from people who have the experience here.

 

[Jabberwocky]

no problems

hopefully you'll be able to work out a resolution with medicaid given the situation. so best of luck.

i'll keep this open so you can update us with results when you speak to your doc.

 

[painenduser]

i'll keep this open so you can update us with results when you speak to your doc.

Thanks for leaving this thread open disposition, and I appreciate the great feedback. I'll know tomorrow what we should be able to do so look for an update tomorrow night. If anyone has anything they want to add that would be great all long as there's no trolls and no dopeheads playing off the fact that I have D's and Fent, as this post is not about that, this is a serious post about a serious condition with someone with a legitimate needs of my medications. If there are any posts that go off that topic disposition can you plz remove them? Thanks again!

 

[Jabberwocky]

of course mate, that's what us mods are here for. BDD is usually clear of idiots for the most part so don't stress your thread will be overtaken with trolling.


or maybe not

 

[painenduser]

or maybe not

lmao!

 

[painenduser]

Just as an FYI I used an opiate conversion program I found on the net and it was for calculating your current opiate med/dose to determine the fent patch you would need. Well according to that app, since I normally take 50-60MG's per 24 hours of Dilaudid, the calculator says I should be at 102.7 mcg/hr of fentanyl patch. So it may not be such a high dose for me after all... Hmmmmm just something to think about.. Here is the site I used. http://www.globalrph.com/fent.cgi

 

[Jabberwocky]

i was going to direct you to that initially but didn't because i thought it only included IV/IM fentanyl conversion though i see you found a patches conversion. it's still to be used only as a guide as stated, it's not definitive

 

[painenduser]

Yeah I still plan on talking to my Dr and medicaid, but now I have an understanding after finding that site why my Dr prescribed me the dose he did, so I think he did the right thing, however with such a powerful drug it would probably be best to have started a little lower and then move up from there. But Ill still talk to him and if he thinks its best to stay where Im at then Ill do it. My liver condition already has me on borrowed time so if I go because of it, at least Ill go happy and in no pain lol j/k My biggest concern is will I go into withdraw from the dilaudid being that I will no loner be taking dilaudid round the clock and may not even need it anymore depending on how the break throughs go. The info in the insert says to avoid withdraws from other opiates while starting the fent, stay on both, but to me that sounds like a bad idea to be taking fent and dilaudid togther round the clock rather then just PRN. Would you know anything about the withdraw part? Also, I am assuming from what I read is once on the fent STAY on the fent, meaning don't take the fent for 3 days on, 3 days off, and so on, my guess is that defeats the purpose of the patch, right?

 

[Jabberwocky]

yeah, there's no need to abstain and clear your receptors as you have to when starting buprenorphine. you'd only be putting yourself through pain and withdrawal for no reason. though when making the switch to fent as your primary pain control dosing the minimum amount of dilaudid to keep you comfortable would be a smart idea. once you're settle on the fent then it's safer and wise to only take the dilauded as needed for breakthrough pain. if you don't need it don't take it!

and yeah, if you remove the patch within the 72 hours and try to reapply it it almost renders it useless upon reapplication. the adhesive goes to shit.

 

[painenduser]

and yeah, if you remove the patch within the 72 hours and try to reapply it it almost renders it useless upon reapplication. the adhesive goes to shit.

Ok cool, thats what I was hoping you'd say, as I have had withdraw from dilaudid before because I couldnt get a script filled when I needed too and it sucked balls BIG TIME!! And what I meant by the patch was not removing the current patch and then trying to put it back, I was referring too more of, I have a box of 5 right now so that is 15 straight days worth, but if I wanted to extend that longer, would it make sense to place the patch for the 72 hours, remove that patch toss, it, wait 3 days then apply another one? Or should I continue with a new patch back to back every 72 hours. Does that make sense now of what I was asking?

 

[Jabberwocky]

given that you're dependent on the painkillers waiting a further 72 hours after finishing the patch is going to put you through withdrawals. fentanyl has a very short halflife and the withdrawals extremely acute (painful) so you'll likely be in full withdrawal should you go that way. take them as intended unless you are able to grin and bear the pain and withdrawals. but it's not a nice ride constantly being in limbo of painfree than withdrawal.

 

[painenduser]

Excellent and understood. And yes your right its not a nice ride, thats why I want off of the dependence of being on dillies as my primary pain control. Being it's a short acting drug, if I miss about 8 hours after my last pill I start to withdraw physically. If I go 2 days with out it, I want to shoot myself and get it over with. Narcs are life savers when it comes to extreme chronic pain but their evil side with the physical withdraws is a killer. I'm imagining the physical withdraw from fent is going to be 10x worse should I ever wide up in that position and that is one position I do NOT want to be in. You know it suck because I live in NJ and the narcotics laws here are some of the strictest in the country, and for people like me who have severe pain, but its not caused by AIDS, cancer, or MS, they make it almost impossible to get treatment. There are so few pain mgt Dr's in this area that do medication management because of that, most just do intervention pain management which would not work for me because I have visceral pain and on top of that I have no insurance because of my illness I cant work so Im stuck with medicaid and welfare (and trust me at 37 yrs old that f'ing sux!) and the cash they give me from welfare is only around $200 a month and that is what I use for my pain mgt dr. Anyway sorry for the rant, I just get heated when I start thinking about how hard it is to get treatment in this state.

Since you said it may take about 6-8 hours begin to start getting the relief, I think I'll start tomorrow morning after my phone calls, this way when I see my other Dr at 1630 I can tell them if I am having any reaction as my Dr is actually at the hospital, so that would be convenient if I go into a nod.

 

[painenduser]

Well it would appear that my Dr wants me to keep it at the 100mcg as he says he wants it to be a complete parallel, no titration required, so I guess the question that I have at this point which I completely forgot to ask my Dr, is how long after my last 8MG dose of Dilaudid should I wait until I place the patch on? He still wants me to keep the dilaudid for break through, so I imagine that once I am comfortable with how Im feeling with the Fent, I could then use maybe only 2 or 4 MG's of the dilaudid if need be. Should I wait an entire night before I start the patch since I just took 8MG's a little bit ago of the dilaudid? Say wait 6-8 hours before starting the patch?