Hi. I came across this site after spending several hours googling for help with a problem. I am prescribed Fentanyl Oral 400mcg (Actiq and/or Oral Transmucosal Fentanyl Citrate). It is a “generic” but it is made by Cephalon (they also made the patented version).
I have had very irregular results with these for breakthrough pain episodes and my doctor will not prescribe Fentanyl vials for IV/IM/Sc injection. Sometimes Fentanyl Oral will work very well, and sometimes I will need two (or three). My insurance will not pay for the medicine and it is getting to cost a lot of money. I can afford $25 a lollipop, which is what it costs me if I only use one per breakthrough pain, but I cannot afford $50 or $75 per breakthrough pain episode (a result of using two units of Fentanyl Oral).
I was hoping someone with experience could tell me how to get the best response from this medication? I have followed the package insert (and even called Cephalon asking for clarification and telling them how my response to Fentanyl Oral is inconsistent) and the only instructions are “put on one side of your mouth, twirl often, while sucking. Paint a picture along your gums.” There must be a better way.
Is it better to put it under your tongue (a lot of threads suggest this-- why doesn't the manufacturer?!?)? Some of the threads I have found from searching say that you shouldn’t suck on it, but rather just leave in your mouth for 15-30 minutes (the package insert says it shouldn’t be used for longer than 15 minutes)? Should I refrain from sucking and just let it dissolve?
I am aware of the poor bioavailability due to first pass metabolism, but I should still be getting between 100-200mcg of Fentanyl (depending on how much I swallow) from a 400mcg Actiq unit. If I am given Fentanyl 100mcg IV (sometimes repeated once), I am pain free. But with 400mcg of Oral Fentanyl, I usually have to take another lollipop 15 minutes later to get relief. This is why I am so confused-- I must not be using it properly.
So, I ask, what is the best way to maximize one 400mcg lollipop? I appreciate your help!
Thank you.
I have had very irregular results with these for breakthrough pain episodes and my doctor will not prescribe Fentanyl vials for IV/IM/Sc injection. Sometimes Fentanyl Oral will work very well, and sometimes I will need two (or three). My insurance will not pay for the medicine and it is getting to cost a lot of money. I can afford $25 a lollipop, which is what it costs me if I only use one per breakthrough pain, but I cannot afford $50 or $75 per breakthrough pain episode (a result of using two units of Fentanyl Oral).
I was hoping someone with experience could tell me how to get the best response from this medication? I have followed the package insert (and even called Cephalon asking for clarification and telling them how my response to Fentanyl Oral is inconsistent) and the only instructions are “put on one side of your mouth, twirl often, while sucking. Paint a picture along your gums.” There must be a better way.
Is it better to put it under your tongue (a lot of threads suggest this-- why doesn't the manufacturer?!?)? Some of the threads I have found from searching say that you shouldn’t suck on it, but rather just leave in your mouth for 15-30 minutes (the package insert says it shouldn’t be used for longer than 15 minutes)? Should I refrain from sucking and just let it dissolve?
I am aware of the poor bioavailability due to first pass metabolism, but I should still be getting between 100-200mcg of Fentanyl (depending on how much I swallow) from a 400mcg Actiq unit. If I am given Fentanyl 100mcg IV (sometimes repeated once), I am pain free. But with 400mcg of Oral Fentanyl, I usually have to take another lollipop 15 minutes later to get relief. This is why I am so confused-- I must not be using it properly.
So, I ask, what is the best way to maximize one 400mcg lollipop? I appreciate your help!
Thank you.