Fentanyl question

[book of revelation]

Hi all, long time lurker first time poster..

I am a chronic pain sufferer and have been successfully treated with opiate therapy for going on 6 years now.

My question relates to fentanyl, specifically Durogesic transdermal system and its effect on existing opiate tolerance.

Cutting to the chase, prior to the use of the fentanyl I had a baseline opiate tolerance of around 30mg of oral oxycodone.

After a period of around 9 months of fentanyl use (75ug p/h) some complications arose with the use of the drug, particularly the patch system and a return to oral oxycodone (oxycontin) at the original (30mg bd) dose was attempted.

This was a spectacular failure, finding myself in the throws of W/D after about half a day. with some off label experimentation I soon found that double that dose (60mg) would arrest and hold off withdrawals, with a small increase to 75mg seeing a return of adequate analgesia and a welcome return to my previous level of activity.

After some discussion with my prescriber, who believed that the previous dose would be sufficient the matter was not resolved and so a specialist referral was obtained which I am at this time waiting to attend.

I wonder if there might be something else going on, or weather it is as I suspect and the fentanyl use has markedly increased my tolerance in that short amount of time ?

Id love to hear some opinions on weather this is indeed the case..

 

[Crankinit]

I had the same experience when using fentanyl recreationally, kicked my tolerance through the roof and it took a few months of abstinance to let it go back down.

I'm curious about what the complication was that forced you back to oxycodone?

 

[MrIbis]

Fentanyl is well known for it's extremely positive analgesia, followed by very little relief after a reasonable duration of use - and increased opiate cross tolerance as is often observed with most opiate users.

I'm a well, yet again, ex-heroin addict, been clean for a little while now - and just getting over withdrawals.

I found the best system to overcome the w/d and tolerance problems (i guess i'm not a chronic pain sufferer) was to taper down using OTHER opioids. I found oxycodone extremely useful for this, as well as tramadol. Whilst neither of them provide me with much of a high, they do remove the monkey for some period, and make the whole thing a little easier to deal with. If i ever do go back to opioid use, given i used the taper system for 2+ months - and thats the amount of time i've been off buprenorphine, I know that my tolerance to most opiates, except codeine, is reduced quite a bit.

 

[book of revelation]

Probably not as dramatic is it may sound, while the pain relief was excellent with the durogesic there was a significant problem with excessive sweating.

This was particularly problematic in social and work situations, where upon even the slightest exertion (walking up a flight of stairs for example) I would end up in a thick lather of sweat, and this would take quite some time to abate, this ofcourse was less than ideal in business meetings or when out to dinner with firends.

Did you have a similar experience ? how long did you use fentanyl for, and how long did it take for your tolerance to settle down to the level prior to your use of fentanyl after you stopped or changed ?

 

[Jabberwocky]

sorry i haven't replied to your PM yet, i will get back to you sometime today. i've been tied up

 

[Jabberwocky]

Hi all, long time lurker first time poster..

I am a chronic pain sufferer and have been successfully treated with opiate therapy for going on 6 years now.

My question relates to fentanyl, specifically Durogesic transdermal system and its effect on existing opiate tolerance.

Cutting to the chase, prior to the use of the fentanyl I had a baseline opiate tolerance of around 30mg of oral oxycodone.

After a period of around 9 months of fentanyl use (75ug p/h) some complications arose with the use of the drug, particularly the patch system and a return to oral oxycodone (oxycontin) at the original (30mg bd) dose was attempted.

This was a spectacular failure, finding myself in the throws of W/D after about half a day. with some off label experimentation I soon found that double that dose (60mg) would arrest and hold off withdrawals, with a small increase to 75mg seeing a return of adequate analgesia and a welcome return to my previous level of activity.

After some discussion with my prescriber, who believed that the previous dose would be sufficient the matter was not resolved and so a specialist referral was obtained which I am at this time waiting to attend.

it's stated on the Janssen Cilag (manufacturer, and it's even in the booklet provided in each box of ifi'm not mistaken) site that a patient beginning fentanyl treatment should have been on no less pain treatment dose equivalent to that of 60mg oxycodone daily for a minimum of 2 weeks prior commencing, starting at 12mcg/hr. you can check this coverter http://www.globalrph.com/fent.cgi (it refers to analgesic properties).

now i know you were on fent and made the change over to oxy (i made the same change, i'm now on morphine) but to be on 75mcg/hr and to be switched back to on 30mg bd oxy is extremely harsh in my opinion, but understandable as he's not a pain management specialist - hence his referral. the worst of it will be over in a matter of 3 days maximum because of fentanyls extremely short half-life. i went through the throws of fent way to many times for my liking when i was (ab)using it for pain managment. it and buprenorphine have been by far the best around the clock pain management control.

I wonder if there might be something else going on, or weather it is as I suspect and the fentanyl use has markedly increased my tolerance in that short amount of time ?

Id love to hear some opinions on weather this is indeed the case..

doesn't sound like anything fishy going on. the fact that your doctor isn't a pain management specialist will be part cause of the inadequate switch over dose - communication is the key here. a bit of advice is drop the dose of the current med you're on before switching over before switching if you have to again, allowing for cross tolerance. also prepare yourself with some otc aids such as NSAIDS, antihistamines, doxylamine succinate, codeine to aid in the future.

and also, yes, fentanyl will absolutely throw your opiate tolerance to the moon because of its potency, especially if you're abusing it. when i switched off fentanyl it was a rough transition to say the least.

 

[book of revelation]

Thanks Left, so how long should I expect my tolerance to linger at that level, or will it come down to meet my current medication regime in time or is it likely to hover around the current level until such time as there is a period of complete abstinence ?

what was your experience with changing away from fent ?

 

[book of revelation]

Bizuump

 

[Jabberwocky]

Thanks Left, so how long should I expect my tolerance to linger at that level, or will it come down to meet my current medication regime in time or is it likely to hover around the current level until such time as there is a period of complete abstinence ?

what was your experience with changing away from fent ?

it will come down to meet your current regime in time, it will just be physically and most probably mentally (ie. if you're psychologically hooked to taking a pill for PM, as a lot of people are) uncomfortable for a short while - a week or two if i were to take a stab at it. it's always different from person to person.

if you up the dose of oxycodone to a level that's equipotent to the fentanyl's effects you're not doing anything for your tolerance, it's going to be the same as on fentanyl. if you drop your dose significantly and stabilise on that dose you're dropping your tolerance a good amount. tolerance is an extremely complicated element of drug use far beyond adjusting doses.

my experience changing from fent?

used correctly as prescribed the polymer matrix delivery of fentanyl used for pain management is a great system which left me with few ill side effects. my only problem arrived through the adhesive becoming unstuck from perspiration. i was abusing the fentanyl (most usually buccally) to the point of having my first OD(wasn't sole reason, but assume would have played a major part). i don't know what else to say that i haven't already somewhere on here about fentanyl; it left me in a bad place of addiction and being there again now i'm finding it hard to talk about some of these topics objectively.