Opioids ORAL FENTANYL PATCH (MOUTH)

[Bent on fent]

https://www.sciencedirect.com/science/article/pii/S2665910720300530, informative article on absorbsion and extraction

 

[Them Witches]

Fentanyl patches do nothing for me. The only opioids I take for chronic pain syndrome are Roxicodone 30mg: 4hrs and Methadone 10mg : 8hrs. I add Clonidine 0.3mg: 8hrs to increase the effectiveness of the narcotic & added comfort. Fentanyl IV is not very good either & is more like speed compared to standard pain killers from morphine and thebaine.

The best combo for pain treatment for oral is Roxicodone & Methadone. Best IV is hydromorphone, oxymorphone, and demerol.

Mallinckrodt's brand name Roxicodone & generic Oxycodone can be dissolved under the tongue for a 4 times best first pass effect and lasts 3 times as long vs oral swallow. The RP 30's suck. The K9 30's also dissolve under the tongue but not as good as Mallinckrot. Many people have slept on this route. I have been prescribed the 30's for the past 14 years and recently had to dissolve them under the tongue for them to work at all.

 

[barberX]

Hi everyone,
I wanted to ask those who know about pharmacology, or anyone who has fairly reliable data on fentanyl patches used in the mouth (since there are no studies as the patch is designed to be used on the skin).
1. Does the dose contained in the patch, if kept in the mouth for a sufficient time between the cheek and the tooth (let's say 3 or 4 hours), release all the fentanyl contained in the patch?
2. Having to do the hair test as they are being treated at a center that delivers methadone, can they understand that the patch is not used correctly, on the skin? (And here we go back to point 1; how much of it would be absorbed by the oral mucosa? On the skin 75 mcg/h in 3 days delivers 5.4 mg. of fent, but the patch contains 12.6 mg. practically more than double!

My Considerations:
One 75 mg/h Durogesic patch contains 12.6 mg fentanyl base.
Dividing it (example) into 4 parts should release 3.15 mg. of fent.
But from my experience I notice that the first hour/ two hours are the ones that release the most of the drug.
So I wonder: is the entire fent released in the patch? Or is there still a kind of "block", which prevents him from dispensing it entirely?
Having previously used PecFent nasal spray 800 mcg (fentanyl citrate), which has a bioavailability of about 80-90%, the effects were obviously faster, but also different when compared to 1/4 patch (3.15 mg.): greater euphoria, less sedative effect.
If anyone has the knowledge to answer me, or even his experiences (only pharmaceutical fent, not those time bombs they sell on the street), I thank him sincerely, so that he can also adjust me for a gradual decrease in doses.
Hi and thank you

PS. I hope you understand the message, and that I did not make too many mistakes, as my English is not good and I used a bot for translations.

Did you manage to decrease your dose while using the Fentanyl patches orally? I am trying but besides cutting thinner strips and timing the time in mouth its very difficult. You do not know how much really gets absorbed like this. It seems to be much less effective after 3 hours in mouth. For some reason i feel bad when putting them on skin..i do it at night now but rip them off in morning because i feel weird if my Fentanyl levels do not go down a bit every so often.it also impacts my bowels worse if i dont have the 'down' time where bowels work.better. im a pain patient and only seem to be able to take fentanyl since all other opiates cause narcotic bowel.syndrome bad no matter how low the dose. Really i much rather be on oxycodone but i cant. So.i try to ween but dont know how like this. Is there a way? Or if have to go cold turkey in clinic with my bowel issues very scary thought. Any advice?

 

[xyz69]

Did you manage to decrease your dose while using the Fentanyl patches orally? I am trying but besides cutting thinner strips and timing the time in mouth its very difficult. You do not know how much really gets absorbed like this. It seems to be much less effective after 3 hours in mouth. For some reason i feel bad when putting them on skin..i do it at night now but rip them off in morning because i feel weird if my Fentanyl levels do not go down a bit every so often.it also impacts my bowels worse if i dont have the 'down' time where bowels work.better. im a pain patient and only seem to be able to take fentanyl since all other opiates cause narcotic bowel.syndrome bad no matter how low the dose. Really i much rather be on oxycodone but i cant. So.i try to ween but dont know how like this. Is there a way? Or if have to go cold turkey in clinic with my bowel issues very scary thought. Any advice?

Hi,
Yes, I managed to reduce the dose and stop methadone completely, but it’s tough: the fentanyl strips aren’t dosable and managing them is a real mess. After about three hours the patch loses consistency, and if you don’t secure it well between your tooth and gum you end up wasting the effect. Your fentanyl levels drop, and putting it in your mouth isn’t a good solution — we both know that.
What I do is: during the day I avoid any extra doses. I just use part of the patch each evening so I don’t have to chase the effect. To help myself I take Laroxil (amitriptyline), Pregabalin, and clonazepam together.
For intestinal issues I’ve had to resort to Pamora (naldemedina, commercial name Rizmoic). It works, but it’s not a walk in the park: it restarts transit by clearing opioid receptors in the gut, and if you’re severely constipated it can trigger vagal episodes. It’s not something to take lightly, but It does not cause central withdrawal.
Without knowing your exact dosages, I can’t gauge the magnitude.
Bye