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Safe Dose of IV Fentanyl ? (first time)

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Unlucky

Bluelighter
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Apr 26, 2007
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I have a neurological condition known as autonomic dysfuction which developed after overdosing on party drugs 8 years ago. It left me with a severe chemical sensitivity and heaps of other symptoms.

Recently due to detereorating joints and chronic pain I was given and tried several painkillers but had adverse reactions to... morphine, oxycodone, codene, tramadol and darvocet.

After going to a pain managment clicin the specialist there decided to try fentanyl for me, I have no opiod tolerance whatsoever and a chemical sensitivity so the clinic is going to have me try an iv fentanyl in hospital under supervision but im still very concerned as they may underestimate the severity of my neurological condition and the chemical sensitivity I have.

So what is a safe dose for a first time person with a pre-existing medical condition, chemical sensitivity and and no opiod tolerance, im also concerned that if they administered "naloxene' to reverse the effects the naloxene itself could cause fatal adverse reactions too?
 
PS> Im going in this Friday so i need as much feedback as possible by then, even if it is in a hospital I dont trust them or my own body as both have let me down many times in the past, even one of my adverse reactions to oxycodone occured in hospital was near fatal as they failed and neglected to treat me properly.
 
There's no real way for us to tell you what YOUR safe dosage level will be. You need to make it clear that you have these pre-existing sensitivities and then start very low. Fentanyl has a very narrow margin of error.

Do you really need to medicate your condition with strong opiates or is it something that you could live with while making some lifestyle changes (diet, exercise, stretching, etc)?
 
Hi Samadhi , my painful condition has only continued to get worse since its onset and ive tried all the alternative therapy's suggested to me so this is a last resort.

I understand its hard to say what dose is safe but can you give me any rough idea as a guideline so I can refuse if I think they ar egiving me too much? Because i dont know anything about the dosage for fentanyl.
 
I'm not telling you to do this, but its probably something like 25-50 micrograms to start.

edit: a microgram is 1/1000th of a milligram, so 25-50 micrograms = .025-.05 milligrams ----- a LOW number
 
Thanks Johannes, i'll try and make sure they dont exceed that amount buy too much.


Ham-milton said:
doesn't seem to matter much- they'll have naloxone on hand.
Click to expand...

Thats what worries me too, I dont want them to be too trigger happy relying on naloxone as that could cause adverse reactions for me too, believe me my body and autonomic nervous system are so messed up, unreliable and unpredicatable I even have severe symptoms to the changes in my own brain chemistry that occur after waking up and through out the day, I constantly overheat and have all sorts of odd symptoms going on thats why im a bit reluctant on naloxone
 
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Unlucky said:
Thanks Johannes, i'll try and make sure they dont exceed that amount buy too much.
Click to expand...


Dude, don't listen to me, especially over doctors. Let them do their thing. They went to school for over a decade for a reason. Just let them do what they do, you can trust them more than you should trust a total strangers word.
 
^ ok thanks for the advice.

Ive also read that "A dose of 100 µg (0.1 mg or 2.0 mL) is approximately equivalent in analgesic activity to 10 mg of morphine or 75 mg of pethidine."

So does that mean if I had an adverse reaction to 5 mg of iv morphine, then fentanyl should not exceed that equvalent amount or is that irrelevant as they are both different totally different medications and act diferently?
 
They act in a similar fashion but they are quite different chemically. Morphine is a classic opiate, fentanyl is a piperazine. There are sure to be pharmacological differences between drugs with such wildly different structures, exactly what I could not even speculate. I think if you express your previous complications clearly they will start plenty low enough since no one wants to deal with dead patients and their lawsuits.
 
^^Piperidine you mean...

As ham-milton points out they will have naloxone, and they might not take too kindly to you suggesting a dose of fentanyl...

Medical school is only 4 years, followed by a residency, and one can get their B.A in 2.5 years (perhaps less if you try)....

Off topic: anyone here get above 40 on their MCAT?
 
Unlucky,
If I remember right you suffer from some form of malignant hyperthermia, it seems that there are many variants of this condition, the classic one is the reaction to inhalational GA but there is some information the literature that suggests that all mu opioids might be capable of inducing hyperthermia in susceptable individuals. probably through up regulation of metabolism in Brown adipose tissue, and other mechanisms. Animal studies point to Brown adipose as the key. Apparently the effect is reversed on administration of naloxone. I do not know whether this is a centrally or peripherally mediated effect. and on the plus side Fentanyl sufentanyl and remifentanyl have all been succesfully used in anaesthesia in potential malignant hyperthermia patients. If it was me I would let them use whatever dose they felt like, I would want an analgesic dose, but I would insist on temperature monitoring and an agreed temperature at which they administer naloxone, and that there is no choice in the matter, if the temperature is greater than that level they must administer naloxone.
it may well be the case that your hyperthermia is different and due to serotinergic mechanisms, but all the same it pays to be cautious.

If you can, talk to an anaesthetist, rather than a pain management specialist, (it almost a certainty that the anesthetist will have forgotten more pharmacology than most doctors will ever know.) most anaesthetists are well aware of MH and how to deal with it, as it is responsible for regularly killing their patients.
Make sure they monitor your core temperature after administration and make damn sure they have a plan and the necessary drugs not just naloxone to deal with any hyperthermic response. it is possible for the hyperthermic response to be delayed for some time after administration. is the IV fentanyl a test to see if long term pain relief is possible using patches or similar, or is it to find a general anaesthetic for a surgical procedure?


one final question, does anyone else in your family suffer from hyperthermia? it seems to be genetic. I looked into this condition when you said that MDMA had triggered it, it seems to me that MDMA had revealed a pre-existing condition rather than directly causing the condition.

Ask awkward questions, try to do it in such a way that doesn't invoke the standard I am God position from the doctor. Quite often a patient can know more about a specific condition than the doctor, who has to know about a range of conditions, but as a rule they are arrogant and dogmatic. They spend 3 semesters working on doctor swagger and arrogance and the remaining years getting drunk and chasing nurses. Evidence based medicine anyone?

I hope it works,
good luck
Vecktor
 
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Hi Vector, You are so wise and insightful, Your comments are along the lines of how I feel and think in regards to situations, doctors and everything else you've said.

You were so close to your thinking that I have MH, I also thought I had MH initially until a caffeine test, but actually what I have acording to my neurologist is a dysfunction in my hypothalamus's preoptic area which controls temperature regulation which was damaged during the severe hyperthermia I experienced and set at a higher point when I overdosed on drugs. To make matters even more complex with the "autonomic dysfunction" I developed itself is a very common factor in causing overheating, so for me its twice as worse and in the form of constant overheating which has distrupted my life severely.

No one else in my family has this, I belive Malignant Hyperthermia is triggered by exposure to certain drugs, so although this is true that I experince hyperthermia due to anything that gives me adverse reactions including opiods the fact that I also experience overheating and fevers on a daily basis in my life for the past 8 years is also a good indication to me that its not MH and in fact a combination of the "Dysautonomia" symptoms and the damage I suffered to my brain during the overdose which seems to get exagurated to a worse level of hyperthermia during adverse reactions to opiods.

This is where things get complicated....every time Ive had an opiod which caused an adverse reaction the overheating has been so severe that I always need to go under a cold shower and stay there for long periods so my biggest fear from fentanyl besides the adverse reaction and respiratory depression is the potential overheating, but im curious how did you know this? you seem very knowledgable on the topic of mu opiod induced hyperthermia, your the only person who has come close to understanding what I experince as youve mentioned so I would be very curios to learn more of what else you know on the mechanics and the connections between of adverse reactions, overheating (hyperthermia), opiods and the condition I have, I could maybe finally understand myself a bit better.

Man you hit the nail on the head when u asked what the purpose of the fentanyl was for...its for both to see if long term pain relief is possible using patches or similar without the adverse reaction experienced from other opiods and also to find a general anaesthetic for a surgical procedure and for emergency situations as something like morphine could be fatal in case of an accident.

thank you for your taking the time to understand me and for sharing your wisdom =)
 
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Sorry I can't contribute anything worthwhile here, but I just have to say that it's great to see Bluelight being able to help out so much in a situation like this. Cheers everyone. :)
 
Surely the person who decides your dose will be the pain management consultant? Here in the UK I don't think you'd find a doctor willing to take your dosage level and give it to you if it didn't tally with his own ideas.

I'd say let the clinic decide. There is no wonder drug for pain, and every strong opiate carries risks. If you decide they're outweighing the pain that's dragging down your quality of life, then go for it, don't worry, and let the specialists do their thing :) They do know what they're doing. Let us know how you get on.
 
in this case he'd be looking lower than the docs; I doubt they'd have a problem with that.
 
Thats exactly right Hamilton, sorry if i was unclear Emerald.

My health is so extremely messed up I could not even begin to explain the things i go through on a daily basis, I hate this stupid chemical sensitivity and condition Ive developed but I guess I brought it upon myself abusing drugs. Im amazed at how the people here are able to take substances so easily and tolerate it even though once upon a time I was like that but now I cant comprehend the idea because even a minute dose of any recreational stimulant now has the potential to be fatal for me. It really sucks =(

PS>You healthy folk are honestly so very lucky, please dont take it for granted as its hard to realise how precious health is until its gone, sorry to preach but I honestly felt the need to express this. Im not suggesting anyone quit but try and spread your usage gap to a wider more sparse timeframe throught out your life span instead of using everyday or once a week, I feel that I was given a limited amount of chances to use drugs before I got sick, if i had know this previously I would have spread it out and enjoyed them a few times a year for the rest of my life and still been able to take drugs now but instead I went crazy like a kid in a candy shop too fast too frequent for too long and burnt myself out and now ive used up all my chances.
 
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I'm so sorry to hear that :( constant chronic severe pain is no fun. I completely agree with your comments - there was nobody fitter than me, until I developed Rheumatoid Arthritis and my life has changed so much it's hard to take.

But I know there are plenty of people suffering more. I wish I had appreciated my good health when I had it. You have my sympathy and I hope you get some improvement and help. If I can ever be there when you need to talk, please PM me and I'll give you my msn address.
 
Hi Emerald, thanks for your kind words and offer to help I really appreciate that. :)
 
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