Aa
weaning off of fentanyl 100 mcg patches
Over a 10 yr period I have been being treated for many severe back problems.Over those 10 yrs I've worked up a tolerance and am now on 100 mcg fentanyl patches every 48 hrs and 10 mg percocet 4 x's a day or as needed.I've been on this dose for over 2 yrs. Over Labor Day wknd my doctor has passed away.Long story short,his father-in-law has taken over the practice because my old doctor apparently left 100's of us addicted to amounts of pain meds.When I first saw new doc, he asked no questions about why I'm taken any of my meds..He just wants me off everything. He cut me down to 75mcg patches ever 3 days and 5mg percocet.I've had the hardest time this first wk and dont think I can handle another wk like this..Pharmacist even said it was way too big of a cut back... what should I do? Is this safe what he's trying to make me do?
I was on fentanyl patch for 5 years or more and it got to where I couldn't get them because of a backlog and that lasted 3 months, I had to go off of the patch and I didn't have anything to fall back on.No Xanax or Loritabs that I was prescribed. I would NOT recomend anyone trying to go off this patch cold turkey!! I woke up on the second morning after taking my last patch off and was freezing. My pulse was 50 bpm and I felt like I was frozen from the inside out.
This was the worst time I have ever went through, the nervous feeling and all the pain that the patch was masking coming back at one time. I really didn't know how much pain I was in until that day, I truly feel for anyone who has to go through this, My problem is what to replace the patch with,
This was the worst time I have ever went through, the nervous feeling and all the pain that the patch was masking coming back at one time. I really didn't know how much pain I was in until that day, I truly feel for anyone who has to go through this, My problem is what to replace the patch with,
worried878 - you reminded me of a good point about the fentanyl patches. While they are supposed to last 3 days, many of them don't. My experience is that the gel pouch patches dispense too fast and run out just over 48 hours. I was totally stoned on day 1, fine on day 2, and beginning withdrawal on day 3. Hot weather noticeably speeded up that process.
jmiss33 - what kind of patches are you currently using? If you haven't tried the Mylan Pharmaceuticals generic, see if you can find them in your area. They don't use the gel system (look like a clear piece of tape), actually last the full 3 days, dispense evenly over that time, and I rarely have problems with them falling off. A change in brand may help you out a bit.
jmiss33 - what kind of patches are you currently using? If you haven't tried the Mylan Pharmaceuticals generic, see if you can find them in your area. They don't use the gel system (look like a clear piece of tape), actually last the full 3 days, dispense evenly over that time, and I rarely have problems with them falling off. A change in brand may help you out a bit.
Fentanyl patches are designed to be changed every 3 days.
U may feel a bit uncomfortable but shouldnt be to bad..no matter how slow u go, u will feel it. as a rule.
It does not sound like your goal is to get off pain meds?
I am not sure of your affliction/pain issue Perhaps u need to consult another dr but drs who RX heavy duty narcs are becoming fewer and fewer due to law suits and govt regulations,
What is your goal?
U may feel a bit uncomfortable but shouldnt be to bad..no matter how slow u go, u will feel it. as a rule.
It does not sound like your goal is to get off pain meds?
I am not sure of your affliction/pain issue Perhaps u need to consult another dr but drs who RX heavy duty narcs are becoming fewer and fewer due to law suits and govt regulations,
What is your goal?
I'm a chronic pain patient and have been on the fentanyl patch for over 5 years. I am currently tapering off at my own request. All I can tell you is what my doctor told me and my own experience with tapering fentanyl.
A couple years ago I asked to drop from 75 to 50 mcg never imagining what was in store for me. Within two days I was a barfing, leg-kicking, insomniac mess. Hot showers/ baths helped tremendously for the worst of it. Of course, my pain skyrocketed and I hurt in places that never hurt before. After about three weeks, my body adjusted to the lower dose and I was fine. I called my doctor on day 2, and she insisted that a 25 mcg decrease could not possibly cause that kind of severe withdrawal symptoms. Apparently she's learned a bit since that episode. Now she says that 25 mcg is too large of a decrease. Wonder where she learned THAT bit of news? LOL!
I've been on the 50 mcg patch with 4 norco a day since my last drop over 2 years ago. My doctor's taper plan is this:
Over the course of four weeks, take one less norco a day per week. At the end of the 4th week, I went to the 25 mcg patch. Knowing that withdrawal would set in, she had me add back the 4 norco a day. That dose continues until I'm stabilized, no matter how long it takes. (Which is where I'm at now.) Then I do the 4 week norco taper again. When complete, I ditch the patch for good and only take the norco. My goal is to have the norco on hand only for the worst of the worst days. It hasn't been too terribly bad so far, and certainly nothing compared to my first experience.
If you have any underlying medical condition - particularly high blood pressure/ cardiovascular/ circulatory issues - such a fast taper "may" be medically dangerous. Hypertension is a necessary evil of withdrawal, so if you already have high blood pressure it's very important to monitor it. If your doctor knew anything about withdrawal, he would have at least prescribed some clonidine to help with the hypertension. Clonidine is an old alpha blocker hypertension medication. For whatever reason, it helps a great deal with the other withdrawal symptoms. Buy a home BP monitor and spend a few extra bucks for one with a proper arm cuff. The finger and wrist monitors aren't very accurate. Keep a written record to show your doctor - IF you can get him to look at it. :-/
I agree with your pharmacist that a 25 mcg decrease of fentanyl along with half your usual dose of percocet is a pretty big drop. How long does he want you to remain at that dose? What kind of withdrawal symptoms are you experiencing specifically? You can definitely expect your pain levels to be out of control for a few weeks along with generalized pain in the rest of your body. Try to remind yourself that it is temporary and WILL go away. It's just the opiate receptors in your brain screaming to be filled.
Is your doctor a primary care physician or a pain management physician? A pain doc should be better educated in detox and have a better taper plan than what he has planned for you. Did he explain exactly why he wants you off the pain meds, and outline a complete detox program and timeline for you? Do you think you still need the narcotics after 10 years? Did he offer any non-narcotic pain therapies or offer to refer you to a different doctor? I don't mean to stick my nose in where it doesn't belong, but these are the kinds of questions that you need your doctor to answer. If he won't, or the answers are unsatisfactory, then you have to find another doctor.
While I agree this taper plan is too fast, it may actually be a good thing for you if you can stick with it. An "opiate vacation" is a medically legitimate technique for dealing with tolerance issues in chronic pain patients. A doctor who only offers increases in dose isn't doing his patients any favors. At some point, the medication will be ineffective regardless of how much you take and possibly prove to be fatal. A slow taper to a very low dose or even no opiates at all will reset the opiate receptors in your brain. When you go back on opiate therapy, a low dose will work far better than the high doses your brain was used to receiving.
Another technique is to change to a different opiate every few months. For example, a doctor might change you from fentanyl to morphine. Any transition to a different medication will result in some problems and probably minor withdrawal for a short time, but the short-term misery is worth it for the long-term benefits. The same reasoning applies to an opiate vacation.
I'm really sorry your doctor left you in the lurch like this, but it happens more often than you can imagine. You certainly aren't alone - not that it helps right now to know that. :-)
A couple years ago I asked to drop from 75 to 50 mcg never imagining what was in store for me. Within two days I was a barfing, leg-kicking, insomniac mess. Hot showers/ baths helped tremendously for the worst of it. Of course, my pain skyrocketed and I hurt in places that never hurt before. After about three weeks, my body adjusted to the lower dose and I was fine. I called my doctor on day 2, and she insisted that a 25 mcg decrease could not possibly cause that kind of severe withdrawal symptoms. Apparently she's learned a bit since that episode. Now she says that 25 mcg is too large of a decrease. Wonder where she learned THAT bit of news? LOL!
I've been on the 50 mcg patch with 4 norco a day since my last drop over 2 years ago. My doctor's taper plan is this:
Over the course of four weeks, take one less norco a day per week. At the end of the 4th week, I went to the 25 mcg patch. Knowing that withdrawal would set in, she had me add back the 4 norco a day. That dose continues until I'm stabilized, no matter how long it takes. (Which is where I'm at now.) Then I do the 4 week norco taper again. When complete, I ditch the patch for good and only take the norco. My goal is to have the norco on hand only for the worst of the worst days. It hasn't been too terribly bad so far, and certainly nothing compared to my first experience.
If you have any underlying medical condition - particularly high blood pressure/ cardiovascular/ circulatory issues - such a fast taper "may" be medically dangerous. Hypertension is a necessary evil of withdrawal, so if you already have high blood pressure it's very important to monitor it. If your doctor knew anything about withdrawal, he would have at least prescribed some clonidine to help with the hypertension. Clonidine is an old alpha blocker hypertension medication. For whatever reason, it helps a great deal with the other withdrawal symptoms. Buy a home BP monitor and spend a few extra bucks for one with a proper arm cuff. The finger and wrist monitors aren't very accurate. Keep a written record to show your doctor - IF you can get him to look at it. :-/
I agree with your pharmacist that a 25 mcg decrease of fentanyl along with half your usual dose of percocet is a pretty big drop. How long does he want you to remain at that dose? What kind of withdrawal symptoms are you experiencing specifically? You can definitely expect your pain levels to be out of control for a few weeks along with generalized pain in the rest of your body. Try to remind yourself that it is temporary and WILL go away. It's just the opiate receptors in your brain screaming to be filled.
Is your doctor a primary care physician or a pain management physician? A pain doc should be better educated in detox and have a better taper plan than what he has planned for you. Did he explain exactly why he wants you off the pain meds, and outline a complete detox program and timeline for you? Do you think you still need the narcotics after 10 years? Did he offer any non-narcotic pain therapies or offer to refer you to a different doctor? I don't mean to stick my nose in where it doesn't belong, but these are the kinds of questions that you need your doctor to answer. If he won't, or the answers are unsatisfactory, then you have to find another doctor.
While I agree this taper plan is too fast, it may actually be a good thing for you if you can stick with it. An "opiate vacation" is a medically legitimate technique for dealing with tolerance issues in chronic pain patients. A doctor who only offers increases in dose isn't doing his patients any favors. At some point, the medication will be ineffective regardless of how much you take and possibly prove to be fatal. A slow taper to a very low dose or even no opiates at all will reset the opiate receptors in your brain. When you go back on opiate therapy, a low dose will work far better than the high doses your brain was used to receiving.
Another technique is to change to a different opiate every few months. For example, a doctor might change you from fentanyl to morphine. Any transition to a different medication will result in some problems and probably minor withdrawal for a short time, but the short-term misery is worth it for the long-term benefits. The same reasoning applies to an opiate vacation.
I'm really sorry your doctor left you in the lurch like this, but it happens more often than you can imagine. You certainly aren't alone - not that it helps right now to know that. :-)
Hi & Welcome,
this is a pretty quick jump but doable. That being said, Fentanyl is a bear to come off of and you are going to have withdrawal symptoms. I can't sugar coat that.
Do you feel that you still need the pain medication? If so, have you considered pain mngt? Only you can be honest about your pain and what your needs are.
As far as safe in dropping down, unless there are underlying health problems there is basically no risk in opiate withdrawal. Again, not pleasant.
What do you feel you need to do?
this is a pretty quick jump but doable. That being said, Fentanyl is a bear to come off of and you are going to have withdrawal symptoms. I can't sugar coat that.
Do you feel that you still need the pain medication? If so, have you considered pain mngt? Only you can be honest about your pain and what your needs are.
As far as safe in dropping down, unless there are underlying health problems there is basically no risk in opiate withdrawal. Again, not pleasant.
What do you feel you need to do?
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