Pancreatic cancer pain control....could we have overdosed??

[mwason]

My aunt fought pancreatic cancer for 1 and 1/2 years, had her pancreas removed even, until her death 6 weeks ago. My sister and I were like her children and were her caregivers. I just was browsing some unrelated things on the internet and found the news about the FDA reporting several patients dying of overdoses from the Fentanyl patches. We started her on one 25 mg patch when the hydrocodone wasn't cutting it anymore. Then, when she still complained of mild pain in her stomach, hospice (on their first visit there)called her oncologist and he approved upping to two 25 mg. patches. So we took off the one and started again with 2 fresh 25 mg patches. She was very out of it the next day. That night, exactly 33 hours after the 2 patches were applied, she was found dead in her bed. She had no signs that death was imminent from the cancer. Also 1 hour before she died that night she was anxious so we gave her a Xanax, which I also just read is NOT to be given with Fentanyl. She had been on Xanax for approximately 2 months for anxiety. No one said to discontinue when on the patches. Did we make a mistake upping to 50 mg, or more probable, give her the Xanax when we shouldn't have causing her death?? Also, she was a diabetic (after removal of her pancreas) and that day her sugar counts were 400+. I just have thought her death was somewhat sudden and now reading some of these Fentanyl warnings and drug interactions I am wondering if it is related. Thanks for your time. I hope this forum topic area is appropriate, I didn't know where else to post it.

[Kevin Pho, MD]

Short of an autopsy, it will be difficult to conclusively say what the cause of death was.  There is always the possibility of an increased dose of narcotic therapy.  That being said, a 50mcg dose of Fentanyl is a very reasonable dose and most people do not overdose on 50mcg.  

As for the interaction with Xanax and Fentanyl - there is certainly the possibly for interaction which can lead to increased lethargy, respiratory supression, or confusion.  Whether this may be led to her death is possible, and impossible to say from afar on the internet.

That being said, the goal of hospice is to make terminal patients as comfortable and pain free as possible.  Optimizing the dose of Fentanyl and Xanax is part of this strategy, and may lead to death in some cases.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com