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387767 tn?1345872027

Please-I need a quick answer about Fentanyl patches

Hi, I have several chronic pain issues--arthritis bad in knees, degenerative discs, herniated discs in neck and back.  I am in unbearable pain every day which has gotten to where I hardly walk or have a quality of life.

The problem over the years has been that I am unable to take a lot of pain medications because they bother my stomach so much.  I have tried vicodin, oxycodone, oxycontin and morphine.  I use one and get such stomach pain and nausea that I stop.  I am not a *pill* person.  I do take antidepressants, ambien and xanax,have HBP and take two drugs for that.

Now my doctor prescribed the Fentanyl Patch 25, and I am terrified to use it.  It says you have to be *opioid tolerant* which I am not.  Also I take the Ambien and Xanax.  Doctor said *be careful* but still, I am terrifed after reading the drug side effects.  I'm scared, and my hubby and son are mad at me because they said I *won't try* anything.

PLEASE HELP--what do I do?  Thanks so much.
9 Responses
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82861 tn?1333453911
No need to apologize ghilly!  It wasn't bad information, maybe just not complete information.  LOL!
Helpful - 0
441382 tn?1452810569
Thanks for the correction, Jaybay.  I had completely forgotten about the other patches.  And yes, it would be a shame for someone to miss out on possible pain relief due to being given bad information.  My apologies!  

Ghilly
Helpful - 0
82861 tn?1333453911
One correction on cutting the patch:  There are two kinds of patches.  One is a pouch containing a gel mixed with the fentanyl.  If that kind of patch is cut, the gel leaks out and dosage is no longer controlled.  If that patch is compromised while wearing it, yes, overdose is a possibility if the gel comes into contact with your skin.  

The other kind of patch looks like a flat piece of clear tape.  The fentanyl is embedded in the adhesive so if it's cut, there is nothing to leak out.  I have been tapering off the patch by cutting it, and I do so with the complete knowledge and support of my doctor.

I'd hate to see you miss out on possible pain relief solely due to fear of the patch.  Opiate therapy can be a crap shoot.  You won't know if the patch will help or hinder you until you try it so give it a whirl.  If you feel overmedicated, remove it and call your doctor just as you would with any other medication problem.  
Helpful - 0
441382 tn?1452810569
I can understand you being afraid to try the patch.  While I most definitely AM opioid tolerant, I STILL worry whenever there's a change in my medication regimen, and I have been a pain management patient for 15 years now and will be for the rest of my life.

If you were completely honest with your doctor about not having taken the opioids he has prescribed for you as they were prescribed, and he still insists that the 25 will be low enough for you to tolerate and he refuses to prescribe the 12 for you, then all I can suggest is to TRY it, but make sure you do it at a time when you will not be home alone at all for a couple of days.  Have family members keep an eye on you to make sure you appear to be behaving normally (sometimes we can FEEL OK but others will notice little things going on with us, for example, slurring of speech) and you yourself remain very aware of how you feel, and if you feel like you're having difficulty breathing or staying awake or functioning in any other way, remove the patch immediately and have a relative take you to the ER so they can check your vitals.  I suspect everything will go just fine, but as long as you have a contingency plan and know that you can rid yourself of the patch and get medical help immediately, it might make you feel more at ease about trying something new.

The average person thinks that morphine is the ultimate "big gun" against pain, so when we hear that Fentanyl is 80 times stronger than morphine, it can scare the poo out of us!  But as Jaybay said, it is dispensed in micrograms to take care of the problem of getting too much at once, so try to comfort yourself with that and think of how much more convenient it will be for you to not have to take pills all the time and have basically a "built-in" pain reliever working for you.  If you REALLY don't like how it makes you feel, take it off.  But if it's just a case of being a bit apprehensive, try not to invent symptoms just so you can stop, because you'll probably find that you really do like how it works on your pain.

Remember to always make sure that your patches are not torn, punctured or leaking in any way before you put them on.  Never EVER cut them in half to lessen the dosage because instead of lessening the dosage, cutting them will cause all the medication to be released at once which will overdose you.  As long as you take those basic precautions, you should be fine.  Oh, and remember that it will take approximately 15 to 24 hours before you're actually feeling the effects of the patch.  It takes about that long to begin absorbing the medication.

Ghilly
Helpful - 0
1611944 tn?1313891994
I'm on 50 and it's the first thing that has ever given me any kind of relief!
Helpful - 0
387767 tn?1345872027
Thank yo all SO much.  I did talk to my dr. and he said the 25 is a really low strength and just try it.  I'm still scared.  I have a problem with being afraid of drugs, although I'm on plenty.

All your support means a lot.
Helpful - 0
82861 tn?1333453911
While fentanyl is extremely potent, it is dispensed in tiny amounts (micrograms rather than milligrams) to account for that.  It is no better or worse as far as tolerance or abuse potential than any other narcotic so try not to fear it so much.

I do agree that you'll likely be overmedicated at 25 mcg since you are admittedly not opiate tolerant.  Since you have so much trouble with pills, the patch is reasonable alternative since it offers 24/7 pain relief and bypasses the GI tract.  Ask your doctor if you can try the 12.5 mcg patch first.  That's roughly equivalent to about 5 or 6 norco a day (50 or 60 mg of hydrocodone).  Even at that, I expect you'll feel overmedicated.

You could also ask your doctor about liquid or sublingual (dissolves under the tongue) narcotic preparations before going on the patch.  For example, Actiq is a fentanyl lollipop that would allow you more control initially as to how much you need and to avoid being overmedicated.  

All narcotics have their pros and cons so making an informed decision before starting opiate therapy is always a good thing.  If you don't get satisfactory answers from your doctor, opiates may not be the best thing for you or maybe you just need a different doctor.  Unfortunately, opiates are the gold standard for pain management so you may miss out on a whole lot of pain relief if you decide not to go that route.  Hope I haven't completely confused you!  :-)
Helpful - 0
614661 tn?1267273924
Hi Cindee...

I use the fentanyl patch, actually I currently use two patches and each are at 75mg. They don't make one patch that equals 150mg. I started out at 75mg with my Degenerated disc disease after using pills to try to relieve the pain. I cannot say how you will react to using the patch but I found that it is better than the pills. I'm also not sure at what level your pain pills are? My thought is that a 25mg patch should not bother you at that level. But everyone reacts differently.

Know that I hate these drugs, I can't wait to get through this and off the medications at some point in my life.

Good luck, Oz
Helpful - 0
Avatar universal
I'm sorry you're having so much pain and difficulty in finding a medication that you can tolerate.

Fentanyl is a very powerful medication - approximately 80 times stronger than morphine - so that is why all the literature says to use only in opoid tolerant patients.  Have you currently been on opiate therapy immediately before your doctor gave you the patch?  If so, then you "technically" could be considered opiate tolerant, meaning your body is accustomed to opiates.

The patch also comes in a 12.5mcg strength - you may want to ask your doctor about changing you to that strength at first to see how your body is going to react to the med, even if you were taking oral meds.   The same as with cooking - it's easier to add spices to what you're cooking than it is to take it out.  It's easier to ADD to medication if needed than it is to take medication out of your system once you have already taken it.

Since you have so many stomach issues with the oral pain meds, the patch may be just what you need to get good pain control - since it's absorbed through the skin, it bypasses the digestive system.  Now, of course, it doesn't mean that you can't get "normal" opiate GI side effects of some nausea and constipation, however, you won't have the actual pain pill "tearing up" your stomach.

Have you gotten the patch prscription filled yet?  If you haven't, I'd suggest either giving your doctor a call and asking if he'd be willing to let you try the lower dose (he's more than likely going to want/need the hard copy prescription you have now back).  You may also just want to go to his office an dsee if you can talk to him in person - that way you're there to return the script he gave you and also pick up a script for the lower dose.

As far as interactions with your other meds and "being careful" - because the other meds can make you drowsy/dizzy, etc. - you'll definitely have to be careful about how it affects you - do NOT drive until you know for sure how it affects you, stay away from dangerous machinery, get up slowly from sitting or laying down, etc.  Before you get the script filled, make sure the pharmacy knows everything you are taking and their computer system will automatically look for other possible reactions.  When I was on the patch, I also was on Ambien and norvasc for HBP, so I do know that the Ambien CAN be taken with it - not sure what you're on for HBP, but if it's norvasc, it should be fine too.

One other thing - like all pain meds, the patch can lower your blood pressure, so you may find that your BP meds might need some adjustments - again, watch for signs of your BP maybe going a bit low - dizziness, especially when getting up from sitting or laying down, etc.

Best of luck and please let us know how things go.
Helpful - 0
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