Fentanyl

When my doc switched me to the fentanyl patch, he had given me a choice of long acting meds to use. Morphine, fentanyl, or methadone. I really had no idea, and after sitting there with a slightly terrified look on my face (it was starting to hit me... these are heavy narcotics, and I was trying to think of anything else to try, but had already tried most pain meds), asked him what he suggested. He said the patch. He wanted me off the roller coaster ride.

Once we got the dose adjusted, it's been working great for pain management. I don't have to use as much BT med (although I still have my days - weather, and this bulging disc problem in my neck). I started off with using the watson brand, and recently switched to the mylan brand, no reservior of med, patches are 1/3 the size, and the adhesive isn't irritating my skin. And they stick better, although I still use a tegaderm patch over them. I love the fact that the pain relief is very steady, the only time I start to hurt is when I've delayed changing my patch for 12 hours (I've done this twice). I love not having to take pills every few hours for pain relief. I don't feel tired and I don't get euphoria, which is great. Just an absence of pain.

I never took morphine, or oxycodone, or methadone, or any other CII meds previously, just hydrocodone 7.5. After reading up, I realized how potent fentanyl really is. Which is ok, I don't abuse it. I'm on 25 mcg/hour every 48 hours.

I do have a question for the fentanyl users here. Knowing the discussions regarding the differences in potency of different generic meds (oxycodone, hydrocodone, etc), has anyone noticed a difference between the different generic brands of fentanyl?  Or the name brand (Duragesic)?

I like the Mylan so much better than the others I have tried.  I have tried Watson and Sandoz.  I never realized how mentally draining the up and downs are when you take any IR med.  Not to mention I get very irritable from the up and downs.  Glad to get off of the roller coaster also.  Take care, htmom

I've been wondering about the summer heat thing now that Fent. makes it possible for me to garden a little bit again. I was way beyond what they call an "avid" gardener before this cancer pain. I wasn't obsessive about it, I just really enjoyed the whole process. I'm having trouble with my body sucking up the pouch/patch in less than 72 hours. I'm changing to the Mylan next week, but you say that it still gets sucked up. I don't think I should ask for an increase since I've only been on the stuff for 3 weeks now. Please p.m. me with your advice, and Thanks in advance!

                                                                             Q        

Thanks for the advice all the way around, especially the part about dosage/frequency being OK to bring up right away. That makes a lot of sense to me because the speed of use showed up immediately so I should mention it right away. If I was to wait another month to say something, then that might seem fishy. I have a wonderful, trusting relationship with my oncologist and I really don't think that it would be a problem one way or the other . . . it's just that this works soooo well that I would hate to jeopardize my Rx. I'm sure you, Ray, and all the rest of us Fentanyl users can understand.

Since my cancer hormone therapy has made me almost androgynous I don't have any body hair to speak of, which is really weird but not as weird as some other stuff that I'm not gonna write about. I do get frequent and intense hot flashes too, as often as 2-3 an hour and sweat just drips off of me. It's like I just stepped out of the shower, my hair (on my head) is very damp and my whole torso, face and neck as well as my legs just spit sweat (YUK!). I never thought about putting it on my arm, I'm gonna try that 'cause my girlish biceps are completely bare of hair. Thanks again . . .

                                                                               Q      

i could ever get one to stick well was on my upper arm.  I tried my stomach, thigh, chest. All of those places I had to shave then wait a day or so before I could put the patch on...It gets irritated really easy when you apply it right after shaving. You do need to rotate spots every time you change. Fentanyl works by being absorbed into the fat under your skin. It moves from an area of high drug concentration (in the patch) to an area of low concentration (the fat in your arm for example).  If you keep applying it to the same place it won't be absorbed, because that area of fat is already saturated with the drug. I just switch arms every time I change, although I use the exact same spot on my arm each time. 2 or 3 days is enough for most of the drug to be absorbed from the old application spot. It's hard for guys, or women (god forbid) that are hairy to find a spot where it will work...The package says not to shave the spot you are going to apply the patch, but if you shave it, then wait a day or so, there is no problem. The only reason they say that is because shaving (or applying it to broken/irritated skin) irritates the skin and will possibly react with the patch, making it itch more than it already does sometimes. Although I can say that the histamine related side effects of fentanyl are nothing compared to other drugs like morphine, oxy, hydro...etc...Happy 4th of July everyone

Ray

Curious if anyone has tried the Buccal version of Fentanyl, Fentora?  Last summer I participated in a Clinical Trial using Fentora for B/T/P and non-malignant cancer pain.   Currently it is only FDA approved for cancer pain.  That is too bad, it would be great for CP patients - smooth delivery and fast action.  Perfect compliment to the patch.

I was on Duragesic for a few months; it provided good pain relief.  However because I am such a sun freak, I switch for the summer months to something where being in the heat is  not a problem.

For me, and again, everyone is different, the Fentora had a better release.  It kind of reminds you of that candy "fizzies", there wasn't much of a taste but the instant it disolved, you could feel that Fentanyl "warmth" throughout your body.   I used the Fentora at 4 to 6 hour intervals, regularily with adequate relief for either duration.  This was a 10 week trial with the comparison between Fentora and Oxycodone IR for B/T/P- again for me, there was a destinct difference between the two with Fentora winning, hands down.  During the four phases, I continued my normal long acting, MS Contin at the time. 

I've only had Actiq once and it was following surgery - meaning that it wasn't the best of settings for a true comparison.  The Actiq while having a fast release had a strong after taste.  In the setting of how I had Actiq, it was not effective for the entire 4 to 6 hours it touts and they had to supplement my IV with Dilaudid.  I would like to be able to try the same trial setting for Atiq versus Fentora in a non-surgical setting, as my comparison is probably somewhat skewed with surgical pain as opposed to normal B/T/P is a different animal.  The delivery method of a fizzie was a winner for me as it faster did what it was supposed to do and for a longer period.

Gee Q, I have no idea about the equilevant dosing as I'm not a doctor, nurse or pharmacy person.  I can only tell you how it was handled in the Trial.  Fentora comes in 100, 200, 300, 400, 600 and 800.  They started me at the 200, titrated to the 400 and then the 800.  With the Oxy they started with the 10, then titrated to the 20 and then the 30.  I finished with the 800 against the 30........but I could not tell you if they are deemed equilevant at those levels or if that was just the perimeters of the trial.  This was the first and only clinical trial I've ever participated in.  It was an interesting process and if it helps to get FDA approval for Fentora for CP, I'll be first in line after that distinction is made.  It helps that you get paid in a trial - I don't know if anyone else has been in or or considered it but if you haven't it's a good way to get meds, new meds for free and in the process, maybe help a good drug serve more people as opposed to one subset.  I'm not sure if this particular Trial is still open, but if interested you could check the gov website for C/T.

I too don't understand the FDA's understanding in that one type of pain is any different from another or why this particular drug was deemed appropriate for only cancer pain. 

And from a personal standpoint, I don't know if cancer pain is any worse than CP.  I only have experience with the latter to include a variety of maladies to include the RA that you have, Failed Back Syndrome, AVN and Fibro which seems to accompany arthritis and for some reason follow Domestic Violence/Abuse.  Like many here, I've run the gamet of meds, both good and bad.  CP is a battle that many of us are fighting, as pain that never sleeps takes its toll.

What I was told was that the FDA only approved Fentora for cancer pain. I am not a physician or pharmacist and don't know if this means that it cannot be prescribed for other things because we all are aware of off-label prescribing.  Don't we have more expertised people that could find this out - like a physician.  It could be that this is one of the insurance loopholes to get out of paying for it.  I don't even know how anyone would check this further - I did though look at the gov C/T site and found the trial I participated in if anyone is interested -

http://www.clinicaltrials.gov/ct2/show/NCT00463047?term=fentora+and+alabama&rank=1

Looks like there is a followup trail recruiting for the next phase.  I'm sorry I don't know more about it.

Hi Allgood, I'm not sure if there is such a list but I wouldn't be surprised if there was. I hope our good Dr. MooreFeen reads this thread, perhaps he could explain the intricacies involved in Rxing drugs off label. I don't know if there is any sort of penalty for a Dr. that prescribes a drug off label but there certainly is one from the patient's Health Insurance Company's (HIC) refusal to cover the cost. That's a penalty that I have to bear on my Rx for the SSRI anti-depressant Cymbalta. Amitriptyline/Elavil has been Rxed off label for trigeminal neuralgia, facial neuralgia, and, as in your case, migraines, for many years. I was Rxed Cymbalta for clinical depression but it is also Rxed off label for CP and it did help to alleviate some aspects of my CP.

As I recall, Allgood, you are currently working towards a degree in Bio-Chemistry with an emphasis on the medical aspects. I realize that this is a gross simplification of your degree goal, please forgive the memory lapse and allow me to pick your brain a bit. I find it intrigueing that certain anti-depressants have this crossover effect for CP. Elavil is classified as a tricyclic anti-depressant . . . it potentiates (or, inhibits the reuptake of) the effects of both seratonin and norepinephrine. In other words, it is an SNRI. This action on the CNS is, to me, obviously at the root of their efficacy as analgesics. What do you think?

OK 3red3red, I'll get back on subject. Off label use of drugs has been around since the day that drugs were first pigeon-holed. The binding side effect of the codeine in Kaopectate comes to mind, as well as the drowsiness side effect of benadryl. In your days of guinea pigging for the Fentoral trial did you ever hear that it's use would be strictly proscribed for any use other than as an analgesic for cancer pain? I believe that such words could easily be put on paper. However, enforcement of such a strict ruling would be impossible, don't you think? 

                                                                             Q 

PS:  Sorry 3red, I was typing this reply while you were busy answering most of my questions. Oh well, such is life in the slow lane.

I'm not sure what you want to know about my experience with Fentora and the Clinical Trail; rahter than writing a book about mostly things yoiu are not interested in, if you could tell me specifically what you want to know that would be helpful

I found out about the Trial from my PCP; he printed the page from the gov website for me.  At that time, I was not under the care of a Pain Management specialist but had been under pain management care for 7 or 8 years.  After reading the information and deciding I thought I met the qualifications, I called the Trial Coordinator (listed on the website) and made an appointment.  I went in, answered a ton of questions and had a drug test; during this interview (more so than an appointment) she asked about current and past medications as well as past back surgeries.  There was also a psychological test of sorts, mainly questions about how pain effects my life.  She called me back in a week and told me I had been accepted. 

I had to refrain from using my normal B/T/P meds for a week.  Had another drug test.  After that and knowing I had passed that step, she gave me the Study medication - which was the Oxycodone.  Over the next two weeks they titrate you up, starting with the 10 and ending with the 30.  You get a Palm Pilot along with the study meds and after each time you use the study medication, you answer a series of questions.  You download the results nightly from your telephone.  You enter starting pain level before (1 -10) before each dose. This very aggravating buzzer goes off at intervals and you enter the 1 -10, is it better, no relief at all, if better what level, etc. 

Okay three weeks, you go back in.  Trade study meds to the Fentora.  Same process with the Palm Pilot.  Same titration up from 200 to 800.  Same three weeks.

The next phase lasts a week with each study medication - this is the blind phase and they do not tell you which study medication you are taking.  During the first phase the Oxy was a pill (duh) and the Fentora, a lozenge.  For the blind phase both drugs are in lozenge form...same process with the Palm Pilot.  If you are like me, I could immediately tell the difference.

A couple of things, you are given exact amounts of study meds based on the number of episodes you normally have of B/T/P - most of us 4 daily.  You have to keep all wrappers for the lozenges and cannot discard anything as they count them.  Rules are that they can call you in at any time and count them.....but that never happened to me.  You do though drug test each time you go in.  I was then paid for the study participation $300.

Alot of your acceptance into the Study depends on the info you provide during your call to the Trial Coordinator and that first interview.  As I understand it, they only take those of us classifed as true CP with a long history of patient compliance.  Obviously your ability to be honest, you availability to make all appointments, your willingness to complete the Trial (12 weeks in all) and your assurance the study meds are used correctly are big factors in who is chosen.  The Trial coordinator makes frequent calls to you at home/work and you are expected to do the same.  It is alot of time and effort.  I hope this is what you need.

After the trial was completed, I asked my PCP for a referral to this PM Specialist and have been with him for almost a year.  He is great and I've been very pleased with his care.  I still also see the same PCP.

The Fentora are about the size of an antiacid and they are pink.  They are individually sealed in plastic and hard to get into.  You put them between your cheek and teeth and let them disolve.   They are not explosive like a pop rock but more like the old fizzie candie (you would have to be mature to remember them)......I have a hard time saying you'd have to be older

Hi Guy, sorry, but you missread an S in SNRI. It stands for Seratonin and Norepinephrine Reuptake Inhibitor. Elavil is like a shotgun though, a very apt description my friend! There are Selective SNRIs out there but, at the moment, I can't think of one. I bring up Elavil's use as an analgesic because I believe it is similar to the "New Wonder Drug" NuCynta which is thoroughly discussed on another thread . . . "A New Analgesic on the Market . . . ". Since Elavil is inexpensive and time tested I think it is being pushed aside by Big Pharm in favor of NuCynta which can cost an uninsured patient as much as $411.00 for 1 month's Rx and it seems to have some very nasty side effects as well.

Take it easy . . . Q

I hear you on that one, allgood.

On Friday my lady and I drove up north and stayed in a hotel then went to the Grand Canyon early Saturday morning. We could've saved a bunch of money (which is pretty short these days) and just drove all the way on Saturday but getting out of the house and breaking the routine was really helpful. Except for the sitting in an uncomfortable driver's seat for too many hours, my pain level was really low this weekend!

Off-topic I know but even small vacations can be great for our mental and physical health. I'm gonna have to make a careful choice about which bill collector I avoid at the end of the month but oh well. It was worth it =)

Let me just say this: this thread has been most iformative.  Thank you all for putting stuff out there that I can truly relate to and understand.  I have been on the 120 mg Avinza capsules for more than 2 years now and I'm up to 4 per day along with the 15 mg oxy ir for BTP.  I have been seriously thinking about moving into the worls of Fentanyl lately as my insurance company is hassling me about the 480 mgs of Avinza per day.  I have to get it approved by them every three months and I thought to myself what other med can I use that would be as effective on me and at the same time, won't send up red flags with my ins. company.  Fentanyl is the answer.  I have used the 75 mcg patches about 4 years ago for a short period because they tore up my skin really bad.  These were the Duragesic Patches from Janssen. I was putting them under my armpits, alongside my chest so that if I had my arm down, you couldn't see it.  That skin is relatively sensative and so I paid for it.  I have scars from them if you can believe that.  Anyway, I wanted to tell a quick story of a person that came into my courtroom at the Marchman Hearings and told me that he had been taking the Duragesic patches prescribed for his grandmother and abusing them.  I was surprised that he was still alive.  A big man at about 6-4 300 lbs he said, no problem, it never did anything to hurt him he just couldn't stop and as a result of his stealing his grandmothers meds, he ended up in jail and then Drug Court and eventually, the Marchman program which is not the thing for this youn man.  He needs serious residential treatment but thats him and I'm going way off topic here.  I just wanted to throw in that story about a man abusing these patches and living to tell about it. Amazing.  I think I'll just stick with the Avinza for now and put up with all the bull "mess" from the ins company every three months because the Avinza at 480 mgs a day works really good for me....

edited.g

herrball please leave out abuse techniques from your posts.

Q..

The Marchman Act provides individuals in need of substance abuse services with emergency services and temporary detention for substance abuse evaluation and treatment when required.

Marchman Act petitions that may be filed in Probate Court Records:

• An Ex Parte Petition for Involuntary Assessment and Stabilization
  or
  
• An Ex Parte Petition for Involuntary Treatment

A Petition for Involuntary Assessment and Stabilization may be filed:

When there is reason to believe that a person is substance abuse impaired and:

1. Because of the impairment, he or she has lost the power of self control with respect to substance use.
2. The person’s judgment is impaired because of substance abuse and he/she is incapable of appreciating the need for, and is unable to make a rational decision in regards to, substance abuse services.
3. He or she has either inflicted, attempted or threatened to inflict, or unless admitted, is likely to inflict, physical harm on himself or herself or another.

The petition may only be filed by:

The person’s spouse or guardian, any relative of the person, a director of a licensed service provider, a private practitioner, or any three adults who have personal knowledge of the person’s substance abuse impairment.

In the case of a minor, only the parents, legal guardian/custodian or licensed service provider can file a petition.

http://clerk.co.pinellas.fl.us/aspInclude2/ASPInclude.asp?pageName=mental.htm

What what are we talking about again??

I was taking Actiq for several years for CP, and it was the hardest thing to come off of. I started out using the 400mcg, and ended up using the 1200mcg because my tolerance went up.  This drug is absolutely one of the strongest medications you can take, and I now understand why they only use it for Cancer patients. Before you ever take this medication for CP please think long and hard about it, because it was so addictive and absolutely ???$* to get off of it. It definately takes all your pain away, at least it did for me, but had I known what I know now I would have never taken it in the first place.

That was my #1 concern when I first considered switching from Oxycodone to Fentanyl. I had read about the incredibly high potential for addiction and I think that I need to remind myself of it more often whenever I consider recommending it to others to try. Thank you for putting that reminder on this thread, it was lacking.

I am a cancer patient and was given a 65% chance of dying within the first 3 yrs. after my diagnosis 28 months ago. After 3 yrs. my odds increase to a 90% chance of living another 10 years, so I've got 8 months and counting! "Quality of Life" is, to me, the single most important factor in my upcoming victory. I was Rxed up to 265 mgs of OxycodoneIR daily, if I felt that wasn't enough they'd Rx me more, no problem. Such is the common pain med situation for cancer cases like mine.

After 2 years of this (I usually kept my daily dose down to 150 to 180 tops, with a semi-weekly "no Oxy day") I was really sick of the constant pill-popping and it seemed like I had exceeded the therapeutic range of the med. By that I mean I was experiencing stronger side effects without getting increased pain relief. My quality of life was at it's lowest at that point.  Every AM I woke to the most incredible "charley-horse" cramps in my calves and feet. These would last for 3-4 hrs without letup. Things like that convinced me to try the Fentanyl patch, as well as very knowledgeable help with info from members of this board . . . especially HtMom. That is the only way to approach a drug this potent, it's certainly not an Rx for Percocet 5/325.

As I have stated several times in this thread, I am completely satisfied with the Rx, it dropped my pain level from 7-8 to 3.5-4.5 immediately. I am so glad that you brought up the difficulties involved with WD or just cessation of use, this thread needed that caveat . . . Thanks! Welcome Aboard, we need more newbies like you!

                                                                            Q      

PS:  Do you think the suckers are more addictive than the patch due to their IR vs. CR formulation? 

I think the non-Mylan or pouch patches contain some form of alcohol in the pouch.  It has been a while since i have used anything but Mylan.  Alcohol can be very irritating to the skin.  When I used the Sandoz patches my skin under the patch would be wet when I changed patches.    I have not had the problem since using the Mylan patches.  So to anyone who might have to move up to Fentanyl, ask the pharmacy what patches they carry.  Herrball I took Avinza for little over 2 years.  It worked great for the first year and a half.  My dr upped me to 120 mgs bid.  I didn't get any more relief than the 120 mgs a day and told the dr to drop me down.  Then I was put on Fentanyl,  and the pain relief is amazing.  Take care, htmom

I prefer the duralgesic patch because I can see the meds. Sometimes it lasts longer than 72 hours, sometimes not. But I get more comfort in seeing the gel. I have tried both types. The feeling was the same. The mylan patch stuck to my skin better and, like I said, I felt no difference. I guess it's just comforting to see the gel so I know that I am not wasting the medication.

That was a good point. It rarely occurs to people that taking pills is %@$$*## the kidneys and liver. I think at a certain point, one must decide to opt for something less impacting on the organs. Especially if they are cancer patients who may have compromised the health of these organs due to cancer or other treatments. The patch does make life easier. It has less of a dramatic impact on the organs and it is not necessary to constantly pop pills.  Pills like vicodin are extremely %@$$*## the stomach. Any pill, when taken to the degree that a cancer patient may have to, will not be good on a persons body. The patch is still being processed through your blood stream but, it is much less dramatic of an effect.