Pharmacist Steve or Dr Steve question about Fentora

[krashleen]

Hi there, I am wondering about Fentora..I have read about after my PM doc prescribed it as a second line of defense after the Relpack for my migraines and Chiari HA's.
I tried the Relpack and it worked great yesterday, thing is when I went to fill the medications yesterday, the pharmacist came and talked to me for a bit about the medication. It is a new one, and I have been a patient of the same PM clinic, same pharmacy for around three years.

We (the doctor and I) have been juggling the break-through meds around to find out what works and what doesn't in conjunction with oxycontin (20mg 3x)and oxycodone 5mg 3x for b/t pain and Zonegran 4/100mg.

I was prescribed a total of 12 of the Fentora, which when I got home, I realize why the pharmacist talked to me at length about the medication. She was not judgemental in any way, but seemed concerned about the type of med, and why I was prescribed it. I told her about my condition(not a lot just the basics with the brain surgery/extraction fusion) so that she would understand that I have horrid headaches. I told her that the dilaudid did squat for me..

When I got home, I read that Fentora is for break-through cancer pain for opiod tolerant patients. My question is ... is it also prescribed for opoid tolerant patients that don't have cancer pain? Is this considered a legitimate reason for prescribing Fentora? My PM doc said he was having good luck with other patients in his practice.

Just curious...I haven't needed to take it, and won't until absolutely necessary.
Thanks to both of you for your help on the forum!

[Eppy]

HI Krashleen,
I am in the same boat. My migraines are horrid and they don't respond well to any medication so my PM dr. prescribed Fentora. To be honest with you, it kind of scares me. I almost think it's a little over the top and won't take unless it is absolutely necessary.

My question is what describes a tolerant patient. When MSIR doesn't work or what? Maybe you and I can find some answers about it Krashleen. Thanks for posting!


Luanne

[krashleen]

Hi Luanne, I am on a Chiari forum/listserv as well and we have discussions about migraines or is it the Chiari headaches and the differences. I have discovered the differences, and I do have migraines.

I have them sealed up, won't tell a soul (shhh!) about it, and told my PM doc that I didn't like the fentanyl patches and he said they aren't like that, that they help with the pain. Kind of like to avoid a trip to the ER type of medication.

So now there is two of us that don't have cancer pain and are opiate tolerant, that have been prescribed this medication.

Luanne, sounds like we both have a good PM doc, but I get concerned when the pharmacist "seems" to question the prescribing decision of my doctor.

Thoughts?

[debhun]

Talking about headachs mine in killing me now. I am waitting for daughter to pick up grandaughter to go get a shot. Toradol is the only thing that will take mine away when it gets past a BC. I am sick and the light ect.. you all know this. Will I have to lay back down.

Well forget that just called and they said they didn't have any thing for me. Why they lie.

[Pharmacist.steve]

A lot of pharmacists - particularly the young ones - only know what they read in the drug literature... just like the docs .. they are only TAUGHT what is permitted uses per the FDA. Off-label use for numerous products is quite common. She could be opiophobic .. she could be just curious and trying to understand your needs/wants .. and learn...

Fentora is the same drug as in the patches .. just a different delivery vehicle. Duragesic patches were originally approved for terminal cancer.. I would have to read the literature to see if that is still the only FDA APPROVED USE... but we all know that Duragesic patches are use regularly for chronic pain patients...

If a patient is taking oxycodone every day.. anything about 20-40mg/day you have a certain degree of opiate tolerance.

Pain is pain... if other meds don't work... then you need to try anything out there to help manage it.

[krashleen]

Hi there and thank you for responding, I am on around 85-90 mg a day of oxycodone. Sometimes the oxycodone doesn't touch the headaches.

The Relpax seems to help quite a bit, but I haven't had a monster migraine since I was prescribed the Fentora. That I am saving for when nothing works.

I don't want the PM doc to get into trouble with the DEA as the pharmacist was very interested but seemed to listen to me about my condition and the reason why I was prescribed the meds.

[Eppy]

Thanks for responding. It does scare me to take this med but if 60 mg of Morphine doesn't do the trick, I guess I won't have any alternative as I can't stand to go to the ER.

Krashleen,
I guess in case of emergency, we'll have to break them open and give them a try. Better than the alternative. :eek: Hopefully, it will be a long time before we have to!

Luanne

[Pharmacist.steve]

Hi there and thank you for responding, I am on around 85-90 mg a day of oxycodone. Sometimes the oxycodone doesn't touch the headaches.

The Relpax seems to help quite a bit, but I haven't had a monster migraine since I was prescribed the Fentora. That I am saving for when nothing works.

I don't want the PM doc to get into trouble with the DEA as the pharmacist was very interested but seemed to listen to me about my condition and the reason why I was prescribed the meds.

I wouldn't be concerned about the doc & the DEA.. I would be more concerned about the insurance company not paying for it... because you don't have cancer. I have seen an increased denial of claims for off-label use ... especially if it involves a very expensive drug - like Fentora

[krashleen]

Thanks for responding. It does scare me to take this med but if 60 mg of Morphine doesn't do the trick, I guess I won't have any alternative as I can't stand to go to the ER.

Krashleen,
I guess in case of emergency, we'll have to break them open and give them a try. Better than the alternative. :eek: Hopefully, it will be a long time before we have to!

Luanne
Hi Luanne,
Yep, its interesting packaging isn't it? I don't know.

Steve, the insurance company did pay, and I dropped off the Relpax script today and picked up a couple more samples..Thats another expensive medication! Sheesh the big pharma companies need to get a grip on reality!

[paigiesmom]

MY NEURO GIVES ME FENTORA FOR MY HEADACHES. i HAVE TRIED SO MANY DIFFERENT MEDS AND THIS IS END OF THE LINE. I HAD GREAT LUCK WITH ACTIQ UNTIL MY TEETH STARTED TO CRACK OFF. I HAVE BEEN ON THE PATCHES AS WELL BUT I DO NOT HAVE PAIN EVERYDAY AND HAD A REALLY HARD TIME GETTING OFF THE PATCH WHEN I NO LONGER WANTED TO BE ON IT BUT HAVE NO PROBLEM WITH FENTORA OR ACTIQ. I ONLY USE MAYBE 2 A WEEK. THEY BOTH WORK WITHIN LIKE 15 MIN BUT THE FENTORA DISOLVES IN LESS THAN 5 USUSALLY. I WILL SAY I DO GET LIKE BLISTERS SOMETIMES AND THE LAST MONTH I HAD A HARD TIME WITH BREAKING OUT IN A RASH. I HAVE HISTAMINE ISSUES SO THAT MAYBE MOST OF THE PROBLEM. I HAVE USED DILAUDID MOST OF THE TIME FOR HEADACHES BEFORE THIS AND I FIND THAT TO HAVE MORE SEDATING EFFECTS THAN THE FENTORA OR ACTIQ. HE HAS DONT THIS FOR MORE THAN A YEAR AND NEVER HAD A PROBLEM WITH DEA.. I HAVE A REASON FOR IT AND HE WRITES IT CORRECTLY AND KEEPS UP WITH HOW THINGS ARE GOING. I USED TO HAVE TO GO TO THE ER ALL THE TIME AND I NEVER HAVE TO GO ANYMORE. ITS SO NICE JUST TO HAVE AT HOME. GOOD LUCK.

[twotoejoe]

I wouldn't be concerned about the doc & the DEA.. I would be more concerned about the insurance company not paying for it... because you don't have cancer. I have seen an increased denial of claims for off-label use ... especially if it involves a very expensive drug - like Fentora


That was going to be my question to those posters who had been prescribed Fentora that didn't have cancer. Did your insurance pay for it? I am fighting with Sierra Rx right now. Last year my Insurance carrier paid for Actiq and now Sierra Rx (even though they told me they covered it when I enrolled) is now denying coverage for Actiq and Fentora.

[Pharmacist.steve]

That was going to be my question to those posters who had been prescribed Fentora that didn't have cancer. Did your insurance pay for it? I am fighting with Sierra Rx right now. Last year my Insurance carrier paid for Actiq and now Sierra Rx (even though they told me they covered it when I enrolled) is now denying coverage for Actiq and Fentora.

They do cover it - for FDA approved diagnosis - CANCER.. of course .. if it was a CHEAP GENERIC .. they could care less if it is being prescribed OFF-LABEL

[sabrina]

My name is Sabrina and I'm new to this site.

[jimac]

Hi Sabrina,

I would like to welcome you to the forum. :)
Feel free to ask questions about anything. This place is full of compassionate and knowledgeable people.

Jim