Fentynal Patch warning

[Rozia]

http://www.latimes.com/news/printedition/asection/la-na-patch22dec22,1,4417645.story?coll=la-news-a_section

[Mark N]

Rozia, thanks for the link. The article has several mistakes in it and is sensationalizing the problem with patches. One example is the reporting of deaths with the patch but it includes terminal patients that died while using the patches and doesn't separate out those deaths. Another point was saying that the patches are 100 times more potent than morphine without explaining they mean if all the medication is released at once compared to lower doses of morphine pills [there are a couple more points like this in the article that aren't accurate]. There are important points made about the patches such as the danger of increased heat from showers or heating pads.

It is important that we get all the information we can about the meds we use or may use in the future but we need to have newspapers print responsible articles with accurate information instead of sensationalizing the stories.

[debhun]

When I went to my PM for the 2nd vist she offered the patch but I turned them down. I am in the sun alot. I love to fish and love a hot bath with my Jets. So I knew that it wasn't for me. But if there come a time I know my pm will give it to me if i want it.
Thank you for the article and I think Mark is right.

Deb

[Lea]

I've been on the patch for almost 3 years and have had no problems with it at all. You do have to be careful about getting too hot, but I still take long hot showers. I sometimes will take a long hot bath after the 3rd day on the patch and take it off before putting on a new one.I recently found out that Biaxin XL can potentiate or increase the plasma levels of Fentanyl which my pharmacist alerted me about after filling this RX for a sinus problem.

Fentanyl has been a life saver for me. It literally gave me my life back and allowed me to back to work. All drugs have potentially lethal side effects, but if you follow your doctors instructions and educate yourself about your meds, there is no reason that this very beneficial med can't be safely used.

[Maggie]

Thanks Rozia for posting this. We need to be aware of what is being printed in different areas of the country. Getting to the source of any article is always important too. I had never heard of the "Safe Drug Marketing Association" (may not be exact name) and found that an interesting side note.
I would hate to think that their actions could prevent the right people from taking advantage of the patch for treatment of their chronic pain. I have been on the patch for 4 years and their warnings regarding use are pretty thorough.

Maggie

[brians2000]

I have heard that fentanyl was 100 time more powerful than morphine and this is probably true but that doesn't mean that the amount your body absorbs is actually 100 times more powerful than a morphine pill. I have been on and off the patch a few years and I have used it since last October with no problems. I take hot showers and it hasn't affected me. I am not saying it could but I haven't noticed a difference. The patch is pretty smooth except for hot flashes after 48 hours. Good luck to other users and have a Merry Christmas. Brian

[Kathi49]

Rozia,

Thanks! I was given the Duragesic patch to try...just haven't yet. But I know it has helped several people. I can say, without a doubt, having used a transdermal estrogen patch for years, you can get a "hit". Silly I know and beside the point. But when I first started using them I would put one on right after a hot shower. Bad move! My pores were still open and within minutes I would get a rush of dizziness. I have learned since then to just wait before applying it. Same thing happened when I used the creams and gels and just applied it to my arms or legs...just a rush of dizziness.

I am a little hesitant in trying it (even though it is only 12mcg); one I think it is a BIG leap from 1-2 Vicodin a day to this dose. And, two, I already have hot flashes or night sweats rather from being post menopausal. So, I worry about the internal heat as well as the external. But these are things I need to ask my PM. He seems to think since I have been on Vicodin for so long I will be fine. But I am not so sure. :eek: :)

[debhun]

Rozia,

Thanks! I was given the Duragesic patch to try...just haven't yet. But I know it has helped several people. I can say, without a doubt, having used a transdermal estrogen patch for years, you can get a "hit". Silly I know and beside the point. But when I first started using them I would put one on right after a hot shower. Bad move! My pores were still open and within minutes I would get a rush of dizziness. I have learned since then to just wait before applying it. Same thing happened when I used the creams and gels and just applied it to my arms or legs...just a rush of dizziness.

I am a little hesitant in trying it (even though it is only 12mcg); one I think it is a BIG leap from 1-2 Vicodin a day to this dose. And, two, I already have hot flashes or night sweats rather from being post menopausal. So, I worry about the internal heat as well as the external. But these are things I need to ask my PM. He seems to think since I have been on Vicodin for so long I will be fine. But I am not so sure. :eek: :)

WOW that is a big jump. But every Dr is to his own way. My PM started me out on about the same as I was taking. 6-8 pec a day. So she stared me out on 5 MG 2 x a day of Opana Then up to 10 MG 2 x aday.

[Kathi49]

I know Deb LOL!

At least I THINK I know. He seems to think that since I have been on Vicodin for so long that I should be fine. So, too, does my Neurologist. The only that disagrees is my NS. But I also know why PM wants to try it this way...and it is only 12mcg NOT 25. Oh, well, I am just a big chicken. When I read that insert, I became even more of one. :D

[lobelsteve]

Go to the source:

http://www.fda.gov/bbs/topics/NEWS/2007/NEW01762.html

Click to the doctor side of the site and read.

Nothing new, bad things happen when inexperienced doctors try and do more than their training. It's called testiculating......

Anyone want me to try and treat their blood pressure in an ICU? I am certain to cause more deaths than the critical care specialist. I lack the appropriate training to save those lives and therefore do not belong in that venue. The PCP needs further education before beginning a foray into long acting opioids.

The trouble is, anyone can call themselves a pain specialist. Please ask about what board certification and what training your physician had before getting involved in a treatment algorithm that may imperil your life.

[Kathi49]

I agee Steve.

Pretty scary stuff. But I am curious...at what point do you (if you have) prescribed 12mcg? Do you ever prescribe it if your patient is opiate tolerant even if on low doses?

And PCP? My PCP didn't prescribe it. I think the people that have posted all said they have PM's.

[BrokenBladder]

I just wanted to shove in here and say thanks for this post. This is something my doctor has talked to me about but I've stayed away from it.

My biggest concern, up until now, is that I break out when there's a patch on me!! Now I'm glad I didn't try this!!

Merry Christmas!!@*candycane

[BrokenBladder]

Steve,

Just one question. Do you think a rheumy has enough experience? Alot of people are surprised that I don't have a PM doctor. I just want your opinion.

[lobelsteve]

I don't want to offend everyone all the time, it just comes out that way.

I am speaking in generalizations and not for anyones particular regimen, care, diagnosis, doctor, etc.

I know Rheumatologists who can do everything except spinal procedures as far as Pain Medicine Specialists go.

I also know rheumatologists who diagnose everything as FMS if they cannot perform expensive and lucrative infusion therapies in that patient.

If I needed a Rheumatologist in Georgia, I would call Gary Myerson. I have never met a Rheumatologist who instills that much confidence in his patients or attendees at his lectures about how he can get a patient better. I'm sure his practice is busting at the seams and it is impossible to get in, but if "I" needed a Rheumatologist.......

There is a reason that Pain Medicine is a fellowship lasting 12 months currently, and this will be increasing to 24 months over the next 2-3 years. In 10 years it will be its own residency program. This is not a correspondence course or GED level education.

To advertise in Texas that you are a Pain Medicine Specialist, you need 4 years of college, 4 years of medical school, a 4 year residency, and a fellowhip in an ACGME (www.acgme.org) approved program. 13 years after graduating high school and you can see your first paying patient.

[Spiney]

I have discussed this problem with both my primary and pain docs. Both have said that at least in THIS neck of the woods, the Fentanyl overdoses have been primarily addicts or kids on the party circuit. There is just a small hand full of doctors in this town who will write it. Even my primary does a consult with my pain doc for his Hospice patients. My pain doc has my home health nurse check and document , each week,that my meds are kept in the safe and I live alone. He says that after treating me for seven years that it isn't a trust matter but that he needs to maintain tight guidelines and documentation for everyone's sake.

[GardeniaGirl]

BB -- I have a very good rheumatologist and he does pain management meds for his patients.

If he feels the needs for pain tx start getting too complex, then he refers out.

He has been scripting my Avinza and muscle relaxers for the past 2 years, but is now sending me out to PM docs because of all the spine pain I am having.

[spondygurl1]

I've been on the patch for 4 years and take hot 2 hour baths and also tan but I cover the patch with a cloth when I'm in the tanning bed. So far I've never noticed any difference in the absorbtion rate.
I remember an article recently that stated teens were starting to use the pathces to try to get high. Somehow they have figured out a way to open them and get the liquid out. Thats why I like the Mylan. They are totally flat and you can't see the meds inside. The last time I filled my script I was given Watson and I hate them. They are bulky,the med is visble and the patches roll up and are bigger than the Mylan. I informed my pharmacist that I only want the Mylan in the future and if not available,not to fill,I'll go elsewhere.
I can see the difference in the two and can see how teens could get the meds out if they really wanted to get to the drugs.
I also remeber an article on addicts stealing the patches off the elderly in nursing homes while working as aids. Pretty damn sad.:(

[BrokenBladder]

Dianne,

I know I've told you before but I'm so sorry for your loss. I can't even imagine the pain you suffer with the loss of a child. May God Bless You!!