The Fentanyl patch thing again...generics, i.e., Mylan??

[jtroy]

I know I have posted about this issue and it's likely getting very old. I'm now very close to the "end" of my opioid "rotation" my doc and I came up with. I have been taking Methadone for years....after adding Lyrics when it came out (my doc has me on 900mg/day which I know is off-label) along with the Doxepin I was just waaay to sedate. My wife was at her wit's end.

Anyway, so we decided to rotate to Fentanyl and while doing that slowly decreasing the Methadone. At 320mg/day I was on a fairly high dosage of Methadone although it was far less than the 800mg I used to take.

So I told my doc I wasn't going to do the 10 100mcg/hr patch thing again...after I studied the conversion tables here in the US as well as the ones used abroad I decided that I ought to be able to cap my opioid intake at 300mcg/hr Fentanyl and no Methadone which he thought was too low knowing me for years and understanding this ridiculous liver I have.

So this past week I am at 300mcg/hr and my Methadone is today at 80mg/day and decreasing.....and I am so wondering why I did the switch way back bc I am getting far better pain relief from Fentanyl. I actually did more work in and out of our home this past week than I've done in literally months before. Also.....I am astounded at the "fog" I was in with the Methadone (which is difficult to explain) and I don't think I want to go back to it.

Finally the question:

I have now tried the Watson generic (holy crapsky was that a terrible product), the Sandoz generic (basically Janssen's Duragesic patch made on the line by Alza) and lastly the Mylan.

As you all who are on the Mylan patch know, it is a "matrix" patch which has no gel resevior....the Fentanyl is in the silicone adhesive. WOW are they smaller....TOTALLY my friend bc I am a "manly" man and I do not like having to shave all that hair....lol...also, I am completely amazed at how well they stick.

Also, my 7-yr old daughter is my life and every time I've ever been on the patch I've always kept them covered with Tegaderm (you can get them cheap on ebay)....

So...is it me or does the Mylan patch seem to "kick in" faster and stronger than say Duragesic or another generic?? Also....I notice that they do tend to really fall off that 3rd day compared to the others but I get a much much smoother intake with the Mylan it seems. Has anyone ever had a problem with the Mylan falling off?? I'm deathly afraid of these things around my kid and I mark them with sharpies so she can see them (I make her refer to them as poison and to never touch anything like them if she sees them)

My ultimate goal is to be totally on Fentanyl and then to slowly titrate it downward. I am using my mixed form of biofeedback and am trying to get as med free as I can.....I want to practice again and I'm not going to renew a license and perform surgery and expect to treat patients if I have to be on powerful CNS drugs. I want to learn how to make my body do the analgesia if that is possible.

Sorry for the length...I'm always a novel....just wanted to get the opinions of all you guys currently on the Fentanyl patch. Wishing you all pain-free days to come!! I look forward to your thoughts.

Thanks,

T. Jones, DVM

[mrsdoubtfyre]

with alcohol before applying the patch. And drying off completely with a hair dryer -- apply patch after the skin returns to normal temperature.

Removing the oils helps. If you have really oily skin, that is one factor for
failure. The downside to this is if you have sensitive skin, you might react
to the adhesive more.

All patches trap moisture under them...some people just excrete more moisture than others.

[Kathi49]

Troy,

What does the insert for Mylan say about the Mylan patch? I know with the Duragesic it specifically states NOT to clean or swab the area with alchohol. Have you tried using a smaller Tegaderam patch to cover it or something similar? Those worked great for me and were like a second skin. :)

[Nana4&cntn]

Troy, I was on the mylan fentyanl patches, my doc prescribed them for 2 days instead of the 3 days because of the reason you are having. I have since stopped using them as I wasn't getting the relief I needed and I was having severe reactions to the adhesive/med. You are right about the size! Isn't it amazing how the same amt of medication can be so much smaller than the Watson patches?

I am wishing you the best with trying to become med free! I know how much practicing means to you!

Take care,
Kathy

[shotspine]

Dear Troy.....
I'm sorry I can't help with your issues but I have a favor to ask. Will you please look at the thread that Diandra started for me "O/T Prayers for Shotspine. It explains what is happening with my Dearly Loved Pal, River. If you can add your thoughts, it would be greatly appreciated.

Having big storm right now so must shut down but I will check back asap.

Thank You, in advance.

Shotspine

[A.K.]

I started the Mylan 50mg today and was amazed how small! I was on the Duragesic about three years ago and those suckers where huge it seemed. The adhesive always took my skin with it and I had square scars all over my upper back and arms for many months after I stopped. I looked like a piece of checkerboard art :) - and still no one took me on a picnic!!!!!:confused:

I pray these bring some relief they are a replacement for my Norco generic that I have been taking 4 x a day 10/325 that my pm doc told me today was the absolute maximum a person could take. I said "the 10mg 4x?" I was shocked because not only were they not helping my back or leg pain but they did nothing for my gum pain after I hap that tooth pulled a couple of weeks ago either. This is the only pain med I have been taking and I weigh 235. How can this be true that it's a max for me? Anyway....

Here I go with the patch....one corner was coming up after about an hour and then I realized I didn't press it down for 30 seconds like it said to so I got one of the patches that come with my sweet husbands blood pressure patches and it worked great.

I'm gonna do a thread on the rest of my visit today, don't miss it.....the beat goes on..da da da da de AK

[Kira]

Regarding the suggestion to clean the application site with alcohol and/or to use a blowdryer...

I double-checked with the Mylan fentanyl patches' insert before posting this, and, sure enough, it specifically says NOT to clean the application site with alcohol, and also specifically says NOT to use sources of heat, especially in the area where the patch is. Both of these things can cause too much fentanyl to be released from the patch & absorbed into the body, which can potentially cause an overdose.

First, here are quotes about using alcohol (and other things) to clean the site where the patch will be applied. From the Mylan patches' insert:


Clean the skin area with water only. Pat skin completely dry. Do not use anything on the skin (soaps, lotions, oils, alcohol, etc.) before the patch is applied.
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If the site of fentanyl transdermal system appilcation must be cleansed prior to application of the patch, do so with clear water. Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics. Allow the skin to dry completely prior to patch application.

Here are several quotes about heat, from the Mylan patches' insert:


All patients and their caregivers should be advised to avoid exposing the fentanyl transdermal system application site to direct external heat sources, such as heating pads or electric blankets, heat lamps, saunas, hot tubs, and heated water beds, etc., while wearing the system. There is a potential for temperature-dependent increases in fentanyl released from the system resulting in possible overdose and death (see PRECAUTIONS: Patients with Fever/External Heat).
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Based on a pharmacokinetic model, serum fentanyl concentrations could theoretically increase by approximately one-third for patients with a body temperature of 40 C (104 F) due to temperature-dependent increases in fentanyl released from the system and increased skin permeability. Therefore, patients wearing fentanyl transdermal system who develop fever should be monitored for opioid side effects and the fentanyl transdermal system dose should be adjusted if necessary.

All patients and their caregivers should be advised to avoid exposing the fentanyl transdermal system application site to direct external heat sources, such as heating pads or electric blankets, heat lamps, saunas, hot tubs, and heated water beds, etc., while wearing the system. There is a potential for temperature-dependent increases in fentanyl release from the system.
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Patients should be advised that while wearing the patch, they should avoid exposing the fentanyl transdermal system application site to direct external heat services, such as: heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated water beds, etc. Patients should be advised that there is a potential for temperature-dependent increase in fentanyl release from the patch that could result in an overdose of fentanyl; therefore, if patients develop a high fever while wearing the patch they should contact their physician.
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Call your health care provider right away if you get a fever higher than 102 F. A fever may cause too much of the medicine in fentanyl transdermal system to pass into your body.
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Do not use heat sources such as heating pads, electric blankets, heat lamps, saunas, hot tubs, or heated water beds. Do not take long hot baths or sun bathe. All of these can make your temperature rise and cause too much of the medicine in fentanyl transdermal system to be released at once and this can be dangerous.


I hope this helps to clarify what the patch manufactureres have to say about cleaning the application site and about heat.

[Spiney]

Never had a problem with Mylan falling off in three years. No skin irritation. I always used the upper arm to place the patch and switched arms when I changed the patches. I took water therapy while on them by going on the days that the patch was to be changed. I took the patch off at home, went to therapy, showered and put a new one on when I got home. BTW, Mylan approved the plan. Best wishes.