Fentanyl Question

[DDC]

Hi everyone hope you can help with my question, my NL put me on Fentanyl Transdermal System 25 mcg/hr apply 1 patch every 3 days. How long does this take to help with the pain, omg it has been so bad again, I had to break out my soma and vicoden again to keep me from crying so much I still can't lay down at all for the nerve pain shooting up and down my arm and my collar bone feels like it is out of joint, severe muscel spasems etc. Just wondering if it takes like 24 hours to really get in my system or what.

I do have an apt with my NS tomorrow afternoon at 3 pm it is about a 1.5 hour drive one way to go to him but I have no choice. I sure hope he can help me. He ordered a MRI and Myelogram back in 2/08 which showed I had pinched nerves and a great deal of the bone on several vertabrais eaten away so not sure what he will do, he may make me have another MRI or Myelogram I sure hope not. I have to find something to help me lay down so I can sleep or get rid of the pain etc. I have sleeping pills but after about an hr of sleeping I waking up sobbing like a baby from the pain.

Thanks Donna

[Pharmacist.steve]

generally it takes 3 days for the Fentanyl to get to 50% blood levels.. with the remainder 50% may take up to 14 days. The transition from oral meds to a fentanyl patch can be sort of "bumpy"

[DDC]

so it want kill me to take 1 vicoden if in sever pain like a level 10?

[Nana4&cntn]

Donna, no you should be fine, but really need to let you PM know how bad things are.

Take care :)
Kathy

[suemck2]

Hi Donna
I'm sorry you are in so much pain.

On average it takes 38 hours for a person to achieve the maximal concentration of fentanyl in their blood with application of the first 25 mcg fentanyl patch. This is based on the manufacturers description of the pharmacokinetics found in the prescibing info. You can look at this info if you go to:

http://www.duragesic.com/duragesic/shared/pi/duragesic.pdf#zoom=100
Manufacturer also says: " With continuous use, serum fentanyl concentrations
continue to rise for the first few system applications. After several sequential 72-hour applications, patients reach and maintain a steady state serum concentration that is determined by individual variation in skin permeability and body clearance of fentanyl."

I don't know if you're using the mylan generic version or the name brand duragesic. I found no difference between the two but I know that others have.

The directions are to change patches every 72 hours but I, and many others, needed to changes patches every 48 hrs - just something to keep in mind to discuss with your Dr. if you find your pain comes back before it's time to change patches.

Also I needed to take breakthru pain meds on top ofbeing on the patch at times. I don't recall what they were at the time as it was a few years ago. Best of luck to you
Sue

[DDC]

Thank you guys for the info, I don't have a pm doctor, my NL gave me the patches, I took them two years ago just before my 4 level lumbar fusion and can't remember. I will go and read the site you gave me.

Well had my NS apt this afternoon, just my luck I drive the 1.5 hours and get there and the girl behind the desk said the Dr was out and would have to see me on Monday, I was so upset and then I have been in pain every since, I think I let the stress get the better of me plus the drive over and back did not help matters either. My arm and neck have been in constant spasems the whole day, not sure how much more of this I can take. It has been 9 days now with little to no sleep, I can't lay down now getting where I can't sit that long as well not sure what to do. I am doing heat, ice getting my hubby and son to gently message my neck etc. today I showed my hubby where my tricep muscle was the size of a tennis ball from the spasems. My thumb is just about dead with no feeling and my hand cramps so bad to try and type or click a mouse. Thought about going to the ER but that would do me no good with this little town, they would just tell me I need to call my NS on Monday. Anyways thanks again and I will try and read the link you posted.

[Maggie]

You should take theallowed amount of your breakthrough meds if needed until the patch starts kicking in. I still have to take some most days. I have 75Mcg/h patches. I started out with 25 mcg/h but that didn't anywhere near take the place of the 40 mgms of lortab I was taking before. After I got titrated up to the 75mcg/h, I could cut back on the lortab to sometimes none a day to one dose a day for breakthrough.

This may not exactly answer your question, but other's experiences can sometimes help you compare where you are with your dosages.

[DDC]

hi all,will try to do this with one hand. Update: now day 11, pain in most of my right arm, neck & sholders with severe muscel cramps. this morning about 5 am my left arm went dead, can't do anything from hand to elbow, on call NS told me to go to ER, I did they gave me steroid shots in my hip then gave me Prednisone 60 mgs for 5 days. I go see my NS on Monday, omg this one finger tying stinks.

[turtle12]

Hello, I have not posted on this forum in a couple of years and it feels good to be back. Donna I feel for you. It sounds like you are just getting started and your pain is not at all managed. I am on 200mcg of fentanyl every 48 hours along with methadone, demerol ( not real helpful orally) and vicodin for breakthrough. I also can get a shot when I am about to simply blow my brains out...........Level 500 on a 1 to 10 pain scale. Please call your doctor, you need relief while fentanyl is kicking in and while you are getting all your tests. I hope you are looking for a pain specialist as I have found these are the most helpful ( and hurtful) docs. Hang in there, keep posting, this forum really saved my life at different times. turtle12

[DDC]

thanks for the advise evl, turtle I did try a pain doctor a couple od years ago she did not even try to help me. my NL bless his heart has been the only one to try he does give me 120 vicodens a month and 90 soma's a month for the past 4 years, the only time I have asked for more was when I was waiting for my 4 level lumbar fusion back 2 yrs ago and now, I see him tomorrow and am going to see if he will do 50 MCG to see that will help better. I was told today I am now looling at two suegeries, pinched nerves in neck and now for the radial nerve palsey in my left arm.