Rashes from my patches

[Kira]

I have been using the fentanyl patches for a month and a half, and I am getting much better pain relief from the patches than I did with the MS contin. I like the patches except for one thing: I have recently started getting really rashy from them. It was pretty good until a week or so ago, but now they itch like crazy and when I take them off there is a red, itchy, raised square in the exact outline of the patch/Tegaderm.

I tried the suggestion of spraying steroid nasal spray on the patch site before applying it, but it didn't really seem to work.

I don't want to stop using the patches because they do seem to work. But I really don't want to keep getting these nasty rashes, either.

Has anyone tried anything else for the rashes?

[ErinENj]

I was put on the patch about a year and a half ago, but it completely didn't work for me and I spent the three weeks I was on them going through withdrawls. But from what I remember, a rash is one of the side effects that are most common. One of the tricks my doc told me is to wipe the area where you put the patch down with rubbing alchohol to make sure the area is clean. I know that's commonly used to make sure that they stick, but I think it may help with the rash.

Just an idea. I can't think of anything else right now, but I hope that someone else may have more information and personal experience with the patches. I'm glad to hear that the patches work for you! :D

[Tbackpain1]

Kira,

For me, for the most part the nasal spray works for me, but it did take about two weeks to get a good effect from it. But there are times of the year when my skin is terribly sensitive (winter skin+eczema= BIG ITCH/Rash). So, when my skin gets really bad, I have Desonide cream and ointment to use on the worst spots, including my patch placement locations. I use the cream on the locations for the patch, immediately after removing it, and rotate to the next site, so that the skin has time to heal and be treated with the topical steriod.

I really don't know if it will work for you or not. I ended up having to work with my dermatologist to get a good routine working for me. It may also have to do with your location of the patch as well...you know how certain parts of skin are more sensitive than others. I ended up having to use my abdomen as patch placement locations for me, as it gave me enough "good" skin area to work with, without having problems with patch absorption, and keeping it on the trunk for optimal performance.

It took some "fiddling" with location, the tegaderm and the topical steriods to get it all working well with no "burns/rashes". But for me, it was worth it, since of all the LA meds out there, I have had the best coverage with the Fentanyl patch, limited medication adjustments and have been able to stay on a steady dose for the past 3 years now.

Theresa

[lobelsteve]

Besides the name brand Duragesic, there are Sandoz and Mylan generics. THe rash is very unlikely related to the Fentanyl and getting a different brand of glue may solve the problem.....

[Tbackpain1]

I had the rashes with Jansen's brand Duragesic. Even with the Tegaderm covers I still ended up with the burn like marks from them. The Sandoz brand has been much less severe, but still an adhesive reaction. Mylan brand did NOT work well for me...the coverage was very poor and I had very bad adhesion with them, and when they did stick, since the entire backing was adhesive, it left a square shaped blister/burn. It was nice that they were smaller, but I had poor luck with them.

I'm a terrible example though, since I've had terrible contact allergies since childhood. Band-aids of any brand always gave me rashes, medical tape really are a problem, even the hypoallergenic ones.

Trying a different brand may help for you. It can't hurt to give it a try.

Theresa

[Kira]

Thanks for the responses... this is annoying but I will deal with it if I have to in order to get pain relief.

I did notice that there is a difference with the different brands... I started out on the 25 mcg/hr patches, and was given the generic Mylan ones. Those don't give me as bad of a rash, though I have started to get a mild rash from those, too.

We increased my dose by 12 mcg/hr last time, and they only make that dose in the name-brand Duragesic patches. That is the patch that is giving me the most problems.

Neither patch will stay on that well for 3 days, so I do put the Tegaderms over them. I do get a rash from Tegaderm, but knew that to begin with. I get rashy from Tegaderm with all of my IVs, etc. I get rashy from most of the tapes they use, too. The paper tape is a little better, but I generally just ask for Coban as much as possible (sticks to itself, not to you) or for those mesh things you can put over IV tubing to keep it next to your skin. I do need something to keep the patches on, though. I tried the paper tape around the edges, but it comes off everytime I shower.

I will ask my doc if we can try the Sandoz ones, at least for the 25 mcg/hr patch. I am still needing quite a bit of breakthrough meds (which are supposed to just be for the "bad" days, but I am having a lot of bad days...), so maybe another option would be to increase by another 12 mcg/hr, since my dose is so low anyway, and then it would just be one 50 mcg/hr patch and I could either try Sandoz or at least use the Mylan one, which is not so bad of a rash.

I did expect to get rashy from the patches, since I react to a lot of the tape adhesives, but was pleasantly surprised when there were not rashes for the first month and a half.

Anyway, thanks for the replies. I will ask about trying Sandoz, since it is the only brand I haven't tried.

[tenacious]

i have just recently started the patches again, and i get the same thing that you are talking about. they also make me itch sooo much when they are on; i actually scratch on top of the patch in hopes i won't scratch through the patch.......LOL

[lobelsteve]

Most pain doctors underestimate the size of the patch they need to start with and then increase by not enough.

12.5mcg patches are for opioid naive patients.
25 is a fair starting dose if you were on a few hydrocodone per day.
50-100 is if we are converting from another long acting opioid.

The conversion tables are entirely inaccurate and the individual response varies so widely that changing from one med to another is always an experiment. The tables put the dose on the low side and the doc then cuts that dose in half due to something called incomplete opioid cross tolerance and the theoretical posibility of causing an overdose by just switching meds.

[tenacious]

Most pain doctors underestimate the size of the patch they need to start with and then increase by not enough.

12.5mcg patches are for opioid naive patients.
25 is a fair starting dose if you were on a few hydrocodone per day.
50-100 is if we are converting from another long acting opioid.

The conversion tables are entirely inaccurate and the individual response varies so widely that changing from one med to another is always an experiment. The tables put the dose on the low side and the doc then cuts that dose in half due to something called incomplete opioid cross tolerance and the theoretical posibility of causing an overdose by just switching meds.

steve,

thank you again for your information. i understand what you are saying about the docs decreasing the new opiate, but how many people do we lose each year d/t suicidal pain levels? we don't know, for it is never checked into. i haven't ever heard of someone committing suicde because of pain.........anyone else? so again, we really don't know, do we? nor do the docs.

thanks again steve.

[Pharmacist.steve]

but how many people do we lose each year d/t suicidal pain levels? we don't know, for it is never checked into. i haven't ever heard of someone committing suicde because of pain.........anyone else? so again, we really don't know, do we? nor do the docs.

The number that I have seen thrown around is in the 12,000 - 15,000 range.. similar to the number of people killed on our highways due to drunk drivers

[Kira]

I will ask if we can go to the 50 mcg/hr dose at my next appointment.

I think one reason that my base dose is so low is that my day-to-day pain is not super bad. It is there, but it is not massive pain. My most severe pain is intermittent and comes with attacks. The doses I am on right now, even with my breakthrough meds, don't touch that pain. We need to work on my breakthrough meds more so I can treat that attack pain. But my background/baseline pain is not as bad as the attack pain. It is bad enough that I definitely need SOMETHING for it, but it is not my most severe pain, if that makes sense.

I think another reason that my doses are low is that I have told her a few times now that I feel uncomfortable about being on opiates at all. So I think she started low and is going slow in part to appease me. To her credit, we have increased or changed something every single time I have been there, including the nurse appointments. And I have only been there 4 times so far.

I was on a low dose of MS contin when we switched to the patches. I was only on 45 mg/day (split in 3 doses). I was needing a lot of breakthrough meds, though, too... I was coming close to using up my 90 5 mg oxy IRs each month. So whatever 45 mg/day of MS contin plus 15 mg/day of oxycodone IR comes to... that is what size patch I should have been started on. I know I am on MUCH less than other people here, but also have a very different TYPE of pain than most here, and I also have a lot of crap going on with my other organ systems, and I have a significant amount of fear.

I don't want to get a lot of flack about being scared... that is just how I feel.

I will ask about going up to the 50 mcg/hr patch, though. Then it would just be one patch and I could use just the Mylan one (or possibly the Sandoz one if there is less rash).

[satchelle]

I have been on the patches for 5 1/2 years. Jansen was the worst. I would not only get the rash but little blisters as well.. The generic was better. What I found that stopped it was only wearing the patch for 48 hours instead of 72..... When I wore for 72 the blisters would appear. Now I only have slight redness with 48 hour dosing and using the non-name brand.

Satch

[roz1950]

gee yall if you are allergic to it then quite using it . there are other things out there.

[Tbackpain1]

Sry Roz, but that kind of statement isn't very helpful. I've been on all the other LA medications that are available and I do NOT do well on them, either from various side-effects, or because of the stomach problems that I have.

None of us know what each person's situation is, not like having a medical chart in front of us, and even then without a physical exam and a medical degree, one can't make judgements.

[anthoney]

The Mylan patches are made different. I don't claim to know how they don't have a bubble but for me and 2 other people I know they don't cause the rash nearly as bad. I do get an occasionally small rash from them (100 mcg) but nothing like leprosy/shingle rashes I got from the real thing and the generic that looks like it, maybe because the Mylan patch weights less they use a different glue.


Anthoney
Cervical Herniation c4 1991
L5/S1 Herniation 1999
L5/S1 discectomy 2001
New pain began radiating down right leg.
New Mri showed Bulge at L3 and Herniation at L4
Underwent 2 sets of RAC treatments.
2002 found tear in Labrum of hip. Insurance won't pay because of a high level of arthritis makes reoccurrence likely.
2004 Full Mri of spine found DDD in lower and upper lumbar and lower Thoracic and the need for a 3 level cervical spine fusion (c4,c5,c6) and a lumbar one (l4,l5 and I think s1)