Switch in pain meds

[curiousforever]

from 90 ms contin to 25 of the patch (fentenal ?).

Past 2 days I've felt like I was going to pass out. I did fall over in fact earlier today. Not sure if I lost conciousness.

Is that an equivilent dose? Should he have continued the ms contin?

Or is this 'normal'?

[Pharmacist.steve]

from 90 ms contin to 25 of the patch (fentenal ?).

Past 2 days I've felt like I was going to pass out. I did fall over in fact earlier today. Not sure if I lost conciousness.

Is that an equivilent dose? Should he have continued the ms contin?

Or is this 'normal'?

Normally, 90mg/24 hrs of morphine will be in the ball park with 25mcg of fentanyl.. Again normally... the fentanyl patch will only provide ~ 50% of the blood level in the first 72 hrs .. that will finally be attained over the next 7 to 10 days.

[Mark N]

I don't know about how yu should feel with the change over but I do know that the triation period is 7 to 10 days but Dr Steve beat me to it. I just wanted to say that make sure you stick with it for a few weeks so you know how it will be with the full amount of triation. I hope you start feeling better with it the next day or so.

[Kira]

Hey Pharmacist Steve... If 90 mg/24 hrs of MS contin is equal to 25 mcg/hr of fentanyl, then they actually increased my dose when we went to the patch (I was only on 45 mg/24 hrs of MS contin at the time). (See my "rash" post and the discussion about my dosages). So I guess that I wasn't being underdosed with the switch after all. I guess I could look all of this up in my pharmacoepia, etc but I am being lazy because we have pharmacists and pain docs here to do the math for us :) hehe...

Curiousforever, I was going to say what Steve and Mark said about how it takes the first day or so to get into your system. My doc had me take an MS contin the morning of my first day on the patch (disclaimer: but my doses were lower, so I am NOT saying to do what mine had me do). Just saying that you may feel lousy while it is getting into your system but may feel better as time goes on.

Good luck with the patch.... it has worked pretty well for me so far (aside from the rashes).

[Pharmacist.steve]

KIRA...

Fentanyl patches will only attain ~ 50% of final blood level in the first 72 hrs... the final stablized blood levels will not be attained for another 7-10 days. Since there are 5 patches in a box .. a final determination of how well these patches are going to work for a particular person .. shouldn't be done .. until the last patch.

Also for some reason ... in a part of the population using these patches they seem to peter-out around 60 hrs .. in this population.. changing the patch every 48 hr is the only way they can maintain adequate pain management.

[Kira]

Fentanyl patches will only attain ~ 50% of final blood level in the first 72 hrs... the final stablized blood levels will not be attained for another 7-10 days. Since there are 5 patches in a box .. a final determination of how well these patches are going to work for a particular person .. shouldn't be done .. until the last patch.


Ah, my bad. I did remember in the back of my head that it took a while to get up to steady-state levels, but didn't realize that it was only 50% after the first patch.

All I meant was that Curiousforever may feel better as time goes on and the levels increase.


About my own meds...
I was interested about the dose equivalency with MS contin. It is good to know that my doc was actually increasing my dose when we switched to the patch. I have been on the patches for a month and a half now, and two weeks ago we increased again by 12.5 (see my other post). On that post, you guys were mentioning that the dose seemed low. So I was just trying to say that I was on a low dose of the MS contin before switching to the patches, and that may be why my patch dose is low. I have only been on long-acting opioids for three and a half months, though.

Also...
Also for some reason ... in a part of the population using these patches they seem to peter-out around 60 hrs .. in this population.. changing the patch every 48 hr is the only way they can maintain adequate pain management.


This is something I have been noticing for myself. The third day, I feel like crap. I was thinking of asking about changing the timing of the patches, but didn't want to ask too much at one visit. I think I will just tell her everything, though, and see what she comes up with to fix it (rashes, end-of-dose failure, still needing some of the BT meds, plan for the "bad days"). If that doesn't work and she wants to keep it at Q72hrs, then I was thinking of trying to gradually change the time I put the new patch on so that the last 12 hrs happen at nighttime and I sleep through it. I don't know.

[curiousforever]

Ok...thanks!

I'll stick with it. It's not too bad painwise in combo with 4 perc's a day.

Just wasn't sure about the feeling faint type of stuff.