Pain med: Duragesic

[Guest guest]

my doc prescribed Duragesic patches at 25 (micrograms over 72 hours I

think). I waited two days, no relief. So I added two more of the

same patches, waited two more days, nothing. Added one more (total

of 3 patches over a day) and it helped a bit.

My question, is the 25 microgram dosage the baby one they start you

out on? Can I demand a higher dosage like 100+ micrograms over 72

hours.

I tried to tell the doc it takes 12mg/hr of morphine in hospital (all

at once mind you, non of that PCA bologny works for me because you

have to stay awake and keep pressing the button) to stop the pain. I

also explained that when going into the ER it takes about 40+ mg

morphine to get me to settle down, but I am still completly lucid. I

mean I can to math and talk like normal. They are amazed I stay

awake at that dosage.

Any suggestions? Any other meds I can talk them into trying? I also

have Phenergan suppositories I use about a half hour before eating

any meal and take Pancrease minutes before each meal. Getting to the

point that I am afraid to eat.

TY

Dick

& Alan (service dog)

[Guest guest]

Ty, Dick, & Alan,

As you mentioned in an earlier post, it is amazing how everyone responds

differently to each medication. The Duragesic (fentanyl) patch comes in 25 mcg,

50 mcg, 75 mcg, and 100 mcg. The protocol is to start at the 25 mcg patch and

tweak up as needed. There is a correlated protocol to transfer people from

morphine to fentanyl to oxycodone, etc., but it seems patients are generally

still started on the 25 mcg patch.

I started on the 25 mcg patch. I was eventually put on three of the 100 mcg

patches. As my pain has cycled in severity, I actually weaned off the patches

completely. It has been about a year and my pain has worsened, so I am going

to talk to my doctor about resuming the patches. In your post you mentioned

the word, 'demand'. My experience in getting the meds I feel I need is to take

a less threatening approach, such as a discussion. Understanding the federal

rules and regulations that apply to prescribing narcotics has helped me

understand why my doctor does what he does.

Karyn E. , RN

Executive Director, PAI

Indianapolis, Indiana

[Guest guest]

Dick,

The starting dose recommended by the manufacter's of Duragesic

patches is 25 mcg., even with opiod tolerant patients. It takes a

full 24 hours for the fentanyl concentration to reach it's full

effect, and it's recommended that no increases be made until after

three days. Over 50% of the patients using the patches do require a

higher dosage than 25 mcg.'s, however it's advised that titration be

done gradually and supplementation with an analgesic for breakthrough

pain be considered if there are periods where pain is insistant.

Many doctors prescribe a fast acting breakthrough analgesic at the

same time as the start of the Duragesic, since there will be times of

wavering coverage that could be handled by the fast acting med,

instead of an increase in fentanyl dosage.

Physicians are advised that it may take up to six days after

increasing the dose of Duragesic for the patient to reach equilibrium

on the new dose. It's advised that the patient should wear a higher

dose through two applications before any further increase in dosage

is made on the basis of the average daily use of a supplemental analgesic.

The 25 mcg. Duragesic patch is for patient's accustomed to 45-134

mgs. of oral morphine per day. A 50 mcg. Duragesic would be for

those used to 135-224 mgs. oral morphine per day, and 75 mcg. is

equal to oral morphine of 225-314 mgs. per day. The 100 mcg. patch

is equal to 315-404 mgs. oral morphine per day. Based on this, and

what you say that you've had while in hospital, your starting dosage

of the Duragesic appears to have been suitable.

Based on past experience, I would suggest that you discuss this with

your doctor, and instead of " demanding " an increase, explain to him

that the initial dose was not at all sufficient, and that you would

like him to consider an increase, along with an appropriate dose of

an analgesic to help with any breakthrough pain. I've had little

success with " demands " with my doctors, but great success when a

problem has been approached with discussion and reasoning.

I've been using the Duragesic patch, in doses of 25 mcg. up to 100

mcg. and back down again. I'm currently using a 75 mcg. patch, but

plan to drop this down at my next appointment to a 50, since I've

used so few breakthrough meds I feel the patch is more than what I

need at this time. I use 10 mgs. of Oxycodone, up to 4 times daily,

for breakthrough. I've tried all other methods of pain relief;

Oxycontin, MS Contin, Morphine, Dilaudid, Demoral, Percocet,

OxycontinIR and hydrocodone, and have had the greatest pain relief

with the minimal amount of side effects with the Duragesic.

I hope this information is helpful. If you have any more questions,

don't hesitate to ask.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

hhessgriffeth@...

SC and SE Regional Rep

Pancreatitis Association, Intl.

Note: All comments or advice are based on personal experience or

opinions only, and should not be substituted for consultation with

your medical professional.

[Guest guest]

TY! I am kinda getting the jist of things. But the morphine I was

on was not oral but intravenious.

In any case, 4 (four) 25mcg Duragesic patches for 3 days each didn't

do the trick. I went through a month's supply of 25's in a little

over a week, and I have to say I got better refief from the Norco

10/325's.

I see the new pain doc tomorrow.

If he isn't going to get on top of this quckly, I will look for a new

doc and break the bad news to him tomorrow. Up here, the doctors

treat their patients like fledgling drug seeking criminals. Gee how

I wish I were back in the city with my doc of 12 years. I sometimes

called his office and got whatever I needed, within reason, without

even the bat of an eye or any scrupulous looks or attitude.

I may need to return to my old doc and make a pilgrimage to see him

every 6 months or whatever he requires.

I have never done darvon, darvocet, and the plethora of others (but

percocet and percodan don't do a thing for me at any dosage) others,

should I maybe bring those up for standbys for breakthrough pain

instead of Norco if we somehow stay with Duragesic and the same doc?

I am only giving this Duragesic patch thing a try as I get it free

through a Janssen program via www.pparx.org in leiu of paying almost

$100/month (#120) for Norco. www.pparx.org is saving me about

$900/month in brand name medications. For those of you without

prescription coverage and gross incomes below $21,000 or so; check it

out.

Thanks again for the great response.

Dick

& Alan

>

>

> Dick,

>

> The starting dose recommended by the manufacter's of Duragesic

> patches is 25 mcg., even with opiod tolerant patients. It takes a

> full 24 hours for the fentanyl concentration to reach it's full

> effect, and it's recommended that no increases be made until after

> three days. Over 50% of the patients using the patches do require a

> higher dosage than 25 mcg.'s, however it's advised that titration be

> done gradually and supplementation with an analgesic for

breakthrough

> pain be considered if there are periods where pain is insistant.

> Many doctors prescribe a fast acting breakthrough analgesic at the

> same time as the start of the Duragesic, since there will be times

of

> wavering coverage that could be handled by the fast acting med,

> instead of an increase in fentanyl dosage.

>

> Physicians are advised that it may take up to six days after

> increasing the dose of Duragesic for the patient to reach

equilibrium

> on the new dose. It's advised that the patient should wear a higher

> dose through two applications before any further increase in dosage

> is made on the basis of the average daily use of a supplemental

analgesic.

>

> The 25 mcg. Duragesic patch is for patient's accustomed to 45-134

> mgs. of oral morphine per day. A 50 mcg. Duragesic would be for

> those used to 135-224 mgs. oral morphine per day, and 75 mcg. is

> equal to oral morphine of 225-314 mgs. per day. The 100 mcg. patch

> is equal to 315-404 mgs. oral morphine per day. Based on this, and

> what you say that you've had while in hospital, your starting dosage

> of the Duragesic appears to have been suitable.

>

> Based on past experience, I would suggest that you discuss this with

> your doctor, and instead of " demanding " an increase, explain to him

> that the initial dose was not at all sufficient, and that you would

> like him to consider an increase, along with an appropriate dose of

> an analgesic to help with any breakthrough pain. I've had little

> success with " demands " with my doctors, but great success when a

> problem has been approached with discussion and reasoning.

>

> I've been using the Duragesic patch, in doses of 25 mcg. up to 100

> mcg. and back down again. I'm currently using a 75 mcg. patch, but

> plan to drop this down at my next appointment to a 50, since I've

> used so few breakthrough meds I feel the patch is more than what I

> need at this time. I use 10 mgs. of Oxycodone, up to 4 times daily,

> for breakthrough. I've tried all other methods of pain relief;

> Oxycontin, MS Contin, Morphine, Dilaudid, Demoral, Percocet,

> OxycontinIR and hydrocodone, and have had the greatest pain relief

> with the minimal amount of side effects with the Duragesic.

>

> I hope this information is helpful. If you have any more questions,

> don't hesitate to ask.

>

> With love, hope and prayers,

> Heidi

>

> Heidi H. Griffeth

> hhessgriffeth@g...

> SC and SE Regional Rep

> Pancreatitis Association, Intl.

>

> Note: All comments or advice are based on personal experience or

> opinions only, and should not be substituted for consultation with

> your medical professional.