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conversion to Fentanyl patch?

dmoonchildddmoonchild Posts: 383
edited 06/11/2012 - 7:28 AM in Pain Medications
My Dr suggested the patch at last appointment. I am seriously considering it. Does anyone know what my dose might me starting out? I am taking oxycontin 40 mg every 12 hours now. I ask so I can call my pharmacy to see what the cost will be before switching. Thanks!


  • that your Dr would start you on a lesser dose first. That is probably 25MG. There is a brand name Duragesic and generic ones. My Dr will only use Duragesic because he and my pain dr think that they work the best. Get ready for sticker shock. I just got a months worth of 50 Mg and my co pay was 304.00. Also, ask if you do go on them about handling instructions and storage. They are very dangerous, life threatning to children.
  • I started out on 12mcg then next month was upped to 25mcg, your body has got to get use to the drug. The first time I put one on it knocked a loop in me. I was walking around the front yard trying to get to the mailbox. I was drunker than a box of rocks lol it was funny to my neighbor but scary to me. I feel find now and drive even.
  • It might not be a good idea to have one of those narcotic converters here. It might give patients the wrong idea about what dosage they think their doctors should put them on when going from one med to another.
    Also it does not take into account cross tolerance issues, which most of us know nothing about.
    It might give patients the wrong idea about what dosages to expect, when changing meds, and that should be left up to our doctors.
    I am just worried that someone will use this, and go in expecting one dosage and finding themselves getting a new script for less, and thinking that it isn't "enough" to control their pain because they used this before seeing their doctor.
    Sandi <-------- always a worry wart....
  • All I can say is please be very careful.

    I don't know if you saw my other posts but my new, and first ever, PM doctor started me on the 50 mcg patch and I ended up in the hospital for 3 days. It was not a very good experience. In my opinion, I would start on the lowest dose and work your way up if needed and tolerated.


  • Edited - didn't want to cause concern. Didn't know that would be questionable. I found it very helpful.

    When I was abruptly taken off my regular meds and thrown into a very serious withdrawal state during an emergency hospitalization in December, the "old school" doc literally told me he had no idea what to put me on, although he would not be giving me what I normally took, NOR would he call my pain management doctor. I was in a dangerous state by the time he decided to give me 12.5 Fentanyl patch, and this was while I was in the middle of an acute pancreatic attack AND pulled off all pain meds. It caused me such heart stress that I was given potassium boluses the rest of the week and delayed my release.

    He did move me to 25mcg and at that point, I was so scared of him and his playing around with the meds that I just tried to make it on that dose. I didn't know if that was too much or too little compared to what I had been on. The stress of that alone nearly killed me. I realize now I should have demanded a new doctor. The minute I got out of the hospital, I called my pain doc and they were speechless at how I was treated and what I was given. They advised me what to do and I was very thankful.

    I've not considered the patch because I am hot-natured and also, we have a pool and I will be wet all day all summer. I heard that can be a negative to using the patch.

  • oh believe me I will be careful. My husband and I had a long talk about using the patch pros and cons. I am in so much pain right now, my meds work very little and I have no quality of life. I have 2 small children and they are my biggest concern. My husband will have them locked in the basement we just have to figure out a good disposal system. I am very nervous about using the patch but I am hearing nothing but good stories about how it gave life back to people. I want to be able to participate in my kids lives.
  • I agree with Sandi, and dose conversion should always be determined by a doctor. My Fentanyl was bumped from 75 to 100 mcg and so far I'm tolerating it well and had no side effects. The reason is probably because I've been in this med for over a year now. Everybody's tolerances are different and some people may start on 25 mcg while others start at 12.5 mcg. Fentanyl is a very powerful medication that should be prescribed by a knowledgeable physician and should be taken with caution.
  • Meydey, is it good pain med for you?
  • I think it is, even if it doesn't take the pain all away. Actually, no one medicine will. I will stay on it as long as they'll prescribe it. I like it because I can put it on and "forget" about it until it's time to change it. As you know, it sucks to take a whole bunch of pills. I use medical tape to secure it and write the date on it so there are no mix ups. You do however need to have a break through med with Fentanyl. They make Fentanyl lollipops (Actiq) but they are extremely expensive. I heard they are very effective in knocking off BT pain but I just can't afford them. Oxycodone, Dilaudid, morphine IR, or Norco are examples of suitalbe substitutions.
  • Hi Laurie,
    fentanyl should never, ever be used in someone who is opiate naive. It's scary that you were given that, especially at 50 mcg. Everyone should start at a low dose, only after they have been on other opiates for some time, if they start the patch, and if needed, work their way up to another dosage.
    A good PM will taper, slowly since it takes a few days for the med to get to a steady blood level once the patch is applied. And having someone come back every two weeks until they get the dosage correct is not a bad idea.
  • It works well for me too. In fact, it's probably the best med that I've been on so far. I also am at a high dose of it, but not as high as last time that I was. I also have a breakthrough med , and between the two of them, they allow me to function again, as best as my body will allow anyway.
  • Thank you for the info, as I said Im nervous about switching and will talk to my Dr at length before doing so. But I think I will give it a try. I need to do whatever it takes to live life to its fullest. Right now I am not. Thanks again for the help.
  • dmoonchild said:
    we just have to figure out a good disposal system.
    Per the instruction packet, fold the used patch with adhesive sides together and then flush it down the toilet. I always flush twice, just to be extra safe. ;)
  • I am reading I will need special tape to keep the patch on. Is this tape also prescibed by my Dr or do I just get it at the pharmacy counter?
  • Hi Dmoonchild, you buy this tape at any pharmacy or grocery store and it is usually about $2-3 dollars. I've used a couple brands and the one I like the best is Nexcare. It won't tear your skin off when you peel it off and it stays on when I shower.
  • I still have the sheet that comes with the Jannsen patches. The recommendation for someone who has been on 68 to 112mg of oral oxycodone per day is the 50mcg patch. One bad thing is the patch can be very expensive.
  • You can just get regular 3M surgical tape and tape around the edges, the best thing though is something like Tegaderm that you can put over the patch, I never could find tegaderm though and it can be expensive.
  • The generic 75 mcg cost $240.00 for 10 patches. The higher the dose, the more the cost. I payed out of pocket $148.00 for 10 25 mcg generic patches. It also depends on where you buy it, so it's good to call around and get a quote first. Right now on my insurance plan, I pay $10 for 15 generic patches.
  • we just got a letter from my husband's ins.co. They have added a bunch of new meds and fentanyl is now part of the plan. oh, I forgot to ask, will I go thru withdrawels from the oxycontin once I start the patch?
  • You'll only have withdrawal symptoms if the fentanyl dose is too low. :)))
  • Ive been doing nothing but getting as much information as I can about switching meds. I think Im ready to do it, but still nervous. Thanks everyone for helping me.
  • I'm going thru a somewhat similar situation. I take a high dose of Oxy's but on bad days sometime take an extra which isn't right but when its bad no choice. My thing is I don't get around good as it is and with the oxys they make life manageable. But I'm heading to Disney World in three weeks with my family and called my DR. to see if I could get patches just for my next refill along with my oxys because going to Disney World for a week with my 9yr old and 6yr old daughters is going to be fun but extremely hard to keep up and keep my pain down. My concern was that with the flight and all of the other hustle and bustle that goes along with travel and Disney I'm worried that I might go thru too much of my medicine while I'm there and short myself as to when I get back. My DR and I have talked about the patch in the past couple months because i'm growing a bigger tolerance and I don't want any more pills. So I'm hoping that the patch will work and maybe even respond better with my body so I can take less pills and eventually nothing as soon as work comp decides to quit trying to NOT fix me and actually fix me. So I hope it works for you and I hope I can have a somewhat comfortable trip (yeah right!) to Disney. We planned it over a year ago before my accident but I could never not go because my girls would be crushed so I will suck it up for them and probably be in bed for a week or two after the trip. Thanks for the subject and listening to my rambleing. Hope all goes well,For Everyone!
  • CMatthews,
    I'm sorry that you find yourself dealing with this pain. Can I ask if your surgeon/PM doctor has you on any nerve pain type meds, like Lyrica, Topamax, Neurontin? If you have a lot of nerve pain, might try increasing your Neurontin or using Lyrica instead. Lyrica was actually made for peripheral neuropathy, so you might have good luck with that.
    Is your pain more mechanical or nerve on increasing your activity levels? If it is more mechanical, your doctor might want to consider a breakthrough pain med for the times in between doses when you are experiencing increased pain levels. It does not appear that you are on anything like that......it may be an avenue to explore with him, especially since you are going to Disney. While they are handicapped accessible, you have to rent the scooters. That might be something for you to consider doing during your trip to ease the pain from walking around.
    I want to caution you on taking an extra dose, no matter how high your pain levels are.....you can kill yourself taking that extra dose. 80 mg of oxycontin is alot of oxy......a whole lot, especially on top of the rest that you normally take. Doing that, will also increase your tolerance levels, especially if you are doing it with any regularity.
    If you are urine screened with in a certain time frame after increasing your dose, it will show up and that will get you fired from your doc's office. On the flip side of that, running out means that you won't have the proper blood levels if they decide to test you toward the end of your monthly supply. It's a dangerous game, increasing meds on your own, and it's one that has consequences you can only imagine at this point. Don't take any more than you are supposed to....if the pain is that unmanageable, go to the ER.....or call your PM and see what he would like you to do to handle the pain.
  • I Love Disney World! We honeymooned there. My family is also going in December and I also am concerned about my pain. We are going with my inlaws and my father in law has an amputated leg so he rides a scooter. I told him I would get one too and we could have races. ANyway, I will let everyone know how I do If my Dr sees fit to put me on the patch. Im getting more nervous as my appointment approaches. I hope I dont chicken out.
  • You are definitely right about increasing amounts w/o permision, is not a good thing. It insn't too often and my Dr is aware of me doing it now and then. He has given me the bad boy talk like he should but sees my reasoning, but doesn't condone it by any means. Yes I'm on Neurontin as well but doesn't seem to be doing much. I have heard about the scooters at Disney so I will have to check into that because I cannot walk longer then a block and a half before my leg is either numb or in so much pain I fall. I have made the trip to the ER quite a few times and I really don't like it. They treat me like a pin cushion and send me home and I'm still in pain. I hate the oxys but it seemed to be the only thing that gave me some relief early on when we were going thru the pain management process of finding what meds helpled. I'm scared and excited for Disney being that I've really never been anywhere in my life as far as travel is concerned and never seen the ocean. So that should be great I just wish I could see it during a better pain free time in my life. I appreciate your feedback on the med issue, I don't really get tested when I see my Dr. probably because he is my family Dr that I've seen pretty much my whole life. I have a few times but he really isn't too strict about monitering. Although sometimes I do get called in for a pill count but I'm never off to a point that is worrysome. I don't take an extra one often at all but I see him this wednesday so hopefully we come to a better solutuion. My work comp has just approved going to try a Pain Management clinic so I'm sure tht will bring a lot of change hopefully for the better. Thanks again for all the info and I appreciate any more knowledge you or anyone else has to offer.
  • Say have you ever been to Disney? Nevermind dumb question (HoneyMoon!! DUH!!!) I havn't but I'm asking because I lnow about renting the scooters for the trip while there just wondering if you knew where to look. And you shouldn't worry about chickening out as far as asking for the patch or any other meds just due to the fact that you want information and to be able to be as comfortable as can be considering your situation. I love my family Dr. because I can say whatever is on my mind and he makes me not feel like it was a dumb question or that I'm lying just trying to get pain meds. His motto is that nobody should have to just deal with pain, he believes in relieving all pain to its fullest extent and fixing the problem. That could be good or bad to some people more than others because some would see it as over prescribing pain meds but he thinks if we have it out there to treat pain then why not use it. This could have a lot to do with the fact that he started his years as a Dr at the Mayo clinic in Rochester, MN. Where he treated cancer patients for the first 15 years of his career. So he has seen a lot of pain in his life, but to me he's very smart at what he does and has never made me nervous about asking him anything that pertains to me feeling better. I hope everyone finds a Dr somewhat similar to this where they can feel comfortable no matter what the subject. Hope you have a great time in Disney next December with your family.
  • Before my Surgery in December, we had an annual pass to Disneyland. I could only go if I rented the electric scooters they have there. They are 55.00 a day and make the trip so much easier. You get them right after you enter, at the same place where you rent strollers.

    I tried the patch today, I had a months supply when I got out of the hospital after my surgery and have never tried them. I gave it a shot today. Too early to tell anything yet.
  • Thankyou for the info on the scooters. I didn't realize that they were that much to rent but I definitely will make it a part of my budget or dad will be stuck in the hotel for most of the trip. My family is really excited but it still is three weeks away but it will be a nice vacation. Even if it hurts for most of the trip. My kids just can't wait and it will be our first real family trip to somewhere out of state. Thanks Again I really appreciate all the info from everyone.
  • I could make that trip with my family. My kids haven't been there yet and it kills me that I can't even dream of going in my present condition. We can't do anything like that, no Disney, no Busch gardens - nothing that requires that amount of walking. Scooters are great but not for long periods of time when you can't sit for more than 5 minutes without pain. Sorry, didn't mean to be a killjoy. I hope you all get to go with family and have a fun pain free experience. Bring me back a Mickey hat or something. 8>
  • The whole sitting on the scooter bit is something I'm gonna have to deal with. I can sit uncomfortably for about 20 minutes before I have to get up because of the leg and tailbone pain. Then I stand for about the same. So I guess its not quite as bad as five minutes but I hear ya. We did almost substitute me for my sister in law but the kids were not having it. So to make the once in a life time trip I must suck it up and do as they wish. We had planned this and payed for the trip over a year ago, before my accident, so thank god it's already paid for. Because my workmans comp is absolutely nothing compared to my pay and I am not physically able to do any of my side jobs on the weekends. There is no way we would be able to afford it if we hadn't done it when we did. So even though I can't lift over ten pounds and can't walk sit or stand as long as I use to I'm still going to try to make the best out of all of it for my kids sake. So hopefully the patch brings a little added help to make it thru the trip. And it will be nice to get out of the cold of Minnesota and enjoy the warmth of Florida. Also it wil be nice since I missed the whole summer here in Minnesota due to the fact my accident happened in the beginning of summer and kept me bed ridden for the first few months other than PT and Dr visits.
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