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Stopping Fentanyl patch...

AnonymousUserAAnonymousUser Posts: 49,623
edited 06/11/2012 - 7:34 AM in Pain Medications
I have been on fentanyl 25 patch for a few months. My new doctor wants me back on Lortab.

How long does it take to get off the patch? I heard that you're just supposed to leave the last one on for 10 days.

I am having so much anxiety, some headaches, a little dizziness, generally feel crappy, etc. But the pain is still the same. No worse.

This is day 6.

Any suggestions would really be appreciated. I feel terrible.

Thank you,
Camille
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Comments

  • Did your doctor not provide you with a written taper schedule? If not, I would call back and ask for one, because trying to taper by leaving the same patch on for 10 days isn't a very good plan. :?

  • No, when I asked him how to wean off it he said to take the Lortab.

    Camille
  • Camille,
    He can either give you a 12.5 microgram patch for a week or so before giving you the lortab or he can switch you right over to the Lortab.
    I am not sure of what the dose would be on the Lortab, but if you are experiencing any withdrawal symptoms, contact your doctor. There is NO way that you should be wearing that patch any more than 3 days , no matter what.
    Sandi
  • Long story but I have been on pain meds for about 10 years. I had a cervical fusion at C-45-5-6 with Myelopathy in 2001 and then several episodes of kidney stones ( severe) and then I had a T-8 Thoracic Myelopathy that required surgery in 2005. It was a MAJOR surgery. Thoracotamy with rib removal etc etc etc. I feel I had a GREAT Outcome and feel very blessed. Still lots of pain but I am getting my life back. I walk a mile 5 days per week and exercise daily. I am working on going back to work but am concerned that I am a RN and feel that I would be crucified if I ever were to have a problem with a patient and my history came out. SO... I want to attempt to go off of my patch. I understand that after this long my brain has changed. I am sure the pain sensory system does not work normally. ( I also had 13 abdominal surgeries and other orthopedic surgeries prior to the spinal issues. I have successfully weaned many times over the years. I am just scared about what I am going to face off of the meds but I feel that I must try. OH... 3 months after my surgery ( thorocotomy) I tried to come off of the meds in 2006 but was not successful. I was still having too much pain. My doctor was fine with me being on them ( surgeon and PCP) but I went to a Pain Rehab Program at Mayo and was treated with very little compassion. (they treated me like an addict and kept talking about pain behaviors), I was devastated by the experience and lost a great deal of trust in the medical field again. I had gone there for support to get stronger and they would not look at anything except my use of the meds.
    So here I am a couple of years later ready to go off because I want to and feel the old feelings coming back. I would LOVE to hear anyone elses experiences especially anyone who has gone off successfully. I am on the Duragesic patch and I do not like all of the side effects, ( chronic withdrawal symptoms due to the patch and absorbtion issues, sleepinesss, gut issues etc etc. Any suggestions regarding protocol? My PA told me to go to 50mcg for a month and to use Hydrocodone for breakthrough. Then 25 the next month. Any other suggestions other than activity and fluids??
  • I called the PM since I was like *going crazy* after 7 days with same patch. His nurse said to take the Lortab 10/500 as prescribed and all will work itself out.

    Well, I have offically been through my first withdrawal of any medication I have ever taken. This is my 2nd day with NO patch! I am still having symptoms. They really haven't gotten any better yet.

    The anxiety is the worst. The spins, dizziness, chills, sweats, and nausea come and go.

    I am all out of Ativan and I am not allowed to get anymore from my PCP even though when I called to give him an update (been seeing him since 1995 so, we have a close relationship) he insisted I could see him and accept the script. I explained about the PM Drs damn *contract* but he was pissed he left me high and dry.

    I will see my PCP tomorrow (sat. morning) because he insists on checking my vitals and seeing my present condition himself.

    I just knew the whole *contract* thing would come back to bite me in the ASS!!!!!!!!!!

    Camille <--suffering and in pain
  • Your PM's plan is pretty typical for a taper from fentanyl. There is a 12.5 mcg patch if you have too much difficulty with the taper at 25 mcg a month. The good thing with fentanyl is that it has a short half life, so the withdrawal symptoms if you have them are shorter lived than those of other narcotics.
    Your PM might also use some clonodine to help with the symptoms if you need him too. Some PM's do use it and it does help ease most of the side effects.
    I wish you plenty of good luck when you begin your taper and remember that it will be over soon. The worst of the symptoms in the taper should be over by the end of the third day and then you should start to feel better .
    Sandi
  • It seems to me that your doctor has no idea what the heck he's doing as a taper for you. :/
    Can you print off anything on the internet about a proper taper from fentanyl and bring it to him? Do you think that he might read it? /:)
    What he is doing is what is making you feel so lousy.
    You can't wear the patch as I said, any longer than 3 days . It is on the manufacturer's patient and prescribing instructions. I believe there is also some references to a tapering plan for fentanyl as well but I am beginning to wonder if this guy even reads?
    There is a huge disparity between fentanyl and lortab, even at 10/500mg. It's no wonder that your regular doc wants to see you.
    #:S
    Do you have any immodium? Gingerale, or gatorade to drink? The spins, I can't really help you with, but the upset tummy and the resulting problems with the frequent visits to the toilet, the legs twitching....are all part of the withdrawal. Some people have taken tylenol pm to help them sleep but with the amount of tylenol in the lortab, I am not sure how often you are taking them so the tylenol pm might not be an option.
    Can you ask your regular doctor for some clonodine? It helps with the withdrawal symptoms and some doctors use it quite often to help people ease some of the symptoms. And it won't violate your PM contract.
    How long have you been taking the ativan? That might also be contributing to how you feel tonight. It's a benzodiazapien and they are not supposed to be just stopped if you are taking them regularly. Copied from Drugs. com

    Do not stop using Ativan suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.
    Your symptoms may return when you stop using Ativan after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using Ativan. Withdrawal symptoms may include tremor, sweating, muscle cramps, stomach pain, vomiting, unusual thoughts or behavior, and seizure (convulsions).

    I am worried about you. If you aren't taking the ativan regularly, you should be okay, but if you are, you need to watch for worsening symptoms listed above. The fentanyl withdrawal should start getting better tomorrow and then the day after should be better than tomorrow. Hang in there. You're almost there, even if your doctor doesn't seem to know what he is doing. :( You might want to consider seeking out a new PM after this. I can't beleive he is presribing and telling patients to keep these patches on for 10 days at a time as a "taper" plan.
    Sandi
  • I don't think he would want to read anything about tapering. How I see it is - he didn't prescribe so, he doesn't want anything to do with it.

    He is my new PM. My last one was a horror with medical board/legal issues.

    I was only on Ativan for anxiety at night because of severe relux that lead to aspiration pneumonia and 4 days in the hospital. Ativan was just very temporary and all done.

    Gatorade is my only drink. Food is very minimal since I have no appetite. I am really feeling weak now.

    I saw my PCP this morning and blood pressure was through the roof but my pulse was very low. My dr is very upset.

    I can't accept any new prescription unless it is for infection; antibacterial, fungal, viral, or respiratory medication according to my contract.

    I am on my own and not doing very well!!

    Thanks for the response - Camille

  • Hello - I know how you feel. It is heck! I went from a 75 patch to 0 - as the patch was running out at 72 hours.

    My choice- I had no BT meds, never provided by my Dr. I got tired of the hill and valley trip that was my experience with the med. I had about 28 to 36 hours of feeling like the pain was controlled.

    It took me 5 days to feel better. I was off work for the week. I walked every day, about 10 minutes at a time, and did it once an hour. It was heck! Nauseous, yes, Diarhea was the worse. My bones ached, deep crushing pain. I don't know that I slept at all. I think I did but it was for very short periods. The emotional roller coaster is just as bad, but I kept telling myself that I was going to be just fine. Eventually, I was, but in order to decrease the back pain, I had to go back onto ER Morphine. Have been on it ever since.

    I do hope your feeling at little better.
  • I know you feel terrible , but you really do need to get something solid into your body. The not eating is probably contributing to the spinning/dizziness.
    Eat some toast and peanut butter and jelly or some rice with butter or something.
    You can't not eat for days without that making you feel worse.
    Even if this is a new PM, he could have given you the 12.5 patches to slow down the taper, and given you the lortab to ease the transition. Even using the lower strength patches for a week would have made the transition easier, or he could have given you clonodine which is simply a blood pressure med that for many eases the symptoms of withdrawal.
    I'm sorry hon that you are going through this.
    Wish that I could offer you some alternative. Hang in there, it is almost over.
    Sandi
  • Been a little better today. I was able to eat tomato soup with rice.

    My blood pressure is usually well controlled with the Hyzaar but this is just messing me all up.

    I wish the new PM tapered me correctly. At this point, I just want the anxiety to end. I can deal with all the rest if I can just *breathe in my skin*.

    I am still amazed how the pain has never changed. The patch did NOT help the pain at all!!!!!!!! That is what I was telling my first PM and he didn't believe me. The patch did not work for me.

    Spins are now *wushes*
    Nausea is now occassionally queasy
    Dizziness is just a headache now
    Stomach still hurts
    Diarrhea still there
    Chills still
    Sweats still
    Joint aches are fading

    The original pain is still the same even on the Lortab 10/500.

    Thanks again - Camille
  • I'm happy to read that you are feeling a little better today.
    You will feel even better tomorrow.
    You could try some immodium for the diarrhea, it helps, but don't take too much or you could wind up with the opposite problem.
    Try to eat something with rice in it, it will also help the diarrhea.
    The wushes should ease as well tonight and tomorrow.
    I took myself off 300 mcg of this stuff a long time ago, back when I didn't know that drugs like these needed to be tapered. In fact, I gave myself seizures from stopping a few other meds that I was also taking at the time.....so believe me, I know how you feel.
    The restlessness will settle down as well. It is mostly nervous anxiety and it will pass.
    Fentanyl, like all of the opiates doesn't work for everyone. Morphine does not work for me, other than to make me throw up....so we all have one or another that doesn't do what it is supposed to.
    Hang in there Camille, you've made it through the roughest part. Now, you will start feeling better.
    I'm still really upset with this PM. Even if he didn't create this problem, he very easily could have eased how you were feeling.
    Sandi
  • Well, this seems to be a long and drawn out process.

    I was at my PCP again yesterday and my score on the COWS (Clinical Opiate Withdrawal Scale) is 30 now. Down from 34. So, I am still in moderate withdrawal.

    My doctor was very convincing in advising that if I don't accept at least Ativan, the withdrawal will drag on longer than it has to. And since my BP was terrible again, I agreed.

    So, I will accept any *punishment* from PM that comes.

    That's kinda sad looking back at the sentence after typing it. But I will own it after I was forced to sign the *non-negotiable* contract with the PM.

    Anyway, my PCP wanted to put me on Suboxone and I REALLY wanted to try it but I bit my lip and went with the Ativan.

    Anyone else have to answer to the COWS elvaluation??
    Very nerve racking but that could've been from the withdrawal.

    You guys have been my rock, my best sources, etc. I cannot thank you enough.

    Camille
  • Camille,
    I would make a call to your PM and let him know that your GP gave you ativan and why. Leave your GP's phone number and give your GP a heads up to what you have done and explain to him that you are referring your PM to your GP because you were left with no option but to accept the ativan because of the blood pressure issues and the ongoing withdrawal. Are you taking any other opiates beside the fentanyl?
    Are you having the other symptoms still? Did you try the Immodium to help with the toilet issues? There is something in immodium that helps ease the withdrawal, why? I don't know but it does. I believe that one of the compounds is a relative of an opiate.
    Anyway, I hope that you are feeling a little better with the ativan, but be careful with it, because you also have to taper off that as well.
    I want to have a talk with your PM, not a friendly one mind you....LOL
    As far as using the suboxone, I would not recommend it. You should be experiencing less withdrawal side effects in the next few days, so going on an even stronger opiate to avoid the withdrawal symptoms wouldn't be the best choice, at least in my opinion. You would have to taper off the suboxone as well. And I have been told that it is far more difficult. I know that the withdrawal seems to depend on the dosing and length of time on it, but, it is kind of counterproductive in situations like yours to use it.
    Hang in there,
    Sandi
  • I called my PM on Tuesday blantantly begging for an appointment to get this withdrawal under control. The first appointment available is Sept. 28th. Then I asked to speak with him and I got his nurse again. She *assured* me all my symptoms were normal and will eventually stop.

    I called my PCP on Thursday at noon but he was booked. They operator gave me to his nurse and said to come in NOW!
    I was there from 12:30pm to 5:30pm. He insisted I have an IV of fluids due to my appearance and vital signs.

    He called the PM while I was with him. The PM was in with a patient so, my PCP left a message. The PM still never returned the call by the time I left.

    P.S. My PCP's office closes at 4:30pm but he and his nurse stayed with me after everyone else left. My PCP saw 32 other patients that day besides me.

    The Ativan is helping alot. My PCP says not to stop taking it as he prescribed due to he wants me to taper off it. I never tapered from it before. I would just take it here and there when I REALLY needed to. I was never on it everyday.

    So, I see my PCP again on Tuesday for a check-up.

    The only thing I am on for pain is what the PM gave me. Lortab 10/500 (150 qty), Soma 350 (30 qty), and Mobic 15 (30 qty). I have been taking all 3 as prescribed but the pain level is still a strong 7 and some days 8.


    I tried the Immodium but it didn't help much so, I stopped it. Still have all the other symptoms. They come and go but the anxiety is still sky high!!!

    Sincerely - Camille
  • I believe that part of the anxiety can be blamed on the action of the fent. I found it to be that way for me as well. When I tried to describe it to my PCP - he didn't believe me, until a week or two later when I began to calm down and was not on meds to do it.

    just a thought! - hope your better
  • It is like magic! I am like 90% better. I still have the stomach pains and diarrhea but that's really it.

    It is amazing.

    I take 1 mg in the morning, 1 mg in the late afternoon and 2 mg before bed.

    Anxiety is almost all gone.

    Thank you everyone for sticking this out with me. I could NOT have gone through this without you!!!!!!!!

    My deepest gratitude - Camille
  • Is that all of us may not have the exact path figured out, but we all as a group can sort things out together!

    Glad to hear your better!
  • Camille,
    I am so glad to read that you are finally feeling better. 'When you see that PM again, I would plan on having a downright serious talk with him about his lack of proper tapering and how it left you physically. No one should have had to endure what you have since this tapering plan of his started.
    Sandi
  • Now that I am lucid, I am seriously ANGRY!! There was NO reason anyone should have to be put through the hell I was forced to go through!

    I see my PM on 9/10 for rx refills and he WILL be getting an earful. I might even leave the practice. I feel violated and then ignored. I was made to suffer for NO reason.

    Camille



  • Mistydawn74MMistydawn74 Posts: 1
    edited 06/08/2015 - 3:09 PM
    I stopped my 25mg fentynal patch how long will it take to withdraw from it I still take my 7.5 lira tabs but I'm achy and have muscle pains and feel sort of emotional like I want to cry and my energy level is so low. Will this end soon
    Misty shores
  • Anonymous said:
    Long story but I have been on pain meds for about 10 years. I had a cervical fusion at C-45-5-6 with Myelopathy in 2001 and then several episodes of kidney stones ( severe) and then I had a T-8 Thoracic Myelopathy that required surgery in 2005. It was a MAJOR surgery. Thoracotamy with rib removal etc etc etc. I feel I had a GREAT Outcome and feel very blessed. Still lots of pain but I am getting my life back. I walk a mile 5 days per week and exercise daily. I am working on going back to work but am concerned that I am a RN and feel that I would be crucified if I ever were to have a problem with a patient and my history came out. SO... I want to attempt to go off of my patch. I understand that after this long my brain has changed. I am sure the pain sensory system does not work normally. ( I also had 13 abdominal surgeries and other orthopedic surgeries prior to the spinal issues. I have successfully weaned many times over the years. I am just scared about what I am going to face off of the meds but I feel that I must try. OH... 3 months after my surgery ( thorocotomy) I tried to come off of the meds in 2006 but was not successful. I was still having too much pain. My doctor was fine with me being on them ( surgeon and PCP) but I went to a Pain Rehab Program at Mayo and was treated with very little compassion. (they treated me like an addict and kept talking about pain behaviors), I was devastated by the experience and lost a great deal of trust in the medical field again. I had gone there for support to get stronger and they would not look at anything except my use of the meds.
    So here I am a couple of years later ready to go off because I want to and feel the old feelings coming back. I would LOVE to hear anyone elses experiences especially anyone who has gone off successfully. I am on the Duragesic patch and I do not like all of the side effects, ( chronic withdrawal symptoms due to the patch and absorbtion issues, sleepinesss, gut issues etc etc. Any suggestions regarding protocol? My PA told me to go to 50mcg for a month and to use Hydrocodone for breakthrough. Then 25 the next month. Any other suggestions other than activity and fluids??
    David Uptain
  • dlu1961ddlu1961 Posts: 2
    edited 07/27/2015 - 5:31 PM
    any drop in the amount of the drug causes some withdrawl symptoms I am in the process of reducing I called the drug manufacture and they say that the FDA suggest a 50% drop every 6 days no way I dropped from a 100 patch to a 50 patch and its been over 3 weeks and i am still feeling the effects of withdrawl it was really really bad after about 2 days I am going to try to reduce another 50% when i see the dr on the 30th he increased my norco10 double to 4 a day but even that has not made a difference it is like this i have been on the 100 patch for 3 years and on different amounts from about 10years its going to hurt and I now realize that I will have to deal with the withdrawl they are some less severe after 3 weeks but I still have the smothering and anxiety and cramps to some degree my dr tried to stop me when i was on just the 50patch because i was getting overdosed when i went outside to do about anything in the heat i didnt want to lie under an aircondisher all day he tried me on loratab 20 which had to be special made the withdrawl was so bad that after only a week i had to go back on the patch he has tried me on severl different drugs but none was as good taking care of the pain methadone made me as high as a kite but did nothing for the pain morephine 30 was too weak fentanyl is a strong drug I read 70xs stronger than morephine so its going to be a battle for a couple months but i want to be able to go outside in the summer months and the withdrawl is bad all the time if i get too hot and the fentanyl goes in too fast and the patch drys out then that night the withdrawl starts my mother and brother are both on morephine 100 but they caint do much either so whats the answer if you take a bunch of meds you caint do anything if your withdrawling or in severe pain you caint do anything either its a toss up but each person is different and it may not be as bad as me i am real sensitive to drugs

    Welcome to Spine-Health
    Please click on link for helpful information!
    David Uptain
  • I was on Fentanyl 50 microgram patches for approximately three years and they worked great for severe back pain from a three-level lumbar Fusion and L5-S1 disc that is out and on 3 nerves that they can see on MRI. I need a discectomy and also have severe stenosis so would benefit from a laminectomy. Though the patch worked great it started to make me perspire profusely- -so much so I felt dehydrated and would drip on everything to my young teen age daughter's embarrassment. Since 2010 I only had two pain doctors. The first left practice to do Sports Medicine. My second doctor was great and I never would never want to leave his practice. The providers I had at his office were two female physician assistance, and at the time I asked to get off the patches they both quit the practice within two-months of each other. However, they said I needed to be on I think 37 micrograms for one month and then a lesser amount for the next month until I was tapered down enough and they would put me on higher oxycodone and oxycontin. With my 50 microgram patch I also could take two 10 milligram oxycodones for breakthrough pain and I usually did. As a dedicated RN prior to my injury I never liked to take any medicine, although I had to take a thyroid pill every morning. After the PAs had gone, I saw the actual doctor at my next appointment and he prescribed three 10 milligram oxycodone/day for the whole month. Now this was still the first month I was weaning off the Fentanyl. Now I thought this unusual and even wrong since it was basically my breakthrough medication alone he was prescribing, but I neglected to say anything thinking he knew what he was doing. It turned out I went into a pain spiral and was in horrific withdrawals. I felt like I was dying and was in bed for 20 days and calling almost every other day to get an appointment with him; yet no matter how I explained the situation they would not see me. My family suffered also from my absence, pain and suffering. My husband was livid seeing me suffering and how I couldn't even get up to shuffle to the bathroom. He finally called and demanded an appointment and they listened to him and gave me an appointment in approximately 4 days. My husband told me to take an extra oxycodone a day regardless whether it broke the contract or not. He was convinced the doctor did not read my chart. When we were at the appointment we told the Dr. I broke my contract and why. He seemed sad but he wasn't upset. I also told him during that time I had thoughts of getting assisted euthanasia because a law is passed in California that permitted it for terminal diseases and diseases that caused zero quality of life. Though I wanted to do this I knew it was wrong because I am a devout Catholic and was very involved in ministry in my church prior to my injury. However, he insisted I see a counselor which I did. He then gave me a prescription oxycodone and oxycontin but it still was not enough. However, I've lived with it and suffered with it. A month later he raised the 10 milligram Oxycontin to 20 milligram Oxycontin and 15 milligrams of Oxycodone instant release. This worked pretty well but not as good as the fentanyl patch. Toward the end of the month I called his office and asked for a Rx for the oxycodones I took when he underdosed me. I thought he would have a script ready for me to pick up because it was only like 5 pills but instead he wanted to see me and that meant paying another Hefty copay. I was upset and complained that it was insignificant and he knew why I took extra because he hadn't read my chart due to the fact he was short on help and hadmultiple offices to contend with. His staff wouldn't listen so I wrote a note out stating I would be about five pills short of oxycodone instant. My husband couldn't read my writing so I dictated it to him and he misunderstood me and wrote I was completely out of my Oxycontin. He told this to the new office manager and she was very cold and angry. My husband came home and told me what he said and I couldn't believe what he did. He is mentally ill due to severe insomnia, anxiety and depression. He also had ECT AKA shock treatment so his memory is deteriorating. But he is the only one I have. I called for an appointment and they couldn't give me one for a week away though I said it was urgent. The next thing I know I was dismissed after being a patient there for approximately five years. They wouldn't listen to me, mis-judged me and frankly didn't want to deal with me for I was too difficult a case, a great inconvenience. When I got a referral to another pain doctor from my PCP, I called to make an appointment and the receptionist told me the new doctor would not see me because of something in my chart. Then I was referred to another pain doctor and got to my appointment early only to be told I had to wait 2 hours. Unfortunately by now I was out of all of my instant release oxycodone and barely able to stand. My only position of comfort is reclining and I told them I could not sit for 2 hours. They told me to come back the next day. At my beloved job prior my injuries, I was nurse of the month and believe I was going to be nurse of the year but none of that is relevant now since my life, job was destroyed by a greedy orthopedic surgeon who did a three-level fusion on me that was totally unnecessary. Now I am treated like a junkie! If you need pain medicine you are looked down upon and ostracized. You are treated like a junkie or someone who is drug seeking. I know I worked the Urgent Care and was a surgical nurse. I would hear the talk amongst nurses and doctors when they would find out a suffering patient was on narcotics. I would never participate in the gossip or judge them because it was against my religion and conscience. It is a terrible and disgraceful irony that a renowned surgeon made me this way, ruined my family and my life so completely and I am the one being being blamed and mistreated and judged as a Junkie because of his mistake. I am really suffering, a suffering so severe I never knew it possible and would not wish it on a terrible person for even a few seconds. If I do not get surgery soon, I pray the Lord would be merciful and take me to Heaven soon in a natural manner. Yet His will be done no matter what. My point of this writing is to show the great Injustice of the medical hierarchy and community in dealing with true pain patients. It is shameful! And something has to be done about it. There is a rule in medicine, "Do no harm." In the pain industry that rule apparently not apply. In fact they seem to find ways to increase your suffering beyond imagination. What is wrong with this world? Where is mercy? Where is compassion and empathy?
    Karen Ann Sayers
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