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Hello... I'm new to the board and have some questions about fentanyl patches.

I'm currently using the 75 mcg dosage and receive mylan patches from the pharmacy. Prior to fentanyl I was taking opana, but an increase in my pain coupled with a change in their formulary meant I needed a change. The fentanyl has been more helpful, period, but I have some issues with the patch that contribute to an unevenness in how much it helps.

Question one anecdote:
My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

After another day of feeling really sick I noticed the second patch not even close to being in full contact with the skin. It was totally stuck to my arm (as in not coming off) but it only stuck to the skin in two small areas. I touched the patch on the inside where it didn't stick to my arm and it wasn't sticky. I could actually feel the flonase product on the patch (slick and brittle). I had both wiped off the leftover product from my arm, and let it air dry before applying the patch. I took off that patch and put a new one on without using the flonase (already burns like mad) and within four hours started feeling better. I think it was withdrawal symptoms that had me so sick.

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.
[QUOTE=MESnap;5003425]I think it was withdrawal symptoms that had me so sick.

[COLOR="Purple"]Yes, it was withdrawals that was making you sick, the patch has to be completely adhesed to your skin for it to work like it's designed to.[/COLOR]

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

[COLOR="purple"]Either your Dr. will have to come up with another solution, or you can try another patch, I"ve used Watson, Sandoz, and Duragesic. You can also use Tegaderms over the patches to help them stick, some manufacturers give these out free to patch patients, if not you can get them at the pharmacy or online in bulk cheap.[/COLOR]

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

[COLOR="purple"]You can request that your Pharmacist order a different brand patch, they usually have a couple of choices, he may not be able to get the specific one you want.[/COLOR]

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

[COLOR="purple"]Even Fent being a continuous BPL med can still not be able to handle pain flares at times. It's important to always change your patch at the same time. Alwasy wear your patch above your breastline. Stay out of hot baths, sauna's, jacuzzi's, not too long in a hot shower, stay out of the heat outdoors for very long. Any of these conditions can and do cause your body heat to rise which causes the patch to release the medication unevenly which will effect how long it lasts.[/COLOR]

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

[COLOR="purple"]You hit the nail on the head...Fentayl is pretty much the strongest "use at home" pain med. Once your on it there's isn't anything stronger to go up to, so the weaker meds aren't going to do much for your pain. That's the risk patients take when they chose to go to a Fent patch.[/COLOR]

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.[/QUOTE]

[COLOR="purple"]I hope things stabilize for you and this works out. As you know Pain Management is not about relieving pain, but making it manageable so that we can live our lilves as we endure it. The Fent patches can work very well but there are a lot of variables to consider. If they don't seem to be lasting long enough or working well enough you can go to a 48 hr. dosing as opposed to the 72 hr., might be something to discuss with your Dr. on the next visit. Also when on Fent, most switch to a more powerful BT med like pure Oxycodone, the weaker ones are like taking baby aspirin at this point. Welcome to the Boards, hope we can be of some use and support to you. [/COLOR]

Kat
I just went through a problem with my Mylan 75's releasing too much because of heat. Mylan sends me the Askina overlays to keep the patch on firmly, and I think the overlay is too much during hot weather. I was wiped out for several days thinking I was just exhausted from working long hours. Once I realized what was going on, I stopped using the overlay to help dissipate heat away from the patch. I wear mine on my chest. Females I've talked to wear theirs below a breast, and low enough that their bra doesn't cover any part of the patch. As for breakthrough pain, I use morphine tabs 15mg PRN, and that cuts the pain down to around a 4. With the patch I'm usually at about a 6, and without it, I'm off the charts. Have you tried other patches than Duragesic? I can't wear that brand, or I'll break out in rashes and sores. I think I might have an allergy to the adhesive. Mylan doesn't give me any problems.
Mylan (75) is the type I have. And today it really released too much. (The heat, I'm sure.). I felt really sick and had to lie down. I got weak, sick at my stomach, dizzy, etc. And I wear it on my arm, on the outside, upper area.

I haven't tried the duragesic brand.

I'm fluctuating wildly from 3 to 10 - like I want to go to a hospital 10.

I think I'm going to either ask to change from fentanyl (not sure which med to try - just know opana doesn't work), or drop the dosage of fentanyl and get a stronger BT medicine. Or propose either or and?

I'm also taking 2400 mg of neurontin a day. It's pretty heavy, but the nerve pain is actually spreading. That scares the crap out of me. It was a neuroma in one spot with referred nerve pain in a second spot from a disc. Now it's in other places as well.
[QUOTE=MESnap;5003425]Hello... I'm new to the board and have some questions about fentanyl patches.

I'm currently using the 75 mcg dosage and receive mylan patches from the pharmacy. Prior to fentanyl I was taking opana, but an increase in my pain coupled with a change in their formulary meant I needed a change. The fentanyl has been more helpful, period, but I have some issues with the patch that contribute to an unevenness in how much it helps.

Question one anecdote:
My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

After another day of feeling really sick I noticed the second patch not even close to being in full contact with the skin. It was totally stuck to my arm (as in not coming off) but it only stuck to the skin in two small areas. I touched the patch on the inside where it didn't stick to my arm and it wasn't sticky. I could actually feel the flonase product on the patch (slick and brittle). I had both wiped off the leftover product from my arm, and let it air dry before applying the patch. I took off that patch and put a new one on without using the flonase (already burns like mad) and within four hours started feeling better. I think it was withdrawal symptoms that had me so sick.

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

- In response to question 1, the same thing happened to me this morning. I was prescribed 50mcg Duragesic patches and Flonase due to the red itchy welts I was getting from the patch site after 36 hours of wear, but the patch is so much more effective than OxyContin, I still choose to use them. (I am about to have a 3 level cervical fusion, with chronic nerve pain.) I picked up the Flonase from the pharmacist yesterday and put the patch on last night. I woke up this morning with bad neck pain and some nausea and digestive problems. Since I upped the dose from 37mcg to 50, this seemed odd.

What I think happened is, I didn't wait long enough for the Flonase to dry and/or sprayed too much when I put the patch on my upper arm and put the NextCare (like Tegaderm) covering over it. So I immediately changed it. The patch smelled like Flonase. I'm pretty sure I used to much, I was just so worried about getting those welts. (which I didn't!). But the patch was useless, so I had to take 2 15mg oxycodone to make my pain manageable. Normally, with 50mcg of Fentanyl, I would only need 2-3 15mg oxycodone pills throughout the day when things are working properly (in conjunction with 100mg of Topamax (non-narcotic) for my nerve pain.

I hope your use of patches gets sorted out, they work so well when we don't have to deal with them falling off, or allergic welts, rashes, etc. :/
There are a couple of things you can do. First, Contact Mylan and they will send you - free of charge - overlays for your patches, so the patch won't fall off. You can swim with these overlays. I order them monthly, and it's free. I know some people get good results from Flonaze. For me, I use generic Benedryl (dyphenhydramine) pills. You can got the non-drowsy formulation. I haven't checked to see if Flonaze has alcohol in it, but if it does, that's probably why the patch won't stick. Any alcohol used on the patch site prior to application will weaken the adhesive.

Also, I've dealt with overdose due to heat with respect to the patches. I'm on the same dose you are. There are many variables: weight, height, etc. I wear cotton shirts - I put the patch either on my upper chest (right and left) or on the side of my abdomen (right and left) If you wear a "breathable" shirt, it will help dissipate the heat.

You can get the generic Benedryl at Wally World and other big box stores very inexpensively. Good luck with this.


[QUOTE=ttomassini;5028612][QUOTE=MESnap;5003425]Hello... I'm new to the board and have some questions about fentanyl patches.

I'm currently using the 75 mcg dosage and receive mylan patches from the pharmacy. Prior to fentanyl I was taking opana, but an increase in my pain coupled with a change in their formulary meant I needed a change. The fentanyl has been more helpful, period, but I have some issues with the patch that contribute to an unevenness in how much it helps.

Question one anecdote:
My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

After another day of feeling really sick I noticed the second patch not even close to being in full contact with the skin. It was totally stuck to my arm (as in not coming off) but it only stuck to the skin in two small areas. I touched the patch on the inside where it didn't stick to my arm and it wasn't sticky. I could actually feel the flonase product on the patch (slick and brittle). I had both wiped off the leftover product from my arm, and let it air dry before applying the patch. I took off that patch and put a new one on without using the flonase (already burns like mad) and within four hours started feeling better. I think it was withdrawal symptoms that had me so sick.

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

- In response to question 1, the same thing happened to me this morning. I was prescribed 50mcg Duragesic patches and Flonase due to the red itchy welts I was getting from the patch site after 36 hours of wear, but the patch is so much more effective than OxyContin, I still choose to use them. (I am about to have a 3 level cervical fusion, with chronic nerve pain.) I picked up the Flonase from the pharmacist yesterday and put the patch on last night. I woke up this morning with bad neck pain and some nausea and digestive problems. Since I upped the dose from 37mcg to 50, this seemed odd.

What I think happened is, I didn't wait long enough for the Flonase to dry and/or sprayed too much when I put the patch on my upper arm and put the NextCare (like Tegaderm) covering over it. So I immediately changed it. The patch smelled like Flonase. I'm pretty sure I used to much, I was just so worried about getting those welts. (which I didn't!). But the patch was useless, so I had to take 2 15mg oxycodone to make my pain manageable. Normally, with 50mcg of Fentanyl, I would only need 2-3 15mg oxycodone pills throughout the day when things are working properly (in conjunction with 100mg of Topamax (non-narcotic) for my nerve pain.

I hope your use of patches gets sorted out, they work so well when we don't have to deal with them falling off, or allergic welts, rashes, etc. :/[/QUOTE]
I'm doing a little better with the patch, after much trial and error. First I just quit using the flonase and dealt with the patch eating my skin alive. I too get welts more on the outside of the patch, and yes, it lifts the edges off of the skin. Once I got the next script filled with 48 hours per patch, I had a little more freedom to try a couple things.

First, the flonase has to dry for a minimum of half an hour for me, and I wipe it off after spraying it.

Second, I have four spots on my body that work for placement: at the top of my arm at my shoulder (on each side), and by cutting the patch into two strips and laying them lengthwise along the muscle edges on each arm. (I have the mylan, not duragesic. I'm also not suggesting anyone cut the patch, bc the kind you have matters so much. It's dangerous if you have the gel patch.) Any other place, and the edges come up. I think you guys hit the nail on the head when you said the edges coming up means the patch dries out, and it has to be in full contact with your skin.

That said, I still have problems. If I use tegaderm, it gets too hot and I get too much. Then I feel sick. If I don't use tegaderm (or something similar) the edge of my tshir can actually catch the patch and pull part of it up.

It's a careful Balancing act I think I'm getting used to. Unfortunately dilaudid seems to be the only other narcotic that my nerve pain responds to, and it's a rough medication for me. So for now, I'm balancing. I'm sorry others are struggling with the patch, but glad we can share experiences on here. It also kind of helps to know I'm not just nuts with the up and down. I think my doctor thinks this should be the most stable med of them all and it's probably in my head.
[QUOTE=tortoisegirl;5031533]I too am completely fed up. I'm still in withdrawal. Its worse than what I had before going up to 200, so its either the flonase I used under half of my dose for two days last week, or I've been taking too much oxycodone for bt (I usually only take a few doses a week, but I've been averaging one a day lately). I'm sure it gets much worse than this, but I can barely function, even allowing myself to take the oxycodone once a day. Anxiety, shaking, chills, nausea, stomach issues, emotional wreck, etc.

Until today I was planning to ask to try the patch for a couple more weeks with a dose increase, but now, I'm ready to go back on the methadone, especially considering we have a big vacation in a month. My appointment is tomorrow at least.

I was only on 70mg/day of methadone before...apparently 200 on the patches is more like 210-268 mg of methadone? I'm not even doing as well as I was on the 70mg of methadone, but I was only taking it twice a day, not four times a day like I'd need. Even considering that, seems like that is the better med for me.

I'm pretty sure now that my skin irritation from these is from my skin literally tearing at the edges since the covers are so big, and my skin doesn't have the space. My skin is crazy sensitive...I often scratch wrong and bleed. At least its not allergic? That would be easier to deal with however.

I now agree that folks either love or hate these things. If I was getting good relief I think I could put up with it, but I just can't hold in that long! I can say though that I haven't had a single issue with any part of it peeling up on the three brands I've tried, since I've used a Tegaderm or similar cover/s on every patch. On the two I missed a small part of the patch with covers, they definitely weren't sticking. Between those and the flonase ones, it would have been easier to have extras.

Hoping my appointment goes smoothly and its agreeable for me to go back to methadone, get my bt med filled early (and possibly switched), and have another follow up before my vacation. Hope everyone else is faring better. Best wishes.[/QUOTE]

I just wanted to wish you luck when you go to the doctor. You are right when it comes to people's opinions on the fentanyl patch. You either love it or hate it. It is all or nothing. I guess I am pretty lucky (even though I don't always feel lucky). I switched from oxycontin to the patch because I had been on it for years and my dose was really high and my doctor believe that it would work for me better. I had doubts because of the horror stories about it. Then I would hear about what a lifesaver the patch is for some people. Needless to say, After getting the proper dosage established, I have to say that I wish I would have switched to the patch a long time ago. I have had different types also and I have never had a problem with none of them. I have had the watson brand (with the gel) and they work great. Never had much of a problem with them. I also took the mylan brand of patches which does not have the gel inside. Never a issue of any of them coming off. I have put tape on them before. But I don't do it that often. I love the way it really keeps my pain at a certain level. I still have pain but it is a pain I can deal with. I have very sensitive skin and I am amazed at the fact that I have yet to break out or even get any rashes from the patch. I hate that you have to go through all this mess. Everyone is different. If the methadone works better for you, then that is what you should stick with. I hope that the doctor get this taken care of for you so that you can get some relief. Let us know what happens when you come back from your appointment. Wishing you many blessings. Muah!
[QUOTE=MESnap;5003425]

Question one anecdote:
My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

I think it was withdrawal symptoms that had me so sick.


Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?


[/QUOTE]

[COLOR="Indigo"][FONT="Century Gothic"][SIZE="3"]In regards to the above "quoted" sections of your post:

I, too, have had some serious burning, mild itching, and left over irritation from my fentanyl patch. I didn't seem to have this problem when I wasn't using the gel type, but now I do use it and it's become a real bother. I had not even heard of the flonase tx for this, and I am wondering how well you are tolerating this currently, as I may consider trying it. Was it just a matter of you getting used to it, or was it a continuous issue?? I wonder if it is the type of adhesive that is used by the various manufacturers or from the actual gel/other "type" being used.......

It is always possible that you had some withdrawal symptoms. When I went through actual withdrawals from 1 week off of the fentanyl, I seriously thought I was going to DIE!!! I've had severe flues coupled with diarrhea and vomiting that felt like heaven in comparison. That's the best way I know how to describe them for you to discern whether they were withdrawals or not.

I have asked my pharmacist for specific brands before, so I don't see why you COULDN'T ask for a different "type," but take note that sometimes ordering a specific brand -- for the pharmacy -- can take up to two weeks for them to receive, so do it well in advance.

In regards as to whether someone has experienced a topsy-turvy problem instead of steady relief...... YES!!!!! I was told when I entered pain management that sometimes finding the "right combination" of medications can take awhile, and sometimes it can be perfect from the get-go, that there would be possible undesirable side-effects that might initiate another tx method, and there might be no relief from a particular med that could initiate a change, as well. Unfortunately, I was not in the perfect group, and I have had bad reactions, poor responses, and irritating side effects. I am STILL seeking steady relief; it hasn't happened yet. Not even close... Is it better on the fentanyl than the other opiods I tried? Yeah, but it's not complete or even steady relief at all times...I have more severe days then others, and I am always in SOME degree of pain. Also, the BT meds don't touch the BT pain most times.

I really think that it takes some effort of both the patient AND the doctor to find the BEST combination of pain relief. And I can tell that YOU are making that effort just by seeking answers here in this forum. Next, I would definitely speak with your doctor about what OTHER options might be available (if you haven't already). And most importantly, stay positive and persistent -- stress, depression, and feelings of hopelessness can ADD to your pain... keep the stress levels down and manage any other emotional consequences of your pain to avoid getting trapped in that vicious cycle of pain/depression/more pain/more stress, etc....

Thank you for your post; it was most informative and thought-provoking!
Take Care!

[/SIZE][/FONT][/COLOR]
Hope your pharmacist can switch them out...I've heard often not, even when unopened. Interesting Mallinkroft is better than Sandoz for you. Most say opposite, but I guess you are only talking about stickiness, not pain relief.

You might want to try Smith & Nephew OpSite Flexifix film. It comes on a 2 or 4 inch roll. Someone else posted it was much more cost effective than Tegaderms. I got some online for about $40 for a 4 inch wide 11 yard long roll, but didn't do the math to see what the cost/patch was. I assume that would make more than 33 (3*11) covers? Ebay has good prices on Tegaderms...I got some that were individually packaged, but were lacking the outer box, for a fraction of the cost. I was even needing two of the small Tegaderms on my Apotex 50s (they are almost as big as a Watson 100 for some reason).

Since my generic copay is only $5, I was paying way more for covers than the patches. Whatever works though. Definitely shop around to ensure you get the best price. If you are fairly sure you will be on these for awhile, there is a good discount for bulk. Even if not, it could be worth it.

I put two covers on some of my patches (had to move them right after application...that might have been another one of my problems) and didn't have a problem, but I thought I'd pass on the warning that some folks do...the more you have covering it, the more heat buildup. Mine always felt significantly warmer than my skin temp. I remember reading Mylan provides free covers, but not sure if any others do. However, the opinion on Mylan patches here is low (on another board, it was high...I assume its individual). I definiately had to change them every 2 not 3 days. Hope your doctor will allow that?

Withdrawal seems gone. Woke up in more pain since the methadone wears off overnight, but maybe the correct dose and schedule could help that. They actually did a supposedly straight switch since I was in withdrawal. They just had me take off the patches and take the methadone right away. Usually you'd want to wait a good bit between at least, or even taper down on the fentanyl first. I was actually a bit woosey last night.

I wouldn't recommend a switch like mine to others unless you have a well educated doctor and they think you can handle it! Apparently this is a type of situation where it is easy to OD, so I was a bit wary to go to sleep last night. I was surprised he was starting me back up on the methadone so high (30mg tid is the max recommended starting dose and we're doing 40mg tid, but I guess since I've been on it before?) and didn't require a break in between the last fentanyl "dose" and first methadone dose. Best wishes.
I haven't done the switch to Milkinkroft yet since I swapped my patch this morning (75 Sandoz) and there was still no neck pain and no allergic reaction to the adhesive either! I think because the glue isn't sticking to me, I'm not getting the rashes, so my best bet is to stick with what is giving me the best pain relief.

I did have to put a Milkinkroft 50 and 2 Sandoz 12 patches on today (to make up for the 4 I wasted....I have some left over from my other script) so I'm curious to see how I will react to the glue. I've stopped with Flonase and Claritin completely, and have managed to overlay the two Tegaderms so they are not on top of each other very much.

Mylan has never worked for me, I immediately go into withdrawal when I use those, I think the medicine just doesn't pass through to my body properly as the patch never seems to lay flat and lifts up too easily. I am looking into future Tegaderm purchases though. :)
[QUOTE=MESnap;5003425]Hello... I'm new to the board and have some questions about fentanyl patches.

I'm currently using the 75 mcg dosage and receive mylan patches from the pharmacy. Prior to fentanyl I was taking opana, but an increase in my pain coupled with a change in their formulary meant I needed a change. The fentanyl has been more helpful, period, but I have some issues with the patch that contribute to an unevenness in how much it helps.

Question one anecdote:
My doctor has given me flonase to spray because the patches were leaving seriously irritated (sometimes bleeding) skin. I tried the spray and a day and a half later felt ill. I hurt so much, couldn't sleep enough, felt nauseated - thought I had a virus or something. When I changed patches I noticed the skin irritation was no longer a problem. The patch hadn't required any tape to not fall off either. Both huge wins for the antihistamine! But I did notice the patch wasn't in full contact with my skin.

After another day of feeling really sick I noticed the second patch not even close to being in full contact with the skin. It was totally stuck to my arm (as in not coming off) but it only stuck to the skin in two small areas. I touched the patch on the inside where it didn't stick to my arm and it wasn't sticky. I could actually feel the flonase product on the patch (slick and brittle). I had both wiped off the leftover product from my arm, and let it air dry before applying the patch. I took off that patch and put a new one on without using the flonase (already burns like mad) and within four hours started feeling better. I think it was withdrawal symptoms that had me so sick.

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.[/QUOTE]
I just started Fentanyl 25mcg. I'm on my second patch. For some reason
(Possibly improper patch placement) the first patch failed. My doctor had give Me Norco to cover the first 12 hours. They didn't touch the pain. I have been on Norco for years but at 9 pills a day it was beginning to not get the job done. The secondp two days of the first patch were horrible. It seemed like the Norco had ceased to work and I felt as though I was in withdrawal. Not fun at all.





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