Pharmacist gave me BAD info, what would you do?? (need advice) - RE: Fentanyl Pain Patches

What would you do about this situation?
5
File a complaint with the corporate office so her supervisor will be notified - 31.3%
2
File a complaint with the store manager - 12.5%
9
Nothing - just let it go - 56.3%

 
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ohthepain
Regular Member


Date Joined Mar 2005
Total Posts : 353
   Posted 8/16/2007 11:06 AM (GMT -7)   

I just started on the Fentanyl pain patches and last night my doctor decided to up my dose because I was still having so much pain. He had originally given me the 25's so he told me to just apply a 2nd patch and it would be the same thing as having a 50 patch on. The manufacturer's 800# is only open from 8am-5pm so I couldn't call them but I wanted to make sure it was ok to apply the 2nd patch on the same arm that the 1st patch is on (so I am able to switch to the other arm when I change them) so I called my pharmacy and I was SHOCKED by what I was told. The pharmacist told me that it was fine to put it on the same arm (which I doubled checked with the manufacturer this morning and they agreed) and she started to ask me questions and I told her that my first patch fell off & I had to throw it away and put a new one on. Well, she told me that I could just tape the patch back on if it fell off.   Every piece of literature I have read, everything I have read on the internet, every (other) pharmacist & doctor I have talked to has told me you absolutely DO NOT EVER put a patch back on if it falls off. If you do the patch could release the medication too quickly & cause an OVERDOSE. I asked her multiple times to make sure I had heard her correctly and she said "I did a residency in pain management, trust me, I know what I am talking about". I even told her that al the literature and every days thats a big but she insisted she was correct. I called the pharmacy this morning to ask the pharmacist who was on today and she, like everyone else, told me that you do not apply a patch that has fallen off or been compromised in any way so I told her what this other pharmacist said and she agreed that was wrong. I asked her to check which pharmacist was on at the time I called the previous night and she said it was not only a pharmacist but THE PHARMACY MANAGER!!!! This is VERY scary!!! Someone could die because this lady is giving out wrong information.

 

Am I overreacting here? What would you guys do? Should I call corporate and file a complaint? I can't file a complaint with the pharmacy at that store since she is the manager. What do you guys think?


 ~Carina
 

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

-Benjamin Franklin


Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 8/16/2007 12:15 PM (GMT -7)   
Carina,

Write to corporate and send a cc to your state medical board and the STORE manager. That person needs to have their license called into question. Also let your doc know. Life threatening mistakes are inexcusable. Makes you wonder what this person has told others in the past.

Chutzie
Co-Mod Fibromyalgia & Chronic Pain Forums
~~~
Fibromyalgia, Ulcerative Colitis, Insulin dependent diabetic, collapsed disk, dermatitis herpetiformus, osteo arthritis in spine and other locations.
***************

The only difference between genius and stupidity is that genius has it's limits. Albert Einstein: (1879-1955)


ohthepain
Regular Member


Date Joined Mar 2005
Total Posts : 353
   Posted 8/16/2007 1:06 PM (GMT -7)   

Chutz,

I went ahead and called the corporate office & filed a complaint with them but I will go ahead and put it in writing and do the cc thing like you said. Thanks. I was outraged at what she was telling me, it really is scary!!!


 ~Carina
 

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

-Benjamin Franklin


stkitt
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Date Joined Apr 2007
Total Posts : 32602
   Posted 8/16/2007 3:18 PM (GMT -7)   

Carina,

I went online and read the patient info on the FDA site and I could find nothing on reapplying if the patch falls off, only mentions to not use patch if it has been altered in anyway so the company is under the gun as far at their packaging of this product and info to patients.

It appears that not only this pharmacists but other caregivers have not been properly educated on the application and dangers of this method of dispensing of a very potent medication.

You did the right thing in reporting the misinformation and you are a true patient advocate. Thank you for being so well educated on your medications.

 


Respectfully
Kitt
Moderator Anxiety ~ Panic Disorders
*~* Not a mental health professional at all *~*
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TexasJen
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Date Joined Dec 2006
Total Posts : 649
   Posted 8/16/2007 5:26 PM (GMT -7)   
I understand your dilemma, being new to the patch and getting conflicting information.  However, there's the literature, and there's real life.  Reapplying a patch that has come off does not make it dispense any faster - if anything, it will go slower because the skin port that forms under the patch is what has been compromised.  You are in more danger of overdosing by being out in the heat and sweating while wearing the patch, rather than taping on one that has fallen off.
 
I can't count the number of times I've had a patch come off and had to re-tape it.  It even happened with the very first one I applied when I took a shower that evening.  I never experienced any ill effects from doing so.  Now, had I played by the rules and simply thrown them away and applied a new one, it would have been a huge problem with not only my doctor, but my insurance company.  I can tell you that truthfully because I DID play by the rules the first few months and got accused of using the patches improperly.  My insurance company balked at paying for more patches than were prescribed for a one month supply and the doctor had to practically sign in blood to get it covered.
 
Obviously, the best thing to do is make sure they never come off - not always an easy thing.  Using tegaderm as a cover has worked very well for me and I now rarely have a patch fall off.
 
Hope things work out OK for you with the patch.  It can take some adjustment, but at least for me, it works very well.
Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but living with my wonderful husband, 2 dogs, 1 cockatiel, and 2 gold fish. 


Boxerlover
Regular Member


Date Joined Dec 2006
Total Posts : 274
   Posted 8/16/2007 6:18 PM (GMT -7)   

I agree with texas, if I threw out every patch that fell off when I first started wearing them, I would have gone through my months worth in the first week. 

Melissa


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13478
   Posted 8/16/2007 11:08 PM (GMT -7)   
Me too, I hard a hard time with them sticking when I first was put on them. I agree with TexasJen about the OD business. I had a terrible time in the summer getting too hot outside and too much being released when I finally figured out what was happening. Tega Derms are great for keeping the patches stuck on you. My pharmacist & dr knew until I got the Tega Derms I had hell keeping them on. Altered was explained to me as being the patch may have a small tear or hole, then too much could be released and we all know heat is a no no.

Susie


Stmll
Regular Member


Date Joined Apr 2007
Total Posts : 106
   Posted 8/17/2007 5:08 AM (GMT -7)   

I also agree,I tape them back on, and my Pharmacist said it would be fine to tape back on, her and  I are good friends, and I think she knows the hardship I would go through with my DR, for coming up short all the time, vs tapping them back on, it has never made me feel light headed almost the opposite, after re-tapping I find the strength not as what it was and I find myself taking more BT meds, I think your phartmacis was atually being very honest with you..I hope the Fentanyl Patch is working for you..

Take Care

Tracey


DX; Loin Pain Hematuria Syndrome, A Very Rare Painful Kidney Disease,No Cure for this disease at this time, only thing is to Control Pain,
RX, Fentanyl Patch,Oxycodone, Amitriplyne,Ace Inhibitors 


ohthepain
Regular Member


Date Joined Mar 2005
Total Posts : 353
   Posted 8/17/2007 11:27 AM (GMT -7)   

My doctor made it clear to me in the beginning not to tape it back on when it falls off. And it is in ALL the literature. I am really surprised it wasn't on the FDA site b/c it's been in everything I read & all the other pharmacists I have spoken to knew about it. They may be being overly safe but I would rather be safe than sorry! Yes, there is a difference between literature & real life but they do generally have reasons for their warnings. When I called my doc's office to let them know I would be a patch short b/c the first had fallen off they said no problem, and they will write the script for an extra patch next time to account for it. I am sure it would be an issue if I was asking the doctor for extra patches constantly but they understand that it does happen and would rather I be safe and just dispose of the patch. I'm also sure it is one thing if your patch falls off into your hand but if you wake up one morning with it on the bed next to you (like I did) then you don't know what happened to it overnight or what has gotten on it that could effect the medication release. Or, if it falls off in the shower and the side with the medication gets wet I would think it would be the opposite & would become way less effective and could put you into withdrawal b/c you aren't getting the medication. The manufacturer says that if a corner comes off that’s no big deal it’s just when most of or the entire patch comes off. Anyway, I am glad that you all have had safe results with reapplying your patches when they come off but I've made the decision to take the advice of the manufacturer, the lit, my doctors, and most of the other pharmacist's (the safe road) and just flush em when it happens.

I seem to be fine with them staying on now thankfully, I am just using regular old medical tape & it is working fine (I do want to get some clear tape next time though) and I am writing the date on the patch so I know when to change it, especially with two on that get changed on separate days . I think the first time I just didn't use a large enough strip of tape. When I spoke to the manufacturer (Mylan) they told me not to use the overlays (Tega Derm, etc.). They recommend you don't cover the patch entirely. I think they are concerned it will get too warm & you wind up having symptoms like Straydog said she experienced during the summer.

FYI: I spoke to the Regional Pharmacy Manager yesterday and after talking to me he called the manufacturer and then he sent an “educational e-mail” to all of his pharmacy staff to inform them that these patches are not to be taped back on when they fall completely off.

Thank you all for your input on this subject.


 ~Carina
 

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

-Benjamin Franklin


Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 8/17/2007 12:24 PM (GMT -7)   
Well, seems the makers of oxycontin are paying a huge sum for telling doctors to script their med differently than the original FDA testing and what the literature says. I wouldn't mess with the original literature. If the manufacturer says NO, then it would be NO for me.

Chutz
Co-Mod Fibromyalgia & Chronic Pain Forums
~~~
Fibromyalgia, Ulcerative Colitis, Insulin dependent diabetic, collapsed disk, dermatitis herpetiformus, osteo arthritis in spine and other locations.
***************

The only difference between genius and stupidity is that genius has it's limits. Albert Einstein: (1879-1955)


dragonfly137927
Veteran Member


Date Joined Sep 2006
Total Posts : 2527
   Posted 8/17/2007 3:16 PM (GMT -7)   
Sorry for the info you were given. I made it a point to read the paper that came in my first box I opened of my Fentanyl patches. The idea of taping is okay if it is one side etc. I have never had one fall off but have had an edge lift. In that instance even in the package insert it says to place medical tape over that edge. Maybe that was what the Pharm. was thinking or maybe she is just well passing bad info
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987
 
 


Stella Marie
Veteran Member


Date Joined May 2005
Total Posts : 601
   Posted 8/17/2007 8:22 PM (GMT -7)   
I have been wearing high dose patches for quite some time. I have to agree with the group above - if I tossed away every patch that came loose and/or fell off, I would have been accused of selling them on the street corner because I went through sooo many each month. I not only put the patch on, but I also cover each one with a Tegaderm. Even if I cover them, they fall off left and right. Using more than the Rx'ed amount is cause for a red flag. There is no way that your insurance company is going to cover all of those patches each month and the story about them falling off will probably not be well received. I have never had the slightest problem retaping patches back on. I have been doing it every couple of days for many years at doses much higher than 25 mg. I can understand your situation, good luck in finding a compromise that you are medically and ethically comfortable with.


Stella Marie

Dx:  Rare progressive neurodegenerative disease called Multiple System Atrophy (brain rot, autonomic system failure, neuropathic pain and a whole lot more).  Added improvements:  Intrathecal pump and a spinal cord stimulator..

 Medications: Sinemet, Requip, Klonopin, Baclofen, Provigil, Lyrica, Fentanyl patches, Lidoderm patches, Dilaudid, Fentora and Zofran

Post Edited (Stella Marie) : 8/18/2007 11:35:09 PM (GMT-6)


rda
New Member


Date Joined Jul 2007
Total Posts : 14
   Posted 8/18/2007 2:38 PM (GMT -7)   

I have to agree, you gone way over with your worrying. Not a bad thing.

Iam on the 100 mg and have taken them all and can't tell much diff. in the brand I use.

This is what i do, clean my arm with alc. and wait 10 mins to put the patch on and it stays for the full 3 days. Before doing it this way I had to tape them on all the time. It says not to do this also but if you wait a let your arm dry a air I don't think theres much to worry about. Anyway you know when your getting to much when you start getting a little sick feeling just like when your getting to much heat on your arm


ohthepain
Regular Member


Date Joined Mar 2005
Total Posts : 353
   Posted 8/20/2007 6:50 AM (GMT -7)   
Other than that first one I haven't had any problems with patches falling off, I wonder why so many people loose THAT many patches. I just apply medical tape at all four edges and it stays. Weird.
 
Has anyone tried switching manufacturers to see if the other patches stay on better? They do say thats a possibility since they are done a little differently (i.e. Mylan's patches contain medication in the adhesive & that can make it harder to stick on some people). What area of the body does everyone prefer to put the patches on? What area of the body do you find it falls off of more?
 
I applied the first patch on my chest (where doc's office said to) and it came right off, I also think I used too small a strip of medical tape that time. Now I use my upper arms....I find I dont have any trouble with the patches coming off there.
 
Would love everyones input on what the best placement is. Thanks.



 ~Carina
 

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

-Benjamin Franklin

Post Edited (ohthepain) : 8/20/2007 8:59:43 AM (GMT-6)


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 8/20/2007 8:48 AM (GMT -7)   
I post on crohns and was just reading on here. I use the BC patch which I know is totally different from a pain patch. But to keep mine on I take it out, slap it on, and then rub it for about 20 full seconds with lots of pressure. Then I rub off or scrub off any extra adhesive that is on the outside of the patch that might stick to my clothes. I have had no problems since I started doing this but before I was losing them left and right. Rubbing that adhesive for a bit really helps.
25 Year old married female.  Diagnosed w/ CD 2 years ago, IBS for over 10 years before that, which was probably the CD.
 
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rda
New Member


Date Joined Jul 2007
Total Posts : 14
   Posted 8/20/2007 11:30 AM (GMT -7)   
i put mine on the upper arm, and yes always get the patch to body temp before using it. i hole mine between my hands for a min or so, and use. afer cleaning my arm with alc. and waiting a few mins. before using.

TexasJen
Veteran Member


Date Joined Dec 2006
Total Posts : 649
   Posted 8/20/2007 12:40 PM (GMT -7)   
Now there's a new idea that hadn't occurred to me before: getting the patch to body temp before applying. Makes sense. Thanks!
Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but living with my wonderful husband, 2 dogs, 1 cockatiel, and 2 gold fish. 


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 8/20/2007 1:49 PM (GMT -7)   
Carina, I'm glad your patch is now staying on good for you. I guess why people have problems is in the placement and where they have to place the patch, I put mine (lidocaine) on my lower back at first it sticks but as soon as I have to pull my pants down to use the restroom it comes loose and starts to slide down. I've even tried the medical tape. I might try the alcohol that rda suggested and wait for the weather to get a lil cooler here too.....Hugz to you Carina and everyone else too.......lets keep hopeing for those painfree days

ohthepain
Regular Member


Date Joined Mar 2005
Total Posts : 353
   Posted 8/21/2007 8:44 AM (GMT -7)   
I find the arm defiantely works best for me so I am sticking with that location, if it aint broke don't fix it ;) Also, I have noticed that the white paper tape works WAY better than the clear tape....the clear tape doesnt stay as well, the edges come off and the edge of the tape digs into my skin in places. Just an FYI for others. I'm going back to the white tape...it's not like the clear tape is clear enough that it does anything to conceal the patch on your body.

Char - The Liodocaine patches are a whole different monster. I do find them much harder to deal with....they are MUCH larger than the pain patches are. I do put medical tape around all four edges and they mostly stay on but like you say, moving can make them come off. Mine don't come off all that often they just seperate from the skin, the tape seems to hold em in place. It is frustrating, thats for sure. Some night I have my back pretty much covered with em. Do you know if you can cut the lidocaine patches to be smaller? I need to put them at my sholder blade area but cannot do this b/c of the size..noooo way it would stay on, I'll have to check on that.
 ~Carina
 

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

-Benjamin Franklin


Stella Marie
Veteran Member


Date Joined May 2005
Total Posts : 601
   Posted 8/22/2007 8:02 PM (GMT -7)   

According to the Patient Information insert in the Mylan brand of patches, it says on page 2:

-         " Fentanyl  transdermal system may not stick to all patients.  If the patch does not stick well or   comes loose after applying, tape the edges down with first aid tape.  If the patch falls off, throw it away and put a new one on at a different skin site."

I am sure each brand has different directions.  The body temp. suggestion is a good one.  Thanks, I definately will give it a try.  I also put mine on my upper arm and have good success.  I have less problem with perspiration and skin movement/stretching which interfers with the patch sticking.  Most doctors give patients a "grace period" when they are start new to a medication and allow for extra doses when unique situations arise.  Once you have been on a medication for awhile, the staff are usually less tolerant of requests for extra doses.  The staff at my PM office account for every patch Rx'ed each month. 

 

 

 


Stella Marie

Dx:  Rare progressive neurodegenerative disease called Multiple System Atrophy (brain rot, autonomic system failure, neuropathic pain and a whole lot more).  Added improvements:  Intrathecal pump and a spinal cord stimulator..

 Medications: Sinemet, Requip, Klonopin, Baclofen, Provigil, Lyrica, Fentanyl patches, Lidoderm patches, Dilaudid, Fentora and Zofran


wishful
New Member


Date Joined Jul 2007
Total Posts : 12
   Posted 8/26/2007 11:54 AM (GMT -7)   
RDA and others... According to Jansen the makers of Duragesic patches," the skin should not be cleansed with alcohol ,soaps,oils,lotions, or other agents that might irritate the skin or alter its characteristics. After you wash with water, you need to wait till it dries to apply the patch." It also says that" the Duragesic patch should not be used if the seal is broken, cut, or altered,or damaged in any way prior to application. This could lead to rapid release of the contents of the Duragesic patch and absorption of a potentially fatal overdose of fentanyl. The transdermal patch should be pressed firmly in place with the palm of your hand for 30 seconds,making sure that the contact is complete,especially around the edges." It is really important to follow the directions that the manufactures give you. They give you these for reasons. I know that it is hard to keep these on, and you can get the bio-occlusive covers from them for free, so I would order them, and they do help to keep them on. But the most important thing is safety in taking these medications. You don't want any chance of an overdose. They can be life threatening.

Suz6
New Member


Date Joined Aug 2007
Total Posts : 5
   Posted 8/29/2007 3:50 PM (GMT -7)   
Hi Guys,, I just weaned myself off the Fentenyl Patch and now trying to weane off the oxycodone. Anyhow if you ask your doc to write for Durigesic name brand then call Durigesic they will supply you with something similiar to Tegaderm from J&J and it is free. Good luck guys. Suz6
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