thanks all. fentanyl and constipation update.

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debilitated
Regular Member


Date Joined Jan 2010
Total Posts : 448
   Posted 2/3/2010 1:23 PM (GMT -7)   
Ok check this. I stumped 2 pharmacists already. Which REALLY bothers me because they are SUPPOSED to know this stuff. I mean they were extremely impressed with my pharmacology knowledge.
Anyways, The fentanyl patches i have are 12mcg. I have BOTH from Mylan and Pricara (jensen).

Heres the Problem. The mylan gives 12mcg/Hr BUT OVERALL each system or patch containes 1.28MG of Fentanyl.
The Duragesic Pricara 12mcg/hr OVERALL each patch containes 2.1MG of Fentanyl.

? Confusing right ? Both Pharmacists at 2 different walgreens said that they had no idea. So I was trying to ask them if the Mylan one would make me less constipated because of technically less OVERALL fentanyl or some ingredients used. Who knows.

Anyways, Thanks Nanners, Champagne and whoever helped with some ideas. I think im going to take miralax Every night before bed and Have Oatmeal for breakfast along with other Fiber containing foods to try to keep me regular for the most part. Hopefully it works.

champagnekindofgal
Regular Member


Date Joined Jan 2010
Total Posts : 221
   Posted 2/3/2010 2:35 PM (GMT -7)   
I think the difference maybe in the amount of time you leave each patch on - i.e. one can actually deliver 3 days at 12mcg/hr where another may be to leave on for 2 or 4 days. Also, some manufacturaters may allow for some overlap (even if the label says it is be changed every three days) as not everyone changes their patches as they should the same time every day, and if they don't the patient could go through withdrawl symptoms.

FYI - I was allergic to the glue in Duragesic and got a special insurance ride to get my patches replaced every two days which helped with skin irritation in case that causes a problem.

Good luck. Sounds like you have a good plan in place. And enjoy the rest, it helped me recharge for a while ... and you will decide how long you want to be on them and when/if you want to wean off.

Keep us updated.
Diagnosed with Crohn's 2004 via pill camera    Imuran (6MP) kicked into remission (along with modified diet) so went off in 2006.
 
2009/2010 acute flare and hospitalization - put back on Imuran. Currently taking 55 mg prednisone.
Current problem - protruding thrombosis hemorrhoid.
 
 
 


champagnekindofgal
Regular Member


Date Joined Jan 2010
Total Posts : 221
   Posted 2/3/2010 2:35 PM (GMT -7)   
I think the difference maybe in the amount of time you leave each patch on - i.e. one can actually deliver 3 days at 12mcg/hr where another may be to leave on for 2 or 4 days. Also, some manufacturaters may allow for some overlap (even if the label says it is be changed every three days) as not everyone changes their patches as they should the same time every day, and if they don't the patient could go through withdrawl symptoms.

FYI - I was allergic to the glue in Duragesic and got a special insurance ride to get my patches replaced every two days which helped with skin irritation in case that causes a problem.

Good luck. Sounds like you have a good plan in place. And enjoy the rest, it helped me recharge for a while ... and you will decide how long you want to be on them and when/if you want to wean off.

Keep us updated.
Diagnosed with Crohn's 2004 via pill camera    Imuran (6MP) kicked into remission (along with modified diet) so went off in 2006.
 
2009/2010 acute flare and hospitalization - put back on Imuran. Currently taking 55 mg prednisone.
Current problem - protruding thrombosis hemorrhoid.
 
 
 


Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 2/3/2010 3:38 PM (GMT -7)   
In my experience I've found pharmacists to be completely useless. Usually when I have a question, if the answer isn't right there in their little book they have no idea.
33 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira 2/27/09. Proferrin iron pills.

Tried SCD, didn't work, now avoiding gluten and dairy.


Go Saskatchewan Roughriders!


champagnekindofgal
Regular Member


Date Joined Jan 2010
Total Posts : 221
   Posted 2/3/2010 8:17 PM (GMT -7)   
Hey debilitated:

I found this post on the Chronic Pain Forum and thouht it had some good info which might help you in your journey as well as give you possible options:

**Just my thoughts and suggestions...not a Dr.***

Fentanyl patches are one of the strongest meds available. I was actually extremely surprised that your Dr. went from codeine to this medicine...Not that I don't think you have the pain to warrant it...but this medicine is supposed to only be prescribed to opiate tolerant patients...
It actual states that opiate tolerant is to have been taking a minimum of 60mg of Morphine daily for more than a few weeks without this alleviating the pain properly..and overdose can occur by not following this guidline..

and the natural progression from codeine is to Norco/Vicoden, then Percocet, then to a LA med like Oxycontin or Morphine , then to the patch starting with a 12mcg or Methadone.

Again...I am not saying that your pain is not needing a strong medicine to help...just the way this Dr. is going about it seems way too aggressive and skipping some steps..

This particular medicine takes time to build up in your system...as in your blood plasma levels..That is why it is prescribed to be changed every 72 hours. It has a long half life.

I'm not sure how many days you have been on this now but it can take a few weeks to a month to really give a new medication time to let your body adjust unless someone is having life threatening side effects.

A good BT medicine that I use is Oxy IR 5 mg as it doesn't have any Tylenol to hurt your liver, and a low enough dose to have control over your dosage. My Dr. prescribes 1-2 every 4 hours as needed...(no more than 8 in a 24 hr. period) which gives me flexiblility when I have good days to not take any...

What other type of medicine (you say seizure med) is he suggesting?

A good regimine in just regards to medicine...for a chronic pain patient...is usually a long acting medicine...a BT med as needed, some sort of muslce relaxer. and possibly an anti-depressant as so many of us have low seratonin levels with our bodies trying to fight pain each day and go through surgeries. As well as some take a sleep aid...there are natural ones or prescription as getting to stage 4 sleep is imperative to restoring our bodies and help us deal with chronic pain.

Now..not that everyone has to have all of these...

For me...I wanted the most possible ways to be flexible with my medicine..my LA medicine is MS Contin...which again..I can still take as needed and can choose none on good days if I want...same with my muscle relaxer..only when needed.

The good part about the patch for those who take it...is the constant release of medicine..which peaks at 20-27 hours...

Please be extremely careful with this medicine...it needs to be worn above the waist...not in any place where you 'sweat' or is rubbing against clothing. Avoid any type of heat...blankets, heating pad or long hot showers and no hot tubs...this could cause an immediate release of the medicine and respiratory failure.

This is not just info from me learning from my Dr. and online research..but I was prescribed this by my Primary Dr. many years ago..She was wonderful and caring and trying to help but did not know much about this medicine..I had not been opiate tolerant at the time...

After applying a 25mcg patch..I took my morning shower...and wound up on the floor..passed out..and rushed to the hospital. It has also been linked to many deaths due to improper dosage/release...

*** I am not trying to scare you away or tell you or others not to take this medicine..It is truly a good medicine when used properly..so I hope I am not misunderstood...just wanting to share my story and information.

Are you currently on a muscle relaxer as well?

If it were me, after a few weeks to a month, if your pain levels are still above a 5 on the pain scale...which is what most PM Dr.s feel is acceptable with a chronic pain patient..than I would suggest adding a BT med and trying that before going higher...

Just my thoughts...certainly NOT a Dr. so please work with him as I certainly hope that this medicine..along with all the other modalities you use, helps keep your pain low...I truly wish and pray for that for all of us!!!

I use this term a lot..but having chronic pain is a marathon...and takes much trial and error and many different things as well as team of people..Dr.s/Pharmacists/Counselor, etc. to keep us at an acceptable level which unfortunately will not be 0 again most likely:(
44-single mom diagnosed with Crohn's 2004 via pill camera    Imuran (6MP) kicked into remission (along with modified diet) so went off in 2006.
 
2009/2010 acute flare and hospitalization - put back on Imuran. Currently taking 55 mg prednisone.
Current problem - protruding thrombosed hemorrhoids (external as well as internal).
 
Fibromyaglia; migraines; herniated disks C5,6 and arthritis in neck; asthma; scolisis in back/arthritis.
 
 
 


debilitated
Regular Member


Date Joined Jan 2010
Total Posts : 448
   Posted 2/3/2010 9:46 PM (GMT -7)   
Champ, I hope this doesnt offend you please. But You have been assuming a lot of things for quite sometime now.. I have no idea what you are talking about.

First off, I have a lower back injury, osteoporosis and crohn's for 9 years now.

I was NEVER on codeine. I was on fentanyl before for 4 months.

Opiate tolerant? Very. I take tramadol, Norco 10/325 every 4-6 hours.
At the moment im just using the fentanyl.

I tolerate fentanyl very well.

And no, my doctors left out no steps.
I am tolerant, never any breathing problems or reactions to fentanyl.

Im Extremely knowledgeable when it comes to medicine.

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 2/4/2010 12:36 PM (GMT -7)   
Message from champagnekindofgal:


didn't mean to offend ... not all of this would apply ... I just copied it all .. take what applies. sorry.


--------------------------------------------------------------------------------
44-single mom diagnosed with Crohn's 2004 via pill camera 6MP kicked into remission (along with modified diet) so went off in 2006.

2009/2010 acute flare and hospitalization - now on Imuran. Currently taking 55 mg prednisone.
Current problem - protruding thrombosed hemorrhoids (external as well as internal).

Fibromyaglia; migraines; herniated disks C5,6 and arthritis in neck; asthma; scolisis in back/arthritis.


snohare
Veteran Member


Date Joined Oct 2004
Total Posts : 2088
   Posted 2/5/2010 10:42 AM (GMT -7)   
shocked Wow, I am gobsmacked at this thread.
You both obviously know a lot about pain meds, which I had not the faintest idea of. I thought that because I knew about the receptors that opiates work on, I was fairly well clued up. That bit about being careful where the patch is worn, and having hot baths....I hadn't a clue ! Never mind the overlap. By comparison, my advice in the chatroom was moronically simplistic in the extreme - eat linseed !
I suppose it just goes to show, there is an art in the simplest thing. One person's "knowledgeable" is another person's "bit basic" (Yeah, that would be me here. eyes yeah)
Oh well, now I am a bit better educated...never know when the information overflow may come in handy some day.. wink
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