Exalgo vs. Fentaynl Patch

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Regular Member

Date Joined Apr 2008
Total Posts : 38
   Posted 5/25/2011 12:41 PM (GMT -6)   
Hi Everyone,

I was wondering if anyone is on Exalgo? If so how do you think it works and what dosage. I was on fentaynl patch 75 mcg for almost 4 years and just within last 2 mths I've been getting terrible rashes from the patch. Also it seems to not be working very well. So the doctor put me on 16 mg tabs take 2 a day together. Doctor says the pills are equal too 75mcg patch.

I also am worried about withdrawl from the patches. He gave me 5 more patches but 25mcg to take with the exalgo and he says that should be fine? I heard its really hard to stop patches. Anyone have any info you can share with me?

Thanks so much!
2002 Carpal Tunnel Surgery, Plantar fasciitis, Migraines / Daily Headaches, 2005 Gastric Bypass surgery (200 lb weight loss), 2006 Hernia repair (due to wls), one week later complications and an emergency surgery Bowel obstruction, March 2008 another Hernia repair, chronic back and leg pain all over muscle pain (doctors say it's related to fast weight loss and loss of laxity in muscles etc, Nerve damage / pain in back legs and arms / hands, herniated discs and spinal stenosis in lower back, high blood pressure, anemia, allergies. Recently had 3 miscarriages and now back on several medications and getting mirena / IUD soon.

Have been on so many different medications! Currently 75mg Fentaynal patch, 1200 mgs Neurontin 3xday, Immitrex as needed, Avapro, Prozac 80 mgs, percocet for break through pain as needed, Skelaxin as needed, Zanaflex (at night to sleep and muscle Relaxer), topamax, Xanax as needed and I think that might be it hehe

If you would like to keep in touch with me on twitter my name is butterflyz0033, please let me know your from Healing well :)

Betsey Ross
Veteran Member

Date Joined Mar 2011
Total Posts : 1056
   Posted 5/25/2011 12:59 PM (GMT -6)   
Hi Girlee!

I was on exalgo er 10 mg.....I took 2 twice a day plus vicadin 10-600 for breakthru pain. For me personally....the exalgo didnt touch my pain and i was taking vicadin every 4 hours. I am now on kadian er 20 mg one a day. i never had a fentanalyl patch. i had a butran patch that didnt work on me.

Good luck Girlee.......i no longer have any faith in hydromorphine drugs...they dont work for me

Keep us informed as to your pain level and your search for pain relief. I will be praying for you.

crushed lower knee and vertical fx of yibia/external fixator placed/plates and screws and tried to place big pieces of cartiledge under knee cap/tremendous pain in affected legcontinously without improving/allergic to metal in left leg/leg isnt straight/need metal removed in July/wait 6 months for healing/then toatal knee replacement/straighten out leg/more phsyxical therapy/take opana er

Veteran Member

Date Joined Jan 2010
Total Posts : 3557
   Posted 5/25/2011 1:46 PM (GMT -6)   
The great part about the Exalgo is it's only taken every 24 hours...the dosage goes from 8mg all the way to 64mg in a day..

A good Dr. will always start you on a lower dosage of a new medication and then tirate up as to watch for any side effects or allergies to it..

The big thing is to just go in with an open mind...Everyone's experience is different...Just because it doesn't work for one person...it works well for others...

And unless there is a life threatening side effect...usually giving a new medicine up to a month is a good trial period to see if it is working well...It takes time to build up in your system...

The main thing is to work with your Dr. and keep a log of how you are feeling each day...and then after some weeks...he may need to up the dosage to get the proper pain control..so it's being a little patient with a new medicine at times and work together..

If your Dr. was ok to prescribe you the Fentanyl patches...then he seems to be a caring Dr. that wants to help with your pain..

Just FYI...this is an extended release medicine that is to never be chewed or crushed to take with food...take whole...

And remember that medicine is just one tool we have in our toolbox to help with our pain...there are many ways like light exercise, stretching, acupuncture, aqua therapy...CBT, a muscle relaxer...etc....this way we never expect a pill to take away all our pain..

I do wish you luck...there are lots of people out there where this medicine works great for them...I hope that will be you!
SB and "the pup who snores loudly" 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006

Veteran Member

Date Joined Aug 2008
Total Posts : 3193
   Posted 5/25/2011 3:08 PM (GMT -6)   
I've not been on the exalgo...but I have much experience w/ hydromorphone IR (dilaudid).  I also have transitioned off/on the fentanyl patches a few times.  Fentanyl is the best thing for my pain...but I can't use it via the patches because of being very fair skinned and the rashes, etc. 
I agree that each person's experience is unique...but, yes, it can be difficult to transition off the patch for some people.  I did find it difficult a couple of times.  I think your doctor is doing the right thing, though - by going down on the fentanyl, instead of pulling you off completely. 
Let us know how you do!  Good luck... --Tina

Veteran Member

Date Joined Dec 2007
Total Posts : 1235
   Posted 5/25/2011 6:13 PM (GMT -6)   
If the doctor does the conversion correctly, you shouldn't have any difficulty with withdrawal symptoms. All he is doing is taking one medication away and replacing it with another.
The last time I went off the fentanyl patches and back onto oral medications, there were no problems with the transitition. I used tegaderm to hold them in place while I used them but found that they weren't sticking as well over the summer and being in the pool or outside in the sun made them less likely to stick.
Snowbunny is correct, most PM doctors when converting from one medication to another, take the old medication, daily dosage, and convert it to the new medication and may reduce the total daily dose amount by 10% or so for cross tolerance. Many patients find when a medication is changed to another, they don't need as much of the new medication, and the reduction is done to make sure that there won't be any problems with switching out medications. If you need to increase the dose, you can do that in a week or so, after this new medication has time to build to a steady blood plasma level before deciding whether or not the dosage needs adjusting.
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis

Regular Member

Date Joined Feb 2008
Total Posts : 314
   Posted 5/25/2011 6:46 PM (GMT -6)   
Also there are some medications that the manufacturers suggest that when you convert to some that you actually increase the dose slightly I can think of opana as being one specifically. If I remember right they said that the doctor may have to incorporate opana IR with the opana ER and on top of your regular instant release medication for some reason with the conversion, my doctor didnt do this and I do remember slight problems not withdraw but just not feeling as well.

New Member

Date Joined Mar 2012
Total Posts : 2
   Posted 3/9/2012 6:58 PM (GMT -6)   
FIRSt off the oringianl response was wrong in so many ways... I have been prescribed every strength of vicodin, percocet, hydromorphone both er and ir and it doesn't come in er form in 10mg, only 8mg,12, and 16mg and ir in 2, 4 and 8. Then the part where hydromorphone or dilaudid is 5x the strength of morphine which is all kadian er is. Kadian is just a er form in a capsule without lactose. If he was on 20mg of hydromorphone a day or 100mg of morphine than and that didn't work then 20mg of morphine definitely wouldn't do the trick. I have my doubts that he has ever taken any of these drugs based on how little seHaving said that I was taken exalgo er and it didn't help my pain at all. I took 16mg a day and about 40-50mg of OxyIR. Fentanyl patches along with percocet of dilaudid for breakthrough pain has worked best for me. I am more than familiar with pain as I am only 25years old and have had 2 spinal fusions and have 8 herniations from top to bottom of my spine.

Maybe he didn't like the hydromorphone bc he was looking for more of a high from it which won't be the same as oxycontin or percocet or every vicodin. Hydromorphone is a lot smoother drug than these are that produces a less euphoric effect but for breakthrough pain I have found nothing better. I don't know what to tell you if a 75mcg fentanyl pacth doesn't help you though? I mean there isn't anything stronger out there other than the 100/mcg/hr doses and the Instant release lollipops. Good luck to anyone in pain in getting it under control and get a clue to the idiot who would rather take 20mg of ms contin than dilaudid. Honestly don't listen to anyone who cannot spell VICODIN correctly, not vicadin chief.

New Member

Date Joined Mar 2012
Total Posts : 2
   Posted 3/9/2012 7:02 PM (GMT -6)   
The only opioid I have never been prescribed oxymorphone either er or ir but for my month nothing works as well as fentanyl patches as low a dose as possible and dilaudid ir for breakthrough.

Veteran Member

Date Joined Jan 2010
Total Posts : 3557
   Posted 3/9/2012 7:24 PM (GMT -6)   

Welcome to HW...

Just FYI but the post you are responding in is 10 months old from last year...

We would like to get to know you better and the best way to do this is to start your own thread with the Post New Topic button...

It sounds like you have a lot of experience with chronic pain...So if you want to start a thread filling us in on how your journey started and what your pain issues are...you will get many more welcomes..

SB and "the pup who snores loudly" 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006

Forum Moderator

Date Joined Feb 2003
Total Posts : 16779
   Posted 3/9/2012 9:50 PM (GMT -6)   
Samsonfred welcome to the chronic pain forum. I am not sure why you bothered responding to a post that is as old as this one is with no current activity.

Normally when a new member comes on board they start their own intro post so all members will see it and be able to give that person a proper hello and welcome aboard.

I will caution you this is a very friendly, supportive forum and because someone does not spell something correctly is no reason to be accusing that person of something illegal. There are forum rules in place here that all members are to abide by and I suggest you take a look at them.

Take care.
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