Fentanyl Brand difference?

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Screaming Eagle
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   Posted 6/12/2012 3:05 PM (GMT -6)   
For those of you on Fentanyl or have used the product in the past,…did you notice any difference in the performance, if the brand/maker was switched.

I have used both the gel filled patch and the tape coated product, and feel that my pain reduction is not as good when on the tape coated type.

I do see my PCD on the 15th (Friday) for a review of my med's, (every 30 days) .....and will do so as long as changes are being made to scripts and dosage. At the moment, I'm on the 25mcg, and at first it seemed to work fairly well, but has not lately ever since I change brands. I also have a complaint with the 72hr length of time I'm supposed to wear it.

I have not noticed a difference of wether I'm working in a warmer environment (Work) or staying at home where it is cooler, and I also switch body placement as well. My PCD also scripted me 120ct of the 7.5 Percocet's,... and I have been keeping a tight reign on use of it, as Im allowed X4…but have been trying to limit them to X2. I just hate using two different narcotics at the same time. I realize the Percocet's are for BT, but it sure seems like they are used as an addition to my baseline if used on a regular basis.

Any thoughts and or past experience would be appreciated.

(forgot to add that I'm hitting the BT med's…all four of them on the third day, and is so aggravating!)

Thanks!

SE Grrr! GRRR! mad
Moderator Chronic Pain Forum

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Post Edited (Screaming Eagle) : 6/12/2012 3:15:51 PM (GMT-6)


Blessedx8
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   Posted 6/12/2012 4:47 PM (GMT -6)   
YES; I think the ones where you "see" the gel (is that the Duragesic? Mylan?) works far superior than the tape looking one.

I told my pharmacist that they worked better and he made sure to stock that brand.

If your goal is to really not use a BT med, then I would say going up to 50mcgs makes sense, at least to try. I just know you are at the end of the line on meds and all, pretty much (as I am, too)... so if the fentanyl IS working, I wouldn't jump higher than 50mcg for as long as you can prolong it.

Ok buddy - gotta get dinner on. More later, my friend!

--Tina
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My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask

Screaming Eagle
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   Posted 6/12/2012 5:02 PM (GMT -6)   
Thanks! I'm glad to hear this! I'm betting that the gel packed one, in a 50mcg will be about right for me. I will discuss this with my Dr this Friday and see what he recommends.

If I could keep the BT med's for flair's or the result of higher physical activity pain, that would be great.

SE wink
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"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Fusiongirl
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   Posted 6/12/2012 5:19 PM (GMT -6)   
Hi everyone

I have used Fentanyl for years and I disagree with what you are saying. I have much better results with the 'duragesic' brand tape type patch than the one with the reservoir. I had problems making the reservoir type stick and I suppose it requires 100% skin contact to be effective, so if it is not sticking well then the drug dosage will be affected. My daughter works in palliative care and she has told me that the patch actually contains more than 72 hours worth of the drug so there really should not be any difference in pain levels on the third day, at least not to do with the drug.
I have always been told that if you are using more between or breakthrough meds then that is an indication that the patch strength should be increased. I did read that when you are hot, say when having a bath, then there is more uptake of the drug so that could certainly be an issue. Not sure how hot you would have to be. My issue is that certain time of life and these awful sweats!!!! Luckily the UK tends not to be hot other than on odd days!
For all of us chronic pain sufferers the problem is that when we are on the same drug for a while, we get used to it, then we need more to have the same effect. I was once told that it is better to alternate pain meds to stop you getting used to them, however my current pain doctor has a different view. It seems to make sense though.
The problem with breakthrough meds is that when you are on a strong drug then it requires a strong drug to help when pain gets bad in between. In the UK I have never heard of perocet, I assume we have another name for the same drug. My breakthrough med is sevredol. In the UK they also strongly advocate the use regular paracetamol, not purely as a painkiller but it seemingly helps opiate pain meds work better. I am forever being told off for not using paracetamol regularly, I seem to have a mind block and just forget to take it!!!
Good luck with your appointment. Hope it goes well.
Jane

Blessedx8
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   Posted 6/12/2012 6:52 PM (GMT -6)   
Jane,

I think this just shows how medications affect people differently.

The patch definitely doesn't last 72 hours for some people - absorption rates differ from person to person - given body temperature; outside temp; just the way our bodies absorb things. Trust me - with how much this medication costs.... insurance would not approve it to be dosed at the 48 hour mark if this wasn't the case for some people.

I do believe in alternating pain medications to help avoid tolerance. I have to do this every year or so to make ANYTHING work for me...

Here is the states, Percocet is Oxycodone w/ Acetaminophen.

Take care -Tina
Moderator - Chronic Pain Forum

My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask

momtofourangels
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   Posted 6/12/2012 8:29 PM (GMT -6)   
Hi Michael They don't feel much different to me, but the clear one sticks better for me. I am using some big ones that you can see, and they don't stick very well even with Tegaderm. I know what you mean about taking breakthru meds, but sometiimes I just can't take it anymore, and have to. So don't be hard on yourself, ok?

I have probably told you this before.but be careful and don't get too hot. The patch may bring out too much medication. That may be why it's not as effective on the third day for you, if it's too hot at your work. It's also not good for you if you get too hot.

Just advising my friend. Take care.

love and hugs
Loretta
Dx: osteoarthritis, bursitis in left hip, Osteoarthrits in right hip, compression fracture in thoracic spine due to falling on frozen ground March 2001 , ddd, spinal stenosis, bone spurs, osteoarthritis in spine, osteoarthritis in both knees
Meds: Fentanyl patch, oxycodone, otc: BenGay, Tylenol Arthritis on occasion

Screaming Eagle
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   Posted 6/12/2012 8:43 PM (GMT -6)   
Thanks Loretta!…and yes I'm careful about being out in the heat with it on. Jane's take on the patch is interesting, because we have several members who are on the 48hr cycle. I'm thinking the higher dosage will fix most of the problem though, at least I hope so!

SE wink
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"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Fusiongirl
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   Posted 6/13/2012 7:02 AM (GMT -6)   
Screaming Eagle

Being in pain is no joy so I guess upping the patch strength is the best option other than trying new medication altogether. That can be fraught with problems too. No matter what though you still need your breakthrough meds for your bad days. Your perocet sounds a bit like what we call 'oxynorm'. Do you have sevredol? It works well for me. Sometimes I feel blessed thAt I live in the UK and don't have to go through what you do to sign up with a pain management doctor. I can't imagine having to submit to pill counts and blood and urine tests. I fear that it may go that way here too, it only takes a few to abuse pain meds forveveryone else to suffer! I am also lucky in having a daughter working in palliative care who has qualifications in pain control, I know it is a different area but she does help me a lot.
Hope all goes well for you, let us know.
Jane

Screaming Eagle
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   Posted 6/13/2012 8:25 AM (GMT -6)   
 
     Morning Jane!  Sevredol is Morphine Sulfate and I believe it is known as MSContin here in the USA.
 
         My Dr has just started me on the Fentanyl patch 30 days ago..and I think the 25mcg is a starting place for me, and a safe one at that, since I have not used it before. My Dr is also a PCD and is the best source of pain management in this city for various reasons. Pain management offices in this city are under heavy DEA eyes, ever since a Local PM was convicted of killing 33 of his patients with overdose's...especially Oxycontin.
 
 I have suffered with CP for the last 10yrs and have tried the MSConitn, Tramadol, Oxycontin, Percocet, and now the Fentanyl. If this does not pan out then we will be looking at the pain pump again. However I hope it does not go that far. I am well aware of what BT med's are for, but it seems that I have to use them as an addition to my baseline....and not really what they are intended for. I believe once my PCD gets the correct dosage on the Fentanyl...I will be able to use the BT med's as they are intended for.
 
      I have also had 8 or 9 Epidurals to date, some with success and others not. Lots of PT with little help...and a tens unit as well.
 
        The bottom line for me is that I hate taking med's, but since I work a full time job, I need some sort of comfort level to keep it. Well actually I need the comfort level no matter what! LOL
 
   The question I was really interested in was a difference in brands of the Fentanyl...and I believe you and Tina gave me some food for thought. Thanks! wink  
 
       I will report back after the 15th and let the members know what was done for me as far as a possible dosage increase.
 
    Thanks!
  SE wink
    
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"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Fusiongirl
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   Posted 6/13/2012 11:48 AM (GMT -6)   
SE
Good luck with it all. You certainly need some relief and I can understand why you hope it won't be a pump. Thank you for explaining the 'across the pond' difference between our medication names, I have often wondered. Can I ask - is you problem back pain. It's just that my pain specialist has upped and upped my fentanyl, I am now on 75mcg, and my pain is not terribly well controlled at present I often wonder if a pump would give me a better effect for a lower amount of drug. I know I have leg issues too but the back pain is more debilitating. When I did mention a pump he told me he only uses it in palliative care patients. As much as fentanyl seems to work, like you, Id rather be without it, or at a lower dose.
Hope all goes well on the 15th

All the best
Jane

Screaming Eagle
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   Posted 6/13/2012 12:15 PM (GMT -6)   
 
     Jane, my pain is from what we call "Failed Back Syndrome" ...what is actually causing the pain?... we don't know, but I have tried the nerve med's with no luck either. The MRI looks good as well.
 
       I also suffer from Cervical pain (bulging disk)...and will someday need another surgery to correct it. I have nerve damage where they opened me up for the double lumbar fusion surgery, but it's livable.
 
        The pump seems like a great device at first glance...after all!...the med's bypass your liver!, and the med dosage is supposed to be a whole lot less! However...it does come with it's own risk!...and there are several. Pumps should be used as a very last resort.
 
     For me, there is a point that I will not let my Dr keep upping a med. I believe my last dosage of Oxycontin was 30mg X3...and was on it way too long, and no longer effective without upping the dose again and again... when I never really got the coverage I should have to begin with.
 
      Hope that helps,
 
        SE
 
  
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Post Edited (Screaming Eagle) : 6/13/2012 12:27:20 PM (GMT-6)


Jacey86
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Date Joined Mar 2012
Total Posts : 124
   Posted 6/13/2012 12:21 PM (GMT -6)   
I was put on Fentanyl patch a few years ago. I can't tell you how scared I was. It just sounded so... serious. I even went and saw my PCP right after being prescribed by my rheumatologist to tell her what I was on in case I died. (Really I'm not like that!)

I also thought I'd 'feel' the pain meds, but didn't. I noticed that the drop off in pain relief was significant and severe after 48 hrs. I told both Dr.'s about that and they said they have heard that a lot, very common. So they wrote for me to change every 48 hrs. I really only have one good day, the middle one, if you could call it 'good'.

The one thing is that I do not sleep at all that first night of the day I change it.

Im on the one that looks like a clear bandaid. Was on the reservoir kind but it didn't stick as well and irritated my skin afterwards.
It's so different for everyone - so definitely trial and error.

PS. I have to use breakthrough meds - that hasnt changed at all. :(

Screaming Eagle
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   Posted 6/13/2012 1:27 PM (GMT -6)   

 

 Jacey...I'm with you on this, and have the same fear of the med. However, I will say that I feel safer being on the tape product rather than the gel filled pack for obvious reasons.

    At first,.. I used the TegaDerm product to help it stick on...but found that the tape type does not really need it...at least so far. rolleyes   ...  I have not lost a single one of them yet due to not being able to stick properly.

     I also noticed that when I do the full three days (72hrs)...it takes a good 12hrs to feel like it's working again when it has been replaced...so I kinda agree with you...it seems like I get a day ...maybe 1.5 days of effectiveness, but really untill I think I get the correct dosage...I'm just not sure.  

 Thanks for sharing!

    SE wink    

    


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"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

mrsm123
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   Posted 6/13/2012 2:04 PM (GMT -6)   
Hi SE,
Yes , there is a difference in the total amount of fentanyl in the differing brands /manufacturer's of the patches. I have both the Mylan brand and Sandoz brand name patches, they are both manufactured by Sandoz by the way, but for the 25 mcg. patches alone,  the Mylan brand name patches contain a total of 2.55 mg of fentanyl in the adhesive of the patch , however the brand name Sandoz patch 4.2 mg of fentanyl in the patch.......Almost double the total amount of fentanyl in the patch. You are not imagining the difference in the patches delivery of fentanyl. My pharmacy normally stocks the Sandoz brand for me, but this month had the Mylan brand in the 25 mcg. patches and I do feel the difference in the levels of pain relief.

Screaming Eagle
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   Posted 6/13/2012 2:08 PM (GMT -6)   
 
        Thank You! ...Thank You! wink
 
    I will have to look this up when I get home here in a bit. Can you tell me where to find this imformation?
 
   SE wink
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Weekly Quote!

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mrsm123
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   Posted 6/13/2012 11:00 PM (GMT -6)   
SE,
You can find it in the prescriber's information on websites like drugs.com or better yet, you can find it on the packages of the fentanyl patches themselves.  Generic versions of medications are allowed by federal law to have variations of up to 20% plus or minus the amount of a specific drug in their products, which explains why you will see such a huge discrepancy in the amounts of fentanyl in this case.
Sandi

Screaming Eagle
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   Posted 6/13/2012 11:22 PM (GMT -6)   
Thanks Sandi! Good information to know, and will relay this to my PCD to see what he has to say about it. I'm going to ask my pharmacist about it as well….he should know this.

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Fusiongirl
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   Posted 6/14/2012 1:23 AM (GMT -6)   
Screaming Eagle

Thank you for sharing your problem with me. Although There is an issue that requires fixing in my back, I worry about failed back surgery syndrome too. My spinal fusion seems to have cured one pain but caused others. I am trying to avoid another MRI scan for the time being, VERY claustrophobic in that machine. Hate being a wimp, it's one of the few things I just can't tolerate!!!
That was very interesting to hear the info re the amount of fentanyl in a patch by mrsm123, I am not aware of the sandoz brand here. I only am given the Duragesic brand, the one that resembles opaque cling film. Was given the reervoir one a few years back but my skin broke out in red itchy rash so my doctor (reluctantly due to cost!) changed my prescription to read Duragesic. I have no probs with them, they stick very well (as long as skin is very dry to begin with) and I have never experienced increased pain after 48 hours. It sounds as though I am very lucky.
I agree pump would be last resort, very invasive, but I would like less drugs going in to me, not more!! I am hoping that after this op and then my knee surgery, I might be able to reduce my pain meds. Then I have said that after every op, three back, countless injections and ablation and more than twenty knee ops, but it always seems to be that something else happens and my meds are upped again! Oh well onwards and upwards as they say.....
This forum has been so good for me, I have never been able to reach out to people who I know will understand and not judge. My husband and daughter are great as are my few close friends, but I am amazed just how judgmental some people can be. One even told me to ditch the pain meds and have a brandy!!! Yes she was serious, thought that would help me sleep and then I would cope during the day. You have to laugh, don't you!
Have a good day
Jane

Screaming Eagle
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   Posted 6/14/2012 3:42 PM (GMT -6)   
Jane I have not had a chance to reply back to you today, and have a busy evening….but will post later tonight. Please check back in later and I will have a nice reply for you.

SE
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

iloveoliver
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   Posted 6/14/2012 3:53 PM (GMT -6)   
The Mylan brand works really well for me. I have tried a few others and always go back to Mylan.

Snowbunny21
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   Posted 6/14/2012 4:43 PM (GMT -6)   
I repsectfully disagree about the 20% and urge people to go directly to the FDA website below:
http://www.fda.gov/downloads/aboutFDA/Transparency/Basics/UCM226568.pdf


***Especially go to page 9 and you will see that this is misinformation about the 20%...
 
But I recommend reading through the entire thing as it's very easy to read (thanks to their font:))
 


A generic drug must meet all the standards of a brand name except for clinical trials, animal studies, and bioavailability...
 
 
(I do not know how to make a link "hot" so you can cut and paste. I would actually urge HW to put this link in their stickies because this comes up a lot on this board and unfortunately many have heard the wrong information and inadvertantly pass it along.)

Post Edited (Snowbunny21) : 6/14/2012 4:47:29 PM (GMT-6)


Screaming Eagle
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   Posted 6/14/2012 5:02 PM (GMT -6)   
uh…Snowy…when you post a reply,…your in the editor!…. and the MCode help is staring you right in the face! tongue

If you can follow simple instructions…you should be able to post a URL easily. smilewinkgrin

oh and one more thing!…I love these friendly debates…and I have to respectfully disagree with you! LOL I did a little research as well! devil

SE tongue
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Post Edited (Screaming Eagle) : 6/14/2012 5:14:46 PM (GMT-6)


Snowbunny21
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   Posted 6/14/2012 5:12 PM (GMT -6)   
I don't know what MCode is??? I just cut/pasted that link directly from the site..

Sorry for not knowing how it works...Could you please quickly explain what I am looking for and how to make a link hot?

I can follow simple instructions...I promise.LOL..but don't know where to look and haven't before posted a link:(
 
I always use the "Quick Reply" at the end of the page when replying so don't see any instructions...

Screaming Eagle
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   Posted 6/14/2012 5:17 PM (GMT -6)   
LOL! Im headed out the door…but will be back in a couple to help…….unless one of our ther members can fill in while Im gone. I promise I will help….but in a hurry here…have a dinner date with my wife and step daughter.

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Snowbunny21
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Date Joined Jan 2010
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   Posted 6/14/2012 5:32 PM (GMT -6)   
No worries...and I truly don't want to hijack your thread...I just don't know all the computer terms:)
 
And yes...you and I love friendly debate...I'm just going on what the FDA rules/laws are, what my PM and Pharmacist told me as well because I am on all generic medications. So, not trying to insert my own personal opinion on this one like usual...LOL..so just wanted others to read the .gov information about generics.

Enjoy your evening!!

Post Edited (Snowbunny21) : 6/14/2012 5:36:14 PM (GMT-6)

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