Fentanyl Patch - Generic VS Name Brand

After being on Oxycontin and Norco for a year and a half, I was started on the 50mcgs Fentanyl patch every 72 hours. I was still taking Norco for breakthrough for the first week. I still had a lot of pain so the doc upped the Fentanyl patch to 75mcgs and told me to stop taking any Norco. I was scheduled for a followup visit two weeks later...

These two weeks were the worst weeks I have had while still medicated for pain. I would switch the patch out every 72 hours as ordered. After 4 to 6 hours of applying the new patch I would crash out for 6 to 8 hours. I am self employed and work from my couch so it wasn't as bad as it could have been but I was still unconscious most of the workday and would still wake up if the phone rang in case of a client emergency. I would have a little trouble waking up the next morning but it wasn't too bad. After about 12 hours of applying the new patch I would get some halfway decent pain relief while laying down but my back would jump straight to 6-7 on the scale of 10 immediately after sitting up. This is a pretty good summary of the first 24 hours.

On day two I would experience some pain relief while laying down but had the same issues when sitting up, this was around 7-8. As the day wore on or if I remained sitting up for ANY length of time the pain would increase. I wasn't exactly sleepy like day 1 but I was very slow and had very little energy. I have started using a cane and am more willing to stand up with the assistance it provides but I would still wait hours before getting up to get a bottle of water or food or use the bathroom. Because of this, I have lost 3 pounds over the last two weeks. It simply hurt to sit up and eat or get up and make anything. This past weekend I broke down sobbing while trying to make a sandwich. This is very unusual for me.

On day three (the last 24 hours of the patch) my back would hurt constantly. I could get no relief in any position and working was next to impossible. If it were just the increased pain, I would be able to deal with it better than I have. I also experience withdrawal symptoms during the last 24 hours of the patch and these do not entirely abate until 8-10 hours after applying a new patch. Withdrawal can be different for everyone but the first thing that always hits me is massive stomach cramps and diarrhea. These stomach cramps are very painful and the only thing I have ever experienced on this level was opiate withdrawal. As I am sure almost all of you have experienced withdrawal, it is very easy to distinguish (at least for me) between this and other ailments like the flu or other bug. Aside from the cramps, I would experience hot/cold flashes (that feeling of being hot and cold at the same time is always so horrible), sweating, full body (but mostly leg) aches and that lovely feeling like I am going to explode right out of my skin. I would have all these withdrawal symptoms just like clockwork during the last 24 hours of the current patch and up to 10 hours after applying the new patch. I also want to mention that these are not full blown, all out withdrawal symptoms. They are more like taking just enough medication to not be in total agony.

I also want to mention that I have broke down and actually sobbed more times than I can remember. I am not a person who cries easily and this is quite different than behavior I have ever exhibited any other time in my life, in pain or not. My wife is quite concerned. For several nights in a row I have gone to bed and laid there talking to her about the condition I am in and swinging from crying softly to uncontrollable sobbing where I can't even say anything. I told my doc about this and he had to look up in a book whether or not Fentanyl could effect your emotions! I could have told him that any opiate can cause depression and that I have never had this problem on any other medication before. I kept my mouth shut and didn't say anything. I have gotten to the point where I realize that I have done more research on these medications that I have been taking than most doctors I have talked to. In the end, he prescribed Wellbutrin for the emotional aspect of this.

Sorry for the long winded preamble but I wanted to explain how I got to this point. So now I get to the point of this post. The doc said that it sounds like I am having trouble with the delivery of the medication. He said it sounds like I am getting too much at first (the sleepiness for the first 24 hours), almost the right dose during the second 24 hours and then almost nothing during the last 24 hours. So it seems like all the medication is coming out too fast and runs out too soon. I can agree with this speculation. It feels almost exactly to me like I would feel if I were taking oral medication and took too many the first day, half my dose on the second day and then just enough to not go through full blown withdrawal on the third day. I have noticed with other generic medications that they do not seem as effective but I have never experienced something so close to a total failure to live up to the expectations of this medication.

So my doc upped my dosage to 100mcgs (because I am still having pain on any of the three days while wearing the patch) and wrote the Rx for the name brand of the patch. He said the two have totally different delivery mechanisms and that the name brand patch should work better. This sounded pretty believable to me. I knew it was going to be a pain when I got to the pharmacy because my insurance has refused to pay for name brand medications before when there was a generic available, even when the doc wrote the script for the name brand drug. So after I sit and wait for them to fill my new medications, my pharmacist actually came around the counter and handed me a sheet of paper with the price of the patches. They cost over $800.00 full price for one month and even with my insurance covering a portion of it, it was still $425.00 out of pocket! I was not happy at all. First, I don't have the money, I haven't been able to work all the time because of this and I am getting behind on everything. They actually shut off the cable TV and I haven't been able to get that back yet. I have a $3,200.00 deductible and I have made it all the way up to $2,900.00 already and this doesn't include the pool therapy or Dr. visit today.

My pharmacy put these patches on hold for me and told me to check with the Dr. and the insurance company to either find a different solution or find out if the patches could possibly be %100 covered once the deductible was reached, respectively. I do not think that they will ever cover more than what they said they would today because I filled two other medications and they were both free. This is typical of what happens for me when I reach my deductible and they pick up %100 of everything; so maybe I did reach it with the charges from therapy and the Dr. today. So if they covered the other, cheaper, medications %100 and wouldn't cover any more than $375.00 of the patches at the same time I filled the others, I don't think they ever will. My Dr. doesn't seem to want to go with anything other than the patch and I am afraid that if I don't eat this cost, I may be stuck with these horrible patches that make me either unconscious or sick, depending on what day you catch me. I really cannot afford to pay this much every month for a single medication, period. I am very tempted to try them and see if they work better but what then??? I almost don't even want to know. What benefit would there be in knowing that something different would help me to not be miserable all the time? I think I would just feel worse knowing that it is beyond my reach.

So have any of you had issues with the generic Fentanyl patch? Especially with semi-bad withdrawal symptoms during the last 24 hours or even the extreme sleepiness during the first 12 hours. I know that these things are different for everyone and maybe I just have freaky skin or something like that. Maybe my skin absorbs it too quick and it would be a problem with whatever brand of patch I use. I probably will never know if I don't try the one that is making the pharmaceutical companies and insurance companies rich. I would like to hear back from others who have tried the generic patch whether or not they had a problem with it. I would especially like to hear from anyone who has had both generic and name brand patches and has some opinion on the differences between the two. These last two weeks have taken a lot out of me and I cannot bear to think of the next two weeks being more of the same.


Thanks guys,


Skrape

It is so very nice to hear that I am not alone in my problems with this medication. I have read about a lot of people that have had to have this medication switched to changing the patch every 48 hours. I heard the nurse telling the doctor about what I had described to her today and she said something to the effect of "well you can't write it for every 48 hours" when I have read about multiple doctors doing just such a thing. I do not want to tell my doc that I want him to do something in particular or that I want a certain medication, etc. (bad idea). It could possibly make a difference that the nurse is also his wife! It is a rather small practice after all.

Thank you for your input and I would certainly check it out if you are having problems. I brought it up with my doc and he was willing to hear me out. His solution might not be the most ideal that I was hoping for but I have to at least give it a fair shake, right?!? That is the attitude I am trying to give it at the moment; after all, what other choice do I have, right?

I also want to mention that the side effects (they don't really seem like side effects to me, more like a general failure of the medication) you have mentioned are so similar to my experience that I am grateful you posted this! It is so nice to know that I am not the only one that has had this experience with the patch.


Skrape

Skrape I use the 50mcgs patch every three days.I have never used the generic brand.I do not get as good pain control on the third day but it is O.K. I do not under stand why your meds. cost so much.I pay $75.00 for a three month supply.My insurance pays $373.22 dollars for that three month supply. I get mine from Express-script mail in pharmacy(I just went to my claims payed out page of my insurance web site to make sure that the dollar amount I am giving you is right). I just started getting this script from the mail order and my local pharmacy charged about the same.My co-pay was $25.00 a month with the local pharmacy.I do not know if it has any thing to do with the strength.I do know that the 25mcg patch is only a few dollars less then the 50 so I would guess that the 100mcg should cost about the same.Maybe you should check around at other pharmacy's to get a price check.If the price is just because of the strength talk to your DR. about wearing two 50 mcg patches.That would still be less money then what thay gave you.

I called the insurance company today and they claim that they will cover it %100 when I reach my deductible. I have racked up $2,900 so far this year and my deductible is $3,200. This was before the pool therapy and additional Dr. visit yesterday so I may have reached it. I took the insurance company at its word and bit the bullet today. I filled the one month supply for $425 and I am hoping they were not wrong because I don't want to find that these work only to have to pay $425 every month. I did find out from the pharmacy that it is actually $890 in cash with no insurance. So I guess I will have to look on the bright side.

HOWEVER I called the doc today because I changed my patch to the last 2 generic 50mcgs I had. Since I have had them on for only about 24 hours, I wanted to know if I could safely change the patch to the name brand today. I was caught up working on a clients server until 6:00pm and before I realized that the doc didn't call me back, it was too late. So now I don't know if I have to endure all day Sunday in WD because he couldn't return a simple phone call. I do not think this is my doc, I am pretty sure it is the same girl that messed up my Rx and failed to schedule my appointment with the PT. I swear she is completely incompetent. Anyway, I am stuck with these generic patches (probably) for the next 2 days so I won't know if the uber-expensive name brand ones will last the whole 72 hours or not. Erg.

I did ask the pharmacist what he thought about changing the patch to the name brand after wearing it for 24 hours. He told me I could overdose but that seems to conflict with the manufacturers documentation that says to remove a patch and replace it if something happens to it while wearing it. Say if you accidentally tore the patch open or something, you are supposed to remove the old one and apply a new one. Unless I am misreading the documentation but this seems to make sense. In all honesty, I am so sick of this whole patch business, I just wish I had a better alternative but the transition to the patch has been absolutely hellish and I do not look forward to another transition, period.

I will update you when I can actually wear the new patch and whether it works better or not. This may be as many as five days from now before I will know for sure. I hope you all are having better luck with CP than I have been lately.


Skrape

I know exactly what you mean about flushing $$$ down the toilet. My pharmacist told me to flush the patches down the toilet after I take them off. I have had to change a patch before 72 hours because of a dosage change and I am literally flushing $$$ down the toilet when I have to do this! It is a strange feeling. Before the patch, I never had to flush any current medications down the toilet. I have only had to do that with old medications that I have stopped taking! LOL

Thanks for the understanding. I hate having so many problems with this treatment and not knowing if or when I can get them to stop. Side effects are such an awful thing to deal with while you are already in so much pain...


Skrape

there are also fentynal suckers, I have them for break-through pain (its a high dose though, 600mcg, you may not need it to be that high)
you could also ask about these also.

I use the fetanyl 25mcg patches and have been changing them every 48 hrs because they SUCK, that is the medicine is inconsistent in how it's released. once I got a box and two of the patches ran out of medicine in less than 40 hours. I'm using the generic Malinroot or Malincorrt these are not the Watson ones with a bubble of medicine that can be popped and easily smeared all over the skin - a lot of ppl who like to get high do that with the watson ones. Anyway I callled the company and complained and told them they have some quality control issues that every patch should last 72 hours like they are supposed to and she told me it depends on the persons metabolism. Well anyway this year my exception ran out and now my doctor won't put me back on 48 hours because his boss is threatening to fire him for writing prescriptions that are "out of protocol" or something like that. I told him that I really think the problem is the generic patchess and that they aren't consistent.. so he wrote me for Duragesic I really doubt my insurance will cover it he says if they don't he will change me to MSCONTIN which i've had before.... they are doing the same kinda crap to my husband he had three failed back surgeries and was taking 150 oxycodones a month, now suddenly they dropped him to 90 and took away his valium as well, as the doctor is no longer allowed to write any muscle relaxers or valiums suddenly. I'm ready to find another clinic this one is the center of DEA attention in Las Vegas and patients are suffering. If anyone can tell me if the real patches work better - I heard they did by someone who was given them while in the hospital - I just want to know it's like generic tylenol it works like crap... it's so freaking WRONG I swear.