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Question regarding Duragesic patch placement

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Posted 12/16/2014 10:02 AM (GMT 0)
Today 10:11
Hi all,

I searched for this topic and could not find something specifically answering my question. If I should have placed this elsewhere please let me know.

I have a question for any chronic pain users that use fentanyl patches for pain in regards to varying relief and side effects directly related to where it is placed on the body. I was recently (about one month ago) switched to this medication so this is still new to me.

I currently use 50mcg/hr Duragesic (matrix format) fentanyl patches. I have found that I get a significantly different result in terms of pain relief and side effects depending where on my body I put the patch. For example, I have tried it on the inside of my forearm on the smooth, mostly hair free skin there, and the pain relief to side effects ratio is optimal. Pain relief could be better, but no side effects such as sleepiness or sedation occur. On the other hand, when I put it on my upper arm/bicep the pain relief is much better however I experience many more side effects and after about 20 hours I find myself extremely sedated and functioning normally is much more difficult (it's possible, just difficult). Is it normal to experience such varying experiences like this depending on where the patch is placed? Would the upper arm have better blood flow through the heart than lower arm? I've documented it to discuss with my doctor. The lower arm is where I've been using it as a result however I do not like people being able to see it so this is not ideal. Perhaps I need a dose reduction and then it may perform better/more optimally on my upper arm... Now that they make the 12mcg/hr patch perhaps only a slight reduction would be necessary, such as combining 25+12mcg/hr patches together for 37mcg/hr.

I take Dilaudid 8mg for breakthrough and it is on average one to three times per day, x2 tabs so about 16mg/breakthrough dose. I did not take any more of it than usual on either occasion above.

Thanks for any information, tips, or suggestions in the meantime before I see my doctor.

Wishing you a wonderful, pain-free day.

-KP
Posted 12/16/2014 11:55 AM (GMT 0)
Hello KP and this is likely the best place to put your question out there since we have many CPers who are currently on or have been on fent at one time or another. In answering your question broadly let me say this. Any type of transdermal delivary system is effected by several things such as heat,cold,lotions,oils,etc. Taking this in to account you have to look at anything that effects the pores in your skin either making them smaller or closing them off or opening them and it is a very real problem for folks who naturally sweat alot or athletes,at the gym and yes even Physical therapy and those who live in hot,humid,dry climates.

So placement is going to change the rate of absorption as well if it is in a place where there is a higher concentration of sweat glands and pores that are unprotected by hair,less oils from skin,and things such as that. Some theory says that placing it in areas in proportion to how the cardiovascular system runs is also relevant but Im not sure I have seen this to be true.

Therefore placing the patch in places that have less oil potential,more sweat glands and likely a warmer area of the skin will effect the rate of delivery and again those areas may vary from person to person as well.
Posted 12/16/2014 1:13 PM (GMT 0)
I put my 50mcg patch on my upper arm.  My second best place is on my back / upper shoulder.  My wife puts them on for me there.  If placed anywhere else they won't stick so I'm limited.

Normally my pharmacy provides me the Watson brand, this time I got the Mallinckrodt ones and they are tiny and you can't see the gel.  They use a different technology than the Watson brand.  I don't think these break down as good and personally I don't get the relief I do with the Watson.  Just my two cents about brands.

Overall the Fentanyl patches do work well for me.  Don't think I want to increase the dosage.

Posted 12/16/2014 5:04 PM (GMT 0)
I have a hard time getting them to work at all so my sweet spot is under my upper arm. My doctor sad it was related to type of skin, that the less sun damage the more pliable the skin is to draw the med into the system to be absorbed.

What it sounds like however is that you may need to drop down a step (to 37.5 or 25mcg). You shouldn't have that many side effects from the patches, it's like a constant low dose med in effect.
Posted 12/16/2014 10:44 PM (GMT 0)
Thank you all for your feedback. Yes I do think that I need to reduce the dose slightly or else continue to use it on my lower forearm as for whatever reason the absorption rate there seems to be less and/or slower as it seems to balance pain relief and no side effects well.

I have an appointment with my doctor next week and will discuss this before I pick up my next refill. Thank you for your thoughts they are greatly appreciated.

-KP
Posted 12/17/2014 4:39 PM (GMT 0)
It's funny because I was reading my 50mcg patch this morning, it only contains 5.5mcg of Fentanyl. So what's the other 44.5? A list of chemicals.
Posted 12/18/2014 7:11 AM (GMT 0)

jpjr50 said...
It's funny because I was reading my 50mcg patch this morning, it only contains 5.5mcg of Fentanyl. So what's the other 44.5? A list of chemicals.

Interesting. My 50mcg/hr patches specifically that they contain 8.4mg of actual fentanyl per patch, distributed as 50mcg of fentanyl per hour for 72 hours.
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