HealingWell
Search Close Search
☰

Need help with discussing my Fentanyl dosing at my next PM appt

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 1/3/2015 2:34 PM (GMT 0)
I started on the Fentanyl patches in July of 2014 for chronic abdominal pain for a combination of pain from Pancreatic Neuroendocrine tumors, Ulcerative Colitis, Crohn's and something called abdominal wall pain. Before the patches I had tried the following medications at different times to try and get some relief: I had tried Tramadol 2x50mg tabs 3x daily, Norco 5/325 1 tab 3x daily, Percocet 10/650 1 tab 3x daily(these were all prescribed by my PCP). Non-Narcotics: Gabapentin, Cymbalta, and I tried Amitriptyline but couldn't tolerate the sedating side effects.

The patches I use are the generic Duragesic made by Watson. I started at 25mcg/hr changing the patches every 72 hours. During my next appointment with my PM doctor 2 weeks later, she increased the dosage from 25mcg/hr to 50mcg/hr and I still change the patches every 72 hours. Starting in the last month or two I have noticed a big change in pain relief from the patches. They don't last the full 72 hours anymore and I don't get as much pain relief from them as I used to.

I'm not sure what I should ask for the next time I see her. Does it sound like I need an increase in dosage to 75mcg/hr or keep the 50mcg/hr but change them every 48 hours? I've come to know her a little bit over the months and I'm guessing she would rather increase to 75mcg/hr than let me change them every 48 hours. What should I say to her?

Once you get up to 75 or 100mcg/hr patches does it take much longer than a few months to become tolerant to it and need higher dosages? I'm hoping if she does increase to 75mcg/hr that I won't need another increase for a year or two, at least, or maybe even longer.

Oh, and we have a really good patient-doctor relationship. She knows I'm in a lot of pain and that I'm not one of those people trying to fake it for drugs and she seems to trust me. Of course, I do have a lot of documentation from doctors explaining my situation. I had records from probably about 6 different doctors sent to her before she started my treatment so my conditions are well documented in her records.

The reason I think she trusts me so much is because the first time I seen her she straight up asked me what I wanted between OxyContin, MSContin, or Fentanyl. I told her I had heard too many bad things about the Oxy and addiction and that I didn't want that "high" feeling from morphine, so she suggested the patches. I've been really pleased so far because the fentanyl doesn't cause the feeling of being "high" like oxy or morphine might.

I have also suffered from Panic Disorder since I was 16 years old. When I first started seeing her my PCP was trying to treat it with 5mg Valium 1x daily, which obviously wasn't working. She basically just asked me what has worked in the past, which is 1mg Klonopin 3x daily. She promptly wrote the prescription for the Klonopin along with my next prescription for my patches.

Here is a list of all my non-narcotic meds that I take:

  • Gabapentin 1800mg/day
  • Lomotil 2.5mg 2 tabs 4x daily
  • Questran Powder 2-4g 2x daily for diarrhea
  • Bentyl 10mg 1 Capsule 3x daily
  • Atenolol 50mg 1x daily
  • Cymbalta 30mg 1x daily
  • Zofran 4mg as needed
  • Zantac 150mg 1/2 tab 2x daily
Posted 1/3/2015 3:03 PM (GMT 0)
I have no personal experience with fentanyl patches but it seems like everyone who goes on them finds they don't last the amount of time they're supposed to.

I take morphine 15mg 4x/day and I don't get high from it. My body (and yours, probably) is so used to narcotics it doesn't react in that way.

Good luck ... I'm sure others will be by with better advice than I have to offer. At any rate I hope you get to a place with your meds that will help you.

Just a question, what do you do to make sure your digestive health is on track? To keep you ... regular, so to speak? That's another thing to be concerned about with morphine - it seems more constipating than other meds I've taken. I don't know how Fentanyl rates on the constipation scale.
Posted 1/3/2015 3:44 PM (GMT 0)
Perhaps try a different brand of fentanyl patches. Ask your pharmacy to order Sandoz. which are the generic for Duragesic.
I have been on fentanyl patches for several years, on and off, and never had the drop off of the medications, except for when the patches were alcohol based and I used different generics.
When the matrix changed for the patches, I never found that the fentanyl patches didn't last the entire time. In fact, when I had a patch fall off, I would leave the new patch in place for an extra day to make up for the lost patch, and I didn't have any issues whatsoever with it.
I stayed at steady doses for over three years, since the patches didn't cause tolerance issues such as oral medications did.
Is your skin overly dry? Are you perhaps too warm at night? There may be other reasons why you are thinking that the patches are dropping off before the 72 hours .
I would be very careful about going up higher in the patches, since being on them can be difficult when/if you need to be hospitalized and converted to oral medications when the dosage is high.

Post Edited (mrsm123) : 1/3/2015 8:48:09 AM (GMT-7)

Posted 1/3/2015 4:37 PM (GMT 0)

Backtolife said...

Just a question, what do you do to make sure your digestive health is on track? To keep you ... regular, so to speak? That's another thing to be concerned about with morphine - it seems more constipating than other meds I've taken. I don't know how Fentanyl rates on the constipation scale.

Well, considering I have chronic diarrhea, I don't have any problems with constipation. I actually have to take 2 anti-diarrhea meds(Lomotil--Diphenoxylate/Atropine-maximum dosage and Questran Powder--Cholestyramine) on top of the pain meds to keep my stools somewhat regular. Even with all those meds that can cause constipation, I still get diarrhea pretty often.

mrsm123 said...
Perhaps try a different brand of fentanyl patches. Ask your pharmacy to order Sandoz. which are the generic for Duragesic.
I have been on fentanyl patches for several years, on and off, and never had the drop off of the medications, except for when the patches were alcohol based and I used different generics.
When the matrix changed for the patches, I never found that the fentanyl patches didn't last the entire time. In fact, when I had a patch fall off, I would leave the new patch in place for an extra day to make up for the lost patch, and I didn't have any issues whatsoever with it.
I stayed at steady doses for over three years, since the patches didn't cause tolerance issues such as oral medications did.
Is your skin overly dry? Are you perhaps too warm at night? There may be other reasons why you are thinking that the patches are dropping off before the 72 hours .
I would be very careful about going up higher in the patches, since being on them can be difficult when/if you need to be hospitalized and converted to oral medications when the dosage is high.

I'm kind of scared of trying a different brand of the patch other than Watson as it has worked so well for me so far. I have heard stories of those matrix patches not working well. The Watson patches are actually supposedly made exactly like the brand name Duragesic patches. My skin isn't dry and I actually use the Tegaderm adhesive films made by 3M which hold the patches on perfectly. My patches never fall off so long as I use the Tegaderm. I'm really starting to wonder if I'm just due for an increase from 50mcg to 50+12.5mcg or from 50mcg to 75mcg.
Posted 1/3/2015 5:22 PM (GMT 0)
Hey Markh...I'm glad to hear from you.  If you'll scroll down, you'll see where I've reached out to you a couple of times over the past week.  I have nothing to add on the Fentanyl.  However, I REMAIN concerned about the pancreatic tumors.  The last report I recall, you were to have exensive testing done, meet with potential surgeon who would determine whether the tumors can be removed.  Correct?

Did you follow through with the treatment plan?  Are the tumors benign?  Has this been confirmed/denied by biopsy?  Can they be removed surgically? If so, why haven't they?  I know these are rapid fire questions, but I think they are worthy of asking.  You were to be scheduled for some heavy-duty consults and tests the last time I saw your posts.  I just don't understand why they're only treating the pain resulting from pancreatic tumors, unless there is no surgical option.  Were they deemed malignant?

I can only speak from my point of view.  However, if I had foreign mutant cells diagnosed in my body,  I would FIGHT to have those removed, rather than suffer endlessly on a plethora of meds.  I'm just VERY concerned about "wait and see" or "monitor" because I clearly recall your "crash and burn" a few months ago.  I don't want to see that happen to you again, friend.

If I missed some update on tumor/surgery status, please clarify for me.

Hugs~~Dixie

BTL...As per constipation, this has been chronic and severe for me with an anatomically impaired colon.  Of course, this became life-threatening as I began opiate trials in PM last year.  The morphine had potential for relief, but I was constantly threatened with writhing belly pain/constipation to the point of bowel obstruction.  Of course, I'm no medical professional, but here are some suggestions for you:  Benefiber stirred into your beverage (hot or cold)  Miralax is used the same way, daily to keep bowels soft and moving.  It takes a little while to get your system on a regimen.  There is Perdiem (in pill form) that is similar to Sennokot.  There are natural supplements at GNC (Cassada Segrada) but they are horse pills that I couldn't swallow.  There is Magnesium Citrate, which is clear and citrus flavored (powerful stuff). I have to take softeners EVERY night of my life, or I don't think my bowels would ever move.  The final, and in my opinion a miracle drug, is LINZESS. It's prescription strength, but costs $258 per month, which I can't afford.  My doctor gives me samples, as I can swallow the capsules more easily that having to drink the fiber additives.  BTL...Whatever you do, sweetie, don't let the Morphine induced constipation beat you down like it did me.  I would realize it had been up to 11 days, with distendend, cramping belly...which put me in the bathroom floor with repeated enemas.  TMI, but better to be proactive=)

Posted 1/3/2015 6:46 PM (GMT 0)
Mark,I'd try to make sure she understands what your saying to us,that the patch is not lasting 72 hrs.Are you going into withdrawal with the patch on?

I would think the 75 mcg patch may not last 72 hrs either.

Are you getting enough pain relief from the 50 mcg during the 48 hr window?

If you have to take a piece of paper with your talking points,do it.I know I forget what I meant to ask sometimes.

Just make sure your Doctor knows exactly what's happening and hopefully y'all can get the dosage right,

edit:I was taking Opana and Dilaudid.I told my PMD that I thought it was affecting my breathing.Now I'm taking MSContin 15 mg x 2 and Morphine IR 15 mg x 4.So far so good.She told me if it wasn't effective we'd go from there.

Take care,

Rick
Posted 1/3/2015 7:16 PM (GMT 0)
The patch doesn't totally wear off before 72hours, I think the main issue is that the 50mcg/hr just doesn't provide the same relief that it used to.

I do not have any withdraws even if I accidentally go a few hours past the 72 hours before changing to a new one. I'm really starting to wonder if all I need is a dosage increase...maybe I've become tolerant to the 50mcg/hr patch.
Posted 1/3/2015 9:39 PM (GMT 0)
Hi Markh, if you don't mind please do not quote the members posts as this uses up expensive space here at HW. I am sure that you are not aware the owner buys our space to post. This helps in small way to keep HW free to us members. Thanks
Posted 1/3/2015 11:35 PM (GMT 0)
Why can't you just tell your doc what's going on & see what she says? I agree with mrsm123 that it's probably worth a try to see if a different generic brand might give you more stable relief. I, too, was very reluctant to try something other than the Watson brand, but when there was a distribution issue and I was unable to get that generic brand, I was forced to try Sandoz & now I ask for that one by name. Everybody's body is different and sometimes we find that changes to the original formulation actually are an improvement -- at least for some.

Like others have suggested, I would watch for any signs you are getting overheated (esp. during sleep, bathing & exercising -- but really any time of day). Not only can that be due to the thermostat, but fentanyl can also mess with your hormone levels and throw off your body's ability to effectively regulate temperature. I personally benefited from seeing an endocrinologist (I assume you have one due to the tumors) who was able to run a full work-up and advise me about how the fentanyl was messing with my reproductive & thyroid hormones. She pulled me off the Pill, changed around another medication & switched up my thyroid medicine. Once she did that, I had far fewer health problems & the lower dose fentanyl worked better.

I also have to be super careful not to have anything that has any caffeine in it (reg/decaf coffee, most tea, sodas, chocolate, OTC migraine products, etc). It took me the longest time to figure that out, but my PM finally explained that caffeine actually kicks fentanyl off some of the opioid receptors, so I don't get as much pain relief.

Hope you can figure something out. Besides the question about whether your doc would prescribe every 48 hours, is the question of whether your insurance would pay for the extra patches. Just be very cautious if you have to keep going up too quickly. If it's not working that well, maybe a different drug would be a better match for you. :)
Posted 1/4/2015 5:52 AM (GMT 0)
Mark, I have been taking the fentanyl patch for 14 years, 100 mcg patch for over ten years. I started on Duragesic brand because that is all that was available at that time. When generic came out it was matrix type patches by Mylan and I prefer them. A few times when my pharmacy was out I had to go elsewhere and received Watson non matrix and they were far inferior to the generic Mylan matrix patches and even the non matrix Duragesic brand patches. I've had Sandoz non matrix too in the past but the Mylan and the Mallinkroft matrix patches work the best for me. The entire surface of the patch is adhered to the skin, not just the edges and the size is appx 2.5 by 2 inches as compared to 5 by 4 inches in the 100 mcg Watson non matrix patch.
Total surface area patch adherence to the skin is everything when wearing a fentanyl patch to obtain the Full dosage and for it to supply a steady blood level. Sometimes I keep a pain diary so that the dr can see when and why I have breakthrough pain and to determine if a dosage change of my patch or my bt medicine is needed and perhaps this would help your dr to see at what times your pain is increasing. I'm glad you have a good relationship with your dr and hope that she makes the right adjustments that you need.

Tirzah, I have never heard about caffeine and fentanyl and the blocking of some opioid receptors and I drink coffee until noon , change to Coke then tea for dinner then more coke!! Would you please let me know more about it? Thank you!

Post Edited (mckaren) : 1/3/2015 11:03:27 PM (GMT-7)

Posted 1/4/2015 7:16 AM (GMT 0)
I will have to look into that for you, mckaren.

All I know is that I had always just assumed that it must have been something like that the caffeine was making me more tense or jittery or something & that's why my pain would increase over time with the caffeine, but my PM said otherwise... that the caffeine was actually competing with my pain meds. I was massively sleep deprived when he told me about it, but I've basically cut the caffeine back out of my life and it seems to have helped.

The one thing I do think matters is quantity/duration... and in my 2 minute search, that seems to be supported. Caffeine can actually be helpful when used on a very occasional basis; it's when you're drinking cup after cup more days than not that it seems to cause issues. Some sites insist it acts directly on the opioid receptors. Others say it is an indirect effect through adenosine receptors, that also impact the CNS. Still others claim that the caffeine does something to the opiates themselves before they have a chance to bind to the receptors. I can try and look into it more when I get over this flu.

All I can say for sure now is that my PM tracks how much caffeine his patients consume & now regularly encourages patients to try and limit our caffeine intake. I honestly could care less WHY it works. It only matters to me that it does work for me (and several others I've talked to in his waiting room). I definitely miss my beloved sweet tea, but at the end of the day I'm willing to limit myself to no more than 12 oz per week... 6 oz if I'm not feeling horribly sad and deprived -- I live in the North, but I was raised Southern and you are not a true southern girl if you don't love sweet tea. :P

The withdrawals from caffeine were not nearly as intense as the ones from fentanyl, but the first time I quit caffeine cold turkey (I had been drinking 12-16 cups of coffee per day -- regular & decaf) they went on for nearly 3 months. I had horrible headaches, nausea & crippling exhaustion. I struggled to keep up with work and school. I definitely wouldn't quit or even dramatically cut back without talking to your doctor first, but it helped me so much that I can't help but tell anyone I know. I've yet to talk to someone who tried it & didn't benefit, but that's not to say it's the right choice for everyone. :) Everything in life is a trade-off & what works for some might not be the best choice for others.
Posted 1/4/2015 6:08 PM (GMT 0)
My problem is my only breakthrough med is Tramadol, which stopped helping less than a month after starting on the patches. So, basically I've been using the 50mcg/hr patch with no breakthrough and I did good for 5-6 months, but now I feel like I either need a breakthrough med that actually works or I need an increase in the patch dosage. I can tell from my talks with my PM doctor that she would rather increase the ER med than prescribe a breakthrough med. Maybe I will just tell her what is going on and she will probably suggest an increase to 75mcg patch. She asked me if I thought I needed the increase to 75mcg about 4-5 months into treatment(around November 2014) and I said no as it was working perfectly at that time. I don't know, maybe she has treated enough people to know that the time for a dosage increase was coming soon for me.
Posted 1/5/2015 7:08 AM (GMT 0)
Thank you Tirzah for the caffeine info! My goodness I didn't see that you had the flu so double, triple thank you'd for looking it up! I will too and see what my dr says. I'm from the South, born and still here and I change to tea about 6 pm. I drink average 3 cups of coffee and 2 cokes a day. It doesn't affect my sleep but my pain has been not as controlled lately. I truly appreciate your taking the time to post and thank you again and I hope that the flu leaves fast!
Mark, I have heard other CP patients discussing their drs not wanting to prescribe bt meds for patients taking fentanyl patches and would rather raise the patch dosage. It took a few years before my dr and I found the right combination of meds including patch, bt and adjunct meds and I have been taking same dosages 10 years. I hope that you and your dr find the right dose and/or new meds added very soon!

Post Edited (mckaren) : 1/5/2015 12:14:56 AM (GMT-7)

Posted 1/5/2015 8:35 AM (GMT 0)
What would be the most commonly prescribed Breakthrough pain med for patients that are on the fentanyl patch? I think I would be willing to try Dilaudid and maybe give morphine a shot. The issue with morphine is that it has never worked for me when given by IV at the hospital. I don't know why though, maybe they just weren't giving me an adequate dosage They usually give me 2mg unless I complain and tell them it doesn't work then they might increase it to 4mg which still doesn't work. Sometimes when I tell the doctor that morphine never works s/he will go ahead and give me 2mg dilaudid via IV which works amazingly well. That is why I mentioned dilaudid first, but isn't the oral BA for both morphine and dilaudid really low? I've never taken morphine or dilaudid orally so I wouldn't know.

I'm kind of scared of starting with oxycodone as I've heard stories of it being the most addictive of all opioids and gives you that high feeling which I've told my PM doctor several times that I do not want to feel drugged up.

The Tramadol used to work quite well before my pain got really bad, would Nucynta be an option? Doesn't it work similarly to Tramadol except for being much stronger? I always thought the actions of Tramadol on serotonin and norepinephrine as a plus because it always seemed to help with my depression. Does Nucynta have the same effects on serotonin and norepinephrine as Tramadol and help with depression as the tramadol does? If so, I might ask about the Nucynta for BT pain relief if it is reasonable to ask for it for BT pain relief. I don't want to go asking for something from my PM doctor for a reason that it is not meant for.

I guess I just want to know what a good option for me for a BT pain med is if she offers me something. She is the type that will give you your options and let you choose what you want to try.
Posted 1/6/2015 6:39 AM (GMT 0)
I was started on 25mcg of the fentanyl patch and then immediately moved up to 50mcg every 72 hours. I was able to stay there quite a while, but then found that my last day on the patch was a struggle regarding the pain. My doc changed me from every 72 hours to every 48 and it made the world of difference. I was on that dosage and frequency for over 4 years. My last raise was to the 75mcg patch which I have now been on coming on 9 years. It still covers my pain very well.

As far as generic goes, I did not have much luck with Mylan, Mallincroidt or Sandoz. I actually went back on the brand and feel it gives better coverage. It's now the entire patch with the meds instead of the reservoir and I think that is much better. I don't have to use a cover and mine sticks on without any trouble.

I also feel breakthrough meds are important. I know some docs do not agree with them, but if you look at almost all of the studies, it shows that pain has peaks and valleys. The longer you wait to treat the pain, the worse it gets and can get to the point where you can no longer get it under control with the medications you currently have.

I would voice your concerns with your doc and see what she says.
Posted 1/6/2015 8:05 AM (GMT 0)
Hey Mark...It's me, the "broken record" again.  I have to say this ONE MORE TIME, friend.  Instead of obssessing about pain med increase and inability to sleep, along with insurance struggles to pay for pain meds...Would it not be a WHOLE LOT simpler to erradicate the CAUSE of most of your pain.  You KNOW it's the pancreatic tumors.  They are draining you of your abilities to absorb nutrients.  The diarrhea is the proverbial clean out crew.  You will, I assure you, only get progressively weaker until you face the truth.  The TRUTH is that YOU NEED SURGERY...IF the tumors are deemed operable, which they are.  I'm no doctor, nor do I pretend to be, but this is so painfully obvious to me.  You are grasping at straws with this mother load of meds to treat the pain caused by mutated cells in your pancreas.  THEY MUST BE REMOVED, Mark.  This should have happened upon initial diagnosis, IMO.  One should never allow known mutant cells to grow within their body.  If these are cancerous, they could be actually killing you while you are focused on pain reduction.

Instead of contacting your insurance for additional Fentanyl, I would be asking my PCP, surgeon, and PM to do whatever means necessary to get your surgery precertified for payment.  They can push this through.  It's life and death...not wait and see.  You've got to PUSH and PUSH your way to the OR, not the drug store!

I don't know how to get through to you, Mark.  Lord knows I've tried. It's like watching a building burn to the ground and reaching for a SOLO cup of water to put it out.  You don't have to suffer this way.  Make the surgery happen!!  You will have no life until you heal your pancreas.  Don't listen to a surgeon who says "Let's watch and wait".  My vet did that with my beloved Dalmatian (a pea sized lump) in 2003.  I wanted it removed immediately.  He said "Let's wait and watch".  Foolishly, we did just that.  Within 2 years, I watched him put her to sleep because she was consumed with cancer from that "pea".  I've never gotten over it.

I lost a beloved lifelong friend in the 90's who had always been the picture of health.  She began losing weight for no reason, other that nausea, vomiting, and diarrhea.  Granted, those are prime reasons, but I mean that no doctor in the tri-state are could diagnose her problem.  She grew so frail that her husband had to literally carry her from the car into the house.  By the time she received Dx, it was too late.  She had late stage pancreatic cancer.  She went from newly married, planning to move to Belize, to the cemetery...in short order.  Cancer of the pancreas is deadly, if left untreated.  Don't let this be YOU, Mark.  Don't get so lost in the pain killers that you lose the opprtunity to SAVE YOUR LIFE through surgery.

Hugs~~Dixie 

Posted 1/6/2015 3:21 PM (GMT 0)
Your dr is your best person to discuss what would work best with Fentanyl. What may work for one person may not work for you at all.
Posted 1/8/2015 2:50 AM (GMT 0)
There are tons of med combos and tons patients who have different experiences.
I'm hoping that you have a good relationship with your dr and you can discuss your concerns. It's just impossible to know what meds will work for you until you try them.
Is there anything surgically that can be done? Nobody likes that option, but lifetime med use is no fun as well.

Let us know what the dr says.
Posted 1/9/2015 11:04 PM (GMT 0)
I've pretty much hit bottom again. I've been pushing and pushing all my doctors to get me into surgeons and I ended up having to go back to the same one and he just said the same thing...the tumors are small now lets just keep an eye on them every 6 months.

The depression is just horrible...I tried to kill myself about a week ago and my wife left me again.
Posted 1/10/2015 7:07 PM (GMT 0)
Mark, I do hope by now that you have decided to go back in for inpatient care. You really seemed to have benefited a great deal from that admission. Let us know.
Posted 1/13/2015 6:34 AM (GMT 0)
I've managed to pull myself back up, with the help of my therapist of course. So I'm working now to find a doctor that will take these tumors more seriously and...trying to get my family back. My wife is just scared and concerned that something will happen and our 6 year old son will be affected. Which I totally understand and the last thing I would want to do is mess up my son's head. It is just going to take some time for her to see that I'm doing better and that there will be no incident's.

I'm also still working on getting on disability at least until I feel well enough to go back to work.
Posted 1/14/2015 2:04 PM (GMT 0)
Mark I'm somewhat in the same boat except I started with Fentanyl 50mcg patches.  Like you the Watson brand has been the best one for me even though it doesn't last 72 hours, more like 38 hours to be exact.

I'm afraid to ask for the 75mcg even though my PM Dr will say yes.  Here is my issue with going to 75.  My pharmacy that provides the patches gave me the Mallinkrodt brand Fentanyl patches which are totally different then the Watson.  This was the month of December and I went through widthdrawl symptoms.  Luckily I was on vacation most of December. 

If I move to 75 and get use to that one it's just going to be worse withdrawl when I do eventually stop taking them.  Probably by then I'll be at 100.  So I'm just going to stay at 50 as long as I can.  I have also changed my oxycodone (Percocet) to oxymorophone (Opana).

Posted 1/16/2015 2:20 PM (GMT 0)
jp,
I don't know about your PM, but mine steps people down when they need to stop taking a med. I've also done that with fentanyl (patch & IR) and it's never a picnic, but it only lasts 3 days & he's sure to drop me down to the lowest available dose before having me go off it altogether. The Walgreen's by me (and the few I've been to in other states while traveling) will break open boxes if the doc writes for only a few doses so that's what we do. I realize not every pharmacy does that & usually I pay a bit higher price to get patches from Walgreen's vs. my local grocery chain, but it's worth it for me since it allows me to step down and not be so miserable... something to keep in mind for the future should it come to that. Imo, a doctor should not just tell a patient to quit a medication cold turkey unless there is a very compelling reason.
Posted 1/16/2015 3:40 PM (GMT 0)
Hi Tirzah,
On your question on changing doses of the patch read your product insert real carefully. In all the small type there is a bit about titration and how it might be necessary to change doses upwards till they hit the sweet spot. It's not a matter of toleration so much as it's the amount your body needs to overcome the pain. . . . Q
Posted 3/30/2015 10:02 PM (GMT 0)
Hi, where do you get the Watson Brand patches? My mother only likes the Watson Brand and the hospital pharmacy doesn't have them this month again so i need to find a pharmacy chain that carries Watson Patches. Thanks
✚ New Topic ✚ Reply
12