Fentanyl Patch - 48 vs 72 Hours

I can provide you with answer to this one. Fentanyl patches were developed by Dr. Janssen in the early 1950s (I went to school with his grandson). They were developed for NATO to be used in case of Nuclear War as morphine injections would be too cumbersome taking into account the enormous number of casualties. They are all designed to last 72 hours. Of course, the dosage is not evenly spread. They loose some of their potency by the third day, just like other pain meds wearing off. Actually the patches kick in somewhere between 20 and 60 minutes, although you might not be aware of this due to prolonged exposure to fentanyl and/or other medication. This has got nothing to do with generic medication. ALl patches haev the same potency (25/50/100 micrograms) and all last 72 hours. The main reason why yuor doctor can't prescribe them every 38 hours is that, should you not remove the old patch, you technically have a double dose once every other day. Take into account that fentanyl is some 50 times more potent than morphine and much more addictive and you see the reason why doctor's are careful (and why you should be too!). Fentanyl was never meeant to be taken for a protracted period of time as it is highly addictive. I've taken it for some sic years and was I glad I finally got rid of them; my life was a living hell and I was a zombie. Be careful with that stuff, it's really dangerous and thye trouble is you don't know it. You consciously taka a pill but these patches keep doping you 24/7. Another drawback is of course you can't change the dosage if your pain in or decreases; pills or droplets are much better. FInal note. I fear that the withdrawal symptoms you refer to the first day of a new patch is actually already an overdose talking as this timeframe is way to short to experience withdrawal effects from fentanyl alone. Fentanyl was never meant to be used for more than 14 days! This drug, just like most others, buld up indise your body. Once the concentration in your blood decreases by the third day because of the patches loss of potency, your body releases some of the fentanyl it stockpile. Now a human body is a lousy accountant and it is very bad a releasing the right amount at thye right moment. This usualy means that by the third day, your body releases too much fentanyl from its stockpile into your bloodstream to compensate for the loss of the patches potency. So the first day of your new patch, releases even more fentanyl in the bloodstream resulting in an overdose, not a withdrawal syndrome. This is roughly the chemical process involed.

skrape, I think your doctor is probably just conveniently interchanging the words "can't" and "won't" as far as changing the patch every 48 hours versus 72 hours.

My doctor told me before I even started the patches that he was going to prescribe them for 72 hours to begin with, but that it wasn't at all uncommon for them not to last the full 72 hours. For the first month I was on the patches, I just took double my BT meds on the third day. When I went back for my 1-month follow-up visit, he changed me to every 48 hours.

It's also addressed in the prescribing information for each different manufacturer. The Duragesic brand prescirbing info can be found here: http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/19813s039lbl.pdf

prescribing info said...
The majority of patients are adequately maintained with DURAGESIC® administered
every 72 hours. Some patients may not achieve adequate analgesia using this dosing
interval and may require systems to be applied every 48 hours rather than every 72 hours.
An increase in the DURAGESIC® dose should be evaluated before changing dosing
intervals in order to maintain patients on a 72-hour regimen. Dosing intervals less than
every 72 hours were not studied in children and adolescents and are not recommended.

I have to respectfully disagree with just about everything you've posted, Morgoth.

When they're prescribed and used appropriately, Fenanyl patches are just as safe as any other narcotic pain medication on the market. Frankly, it's the level of misinformation surrounding Fentanyl patches that fuels the hysteria surrounding them.

For example, Fentanyl patches are absolutely contraindicated for short-term use. There have been numerous warnings issued to doctors for inappropriately prescribing fentanyl patches to patients that don't require long-term, 24/7 dosing of narcotics to manage their pain. For patients that require short-term management of their pain, the risks involved with the patches don't outweigh the benefits; those patients can and should be treated with oral medications.

In addition to that, based on the nominal rate at which a new patch infuses fentanyl into the skin and the half-life of the residual fentanyl remaining after the old patch is removed, it is mathematically impossible to get a "double" dose by removing an old patch and placing a new patch - whether you do it at 48 hours or 72 hours. The actual numbers for each brand are readily available and can also be found under the pharmicokinetics section of the prescribing information (linked above).

prescribing information said...
Peak serum concentrations of fentanyl generally occurred between 24
and 72 hours after initial application (see Table A). Serum fentanyl concentrations
achieved are proportional to the DURAGESIC® delivery rate. With continuous use,
serum fentanyl concentrations continue to rise for the first few system applications. After
several sequential 72-hour applications, patients reach and maintain a steady state serum
concentration that is determined by individual variation in skin permeability and body
clearance of fentanyl (see graph and Table B).

After system removal, serum fentanyl concentrations decline gradually, falling about
50% in approximately 17 (range 13-22) hours. Continued absorption of fentanyl from the
skin accounts for a slower disappearance of the drug from the serum than is seen after an
IV infusion, where the apparent half-life is approximately 7 (range 3-12) hours.

I have used every brand of patches before, the 75mcg, and they would all last up to 5 days before I felt a decrease in the meds, but of course they hardly would stick on for that long, even with those special patches you can get to go over them. I think the problem with them is that they start to fall off, and kinda bubble up over the skin, so we dont get all the med, but thats just my theory. Also one time I was asked to remove it for surgery, and after they discharged me after the procedure, I was too ill, and didnt have the energy to go to the back of my apartment where my bedroom is and unlock my lockbox to get another patch, and about 4am that next morning, I woke up in the worst, most nasty withdrawals I have ever felt. And I always thought their was enough meds still left in my body after removing my patch to last atleast a while, but I was suffering from terrible withdrawals. I was literally kicking my couch so hard that I am surprised I didnt break the couch's arm. And I waited 2 hours for the new patch to work, but it wasnt working, so I went he ER and had to get a shot of fentanyl to kinda "jumpstart" the patch, it wasnt fun at all!!!!

-hellokitty

Some extra skin care ahead of time can help make the patches stick better.

First, get yourself a little spray bottle that holds about 8-10 ounces. In the bottle, mix 8 ounces of plain water with 1/8 teaspoon of clorox. The bleach solution is about the same as water you'll find in a swimming pool. If you don't tolerate chlorinated water, you can use plain white vinegar instead, mixed 3 parts water to 1 part vinegar. Label the bottle appropriately, of course, so that anyone else in the house realizes it's not just plain water.

Each day, when you go through your daily hygiene activities and after every shower, take the bottle and mist each of your patch sites that's not in use at the time, let it sit for a few seconds, then rinse/wipe it away with plain water and a wash cloth. The only exception to "spray day" is that you should not spray a patch site if you're planning to place a new patch on it that day - the only thing you should wash a patch site with before you apply a patch to it is plain, clear water.

By spraying the sites on a daily basis, the vinegar or clorox will gently strip the excess oils, dead skin, and some minerals that build up in your skin, which will make the patch stick better. Just make sure you don't apply any body lotions or creams to the areas after you use the clorox or vinegar solution, because it will defeat the purpose.

Post Edited (BionicWoman) : 6/6/2009 7:34:28 AM (GMT-6)

Hi all! I just started Fent patch therapy at 25mcg change every 72. I noticed in the fourth week about day 2 im feeling nauseated, diarrhea, general malaise and super depressed. My doc says most patients he has on the patches say it only lasts about 48 hours so its quite common and many docs I know do change the sig to q 48. I also agree with the disagreement as well in regards to not being used long term. They are NOT meant for short term therapy and if you dont believe that just read the prescribing info package insert. Almost ALL opiates carry risk of dependence and or addiction (two VERY different things). Tolerance is a huge issue aand it sucks! Titrating up and being dependent sucks but you really have to weigh the risk/benefit etc. It has been studied and proven that addiction is MORE likeley to develop if your pain isnt adequately controlled and you wait and pop the pill to get relief(activates the pleasure reward system). Pain itself is also harmful to the body, mind and spirit. Untreated pain can lead to hypersensiti ity to pain as well as adrenal malfunctiin. That being said..opiate treatment has its issues as well so weighing the risks and benefits and making an informed decision is a must. Opiates can also wreak havoc on the adrenals and lower your immune system and lead to depression as well..not everyone has these issues but it happens!! Ive known and treated many men with low T as a direct result of long term opiate therapy, others are fine.
perhaps fentanyl isnt the drug for you? I also know the Mylan patches seem to be the best for adhesion. Ive showered, soaped up over the patches without thinking without issues at all. You do have to be sure to clean and prep the area well prior to application.
i hear you with the "I cant take much more of this" chronic pain and trying to function and treat it is a lifelong struggle and very draining physically and emotionally. I hope your doc is more open minded to changing meds or the sig or dose. If not maybe a new doc?
The stigma attached to opiate treatment and chronic pain is awful and long term opiate therapy for chronic pain is controversial as well. Some say its bad others are saying untreated or undertreated pain is worse...but..if the drugs arent treating the pain you shouldnt stick with them as you are putting yourself through more stress than just the pain alone.
Hope that made SOME sense! Lol
I am a long term chronic pain survivor as well as an RN with many years of practice so I do get where your coming from! ;-)

Watson brand has been only one, so far, that does NOT cause adverse slin reactions for me. Initially changed every 72 hr, as pain relief lessened, my PM Dr recommended changing to 48 hr between applying new patches.

I Am not a dr !! Read the following prep online years & it works for me.

I prepare site, often just after shower, by wiping skin w/rubbing alcohol, let dry. Then spray on the prescription nasal spray Flunase (?), let dry. Then apply patch.
I set my timer for 10 minutes & put heating pad over patch. Then remove heat source when timer goes off. This seems to aid in entire patch sticking / adhering to skin.

Please be careful with any external heat sources - heating pads, jacuzzi, even running a fever!!

The insurance company pays for nasal spray for this use - dr wrote on scrip what it is to be used for & was no problem.

Usually I put a small strip of hypoallergenic tape across the top just before I get in the next shower.. I have tried other covers but those caused skin reaction.