Duragesic / Fentanyl instead of MS Contin?

[anniedan]

Because of chronic pains I'm on MS Contin and have been for over 2 years now. Now I'm at 100mg, twice a day. I went up to 300mg a day (150mg, twice a day), but the only difference I could see was the side effects, so I went back to only 200.

I really want to try Duragesic/Fentanyl because of the side effects of MS Contin, because of the fact a patch would be easier to deal with and because I'm hoping it could work better (the MS Contin only makes the pain easier to deal with, about 50-60% better, and in "crisis" I can only take Tylenol and/or Advil which help a little but never completely remove the pain... but which in the long run, have side effects too!).

I'd like to try something else, anything!, but my doctor doesn't seem to know of anything else... Or so he says.
I'm hoping the Duragesic/Fentanyl patch could be it.

I'd like to know if someone here have done that switch, and from a comparable dose of MS Contin... because my doc just refused to give me the patch! He said it was too high a dose for me, that there was nothing in the patch comparable to where I was at in the MS Contin, nothing even close.
Of course I wouldn't like something too "hard" for me... I wouldn't care trying something a little higher-dosed, though... since the MS Contin is not 100% effective at the does I'm at!
But since the doc doesn't seem to really try and help me lately, I've been wondering if what he said was true...
(The doc even said the side effects were as bad, while I read the contrary in here!)

When he got me at 300mg/day, he had told me I was almost at the highest dose I could get... and I've heard of people switching from MS Contin to the patch... so either he lied then, either he is now!

I searched around and learned the lowest dose of Duragesic was 12mcg/hour.
It's hard for me to see if it's comparable to 300mg a day of MS Contin... Of course, the active agents are certainly not the same (codeine and morphine are both opioids, but are not the same)... but they must be close...
Are 300mg in 24hrs that far from 12mcg in one hour? I may be doing it wrong, but it gives me 12.5mg/hour of MS Contin, or 288mcg/day of Duragesic... Now I'm trying to compare apples and oranges, or miligrams and micrograms, but still... It makes me wonder.

I'd like to know, because if it's not that far from one another, and it was just another episode of that doctor not even trying to help, I may be able to ask my GP at my next visit... until I find myself a new specialist...

Thanks!

[Tapering]

Because of chronic pains I'm on MS Contin and have been for over 2 years now. Now I'm at 100mg, twice a day. I went up to 300mg a day (150mg, twice a day), but the only difference I could see was the side effects, so I went back to only 200.

I really want to try Duragesic/Fentanyl because of the side effects of MS Contin, because of the fact a patch would be easier to deal with and because I'm hoping it could work better (the MS Contin only makes the pain easier to deal with, about 50-60% better, and in "crisis" I can only take Tylenol and/or Advil which help a little but never completely remove the pain... but which in the long run, have side effects too!).

I'd like to try something else, anything!, but my doctor doesn't seem to know of anything else... Or so he says.
I'm hoping the Duragesic/Fentanyl patch could be it.

I'd like to know if someone here have done that switch, and from a comparable dose of MS Contin... because my doc just refused to give me the patch! He said it was too high a dose for me, that there was nothing in the patch comparable to where I was at in the MS Contin, nothing even close.
Of course I wouldn't like something too "hard" for me... I wouldn't care trying something a little higher-dosed, though... since the MS Contin is not 100% effective at the does I'm at!
But since the doc doesn't seem to really try and help me lately, I've been wondering if what he said was true...
(The doc even said the side effects were as bad, while I read the contrary in here!)

When he got me at 300mg/day, he had told me I was almost at the highest dose I could get... and I've heard of people switching from MS Contin to the patch... so either he lied then, either he is now!

I searched around and learned the lowest dose of Duragesic was 12mcg/hour.
It's hard for me to see if it's comparable to 300mg a day of MS Contin... Of course, the active agents are certainly not the same (codeine and morphine are both opioids, but are not the same)... but they must be close...
Are 300mg in 24hrs that far from 12mcg in one hour? I may be doing it wrong, but it gives me 12.5mg/hour of MS Contin, or 288mcg/day of Duragesic... Now I'm trying to compare apples and oranges, or miligrams and micrograms, but still... It makes me wonder.

I'd like to know, because if it's not that far from one another, and it was just another episode of that doctor not even trying to help, I may be able to ask my GP at my next visit... until I find myself a new specialist...

Thanks!

The following is a crude dosing conversion. http://www.eperc.mcw.edu/fastFact/ff_002.htm However, I would warn against beginning the patch. First, there is little control on your part to take less. Second, beginning at such a high dose with the patch leaves you little room to increase to a reasonable dose. Third, when the time comes to discontinue the patch, you have to drop down no less than 12.5 mcg per step, which right now may not seem like much to you, but believe me, the drop will be noticeable.

I discontinued the patch at 87.5 mcg /48 hours 33 days ago and is was quite difficult.

While it is certainly not my place to tell you how or what you should decide as far as your medications are concerned, I would think twice regarding the patch.

Another consideration is the availability of the patches. Many of the manufacturers of the generic and brand patches have issued recalls for one reason or another and it became quite difficult to find a pharmacy that had them in stock. All fentanyl transdermal patches are not made the same. Some are more effective than others. There are many factors that play into the dispensement of the drug as well; placement on the body, body temp, sweating, showering, bathing. It is not as easy as it may seem. The adhesives have been to known to cause skin reactions.

Also, after reading many of the testimonials of persons discontinuing fentanyl, it seems that the withdrawal symptoms are considered to be worse that those experienced with other "time-released" or constant dosing medications. While I can not attest to that fact, since this is the only medication I used after hydrocodone, it sure seems to be the general consensus.

So, I would certainly think long and hard regarding this switch.

For what it is worth.

[Robert_325]

http://www.eperc.mcw.edu/fastFact/ff_002.htm

So, I would certainly think long and hard regarding this switch.
For what it is worth.

You made some good points in your post. I have not seen the above link that you referenced here before. It has some good information. There is also some really good information available on the links at this page. If you follow the links through it shows several opiate conversions, includes methadone information, has a lot of good stuff. I saved this page. Thanks.

[Tapering]

You made some good points in your post. I have not seen the above link that you referenced here before. It has some good information. There is also some really good information available on the links at this page. If you follow the links through it shows several opiate conversions, includes methadone information, has a lot of good stuff. I saved this page. Thanks.

No problem! After experiencing the advantages and definite disadvantages of using the fentanyl patch, it would most certainly be one of my last choices in pain control. There seem to be just too many variables. I have personally come to the conclusion, that you can not control pain at a 100% level and I don't think that the goal should be as such. If that is your goal, you are doomed to a road that leads to escalating opioid use.

As stated before, getting the body back to a somewhat opioid naive state has its advantages. Lower doses can be taken to control pain, if controlling pain is your true motive. I think this has to be approached with a well balanced plan in mind. One of the most beneficial activities I have found at controlling pain is activity itself. One can fall into an either or situation making neither work. That is why it is so important to find a physician who uses a multi-disciplined approach; you don't want to get caught in a vicious cycle. You have to control pain so you can remain active and take a pro-active and responsible approach for yourself. The doc can't to it all.

[gristd]

I was on oxy contin 80 mg 3x a day + 40mg 3x a day as needed for break through pain....more on that in a minute. I ultimately switched to the durgesic patch. While I have had pretty good results with it, it's not the miracle drug it's cracked up to be. The 3rd day jitters are ridiculous. When I first switched, my doc placed me on 100mcg every 3 days. I tried that for the first 2 weeks with very minimal pain relief, especially on the 2nd night and the 3rd day. I told my doc this and he upped me to 2 - 100 mcg patches every 3 days. That was almost 4 years ago. I am still on the same dose. The first and second day are OK, the 3rd day is an absolute nightmare. I have almost no pain relief from the patch. My stomach is in a constant state nausea. I get the cold sweats. This happens more in the summer months than the winter months. Also the patch really screws up your summer, because you can't expose the patch to the direct sunlight, which I understand, but they also leave you very limited application locations. Mine are on my upper arms. Unfortunately for me I can't wear any thing shorter than a short sleeve shirt. I've also found that when I go swimming the chlorinated water dissolves the glue on the patch, ultimately causing them to fall off, so that means no swimming. To say the least, there are definitely a few life syle changes that you would have to make, if you decided to try the patch. Be careful if you use the generic patch, they use a different glue base, which cause alot of skin irritation. I only use the brand name, unless I am forced to use the generic. In regards to my opening comment, before anyone blogs that you can't take oxycontin for break through pain, your wrong. It is probably the best break through pain med on the market to take if you are on oxycontin.....Look at this way, your already taking oxy contin. The break through pain is usually caused by a sudden drop in your med levels, rather than use a totally different drug for the break through pain and have to wonder if it is going to work, why not just take a 1/2 dose of the medication you are already taking and increase your levels. It work wonderful for me. Finally, I'm not trying to scare you away from switching to the patch, I'm just trying to give an honest opinion on the patch. Would I switch back to Oxy contin if I had the chance? Probably not, but that doesn't mean that I am singing praise for the patch either. They both have their negatives, you have to decide which set of negatives are easier for you to deal with. Best of luck in your search for pain relief.

[DMcPershing]

I have just recently started the Fentanyl Patch. I had been taking Vicodin ES 7.5/750 for several months. It got to the point where I was taking 7-8 tabs daily so, my doctor was concerned of acetaminophen levels. I started the patch at 25mcg for 3 days and had no relief for a week so, I was taking the Vicodin for breakthrough pain regularly. She upped the patch to 50mcg per 3 days and I am on 5th day now and it still isn't working. I dont want to keep having my doctor up the dosage but, this is not working at all. I was told it would be a much better option than Contin. I don't know what to do at this point. Please advise if you can. Thanks.

[Robert_325]

I have just recently started the Fentanyl Patch. I had been taking Vicodin ES 7.5/750 for several months. It got to the point where I was taking 7-8 tabs daily so, my doctor was concerned of acetaminophen levels. I started the patch at 25mcg for 3 days and had no relief for a week so, I was taking the Vicodin for breakthrough pain regularly. She upped the patch to 50mcg per 3 days and I am on 5th day now and it still isn't working. I dont want to keep having my doctor up the dosage but, this is not working at all. I was told it would be a much better option than Contin. I don't know what to do at this point. Please advise if you can. Thanks.

You are not taking much Fentanyl considering you were taking 8 Vicodin ES per day. She had you taking the Fentenyl plus the Vics so you were still getting the apap. What is the cause of your pain??? If this will be a longterm treatment then I would recommend that you see a pain management specialist. They would be best suited to help you. You need to do something different than what you are doing now but we don't even know what is wrong with you. If this is only a short term problem then I contend the Fentanyl/Vic combo is probably worse than the high dose of acetaminophen. The Fentanyl will be very tough when it comes time to stop if you are given a dose that is sufficient to adequately deal with your current pain. Good luck.

[DMcPershing]

This is for a long term condition. It was a specialist who put me on the patch. I am still on the Vicodin for breakthrough pain which we expected
to be 2 or 3 tabs a day. So the plan was to greatly reduce the Vicodins which would decrease the acetaminophen intake. My concern is that Fentanyl is supposed to be more effective and give me better control but as of yet I have not gotten any relief. If this keeps up I may ask them to switch me to Oxycontin. For the time being I would rather not mention my medical conditions. I do however appreciate any advice.

[Robert_325]

This is for a long term condition. It was a specialist who put me on the patch. I am still on the Vicodin for breakthrough pain which we expected
to be 2 or 3 tabs a day. So the plan was to greatly reduce the Vicodins which would decrease the acetaminophen intake. My concern is that Fentanyl is supposed to be more effective and give me better control but as of yet I have not gotten any relief. If this keeps up I may ask them to switch me to Oxycontin. For the time being I would rather not mention my medical conditions. I do however appreciate any advice.

If it's a permanent condition or very longterm then I would ask for OC, more fentanyl or methadone. Lots of people who use the patch for serious conditions take 100mcg every two days. Your current dose is not anywhere close to that. I am not promoting high dose fentanyl understand. You can see how I feel about it by the posts above. But if you are going to take it then you should take enough to work. I would rather take methadone for longterm therapy than fentanyl. At least a methadone dose is easier to control than a patch.

[Drewz10]

Certianly the doses are different in your medications. The best thing to do is check with a pharmacist in your area.

[LCH77]

Due to chronic axial pain from a 'pinched nerve' for 7 years that was not relieved by a 3 level fusion 3 years ago, I am taking high doses of narcotics. However, until recently, they were mostly for daytime relief as being prone relieves most of the pain.

After starting Cymbalta 7 months ago, the dosages increased to a 100 mg MS Contin (less expensive than Oxycontin) tablet at 8 & 11 AM and one more around 2 PM. Any more than 300 mg made me feel sick. I was also taking around 8 Oxycodone 5 mg tablets mostly in the afternoon and evenings. All of this made me very drowsy.

A month a go I suggested a switch to Fentanyl patches. I started at 100 µcg/hr but was still taking too much medication for breakthrough pain and increased to 125 and finally 150 µcg/hr. Again, I didn't feel well at 150µcg/hr so I dropped down to 125 µcg/hr along with 1 MS Contin 100 mg midday, and an average of 4 oxycodone 5 mg in the afternoon and evening. This combination has made me feel better than I have in many years.

Two problems:
1. My family doctor does not want me to take 2 different, long lasting narcotics (i.e Fentanyl and MS Contin). He prefers one or the other plus a breakthrough med., because of "studies." What is the concern?

2. Even though my dosage was high when I was taking the MS Contin & Oxycodone, I didn't have withdrawl symptoms if I missed my 8 AM or 10 AM dose. I would sometimes wait until it started to hurt. I will be trying a morphine pump next month. That doctor (pain specialist) wants to use a constant dose pump. Since a variable dose pump is available, I think I should try low dose overnight, with the dose increasing during the day when pain usually increases. Your thoughts? Or it doesn't matter since the dose is only about 4 mg of morphine daily?

[Robert_325]

I am not judging you in any way so don't mistake what I'm about to say. I've been one of the worst addicts I know for 35 years of my life and would not judge anyone. I've also been clean for over 8 years now and never thought it would be possible for me. I don't like to talk about my past drug use, I prefer to stay in the solution.

When people have acute pain fast acting meds are what I recommend. It appears from what you've said that you have a longterm chronic condition that will last for a very long time, perhaps even for the rest of your life.

You are taking horrid amounts of RX narcotics and your tolerance will only increase to where you will definitely become a full fledged drug addict possibly leaving you in a very dangerous health situation. You're taking WAY too many drugs bottom line.

I don't like to make suggestions to people that they take methadone. But in your situation I believe that a level dose of methadone along with a minimal amount of breakthrough pain meds would be a much better choice than what you are currently doing. Methadone is a "last choice" treatment for people like yourself. You're risking your life doing what you're doing and methadone taken properly is a great medication for those people who are doomed to be on narcotics for many years or for life. Fentanyl sucks the life out of you and I don't think it should be used unless a person has a terminal prognosis. I DETEST that medication.

Take my advice knowing that I know what I'm doing. I could taper you down to nothing and see if you could make it on much less medication but if you are going to take this level of meds for life then methadone would be a much better choice and safer for you. I willl be happy to help you if you choose to go along with me. But you're playing with fire doing what you're currently doing. God bless.

[doc.rose]

Due to chronic axial pain from a 'pinched nerve' for 7 years that was not relieved by a 3 level fusion 3 years ago, I am taking high doses of narcotics. However, until recently, they were mostly for daytime relief as being prone relieves most of the pain.

After starting Cymbalta 7 months ago, the dosages increased to a 100 mg MS Contin (less expensive than Oxycontin) tablet at 8 & 11 AM and one more around 2 PM. Any more than 300 mg made me feel sick. I was also taking around 8 Oxycodone 5 mg tablets mostly in the afternoon and evenings. All of this made me very drowsy.

A month a go I suggested a switch to Fentanyl patches. I started at 100 µcg/hr but was still taking too much medication for breakthrough pain and increased to 125 and finally 150 µcg/hr. Again, I didn't feel well at 150µcg/hr so I dropped down to 125 µcg/hr along with 1 MS Contin 100 mg midday, and an average of 4 oxycodone 5 mg in the afternoon and evening. This combination has made me feel better than I have in many years.

Two problems:
1. My family doctor does not want me to take 2 different, long lasting narcotics (i.e Fentanyl and MS Contin). He prefers one or the other plus a breakthrough med., because of "studies." What is the concern?

2. Even though my dosage was high when I was taking the MS Contin & Oxycodone, I didn't have withdrawl symptoms if I missed my 8 AM or 10 AM dose. I would sometimes wait until it started to hurt. I will be trying a morphine pump next month. That doctor (pain specialist) wants to use a constant dose pump. Since a variable dose pump is available, I think I should try low dose overnight, with the dose increasing during the day when pain usually increases. Your thoughts? Or it doesn't matter since the dose is only about 4 mg of morphine daily?

Hi! How about getting a second opinion? Find a different pain specialist and take all of your records to him/her. There might be other options for you. Being that you suffer from a chronic pain condition, it would be best to get a couple of different opinions before making a final decision. This is your life, do what is best for you. Take care!

[annie1962]

My sister was on that....big warnings about the medication ...it gave her a fatal dose and she passed away.....The kids just won a 250.000 dollar settlement but how does that replace their mother...Please don't it's very dangerous....

[The Mad Man]

I have been on the Fentanyl patch since before Nov. 2011, my last surgery. I have been advised by many doctors that I may never be pain free and I just have to accept that. (Heard it too many times already). My Fentanyl patch is 50mcg every 3-4 days. I take Norco once a day in the am for breakthrough pain as needed. AS NEEDED! Important factor. If the pain medication you are taking is not working...HINT...Find out why. If you are on a strong dosage of Fentanyl or any other pain medication, and need something for break through pain relief, UNDERSTAND what these pain medications do to your system. If they are not working, find out why and seek out second and third opinions. Check with a pain management SPECIALIST to understand what and why these medications work they way they do.
MS Contin (morphine) was horrible for me. I had major side effects and will never use that again. I have been on all the pain medications until my last operation when they took the metal out of my back that was impeding on a nerve. Since then, I have been on the Fentanyl patch and I change it every 3-4 days, the latter if possible. This drug is release slowly into the system over a period of time. So far, I am happy with the results and find I need less and less Norco or any other pain medication. I use a Lidocane patch AS NEEDED at night mostly when the pain is at its worse. Understand the dosage and what these medications do to your system and do your own research so you have questions to ask your doctor. Find a doctor you trust! I have known my family doctor for almost 30 years. He knows my pain history and recommended the Fentanyl patch because we tried everything else. This Fentanyl patch can also be addictive and I may never be able to come off the patch. (I have already gone through withdrawal and don't recommend that to anyone). I can tolerate the pain levels I have now about a 3-4 at the most on the pain scale. I have Degenerative joint/Disk disease and my bones are in horrible shape but after a talk with my family doctor who knows my history, the surgeries I have undergone, and the pain management specialists I have seen, he put me on the patch and I tried to go to a lower dosage but the 25mcg was not enough for me, so I went back to the 50mcg.
I have accepted the fact that I may never be pain free but the Fentanyl patch gets me through the day. I shouldn't need any other pain medication and if the pain gets worse, I need to find out why and not rely on medication or a doctors word about an additional pain medication.
Do the research, you are in charge of your own pain management, all the doctor do is guide you through what they think will work. I had to hound my pain management doctor to talk to the surgeon to find out why my pain levels got worse and after much nagging, they finally connected and I received my last surgery (I hope) on Nov. 3,2011. The healing time was horrible but her it is 2012 and I can manage the pain presently.
Watch what you are taking and what it does to your system, that is the worse part of pain management. Your system can get used to the medications very easily but if you need to up the dosage, find out why. Please for your own health and state of mind.