My story I have a very severe case of fibromyalgia and myofacial pain syndrom. After years of NSAIDs and other medications, at one point as many as 15 medications and drugged into a zombie state, I found my way to a great pain management doctor who understood that sometimes a single, heavier bat just might be better if you're swinging blindly with 15 smaller ones. This was before lyrica. For the first time in years, I had pain relief, and was down to only 3 medications. I could actually THINK! Hold conversations. GET OUT OF BED!!!!
I started on 50mcg, changed every 72 hours. But because I have little body fat, and have a tendancy to run fevers, we had to adjust that to first every 60 hours, then to every 48 hours. I now have the freedom to change it between 60-48, as it depends on if I'm running a lot of fevers and how many showers I take, etc. I'm not sure what body fat has to do with it, but my pharamsist made mention of a study that indicated those with little body fat tended to require changes sooner with the fentanyl patch. 4 years later, we did have to raise it to 75mcg. But I take no breakthrough medications, other then lyrica, which isn't really for breakthrough, but for the type of pain that fentanyl was never designed to treat. Compared to short acting opiods where the pain would return too soon before the next scheduled dose, with fentanyl, I've never felt the need or urge to take more medication then prescribed. In fact, during my good weeks, I can often push the scheduled change time for up to 8 hours later, depending. Fentanyl Brand Comparison's: My Experience
I have tried several brands of fentanyl transdermal, including
Duragesic, Sandoz, Watson Labs, and Mylan. What I've found is that despite claims to the contrary, in this case there are differences between them, in the types of plastic, adhesive, carrier for the medication and cell-whatever backing. What's important to understand is that those differences are highly specialized and subjective to the patient.
Personally, I prefer MYLAN brand over all the others, including brand name -- while several of the pharmacist's I've used over the years tell me very few of their patients care for it.
Personally, I prefer the MYLAN brand because the 75mcg patch is HALF THE SIZE as the other brand's patches. It is also made of a softer plastic - this means it tends to bend with my movement better (so it doesn't get ripped off the first time I bend over) and most importantly, it does not cut into my skin.
Because of muscle movement or my long hair getting caught, I'm very limited to where I can place the patches anyway. When I've been forced to switch back to one of the other generic brands, my skin ends up callused, sore, and cut up from the edges. My stomach becomes inflamed and red from the edges cutting into the skin. Not to mention I am also more prone to yeast infections on the skin because of the constant damp status of the skin under the patches. With the Mylan brand, I have 4 places on my stomach that can take turns, and only 2 with the other brands.
I found the Mylan brand adhesive sticks better on my skin then the others, rarely needing tape. But I also have several friends who found this not to be true, which makes me suspect it is subjective to your individual chemical make up, skin type, and what you secreate in your sweat.
And I rarely have to get out the adhesive remover (read: goop off); soap and water works just fine.
And finally, as far as pain, I personally found mylan to release the medication more evenly. Perhaps because unlike all the other brands, it is not filled with that clear gel as a carrier for the fentanyl? Not sure. It doesn't seem as affective by a hot shower or fever as the others. And just seemed to cover the pain in a more consistant fashion. But again, I've heard others say the opposite.
As for a difference between the other generics compared to brand, I did notice that some stick better then others, and some didn't seem to transfer the medication as well. I'm also not thrilled with Watson Lab's little tab on their patch, as it's just another thing to cut and irritate the skin, and to get caught on something and pull the patch off.
I did not notice any of the other more common side effects, like chronic constipation, dry mouth, etc, any worse or better with any of the brands.
I actually have to get my pharmasist to order my Mylan patches, because he only has 3 of us who prefer them while all his other customers like the others.
So I guess in the end, my advice to anyone who is on fentanyl patches: you may need to try several of the generics before you find the one that works best for YOU. Ignore the pharmacists or doctors who insist they are all the same. How can that be true of the carrier system (no gel) for the Mylan brand, for example, is completely different then the other generics? And it's plastic is different? And I'm certain the adhesives are different for all the brands. It makes a difference. It's just what difference will it make for YOU, personally.
The New Mylan Fentanyl Patch 
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