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Old 01-06-2008, 08:12 PM
mmglobal mmglobal is offline
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Default FDA Fentanyl Warning

Interesting email from Dr. Baumbach included a warning about use of Fentanyl transdermal patches. This is an update (posted last month) to a 2005 advisory.

http://www.ispine.org/article-librar...tanyl-fda.html

I'm curious to hear from patch users. Were you told that running a fever of 102 or sunbathing with the patch on can cause dangerous levels of fentanyl to be delivered?

I hope this helps someone.

Mark
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Old 01-07-2008, 05:27 AM
gizmogirl gizmogirl is offline
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wow, never got warned that, and thought I skimmed the paper when I tried the patch. Got off because I wanted to be able to skip doses on good days, so I'm no expert. Good for you to warn us so we can warn others.
Thanks,
Jane
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Old 01-07-2008, 09:44 AM
Tbackpain1 Tbackpain1 is offline
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Yes, I was warned about that waay back when I started the patch a few years ago...its nothing new. Don't get me started on this topic...everytime I see this sort of stuff it makes me gnash my teeth. Proper education, from the physican all the way down to the consumer would save a WORLD of problems from occuring.
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Old 01-09-2008, 08:57 PM
sandomania sandomania is offline
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Yes I was forewarned about the possibility of too much medicine being released if you were running a fever or used a hot tub. I could not tolerate it as I was running a fever almost every other week by the time you remove the patch the medicine has already started to be released. It made me sick to stomach, dizzy etc. Though I did get good pain relief however it was too much up and down. Sandi
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Old 01-09-2008, 09:30 PM
Kathi49 Kathi49 is offline
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My PM prescribed the 12mcg patch awhile back. But I am afraid of it LOL! Sooo..it is still in my fridge. In all seriousness though, I did ask a Pharmacist about heat (already aware of the warnings). But I was asking in terms of post menopausal hot flashes...and usually night sweats. And he said...heat is heat...no matter if it is internal or external. So, I am hesitant to really try them.
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Old 01-10-2008, 10:09 PM
DougB DougB is offline
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I'm amazed that docs don't warn patients about the dangers of getting too warm while using the patch... this is not a minor detail, either- this stuff can kill you (and has) if it's taken by people who aren't opioid tolerant or by getting overheated. Yet I know the patch gets slapped on many older people for post surgical pain, with no warnings given, nothing!

It's been what, 6 years of no hot tubs for me and I had to learn this on my own.

Maybe, deep down inside, some docs are so opioid-phobic that they omit mentioning such things (and if the patient dies, well, there's just more proof this stuff is bad for you, etc.)
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Old 07-31-2008, 03:19 AM
mmglobal mmglobal is offline
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I've been communicating with a client who has such very serious problems that he's on the 75 mcg patch. It was prescribed with little fanfare and no warnings. He did ramp up to 75's or he'd probably be dead now. Not only was his medication prescribed with little fanfare and no warnings, but his insurance requires him to get maintenance medications from sponsored mail-order, so there was no opportunity for a pharmacist to be of assistance here.

He's very severely disabled by pain. Like most of us, he can function around the house on a limited basis and get in his car for doctor appointments and small errands, but he's probably an "18 or 20 hour a day laying down" patient. He's been my client for well over a year. He's somewhat sleep disordered and frequently complains of problems that don't seem spine, but often seem spine syndrome and medication related.... confusion, dizziness, difficulty breathing. Every once in a while I'd hear it first hand over the phone. I know the client very well and I'm not concerned about abuse issues... he's religious about the meds and I've spent a lot of time with him... he's not abusing his meds... intentionally, that is.

It seems that the only thing that gives him relief has to do with hot water. In addition to long, hot showers; he uses his hot tub twice a day.

I cannot stress how dangerous this situation is. Note that his patches did not work very well at the prescribed 3-day interval, so his doctor moved him to 2-day changes. How could it last if he FREQUENTLY accelerated the delivery rate??

At the suggestion of Peter Holzner, the amazingly helpful pharmacist in Bogen, I'm contacting the manufacturer... they should have data on release rates. The client and I reviewed the package insert and it warns of hot tub use. Not only does it not specifically warn about showers, but it says that you can shower with it on. Physical problems with the patches and water can also cause damage the patch (I've seen it), not only making an extra change necessary, but I wonder about the release in a damaged patch?

>> What must it do to all of your systems to get a 'booster' 2-4 times a day?

>> What must it do to the effectiveness of the medication at non-boosted time?

>> What must it do to accelerate tolerance, dependence and addictions issues?

>> What must it do to the risk of confusion related accidents. People who are over medicated not only have accidents and function very poorly because of the confusion and drowsinesses, but they also make mistakes with other medications that can be very dangerous.

I'm sure that this list should be much longer, but I have to go now... I just wanted to get the word out. I'll let you know what I get from the manufacturer.

All the best,

Mark
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1997 MVA, 2000 L4-5 Microdiscectomy/laminotomy, 2001 L5-S1 Micro-d/lami,
2002 L4-S1 Charite' ADR - SUCCESS! 2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova,
Summer 2009, more bad thoracic discs - back to the house of pain!
President: Global Patient Network, Inc., Founder: www.iSpine.org
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  #8  
Old 07-31-2008, 11:55 AM
Mark N Mark N is offline
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Mark, you bring up some good questions with the use of the patch. It is a great delivery system for people that are well educated about it and I wouldn't want any action to limit its use. However, there does need to be more effort to make sure all user of the patch are educated about the dangers of heat and the delivery of the medication. More patients should be informed the way Theresa has been by her doctor.
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  #9  
Old 07-31-2008, 05:25 PM
marijo marijo is offline
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I'm on 50mcg patch changing every 3days, with tramadol underpinning if necessary at night only. I swim quite a lot, and sometimes use the hot tub after, not that often, and as I have only just rejoined the club I haven't really noticed whether or not it makes a difference. I can't understand how bringing forward the change day from 3 to 2 days would improve the level of analgesia though as this is supposed to be a measured dose, unless of course you leave the old patch on so that for the third day you actually have two patches on. I did that by mistake once, on the third day I forgot to take the old patch off, and I was very sick indeed, which indicates that there must be quite a bit of the drug left in the patch after three days.I'd appreciate any opinions anyone has on this, especially the change after two days issue. I really don't understand that one. I have been on this patch for a couple of years now. I still have a fairly high level of pain, and also chronic nerve pain. I often wonder what would happen if I came off this medication. Clean break. Has anyone tried this, ...Maybe start again from the bottom. Frankly I'm a bit scared I guess. I would just like to find out what my body would be like without medication. I am so tired a lot of the time, especially when I'm driving, that I am unable to drive more than about 10 miles without feeling dreadful, and I sometimes feel very very lonely because there is no-one I can talk to about it because its the very last thing people want to hear. In fact when people ask me how I am I always say very positive things, because in a way that makes me feel better also, but being realistic, my attitude, which is good, is not quite good enough to stop me going to sleep when driving! amongst other things.
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Old 07-31-2008, 08:36 PM
Maggie Maggie is offline
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I've noticed that there is medication left in my patch when I change it on the second day. It does NOT do any good on the third day. I think there are a lot of variables that could cause this. Some of those include temperature as well as individual reactions or resorption rate.

Because I don't tolerate dosages any higher than my McgM 75/hr, I have to depend on breakthrough meds a little more. I have limited my activities because I don't want to use these too often.
Maggie
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