NEED ADVICE FAST: Instant release fentanyl

[exitwound]

I am about to go see my doc about new meds.....most likely, the combination of Duragesic patches and some kind of instant-release Fent.

I am curious.....does anyone have ideas as to what the best/most desirable form of IR Fentanyl is?

The options I'm aware of:

*Actiq pops
*Sugar-free pops/lozenges
*Fentora, effervescent "buccal" (held in cheek) pill which is roughly twice as efficient as Actiq & other oral fent, so the doses are only half the size.

Any suggestions/thoughts/comments/reviews of these different forms? I am thinking about Fentora but I could see the "effervescent" thing being unpleasant in some circumstances. Either way, I like the appeal of the very long-acting Duragesic combined with the very fast-acting IR fentanyl.....and hope my doc will be open to it.

Please, respond ASAP.....I only have an hour before my appointment!

[jacky]

the fentora sounds like the way to go to me!

the fent patches are better than nothing, but dont have that instant grat. appeal.

[exitwound]

the fentora sounds like the way to go to me!

the fent patches are better than nothing, but dont have that instant grat. appeal.

Yeah, that's certainly true. Thanks for chiming in, Jacky! Always good to talk with you.

I definitely did have an eye on the Fentora. I'm sure that my coverage provider would rather that I use the generic patches and the generic pops, but I'm fairly sure that I will do a lot better with the brand Duragesic and some brand breakthrough meds like Fentora possibly.

[flipside]

Hey EW, saw this too late, so be sure to let us know how you made out. Fingers and toes crossed for ya!

[exitwound]

So, it turns out that I did indeed get the patches, which were the big thing. I'm starting at 75mcg/hr and will end up at 150mcg/hr for this first month. Then I'll probably go up to 175-200 in the next couple of months, and hopefully with a more powerful breakthrough med.

My doc hadn't heard of Opana yet, and there was no mention of it in his PDR so he'll look at that for next time. I didn't want to push IR Fentanyl since this is the first time my doc has ever prescribed Fentanyl for anything other than Cancer pain.

All in all, I'm pleased.....my pharmacy had the 75mcg/hr patches in stock so I didn't have to wait for them to be ordered in. I can use the oxycodone to sort of cross-taper between the drugs, and so that I don't suddenly withdrawal from any unique aspects of the Oxy such as the way it boosts serotonin levels for example, which many other opiates don't.

Then, next month or down the road, i can adjust the BT meds to be more appropriate. Obviously a mere 20mg of instant-release oxy per day isn't going to cut it......but I don't want to push my doc too hard.

Still, today was a pretty good day. Hopefully the patches will work as well as I've been hoping!

[flipside]

WOOOPEEEEEEEE!!!!!! Thats great EW, I know you've been waiting a long time for this. Hope it brings you some much desreved relief!

[exitwound]

You and me both, flip :-)

I had high hopes when I was put on Oxycontin, and that didn't pan out quite as well as I had hoped.....with luck, fentanyl will be different. After all, it is a truly unique narcotic.....and the very low dosages, in theory, may help slow down tolerance. Some pharmacologists believe that the higher mass is required to achieve a given equivalent narcotic dosage (eg, 200mg of MS Contin is equal to 133MG of OxyContin is equal to 75mcg/hr of Fentanyl patch), the faster tolerance develops.

In any case, I will be keeping my fingers crossed and I will take as much OxyIR as I need to achieve decent relief. If that means I need an early BT refill, the hell with it! I will need a second script for more 75mcg patches in a few days anyway, to get me to 150mcg, and if I'm falling behind on breakthrough meds I will ask either for some Opana, or more OxyIR (probably the 15mg since the 5's are obscenely weak for my purposes).

[(inaudible screams)]

Cook a gel patch and smoke it. Definitely IR.

[exitwound]

Cook a gel patch and smoke it. Definitely IR.

Heh.....I'm on such a strict schedule that I could spare at most, one patch in a month. If that. And these Mylan generic patches aren't like the brand Duragesics. They don't have gel.....the fentanyl is in the silicone patch itself, and in the adhesive.

[Chemical_Boy]

I look forward to hearing how the patches work for you. Good luck!!

[Ginger Snap]

You can request the Sandoz patches instead of the Mylan at the pharmacy. You may have to call around, but they are FAR superior as you can put a small hole in them and put the gel under your tongue. GO SLOW, until you know your tolerance. I get 300-500mcg of patches a month plus 240 800 mcg Actiq so my tolerance is quite high. A 75 mcg patch sublingual makes me just fine for 8-10 hrs with a few lollies thrown in. The new Fentora is VERY EXPENSIVE as is Actiq. Good Luck!

Ginger

[Curio]

let us know EW if you find that the patches work for shorter and shorter lengths of time...
I hated the patch after falling in love with the dosing schedule and not having to take pills, etc...but I developed a terrible tolerance and sometimes the patch would "run out" after 2 days very abruptly and I'd be in pain and w/d's that were awful compared with oral OC and the like...
I finally crossed back to OC after the patch would only last 1-2 days at most and like you mentioned I was also on a strict dosing schedule as far as patch amounts prescribed...

[exitwound]

Well, I always knew that I'd be giving up the flexibility of long-acting pills but I was willing to give that up for less WD issues and problems with dose timing.....and I have always expected that the patches will only last at full strength for about 2 days after a couple of months of taking them (at most). I'm prepared for that and I think my doctor will be OK with scripting me 15 patches of each strength per month instead of 10.

And I think my doc will be willing to switch me back to OC, or over to another medication possibly like Opana ER for example, as long as he doesn't freak out when he discovers that Opana is Oxymorphone (I didn't specify the chemical when I talked to him about it; he couldn't find it in his October edition mini-PDR). He hasn't been a fan of Hydromorphone so I don't expect to ever be able to get Dilaudid from him. Palladone, if it came back on the market, would be pretty unlikely but not necessarily quite as impossible, if for some reason I really thought it was the way to go.....which is unlikely because I think that Opana ER is a superior medication anyway.

My hope is to quickly move up to 175mcg/hr next month, and probably swapping the patches (officially) every 2 days although I might just have a one-day overlap in some cases allowing me to have three/four patches on at a time and avoid the third-day dropoff without sacrificing the micrograms of Fentanyl that the third day still delivers.....I'll probably stabilize in a couple of months at 200-225 or even 250mcg/hr depending on how strong of a breakthrough med I end up on. 180 count Opana 10mg per month would probably be enough to get me by on 175-200mcg/hr; at least I damn well hope it would be!

My pain now is so outrageous, I will rule out virtually nothing that could help me function better for my baby and my family. They deserve better than this, and so do I. 8.5-9.5 pain constantly is no way to live. :(

[insaneike]

Well the Fentor sounds like your best bet. THough personaly, speaking from a fellow severe CP sufferer, and user of the Fentanyl transdermal patches, I would suggest something other than fent for the oral breakthrough pain, such as Hydromorphone or Oxymorphone if you have a huge toler and severe ass pain such as myself.

Personaly, oral fent just puts me out of it, to the extent of 'ggghahagahhag "*drooooool*' :p WHile smoked fent perks me up(you know what i meant if you've done smoked fent or smack) and is better than IV morphine(in hospital doses) in anagesic effects and in euphoria.

I have not been on any fent legaly aside from the Duragesic patches though, man. I get the Sandoz brand, which are GREAT. They are better than the Duragesic brand if you smoke them, but who smokes fkn fent aside from junkies ;) The mylan ones are worthless as far as wearing goes, as they don't stick good or proper. They do for like 1.5 days tops, then it's all kinda coming off at the outer parts and you gotta tape em on if you want them to stay and absorb through an adqueaus base shit or w/e. Thus not as much as the drugs is absorbing that should be and you end up with alot of leftover gel in the patches(good shit left behind if you wear them too!!!). Srry, im opiated myself from my meds and just gotsta talking...

Though, man, I hope you get what you deserve and something that helps with your pain and suits your pain severity and tolerance. As I went two years before a doc would take me seriosuly! Now I'm still kind of in that baot but atleast I get the 25mcg/hr fent and percs. The only oral fent I've has was Actiqs, and those were more Sedating than euphoric, but fkn GRRREAT for pain releif. Just you can't do daily activites on them, as they're too sedating, and I have one mad toler... but if someone was to smoke fent(but who would do that?) you can actualy go about your day, not be drooling on yourself sleepy fucked up noddin, and be so opiated you're pain free. The only drawback I find with fentnayl for severe pain and conditions is that you feel so good that you seem to do more activities than you should/are really able too lol! My doc took me off it for a month because i was doin too much on it, when i shoulda been resting :P

srry, i dont think i helped but im opiated as hell and just gotsta talking... :P

later

[flipside]

EW, you know how high my tolerance is and those actiq suckers barely made me feel anything but pain free. I think at those doses and with something for breakthough ( even if you have ti go back to the morphine ) you should be fine. Fingers and toes crossed. Flip

[Paregoric Kid]

rapinyl, a sublingual fentanyl tablet, will be out on the market soon.

[PantyShot9]

Heh.....I'm on such a strict schedule that I could spare at most, one patch in a month. If that. And these Mylan generic patches aren't like the brand Duragesics. They don't have gel.....the fentanyl is in the silicone patch itself, and in the adhesive.


They Mylans sublingualy work very well. I remember putting half of a 75 mcg under my tongue after taking like 7 mgs of Klonopin and was nodding within at most 5 minutes.

[PantyShot9]

rapinyl, a sublingual fentanyl tablet, will be out on the market soon.


That sounds sort of dirty lol. I would kill for Opana.

[insaneike]

rapinyl, a sublingual fentanyl tablet, will be out on the market soon.

I can't wait to see those things, but oral and transdermal fent just pus your ass out! Fkn godsend for pain though :)

later

[flipside]

rapinyl, a sublingual fentanyl tablet, will be out on the market soon.

Good to know PG, I'll keep my eye out for it, might be good option for me for breakthrough to suplement the patch. Do you know which pharm co is gonna market it?

[earthenone]

I always liked the first night of new patch, i put them on my stomach on the side, then when you go to bed, under the covers, it gets warm, especially if you put a heating pad on it, or happen to sit in a hottub, they release fast, nice glow, but who would do that it says right on the label not to!, I once had one of the bad batches and it was a 100 that insta released when i went to bed, and i wasnt planning on it, 2 hrs later i had 3 days worth of fent in me, i was clawing at my face, it was early on in my journey, but it was good i had a good tollerance or i coulda od'd, i saw a couple of people did, just goes to show you that sometimes if you abuse and get your tollerance up it could save your life...lol that's my story and im sticking to it!

[Ginger Snap]

Fentora is a new sunlingual fentanyl that is just on the market. It is like a fizzy tablet used sublingually. Any of you old enough to remember Fizzies? You dropped the tab in water and it made a carbonated soda beverage? My fave was the root beer!!!! Fentora is made by Cephalon, same as Actiq. I guess that they had to make another hugely expensive drug to make up for Actiq going generic. Coincidently, Cephalon discontinued their patient assistance program for Actiq. I had approval thru March, and they sent me a letter saying as of Oct 1, (I got it on Oct 16) the program would stop.However, out of the goodness of their corporate hearts they would give me until Dec 29 to make other arrangements.NO PROBLEM!!! I have cancer, and no insurance. Let me pay for $10,000 of Actiq a month!!! My tolerance is really high also. I could easily use 45 lollies in a day. That's a light pain day. I am going to ask my Doc for the Fentora and apply for the PA program again. Good Luck.

Wishes for pain free days and nights,
Ginger Snap:p

[exitwound]

Damn, Ginger that's some rough shit!

I'm glad that my tolerance isn't so high. But then, despite the incredible pain I'm in, it's not cancer either. And I've really only been on opiates daily, this time around, for about 16 months even though I've had these conditions for a total of almost 5 years now. So I'm just getting started, quite probably =/

I am looking for patient assistance programs that might help me get some of the meds that my insurance won't cover without ridiculously complex requirements. Like the patches, and possibly some instant-release fentanyl products as well. Fentora maybe.

For now, I have to cope with the same old Oxycodone and pray that my doc & insurance will be willing to let me try other options like Opana.....

[Dilaudid]

Hello opiophiles,

Exitwound I use Actiq for breakthrough pain (and only for pain) and I am pretty satisfied with it.
I don't know the others galenic forms (I live in France and we don't have them).
Hydromorphone (we have hydromorphone 12h extended relase here) and oxycodone (in oxycontin or in IR or liquid forms) works good for me too.

Here physicians prescribe one patch per 48h because plasmatic consentrations of fentanyl drop 48h after wearing the Duragesic patch.
Insanelike is right when he says: "fentanyl is more sedating than euphoric".
Use Actiq for pain in late afternoon or at night and prefer somthing like oxycodone or hydromorphone for the rest of the day.

A last word for Exitwound you've said: "oxycodone boost serotonin levels"
It's wrong only the phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.

ref:

Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.
GILLMAN P. K.
British Journal of Anaesthesia (Br. J. Anaesth.)
2005, vol. 95, no4, pp. 434-441

Serotonin syndrome induced by fluvoxamine and oxycodone
KARUNATILAKE Harindra; BUCKLEY Nicholas A.
The Annals of pharmacotherapy (Ann. pharmacother.)
2006, vol. 40, no1, pp. 155-157