Depends of tolerance,cut 1/8

Put on tongue. Till desolve15min to2h.

yes you can, there is however and increased risk of CNS depression and psycho-motor impairment, so be careful and only do so if instructed to by your doctor

Just Fentanyl itself - the rest is a gel suspension that allows for timed release of the patch dosage.

Almost all over-the-counter pain medications can be taken with fentanyl. Example: Tylenol, Ibuprofen, Aleve, Advil, Naproxen, and Aspirin all have no interactions with fentanyl.

On a side note, fentanyle should never be taken in combination with any MAO Inhibitors.

Everyone is different, but I was clear after 72-84 hours.

Duragesic (Fentanyl Transdermal) patches are used for Primary Chronic Pain; they last for up to 3 days depending on the patient and tolerance level. For example, I'm one of a small percentage of the population that only gets 48 hours from my patches, and that's due to my high tolerance level - I've been using them for 9 years.

Percocet (Oxycodone and Tylenol) is used for Breakthrough Pain - Breakthrough Pain is that pain which the patient feels after activity causes pain being controlled by the patches to exceed the pain controlling capability of the Fentanyl. Percocet, being an Acute pain drug, is used to compensate for the temporary increase in pain.

The combination of Fentanyl patches and Percocet is very common - I myself have used the combination in varying strengths and doses for a very long time. While I'm currently using the strongest doses available, at times I've had to increase my dosages and augment them with other opiates such as Demerol and MS Contin.

Vicodin, like Percocet, is prescribed for patch users as a pain breakthrough drug. Normally, you'd take it in instances where increased activity has increased your pain level beyond the patch's control point (breakthrough) and you need something short term to handle the pain.

You can also use it if you've waited a bit too long to change out your patch to a new one. It usually takes a while for a new patch dose to ramp up to where you're feeling the effects, so in those cases, you can use Vicodin to bridge the withdrawals until the Fentanyl takes effect.

Death

Absolutely not. It will cause the med to absorb to quickly and may cause death.

You don't. You get Watson brand and eat them.

It depends entirely on the individual. Fentanyl stays in the system for a lot longer than acute meds do, so you've got several hours to either put a new patch on or swap the old one. Ideally, you want to put a new patch on a couple of hours before the old one is supposed to expire, but it's important to note that the normally prescribed 72 hour mark doesn't apply to everyone, and isn't fixed in stone, something that a lot of pain doctors have trouble understanding.

Fentanyl transdermal patches regulate the dosage by body heat - this means if you're engaged in physical activity or anything else that raises your body temp, the dosage delivery is increased, and the expiration time is decreased. Also, a small percentage of the population (myself included) require a 48 hour change rather than 72. It's more typical of high-dose opiate patients like myself.

The problem lies in that for many years, Janssen Pharmaceuticals' literature on Duragesic had 72 hours as the effective dosage period. However, they knew that some people didn't get that much. Though they finally changed the literature about 4 years ago to say that 48-72 hours, a lot of doctors don't keep up with those kinds of minor changes, and a lot of pain patients don't understand the proper way to communicate with their pain doctors. The real problem is that if you're getting patches based on a 72 hour dosage rate, and you're falling shorter, you'll wind up having less patches for your monthly prescription. In those cases, keeping an accurate Pain Diary is essential in showing your doctor that his prescription isn't right for your particular case and needs to be adjusted. If you're a fairly new Pain Management patient, or have an idiot for a pain doctor, it can be frustrating.

Where you place the patch is important as well. I've always used my biceps in the 10 years I've been using them, since it's easy to add them and the skin doesn't flex as much as it does in other areas. Even during the times when I've had to increase to 200mcg (2x100mcg patches), I still use both arms, taking on patch off for a few hours to let the skin breathe, clean it, then put a new one on, and then do the same with the other one.

As I said, if you overlap the patches (put a new one on in a new location as the other one is about to expire) you'll have no withdrawals to deal with. It takes a couple of hours for the new patch to ramp up to full delivery, so as the old one is getting weaker the new one is slowly catching up. The result helps to keep your overall maintenance dose fairly steady.

No

Ending Duragesic dependence is not easy, nor can it be done in a short time. Of course it totally depends on the patient's current dosage and how long they've been using it as to how long it will take to get off it it. I can tell you that after 10 years of Duragesic use (2 100mcg patches, plus 120 Percocet 10/325's per month) it took a total of 8 months to lower my dependence enough to where I could switch to Percocet and lower those amounts as well.

Keep in mind that it comes with a cost - you'll find out how much real pain you're in once your levels are low enough, and in the end it might be easier to keep using it. It'll take time, as there's a point where the withdrawal pain is strong enough you can't get a good read on your actual pain. You'll know when it's gone and your real pain is letting you know it's still there.

Even though I've not used one since August '09, my pain is still strong enough that I consider starting to use them again every day. But for me, I resigned myself to the fact years ago that I'd be an opiate patient the rest of my life. I've experienced extremely high levels of pain without the benefit of opiates in the past (hospital & doctor screwups - read my bio if you're curious) and as such my mental tolerance for pain is extremely high. But regardless of how mentally focused you are, you can't keep it up all the time - all of us who are chronic pain patients need some type of pain relief, and that's just reality. If you're at the point where your pain is low enough you can discontinue Duragesic, that's great. But be prepared for the possibility that you might not like what you find once your opiate levels are lowered to the point where your brain is really feeling your pain. Regardless, it's good to do it to better assess your actual pain level, which you can't really do while using Fentanyl.

Depending on your current dose, there's a couple of ways you can do it. You can get lower patch doses and drop your dependence that way, using your breakthrough meds to cover the withdrawals from the difference in dosage. Over the many years I've used Duragesic, I've had to increase my dosages several times from 100 to 200mcg's and then back again - I never did it by using smaller patch doses as it's easier to do it another way. But everyone's different.

First off, you need to stretch your patches to where you're getting the absolute most out of them - change them only when the current one has expired and you're already dealing with withdrawals. Use smaller doses of your breakthrough meds to help ease the pains. Eventually you'll get used to incremental lowering, and be ready to head into your first major withdrawal period. For me, it was about 5 days of major withdrawals - I used Percocet instead of Duragesic until the withdrawals were such that I had to apply a patch. After another month, I was at a point where I was able to do it again, and successfully switched back to Percocet after 3 weeks of withdrawals that weren't nearly as bad as the first period.

To say it's not easy is an understatement, but it's not impossible either. Aside from setting aside time to deal with it, the things I always recommend are:

1. Be completely prepared mentally - eventually you'll get to the point where you'll know you're ready to deal with the discomfort that's to come. Anyone who uses Fentanyl deals with withdrawals regularly - it's no different, just longer.

2. Have lots of water and Gatorade available - Staying well hydrated is essential, as you'll be sweating buckets. You can literally smell and taste the Fentanyl sweating out of your pores. Keeping your electrolytes up is essential as well.

3. Stay warm - You'll be sweating but freezing as well. The best way to describe it is like having the flu, but without the fever. I did it in the middle of Summer, and I was freezing every day.

4. Have a family member around - Trust me when I say you're not going to feel like doing much of anything besides getting up, going to the bathroom, and going back to bed for more misery. That includes making something to eat.

5. Stay sedated - Virtually every instance where I've needed to lower my dosage levels and had to deal with withdrawals for extended periods, I've asked my doctor for something or used one of my other meds to help keep me sedated. When you're sedated, the discomfort is much easier to deal with.

6. Anti-anxiety / Anti-nausea meds - Anti-anxiety meds will help with the withdrawal pain; Anti-nausea meds help when you're near the end.

7. Movies, Music, Games - Anything to distract your mind from the discomfort. Personally I use David Gilmour (Remember That Night BD Live), though gaming helps a lot as well. I also got a lot of WikiAnswers Supervisor work done on this and my other categories during that period. It doesn't really matter what it is, as long as it's a mental distraction strong enough to focus your attention away from the discomfort.

8. Breakthrough Meds - Don't even think about this unless you've got a good supply of Percocet or other meds that you can use to help lower your dependence. My normal supply/dose is 120-150 Percocet 10/325's per month. I started with 10's, then cut them in halves and quarters, taking them together to make 7.5 and then 5mg's.

9. OTC Meds - 2 OTC meds I've used for years are Bayer Back & Body Aspirin and Tylenol Extra Strength Rapid Release Gel-Tabs. Both work fast and really ease pain, enough that I've used them when I don't feel the need for a Percocet. They'll help take up the slack for the pain that your BT med can't cover so you don't have to take as much of it.

10. Doctor - Make sure your doctor knows what you're doing - most will support your efforts. But don't get discouraged if you find that your pain is still great enough you need to continue using it. Remember Duragesic use for all of us is a quality-of-life decision. Using it sucks, since none of us like being a slave to Schedule 2 opiate regulations. But being in constant agony 24/7 isn't a picnic either.

If you've got any specific questions, feel free to contact me through my WA Supervisor email address on my bio page.

Duragesic Transdermal Patches contain different amounts of Fentanyl, a synthetic opiate that is 100 times stronger than morphine. Fentanyl is regularly used in hospitals as an anesthetic, when the patient needs to be conscious but in a state where no pain is felt (twilight state). It is normally used by Cancer patients (terminal or otherwise) and those like myself who are long-term extreme chronic pain patients that require pain relief on a continuing basis. It is not for patients who have pain that is only for a short period, and patients who switch to Duragesic must be opiate tolerant (i.e., have been on other oral opiate meds for some time before converting).

Duragesic comes in 5 doses, which contain increasing amounts of Fentanyl. The patches are a timed-release medicine, meaning the dose is released transdermally (through the skin, regulated by body heat) over a 2-3 day period, depending on the patient. Most patients get 3 days - a small percentage, like myself, only get 2. The nominal delivery rate is 12.5mcg per hour.

Patch doses and amounts of Fentanyl in each are:

12mcg (microgram) patch - 2.1 mg (milligrams) Fentanyl

25mcg - 4.2 mg

50mcg - 8.4 mg

75mcg - 12.6 mg

100mcg - 16.8 mg

Absolutely, but you need to keep in mind your tolerance level because you are slowing your respritory systym down and your breathing slows down . I take it together but everyone is different

No it won't show up as morphine or hydromorphone. Its totally unrelated chemically. If there is a test category for 'opioids' this might test for fentanyl, but I believe this is fairly uncommon. If there is a test for 'fentanyl' or 'synthetic opioids' these will/may test for it, respectively.

Depending on your current opiate tolerance level, it usually takes about a week or two before you get the dosage right.

The initial opiate dose conversion charts that calculate the conversion equivalence for acute opiates (e.g., Oxycodone) to an initial patch dose are purposely skewed toward the low end for safety reasons. That's in case a new user isn't yet tolerant enough to a higher dose, as too much can cause respiratory problems (or worse). As such, for most people the initial dose is too low, and it often takes a few days to adjust the dosage to get it right.

The conversion charts are pretty close though - as long as you've got enough breakthrough meds to compensate, you'll be okay. Just make sure you've got plenty of breakthrough meds available, and track your pain throughout the initial patches so that you and your doctor can tweak the dosages to where it's effective.

There is no average dose - all fentanyl patients must first be "opiate tolerant", meaning they are already tolerant to the effects of opiate medications. Most, like myself, only start using it when other meds (Oxycodone, Morphine, etc.) aren't effective and long-term pain control is needed.

Initial dosages are based on the patient's current medication. All opiates have a morphine-equivalency rating, as does Fentanyl. The patient's current med doses are converted its morphine equivalent, adjusted for increased pain control if necessary, then matched with one of the standard Fentanyl doses available as an initial dose. Dosage adjustment goes from there.

Most initial doses are low - this is because the Morphine-Fentanyl equivalency charts are purposefully kept on the low end for patient safety considerations.

Medications like Duragesic and their generic counterparts deliver the dose transdermally, meaning that the drug is delivered through the skin membrane and thus into the bloodstream.

Duragesic patches work by containing the drug in a suspension gel, contained inside a small pouch on the patch. The bottom of the patch is made of a material that is both adhesive and similar to a porous membrane, which will release the drug into the skin when it's heated by normal body heat. The dosage is regulated over the life of the patch by body heat, which is why overheating the patch (fever, external heat sources,etc.) can significantly increase the delivery rate to the bloodstream. In those cases, even in patients who are opiate tolerant, delirium or respiratory depression can occur. In many cases, for most people who aren't tolerant to high doses (or those who abuse them), it can lead to death.

"Transdermal" means "through the skin". These cannot be injected.

It depends entirely on the situation. If you just add another patch to one that's still effective at full dosage delivery, then you're adding to the overall dosage rate and if you're not tolerant enough you can experience severe respiratory depression or death if you're not careful.

If you're referring to a patch that's in the last few hours of expiration (e.g., 64 hours of a 72 hours prescription period or 40 of a 48 hour period) then you won't feel much difference. It takes the new patch time to start delivery, and depending on how low your current patch is your overall maintenance dose is likely starting to get low anyway.

Over the years I've added a new one as my current one was winding down. This helps to keep the overall dose constant and avoid any withdrawal symptoms. But each person is different, and it's important to know the signs of higher dosages if you're not tolerant to high levels of opiates.

Most Duragesic users know what's normal and what isn't when it comes to patch use over long periods of time, so when something isn't right, it's important to take notice of your symptoms. High dosages can come from different ways other than just adding a patch - increased activity raises body heat, which in turn increases the dosage delivery rate (that's why you're not supposed to expose it to heat or direct sunlight). The first symptoms for most are drowsiness and sometimes trouble breathing, depending on how tolerant they are. Confusion and loss of cognitive ability is the most common though - imagine knowing what's happening to you, but your mind can't direct your body to help itself, and you'll get an idea.

In such cases, the 2 things to do are to immediately remove the patch(es) (make sure you don't fold them - you can re-apply later contrary to what some think), and cool yourself down externally and internally. It's important to also let family/friends know about this as well, so that they know what to do if you suddenly start acting like a wacko. My daughter has had to help me a couple of times when I've become overheated and my dosage rate increased fast (I have an extremely high opiate tolerance level, so respiratory depression doesn't happen, just increased side effects).

If you're using breakthrough meds like Percocet or Vicodin, then your overall tolerance is higher than your patch dose anyway, Just make sure that if you overlap the patches, one is expiring.

The last thing you want to do is ask up front - in today's climate, even with the medical community more aware of opiates as a viable therapy, simply asking for pain meds will likely get you tagged as a drug seeker, and it'll really hamper yourself in the long run if you've got real pain issues.

If you've got real problems, then start keeping a Pain Diary. PD's are commonly used by first-time chronic pain patients (and even short term acute pain patients) to document their pain over time, giving the doctor a visual record of your problem, especially if there's nothing evident on X-rays, MRI's, CT's, etc. Real pain and recording it is extremely difficult to fake - most doctors, and other pain patients like myself, can easily tell when someone is BS'ing about having pain bad enough to require pain meds.

You also need to show that you've tried alternate meds and therapies, which is something most patients are willing to do; they just want a quick remedy for pain. Problem is, real pain has no quick remedy.

Seeing a Pain Specialist is also preferable than a General Practitioner, since they're authorized to prescribe more pain meds than regular doctors are. Regular doctors and the groups they belong to tend to pull back from any long-term prescriptions involving pain meds that are Schedule II (Duragesic, Percocet, Morphine, etc.), and even Schedule III and IV drugs (Vicodin, Codeine mixes, etc.)

It depends on your overall condition, reason for pain, your overall tolerance level, and the length of time you've been using Fentanyl Transdermal patches of any type. However, in general, if you're up to the task, then yes, it's okay, as long as you're aware of the potential risks involved.

Fentanyl patches (either Duragesic or its generic alternatives) work by slowly releasing the drug through a transdermal membrane into the bloodstream via the skin layer. The dosage delivery is controlled by body heat, and naturally any strenuous physical activity will increase your heart rate and elevate your core body temperature. This alone increases the dosage delivery rate, and if you're not yet that tolerant to the drug or opiates in general (rare since the patches are only supposed to be prescribed to prior opiate tolerant patients), then confusion or other increased side effects can occur.

As a long time Duragesic user and chronic pain patient on opiate therapy for many years (see my bio for specifics), I've experienced this several times while doing outside work or remodeling around my home. Even though I knew what was happening, the confusion level is so much that it's difficult to get out of the situation on your own. I describe it as being stuck in a loop you can't get yourself out of. Only removing the patch (if you do it properly you can re-attach it later - see my answer on that) or cooling your body to normal will alleviate the problem. It's also important to understand that opiates are Vasodilators, meaning they open the blood vessels (that's why you feel cold when the dosage tapers off - they start constricting). Opening the blood vessels wider naturally warms your body, but again if you're tolerant to the constant dosage over time then your body is already used to it.

However, if you take simple precautions to keep yourself from getting overheated (stay hydrated and cool while working) and your overall physical condition doesn't limit you from the work (e.g., you're dealing with extreme pain but are physically able to work), and you're prepared for what can happen (my family knows what to do if they find me in such a situation, and I always have my cell with me when working) then there isn't much you can't normally do that you didn't do before.

As you become more tolerant, the depressant effects will become less. I found years ago that a cerebral stimulant will help overcome the depressant effects to the point where I feel relatively normal. Of course I don't use them often, only when I'm using higher opiate dosages to control pain.

As far as driving, it's an individual situation. Not everyone handles opiate therapy the same way, and again only tolerant individuals can deal with the depressant side effects over time. I've never had any driving restrictions, though I've always been acutely aware that in any accident it would likely be an issue. Having said that, unless I told you that I was a high level opiate patient you'd never know as I feel normal most of the time. It's really a topic for your pain specialist and yourself, but if you've already got handicap driver plates or a placard, then your doctor has already signed off on the fact that he/she believes that you're okay to drive. How responsible you are is totally up to you. I won't drive if I need to increase my normal dosages to deal with increased pain.

You should also be aware of the fact that the patches will and do slow your reaction time, so you need to be more aware of safety factors and compensate for your slower reaction than normal when working. Also, remember that opiates work by altering the brain's perception of pain, and if you over-exert yourself, you could further aggravate your condition without realizing it until the pain becomes worse. Be smart.

If you're wondering, at my highest dosages I was using 2 100mcg Duragesic patches for primary pain, Percocet 10/325's for breakthrough (120/150 per month), 100mg Demerol tabs, and 30mg MS Contin tabs for pain. My normal dosages are 1 100mcg patch and the same amount of Percocet monthly. Those have been my normal dosages for about 9 years.