Ok, for one thing, Roxicet is NOT Fentanyl (or Duragesic). It is a Morphine time release patch.
As Wayne suggests DO NOT EVER cut a patch (whatever type of patch it is) or use one that is damaged in any way. The narcotic is released through a permeable membrane on the skin side of the patch. Damage would release the entire dose at once. It can cause an potentially lethal overdose. Use great care or gloves while handling the patch and be very careful about strictly following the disposal recommendations of the manufacturer. The skin must be clean and dry and the patch applied to a hairless location for maximum effectiveness. I used either 99% pure alcohol (available in supermarkets -do NOT use rubbing alcohol as it has a high water content)or acetone to degrease the area where the patch is going to be applied. If the patch is peeling off prematurely then you have a problem. I have had batches of patches with bad adhesive - notify your pharmacist immediately. A properly applied patch will tolerate showers so bathing shouldn't be a problem. It's also wise to move the patch to different locations when applying new ones. Don't reapply them to the exact same spot right away. Give the skin application area a rest.

Fentanyl is a much more powerful drug than Morphine and is administered starting with 25 mcg patches and some patients can work up to 300 mcg (but I've never heard of anyone here getting more than 150 mcg - I was up to 75 mcg myself). It is a synthetic narcotic and 100 times more potent than heroin (which is 2X more potent than Morphine). It is indicated for 72 hour use and takes about 24 hours to come up to full therapeutic dose rate the first time the patch is applied. Subsequent application of patches will have a residual effect from the previous patch(es) and the transistion from one patch to the next will be seemless. This class of narcotics are specifically designed for "long term" pain management when months or longer of pain is anticipated.

He should also have a "breakthrough", fast acting, narcotic as well. These are typically also known as "short term" narcotics and are used when pain is anticipated to be of a short duration. Morphine is commonly used for this and the liquid form, oral or (PEG) tube applied, typically acts in about 4-5 minutes. Tablets in about 30 minutes.

Adequate pain management is a basic patient right and he should see his doctor immediately. Use the 0-10 scale, with "10" being the worst to describe his pain levels.


Gary Allsebrook
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Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
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"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)