David is 6 weeks post rad/chemo as of last friday but has EXTREME sore throat. He is still on fentanyl patch and now on Vicodin for breakthrough (he has been taking up to 10). Has anyone had trouble with the patch? We moved the RX to Walgreen as opposed to CVS be cause the did not have them in stock when he needed them and the patch from Walgreen is small oblong patch. Looks like piece of tape I inch long. The ones we got from CVS were sqare and you see the medicine in the inner square, That patch was about 2 X 2. He has had more problems with pain control since changing to the walgreen One. ANyone else????

The pain is constant. The vicodin may dull a little but it is there constantly. He says feel likes there is something in his throat. He still is not taking food by mouht. He has tried. Even smooth Creamy pudding burns and gets caught in his throat. He still has white patches in back of throat on on roof of his mouth. He cannot cough when the build up is bad in the back of his mouth throat area. He cannot blow his nose as well. I look at his mouth and throat every day and it is still flaming red. It is so dry mouth and throat. He is using the Biotene products..Toothpaste he loves..The rinse and gel are not helping.

I have read about thrrush but cannot tell it this is it ..Can't see down his throat but the white patches which turn to brown almost scabby looking area on roof of mouth going to back of throat look suspicious. I have talked to his RO nurse she says it just the ulcerations popping and healing!!

On the bright side he is passed the sleep all day time. He is awake more through the day but very uncomfortable. Also when he tried the pudding he could taste it!!!!!!

Dear T- are you sure the dosage is the same on the new patch from Walgreens? Keep bugging the nurses and Docs about his pain. ABut remember, radiation is the gift that keeps on giving so it will be awhile before he feels better[but he should not hurt so much]. Amy in the Ozarks

I have to jump in with Amy on this one. In 2005 the FDA cleared a generic Fentanyl patch by a company called Mylan. J&J also released a generic patch and there were big problems with the adhesives and the patch sticking properly. The delivery system on the generics is different in that the drug passes through the adhesive. Many complained about the generic and it's efficacy in 2005. I have not been able to find anything more recent so perhaps the problems with the generic patches not sticking has been solved.

The original Duragesic patch uses a time release transdermal transfer system through a permeable membrane. I used the Jensen patches (Duragesic) and occasionally had a patch the didn't adhere well but basically had an overall positive experience with them. They worked quite well. I also used Vicodin for a while until they switched me to Morphine Sulphate for breakthrough pain. It is much faster acting and more effective than Vicodin. I was also up to 3 25 mcg patches at a time. Some here have had as much as 300 mcg, In some extreme caes they can go up to 500 mcg (5-100mcg patches).

They have a titration formula that is a balance between his long term meds (Fentanyl) and his short term (Vicodin). If he is taking 10 a day then he should either get a stronger breakthrough med or have his fentanyl dose increased. DO NOT do this yourself without strict supervision or orders from your doctor. Be very careful handling these patches, NEVER use a damaged patch and follow the manufacturers instructions for use meticulously. Even after they are used they can still contain lethal doses for children and pets. They should be folded in half and flushed down the toilet after use.

I was on the patch for at least 4 months.

If his pain level is greater than 3 (out of 10) then they have to up the dosage. For most of us the worst pain occured immediately post Tx.

Your husband should not have that much pain. I absolutely LOVE Fentanyl. I used it for burns I was told were the worst ever seen post rad. However, with those patches, I felt NO pain at all. It took weeks for the burns to heal and those patches let me get on with my iife as my energy returned. This was before the generics surfaced, so that may be a difference. DO call the nurse/doc for pain relief. When one is in pain, one does not heal well.

The Maker is Mylan but it is not Generic. It is labeled as Fentanyl 25MCG/HR.

WE switched the vicodin and now he is taking the roxicet yesterday and today and it has been the best 2 days in 4 months. He felt so great yesterday he even attempted eating. He was able again to get down Chicken and noodle soup but he did not straing and wince. He is still haveing trouble with everything getting caught but the Roxicet helped tremendously with pain. I am going to go to pharmacy with the Fentanyl patches remaining and see what can be done. with that.

This is great info with different makers. I do want to stress though this patch Mylan is not labeled as generic. We had problem with one by Mylan not sticking. Can this be generic but not labeled as such?

OK, I know I say this a lot, but Please see if you can get a Swish and swallow for Thrush or Fungi infection.

Sometime it is hard to detach. It can be over looked real easy. The red and inflamed mouth and sore are good indications of that. So please get something for it. I had liquid Nystatin. It will take a few days but should see & feel a difference.

Take care
Diane

we contacted our RO nurse and she had just seen the type we were referencing by Mylan. She stated that the patch may not actually contain enough of the medication as listed. This seems so obsurd to me that a maker could potentially pass off a drug with a listed content that may not be...I would if I was any of you make sure I knew which maker for the Fentanyl patch I was getting from a pharmacy because they are truly not the same. She had him place another patch on so he has 2 on now and the pain is much more under control. No supplemental pain meds!!!! And he is feeling better to the point he is up moving around more.

We did call pharmacy where we got them and their response was no one has Ever questioned thier effectiveness..We go to for our Follow-up CT and pet scan on Tuesday and the nurse is going to give us new RX with increased dosage and we will go back to original pharmacy with it.

DM - we have Questioned the nurse on Thrush and/or infection and she has continually stated it does not seeem like it.

Thanks to everyone for the great information.

Tonsilless --

The Mylan product is indeed a generic fentanyl patch, according to the company's own website . The company describes itself as "the market leader in generic transdermal drug delivery technology" and manufactures only generic products. Its generic fentanyl patch was approved by the FDA in 2005.

The brand-name fentanyl product is Duragesic (in Europe it's Durogesic), initially developed in 1960 by Janssen Pharmaceutica of Belgium and now marketed in the US by Ortho-McNeil Inc. (both are part of Johnson & Johnson).

Gary's post describes a difference between the generic and brand-name products in the way the drug is passed from the patch into the body. Perhaps that can help explain the problems your husband was having.

-- Leslie