O.K., you have my permission to laugh or shake your head or whatever as you read this post, but I need help here. I am pretty sure I put John's 1st patch on wrong and I not sure about the one that I applied today. I can't see all the little 'protective" plastic strips very well. From what I can tell, there is one big one on one side of the patch and on the other side there is a split cover. Will someone walk me through the actual application - and how to tell which side of the patch has the gel without sticking your finger on it ? [I said you could laugh} Amy

Hi Amy :-) I have the same patch on. I thought it was awkward too. Here's how: inside of the bag there's a plastic film, remove both sides (they are not sticking onto the patch). The patch is inside these two films you'll notice a mark in the middle of path. There are two films here two. Tearing in the middle the side of the patch that is sticking shows. Apply the sticky half side on his arm and then remove the other half of the film by peeling it off. Got it?
Have a great night . .
Edgar
39 IMRT radio 3 cisplatin 3 Erbitux
Tonsil Cancer 3/4

Yep- I might have put this one on backwards also. Thanks Edgar- I'm printing this thread before I apply the next one.

Here are the manufacurer's instructions:

"The patch should be applied to a clean, dry area on the upper arm or back. If necessary, clip hair from the site prior to applying the patch. Remove the the patch from the package, peel off the protective strip and immediately apply to the skin. Press firmly for 10-20 seconds to make sure that the patch stays in place. Be sure that the edges are held firmly to the skin. Wash your hands after applying the patch. Each patch may be worn for 72 hours even while showeting or bathing. Remove the patch carefully and immediately flush down the toilet. Apply each new patch to a different area to prevent skin irritation. Use this medication exactly as prescribed by your doctor. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using this drug without your doctors approval. Over time, this drug may not work as well. Consult your doctor if this medication is not relieving the pain sufficiently."

Also, when it comes time to stop using the patch, remember that fentanyl is a powerful drug and you should taper off use, rather than stopping abruptly.

As you taper off, it can be helpful to cut a patch in half so that you can get a fractional dosage as you stop using it. - Sheldon

Gary, I got out my magnifying glass and read the manufacturer's instructions before applying the 1st patch. [tho I appreciate your effort above] I have one sighted eye [with a cataract] This patch has 2 long pieces of plastic on the outside [I think] and then a piece cut in 1\2 covering the gel [I think] Edgar's post confirms that [I think]
It is my opinion that the "application instructions" leave alot to be desired At least for this old lady.Oh well, practice makes perfect. Thanks, guys. Anyone want to come down and show me how? Amy

Must concur on the tapering off. It will be a while before you need to worry about it but, take heed. I went from 150mg to 0 in about a week and ended up like a heroin addict going into detox. Not a fun time. Take it slow when it's no longer needed.

150mg = 150 micrograms

That is incorrect. mg is milligrams, mcg is micrograms

While we are on the subject if you wish to better read your Rx's, here's a list of definitions.

abbreviation=English=Latin

ad.lib =freely as wanted=ad libitum
aq.=water=aqua
b.i.d.=twice a day=bis in die
cap.=capsule=capula
c with bar on top=with=cum
div.=divide=divide
eq.pts.=equal parts=equalis partis
gtt.=a drop=gutta
h.=hour=hora
no.=number=numero
O.=pint=octarius
p.r.n.=as occasion requires=pro re nata
q.s.=a sufficient quantity=quantum sufficiat
q4h=every 4 hours=quaque 4 hora
q6h=every 6 hours=quaque 6 hora
q1d=every day=quaque 1 die
q1w=every week
q.i.d.=four times a day=quater in die
s.i.d.=once a day=semel in die
Sig., or S.=write on the label=signa
stat.=immediately=statim
tab.=a tablet=tabella
t.i.d.=three times a day=ter in die

Weight

1000 picograms=1 nanogram (ng)
1000 nanograms =1 microgram (ug)
1000 micrograms=1 milligram (mg)
1000 milligrams=1 gram (g)
1000 grams=1 kilogram (kg)

Volume
1000 milliliters (ml)=1 liter (L)

Hi Everyone:

Just one quick point to echo Brian's. Fentanyl (AKA Duragesic) is dosed in micrograms. the general rule is to start low and go slow on the upswing and taper down slowly as well.

It's also important to remember that it can take 3-5 days to build up an adequate blood level of the drug to feel relief from pain. So, don't assume poor relief in the first few days means the dose is incorrect.

The issue about applying the patch is the one we medical providers hear about most often.The manufacturers don't make it easy and many caregivers get the medication on their hands while trying to apply the patch to their loved ones. Make sure you wash your hands before and after applying the patch.

The other tip to remember is that basic drugs, such as Tylenol and Motrin, is they can bee taken without side effects, work well in conjuction with the patches and often boost the effect of the narcotic.

Kim

Someone mentioned cutting the patch in half to taper off Fentanyl. I thought I read somewhere that cutting the patch can cause more of the fentanyl to be released into the system, and should therefore never be done. I may be mistaken; has anyone else heard this?

I understand that they have issued 15 mcg patches so tapering down should be even easier. Besides you can also take the equivalent amount of Vicodin or Codeine and take one less pill per day. You MUST develop a phase out plan with your doctor!

A sudden release of Fentanyl, into the system could cause an overdose, much the same as if you took a time released pain med, ground it up and poured it down your PEG tube. Sherry has it exactly right.

From the manufacturers warnings and precautions:

"DURAGESIC

This has been a very helpful thread for me. And I was particularly glad to read Kim's comments because now I don't feel so inept :rolleyes: Amy

Another factoid on Fentanyl - it's 40 times more potent then heroin

Gary, re: your post about 24 to 72 hrs. for maxinum effectiveness, it that for the first dose or does it apply to cach new application after the patch is started? The 50 mcg patch is controlling John's headache for now, but not relieving the mouth pain. [or maybe it would be worse without the patch- don't know] Amy

Amy, when I was on the patches, it was only for the first one that the time lag applied. When it was time to change it (or them) there was still enough medication in my system that there was no break in the pain control. I had no side effects, but then I wasn't taking anything else either, and the chemo was finished by the time I began the patches.

Yes the 24 hours was for the full effect to kick in. After that Joanna covered it nicely. If, after 72 hours, the pain isn't being managed to the level of about "3" or less then ask his doctor to increase the dose to 75 mcg. They will only increase it 25 mcg at a time and can go as high as 300 mcg.

Caution: DO NOT increase the dose rate or add additional patches without your doctors permission.

There is a formula for how strong the Fentanyl should be in relation to the amount of breakthrough medications taken.

Is he doing a morphine based "swish & spit" as well? i.e., "Pink Magic"

Another factoid on Fentanyl - it's 80 times more potent then morphine.

I wanted to mention that the suggestion about cutting a 25 mcg patch as part of the tapering off process was the advice to me of a physician specializing in palliative and pain management medicine.

This was before there was a 15 mcg patch available so the point is kind of irrelvant now. However, I suspect his thinking was that coming down from 175 mcg to 25 to 1/2 a 25 mcg patch would be pretty low risk given the tolerance to Fetanyl that one develops over time.

In any case, with the new lower dose patch, there is no reson to cut one now. - Sheldon

Hi JAM,

This is our experience with the patch. We found that there is the brand name and the generic.

The brans name is enclosed in a pouch and there is a single plastic backing film which is larger than the patch. To activate the glue on the patch rub the patch before removing from the plastic backing between in your hands for a few second and than peel off the patch from the backing and place on the upper arm or shoulder were there is no hair. Place your hand over the patch and hold for 10 to 30 seconds.

The generic type also comes in a pouch. The backing for this patch consist of two half plastic films. Again, rub the patch and backings between you hands for a few seconds to activate the glue. Remove one of the half backing films and apply to the patch skin than remove the other half film a fully apply to the skin.

It is important to wash the hands with a lot of cold water following application of the patch because of the possibility of having come in to contact with the fentynal.

Well guys, I have certainly learned ALOT about fentanyl in a very short amount of time :rolleyes: Since John started on the 1st one on July 6th, he has gotten progressively incoherent, confused, irritable and in short -looney! This am., when he registered a 101.5 degree fever I yanked the patch off.[O.K. there is more to the story, but I won't bore you] His Chemo Doc was not in favor of the patch to begin with and when we got to his office this am, he was glad it was gone. I really questioned him about needing to reapply smaller doses to let John come down off of the 50 mcg slowly.[John got mad at me, says I was too pushy with the Doctor] He said the Hydrocodone John is taking would stop any withdrawal symptoms. If it does not, I am going to be as mad as the proverbial Wet Hen! I do hope this thread will be of benefit to others who need to use this drug. It works great for many people, but it just did not work for us. Amy