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Opinions - How to make fentanyl patches stick much better

Discussion in 'Fentanyl' started by BHarper, Apr 28, 2009.

  1. BHarper

    BHarper Newbie

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    I used to have a huge problem with these patches coming off during the three days that are supposed to stay stuck. The problem that I have found is that I get very itchy under the patch and it also gets very sweaty since it has no way for air to access the skin. This makes me scratch and rub the patch, which in turn often causes the patch to fall off or at least not it wouldn't make full contact. This causes the patch to not be as effective and the user is left to suffer under performing medication.

    Here is the fix that I have come up with and it seems to be VERY effective. First off, you need to get fentanyl patches that do NOT have gel inside of them. The only ones I've ever used that don't have gel are made by Mylan and are prices very reasonable (Extra points!!).

    Before putting the patch on, I cut the patch (75mcg/hr) into 3 pieces. Shower (sometimes) and SCRUB / exfoliate the area where the patch pieces are going to go. Immediately prior to applying the patches, I thoroughly wipe/scrub the area with rubbing alcohol and allow to totally dry. I've actually found that the best place to apply the patches, where the patches stick the longest, are on my side / hips right near my underwear line but slightly lower but you may have your own favorite.

    Cutting the patches makes all the difference. I'd cut the 25's into 1-2, the 50's into 2-3 pieces, the 75's into 3-4 and the 100's into 4-5. The reason this works better is because as your skin flexes, the smaller sticker has less continuity of surface area for the skin to "fight" with. It is also MUCH easier to scratch around the patch and get relief while not scratching the patch of a larger, entire patch, causing it to loosen and lose contact.

    This is just a thought and is something that I have found to work very well for me. That solves a large problem that I have with pain patches. Now only if I can make them last longer somehow. Here is what I would recommend if anyone is not getting 3 days out fo the patches.

    Cut your patch into 3 pieces and apply one piece each day and leave each on on for 4 days. You could put 2 on each side and rotate. This should give you a more stable level of medication and won't leave you without pain medication the last day or so as I have had to deal with for a long time.

    It really annoys me when the pharmacist tells me that I can't cut them because they won't last as long. Does this make sense? I was told that even if i cut them into X number of pieces and apply them all, it won't work the same. I could understand if it was a gel, which would leak out if cut inside the patch, but it isn't.

    Anyway, hope this helps someone!
     
  2. OhCasey

    OhCasey Palladium Member

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    You should read over the rules since no one talks about using drugs in the first person here. As far as the itching goes someone who isnt you could bring that up to your doctor and he could prescribe an antihistamine or you can find them otc.
     
  3. trannyboy

    trannyboy Newbie

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    Yeah, we all use SWIM or my pet parrot or whatever. If you want to stay you are going to have have to find a "SWIM" or pet that uses this medication to talk about;). My only concern is I have been told that cutting those patches causes them to dump the medication. If that is the case you might be unwittingly overdosing. Hopefully others with more experience will be alone shortly to give further advice on this subject.

    trannyboy
     
  4. BHarper

    BHarper Newbie

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    Swim totally forgot about the SWIM thing as everything swim use is legally prescribed and am under guidance of a doctor.

    Swim know that this thread may sound stupid to some people, but to those who have chronic pain and have to live with these everyday understand the torture of the itch that occurs under these patches at times. After a year, swim finally figured out that this method provides SO much relief that swim had to share.

    You mention the possibility of cutting the patches and it "dumping" the medication out. SWIM specifically said that it had to be the Mylan's that did not have gel inside which means that there is nothing to "dump" out. If you picture a sticker, that is what these patches look like. If you cut a sticker in half, nothing dumps out of those, just as like these patches.

    The itching is just something that goes with the patches says the doc. The larger they are, the more area you have covered (obviously) so there is more chance of an itch under the patch. As swim said before, if you have an itch under the patch it is basically impossible to adequately scratch it with the patch on but you can scratch very firmly AROUND the patch and get relief. This is why cutting them will allow you to scratch around the outside of the smaller piece and get to the itch more effectively.

    BHarper added 3 Minutes and 21 Seconds later...

    The itching is not a histamine response from the pain meds. It is due to the physical patch, lack of air on the skin, sweat build up under the patch and dead skin under the patch. All this adds up to ITCHINESS that benadryl will not address. Thanks for the idea though, it does help with the itch associated with opiates.
     
    Last edited: Apr 30, 2009
  5. LinusMundane

    LinusMundane Silver Member

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    SWIM thinks that SWITranny meant that cutting the patches causes them to release the medicine at a quicker rate.

    SWITranny used the term "dump" not to physically mean dump as in the gel falls out, but that the medicine is no longer regulated by whatever internal regulator the patches have built into them.
     
  6. trannyboy

    trannyboy Newbie

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    Linus got my point. I know with every other topical medication delivered by patch that cutting the patch seriously interferes with the dosage delivery system not just in say getting half the dose with half the patch. I am not certain with this one you are using. For example the nicotine patch doesn't contain a gel but if cut will release or dump the nicotine very quickly into the body and has caused heart problems for those patients. Every topical patch medication I have seen includes warnings to that effect in the packaging. Your pharmacist was correct even if you find it annoying.

    However have you consider having a topical fentanyl cream or gel compounded by a compounding pharmacist? That would allow for proper treatment and no patch needed per se but you may want to cover the area with an occlusive dressing for the first hour or so to help the medication absorb into your skin. I know others who hate the patch because of the same effect you mention but have great success with a topical formulation. The only draw back is it would need to be applied much more frequently then the patch. Not that is always a bad thing because you can time smaller doses for times like while you are sleeping and larger doses for when you are doing something that will increase your pain like working out. Good luck

    trannyboy
     
  7. OhCasey

    OhCasey Palladium Member

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    I doubt that since many swimmers have noticed the same thing and they have found it to be the fact that the skin is much more sensitive to the absorption of opiates. If you put a piece of tape over your skin for two days and experience itching similar to the fentanyl patch then maybe you are an excessive sweater or need to scrub the area a lot better before applying the patch. 2 days isnt that long to have your skin covered with a piece of plastic. It shouldnt be because of sweating, dead skin or lack of air.
     
  8. thebige

    thebige Newbie

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    At the pharmacy/chemist swiy should be able to find Transdermal tape...same type used at hospitals/er......the same kinda tape used for butterfly's/iv drips etc..
    They allow air to pass through and help hold the patch on for 3 days+ even through everyday showers............also cuts down on itch and or latex allergies due to certain kinds of tape used(white tape,paper tape)
    Swim found them large enough to completely cover his 75mcg patch's (about 3/4s of a inch completely around the patch)
     
  9. La1975

    La1975 Silver Member

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    SWIM uses 75mcg patches as prescribed and usually only has problems with the patch sticking only in the summer or after working out. When SWIM was in the hospital more often they would just swipe some Tegaderm, which is the breathable and clear but its too expensive to buy. SWIM now uses clear medical tape around the edges if needed. They also use alcohol first, let it dry well and then apply the patch. Even the Mylan brand patches (kind without the gel pocket layer) can still give out incorrect doses if cut up.
    Last point, some people jsut have sensitive skin and no matter what the patch will itch them. SWIM has had skin irritations a few times but is usually ok.
    SWIM also doesn't quite get why they need to use SWIM when talking about prescribed meds.
     
  10. Personal

    Personal Newbie

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    Where is the patch going? When SWIM used to be on the nicotine patch he too had problems with it comming off at work. An SWIM works in an office! Those things just arent made to stay put. SWIM was that the dentist one day and the dentist gave him a high grade medical tape that is made for being in moist environments (so says the dentist at least?) It worked very well. SWIM ran out then found something that compairs pretty well at a drug store, He was in the "cane and walker" isle and he found "nexcare water proof tape" It works great! SWIM wore the patch with the tape even in the shower, then all day long with no problems at all! Hope this helped!
     
  11. drumlord420

    drumlord420 Newbie

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    I see what you're saying, but remember...ALL itching is a symptom of histamine release...ALWAYS...It's the body's reaction to lack of air, sweating, dead skin...just like with a sunburn...It itches and there is dead skin...It's ALL histamine...
     
  12. ikcaj

    ikcaj Silver Member

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    I need to move my original post to this thread.

    I'm about to pay $30 for the tegederm film but some people say the patch can't "breathe" through that and other people say tegederm is made specifically for these patches.

    Any one else try cutting the patches and putting them in different places?
     
  13. laadyemerald

    laadyemerald Newbie

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    Tegaderms themselves are breatheable and mimick the skin, designed to stay in place up to 7 days, so I'm confused by that.. Also to save you a bit of money, I probably should have mentioned on my post that there are two kinds of Tegaderms, a newer and older version. The older version is literally identical to the newer version, but is nearly half the price. The newer version has the centerpiece peeled off for you and comes with a special label (for dates and times). The older version requires that you peel the centerpiece off by yourself (how hard..) and comes with no fancy label you probably didn't want anyway.

    Thanks for the thoughts with the sticking problem but keep in mind that this cutting method doesn't work for people who require reservoir (gel) patches, which are stronger than any matrix patch on the market because of their delivery system, not because of the amount of fentanyl in them.. It's pretty painful trying to go from a reservoir to anything else, even brand which is now a matrix. And no I seriously doubt cutting the patches will decrease their effectiveness; I once had a doctor tell a friend of mine that they could be cut without a problem.

    laadyemerald added 12 Minutes and 36 Seconds later...

    Oh, also no Tegaderms are not made specifically for these patches, though for those that use them it sometimes feels that way. Tegaderm film is designed as a hospital dressing, used for dressing wounds and IVs (people don't recognize them, but the clear film put over IVs are also Tegaderms.) It's the hospital's version of a band-aid, used for all kinds of things, including helping patches stick.
     
    Last edited: Dec 3, 2012
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