Fentanyl (morphine) Patches

[Mari]

Hello All,
I am trying fentanyl patches (Durogesic/D-trans) and have been experiencing strong side effects. I wondered if it was a case of my body getting used to it, then it would calm down, or if it meant my body didn't like it and would never tolerate it. My GP thought the latter but my pain consultant wants me to persist, saying it can take a few weeks before it calms down.

So I wondered what others' experiences of the Fentanyl patches had been?

Mari

[Sandy L]

I have never had need of them myself, but a couple of patients have. One found he could adapt to it over time; the other didn't want to push for that and did not continue. With other, similar drugs, some people can get past unacceptable side effects and for some it does not stop. Depending on both the severity of side effects and what other options are open, you might want either to push on for a while to see if it will work or go back to an alternative.

[LucyM]

Hi mari,

You definitely are following the same meds pattern as me, I was only on them for 3 days before I had an allergic reaction, I hope they settle down with you. Do try and persist with them until your body gets used to them - As if it does work for you, once the meds settle down will only benefit you in the long run.

As always you are in my thoughts, pm at a later date to let me know how things are getting on.

Take care
LucyM

[flyingfairy]

Has anyone tried Morphine patches was thinking of giving them a try?

[janey]

My daughter was prescribed them when she was 14 for pain following a hip dislocation. Although they were very effective for the pain, she found the side effects, particularly nausea, very hard to cope with and gave up after 2 days. I don't know whether these side effects wear off after a while and I guess it is all very individual. She now has very minimal doses of pain killers for similar dislocations and prefers to cope with some pain and be a bit more 'with it' but again it is all very individual.
Hope you find the right solution for you.

[sarahh]

Hi Flyingfairy I am on Fentanyl patches I haven't had any side effects from them apart from the night I first put one on but I think it was more that I hadn't slept for 24hours and then starting these I felt a bit nauseated at first but don't have any problems with them now.

Before I applied mine I read all the leaflet first about where I could put it etc.

Sarah x

[rubygloom]

i have just been given these after becoming alergic to beuponorphine patches(after a couple of months)
so i am hoping they will work well
its only been a couple of hours so nothing to report yet

[LucyM]

I developed an allgeric reaction to these after 48 hrs. I am now allergic to everything in the morphine family. I hope these work for you

[Sandy L]

I developed an allgeric reaction to these after 48 hrs. I am now allergic to everything in the morphine family. I hope these work for you

From a practical standpoint, it is splitting hairs to say that statement is probably wrong, since the bottom line is you must avoid them, but the details on how the hair can be split might be interesting.
1. Fentanyl is an opioid, not an opiate. Its chemical structure bears little resemblence to the drugs in the opium-derived families.
2. As a consequence of #1, it is quite a bit less likely to react with immune molecules that fit morphine.
3. Small molecules do not make good allergens. Sometimes, they can react with large molecules in the blood or tissue, altering them so that immune cells no longer recognize them as family and make immune molecules to attack. Neither fentanyl nor the opiates are very reactive in the chemical sense, hence they are not likely to do this.
4. If the reaction was itching, it has recently been shown that is an effect of the interaction of the opiate or oioid with the mu receptor on nerve cells. Th mu receptor is the principal point of action for these; if you block that, you block the pain-relieving effect. Benadryl is not very helpful in treating the itching, but narcotic antagonists are. This may at times be an important distinction. If you are allergic to a drug, taing it risks fatal anaphylactic reactions, and you may have to avoid it, no matter how high the need for it may become. If the reaction was itching, you could weigh that aainst the severity of the pain and decide to tolerate the itch.

[LucyM]

According to my GP it was a allergic reaction. I swelled up everywhere couldnt see out my eyes as they were swollen shut and my skin was red and extremely itchy everywhere, this has happened with Butrans, fentanyl, and all the morphine type patches out there. So call the reaction what you like either way I cant use anything like that.....

[Sandy L]

That's allergic, all right. It went well beyond itching.

[LucyM]

Its quite scary - I have multiple chemical allergies. The Docs hate changing my meds as its always like playing Russian Roulette. They cant fathom why it happens and say its just on of those things.

[Rosie]

Sandy - I have had an allegic reaction to asprin (stomach lining bleeding) and augmentin (swelling in eyes, fingers, lips, mouth plus uticaria everywhere). Am I right in thining that a second reaction is likely to be more severe than the first, or is that another of those old wives tales?



Rosie

[Sandy L]

The reaction to aspirin is a direct effect of its action in blocking prostaglandin synthesis in both the cyclooxygenase pathways instead of just the COX2 anti-inflammatory pathway. It is not an allergic reaction, and would not necessarily be worse with a subsequet exposure, but you should use any of several means to protect yourself if you use aspirin or any of the general NSAIDs. You could use celecoxib (Celebrex) or, I thnk, some COX2 inhibitors that are not available in the US. You could use it in conjunction with misoprostol, a synthetic prostaglandin E2 (with caveats re: pregnancy). You could use an H2 inhibitor like cimetidine, rantidine, or others. You could use it with a hydrogen pump (proton pump) inhibitor like Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), or Aciphex (raberprazole).

Some people exhibit a different reaction, that does resemble allergic reactions, and those people should not use any COX inhibitor, whether a selective COX2 inhibitor or one of the older NSAIDs. That may not be a true allergic rection, mediated by immunoglobulin E. It may be that the cyclooxygenase inhibition shunts eicosenoic acid or arachidonic aid into a pathway that makes leukotrienes, but the effect can be very dangerous in any case.

The reaction to Augmentin probably is a true allergic reaction and probably means that any penicillin derivitive is dangerous; you should use another antibiotic, and your chart should be flagged "Allergic to penicillin." You might want that on an ID bracelet, wallet card, and/or neck pendant. Those who have an allergic-type of reaction to NSAIDs should also have the chart flagged and perhaps note it on an emergency ID bracelet, tag, and/or card.

[Mad Mum Madz]

Just wanted to add my experiences with Fentanyl.

I went on to Fentanyl after MST prolonged release caused side effects including terrible mood swings (to the point that I was violent with my husband).

I started on *** patches, I am now on *** and will probably we put up to *** tomorrow. (Not sure what will happen is I am still struggling with the pain after that). I use them not just for Hypermobility pain but because I have Symphysis Pubis Dysfunction (SPD) linked to the HMS and am in extreme pain waiting for surgery.

Mod edit - Dosages removed - Please see board rules!

I have found that side effect wise I have coped better than with the morphine. I dont get the itching I had with morphine (but as I still use oramorph for breakthrough pain I use Fexofenadine for the itching which helps), the constipation is better and I have been able to lower my dose of Lactalose, the mood swings are more manageable and I am only nauseous just after a dose increase or when I am having a bad pain flare up.

The pain is being managed - I know it must be because when I forget to change my patch after 3 days I definately know about it the following day as the effects wear off. Although I do need my dose put up I am coping better than I was on the plain MST.

Good luck to those who try Fentanyl - I hope you are lucky with it too.

PS. I would say if you find you are having unwanted side effects when you first try Fentanyl I would recommend sticking it out for a couple of weeks if you can as I find that after a week or so of a dose increase the side effects that have come back start to wear back off and I can start to carry on life as normal (whatever that is!).