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    Fentanyl replacement?
    smartin9 posted:
    Does anyone know of a medication that is an equal replacement for fentanyl patches 25 mcg? I've been using this for 3 years and it doesn't seem to be helping very well with the pain like it was and part of that is probably because I live in a hot climate and I am going to be outside even more in the future. I'm not wanting something that is going to cause me to go into withdrawal though (a med w/ a different structure than an opiod) but I want something that will continue to help with the pain. Thank you.
    teresakitty2 responded:
    Hi smartin9, You are going through the normal progression of tolerance to opiate medication despite whether it is hot or not. Tolerance builds up after a period of time and requires increasing meds or changing to another type. The dosage can be increased to either 37 mcg (12mcg + 25 mcg) or 50 mcg. You are still on a relatively low dose of Fentanyl now and have room to go up if that is what you choose. Do you have and short acting break through meds to help when you have a lot of pain? If not, ask your doctor about adding those to help in addition to your long-acting Fentanyl when your pain is at its worst. If you really want to change, there are other opiate drugs available in equivalent dosages that you can discuss with your physician and pharmacist. Teresa
    cweinbl responded:
    "Smartin9," there is no equivalent replacement for Fentanyl Transdermal (Duragesic). At more than 80 times more potent than morphine, Fentanyl is by far the most powerful pain medication available. We all become tolerant to narcotics over time. That's one reason why doctors start patients out on the lowest appropriate dosage. It is normal to require a higher dose years later, in order to achieve the same effect. Just tell your doctor that the 25 mcg patch isn't helping enough. He or she should be willing to bump you up to the 50 mcg or 75 mcg patch. Note also that there is a 12.5 mcg patch, to fine tune the dosage. Medication titration is a normal and routine function of a physician. It is normal for someone using a 25 mcg patch to need a higher dosage after three years. I suspect that the 50 mcg or 75 mcg patch will give you the same relief that you experienced with the 25 mcg patch three years ago.
    teresakitty2 responded:
    Hi, According to the many conversion tables used for cancer patients in palliative care, there are oral morphine doses that can be taken Q4 hours that equal 25 mcg/h Fentanyl patches. Don't feel it is appropriate to get into the mechanics of drug dosing here as Charles mentioned, since it is a more pharmachological issue that can be addressed by your physician and pharmacist if you wish comparable morphine instead of Fentanyl.
    annette030 responded:
    There are many other medication options for you, especially while you are on such a low dose of fentantyl. You can switch to any of the oral long acting opioids without having to go through withdrawal. Discuss all the pros and cons with your doctor. I personally feel any of the oral meds will work for most people if the dose is adjusted properly. I recently switched from a generic MS Contin that I was taking twice a day (it did work fine for twice a day dosing) to methadone. Because I opted to start at half the dose my doctor said would probably end up best for me, I have a bit more pain, but I am using BT meds for that. She and I discussed a plan and I am using that to make the change. I really wanted to start low and move up slowly, because methadone acts a bit differently than other drugs. I will increase the dose after one week if necessary. I opted to make the change for financial reasons because I am going on Medicare part D, and I do not want to end up in the donut hole every year. I need to keep my med costs down in order to do that. Methadone is really cheap, $5-7 dollars a month at the dose my doctor thinks I will end up on for now. You also don't need to take oral morphine every 4 hours, there are generic long acting morphine formulas that work fine and are cheaper than the brand name drugs. Talk all this over with your doctor!!! Take care, Annette
    teresakitty2 responded:
    Hi, Was only using oral morphine Q4h as an example of conversion with fentanyl. T.
    annette030 responded:
    I understand that. I just wanted the poster to be aware that there are both long and short acting forms of morphine available. Take care, Annette
    smartin9 responded:
    How come when I look online all of the "official" articles about methadone refer to it as being a medication for opiate addicts. The only info. on the internet about using methadone for pain are blogs where people talk about their experience, nothing official. Also, I had a dr. once tell me a few years ago that methadone was strictly for addicts. Have doctors become better educated and why is there so little info about using methadone for pain rather than just for addicts trying to wean themselvs off an opiate or heroin?

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