lespierce
Journeyman
Reged: 11/25/03
Posts: 56
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I had a consultation with my Doctor today, and because of chronic pain, as a result of severe osteoarthritis, I am going to start using the Duragesic Patch. I had forgoten to ask my Doctor if it was OK to just stop taking the Vicodin, because I have been on Vicodin for about 6 months now, taking it at least 4 times per day. I have been taking the 10/500 strength (Actually Lortab), but I am wondering if I stop taking it, if I will have W/D. I will be starting the patch tomorrow, and I called the pharmacy, and they thought it was a good question, that I should ask my Doctor about. Has anyone else made a switch like this? I am obviously going to ask my Doctor about this, but I thought maybe someone on the boards may have done something like this already, and could offer some real world experience.
Thanks!
Edited by lespierce (03/11/04 06:12 PM)
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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I HIGHLY doubt you would experience ANY withdrawal symptoms from jumping from hydro to fentanyl. It's a virtual impossibility as it is a FAR stronger narcotic. The only reason I could see for any withdrawal symptoms would be poor patch adhesion or such a small dose of fentanyl compared to your dose of hydro--40mgs of hydro a day is a relatively low/medium amount for a chronic pain patient. I don't recall if you mentioned the strength of your Duragesic patches or not.
I would think you would get superior pain relief from the fentanyl and it will also be continuous--a definite advantage to oral hydrocodone.
I wouldn't stop taking the Vicodin until you have adhered the fentanyl patch. But definitely give the Vicodin a rest until you understand how much the fentanyl will affect you. And it will also give you the opportunity to objectively compare the pain relief you get from the patch.
If you doc continues to prescribe hydro, I would think it would be for "breakthrough" pain...i.e. shoveling your driveway increases your pain to an intolerable level, hence you would use one of the Vicodin.
HOWEVER, do consult with your physician for his/her specific instructions about using the hydro in combination with the fentanyl. Always better to be safe rather than sorry! Good luck!
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Never underestimate the predictability of stupidity.
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lespierce
Journeyman
Reged: 11/25/03
Posts: 56
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Thanks, night_shade! I will be taking the 50 microgram version of Duragesic. I didn't think I would experience any W/D, and I am looking forward to some relief. The 40 mg of Hydro per day, was not cutting it. I would be lucky if I got 4 hours of relief from the Hydro. I have tried all the Cox-2 drugs, and had severe stomach problems with them, even though they are supposed to be easier on the stomach. And forget NSAID's, they don't touch the pain, and make my stomach feel like there is a hole burning through.
I am really hoping that the Duragesic Patch does the trick for me. I will probably keep some hydro around for the breakthrough pain. I am usually in some intense pain after shovelling from a snowstorm. Now I know why so many people move south, when they get arthrtis, and I am still fairly young. I was in a severe MVA when I was 19, and I am lucky to be typing this right now.
PS: I like your loc: The State of Hockey
Playoffs are coming shortly 
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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You may need to take the hydrocodone for another 18-36 hours.
It takes about 18-36 hours for the fentanyl to get into your system and start working when it is administered via patch.
After that, you will reach steady levels of the drug, if I recall correctly within 72 hours.
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LumbarSpasm
Or just a pain in the butt?!
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Good point, Lumbarspasm...I had forgotten that the transdermal system took a bit to start working effectively.
lespierce- There's no hope for playoffs for us this year! 
I've never had any experience with the fentanyl patch, but I've fentanyl multiple times as both pre and post-op pain control.
50mcgs Fentanyl transdermal is roughly equivalent to the following meds:
400-700 mgs of oral codeine/day
45-90 mgs of oral hydrocodone/day
15-30 mgs of oral hydromorphone/day
3-6mgs of IV hydromorphone/day
150-250 mgs of Demerol (IV/IM) per day
45-70 mgs of oral methadone/day
135-225 mgs of oral morphine/day
65-125 mgs of oxycodone/day (oral)
and it's half life is increased from 1.5-6 hours to 17 hours when administered transdermally.
So it looks like you should get some good relief on the patch once it kicks in.
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Never underestimate the predictability of stupidity.
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lespierce
Journeyman
Reged: 11/25/03
Posts: 56
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I thank both of you so much for you contribution. This is much more information than the pharmacy had for me, and I don't really think I need to call my Doctor now. I did some more searching, and found about the same information. I have had the patch on now for 4 hours, so hopefully by 8 or 9 tonight I will feel it kick in.
I was trying to search for the equivalent dosing calculator on the net, but I couldn't seem to find it, so thanks for that useful information, too.
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