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Should I Increase The Dose Of Fentanyl 50 Mg Patch To 75 Mg To Get Relief From Pain?

Posted on Sat, 30 Mar 2013

Question: My fentanyl 50 mg patch quits after 48 hours.My Dr. wants to up dosage to 75mg.How will that solve the patch quitting early and giving me pain relief the last 24 hours. She also did not want to change the patch at 48 hour which I feel would give me continuous relief..
.I did not like the answer of increasing the dosage to solve the time problem so I did nothing.Any ideas please,
XXXXXXX

Answered by Dr. Robert Galamaga (4 hours later)

Hello and thank you for sending a question.

Your question is a very good one and I will work on providing you with some information and recommendations.

I actually agree with escalation of the dose of the patch. This should help to keep your pain under control for a longer period of time.It is possible that the higher dose of pain medication might help to saturate the opioid receptors for a longer period of time which would subsequently provide you with more relief. I think it is worth a trial to see if this provide you with a significant degree of relief of your pain.

Another alternative would be to provide you with longer acting oral pain medication which you would have to take at least twice per day. I am sure your doctor has talk to about this option.

At this time there is no FDA approved indication to change the patch any more frequently than every 72 hours.

Thanks again for sending your question. Please let me know if you have any additional concerns or would like to discuss this in more detail.

Sincerely,

Dr. Galamaga

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Robert Galamaga (9 hours later)

@ the level I am on now ,after 2 months on the patch,my body is not itching nor having light nausea nearly as bad as at first.I am conserved that the higher level will have greater side effects that as the lower dose. Another concern is developing a tolerance level at the higher dose and so on and son on..I am using Nucynta 100mg 90/ month for BT. I am trying to be more active ,more so than for a long time, when feeling better but finding that 90 is not enough for a more active level and by the end of month running out of BT. Dr. Does not want to raise Nucynta level.. Thanks for your reply, XXXXXXX

Answered by Dr. Robert Galamaga (8 hours later)

Thanks for the additional information.

I still think it would be reasonable to consider a titration of the patch at this time. If you are not happy with side effects or pain control you can always go back to the lower dose and continue the breakthrough medication.

Thanks again for sending your question. Please let me know if there's anything else you would like to discuss.

Sincerely,

Dr. Galamaga

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Robert Galamaga (1 hour later)

What BT med..do you recommend.I have very limited knowledge in this area.The oxy family does make me itch a great deal.Nucynta has limited side effects but do not know if this the best choice.I t is very expensive..Thanks

Answered by Dr. Robert Galamaga (3 hours later)

Hello and thanks for the follow up question.

I think you should possibly consider discussing long-acting morphine as a good alternative for breakthrough pain. There is also liquid morphine which can be placed under the tongue for breakthrough pain in some cases. This liquid morphine is often effective within 15 or 30 minutes.

Again a thorough discussion regarding pain management is something that is very important for you to maintain between yourself and your physician.

Thanks again for sending your question. Please let me know if you have any additional concerns.

Sincerely,

Dr. Galamaga

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar