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Fentanyl patches - 'Mallinckrodt' vs 'Watson'

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Unread 01-04-2013, 01:35 PM   #1
Rrae
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Default Fentanyl patches - 'Mallinckrodt' vs 'Watson'

Hello!
I've been using Fentanyl patches for 3 yrs (manufactered by Watson).
They've been very helpful.

Today I picked up my monthly refill and the pharmacy has switched manufacturers. These are made by Mallinckrodt.

I haven't opened them up yet, as it's not quite time to change my patch, but my immediate concern is that these patches are significantly smaller than those made by Watson. These are the matrix kind, which is administered via the adhesive. I've never used the matrix kind, only the gel ones. After what I've been reading online, I'm getting very concerned that these patches are for the birds and that I'm going to be in bed with pain and w/d symtoms. For one thing, I'm not finding very much info whatsoever and the few reviews that I do find are all negative.

Has anybody used both of these brands and if so, is there a significant difference in them?


Any insight would be much appreciated.

Rae

Last edited by Rrae; 01-04-2013 at 08:08 PM.
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Unread 01-04-2013, 08:35 PM   #2
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Rare

The matrix patches are just as effective as the reservoir (gel) patches. They work extremely well and are very easy to live with because they are completely flat with no risk of loss of the drug from the patch by puncturing etc. I appreciate they may not look like much but I can assure you they are highly effective.

However, the two types are not interchangeable. If you are using reservoir patches then you should be continuing with them and shouldn't suddenly be prescribed the other type because the dosing isn't quite the same. In theory there should be no difference in the effectiveness of different manufacturers' patches provided they are both reservoir or both matrix types. In reality, some people find that they will get on better with one particular manufacturer's patches.

If you are being deliberately swapped from one type to the other then your prescriber should be discussing that with you and making allowances for any dosing difference but it sounds as though this has change happened to you by accident. I think you should check the situation with your prescriber and take advice before doing anything else.

The matrix patches are extremely difficult to abuse so it would seem likely that their use will increase. The reservoir type can be cut open and the whole contents eaten by drug abusers to provide a 'hit'. This is impossible with the matrix patches - they will only deliver at the stated rate so they are of little interest to abusers.
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Unread 01-04-2013, 09:11 PM   #3
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Smile Thanks for this Neurochic

I very much appreciate your feedback. I can at least sleep tonite

You're right, I picked these up from the pharmacy today with no warning or discussion whatsoever regarding the different brand and it being matrix instead of the gel that I've been used to for 3 yrs.
I don't think my Dr has a clue that this pharmacy switched manufacterers, so I'll probably have to call the pharmacy first to see 'why' they switched me.

I guess it's a 'wait and see' thing.
When you say that the 2 are not interchangable, do you mean that it's possible my body could have a reaction?

Thanks for your help!

Rae
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Unread 01-04-2013, 09:37 PM   #4
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When I say that they are not interchangeable, what I mean is that although the drug is just the same, the 2 types of patches physically work differently. This means that they won't necessarily be delivering the same dose per hour.

The key feature of transdermal delivery (ie patches) is that they release a steady dose of medication over a set period. In theory, provided you always use the same delivery system, then you will get the same dose every hour and your body won't be subject to fluctuations in the level of the drug in your system. If you chop and change the delivery system (ie reservoir to matrix or vice versa) then you are at risk of receiving a different dose each hour. It may be minimal or your body may be insensitive to the difference so there are no noticeable issues. However, if the difference is significant or you are sensitive to even small fluctuations in the drug level, you may experience increased side effects or withdrawal symptoms. Both potentially dangerous and at the very least a bit unpleasant.

Transdermal delivery and the nature of how fentanyl is absorbed and used, means that its difficult to make rapid adjustments to fentanyl levels either up or down to manage any problems that do arise. For these reasons, it is advised that the different types of patch are not interchangeable.

It's possible to be swapped from one to another in a managed fashion but that would be a single swap over with the intention of sticking to the new delivery system for the longer term, not just changing each time the pharmacy has a different type of patch in stock. A managed swap would take into account any anticipated variations in the hourly dosage rate and compensate for that.

Hope that explains. I find the matrix patches are excellent - so unobtrusive and easy to tolerate since they are essentially no more than a little piece of Sellotape.
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Unread 01-05-2013, 12:37 PM   #5
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Thanks for explaining so well!
Last night I put the matrix patch on and this morning I woke up completely pain free! Usually I have to take my breakthru med first thing in the morning, despite having put on a brand new transdermal patch. So, this is a good sign!

I've read several testimonies that the matrix works real well at first, but then it loses it's effect by 48 hrs. I don't take much stock in the sites I was getting this info from tho.

I think I'm gonna like these things, for all the reasons you mentioned.
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Unread 01-07-2013, 06:53 PM   #6
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I'm glad it seems to be working well for you.

I think you will find that the length of time you have full effectiveness of the patch is a very individual thing. I can find that my pain can increase in the third 24 hour period. I normally just suck it up and live with any increased pain but if I'm desperate I change the patch a bit earlier although only very rarely at 48 hours. If it is a major problem and is happening on a regular basis, it is possible for doctors to specifically prescribe that the patch be changed every 48 hours instead.

The rate of absorption of the drug can be affected by countless things such as where you stick it to your skin, how hairy you are, how well each patch adheres, your body temperature, external temperature changes such as use of a sauna or lying in a hot bath, how physically active you are, how many layers of clothes you have over it and so on. Things like saunas and hot baths are supposed to be avoided due to the risks of a high dose being released too quickly but I use saunas, steam rooms, spas and have been on holiday to spectacularly hot places and so on and have never had any issues.

The drug is delivered into the skin by the adhesive so if you don't get good adherence it can shorten the effective lifespan of the patch. Sometimes this happens if skin is a bit greasy or too dry. I have virtually no body hair so adhesion issues from hair don't affect me!!

I often have to change the patch an hour or two before the 72 hours is up, especially if I start to feel withdrawal symptoms coming on. I have been using the patches for years now so I know exactly what it feels like for me when the level of the drug in my system starts to drop to a point when it will kick off the start of withdrawal. It's deeply unpleasant although not dangerous as its only just the very start of that process so I am always careful on the third day to try and get the thing changed in good time. I have discovered that I get best results by leaving the old patch on for around 12 hours after I've stuck the new one on. This means I have 2 in place for up to half a day with one of them theoretically empty but it seems to give me the best transition.

As always, a bit of trial and error is required.
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Unread 01-08-2013, 01:29 AM   #7
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I told my doc at my recent visit that a couple (maybe 3) times a month, I end up putting on a new patch at about 60 hours rather than 72. Depends if I've been exherting myself & pain spikes, or like you said, predisposing myself to higher temps, which will drain the patch quicker... He surprised me by giving me TWO extra patches this time! What a pleasant surprise .
It IS hard to make 10 patches last 30 days. Putting on a new patch 12 hrs early a couple times a month uses up one extra day.....if there are 31 days in the month, well that works against us....so it's very easy to fall short somewhere along the line, thus suffering w/d symptoms for a period of time.
Also by day 3, I begin to get pretty severe depression symptoms and anxiety. I just hate the fact that my life seems to revolve around these patches, but at the same time I'm very grateful to have this pain management.

At one point a couple years ago, I was prescribed for every 48 hours. Absolutely NO room for withdrawal symptoms in that case, which of course is very nice, but that's keeping a pretty heavy stream of fentanyl in the system....not to mention the extra cost.
You're right, it is a very individualized thing.
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Unread 01-08-2013, 02:09 PM   #8
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In the UK we don't have the same issues on prescribing. The rules allow doctors to prescribe no more than 30 days worth of this type of drug at a time but if I use mine up early it doesn't matter, I just request more and there are no issues getting another 30 days supply. That way if I have to change a few patches early it makes no difference and I never have to suffer more pain or withdrawal problems.

I know there are lots of people based in the US on this site who think our nationalised system is backward and awful but there are many aspects where we are well ahead of the US. Where I live in the UK all prescribed drugs are completely free of charge - we pay nothing for any of our medication at all.
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Unread 01-10-2013, 11:58 PM   #9
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That's fantastic! No, I've never heard of anyone on this site implying the UK is backward. (?)
The DEA here has cracked down WAY too much on prescribing. It makes me sick how people who are in genuine horrible pain have to jump thru so many hoops and alot of times deal with the humiliation of being labeled addicts.
This is what it's come to because of those who DO abuse and sell prescription pain meds. And if this isn't bad enuf, big pharma has ridiculously overpriced meds, so that people can't afford them......and oh my Lord, I better not even go into the healthcare mess we've got here. I'll end up blowing a gasket
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Unread 01-12-2013, 11:28 PM   #10
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Back when I lived in the boondocks, the county I lived in had two mom and pop pharmacies and no large ones. Once in a while they would try to switch my Fentanyl patch and it was always because they were out of what I normally took. I couldn't use the Watson brand because they made me break out so I had my pharmacist buy my brand from the pharmacy down the road and then resell it to me. Perfectly legal. Otherwise, I would need to get permission from my pain doc to use a different pharmacy per my drug contract.
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