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Generic Fentanyl-Duragesic Patch

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Unread 09-06-2006, 06:00 PM   #1
Ragtop
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Default Generic Fentanyl-Duragesic Patch

Greetings to all the familair names here, well.... all the unfamiliar ones too!
I was happy to see this site come up during the dragged out downtime on BT.
A big thanks to the Doc for helping us all out, way to go!!
Also thanks to Bobbi, for letting me know about this site.

Now to the topic.

I would like to hear any comments, or your experiences with the generic
fentanyl patch. I have always used the brand name patch, but recently
they increased my copay to $45 for the brand name, so I find the need to
try the other brands. I first tried the Mylan version, and it didn't seem to work as well as the real deal, so I went back on the brand name, and got better pain control right away. This month I tried the Sandoz brand.
I thought I would get better results, since this brand looked the same as the Janssen, and I have also heard that they were supposedly made by the same manufacturer. On close inspection, it does not appear to have the same amount of gell as the original, and the glue is different, a lot stickier.
The first day I used it, my pain levels went right up, and I had to take more BT meds to compensate. I normally change the patch every 2 days, but find with the generic, there is still a lot of gell left inside, when I change it. With the brand name, there isn't very much left at all after 2 days, that makes me wonder if the absorbtion rate is different with the two. I am taking into consideration that more will be absorbed on a hot day, or if I am exerting myself doing some task.
Has anyone had a similiar experience with the generics?
If this is what they are like, I will gladly pay the extra $40 for the real deal.
I'm sure the generic/brand name thing has been beaten to death in many posts, but I would like some input as far as the fentanyl patch goes.
I am nuts or what? To me there is a real difference with these products.
People may say that since I don't expect them to work as well, then they don't, but I really don't buy that, since the pain I feel is very real, and is very much affected by these different brands.
I realize by law, they must use the correct amount of the med, in my case7.5mgs of fentanyl, or a 75ugram/hr patch. I think the differance might be with the transfer layer in the gelpack, or possible the glue itself, which also has the medecine in it, but may not be transfering as well with the generic.
I have had similar experience with other generic drugs, the biggest one was
Darvocette, I was on them for years, and the generics were total junk.
So, is it me? am I just to sensitive to the changes, or am I not really getting what I pad for at my pharmacy. I wonder how how much testing is done with these products (generic) before they are allowed on the market? Or is more like, since the manufacturer already makes the brand name, its easier to get the generic on the market then, since the testing was already done on the brand name? Making it easier for drug company to slip an inferior product to the marketplace. I'm just saying.....they are NOT the same.

Peace
Rags

One added note, I love the speed of this site!!
Thanks to the Doc for the extra bandwidth!
BT-BT2 is like the tortise and the hare...

Last edited by Ragtop; 09-06-2006 at 06:15 PM.
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Unread 09-06-2006, 07:35 PM   #2
Wittesea
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Rags,

I was on the generic duragesic patches (75mcg) for a few months at the beginning of this year (I switched back to oxycontin in the summer because the patches started giving me a heat rash).

I never tried the name brand patches, but I did try both generics (sandoz and mylan) and in terms of pain control the sandoz was much better for me.... and I also noticed that there was always gel left over when it was time to change to a new patch (I changed mine every 60 hours - every two and a half days).

One thing I did notice almost immediately after I started using the patches was that I got much better pain control if I used Tegaderm-type covers over the patches. (I used Invacare brand because it was much cheaper than actual tegaderm).

For me, the patches stuck well enough on their own but I got the covers just in case, and the first time I used a cover I noticed better pain relief. I tested the theory by trying the patches with and without the covers and overall my pain relief was much better when I had a tegaderm-type covering. I have no idea why the covers helped with better pain control, but it was working so I didn't really care why.

My point here is that maybe using a cover would help you too - it's at least worth a try.

Take care,
Liz
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Unread 09-07-2006, 01:32 PM   #3
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Thank you for your post Liz,

I do use the Bioclusive covers sometimes, especially when its hot, or
for some reason I have to do some yardwork or anything that makes me sweat, since the patches like to start peeling off in hot weather.
Can't say that I have noticed any difference, but I will try using them all the time, and see if it helps at all.
I've got the feeling that I will just go back to the brand name product, since it is far superior in my opinion.
I have tried to get my doctor to let me try oxycontin, but he refuses to prescribe them, saying that they are too expensive. In reality I think he just wants to stay away from that drug, because of all the bad press it has been getting. He stated that he refuses to buy into the whole deal, the drug companies making far too much money on it, and all the problems it causes with drug addicts. He is a really great doctor, and he will generally give me what I want, with the exception of oxycontin, so I don't push the issue with him. Perhaps he may change his mind now that the generic oxy is out. Besides, have you noticed the price of the patch? My 15 patches show on the pharmacy slip as costing anywhere from $650-750 a month, I can't imagine that the brand name oxy costs that much!
I may ask him to let me try methadone, I've heard it's a really good pain killer, and cheap as well. It's just that after 5 years on the patch, they just don't seem to work as well as they used to, and I have had to have my dosage increased 2 times. I realize that this is probably normal, so that's why I want to change to something else, at least for awhile.
He tried me on ER morphine last year, but he started me at such a low dose, (15mg BID), that I was sick as a dog for a whole week, probably from withdrawal from the patch. I ended up putting a patch on when I just couldn't stand the pain anymore, and I was ok again within 4-6 hours.
I can't imaine putting me on 30mgs of morphine, when I was on a 75ugram patch, with percocets for BT pain. Beside I didn't like the way the morphine made me feel at all, if I took enough to get any relief, then I felt like a hospital patient, very, foggy, sleepy, and groggy. So if that was a preview of the morphine, he can keep it....LOL
I would think a reasonable dose of morphine would have been something like
80-120mgs per day, not the 30 he started me on! I know they always start low on a new drug, but give me a break, 30mg wasn't even woking at all.
I would have asked him for an increase, but just didn't like the drug compared to the fentanyl.

I appreciate you taking the time to answer my post.
I hope you are having a low pain day, I was glad to see the sun today, that means my levels will be down a little bit anyway.

Peace
Rags
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Unread 09-08-2006, 08:59 AM   #4
Wittesea
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I know the exact price of generic Oxycontin becuase my insurance company has this thing where they force me to pay cash at the pharmacy and then they reimburse me a week later.

It's a pain in the butt, but since oxy is the best long-acting for me I deal with it. Although this weird thing with the insurance is why I switched the the patch eariler this year because I didn't want to deal with the hassle, but whe the patch gave me a heat rash I decided to deal with the hassle because oxycontin gives me the best relief.

Anyway, for 20mg generic Oxycontin, 120 pills a month, the cost is $325 at my pharmacy.

For conversion... I went from 20mg oxycontin three times a day to 50mcg patches, then the doc upped the patches to 75mcg. When I had the problem with the heat rash and went back to the oxycontin I went fom 75mcg patches right back to 20mg oxycontin three times a day. I didn't have any problems with any of the conversions, no withdrawls, no incrased pain, no problems at all.

I now take 20mg oxycontin 3 times a day, with the option to take a 4th pill as needed. The doc writes "take 2 in the am and 1 or 2 in the pm" on the script with the oral instruction to me to take it every 8 hours and take the extra pill as needed at any time of day. This works great for me because on bad pain days I don't have to load up on percocet to fight the pain.

One of the things my doc and I have done to combat tolerance is to switch me off of oxy and onto MS contin for 2-3 months, and then back to oxycontin at my original dose. We do this every 12-18 months depending on when I feel like the oxycontin is less effective.

Although the conversion charts say that 20mg oxycontin equals 30mg MS Contin, for me, we have found that I do fine switching from 20mg oxycontin three times a day to 15mg MS Contin three times a day.

I personally don't like MS Contin as a pain med - it's makes me tired and groggy and causes too much constipation - but it does work on my pain, I just hate the side effects.... but to combat oxycontin tolerance I am willing to be on ms contin for 2-3 months every once in a while so that I don't have to constantly increase my oxycontin dose to make it effective.

I have been on oxycontin for several years now, and until this summer I stayed at 20mg three times a day and it was effective. It was just recently that the doc added the option to take a 4th pill a day, and that was not a tolerance issue but a pain increase issue.

Sorry to ramble, but hopefully I said something helpful

take care,
Liz
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Unread 09-09-2006, 02:04 PM   #5
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>>though the conversion charts say that 20mg oxycontin equals 30mg MS Contin, for me, we have found that I do fine switching from 20mg oxycontin three times a day to 15mg MS Contin three times a day.<<


Hello Liz,
I am surprised that you get good relief from that amount of MS Contin,
compared to the 75 patch.
Goes to show that we all react differently to pain meds.
I am going to ask the doc one more time about the oxy's. Looks like his price theory doesn't hold water anymore, especially now that they have the generics. It wouild be much cheaper for me to be on the generic oxy's.
Your experience with both of the generic patches, tells me that it is not in my head, the different brands do have different results. That's what I was looking for, someone who has tried them both.
Would you have stayed with the patch, if they didn't cause the rash?
Was the pain relief as good with the patch as it is with the Oxy?

I think the idea of changing meds every so often sounds like the way to go.
I think I'll try to get the doc to let me try something else, for that reason.
Hopefully he will let me try the oxy this time, if not, maybe methadone.
I was talking to my pharmicist, and she was the one who mentioned the methadone.

>>>>It was just recently that the doc added the option to take a 4th pill a day, and that was not a tolerance issue but a pain increase issue.<<<<

For me, I have a hard time telling the difference, I mean, am I am in more pain now, or is it part of the tolerance thing?
It very hard for me to tell if I am more pain because the drug isn't working as well, or if my pain has increased. I always blame the tolerance, maybe I'm wrong.
I am surprised that you have been able to stay pretty much on the same level for so long with the oxy. I have friends that have to be increased every year, one of them is now up to 40mgs twice a day, with a few 10mg oxy IR's
as needed. That make me wonder about oxy tolerance.
I was doing just fine on my 75ugram patch until I changed to the generic.
I don't know what to do now, maybe just go back to the brand name, and pay the extra $40...
Thanks for your replies, I do appreciate it.

Peace
Rags
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Unread 09-09-2006, 08:14 PM   #6
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Rags,

Just based on my own experience my thoughts about Oxy tolerance is that the people who seem to have tolerance issues - needing higher and higher doses to get the same relief - well everyone I have ever met or talked to who had/have that issue take their oxycontin every 12 hours.

In the literature the drug company gives to the doctors it says something like "if the dose is wearing off before 12 hours then raise the dose"... well my doctor decided that made no sense. If a person is getting perfect pain relief for 9 hours and then it goes down the tubes, then why give a higher dose instead of decreasing the time between doses?

This is just based on my own experience, but patients on 12 hour dosing schedules have a lot more tolerance issues that those who are on an 8 or 6 hour schedule.

When I needed the 4th pill added I knew it was an increase in pain instead of tolerance because of an actual physical change. It wasn't just a pain increase that I was having, it was a pain increase in one body area due to a specific problem - so it was clear that it was an increase in pain and not tolerance.... but without a clear physical change it is hard to tell the difference, and when my doc and I can't tell we switch me to a different med for a while and then it becomes more clear about whether it is med tolerance or pain increase.


I would have stayed on the patch if it didn't cause the rash... BUT, I am glad it caused the rash because I get much better relief with far fewer side effects from oxycontin. I got good pain relief from the patch, and if for some reason oxycontin was no longer available then I would choose the patch over morphine products, but for me OC works the best. Don't know why, don't care why, I just know it works and works well so I'm happy
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Unread 09-09-2006, 09:45 PM   #7
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I was on the fentanyl patch for about three years, switching back and forth between 50 mcg and 75 several times. 50 wasn't enough and the side-effects from 75 were too much. I agree that the Duragesic worked better than the generic brands, but to me the difference wasn't all that dramatic.

I went off the patch in February because I just couldn't stand it any more. For three years I'd felt like I was just existing in some strange different world by myself. I tried methadone, but got hardly any pain relief from it, and it made me feel sick a lot, so I stopped taking it after only a month.

Now I try to get by on nothing but Dilaudid, which I was taking all along for B/T pain anyway. My doc is willing to try whatever I want, but for as long as I can I'm going to try to live without it. Most people have problems with drug tolerance, but for me the effect seems to be the exact opposite. The longer I take a drug, the more intolerant of it my body becomes, at least when it comes to the side-effects. Besides, no matter what I've tried, the relief I got from pain has always been marginal at best. I guess for some of us, effective pain relief is just a dream.
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Unread 09-11-2006, 10:58 PM   #8
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I'm so glad I found you all. I happened to check back on the Spiney Land site and saw this posted in one of the posts.

I have been on the patch for 2 years and am glad to see someone else finds a difference between the different brands. I started out with the brands and then they sent the generics and I felt as if I had the flu. Everyone assured me that they were made in the exact place. My internist suggests it is the adhesive. No matter, there IS a difference. I got the brands again by mistake and felt so much better so I'm fighting the insurance company now for the brand names.

After changing back and forth two or three times it is like night and day.
Keep us posted. I finally feel that I wasn't delusional.
Maggie
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Last edited by Maggie; 09-30-2006 at 08:51 PM.
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Unread 09-30-2006, 02:42 PM   #9
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Thumbs down I am not crazy, and I have proof now! LOL

Greetings to All,
I wanted to post my findings about the generic Sandoz brand of the fentanyl patch. After suffering all month waiting to get my monthly script, so I could get the Duragesic brand once again, I finally got the Janseen/Duragesic brand name again. There definitely IS a difference with these generics patches, it is NOT in my head, and the posters here seem to agree with me.
I did a little experiment with the Sandoz brand, which is closer to the Duragesic in looks, and how it works, transfer mechanism, etc. I cannot believe that these are exactly the same product, and here is my proof.
I weighed a Sandoz patch after peeling of the protective layer, and it weighed 1.4 grams. Then I weighed it again after it was on 2 full days, and it now weighed 1.3 grams. I though, OK, I better do some more weighing to be sure, and every patch weighed 1.4 when new, and 1.3 after 2 days.
Then after getting the Duragesic, I again weighed it after peeling off the protective film, and it also weighed 1.4 grams, BUT, after having it on for 24 hours,(I timed it), it weighed only .9 grams after taking it off!
I will retry this again in 2 days to see if the results are the same.
This tells me what I already thought was the case, the Duragesic brand transfers much more of the gel to my system than the Sandoz did.
I don't know if it is something to do with the glue, or the transfer layer in the patch, but after 2 days, the Duragesic is all but empty, while the Sandoz still had most of its gel left, it looks like most all the gel was still in the reservoir.
So, only .1 gram of the gel was getting into my system with the Sandoz/generic brand, and .5 grams was getting through with the Duragesic.
This is a HUGE difference in my opinion, and probably accounts for the poor performance of the generics.
I would like know how they can say these things are the same, when they obviously are not. I didn't even bother testing the Mylan brand, as they hardly provided any relief at all for me, so I refuse to buy them after suffering with them for a whole month, feeling like I was in withdrawal all the time.
The pharmisist was very surprised when I asked to go back on the brand name, she said that she has never heard of any complaints about the generic patches, but I haven't told her about my weigh in test yet.

Thanks to Liz, Maggie, and Idealist for answering my post, I do appreciate your input!
My wish to all is, less pain, and more life!
Peace
Rags
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Unread 09-30-2006, 09:05 PM   #10
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I've been back on the generics for two months until I can get insurance cleared up. I am having a lot more pain but did finally quit having the withdrawal symptoms. That makes me wonder if maybe a higher dosage than the brand would work.
Bets on that going over good with the Doctor?
Maggie
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I'm a retired nursing prof. I've had 5 surgeries on my lumbar spine, and now have a titanium cage for stability. My condition is early onset spinal stenosis. (29 yrs. old, 1st.surgery)
Had the morphine pump for 5 years and it was removed when the battery ran down. I'm now using the duragesic patches.
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