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Using buprenorphine patches for chronic pain and taking fentanyl. Feeling sick and forgot to take the old one. Suggest treatment

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Addiction Medicine Specialist
Practicing since : 2002
Answered : 1486 Questions
my husband has been on buprenorphine patches 20mcg/hr for chronic pain and has just been put on fentanyl 50mcg/hr. He still had his buprenorphine patch on which was working at it's strongest when i put the new fentanyl patch on and forgot to take the old one off, he woke yesterday feeling very woozy and sick i then realized what had happened and quickly whipped the older patch off but he still feels bad today. How long will this take to wear off or does he need treatment of any kind, what can i do to help him
Posted Tue, 19 Nov 2013 in Mental Health
Answered by Dr. Preeti Parakh 6 hours later
Brief Answer:
He should be fine within a week.

Detailed Answer:

Welcome to Healthcare Magic!

Please do not worry but this is is going to continue for a week or so. At present, what you are seeing are the signs of opioid intoxication. He is drowsy, may be slightly confused and his pupils probably are constricted. You can check with a torch. This phase usually can be expected to last for 48 to 72 hours. There is no need to worry now for intoxication related serious events as around twenty four hours have passed and he is now better than yesterday. So I do not feel that there is any risk of respiratory depression or stupor. But please keep a close watch on him to see any signs of altered sensorium or respiratory difficulty. If you notice any, please inform your doctor.

Once this phase ends, it is possible that he may experience mild withdrawal symptoms. Though he is on another opioid, the effect of fentanyl will not be equivalent to that of both together, even though it was only for a short time. That is why he may experience very mild withdrawal symptoms as buprenorphine leaves his body. He may experience some increase in pain, and possibly some sneezing, lacrimation, running nose etc. His pupils may appear to be slightly dilated. However, I do not expect any major withdrawal and I expect fentanyl to adequately cover for that. During this period, ensure that he is well hydrated. He will not need any treatment if he is able to tolerate these symptoms. Reassure him that these will improve in a few days.

Please keep in mind that the increase in his pain during the next few days does not necessarily indicate that fentanyl is not working well at the current dose. Observe for at least a couple of weeks before deciding if the dose of fentanyl needs a hike or not.

Please do not worry. Just keep an eye on him for the next few days. Ensure that he does not take any other medicines that can increase his drowsiness. Please ask him to keep away from alcohol also, as it can add to the drowsiness and confusion.

Hope this allays your anxiety. Please feel free to ask if you need any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry
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