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Suggest remedy for withdrawal symptoms from Fentanyl patch

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Posted on Mon, 11 May 2015
Question: I HAVE BEEN ON MANY, MANY DIFFERENT PAIN MANAGEMENT NARCOTICS FOR YEARS. HAVE BEEN TAKING A 75 FENTANYL PATCH, BUT CHANGED TO A MS CONTIN. MY PA-C PRESCRIBED 30MG 2X A DAY, BUT I AM DYING! I HAVE GONE THROUGH WITHDRAWAL BEFORE. I COULD NOT GET AHOLD OF DOC, SO I ENDED UP TAKING MORE. SO I CALLED A FEW PHARMACIES AND LOOKED ONLINE, AND THEY SAID BETWEEN 180MGS AND 260MGS OF MS IS EQUIVALENT AND 180 IS OK, BUT STILL GOING THROUGH W/D. WHAT MG OF THE MS DO YOU FEEL WOULD BE COMPARABLE? MY PA-C SAID 60MG! IS THAT CORRECT? I DO NOT FEEL IT CAN BE?
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Answered by Dr. Matt Wachsman (1 hour later)
Brief Answer:
a few other issues

Detailed Answer:
taking extra narcotics wtihout input from the doctor is not a very good thing. Fentanyl.... is.....tricky. It doesn't necessarily have a predictable equivalent BUT 60 of morphine seems a bit low. On the other hand, 75 of fentanyl is quite a high dose. AND it is continuous. Continuous long acting high dose narcotics are more likley to produce withdrawal and more severe withdrawal. AND... for many conditions a short acting narcotic is more helpful even if it is on top of another narcotic.

So... first, is whether any narcotics are appropriate. If it is toothache, or a minor problme or a short term problem (broken bone) then long term high dose narcotics would NOT be appropriate..

An alterntive would be to treat withdrawal symptoms. The medications to lower the symptoms of withdrawal can be phoned in. they are safe and not addictive.

then, whether long acting ONLY is appropriate or a low dose of long acting with a low dose of short acting along with it.

my bias would be muscle relaxant, over the counter non-steroidal meds, anti-ulcer med, and a withdrawal blocker such as clonidine. and anti-nausea medications.


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

Addiction Medicine Specialist

Practicing since :1985

Answered : 3926 Questions

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Suggest remedy for withdrawal symptoms from Fentanyl patch

Brief Answer: a few other issues Detailed Answer: taking extra narcotics wtihout input from the doctor is not a very good thing. Fentanyl.... is.....tricky. It doesn't necessarily have a predictable equivalent BUT 60 of morphine seems a bit low. On the other hand, 75 of fentanyl is quite a high dose. AND it is continuous. Continuous long acting high dose narcotics are more likley to produce withdrawal and more severe withdrawal. AND... for many conditions a short acting narcotic is more helpful even if it is on top of another narcotic. So... first, is whether any narcotics are appropriate. If it is toothache, or a minor problme or a short term problem (broken bone) then long term high dose narcotics would NOT be appropriate.. An alterntive would be to treat withdrawal symptoms. The medications to lower the symptoms of withdrawal can be phoned in. they are safe and not addictive. then, whether long acting ONLY is appropriate or a low dose of long acting with a low dose of short acting along with it. my bias would be muscle relaxant, over the counter non-steroidal meds, anti-ulcer med, and a withdrawal blocker such as clonidine. and anti-nausea medications.