Talk:Fentanyl

Tomo1952 04:01, 24 August 2006 (UTC)The text of the original version of this article was taken from the public domain source at http://www.usdoj.gov/dea/concern/fentanyl.html

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OK, someone on a TV show that most people haven't heard of or have seen died of a fentanyl overdose. Is this a really big story that increases the notoriety of the drug? Opiate overdose isn't all that big of a story.

Halothane is definitely not a fentanyl derivative.

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After having copyedited the phrase about oxygen displacement in the Moscow theatre siege, I'm uneasy about the ways in which a complex situation (including pharmacologically-speaking) has been rendered with a rather brittle 2-D certainty. What about respiratory depression? The chance that no provision was made for antagonist/naloxone-type reversal? See: * Wax PM, Becker CE, Curry SC. Unexpected "gas" casualties in Moscow: a medical toxicology perspective. Ann Emerg Med 2003;41:700-5. PMID 12712038. Armeria 16:21, 22 November 2005 (UTC)

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I added the phrase 'other examples of chronic, nonmalignant pain' because the four nonmalignant disorders listed are not exclusive to treatment with Actiq. I also changed the flavor from citrus to berry, because Actiq is not citrus-flavored. It's tastes like a cross between raspberry and grape, and the flavoring decreases in effectiveness as the concentration of medication in the lozenge increases, so the 1200mcg lozenge actually tastes more bitter than sweet. My source: me. I'm a patient who has taken this drug, in both Duragesic and Actiq forms, for nearly 4 years. Trust me - I know how the stuff tastes. :-) ddlamb 02:54, 30 November 2005 (UTC)

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The article definitely needs an explanation about why the two external links about MPTP and Parkinsons's disease are here. I know MPTP is a by-product of the illegal manufacture of fentanyl, but I'm unable to find very much about it and at what point in the manufacturing process MPTP is made. Someone with a better knowledge of the chemical structure needs to address it. There's no mention of MPTP or Parkinson's in the article's body - just those two external links. ddlamb 08:27, 1 December 2005 (UTC)

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Well, after crawling through those links and some other searches, it seems that those externals have no reason to be there. MPTP is a failed attempt at synthesizing MPPP - which was supposed to be a meperidine (aka Demerol and a zillion other names) derivative. The unfortunate chemist attempted to make MPPP, and made MPTP instead, a highly toxic and Parkinson-causing substance. Someone sold it on the street, and several young users came were admitted to hospitals with Parkinson's symptoms (taken from one of the external links). So, while that's a fascinating tale in and of itself, it does not seem to be pertinent to Fentanyl. Their only similarities are 1) being synthetic opioids and 2) being sold as synthetic herion. These, I feel, do not constitute enough of a similarity to merit an external link (or two), with or without explanation. I will take the liberty of removing the links if no other explanation comes forth.
Most of my information was obtained from this erowid page and from here. (EDIT): I removed the external links. --Silvem 09:12, 7 January 2006 (UTC)

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It seems like it would be more appropriate to list C22H28N2O as the formula, rather than including the HCl. http://www.genome.jp/dbget-bin/www_bget?dr:D00320

LD50

LD50 isn't really a useful parameter for most drugs used in humans because doses used are pretty much always far sub-lethal (except with cancer chemo and stuff). ED50 (effective dose) and therapeutic range are more relevant. I reckon LD50 should be chopped out of the intro paragraph... ben 04:25, 16 May 2006 (UTC)

I wouldn't object to moving that content, but I don't think it should be removed. The ratio between the ED50 and LD50 is commonly used to identify how safe it is to administer a medication. Of course, we don't have the ED in the article, but I still think that the LD is relevant. --Arcadian 20:10, 19 May 2006 (UTC)

Especially since there are news reports about how fentanyl is deadly when mixed with illegal drugs: "Just one hundred and twenty-five micrograms -- the equivalent of six grains of salt -- is enough fentanyl to kill." (Kim Norris, Detroit Free Press, June 16, 2006) I originally came to this page to see how accurate that statement is. If the LD50 is 3 mg/kg, that number is probably a bit sensationalized. -- Tmhand 14:08, 16 June 2006 (UTC)

For opiod-tolerant patients or "recreational" users, 125 mcg. is probably safe, but for those who are not, 125 mcg. can kill. So any user should always start with the lowest dose, under doctor supervision; a doctor that knows about opiods. MeekMark 17:57, 2 August 2006 (UTC)

Half-life

I think the thing with the half-life is that heroin itself has a half-life of a few minutes, because it's broken down into morphine, but then morphine has a half-life of several hours. That's why fentanyl is considered to have a shorter half-life (I've read in multiple places that its effects are shorter-lasting). I'm too tired to find a good source for this right now, but if it's correct it should be noted (probably in both articles). --Galaxiaad 08:28, 2 August 2006 (UTC)

It was good to remove the information on half-life for the Duragesic transdermal patch, as it continuously administers the drug while the patch is on, and some of the drug is continued to be absorbed even after the patch is removed; IE: After the patch is removed, some of the drug is in the process of being absorbed and transmitted through the skin. MeekMark 17:53, 2 August 2006 (UTC)

Added the section about the different ways the patch flow rate is altered by external factors. Was amused by a package insert that suggested shaving over the sub clavian artery to fix the patch there. I find that putting them over an area with a layer of fat underneath helps to keep the flow steady. I put them on my side which is convenient for positioning a cold pack over if I want to be outside for a while in the heat. Hard to concentrate at my dosage so clarity edits on the language is appreciated. I understand that that was a major edit but Am not sure how to do the instruction for that or how to do the name sign thing. New knowledge doesn't retain well at significant doses. Tomo1952 04:01, 24 August 2006 (UTC)

Fentanyl and length of action

I use the 50mcg/hr patch. I place this on my thigh due to reasons where I can't place them on my arm/back due to using a heating pad for neck/shoulder pain. Since the uptake seems to increase and can become dangerous from my understanding if heated. I am an opiate tollarant patient and using this for pain management. My curiousity is why is this patch only lasting 36+/- hrs? Is is due to the placement on my thigh (which btw, I don't have much adipose tissue)? I've tried placing them on my side, but have a problem with the patch coming off too early. And if I placed it on my chest which there's no adipose tissue there either; would this increase the uptake and half life of the medication due to location of a main artery? Also, does the uptake of the medication stay at a constant delivery if the body temp is cool? I stay cold all the time. Or is the uptake of delivery depend on the metabolism of each patient? I am thinking that I will need to increase this dose and will speak to my doctor concerning this issue. I don't have any other medications for "break through" pain at this moment. We have tried Dilaudid, which MS, be it synthetic or the real thing is not a good drug for me since I have horrible side affects. So, what's next? Anyone have any ideas? 75.12.45.205 05:21, 18 September 2006 (UTC)

I am currently taking Duragesic patches for fibro mayalga and another disease of the muscles' surrounding tissue that I am not too adept in remembering the name of. My current dose is 200ug/h, with two 100ug patches placed on the soft part of the bottom of my back. I switch it up every three days, I'll put the two 100ug patches on the lower part of my back, then the next three, days, on my thighs (well, two patches on a single leg, to avoid any problem with one of the patches ripping off, as I can always ensure that a side will be "patchless"). Anyways, I've found (like you, I use heating pads as well for back and neck pain), that the patches on my back seem to metabolize more quickly. For me this may be a bit different from you, because the fat on my back is rather thin, and the doses on my back take effect within 11 hours usually, and always feel more potent than 11-12hours later than the ones placed on my thighs. The heating pads also ALWAYS increase the potentcy, or, rather the intake of trandermal doses on my back. I've even felt doses take effect almost an hour more quickly while sleeping on a heating pad than without, though I am not an expert in this field, so this is mainly a personal notice. I've asked about placement of the patches, and I've been told that physical placement has a rather profound effect on intake of trandermal fentanyl, with respect to an increase in the time it take the fentanyl to be metabolized. It has to do mainly with the tissues that the fentanyl has to work its way through physically, to make it to the bloodstream. Also, heat can decrease the viscosity and increase the intake of fentanyl transdermally as well. None of these effect though is so huge as to create a dramatic difference in the placement of the patches, so it really becomes a comfort issue, and where you can place the patches to feel most comfortable.

PS - have you ever had a patch rip-off, and had to place another one on in place of it (that's what I've been instructed to do)

Answer -

It's the worst feeling, because it takes a few extra hours to "quick-start" the next patch you place on, and will make the next few hours of the day a little more annoying than they should be. I even did this so often one month that they thought I was selling them or something; I say "something" because I have no idea. I tried to order more when I was getting low, and for the first couple minutes of the conversation they weren't gonna give them to me. However, they finally realized how ridiculous they were sounding and I was ok. Having chronic use for opiates, I think you would know how horrible it would be to suddenly find yourself without the proper medication for almost two weeks, which is an ETERNITY when you suffer from chronic pain.

I'm actually having some breakthrough pain right now, so I'll write back later and check over my writing when I'm feeling a little better, but that brings me perfectly to your next question. I have been prescribed Statex brand Morphine Sulfate tablets, 25mg, about 20-30 a day. My tolerance is so high that it doesn't matter so much how varied my morphine doses are, as they are relatively non-potent. Orally, I receive about 8mg per 25mg pill I believe is what I've been told. Initially, they made me very itchy when I first took them, but to combat that, all I had to do was take some dimenhydrinate or diphenhydramine (anti-histamines) to combat what they told me was a histamine reaction with the morphine and some people. It worked perfectly! And it has been handling my break-through pain for the last 3 years and 7 months.-TAz69x 17:23, 29 September 2006 (UTC)

Duragesic Patches

I heard this somewhere, and although I've been using Duragesic patches for over two years now, I don't know if this is true. I heard that the adhesive layer of the Duragesic patches (I have the 25's, 50's, 75's, and 100's, although I use two 100's currently every three days), anyways, I heard that the adhesive layer of the patches contains fentanyl itself. I was wondering if this is true. In a few of my old patches that had remained unused, usually from dosage changes or simply having a couple left over, over time in a few of them a crystalline pattern appears within the patch itself and along the outer-part of the patch, where there's still an adhesive layer, but no gel above it. Even on some of my empty patches that I had forgotten to flush, there formed a crystalline pattern underneath and somewhat within (I think, it looks like it's inside the patch, but I'm not sure, it might be formed on the under-part of the patch). So I was wondering a couple of things:

1. Does the adhesive part of the Duragesic-brand patches (the one with the gel) contain fentanyl itself?

Answer -

Depends. Janssen's Durogesic (here in central Europe) comes in two variants -- Durogesic TTS (with active compound reservoire) and Durogesic SMAT (matrix-based patches). The TTS's contains fentanyl in a reservoir behind a permeable membrane, in the patch, in a form of gellified, alcohol-water solution. The fentanylö absorption rate is regulated via the semipermeable membrane in this case. The SMAT variant contains fentanyl mixed up with additives in the adhesive layer matrix. The absorption is here regulated by the concentration of fentanyl in the adhesive layer matrix and its polymer-based composition. So, Durogesic TTS does not contain fentanyl in its adhesive layer, while Durogesic SMAT does.--84.163.111.204 02:46, 1 April 2007 (UTC)

and 2. Is that crystalline structure that sometimes forms on older used patches perhaps pure fentanyl dried to form its original crystalline structure?

Answer -

No, it certainly is not. It is a mixture of gellifying additives and admixture of fentanyl that precipitates.--84.163.111.204 02:46, 1 April 2007 (UTC)

or perhaps simply non-exposure to air but simply age has instructed the fentanyl to form these crystalline structures?

Answer -

See 2.. It is not pure fentanyl.--84.163.111.204 02:46, 1 April 2007 (UTC)

Thanks so much for your help.

E-Trans(tm) Fentanyl

There appears to be a new product utilizing iontophoresis to deliver fentanyl quickly via a patch for acute post-operative pain management. It's the "E-trans" from the same company that makes Duragesic (Alza).

I should note that Alza also makes a "generic" fentanyl patch (unrelated to the above one) that is identical to their Duragesic patch for less money. I guess they want to make money from what people think is generic, while also making money from the brand name.

Njyoder 71.166.141.31 04:36, 19 February 2007 (UTC)

Respiratory depression references

I have added in references referring to respiratory depression relating to fentnayl.
--Claud regnard 00:11, 10 May 2007 (UTC)

Fentanyl Abuse

I would just like to make anybody reading on Fentanyl who is using it illicitly that it is nothing to get in to. I have used fentanyl for year and spent so much of my life and money on it. I was always a popular, hard working, athletic kid and never thought anything like this could happen to me. i started off takin hydrocodones and eventually went on to oxys, morphine, fentanyl, heroin and everything else in this category. fentanyl was the most powerful out of all of these even heroin which surprises alot of people. the withdrawal symptons are horrible. i have stopped using and go to a out patient rehab. the only way to stop use is throught the suboxone program.

                                 Scott from NY age 22

                                                    Skooter80 05:12, 28 September 2007 (UTC)

Anybody have results with the "generic" of the fentanyl patch? My doctor recently was thrilled that the patches I had been given weren't "large, sticky and gooey and slide all over the place". Is that the generic patch or is that by manufacturer? The patches I have are very thin and your skin must be completely oil free, like washed with alcohol or some other cleanser besides normal shower soap or the patch won't adhere well. Put on "right" they adhere very well. Mylan is the name on the box so I assume that's the pharmacuetical that makes them. Thanks in advance and God bless. V.Holland

Indications for TD fentanyl

I have undone a change in the first indication for fentanyl about patients with swallowing problems. It had been changed to mention a trade name preparation of fentanyl (I note the IP address of the person changing the test is registrered to the Johnson and Johnson Company and I hope the contributor is not trying to promote one product!), had removed mention of subcutaneous administration (the most common parenteral route used in palliative care) and had changed 'persistent swallowing' to 'diffcult swallowing' (temporary swallowing problems are not an indiation for switching to TD fentanyl). I am happy to discuss these issues further. --Claud Regnard (talk) 10:18, 6 April 2008 (UTC)