Those pt information printouts are given to you for a reason

stevemailboxI was recently contacted by a Mother caring for her young adult son. The son was a chronic pain pt and was on a long acting and short action opiate that was not adequately controlling his pain. The prescriber decided to try 100mcg Fentanyl patches to help improve his pain management.

When the Mother took this new Rx to her local chain store.. the female Pharmacist refused to fill because it would “kill her son”..

I showed the Mother the conversion formulas that suggested that using “morphine equivalents” that the increase using the 100 mcg Fentanyl patches was “modest” and given her son’s opiate tolerance. I personally did not see much of a risk of to her son’s well being.

I asked the Mom if they had been advised of the slow on set of Fentanyl patches and that the transition could be rather rough for the first week or two.. NOPE…

I advised the Mom about the half life of the two opiates that he had been on before and that they may have to be taken during the transition.  As I anticipated, the transition started out rather badly… I believe without proper counseling… the son would have stopped the patches and never figured out if these patches would improve his pain management..

The transition was “bumpy” but progress was made and then one day about one week into the transition.. everything went “south”. Once again the Mom reached out to me… I asked if the patches had been exposed to some heat source ?  A day or so later, she responded that the son had decided to put a HEATING PAD over the patches.. While that would have caused the patches to transfer medication faster.. the medication is very heat sensitive and would have started DESTROYING the medication in the patch and thus the son would get less medication and would have been thrown into WITHDRAWAL.

Basically, the son had to start over with the transition… but the good news is that the intensity of his pain is now improving/lowering.  I am sure that the pt information printouts furnished with the patches would have warned about using a external heat source (heating pad, hot tub) while using the patches. This is a good example of why pt should read those informational printouts when getting new medications.

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