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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
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Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Have been using bupenmorphin 15 patches but because of

Resolved Question:

Have been using bupenmorphin 15 patches but because of severe rash have been advised to change to fentanyl patch 12 to 25mcg per hour according to my needs.The doctor started me off on a patch of 12mcg saying that if felt no benefit I could add another patch which I did 24 hrs later.This means that the dose is not synchronised does this matter?
I do not like the fentanyl patches and the doctor has given me slow release Morphine capsules advising me to keep the fentanyl patches on and take ONE Morphine capsule at the same time an then 12 hrs later remove both patches and take second Morphine capsule.Given the fentanyl patches re not synchronised is this OK?
The second Patch is due to be replaced this morning.Can you advise me please.
Submitted: 6 months ago.
Category: Medical
Expert:  Dr. D. Love replied 6 months ago.

Hello from JustAnswer.

The fact that the patches are not synchronized does not really matter, as long as it is kept straight which patch was applied each day. Even in someone that will be on two patches indefinitely, it would be OK for the patches to not be synchronized. The patches essentially release a steady amount of the drug over 72 hours. There is a slight drop-off in blood levels towards the end of the 72 hours, but it is typically not enough to be clinically apparent and the patient does not notice any change in the effectiveness of the drug. If two patches are not synchronized, but each are left in place for the usual 72 hours, it will work the same. The difficulty is in not confusing which patch is due to be replaced on each day, and if the wrong patch is replaced, then it would make a significant difference.

In your case, since you are instructed to remove the patches once the morphine is given time to get into your system, the fact that the patches are not synchronized also will not matter, as long as both patches are still within the 72 hour window. When both patches are removed, then the drug will not longer be released, and the fact that one is 24 hours older than the second does not make a difference, since both are still within the period of steady release of the drug. Since it is less prone to error, we typically prefer to use two patches on the same schedule, but there is nothing intrinsically wrong with the patches not being synchronized.

If the second patch is due to be replaced before the morphine has time to get into your system, then you should still replace the patch on schedule, and then remove it at the designated time after the morphine is in your system. It may only be in place for 12 hour, but if you do not replace it, there will be a more significant lowering of the drug levels before the morphine is in your system.

If I can provide any clarification, please let me know.

Customer: replied 6 months ago.
Thank you just be clear. The first patch was changed yesterday the second patch is due to be replaced now. When can I start the morphine tablets.Thank you this now becoming urgent.
Customer: replied 6 months ago.
Ji
Expert:  Dr. D. Love replied 6 months ago.

You can take the morphine at the same time as either patch. So, since the second patch is due to be changed now, then take the morphine as prescribed by your doctor at the same time as the changing of the second patch, and then remove both patches 12 hours later when you will also take the second dose of the morphine.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17664
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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