Expert: Dr Ian Jackson - please note UK based - 5/31/2011

Question
Dear Sir / Madam

           I have recently had a bad experience with the medication of Fentanyl and some other drugs that i have been taking for quite a while. I have had the fentanyl patch over twelve months ago but recently was put back on it at 100mg as i am sure you know my body went haywire and was admitted to hospital, suffering from an overdose of Fentanyl. The counsultant must not have read my notes as i was perscribed oromorpth and went unconsious, i was given Naloxone as a reversal of opioids and came round to the living. I was then put back on the patch with a cocktail of medicine and again my breathing went down again and went into a coma, i was again given Naloxone and brought round again. My urine went for a drug test and i was positive of opioids and Benzodiazopines, i have never taken anything of the sorts apart from medication that mt GP and hospital had given me. After a few days i was put on a lower dose of fentanyl 50mg and again my breathing went shallow and i had pinpoint eyes, i was again given naloxone { Narca } and again fentanyl and went into another come and brought back to life with naloxone. My family were all the while telling the staff not to give me Fentanyl which was then stopped and after settling down to a normal breathing and with my family advice discharged myself and have not had any more episodes with breathing problems. Can you confirm the apisodes of shallow breathing was due to Fentanyl?

Other medication
Amitriptalyne 150mg at night
Baclofen 20mg x 3 a day
Duloxatine 30mg x 2 a day
Pregabalin 300mg x 2 a day
Methadone 20mis at night
Narameg 2.5mg as required

  Kind regards

     M Fowler

Answer
John
You are obviously on many medications for the management of some chronic pain syndrome. I am puzzled as to why you were put back on fentanyl patches - I assume you were having a tough time managing the pain.
My knowledge of the use of these patches is poor as I do not specialise in chronic pain. However my understanding is that they come in sizes that indicate the absorption rate so the 100 is 100 micrograms per hour absorption rate.
If this is the size you were given then it is indeed a large dose and it seems likely this caused your breathing problems. Indeed the 50 size is also a large dose if you were on no other opiates (other than the methadone)
Hope that helps
Dr Ian Jackson