What happens if you forget to take off patch an put on another Fentanyl patch?

It depends entirely on the situation. If you just add another patch to one that's still effective at full dosage delivery, then you're adding to the overall dosage rate and if you're not tolerant enough you can experience severe respiratory depression or death if you're not careful.

If you're referring to a patch that's in the last few hours of expiration (e.g., 64 hours of a 72 hours prescription period or 40 of a 48 hour period) then you won't feel much difference. It takes the new patch time to start delivery, and depending on how low your current patch is your overall maintenance dose is likely starting to get low anyway.

Over the years I've added a new one as my current one was winding down. This helps to keep the overall dose constant and avoid any withdrawal symptoms. But each person is different, and it's important to know the signs of higher dosages if you're not tolerant to high levels of opiates.

Most Duragesic users know what's normal and what isn't when it comes to patch use over long periods of time, so when something isn't right, it's important to take notice of your symptoms. High dosages can come from different ways other than just adding a patch

• increased activity raises body heat, which in turn increases the

dosage delivery rate (that's why you're not supposed to expose it to heat or direct sunlight). The first symptoms for most are drowsiness and sometimes trouble breathing, depending on how tolerant they are. Confusion and loss of cognitive ability is the most common though - imagine knowing what's happening to you, but your mind can't direct your body to help itself, and you'll get an idea.

In such cases, the 2 things to do are to immediately remove the patch(es) (make sure you don't fold them - you can re-apply later contrary to what some think), and cool yourself down externally and internally. It's important to also let family/friends know about this as well, so that they know what to do if you suddenly start acting like a wacko. My daughter has had to help me a couple of times when I've become overheated and my dosage rate increased fast (I have an extremely high opiate tolerance level, so respiratory depression doesn't happen, just increased side effects).

If you're using breakthrough meds like Percocet or Vicodin, then your overall tolerance is higher than your patch dose anyway, Just make sure that if you overlap the patches, one is expiring.