# Calculate morphine equivalent

In order to calculate an oral Morphine Equivalent Daily Dose (oMEDD), multiply the current daily opioid dose by the conversion factor in column 3. For example, oMEDD of oxycodone 40mg/day = 40 x 1.5 = 60mg/day

## Is there maximum daily morphine equivalent?

Morphine is normalized to 1.0 and the conversion factor reflects the relative potency of other opioid drugs. So, if the daily MME is 90 (3) then a patient may receive no more than 90 mg of morphine, 90 mg of hydrocodone, 60 mg of oxycodone, or 30 mg of oxymorphone per day.

## What is a substitute for morphine?

Scientists have developed a new drug that could be a safer alternative to morphine for medical use. The researchers found that engineered variants of endomorphin, a naturally occurring chemical in the body, are as strong as morphine when it comes to killing pain.

## What is the maximum dosage of morphine?

Recommended dose: 5-20 mg (2.5-10 ml) every 4 hours. Maximum daily dose: 120 mg per day. Children 6-12 years: Recommended dose: 5-10 mg (2.5-5 ml) every 4 hours. Maximum daily dose: 60 mg per day. Children 1-5 years: Recommended dose 5 mg (2.5 ml) every 4 hours. Maximum daily dose: 30 mg per day . Children under 1 year: Not recommended.

## What is the equivalent of oxycodone to morphine?

oxycodone – alternative to morphine in patients with severe adverse effects from morphine or who have developed tolerance to morphine or who have renal impairment (may get less toxicity than with morphine but may still be at risk) *Note 10 mg morphine injection is equivalent to 10 mg oxycodone injection

## How is MME determined?

MME is determined by using an equivalency factor to calculate a dose of morphine that is equivalent to the ordered opioid. According to the CDC guidelines, opioids should be prescribed at the lowest effective dose and calculations re-checked.

## How to print calculator results?

Steps on how to print your input & results: 1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate. 2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

## Should opioids be prescribed at the lowest effective dose?

According to the CDC guidelines, opioids should be prescribed at the lowest effective dose and calculations re-checked. Also, concurrent opioid and benzodiazepine prescribing should be avoided as it increases overdose risk. Do not use in pediatric patients, to avoid unpredictable rates of absorption and risk of overdose.

## What is a MED conversion calculator?

The Morphine Equivalent Dose ( MED) conversions calculator allows a clinician to generate an equivalent dose of morphine for a patient taking one or more common opioids. This tool also provides precise control over methadone conversions as well.

## Is equianalgesic ratio crude?

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.

## Why is buprenorphine not included in the calculator?

Buprenorphine is not included in the calculator because it is a partial agonist and morphine equivalent doses are uncertain. Please refer to the label for dosing parameters.

## Can a patient be co-prescribed with benzodiazepines?

Is the patient co-prescribed benzodiazepines? Yes No

## Why do you switch analgesics?

There may be several possible reasons to switch analgesics including: drug cost, availability, lack of effectiveness of the current drug, or to minimize adverse effects . This tool also provides precise control over methadone conversions as well as corrections for incomplete cross-tolerance.

## Is equianalgesic ratio crude?

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.

## What are the patient specific factors in the equianalgesic table?

Patient-specific factors: No equianalgesic table is able to take into account patient-specific factors — primarily hepatic function, renal function, and age. Opioid metabolism and excretion do differ among the opioids; therefore, alterations in drug disposition will alter the relative potencies of different opioids.

## Why do opioids overestimate potency?

When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete cross-tolerance. Incomplete cross-tolerance can occur due to variability in opioid binding. There is no evidence-based recommendation for an appropriate reduction. The American Pain Society guidelines and most pain experts recommend a dose reduction between 25-50% when converting between different opioids, 9, 11 with a consideration for little or no cross-tolerance reduction in patients with poorly controlled pain. 5

## Is equianalgesic table the best?

While these equianalgesic tables are current the “best” solution, their limitations should be emphasized:

## Is there a lack of data regarding equianalgesic conversions?

There is an overall lack of data regarding most equianalgesic conversions, and there is a significant degree of interpatient variability. For this reason, reasonable clinical judgment, breakthrough (rescue) opioid regimens, and dose titration are of paramount importance. reasonable clinical judgment, breakthrough (rescue) opioid regimens, …