# Morphine equivalency

CALCULATION OF DAILY MORPHINE EQUIVALENT DOSE (MED) Strength per Unit X (Number of Units/ Days Supply) X MME conversion factor = Daily MED Example: 10 mg oxycodone

## Oxycodone

This medication is used to help relieve moderate to severe pain.

tablets X (120 tablets/ 30 days) X 1.5 = 60 Daily MED

equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour day. Example: 25 ug/hr fentanyl patch X 24 hrs = 600 ug/day fentanyl = 60 mg/day oral morphine milligram equivalent.

## How do you calculate morphine equivalents?

• Calculate the 24 hour current dose: 90mg q 12 = 180 mg Morphine/24 hours
• Use the oral to parenteral equianalgesic ratio: 30 mg PO Morphine = 10 mg IV Morphine
• Calculate new dose using ratios: 180/30 x 10 = 60 mg IV Morphine/24 hours or 2.5 mg/hour infusion

More items…

## 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 the maximum morphine equivalent per day?

The rules limit opioid prescriptions to no more than a seven-day prescription for adults with acute pain. Minors may be prescribed no more than a five-day prescription with written consent by a parent or guardian. The rules also limit patients with acute pain to an average of 30 morphine equivalent dose (MMD) per day.

## Is oxycodone stronger than morphine?

Oxycodone is 50 percent stronger than morphine. It’s prescribed and abused similarly to hydrocodone and maybe a bit more dangerous since it’s more potent. You can get oxycodone alone (OxyContin, Roxicodone) or oxycodone/acetaminophen (Percocet). Methadone is three times more potent than morphine.

## 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.

## 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.

## 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.

## 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

## Does methadone cause cardiac arrhythmias?

In addition, methadone is associated with cardiac arrhythmias along with QT prolongation on the electrocardiogram.

## 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, …