# Morphine equivalent dose calculator

## 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…

## How much morphine is considered a safe dose?

The recommended dosage amount for IV morphine varies depending on the patient’s needs. The average starting dose is between 2.5 and 5mg every 4 hours, but patients with previous opioid exposure may require higher doses.

## How to determine morphine equivalents?

Morphine Equivalent Dosing RxPerts Industry Insights 3 Do the Math Milligram Morphine Equivalent (MME) is a value assigned to opioids to represent their relative potencies. MME is determined by using an equivalency factor to calculate a dose of morphine that is equivalent to the ordered opioid. Daily MED is the sum of

## What is the maximum daily dose of morphine?

Usual dose 100 mg every 12 hours; up to 600 mg every 12 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under Prescribing in palliative care. Initially 5 mg every 4 hours.

## 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

## 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

## How often can you give a rescue IV?

In an inpatient setting, rescue doses can be provided IV every 15-30 minutes. Oral rescue doses can be offered as needed over the normal dosing interval of the drug (typically every 4 hours). As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount.

## 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, …

## 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.

## Do conversion ratios apply to repeated doses of opioids?

Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch.

## Opioid Conversions (Advanced) – Equianalgesic pain relief

Opioid Conversions (Advanced) – Equianalgesic pain relief
The opioid (equianalgesic) conversions calculator allows a clinician to generate an equivalent dose (equal amount of analgesia) when switching between different opioid analgesics.

## P lease review these important points

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.

## Review only if converting FROM chronic oral methadone

Converting FROM chronic Methadone to another opioid :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Highly variable – extreme caution required. Raising this value will lower the estimated dose of the new opioid. Consider increasing this number for larger previous doses of methadone and monitor the patient closely.

## Review if converting ‘FROM’ or ‘TO’ I.V. or transdermal fentanyl

Converting FROM transdermal fentanyl:
0.3 0.36
Converting TO transdermal fentanyl:
0.3 0.36
Converting FROM IV fentanyl:
0.1 0.25
Converting TO IV fentanyl:
0.1 0.25
Derivation of default factors : (note: default factors are set to maximize safety – modify as needed):
Transdermal Fentanyl conversions:
Assumption one 11,15: morphine (oral) 60 mg = Fentanyl transdermal 25 mcg/hr (600mcg/day).