25 µg/hr fentanyl patch X 24 hrs = 600 µg/day fentanyl = 60 mg/day oral morphine milligram equivalent. In other words, the conversion factor not accounting for days of use would be 60/25 or 2.4.
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
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 to calculate Mme morphine?
How to Calculate the Total Daily MME 2:
- Calculate the total daily dose of each opioid the patient is taking. …
- Convert each total daily dose to MME by multiplying by its respective MME conversion factor. …
- Add the daily MME for each opioid to get the total daily MME.
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.
ABOUT THE PUBLIC WORKSHOP
The Food and Drug Administration (FDA or Agency) is announcing the following public workshop entitled ‘‘Morphine Milligram Equivalents: Current Applications and Knowledge Gaps, Research Opportunities, and Future Directions.’’ The purpose of the workshop is to bring stakeholders together to discuss the scientific basis of morphine milligram equivalents (MMEs) with the goals of providing an understanding of the science and data underlying existing MME calculations for opioid analgesics, discussing the gaps in these data, and discussing future directions to refine and improve the scientific basis of MME applications..
REGISTRATION
The public workshop will be held virtually and via webcast on June 7 and 8, 2021, from 9 a.m. to 5 p.m. Eastern Time each day. Please provide complete contact information for each attendee, including name, title, affiliation, address, email, and telephone. Registration is free.
How to calculate MME for fentanyl?
The daily MME for fentanyl is calculated by multiplying the strength of the transdermal patch in mcg/hour by the MME conversion factor for fentanyl.
Why is it important to convert opioids to MME?
Converting a patient’s total daily dose of opioids to MME is a useful tool to help identify patients who are candidates for closer monitoring or overdose risk mitigation. 2 Total daily MME can be a valuable prompt to consider initiating a dose taper, educating on naloxone, or offering treatment for opioid use disorder.
What is the risk of overdose from opioids?
The Centers for Disease Control and Prevention (CDC) found that higher doses of opioids are associated with an increased risk for motor vehicle accidents, overdose, and opioid use disorder. 1 Their review of clinical trials discovered that when certain MME levels were surpassed, the risk for overdose drastically increased. Compared to opioid doses under 20 MME/day, the risk for overdose increased by a factor of 1.9 to 4.6 with doses between 50 and100 MME/day and a factor of 2.0 to 8.9 with doses over 100 MME/day. Lower doses of opioids corresponded with reduced risk for overdose; however, the CDC was unable to find evidence of a specific MME level that conferred no risk of overdose.
What is MME in medicine?
Morphine milligram equivalents (MME) is a unit of measure used to compare opioids of varying potencies. 1,2 By converting different opioids to a standard value a prescriber is more able to assess a patient’s potential risk for dose-related adverse events.
Does MME increase with daily doses?
The MME conversion factor for methadone increases with higher daily doses. 2
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.
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.
