OPIOID MMEEquianalgesic Converter
Medication Parameters
mg/day
Note: Equianalgesic doses are estimates and do not account for incomplete cross-tolerance.
Daily Load (MME)
0.0
mgSafety Guidance
Standard dosing range. Continue routine monitoring for side effects.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
Clinical Use
Converting from intravenous to oral formulations prior to hospital discharge.
Rotating from one opioid to another due to tolerance, renal impairment, or severe side effects.
Calculating total 24-hour baseline opioid requirements to design a long-acting (ER) regimen with appropriate short-acting breakthrough dosing.
How it Works
Standard Conversion Ratios
| Opioid | Oral/Enteral (mg) | Parenteral/IV (mg) |
|---|---|---|
| Morphine | 30 | 10 |
| Hydromorphone (Dilaudid) | 7.5 | 1.5 |
| Oxycodone | 20 | N/A |
| Hydrocodone | 30 | N/A |
| Fentanyl | N/A | 0.1 (100 mcg) |
Clinical Pearls
Incomplete Cross-Tolerance
The most dangerous mistake in opioid rotation is a straight mathematical conversion. Because mu-receptors adapt differently to different synthetic opioids (incomplete cross-tolerance), the newly calculated dose of the new opioid MUST be reduced by 25% to 50% to prevent fatal overdose.
Fentanyl Patches & Methadone
Fentanyl Transdermal: Roughly, a 25 mcg/hr patch equates to 50-60 mg of oral morphine per day. Do not use patches for acute, unstable pain.
Methadone: Conversions are non-linear and highly complex. The ratio changes drastically depending on the current morphine dose (ranging from 3:1 up to 20:1). Methadone rotation requires palliative care specialist consultation.
The Evidence
Key Reference
Adult Cancer Pain
NCCN Guidelines • National Comprehensive Cancer Network. Current Version;Clinical Practice Guidelines
Last Comprehensive Review: 2026