Table 8. Opioid Equianalgesic Table (Stanford College of Medicine, 2022) Medication Approximate Equianalgesic Oral Dose Approximate Equianalgesic Intravenous Dose
Conversion Factor to Oral Morphine
Parenteral morphine is 3 times as potent as oral morphine. Oral oxycodone is roughly 1.5 times more potent than oral morphine. Oral hydrocodone is roughly 1.5 times more potent than oral morphine. Oral hydromorphone is about 4 to 7 times as potent as oral morphine. Parenteral hydromorphone is 20 times as potent as oral morphine. Transdermal fentanyl is about 80 times as potent as oral morphine. (See Table 7 to convert morphine to fentanyl transdermal patches.)
Morphine
30 mg
10 mg
Oxycodone
20 mg
Hydrocodone
20 to 30 mg
Hydromorphone
7 mg
1.5 mg
100 mcg (0.1 mg) 15 mcg/hour
Fentanyl
Methadone
Variable
Variable
Tramadol Codeine
300 mg
0.1
200 mg
0.15
Oral morphine is about 10 times more potent than oral meperidine and about twice as potent as parenteral meperidine (mg for mg).
75 mg of parenteral meperidine
Meperidine
300 mg of oral meperidine
Note : To convert to ER/LA opioids, see conversion factors listed in Table 7. Calculation of equianalgesic dosages Follow these three steps to calculate equianalgesic dosages when changing to a different opioid analgesic: Step 1 : Calculate the total daily dose of the current opioid. Step 2 : Determine the equianalgesic dose using the appropriate conversion factor or ratio. Step 3 : Reduce the new opioid analgesic dose by 33% to 50%
Step 2 : Determine the equianalgesic dose using the appropriate conversion factor or ratio. Oral hydromorphone to oral morphine conversion ratio: 4 28 mg hydromorphone/day × 4 = 112 mg morphine/day OR 28 mg hydromorphone equianalgesic dose of morphine = 7.5 mg 30 mg Equianalgesic dose of morphine/day = 112 mg Step 3 : Reduce dose by 33% to 50% to account for cross- tolerance; determine a new regimen based on available dosage forms of the new opioid.
to account for cross-tolerance, dosing ratio variation, and patient variability. Determine a new regimen based on the available dosage form(s) of the new opioid. Clinical case example CD is a 32-year-old female with chronic pain. She is taking Exalgo 16 mg once daily and hydromorphone immediate-release 4 mg three times daily for breakthrough pain. The patient should be transitioned to MS Contin due to insurance issues. What dose of MS Contin should be started? Step 1 : Calculate the total daily dose of the current opioid. Exalgo 16 mg once daily + hydromorphone immediate-release 4 mg three times daily = 28 mg/day hydromorphone
Total daily dose of morphine = 74 to 56 mg/day New regimen: MS Contin 30 mg every 12 hours (Total morphine dose = 60 mg/day)
Healthcare Consideration: Opioid equianalgesic dose conversions are not the same as MME conversions. Therefore, do not use MME factors to convert between opioid medications, as this may lead to serious adverse effects, including respiratory depression, overdose, and death. determine if changes or discontinuation of opioid therapy is/are required. Functional improvements may be incremental and occur over months or years. Further, some patients who begin showing solid progress may plateau. In these cases, consider reassessment.
Monitoring adults receiving chronic opioid therapy Ongoing patient monitoring and reiterating vital components of the agreed-upon treatment plan are necessary during long- term therapy with opioids. In addition, continue to assess patient- specific improvement versus risks of opioid treatment to
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