Example MME calculation Patients evaluated in the clinic report taking the following medication for their back pain: ● OxyContin 20 mg twice daily. ● Oxycodone 10 mg three times a day (usually).
The total amount of oxycodone per day: 70 mg (20 mg × 2) + (10 mg × 3) MME/day = 105 (70 mg/day oxycodone × 1.5 [MME conversion factor])
● Flexeril 10 mg three times a day. ● Xanax 0.5 mg three times a day.
Table 8: Examples of 50 and 90 MME/Day for Commonly Prescribed Opioids Opioid Strength 50 MME/Day 90 MME/Day
Hydrocodone- acetaminophen
5 mg/325 mg 50 mg (10 tablets) Exceeds acetaminophen maximum daily dose
10 mg/325 mg 50 mg (5 tablets)
90 mg (9 tablets)
Oxycodone sustained release
15 mg
33 mg (~2 tablets) 60 mg (4 tablets)
30 mg
33 mg (~1 tablet) 60 mg (2 tablets)
Methadone
5 mg
12 mg (<3 tablets) ~20 mg (4 tablets)
Equianalgesic dosing of opioids Opioid medications have differing potencies. When converting from one opioid medication to another, it is critical to understand the equivalent analgesic (equianalgesic) dose to ensure continued efficacy without untoward side effects. The dose, administration route, and therapy duration must be considered. Multiple opioid conversion charts
are available. Clinicians must consider individual patient factors and the characteristics of the opioid medications and delivery systems when converting between opioid products. Closely monitor patients following conversion for efficacy and potential adverse effects.
Table 9: Opioid Equianalgesic Doses 83 Medication
Approximate Equianalgesic Oral Dose
Approximate Equianalgesic Intravenous Dose
Conversion Factor to Oral Morphine
Morphine
30 mg
10 mg
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 ~80 times as potent as oral morphine. (See Table 8 to convert morphine to fentanyl transdermal patches.)
Oxycodone
20 mg
Hydrocodone
20 to 30 mg
Hydromorphone
7 mg
1.5 mg
Fentanyl
100 mcg (0.1 mg) 15 mcg/hour
Methadone
Variable
Variable
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Book Code: TN24CME
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