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Approximate opioid dose conversions and oral total daily morphine milligram equivalents (MMEs; refer to important notes below)

Approximate opioid dose conversions and oral total daily morphine milligram equivalents (MMEs; refer to important notes below)
Approximate dose conversions for commonly used opioids (refer to important notes below)
Morphine Hydromorphone (Dilaudid) Oxycodone Fentanyl transdermal*
IV (mg/day) Oral (mg/day) IV (mg/day) Oral (mg/day) Oral (mg/day) Patch (mcg/hour)
5 15 0.6 3 10 NA
8.5 25 1 5 15 12
10 30 1.2 6 20 12
17 50 2 10 30 25
33 100 4 20 65 50
50 150 6 30 100 75
67 200 8 40 130 100
83 250 10 50 165 125
100 300 12 60 200 150
117 350 14 70 230 175
133 400 16 80 265 200
150 450 18 90 300 225
167 500 20 100 330 250
183 550 22 110 360 275
200 600 24 120 400 300
Conversion ratios to determine daily total ORAL morphine milligram equivalent (MME)
Drug Approximate equivalent oral dose Approximate equivalent IV or subcutaneous dose Conversion ratio to determine daily total ORAL morphine milligram equivalent (MME)
Morphine 30 mg 10 mg
  • Parenteral morphine to oral morphine: 1:3
Fentanyl Not available 0.1 mg (100 mcg)
  • Parenteral fentanyl to oral morphine: 1:300
Hydrocodone 30 mg Not available
  • Oral hydrocodone to oral morphine: 1:1
Hydromorphone 6 mg 1.2 mg
  • Oral hydromorphone to oral morphine: 1:5
  • Parenteral hydromorphone to oral morphine: 1:25
Oxycodone 20 mg Not available
  • Oral oxycodone to oral morphine: 1:1.5
Oxymorphone 10 mg 1 mg
  • Oral oxymorphone to oral morphine: 1:3
  • Parenteral oxymorphone to oral morphine: 1:30
Important notes:
  • The doses included here provide a starting point for the purpose of comparing and switching different opioids during maintenance therapy.
  • Equianalgesic conversions serve only as a general guide to estimate opioid dose equivalents. When switching to a new opioid, the initial daily dose for the new opioid determined by using the conversions in the first part of this table should be further reduced by 25 to 50% to adjust for lack of complete mu receptor cross-tolerance (except when switching to methadone, which requires a 75 to >90% reduction; refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia). In contrast, when switching between intravenous and oral administration of the same opioid, an empiric reduction of the equianalgesic dose estimate shown above is generally not necessary.
  • The calculated starting dose of the new opioid or new route of administration will require monitoring and further titration after making the conversion. For a review of multiple factors that must be considered for safely individualizing conversion of opioid analgesia in patients with cancer, refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia.
  • The approximate equivalences have been rounded. Further rounding may be necessary for available tablet strengths.
  • The second part of this table provides conversion factors to assess the total daily oral morphine milligram equivalent (MME) dose. Total daily oral MME dose >50 mg is one factor among several that can help identify patients who may be at higher risk for overdose and may benefit from closer monitoring and coprescription of naloxone. A high daily MME dose may also be useful for identifying tolerance, and can suggest that a patient may benefit from opioid rotation. For further information refer to UpToDate content on chronic pain management.

IV: intravenous; mcg: microgram.

* Suggested doses for conversion to transdermal fentanyl from other opioids are less conservative than recommendations in the United States product labeling. The recommendations in this table are based on guidance available at experienced centers.

¶ Wide interpatient variability in response.

Courtesy of Kathleen Broglio, DNP, MN, ANP-BC, ACHPN and Russell K Portenoy, MD.

Additional data from:
  1. National Comprehensive Cancer Network. Adult Cancer Pain, Version 2.2021.
  2. Dowell D, Ragan KR, Jones CM, et al. CDC Clinical Practice Guideline For Prescribing Opioids for Pain – United States, 2022. MMWR Recom Rep 2022; 71:1.
  3. UpToDate Lexidrug. More information available at https://online.lexi.com/.
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