Opioid Conversion Calculator
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Opioid rotation starts by converting the current daily dose to morphine milligram equivalents (MME), then to the new drug, and then reducing by 25% to 50% because cross-tolerance is incomplete. 30 mg/day of oxycodone is 45 MME, or about 9 mg/day of hydromorphone before reduction.
| Morphine milligram equivalents | 45 MME/day |
| Equianalgesic hydromorphone | 9 mg/day |
| After 25% cross-tolerance reduction | 6.75 mg/day |
| CDC conversion factors used | oxycodone 1.5, hydromorphone 5 |
Show steps
- MME/day = daily dose × conversion factor (CDC 2022 Clinical Practice Guideline).
- Equivalent dose = MME ÷ target factor.
- Because cross-tolerance is incomplete, guidelines advise starting the new opioid 25% to 50% lower and titrating.
How the conversion works
- MME/day = daily dose × CDC conversion factor.
- Equianalgesic dose of the new opioid = MME ÷ its factor.
- Reduce by 25% to 50% for incomplete cross-tolerance, then titrate to effect and safety.
CDC 2022 conversion factors
| Opioid | Factor |
|---|---|
| Codeine | 0.15 |
| Tramadol | 0.2 |
| Tapentadol | 0.4 |
| Hydrocodone, morphine | 1 |
| Oxycodone | 1.5 |
| Oxymorphone | 3 |
| Hydromorphone | 5 |
| Fentanyl patch (mcg/h) | 2.4 |
Important limits
These factors estimate overdose risk and are not perfect equianalgesic ratios. Methadone and buprenorphine need specialist conversion. Higher MME doses carry higher overdose risk; naloxone should be considered.
Opioid Conversion Calculator quiz: 10 questions
Test yourself with 10 multiple-choice questions. Choose an answer and press Submit to see if you are right and why. Your score appears at the end.
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Frequently asked questions
What is an MME?
Morphine milligram equivalent: a common unit for comparing opioid doses.
Why reduce the dose when switching?
Tolerance to one opioid does not fully carry over to another, so the new drug can be stronger than the table suggests.
Can patients use this?
No. It is a reference for licensed clinicians; patients should never change doses on their own.
Why is methadone not included?
Its conversion ratio changes with dose and it has a long, variable half-life.
Is there an MME calculator?
Yes, our MME calculator totals MME across several opioids.
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