Opioid Conversion Table Chart
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1Chronic Pain
Opioid Conversion Table
Management
Toolkit
Calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid
medications. There are a number of conversion charts available, so caution is needed when performing calculations. As
with all medications, consulting the package insert for dose titration instructions and safety information is recommended.
Treatment should be individualized and begin with lower doses and gradual increases to manage pain.
Once the dose is calculated, the new opioid should not be prescribed at the equivalent dose. The starting dose should
be reduced by 25-50% to avoid unintentional overdose due to incomplete cross-tolerance and individual variations in
opioid pharmacokinetics. This dose can then be gradually increased as needed.
To calculate the total daily dose:
1. Determine the total daily doses of current opioid medications (consult patient history, electronic health record, and
PDMP as necessary).
2. Convert each dose into MMEs by multiplying the dose by the conversion factor.
3. If more than one opioid medication, add together.
4. Determine equivalent daily dose of new opioid by dividing the calculated MMEs of current opioid by new opioid’s
conversion factor. Reduce this amount by 25-50% and then divide into appropriate intervals.
Calculating Morphine Milligram Equivalents (MME)*
Sample Case
Opioid
Conversion Factor
Duration
Dose Equivalent
Your patient is a 45-year-old man who is taking
(convert to MMEs)
(hours)
Morphine Sulfate (30mg)
oxymorphone 10 mg 4 times a day for chronic
Codeine
0.15
4-6
200 mg
pain. You have determined he is an appropriate
Fentanyl (MCG/hr)
2.4
12.5 mcg/hr**
candidate for a long-acting regimen and decide
Hydrocodone
1
3-6
30 mg
to convert him to extended release oxycodone.
Hydromorphone
4
4-5
7.5 mg
1. Total daily dose of oxymorphone à 10 mg
X 4 times /d = 40 mg/d
Morphine
1
3-6
30 mg
Oxycodone
1.5
4-6
20 mg
2. Convert to MMEs (oxymorphone conversion
factor = 3) à40 X 3 = 120 MME
Oxymorphone
3
3-6
10 mg
3. Determine MMEs of oxycodone (oxycodone
Methadone
†
conversion factor = 1.5) à 120/1.5 = 80
1-20 mg/d
4
7.5 mg
mg/d
21-40 mg/d
8
3.75 mg
4. Decrease dose by 25% à 25% of 80 = 20
41-60 mg/d
10
3 mg
à 80 – 20 = 60
>61 mg/d
12
2.5 mg
5. Divide by interval (q 12 hours) à 60/2 = 30
* The dose conversions listed above are an estimate and cannot account for an
individual patient’s genetics and pharmacokinetics.
The starting dose of extended release oxyco-
** Fentanyl is dosed in mcg/hr instead of mg/day, and absorption is affected by
done is 30 mg q 12h.
heat and other factors.
†Methadone conversion factors increase with increasing dose.
Additional Resources
CDC Opioid Conversion Guide
https://
HOP16091451
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