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    Morphine Milligram Equivalents (MME) Calculator

    Calculates total daily morphine milligram equivalents.
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    IMPORTANT

    There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose.

    INSTRUCTIONS

    For combination drugs (e.g. Percocet = acetaminophen + oxyCODONE), enter only the dose of the opioid component (e.g. if 5 mg/325 mg, enter "5"). Do not use in pediatric patients, due to unpredictable rates of absorption and risk of overdose.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Use in opioid-naïve and opioid tolerant adult patients.

    • Do not use in pediatric patients, due to unpredictable rates of absorption and risk of overdose.

    • Do not use in patients with malignant pain or those requiring end-of-life care.

    • Uses morphine as the reference point for conversion of other oral opioids to MME.

    • Should be used only for oral opioid conversion to MME, not for conversion of one opioid to another.

    • Equianalgesic dose ratios are approximations and do not account for genetic factors, incomplete cross-tolerance, and pharmacokinetics.

    • Does not give information on efficacy, but is used to assess comparative potency of other analgesics.

    • Pharmacokinetics and conversion for methadone and tapentadol are particularly complex, and clinicians should err on the side of being especially conservative with those conversions in particular.

    • MME is a numerical standard against which most opioids can be compared, yielding a comparison of each medication’s potency.

    • Helps determine whether a cumulative daily dose of opioids is associated with increased risk of overdose.

    • Helps identify patients who may benefit from closer monitoring, reduction or tapering of opioids, naloxone prescription, and other measures to reduce risk of potential opioid abuse and/or overdose.

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    Evidence
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    Management

    • CDC guidelines recommend prescribing the lowest effective opioid dose and to use caution when prescribing opioids at any dosage, particularly when increasing dosage to ≥50 MME/day. Doses ≥99 MME/day should be avoided or carefully justified (and titrated accordingly).
    • American College of Emergency Physicians (ACEP) guidelines recommend avoiding routinely prescribing outpatient opioids in patients with acute exacerbation of chronic noncancer pain in emergency settings.

    Critical Actions

    Avoid concurrent opioid and benzodiazepine prescribing, as it increases the potential for overdose (CDC guidelines).

    Content Contributors
    • Sergey Motov, MD
    About the Creator
    Centers for Disease Control and Prevention
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    Content Contributors
    • Sergey Motov, MD