PO / transdermal opioids β MME β IT equivalents Β· PO cross-conversion Β· PO β IV Β· IT β MME
For licensed clinicians only. All conversions are approximations (CDC 2022; PACC 2017; standard equianalgesic tables). When rotating opioids, apply a 25β33% dose reduction for incomplete cross-tolerance. Verify all calculations independently before clinical use.
Current oral / transdermal opioids
Total daily MME
MME/day
Intrathecal equivalents
PACC 2017 consensus estimates. Use lowest effective starting dose; titrate per clinical response.
IT Morphine
mg/day
MME Γ· 300 Ceiling: 15 mg/day
IT Hydromorphone
mg/day
IT morphine Γ· 5 Ceiling: 4 mg/day
IT Fentanyl
mcg/day
IT morphine Γ 100 Ceiling: 1000 mcg/day
Enter opioid doses above to calculate intrathecal equivalents.
Oral equianalgesic equivalents
Calculated via MME bridge. Reduce by 25β33% for incomplete cross-tolerance when rotating opioids. Shown doses are equianalgesic estimates, not clinical starting doses.
Drug
Equivalent dose
Notes
β Methadone reverse conversion is dose-dependent and highly variable β do not calculate without specialist input. Tramadol (max 400 mg/day) and codeine (max ~360 mg/day) are not appropriate at high MME. Buprenorphine SL MME is an approximation.
Enter opioid doses above to calculate oral equivalents.
IV equivalents
Daily totals shown; hourly infusion rates listed below each. Equianalgesic estimates only β always titrate to effect.
IV Morphine
mg/day
PO:IV = 3:1 MME Γ· 3
IV Hydromorphone
mg/day
PO:IV β 5:1 MME Γ· 20
IV Fentanyl
mcg/day
Via IV morphine Γ 10 mcg/mg MME Γ 10/3
IV Methadone
Specialist guidance required
PO:IV ratio β 2:1 (variable). QTc monitoring required. Dose-dependent equianalgesic ratios apply. Consult pharmacy or palliative/pain specialist.
IV / IM Ketorolac
15β30 mg q6h
Non-opioid adjunct β not MME-derived. Max 120 mg/day Β· Limit β€5 consecutive days Caution: renal impairment, elderly, GI/bleeding hx.
Enter opioid doses above to calculate IV equivalents.
Current intrathecal opioids
Enter pump daily doses. PO MME equivalent shown below.
IT Morphine
mg/day
Γ 300 = PO MME
IT Hydromorphone
mg/day
Γ 1500 = PO MME
IT Fentanyl
mcg/day
Γ· 100 Γ 300 = PO MME
PO MME equivalent
MME/day
IT MME equivalents are estimates. IT pharmacokinetics differ substantially from oral delivery β these figures reflect equianalgesic approximations only.
Current IV opioids
Enter continuous infusion or scheduled IV doses. Converts to PO MME equivalent via standard equianalgesic ratios.
IV Morphine
mg/day
Γ 3 = PO MME PO:IV ratio 3:1
IV Hydromorphone
mg/day
Γ 20 = PO MME PO:IV ratio 5:1
IV Fentanyl
mcg/hr
Γ 7.2 = PO MME (mcg/hr Γ 24 Γ 0.3)
PO MME equivalent
MME/day
Oral equianalgesic equivalents
Reduce by 25β33% for incomplete cross-tolerance when transitioning from IV to PO. Shown doses are equianalgesic estimates, not starting doses.
Drug
Equivalent dose
Notes
β Methadone conversion is dose-dependent β specialist input required. Tramadol max 400 mg/day; codeine max ~360 mg/day. IV fentanyl infusion rates have variable bioequivalence depending on context.
Enter IV opioid doses above to calculate PO equivalents.
Conversion reference tableclick to expand
Agent
POβMME
ITβMME
PO:IV
Notes
PO MME factors: CDC 2022. Fentanyl patch: 1 mcg/hr = 2.4 MME/day. IT ratios: Deer TR et al. Neuromodulation 2017 (PACC). IV PO:IV ratios: standard equianalgesic tables. Methadone conversion is dose-dependent and variable in both directions.
