| Drug / Route | Dose | = MME (mg) |
|---|---|---|
| Morphine IV | 10 mg | 30 |
| Morphine PO | 30 mg | 30 |
| Fentanyl IV | 100 mcg | 30 |
| Hydromorphone IV | 1.5 mg | 30 |
| Hydromorphone PO | 7.5 mg | 30 |
| Oxycodone PO | 20 mg | 30 |
| Hydrocodone PO | 30 mg | 30 |
| Codeine PO | 200 mg | 30 |
| Tramadol PO | 300 mg | 30 |
| Drug | Bolus | Lockout |
|---|---|---|
| Morphine (1 mg/mL) | 0.5-2.5 mg | 5-10 min |
| Fentanyl (10 mcg/mL) | 10-20 mcg | 4-10 min |
| Hydromorphone (0.2 mg/mL) | 0.05-0.25 mg | 5-10 min |
| Methadone (1 mg/mL) | 0.5-2.5 mg | 8-20 min |
Bordi, S. K. (2023). Acute pain: Physiology and management. In S. Elisha, J. S. Heiner, & J. J. Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 1293-1309). Elsevier.
Morphine milligram equivalent (MME) conversion translates different opioids into a common oral morphine reference so total daily opioid exposure can be compared across agents. Using morphine as the reference (factor of 1), oxycodone converts at 1.5, hydromorphone at 5, hydrocodone at roughly 1, and transdermal fentanyl at 2.4 per mcg per hour of patch strength (Hurley et al., 2025, pp. 2530-2532).
These factors are rough population level estimates, not precise individual predictions. When rotating from one opioid to another, cross tolerance is incomplete, so the new opioid can be more potent in that patient than the equianalgesic dose predicts. Reduce the calculated dose to about 50 to 75% and then titrate, to avoid oversedation and respiratory depression (Hurley et al., 2025, pp. 2530-2532).
Hurley, R. W., Elkassabany, N. M., & Wu, C. L. (2025). Acute postoperative pain. In Miller's anesthesia (10th ed., pp. 2512-2537). Elsevier.