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Calculates total daily morphine milligram equivalents. 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.
In patients receiving long-acting opioid formulations (SR, transdermal), a "rescue" dose for breakthrough pain is recommended. 12 Generally, an immediate-release form of the same opioid is used (eg, morphine IR with morphine SR). The size of the breakthrough dose should be 5-15% of the patient's 24-hour baseline dose.
Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. Particular care is required when dealing with high doses of opiates.
The FDA defines an opioid-tolerant patient as receiving for 1 week or longer at least 60 mg oral morphine/day or an equianalgesic dose of another opioid. OME calculations facilitate monitoring changes in opioid utilization over time.
As the total daily chronic dose of morphine increases, the equianalgesic dose ratio (morphine:methadone) changes (American Pain Society 2016). Total daily dose should be divided by 3; delivered every 8 hours.
Use the conversion chart to work out the equivalent doses of different opioid drugs by different routes. The formula to work out the dose is under each drug name. Examples are given as a guide. Renal failure/impairment GFR<30mL/min: Morphine/Diamorphine metabolites accumulate and should be avoided. Fentanyl patch if pain is stable.
14 sie 2023 · IV: 0.1 mg to 0.2 mg/kg via slow IV injection every 4 hours as needed to manage pain; alternatively, 2 to 10 mg IV (based on 70 kg adult) IM: 10 mg IM every 4 hours as needed to manage pain (based on 70 kg adult)
