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Morphine Milligram Equivalent (MME)

Calculates daily opioid dose in morphine equivalents for safety monitoring.

When to use: Used to standardise opioid doses across different agents for safety monitoring. CDC guidelines recommend caution above 50 MME/day and avoid exceeding 90 MME/day for chronic non-cancer pain. Essential for detecting high-risk prescribing.
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Formula
Daily MME = Opioid conversion factor × dose per administration × doses per day Conversion factors: Codeine ×0.15, Tramadol ×0.1, Morphine oral ×1, Oxycodone oral ×1.5, Hydromorphone oral ×5, Fentanyl patch (mcg/hr) ×2.4
Key Points for NEET PG
  • CDC 2022 guidelines: avoid exceeding 90 MME/day for chronic non-cancer pain
  • Fentanyl patch conversion: 25 mcg/hr patch ≈ 60 MME/day (oral morphine equivalent)
  • IV:oral morphine ratio = 1:3 (10mg IV = 30mg oral)
  • Opioid rotation: when switching, reduce calculated equianalgesic dose by 25–50% for incomplete cross-tolerance
  • Tramadol also has SNRI activity — monitor for serotonin syndrome when combined with antidepressants
References
CDC Clinical Practice Guideline for Prescribing Opioids, 2022 · MMWR (2022)
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For educational purposes only. Not for clinical decision-making without professional oversight.