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Calculating morphine milligram equivalents (MME) morphine OPIOID (doses in mg/day except where noted) CONVERSION FACTOR Fentanyl transdermal (in mcg/hr) These dose conversions are estimated and cannot account for all individual differences in genetics and pharmacokinetics .
USE EXTRA CAUTION: • Methadone: the conversion factor increases at Do not use the calculated dose in MMEs to determine dosage for converting one opioid to another—the new opioid should be lower morphine to avoid unintentional overdose caused by incomplete cross-tolerance and individual differences in opioid pharmacokinetics .
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• Fentanyl: dosed in mcg/hr instead of mg/day, and absorption is affected by heat and other factors HOW SHOULD PROVIDERS USE THE TOTAL DAILY OPIOID DOSE IN CLINICAL PRACTICE? Use caution when prescribing opioids at any dosage and prescribe the lowest morphine mg morphine liquid storage morphine nursing implications morphine vs ms contin morphine effective dose .
Use extra morphine precautions when increasing to ≥50 MME per day* such as: – Monitor and assess pain and function more frequently .
– Discuss reducing morphine dose or tapering and discontinuing opioids if benefits do not outweigh harms .
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Avoid or carefully justify increasing dosage to morphine ≥90 MME/day . * * These dosage thresholds are based on overdose risk when opioids are prescribed for morphine pain and should not guide dosing of medication-assisted treatment for opioid use disorder .
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