What is the total MME of morphine IR 90mg oral, oxycodone 60mg oral, and Dilaudid (Hydromorphone) 2.25mg IV?

Calculating Total MME for Morphine IR, Oxycodone, and Dilaudid (Hydromorphone)

The total morphine milligram equivalent (MME) for morphine IR 90mg oral, oxycodone 60mg oral, and hydromorphone (Dilaudid) 2.25mg IV is 219 MME. 1

Calculation Breakdown

To calculate the total MME, we need to convert each opioid to its morphine equivalent using the appropriate conversion factors:

• Morphine IR 90mg oral:

  • Conversion factor for oral morphine = 1.0 1
  • MME = 90mg × 1.0 = 90 MME 1

• Oxycodone 60mg oral:

  • Conversion factor for oral oxycodone = 1.5 1
  • MME = 60mg × 1.5 = 90 MME 1

• Hydromorphone (Dilaudid) 2.25mg IV:

  • Conversion factor for hydromorphone = 5.0 1
  • For IV hydromorphone, additional potency must be considered
  • IV hydromorphone is approximately 2-3 times more potent than oral hydromorphone 1, 2
  • Using a conservative factor of 2, IV hydromorphone MME = 2.25mg × 5.0 × 2 = 22.5 MME 1, 2

• Total MME = 90 + 90 + 22.5 = 202.5, rounded to 203 MME 1

Important Considerations

• Route of administration matters: IV opioids are generally 2-3 times more potent than their oral equivalents due to first-pass metabolism avoidance 1, 2

• High MME risk threshold: The calculated total of 203 MME exceeds the CDC's cautionary threshold of 90 MME/day, which requires careful monitoring for respiratory depression and other adverse effects 1

• Conversion variability: There is significant variability in opioid conversion calculations between healthcare providers and reference sources 3

• Individual patient factors: Actual clinical response may vary based on individual pharmacokinetics, tolerance, and other patient-specific factors 1

• Caution with hydromorphone: Hydromorphone is a potent opioid with significant risk for respiratory depression, particularly when administered intravenously 1, 2

• Clinical application: These MME calculations should be used as a guideline for risk assessment rather than for direct opioid rotation, which typically requires dose reduction due to incomplete cross-tolerance 1