From the Guidelines
The morphine equivalent dose (MEE) for oxycodone 10 mg taken 4 times per day is 60 mg of oral morphine per day, based on the conversion factor of 1.5 mg of oral morphine per 1 mg of oxycodone, as indicated in the most recent and highest quality study 1.
Calculation
To calculate the MEE, we use the conversion factor where 1 mg of oxycodone is equivalent to approximately 1.5 mg of oral morphine. Therefore, 10 mg of oxycodone taken 4 times daily (40 mg total daily dose) equals 60 mg of oral morphine.
Importance of MEE
This conversion is important for comparing the relative potency of different opioid medications and for calculating total opioid burden when patients are on multiple pain medications. Healthcare providers use morphine equivalent doses to assess risk for opioid-related adverse effects, monitor appropriate dosing, and guide safe opioid prescribing practices.
Risks Associated with High MEE
When tracking morphine equivalent doses, it's essential to note that doses exceeding 50-90 mg per day are associated with higher risks of overdose and adverse effects, as highlighted in the guidelines for prescribing opioids for chronic pain 1.
Key Considerations
- The calculation of MEE is based on the conversion factor provided in the most recent study 1.
- The risks associated with high MEE doses should be carefully considered when prescribing opioids, and doses above 90 MME per day should be avoided if possible, or carefully justified based on individual patient needs and risks 1.
From the Research
Oxycodone Dosage and Equivalence
- The dosage of oxycodone 10 mg 4 times per day is a common regimen for managing moderate to severe pain 2, 3.
- The equivalence of oxycodone to morphine is 1:2, meaning that 10 mg of oxycodone is equivalent to 20 mg of morphine 2.
- Oxycodone has a faster onset of action compared to morphine, with a plasma half-life of 3-5 hours 2.
Clinical Efficacy and Safety
- Oxycodone has been shown to be an effective analgesic in acute postoperative pain at doses over 5 mg, with a dose-response relationship demonstrated for combination therapy with paracetamol 4.
- The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain 2.
- Long-term administration of oxycodone may be associated with less toxicity compared to morphine 2.
Dose-Ranging and Titration
- A dose-ranging study of oxycodone for chronic pain in advanced cancer found that pain relief was obtained with doses up to 60 mg every 4 hours 3.
- Patients older than 65 years required lower doses of oxycodone, suggesting pharmacokinetic similarities between oxycodone and morphine 3.
- Oxycodone has been shown to be as versatile and flexible as oral morphine in the management of chronic pain in patients with advanced cancer 3.