Morphine Equivalent Dose Calculation
The total morphine equivalent dose (MME) for hydromorphone 6 mg per day plus T3 (Tylenol #3: acetaminophen 300mg/codeine 30mg) × 2 per day is 48 MME/day. 1
Calculation Breakdown
Hydromorphone Component
- Hydromorphone 6 mg/day × conversion factor of 5.0 = 30 MME/day 1
- The CDC updated the hydromorphone conversion factor from 4.0 to 5.0 in 2022, reflecting more recent evidence about hydromorphone's relative potency 1
- Note that older guidelines from 2016 used a conversion factor of 4.0, which would yield 24 MME/day, but the most current CDC recommendation is 5.0 2, 1
Codeine Component (T3)
- T3 × 2 per day = 60 mg codeine per day (30 mg × 2 tablets) 2
- Codeine 60 mg/day × conversion factor of 0.15 = 18 MME/day 2, 1
Combined Total
- 30 MME (hydromorphone) + 18 MME (codeine) = 48 MME/day total 1
Clinical Significance and Risk Assessment
This patient is approaching the 50 MME/day threshold where the CDC recommends pausing and carefully reassessing benefits versus risks before any further dose escalation. 1
- At dosages approaching 50 MME/day, patients experience progressive increases in overdose risk without necessarily experiencing proportional improvements in pain control or function 1
- Before increasing beyond 50 MME/day, clinicians should pause and carefully reassess individual benefits and risks, as many patients do not experience benefit from higher doses 1
Critical Conversion Caveat
These conversion factors are specifically for calculating MME for comparison purposes only and should NEVER be used directly when switching patients between opioids. 1
- When actually converting between opioids, the new opioid should be dosed substantially lower (typically 25-50% reduction) than the calculated MME to avoid overdose due to incomplete cross-tolerance 3, 1
- The conversion factors provided are for risk assessment and monitoring purposes, not for equianalgesic dosing when rotating opioids 2, 1