What is the total morphine‑equivalent daily dose for a 59‑year‑old woman with metastatic breast cancer taking MS Contin (morphine) 30 mg orally twice daily?

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Morphine Equivalent Daily Dose (MEDD) Calculation

The total MEDD is 60 mg.

Calculation Algorithm

Since the patient is taking MS Contin (oral morphine sulfate) 30 mg twice daily, the calculation is straightforward:

  • Calculate the total 24-hour oral morphine dose by multiplying the individual dose by the number of daily administrations 1, 2

  • 30 mg × 2 doses per day = 60 mg/day oral morphine

  • Because the patient is already taking oral morphine, no conversion factor is needed – oral morphine is the reference standard for calculating morphine equivalent daily dose 2

  • The MEDD equals the total daily oral morphine dose directly: 60 mg 1, 2

Clinical Context

  • MS Contin is a controlled-release formulation designed for 12-hour dosing intervals, providing sustained therapeutic plasma morphine concentrations throughout the dosing period 3, 4, 5

  • The fact that the patient cannot take oral medications due to intractable nausea and vomiting does not change the MEDD calculation – MEDD represents what the patient was taking, not what route is currently feasible 2

  • This MEDD calculation (60 mg/day) would serve as the baseline for converting to an alternative route of administration (such as IV or subcutaneous morphine) if needed, using a 3:1 oral-to-parenteral conversion ratio 2, 6

Common Pitfall to Avoid

  • Do not confuse the individual dose (30 mg) with the total daily dose – the question asks for total MEDD, which requires summing all doses in 24 hours 1, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Opioid Conversion Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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