Approximate dose conversions for commonly used opioids (refer to important note below)

Approximate dose conversions for commonly used opioids (refer to important notes below)
Morphine		Hydromorphone (Dilaudid)		Oxycodone	Fentanyl transdermal*
IV (mg/day)	Oral (mg/day)	IV (mg/day)	Oral (mg/day)	Oral (mg/day)	Patch (mcg/hour)
5	15	0.75	3.5	10	NA
8.5	25	1.25	6.5	15	12
10	30	1.5	7.5	20	12
17	50	2.5	12.5	30	25
33	100	5	25	65	50
50	150	7.5	37.5	100	75
67	200	10	50	130	100
83	250	12.5	62.5	165	125
100	300	15	75	200	150
117	350	17.5	87.5	230	175
133	400	20	100	265	200
150	450	22.5	112.5	300	225
167	500	25	125	330	250
183	550	27.5	137.5	360	275
200	600	30	150	400	300
Conversion ratios to determine daily total ORAL morphine milligram equivalent (MME)
Drug		Approximate equivalent oral dose		Approximate equivalent IV or subcutaneous dose	Conversion ratio to determine daily total ORAL morphine milligram equivalent (MME)
Morphine		30 mg		10 mg	Parenteral morphine to oral morphine: 1:3
Fentanyl		Not available		0.1 mg (100 mcg)	Parenteral fentanyl to oral morphine: 1:300
Hydrocodone		30 mg		Not available	Oral hydrocodone to oral morphine: 1:1^¶
Hydromorphone		7.5 mg		1.5 mg	Oral hydromorphone to oral morphine: 1:4 Parenteral hydromorphone to oral morphine: 1:20
Oxycodone		20 mg		Not available	Oral oxycodone to oral morphine: 1:1.5
Oxymorphone		10 mg		1 mg	Oral oxymorphone to oral morphine: 1:3 Parenteral oxymorphone to oral morphine: 1:30

Important notes:

The doses included here provide a starting point for the purpose of comparing and switching different opioids during maintenance therapy; these are not recommended doses for the initiation of opioid therapy.
Equianalgesic conversions serve only as a general guide to estimate opioid dose equivalents. When switching to a new opioid, the initial daily dose for the new opioid determined by using the conversions in the first part of this table should be further reduced by 25 to 50% to adjust for lack of complete mu receptor cross-tolerance (except when switching to methadone, which requires a 75 to >90% reduction; refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia). In contrast, when switching between intravenous and oral administration of the same opioid, an empiric reduction of the equianalgesic dose estimate shown above is generally not necessary.
The calculated starting dose of the new opioid or new route of administration will require monitoring and further titration after making the conversion. For a review of multiple factors that must be considered for safely individualizing conversion of opioid analgesia in patients with cancer, refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia.
The approximate equivalences have been rounded. Further rounding may be necessary for available tablet strengths.
The second part of this table provides conversion factors to assess the total daily oral morphine milligram equivalent (MME) dose. Total daily oral MME dose >50 mg is one factor among several that can help identify patients who may be at higher risk for overdose and may benefit from closer monitoring and coprescription of naloxone. A high daily MME dose may also be useful for identifying tolerance, and can suggest that a patient may benefit from opioid rotation. For further information refer to UpToDate content on chronic pain management.

IV: intravenous; mcg: microgram.
* Suggested doses for conversion to transdermal fentanyl from other opioids are less conservative than recommendations in the United States product labeling. The recommendations in this table are based on guidance available at experienced centers.
¶ Wide interpatient variability in response.

Courtesy of Kathleen Broglio, DNP, MN, ANP-BC, ACHPN and Russell K Portenoy, MD.
Additional data from:

National Comprehensive Cancer Network. Adult Cancer Pain, Version 2.2021.

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