Result
Loading calculator
No dose is available until the calculator finishes loading.
Uses a 3.0 multiplier for oral methadone only.
- Target calculation
- Not available
- Safety reduction applied
- Not applied
- After safety reduction
- Not available
- Renal-adjusted target
- Not applied
- Hepatic-adjusted target
- Not applied
- Organ guidance summary
- Organ guidance is not available until the calculator loads
No renal band selected
Enter eGFR to turn on the renal adjustment guidance.
No hepatic class selected
Select mild, moderate, or severe hepatic impairment to show the liver dosing guidance for the target opioid.
| Drug and route | Regimen | Daily totals |
|---|
Before ordering
- Multi-drug totals are intended for regimen-level review; they do not replace opioid-specific bedside assessment.
- Patch entries are treated as standing 24-hour exposure estimates and not as initiation or titration instructions. A fractional quantity is not an instruction to cut a patch.
- Methadone totals are especially approximate; use the methadone tab and specialist input when rotating to methadone.
- Renal and hepatic cards show dose-guidance estimates; they are not validated severity scores.
- Reassess analgesia, respiratory rate, sedation, organ function, and adverse effects after conversion.
Methadone result
Calculated methadone estimate
- Morphine:methadone ratio
- Not available
- Raw oral methadone
- Not available
- Route adjustment
- Not applied
- Reduction applied
- Not applied
- If divided q8h
- Not available
- If divided q12h
- Not available
Methadone cautions
- Use only with clinician experience or pain/palliative specialist input.
- Methadone requires slow titration to the intended dose due to its long and variable half-life and risk of accumulation; if you are not comfortable or experienced with methadone, please consult a pain or palliative care specialist.
- Account for long and variable half-life, delayed toxicity, QTc risk, CYP interactions, and renal/hepatic context.
- No automatic rounding to tablet or liquid formulation is performed.
Schedule
30-59 mg MEDD
| Day | Full agonist | Buprenorphine |
|---|
Buprenorphine transition cautions
- Confirm the MEDD range, diagnosis, formulation access, and payer constraints before using this schedule.
- Belbuca and Suboxone both contain buprenorphine, but they are different formulations with different dose units and administration routes.
- Monitor for withdrawal, oversedation, respiratory depression, worsening pain, and adherence during cross-titration.
- For MEDD above 300 mg/day or unstable patients, consult pain, palliative care, or addiction medicine.
Benzodiazepine result
Calculated benzodiazepine equivalent
- Source diazepam equivalent (unreduced)
- Not available
- Reduced diazepam equivalent
- Not available
- Safety reduction applied
- Not applied
Critical clinical cautions
- This estimates equivalent daily doses; it does not provide a taper schedule.
- NEVER abruptly discontinue benzodiazepines. Abrupt cessation carries a high risk of severe withdrawal symptoms, including life-threatening seizures, delirium, and severe autonomic instability. Always use a gradual, clinical taper.
- Combining benzodiazepines with opioids dramatically increases the risk of profound sedation, respiratory depression, coma, and death. Use extreme caution when co-prescribing.
- Midazolam (Versed) is included because it is commonly used in ICU settings; oral and IV midazolam are not 1:1.
- Clonazepam, alprazolam, chlordiazepoxide, and oxazepam are shown as oral-only options because they do not have routine IV formulations.
- Equivalent doses are approximate. Patient-specific factors such as half-life (e.g., active metabolites in diazepam/chlordiazepoxide vs. short-acting alprazolam/triazolam), age, and liver function heavily influence clinical effects.
- Start conservatively and titrate based on individual clinical response and tolerability.
Reference Conversion tables and sources Open to review conversion values, organ guidance, and references.
Reference
Equianalgesic values used
| Medication | Route | Reference dose | Oral morphine equivalent | Use |
|---|
Equianalgesic values are approximate and may differ across sources, formulations, routes, and institutional protocols. Independently verify each conversion before clinical use.
Hepatic
Hepatic adjustment guide
| Medication | Mild | Moderate | Severe |
|---|
Renal guidance shown here: eGFR above 50 mL/min uses no automatic reduction; eGFR 30-50 mL/min applies a 25% reduction for uncontrolled pain or 50% for well controlled pain to morphine, codeine, and meperidine; eGFR below 30 mL/min marks morphine, codeine, and meperidine as avoid and highlights oxycodone or hydromorphone as moderate-kidney-effect alternatives and methadone, fentanyl, or buprenorphine as minimal-kidney-effect alternatives.
Sources
External references
| Source | How it is used here | Link |
|---|
How to use this calculator
Using the opioid conversion and MME calculator
calc.med is an equianalgesic dose calculator for clinicians. Review a single medication or a regimen, compare opioid doses, and consult the conversion tables and pharmacokinetics references on this page. Calculations run in your browser; JavaScript is required to use the tools.
Choose the calculation you need
- Total MME calculator — see the regimen's daily oral morphine equivalent (OME), also expressed here as morphine milligram equivalents (MME).
- Opioid conversion calculator — select a target drug and route, then review the equianalgesic estimate and safety adjustments.
- Methadone conversion calculator — use the separate oral morphine-to-methadone tool and its cautions.
- Buprenorphine transition schedules — view the existing schedules and their formulation-specific cautions.
- Benzodiazepine equivalence calculator — compare the listed benzodiazepines using the tool's diazepam reference.
MME (morphine milligram equivalents), OME (oral morphine equivalent), and MEDD (morphine equivalent daily dose) all describe the same daily oral morphine total in these tools.
Enter a regimen and review the result
Select each drug and route, enter the dose per administration and doses per day, and add another drug when needed. Check the units and entry summaries. For conversion, choose the target opioid and the intended safety reduction, then review any kidney or liver guidance separately. A regimen MME total and a target-drug dose answer different questions; confirm which tool and units you are using.
References and clinical use
Open conversion tables and sources to inspect the values and references used. These include UCSF's oral morphine equivalent reference and the CDC opioid prescribing guideline. Equivalences are approximate; sources, routes, and formulations can differ. This clinical decision support tool does not replace patient-specific assessment, institutional policy, or pharmacist review.