Opioid Rotation Planner
Specify the current opioid, route, and total daily dose, then select the target opioid. The calculator converts through morphine milligram equivalents (MME) and applies a safety reduction for cross-tolerance.
Source regimen
Target regimen
Typical reduction: 25–50% depending on risk factors.
Conversion Summary
Source MME
60.0 MME/day
60.0 mg/day × factor 1.
Adjusted MME
45.0 MME/day
Reduction applied: 25% for incomplete cross-tolerance.
Target opioid dose
30.00 mg/day
How to Use This Calculator
Confirm accurate source dosing
Calculate the patient’s total daily opioid intake (scheduled + PRN). Ensure stability before rotating.
Select the target opioid/route
Choose the new regimen and consider pharmacokinetics, breakthrough rescue plans, and patient goals.
Apply cross-tolerance reduction
Start conservatively (25–50% reduction) to minimize overdose risk, then titrate based on response.
Formula
Source MME = Source dose × MME conversion factor.
Conversion factors adapted from CDC opioid prescribing guidelines (2016, 2022 updates) and equianalgesic tables.
Frequently Asked Questions
Why reduce for cross-tolerance?
Different opioids have variable receptor binding. Patients may respond more strongly to the new opioid, so starting lower reduces overdose risk.
Can I convert to methadone?
Methadone conversions are complex and dose dependent. Use specialist guidance and conservative dosing beyond this calculator.
How do I handle breakthrough dosing?
Provide short-acting rescue doses (e.g., 5–15% of total daily morphine equivalent) while monitoring for sedation and respiratory depression.
Is this calculator for acute pain?
Designed for chronic opioid therapy. Acute pain conversions may require inpatient monitoring and more aggressive adjustments.
What patient factors modify the plan?
Age, organ dysfunction, sleep apnea, benzodiazepine use, and opioid tolerance all influence final dosing and monitoring frequency.