Tramadol

[fathead88]

Anyone else notice tramadol is now a 0.2 conversion to morphine?

I.e. 50 mg tramadol BID is 20 MME. I started noticing this on PDMP checks and it’s backed up by the CDC opioid conversion table?

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 | MMWR

This report describes CDC’s updated clinical practice guideline for prescribing opioids for pain.

www.cdc.gov

So 2 tramadol a day is now a higher MME dose than oxycodone 5 BID?

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[MitchLevi]

Anyone else notice tramadol is now a 0.2 conversion to morphine?

I.e. 50 mg tramadol BID is 20 MME. I started noticing this on PDMP checks and it’s backed up by the CDC opioid conversion table?

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 | MMWR

This report describes CDC’s updated clinical practice guideline for prescribing opioids for pain.

www.cdc.gov

So 2 tramadol a day is now a higher MME dose than oxycodone 5 BID?

Your math doesn't make sense.

2 x 0.2 =/= 20 MME.

 

[fathead88]

Your math doesn't make sense.

2 x 0.2 =/= 20 MME.

2 tabs of 50 mg tramadol. So 100mg x 0.2.

 

[MitchLevi]

That isn't how that works

 

[so55b]

That isn't how that works

then can you explain how that works?

 

[fathead88]

That isn't how that works

This is on my phone during clinic so I must not be explaining properly.

A patient on tramadol 50 mg BID is now converting to a daily morphine equivalent of 20 mg. It used to be 10 mg.

A patient on oxycodone 5 mg bid equates to a daily morphine equivalent of 15.

 

[MitchLevi]

then can you explain how that works?

I cannot explain how tramadol 50mg BID would equate to 20 MED.

The only thing that would make sense would be tramadol 50mg as a standard unit, not 1 mg of tramadol being equal to 0.2.

 

[lobelsteve]

Dilaudid went from 1mg = 4 MME to 5MME
Nucynta is still way over-rated in MME based on mu binding.
Tramadol mu binding is 1/5000 or so of morphine, so making it count against MME is stupid.
Still needs to be controlled for PDMP purposes but abuse potential greatly overstarted.

 

[paindoctor2014]

Dilaudid went from 1mg = 4 MME to 5MME
Nucynta is still way over-rated in MME based on mu binding.
Tramadol mu binding is 1/5000 or so of morphine, so making it count against MME is stupid.
Still needs to be controlled for PDMP purposes but abuse potential greatly overstarted.

Yeah the nucynta conversion is crazy

 

[MitchLevi]

This is the same CDC that lead us fearlessly through the 'rona thing?

 

[Force440]

There was a time when MME was used to calculate analgesic equivalency of a drug. Somehow it has now been equated with risk for a medication related adverse event.

 

[paindoctor2014]

There was a time when MME was used to calculate analgesic equivalency of a drug. Somehow it has now been equated with risk for a medication related adverse event.

We need a full reset

 

[Ferrismonk]

There was a time when MME was used to calculate analgesic equivalency of a drug. Somehow it has now been equated with risk for a medication related adverse event.

That's true, but there is a correlation between dose of drug and overdose risk.