Analgesia

Opioid Ramp & Taper Helper

Use your patient's current opioid regimen and 24-hour MME to plan cautious dose increases or tapers. The tool shows its math and nudges toward multimodal analgesia; it does not replace clinical judgment or local policies.

Always verify doses, check renal/hepatic function, and follow local prescribing guidelines.

Baseline opioid regimen & 24-hr MME

Enter an existing inpatient regimen or patient's most recent 24-hour MME.

Enter the patient’s exact opioid regimen to generate a tailored ramp/taper plan for each medication.

Paste inpatient opioid regimen

Paste directly from the MAR or discharge summary to avoid dropdown fatigue. The parser will keep uncertainty visible instead of guessing silently.

Regimen text (one line per opioid works best)

Paste a regimen above or click “Build manually” to unlock editing.

Drug

Route

Dose (mg)

Freq (hours)

PRN?

Avg PRN/day

ER / LA? (Extended Release/Long Acting)

OME breakdown

Tylenol/day: 0 mg

Dosing equivalents (reference)

Agent	PO dose	IV dose
Morphine	30 mg	10 mg
Hydromorphone	7.5 mg	1.5 mg
Oxymorphone	10 mg	1 mg
Meperidine	300 mg	75 mg
Fentanyl	—	0.1 mg
Oxycodone	20 mg	—
Hydrocodone	30 mg	—
Codeine	120 mg	—

Conversion factors are adapted from commonly used opioid equivalence charts, including the SinaiEM Opioid Conversion Chart (see image). Always verify with your institution's preferred reference.

Total estimated OME:~0 mg/day

Choose ramp or taper strategy

Set whether you’re escalating or tapering, how well pain is controlled, and how aggressive you’d like the change to be.

Mode:

Pain control on current regimen:

Multimodal regimen in place?

Escalation Presets:

Current setting: Moderate (≈20–35% increase)

+30%applied to total MME

Smaller changeLarger change

Most guidelines favor 5–20% changes per step; larger shifts may require closer monitoring.

24-hr MME (base → target)

0 → 0 MME/day

Approx 0% change; factor ≈ 1.00 applied to each dose.

Lower MME (demo)

Review suggested ramp/taper plan

See the calculated target MME and, when a regimen is entered, per-drug suggested dose changes.

Caution

Regimen entered but 24-hr MME is ~0 mg/day. Check doses and frequencies.

Multimodal regimen is not marked as in place. When safe, consider non-opioid adjuncts (e.g., acetaminophen, NSAIDs, neuropathic agents, regional techniques, non-pharmacologic measures) rather than escalating opioids alone.

Show calculation details

Baseline MME from regimen: ~0 mg/day.
Effective baseline used for planning: ~0 mg/day (manual override if provided > 0).
Scaling factor based on mode and slider: 1.00.
Target MME ≈ base × factor = 0 × 1.00 ≈ 0 mg/day.
Each complete regimen row's dose is multiplied by the same factor, then rounded to a practical mg amount.

Show references & guidance

CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022). CDC MMWR 71(3).
VA/DoD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain. VA/DoD COT guideline.
Morphine Milligram Equivalents (MME) Calculator. MDCalc MME calculator.
Visual equianalgesic chart similar to this tool's Dosing equivalents reference table: Sinai EM equianalgesic image.

This tool is meant as a structured thinking aid and does not replace institutional policies, guidelines, or bedside clinical judgment.