What is the equivalent dosage of intravenous (IV) steroids to oral steroids?

From the Guidelines

When converting from oral to intravenous (IV) steroids, the general rule is that prednisone 5 mg orally is equivalent to methylprednisolone 4 mg IV, with a conversion factor of approximately 1.25:1, as seen in clinical practice guidelines 1. To apply this conversion, for a typical dose of oral prednisone 60 mg, the equivalent IV methylprednisolone dose would be 48 mg. Other common conversions include: oral prednisone 20 mg equals IV methylprednisolone 16 mg, and oral prednisone 40 mg equals IV methylprednisolone 32 mg. When switching from IV back to oral steroids, the same conversion factors apply in reverse. Key considerations for conversion include:

• The patient's clinical status
• The reason for switching routes
• Potential need for dose adjustments based on clinical response
• Monitoring for both therapeutic effects and potential adverse reactions when changing between oral and IV steroid administration, as recommended in guidelines for managing immune-related adverse events 1. IV steroids generally have faster onset of action (within hours versus days for oral) and may be preferred in acute situations requiring rapid anti-inflammatory effects. The bioavailability of oral steroids is approximately 80% compared to IV administration, which explains the dosing difference, although specific bioavailability data is not provided in the referenced studies 1.

From the Research

Oral Steroids to IV Steroids Conversion

• The conversion of oral steroids to IV steroids is a common practice in the treatment of acute asthma exacerbations, with studies suggesting that oral prednisone can be as effective as intravenous methylprednisolone in hospitalized children 2.
• A study comparing the efficacy of oral prednisone and intravenous methylprednisolone in children with acute asthma exacerbations found no significant difference in length of hospital stay, but patients receiving oral prednisone required supplemental oxygen for a shorter duration 2.
• Another study reviewed the evidence for different oral corticosteroid regimens for acute asthma and found no convincing evidence of differences in outcomes between higher and lower doses or longer and shorter courses of prednisolone or dexamethasone 3.
• In terms of specific IV corticosteroids, a study compared the efficacy of methylprednisolone, hydrocortisone, and dexamethasone in acute severe pediatric asthma and found no difference in durations of beta-2 agonist treatment, PICU and hospital length of stay, or need for mechanical ventilation 4.
• However, it's worth noting that hypersensitivity reactions to corticosteroids can occur, and patients can develop allergic reactions to oral, IV, or topical corticosteroids 5, 6.
• The prevalence of type I steroid hypersensitivity is estimated to be 0.3-0.5%, and allergic contact dermatitis is the most commonly reported non-immediate hypersensitivity reaction 6.

Key Considerations

• When converting oral steroids to IV steroids, the choice of corticosteroid and dosage should be based on the individual patient's needs and medical history.
• Patients with a history of hypersensitivity reactions to corticosteroids should be closely monitored and alternative treatments considered.
• The efficacy and safety of different oral corticosteroid regimens and IV corticosteroids should be carefully evaluated in clinical practice.