What are the equivalent doses of prednisone to methylprednisolone and dexamethasone?

From the Guidelines

Prednisone 60 mg is equivalent to 48 mg of methylprednisolone and 10 mg of dexamethasone, as stated in the clinical practice guideline for sudden hearing loss 1. When converting between these corticosteroids, it is essential to consider their different potencies to maintain therapeutic effects.

• The potency of prednisone, methylprednisolone, and dexamethasone varies, with prednisone being the least potent and dexamethasone being the most potent.
• According to the guideline, prednisone is 4 times, methylprednisolone is 5 times, and dexamethasone is 25 times more powerful than hydrocortisone 1.
• The equivalent doses are crucial in clinical practice, as underdosage or overdosage can significantly impact patient outcomes.
• For example, a patient taking 60 mg of prednisone would need 48 mg of methylprednisolone or 10 mg of dexamethasone for equivalent effect, as stated in the guideline 1.
• Another study provides dosage information for prednisone and its equivalent in methylprednisolone, stating that 25 mg of prednisone is equivalent to 20 mg of methylprednisolone 1. However, the most recent and highest quality study, which is the clinical practice guideline for sudden hearing loss 1, provides the most accurate equivalent doses.
• The guideline emphasizes the importance of early treatment and adequate dosing, as well as the need for individualized treatment plans and shared decision-making with patients.
• In clinical practice, physicians must consider the potency differences and adjust dosages accordingly to maintain therapeutic effects and minimize adverse effects.

From the Research

Equivalent Doses of Prednisone to Methylprednisolone and Dexamethasone

• The equivalent doses of prednisone to methylprednisolone and dexamethasone are as follows:
  • 500 mg of methylprednisolone is equivalent to 100 mg of dexamethasone and 625 mg of prednisone 2
• The dosing regimens for pulse glucocorticoid therapy are not standardized, but typical doses are:
  • 10 to 20 mg per kilogram of body weight for methylprednisolone (250-1000 mg)
  • 2 to 5 mg per kilogram of body weight for dexamethasone (50-200 mg) 2
• In the treatment of COVID-19 pneumonia, high-dose methylprednisolone (250-500 mg daily for 3 days) followed by oral prednisone (50 mg daily for 14 days) has been compared to dexamethasone (6 mg daily for 7-10 days) 3
• A study comparing the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome found that dexamethasone may have more favorable clinical outcomes compared to methylprednisolone and hydrocortisone 4
• The pharmacokinetics of methylprednisolone and prednisolone have been evaluated after single and multiple oral administration, showing that methylprednisolone has linear pharmacokinetics while prednisolone has marked dose dependency and time-dependent pharmacokinetics 5