What is the dose equivalence of different steroids, such as prednisone (corticosteroid), methylprednisolone (corticosteroid), dexamethasone (corticosteroid), and hydrocortisone (corticosteroid)?

Corticosteroid Dose Equivalence

The equivalent doses of commonly used corticosteroids are: prednisone 5 mg = prednisolone 5 mg = methylprednisolone 4 mg = dexamethasone 0.75 mg = hydrocortisone 20 mg. 1

Relative Potency and Duration of Action

Corticosteroid	Relative Potency	Equivalent Dose (mg)	Duration of Action
Hydrocortisone	1	20	Short (8-12h)
Prednisone	4	5	Intermediate (12-36h)
Prednisolone	4	5	Intermediate (12-36h)
Methylprednisolone	5	4	Intermediate (12-36h)
Dexamethasone	25-30	0.75	Long (36-72h)

Clinical Applications and Dosing Considerations

Conversion Between Different Steroids

When switching between different corticosteroids, use the equivalent doses to maintain the same anti-inflammatory effect:

• 20 mg hydrocortisone = 5 mg prednisone/prednisolone = 4 mg methylprednisolone = 0.75 mg dexamethasone 1
• For example, if a patient is on prednisone 60 mg daily, the equivalent methylprednisolone dose would be 48 mg daily 2

Disease-Specific Dosing Examples

1. Inflammatory Bowel Disease:

   • Initial doses typically 40-60 mg prednisone daily with tapering 2
   • For colitis, prednisone 1 mg/kg/day (or equivalent methylprednisolone dose) 2
   • If no improvement in 48 hours, increase to prednisone 2 mg/kg/day 2

2. Sudden Hearing Loss:

   • Prednisone 1 mg/kg/day (maximum 60 mg daily) for 10-14 days 2
   • Equivalent methylprednisolone dose would be 48 mg/day 2
   • Equivalent dexamethasone dose would be 10 mg/day 2

3. Perioperative Dosing:

   • Prednisolone 5 mg is equivalent to hydrocortisone 20 mg for perioperative coverage 2
   • For patients on chronic steroids undergoing surgery, stress dosing with hydrocortisone is recommended 1

Special Considerations

Liver Disease

• In patients with significant liver disease, prednisolone is preferred over prednisone 1
• Prednisone is a prodrug that requires conversion to prednisolone in the liver 1
• Both medications have identical potency (4× more potent than hydrocortisone) when liver function is normal 1

Tapering Recommendations

• Corticosteroids should be tapered rather than stopped abruptly to avoid adrenal insufficiency 3, 4
• Typical tapering schedule: reduce by 5 mg weekly until reaching 10 mg/day, then by 2.5 mg weekly until reaching 5 mg/day 1
• For short courses (less than 3 weeks), abrupt discontinuation may be possible if the total dose is not excessive 3

Monitoring and Side Effects

• All corticosteroids at equivalent doses have similar side effect profiles 1
• Common side effects include hypertension, glucose intolerance, weight gain, decreased bone density, and adrenal suppression 1
• Severe complications typically develop after prolonged therapy (>18 months) at doses exceeding 10 mg prednisone daily 1

Practical Application

When converting between different corticosteroids, multiply the current dose by the conversion factor:

• To convert from prednisone to methylprednisolone: multiply by 0.8 (4/5)
• To convert from prednisone to dexamethasone: multiply by 0.15 (0.75/5)
• To convert from prednisone to hydrocortisone: multiply by 4 (20/5)

Pitfalls to Avoid

1. Underdosing: The commonly prescribed methylprednisolone dose pack (4 mg tablets, total 84 mg over 6 days) only provides the equivalent of 105 mg prednisone, which may be insufficient for certain conditions requiring higher doses 2

2. Abrupt Discontinuation: Always taper corticosteroids after prolonged use to prevent adrenal insufficiency 3, 4

3. Liver Disease Considerations: In patients with significant hepatic impairment, prednisolone is preferred over prednisone as it doesn't require hepatic conversion 1

4. Equivalent Dose Confusion: Remember that equivalent doses produce the same anti-inflammatory effect but may have different mineralocorticoid effects or duration of action 1