Corticosteroid Conversion Doses
The standard corticosteroid equivalent doses are: 5 mg prednisone = 4 mg methylprednisolone = 0.75 mg dexamethasone. 1
Detailed Corticosteroid Equivalence Table
| 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) |
| Betamethasone | 25-30 | 0.6 | Long (36-72h) |
| Triamcinolone | 5 | 4 | Intermediate (12-36h) |
| Fludrocortisone | 10 | 2* | Intermediate (12-36h) |
*Note: Fludrocortisone also has significant mineralocorticoid activity at doses of 0.05-0.1 mg/day
Clinical Applications of Corticosteroid Conversion
When converting between corticosteroids, it's important to consider:
Potency differences: Dexamethasone is approximately 30 times more potent than hydrocortisone and about 6-7 times more potent than prednisone or methylprednisolone 1
Duration of action:
- Short-acting: Hydrocortisone (8-12 hours)
- Intermediate-acting: Prednisone, prednisolone, methylprednisolone (12-36 hours)
- Long-acting: Dexamethasone, betamethasone (36-72 hours) 1
Clinical context: Different conditions may require different corticosteroids based on:
Practical Conversion Examples
- 40 mg prednisone = 32 mg methylprednisolone = 6 mg dexamethasone
- 60 mg prednisone = 48 mg methylprednisolone = 9 mg dexamethasone
- 100 mg prednisone = 80 mg methylprednisolone = 15 mg dexamethasone
Special Considerations
Hepatic impairment: Prednisone requires hepatic conversion to prednisolone to become active. In severe liver disease, dexamethasone or methylprednisolone may be preferred 1
Medication adherence: For patients with adherence challenges, longer-acting corticosteroids like dexamethasone may be beneficial due to less frequent dosing 1
Mineralocorticoid effects: Dexamethasone has minimal mineralocorticoid effects compared to prednisone or methylprednisolone, which may be relevant in patients with fluid retention concerns 1
Tapering: When converting between corticosteroids during a taper, maintain equivalent anti-inflammatory doses to prevent withdrawal symptoms 3
Remember that these conversion ratios are approximate guidelines, and clinical response should be monitored when switching between different corticosteroids.