Hydrocortisone to Prednisone Dose Equivalency
200 mg of hydrocortisone is equivalent to 50 mg of prednisone, based on the established 4:1 conversion ratio. 1, 2
Standard Conversion Ratios
The fundamental conversion is 20 mg hydrocortisone = 5 mg prednisone (4:1 ratio), which is consistently cited across multiple authoritative guidelines 1, 2
Using this ratio, 200 mg hydrocortisone ÷ 4 = 50 mg prednisone equivalent 1
The FDA drug label for hydrocortisone explicitly states: "20 mg of hydrocortisone is equivalent to 5 mg of prednisolone" 2
Clinical Context and Validation
This conversion is based on the maximum adrenal output of hydrocortisone (cortisol) during stress being 200-300 mg/day, with prednisone being 4 times more potent than hydrocortisone 1
The equivalent dose relationships are: prednisone 60 mg = methylprednisolone 48 mg = dexamethasone 10 mg = hydrocortisone 240 mg 1
Multiple guidelines confirm that prednisolone 5 mg = hydrocortisone 20 mg = methylprednisolone 4 mg when managing perioperative steroid coverage 1
Important Clinical Caveats
These are total daily dose equivalencies, not necessarily bioequivalent on a pharmacokinetic basis - research shows that while dose tables reflect reasonable equivalency for most clinical purposes, individual patient responses may vary 3
The conversion assumes equivalent anti-inflammatory potency; however, prednisolone has approximately 25 times less mineralocorticoid activity than hydrocortisone, which may be clinically relevant in certain contexts 1
When converting between formulations in acute settings (such as perioperative management or acute illness), the 4:1 ratio remains the standard for calculating equivalent anti-inflammatory doses 1