What are the equivalent doses of other corticosteroids (corticosteroids) to prednisone (prednisone)?

Corticosteroid Equivalent Doses to Prednisone

The standard equivalent doses to 5 mg of prednisone are: 4 mg methylprednisolone, 5 mg prednisolone, 20 mg hydrocortisone, and 0.75 mg dexamethasone. 1, 2, 3

Standard Dose Equivalencies

The following conversions are based on FDA-approved drug labeling and established clinical practice:

• Prednisone 5 mg = Prednisolone 5 mg 4

  • These are considered completely equivalent and interchangeable at the same dose
  • Both are used identically in clinical trials depending on country of origin

• Prednisone 5 mg = Methylprednisolone 4 mg 4, 3

  • FDA labeling confirms 4 mg methylprednisolone equals 5 mg prednisolone/prednisone
  • Commonly used in both oral and IV formulations

• Prednisone 5 mg = Hydrocortisone 20 mg 2

  • FDA labeling explicitly states this 4:1 ratio
  • Hydrocortisone has the shortest half-life (12-36 hours) requiring more frequent dosing

• Prednisone 5 mg = Dexamethasone 0.75 mg 4

  • Dexamethasone is approximately 6-7 times more potent than prednisone
  • Has the longest half-life (36-72 hours) allowing single daily or alternate-day dosing

Practical Dosing Conversions

When converting between corticosteroids for clinical use:

• For moderate-to-severe conditions requiring 1 mg/kg prednisone: 4

  • Use 0.8 mg/kg methylprednisolone (slightly lower due to increased potency)
  • Use 1 mg/kg prednisolone (equivalent dosing)
  • Use 4 mg/kg hydrocortisone (4-fold increase)
  • Use 0.15 mg/kg dexamethasone (approximately 6-7 fold reduction)

• For high-dose therapy (2 mg/kg prednisone): 4

  • Use 1.6 mg/kg methylprednisolone
  • Maximum doses should not exceed prednisone 60-80 mg equivalent regardless of indication

Important Clinical Considerations

Bioavailability differences in liver disease: 5

• Prednisone requires hepatic conversion to prednisolone (the active form)
• In patients with active liver disease (elevated bilirubin/transaminases), prednisone-to-prednisolone conversion is impaired
• Prednisolone should be used directly in severe liver disease rather than prednisone
• Plasma half-life of prednisolone is prolonged in chronic liver disease

Route of administration equivalency: 6

• Oral and intramuscular corticosteroids show similar efficacy for acute conditions
• IM dexamethasone may improve compliance compared to multi-day oral prednisone courses
• No dose adjustment needed when switching between oral and IM routes for the same corticosteroid

Timing of administration: 1, 3

• Single daily doses should be given in the morning (before 9 AM) to minimize HPA axis suppression
• Maximal adrenal activity occurs between 2 AM and 8 AM
• Multiple daily doses should be evenly spaced throughout the day

Common Pitfalls to Avoid

Do not assume all corticosteroids are interchangeable without dose adjustment - the potency differences are substantial and failure to convert properly can result in under- or over-treatment 1, 2, 3

Do not use prednisone in severe liver disease - use prednisolone instead since hepatic conversion is required for prednisone activity 5

Do not abruptly discontinue after prolonged use - all corticosteroids require gradual tapering to allow HPA axis recovery, regardless of which agent was used 1, 2, 3

Do not exceed maximum effective doses - doses above prednisone 60-80 mg equivalent (or methylprednisolone 2 mg/kg) provide no additional benefit and increase adverse effects 4