What is the dose adjustment for switching from dexamethasone to hydrocortisone (corticosteroid) injection?

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Dexamethasone to Hydrocortisone Injection Dose Conversion

When converting from dexamethasone to hydrocortisone injection, use a potency ratio of approximately 1:100 (dexamethasone to hydrocortisone), meaning 1 mg of dexamethasone equals approximately 100 mg of hydrocortisone. 1

Conversion Ratios

The conversion between these corticosteroids depends on the clinical context:

Standard Glucocorticoid Equivalency

  • Dexamethasone is 25 times more potent than hydrocortisone for general anti-inflammatory effects 2
  • However, for adrenal suppression and stress coverage, dexamethasone is 80-100 fold (or greater) more potent than hydrocortisone 3
  • Dexamethasone 6-8 mg IV provides equivalent coverage to hydrocortisone 200 mg over 24 hours 1, 4, 5

Practical Conversion Guidelines

For perioperative stress coverage:

  • Dexamethasone 6-8 mg IV = Hydrocortisone 200 mg/24 hours 1, 4
  • This means approximately 0.75-1 mg dexamethasone = 100 mg hydrocortisone in the stress dose context 1

For replacement therapy:

  • The standard oral equivalency uses: Dexamethasone 10 mg = Prednisone 60 mg = Methylprednisolone 48 mg 2
  • Since prednisone is 4 times more potent than hydrocortisone, 10 mg dexamethasone ≈ 240 mg hydrocortisone for replacement purposes 2

Clinical Application

When Switching from Dexamethasone to Hydrocortisone Injection:

For acute stress/crisis situations:

  • If patient received dexamethasone 8 mg IV, switch to hydrocortisone 100 mg IV every 6 hours (400 mg/24 hours total) 4
  • Alternatively, use hydrocortisone 200 mg/24 hours as continuous infusion 4

For perioperative coverage:

  • Replace dexamethasone 6-8 mg with hydrocortisone 100 mg IM/IV every 6 hours 1, 4
  • Continue for 24-48 hours postoperatively, then transition to oral dosing 4

For labor and delivery:

  • Use hydrocortisone 100 mg IM initially, followed by 50 mg IM every 6 hours 1

Important Clinical Considerations

Critical Differences Between Agents

Mineralocorticoid activity:

  • Dexamethasone lacks mineralocorticoid activity, making it inadequate as sole coverage for patients with primary adrenal insufficiency 1
  • Hydrocortisone has mineralocorticoid activity, which is essential in primary adrenal insufficiency 1
  • When switching from dexamethasone to hydrocortisone in primary adrenal insufficiency, ensure fludrocortisone is added once enteral feeding is established 4

Duration of action:

  • Dexamethasone has a much longer biological half-life than hydrocortisone 2
  • Dexamethasone 6-8 mg provides sufficient coverage for 24 hours, while hydrocortisone requires dosing every 6 hours 1, 5

Common Pitfalls to Avoid

  • Do not use the 25:1 ratio for stress dosing - this significantly underestimates dexamethasone's potency for adrenal suppression and will result in inadequate hydrocortisone dosing 3
  • Avoid dexamethasone for routine replacement therapy in adrenal insufficiency, as it should be avoided in this context 2
  • Monitor for excessive glucocorticoid coverage if switching during ongoing treatment, as overlapping doses may cause hyperglycemia 5
  • In neonates, recognize that high-dose dexamethasone (0.5 mg/kg/day) is equivalent to at least 15-20 mg/kg/day of hydrocortisone, far exceeding typical replacement doses 2

Monitoring After Conversion

  • Monitor blood pressure, electrolytes (sodium, potassium), and glucose 4
  • Assess for signs of under-replacement: hypotension refractory to fluids, hyponatremia, hyperkalemia 6
  • Watch for over-replacement: hyperglycemia, hypertension, fluid retention 5

References

Guideline

Intramuscular Use of Hydrocortisone and Dexamethasone

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Hydrocortisone Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Perioperative Glucocorticoid Use

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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