Prednisolone to Prednisone Dose Equivalency
60 mg of prednisolone is equivalent to 60 mg of prednisone. These two corticosteroids are considered bioequivalent and are used interchangeably at the same dosage in clinical practice 1, 2, 3.
Direct Evidence for 1:1 Equivalency
The FDA drug labels explicitly state that prednisone and prednisolone are equivalent and used in the same dosage 2, 3. The prednisolone FDA label confirms that "5 mL of prednisolone sodium phosphate oral solution (20.2 mg prednisolone sodium phosphate) is equivalent to...Prednisone, 15" mg, establishing a 1:1 ratio 2.
Multiple clinical practice guidelines from KDIGO (Kidney Disease: Improving Global Outcomes) confirm this equivalency, stating that "prednisone and prednisolone are equivalent, are used in the same dosage, and have both been used in randomized controlled trials depending on the country of origin" 1.
The American Academy of Otolaryngology-Head and Neck Surgery guidelines also support 1:1 dosing, noting that prednisone 60 mg is equivalent to prednisolone 60 mg when discussing corticosteroid dosing regimens 1.
Clinical Context
The reason for interchangeable dosing relates to their metabolic relationship:
Prednisone is a prodrug that is rapidly converted to prednisolone (the active form) in the liver 4, 5. This conversion is so efficient in most patients that the clinical effects are identical at equivalent doses.
Both drugs demonstrate similar pharmacodynamic effects on immune cell trafficking and adrenal suppression when given at equivalent doses 6.
Important Caveats
In patients with severe liver dysfunction, prednisolone may be preferred since it is the active form and does not require hepatic conversion 4. However, the dosing remains 1:1 when switching between the two agents.
Do not confuse prednisolone/prednisone with methylprednisolone, which has a different potency ratio. Methylprednisolone 48 mg is approximately equivalent to 60 mg of prednisone or prednisolone 1, 7.