What is the equivalent dose of methylprednisolone for an adult patient with suspected leprosy receiving 50mg of hydrocortisone every 8 hours?

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Hydrocortisone to Methylprednisolone Conversion

For a patient receiving hydrocortisone 50mg every 8 hours (150mg/day total), the equivalent methylprednisolone dose is 30mg daily, given as either 10mg three times daily or 30mg once daily. 1

Conversion Calculation

The standard potency ratio is 5:1 (hydrocortisone:methylprednisolone), meaning methylprednisolone is 5 times more potent than hydrocortisone. 1

Direct calculation:

  • Hydrocortisone 50mg every 8 hours = 150mg/day total
  • 150mg hydrocortisone ÷ 5 = 30mg methylprednisolone per day
  • This can be administered as 10mg three times daily to mirror the 8-hourly dosing pattern 1

Clinical Context for Leprosy Reactions

For leprosy Type 1 reactions with nerve function impairment, oral prednisolone (not methylprednisolone) is the standard treatment, typically starting at 40-60mg daily and tapering over 12-20 weeks. 2, 3 The evidence specifically supports prednisolone rather than methylprednisolone for this indication.

If converting to prednisolone instead (which is more appropriate for leprosy):

  • Hydrocortisone 150mg/day = prednisolone 37.5mg/day (using the 4:1 ratio)
  • Round to prednisolone 40mg daily for practical dosing 1, 4

Important Dosing Considerations

Methylprednisolone has minimal mineralocorticoid activity compared to hydrocortisone, which has substantial mineralocorticoid effects. 1 When switching from hydrocortisone to methylprednisolone:

  • Monitor potassium levels as supplementation needs may decrease 1
  • Watch for signs of mineralocorticoid deficiency if the patient has adrenal insufficiency 1

For leprosy reactions specifically, high-dose intravenous methylprednisolone (1000mg daily for 3 days) followed by oral prednisolone has been studied, but showed no significant advantage over oral prednisolone alone except for preventing sensory deterioration between days 29-113. 2 Standard oral corticosteroid therapy remains the mainstay.

Duration matters: 50% of patients with Type 1 reactions require additional corticosteroids despite 16 weeks of treatment, suggesting more prolonged courses may be necessary. 2

References

1
Guideline

Corticosteroid Conversion and Clinical Considerations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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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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