What are the equivalent anti‑inflammatory doses of common glucocorticoids (hydrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone) and how should they be converted?

Glucocorticoid Equivalent Doses

The standard anti-inflammatory equivalent doses are: hydrocortisone 20 mg = prednisone/prednisolone 5 mg = methylprednisolone 4 mg = triamcinolone 4 mg = dexamethasone 0.75 mg = betamethasone 0.75 mg. 1, 2, 3, 4, 5

Standard Conversion Table

The following conversions represent equivalent anti-inflammatory potency for oral or intravenous administration 1, 5:

• Hydrocortisone 20 mg 1, 3
• Prednisone 5 mg 1, 2, 5
• Prednisolone 5 mg 1, 2, 5
• Methylprednisolone 4 mg 1, 2, 5
• Triamcinolone 4 mg 4
• Dexamethasone 0.75 mg 1, 2, 4, 5
• Betamethasone 0.75 mg 4, 5

Potency Ratios for Clinical Conversion

When converting between glucocorticoids, use these multipliers relative to hydrocortisone 1, 2, 3:

• Prednisone/Prednisolone is 4 times more potent than hydrocortisone (divide hydrocortisone dose by 4) 1, 2, 3
• Methylprednisolone is 5 times more potent than hydrocortisone (divide hydrocortisone dose by 5) 1, 2
• Dexamethasone is 25 times more potent than hydrocortisone (divide hydrocortisone dose by 25) 1, 2
• Dexamethasone is 5-6 times more potent than prednisone (divide prednisone dose by 5) 2, 6

Common Clinical Conversions

High-Dose Equivalents

For pulse therapy or high-dose situations 2, 7:

• Prednisone 60 mg = Methylprednisolone 48 mg = Dexamethasone 10 mg = Hydrocortisone 240 mg 2, 3
• Prednisone 20 mg = Dexamethasone 4 mg 2, 6
• Methylprednisolone 500 mg = Dexamethasone 100 mg = Prednisone 625 mg (pulse dose equivalents) 7

Perioperative Conversions

When converting for surgical stress coverage 1, 2, 6:

• Prednisolone 5 mg oral = Hydrocortisone 20 mg IV = Methylprednisolone 4 mg IV 2, 6
• Hydrocortisone 200 mg/24 hours IV = Prednisolone 50 mg oral 2
• Dexamethasone 8 mg = Hydrocortisone 200 mg (provides 24-hour coverage) 1

Critical Clinical Considerations

Mineralocorticoid Activity

Dexamethasone and betamethasone have NO mineralocorticoid activity and are inadequate as stress coverage in primary adrenal insufficiency. 1 Hydrocortisone has substantial mineralocorticoid effects, while prednisone/prednisolone have approximately 25 times less mineralocorticoid activity than hydrocortisone. 3 When converting from hydrocortisone to methylprednisolone or dexamethasone, monitor potassium levels as supplementation needs may decrease. 2

Route-Specific Caveats

These dose relationships apply ONLY to oral or intravenous administration. 4, 5 When glucocorticoids are injected intramuscularly or into joint spaces, their relative properties may be greatly altered. 4, 5 All oral formulations have excellent bioavailability and are rapidly absorbed. 1

Duration of Action

The plasma elimination half-life of hydrocortisone is approximately 90 minutes, which may be shorter in patients taking CYP3A4 inducers or with hyperthyroidism, and longer in critically ill patients. 1 Dexamethasone is a long-acting glucocorticoid that provides coverage for 24 hours. 1, 2

Common Pitfalls to Avoid

Do not confuse methylprednisolone with methylprednisone—they are different compounds. 2 When using dexamethasone for perioperative coverage, remember it provides no mineralocorticoid support for patients with primary adrenal insufficiency. 1

Dexamethasone carries significantly higher risk of neuropsychiatric adverse events (RR 4.55) and myopathy (RR 7.05) compared to prednisone, so use the lowest effective dose and monitor closely. 6

For patients on chronic glucocorticoids (≥4 weeks), always provide stress-dose coverage during physiological stress or surgery to prevent adrenal crisis. 1, 6 The traditional conversion ratios may need adjustment in obese patients or those taking CYP3A4 inducers, though hard evidence is limited. 1