What oral prednisone dose is equivalent to methylprednisolone 50 mg?

Methylprednisolone 50 mg Oral Dose Equivalence

Methylprednisolone 50 mg is equivalent to prednisone 62.5 mg based on the standard conversion ratio of 1.25:1 (prednisone:methylprednisolone).

Standard Conversion Ratio

• The FDA-approved conversion establishes that methylprednisolone 12 mg equals prednisone 15 mg, yielding a ratio of 1.25:1 1
• Using this ratio: 50 mg methylprednisolone × 1.25 = 62.5 mg prednisone 1
• This conversion applies to both oral and intravenous administration, as bioavailability of both oral formulations is excellent 2

Clinical Context from Guidelines

• The European Society of Cardiology confirms that prednisone 25 mg is equivalent to methylprednisolone 20 mg, which maintains the same 1.25:1 ratio 3
• For polymyalgia rheumatica management, guidelines reference this conversion when switching between methylprednisolone 10-20 mg daily and prednisone 12.5-25 mg daily 2
• The EULAR/ACR collaborative guidelines note that intramuscular methylprednisolone 120 mg every 3 weeks was used as an alternative to oral prednisone regimens in clinical trials 3

Pharmacokinetic Considerations

• Methylprednisolone demonstrates linear, predictable pharmacokinetics with no dose or time dependency, making conversions straightforward 4
• In contrast, prednisolone (the active metabolite of prednisone) shows dose-dependent pharmacokinetics due to saturable protein binding at higher doses 4
• Research confirms that current dose equivalency tables reflect reasonable relationships when assessed by mechanistic models for biomarkers including T-cell trafficking and cortisol suppression 5

Practical Application

• When converting from methylprednisolone 50 mg to prednisone, prescribe prednisone 60 mg once daily (rounding 62.5 mg to the nearest practical dose) 2, 6
• Maintain the same dosing frequency initially; prednisone is typically given as a single morning dose 6
• If the patient was taking methylprednisolone in divided doses, consolidate to once-daily prednisone dosing after conversion 6

Important Caveats

• This conversion ratio applies only to oral or intravenous routes; intramuscular or intra-articular administration may markedly alter relative potency 1
• Both medications require identical bone protection measures: calcium and vitamin D supplementation, with bisphosphonates for patients expected to take prednisone ≥7.5 mg daily (methylprednisolone ≥6 mg daily) for ≥3 months 2
• Wait at least 1-2 weeks between corticosteroid courses; extend to 3-4 weeks for patients with diabetes, hypertension, osteoporosis, or glaucoma 7, 6