Corticosteroid equivalency

Convert between systemic corticosteroids on the basis of approximate glucocorticoid potency.

What is this for?

Corticosteroids differ in glucocorticoid potency by more than forty-fold from hydrocortisone to betamethasone. The equivalency table lets a dose be carried across when switching agents — but it compares glucocorticoid effect only, and says nothing about mineralocorticoid activity or duration.

How to use it

Select the agent the patient is currently taking and enter the dose.
Select the agent you are switching to.
Check the full table below the result — it shows every agent at once, which is useful when several options are being considered.

Worked example

A patient on prednisone 40 mg daily is being switched to intravenous methylprednisolone. What is the equivalent dose?

Answer: 40 mg × (4 ÷ 5) = 32 mg of methylprednisolone. In practice this is often given as 30 mg or 40 mg depending on available vial sizes and the clinical situation.

Clinical pearls & pitfalls

Hydrocortisone and cortisone have substantial mineralocorticoid activity; dexamethasone and betamethasone have essentially none. Switching a patient on hydrocortisone for adrenal insufficiency to dexamethasone leaves their mineralocorticoid requirement unmet.
Duration of action varies widely: hydrocortisone is short-acting at 8–12 hours, prednisone intermediate at 12–36 hours, and dexamethasone long at 36–72 hours. An equivalent daily dose of a long-acting agent produces much greater adrenal suppression.
Prednisone is a prodrug requiring hepatic conversion to prednisolone. In significant liver impairment, prednisolone is preferred.
Equivalency does not authorise abrupt switching. A patient on long-term steroids has a suppressed axis, and any change should preserve total glucocorticoid exposure and be tapered where appropriate.
Inhaled and topical corticosteroids have entirely separate potency rankings. Do not apply this systemic table to them.

Assumptions & limitations

Compares glucocorticoid potency only, not mineralocorticoid activity, half-life, or tissue penetration.
Values are approximate and differ modestly between published sources.
Not applicable to inhaled, intranasal, topical, or intra-articular preparations.
Does not account for the different anti-inflammatory versus immunosuppressive profiles that make specific agents preferred in specific indications — dexamethasone in cerebral oedema, for instance.

References

Liu D, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.
Bornstein SR, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
Product labelling for prednisone, methylprednisolone, dexamethasone, and hydrocortisone.