1Why Corticosteroid Dose Conversion Matters in Practice
Converting between corticosteroids is a routine yet error-prone responsibility in acute and chronic care—such as switching a patient from IV hydrocortisone to oral prednisolone prior to hospital discharge, tapering dexamethasone post-COVID-19, or adjusting inhaled/oral budesonide regimens in inflammatory bowel disease.
Because corticosteroids differ drastically in anti-inflammatory potency, mineralocorticoid activity (sodium/water retention), and duration of action, a naive milligram-for-milligram switch can lead to severe iatrogenic complications or therapeutic failure.
2Corticosteroid Equivalence Reference Table
| Corticosteroid | Equivalent Dose (mg) | Anti-inflammatory Potency | Mineralocorticoid Activity | Plasma Half-Life | HPA Suppression |
|---|---|---|---|---|---|
| Cortisone acetate | 25 mg | 0.8× | 2+ (Moderate) | 8–12 h | Short |
| Hydrocortisone (Cortisol) | 20 mg | 1× (Reference) | 2+ (Moderate) | 8–12 h | Short |
| Prednisolone / Prednisone | 5 mg | 4× | 1+ (Mild) | 12–36 h | Intermediate |
| Methylprednisolone | 4 mg | 5× | 0 (None) | 12–36 h | Intermediate |
| Triamcinolone | 4 mg | 5× | 0 (None) | 12–36 h | Intermediate |
| Dexamethasone | 0.75 mg | 25–30× | 0 (None) | 36–54 h | Long (Potent) |
| Betamethasone | 0.6 mg | 25–30× | 0 (None) | 36–54 h | Long (Potent) |
| Budesonide (Oral) | ~1.2 mg | ~15× (Topical) | 0 (None) | 12–24 h | Moderate (First-pass) |
3Key Clinical Notes & Tapering Protocols
Dexamethasone, betamethasone, and methylprednisolone possess negligible mineralocorticoid potency. They do not cause sodium and water retention, making them ideal for patients with heart failure, hypertension, or cerebral edema where fluid overload must be avoided.
Hypothalamic-Pituitary-Adrenal (HPA) axis suppression occurs after approximately 3 weeks of continuous systemic glucocorticoid therapy at doses equivalent to prednisolone ≥5 mg/day. Taper gradually by 10%–20% every 1–2 weeks once disease activity is controlled. Physiological replacement is approximately prednisolone 5 mg/day (hydrocortisone 20 mg/day).