Corticosteroid Dose Converter
Enter dose in milligrams (mg)
Equivalent Doses for — — mg
Corticosteroid Equivalence Reference Table
| Steroid | Anti-inflammatory Equiv. (mg) | Anti-inflam. Potency | Mineralo. Potency | Duration (hours) | HPA Suppression |
|---|---|---|---|---|---|
| Cortisone acetate | 25 | 0.8× | 2+ | 8–12h | Short |
| Hydrocortisone (cortisol) | 20 | 1× (reference) | 2+ | 8–12h | Short |
| Prednisolone / Prednisone | 5 | 4× | 1+ | 12–36h | Intermediate |
| Methylprednisolone | 4 | 5× | 0 | 12–36h | Intermediate |
| Triamcinolone | 4 | 5× | 0 | 12–36h | Intermediate |
| Dexamethasone | 0.75 | 25–30× | 0 | 36–54h | Long (strong) |
| Betamethasone | 0.6 | 25–30× | 0 | 36–54h | Long (strong) |
| Budesonide (oral) | ~1.2 | ~15× | 0 | 12–24h | Moderate (first-pass) |
Key Clinical Notes
- Prednisolone vs Prednisone: Prednisone is converted to prednisolone in the liver. They are clinically interchangeable for most patients. Prednisolone is preferred in severe hepatic impairment (bypasses hepatic conversion)
- Dexamethasone has no mineralocorticoid activity: Does NOT cause sodium/water retention. Preferred when oedema is a concern, or in patients with hypertension or heart failure needing high-dose steroids. Also preferred for brain oedema, pre-term lung maturation, and COVID-19 (RECOVERY trial)
- Hydrocortisone has strong mineralocorticoid activity: Used for physiological replacement in adrenal insufficiency. 20 mg hydrocortisone = daily cortisol production. At stress doses (200–300 mg/day) it provides both glucocorticoid AND mineralocorticoid cover in septic shock
- Methylprednisolone IV: No mineralocorticoid activity, rapid onset, widely used for acute severe asthma (1–2 mg/kg/day), ARDS, MS relapse (1g IV × 3 days), spinal cord injury (controversial), organ rejection prophylaxis
- Budesonide (oral, e.g. Budecort): High first-pass metabolism means 90% is inactivated by liver — much lower systemic exposure than equivalent prednisolone dose. Used in Crohn's disease, microscopic colitis, and as bridge therapy
Steroid Tapering — Preventing Adrenal Insufficiency
- HPA axis suppression occurs after approximately 3 weeks of any dose equivalent to prednisolone ≥5 mg/day, or any dose of dexamethasone for >1 week
- Taper rule of thumb: reduce by 10–20% of total dose every 1–2 weeks once the underlying condition is controlled. Slower taper as you approach physiological doses
- Physiological dose: prednisolone 5 mg/day = approximately 20 mg hydrocortisone/day. Do NOT stop abruptly at this dose — continue until morning cortisol/short Synacthen test confirms HPA recovery
- Sick day rules: patients on long-term steroids should double or triple their dose during acute illness, surgery, or trauma to prevent Addisonian crisis
- Stress doses (surgery/critical illness): IV hydrocortisone 200 mg/day continuous infusion, or 50 mg QID, for major surgery. Can switch to oral as soon as patient tolerating
Related Calculators
⚠ Critical Safety Warning: Steroid dose equivalences are approximate and based on anti-inflammatory potency only. They do NOT account for differences in route of administration, pharmacokinetics, mineralocorticoid activity, or individual patient factors (hepatic/renal impairment). Do NOT convert steroid doses in patients with adrenal insufficiency using this table — physiological replacement dosing is different from anti-inflammatory dosing. Always verify with a pharmacist or senior physician before switching steroids in critically ill patients.