Why Steroid Dose Conversion Matters
Converting between corticosteroids is a routine but error-prone part of daily practice — switching a patient from IV hydrocortisone to oral prednisolone before discharge, adjusting a taper before stopping dexamethasone after a COVID-19 admission, or working out an equivalent budesonide dose for a patient with Crohn's disease who can't tolerate systemic steroids. Because corticosteroids differ enormously in anti-inflammatory potency, mineralocorticoid activity, and duration of action, a simple "double the dose" approach can leave a patient under-treated or over-exposed to unwanted sodium and fluid retention.
This steroid equivalence calculator converts between the eight corticosteroids most commonly prescribed in Indian hospitals and OPDs — hydrocortisone, cortisone acetate, prednisolone, prednisone, methylprednisolone, triamcinolone, dexamethasone, betamethasone, and oral budesonide — using published anti-inflammatory potency ratios referenced to hydrocortisone. Enter the current steroid and dose, and the tool instantly returns the equivalent dose for every other corticosteroid on the list, alongside each drug's relative mineralocorticoid activity, duration of action, and HPA-axis suppression risk.
The reference table further down expands on the anti-inflammatory potency values used, and the clinical notes below it cover common switch scenarios — prednisolone-to-hydrocortisone conversion for stress dosing, dexamethasone for cerebral oedema and antenatal lung maturity, and safe tapering to prevent adrenal insufficiency.
As with any dose-conversion tool, these equivalences are approximations drawn from anti-inflammatory potency alone — they don't account for a drug's specific indication, route of administration, or a patient's hepatic or renal function. Always cross-check with a pharmacist or senior colleague before switching steroids in a critically ill or physiologically fragile patient.
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