Corticosteroid Equivalency Converter

Why use it

Corticosteroid conversions are one of the most common but error-prone tasks in clinical medicine. Under-dosing risks inadequate immunosuppression or adrenal crisis; over-dosing risks serious adverse effects including hyperglycemia, hypertension, immunosuppression, avascular necrosis, and adrenal suppression. This converter provides a quick, evidence-based reference for bedside conversions with important clinical context for each agent.

About

The Corticosteroid Equivalency Converter translates doses between commonly used systemic corticosteroids based on their relative anti-inflammatory (glucocorticoid) potency compared to hydrocortisone. Corticosteroids vary considerably in potency, mineralocorticoid activity, plasma half-life, and biological duration of action. This tool enables clinicians to safely switch between agents when a given corticosteroid is unavailable, when minimizing mineralocorticoid side effects, when tapering from intravenous to oral formulations, or when adjusting steroid doses for critically ill patients. The equivalency table is based on well-established pharmacological consensus from major endocrinology and pharmacology references. Note: equivalencies apply to SYSTEMIC anti-inflammatory effects only — inhaled corticosteroid doses are not interchangeable with these equivalences.

When to use

• Switching a patient from IV methylprednisolone to oral prednisone during step-down
• Converting dexamethasone (used for cerebral edema or COVID-19) to prednisone equivalent for tapering
• Calculating hydrocortisone stress dosing equivalents from chronic oral prednisone dose
• Comparing total steroid exposure across different agents in a complex patient
• Determining equivalent dosing when a specific corticosteroid is unavailable
• Translating dosing protocols from clinical trials (often in dexamethasone) to bedside practice

Formula

Pearls & pitfalls

• Dexamethasone has ZERO mineralocorticoid activity — preferred when fluid retention or hypertension is a concern; however it provides NO mineralocorticoid coverage in adrenal insufficiency.
• Hydrocortisone has the highest mineralocorticoid activity (~1× fludrocortisone equivalent) — useful for adrenal crisis or septic shock but causes sodium retention at high doses.
• These equivalencies are for ANTI-INFLAMMATORY potency only — pharmacokinetics, tissue penetration, and receptor affinity differ.
• Biological duration (not plasma half-life) determines dosing frequency: hydrocortisone 8–12h, prednisone 12–36h, dexamethasone 36–72h.
• The HPA axis suppression risk is proportional to biological duration and dose — dexamethasone suppresses the HPA axis more than equivalent anti-inflammatory doses of hydrocortisone.
• Converting from one steroid to another should be done in a single-step calculation — avoid double-converting (e.g., A→B→C).
• These equivalences are averages; individual patient pharmacokinetics can vary by 2–3 fold.
• Betamethasone and dexamethasone are used for fetal lung maturation (antenatal corticosteroids) — cross placenta efficiently due to low protein binding.
• Methylprednisolone has slightly lower mineralocorticoid activity than prednisone and is available IV — preferred in IV steroid pulses for MS, SLE nephritis, AERD.

Next steps

Confirm the converted dose is appropriate for the clinical indication — potency equivalences apply to anti-inflammatory effects but not all effects (e.g., mineralocorticoid activity, duration). Consider mineralocorticoid replacement in adrenal insufficiency (fludrocortisone 0.05–0.1 mg/day). Taper steroids slowly (≥2 weeks) to avoid adrenal insufficiency when discontinuing after chronic use. Monitor blood glucose (especially with high-dose or changing regimens), blood pressure, and electrolytes.

Evidence

Steroid equivalency tables are based on classic radioligand binding studies and clinical pharmacology data from the 1960s–1980s. Published in Brunton LL et al. Goodman & Gilman's: The Pharmacological Basis of Therapeutics (13th ed. 2018); Sutter MC & Loh E (Lancet 2001); Furst DE & Saag KG (UpToDate); and multiple clinical pharmacology references. The equivalence values represent consensus clinical estimates — minor differences exist across sources.

References

1. Brunton LL et al. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. McGraw-Hill. 2018. — link
2. Furst DE, Saag KG. Glucocorticoid equivalency and conversion. UpToDate. 2023. — link
3. 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. — link