Corticosteroid Equivalent Dose Calculator
Corticosteroid Equivalent Dose Calculator
Convert a corticosteroid dose to another agent's equivalent using relative glucocorticoid potency — and see why mineralocorticoid activity does not travel with it.
Corticosteroid Equivalent Dose
Dose × potency ratioHydrocortisone 20 mg/day converted to prednisolone-equivalent
Formula
- equivalent mg
- the dose of each agent judged to have equal anti-inflammatory (glucocorticoid) effect — 20 mg hydrocortisone ≈ 5 mg prednisolone ≈ 4 mg methylprednisolone ≈ 0.75 mg dexamethasone
- scope
- glucocorticoid potency only — see the mineralocorticoid caveat below before applying this to a patient with adrenal insufficiency
Worked example
Hydrocortisone 20 mg/day converted to prednisolone-equivalent
20 × 5 ÷ 20 = 5.00 mg prednisolone-equivalent
Below 7.5 mg → physiological or low dose
Approximate glucocorticoid equivalence
| Agent | Equivalent dose | Mineralocorticoid activity | Duration of action |
|---|---|---|---|
| Hydrocortisone | 20 mg | Marked | Short (8 – 12 h) |
| Cortisone acetate | 25 mg | Marked | Short (8 – 12 h) |
| Prednisolone | 5 mg | Slight | Intermediate (12 – 36 h) |
| Prednisone | 5 mg | Slight | Intermediate (12 – 36 h) |
| Methylprednisolone | 4 mg | Minimal | Intermediate (12 – 36 h) |
| Triamcinolone | 4 mg | None | Intermediate (12 – 36 h) |
| Deflazacort | 6 mg | Minimal | Intermediate (12 – 36 h) |
| Dexamethasone | 0.75 mg | None | Long (36 – 72 h) |
| Betamethasone | 0.6 mg | None | Long (36 – 72 h) |
What travels across the conversion, and what does not
These equivalences describe anti-inflammatory, or glucocorticoid, potency only. They do not carry mineralocorticoid activity across the conversion, which is the single most important caveat attached to this calculator: hydrocortisone and cortisone acetate retain substantial mineralocorticoid effect, prednisolone a little, and dexamethasone and betamethasone essentially none. Converting a patient with primary or secondary adrenal insufficiency from hydrocortisone to a glucocorticoid-equivalent dose of dexamethasone leaves them with no mineralocorticoid cover at all, and can precipitate a genuine adrenal crisis even though the “equivalent” dose looks correct on paper.
Duration of action differs just as much and is easy to overlook. Hydrocortisone acts for roughly 8 to 12 hours, prednisolone for 12 to 36, and dexamethasone for 36 to 72 — a spread that changes not just how often a drug needs dosing but how completely it suppresses the hypothalamic-pituitary-adrenal axis. A short-acting agent given once daily allows more axis recovery between doses than a long-acting one at an equivalent total dose.
The potencies quoted here also determine when to worry about suppression. Above roughly 7.5 mg of prednisolone daily — or its equivalent — continued for more than about three weeks, it is reasonable to assume the HPA axis has been suppressed and to taper the dose down rather than stopping abruptly, even if the original indication has resolved.
Some listed doses are shared deliberately rather than by error: prednisolone and prednisone are equipotent at 5 mg, and methylprednisolone and triamcinolone at 4 mg — different drugs judged clinically equivalent in anti-inflammatory strength, not a mistake in the table.
Frequently asked questions
Does this conversion carry mineralocorticoid activity across as well?
No — this is glucocorticoid (anti-inflammatory) potency only. Hydrocortisone and cortisone acetate have substantial mineralocorticoid effect that prednisolone barely retains and dexamethasone and betamethasone do not have at all, so a patient dependent on mineralocorticoid cover needs that assessed separately.
Why do prednisolone and prednisone show the same equivalent dose?
They are genuinely equipotent for glucocorticoid effect at 5 mg — as are methylprednisolone and triamcinolone at 4 mg. These are different drugs judged clinically equivalent, not a duplication error.
When should I assume the HPA axis is suppressed?
Above roughly 7.5 mg of prednisolone-equivalent daily for more than about three weeks. At that point plan a taper rather than stopping abruptly, regardless of whether the original indication has resolved.
Why does duration of action matter when converting steroids?
Hydrocortisone lasts 8 to 12 hours, prednisolone 12 to 36, and dexamethasone 36 to 72. A longer-acting agent at an “equivalent” dose suppresses the HPA axis more completely because it allows less recovery time between doses.
Related calculators
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):364–89.
Medical Disclaimer: The tools and content provided here are for educational and reference purposes only. They are not intended to substitute for professional medical advice, diagnosis, or treatment. Clinical decisions should always be based on the comprehensive assessment of a qualified healthcare professional.