Steroid Equivalent Dose Converter
Convert between hydrocortisone, prednisone, methylprednisolone, dexamethasone and other glucocorticoids by equipotent dose. Anti-inflammatory potency, mineralocorticoid activity and duration of action included.
All equivalents from 20 mg Hydrocortisone
Hydrocortisone reference
Frequently asked questions
Standard equipotent ratios put 5 mg of prednisone at roughly 20 mg of hydrocortisone, so 1 mg of prednisone corresponds to about 4 mg of hydrocortisone (anti-inflammatory equivalence only). Prednisone is roughly four times more potent than hydrocortisone on an anti-inflammatory basis, but hydrocortisone also has stronger mineralocorticoid activity, so the two drugs are not interchangeable when mineralocorticoid effect matters (e.g. adrenal insufficiency).
No. On the consensus equipotent scale, 4 mg of methylprednisolone is roughly equivalent to 0.75 mg of dexamethasone — dexamethasone is about 5–6 times more potent than methylprednisolone milligram-for-milligram. The Endocrine Society and most pharmacology references give dexamethasone an anti-inflammatory potency of about 25 relative to hydrocortisone at 1 (some texts cite 25–30). Switching mg-for-mg between these two drugs without converting first leads to substantial over- or under-dosing.
Equipotent tables built on systemic anti-inflammatory potency are derived from oral or intravenous pharmacology. Topical, inhaled, intra-articular and ophthalmic glucocorticoids have very different absorption, vehicle, and local-tissue activity profiles — beclometasone inhaled and beclometasone systemic are not directly comparable. NCBI Endotext and Czock 2005 list separate potency frameworks for topical/inhaled routes, which the calculator deliberately does not mix in.
There is no single answer — choice depends on the indication. Short-acting agents (hydrocortisone, cortisone) are often preferred for replacement therapy in adrenal insufficiency because their pharmacokinetics mimic the natural cortisol curve. Intermediate-acting agents (prednisone, prednisolone, methylprednisolone) are common for chronic inflammatory disease where once-daily dosing is convenient. Long-acting agents (dexamethasone, betamethasone) have the highest HPA-axis suppression per mg and are usually reserved for specific indications such as cerebral oedema, antenatal lung maturation, or short anti-emetic courses. Equivalent doses, monitoring, and tapering schedules are detailed in Liu 2013.
The equipotent ratios are the same in paediatric practice — 4 mg of methylprednisolone is still equivalent to about 5 mg of prednisone in a child. What changes is dose selection: paediatric corticosteroid dosing is computed per kilogram of body weight or per square metre of body surface area, not by adult flat doses. This tool converts a given dose between drugs; it does not select the appropriate paediatric dose. Use the BSA calculator and a paediatric dose reference for that step.
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