Steroid Conversion
Below are approximate equivalent synthetic steroid doses (administered by the oral or IV routes), and their relative glucocorticoid and mineralocorticoid potencies.
When charting the same, ensure appropriate administration intervals and check with local protocols and your pharmacist colleagues regarding the same (e.g. 50 mg daily of prednisone po, would be equivalent to 50 mg 6 hourly of hydrocortisone IV, or 200 mg IV daily).
| Agent | Equivalent dose (mg) | Anti-inflammatory potency | Mineralocorticoid potency | DoA |
| Cortisone | 25 | 0.8 | 0.8 | Short |
| Hydrocortisone | 20 | 1 | 1 | Short |
| Prednisone | 5 | 4 | 0.3 | Intermediate |
| Prednisolone | 5 | 5 | 0.3 | Intermediate |
| Triamcinolone | 4 | 5 | 0 | Intermediate |
| Methylprednisolone | 4 | 5 | 0.25 | Intermediate |
| Betamethasone | 0.6 | 25-40 | 0 | Long |
| Dexamethasone | 0.75 | 25 | 0 | Long |
| Fludrocortisone* | 2 | 10* | 250 | Intermediate |
Duration of Action (DoA)
- Short: 8-12 hours
- Intermediate: 12-36 hours
- Long: 36-72 hours
References and Links
Introduction to ICU Series
Introduction to ICU Series Landing Page
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INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
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LITFL
- Basic Science – Pharm 101: Corticosteroids
- CCC – Corticosteroids Overview
- CCC – Steroids and Septic Shock Literature Summaries
- CCC – Adrenal Insufficiency
References
- Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill Education; 2018.
- MDCalc — Steroid Conversion Converter
- Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30. doi: 10.1186/1710-1492-9-30. PMID: 23947590; PMCID: PMC3765115.
- Meikle AW, Tyler FH. Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med. 1977 Aug;63(2):200-7. doi: 10.1016/0002-9343(77)90233-9. PMID: 888843.
- Vanderah, T. W., & Katzung, B. G. (2024). Katzung’s Basic and Clinical Pharmacology (16th ed.). McGraw-Hill Education.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
ICU Provisional Fellow BMedSci [Newcastle], BMed [Newcastle], MMed(CritCare) [Sydney] from a broadacre farm who found himself in a quaternary metropolitan ICU. Always trying to make medical education more interesting and appropriately targeted; pre-hospital and retrieval curious; passionate about equitable access to healthcare; looking forward to a future life in regional Australia. Student of LITFL.
3 Comments
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Isn’t 5 mg of pred equivalent to (20 mg hydrocortisone QID)?
Hi DH,
Not according to our sources (see in the references). 5mg of prednisone would be equivalent to 5mg QID of hydrocortisone — a total dose of 20mg. Keep in mind that we need to dose with an appropriate interval for the hydrocortisone due to a shorter half-life to have a similar effect over a similar amount of time. 20mg QID of hydrocortisone (or 80mg a day) would be equivalent to 20mg daily of prednisone.
Thanks,
James
Usually the daily dose is converted, and then the frequency of adminstration is accounted for – so 5mg prednisone po daily is 20mg hydrocortisone IV daily, which is 5mg hydrocortisone IV 4 times a day.