Steroid Conversion
Below are approximate equivalent synthetic steroid doses, 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. 5 mg daily of prednisone, would be equivalent to 5 mg 6 hourly of hydrocortisone).
| 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 | 30 | 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
LITFL
- Basic Science – Pharm 101: Corticosteroids
- CCC – Corticosteroids Overview
- CCC – Steroids and Septic Shock Literature Summaries
- CCC – Adrenal Insufficiency
References
- MedCalc — Steroid Conversion Converter
- Katzung, B., & Trevor, A. (2014). Basic & Clinical Pharmacology (13th ed., p. 686). United States of America: McGraw-Hill.
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
ICU Advanced Trainee BMedSci [UoN], BMed [UoN], MMed(CritCare) [USyd] 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.