Corticosteroid conversion (prednisolone equivalent)
Convert a systemic glucocorticoid dose to its prednisolone-equivalent dose
Sources last checked: 2026-10-13
Corticosteroid conversion (prednisolone equivalent)
Convert a systemic glucocorticoid dose to its prednisolone-equivalent dose
Equivalences describe glucocorticoid (anti-inflammatory) potency only — mineralocorticoid activity and duration of action differ widely (hydrocortisone vs dexamethasone). Approximate values for oral/IV use; not a substitute for a tapering or stress-dose plan.
Interpretation
| < 2.5 mg/day — low dose | Low-dose band in the FRAX glucocorticoid adjustment (Kanis 2011, reproduced in Liu 2013 Table 7): fracture probability adjusted downwards. |
|---|---|
| 2.5–7.5 mg/day — medium dose | Medium-dose band: no FRAX adjustment. |
| ≥ 7.5 mg/day — high dose | High-dose band: FRAX fracture probability adjusted upwards (Kanis 2011, reproduced in Liu 2013 Table 7). |
| ≥ 40 mg/day — immunosuppressive | Liu 2013 Table 6 states that live vaccines are to be avoided at ≥ 40 mg/day prednisolone (or equivalent) for > 7 days and postponed for ≥ 3 months after high-dose therapy. |
What is the Corticosteroid conversion (prednisolone equivalent)?
Systemic glucocorticoids differ in potency, so doses are compared as prednisolone equivalents. This calculator uses the equivalent-dose table in Liu et al. (2013), adapted from NICE and Furst: 5 mg prednisolone ≈ 20 mg hydrocortisone ≈ 4 mg methylprednisolone ≈ 0.75 mg dexamethasone. The bands show dose thresholds from the same review used for fracture risk (FRAX) and live-vaccine safety.
When to use it
- Switching between glucocorticoids, e.g. dexamethasone to prednisolone
- Summing exposure to compare it with the FRAX and live-vaccine dose thresholds in Liu 2013
- Comparing doses in literature or discharge letters
When not to use it
- Mineralocorticoid replacement (fludrocortisone) or adrenal-insufficiency regimens, where mineralocorticoid effect matters
- Inhaled, topical, intra-articular or depot preparations
How it is calculated
Prednisolone equivalent (mg) = dose (mg) × 5 / equivalent dose of the drug (mg) Equivalent doses: hydrocortisone 20, cortisone 25, prednisone 5, prednisolone 5, methylprednisolone 4, triamcinolone 4, dexamethasone 0.75, betamethasone 0.6
Clinical pearls and limitations
- Equivalences describe glucocorticoid (anti-inflammatory) potency only — mineralocorticoid activity and duration of action differ widely (hydrocortisone vs dexamethasone). Approximate values for oral/IV use; not a substitute for a tapering or stress-dose plan.
- Equivalence is for anti-inflammatory potency only; dexamethasone and betamethasone have almost no mineralocorticoid effect, hydrocortisone a substantial one.
- Duration of action differs: hydrocortisone 8–12 h, prednisolone 12–36 h, dexamethasone 36–72 h.
- Prednisone is a prodrug converted to prednisolone in the liver; doses are equivalent.
Frequently asked questions
How much prednisolone equals 4 mg dexamethasone?
About 27 mg (4 × 5 / 0.75), using an equivalent dose of 0.75 mg dexamethasone per 5 mg prednisolone.
What is the methylprednisolone to prednisolone conversion?
4 mg methylprednisolone ≈ 5 mg prednisolone, i.e. multiply by 1.25.
How much hydrocortisone equals 5 mg prednisolone?
About 20 mg hydrocortisone.
Evidence and guidelines
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