How does the conversion work?

Each steroid has a standard dose that equals 20 mg of hydrocortisone in anti-inflammatory potency. The target dose equals the source dose times the ratio of the target's equivalent to the source's equivalent, so the anti-inflammatory effect stays the same.

What are the standard equivalent doses?

Roughly equal anti-inflammatory doses are hydrocortisone 20 mg, cortisone 25 mg, prednisone and prednisolone 5 mg, methylprednisolone and triamcinolone 4 mg, dexamethasone 0.75 mg, and betamethasone 0.6 mg. Each equals about 20 mg hydrocortisone.

Does the conversion account for mineralocorticoid effect?

No. The table reflects glucocorticoid anti-inflammatory potency only. Hydrocortisone and cortisone have strong salt-retaining activity, prednisolone has mild activity, and dexamethasone and betamethasone have almost none, which matters when treating adrenal insufficiency.

Does it account for duration of action?

No. Short-acting hydrocortisone, intermediate prednisolone, and long-acting dexamethasone differ markedly in half-life and HPA-axis suppression. Factor the duration in when switching, especially around once-daily versus divided dosing.

Why is budesonide not included?

Budesonide is used topically or enterically and undergoes extensive first-pass metabolism, so there is no reliable single systemic equivalence figure. Publishing one would be misleading, so it is intentionally omitted from this systemic converter.

What is the Corticosteroid Equivalence Converter?

Free corticosteroid equivalence converter. Convert anti-inflammatory doses across hydrocortisone, prednisolone, prednisone, methylprednisolone, dexamethasone, betamethasone, and others using standard potency tables. Runs entirely in your browser. It runs free in your browser on Gera Tools, with nothing uploaded.

Corticosteroid Equivalence Converter

Name: Corticosteroid Equivalence Converter
Creator: Gera Tools
License: https://creativecommons.org/licenses/by/4.0/

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The corticosteroid equivalence converter translates a dose of one glucocorticoid into the equivalent dose of another, based on their relative anti-inflammatory potency. It is the everyday tool for switching steroids, planning a taper, or converting an IV regimen to oral.

How it works

Every glucocorticoid is anchored to hydrocortisone (cortisol). The table lists the dose of each drug that equals 20 mg of hydrocortisone in anti-inflammatory effect:

Steroid	Equivalent dose (anti-inflammatory)
Hydrocortisone	20 mg
Cortisone acetate	25 mg
Prednisone	5 mg
Prednisolone	5 mg
Methylprednisolone	4 mg
Triamcinolone	4 mg
Deflazacort	7.5 mg
Dexamethasone	0.75 mg
Betamethasone	0.6 mg

To convert, the tool applies:

Target dose = source dose × (target equivalent ÷ source equivalent)

For example: 40 mg prednisolone × (0.75 ÷ 5) = 6 mg dexamethasone.

Worked conversion example

A patient on 30 mg prednisolone daily needs to switch to dexamethasone:

Source: prednisolone, equivalent dose = 5 mg
Target: dexamethasone, equivalent dose = 0.75 mg
Conversion ratio = 0.75 / 5 = 0.15
Dexamethasone dose = 30 mg × 0.15 = 4.5 mg

This means 4.5 mg dexamethasone provides roughly the same anti-inflammatory effect as 30 mg prednisolone. In practice, dexamethasone’s much longer half-life means dosing frequency also changes.

Three properties the table does NOT match

Understanding what this conversion does not cover is as important as the numbers themselves.

1. Mineralocorticoid (salt-retaining) effect

Hydrocortisone and cortisone have substantial aldosterone-like activity, causing sodium and water retention. Prednisolone has mild mineralocorticoid activity. Dexamethasone and betamethasone have almost none. This distinction is clinically critical in adrenal insufficiency, where physiological replacement requires covering both glucocorticoid and mineralocorticoid needs. Switching from hydrocortisone to dexamethasone for adrenal replacement using only this equivalence table would leave the patient without mineralocorticoid coverage.

2. Duration of action and dosing frequency

Short-acting steroids (hydrocortisone: 8–12 hours) are given two or three times daily; intermediate-acting agents (prednisolone: 12–36 hours) once daily; long-acting agents (dexamethasone: 36–54 hours) once daily or every other day. An equivalent anti-inflammatory dose does not mean the same dosing schedule.

3. HPA-axis suppression

Long-acting agents such as dexamethasone suppress the hypothalamic-pituitary-adrenal axis more continuously than short-acting agents at equivalent doses. This matters when planning a steroid taper or when assessing surgical stress coverage.

Budesonide and inhaled steroids

Budesonide undergoes extensive first-pass hepatic metabolism when absorbed systemically, so there is no reliable single number for systemic equivalence. It is intentionally excluded from this converter. Inhaled corticosteroids (ICS) similarly have published topical potency rankings that do not translate into meaningful systemic equivalence figures for anti-inflammatory dosing.

Safe use note

Never stop chronic corticosteroids abruptly — even a short course can suppress the HPA axis enough to require a gradual taper. This tool assists with dose calculations for educational and planning purposes; all dose decisions should be confirmed by a prescribing clinician. All calculation runs locally in your browser with nothing uploaded.