- Select the source corticosteroid (the agent currently prescribed).
- Enter the dose in mg of the source corticosteroid.
- Select the target corticosteroid (the agent to convert to).
- The result shows the equivalent anti-inflammatory dose of the target agent in mg, plus a property reference card for both agents (duration of action and mineralocorticoid activity).
All computation runs in your browser; no values are stored or transmitted. Equivalencies are approximate — verify with a pharmacist or current prescribing references before clinical use.
When to Use
Use this calculator when switching a patient from one systemic corticosteroid to another to maintain equivalent anti-inflammatory effect — for example, converting from oral prednisone to methylprednisolone IV during a lupus nephritis flare, or from dexamethasone to prednisolone for outpatient continuation. The same equivalency table is widely used in rheumatology, nephrology, and general internal medicine to guide corticosteroid transitions.
Appropriate use
Converting between systemic (oral or IV) corticosteroids for anti-inflammatory or immunosuppressive indications: lupus nephritis, vasculitis, glomerulonephritis, IgA nephropathy with crescents, transplant rejection, IBD, rheumatoid arthritis, and other steroid-responsive conditions.
When NOT to rely on it
This calculator applies to systemic (oral/IV) formulations only. Equivalencies are NOT valid for inhaled, topical, intra-articular, or epidural corticosteroids — those routes have entirely different potency and bioavailability profiles. Do not use for tapering calculations without separately accounting for adrenal suppression and the clinical indication. Always verify against current prescribing information and consult a pharmacist for critical decisions.
Pearls & Pitfalls
Mineralocorticoid activity matters in nephrology
Hydrocortisone and cortisone have significant mineralocorticoid (sodium-retaining) activity. In patients with hypertension, edema, or heart failure — common in CKD and lupus nephritis — methylprednisolone, triamcinolone, dexamethasone, or betamethasone are preferred as they have negligible mineralocorticoid activity. Prednisone/prednisolone have low but non-zero mineralocorticoid activity; at high doses this becomes clinically relevant.
Duration of action guides dosing frequency
Short-acting agents (hydrocortisone, cortisone: 8–12 h) are typically dosed 2–4× daily for anti-inflammatory use. Intermediate-acting agents (prednisone, prednisolone, methylprednisolone, triamcinolone: 12–36 h) are usually once-daily in standard protocols. Long-acting agents (dexamethasone, betamethasone: 36–54 h) require less frequent dosing. Switching duration class without adjusting the interval is a common prescribing error.
Critical pitfalls
- Equivalencies are anti-inflammatory approximations only — they do not translate mineralocorticoid effect, bioavailability, half-life, or tolerability.
- Prednisone ≠ prednisolone in liver disease: Prednisone is a prodrug converted to prednisolone in the liver; in severe hepatic impairment, use prednisolone directly.
- Not for tapering guidance: Dose reductions during tapering must account for hypothalamic-pituitary-adrenal suppression and clinical recurrence risk — this table does not model those factors.
- Not for inhaled/topical/intra-articular routes: The systemic equivalency table does not apply to non-systemic formulations.
Why Use It
Dose calculation errors are among the most common prescribing mistakes in corticosteroid management, with both over- and under-dosing carrying significant risks — Cushingoid effects, adrenal suppression, hyperglycemia, and osteoporosis from excess; inadequate immunosuppression and disease flare from under-dosing. A standardized reference based on published pharmacokinetic equivalencies reduces cognitive load and transcription errors at the point of care. The equivalency values used here are derived from widely cited pharmacology references (Liu et al. 2013; Czock et al. 2005) and are consistent with standard nephrology and rheumatology practice in the Philippines and internationally.
Corticosteroid Conversion Calculator
Select the source and target corticosteroids and enter the dose. The result gives the equivalent anti-inflammatory dose and a side-by-side property reference for both agents.
| Property | Source | Target |
|---|---|---|
| Duration of action | — | — |
| Mineralocorticoid activity | — | — |
| Anti-inflam. equiv. dose | — | — |
⚕ Formula: equivalent dose = entered dose × (target equiv. dose / source equiv. dose). Reference equivalencies (anti-inflammatory): hydrocortisone 20 mg = cortisone 25 mg = prednisone 5 mg = prednisolone 5 mg = methylprednisolone 4 mg = triamcinolone 4 mg = dexamethasone 0.75 mg = betamethasone 0.6 mg. These are approximate anti-inflammatory equivalences only — they do NOT capture mineralocorticoid effect, bioavailability, half-life, or tapering dynamics. Verify with a pharmacist and prescribing information before clinical use.
Next Steps
The calculated equivalent dose is a starting point — individualise the prescription.
- Adjust the dose interval to match the target agent's duration of action (see the property reference table in the result box).
- For patients with liver disease, prefer prednisolone over prednisone (prednisone requires hepatic conversion).
- When switching to an agent with different mineralocorticoid activity (e.g., from hydrocortisone to methylprednisolone), monitor blood pressure, electrolytes, and fluid balance closely — especially in CKD, hypertension, and heart failure.
- For corticosteroid tapering, involve the clinical pharmacist. Tapering must account for adrenal suppression; the equivalency table alone does not model hypothalamic-pituitary-adrenal recovery.
- In lupus nephritis and vasculitis, confirm that the target dose is consistent with the relevant guideline protocol (KDIGO, ACR/EULAR); document the indication and expected duration.
- Counsel patients on steroid side effects (hyperglycemia, bone loss, mood changes, infection risk) and the importance of not stopping abruptly after prolonged use.
Evidence & References
Formula
Equivalent dose (mg) = Entered dose (mg) × [Target equiv. dose (mg) ÷ Source equiv. dose (mg)]
Equivalency Table
| Corticosteroid | Anti-inflam. equiv. dose (mg) | Duration of action | Mineralocorticoid activity |
|---|---|---|---|
| Hydrocortisone | 20 | Short (8–12 h) | High |
| Cortisone | 25 | Short (8–12 h) | High |
| Prednisone | 5 | Intermediate (12–36 h) | Low |
| Prednisolone | 5 | Intermediate (12–36 h) | Low |
| Methylprednisolone | 4 | Intermediate (12–36 h) | None |
| Triamcinolone | 4 | Intermediate (12–36 h) | None |
| Dexamethasone | 0.75 | Long (36–54 h) | None |
| Betamethasone | 0.6 | Long (36–54 h) | None |
Equivalencies represent approximate anti-inflammatory potencies only and do not account for mineralocorticoid effect, bioavailability differences, route, or half-life. The table applies to systemic formulations. Always verify against current prescribing information.
References
- Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.
- Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61–98.
- Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis. Kidney Int. 2024;106(1S):S1–S69.
