Are these conversions exact?

No. Equipotent doses reflect average anti-inflammatory potency ratios and are approximations. Individual patients may respond differently. Clinical response, not just dose conversion, should guide therapy. Mineralocorticoid effects, half-life, and formulation bioavailability also affect clinical equivalence.

Why is dexamethasone preferred in some situations?

Dexamethasone has the longest biologic half-life (36-54 hours), zero mineralocorticoid activity (no salt/water retention), highest potency (smallest volume), and excellent CNS penetration. It is preferred for cerebral edema, chemotherapy antiemesis, and when sodium retention must be avoided.

When must I taper and not stop abruptly?

Taper is needed after: >5-7 days of supraphysiologic doses, any duration >3 weeks, or any dose if the patient has features of adrenal suppression. The longer the duration and higher the dose, the slower the taper must be. Below physiologic replacement (5 mg prednisone), taper very slowly and check AM cortisol.

What is the difference between prednisone and prednisolone?

Prednisone is a prodrug that must be converted to prednisolone (the active form) by the liver. In patients with severe liver disease, prednisolone is preferred because it does not require hepatic activation. Otherwise, they are clinically interchangeable at the same dose.

Does the conversion account for mineralocorticoid effects?

No. The conversion is based on anti-inflammatory (glucocorticoid) potency only. Hydrocortisone has significant mineralocorticoid activity (salt retention, hypokalemia), while dexamethasone has none. When replacing adrenal function, fludrocortisone may be needed separately for mineralocorticoid coverage.

What prednisone dose causes Cushingoid features?

Prednisone ≥ 7.5 mg/day (or equivalent) for more than 3 weeks commonly causes moon face, weight gain, and other Cushingoid features. Even 5 mg/day long-term can cause osteoporosis. Cumulative dose matters — tracking lifetime steroid exposure is emerging as a best practice.

Corticosteroid Conversion Calculator — Steroid Equivalency

Convert between corticosteroids using equipotent anti-inflammatory dose equivalency. Compares 8 steroids with relative potency, mineralocorticoid activity, half-life, and exposure context.

⚠️ Medical Disclaimer: Steroid equivalency calculations provide anti-inflammatory dose equivalency only. Differences in mineralocorticoid activity, half-life, formulation, and indication still matter. Use this as a conversion reference, then verify the actual plan with the prescribing team or pharmacist.

Current Steroid

From (Current Steroid)

Dose per administration (mg)

Frequency

Convert To

Target Steroid

Body Weight (kg)

Target Dose (per administration)

6 mg

dexamethasone × 1/day

Target Daily Dose

6 mg/day

dexamethasone total daily

Hydrocortisone Equivalent

160 mg/day

8× physiologic

Prednisone Equivalent

40 mg/day

Standard reference unit

Source mg/kg/day

0.57 mg/kg

prednisone

HPA Suppression Risk

High dose — adrenal suppression likely if > 5 days

Cushing: Elevated if continued > 3 weeks

40 mg prednisone = 6 mg dexamethasone

Hydrocortisone equivalent: 160 mg/day (8× physiologic)

Corticosteroid Equivalency Table

Steroid	Equiv Dose (mg)	Relative Potency	Mineralocorticoid	Duration
hydrocortisone	20	1×	1×	Short (8–12 h)
cortisone	25	0.8×	0.8×	Short (8–12 h)
prednisone	5	4×	0.8×	Intermediate (12–36 h)
prednisolone	5	4×	0.8×	Intermediate (12–36 h)
Methylprednisolone	4	5×	0.5×	Intermediate (12–36 h)
triamcinolone	4	5×	0×	Intermediate (12–36 h)
dexamethasone	0.75	25×	0×	Long (36–54 h)
betamethasone	0.6	25×	0×	Long (36–54 h)

General Tapering Context

Duration of Use	Taper Needed?	Approach
< 1 week (any dose)	Often minimal	Short courses are commonly simpler, but the exit plan still depends on indication and prior exposure.
1–3 weeks (high dose)	Case-dependent	Many teams taper briefly here, especially when the course has been clearly supraphysiologic.
> 3 weeks	Often yes	Longer courses usually need a gradual plan rather than an abrupt stop.
> 3 months	Usually slow	Long-term exposure often needs a more careful, individualized taper and follow-up strategy.

Planning notes, formulas, and examples

About the Corticosteroid Conversion Calculator — Steroid Equivalency

Corticosteroid dose conversion is one of the most common clinical calculations in medicine, required whenever switching between steroid formulations, converting from IV to oral, adjusting for pharmacokinetic differences, or assessing cumulative steroid exposure. Since different corticosteroids have dramatically different potencies — dexamethasone is 25-30 times more potent than hydrocortisone — accurate conversion is essential to maintain therapeutic efficacy while avoiding over- or under-treatment.

This calculator converts between eight commonly used systemic corticosteroids based on their anti-inflammatory (glucocorticoid) equipotent doses. It calculates the hydrocortisone equivalent to assess physiologic vs supraphysiologic dosing, provides prednisone-equivalent doses for standardized communication, estimates HPA axis suppression risk, and includes mineralocorticoid activity and biologic half-life for each agent.

Beyond simple conversion, the tool also gives broader exposure context. The hydrocortisone-equivalent and prednisone-equivalent outputs make it easier to compare regimens, while the tapering section is intentionally general and should not be treated as a patient-specific steroid plan.

When This Page Helps

Corticosteroid conversions are easy to misremember because each drug combines different potency, half-life, and mineralocorticoid effects. This calculator keeps the equivalency math visible, standardizes the hydrocortisone and prednisone reference points, and provides general taper context without pretending to replace the actual clinical plan.

How to Use the Inputs

Select the current (source) corticosteroid and enter the dose per administration in mg.
Select the dosing frequency (once, twice, three, or four times daily).
Select the target corticosteroid you want to convert to.
Enter body weight for mg/kg calculations.
Review the equivalent dose, daily totals, hydrocortisone equivalent, and exposure context.
Consult the equivalency table for a comprehensive comparison of all 8 corticosteroids.

Formula used

Target Dose = Source Dose × (Source Equivalent / Target Equivalent)
Hydrocortisone Equivalent = Total Daily Dose × (20 / Source Equivalent Dose)
Physiologic replacement ≈ 20 mg hydrocortisone/day (≈ 5 mg prednisone)
Relative potency referenced to hydrocortisone = 1×

Example Calculation

Result: 6.0 mg dexamethasone daily = 40 mg prednisone daily

Prednisone equivalent dose is 5 mg, dexamethasone is 0.75 mg. Ratio: 5/0.75 = 6.67. So 40 mg prednisone = 40/6.67 = 6.0 mg dexamethasone. Hydrocortisone equivalent = 40 × (20/5) = 160 mg/day — 8× physiologic. At this level, HPA suppression is likely if used > 5 days.

Tips & Best Practices

Always specify both the steroid name and the dose when communicating the result.
The equivalency table reflects anti-inflammatory potency, not a full replacement for mineralocorticoid planning.
Dexamethasone and betamethasone stand out because they have essentially no mineralocorticoid activity.
The longer the course and the higher the hydrocortisone-equivalent exposure, the more taper strategy matters.
Use the taper section as context only; actual withdrawal plans are indication- and history-dependent.

What the Conversion Represents

The conversion on this page is based on anti-inflammatory equipotent dosing. That makes it useful for comparing relative glucocorticoid exposure, but it does not automatically answer questions about mineralocorticoid replacement, taper speed, or the best drug for a specific diagnosis.

Why Hydrocortisone and Prednisone Equivalents Help

Using hydrocortisone and prednisone equivalents makes very different regimens easier to compare on one scale. It also gives the user a better sense of whether the total exposure is near physiologic replacement or far above it.

Use Taper Context Carefully

The tapering section is intentionally broad. Real taper decisions depend on duration, prior exposure, adrenal-suppression risk, disease activity, and the reason the steroid was started in the first place.

Sources & Methodology

Last updated: March 28, 2026

Methodology

This page converts one systemic corticosteroid to another by comparing the entered daily dose with a standard anti-inflammatory equivalency table. It also expresses the regimen as hydrocortisone-equivalent and prednisone-equivalent exposure so the user can compare total glucocorticoid burden, biologic half-life, and mineralocorticoid activity on one worksheet.

The result is a reference conversion, not a patient-specific taper or replacement plan. Clinical equivalence still depends on indication, route, timing, mineralocorticoid needs, adrenal-suppression risk, and the disease being treated.

Sources

Glucocorticoid Withdrawal-An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice (PubMed Central / Frontiers in Endocrinology) — Contains a commonly used equivalency table for hydrocortisone, prednisone, methylprednisolone, and dexamethasone with relative mineralocorticoid activity.
Glucocorticoid Therapy and Adrenal Suppression (Endotext) — Reference source for glucocorticoid potency, duration, and adrenal-suppression context.

Frequently Asked Questions

No. Equipotent doses reflect average anti-inflammatory potency ratios and are approximations. Individual patients may respond differently. Clinical response, not just dose conversion, should guide therapy. Mineralocorticoid effects, half-life, and formulation bioavailability also affect clinical equivalence.