Convert between corticosteroids using equipotent dose equivalency. Compares 8 steroids with relative potency, mineralocorticoid activity, half-life, and HPA suppression risk.
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 addresses the critical clinical consideration of steroid tapering. Abrupt discontinuation of supraphysiologic corticosteroid doses after more than 5-7 days can precipitate adrenal crisis — a life-threatening emergency. The taper guidance table provides evidence-based recommendations based on treatment duration and dose level.
Corticosteroid prescribing errors are among the most common medication errors in hospital medicine. Converting between steroids requires knowing relative potencies that clinicians often memorize imperfectly. This calculator eliminates arithmetic errors, accounts for dosing frequency, flags supraphysiologic dosing, and provides taper guidance — reducing the risk of both therapeutic failure from under-dosing and adrenal crisis from improper discontinuation.
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×
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.
Use consistent units, verify assumptions, and document conversion standards for repeatable outcomes.
Most mistakes come from mixed standards, rounding too early, or misread labels. Recheck final values before use. ## Practical Notes
Use this for repeatability, keep assumptions explicit. ## Practical Notes
Track units and conversion paths before applying the result. ## Practical Notes
Use this note as a quick practical validation checkpoint. ## Practical Notes
Keep this guidance aligned to expected inputs. ## Practical Notes
Use as a sanity check against edge-case outputs. ## Practical Notes
Capture likely mistakes before publishing this value. ## Practical Notes
Document expected ranges when sharing results.
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.
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.
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.
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.
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.
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.