How much dexamethasone equals prednisolone?

Dexamethasone is approximately 6-7 times more potent than prednisolone. 1mg of dexamethasone is roughly equivalent to 6.67mg of prednisolone. So 4mg dexamethasone is approximately equivalent to 25mg prednisolone. Dexamethasone has a much longer duration of action (36-54 hours vs 12-36 hours for prednisolone) and no mineralocorticoid activity.

What is the equivalent dose of hydrocortisone to prednisolone?

Hydrocortisone (cortisol) is 4 times less potent than prednisolone. 20mg of hydrocortisone is equivalent to 5mg of prednisolone. Hydrocortisone has significant mineralocorticoid activity (causes salt and water retention) while prednisolone has moderate mineralocorticoid activity. Hydrocortisone is preferred for adrenal replacement therapy because it mimics physiological cortisol.

What are the equivalent doses of common corticosteroids?

Based on anti-inflammatory potency, the equivalent doses are: hydrocortisone 20mg = cortisone 25mg = prednisolone 5mg = prednisone 5mg = methylprednisolone 4mg = triamcinolone 4mg = dexamethasone 0.75mg = betamethasone 0.6mg. These equivalences are approximate and based on anti-inflammatory effect. Duration of action, mineralocorticoid effect, and clinical context all affect the choice of steroid.

Steroid Equivalence Converter

Convert between corticosteroid doses. Enter a dose of any steroid — see the equivalent in all others.

📋 Source: Corticosteroid equivalence based on standard pharmacology references (Australian Medicines Handbook, NPS MedicineWise, Goodman & Gilman). Anti-inflammatory potency relative to hydrocortisone. Approximate equivalences — individual variation exists.
Your doctor or healthcare provider knows your history and circumstances — always follow their personalised advice over general information.

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Clinical tool. Equivalences are based on anti-inflammatory potency and are approximate. Clinical context, duration of action, mineralocorticoid effect, and indication all affect steroid choice. This does not replace clinical judgement.

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Corticosteroid equivalence table

Steroid	Equivalent dose (mg)	Relative potency	Duration	Mineralocorticoid
Hydrocortisone	20	1×	8–12 hrs	++
Cortisone	25	0.8×	8–12 hrs	++
Prednisolone	5	4×	12–36 hrs	+
Prednisone	5	4×	12–36 hrs	+
Methylprednisolone	4	5×	12–36 hrs	—
Triamcinolone	4	5×	12–36 hrs	—
Dexamethasone	0.75	26.7×	36–54 hrs	—
Betamethasone	0.6	33.3×	36–54 hrs	—

Relative potency based on anti-inflammatory effect compared to hydrocortisone. Mineralocorticoid activity: ++ = significant (salt/water retention), + = moderate, — = negligible.

Asthma flare-up: Prednisolone 50mg daily for 5 days = Dexamethasone 8mg daily for 2 days. Dexamethasone is increasingly preferred (shorter course, better compliance, less nausea).

Croup (paediatric): Dexamethasone 0.15–0.6mg/kg single dose (max 12mg) = Prednisolone 1mg/kg/day for 3 days.

Adrenal crisis / sick day rules: Double the usual hydrocortisone dose. Standard replacement: hydrocortisone 15–25mg/day in divided doses (e.g. 10mg morning, 5mg midday, 5mg evening) = prednisolone ~4–6mg/day.

Switching IV to oral: IV hydrocortisone 100mg = oral prednisolone 25mg (approximately). Remember IV has 100% bioavailability.

Tapering: If on prednisolone >7.5mg daily for >3 weeks, taper gradually — the adrenal axis may be suppressed. Reduce by 2.5–5mg every 1–2 weeks. Below physiological replacement (prednisolone 5mg = hydrocortisone 20mg), taper more slowly.

Prednisone is a prodrug — it is converted to prednisolone in the liver. For most patients they are interchangeable at the same dose. In severe liver disease, prednisolone is preferred as it does not require hepatic conversion. Australia primarily uses prednisolone. The US primarily uses prednisone. Same dose, same effect in most patients.

Advantages of dexamethasone: Longer duration (one daily dose vs multiple), shorter course needed (2 days vs 5), less nausea, no mineralocorticoid effect (less fluid retention), smaller tablet. Preferred in croup, COVID, and increasingly in asthma and COPD exacerbations.

Advantages of prednisolone: More familiar, easier to taper (shorter half-life), available as liquid for children, preferred where gradual dose reduction is needed.