Steroid Conversion Calculator

Steroid conversion means swapping one corticosteroid for another at an equal anti-inflammatory dose. Doctors do this when they change the route, the brand, or the drug itself. The calculator above uses the standard published equivalence table. Enter the current drug and its dose in milligrams. The result lists the equivalent dose of all eight common corticosteroids. Those eight drugs cover the great majority of everyday systemic steroid therapy. The table behind them has stayed stable in textbooks for decades.

This page explains the table, the math, and the limits of simple equivalence. It is an educational guide, not medical advice. Steroid switches are prescriber decisions, shaped by the illness, the patient, and the treatment plan. Never change a steroid dose on your own based on a conversion. Used well, the numbers simply make a planned switch transparent and checkable.

What Steroid Conversion Means

Corticosteroids are synthetic versions of cortisol, the stress hormone. They differ widely in strength milligram for milligram. Five milligrams of prednisone match twenty milligrams of hydrocortisone. Less than one milligram of dexamethasone matches that same dose. Conversion tables capture those strength differences in one place. Prescribers use them when a patient switches from intravenous to oral therapy. They also use them when side effects push a change of drug. Pharmacists check them when a hospital substitutes one agent for another. Without a table, every switch would rest on memory and guesswork. Conversion also appears when doses move between care settings. A hospital team may start a drug intravenously during an emergency. Days later, the same patient goes home on tablets. Each handover carries a small risk of a strength error. A shared table keeps every team speaking the same dose language.

The Standard Equivalence Table

The table below anchors every drug to a standard equivalent dose. Each entry produces roughly the same anti-inflammatory effect.

• Cortisone: 25 mg
• Hydrocortisone: 20 mg
• Prednisone: 5 mg
• Prednisolone: 5 mg
• Methylprednisolone: 4 mg
• Triamcinolone: 4 mg
• Dexamethasone: 0.75 mg
• Betamethasone: 0.6 mg

Relative potency climbs down the list. Hydrocortisone carries a potency of 1 by definition. Prednisone and prednisolone sit near 4. Methylprednisolone and triamcinolone sit near 5. Dexamethasone and betamethasone reach roughly 25 to 30. Small decimal doses therefore deserve extra care when reading the result. The table groups naturally by duration as well. Cortisone and hydrocortisone are short acting. Prednisone, prednisolone, methylprednisolone, and triamcinolone are intermediate acting. Dexamethasone and betamethasone are long acting. That grouping explains why equal doses follow different daily schedules. Keep the anchor list visible whenever you check a result.

How the Conversion Math Works

The math is a simple ratio. Divide the dose by the equivalent dose of the starting drug. That step converts the dose into standard units. Then multiply by the equivalent dose of the target drug. Converting 10 mg of prednisone to hydrocortisone shows the pattern clearly. Ten divided by 5 gives 2 standard units. Two times 20 gives 40 mg of hydrocortisone. The calculator runs that ratio for all eight drugs at once. The ratio works in both directions without any new steps. Converting 40 mg of hydrocortisone back gives 2 units, then 10 mg of prednisone again. Rounding deserves a mention too. Real tablets come in fixed strengths, so prescribers round to practical doses. A calculated 1.5 mg may become a real-world tablet combination the pharmacist confirms. Errors usually come from picking the wrong anchor, not from the arithmetic itself. Many clinicians keep a pocket card with the anchors for exactly this audit. Two people checking the same ratio rarely repeat the same mistake.

How to Use the Steroid Conversion Calculator

The whole conversion takes a few seconds.

1. Select the steroid the patient currently takes.
2. Type the dose in milligrams.
3. Press Calculate to build the equivalence table.
4. Find the target drug row and read its dose.
5. Use Reset before starting a different conversion.

The row for the starting drug repeats the dose you entered, which confirms the entry. Rows follow the same order as the printed table in this article. That consistency makes double-checking against the textbook table quick. If a row looks wildly out of line, re-enter the dose and try again before trusting it.

Worked Example 1: Prednisone 10 mg to Hydrocortisone

A clinic plans to switch a patient from prednisone to hydrocortisone. The current dose is 10 mg of prednisone once daily. Prednisone anchors at 5 mg in the standard table. Ten divided by 5 gives 2 standard units. Hydrocortisone anchors at 20 mg. Two times 20 gives an equivalent of 40 mg. The full result row shows every other option as well. Cortisone comes out at 50 mg, and prednisolone matches prednisone at 10 mg. Methylprednisolone and triamcinolone both land at 8 mg. Dexamethasone lands at just 1.5 mg, and betamethasone at 1.2 mg. Those tiny long-acting doses already hint at the half-life issue covered below. Notice how the short-acting hydrocortisone dose is usually split across the day. The prednisone dose it replaces was taken just once each morning. Same total strength, different rhythm — that contrast is the lesson of this example.

Worked Example 2: Dexamethasone 6 mg to Prednisone

A hospital team wants the prednisone equivalent of 6 mg of dexamethasone. Dexamethasone anchors at only 0.75 mg in the table. Six divided by 0.75 gives 8 standard units. Prednisone anchors at 5 mg. Eight times 5 gives an equivalent of 40 mg. The same result lists hydrocortisone at 160 mg. It also lists methylprednisolone at 32 mg. The result table removes that doubt in one glance. The jump in size often surprises people new to the table. It simply reflects how potent dexamethasone is per milligram. Potency, however, is only half the story, as the next section explains. Clinicians meeting this conversion for the first time often recheck the arithmetic. That instinct is healthy, because dexamethasone conversions are a classic source of decimal slips.

Why Equivalent Doses Do Not Feel Identical

Equivalence tables compare anti-inflammatory strength at a single moment. Bodies, however, clear these drugs at very different speeds. Hydrocortisone acts for roughly 8 to 12 hours. Prednisone and methylprednisolone act for about 18 to 36 hours. Dexamethasone keeps working for 36 to 54 hours or longer. A once-daily dexamethasone dose therefore presses on the body around the clock. The same daily prednisone dose gives tissues a quieter window overnight. Blood sugar, sleep, and mood effects can differ for the same reason. Equivalent also ignores how each drug behaves in a given illness. Some conditions favor one agent for reasons beyond raw potency. Clinicians weigh all of this when they choose the switch. Dosing frequency changes with the drug as well. A short-acting agent may need three doses a day to hold the same coverage. A long-acting agent may need only one dose every day or two.

Routes of Administration and Switching Between Them

Steroids reach the body by mouth, by vein, by muscle injection, and by other routes. The equivalence table assumes the drug actually reaches the circulation. Most oral corticosteroids absorb very well. Prednisone, prednisolone, and dexamethasone tablets are therefore close to their intravenous forms milligram for milligram. Hospital teams lean on that fact when a patient starts eating again. Hydrocortisone often begins intravenously in emergencies because swallowing may be unsafe. Methylprednisolone is a common intravenous choice for severe flares. Once the crisis settles, the same strength continues by mouth. Inhaled and topical steroids follow entirely different logic. They aim at one organ and barely enter the wider circulation. Never convert those products with this systemic table. Route changes are therefore mostly about safety and convenience, not about new math.

Mineralocorticoid Activity and Fludrocortisone

Glucocorticoid strength is only one axis of difference. These drugs also vary in mineralocorticoid activity, the salt-retaining effect. Hydrocortisone and cortisone retain salt fairly strongly. Prednisone retains a little, and dexamethasone retains almost none. That difference matters in blood pressure, swelling, and potassium balance. Fludrocortisone sits outside this table entirely. Doctors use it mainly as a mineralocorticoid, for salt and water balance. Its anti-inflammatory dose equivalents are not part of routine conversion tables. Never substitute it using the numbers on this page. Patients with heart failure or high blood pressure feel this difference most. Extra retained fluid can raise weight and breathlessness within days. Potassium shifts can also disturb heart rhythm in sensitive patients. Prescribers weigh these effects alongside the anti-inflammatory goal.

Tapering and HPA Suppression Are Prescriber Decisions

Steroids taken for more than a few weeks can quiet the body’s own cortisol system. That system is called the HPA axis. Stopping suddenly after long treatment can trigger a dangerous withdrawal state. Prescribers therefore taper doses gradually, on schedules they design. They also raise doses during illness or surgery when suppression is suspected. A conversion table cannot judge any of that. It only translates strength between drugs at one dose. Decisions about duration, tapering, and stress dosing belong to the prescribing clinician. Patients should raise any concern with that clinician rather than adjusting doses alone. Warning signs of too little cortisol include deep fatigue, dizziness, nausea, and low blood pressure. Anyone with those symptoms during a taper should contact the prescriber promptly. Medical alert cards exist for long-term steroid users in many countries.

Special Situations That Change the Picture

Some situations bend the simple table math. Liver disease can slow the activation of prednisone into prednisolone. Clinicians then often choose prednisolone directly. Pregnancy changes the balance too, because the placenta breaks down some steroids before they reach the baby. Prednisolone crosses far less than dexamethasone for that reason. Children need weight-based dosing rather than fixed adult anchors. Older adults face higher risks of bone loss, diabetes, and confusion at equal doses. Interactions matter as well, since some medicines speed or slow steroid breakdown. Each of these situations belongs in prescriber hands, with the table as a supporting reference only. Genetic differences in liver enzymes add one more layer of variation between patients. None of these factors change the anchors themselves, only their application.

Tips for Using Steroid Conversions Safely

A few habits keep conversions accurate and safe. They suit students, clinicians, and patients reviewing a planned switch.

1. Confirm whether the dose is per dose or per day before converting.
2. Double-check decimal doses of dexamethasone and betamethasone twice.
3. Remember that equivalence ignores half-life, so schedules may change too.
4. Ask a pharmacist to verify any switch before the first new dose.
5. Never taper or stop a long course without the prescriber’s plan.
6. Record the conversion and the date, so later teams can trace the switch.

Frequently Asked Questions

General Questions

1. What is a steroid conversion?

A steroid conversion translates a dose of one corticosteroid into the equal anti-inflammatory dose of another. Prescribers use it when switching drugs or routes. The standard equivalence table supplies the conversion factors. The calculator above applies that table to eight common drugs.

2. Which table does this calculator use?

It uses the standard published anti-inflammatory equivalence table. In that table, 5 mg of prednisone equals 20 mg of hydrocortisone. It also equals 4 mg of methylprednisolone and 0.75 mg of dexamethasone. Most textbooks and formularies print the same anchors.

3. Are prednisone and prednisolone interchangeable?

Their equivalent doses are identical at 5 mg each. Prednisone converts into prednisolone inside the liver. People with severe liver disease often receive prednisolone directly. A prescriber still makes the final choice for each patient.

4. Why is the dexamethasone dose so small?

Dexamethasone is roughly 25 to 30 times as potent as hydrocortisone. Only 0.75 mg matches a full 20 mg of hydrocortisone. Its long action also means small doses keep working for days. Decimal errors with this drug are especially risky.

5. Does this calculator cover every steroid?

No. It covers the eight corticosteroids in the standard systemic table. It leaves out inhaled, topical, and injected joint steroids. Those products act locally and follow different rules. Fludrocortisone is also excluded, for reasons explained on this page.

How the Calculation Works

6. How is an equivalent dose calculated?

Divide the starting dose by its table anchor to get standard units. Then multiply those units by the anchor of the target drug. Ten milligrams of prednisone becomes 2 units, then 40 mg of hydrocortisone. The calculator repeats this for every row.

7. Can I convert between any two drugs in the table?

Yes. Pick any of the eight drugs as the starting point. The result lists equivalents for all eight, including the starting drug itself. That full row makes cross-checking easy. It also prevents a second manual calculation.

8. What does anti-inflammatory potency mean?

Potency describes how much effect each milligram delivers. A potency of 4 means one milligram does the work of roughly 4 mg of hydrocortisone. Potency says nothing about duration, though. Duration depends on biological half-life, which the table does not capture.

9. Why are cortisone and hydrocortisone doses the largest?

They are the weakest drugs in the table per milligram. Cortisone anchors at 25 mg and hydrocortisone at 20 mg. Both resemble the cortisol the body makes itself. Stronger synthetic drugs need far fewer milligrams for the same effect.

10. How accurate is the equivalence table?

The table is a well-tested clinical guide, not an exact physical law. Individual patients respond somewhat differently to each agent. Clinicians treat the converted dose as a starting point. They then adjust based on response and side effects.

Safety and Practical Questions

11. Can I switch my own steroid using this tool?

No. Switching steroids changes duration, salt effects, and suppression risk. Those factors need a prescriber who knows your history. Use the result to prepare questions for that clinician. Never adjust the dose before that conversation happens.

12. Why does half-life matter when switching?

Half-life decides how long each dose keeps acting. Dexamethasone can act for more than two days per dose. Hydrocortisone fades within about half a day. Equal daily doses can therefore feel very different across a full week.

13. What is HPA suppression?

HPA suppression means the body’s own cortisol production has quieted down. Steroids taken for weeks can cause it. Stopping suddenly then leaves the body short of cortisol. Prescribers taper doses slowly so the system can wake up safely.

14. Why is fludrocortisone not in the table?

Fludrocortisone is used mainly for its salt-retaining mineralocorticoid effect. Doctors prescribe it for conditions like adrenal insufficiency and low blood pressure on standing. Its job differs from anti-inflammatory therapy. Standard anti-inflammatory conversion tables therefore leave it out.

15. When should a conversion be double-checked urgently?

Double-check whenever the new dose looks ten times larger or smaller than expected. Decimal slips with dexamethasone and betamethasone are the classic trap. A pharmacist can verify the math in minutes. That check is cheap insurance against a serious error.

CONCLUSION

Steroid conversion rests on one small, well-tested table of equivalent doses. The calculator above applies that table to all eight common drugs at once. Use the results to understand a switch and to prepare better questions. Keep the limits in view: half-life, salt retention, and tapering all sit beyond the math. Final decisions always belong to the prescriber who knows the patient. That partnership between quick math and careful judgment is the safe way to use any conversion.