Hydrocortisone to Prednisone Dose Equivalency

Standard Conversion Ratios

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that 20 mg of hydrocortisone is equivalent to 5 mg of prednisone, based on the established 4:1 conversion ratio 1, 2, 3
• Using this ratio, 200 mg hydrocortisone is equivalent to 50 mg prednisone 1, 2, 3

Clinical Context and Validation

• The maximum adrenal output of hydrocortisone during stress is 200-300 mg/day, with prednisone being 4 times more potent than hydrocortisone 1
• The equivalent dose relationships are: prednisone 60 mg = methylprednisolone 48 mg = dexamethasone 10 mg = hydrocortisone 240 mg 1
• Multiple guidelines confirm that prednisolone 5 mg = hydrocortisone 20 mg = methylprednisolone 4 mg when managing perioperative steroid coverage 2, 3

Important Clinical Caveats

• The conversion assumes equivalent anti-inflammatory potency; however, prednisolone has approximately 25 times less mineralocorticoid activity than hydrocortisone, which may be clinically relevant in certain contexts 1
• When converting between formulations in acute settings, the 4:1 ratio remains the standard for calculating equivalent anti-inflammatory doses 2, 3, 4