UKMedCalc

For healthcare professionals. Educational tool only — not a medical device. Verify all results against the current BNF, NICE guidance and local policy, and apply clinical judgement.

ConversionsEndocrine

Corticosteroid Equivalence Conversion

Converts between oral corticosteroids using standard anti-inflammatory equivalence (hydrocortisone 20 mg basis).

mg
Enter the required values to see the result.

Formula

Target dose=Current dose×equivalent dose of targetequivalent dose of current\text{Target dose} = \text{Current dose} \times \frac{\text{equivalent dose of target}}{\text{equivalent dose of current}}

Equivalence is expressed relative to hydrocortisone 20 mg (anti-inflammatory activity). It does not account for differences in mineralocorticoid activity or duration of action.

Caveats & limitations

  • Approximate equivalence — sources vary slightly; always titrate to clinical response.
  • Duration of action differs: long-acting agents cause more HPA-axis suppression per anti-inflammatory effect.
  • Patients on >3 weeks of systemic steroids need gradual tapering and sick-day rules — do not stop abruptly.
  • Deflazacort has limited availability in the UK; betamethasone/dexamethasone cross the placenta (used in obstetrics).

Evidence & UK guidance

Primary evidence

  • Speiser PW, Arlt W, Auchus RJ, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(11):4043–4088. (Includes glucocorticoid dose equivalence table.)

    PubMedDOI

UK practice

The BNF presents corticosteroid equivalence in its 'Corticosteroids, general use' treatment summary. Equivalence is anti-inflammatory only: hydrocortisone and cortisone have marked mineralocorticoid activity (relevant for adrenal replacement), while dexamethasone and betamethasone have essentially none. For adrenal insufficiency replacement and sick-day rules, follow Society for Endocrinology guidance — do not convert replacement doses with this table alone.

Official resources

Formula and citations last verified: 2026-08-03

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