A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

Table 3 Properties, dosing equivalents and therapeutic indications of systemic corticosteroids, relative to hydrocortisone

	Approximate equivalent dose* (mg)	Relative glucocorticoid activity	Relative mineralocorticoid activity	Duration of action (hours)	General therapeutic indications
Glucocorticoids
Short-acting
Hydrocortisone	20	1	1	8-12	• Relatively high mineralocorticoid activity makes it suitable for use in adrenal insufficiency
Cortisone	25	0.8	0.8	8-12	• Similar to hydrocortisone
Intermediate-acting
Prednisone	5	4	0.8	12-36	• High glucocorticoid activity makes it useful for long-term treatment, and as an anti-inflammatory/ immunosuppressant
Prednisolone	5	4	0.8	12-36	• Similar to prednisone
Methylprednisolone	4	5	Minimal	12-36	• Anti-inflammatory/immunosuppressant
Triamcinolone	4	5	0	12-36	• Anti-inflammatory/immunosuppressant
Long-acting
Dexamethasone	0.75	30	Minimal	36-72	• Anti-inflammatory/immunosuppressant; used especially when water retention is undesirable given its minimal mineralocorticoid activity
Dexamethasone	0.75	30	Minimal	36-72	• Usually reserved for short-term use in severe, acute conditions given its high potency and long-duration of action
Betamethasone	0.6	30	Negligible	36-72	• Similar to dexamethasone
Mineralocorticoids
Fludrocortisone	**	10-15	125-150	12-36	• Used for aldosterone replacement

Table adapted from NICE, 2012 [1]; Furst et al., 2012 [8].
*Equivalent dose shown is for oral or IV administration. Relative potency for intra-ocular or intramuscular administration may vary considerably.
**Glucocorticoid doses which provide a mineralocorticoid effect that is approximately equivalent to 0.1 mg of fludrocortisone are: prednisone or prednisolone 50 mg, or hydrocortisone 20 mg.

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