Glucocorticoid equivalence
| Drug | Equivalent dose | Relative potency | Mineralocorticoid | Duration |
|---|---|---|---|---|
| Hydrocortisone | 20 mg | 1 | ++ | Short (8–12 h) |
| Prednisolone | 5 mg | 4 | + | Intermediate (12–36 h) |
| Methylprednisolone | 4 mg | 5 | Minimal | Intermediate (12–36 h) |
| Dexamethasone | 0.75 mg | 25–30 | None | Long (36–72 h) |
Physiologic replacement ≈ hydrocortisone 15–25 mg/day (prednisolone 4–6 mg). Doses above this suppress the HPA axis.
Common ward indications
| Indication | Drug | Dose | Duration | Source |
|---|---|---|---|---|
| Asthma exacerbation | Prednisolone PO | 1 mg/kg OD, max 50 mg; cannot swallow → methylprednisolone 40 mg IV | 5–7 days | GINA 2026 |
| COPD exacerbation | Prednisolone PO | 40 mg OD | 5 days, no taper | GOLD 2026 |
| Anaphylaxis (not routine) | Hydrocortisone IV | 200 mg | Consider in refractory or recurrent cases only | Resus Council UK 2021 |
| Bacterial meningitis | Dexamethasone IV | 0.15 mg/kg (max 10 mg) q6h | 4 days, with or before the first antibiotic dose | IDSA 2004 / NICE NG240 |
| Septic shock (refractory) | Hydrocortisone IV | 50 mg q6h (200 mg/day) | Until vasopressors stopped or tapered | SSC 2026 |
| Cord compression | Dexamethasone IV/PO | 16 mg/day (in divided doses) | Per oncology team | NICE NG234 |
| Raised intracranial pressure (tumour) | Dexamethasone IV/PO | 8–16 mg/day | Per neurosurgery | NICE NG99 |
| Adrenal crisis | Hydrocortisone IV | 100 mg stat, then 200 mg/24 h (50 mg q6h or continuous infusion) | Taper to maintenance over 1–3 days once stable | Endocrine Society 2016 / ESE 2024 |
Stress-dose steroids
| Scenario | Dose |
|---|---|
| Minor illness (fever, nausea, unable to take PO) | Double the usual oral dose; switch to IV hydrocortisone 50 mg q8h if unable to swallow |
| Moderate stress (surgery under GA, significant infection) | Hydrocortisone 50 mg IV q8h for 24–48 h, then resume usual dose |
| Major stress / adrenal crisis | Hydrocortisone 100 mg IV stat, then 200 mg/24 h (50 mg q6h); fluid resuscitation |
Stress dosing applies to any patient on long-term steroids (≥ 4 weeks), on physiologic replacement, or within 12 months of stopping a long course.
Do I need to taper?
| Question | Answer |
|---|---|
| Course ≤ 3–4 weeks? | Stop without taper (ESE/Endocrine Society 2024, Rec 2.1) |
| Course > 3–4 weeks? | Taper required. Reduce gradually toward physiologic dose (~5 mg prednisolone), then slow taper (1 mg/month) or check 8–10 am cortisol. Sick-day rules apply throughout. |
| Repeated short courses? | Consider taper if new short course starts within 12 months of stopping a long course. |
| Not sure? | Ask pharmacy or endocrinology; do not stop abruptly |
Taper schedule depends on the disease (e.g. GCA, nephrotic syndrome): this table covers adrenal safety, not the disease-specific schedule; above physiologic dose, taper by disease response (clinical + inflammatory markers).
Monitoring
| Side effect | Action |
|---|---|
| Hyperglycemia | Check glucose in all patients on steroids; see inpatient hyperglycemia |
| Infection risk | Low threshold for septic screen; atypical presentations on steroids |
| GI | PPI if concurrent NSAID or GI risk factors (not routinely otherwise) |
| Osteoporosis | Consider bone protection if expected course > 3 months (specialist decision) |
Educational reference for clinicians. Doses are typical adult starting points. Cross-check allergies, interactions, current local policy, the formulary, and renal/hepatic function before prescribing.
Last updated · October 2026