Different steroids and their mineralocorticpid and glucocorticoid effects
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corticosteroids AND mineralocorticoid
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Endotext glucocorticoid equivalency table mineralocorticoid potency hydrocortisone prednisone dexamethasone
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https://www.ncbi.nlm.nih.gov/books/NBK279156
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Relative glucocorticoid and mineralocorticoid effects of corticosteroids
Values are relative to hydrocortisone (cortisol) = 1 for both actions. They are useful for comparing systemic steroid drugs.
| Steroid | Approx. equivalent anti-inflammatory dose | Glucocorticoid effect | Mineralocorticoid effect | Duration |
|---|---|---|---|---|
| Hydrocortisone (cortisol) | 20 mg | 1 | 1 | Short |
| Cortisone | 25 mg | 0.8 | 0.8 | Short |
| Prednisone | 5 mg | 4 | 0.3 | Intermediate |
| Prednisolone | 5 mg | 4-5 | 0.3 | Intermediate |
| Methylprednisolone | 4 mg | 5 | Minimal to none | Intermediate |
| Triamcinolone | 4 mg | 5 | None | Intermediate |
| Dexamethasone | 0.75 mg | 25-30 | None | Long |
| Betamethasone | 0.6-0.75 mg | 25-30 | None | Long |
| Fludrocortisone | Not used chiefly for anti-inflammatory equivalence | High | Very high, about 125-250 | Intermediate |
| Desoxycorticosterone acetate (DOCA) | - | None | High, about 20 | Long |
What the two effects mean
- Glucocorticoid effect: anti-inflammatory, immunosuppressive, increases gluconeogenesis and blood glucose, contributes to protein breakdown and osteoporosis with prolonged high exposure.
- Mineralocorticoid effect: sodium and water retention, potassium and hydrogen ion loss. Excess can cause edema, hypertension, hypokalemia, and metabolic alkalosis.
Practical clinical interpretation
- Hydrocortisone has both meaningful glucocorticoid and mineralocorticoid activity. It is useful when replacing cortisol in adrenal insufficiency and in adrenal crisis.
- Prednisone/prednisolone have strong anti-inflammatory activity but still some salt-retaining effect. Edema or hypertension may occur, especially at larger doses.
- Methylprednisolone has negligible mineralocorticoid activity, so it is often preferred when fluid retention is undesirable.
- Dexamethasone and betamethasone are very potent, long-acting glucocorticoids with essentially no mineralocorticoid activity. Dexamethasone does not provide mineralocorticoid replacement in primary adrenal insufficiency.
- Fludrocortisone is mainly a mineralocorticoid. It is used for salt-retaining replacement, such as in primary adrenal insufficiency, rather than for routine anti-inflammatory therapy.
A concise way to remember the pattern:
Hydrocortisone retains salt; prednisone retains a little; methylprednisolone, dexamethasone, and betamethasone essentially do not. Fludrocortisone retains salt strongly.
The Endotext steroid table provides a comparable glucocorticoid-equivalency framework. Relative values can differ slightly among references, so use local protocols for dose conversion, especially when switching drugs or treating adrenal insufficiency.
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