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Here is a complete overview of steroid tablets (oral corticosteroids) with examples, potencies, and uses:
Steroid Tablets - Examples of Oral Corticosteroids
Steroid tablets are synthetic analogues of natural steroid hormones produced by the adrenal cortex. They are available as oral tablets and differ in potency, mineralocorticoid activity, and duration of action.
Potency Comparison Table (relative to Cortisol = 1)
Source: Firestein & Kelley's Textbook of Rheumatology, Table 60.2
| Steroid Tablet | Equivalent Dose (mg) | Glucocorticoid Potency | Mineralocorticoid Activity | Duration of Action |
|---|---|---|---|---|
| Cortisone | 25 | 0.8 | 0.8 | 8-12 hrs (short) |
| Hydrocortisone (Cortef) | 20 | 1 (reference) | 1 | 8-12 hrs (short) |
| Prednisolone | 5 | 4 | 0.8 | 12-36 hrs (intermediate) |
| Prednisone (Deltasone) | 5 | 4 | 0.8 | 12-36 hrs (intermediate) |
| Methylprednisolone (Medrol) | 4 | 5 | 0.5 | 12-36 hrs (intermediate) |
| Triamcinolone | 4 | 5 | Minimal | 12-36 hrs (intermediate) |
| Dexamethasone | 0.75 | 30 | Minimal | 36-72 hrs (long) |
| Betamethasone | 0.6 | 30 | Minimal | 36-72 hrs (long) |
Memory tip: For equivalent doses: 0.75 (dexamethasone) = 4 (methylprednisolone) = 5 (prednisone/prednisolone) = 20 (hydrocortisone)
Classification by Duration
Short-acting (8-12 hrs):
- Cortisone 25 mg
- Hydrocortisone 20 mg
Intermediate-acting (12-36 hrs):
- Prednisone 5 mg (most commonly used)
- Prednisolone 5 mg (preferred in liver disease - prednisone requires liver conversion)
- Methylprednisolone 4 mg
- Triamcinolone 4 mg
Long-acting (36-72 hrs):
- Dexamethasone 0.75 mg (most potent, minimal mineralocorticoid effect)
- Betamethasone 0.6 mg
Important Notes
Prednisone vs Prednisolone:
- Prednisone is a prodrug - it must be converted in the liver by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) to its active form, prednisolone.
- In liver disease or hypoalbuminemia, prednisolone is preferred over prednisone since conversion may be impaired. - Washington Manual of Medical Therapeutics
Protein Binding:
- About 90% of circulating glucocorticoid is protein-bound; only the free (unbound) fraction is pharmacologically active. - Goodman & Gilman's Pharmacological Basis of Therapeutics
Mineralocorticoid effects:
- Dexamethasone and betamethasone have minimal mineralocorticoid activity (least water/salt retention)
- Hydrocortisone and cortisone have significant mineralocorticoid activity (cause more fluid retention)
Common Clinical Uses of Steroid Tablets
| Condition | Drug of Choice |
|---|---|
| Rheumatoid arthritis / autoimmune diseases | Prednisone / Prednisolone |
| Severe asthma / COPD exacerbation | Prednisolone / Methylprednisolone |
| Brain edema / cerebral inflammation | Dexamethasone |
| Adrenal insufficiency (replacement) | Hydrocortisone / Cortisone |
| Inflammatory bowel disease | Prednisone / Budesonide |
| Giant cell arteritis (GCA) | Prednisone 40-60 mg/day |
| Leprosy reactions (moderate-severe) | Prednisolone |
| Nephrotic syndrome / kidney disease | Prednisolone / Methylprednisolone |
Mechanism of Action (Anti-inflammatory)
Glucocorticoid tablets work by suppressing multiple inflammatory mediators, including:
- Inhibit COX-2 and phospholipase A2 - reducing prostaglandins and leukotrienes
- Block cytokines: IL-1, IL-2, IL-6, TNF-alpha, GM-CSF
- Reduce adhesion molecules (ELAM-1, ICAM-1) on endothelial cells
- Suppress T-cell and macrophage activity
The key steroid tablets to remember are: Hydrocortisone, Prednisolone, Prednisone, Methylprednisolone, Triamcinolone, Dexamethasone, and Betamethasone - each with a distinct potency profile suited to different clinical situations.
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