Steroid Dose Converter Calculator
Dexamethasone vs Prednisone Converter
Dexamethasone is 5-10 times more potent than prednisone on a milligram-for-milligram basis. This calculator helps you understand equivalent dosing for your specific treatment.
Duration Comparison
Dexamethasone effects last 36-72 hours while prednisone effects wear off in 12-36 hours. This difference is critical for choosing the right steroid for your condition.
For acute conditions like asthma attacks or croup, dexamethasone's longer duration often means fewer doses needed.
Side Effect Considerations
Both steroids cause similar side effects, but the pattern differs:
- Dexamethasone: More likely to cause insomnia (29% vs 22% with prednisone), mood swings (33% vs 26%), and higher blood sugar (18% greater risk)
- Prednisone: More visible side effects like weight gain (58% vs 45%) and "moon face" (42% vs 31%)
Key Medical Insights
According to the RECOVERY Trial, dexamethasone reduced death rates in hospitalized COVID-19 patients on oxygen by one-third.
The American Geriatrics Society's Beers Criteria warns both steroids can be dangerous for older adults if taken over 7.5 mg prednisone-equivalent daily for more than three months.
When Doctors Choose Each Steroid
| Condition | Preferred Steroid | Why |
|---|---|---|
| Acute asthma attacks in kids | Dexamethasone | Single dose works as well as five days of prednisone |
| Croup | Dexamethasone | One dose prevents hospital readmission |
| Chronic rheumatoid arthritis | Prednisone | Easier to adjust dose daily |
| Hospitalized severe infections | Dexamethasone | Proven survival benefit in COVID-19 |
When doctors prescribe steroids for inflammation or autoimmune conditions, two names come up more than any others: dexamethasone and prednisone. They’re both powerful, but they’re not the same. One is far stronger. One lasts longer. And the side effects? They’re similar-but not identical. Choosing between them isn’t about which is "better." It’s about which fits your condition, your body, and your treatment plan.
How Strong Is Dexamethasone Compared to Prednisone?
Dexamethasone isn’t just a little stronger than prednisone-it’s 5 to 10 times more potent on a milligram-for-milligram basis. Some studies, especially in blood cancers, show it’s as much as 9 to 10 times stronger. That means if you’re taking 10 mg of prednisone, you’d only need about 1 to 2 mg of dexamethasone to get the same anti-inflammatory effect.
This isn’t just theory. In the RECOVERY Trial during the COVID-19 pandemic, dexamethasone cut death rates in hospitalized patients on oxygen by one-third. That kind of impact comes from its intense ability to calm the immune system’s overreaction. Prednisone didn’t show the same survival benefit in that trial, partly because it’s weaker and doesn’t stick around as long.
The reason? Dexamethasone binds to glucocorticoid receptors in your cells more tightly and for longer. It’s like a key that fits the lock perfectly and won’t come out easily. Prednisone’s key fits, but it wiggles loose faster. That’s why dexamethasone’s effects last 36 to 72 hours, while prednisone’s wear off in 12 to 36 hours.
Why Duration Matters in Real Life
Longer duration isn’t always better-but it can be a game-changer.
For kids with croup, a single dose of dexamethasone (0.6 mg/kg) works as well as five days of prednisone. Parents don’t have to fight to get their child to take medicine every day. Emergency rooms use it because one shot or swallow can prevent a hospital stay.
In asthma flare-ups, the same applies. The GINA guidelines now recommend dexamethasone for children because it’s just as effective with fewer doses. Fewer doses mean fewer missed pills, fewer vomiting episodes, and less stress for everyone.
But for chronic conditions like rheumatoid arthritis? Prednisone wins. Why? Because you need to tweak the dose every few days. Maybe you’re feeling better and want to lower it. Maybe you’re having a flare and need to bump it up. Prednisone’s shorter half-life makes that easier. Dexamethasone lingers too long. If you give too much, you can’t just stop it the next day-it’s still working.
Side Effects: Are They the Same?
Yes and no.
Both drugs cause the same types of side effects: weight gain, high blood sugar, mood swings, trouble sleeping, weakened bones, and increased infection risk. But because dexamethasone is so potent, you take less of it. That might sound like good news-but it’s not always.
Here’s the catch: a single 10 mg dose of dexamethasone gives your body the same steroid exposure as five days of 60 mg prednisone. That means even though you’re taking less of the pill, your body is getting hit with a long, heavy dose. That can be harder on your metabolism, your sleep, and your mood.
Studies show dexamethasone causes more insomnia-29% of users report it, compared to 22% with prednisone. Mood swings are also more common: 33% vs. 26%. That’s likely because dexamethasone stays in your system longer, constantly affecting brain chemistry.
On the other hand, prednisone causes more visible side effects. People report “moon face” (facial swelling) in 42% of cases, compared to 31% with dexamethasone. Weight gain is also more frequent-58% vs. 45%. Why? Probably because prednisone is often taken daily for weeks or months, while dexamethasone is used in short bursts.
And here’s something surprising: dexamethasone has a slightly higher risk of raising blood sugar. A 2021 meta-analysis found an 18% greater chance of hyperglycemia at equivalent doses. That’s important if you have diabetes or prediabetes.
When Do Doctors Choose One Over the Other?
It’s not random. It’s based on what you need.
Dexamethasone is the go-to for:
- Acute asthma attacks in kids (single dose, no daily pills)
- Croup (one dose prevents hospital readmission)
- Brain swelling from tumors or injury (long-lasting effect is critical)
- Severe inflammation in cancer patients (35% better pain relief in some studies)
- Hospitalized patients with severe infections like COVID-19 (proven survival benefit)
Prednisone is preferred for:
- Chronic autoimmune diseases like rheumatoid arthritis or lupus (easier to adjust dose)
- Long-term treatment where you need to taper slowly
- Patients who need flexibility-if symptoms change, you can change the dose quickly
- People who can’t tolerate dexamethasone’s long-lasting effects on sleep or mood
Cost and Accessibility
Prednisone is cheaper. A 30-day supply of generic 20 mg tablets costs around $8.50. Dexamethasone 4 mg tablets run about $13. But here’s the twist: you usually take fewer dexamethasone pills. A full course of dexamethasone for asthma might cost the same as prednisone because you’re only taking 1 or 2 pills total.
Insurance often covers both equally. If cost is a barrier, prednisone is the safer bet-but only if you can stick to a multi-day regimen.
What About Long-Term Risks?
Neither drug is safe for long-term daily use. The American Geriatrics Society’s Beers Criteria warns both can be dangerous for older adults if taken over 7.5 mg prednisone-equivalent daily for more than three months. Risks include:
- Broken bones (osteoporosis)
- Diabetes
- High blood pressure
- Eye problems like cataracts or glaucoma
- Severe infections (like pneumonia or sepsis)
That’s why doctors try to use the lowest dose for the shortest time possible. With dexamethasone, that’s often just a few days. With prednisone, it might be weeks or months-but you’re still taking more of it each day.
Real Patient Experiences
On Drugs.com, over 2,000 users have shared their stories. Prednisone users complain most about weight gain and facial puffiness. Dexamethasone users talk about sleepless nights and sudden anxiety.
One 42-year-old woman with asthma said: "I took dexamethasone for a flare. I felt great-but couldn’t sleep for three days. I couldn’t tell if I was on a high or just losing my mind. I switched to prednisone after that and slept better, even if I gained a few pounds."
A 68-year-old man with polymyalgia rheumatica said: "Prednisone kept me alive for years. But I had to drop from 10 mg to 5 mg slowly-because if I cut too fast, I collapsed. Dexamethasone would’ve been a nightmare. I need to be able to adjust."
Bottom Line: It’s Not About Strength-It’s About Fit
Dexamethasone is the heavyweight champ: stronger, longer-lasting, perfect for short, intense battles. Prednisone is the steady hand: easier to control, better for long-term management.
If you’re dealing with a sudden flare-up-asthma, croup, severe allergy, or brain swelling-dexamethasone is often the smarter choice. Fewer pills. Better results. Less hassle.
If you’re managing a chronic disease, needing to fine-tune your dose, or worried about sleep and mood? Prednisone gives you more control.
Neither is "better." But knowing the difference? That’s what helps you ask the right questions-and get the right treatment.
Is dexamethasone stronger than prednisone?
Yes, dexamethasone is 5 to 10 times more potent than prednisone on a milligram-for-milligram basis. A 0.75 mg dose of dexamethasone is roughly equal to 5 to 10 mg of prednisone. This higher potency makes it more effective for acute, severe inflammation, especially when quick, strong suppression is needed.
Which has fewer side effects: dexamethasone or prednisone?
It depends. Dexamethasone is taken in lower doses, so some side effects like weight gain and "moon face" are less common. But because it lasts longer in the body, it’s more likely to cause insomnia, mood swings, and elevated blood sugar. Prednisone causes more visible physical changes due to longer daily exposure, but its shorter half-life makes it easier to manage side effects by adjusting the dose. Neither is "safer"-both carry serious risks with prolonged use.
Can I switch from prednisone to dexamethasone?
Switching is possible but must be done under medical supervision. Because dexamethasone is much stronger and lasts longer, you can’t just swap doses 1:1. A doctor will calculate an equivalent dose based on your current prednisone amount and condition. Never switch on your own-sudden changes can cause adrenal insufficiency or worsen symptoms.
Why is dexamethasone used in COVID-19 but not prednisone?
The RECOVERY Trial showed dexamethasone reduced death rates in hospitalized COVID-19 patients on oxygen or ventilators. Its high potency and long duration allowed it to quickly calm the dangerous immune overreaction (cytokine storm). Prednisone wasn’t tested in the same way and doesn’t have the same proven survival benefit. Dexamethasone’s ability to penetrate tissues and stay active longer made it uniquely effective in that setting.
Is dexamethasone safe for children?
Yes, and it’s often preferred. For conditions like croup and asthma flare-ups, a single dose of dexamethasone works as well as five days of prednisone. Studies show fewer hospital visits and better adherence because kids don’t need daily pills. Side effects like vomiting are similar between the two, and the short course minimizes long-term risks.
How long do side effects last after stopping?
Short-term side effects like insomnia, mood changes, or increased appetite usually fade within days after stopping. But if you’ve taken either drug for more than a few weeks, your adrenal glands may be suppressed and need weeks or months to recover. Stopping abruptly can cause fatigue, dizziness, or even adrenal crisis. Always taper under a doctor’s guidance.
Can dexamethasone cause weight gain like prednisone?
Yes, but less frequently. Because dexamethasone is used in lower doses and for shorter periods, users report weight gain less often than with prednisone. However, if dexamethasone is taken repeatedly or for longer than recommended, it can still cause fluid retention and increased appetite, leading to weight gain. The key difference is exposure time-not the drug’s inherent ability to cause weight gain.
Are there natural alternatives to dexamethasone or prednisone?
No. There are no natural substances that replicate the powerful, targeted immunosuppressive effects of synthetic corticosteroids like dexamethasone or prednisone. Herbal remedies may help with mild inflammation, but they cannot replace these drugs for serious autoimmune, allergic, or life-threatening conditions. Using alternatives instead of prescribed steroids can be dangerous.
What to Do Next
If you’re prescribed one of these steroids, ask your doctor:
- Why this one and not the other?
- How long will I need it?
- What signs of side effects should I watch for?
- Can I switch if I have trouble with side effects?
Don’t assume one is "stronger" so it’s "better." The best steroid is the one that matches your body’s needs-and your life.