Corticosteroid (potency)

Corticosteroids in general:

Note that mineralocorticoid side effects are most marked with fludrocortisone, but are significant with cortisone, hydrocortisone, corticotropin, and tetracosactide (tetracosacrtin). Minerlacorticoid actions are negligible with the high potency glucocorticoids, betamethasone and dexamethasone, and occur only slightly with methylprednisolone, prednisolone, triamcinolone.

Comparison of prednisolone and hydrocortisone (2):

• Glucocorticoid activity
  • hydrocortisone has a 1 to 1 ratio for glucocorticoid (anti-inflammatory) and mineralocorticoid (water retention) properties.
  • prednisolone has a 4 to 0.8 ratio for glucocorticoid (anti-inflammatory) and mineralocorticoid (water retention) properties.
• the relatively high mineralocorticoid activity of hydrocortisone makes it unsuitable for disease suppression on a long-term basis

If switching between intravenous hydrocortisone to oral prednisolone (2):

• when comparing anti-inflammatory potency, 5mg of oral prednisolone is equipotent to 20mg of oral hydrocortisone.
• oral hydrocortisone has a bioavailability of near 100%.
• based on this, 5mg of oral prednisolone is similar in anti-inflammatory potency to 20mg of IV hydrocortisone.
• note that local policies for IV hydrocortisone administration may differ. Please refer to your local policy in the first instance

Topical corticosteroids:

The potency of topical corticosteroids is determined by

• the extent to which it inhibits inflammation (3)
• the specific modification (esterification) of the steroid molecule e.g. - hydrocortisone (acetate) 1% is mild but hydrocortisone butyrate 0.1% is a potent preparation (4)
• the formulation
• presence of other ingredients such as urea or salicylic acid which may increase the absorption of the drug (5)
• occlusive dressings or increasing hydration of the stratum corneum (increases steroid absorption) (6)

POTENCY EXAMPLES

• mild
  • hydrocortisone 0.1-1%
    
    
• moderate
  • clobetasone butyrate 0.05%
    
    
• potent
  • hydrocortisone butyrate
  • betamethasone valerate 0.1%
    
    
• very potent
  • clobetasol propionate 0.05%

The respective summary of product characteristics must be checked before prescribing any of the drugs described.

Reference:

• (1) NICE - Equivalent anti-inflammatory doses of oral corticosteroids (Accessed 4/10/23)
• (2) NHS Specialist Pharmacy Service (September 2023). Switching between oral prednisolone and IV hydrocortisone
• (3) National Institute for Health and Clinical Excellence (NICE) 2004. Frequency of application of topical corticosteroids for atopic eczema
• (4) National Institute for Health and Clinical Excellence (NICE) 2007. Atopic eczema in childrenmanagement of atopic eczema in children from birth up to the age of 12
• (5) MeReC. Using topical corticosteroids in general practice. MeReC Bulletin 1999;10(6), 21-24
• (6) Tadicherla S et al. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8(12):1093-105