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Alert Number 214
Date: January 20, 2024
Several of our members have written to me in the past few months with questions about steroid therapy and potential diseases of the eye. There is also confusion about the dosage equivalency of the various corticosteroids used and their brand names. Below is an easy cheat-sheet with the generic names, commonly used brand names and the dosage equivalency.
| Corticosteroid | Activity | Relative Potency |
Equivalent Dose (mg) |
Brand Name |
| Dexamethasone | Long-acting | 25 | 0.75 | Decadron |
| Prednisone | Intermediate | 4 | 5.0 | Deltasone |
| Methylprednisolone | Intermediate | 5 | 4.0 | Solumedrol |
| Hydrocortisone | Short-acting | 1 | 20.0 | Several |
Link: http://www.aafp.org/afp/980800ap/zoorob.html, A Different Look at Corticosteroids.
Eye problems are listed among the long list of adverse effects (Table 2, in the article linked above). Prolonged use of steroidal drugs may case damage to the ocular nerve. Glaucoma and subcapsular cataracts are also listed as potential problems. In keeping with their immune suppressive effect, steroid use may also make you more vulnerable to fungal or viral infections of the eye. Herpes simplex infection of the eye (think of shingles in your eye) may be one of the risk factors. If you are considering steroid therapy, it is worth reading the whole article. Bear in mind we do not always have the luxury of just saying “NO”. All therapy decisions have to be weighed in terms of the risks and rewards, even when you are looking at making the best of several not-so-good options.
What constitutes a low dose, medium dose and massive dose? Here is what the AFP has to say on the subject:
A low or maintenance dosage is approximately 0.1 to 0.25 mg per kg per day of prednisone, a moderate dosage is approximately 0.5 mg per kg per day of prednisone, a high dosage is 1 to 3 mg per kg per day of prednisone, and a massive dosage is approximately 15 to 30 mg per kg per day of prednisone.
For a 60 kg woman (132 lbs), this works out to
Low dose: 6 - 15 mg prednisone
Medium dose: 30 mg prednisone
Massive dose: 900 - 1,800 mg prednisone.
For comparison, the R + HDMP used 1,750 mg methylprednisolone ( dosage at 1,000 mg/m2, assuming a BSA of 1.75 for our 60 kg woman), three times for each monthly cycle. That adds up to the equivalent of 2,188 mg of prednisone, three times for each monthly cycle. I suppose the name HDMP (high dose methylprednisolone) is quite justified.
Be well,
Chaya
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