INJECTION FREQUENTLY ASKED QUESTIONS
INJECTION FREQUENTLY ASKED QUESTIONS
VIDEOS ON INJECTIONS CAN BE FOUND HERE (JUST TYPE THE NAME OF THE INJECTION) : https://viewmedica.com/ondemand-patient-education-videos/see-videos/
RESEARCH STUDIES CAN BE FOUND HERE: https://pubmed.ncbi.nlm.nih.gov/
THE MOST ACCURATE AI SEARCH DATABASE CAN BE FOUND HERE: https://www.openevidence.com/
1. What is the reference standard for steroid equivalency?
Prednisone 5 mg PO is the standard comparator. All other corticosteroid doses are expressed relative to this for anti-inflammatory potency.
2. What are the equivalent doses of common oral steroids?
Hydrocortisone 20 mg = Prednisone 5 mg
Cortisone 25 mg = Prednisone 5 mg
Prednisolone 5 mg = Prednisone 5 mg
Methylprednisolone 4 mg = Prednisone 5 mg
Triamcinolone 4 mg = Prednisone 5 mg
Dexamethasone 0.75 mg = Prednisone 5 mg
Betamethasone 0.6 mg = Prednisone 5 mg
3. What are the equivalents for high-dose oral Dexamethasone?
Dexamethasone 4 mg ≈ Prednisone 26.7 mg ≈ Methylprednisolone 21 mg
Dexamethasone 10 mg ≈ Prednisone 66.7 mg ≈ Methylprednisolone 53 mg
4. What are the equivalents for injectable depot steroids like Depo-Medrol and Kenalog?
Depo-Medrol 40 mg (methylpred acetate IM) ≈ Prednisone 50 mg ≈ Dexamethasone 7.5 mg
Depo-Medrol 80 mg ≈ Prednisone 100 mg ≈ Dexamethasone 15 mg
Kenalog (Triamcinolone acetonide) 40 mg ≈ Prednisone 50 mg ≈ Dexamethasone 7.5 mg
Kenalog 80 mg ≈ Prednisone 100 mg ≈ Dexamethasone 15 mg
5. Are oral and injectable steroids equivalent mg-for-mg?
Yes, for anti-inflammatory potency. But route changes bioavailability, onset, and duration:
Oral: absorbed via GI tract, first-pass metabolism
IV: 100% bioavailability, rapid onset
IM depot: slower onset but prolonged release (weeks)
6. How do half-lives and durations of action differ among steroids?
Short-acting (8–12 h): Hydrocortisone, Cortisone
Intermediate (12–36 h): Prednisone, Prednisolone, Methylprednisolone, Triamcinolone
Long-acting (36–72 h): Dexamethasone, Betamethasone
7. How long do depot injections (Kenalog, Depo-Medrol) last compared to oral therapy?
Depot forms last 1–4 weeks, depending on dose and site, because of slow crystal release. Oral/IV doses last hours to a day.
8. What about mineralocorticoid activity?
High: Hydrocortisone, Cortisone (important in adrenal insufficiency)
Moderate: Prednisone, Prednisolone, Methylprednisolone
Minimal/None: Dexamethasone, Betamethasone, Triamcinolone (better for edema, cerebral swelling, oncology)
9. Why is prednisone considered a prodrug?
Prednisone requires hepatic conversion to Prednisolone. In patients with severe liver dysfunction, Prednisolone should be used directly to ensure efficacy.
10. How do clinicians choose the right steroid?
Acute systemic needs: IV hydrocortisone, methylprednisolone, dexamethasone
Chronic oral therapy: Prednisone, Prednisolone, Methylprednisolone
Depot/long-acting IM: Kenalog, Depo-Medrol for joint injections or prolonged effect
Minimal fluid retention needed: Dexamethasone/Betamethasone (low mineralocorticoid activity)
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