UMEM Educational Pearls

Title: Avoiding Excessive Steroid Dosing

Category: Pharmacology & Therapeutics

Keywords: steroids, asthma, copd (PubMed Search)

Posted: 8/7/2025 by Ashley Martinelli (Updated: 8/14/2025)
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There are various reasons to give corticosteroids in the emergency department. Many decisions regarding IV vs PO, and the numerous available products can lead to excessive dosing (such as 125mg methylprednisolone). Below is a reference for the most common indications as well as conversion recommendations for each product

Guideline Recommended Dosing for Common ED Indications:

COPD: 40 mg of prednisone x 5 days
Asthma: 50 mg prednisone or 200 mg hydrocortisone divided x 5 days
Anaphylaxis: consider 80 – 125mg methylprednisolone, 60 mg prednisone
Sepsis: 200mg hydrocortisone divided--50 mg q6h or continuous infusion

Take-away: Methylprednisolone 125mg is frequently requested but provides a dose equivalent to prednisone 150mg. Consider guideline directed dosing and conversion of products to prevent excessive initial steroid dosing.

References

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2025. Available from: www.goldcopd.org.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. Available from: www.ginasthma.org
Evans, L et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337
https://www.mdcalc.com/calc/2040/steroid-conversion-calculator?drug_input=5&drug_dosage=40#evidence