Alternatives to Hydrocortisone If You Can't Fill Your Prescription

Hydrocortisone is the most physiologically natural corticosteroid — it's literally the same hormone your adrenal glands make. But with the ongoing shortage that has persisted since 2020, many patients find themselves unable to fill their prescriptions. If this has happened to you, don't panic — and don't stop taking your medication without talking to your doctor.

Important warning: Never switch corticosteroids on your own. Dose conversions between steroids are complex and must be calculated by your doctor. Abrupt stoppage can trigger an adrenal crisis in patients with adrenal insufficiency, which is a life-threatening emergency.

Why Can't You Just Switch Steroids on Your Own?

Each corticosteroid has a different potency per milligram. The conversion ratio is not one-to-one. For example, 20 mg of hydrocortisone is roughly equivalent to 5 mg of prednisone or 0.75 mg of dexamethasone. If you accidentally took the wrong dose of a more potent steroid, you could experience serious side effects, or — if you took too little — risk adrenal crisis. Only your doctor can determine the right equivalent dose.

Option 1: Prednisone — The Most Common Alternative

Prednisone is the most widely available oral corticosteroid and is the most common substitute when hydrocortisone is unavailable. It is widely stocked at virtually all pharmacies and is very inexpensive (often under $10 for a 30-day supply).

Conversion: 20 mg hydrocortisone ≈ 5 mg prednisone

Duration of action: 12-36 hours (vs. 8-12 for hydrocortisone), so often dosed once daily

Note: Prednisone is a prodrug — it must be converted by the liver to its active form (prednisolone). Patients with significant liver disease should use prednisolone instead.

Downside: Less precise mimicry of the natural cortisol circadian rhythm; once-daily dosing may not suit patients with adrenal insufficiency who benefit from multiple smaller doses.

Option 2: Prednisolone — Good for Children and Liver Patients

Prednisolone is the active form of prednisone. It doesn't need liver conversion, making it preferable for patients with liver disease. It is also available as a liquid, which can be helpful for children or patients who have difficulty swallowing tablets.

Conversion: 20 mg hydrocortisone ≈ 5 mg prednisolone

Forms: Tablet and oral solution

Best for: Liver disease patients, children, patients who need liquid form

Option 3: Methylprednisolone (Medrol) — More Potent Anti-Inflammatory

Methylprednisolone (brand name Medrol) is about 20% more potent than prednisone and prednisolone. It is available as oral tablets (2 mg, 4 mg, 8 mg, 16 mg, 32 mg) and as an injectable (Solu-Medrol, Depo-Medrol). It may be more appropriate for patients using hydrocortisone as an anti-inflammatory rather than for adrenal replacement.

Conversion: 20 mg hydrocortisone ≈ 4 mg methylprednisolone

Advantage: Minimal mineralocorticoid activity (less water retention)

Option 4: Dexamethasone — Longest-Acting, Most Potent

Dexamethasone is 40-50 times more potent than hydrocortisone per milligram and has a much longer duration (18-36 hours). It is typically used when a single daily dose is preferred or when stronger anti-inflammatory action is needed. It has essentially no mineralocorticoid activity.

Conversion: 20 mg hydrocortisone ≈ 0.75 mg dexamethasone

Caution: Very small dosing margins — tiny errors can have big effects. More likely to cause HPA axis suppression with long-term use. Generally not preferred for long-term adrenal replacement.

What About Cortisone Acetate?

Cortisone acetate is another short-acting corticosteroid sometimes used for adrenal replacement. It is a prodrug that the liver converts to cortisol (hydrocortisone). The typical dose is about 25 mg cortisone acetate = 20 mg hydrocortisone. It is less commonly available than the options above and may require your doctor to specifically seek it out.

Steroid Conversion Chart at a Glance

The following conversions are approximate — your doctor must calculate the right dose for you:

Hydrocortisone 20 mg = Prednisone 5 mg = Prednisolone 5 mg = Methylprednisolone 4 mg = Dexamethasone 0.75 mg

Never use this chart to self-medicate. Always consult your doctor for proper dosing.

Before You Assume Hydrocortisone Is Completely Unavailable

The shortage doesn't mean hydrocortisone is impossible to find — it means you need to look harder. Try using medfinder to quickly check multiple pharmacies near you for current stock. Many patients find a pharmacy within a reasonable distance that has their medication. Only after exhausting these options should you discuss a switch with your doctor.

For more tips, see our guide: How to Find Hydrocortisone in Stock Near You.