Intravenous pulse steroid therapy consists of administration of supraphysiological doses of glucocorticoids. It is useful in conditions where rapid immunosuppression and antiinflammatory effect is desired, as in systemic lupus erythematosus, pemphigus, renal transplantation, steroid resistant nephrotic syndrome and crescentic glomerulonephritis. This therapy may be associated with significant adverse reactions including hypertension, arrhythmias, hypokalemia, psychosis and infections. High dose steroid therapy should therefore be used in selected cases and under careful supervision. The drug most widely used for this treatment is methylprednisolone. However, in view of its easy availability and cost, dexamethasone has been often used in India for the above conditions. While there are no controlled studies comparing the two drugs, it appears that the two drugs may be similar in efficacy. Patients requiring high dose intravenous steroid therapy may be treated effectively with either methylprednisolone or dexamethasone.