American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.

TEACHERS TOPICS
Introduction to Pharmaceutical Calculations

Michael C. Brown, PharmD

College of Pharmacy, University of Minnesota

This manuscript describes material presented in the first lecture of a pharmaceutical calculations lec-
ture series. The first lecture focuses primarily on the key concepts needed to approach pharmaceutical
calculations systematically and in a manner that will develop good calculation habits and ultimately
lead to optimal patient care. Much of the content of subsequent lectures is specific to the respective
topics covered (calculations related to dosing, parenteral preparation, isotonicity, milliequivalents,
concentrated acids, etc). Concepts covered in the first lecture are emphasized through application in
subsequent lectures in the series.
Keywords: Pharmaceutical calculations

INTRODUCTION 3. Provide recommendations for improving effi-

ciency and accuracy while avoiding errors and mis-
Accurately performing pharmaceutical calculations is interpretations when completing pharmaceutical
a critical component in providing patient care in every calculations.
pharmacy practice environment. Consequently, phar-
maceutical calculations are a vital part of any phar- 4. Describe methods for double-checking calcula-
macy curriculum. Although most pharmaceutical cal- tions.
culations are not ‘difficult,’ it is a topic that deserves Frequent Perceptions
attention because it requires flawless accuracy. Before
students are able to become optimally proficient at Like any class, students come to a pharmaceutical
performing pharmaceutical calculations and using calculations class with perceptions and expectations.
them to contribute to optimal patient care, they must Some of these are accurate and some require refinement
understand approaches to pharmaceutical calculations or explanation. The following issues often come up
that help minimize error and maximize accuracy. The when students first come to the calculations course.
objectives of this introduction to pharmaceutical cal- “I already know how to do this — it is just simple
culations are: math.”—Although some pharmaceutical calculations
1. Openly address common student perceptions so require basic science knowledge, such as interpreting a
that these perceptions do not hinder students’ fo- chemical formula to determine the number of equiva-
cus on pharmaceutical calculations. lents per mole or knowing that 1ml of water weighs 1g,
a large part of performing pharmaceutical calculations
2. Review the two main approaches to pharma- requires math skills learned prior to high school. Stu-
ceutical calculations, proportion and dimensional dents quickly recognize this fact and some may perceive
analysis, and describe advantages and shortcom- that pharmaceutical calculations should be easy. The
ings of each. fact of the matter is that pharmaceutical calculations are
NOT easy. No student in 8th grade was expected to be
correct 100% of the time. The major difficulty in phar-
Corresponding Author: Michael C. Brown, PharmD.
Mailing Address: College of Pharmacy, University of maceutical calculations is not the math, it is the fact that
Minnesota, 3-130 Weaver Densford Hall, 308 Harvard the margin for error is non-existent.
St. SE, Minneapolis, MN 55455. Tel: 612-626-2340. Some of the content of the remaining discussion will
Fax: 612-625-9931. E-mail: [email protected]. provide mathematical reviews that will be quite basic to
some students. This level of detail is purposely provided

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.
so that ALL students fully understand these basic most pharmaceutical calculations: proportion, dimen-
mathematical concepts, as their future patients’ doses, sional analysis, and empiric formulas.
dosage forms, and lives will depend on it.
Proportion
“I can do this in my head.”—As students and
later as practitioners, there are occasions when calcu- Ratios define the relationship between 2 amounts,
lations are done without a paper and pen. Most stu- and they are the building blocks of proportions. Exam-
dents and pharmacists do not need a paper and pen to ples of ratios include the number of milliequivalents of
determine that if 1 tsp contains 250 mg of amoxicillin, drug per tablet (eg, 10 mEq potassium per tablet) and
one half tsp will contain 125 mg. Students need to the number of milligrams of drug per volume of product
show their work for even the simplest calculations, (eg, 80 mg acetaminophen per 0.8 mL suspension). One
however. The obvious reason for this (grading) is not might think of a ratio as a concentration, such as grams
the most important. Showing their work allows a stu- of steroid per pound of ointment, but ratios can express
dent to visualize the problem and slow down their any relationship between 2 amounts, such as 1 kg per
thought process, making it less likely for errors to oc- 2.2 lbs, whether or not they reflect a concentration.
cur. It also develops good habits for practice, when The use of proportions in pharmaceutical calcula-
documentation allows other practitioners to double- tions can be shown through the following example. A
check work and easily see the method of calculation suspension is labeled to contain 250 mg of amoxicillin
used. per 5 mL of product. If a patient’s dose is 125 mg, what
“It is boring — let’s get to the exciting volume of suspension should the patient receive? Given
stuff.”—Pharmaceutical calculations are not glamor- the known ratio of 250 mg of amoxicllin per 5 mL of
ous. In fact, one could argue that they are somewhat product, the volume needed can be calculated as shown
mundane. This can be particularly true early in a lec- in Figure 1a. The proportion is set up with the known
ture series on pharmaceutical calculations, when the ratio on the left side. Because the numerator of the ratio
topic focuses on understanding the basic concepts of on the left side contains mg of amoxicillin, the desired
proportions and dimensional analysis (before diving dose of 125 mg amoxicillin must go in the numerator of
into the slightly more glamorous calculations them- the ratio on the right side. The units in both numerators
selves). The challenge lies in the fact that many stu- of the proportion must be the same, as must be the de-
dents (and instructors alike) would rather spend time nominators’ units. The denominator of the ratio on the
discussing new and innovative therapies for a condi- right side is entered as unknown. One can then cross-
tion than basic concepts in pharmaceutical calcula- multiply (Step 1) and divide (Step 2) to determine the
tions, and consequently, it is tempting to rush through unknown (Figure 1b), multiplying the known value in
introductory material. Calculations can be occasion- the numerator on the right side (125 mg) by the known
ally mundane, particularly the repetition necessary to value in the denominator on the left side (5 mL) and
develop confidence as well as accuracy. Nevertheless, then dividing this product (625 mg·mL) by the value in
deliberate and undivided attention to detail is required the numerator on the left side (250 mg), giving the un-
to clearly understand the basic concepts that will known value (2.5 mL).
serve as building blocks during later coursework. Where the unknown is located does not matter (nu-
There can be no misunderstanding of the basic con- merator versus denominator); the principles still apply.
cepts among students. Correct calculations contribute Consider a situation where the suspension above has
just as much to patient outcomes as the newest meth- been taken home and the child is inadvertently adminis-
ods and guidelines for diagnosis, treatment, and pre- tered 12.5 mL of suspension rather than 2.5 mL. How
vention. Furthermore, errors in calculations can make many milligrams of amoxicillin did the patient receive
the otherwise best attempts at optimal patient care when administered the 12.5 mL? The set up and solution
catastrophic. is shown in Figure 1c. As above, the known ratio is on
With these perceptions and their implications dis- the left side of the proportion. The known volume ad-
cussed, the focus will shift to the basic concepts of ministered (12.5 mL) is entered in the denominator on
pharmaceutical calculations themselves. the right side — the denominator is the correct location
because the units of 12.5 mL match the units of the left
CALCULATION METHODS side proportion (5 mL). The numerator (the number of
One of the common difficulties students have re- milligrams of amoxicillin) is the unknown. Cross-
lated to pharmaceutical calculations is setting up the multiplying 12.5 mL times 250 mg gives a product of
calculation. There are three basic ways to approach

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.
1a.
250 mg amoxicillin 125 mg amoxicillin
=
5 mL suspension x mL suspension
1b.
Step 1. Cross-multiply:
5 mL suspension × 125 mg amoxicillin = 625 mg amoxicillin · mL suspension
Step 2. Divide product by unused known:
625 mg amoxicillin · mL suspension
= 2.5 mL suspension
250 mg amoxicillin
1c.
250 mg amoxicillin x mg amoxicillin
= x = 625 mg amoxicillin
5 mL suspension 12.5 mL suspension
Figure 1. Example of Calculation Using Proportion.

3125 mL·mg, which when divided by 5 mL gives an mg diphenhydramine HCl per 5 mL solution. This prob-
answer of 625 mg amoxicillin. lem requires 4 proportion calculations: (1) convert
The use of proportions to solve calculations has pounds to kilograms, (2) convert mg/kg/day to mg/day,
an important consideration. A single proportion can (3) convert mg/day to mg/dose, and (4) convert mg/dose
only solve 1 step of the calculation. In the example to mL solution/dose. With dimensional analysis it re-
above, this was not a problem because the entire ques- quires one setup, as shown in Figure 2a. The setup be-
tion only required 1 step. In more complex calcula- gins by placing the units and description of the desired
tions, it takes multiple steps to reach an answer, each answer at the right of an equal sign, mL diphenhy-
requiring a separate proportion. This is good and bad. dramine HCl solution per dose. The pertinent ratios are
It is bad because it is inefficient. It is good because it then placed on the left side of the equal sign with multi-
allows the student or practitioner to see their interme- plication signs between them. Ratios often need to be
diate answers throughout the steps of the calculation inverted to place the units in the correct orientation
and more easily identify mistakes if they occur. (numerator versus denominator) so that they cancel each
other out and leave only the desired final units. The ra-
tios are then multiplied together and the units canceled
Dimensional Analysis to give the final answer of 7.3 mL diphenhydramine
HCl solution (Figure 2b). (For students struggling with
Similar to proportions, dimensional analysis is this concept it may be necessary to give a stepwise ap-
heavily dependent on the use of ratios. It has 2 main proach to picking each individual ratio on the left side of
differences compared to proportions: the ability to the equal sign. That discussion is not provided here.)
“cancel units” to help verify the setup of the problem
and the ability to handle multiple steps of a calcula- As stated earlier, dimensional analysis provides a
method of verifying the setup of the calculation through
tion at once. The first of these differences is the most
canceling units that proportion does not. Like propor-
important. The units of all numbers involved in the
tions, however, dimensional analysis is NOT fool-proof.
calculation should algebraically cancel so that the
It is still dependent on the student or practitioner prop-
only units remaining are those desired for the calcu-
erly identifying relationships between the patient and
lated answer.
general data that should be used as ratios in the calcula-
As was done with proportions, the use of dimen- tion.
sional analysis can be shown through an example. A
patient weighs 32 pounds and is prescribed 5 Empiric Formulas
mg/kg/day of diphenhydramine HCl. The daily dose Empiric formulas, such as those for calculating ideal
is to be divided into 4 doses, each administered 6 body weight and estimated creatinine clearance, are not
hours apart. The practical information a parent will covered in detail in this discussion. They are mentioned,
need to know is how much diphenhydramine HCl so- however, because an important point related to units
lution needs to be administered to the child every 6 needs to be made. In proportion, the units on either
hours. The solution comes in a concentration of 12.5

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.

Figure 2. Example of Calculation Using Dimensional Analysis.

side of the equal sign need to be equal. In dimensional by diligently watching for other practitioners’ use of
analysis, the units on the left side of the equal sign non-conventional abbreviations.
need to cancel to leave only the desired units on the To illustrate the importance of units and the descrip-
right. In empiric formulas, neither of these is true. tive name, consider another example. A pharmacist is
Using ideal body weight for a woman as an example compounding 60 mL of a topical solution. The order is
(IBW = 45.5 kg + 2.3 kg times height in inches over 5 written so that the final solution is 40%(v/v) isopropyl
feet), the units are important, but they do not mathe- alcohol. The pharmacist’s source of isopropyl alcohol is
matically cancel. The calculation relies on the height a 70%(v/v) solution. Figure 3a shows the calculations
over 5 feet being entered in inches and no other units for this problem with numbers written with their nu-
of measurement. Similarly, calculations for estimating merical value, units, and descriptive name. Notice from
creatinine clearance rely on the values expressed in this figure that a distinction is made in calculations in-
defined units to give the correct result. volving ‘isopropyl alcohol (pure)’ and ‘isopropyl alco-
CALCULATION RECOMMENDATIONS hol 70% solution’. The calculations in Figure 3a can be
clearly followed and the pharmacist’s work double-
While performing pharmaceutical calculations checked. Compare this with Figure 3b. Figure 3b shows
with the methods outlined above, there are several the same calculation, but because of the failure to use
recommendations that can improve proficiency and discriminating descriptive names, it is not immediately
foster good habits that can be carried forward into clear which volumes correspond to isopropyl alcohol
practice. (pure) and which to isopropyl alcohol 70% solution. The
The ‘Number’ Should Always Have Three Parts ability to follow the logic in the series of calculations
shown in Figure 3b and double-check the work is se-
In Figures 1 and 2, all examples of numbers ex-
verely hampered. This would be further hampered if the
pressed in the calculations have included 3 essential
isopropyl alcohol descriptions were omitted completely
components: the numerical value (ie, 12.5, 250, 5),
the units of measure (ie, mg, mL), and a descriptive and/or if the units of volume (milliliters) were omitted.
name of the substance (ie, diphenhydramine solution, The Numerical Value Should NEVER Contain a Na-
amoxicillin). It is critical that all numbers in a calcula- ked Decimal Point or Trailing Zero
tion or series of calculations include all 3 components This is an example of a trailing zero: 1.0. This is an
in order to minimize the likelihood that mistakes oc- example of a naked decimal point: .1. Students and prac-
cur due to confusion between similar ingredients. It is titioners should NEVER write numbers this way! Stu-
unfortunate that the entire health care system does not dents have a difficult time with this concept, especially
follow a single convention when writing units. Con- when they want to use trailing zeros to convey precision
sequently, the abbreviations chosen for units should with “significant figures.” For clinical purposes, the im-
be common, and once in practice, one should follow portance of showing all significant figures is outweighed
conventions established at a given practice site. Real- by the occasional disastrous consequences of including
izing that not all practitioners within a single practice them. Students should still calculate to the desired num-
site or between practice sites will adopt a common set ber of significant digits, but not show them on paper
of abbreviations, care should be taken to avoid errors when they result in a trailing zero. It is amazing and un-
fortunate that something so simple can lead to medica-

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.

Figure 3. Example of Good and Poor Use of Descriptive Names When Writing Numbers

tion errors, but trailing zeros have led to errors when should have a favorite calculations textbook or elec-
the decimal point is not noticed (1.0 interpreted as 10, tronic database of conversions handy.
for example).1-3 Similarly, naked decimal points cause
errors.2,3 The number .1 can and has been interpreted
THE FINAL CHECK
as a 1, leading to medication errors. It is critical that Double-checking
students begin writing numbers without naked deci-
There are 3 ways to check the answer: (1) estimate
mal points or trailing zeros early so that doing so is
before the calculation and then compare the estimation
second nature to them by the time they are in practice. to the answer, (2) verify the answer by a different
Memorize the Definitions of Standardized Expres- method, and (3) have 2 people independently perform
sions of Concentration the calculation and compare answers. Estimation is a
Flawless precision in pharmaceutical calculations good approach because it provides a ballpark in which
is completely dependent on a flawless understanding one can expect the answer to fall. Many students and
of the terminology of standardized concentrations. hopefully most practitioners could look at the amoxicil-
Concentrations can be expressed in many standard- lin 250mg/5 mL example above and estimate that the
ized ways. Five of the most frequently encountered dose of 125 mg will be contained in 2.5 mL. Estimation
standardized expressions of concentration include is more difficult when the numbers are more complex. It
%w/w, %w/v, %v/v, ratio strength, and molarity. In then relies on rounding numbers to the nearest number
order to use these standardized expressions of concen- that can be calculated in one’s head or quickly on paper.
tration in proportion and dimensional analysis calcu- Estimation is a good practice.
lations, they need to be expressed as ratios. Table 1 “Verifying the answer by a different method” can
provides the definition of these 5 standardized expres- have multiple meanings. In the first, the student calcu-
sions of concentration along with examples and their lates the answer both with proportion and with dimen-
respective ratios. The definitions of each should be sional analysis and then checks that the answers match.
memorized. The ratio expression should be repro- While in concept this is a very good idea, often the pro-
ducible from the definition. portion and dimensional analysis calculations will be
Memorize Common Conversions dependent on the same ratios. If the ratio is incorrect in
one calculation, it is likely incorrect (and therefore caus-
There are some common conversions that stu- ing the same error) in both. If care is taken to set up ra-
dents and practitioner will use so frequently that they tios with the known values properly, this method of
need to be committed to memory. These are shown in double-checking is reasonable.
Table 2. (There are many more conversions one may
choose to memorize. It is not the purpose of Table 2 “Verifying the answer by a different method” can
to exhaustively list them all.) On occasion, either be- take on a second meaning in some situations. Consider
cause of a memory lapse or a lack of use, conversions isotonicity. The amount of solute required to make a
are not remembered. In such a case a practitioner solution isotonic can be calculated using 3 methods:

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.
Table 1. Definitions of Standardized Expressions of Concentration
Expression Definition Example(s) Written as Ratio
% w/w Grams of substance con- 2.5%(w/w) hydrocortisone cream =
tained in 100 grams of prod-
uct 2.5 grams hydrocortisone
100 grams cream
% w/v Grams of substance con- 5%(w/v) dextrose =
tained in 100 mL of solution
5 grams dextrose
100 mL solution
% v/v Milliliters of substance con- 95%(v/v) ethanol =
tained in 100 mL of solution
95 mL ethanol
100 mL solution
Molarity (M) Moles of substance con- 3 M NaOH solution =
tained in 1 L of solution
3 moles NaOH
1 L solution
Ratio Strength Grams (solids) or milliliters Benzalkonium chloride 1:5000 solution =
(liquids) of substance in a
specified weight (in grams) 1 gram benzalkonium chloride
or volume (in mL) of prod- 5000 mL solution
uct

Hydrocortisone 1:20 cream =

1 gram hydrocortisone
20 grams cream

Isopropyl alcohol 1:2 solution =

1 mL isopropyl alcohol
2 mL solution

(1) the sodium chloride equivalents method, (2) the Ask Oneself: Does This Answer Make Sense?
USP method, and (3) the freezing point depression Despite best efforts to use care when performing
method.6 If a student or practitioner is reasonably and double-checking calculations, it can still happen: the
comfortable with 2 of these 3 methods, they can cal- 10 pound baby that weighs 22 kilograms, the 50 mL
culate the answer with both methods and verify that piggyback bag with 3 mL of additive ordered to run
the answers match. over 30 minutes with a flow rate of 0.1 mL/min, the IM
Finally, in a practice setting and in some learning injection volume calculated to administer 25 mL. All
activities, accuracy can be verified when 2 individuals people make mistakes, including students and practitio-
independently perform the calculation and the result- ners, but there has to be a last step that requires the stu-
ing answers are compared. This is ideal, as the prob- dent or practitioner to ask, “Does this make sense?” This
ability of 2 individuals independently making the is an absolutely critical step. Certainly a person’s weight
same mistake is low. Double-checking with 2 inde- in kilograms should not be more than it is in pounds,
pendent persons performing the calculation should and the flow rate of a 50 mL bag set to run over one half
always be done when possible. hour should be greater than 1 mL/min, and the volume

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.
Table 2. Conversions to Memorize

Length
100 centimeters = 1 meter

1,000 millimeters = 1 meter

2.54 centimeters = 1 inch

12 inches = 1 foot

Volume

1 liter = 1,000 milliliters

1 pint = 473 milliliters (480 milliliters)

1 fluid ounce = 29.57 milliliters (30 milliliters)

1 teaspoonful = 5 milliliters

1 tablespoonful = 3 teaspoonsful

Weight

1 gram = 1,000 milligrams

1,000 grams = 1 kilogram

1 kilogram = 2.2 pounds*

16 ounces = 1 pound*

1 grain = 65 milligrams

*All pounds are avoirdupois pounds, not apothecary pounds

calculated to administer by the IM route should not be CLOSING

bigger than a volume that could be safely adminis-
tered. Early in their pharmacy education this is a dif- This first discussion of calculations is necessary to
ficult question for students to answer because they raise students’ awareness of common perceptions and
might not always recognize the ‘impossible’ or ‘im- introduce the critical concepts in pharmaceutical
probable’ answers. Nevertheless, students need to be calculations. The success of this presentation lies in its
constantly driven to verify the sensibility of the an- application in subsequent course and curricular material.
swer so that calculation mistakes that manage to make Only through the combination of presentation content,
it through the rest of the calculations process can still practice, occasional error, more practice, timely feed-
be caught. It is, after all, the non-sensible answers that back, application, and assessment will pharmacy stu-
have the highest potential for negative patient out- dents develop the confidence and accuracy in pharma-
comes. ceutical calculations that their profession demands and
their future patients deserve.

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 American Journal of Pharmaceutical Education 2003; 67 (2) Article 67.
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Baltimore, Md: Lippincott Williams and Wilkins;2001:13-20.
1. Dunn EB, Wolfe JJ. Missing the point! Vet Hum Toxicol.
2002;44:109-10. 5. O’Sullivan TA. Understanding Pharmacy Calculations. Washing-
ton, DC: American Pharmaceutical Association;2002:8-9.
2. Lilley LL, Guanci R. Careful with the zeros! Am J Nurs.
1997;97:14. 6. Thompson JE. A Practical Guide to Contemporary Pharmacy
Practice. Baltimore, Md: Lippincott Williams and Wil-
3. ASHP guidelines on preventing medication errors in hospitals. kins;1998:10.1-10.8.
Am J Hosp Pharm. 1993;50:305-14.