Dosage Calculations

By: Racquel Aurea C. Balangue, RPh, MSPh

 DOSE
quantitative amount administered or taken by a patient for the intended medicinal
effect. Ansel H. (2014): Pharmaceutical calculation
 the measured quantity of a therapeutic agent to be taken at one time. Merriam-Webster
dictionary
 DOSE
Basis for dosage of a drug
1. biochemical and pharmacologic activity – beneficial or adverse effects
2. physical and chemical properties – solid, liquid, toxicity, reactivity etc…
3. the dosage form used – tablet, solution, suppository, intravenous etc…
4. route of administration – oral, parenteral, rectal etc..
5. patient factors – patient’s age, weight, BSA, general physical health, liver and kidney function,
severity of illness etc…
 DEFINITION OF TERMS
Single dose – amount taken at one time
Daily dose - assumed average maintenance dose per day for a drug used for its main
indication
Therapeutic dose - amount taken during the course of therapy
Divided dose - a definite fraction of a full dose; given repeatedly at short intervals
so that the full dose is taken within a specified period
Dosage regimen - schedule of dosing
Dosage form - physical form in which a drug is produced and dispensed
 DEFINITION OF TERMS
Usual adult dose - amount that ordinarily produces the medicinal effect intended in
the adult patient
Usual pediatric dose - amount that ordinarily produces the medicinal effect
intended in children
Usual dosage range - indicates the quantitative range or amounts of the drug that
may be prescribed within the guidelines of usual medical practice
 DEFINITION OF TERMS
Median effective dose - amount that produces the desired intensity of effect in 50%
of the individuals tested
Median toxic dose - amount that produces toxic effects in 50% of the individuals
tested
Minimum effective concentration - minimum concentration determined that can be
expected to produce the drug’s desired effects in a patient.
Minimum toxic concentration - The base level of blood serum concentration that
produces dose-related toxic effects
 DEFINITION OF TERMS
Priming or loading dose - a quantity of medicine prescribed to be taken at one time
Maintenance doses - A dose of a drug administered after achieving stable levels in
the body to maintain a therapeutic status quo
Low-dose therapy - doses that are much smaller than the usual dose
High-dose therapy - doses that are much larger than the usual dose
Monotherapy – primary drug treatment
Adjunctive therapy - additional to or supportive of a different primary treatment
 DEFINITION OF TERMS
Prophylactic doses - medications to prevent or protect against diseases
Therapeutic doses - amount of medication required to produce the desired outcome
Fixed dose - a medicine that includes two or more active ingredients combined in a
single dosage form
Compounding - fabrication of a pharmaceutical product from individual ingredients,
carefully weighed, measured, and mixed.
Combination products - Products containing more than one therapeutic agent
Route - way of administering a drug to a site in a patient
 ROUTE OF ADMINISTRATION
1. Oral – taken by mouth 8. Otic – placed in the ear
2. Topical – applied to skin 9. Sublingual – placed under the tongue
3. Rectal – inserted in rectum 10. Buccal – placed between the gums and
4. Parenteral – given by injection cheek
a. Intravenous – into a vein 11. Transdermal – across the skin for
b. Intramuscular – into a muscle systemic distribution
c. intrathecal – into space around spinal 12. Urethral – inserted into urethra
chord 13. Nasal – through the nose
d. Subcutaneous – beneath the skin
e. Intraspinal – into spinal cord
5. Vaginal – inserted in vagina
6. Inhalation – breathed into the lungs
7. Ophthalmic/Ocular/Conjunctiva – placed in
the eye
 DOSAGE FORMS
1. Solid – powders, tablet, capsules
2. Semi-solid – cream, paste, gel, ointment, lotions
3. Liquid – syrups, solutions, elixir, emulsion
4. Gas – inhaler, aerosol
 DOSE MEASUREMENTS
Household measurements
1 teaspoon = 5ml
1 tablespoon = 15ml
1 ml = 20 drops
 DOSE CALCULATIONS
Total quantity
Number of doses = Size of dose
Total quantity
Size of dose = Number of doses
Total quantity = Number of doses x Size of dose
Doses may also be calculated by setting up a proportion
SAMPLE CALCULATIONS
1. How many capsules, each containing a 150-mcg dose of a drug may be prepared from 0.12 g of the drug?
0.000150g : 1 cap = 0.12g : x  x = 800 capsules
2. Physician reduces a patient’s once-daily dose of conjugated estrogen (PREMARIN) from tablets containing
0.625 mg to tablets containing 0.45 mg. What is the total reduction in conjugated estrogens taken, in milligrams,
during a 30-day month?
Total quantity = Number of doses x Size of dose = 30 x 0.625mg = 18.75mg
Total quantity = Number of doses x Size of dose = 30 x 0.45mg =13.5mg
18.75mg – 13.5mg = 5.25mg
3. RESTASIS Ophthalmic Emulsion contains 0.05% w/v cyclosporin. If a dose of one drop measures 28 µL,
how many micrograms of cyclosporin are present?
0.05g : 100ml = x : 0.028ml  x = 0.000014g or 14µg
4. If a liquid medicine is to be taken three times daily, and if 180 mL are to be taken in 4 days, how many
tablespoonfuls should be prescribed for each dose?
180ml/4days = 45ml  45ml/3 = 15ml  15ml = 1 tbsp
5. The oral dose of a drug is 2.5 mg. If a solution contains 0.5% w/v of the drug in a dropper bottle that delivers
12 drops/mL, how many drops would supply the dose?
0.5g : 100ml = 0.0025g : x  x = 0.5ml
12 drops/ml = x drops/0.5ml  x = 6 drops
 DOSE CALCULATIONS
Specific patient parameter that determines drug dosage
 patient's age, weight, body surface area, and nutritional and functional status.
Patients requiring individualized dosage
 neonates and other pediatric patients
 elderly patients with diminished biologic functions
 individuals of all age groups with compromised liver and/or kidney function (and thus
reduced ability to metabolize and eliminate drug substances)
 critically ill patients, and patients being treated with highly toxic chemotherapeutic
agents.
 PEDIATRIC DOSE
Pediatrics is the branch of medicine that deals with disease in children from birth
through adolescence
Neonate (newborn) - From birth to 1 month
o Premature - born at less than 37 weeks’ gestation
Infant - month to 1 year
Early childhood - 1 year through 5 years
Late childhood - 6 years through 12 years
Adolescence - 13 years through 17 years of age
 PEDIATRIC DOSE
Factors affecting proper drug dosing
patient’s age and weight
overall health status
condition of biologic functions as respiration and circulation
stage of development of body systems for drug metabolism and drug
elimination
 DOSE CALCULATION
• Young’s Rule
• For children 2 years and older
𝐴𝑔𝑒 (𝑦𝑟)
• Child’s dose = 𝐴𝑔𝑒 𝑦𝑟 +12
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

• Clark’s Rule
𝑊𝑒𝑖𝑔ℎ𝑡 (𝑙𝑏𝑠)
• Child’s dose = 150
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
• Fried’s Rule
• For infants up tp 2 years old
𝐴𝑔𝑒 (𝑚𝑜𝑠)
• Infant;s dose = 150
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
𝐴𝑔𝑒 𝑎𝑡 𝑛𝑒𝑥𝑡 𝑏𝑑𝑎𝑦 (𝑦𝑟𝑠)
• Cowling’s Rule = 24
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
SAMPLE CALCULATIONS
1. The adult dose of Atropine sulfate is 0.5mg. Calculate the dose for a 2 year old child who weighs 30
lbs by the use of:
a. Young’s rule
b. Clark’s rule
c. Fried’s rule
d. Cowling’s rule
𝐴𝑔𝑒 (𝑦𝑟) 2
a) Child’s dose = 𝐴𝑔𝑒 𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 = 2 +12 𝑥 0.5𝑚𝑔 = 0.07mg
𝑦𝑟 +12
𝑊𝑒𝑖𝑔ℎ𝑡 (𝑙𝑏𝑠) 30
b) Child’s dose = 𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 = 150 𝑥 0.5𝑚𝑔 = 0.1mg
150

𝐴𝑔𝑒 (𝑚𝑜𝑠) 24
c) Infant;s dose = 𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 = 𝑥 0.5𝑚𝑔 = 0.08mg
150 150

𝐴𝑔𝑒 𝑎𝑡 𝑛𝑒𝑥𝑡 𝑏𝑑𝑎𝑦 (𝑦𝑟𝑠) 3

d) Cowling’s Rule = 24
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒= 24 𝑥 0.5𝑚𝑔 = 0.063mg
 GERIATRIC DOSE
Geriatric medicine or geriatrics is the field that encompasses the management of illness
disability in the elderly.
 The term "elderly" is subject to varying definitions with regard to chronologic age
 The functional capacities of most organ systems decline throughout adulthood and
important changes in drug response occur with advancing age.
 Many elderly patients have coexisting pathologies that require multiple-drug therapies.
 Medications in the elderly are prescribed not only to relieve symptoms and manage diseases
but also to improve bodily function, enhance the quality of life, and prolong survival.
 GERIATRIC DOSE
Special Considerations in Dose Determinations for Elderly Patients
 Therapy is initiated with a lower-than-usual adult dose.
 Dose adjustment may be based on the therapeutic response.
 The patient's physical condition may determine the drug dose and the route of administration
employed.
 The dose may be determined, in part, on the patient's weight, body surface area, health and disease
status, and pharmacokinetic factors.
 Concomitant drug therapy may affect drug/dose effectiveness.
 A drug's dose may produce undesired adverse effects and may affect patient compliance.
 Complex dosage regimens of multiple drug therapy may affect patient compliance.
 Dosage Forms Applicable to Pediatric and
Geriatric Patients
Solid dosage forms, such as tablets and capsules:
 are preferred for the oral administration of drugs because of their convenience, ease of
administration, ready identification, transportation, and lower cost per dose.
 are difficult or impossible for the pediatric, geriatric, or infirm patient to swallow.
Liquid forms are preferred, such as oral solutions, syrups, suspensions, and drops.
 An advantage of liquid forms is that the dose can easily be adjusted by changing the volume
of liquid administered.
 When necessary, liquid forms of medication may be administered by oral feeding tube.
Chewable tablets and solid gel forms (medicated "gummy bears") that disintegrate
or dissolve in the mouth are also often used for pediatric and geriatric patients.
 DRUG DOSAGE BASED ON AGE
 Frequently a consideration in the determination of drug dosage, especially in the
young or elderly.
 Newborns are abnormally sensitive to certain drugs because of the immature state
of their hepatic and renal function.
 Elderly individuals may also respond abnormally to the usual adult dose of a drug
because of impaired ability to metabolize or eliminate the drug or because of other
concurrent pathologic conditions.
 For pediatric use, doses generally are based on age groupings, e.g., 2 to 6 years old; 6
to 12 years old; and, over 12 years of age.
 For children 2 years of age or younger, the label recommendation generally states
"consult your physician."
 DRUG DOSAGE BASED ON BODY
WEIGHT
The usual doses for drugs are considered generally suitable for 70-kg (154-lb)
individuals.
The ratio between the amount of drug administered and the size of the body
influences the drug concentration at its site of action.
 drug dosage may require adjustment from the usual adult dose for abnormally lean or obese
patients.
Considered more dependable than that based strictly on age
The dosage of a number of drug substances is frequently expressed on a milligram
(drug) per kilogram (body weight) or milligram per pound basis.
 DRUG DOSAGE BASED ON BODY
SURFACE AREA (BSA)
widely used in two types of patient groups:
 1) cancer patients receiving chemotherapy,
 2) pediatric patients of all childhood ages,
Exception: premature and full-term newborns, whose immature renal and liver
functions require additional assessment in dosing.
The pediatric dose is expressed as a percentage of the adult dose, based on the
relationship of the square meter area of a given weight and the average adult
surface area of 1.73 m2
 DOSE CALCULATIONS
Based on body weight
Drug dose (mg)
Patient’s dose (mg) =Patient’s weight (kg) x 1kg
Based on body surface are
Patient′s BSA (m2)
Patient’s dose (mg) = 1.73m2 x Drug dose (mg)

Patient’s height (cm) x Patient’s weight (kg)

Patient’s BSA (m2 ) = 3600
 SPECIAL DOSING CONSIDERATIONS IN
CANCER CHEMOTHERAPY
Cancer treatment:
 Chemotherapy
 Surgery
 radiation therapy
 hormone therapy
 Immunotherapy
 Alternative treatments
 complementary therapy.
 Combination therapy (e.g., radiation and chemotherapy)
 SPECIAL DOSING CONSIDERATIONS IN
CANCER CHEMOTHERAPY
• Chemotherapy
 applies to the treatment of disease with chemicals (drugs).
 often is associated with the treatment of cancer with chemotherapeutic agents.
 Combinations of drugs may be given by the same or by different routes of administration.
 The days of treatment generally follow a prescribed format of written instructions
o "D" for day, followed by the day(s) of treatment during a cycle,
• a dash (-) meaning "to"
• a comma (,) meaning "and."
o Example:¨"D 1-4" means days 1 to 4, and "Dl,4" means days 1 and 4.
SAMPLE CALCULATIONS
1. The usual initial dose of chlorambucil is 150 mcg/kg of body weight. How many milligrams should
be administered to a person weighing 154 lb.?
Drug dose (mg) 0.150mg
Patient’s dose (mg) =Patient’s weight (kg) x = 70 kg x = 10.5mg
1kg kg
*154lb x 1kg/2.2lb = 70kg; 150mcg x 1mg/1000mcg = 0.150mg
2. A physician desires a dose of 40 mcg/kg of digoxin for an 8-lb. newborn child. How many
milliliters of an injection containing 0.25 mg of digoxin per milliliter should be given?
Drug dose (mg) 0.04mg
Patient’s dose (mg) =Patient’s weight (kg) x = 3.6kg x
1kg kg = 0.14mg * 8 lb = 3.6kg
0.25mg/ml = 0.14mg/x  x = 0.58 ml
3. A physician orders 2 mg of ampicillin to be added to each milliliter of a 250-mL bottle of 5%
dextrose in water (D5W) for intravenous infusion. a) How many milligrams of ampicillin should
be added? (b) If the 250 mL of solution represents a single dose and if the dose of ampicillin is 25
mg/kg of body weight, how many pounds does the patient weigh?
a) 2mg/ml = x/250ml  x = 500mg
Drug dose (mg)
b) Patient’s dose (mg) =Patient’s weight (kg) x 1kg
1kg 1kg
Patient’s weight = Patient’s dose (mg) x = 500mg x = 20kg  20kg x 2.2lb/1kg = 44 lbs
Drug dose (mg) 25mg
SAMPLE CALCULATIONS
4. If the daily dose of a drug is given in the literature as 8 mg/kg of body weight or 350 mg/m2, calculate the
dose on each basis for a patient weighing 150 lb. and measuring 5 ft. 8 in. in height.?
68 in x 2.54cm/1in = 172.72 cm; 150 lb x 1kg/2.2 lb = 68.18 kg
Drug dose (mg) 8mg
Patient’s dose (mg) =Patient’s weight (kg) x = 68.18kg x
1kg kg = 545.44 mg
Patient’s height (cm) x Patient’s weight (kg) 172.72 x 68.18
Patient’s BSA (m2 ) = = = 1.80 m2
3600 3600
350mg/m2 m2
= x/1.80  x =630mg
5. If the adult dose of a drug is 100 mg, what would be the dose for a child with a body surface area of 0.70 m2?
Patient′s BSA (m2) 0.70m2
Patient’s dose (mg) = x Drug dose (mg) = 1.73m2 x 100mg = 40.46 mg
1.73m2
6. If the adult dose of a drug is 75 mg, what would be the dose for a child weighing 40 lb and measuring 32 in. in
height?
40 lb x 1 kg/2.2 lb = 18.18kg; 32 in x 2.54 cm/1 in = 81.28 cm
Patient’s height (cm) x Patient’s weight (kg) 81.28 x 18.18
Patient’s BSA (m2 ) = 3600
= 3600
= 0.64 m2

Patient′s BSA (m2) 0.64m2

Patient’s dose (mg) = x Drug dose (mg) = 1.73m2 x 75 mg = 27.7 mg
1.73m2
Patient′s BSA (m2) 0.60m2
Patient’s dose (mg) =
1.73m2 x Drug dose (mg) =
1.73m2 x 75 mg = 26 mg  using nomogram
SAMPLE CALCULATIONS
7. A high-dose treatment of osteosarcoma includes the use of methotrexate at a starting dose of 12 g/m2 as a 4-
hour intravenous infusion. For a patient having a BSA of 1.7 m2 and weighing 162 lb., calculate the dose on the
basis of mg/kg/min?
12 g/m2 = x/1.7m2  x = 20.4g
20.4 g /73.64kg = 0.277g/kg
0.277 g/kg : 240min = x : min = 0.00115g/kg/min or 1.15 mg/kg/min