PHARMACEUTICAL CALCULATIONS

DOSE – the amount of medicine you’re supposed to take. It is the specific quantity of the medicine or
the drug preparation taken or recommended to be taken at a particular time.

The dose of a drug :

 is the quantitative amount administered or taken by a patient for the intended medicinal effect.

It may be expressed as:

 a single dose, the amount taken at one time;

 a daily dose;
 a total dose, the amount taken during the time-course of therapy, for example, total dose of
antibiotic regimen for 1 week therapy, single dose is 500mg per day, the total dose for 7 days is
3500mg of antibiotic regimen.

A daily dose

 may be subdivided and taken in divided doses,

 two or more times per day depending on the characteristics of the drug and the illness.
 The schedule of dosing {e.g., four times per day for 10 days) is referred to as the dosage
regimen.

Defined Daily Dose (DDD) is the assumed average maintenance dose per day for the drug used in its
main indication usually in adults. Pharmacoeconomic term for the average maintenance dose for the
clinical indication of the drug in adult patients.

Dosage Regimen it is defined as the manner in which the drug is taken. The schedule of dosage for
example 3 times a day for 7 days or 4 times a day for 5 days it is referred to as dosage regimen. Dosage
regimen establish the drug and to provide the correct plasma level without excessive fluctuation and
drug accumulation outside the therapeutic window. It is a schedule of dosing for a specific drug
preparation.

USUAL ADULT DOSE: amount that ordinarily produces the medicinal effect intended in adult patient.

USUAL PEDIATRIC DOSE: amount that ordinarily produces the medicinal effect intended in pediatric
patient. Most drug in children are dose according to their body weight mg/kg or the body surface area
or mg/m^2. Pediatric dose care must be taken to properly convert body weight.

USUAL DOSAGE RANGE: quantitative range or the amounts of drug that may be prescribed within the
guidelines of usual medical practice.

Median effective dose of the drug it is the amount that produces the desired intensity of the effects in at
least 50% of the individuals tested.
Median toxic dose it is the amount that produces toxic effects or the side effects or adverse effects in
50% of the individuals tested.

Prophylactic dose such as the vaccines, the biologic and immunologic products, it can be administered in
patients to protect them from contracting the specific disease.

Therapeutic dose counters the disease after exposure or contraction for certain disease. Therapeutic
dose is usually administered such as for antitoxins

Routes of Administration

A route of administration is the path by which a drug, fluid, poison or other substance is brought into
contact with the body.

Oral Route examples are the tablets, capsules, solutions, drops (must be through GI tract), syrup,
suspensions, other solutions and lozenges

Sublingual – these are the tablets that are usually placed under the tongue

Parenterals usually through injection, it can be solutions and suspensions for injections;

Epicutaneous suspension or ointments, creams, powders which are usually for subcutaneous or
epicutaneous

Transdermal such as transdermal patches, conjunctival solutions, eye-drops, nasal drops, rectal and
vaginal ointments suppositories, urethral solutions and suppositories.

Route of administration Advantages Disadvantages

Sublingual Avoid first pass effect, rapid Small dose limit, inconvenience
absorption, drug stability, can for some patients
be administered for local effect
Oral Convenient (portable, easy, May be inefficient (high dose,
painless0 economical to the low solubility), first pass effect
patients (non-sterile, compact), (the concentration of a drug is
variety (tablets, capsules, liquid, greatly reduced before reaching
fast, slow release), high dose the systematic circulation), food
possible, high surface of interaction, local effect (GI
absorption, good permeability flora), not suitable for
of GI barrier unconscious patients
Inhalation Bypasses Liver, large surface of Difficulties in regulating the
absorption exact amount of dosage,
difficulties administering the
drug via inhaler
Rectal (Vaginal & Urethral) Bypasses liver, useful for Unpredictable absorption, not
children or older people drug well accepted by patients
 released at slow, steady state
Intravenous Direct access to blood central Increased risk of infection and
compartment, bypasses the overdose, risk of the peripheral
digestive system, does not harm vein or arterial damage, limited
the lungs or mucous to highly soluble drugs, fear,
membranes, rapid onset of trained personnel is needed,
action sustained/controlled action not
possible
Intramuscular Depot or sustained effect is Unpredictable or incomplete
possible absorption, trained personnel is
needed
Subcutaneous Can be self-administered, slow, Painful tissue damage from
but generally complete irritant drugs, max. 2mL
absorption injection

General dose calculations

number of doses = total quantity/size of doses

ex. If the dose of the drug is 200mg, how many doses are contained in 10g?

10g = 10,000mg = total quantity

280mg = size of dose

10,000/200 = 50 doses – number of doses

If the dose of the drug is 25mg, how many doses are contained in 100mg?

100mg (total) /25mg (size)

4mg (number of doses)

If the dose of a drug is 50mcg, how many doses are contained in 0.020g?

50mcg = 0.05mg

20mg

20/0.05 = 400 doses

size of a dose:

total quantity/number of doses

◦ ex: How many teaspoonfuls would be prescribed in each dose of a liquid medicine if 180ml contained
18doses?
◦ total quantity/number of doses

◦ 180ml/18 doses = 10 ml = 2tsp

How many drops would be prescribed in each dose of a liquid medicine if 15mL contained 60 doses? The
dispensing dropper calibrates 32drops/mL

15 x 32 = 480 drops/60 doses = 8 drops

Total quantity

Number of doses x size of dose

Ex. How many milligrams of a drug will be needed to prepare 72 dosage forms (size) if each is to contain
30mg (number of doses)?

72 x 30 = 2160mg

How many milliliters of a liquid medicine would provide a patient with 2 tablespoonfuls twice a day for 8
days?

2 tbsp x 15mL/1tbsp = 30mL

8 days x 2 = 16

Total quantity = 30 x 16 = 480mL

How many milliliters of a mixture would provide a patient with a teaspoonful dose to be taken three
times a day for 16 days?

3 x 16 = 48 Total quantity = 48 x 5 = 240mL

1tsp = 5mL

Problem Solving:

Size of the dose

How many milligrams would be prepared for a paper tablet if each dose of a tablet medicine is 500 mg
contained 20 doses?

500mg/20doses = 25mg/paper tablet

If 15 ml is prescribed as the dose, approximately how many doses will be contained in 1 pint of the
medicine?

1 pint = 473mL

473mL/15mL = 31 doses

How many capsules, each containing a 150mcg dose of a drug may be prepared from 0.12g of drug?

150mcg = 0.15mg

0.12g = 120mg

120mg (number of quantity) / 0.15mg (size of dose) = 800 capsules

If Ventolin inhaler contains 20mg of salbutamol, how many inhalation doses can be delivered if each
inhalation dose contains 90 mcg?

90mcg = 0.09mg

20mg/0.09mg = 222.22mg

If Dermatix ultra gel contains 50mg of vitamin c ester, how many vitamin c ester can be delivered if each
topical gel contains 10mcg?

10mcg = 0.01mg

50mg/0.01mg = 5000 vitamin c ester

How many bottles of vitamin C each containing a 150mL dose of a drug may be prepared from 1 gallon
preparation (US)?

3785mL/150mL = 25.23 or 25 bottles

It takes approximately 4g of ointment to cover an adult patient’s leg. If a physician prescribes an

ointment for a patient with total leg eczema to be applied twice a day for 1 week, which of the following
product sizes should be dispensed: 15g, 30g, or 60g?

2 twice a day x 7 days = 14 number of doses x 4 grams (size of dose) = 56g

The patient can buy 60g of the ointment

A cough mixture contains 48mg of hydromorphone hydrochloride in 8 fl. Oz. How many milligrams of
hydromorphone hydrochloride are in each 2-teaspoonful dose?

Calculation of Doses: Patient Parameters

Usual dose of a drug is the amount that ordinarily produces the desired therapeutic response in the
majority of patients in a general, or otherwise defined, population group.

The drug’s usual dosage range is the range of dosage determined to be safe and effective in that same
population group.

Dosage Calculations with the patient parameters

Dosage calculations – it is the administration of the drug preparation or the agent and prescribed
amounts and at the prescribed intervals

Dosage of drug preparation is necessary for every patient since we have so called therapeutic index or
window wherein it is the comparison of the amount of the therapeutic agent that causes the
therapeutic effect to the amount that causes toxicity to the patient.

A drug preparation can be also a poison to the patient specially if that drug preparation has a narrow
therapeutic index since when we say

narrow therapeutic index – it has smaller range between the effective concentration and the maximum
tolerated range for the dosage

Usual drug will have a usual dose wherein it is the amount that are ordinarly produces the desired
therapeutic response in the majority of the patients.

The drug usual dosage range is the range of the dosage which is determined to be safe and effective in
the same population group

For certain drugs and for certain patients, drug dosage is determined on the basis of specific patient
parameters. These parameters include:

1. The patient’s age

2. Patient’s weight

3. Body surface area

4. Nutritional and functional status

Patients requiring individualized dosage are:

 Neonates and other pediatric patients. Child and elderly 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,
 Patients being treated with highly toxic chemotherapeutic agents.

The usual dose is expressed as specific quantity of drug per unit of the patient weight. Example the
milligram per kilogram of the body weight of our patient. In dosing with the parameters, it makes the
quantity of the drug administered specific to the weight of the patient being treated.

Individualize dosage for the patients with specific diseases.

Pediatric Patients: Pediatrics is the branch of medicine that deals with disease in children from birth
through adolescence.

Calculation of Doses

 Patient Parameters – usually based on the age of the patient (Pediatric and Geriatric)
 Geriatric medicine or geriatrics: is the field that encompasses the management of illness in the
elderly.
 Pediatrics: is the branch of medicine that deals with disease in children from birth through
adolescence.
 Neonate (newborn), from birth to 1 month; A neonate is considered premature if born at less
than 37 weeks’ gestation. Example: renal function
 Infant, 1 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.
 Adult, 18 years through 59 years;
 Geriatric, when their age is in senior citizen like 60 above.

Geriatric Patients: Although the term elderly is subject to varying definitions with regard to chronologic
age, it is clear that the functional capacities of most organ systems decline throughout adulthood, and
important changes in drug response occur with advancing age.

Geriatric medicine or geriatrics is the field that encompasses the management of illness in the elderly. It
refers to the medical care for older adults however the age group is not easy to define since some
textbooks or references it can be over 65 years old, it can be over 70 years old or it can be over 60 years
old.

Dose determinations for elderly patients frequently require consideration of some or all of the
following:

1. Therapy is often initiated with a lower - than - usual adult dose.

2. Dose adjustment may be required based on the therapeutic response.

3. The patient’s physical condition may determine the drug dose and the route of administration
employed.

4. The dose may be determined, in part, on the patient’s weight, body surface area, health and disease
status, and pharmacokinetic factors.

5. Concomitant drug therapy may affect drug / dose effectiveness.

6. A drug’s dose may produce undesired adverse effects and may affect patient compliance.

7. Complex dosage regimens of multiple drug therapy may affect patient compliance.

One of the most common type and disease in elderly is the Alzheimer’s disease and dementia.

Geriatric patients, functional capacity of their organ systems it usually declines throughout adulthood.
There are important changes in drug response which occurs in geriatric patients.

Some solid dosage forms are often difficult or impossible for the pediatric and geriatric patients to
swallow. For geriatric patients, they prefer liquid forms such as the oral solution, the suspensions,
syrups, and drops.

Dose can be easily adjusted by changing the volume of the liquid administered unlike if it is in tablet
preparation.

Some geriatric patients need multidrug therapy. Because of it, it has an increase possibility of drug
interaction and adverse drug reaction.

There are difficulties in patient compliance due to impaired cognition or adverse effects, the confusions
and because of their age, they can have this confusion over various dosing schedules especially if they
have these multidrug therapy.

Another factor for patient compliance is the economic status of patient. Economic reasons and because
of adverse effects such as depression, apathy, impaired cognitions, nausea and vomiting.

The drug dose should be reduced in elderly patients because of their general decline in the body
function and the lean body mass decreases and the body fat increases by almost 100% in elderly persons
as compared to the adults. Age-related changes can affect the renal emphatic function of the drug
preparation which affects the clearance of the drugs inside the body.

Patient’s weight is usually recorded as the standard practice for hospital admissions. It is important in
the areas of medications prescribing fluid balance and assessment of nutrition. The height and weight
can assess the body mass index of the individual. It can estimate the total body fat of the patient. It is an
essential parameter for the medication safety infection management and effective patient care

Patient's Dose = weight in kg x (drug dose/1 kg)

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.?
150mcg = 0.15mg

154lb. = 70 kg

70kg x 0.15mg/kg = 10.5mg or 10,500mcg

Calculate the dose of amoxicillin suspension in mLs for otitis media for a 1-yr-old child weighing 22lb.
The dose required is 40 mg/kg/day divided BID(twice a day) and the suspension comes in a
concentration of 400mg/5mL.

Step 1. Convert pounds to kg: 22lb x 1kg/2.2lb = 10kg

Step 2. Calculate the dose in mg: 10kg x 40mg/kg/day = 400mg/day

Step 3. Divide the dose by the frequency: 400mg/day ÷ 2 (BID) = 200mg/dose BID

Step 4. Convert the mg dose 200mg dose to mL: 200mg/dose ÷ 400mg/5mL = 2.5mL BID

400:5mL::200mL:x = 2.5mL BID

The usual initial dose of salbutamol is 5mcg/kg of body weight. How many milligrams should be
administered to a person weighing 25kg?

5mcg = 0.005mg

0.005mcg:1kg::x:25kg

= 0.125mg

The usual dose of sulfisoxazole for infants over 2 months of age and children is 60 to 75 mg/kg of body
weight. What would be the usual range for a child weighing 44lb.?

44lb/2.2. = 20kg

60 x 20 = 1200mg

75 x 20 = 1500mg

Calculate the dose of ceftriaxone in mLs for meningitis for a 5-yr-old weighing 18kg. The dose required is
100mg/kg/day given IV once daily and the drug comes prediluted in a concentration of 40mg/mL.

18kg x 100mg/kg/day = 1800mg/day ÷ 1day = 1800mg

1800mg:x::40mg:mL

X=45mL
Patient’s weight

Calculating Dose Based on Weight

0.3mg/1kg = x/20.9kg

6.27mg/1x

X = 6.27mg

2 – 3 x daily

Example:

132Lb woman is prescribed Acyclovir 5mg/kg

 First convert Lbs. to Kg

 (132 ÷ 2.2) = 60kg
 The prescription calls for 5mg per Kg
 60 x 5mg = 300mg

Example:

11 year old girl with 70 lbs

Adult dose is 500mg

70 lbs = 31.82 kg

31.82 kg x 500mg = 15910

Fried’s Rule

Pediatric dose = child’s age in months / 150 x Adult Dose

The average adult those of a medication is 25mg. What is the appropriate dose for a child who is 22
months.

New borns are abnormal to sensitive drugs because of their immature renal, same with geriatric
patients because of failure to metabolize or eliminate the drug because of the decline function of the
organ system or pathologic conditions.

Computations:

1. Cowling’s rule

2. Young’s rule
3. Clark’s rule

4. Fried’s rule

Formula

Patient’s Age:

Cowling’s Rule:

Age at next birthday / 24 x Adult dose = Dose for child

6/24 x 12.5 = 3.13mg 2 – 3 x daily

Example:

If a doctor prescribes 75 milligrams of Tamiflu for an adult, then how many milligrams would she
prescribe for an eleven-year-old child using Cowling’s rule?

=(11+1/24) x 75mg

=37.5 mg

An age-based formula for calculating the pediatric dose of a drug: [(child's age in years + 1) x adult
dose]/24.

Young’s Rule
Age/Age + 12 x Adult dose = Dose for child

5/5+12 x 12.5mg = 3.67mg 2 – 3 x daily

11 year old girl / 70 Lbs

500mg X (11 ÷ (11+12)) = Child's Dose

500mg X (11 ÷ 23) = Child's Dose

500mg X .48 = Child's Dose

Child's Dose = 240mg

The pediatric dose for a 9-year old child who weighs 63lbs needs to be determined. You learn that the
adult dose for the same drug is 200mg. Using Young’s rule, what dose should the child be given?

9/9 + 12 x 200mg

=86mg

Fried’s Rule

Pediatric dose = child’s age in months/150 x Adult Dose

The average adult dose of a medication is 25mg. What is the appropriate dose for a child who is 22
months.

22/150 x 25

= 3.67mg

Use the Clark Rule to find the child’s dose of amoxicillin. Round answer to the nearest whole mg. The
child’s dose is based on the normal adult dose. Adult dose: amoxicillin 250mg

Child’s weight: 18kg

Child height: 94cm

Child’s dose = weight of child in pounds x adult dose

150lbs

18kg x 2.2lbs = 39.6lbs

1kg
Child’s dose = 39.6lbs x 250mg = 66mg

150lbs

Note: Clark’s rule required conversion to pounds before using the formula

Using Clark’s rule, what is the dose for a 12-year old girl who weighs 31.7kg if the average adult dose is
500mg?

31.7kg x 2.2 = 70lbs

70lbs/150lbs x 500mg

= 235mg

The average adult dose for a drug is 250mg. Using Clark’s rule, what dose should be given to an 8-year
old child who weighs 57lbs?

57lbs/150lbs x250mg

= 95mg

Salisbury

Body Surface Area

Penn’s
Calculate the dose for a child 4 years of age, 39 in in height and weighs 32 lbs for a drug with an adult
dose of: 100 mg, using the following:

A. Young's rule:

B. Cowling's rule:

C. Clark's Rule:

D. BSA

The body surface area (BSA) method of calculating drug doses is widely used for two types of patient
groups: cancer patients receiving chemotherapy and pediatric patients, with the general exception of
neonates.

Patient's Dose = (BSA/1.73) x drug dose

1.9 – M

1.7 – F

Calculate the BSA for a patient measuring 165cm in height and weighing 65kg.
If the adult dose of a drug is 100mg, what would be the dose for a child with a body surface area of 0.70
m2?

Using the equation to calculate BSA, determine the BSA of the adolescent weighing 90lb and measuring
4ft 2 in. If the adult dose of a drug is 250mg, what would be the dose for a child?
Calculate the dose of vincristine in mLs for a 4yr old with leukemia weighing 37 lb and is 97 cm tall. The
dose required in 2mg/ml^2 and the drug comes in 1mg/ml concentration.

If the adult dose of a drug is 75mg, what would be the dose for a child weighing 40lb and measuring 32
in. in height? (Use the body surface area method).

From the nomogram, the BSA = 0.60m^2n 0.60(m^2)/1.73(m^2) x 75 mg = 26 mg answer.

BMI = kg/ height (m)^2

BMI classification

Chemotherapy