Dosage Calculation

Competency
 Competency PH1.12 Calculate the dosage of drugs using appropriate formulae
for an individual patient, including children, elderly and patient with renal
dysfunction.
 Competency PH2.4 Demonstrate the correct method of calculation of drug
dosage in patients including those used in special situations (CLINICAL
PHARMACY).
DR. RADHIKA PANCHAL
MD PHARMACOLOGY
NAMOMERI (SILVASSA)

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 Learning objectives-

 At the end of this class the student should be able to:

 Calculate the dosage of drugs using appropriate formulae for an
individual patient.
 Calculate the dosage of drugs for children.
 Calculate the dosage of drugs for elderly.
 Calculate the dosage of drugs for patients with renal dysfunction.

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 General information
 Dose:

 It is the amount of drug given at a time and which can be repeated by appropriate
interval to produce desired therapeutic effect.

 Effective drug therapy requires administration of a correct dose of each drug.

 This is important to ensure maximum therapeutic effect with minimum adverse

effects.

 Study of drugs is called Posology.

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 Factors influencing dose of a drug :

 Patient factors:
 Age, weight, body surface area

 Drug factors:-
 Chemical nature of the drug, pharmacokinetic properties

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 Doses are expressed in following ways:-

 For adults:-

 Adult doses are expressed as mg or gm/day in divided doses.

 They represent the dose for an average adult weighing 70 kg.

 Solid drugs in mg or gm/day in daily divided doses

 Liquids in millilitre (ml)
 Biological preparations (e.g. Insulin) in I.U. (International Units)

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 For paediatric patients:-

 Two methods are currently used for calculating paediatric doses based
on:

I. Body weight- e.g. mg /kg /dose OR mg/kg/day in divided doses

II. Body surface area (square meter)

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Determination of children’s doses from adult doses on the basis of body surface area
Weight (kg) Approx. Surface area in Approx. percentage of
square meters adult dose**

2 0.15 9
4 0.25 14
6 0.33 19
8 0.40 23
10 0.46 27
15 0.63 36
20 0.80 46
25 0.95 55
30 1.08 62
35 1.20 70
40 1.30 75
45 1.40 81
50 1.51 87
55 1.58 91
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 Body surface area (BSA) is more reliable than body weight for paediatric
dose calculation.
 Several other formulae, based on age of the child and the body weight
are suggested for calculations of paediatric dosage but they are less
reliable:
Young’s formula-
Dose = Adult dose X Age of child (years)
Age + 12
Clark’s formula:
Dose=Adult dose ×Weight (kg)/70
OR Dose=Adult dose ×BSA (m2)/1.8
OR (1.5 X weight in kg) +10 = percentage of adult dose to be given to the child

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Unit : It is a biological activity to contain in a given amount of drug. It may
be expressed as an I.U. and Unit. International unit has some international
standard. Unit is according to countries or pharmacopoeia.
Dose expression-
Dosage form Dose expression
1 Solid: Tablet / Capsule gm/ mg/ µg/ kg per day As a single/divided dose
2 Liquids :Suspension ml /day As a single/divided dose
3 Aerosol Puff / day As a single/divided dose
e.g. salbutamol,
1 puff = 50 µg

4 Parenteral injection IU/ µg / mg/ gm / kg per day As a single/divided dose

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 If we add the liquid, semi solid or solid medicament in to another solid
semi solid or liquid medicament than strength of such a pharmacological
expression is express in terms of :

 1. Percentage 2. Ratio

 1% w/w - 1 gm in 100 gm 1: 1000 w/v - 1 gm in 1000 ml

 1% v/v - 1ml in 100 ml 1: 10000 w/v - 1 gm in 10000 ml

 1% w/v - 1gm in 100 ml

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 A concentrated drug solution can be prepared, stored and diluted to
desired concentration before use.
 Strength of a drug can be expressed as gm, mg, percentage or
proportion.
 1% solution means 1 g of solute in 100 ml (10 mg/ml).
 3% framycetin ointment contains 3 g of framycetin in 100 g of ointment.

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 70% ethyl alcohol contains 70 ml ethyl alcohol in a total of 100 ml
aqueous solution (i.e. 70 ml of ethyl alcohol + 30 ml of water).
 Strength of some formulations is also expressed as proportion. e.g.
1:1000 adrenaline hydrochloride injection means 1g (1000 mg) of active
ingredient in 1000 ml, which amounts to 1 mg adrenaline/ml.

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 For elderly patient (for 65 years
and above) :-
 There are no fixed rule or formulae.

 Dose may be reduced to 2/3 of adult dose due to decrease in renal/liver

function and lean body weight. Though there is no fixed rule or formula,
the following dose modification is suggested due to age related
decrease in renal / liver function and lean body weight.

 65 – 74 yrs = 3/4th of the adult dose

 75- 84 yrs = 2/3rd of the adult dose

 85 yrs & above- 1/2 of the adult dose

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 For patient of renal failure :-

 Special care should be taken for drug excreted predominantly by kidney

in patient with impaired renal function.

 Dosage calculation for these patients is based on creatinine clearance

and following formula can be used.
 Dose = Adult dose X Creatinine clearance in renal insufficiency

Creatinine clearance in normal individual

 Normal creatinine clearance (CrCL) for 70 kg healthy man is 100 - 120 ml /minute.

 CrCL in renal insufficiency = ( 140 - Age ) X Weight ( kg ) {multiply by 0.85 ( If females)}

72 x S. Creatinine ( mg / ml )
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 Other relevant formulas for dose calculation:
 Elimination kinetics
 Repeated drug administration : at short interval, it accumulates in body
until elimination balances input and Steady state plasma concentration
(Cpss) is attained-
 Cpss = Dose rate
CL (CL = clearance)
 Dose rate needed to achieve the target Cpss can be determined-
 Dose rate = target Cpss x CL
 After oral administration, often only a fraction (F) of the dose reaches
systemic circulation in the active form. In such a case--
 Dose rate = target Cpss x CL
F
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 Michaelis Menten kinetics,
 Rate of drug elimination= (Vmax)(C)
Km + C
 Where C is the plasma concentration of the drug,
 Vmax is the maximum rate of drug elimination, and
 Km, is the plasma concentration at which elimination rate is half
maximal.

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 Target level strategy

 For drugs whose effects are not easily quantifiable and safety margin is

not big e.g. Anticonvulsants, antidepressants, lithium etc. or those given

to prevent an event, it is best to aim at achieving a certain plasma

concentration which is in therapeutic range.

 They are often administered by loading & maintenance dose.

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 Loading dose
 This is a single or few quickly repeated doses given in the beginning to attain target
CL concentration rapidly. It may be calculated as-
 Loading dose = target Cp x V
F
 Thus, loading dose is governed only by V and not by CL or t½.
 Maintenance dose
 In case of drugs obeying first order kinetics:
 Revised Dose Rate= Previous dose rate x Target Cpss
Measured Cpss

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 Therapeutic drug monitoring (TDM) is
particularly useful in the following:
1. Drugs with low safety margin, e.g. -digoxin, anticonvulsants, antiarrhythmics,
theophylline, aminoglycoside antibiotics, lithium, tricyclic antidepressants.
2. If individual variations are large, E.g.- antidepressants, lithium.
3. Potentially toxic drugs used in the presence of renal failure, E.g.
aminoglycoside antibiotics, vancomycin
4. In case of poisoning.
5. In case of failure of response without any apparent reason E.g. Antimicrobials
6. To check patient compliance, e.g. psychopharmacological agents

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 First-pass (Presystemic) Metabolism

 The hepatic extraction ratio (ER liver) of a drug is the fraction of the absorbed
drug prevented by the liver from reaching systemic circulation.
 Both presystemic metabolism as well as direct excretion into bile determine
ERL which is given by the equation:
 ER= CL Liver

Hepatic Blood flow

 Hepatic blood flow Accordingly the systemic bioavailability (F) of an orally
administered drug will be:
 F = fractional absorption x (1- ER)

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 Assignment :

1. 20 gm of Soframycin cream contains : Framycetin sulphate - 1% w/w. Calculate

the amount of Framycetin present in this preparation in mg.

2. Calculate the daily dose of Amikacin for 75 years old female obese patient weight
90 kg having S. creatinine – 2.5 mg/ml suffering from renal parenchyma disease.
Adult dose is 500 mg.

3. Calculate the required volume in ml for oral administration from 30 ml Cefadroxil

Suspension containing 250 mg/5 ml for a child weight is 10 kg suffering from
tonsillitis. Dose is 30 – 40 mg/kg/day orally in 2 divided doses, not to exceed 2 g
per 24 hours.
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4. A solution of Adrenaline contains Adrenaline in dose of 1:10000. If you want to
inject 1 mg Adrenaline, how much volume of Adrenaline solution be injected ?

5. To calculate the required volume in ml and fill up syringe for intra venous
injection from a vial of 30 ml . The vial contain Chloroquine base 40 mg/ ml for a
patient weighing 40 kg at the dose of 3 mg / kg body weight , suffering from
Malaria. Things Required : Chloroquine phosphate vial - 30 ml containing
chloroquine base 40 mg/ml, Disposable syringe – 5 ml / Disposable needle – 24
G / Spirit swab.

6. To calculate the required volume in ml for intramuscular injection from a vial

containing Benzyl Penicillin G (sodium salt) 10 lac unit after reconstitution, 5 lac
units per ml for a child weighing 5 kg at the dose of 20,000 units per kg.

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1. 20 gm of Soframycin cream contains : Framycetin sulphate - 1% w/w. Calculate the amount
of Framycetin present in this preparation in mg.

Answer 1
1. 20 gm total cream
1 % w/w means, 1 gm in 100 gm
So, here how much in 20 gm ?
100 gm 1 gm
20 gm ?
20 X 1 = 0.2 gm
100
Now, converting gm to mg, 1gm= 1000 mg; 0.2 gm= 200 mg.

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2. Calculate the daily dose of Amikacin for 75 years old female obese patient weight 90 kg
having S. creatinine – 2.5 mg/ml suffering from renal parenchyma disease. Adult dose is 500
mg.
Answer 2
75 years old female ; weight 90 kg ; S. creatinine – 2.5 mg/dl; Adult dose- 500 mg BD
Dose = Adult dose X Creatinine clearance in renal insufficiency
Creatinine clearance in normal individual
Normal creatinine clearance (CrCL) for 70 kg healthy man is 100 - 120 ml /minute.
CrCL in renal insufficiency = ( 140 - Age ) X Weight ( kg ) multiply by 0.85 ( If females)
72 X S. Creatinine ( mg / ml )
CrCLri = 140 – 75 x 90 x 0.85 = 27.625 ml/minute
72 X 2.5

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 Now,
Dose = Adult dose X Creatinine clearance in renal insufficiency
Creatinine clearance in normal individual
= 500 X 27.625 = 138= 140 mg
100

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3. Calculate the required volume in ml for oral administration from 30 ml Cefadroxil
Suspension containing 250 mg/5 ml for a child weight is 10 kg suffering from tonsillitis. Dose is
30 – 40 mg/kg/day orally in 2 divided doses, not to exceed 2 g per 24 hours

Answer 3
 5ml 250 mg
30 ml ? = 30 x 250/ 5 = 1500 mg total in 30 ml suspension
 Dose is 30-40 mg/kg; child weight = 10 kg
 Child need 10 x 30 to 40= 300 to 400 mg
 1500 mg 30 ml
300 mg ? 300 x 30/1500= 6 ml
400 mg ? 400 x 30/1500= 8 ml
 6-8 ml in two divided doses, 3-4 ml/dose 12 hourly

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4. A solution of Adrenaline contains Adrenaline in dose of 1:10000. If you want to inject 1
mg Adrenaline, how much volume of Adrenaline solution be injected ?

Answer 4
 1:10000 means 1 gm in 10000 ml
 We need to give 1 mg
 Now, 1 gm = 1000 mg, so 1gm in 10000 ml= 1000mg in 10000 ml
 1000 mg 10000 ml
1 mg ? = 1 x 10000/1000 = 10 ml

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5. To calculate the required volume in ml and fill up syringe for intra venous injection from a
vial of 30 ml . The vial contain Chloroquine base 40 mg/ ml for a patient weighing 40 kg at the
dose of 3 mg / kg body weight , suffering from Malaria. Things Required : Chloroquine
phosphate vial - 30 ml containing chloroquine base 40 mg/ml, Disposable syringe – 5 ml /
Disposable needle – 24 G / Spirit swab.

Answer 5
 Dose 3 mg/kg; so for 40 kg child needed dose is 40 x 3 = 120 mg
 Now, vial contains 40 mg per ml, 1 ml = 40 mg,
40 mg 1ml
120 mg ? 120 x 1 / 40 = 3 ml

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6. To calculate the required volume in ml for intramuscular injection from a vial containing
Benzyl Penicillin G (sodium salt) 10 lac unit after reconstitution, 5 lac units per ml for a child
weighing 5 kg at the dose of 20,000 units per kg.
Answer 6
 Dose to be given 20000 U per kg
 For 5 kg child, 5 X 20000= 100000= 1 lac U
 VIAL contains 5 lac U /ml,
 5 lac U 1ml
1 lac U ? = 1X 1/5= 0.2ml

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 THANK YOU

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