Calculation of Doses

IP 121 Lecture
2nd semester, AY 2012-2013
Department of Industrial Pharmacy
College of Pharmacy
UP Manila

A Dose of Definitions
Dose
Quantitative amount administered or taken by
a patient for an intended medical effect
-

Single dose
Daily dose
Total dose
Divided doses

Dosage Regimen (vs. dosing frequency/interval)

Schedule of dosing with duration of treatment
Ex. 3x a day for 7 days
Ex. 5 mL q12h s.o.s.

A Dose of Definitions
Usual Adult Dose
the amount that ordinarily produces the
medicinal effect intended in adults
Usual Pediatric Dose
amount that ordinarily produces the medicinal
effect intended in infants or children

Usual Dosage Range

indicates the quantitative range or amounts of
the drug that may be prescribed within the
guidelines of usual medical practice

A Dose of Definitions
Prophylactic Dose
Given to protect the patient from
acquiring/contracting a specific disease
Therapeutic Dose
Given to counter an existing condition, sign,
symptom, or disease once contracted
Maintenance Dose
Based from a usual dose, given according to
dosage regimen to sustain drug levels or effects
throughout the course of therapy

Dosing
Calculating the amount of a medicinal substance
or preparation to be administered to a patient to
obtain the desired therapeutic effect

Dosage Problem
Calculations:
Miscellaneous

Number of Doses in a Specified

Amount of Medicine
Total amount
Number of doses
Size of one dose
Example:
If the dose of a drug is 150 mg, how many doses
are contained in 6g?
6g
6,000 mg
No. of doses = ------------- = ------------------- = 40 doses
150 mg
150 mg

Size of each dose and total

amount of medicine
Example:
How many drops would be prescribed in each dose
of a syrup if 15 mL contained 30 doses? The
dropper to be used calibrates 16 drops/mL.
1. Size of dose = total amt. / # of doses
= 15 mL / 30 doses
= 0.5 mL/dose
mL
drops
2. # of drops = 0.5
x 16
= 8 drops/dose
dose
mL
Total amount
Number of doses
Size of one dose

Quantity of ingredient in each specified

dose, given quantity in total amount
Quantity in total amount
Quantity in each dose
Number of doses
Example:
If 0.05 g of a substance is used in preparing 200
tablets, how many micrograms does one tablet
contain?
1. 0.05 g x 1000 mg/g x 1000 g/mg = 50,000 g

2. g/tablet = 50,000 g / 200 tablets = 250 g

Quantity of ingredient in each specified

dose, given quantity in total amount
When the number of doses is not given, a simple
dimensional analysis is used:

Qty. of drug in that total Qty. in each dose

Total amt.
Size of dose
Example:
1.8 g of fluconazole was used in compounding a 60mL
suspension. If one dose is one teaspoonful, how
many mg are contained in one dose?
1.8 g
x

60 mL 5 mL

x = 0.15 g = 150 mg

Easing Patients Into or

Out of Doses
Dose Titration
Desensitization
Tapering

Dose Titration
The process of gradually adjusting the dose
of a medication (based on recommended
dose range and frequency) until optimal
results are observed
- Helps the body adapt to certain medications
- Often reduces side effects
- Adjustment can be increasing or decreasing

Desensitization
Process starting a patient with very small
doses and then rapidly increasing the dose
for the patient to develop tolerance to the
immune response caused by the drug
When patient is already immune to the drug for
which there is no optimal alternative

Tapering

Process of easing a patient

into or out of a certain
medication dose
Not starting on a full dose of
a drug right away or not
discontinuing a medication
dose abruptly

Sample problem
A patient brings in a prescription for a prednisone taper
as follows:
prednisone 30 mg po tonight
20 mg po BID tomorrow and day 3
10 mg po BID days 4 and 5
10 mg po qd days 6 and 7
5 mg po qd days 8 and 9
then off

The available prednisone tablets in the pharmacy are in

1-, 5-, 10, 20, and 50-mg. As the pharmacist, what
strength and quantity should you dispense? What
instructions will you give the patient?

Sample problem (contd.)

The patient will find it easier if he only has to handle 1 type of tablet
for all the doses. The tablet strength that may be used for all doses
is the 5-mg. A total of 36 tablets of the 5-mg strength will be
dispensed. You should give the following instructions to the patient:

Day 1: 6 tablets tonight

Day 2: 4 tablets twice daily
Day 3: 4 tablets twice daily
Day 4: 2 tablets twice daily
Day 5: 2 tablets twice daily
Day 6: 2 tablets once daily
Day 7: 2 tablets once daily
Day 8: 1 tablet daily
Day 9: 1 tablet daily
Day 10: off (stop taking tablets)

Drug Dosage
Adjustments
Based on Age
Based on Body Weight
Based on Surface Area

The Pediatric Population

Neonates: 0-30 days

Infants: Birth to
12 months
Toddlers: 1-3 years

Preschoolers:
3-5 years
School age aka
late childhood:
6-12 years
Adolescence: 13-17 years

Special Dosing Considerations

Doses in children need to be
adjusted because
Underdeveloped body systems
o Kidney function
o Liver enzymes
o Others

Smaller total body mass

Similarly, dosing in geriatric patients can be
lower than typical adult dosing due to
degeneration of drug handling systems

Youngs Rule
For children from 1-12 years

Age
Child dose
Adult dose
Age 12

Cowlings Rule
Age (years) 1
Child dose
Adult dose
24

Frieds Rule for Infants

For infants and children up to 2 years

Age (months)
Infant dose
Adult dose
150

Disadvantage of the 3 rules: children treated as

miniature adults

Drug Dosage based on Body

Weight
Considered more dependable than relying
strictly on age
Usual adult dose is in general most suitable
for a 70-kg (154-lb) man
Dosage based on body weight frequently
expressed on a mg/kg basis (mg of drug per
kg of body weight)
Consideration of physiological/pathological
state is still more superior than this

Drug Dosage based on Body

Weight
Sample problem:
The initial dose of ondansetron is 0.15 mg/kg
given 30 minutes before the start of
emetogenic therapy. How many milligrams
should be administered to a 129-lb individual?
1 kg
0.15 mg
129 lb. x
x
= 8.8 mg
2.2 lb
kg

Clarks Rule
Based on weight

Weight (lb)
Childdose
Adult dose
150
*150 conveniently based on 154 lb, which is the average
weight of an adult

Drug Dosage based on Body

Surface Area (BSA)
Measure of drug dosage based on a
measured or calculated surface of a human
body

BSA unit is in m2 (doses can be expressed

per m2)
Better indicator of metabolic mass than body
weight alone
Often used in calculation of doses of:
Anticancer agents in chemotherapy
Pediatric patients (except premature and neonates)

Drug Dosage based on Body

Surface Area (BSA)
Commonly used methods to calculate BSA:
1. DuBois formula most widely used

BSA W

0.425

0.725

0.007184

2. Mosteller formula

W H
BSA
3600
Where W = weight (expressed in kg)

H = height (expressed in cm)

BSA units: m2

Drug Dosage based on Body

Surface Area (BSA)
Mosteller formula
If weight is expressed in pounds (lbs) and
height in inches (in):

W H
BSA
3131
BSA is still in m2

Drug Dosage based on Body

Surface Area (BSA):
Using a nomogram
BSA Nomogram a standard table which allows
simple graphical determination of BSA using
two columns of weight and height and a
corresponding column for BSA
How to use: Draw a straight line connecting the
height and weight of the patient, found in their
specific columns. The line will intersect the
BSA column in between them, and the value it
intersects is the corresponding BSA.

West nomogram
Allows calculation of
BSA for children of
normal height and
weight using weight
alone

Dosage Calculation in Children

based on BSA
Using the adult dose and a childs BSA:
2

Child's BSA (m )
Childdose
adult dose
2
1.73 m
1.73 m2 average adult BSA
If dose per sqm. Is given:
Child dose = child BSA x dose per sqm.

BSA Dosage Calculation:

Sample problem
A physician prescribed Benadryl for an 8-year old child
who weighs 74 pounds and is 4 feet, 2 inches tall. The
normal adult dose is 25 mg t.i.d. How much Benadryl
must be administered to the child? Use both DuBois and
Mosteller formulas.
1. Change feet to inches and corresponding cm.
(4 ft x 12 in/ft) + 2 in = 50 inches
50 in x 2.54 cm/in = 127 cm
2. Use the Mosteller formula to compute for BSA.

BSA

74 50
1.087m2
3131

BSA Dosage Calculation:

Sample problem
A physician prescribed Benadryl for an 8-year old child
who weighs 74 pounds and is 4 feet, 2 inches tall. The
normal adult dose is 25 mg t.i.d. How much Benadryl
must be administered to the child? Use both DuBois and
Mosteller formulas.
3. Convert pounds to kg and then use the DuBois eqn.
or integrate the conversion already in the DuBois eqn.

1kg 0.425
BSA (74 lb
)
(127cm) 0.725 0.007184
2.2lb
BSA 1.073 m2

BSA Dosage Calculation:

Sample problem
A physician prescribed Benadryl for an 8-year old child
who weighs 74 pounds and is 4 feet, 2 inches tall. The
normal adult dose is 25 mg t.i.d. How much Benadryl
must be administered to the child? Use both DuBois and
Mosteller formulas.
4. Ratio with 1.73 m2 and multiply with the usual adult
dose.
Using DuBois result:
Using Mosteller result:
1.073 m2
1.087 m2
Childdose
25 mg
Childdose
25 mg
2
2
1.73 m
1.73 m
Child dose = 15.5 mg
Child dose = 15.7 mg
The practical dose to give is 16 mg t.i.d.

Intravenous
Admixtures and
Rate of Flow of
Intravenous Fluids

Intravenous Fluids
Sterile preparations intended for parenteral
administration into a vein
Functions
Fluid volume replenishment
Such as in severe vomiting and diarrhea

Electrolyte imbalances
Administration of nutrients
As a means of administering medication
Rapid delivery of a large dose of medication when
needed
Delivery of small amounts of medication over
controlled and pre-determined periods of time

Intravenous (IV) Injections

Large volume parenterals (LVP)

Contain 100-1000 mL of liquid, administered by infusion

When used alone:
Fluid/electrolyte/blood volume restoration
Nutrition
Vehicle for administering other drugs
Packaged into collapsible plastic bags or glass bottles

Small volume parenterals (SVP)

Contain up to a maximum of 100 mL of liquid

Contains drugs or additives for dilution into LVPs or for
direct administration
Packaged also into ampules, vials, and pre-filled
syringes

IV Infusion
Continuous infusions are LVPs with or without
drugs and are run into a vein uninterrupted for
a specified time duration

Intermittent infusions are administered during

scheduled periods
In glass or plastic bottles or collapsible plastic
bags in volumes of 50, 100, 250, 500 and
1000mL

IV Push (IVP)
A relatively large dose of medication
administered into a vein in a short period or in
one immediate shot (usually less than 1
minute)
rapid injection in an emergency or critical care
situation
Also called IV stat or IV bolus
Intended to quickly control heart rate, blood
pressure, cardiac output, respiration, or other
life threatening conditions
Depends on precise calculations of dose and
rate of administration

Intravenous Admixtures
Preparation involves the addition of one or
more drugs (with or without additives) to LVPs
e.g. NaCl Injection, Dextrose Injection,
Lactated Ringers Injection, etc.
Additives include electrolytes, antibiotics,
vitamins, trace minerals
- As SVPs packaged in ampoules, vials, piggybacks
or sterile solids requiring constitution

Rate of Flow of IV Fluids

LVPs are intended for infusion of medications
and/or nutrients in the institutional or homecare setting
On medication orders, the physician specifies
the rate of flow of IV fluids in mL per minute,
drops per minute, amount of drug per hour
(mg/hr), or, more frequently as the
approximate duration of administration of the
total volume of the infusion

Pharmacists may be called upon to perform or

check rate of flow calculations
Calculations usually involve the relation of the
dosing regimen to the flow rate of the parenteral

IV Fluids & Rate of Flow

Sample Problem #1
A medication order for a patient weighing 154 lb calls
for 0.25 mg of amphotericin B per kg of body weight to
be added to 500 mL of 5% dextrose injection. If the
amphotericin B is to be obtained from a constituted
injection that contains 50 mg/10mL, how many mL
should be added to the dextrose injection?

1 kg
154 lb
70kg
2.2 lb
0.25mg
70 kg
17.5 mg
kg

x mL
10 mL

17.5 mg 50 mg

x = 3.5mL

IV Fluids & Rate of Flow

Sample Problem #1
A medication order for a patient weighing 154 lb calls
for 0.25 mg of amphotericin B per kg of body weight to
be added to 500 mL of 5% dextrose injection. If the
amphotericin B is to be obtained from a constituted
injection that contains 50 mg/10mL, how many mL
should be added to the dextrose injection?

1 kg 0.25mg 10 mL
154 lb

3.5 mL
2.2 lb
1 kg
50 mg

IV Fluids & Rate of Flow

Sample Problem #2
A medication order calls for 1000 mL of D5W to be
administered over an 8-hour period. Using an IV
administration set that delivers 10 drops/mL, how many
drops per minute should be delivered to the patient?

1000mL 10 drops
1 hr

20.833 21drops/min
8 hr
mL
60 min

IV Fluids & Rate of Flow

Sample Problem #3
If 5 mg of a drug are added to a 500 mL LVP fluid, what
should be the rate of flow, in mL/hr, to deliver 250 mcg
of drug per hour? If the infusion set delivers 18 gtt/mL,
what should be the rate of flow in drops/min? How
many hours should the total infusion last?

250 mcg = 0.25 mg

500 mL
x mL

5 mg
0.25mg

mL 18 drops
1 hr
25

7.5 drops/min
hr
mL
60 min

x = 25 mL;
therefore, 25 mL/hr

1 hr
x hr

25 mL 500 mL

500 mL
= 20 hours
25 mL/hr

IV Fluids & Rate of Flow

Sample Problem #4
Compare:
a) the number of drops and
b) the length of time, in minutes , required to deliver
150-mL of intravenous solution, when using a
microdrip set at 60 drops/mL, and a standard
administration set, at 15 drops/mL, if in each case
one drop is to be administered per second.
Microdrip set:

150 mL

60 drops
9000drops
mL

Standard set:
15 drops
150 mL
2250drops
mL

1s
1 min
1 hr
9000drops

1 drop 60 s 60 min
= 2.5 hours

1s
1 min
1 hr
2250drops

1 drop 60 s 60 min
= 0.63 hours ~ 38 mins