OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF PHARMACY
Valenzuela. Quezon City. Antipolo. Pampanga. Cabanatuan. Laguna

Calculation of
Medication Doses
Unit 6
Instructor- College of Pharmacy
Course Facilitator
 Unit Outcomes
At the end of this unit, the student are expected to:

1) Describe factors to consider in

determining doses for pediatric and
elderly patients.
2) Calculate doses based on factors of
age, body weight, and body surface
area.

3) Calculate doses using ratio &

proportion.
 Unit Outline
1. Terms related to Dose

2. Pediatric and Geriatric Patients

3. Rules for approximate doses

for infants and children

4. Calculation based on Body

weight & BSA

5. Dimensional Analysis
 Required Reading
• Chapter 8: Calculation of Doses: Patient Parameters
Ansel, H.C. Pharmaceutical Calculations 14th Edition
(2012)
• Remington, J. P., Beringer, P. Remington, The
Science and Practice of Pharmacy. 21st Edition
(2015)
Dose and Dosage
Dose
- the specified amount of a drug that is to be given to a
patient. There's also something known as the relative dose, a
dose relative to the patient's body weight.
- Example: 5 mg is a dose. 5 mg/kg is a relative dose.

Dosage
- The how the medicine is given to the patient (number of
doses and schedule)
- The frequency at which a dose is administered.
- 500 mg is a dose. 5 mg/kg is a relative dose. 500 mg
every 12 hours is the dosage regimen.

Dosage range
- amounts of drug that may be prescribed within the work of
usual medical practice
What is the Dose and Frequency?
What is the Dose and Frequency?
Terms related to Dose
§Adult Dose §Initial Dose §Pediatric Dose & Geriatric
§Also known as Usual dose §also the priming or Dose
§the amount that may be loading dose §Dose that is administered
expected to produce, to children
§is the amount required
in adults, the medicinal to attain the desired §Dose applicable to
effect for which it is concentration of the drug in patient’s 65 years and
intended the blood or tissues. above.

§Maintenance Dose
§Prophylactic Dose Therapeutic Dose
§Dose required to maintain
§the amount administered the amount which is
clinical
to a patient before administered to a patient
effectiveness/therapeutic
exposure or contraction of after the exposure or
concentration according to
the illness contraction of an illness
dosage regimen
Calculation of Dose
Pharmaceutical dispensing and compounding calculations use simple arithmetic.
The errors that may arise often are due to carelessness, as in improper placing of
decimal points, incorrect conversion from one system of measurement to another, or
uncertainty over the system of measurement to be used.

• very dangerous
Overdose because of undesirable
of effect and toxicity.

• decrease effectivity of
Underdose the drug to the patient
Calculation of Dose
For certain drugs and for certain patients, drug dosage is determined on the
basis of specific patient parameters.

These parameters include the:

1. patient’s age & weight
2. body surface area
3. nutritional and functional status
4. Pharmacokinetic
When do we need to calculate the dose?
Decrease in number of cells,
For adults that have normal condition, usual dose or the adult enzyme systems, intestinal
dose is already appropriate that means dose calculation is not and liver blood flow, rate of
emptying and motility
required.

Dose individualization is required to:

1. neonates and other pediatric patients
2. elderly patients with diminished biologic functions,
3. individuals of all age groups with compromised liver and/or kidney
function (and thus reduced ability to metabolize and eliminate drug
substances)
4. critically ill patients
5. patients being treated with highly toxic chemotherapeutic agents.
6. certain drugs with a narrow therapeutic window often require
individualized dosing based on blood level determinations and
therapeutic monitoring
Pediatric Patients
Pediatrics is the branch of medicine that deals with disease in children from
birth through adolescence.
Because of the range in age and bodily development in this patient
population, the inclusive groups are defined further as follows:

Premature if born at less than 37 weeks’ gestation

Neonates newborn) – from birth to one month
Infant 1 month to 1 year (28 days-23 months)
Early childhood 2 years through 5 years
Late childhood 6 years through 11 years
Adolescence 12 years through 18 years
Pediatric Patients Gray baby syndrome with chloramphenicol

Why there is a need to calculate dose for pediatric ‘Gasping syndrome’ with benzyl acohol
patients? Hepatotoxicity, hypotension, renal
Factors in Dosing Pediatrics: failure and death with the solvent
propylene glycol
1. Patient’s age and weight
Enamel dysplasia with tetracycline
2. Overall health status
3. Stage of development of body systems for drug metabolism (liver
enzymes) and Drug elimination (renal system) - In neonate, these
biologic functions and systems are underdeveloped.
Aside from dosage calculation, there is a need to select pediatric
dosage forms that permit more accurate dosing and patient
compliance. Device are also needed to promote compliance to
medication in pediatric patients:
• Calibrated medicine dropper
• remeasured teaspoon (5ml)
• Nebulizer for inhalational products
Pediatric Patients
According to the official U.S. Pharmacopeia, the following are the
household equivalents:

1 measuring cup = 8 oz or 240 mL (1 oz = 30 mL)

1 medium-size
= 8 oz or 240 mL
glass (tumbler size)
1 ounce (oz) = 2 tablespoons or 30 mL
1 tablespoon (T) = 3 teaspoons or 15 mL
1 teaspoon (t) = 60 drops (60 gtt)
Geriatric Patients
Geriatric medicine or geriatrics is the field that encompasses the management
of illness in the elderly.

• 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.

Age Term
65-75 years Young old
75-85 years Old
> 85 years Old old
Geriatric Patients
Dose determinations for elderly patients frequently require
Metabolic changes
consideration of some or all of the following: Reduced drug clearance

§The patient’s physical

Therapy is often initiated §Dose adjustment may be condition may determine
with a lower-than-usual required based on the the drug dose and the route
adult dose therapeutic response. of administration employed.

§ 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.
§ The long-term use of maintenance drugs Metformin – decreased appetite, tiredness,
§ Difficulties in patient compliance kidney or liver disease
Statins - , neuropathy, development of Type 2
Calculation Based on Age
The age of the patient is a consideration in the determination
of drug dosage.

As stated previously, neonates have immature hepatic and

renal functions that affect drug response.

The elderly, in addition to diminished organ function,

frequently have issues of concomitant pathologies and increased
sensitivities to drugs.
Calculation Based on Age
Today these rules are not in general use because age alone is no longer
considered a singularly valid criterion in the determination of accurate dosage
for a child, especially when calculated from the usual adult dose, which itself
provides wide clinical variations in response.

Currently, when age is considered in determining dosage of a potent

therapeutic agent, it is used generally in conjunction with another factor, such
as weight.
What is the clinical significance of
calculation based on age?
• In situations where the pediatric patient's weight is unknown, for instance, at
the point of injury, then Calculation of dose based on age can be safely
implemented if their age and the recommended adult dosing are known.

• Age-based dosing has demonstrated to be a safe and effective approach.

However, caution should be used depending on the class of the drug.
Example: certain classes of medications require weight-based dosing, such as antibiotics and
antiepileptics. Example of formula that is weight base is Clark’s Rule.
Rules for approximate doses for
infants and children:
1. Young’s Rule (for children 2 years old and older)

2. Clark’s Rule

The number 150 in Clark’s rule was an estimate of the weight of an individual who
likewise would receive an adult dose.
Rules for approximate doses for
infants and children:
3. Fried’s Rule (for infants up to 2 years old)

The value of 150 in Fried’s Rule was an estimate of the age (12.5 years or
150 months) of an individual who would normally receive and adult dose

4. Cowling’s Rule
Problem 1:
What is the dose for an 8-month-old infant if the
average adult dose of a drug is 250 mg?

Identify what formula is appropriate based on the given:

Dose 8 months
250mg
150 months
13.33 mg or 13mg
Rules for approximate doses for
infants and children:
5. The Square Meter Surface Area Method relates the surface area of
individuals to dose. It is thought that this is a more realistic way of relating
dosages.

The average body surface area for an adult has been given as 1.73 square
meters (m2);
Problem 2:
If the adult dose of a drug is 100 mg, calculate the
approximate dose for a child with a BSA of 0.83 m2

0.83 m2 100mg 47.98 mg

1.73 m2 Approximate dose for the child
with BSA of 0.83m2
Calculation Based on B.S.A.
(Body Surface Area)
Many drugs have doses stated as the amount of drug/m2 body surface area
and may be calculated as follows:

Many physiological functions are proportional to body surface area, such as

metabolic rate and kidney function.
Widely used for two types of patient groups: cancer patients receiving chemotherapy
and pediatric patients.
Calculation Based on B.S.A.
(Body Surface Area)
If there is need to determine the patient’s BSA, the following equation may be
used:

𝑷𝒂𝒕𝒊𝒆𝒏𝒕' 𝒔 𝒉𝒆𝒊𝒈𝒉𝒕 𝒄𝒎 𝒙 𝑷𝒂𝒕𝒊𝒆𝒏𝒕' 𝒔 𝒘𝒆𝒊𝒈𝒉𝒕 𝒌𝒈

𝑷𝒂𝒕𝒊𝒆𝒏𝒕'𝒔 𝑩𝑺𝑨 𝒎𝟐 =
𝟑𝟔𝟎𝟎

𝑷𝒂𝒕𝒊𝒆𝒏𝒕' 𝒔 𝒉𝒆𝒊𝒈𝒉𝒕 𝒊𝒏 𝒙 𝑷𝒂𝒕𝒊𝒆𝒏𝒕' 𝒔 𝒘𝒆𝒊𝒈𝒉𝒕 𝒍𝒃𝒔

𝑷𝒂𝒕𝒊𝒆𝒏𝒕'𝒔 𝑩𝑺𝑨 𝒎𝟐 =
𝟑𝟏𝟑𝟏
Calculation Based on B.S.A.
(Body Surface Area)
Useful conversion of units:
Length
1m = 39.37 in
1 in = 2.54 cm
1ft = 30.48 cm

Weight
1 kg = 2.2 lb
1g = 1000mg
1mg = 1000mcg
Problem 3:
The dose of mitomycin injection is 20mg/m2 per day.
Determine the daily dose for a patient who weighs 144 lb.
and measures 68 in. in height.

Step 1. Compute the BSA of patient:

'
𝑷𝒂𝒕𝒊𝒆𝒏𝒕' 𝒔 𝒉𝒆𝒊𝒈𝒉𝒕 𝒊𝒏 𝒙 𝑷𝒂𝒕𝒊𝒆𝒏𝒕'𝒔 𝒘𝒆𝒊𝒈𝒉𝒕 𝒍𝒃𝒔
𝑷𝒂𝒕𝒊𝒆𝒏𝒕 𝒔 𝑩𝑺𝑨 𝒎𝟐 =
𝟑𝟏𝟑𝟏

√68 in 144 lb.

BSA
3131
1.77m2
Problem 3:
Step 2. Compute the daily dose:

Dose 20mg 1.77 m2

1m2
35.4 mg
Calculation Based on Weight
Drug doses are often stated in mg/kg body weight and may be calculated as
follows:

This is the most common way of determining children’s doses.

This equation is based on drug dose in mg/kg and the patient's weight in
kilograms. When different units are given or desired, other units may be
substituted in the equation as long as the terms used are constantly applied.
Dimensional Analysis
The problem-solving method illustrated in solving pharmaceutical problems is
dimensional analysis (which is based on ratio and proportion).

Dimensional analysis
- widely used in many scientific disciplines and offers a consistent way to solve
problems.
- It also overcomes many difficulties students and pharmacy practitioners have
in problem interpretation and provides a well-defined, consistent starting
point in the solution of pharmaceutical problems.
Dimensional Analysis
The basis for dimensional analysis is the formation of relationships between
quantities, multiplication and canceling units until only the units of the desired
answer remain.
Dimensional Analysis
Dimensional analysis can be used to solve most pharmaceutical
problems, regardless of complexity, using a consistent procedure:
1. Collect all the information and relationships in the problem complete with
units and labels.

2. Identify the unit(s) and label of the answer.

3. Select a starting point corresponding to the unit(s) and label of the answer in
the numerator.

4. Complete the process using relationships in the problem and known

conversions to cancel units.

5. Solve the problem mathematically.

Problem 4:
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.?
Step 1. Compute for the weight of patient in kg:

1kg X kg
2.2lb 154lb Body weight
154lb 1 kg 2.2lb X kg
70 kg
Problem 4:
Step 2. Compute for the dose appropriate for the
patient using ratio and proportion:

150mcg X mcg
1kg 70kg Body weight
70kg 150 mcg 1 kg X mcg
10,500 mcg
Problem 4:
Step 3. Convert the dose of the medication
expressed in mcg to mg:

10, 500mcg 1, 000 mcg

X mg 1 mg
10, 500mcg 1 mg 1, 000 mcg X mg
10.5 mg
Problem 5:
You receive a prescription ordering Amoxicillin 100mg PO qid.
The available amoxicillin in your drugstore is a suspension with
a label given below. How many milliliters should the patient
receive per day?
Dose of the available drug is 228.5mg/5ml.

100mg 228.5mg
X ml 5 ml
100 mg 5 ml 228.5 mg X ml
2.18 ml or 2ml
4 8 ml/ day
Problem 6:
How many capsules, each containing 250 mg of
clarithromycin, are needed to provide 50mg/kg/day for 7
days for a person weighing 176 lb.?

Step 1. Convert the weight of the patient to kg:

176 lb 2.2 lb
X kg 1 kg
176 lb 1 kg 2.2 lb X kg
80 kg
Problem 6:
Step 2. Compute the dose appropriate to the patient:

80kg 1 kg
X mg 50 mg
80 kg 50 mg 1 kg X mg
4, 000 mg/day 7 days

28, 000 mg
Problem 6:
Step 3. Compute the total capsule needed:

28,000mg 250 mg
X cap 1 cap
28,000mg 1 cap 250mg X cap
112 capsules
 ANY
QUESTIONS?
You can find me at:
dpbacalzo@fatima.edu.ph
facebook.com/
OLFUAntipoloPharmacy/ (8)-661-3023 loc. 106