Syllabus

Posology: Definition, Factors affecting posology. Pediatric dose calculations based on age, body
weight and body surface area.
POSOLOGY

Posology (‘Posos’ means ‘how much’ and ‘logy’ means ‘study’) is a branch of
medical science which deals with dose or quantity of drugs which can be administered to a
patient to get the desired pharmacological actions. The dose of a drug cannot be fixed rigidly
because there are so many factors which influence the doses.

FACTORS INFLUENCING DOSE

The following are some of the factors which influence the dose:

 Age
 Sex
 Body weight
 Route of administration
 Time of administration
 Environmental factors
 Emotional factors
 Presence of disease
 Accumulation
 Additive effect
 Synergism
 Antagonism
 Idiosyncrasy
 Tolerance
 Tachyphylaxis
 Metabolic disturbances

1. AGE

The pharmacokinetics of many drugs changes with age. So while determining the dose of
a drug, the age of an individual is of great significance. Children and old people need lesser
amount of drug than the normal adult dose, because they are unable to excrete drugs to that
extent as adults. Children can tolerate relatively larger amounts of belladonna, digitalis and
ethanol, whereas ,elderly patients are more sensitive to some drug effects.

Doses proportionate to age: There are number of methods by which the dose for a child can be
calculated from the adult dose.
YOUNG’S FORMULA

The formula used for calculating the doses for children less than 12 years of age.

Age in years
Dose for the child = X Adult dose
Age in years +12

DILLING’S FORMULA

The formula used for calculating the doses for children in between 4 to 20 years of age. This
formula is considered better because it is easier and quick to calculate the dose

Age in year
Dose for the child = X Adult dose
20
FRIED’S RULE

This method is used for calculating the doses for Infants or children

Age in months
Infant’s or Child’s dose = X Adult dose
150
COWLING’S FORMULA

Age in years +1
Dose for the child = X Adult dose
24
BASTEDO’S FORMULA

Age in years +3
Dose for the child = X Adult dose
30
2. SEX

o Women do not always respond to the action of drugs in the same manner as it is done in
men. Females require comparatively smaller amount of dose than the males due to the
presence of more body fat. However, few exceptions such as haematinics and iron
preparations, since females tend to loose blood during menstruation. Morphine and
barbiturates may produce more excitement before sedation in women.

o Special care to be taken when drugs are administered during menstruation, pregnancy and
lactation. The strong purgatives such as aloes should be avoided during menstruation.
 Similarly the drugs which may stimulate the uterine smooth muscle must be avoided
during pregnancy.

o Drastic purgatives, antimalarial drugs and ergot alkaloids are contra indicated during
pregnancy.

3 . BODY WEIGHT

The patients with heavy physique needs larger dose as compared to the weak and skinny
patients. The average dose is mentioned either in terms of mg per kg body weight or as a total
single dose for an adult weighing between 50-100 kg. However, the dose expressed in this
fashion may not apply in cases of obese patients, children and malnourished patients. It should
be calculated according to body weight.

Dose proportionate to body weight: Clark’s formula is used to calculate the dose for the child
according to body weight.

CLARK’S FORMULA
Child’s weight in kg
Child’s dose= X Adult dose
70

3. DOSES PROPORTIONATE TO BODY SURFACE AREA

This method is widely used for two types of patient groups, i,e., cancer patients receiving
chemotherapy and pediatric patients. Dose of methotrexate is 100mg for an adult whose body
surface area is 1.73m2 whereas for an adult with body surface area 0.62m2, the dose is nearly
35mg.

Physiological factors such as electrolytes present in body fluids, glomerular filtration rate, and
plasma volume etc., changes with the body surface area. This causes a change in the distribution
and clearance of a drug, due to which its dose also changes. The child dose is calculated based on
the following formula,

Surface area of child

Child’s dose = X Adult dose
2
Surface area of adult (1.73m )
The body surface area is calculated from the height and weight of the child.

4 .ROUTE OF ADMINISTRATION

This is an important factor, since the drug administered parentrally is much less in
quantity when compared to orally administered drug. The drugs administered intravenously enter
the blood stream directly. Due to this reason the onset of drug action is quick with intravenous
route and this might enhance the chances of drug toxicity. The effectiveness of drug formulation
is generally controlled by the route of administration.

Example:
o Oral dose of morphine is 10-30mg whereas Intra venous dose is 2.5-5mg
o Oral dose of Salbutamol is 2-4mg whereas Inhalational dose is 100-200µg

5. TIME OF ADMINISTRATION

This factor also plays a vital role, since there are drugs which when taken orally before
meals are absorbed more quickly compared to when administered post meals. The presence of
food in the stomach delays the absorption of drugs. The drugs are more rapidly absorbed from
the empty stomach. So the amount of drugs which is very effective when taken before a meal
may not be that much effective when taken during or after meals. The irritating drugs are better
tolerated if administered after meals.

Example:
o Ferrous sulphate is given between meals
o L-Thyroxine / Omeprazole are given on empty stomach
o Diclofenac sodium is given after meals

6. ENVIRONMENTAL FACTORS

o Daylight is stimulant, enhancing the effect of stimulating drugs and diminishing the
effect of hypnotics. Darkness is sedative. Hypnotics are more effective at night.

o The amount of barbiturate required to produce sleep during day time is much higher than
the dose required to produce sleep at night.

o Alcohol is better tolerated in cold environments than in summer.

7. EMOTIONAL FACTORS

o Drug responses in some individuals are influenced by psychological and emotional

factors. The personality and behavior of a physician may influence the effect of drug
especially the drugs which are intended for use in a psychosomatic disorder.

o Inert dosage forms called placebos which resemble the actual medicament in the physical
properties are known to produce therapeutic benefit in diseases like angina pectoris and
bronchial asthma.

Example

o General anesthetics- higher doses are needed in nervous or anxious patients than in
normal individuals
 o Chlorpromazine-50-100mg is required to produce tranquilization (calming effect) in
normal patients whereas in schizophrenic patients 500-1000mg is needed for the same
effect.

8. PRESENCE OF DISEASE

o Hepatic impairment may increase the bioavailability of certain drugs undergoing first
pass hepatic metabolism.

Example: Drugs like barbiturates and chlorpromazine (tranquillizer) may produce

unusually prolonged effect in patients having liver cirrhosis

o Renal diseases may decrease the excretion and accumulation of drugs.

Example: Streptomycin is excreted mainly by the kidney may prove toxic if the kidney
of the patient is not working properly.

9. ACCUMULATION

A normal body absorbs, detoxifies, and excretes the drug simultaneously. The drugs which are
slowly excreted may built up a sufficient high concentration in the body and produce toxic
symptoms if it is repeatedly administered for a long time. The cumulative effects are usually
produced by slow excretion, slow degradation and rapid absorption of drugs.

This can be overcome by decreasing the dosing frequency. Sometimes, a cumulative effect is
desired in drugs like phenobarbitone in the treatment of epilepsy.

Example
o Digitalis toxicity
o Emetine toxicity
o Heavy metals toxicity

10. ADDITIVE EFFECT

When the total pharmacological action of two or more drugs administered together is
equivalent to sum of their individual pharmacological action, the phenomena is called as an
additive effect.

Examples

o Combination of ephedrine and aminophylline in the treatment of bronchial asthma

o Combination of aspirin and codeine in relieving pain. Both are acting in different
mechanism
11. SYNERGISM

When the combined action of two or more drugs is relatively more than the sum of their
individual effect, it is known as synergism. In such case, the amount of dose is reduced.
Synergism is very useful when desired therapeutic result needed is difficult to achieve with a
single drug.

Example

Procaine and adrenaline combination, adrenaline will increase the duration of local anesthetic
action of procaine.

12. ANTAGONISM

When the action of one drug is opposed or decreased by the other drug on the same
physiological system is known as drug antagonism. To overcome this, the amount of dose is
increased.

Example

o Adrenaline and acetylcholine are given together , they neutralize the effect of each other
due to antagonism because adrenaline is vasoconstrictor and acetylcholine is vasodilator.

13. IDIOSYNCRASY or DRUG ALLERGY

An extraordinary response or abnormal response to a drug which is different from its

characteristic pharmacological action is called idiosyncrasy or drug allergy.

Example
o Small quantity of aspirin may cause gastric haemorrhage
o Small dose of quinine may produce ringing in the ears.
o Asthma and diarrhoea are observed upon administration of quinine or quinidine in
certain individuals

14. TOLERANCE

In a particular individual some drugs show decreased therapeutic efficacy on prolonged

usage. Due to this, the patient on long term therapy require increased amount of dose for getting
the same therapeutic efficacy. This condition is called as tolerance.

o True tolerance which is produced by oral and parentral administration of the drug.
o Pseudo tolerance which is produced only to the oral route of administration. It is due to
other factors such as disease progression, new disease, increased physical activity, lack of
compliance, change in medication, drug interaction, addiction etc.
o Cross tolerance –tolerance developed by some other drug
Example
o Smokers can tolerate nicotine
o Alcoholics can tolerate large quantity of alcohol
o Tolerance to sedatives and anesthetics due to addiction to alcohols, barbiturates, narcotics
etc. (Cross tolerance)

15. TACHYPHYLAXIS or ACUTE TOLERANCE

When certain drugs are administered repeatedly at short intervals, the cell receptors get
blocked up and pharmacological response to that particular drug is decreased. The decreased
response cannot be reversed by increasing the dose. This phenomenon is known as tachyphylaxis
or acute tolerance.

Examples
o Ephedrine when given in repeated doses at short intervals in the treatment of bronchial
asthma may produce very less response
o Similarly, drugs like amphetamine , cocaine and nitrates behave in this ways.

16. METABOLIC DISTURBANCES

Changes in water electrolyte balance and acid- base balance, body temperature and other
physiological factor may modify the effects of drugs

Example
o Salicylates reduce body temperature only in case an individual has rise in body
temperature.
o The absorption of iron from G.I.T is maximum if the individual has iron deficiency
anaemia.