EFFECTIVE DOSE

An effective dose (ED) in pharmacology is the dose or amount of drug that

produces a therapeutic response or desired effect in some fraction of the
subjects taking it.

It has been stated that any substance can be toxic at a high enough dose.
Cardioactive Drugs
• Digoxin
Forms and strengths
Generic: Digoxin

Form: Oral tablet

Strengths: 62.5 mcg, 125 mcg, 187.5 mcg, and 250 mcg

Brand: Lanoxin

Form: Oral tablet

Strengths: 125 mcg and 250 mcg
• Dosage for mild to moderate heart failure and atrial fibrillation
in adults (ages 18 years and older)

• Loading Dose: The total dose is 10–15 mcg/kg of bodyweight divided

and taken 3 times per day.
• You should take half of the loading dose first, and then take half of
the remaining dose 6 to 8 hours later. Take the rest of the dose 6 to 8
hours after that.
• Maintenance Dose: The maintenance dose is individualized. It’s
based on weight, age, kidney function, current medical conditions,
and other medications.
• The maintenance dose is taken once per day.

(A loading dose is an initial higher dose of a drug that may be given at the
beginning of a course of treatment before dropping down to a
lower maintainace dose.)
Dosage for heart failure in children (ages 11 to 17 years)

• Loading Dose: The total dose is 10 to 15 mcg per kilogram (kg) of bodyweight divided and taken 3
times per day.
• You should take half of the loading dose first, and then take half of the remaining dose 6 to 8
hours later. Take the rest of the dose 6 to 8 hours after that.
• Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney
function, current medical conditions, and other medications.
• The maintenance dose is taken once per day.

Child Dosage (ages 5 to 10 years)

• Loading Dose: The total dose is 20–45 mcg/kg divided and taken 3 times per day.
• You should take half of the loading dose first, and then take half of the remaining dose 6 to 8
hours later. Take the rest of the dose 6 to 8 hours after that.
• Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney
function, current medical conditions, and other medications.
• The maintenance dose is taken two times per day.
Special Considerations

• Kidney disease: Digoxin is cleared from your body by your

kidneys. If you have kidney disease, your dose of digoxin will be
lower.
• Thyroid disorders: If you have hypothyroidism, you might be
more sensitive to digoxin. Because of this, your dose of digoxin
may need to be reduced.
• Quinidine
Form and strength
Generic: Quinidine sulfate
Form: oral immediate-release tablet
Strengths: 200 mg and 300 mg

Generic: Quinidine sulfate

Form: oral extended-release tablet
Strength: 300 mg

Generic: Quinidine gluconate

Form: oral extended-release tablet
Strength: 324 mg
Quinidine sulfate oral tablet
• Treatment for irregular heart rate: There is no optimal dose for
quinidine in treating irregular heart rates.
• Prevention of irregular heart rate and treatment of irregular heart
rate in the ventricles: Typical dosage is 200 mg taken every 6 hours.
Quinidine sulfate oral extended-release tablet
• Treatment for irregular heart rate: Typical dosage is 300–600 mg
every 8–12 hours.
• Prevention of irregular heart rate and treatment of irregular heart
rate in the ventricles: Typical dosage is 300 mg taken every 8–12
hours.
• Procainamide
injection solution
100 mg/mL
500mg/mL
IV Administration
• Loading dose: 100-200 mg/dose or 15-18 mg/kg; infuse slowly over 25-30
min not to exceed 50 mg/min
• Maintenance: 1-4 mg/min by continuous IV infusion
Renal Impairment
• Reduce loading dose to 12 mg/kg
• Reduce infusion to one third in moderate renal or cardiac impairment and
two thirds in severe renal or cardiac impairment
Hepatic Impairment
• Reduce dose by 50%
Antibiotics
• Aminoglycosides –group of chemically related antibiotics used for
treatment of infections with gram negative bacteria that are resistant
to less toxic antibiotics
Most commonly encounter:
-gentamicin
-tobramycin
-kanamycin
-vancomycin
Gentamicin
Usual Adult Dose for Bacterial Infection
• 1.5 to 2 mg/kg loading dose, followed by 1 to 1.7 mg/kg IV or IM
every 8 hours, or 5 to 7 mg/kg IV every 24 hours
• Duration of therapy: 7 to 21 days, depending on the nature and
severity of the infection

Note : Limiting the duration of gentamicin therapy may help limit

toxicity. Once the patient is stable for at least 48 hours, less toxic IV or
oral antibiotic therapy may be considered according to microbiology
sensitivity data.
Usual Pediatric Dose for Bacterial Infection

• 0 to 4 weeks, birthweight <1200 g: 2.5 mg/kg IV or IM every 18 to 24

hours
• 0 to 1 week, birthweight >=1200 g: 2.5 mg/kg IV or IM every 12 hours
• 1 to 4 weeks, birthweight 1200 to 2000 g: 2.5 mg/kg IV or IM every 8
to 12 hours
• 1 to 4 weeks, birthweight >=2000 g: 2.5 mg/kg IV or IM every 8 hours

• >1 month: 1 to 2.5 mg/kg IV or IM every 8 hours

Tobramycin
Usual Adult Dose for Bacteremia
• Serious infections: 1 mg/kg IV or IM every 8 hours
• Life-threatening infections: Up to 5 mg/kg/day may be administered IV or
IM in 3 or 4 equal doses; however, the dosage should be reduced to 3
mg/kg/day as soon as clinically indicated.

Note: To prevent increased toxicity due to excessive blood levels, dosage

should not exceed 5 mg/kg/day unless serum levels are monitored.
-Limiting the duration of tobramycin therapy may help limit toxicity; once
patient is stable for at least 48 hours, less toxic IV or oral antibiotic therapy
may be considered according to microbiology sensitivity data.
Some experts recommend:
• Extended-interval dosing: 4 to 7 mg/kg IV every 24 hours

Note: A loading dose of 1.5 to 2 mg/kg has been recommended.

Kanamycin
Usual Adult Dose for Bacterial Infection
• Parenteral: 15 mg/kg/day IM or IV in divided doses every 8 to 12 hours
• Duration: 7 to 10 days

• Aerosol: 250 mg in 3 mL normal saline via nebulizer 2 to 4 times daily.

• Irrigation: Kanamycin 2.5 mg/mL has been used for the irrigation of peritoneal
and ventricular cavities, abscess cavities, and pleural space.

• Maximum dose: The maximum recommended dose by all routes is 1.5 g/day.
Serum levels should be monitored during treatment. Peak concentrations >35
mcg/mL and trough levels >10 mcg/mL should be avoided.
Usual Pediatric Dose for Bacterial Infection
• <7 days:
• <2 kg: 15 mg/kg/day in divided doses every 12 hours.
• >=2 kg: 15 to 20 mg/kg/day in divided doses every 12 hours.

• >=7 days:
• <2 kg: 15 to 22.5 mg/kg/day in divided doses every 8 hours.
• >=2 kg: 15 to 30 mg/kg/day in divided doses every 8 hours.

• >=1 month: 15 to 30 mg/kg/day in divided doses every 8 to 12 hours.

Vancomycin
Usual Adult Dose for Bacterial Infection
• 500 mg IV every 6 hours OR 1 g IV every 12 hours

Note: This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is
longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use:
• -Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of
methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to
respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms
that are resistant to other drugs

Infectious Diseases Society of America (IDSA) Recommendations:

• 15 mg/kg IV every 12 hours
Antiepileptic drugs

-AEDs make the brain less likely to have seizures by altering and
reducing the excessive electrical activity (or excitability) of the
neurones that normally cause a seizure.
• Phenobarbital

Usual Adult Dose for Seizures

Acute Convulsions
Parenteral:20 to 320 mg IM or IV every 6 hours as necessary

Anticonvulsant:
Oral:60 to 200 mg orally per day

Uses: Treatment of generalized and partial seizures;

treatment/prophylaxis of febrile seizures
Usual Pediatric Dose for Seizures
Anticonvulsant:
Oral:
-Initial dose: 15 to 20 mg/kg orally
-Recommended dose: 3 to 6 mg/kg orally

Parenteral:
4 to 6 mg/kg/day for 7 to 10 days or 5 to 15 mg/kg/day IM or IV

Status epilepticus:
Parenteral:Initial dose: 15 to 20 mg/kg IV over 10 to 15 minutes
• Phenytoin
Usual Adult Dose for Seizures:
Oral (except suspension) Loading dose: Only when indicated for inpatients.
1 g orally divided in 3 doses (400 mg, 300 mg, 300 mg) given at 2 hour intervals.
Then normal maintenance dosage started 24 hours after loading dose.

Initial dose: 100 mg extended release orally 3 times a day.

Maintenance dose: 100 mg orally 3 to 4 times a day. If seizure control is established
with divided doses of three 100 mg capsules daily, once-a-day dosage with 300 mg
of extended release phenytoin sodium may be considered. Alternatively, the dosage
may need to be increased up to 200 mg orally 3 times a day, if necessary.
Suspension: Patients who have received no previous treatment may be started on
125 mg (one teaspoonful) of the suspension three times daily, and the dose is then
adjusted to suit individual requirements. An increase to five teaspoonfuls daily may
be made, if necessary.
IV: Do not exceed the infusion rate of 50 mg/min.
Loading dose: 10 to 15 mg/kg IV slowly.
Maintenance dose: 100 mg IV every 6 to 8 hours.
IM: Avoid the IM route due to erratic absorption.
Psychoactive Drugs
-is a chemical substance that acts primarily upon the central
nervous system where it alters brain function, resulting in temporary
changes in perception, mood, consciousness and behavior.
Lithium
Usual Adult Dose for Bipolar Disorder

Acute Control: 1800 mg/day

-Regular release formulations: 600 mg orally 2 to 3 times a day
-Extended release formulations: 900 mg orally 2 times a day

Long-term Control: 900 to 1200 mg/day

-Regular release formulations: 300 to 600 mg orally 2 to 3 times a day
-Extended release formulations: 600 mg orally 2 times a day
Note:Regular release formulations should be given in the morning,
afternoon, and nighttime (2 times a day dosing) or in the morning and
at nighttime (2 times a day dosing).
-Extended release formulations should be given in the morning and at
nighttime.
-Dosing must be individualized according to serum levels and the
response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a
day (acute control) and 300 mg 3 to 4 times a day (long-term control).
Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder
• Clozapine
Usual Adult Dose for Schizophrenia
Initial dose: 12.5 mg orally once or twice a day
Titration and Maintenance dose: May increase total daily dose in
increments of 25 mg to 50 mg per day to a target dose of 300 mg
to 450 mg per day (administered in divided doses) by the end of
week 2. Subsequent dose increases can be in increments of up to
100 mg once or twice weekly.

Maximum dose: 900 mg per day

Uses:
-For the treatment of severely ill patients with schizophrenia who fail to
respond adequately to standard antipsychotic treatment
-To reduce the risk of recurrent suicidal behavior in patients with
schizophrenia or schizoaffective disorder, who are judged to be at
chronic risk for re-experiencing suicidal behavior, based on history and
recent clinical state.

• Olanzapine
Fasting IM injection:A dose of 2.5 to 10 mg per injection.
Immunosupressive Drugs
-are a class of drugs that suppress, or reduce, the strength of the
body's immune system. Some of these drugs are used to make the
body less likely to reject a transplanted organ, such as a liver, heart, or
kidney. These drugs are called anti-rejection drugs
-Immunosuppression may result from certain diseases, such as
AIDS or lymphoma, or from certain drugs, such as some of those used
to treat cancer.Immunosuppression may also be deliberately induced
with drugs, as in preparation for bone marrow or other organ
transplantation, to prevent the rejection of a transplant.
• Cyclosporine

Usual Adult Dose for Organ Transplant - Rejection Prophylaxis

ORAL FORMULATION (MODIFIED):
-Note: The dose is dependent upon type of transplant and formulation; refer
to local protocol for specific dosing.
-Initial dose: Give 4 to 12 hours prior to transplantation or postoperatively;
the initial dose varies depending on the organ and concomitant
immunosuppressives.
NEWLY TRANSPLANTED PATIENTS:
-Renal: 9 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
-Liver: 8 mg/kg/day (plus or minus 4 mg/kg/day) orally in 2 divided doses
-Heart: 7 mg/kg/day (plus or minus 3 mg/kg/day) orally in 2 divided doses
• Tacrolimus
Usual Adult Dose for Organ Transplant - Rejection Prophylaxis
KIDNEY TRANSPLANT:
IMMEDIATE RELEASE:
-In combination with azathioprine: Initial dose: 0.1 mg/kg orally every
12 hours. Initiate within 24 hours of surgery, but delay until renal
function has recovered.
-In combination with mycophenolate mofetil (MMF)/interleukin-2 (IL-2)
receptor antagonist: Initial dose: 0.05 mg/kg orally every 12 hours.
Initiate within 24 hours of surgery, but delay until renal function has
recovered.
• Mycophenolic Acid
Usual Adult Dose for Organ Transplant - Rejection Prophylaxis
720 mg orally 2 times daily

Note: This drug should be used in combination with cyclosporine and

corticosteroids.
-Take on an empty stomach 1 hour before or 2 hours after food.
-Swallow tablets whole; do not crush, chew, or divide.

Use: For prophylaxis of organ rejection in kidney transplant

Antineoplastics
-drugs that control or kill neoplastic cells, used in chemotherapy
to kill cancer cells, all have unpleasant side effects that may include
nausea and vomiting and hair loss and suppression of bone marrow
function.(e.g. methotrexate)