Dose

Calculation
BY
Dr Santhi Lakshmi
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.

Factors influencing dose of a drug:

Patient factors: Age, weight, body surface area
Drug factors:- Chemical nature of the drug,
pharmacokinetic properties
 S.N
Doses are expressed in following ways:-
Dosage form Dose expression

1 Solid: Tablet / Capsule gm/ mg/ μg/ per kg/day

2 Liquid: ml /day
Suspension/emulsion

3 Aerosol Puff / day (e.g. salbutamol),

1 puff = 50 μg

4 Parenteral injection I.U./ μg / mg/ gm / kg/ day

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 Milliliter (ml).
Biological preparations (ex. Insulin) in I.U.
(International Units).
For paediatric patients: Two methods are currently
used for calculating paediatric doses based on:
Body weight- e.g. mg /kg /dose OR mg/kg/day in
divided doses.
Body surface area (square meter).
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.
Dosage calculation based on body weight:
Example: 1

Metronidazole is prescribed for a child weighing 10 kg,

suffering from acute amoebiasis. The dose for
metronidazole is 50 mg/kg/day in 3 divided doses.
Calculate the total dose required?

The dose required will be:

 Child weight =10 Kg, Dose = 50mg/kg/day.

 Required dose =50 x10 = 500 mg/day.

Dosage calculation based on body surface area
(BSA):
BSA method is a more reliable method for paediatric
dose calculation than that based on body weight.
By referring to the table given below, body surface area
(square meter) and the approximate percentage of
adult dose can be obtained if the weight of the child is
known. Average body surface area of an adult is
considered 1.73 sq.m.
Determination of children’s doses from adult doses on the basis of body surface area

Weight (kg) Approx. Surface area Approx. percentage of

in 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
** Based on average adult surface area of 1.73 sq. meters
For a child weighing 55 kg and above, adult dose can be
used.
In infants and children, the ratio of total body surface
area to body mass far exceeds that in adults. Moreover,
problems like immature drug metabolizing enzymes
and renal functions can alter the hepatic and renal
clearance of drugs in this group. Hence, it is safer to
follow worked out dosage tables for neonates and
infants than to use formula based on body weight (or)
BSA.
EXAMPLE: 1
Metronidazole is prescribed for a child weighing 10 kg,
suffering from acute amoebiasis; Dose can be
calculated by using BSA method as follows:
For 10 kg body weight, BSA will be 0.46 square metre
(from the table). Therefore,
Dose =BSA of child x Daily dose for adult (mg.)
1.73
= 0.46 x 2400 = 638
1.73
Example: 2

Calculate the Dose using Young‫ﹸ‬s formula for a 11 year

old girl child weighing 11 kg & suffering from sore
throat with high grade fever. The patient is prescribed
azithromycin. Adult dose of azithromycin is 500 mg
once a day.
Young’s Rule :

Formula:
Child’s Dose = Age of child in years x average adult dose
(Age of child+12)
Child’s weight= 11kg Child’s age = 11 yrs
Child’s dose = 11/ (11+12) X 500
Child’s Dose = 11 x 500 mg
23
 Child’s Dose = 240 mg
Clark’s Rule:
Formula:
Child’s Dose = Adult Dose x Weight (lbs)
150
Note: Clark’s Rule uses Weight in lbs, NOT in kg.
Certain drugs like aminoglycoside, antibiotics,
carbenicillin, vancomycin, digoxin, methotrexate etc are
eliminated primarily by renal route. In patients with renal
insufficiency, there is a decrease in clearance of such
drugs resulting in accumulation and increased likelihood
of toxicity. Hence, dosage schedules of these drugs may
require to be modified in patients with renal dysfunction
either by reduction of individual dose or by prolonging
the dosage interval. It is particularly important for drugs
with long half-life and narrow therapeutic index e.g.
Digoxin. This is done based on creatinine clearance.
Normal CLcr for a 70 kg. healthy adult male (1.73 sq.m.
BSA) is 100-120 ml/min.
For a female, normal creatinine clearance is
considered to be 85 % of healthy adult male.
Dose calculation in Renal
Dysfunction:
Creatinine clearance can be calculated by Cockroft
Gault’s formula as follow:

C CL in renal insufficiency in Male

= ( 140 - Age ) X Weight ( kg )
72 x S.Creatinine ( mg / ml )
C CL in renal insufficiency in Female

= ( 140 - Age ) * Weight ( kg ) X 0.85

72 X S. Creatinine ( mg / ml )
Dose calculation in renal impairment(Doseri)

Dose ri = Dose x CL ri (clearance in renal failure)

CL (normal clearance)
Where ri = renal insufficiency
CL = Clearance from whole body with normal renal
function. CLri = CL from whole body with impaired
renal function.
Dose = Maintenance dose with normal renal function
(CLcr=100 ml/min.approx.) The normal clearance and
clearance in renal impairment are calculated as follows:
CL total = CL renal + CL nonrenal
CLri = [CL renal x measured CLcr/100 ml/min.] + CL
nonrenal
Example: 3
Vancomycin is prescribed to a Kamalbhai 80-year-old
male patient weighting 70kg. His serum creatinine of
2mg/dl. Dose of Vancomycin is 500mg 6 hourly.
Creatinine clearance is 29.2 ml/min. Calculate the
dose required in this patient.
Dose ri= Dose x CL ri (clearance in renal failure)
CL(normal clearance)
CL (normal clearance)= 100

= 500 x 29.2
100
= 146 mg 6 hourly.
Dosage calculation in liver failure:
The rate of drug metabolism and the release of active
metabolites is primarily dependent on hepatic function.
Many drugs are eliminated entirely by hepatic
clearance. Hepatic elimination of drug is described as:
 High hepatic clearance which is blood flow limited
Examples: Propranolol, Lignocaine, Morphine,
Pethidine
 Low hepatic clearance- capacity limited & protein

binding sensitive. Examples: Phenytoin, Warfarin,

Digitoxin
 Low hepatic clearance- capacity limited & protein

binding insensitive. Examples: Paracetamol,

Cholramphenicol, thiopental sodium.
 Special considerations in dose determination for elderly patients:

Therapy is often initiated with a lower-than-usual adult

dose.
Dose adjustment may be required based on the
therapeutic response.
The dose may be determined, in part, on the patient’s
weight, body surface area, health and disease status like
liver and hepatic disease and pharmacokinetic factors.
Concomitant drug therapy may affect drug/dose
effectiveness
A drug’s dose may produce undesired adverse effects
and may affect patient compliance.
Assignment:

A child 12kg child is prescribed Inj.gentamicin sulfate(20

mg/ml), 2 ml to be injected I.M. eight hourly. The
maximum paediatric dose for gentamicin is 5 mg/kg in
three divided doses. Is the dose mentioned correct? If not,
what should be the correct dose?
Calculate the daily dose of amikacin for 75 years old obese
female obese patient weight 90 kg having with S.
creatinine 2.5 mg/dl suffering from renal parenchyma
disease.
Mention examples of drugs that are hepatotoxic.
Mention examples of drugs that are nephrotoxic.
1
Metronidazole is prescribed for a child weighing 10 kg,
suffering from acute amoebiasis; The dose for
metronidazole is 50 mg/kg/day in 3 divided doses.
Calculate the dose required per day?
Child weight =10 Kg, Dose = 50mg/kg/day.
Required dose =50 x10 = 500 mg/day.
Syrup Metronidazole 5mL 3 times daily.
2
Calculate the Dose using Youngُs formulas for a 11 year old girl child
weighing11 kg & suffering from sore throat with high grade fever. The patient
is prescribed azithromycin. Adult dose of azithromycin is 500 mg once a day.
Child’s weight= 11kg
Child’s age = 11 yrs
Young’s Rule : Age of child in years/ (Age of child+12) × Average adult
dose
Child’s dose = 11/ (11+12) X 500
Child’s Dose = 11 x 500 mg
23
Dose = 0.48 x 500 mg
Child’s Dose = 240 mg.
 
3
Vancomycin is prescribed to a Ram babu 80-year-old
male patient weighing 70kg. His serum creatinine of
2mg/dl. Dose of Vancomycin is 500mg 6 hourly.
Creatinine clearance is 29.2 ml/min. Calculate the
dose required in this patient.
Dose ri=Dose x CL ri (clearance in renal failure) / CL
(normal clearance)
 Dose ri = 500 x 29.2 / 100 = 146 mg 6 hourly.
4
Determine the creatinine clearance rate for an 60 year
old female patient weighing 55 kg and having serum
creatinine of 1mg/dl by using Cockcroft- Gault equation.
CrCl =( 140 – patient age in years) × body weight in kg ×
0.85
72× serum creatinine in mg/dl

= (140 – 60) × 55 × 0.85

72 × 1
= 51.94 ml/min.
5
Determine the creatinine clearance rate for an 70 year old male
weighing 80 kg and having serum creatinine of 3 mg/dl by
using Cockcroft- Gault equation.
CrCl = ( 140 – patient age in years) × body weight in kg

72× serum creatinine in mg/dl

(140 – 70)×80
=
72 × 3
= 25.92 ml/ min.
6
A renal failure male patient having 30 years age 70 kg weight
with serum creatinine 2 mg%. Calculate the dose and dosing
interval for him. Note that the normal dose of a drug is
200mg and normal dosing interval is 2 hours.
For males, ClCr
= (140 – patient age in years) × body weight in kg

72× serum creatinine in mg/dl

= ( 140-30) × 70 / 2 × 72
= 110 × 70 / 144
ClCr = 53.47.
Renal function (RF) = ClCr of patient / ClCr of normal person
= 53.47 / 120
RF= 0.445
Patient Dose = Normal dose × Renal function ( dosing interval is
constant)
= 200 × 0.445
= 89
Patient dose = 89 mg / for every 2 hours
Patient dosing interval = Normal dosing interval/ Renal function
= 2/ 0.445
= 4.494
Patient dosing interval = 200 mg every 4.494 hrs.
7
Drug x is excreting renally only in 0.3 fraction, patient RF value found
as 0.25, the normal dose of the drug is 500mg. Now calculate the dose
for the patient.

Renal excretion is 0.3 ( it is clear that drug is excreting non renally also)
Renal excretion + non renal excretion = 1
Non renal excretion = 1 – 0.3
= 0.7.
Patient dose = Normal dose ( RF × Fraction excreted in urine × Fraction
excreted Non renally)
= 500 ( 0.25 × 0.3 × 0.7)
= 500 ( 0.775)
Patient dose = 387.5 mg
8
If Propranolol normal dose is 150 mg, then calculate the dose for
hepatic failure patient found with serum albumin concentration
2.5g/ dl. (Normal albumin concentration is 4g/dl)

Patient in hepatic failure so dose adjustment is necessary.

Hepatic Function ( HF) = Patient albumin concentration

Normal albumin concentration

= 2.5 ÷ 4 (normal albumin concentration.)

HF = 0.625.
Patient dose = Normal dose × HF
= 150 × 0.625
= 93.75 mg.
9
Frusemide is available as 80mg/2 mL. It is prescribed to
administer 20mg i.v. bolus. What amount of frusemide should be
administered?
Given: Amount desired (D) = 20 mg
Amount on hand (H) = 80 mg
Quantity = 2mL
Formula: Volume required
= Dose x Volume of solution in ampoule
Amount of drug in ampoule
Volume = 20 mg x 2mL = 0.5 mL
80mg
It means administer 0.5 mL of Frusemide (80mg/2mL).
10
 A patient has been prescribed 2.5 litres of normal saline. The flow rate is set
at 200 mL/H. How much time will be required to complete the infusion?
 
Formula: Volume (mL) = rate (mL/h) x time (h)
We need to calculate Time required to complete the infusion.
From the above formula,
Time (h) = Volume (mL)
Rate (mL/h)
Convert the units of saline to mL by multiplying by 1000,
2.5 litre = 2.5 x 1000 = 2500 mL
Time (h) = 2500 mL
200mL/h
= 25/2 = 12.5 h
12.5 hours is required to complete the infusion.
11
 It has been prescribed to infuse 1 unit of blood ( 1 unit of blood = 350
mL) over 4 hours using a macro drip set. Calculate the rate of infusion
that is number of drops per minute.
Amount of blood = 350 mL
Time = 4 hour x 60 = 240 minutes.
 
Formula : Rate (mL/h) = Volume (mL)
Time (min)
= 350 mL = 1.45 mL / min
240 min
= 1.45 x 15 = 22 drops / min
( A macro drip set and blood administration set deliver 15 drops per minute,
while micro drop set about 60 drops per minute)
THANK YOU