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Posology and Dosage Regimen:

 Posology: (Derived from the Greek posos- how much,

Posology
and logos- science) is the branch of medicine/pharmacy
dealing with doses.

 “Posology is a branch of medical science which deals

with dose quantity of drug which can be administered to
a patient to get the desirable pharmacological action.”

 Dose: is the quantitative amount administered or taken

by a patient for the intended medicinal effect.

Factors Affecting Drug Dosage:

Various rules of dosage in which the pediatric dose was a
1) Age: fraction of the adult dose:

 Newborn Infants (Pediatric): 1. Young’s Rule, based on age:

 Sensitive to certain drugs because of the immature
state of their hepatic and renal function For calculating doses for children 12 years of age.
 Failure to detoxify and eliminate drugs results in
their accumulation in the tissues to a toxic level.
Age
 Elderly Patients (Geriatric): Dose for child = Adult dose x
Age + 12
 The decline in renal and hepatic function may slow
drug clearance and increases the possibility of drug
accumulation in the body and subsequent toxicity.
 Elderly individuals may also respond abnormally to the
usual amount of a drug because of age-related
alterations in target tissues and organs. 3 4

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2- Cowling’s Rule:
For calculating doses for children two years of age or
older. 4- Dilling’s Rule:
Dose for child = Adult dose x Age at next birthday (in years) For calculating doses for 4 to 20 yrs age.
Age + 12

Age (in yrs)

3- Fried’s Rule for Infants: Dose Required = Adult dose x
20
For calculating doses for infants younger than one year
of age.

Dose for infant = Adult dose x Age (in months)

150

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Rule Age Formula 2) Body Weight:

Adult Dose X  The official usual doses for drugs are considered
Young’s Rule 12 Yrs
(Age/Age+12) suitable for 70 kg (150 pounds) individuals.
Adult dose
Cowling’s Rule >2 Yrs X [Age at next birthday  The ratio between the amount of drug administered and
(in years)/24] the size of the body influences the drug concentration at
the site of action.
Fried’s Rule for Adult dose
Infants <1 Yr
Infants X (Age in months/150)  Therefore, drug dosage may require adjustment from
the usual adult dose for abnormally lean or obese
Adult dose X (Age in
Dilling’s Rule 2- 20 Yrs patients.
Yrs/20)

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3) Body Surface Area:

To calculate the dose of a drug for children based on
body weight:  A close relation exists between a large number of
physiological processes and body surface area (BSA).
 The determination of drug dosage for children on the
 Many physiological factors such as plasma volume,
basis of body weight is more dependable than that oxygen consumption, body electrolyte are
based on age. proportional to the surface area.

 Clark’s Rule:  The surface area used to calculate dose.

 Eg. Anticancer drug Methotrexate is administered on mg

Weight in pounds per sq.mm of body surface.
Dose for child = Adult dose x
150
 Average body surface area of a 70kg adult is 1.7 to 1.8
sq.meters

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 To calculate the dose of a drug for children based on body 4) Sex:

surface area as related to weight:
 Women are more susceptible to the effects of certain
 Many physicians believe that doses for children should be drugs than are men.
based upon body surface area, since the correct dosage
of drugs seems more proportional to the surface area.  On the basis of body weight female adults generally
requires smaller doses than males.

 Because % of adipose tissue is greater and % of

BSA of child (in m2) water is lower in adult females as compared to adult
Approximate dose = Adult x
for child dose 1.8 m2 (average adult BSA) males.

 Pregnant women and nursing mothers should use

If the dose per m2 is given, medications only with the advise and under the
guidance of their physician.
Approximate dose = Dose per m2 x BSA of child (in m2)
for child
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 Examples of drugs that are transported from the 5) Pathological State:

maternal to the fetal circulation e.g. alcohol, anesthetic
gases, barbiturates, anticoagulants, etc.  Because of pathological conditions like renal function
impairments or liver disease many drugs remain in the
body for longer period of time.
 Because of the undeveloped drug detoxification and
excretion mechanisms present in the fetus,  The effects of certain drugs may be modified by the
concentrations of drugs may reach a higher level in the pathological condition of the patient and must be
fetus than in the maternal circulation. considered in determining the dose.

 The transfer of drugs from the mother to the nursing  Warning and precautions are used in the drug labeling to
infant through human milk may occur with various drugs alert the physician to certain restrictions in the use of a
particular drug.
with the drug effects becoming manifest in the infant.

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Precaution:
 It is used to advise the prescriber of some possible
problems attendant with the use of the drug. It is less
restrictive than warning.
 Ex: The use of tetracycline antibiotic may result in Contraindication:
overgrowth of fungi.
 A term that used to indicate an absolute prohibition to
the use of a drug in the presence of certain stated
Warning:
conditions.
 It is used when the potential for patient harm is greater  It is the most restrictive of the warnings which limits
than in instances in which the precaution is used. the use of drugs.
 Ex: If tetracycline is used in the presence of renal
impairment, it may lead to accumulation of the drug and
possible liver toxicity.
 So, lower than usual doses are indicated.

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7) Time of Administration:
6) Route of Administration:  The time at which a drug is administered sometimes
influences dosage. This is specially true for oral therapy
 Drugs administered intravenously enter the blood stream in relation to meals.
directly and thus the full amount administered is present
in the blood.  Absorption proceeds more rapidly if the stomach and
upper portions of the intestinal tract are free of food,
 In contrast, drugs administered orally are rarely fully and an amount of a drug that is effective when taken
before a meal may be ineffective if administered during
absorbed due to the various physical, chemical and or after eating.
biologic barriers to their absorption, including interactions
with the gastric and intestinal contents.  Gastric emptying rate affect dose.

 Thus, a lesser parenteral dose of a drug is required than  Irritating drugs are better tolerated by the patient if
the oral dose to achieve the same blood levels of drug. food is present in the stomach to dilute the drug’s
concentration.

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8) Frequency of Administration: 9) Additive Effect:

 Drugs having short half-life gets rapidly excreted from
the body.  Total pharmacological action of 2 or more drugs
administered together is equivalent to the sum of their
 In such case, to maintain steady state plasma individual pharmacological action.
concentration it requires frequent dosing.
 Ex. Combination of Ephedrine and Aminophylline for the
 Hence controlled or sustained release formulations are treatment of bronchial asthma.
developed.

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10) Synergism: 11) Antagonism:

 When 2 or more drugs used in combination, then total  The action of one drug is opposed by the other drug on same
physiological system
pharmacological action is the combination is increased.
 This phenomenon is generally applied in the treatment of
 It is useful when desired therapeutic result needed is poisoning.
difficult to achieve with a single drug.
 Ex. Milk of magnesia is given in acid poisoning
 Ex. Procaine and Adrenaline combination increases the
duration of action of Procaine.  Ex. Adrenaline – Vasoconstrictor

Acetylcholine – Vasodilator

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12) Tolerance:
 The ability to endure the influence of a drug,
particularly when acquired by a continued use of the  The development of tolerance can be minimized by:
substance.
 Tolerance occurs commonly in such drugs.  Initiating therapy with the lowest effective dose.
 e.g. Anti-histaminics, Narcotic Analgesics.  Avoiding prolonged administration.
 Drug tolerance: When usually large dose of drug is  Eg. Smokers can tolerate more nicotine.
required to elicit a normal pharmacological action is
knows as Tolerance.
 Alcoholics can tolerate more alcohol .
 Types of Tolerance:
 True tolerance: Produced by oral and parenteral
administration of drugs.
 Pseudo tolerance: Produced only to the oral route of
administration. 23 24

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14) Idiosyncrasy & Hypersensitivity:

13) Elimination of Drug:  Idiosyncrasy is defined as “Genetically determined
abnormal or unusual response to a drug.”
 Body considers drugs as foreign substances and
continuously works at eliminating them.  Hypersensitivity or drug allergy is an adverse to
particular chemical resulting from a previous exposure to
 Hydrophilic Drug: Easily eliminated the substance, occurring in only a small fraction of all
people receiving the particular drug.
 Hydrophobic drug: Dissolved in fat & lipoidal
membrane  eg. Skin rashes, edema, anaphylactic shock, broncho-
spasm etc.
 Hence doses of hydrophilic drug requires more than that
of hydrophobic drugs.  eg. Sometimes small quantity of Aspirin causes gastric
hemorrhage and Quinine causes ringing sensation in
ears.
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Question Bank
15) Tachyphylaxis:
2 Marks
 When certain drugs are administered repeatedly at
• Define posology & state Dilling's formula for calculating doses
short interval, the cell response get blocked &
for children.
pharmacological response to that particular drug is
decreased. • Give Clark’s and Young’s formula for the calculation of doses.
• Give Young’s and Dilling’s formula for the calculation of doses.
 The decreased response can not be reversed by
5 Marks
increasing dose.
• Short Note: Posology
 Eg. Ephedrine in treatment of bronchial asthma at short 10 Marks
intervals may produce very less response due to
• Define posology and discuss the factors affecting does of drug
tachyphylaxis.
& action of drug on human body.
• What do you mean by dose? Explain the factors affecting
27 doses and action of drug on the human body. 28