Drug Doses: Department of Pharmacy Practice Faculty of Pharmacy - Universitas Airlangga SURABAYA - 2020

DRUG DOSES
Department of Pharmacy Practice

Faculty of Pharmacy – Universitas Airlangga
SURABAYA – 2020
Definition
• A dose is the quantity or amount of a drug or drug
formulation taken by or administered to a patient to
achieve a therapeutic outcome
Terms
• Single dose: a dosing that consists of one dose

– Mebendazole dose 100 mg every 6 months (Anthelmintic)
– One-time dose of Paracetamol 500 mg (Antipyretic analgesics)
• Daily dose: dose in a day
– Amoxicillin dose 1500 mg per day
• Daily divide dose: the dose of use in a day divided into
several times
– Metronidazole dose of 7.5 mg/kg of body weight per day given
in four times
Terms
• Dosage regimen: the schedule of doses of a drug per
unit of time
– The dose of Cefadroxil is given in a dose of 500 mg every 12
hours
• Usual/therapeutic/medicalis dose: the dose to achieve
the therapeutic effect of the drug  the usual dose
must be exceeded
– Antalgin dose 500 mg once
• Maximum dose: the highest dose that is safe for the
patient
– Benzidamine-HCl 36 mg daily
Terms
• Initial/loading dose: initial dose of medication to
accelerate the attainment of the minimum effective level
– Dose of Ampisilin 1000 mg
• Maintenance dose: the amount of a medication
administered to maintain a desired level of the
medication in the blood
– Dose of Ampisilin 500 mg
• Toxic dose: doses that exceed the maximum dose and
cause poisoning
• Lethal dose: quantity of an agent that will or may be
sufficient to cause death
Terms
Factors affecting dose
• Drug:
– Physical characteristic: solubility, partition coefficient
– Chemical characteristic: pH, pKa, acids, bases, salts
– Therapeutic index
– Toxicity
• Routes of use: oral, topical, parenteral, rectal
• Patient:
– Age, weight
– Gender
– Obesity
– Certain pathophysiological conditions
Pediatric dose
Problems in circumstances :
– Premature
– New born organs are not yet perfect
– Baby
liver, kidneys, CNS, body fluids
• The liver system is not yet perfect

• Glomerular filtration in the kidneys is not yet perfect
• Coordination of the Central Nervous System & Autonomous
Nervous System is not yet perfect
• Children <1 year old need water 4-6 x adult per unit body weight
Pediatric dose
Factors that cause different responses:
1. ADME pattern
• Difference in absorption  relative difference in cell density
• Difference in distribution  percentage of extracellular fluid & total
body fluid are relatively higher
• Difference in metabolism  enzymatic processes are not yet perfect
• Difference in excretion  the glomerulus and tubules in the kidney
are not yet complete
2. Differences in intrinsic sensitivity of receptors to drugs
3. Endogenous cell redistribution
Pediatric dose
Determination:
1. Comparison of the adult dose
• Age comparison
Adult: 20 – 24 tahun  not appropriate
• Weight comparison
Adult: 70 kg
• Body surface area comparison
Adult: 1,73 m2
• Individual physical size
• Child weight in kg
• Child's body surface area in m2
Calculation For Child's Dose
AGE
WEIGHT
BODY SURFACE AREA (BSA)
Pediatric dose
Determination:
Pediatric dose
Attention:
• Age comparison is actually not quite right same
age, different weight or BSA
• Weight comparison children and adults do not apply
to all drugs
– Narcotics  child’s dose < adult dose
– Phenobarbital, atropine  child’s dose > adult dose
• Calculation of the physical size of the individual child
is more precise, but accurate calculation of the BSA is
difficult to do.
Geriatric dose
• Geriatrics: age > 60 years
• Problems:
– Physiological & pathophysiological changes
– Pattern change of LADME
– Drug concentration changes in the body

Geriatric dose
Liberation
• HCl secretion decreases  the dissolution rate of the drug
decreases
Absorption
• GI mucosal changes  the absorption process is reduced
• Gastric emptying rate decreases
• Decreased intestinal motility
• Mesenteric blood flow decreases
Geriatric dose
Distribution
• The total body fluid decreases  the volume of distribution
of body fluids decreases  The concentration of the drug in
the body increases
• The albumin level decreases  The free drug concentration
in the body increases
Metabolism
• Liver function has not changed much
• Slows down metabolism in certain drugs
Geriatric dose
Excretion
• Glomerular filtration rate < 0.66%
• Maximum transport for secretions < 0.62%
• The elimination process is slower

• t½ is longer
• The drug effect lasts longer
• In long term use there may occur accumulation

• Side effects increase
Geriatric dose
Attention:
• Reduce drug dose (50 - 80% of adult dose)
• Extend time interval
• The combination of both
Examples of drugs that are often given:

- Allopurinol
- Digoxin
- Aminoglycosides
- Piroxicam & its derivatives
Doses for obese patients
• Obesity: Weight > 20% ideal weight
• Calculation of BMI: Weight (kg) divided by height (m)²
– Pria > 27,8
– Wanita > 27,3
• Ideal weight (Ritschel):
(Height (cm) – 100) x 0,9 kg
• Problem:
– Drug solubility in fat
– Drug distribution in fatty tissue & body fluids
• Lipophilic drugs :
– The distribution of the drug in the body is large
– The half-life elimination increases
– Determination of doses based on real body weight
– Example: Benzodiazepines
• Lipophobic drugs :
– Determination of doses based on lean weight
– Example: Digitoxin, Streptomycin, Gentamicin
• Lean weight determination:
– Stage 1: determining body density
– Stage 2: calculating % fat
– Stage 3: calculating lean weight
Related:
– ASF = Abdominal Skinfold Thickness (mm)
– BSF = Back Skinfold Thickness (mm)
– DB = body density (g/ml)
The use of dtd in prescription
• If in R/ there is “dtd”  the drg. Abiyanto Nugroho
Jl. Merdeka no. 210 Surabaya
number of drugs listed is 031 – 5790512
SIP: 3456/IPDU/2018
intended for one unit of Surabaya, ..................
16/11/2020
preparation (pack/capsule)
R/ Spiramisin 250 mg
• The amount of drug to be Metronidazol 125 mg
m.f.l.a. caps. dtd No. XII
prepared is multiplied by the S 4 d d caps I
desired dosage number
• Make it easier to write doses
on a prescription
• Make it easier dosage
Nama : ......................................................
Ny. Hartati
calculations Usia : ……................... BB : ..................
Alamat : ......................................................
Tool for measuring drug doses
• Measuring spoon:
C = cochleare = 15 ml
cth = cochleare theae = 5 ml
Remember! There is no standard
measuring spoon at home
• Drug dropper:
1 ml = 20 drops of distilled water
at 20ºC
– Avoid using the number of drops if a
dropper is not available on the
packaging
Drg. Abiyanto
Jl. Merdeka 120 Surabaya
SIP.123/X/2018
---------------------------------------------------------------
Surabaya, 16 November 2020
R/ Paracetamol 400 mg
Codein 10 mg
Glucose qs.
m.f. pulv da in caps. dtd No. XII
s 4 dd caps I
Pro. Tn Ari.
Calculate:
- Single use and daily dose of each drug!
Drg. Abiyanto
Jl. Merdeka120 Surabaya
SIP.123/X/2018
---------------------------------------------------------------
Surabaya, 16 November 2020
R/ Theophyllin 4
Propilenglikol 2
Syr. simpleks 20
Aqua ad 100 ml
m.f. sol
s. 3.dd.Cth. I
Calculate:
- Single use and daily dose of theophyllin!
Example of amoxicillin doses in Martindale 36

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DRUG DOSES

Department of Pharmacy Practice

• Single dose: a dosing that consists of one dose

• The liver system is not yet perfect

– Pattern change of LADME

– Drug concentration changes in the body

• The elimination process is slower

• In long term use there may occur accumulation

Examples of drugs that are often given:

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