Special Dosage Regimens
Geriatric and pediatric patients require special consideration when designing dosage regimens. In geriatric patients, the organs are often not functioning efficiently as a result of age-related pharmacokinetic changes or disease. For these patients, modifications in dosing regimens are available in references such as
USP Drug Information.
For pediatric patients, where organs are often not fully developed and functioning, careful consideration must be applied during dosing. Modifications in dosing regimens for pediatric patients are also available in references such as USP Drug Information. General rules for calculating doses for infants and children are available in pharmacy calculation textbooks. These rules are not drug-specific and should be used only in the absence of more complete information.
The usual method for calculating a dose for children is to use the information provided for children for the specific drug. The dose is frequently expressed as mg of drug per kg of body weight for a 24-hour period, and is then usually given in divided portions.
The calculation may be made using the following equation:
(mg of drug per kg of body weight ) × (kg of body weight) = dose for an individual for a 24-hour period
A less frequently used method of calculating the dose is based on the surface area of the individual's body. The dose is expressed as amount of drug per body surface area in m2, as shown in the equation below:
(amount of drug per m2 of body surface area) × (body surface area in m2) = dose for an individual for a 24-hour period
The body surface area (BSA) may be determined from nomograms relating height and weight in dosage handbooks. The BSA for adult and pediatric patients may also be determined using the following equations:
BSA (m2) = square root of {[Height (in) × Weight (lb)] / 3131}
BSA (m2) = square root of {[Height (cm) × Weight (kg)]/ 3600}
Rx for Spironolactone Suspension 25 mg/tsp. Sig: 9 mg BID for an 18 month-old child who weighs 22 lbs.
The USP DI 2002, 22nd ed., states that the normal pediatric dosing regimen for Spironolactone is 1 to 3 mg per kg per day. In this case, the weight of the child is 22 lbs, which equals 22 lbs/(2.2 lbs/kg) = 10 kg. Therefore the normal dose for this child is 10 to 30 mg per day and the dose ordered is 18 mg per day as a single dose or divided into 2 to 4 doses. The dose is acceptable based on published dosing guidelines.