Drug Dosing Issues and Resources

One challenge in arriving at the therapeutic dosage for a medication is the need to adjust to levels of organ function. Automated dosage checking converts a string of inputs such as amount, unit, frequency, etc. which can be compared to defined ranges which are based on age, weight, and other parameters. In the absence of specific information (such as creatinine clearance) the system generally defaults to a range which corresponds to normal organ function. Although a pediatric dosage calculator or pediatric dosage chart may be used in the original dose estimation, organ function cannot be assumed to be normal. Automated checking prior to dose administration should prompt the user to evaluate these factors. Ideally, pediatric dose calculations are modified by indicators of organ function. Hepatic function, in particular, is difficult to estimate objectively. Synthetic activity, detoxification, and genetic factors are important parameters to evaluate. Dosage precautions which are embedded into EMR applications (dose range checking, dosing advice) facilitate the appropriate adjustment of dose based on these parameters. Periodic review of medicine lists may permit the identification of therapies which were initiated at unadjusted dosages. Medicine interactions may also be reviewed in light of changes in organ function changes to ensure medication safety.