Drug Dosing Calculator
Renal adjustment, weight-based dosing, and TDM tools
Patient Parameters
CrCl (Cockcroft-Gault)
75 mL/min
IBW
68 kg
BMI
24.3
Vancomycin AUC/MIC Calculator
Estimated AUC₀₋₂₄ (ASHP 2020 target: 400–600)
2679 mg·h/L
Supra-therapeutic — reduce dose
Heparin Protocol (Weight-based)
Loading bolus (80 units/kg)5760 units IV
Infusion rate (18 units/kg/h)1296 units/h
Therapeutic aPTT target60–100 seconds
First aPTT check6 hours after initiation
Renal Dose Adjustments
| Drug | Normal Dose | CrCl 30–60 | CrCl < 30 | HD |
|---|---|---|---|---|
| Metformin | 500–1000 mg BD | 500 mg BD — monitor | Contraindicated | Stop |
| Gentamicin | 5 mg/kg/24h | Q36–48h | Q48–72h | Post-HD supplement |
| Enoxaparin | 1 mg/kg BD | 1 mg/kg daily | 0.5 mg/kg daily | Use UFH |
| Gabapentin | 300 mg TDS | 300 mg BD | 300 mg OD | Post-HD: 200 mg |
| Allopurinol | 300 mg/day | 200 mg/day | 100 mg/day | 100 mg post-HD |
Current patient CrCl: 75 mL/min
Inotrope / Vasopressor Dosing
| Drug | Starting Dose | Therapeutic Range | Max |
|---|---|---|---|
| Noradrenaline | 0.01–0.05 | 0.05–0.3 | 2.0 mcg/kg/min |
| Adrenaline | 0.01–0.05 | 0.05–1.0 | 2.0 mcg/kg/min |
| Dobutamine | 2.5–5 | 5–20 | 40 mcg/kg/min |
| Dopamine | 2–5 (renal) | 5–20 | 50 mcg/kg/min |
| Vasopressin | 0.03 units/min | Fixed at 0.03 | 0.04 units/min |