EXAMPLE: A 70-yr old male weighing 95lb is 5ft tall and has a serum creatinine of 1.1mg/dL.

He is
admitted to the hospital complaining of shortness of breath; he denies chest pain. Digoxin is prescribed
for him. You are asked to design a dosage regimen using tablets for him to achieve and maintain a C
target ss of 1ng/mL.

The pharmacokinetic (PK) parameters for digoxin are as follows:

CL= 2.7mL/min/Kg (total body weight, or TBW);
fe= 0.68
Vss 6.7 L/Kg
F of tablet is 0.75

STEPS EQUATION
I. Creatinine Clearance Cockcroft-Gault Equation = (140 – age) x IBW x 0.85 (if female)
72 x SCr

Patient’s weight is 95 lbs or 43kg , height is 5ft

IBW for male = 50 Kg + 2.3 kg for every inch over 5 ft
= 43kg

= (140-70 y/o) x 43kg

72 x 1.1mg/dL
= 38ml/minute Crea clearance of patient

II. Q factor
Creatinine clearance = CrCl of patient
CrCl of normal renal

= 38ml/min
120ml/min
= 0.32
III. Total clearance of
patient Cltotal = Clearance of patient (1-Fe(1-Q)

Clearance = ml/min
Clearance of patient = ( 2.7ml/min/kg ) x 43kg
= 116.1ml/min

= Clearance of patient (1-Fe(1-Q)

= 116.1ml/min (1-0.68 (1-0.32)
= 62.4 ml/min

IV. Dose Rate Dose = Conctarget x Cltotal

F
= 1ng/mL x 62.4 ml/min
0.75
 = 83.22ng/min ~ 4993.22ng/hour ~ 0.00499322mg/hour

V. Dosing Interval By estimating the half life

t ½ = 0.693 x V inL
Cltotal

*Vss = 6.7L/kg = 6.7L /kg x 43kg =288.1L ~ 288,100mL

= 0.693 x 288,100 mL
62.4ml/min
= 3199.57 min ~ 53.32 hours or 54 hours

= 0.00499322mg/hour x 54 hours = 0.2696mg/54 hours

However Digoxin is normally administered every 24 hours. It could be administered as 0.250mg every
48 hours (t=48h).