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Five Accepted BSA Formulas, and They Disagree by 4% on a Large Patient

They agree closely on an average build and diverge at the extremes, because most were fitted on small samples of average people.

BSA

 

Spread between formulas

Dose

Dose range across formulas

Every formula

Working

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How the calculation works

Four formulas, two bodies 175 cm, 70 kg — they agree within 0.50% Mosteller1.8447 Du Bois1.8481 Haycock1.8468 Gehan1.8539 185 cm, 120 kg — they disagree by 4.27% Du Bois2.4195 Haycock2.5227

How to Use This Tool

Enter height and weight. Every formula is shown, because the disagreement between them is the useful output.

Why surface area rather than weight

Metabolic rate, cardiac output, blood volume and glomerular filtration all scale more closely with surface area than with mass. So for a small number of drugs — most visibly cytotoxic chemotherapy — the dose is prescribed per square metre.

The convention is old and imperfect. It was adopted partly because it seemed more physiological than weight and partly because it happened to work in early trials, and there is a long-running argument in pharmacology about how much variation in drug exposure it actually removes. It remains standard practice for particular agents.

Which formula

  • Mosteller (1987) — √(height × weight ÷ 3600). The usual default, mainly because it can be checked mentally and agrees closely with the others in the normal range.
  • Du Bois and Du Bois (1916) — still widely used and fitted on nine subjects, none of them obese. It is known to underestimate at high body mass.
  • Haycock (1978) — developed with children in the sample, so often preferred in paediatrics.
  • Gehan and George (1970) — fitted on a much larger dataset.
  • Boyd (1935) — the most complex, with a weight-dependent exponent.

For 175 cm and 70 kg they land between 1.8447 and 1.8539 — a spread of half a per cent, which is clinically irrelevant. For 185 cm and 120 kg they range from 2.4195 to 2.5227, a spread of 4.27%, and at 350 mg/m² that is 36 mg of difference produced by nothing but the choice of equation.

185 cm, 120 kg at 350 mg/m² BSA 2.483 869 mg capped at 2.0 700 mg — 19.5% less Capping is a real policy in some protocols and absent from others.
Whether to cap is a clinical decision with published arguments on both sides.

The 2 m² cap

Some protocols cap calculated BSA at 2.0 m² regardless of the patient, historically out of concern that dosing a large patient on true BSA would produce excessive toxicity.

The practice is contested. Capping reduces the dose by 19.5% for a patient calculated at 2.483 m², and several bodies now advise against automatic capping for many regimens on the grounds that it under-treats. Whether it applies is set by the protocol, not by the arithmetic, which is why it is a checkbox here rather than a default.

Read this as arithmetic, not as a dose

This page multiplies two numbers you typed. It knows nothing about renal or hepatic function, prior toxicity, age, performance status, drug interactions, the specific protocol, or whether BSA is even the right basis for the agent in question — several are dosed by weight, by a flat amount, or by target AUC instead.

Dose calculations in practice are performed and independently checked by clinicians against a specific protocol. Use this to understand where the numbers come from, and never as a source for a dose. This is general information, not medical advice.

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Frequently Asked Questions

What is the Mosteller formula for BSA?
The square root of height in centimetres times weight in kilograms, divided by 3600. For 175 cm and 70 kg that gives 1.8447 m². Its main advantage is that it can be checked without a calculator.
Which BSA formula is most accurate?
None is authoritative — they are all regressions fitted to different samples. Mosteller is the common default, Haycock is often preferred in paediatrics, and Du Bois underestimates at high body mass because its 1916 sample of nine people included no obese subjects.
How much do BSA formulas disagree?
Very little on an average build and considerably at the extremes. For 175 cm and 70 kg the spread is 0.50%; for 185 cm and 120 kg it is 4.27%, which at 350 mg/m² is 36 mg of difference from the choice of equation alone.
Why are some drugs dosed by body surface area?
Because metabolic rate, cardiac output and renal clearance scale more closely with surface area than with mass. The convention is long-standing and imperfect, and how much variation in drug exposure it actually removes is still debated.
Should BSA be capped at 2 square metres?
It depends entirely on the protocol. Capping a patient calculated at 2.483 m² cuts the dose by 19.5%, and several bodies now advise against automatic capping for many regimens because it under-treats. It is a clinical decision rather than an arithmetic one.
Can I use this to work out a dose?
No. This multiplies two numbers you typed and knows nothing about renal function, prior toxicity, the specific protocol, or whether the drug is even dosed by BSA. Real dose calculations are performed and independently checked by clinicians. This is general information, not medical advice.

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