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| BSA (m2) | Loading dose day 1 | Maintenance dose—starting on day 2 |
|---|---|---|
| 0.4 to 0.59 | 100mg | 50mg daily five days per week |
| 0.6 to 0.79 | 100mg | 50mg daily |
| 0.8 to 1.2 | 100mg BID | 50mg daily alternating with 100mg daily |
| 1.21 to 1.6 | 150mg BID | 100mg daily |
| > 1.6 | 150mg BID | 100mg daily alternating with 150mg daily |
