Mannitol B.P 20 g/100 mL

(Sterile, Pyrogen Free)

Indication

Mannitol Infusion is indicated for the promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established; widely used in the management of raised intracranial pressure (ICP) and brain mass, for renal protection in ...read more

It is diagnostically used in the measurement of glomerular filtration rate.

Dosage and Administration

Administer intravenous at 30 to 37°C (86 to 98.6°F).

Cerebral Oedema:

Adult: 0.25 - 2 g/kg, repeated if necessary, to be administered over 30 - 60 minutes, dose may be repeated 1 - 2 times after 4 - 8 hours. Raised Intra-cranial Pressure:

Adult: 0.25 - 2 g/kg, repeated if necessary, to be administered over 30 - 60 minutes, dose may be repeated 1 - 2 times after 4 - 8 hours.

Each 100 mL contains:

Mannitol B.P ... 20 g

Water for Injection B.P ... q.s.

Description

Mannitol, a carbohydrate, is confined to the extracellular compartment. It causes fluid to pass from the intracellular to the extracellular compartment. Mannitol most extensively employed as osmotic diuretic. Chemically it is D-enantiomer. Its molecular formula is C6H14O6 and molecular weight is 182...read more

Clinical Pharmacology

Mechanism of Action

Systemically, parenteral mannitol elevates blood osmolarlity, which increases the osmotic gradient between blood and tissues, thereby facilitating the flow of fluid out of tissues, including the brain and eye, and into the interstitial fluid and blood. This activity reduces cerebral edema, intracran...read more

Pharmacokinetics

Absorption: Only the small amounts of mannitol are absorbed from the GI tract. Following intravenous injection, mannitol is excreted rapidly by the kidneys before any very significant metabolism can take place in the liver. Mannitol does not cross blood brain barrier or penetrate the eye. The amount...read more

Metabolism: When administered intravenously mannitol (mannitol injection) is confined to the extracellular space, only slightly metabolized and rapidly excreted by the kidneys approximately 80% of a 100g dose appears in the urine in 3 hours. The drug is freely filtered by the glomeruli with less tha...read more

Contraindication

Well established anuria due to severe renal disease.

Severe pulmonary congestion or frank pulmonary edema.

Active intracranial bleeding except during craniotomy.

Severe dehydration.

Progressive renal damage or dysfunction after institution of mannitol therapy, including increasing oliguria and azotemia.

Progressive heart failure or pulmonary congestion after institution of mannitol therapy.

Do not administer to patients with a known hypersensitivity.

Warning and Precaution

If crystals form visually on the bag, warm with overwrap intact and agitate to dissolve. Do not use if bag leakage is found and solution is not clear. Must not be used in series connections.

Renal Function: Mannitol when given IV is excreted in glomerular filtrate rapidly. It increases renal blood flow and glomerular hydrostatic pressure at afferent arteriole. Because of the rapidity of its excretion it exceeds the reabsorption capacity of the tubule and excess appears in the urine acco...read more

Cardiovascular Function: Cardiovascular status should also be evaluated; do not administer electrolyte-free mannitol solutions with blood. Tell your doctor if you suffer from abnormal fluid retention in your body cells (called oedematous conditions) associated with reduced heart function. Mannitol i...read more

Surgery: Neurosurgical patients receiving intravenous mannitol should be monitored for increased cerebral blood flow.

Elderly: Elderly patients are more likely to be affected by the side effects associated with mannitol. This is due to diminished kidney function and heart capacity. You should therefore be given a test dose as described below for patients with any kidney impairment. Hypersensitivity: Anaphylatic/ an...read more

CNS Toxicity: This toxicity may result from high serum mannitol concentrations: Serum hyperosmolarity resulting in intracellular dehydration within the CNS. Hyponatraemia or other disturbances of electrolyte and acid/base balance secondary to mannitol administration. At high concentrations, mannitol...read more

In patients with pre-existing compromised blood brain barrier, the risk of increasing cerebral oedema (general or focal) associated with repeated or continued use of mannitol must be individually weighed against the expected benefits. A rebound increase of intracranial pressure may occur several hou...read more

In pregnancy and lactation, mannitol should be used only when necessary.

Adverse Effects

Adverse reactions more commonly reported during or after the infusion of mannitol include: Pulmonary congestion, fluid and electrolyte imbalance, acidosis, electrolyte loss, dryness of mouth, thirst, marked diuresis, urinary retention, edema, headache, blurred vision, convulsions, nausea, vomiting, ...read more

Reactions which may occur because of the solution or the technique of administration include febrile response, infection technique of administration include febrile response, infection technique of administration include febrile response, infection at the site of injection, venous thrombosis or phle...read more

Overdose

Too rapid infusion of large amounts of mannitol will cause a shift of intracellular water into the extracellular compartment resulting in cellular space with hyponatremia, congestion heart failure and pulmonary edema. Repeated doses should not be given to patients with persistent oliguria as this ca...read more

Drug Interaction

Mannitol can potentiate the effects of other diuretics when these drugs are administered concurrently.

Mannitol promotes the urinary excretion of salicylates, barbiturates, imipramine and bromides, and it may be used as an adjunct in patients with severe intoxication of these substances. In addition, salicylates can increase the risk of renal insufficiency in patients receiving diuretics because sali...read more

Diuretics that act at the proximal tubule (Mannitol) are likely to enhance lithium clearance more than other diuretics since they can interfere with the primary site of lithium tubular reabsorption. Patients receiving these agents concomitantly should be monitored to ensure that the desired clinical...read more

Storage

Should be stored between 20°C to 30°C. Avoid excessive heat (Not more than 40°C or 104°F). Protect from freezing.