Brands, Medical Use, Clinical Data
Drug Category
- Diuretics, Osmotic
- Sweetening Agents
Dosage Forms
- Liquid
- Powder for solution
- Solution
Brands / Synonyms
Cordycepic acid; D-Mannitol; d-mannitol extra pure
; Diosmol; Hexanhexol; Hexitol; Isotol; Manicol; Maniton-S; Manna sugar; Mannazucker; Mannidex; Mannigen; Mannistol; Mannit; Mannite; Mannitol 10%; Mannitol 10% In Plastic Container; Mannitol 15%; Mannitol 15% In Plastic Container; Mannitol 20%; Mannitol 20% In Plastic Container; Mannitol 25%; Mannitol 5%; Mannitol 5% In Plastic Container; Mannitol BP; Mannitol, D-; Mushroom sugar; Osmitrol; Osmitrol 10% In Water; Osmitrol 15% In Water; Osmitrol 20% In Water; Osmitrol 5% In Water; Osmosal; Resectisol; Resectisol In Plastic Container; SDM-25; Sorbitol-Mannitol
Indications
Used for the promotion of diuresis before irreversible renal failure becomes established; The reduction of intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic substances.
Pharmacology
Chemically, mannitol is an alcohol and a sugar, or a polyol; it is similar to xylitol or sorbitol. However, mannitol has a tendency to lose a hydrogen ion in aqueous solutions, which causes the solution to become acidic. For this reason, it is not uncommon to add a substance to adjust its pH, such as sodium bicarbonate. Mannitol is commonly used to increase urine production (diuretic). It is also used to treat or prevent medical conditions that are caused by an increase in body fluids/water (e.g., cerebral edema, glaucoma, kidney failure). Mannitol is frequently given along with other diuretics (e.g., furosemide, chlorothiazide) and/or IV fluid replacement.
Mechanism of Action
Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. As a result, cerebral edema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure may be reduced. As a diurectic mannitol induces diuresis because it is not reabsorbed in the renal tubule, thereby increasing the osmolality of the glomerular filtrate, facilitating excretion of water, and inhibiting the renal tubular reabsorption of sodium, chloride, and other solutes. Mannitol promotes the urinary excretion of toxic materials and protects against nephrotoxicity by preventing the concentration of toxic substances in the tubular fluid. As an Antiglaucoma agent mannitol levates blood plasma osmolarity, resulting in enhanced flow of water from the eye into plasma and a consequent reduction in intraocular pressure. As a renal function diagnostic aid mannitol is freely filtered by the glomeruli with less than 10% tubular reabsorption. Therefore, its urinary excretion rate may serve as a measurement of glomerular filtration rate (GFR).
Absorption
Approximately 7% of ingested mannitol is absorbed during gastrointestinal perfusion in uremic patients.
Toxicity
LD50=1700 mg/kg (rat oral)
Biotrnasformation / Drug Metabolism
Mannitol is metabolized only slightly, if at all, to glycogen in the liver.
Contraindications
OSMITROL Injection (Mannitol Injection, USP) is contraindicated in patients with:
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, and
Progressive heart failure or pulmonary congestion after institution of mannitol therapy.
Drug Interactions
No information provided.
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