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Drug overview for MANNITOL (mannitol):
Generic name: MANNITOL
Drug class: Osmotic Diuretics
Therapeutic class: Cardiovascular Therapy Agents
Mannitol is a diagnostic agent used to measure the glomerular filtration Mannitol is an osmotic diuretic. rate (GFR).
Mannitol has been used to measure the glomerular filtration rate (GFR), which is an index of renal function. Because mannitol undergoes some tubular reabsorption, the usefulness of the drug in measuring GFR is limited and inulin has generally replaced mannitol for determination of GFR. For use of mannitol as an osmotic diuretic and as an irrigating solution in transurethral resection of the prostate, see Mannitol (Diuretic) 40:28.12.
Generic name: MANNITOL
Drug class: Osmotic Diuretics
Therapeutic class: Cardiovascular Therapy Agents
Mannitol is a diagnostic agent used to measure the glomerular filtration Mannitol is an osmotic diuretic. rate (GFR).
Mannitol has been used to measure the glomerular filtration rate (GFR), which is an index of renal function. Because mannitol undergoes some tubular reabsorption, the usefulness of the drug in measuring GFR is limited and inulin has generally replaced mannitol for determination of GFR. For use of mannitol as an osmotic diuretic and as an irrigating solution in transurethral resection of the prostate, see Mannitol (Diuretic) 40:28.12.
DRUG IMAGES
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The following indications for MANNITOL (mannitol) have been approved by the FDA:
Indications:
Cerebral edema
Ocular hypertension
Professional Synonyms:
Brain edema
Increased intraocular pressure
Increased IOP
Raised intraocular pressure
Indications:
Cerebral edema
Ocular hypertension
Professional Synonyms:
Brain edema
Increased intraocular pressure
Increased IOP
Raised intraocular pressure
The following dosing information is available for MANNITOL (mannitol):
Mannitol is administered by IV infusion. To measure glomerular filtration rate (GFR), one manufacturer recommends that 100 mL of a 20% solution (20 g) of mannitol be diluted with 180 mL of 0.9% sodium chloride injection, and the resulting 280 mL of solution infused at a rate of 20 mL/minute.
Another source suggests that 200 mg/kg, in a 15-25% solution, be administered in 3-5 minutes.
Mannitol clearance is determined by simultaneously measuring plasma mannitol concentrations and the quantity of mannitol excreted in urine in a given time and calculating the ratio of the amount of mannitol excreted to the plasma mannitol concentration. Catheterization is performed to facilitate complete urine collection. Mannitol clearance, and therefore GFR, is calculated using the formula:
where U is the average concentration of mannitol in the urine in mg/dL, V is the average volume of urine collected per minute in mL, and P is the average concentration of mannitol in plasma in mg/dL. Normal values for mannitol clearance (and consequently GFR), corrected to a standard 1.73 m2 of body surface area, average 125 mL for men and 116 mL for women.
The dosage, concentration of solution, and rate of administration of mannitol vary with the condition being treated and the patient's fluid requirements, urinary output, and response to the drug.
Patients with marked oliguria or suspected inadequate renal function should receive a dose of about 0.2 g/kg or 12.5 g as a 15 or 20% solution infused over a period of 3-5 minutes to test renal response before mannitol therapy is initiated.
A response is considered adequate if at least 30-50 mL of urine per hour is excreted over the next 2-3 hours. If an adequate response is not attained, a second test dose may be given. If a satisfactory response is not obtained after the second test dose, the patient should be reevaluated and mannitol should not be used.
Mannitol dosage requirements for patients 12 years of age and younger have not been established. However, some clinicians have suggested the following dosages for pediatric patients. In oliguria or anuria, a test dose of 0.2
g/kg or 6 g/m2 may be given as a single dose over 3-5 minutes. For therapeutic purposes, 2 g/kg or 60 g/m2 may be given. For the treatment of edema and ascites, this dose may be given as a 15 or 20% solution over 2-6 hours.
To reduce cerebral or ocular edema, the dose may be given as a 15 or 20% solution over 30-60 minutes. For the treatment of intoxications, the drug may be given as a 5 or 10% solution as needed.
Another source suggests that 200 mg/kg, in a 15-25% solution, be administered in 3-5 minutes.
Mannitol clearance is determined by simultaneously measuring plasma mannitol concentrations and the quantity of mannitol excreted in urine in a given time and calculating the ratio of the amount of mannitol excreted to the plasma mannitol concentration. Catheterization is performed to facilitate complete urine collection. Mannitol clearance, and therefore GFR, is calculated using the formula:
where U is the average concentration of mannitol in the urine in mg/dL, V is the average volume of urine collected per minute in mL, and P is the average concentration of mannitol in plasma in mg/dL. Normal values for mannitol clearance (and consequently GFR), corrected to a standard 1.73 m2 of body surface area, average 125 mL for men and 116 mL for women.
The dosage, concentration of solution, and rate of administration of mannitol vary with the condition being treated and the patient's fluid requirements, urinary output, and response to the drug.
Patients with marked oliguria or suspected inadequate renal function should receive a dose of about 0.2 g/kg or 12.5 g as a 15 or 20% solution infused over a period of 3-5 minutes to test renal response before mannitol therapy is initiated.
A response is considered adequate if at least 30-50 mL of urine per hour is excreted over the next 2-3 hours. If an adequate response is not attained, a second test dose may be given. If a satisfactory response is not obtained after the second test dose, the patient should be reevaluated and mannitol should not be used.
Mannitol dosage requirements for patients 12 years of age and younger have not been established. However, some clinicians have suggested the following dosages for pediatric patients. In oliguria or anuria, a test dose of 0.2
g/kg or 6 g/m2 may be given as a single dose over 3-5 minutes. For therapeutic purposes, 2 g/kg or 60 g/m2 may be given. For the treatment of edema and ascites, this dose may be given as a 15 or 20% solution over 2-6 hours.
To reduce cerebral or ocular edema, the dose may be given as a 15 or 20% solution over 30-60 minutes. For the treatment of intoxications, the drug may be given as a 5 or 10% solution as needed.
Mannitol injections are administered by IV infusion. An administration set with a filter should be used for infusion of injections containing 20% or more, since mannitol crystals may be present. For transurethral prostatic resection, mannitol irrigation solutions are instilled into the bladder via an indwelling urethral catheter.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| MANNITOL 25% (12.5 GM/50 ML) | Maintenance | Adults infuse 0.25 gram/kg by intravenous route every 4 hours |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| MANNITOL 25% (12.5 GM/50 ML) | Maintenance | Adults infuse 0.25 gram/kg by intravenous route every 4 hours |
The following drug interaction information is available for MANNITOL (mannitol):
There are 0 contraindications.
There are 1 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Sodium Phosphate Bowel Cleanser/Diuretics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Bowel cleansing with sodium phosphate causes dehydration, decreased intravascular volume and hyperphosphatemia, which increases phosphate levels in the renal tubules. Abnormally high levels of calcium and phosphate in the renal tubules may precipitate out, resulting in renal injury.(1) CLINICAL EFFECTS: Use of sodium phosphate for bowel cleansing in patients maintained on diuretics may increase the risk of acute phosphate nephropathy, which is an acute kidney injury associated with deposits of calcium phosphate crystal in the renal tubules that may result in permanent renal function impairment. Acute phosphate nephropathy presents as acute kidney injury with minimal proteinuria and a bland urine sediment.(2) Use of oral sodium phosphate products at laxative doses has not been associated with acute kidney injury.(3) PREDISPOSING FACTORS: Patients who may be at an increased risk of acute phosphate nephropathy include those who are over age 55; are hypovolemic or have decreased intravascular volume; have baseline kidney disease, bowel obstruction, or active colitis; and who are using medications that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotension receptor blockers (ARBs) and possibly nonsteroidal anti-inflammatory drugs (NSAIDs).(2) PATIENT MANAGEMENT: If possible, use an alternative agent for bowel cleansing.(1) Use sodium phosphate products with caution in patients taking medications that affect kidney function or perfusion, such as diuretics. Obtain baseline and post-procedure labs (electrolytes, calcium, phosphate, BUN, creatinine, and [in smaller, frail individuals] glomerular filtration rate). Instruct patients to drink sufficient quantities of clear fluids before, during, and after bowel cleansing and to avoid other laxatives that contain sodium phosphate. Consider hospitalization and intravenous hydration during bowel cleansing to support frail patients who may be unable to drink an appropriate volume of fluid or who may be without assistance at home.(2) Use of an electrolyte solution for rehydration may decrease the risk of acute phosphate nephropathy.(4,5) DISCUSSION: Since May 2006, the FDA has received 20 reports of acute phosphate nephropathy associated with the use of Osmo Prep. Concomitant medications included ACE inhibitors or ARBs (11), diuretics (6), and NSAIDs (4).(2) In a retrospective review of colonoscopy patients, simultaneous use of ACE inhibitors or ARBs significantly increased the risk of acute kidney injury from oral sodium phosphate. Diuretic use was also a risk factor.(6) In a case series study of 21 cases of acute phosphate nephropathy in patients who had used oral sodium phosphate, 14 patients received an ACE inhibitor or ARB, 4 used a diuretic, and 3 used an NSAID.(7) Cases have also been reported with rectal products.(8) |
MB CAPS, SODIUM PHOSPHATE DIBASIC, URIMAR-T, URNEVA |
There are 2 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Tobramycin Inhalation/Selected Diuretics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The combination may have additive or synergistic risks for ototoxicity and/or nephrotoxicity.(1,2) CLINICAL EFFECTS: Concurrent use may result in an increased risk of aminoglycoside toxicity.(1) PREDISPOSING FACTORS: Severe renal impairment, sepsis, or concomitant use of additional ototoxic or nephrotoxic agents may further increase the risk for toxicity. Patients carrying certain variants in the MT-RNR1 gene (m.1555A>G, m.1095T>C, and m.1494C>T) are at greatly increased risk of developing ototoxicity. An additional risk factor includes patients with a maternal relative known to have a clinically relevant MT-RNR1 variant. The risk of ototoxicity can occur at standard recommended doses of aminoglycosides.(3) PATIENT MANAGEMENT: Instruct patients to contact their provider for new onset or worsening tinnitus. Tinnitus may be a sentinel symptom of ototoxicity. In clinical trials of tobramycin inhalation 8 patients (3%) receiving tobramycin reported tinnitus while no patients in the placebo group reported this symptom.(1) For renally impaired patients receiving long term tobramycin inhalation therapy, consider measurement of serum tobramycin to assure low systemic levels. The manufacturer of tobramycin for inhalation states that the product should not be administered concurrently with ethacrynic acid, furosemide, intravenous mannitol, or urea.(1) DISCUSSION: Although systemic absorption of inhaled tobramycin is limited, the manufacturer states that because these diuretics may enhance the risk for aminoglycoside toxicity, they should not be administered concurrently with inhaled tobramycin.(1) |
BETHKIS, KITABIS PAK, TOBI, TOBI PODHALER, TOBRAMYCIN |
| Zoledronic Acid/Diuretics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Concurrent use of zoledronic acid and a diuretic may have adverse effects on the renal system.(1,2) CLINICAL EFFECTS: Concurrent use of zoledronic acid and a diuretic may result in renal dysfunction. Deterioration in renal function, acute renal failure requiring dialysis, and death have been reported.(1) PREDISPOSING FACTORS: The interaction may be more likely in elderly patients, patients who are taking other drugs that impact renal function, patients with pre-existing renal compromise, and patients who are dehydrated.(1) PATIENT MANAGEMENT: Patients should be adequately hydrated with 500 ml (2 glasses of water) before and after zoledronic acid administration.(1) Creatinine clearance should be monitored before and after therapy and zoledronic acid should not be administered in patients with a creatinine clearance less than 35 ml/min.(1,3) DISCUSSION: Zoledronic acid has been associated with renal dysfunction, including deterioration in renal function, acute renal failure requiring dialysis, and death. Risk factors include advanced age, concomitant nephrotoxic agents, and dehydration.(1) The FDA has received 16 reports of fatal acute renal failure and 9 reports of renal injury requiring dialysis following the administration of Reclast (zoledronic acid).(3) |
RECLAST, ZOLEDRONIC ACID |
The following contraindication information is available for MANNITOL (mannitol):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 5 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Anuria |
| Capillary fragility |
| Pulmonary congestion |
| Severe chronic heart failure |
| Severe dehydration |
There are 3 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Hypernatremia |
| Intracranial bleeding |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
There are 3 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Hyperkalemia |
| Hyponatremia |
| Hypovolemia |
The following adverse reaction information is available for MANNITOL (mannitol):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 31 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Urticaria |
| Rare/Very Rare |
|---|
|
Acute renal failure Allergic dermatitis Anaphylaxis Anuria Azotemia Cardiac arrest Chest pain Chills Chronic heart failure Coma Dysuria Fever Hematuria Hyperkalemia Hypernatremia Hypertension Hypervolemia Hypokalemia Hyponatremia Hypotension Hypovolemia Kidney disease with reduction in glomerular filtration rate (GFr) Metabolic acidosis Muscle rigidity Pulmonary congestion Pulmonary edema Seizure disorder Tachycardia Urinary retention Venous thrombosis |
There are 28 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Headache disorder Nausea Polydipsia Polyuria Vomiting Xerostomia |
Blurred vision Dizziness Skin rash |
| Rare/Very Rare |
|---|
|
Acute cognitive impairment Back pain Cough Dehydration Dyspnea Edema General weakness Hyperhidrosis Injection site sequelae Lethargy Malaise Myalgia Oliguria Pain Palpitations Peripheral edema Phlebitis after infusion Pruritus of skin Rhinitis |
The following precautions are available for MANNITOL (mannitol):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Animal reproduction studies have not been performed with mannitol. It is also not known whether mannitol can cause fetal harm when administered to pregnant women. Mannitol should be used during pregnancy only when clearly needed.
Animal reproduction studies have not been performed with mannitol. It is also not known whether mannitol can caused fetal harm when administered to pregnant women. Mannitol should be used during pregnancy only when clearly needed.
Animal reproduction studies have not been performed with mannitol. It is also not known whether mannitol can caused fetal harm when administered to pregnant women. Mannitol should be used during pregnancy only when clearly needed.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for MANNITOL (mannitol):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for MANNITOL (mannitol)'s list of indications:
| Cerebral edema | |
| G93.6 | Cerebral edema |
| P11.0 | Cerebral edema due to birth injury |
| Ocular hypertension | |
| H40.05 | Ocular hypertension |
| H40.051 | Ocular hypertension, right eye |
| H40.052 | Ocular hypertension, left eye |
| H40.053 | Ocular hypertension, bilateral |
| H40.059 | Ocular hypertension, unspecified eye |
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