MANGANESE SULFATE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MANGANESE SULFATE (MANGANESE SULFATE).

How it works

Manganese sulfate is a source of manganese, a trace element that acts as a cofactor for various enzymes including arginase, pyruvate carboxylase, and superoxide dismutase. It is essential for normal bone formation, blood clotting, and nervous system function.

What the body does with it

Metabolism	Manganese is primarily excreted via bile into feces; small amounts are reabsorbed. Some metabolism may occur via hepatic conjugation.
Excretion	Primarily fecal (biliary) elimination of unabsorbed manganese; absorbed manganese is excreted mainly in bile (99%) with minimal renal excretion (<1%). Small amounts secreted in pancreatic juice and reabsorbed enterally.
Half-life	Terminal elimination half-life approximately 37 days (range 30–45 days) in whole body; reflects slow turnover in tissues, especially bone and liver. Clinical context: Accumulation occurs with chronic high exposure or impaired biliary excretion (e.g., hepatic disease).
Protein binding	Approximately 80–90% bound in serum; primarily to transferrin and albumin, with minor binding to alpha-2-macroglobulin. In the brain, transported via transferrin receptor-mediated uptake.
Volume of Distribution	Apparent Vd ~2–4 L/kg based on total body manganese; concentrates in mitochondria-rich tissues (liver, pancreas, kidney, brain). High Vd indicates extensive tissue distribution, especially bone (skeleton contains ~40% of total body manganese).
Bioavailability	Oral bioavailability is low, estimated at 3–5% due to limited gastrointestinal absorption and extensive hepatic first-pass extraction. Variable based on dietary factors, chelators, and iron status (competing transporters).
Onset of Action	Intravenous: Rapid (within minutes) as a cofactor for enzymatic systems; clinical effects (e.g., antioxidative function) not immediately observable. Oral: Absorption occurs over 4–6 hours; systemic effects delayed.
Duration of Action	Duration depends on tissue storage and turnover; single dose effects persist for days to weeks due to slow elimination. Clinical note: Manganese is an essential trace element and is tightly regulated; prolonged supplementation can lead to accumulation.

Classification & Brands

Dosing & administration

Intravenous: 0.1-0.2 mg manganese/kg/day (as manganese sulfate) added to TPN. Maximum 0.15-0.8 mg/day. Injection IV: 0.1-0.2 mg manganese/kg/day.

Dosage form	INJECTABLE
Renal impairment	GFR >50 mL/min: No adjustment. GFR 10-50: Reduce dose by 50% or monitor manganese levels. GFR <10: Avoid use or monitor levels closely; consider discontinuation.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and monitor levels. Child-Pugh C: Avoid use due to risk of manganese accumulation.
Pediatric use	Neonates and infants: 1-2 mcg/kg/day (0.001-0.002 mg/kg/day) IV. Children: 2-5 mcg/kg/day (0.002-0.005 mg/kg/day) IV. Maximum 0.05 mg/day. Use weight-based dosing via TPN or direct supplementation.
Geriatric use	Start at lower end of dosing range (0.1 mg/kg/day IV) due to potential reduced renal function. Monitor serum manganese levels and neurological status regularly. Adjust dose based on renal clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MANGANESE SULFATE (MANGANESE SULFATE).

Breastfeeding	Manganese is present in breast milk; M/P ratio approximately 0.3-0.7. Concentrations are regulated homeostatically. Use with caution; avoid excessive supplementation.
Teratogenic Risk	Manganese is an essential trace element; however, excessive exposure during pregnancy may be associated with neurodevelopmental toxicity. No adequate human studies exist. Animal studies show fetal toxicity at high doses. Risk cannot be excluded.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to manganese sulfate; severe hepatic insufficiency; known manganese toxicity.

Clinical Precautions

Precautions

Use with caution in patients with hepatic impairment due to reduced biliary excretion; risk of manganese accumulation and neurotoxicity (manganism). Monitor manganese levels in long-term parenteral nutrition; avoid excessive intake.

Clinical Tips & Counseling

Drug interactions

Loading safety data…

MANGANESE SULFATE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MANGANESE SULFATE (MANGANESE SULFATE).

How it works

What the body does with it

Metabolism	Manganese is primarily excreted via bile into feces; small amounts are reabsorbed. Some metabolism may occur via hepatic conjugation.
Excretion	Primarily fecal (biliary) elimination of unabsorbed manganese; absorbed manganese is excreted mainly in bile (99%) with minimal renal excretion (<1%). Small amounts secreted in pancreatic juice and reabsorbed enterally.
Half-life	Terminal elimination half-life approximately 37 days (range 30–45 days) in whole body; reflects slow turnover in tissues, especially bone and liver. Clinical context: Accumulation occurs with chronic high exposure or impaired biliary excretion (e.g., hepatic disease).
Protein binding	Approximately 80–90% bound in serum; primarily to transferrin and albumin, with minor binding to alpha-2-macroglobulin. In the brain, transported via transferrin receptor-mediated uptake.
Volume of Distribution	Apparent Vd ~2–4 L/kg based on total body manganese; concentrates in mitochondria-rich tissues (liver, pancreas, kidney, brain). High Vd indicates extensive tissue distribution, especially bone (skeleton contains ~40% of total body manganese).
Bioavailability	Oral bioavailability is low, estimated at 3–5% due to limited gastrointestinal absorption and extensive hepatic first-pass extraction. Variable based on dietary factors, chelators, and iron status (competing transporters).
Onset of Action	Intravenous: Rapid (within minutes) as a cofactor for enzymatic systems; clinical effects (e.g., antioxidative function) not immediately observable. Oral: Absorption occurs over 4–6 hours; systemic effects delayed.
Duration of Action	Duration depends on tissue storage and turnover; single dose effects persist for days to weeks due to slow elimination. Clinical note: Manganese is an essential trace element and is tightly regulated; prolonged supplementation can lead to accumulation.

Classification & Brands

Dosing & administration

Intravenous: 0.1-0.2 mg manganese/kg/day (as manganese sulfate) added to TPN. Maximum 0.15-0.8 mg/day. Injection IV: 0.1-0.2 mg manganese/kg/day.

Dosage form	INJECTABLE
Renal impairment	GFR >50 mL/min: No adjustment. GFR 10-50: Reduce dose by 50% or monitor manganese levels. GFR <10: Avoid use or monitor levels closely; consider discontinuation.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and monitor levels. Child-Pugh C: Avoid use due to risk of manganese accumulation.
Pediatric use	Neonates and infants: 1-2 mcg/kg/day (0.001-0.002 mg/kg/day) IV. Children: 2-5 mcg/kg/day (0.002-0.005 mg/kg/day) IV. Maximum 0.05 mg/day. Use weight-based dosing via TPN or direct supplementation.
Geriatric use	Start at lower end of dosing range (0.1 mg/kg/day IV) due to potential reduced renal function. Monitor serum manganese levels and neurological status regularly. Adjust dose based on renal clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MANGANESE SULFATE (MANGANESE SULFATE).

Breastfeeding	Manganese is present in breast milk; M/P ratio approximately 0.3-0.7. Concentrations are regulated homeostatically. Use with caution; avoid excessive supplementation.
Teratogenic Risk	Manganese is an essential trace element; however, excessive exposure during pregnancy may be associated with neurodevelopmental toxicity. No adequate human studies exist. Animal studies show fetal toxicity at high doses. Risk cannot be excluded.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to manganese sulfate; severe hepatic insufficiency; known manganese toxicity.