MANNITOL 10% IN PLASTIC CONTAINER
Clinical safety rating
safeOther diuretics may have additive effects Can cause fluid and electrolyte imbalances and pulmonary congestion.
Mannitol is an osmotic diuretic that increases plasma osmolarity, drawing water from tissues into the bloodstream and enhancing water excretion by the kidneys. It also reduces intracranial pressure by creating an osmotic gradient across the blood-brain barrier.
| Metabolism | Mannitol is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration. |
| Excretion | Renal: >90% as unchanged drug; minimal biliary or fecal excretion. |
| Half-life | Terminal elimination half-life is 0.25–1.5 hours; prolonged in renal impairment (up to 36 hours). |
| Protein binding | Negligible (<0.1%); no specific binding proteins. |
| Volume of Distribution | 0.2–0.5 L/kg; primarily confined to extracellular fluid; increases with dehydration. |
| Bioavailability | IV: 100%; oral: <10% due to poor absorption. |
| Onset of Action | IV: Reduction of intracranial pressure within 15–30 minutes; diuresis within 1–3 hours. |
| Duration of Action | IV: 4–6 hours for osmotic diuresis; 1.5–6 hours for intracranial pressure reduction (dose-dependent). |
| Molecular Weight | 182.17 |
Adults: 50-100 g intravenously over 30-60 minutes, typically as a 15-25% solution. For reduction of intracranial pressure, 1.5-2 g/kg as a 20% solution IV over 30-60 minutes. For promotion of diuresis, 50-100 g as a 5-25% solution IV.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in anuria or severe renal impairment (GFR < 20 mL/min). For GFR 20-50 mL/min, reduce dose by 50% and monitor serum osmolarity and urine output. No specific dose for GFR >50 mL/min. |
| Liver impairment | No specific dose adjustment for hepatic impairment. Caution in patients with cirrhosis due to risk of fluid overload. |
| Pediatric use | Children: For reduction of intracranial pressure, 0.25-1 g/kg as a 15-25% solution IV over 30-60 minutes. For diuresis, 0.5-2 g/kg as a 5-25% solution IV every 6-12 hours. Maximum dose 2 g/kg/dose. |
| Geriatric use | Elderly: Use lower doses and titrate carefully due to increased risk of fluid overload, electrolyte disturbances, and renal impairment. Monitor renal function and serum osmolarity. Start with the lower end of adult dosing range. |
| 1st trimester | Mannitol is generally used in pregnancy only if clearly needed. There are no well-controlled studies in pregnant women. Mannitol crosses the placenta, and fetal effects are unknown. Use only if potential benefit justifies potential risk to the fetus. |
| 2nd trimester | Same as T1. Mannitol may cause fluid and electrolyte disturbances in the mother, potentially affecting the fetus. Use with caution. |
| 3rd trimester | Same as T1. Administration during labor may cause uterine hypertonicity or fetal distress. Avoid near term if possible. |
Clinical note
Other diuretics may have additive effects Can cause fluid and electrolyte imbalances and pulmonary congestion.
| FDA category | Animal |
| Placental transfer | Mannitol is known to cross the placenta. After maternal administration, it appears in fetal serum and amniotic fluid. The degree of transfer is significant but may be influenced by maternal dose and placental function. |
| Breastfeeding | It is not known whether mannitol is excreted in human milk. Caution should be exercised when administered to a nursing woman. Consider the benefits of breastfeeding and the mother's need for mannitol, along with potential risks to the infant. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Mannitol 10% is a hyperosmolar agent. Limited human data. No known teratogenic effects reported in animal studies. Fetal risk cannot be excluded; use only if clearly needed. First trimester: theoretical risk from osmotic shifts. Second/third trimester: monitor for maternal hemodynamic changes (e.g., pulmonary edema) that may affect placental perfusion. |
| Fetal Monitoring | Monitor maternal vital signs (blood pressure, heart rate, central venous pressure), urine output, serum electrolytes, and osmolality. Assess for signs of pulmonary edema or congestive heart failure. Fetal monitoring (heart rate, growth) if prolonged use or maternal instability. |
| Fertility Effects | No specific data. Unlikely to directly impair fertility; however, underlying conditions requiring mannitol (e.g., cerebral edema) may impact reproductive function. |
■ FDA Black Box Warning
None
| Common Effects | edema |
| Serious Effects |
Anuria due to severe renal diseasePulmonary edemaSevere dehydrationActive intracranial bleeding (except during craniotomy)Hypersensitivity to mannitol
| Precautions | May cause volume expansion and pulmonary edema in patients with impaired renal function. Monitor renal function, serum electrolytes, and fluid balance. Avoid extravasation as it may cause tissue necrosis. Use with caution in patients with congestive heart failure or severe dehydration. |
| Food/Dietary | No significant food interactions; maintain adequate hydration unless contraindicated. |
| Clinical Pearls | Administer via large-bore IV; monitor serum osmolality and renal function; ensure urine output >30 mL/h; avoid extravasation; use with caution in patients with pulmonary congestion or CHF. |
| Patient Advice | You may experience increased urination during treatment. · Report any chest pain, difficulty breathing, or swelling to your doctor immediately. · You may feel thirsty or have a dry mouth; this is expected. · Your blood sugar levels may be monitored if you have diabetes. · Avoid consuming large amounts of salt or salty foods. |
Loading safety data…