MANNITOL 10% IN PLASTIC CONTAINER
Clinical safety rating: safe
Other 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). |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Other diuretics may have additive effects Can cause fluid and electrolyte imbalances and pulmonary congestion.
| FDA category | Animal |
| Breastfeeding | Unknown if excreted in human milk. No available data on M/P ratio. Consider benefits of breastfeeding vs. potential risk of osmotic effects or maternal dehydration. Caution advised. |
| 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. |
■ FDA Black Box Warning
None
| Common Effects | edema |
| Serious Effects |
Anuria due to severe renal disease, severe pulmonary congestion or edema, active intracranial bleeding (except during craniotomy), severe dehydration, known 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. |
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| 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. |