MANNITOL 15% 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 osmolality, thereby drawing water from extravascular spaces into the plasma and reducing intracranial pressure. It also increases renal tubular osmotic pressure, inhibiting water reabsorption and promoting diuresis.
| Metabolism | Mannitol is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration, with a small amount reabsorbed in the proximal tubule. |
| Excretion | Renal: >90% excreted unchanged in urine within 24 hours; minimal biliary/fecal elimination (<2%). |
| Half-life | Terminal elimination half-life approximately 0.5–1 hour in normal renal function; prolonged to 24–36 hours in anuria or severe renal impairment. |
| Protein binding | Negligible protein binding (<0.5%); no specific binding proteins identified. |
| Volume of Distribution | Approximately 0.5–0.7 L/kg (confined to extracellular fluid space; does not cross cell membranes significantly). |
| Bioavailability | Intravenous: 100% (only route used clinically); no oral bioavailability due to poor absorption and osmotic diarrhea. |
| Onset of Action | Intravenous: diuresis within 1–3 hours after infusion; reduction of intracranial pressure within 15–30 minutes. |
| Duration of Action | Diuresis lasts 3–6 hours; intracranial pressure reduction persists 4–6 hours; rebound effect may occur after cessation. |
| Molecular Weight | 182.17 |
Intravenous: 50-100 g (1-2 g/kg) as a 15-25% solution over 30-60 minutes. For cerebral edema: 0.25-1 g/kg IV every 4-6 hours. For oliguric acute kidney injury: test dose of 0.2 g/kg IV over 3-5 minutes; if urine output >50 mL/hr, administer 50-100 g as 15-20% solution over 2-6 hours.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in anuria. GFR <15 mL/min: avoid use. GFR 15-30 mL/min: use with caution, monitor serum osmolarity and electrolytes. No specific dose adjustment for mild-moderate renal impairment; clinical judgment required. |
| Liver impairment | No specific dose adjustment for hepatic impairment; monitor for fluid and electrolyte disturbances. |
| Pediatric use | Intravenous: 1-2 g/kg as a 15-20% solution over 30-60 minutes. For acute renal failure: test dose of 0.2 g/kg IV over 30 minutes; if urine output >1 mL/kg/hr, continue with 0.5-1 g/kg every 4-6 hours. For cerebral edema: 0.25-1 g/kg IV every 4-6 hours. Maximum infusion rate: 60 g/hour. |
| Geriatric use | Start at lower end of dosing range; monitor renal function, fluid balance, and electrolytes closely due to age-related decreased renal function and higher risk of volume overload. |
| 1st trimester | Crosses placenta; use only if clearly needed due to potential maternal dehydration/electrolyte disturbances. |
| 2nd trimester | Crosses placenta; use only if clearly needed due to potential maternal dehydration/electrolyte disturbances. |
| 3rd trimester | Crosses placenta; may cause fetal dehydration/electrolyte imbalance; use only if clearly needed. |
Clinical note
Other diuretics may have additive effects Can cause fluid and electrolyte imbalances and pulmonary congestion.
| FDA category | Animal |
| Placental transfer | Readily crosses the placenta by simple diffusion; achieves similar concentrations in fetal plasma as in maternal plasma. |
| Breastfeeding | Excreted into breast milk in small amounts; unlikely to cause adverse effects in infant due to poor oral bioavailability. However, monitor infant for diarrhea or electrolyte imbalance if large maternal doses used. |
| Lactation Rating | L2 - Limited data, probably compatible |
| Teratogenic Risk | Mannitol is a pregnancy category C drug. There are no adequate and well-controlled studies in pregnant women. Animal studies have not been conducted. Mannitol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. In the first trimester, risks are unknown; in second and third trimesters, maternal administration may cause fetal electrolyte disturbances due to osmotic diuresis. |
| Fetal Monitoring | Monitor maternal vital signs, serum electrolytes (sodium, potassium, chloride), serum osmolality, urine output, and fluid balance. Fetal monitoring (heart rate) should be considered if administered during pregnancy, especially if high doses are used, due to potential maternal fluid shifts. |
| Fertility Effects | There are no data on the effects of mannitol on human fertility. Animal studies have not been conducted. It is unlikely to have a direct effect on fertility, but its osmotic diuretic action could theoretically affect reproductive function if significant electrolyte or fluid disturbances occur. |
■ FDA Black Box Warning
None.
| Common Effects | edema |
| Serious Effects |
AnuriaCongestive heart failurePulmonary edemaSevere dehydrationHypernatremiaIntracranial hemorrhage (except during craniotomy)
| Precautions | Use with caution in patients with heart failure, pulmonary congestion, or renal impairment due to risk of fluid overload and electrolyte disturbances., Monitor serum electrolytes, osmolality, and renal function during therapy., Avoid in patients with anuria due to severe renal disease., Rapid infusion may cause circulatory overload resulting in hyponatremia and hyperosmolality. |
| Food/Dietary | No specific food interactions. Maintain adequate hydration unless contraindicated. Avoid excessive salt intake as it may counteract diuretic effect. |
| Clinical Pearls | Mannitol 15% is an osmotic diuretic used primarily for reduction of intracranial pressure (ICP) and cerebral edema. In emergency settings, administer via IV bolus (0.25-1 g/kg) over 30-60 minutes; onset of ICP reduction occurs within 15-30 minutes. Monitor serum osmolality and avoid if >320 mOsm/L. Use with caution in acute tubular necrosis. Can cause transient volume expansion followed by diuresis; watch for pulmonary edema in heart failure patients. Crystallization may occur at low temperatures; warm and inspect before use. |
| Patient Advice | This medication is given intravenously to reduce swelling in the brain. · You may experience increased urination, headache, or dry mouth. · Report any chest pain, difficulty breathing, or unusual swelling. · Do not stop or change the infusion rate without medical advice. · Tell your doctor if you have kidney disease, heart failure, or electrolyte imbalances. |
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