MANNITOL 15% 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 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. |
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 | 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 | It is not known whether mannitol is excreted in human milk. The M/P ratio is not established. Caution should be exercised when mannitol is administered to a nursing woman. The drug should be used only if clearly needed, considering the potential for adverse effects in nursing infants such as osmotic diuresis and electrolyte imbalance. |
| Teratogenic Risk |
■ 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)","Dehydration","Hypersensitivity to mannitol"]
| 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."] |
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| 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. |