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mannitol (Osmitrol, Resectisol)
Tradenames: Osmitrol.
Indications:
1) osmotic diuresis
a) promote urinary excretion of toxins
b) supportive treatment of edema
2) prevention &/or treatment of oliguric renal failure
3) reduction of increased intracranial pressure & increased intraocular pressure
4) irrigation solution for transurethral prostatic resection
5) promote diuresis of chemotherapeutic agents
Dosage:
1) must be filtered prior to IV administration
2) never administer SC or IM
3) patients with oliguria should receive a test dose of 12.5 g over 3-5 minutes
a) a response is considered adequate > 30-50 mL of urine is produced over the next 2-3 hours
b) if an adequate response is obtained, additional test doses may be given, up to 50 g in 1st hour
c) if response is inadequate, mannitol should not be used
4) infusion of 50-100 g of mannitol as a 15-25% solution to maintain urine output of > 50 mL/hr
5) intracranial or intraocular hypertension:
a) 1.5 to 2 g/kg over 30-60 min
b) 50 g over 30 minutes as needed
c) hold if osmolality > 315-320 mOsm/kg
6) decrease in nephrotoxicity of cisplatin
a) 12.5 g IV push just prior to cisplatin
b) 10 g/hr as 20% solution for 6 hours
c) replace fluids with 0.45% NaCl with 20-30 meq KCl/L at 250 mL/hr for 6 hours
c) maintain urine output > 100 mL/hr with mannitol infusion
Injection: 25% (50 mL).
Pharmacokinetics:
1) onset of diuresis is 1-3 hours
2) reduction in intraocular pressure
a) onset: 30-60 minutes
b) duration: 4-8 hours after discontinuation of infusion
3) reduction in intracranial pressure
a) onset: within 15 minutes
b) duration: 3-8 hours after discontinuation of infusion
4) elimination 1/2life is about 2 hours
Adverse effects:
1) common (> 10%)
- headache, increased urination, nausea/vomiting
2) less common (1-10%)
- dizziness, blurred vision, rash
3) uncommon (< 1%)
- difficult urination, chills, fluid & electrolyte imbalance*, fluid overload, congestive heart failure, water intoxication, pulmonary edema, dehydration & hypovolemia#, dry mouth, convulsions, tissue necrosis, allergic reactions
4) other
- acute renal failure with high doses
* fluid & electrolyte imbalance due to excessive loss of electrolytes
# dehydration & hypovolemia due to rapid diuresis
Drug interactions:
1) increased urinary excretion of Li+
2) increased urinary excretion of aminoglycosides
Mechanism of action:
1) osmotic diuretic
2) elevates osmotic pressure of glomerular filtrate
3) inhibits tubular reabsorption of water
4) resorption of solutes is inhibited by increased urine water
5) inhibits Na+ & Cl- absorption from the proximal tubule & ascending loop of Henle
6) increased excretion of Na+, K+, Ca+2, phosphate
Interactions
drug interactions
drug adverse effects (more general classes)
monitor with osmotic diuretics
General
neurologic agent
osmotic diuretic
sugar alcohol
Properties
MISC-INFO: elimination route KIDNEY
1/2life 2 HOURS
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
Component-of
mannitol/sorbitol