Mannitol, 150 mg/ml 200 ml

Mannitol is an osmotic diuretic which, by increasing the osmotic pressure of blood plasma and filtration in the renal glomeruli, without subsequent tubular reabsorption (mannitol is little reabsorbed), leads to water retention in the renal tubules and increased urine volume.

Mannitol acts mainly in the proximal tubules, although the effect persists to a small extent in the descending nephron loop and in the collecting tubes. It does not penetrate cellular and tissue barriers (e.g., blood-brain barrier) and does not increase residual nitrogen in the blood.

Magnifying blood plasma osmolarity causes fluid transfer from tissues (in particular from the eyeball, brain) into the vascular system. Diuresis is accompanied by a moderate increase in natriuresis without a significant effect on potassium excretion. The diuretic effect is the greater the concentration (dose).

Ineffective in impaired renal filtration function as well as in azotemia in patients with cirrhosis and with ascites: Causes increased circulating blood volume.

Indications

Cerebral edema, intracranial hypertension (in renal or renal-hepatic failure); oliguria in acute renal or renal-hepatic failure with preserved renal filtration capacity (in combined therapy), post-transfusion complications after administration of incompatible blood, forced diuresis in poisoning with barbiturates, salicylates; prophylaxis of hemolysis during surgical interventions with the use of extracorporeal circulation in order to prevent renal ischemia and associated acute renal failure.

Active ingredient

Composition

Active substance:

mannitol – 150 g;

Auxiliary substances:

Sodium chloride – 9 g,

water for injection – up to 1 liter.

How to take, the dosage

Intravenously (slow-flow or drip).

The prophylactic dose is 0.5 g/kg of body weight, therapeutic 1.0-1.5 g/kg; the daily dose should not exceed 140-180 g.

The drug should be warmed up to 37 ° C (can be in a water bath) before administration. When operating with artificial circulation the drug is injected into the apparatus in a dose of 20-40 g immediately before the start of perfusion.

Patients with oliguria should be given a test dose (200 mg/kg) by intravenous drip for 3-5 minutes beforehand.

If no increase in diuresis rate to 30-50 ml/h is noted within 2-3 hours thereafter, further administration of the drug should be discontinued.

Interaction

The toxic effects of cardiac glycosides may increase (with hypokalemia).

Special Instructions

In case of left ventricular insufficiency (due to the risk of pulmonary edema), mannitol should be combined with rapid-acting “loop” diuretics. Control of blood pressure, diuresis, serum electrolyte concentrations (potassium, sodium) is necessary.

If headache, vomiting, dizziness, visual disturbances occur during drug administration, the administration should be stopped and the development of such complications as subdural and subarachnoid bleeding should be excluded.

In case of signs of dehydration it is necessary to administer fluids. It is possible to use in heart failure (only in combination with “loop” diuretics) and in hypertensive crisis with encephalopathy.

Repeated administration of mannitol should be carried out under control of blood water-electrolyte balance parameters.
Mannitol administration in anuria caused by organic kidney disease may lead to pulmonary edema.

Contraindications

Hypersensitivity to the drug, anuria with acute renal tubular necrosis, left ventricular failure (especially accompanied by pulmonary edema), hemorrhagic stroke, subarachnoid hemorrhage (except during craniotomy), severe dehydration, hyponatremia, hypo-chloremia, hypokalemia.

With caution
Pregnancy, lactation, advanced age.

Side effects

Dehydration (dry skin, dry mouth, thirst, dyspepsia, muscle weakness, seizures, hallucinations, decreased blood pressure), disorders of water-electrolyte exchange (increased circulating blood volume, hyponatremia, rarely – hypokalemia).

Rarely – tachycardia, pain behind the chest, thrombophlebitis, skin rash.