Mannitol - instructions for use, dose, side effects, contraindications

Pharmacodynamics:Mannitol is an osmotic diuretic, which, due to an increase in the osmotic pressure of the blood plasma and filtration in the renal glomeruli, without subsequent tubular reabsorption (mannitol is slightly reabsorbed), leads to retention of water in the renal tubules and an increase in the volume of urine.There is mannitol, mainly in the proximal tubules, although the effect is preserved to a negligible degree in the descending loop of the nephron and in the collecting tubes. Does not penetrate through cellular and tissue barriers (for example, blood-brain barrier), does not increase the content of residual nitrogen in the blood. Raising the osmolarity of the blood plasma, causes the fluid to move from the tissues (in particular, the eyeball, brain) to the vascular bed. Diuresis is accompanied by a moderate increase in natriuresis without significant effect on the excretion of potassium. The diuretic effect is higher, the higher the concentration (dose). Ineffective in violation of the filtration function of the kidneys, as well as in the case of azotemia in patients with cirrhosis and ascites: Causes an increase in the volume of circulating blood.

Pharmacokinetics:

Mannitum is poorly absorbed at ingestion and therefore it is administered intravenously. The volume of mannitol distribution corresponds to the volume of the extracellular fluid, since it is distributed only in the extracellular sector. Mannitol can undergo a slight metabolism in the liver with the formation of glycogen. The half-life of mannitol is about 100 minutes.The drug is excreted by the kidneys. The excretion of mannitol is regulated by glomerular filtration, without significant involvement of tubular reabsorption and secretion. If you inject 100 grams of mannitol, then 80% of it is determined in the urine for 3 hours.

In patients with renal insufficiency, the half-life of mannitol can increase to 36 hours.

Indications:Edema of the brain, intracranial hypertension (with renal or renal-hepatic insufficiency); oliguria in acute renal or renal-hepatic insufficiency with preserved filtration ability of kidneys (as part of combination therapy), posttransfusion complications after introduction of incompatible blood, forced diuresis in case of poisoning with barbiturates, salicylates; prevention of hemolysis in surgical interventions with the use of extracorporeal circulation in order to prevent kidney ischemia and associated acute renal failure.

Contraindications:Hypersensitivity to the drug, anuria on the background of acute necrosis of the renal tubules, left ventricular failure (especially accompanied by pulmonary edema), hemorrhagic stroke,subarachnoid hemorrhage (bleeding except during craniotomy), severe dehydration severity of hyponatremia, chloropenia, hypokalemia.

Carefully:Pregnancy, lactation, elderly.

Pregnancy and lactation:Take with caution during pregnancy and lactation.

Dosing and Administration:

Intravenously (slowly drip or drip).

Prophylactic dose is 0.5 g / kg body weight, therapeutic dose is 1.0-1.5 g / kg; daily dose should not exceed 140-180 g before introduction of the drug should be heated to a temperature of 37 ° C (can be a water bath). When operations with cardiopulmonary bypass preparation is administered in a unit dose of 20-40 g immediately before perfusion. Patients with oliguria must first introduce a test dose intravenously (200 mg / kg) for 3-5 minutes. If thereafter for 2-3 hours will be noted increase diuresis rate of 30-50 ml / hr, the further injection should be discarded.

Side effects:

Dehydration (dry skin, dry mouth, thirst, neuralgia, muscle weakness, seizures, hallucinations, lowering blood pressure), disruption of water-electrolyte metabolism (increased blood volume, hyponatremia, rarely - hypokalemia).

Seldom - a tachycardia, pains behind a breast bone, a thrombophlebitis, a skin rash, interaction with other medical products.

Interaction:It is possible to increase the toxic effect of cardiac glycosides (against hypokalemia).

Special instructions:

With left ventricular failure (due to the risk of developing pulmonary edema) it is necessary to combine mannitol with fast-acting "loop" diuretics.

It is necessary to control blood pressure, diuresis, the concentration of electrolytes in the serum (potassium, sodium).

In case of appearance of a headache, vomiting, dizziness, or visual impairment, the introduction should be discontinued and the complication such as subdural and subarachnoidal bleeding should be avoided.

When signs of dehydration appear, it is necessary to introduce liquid into the body. Possible use in heart failure (only in combination with "loop" diuretics) and with hypertensive crisis with encephalopathy.

Repeated administration of mannitol should be carried out under the control of indicators of water-electrolyte balance of blood.

The introduction of mannitol in anuria caused by organic kidney disease can lead to the development of pulmonary edema.

Form release / dosage:Solution for infusions 150 mg / ml.

Packaging:

For 100, 200 and 400 ml in glass bottles of MTO brand for blood, transfusion and infusion preparations with a capacity of 100, 250, 450 and 500 ml, respectively.

To 100, 250, 500 ml in polymeric containers for single-use infusion solutions made of polyvinyl chloride.

Each polyvinyl chloride container is placed in a bag of polyethylene film.

One bottle with instructions for medical use of the drug is placed in a pack of boxboard.

For 28 bottles with a capacity of 100 or 250 ml or 15 bottles with a capacity of 450 or 500 ml with the appropriate number of instructions for medical use of the drug placed in a box of corrugated cardboard [for hospitals].

For 72 bags with a 100 ml container, 34 bags with a 250 ml container or 22 bags with a 500 ml container with the appropriate number of instructions for the medical use of the drug are placed in a box of corrugated cardboard [for hospitals].

Storage conditions:

At a temperature not exceeding 20 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiration date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:P N002946 / 01

Date of registration:10.09.2008 / 18.05.2012

Expiration Date:Unlimited

The owner of the registration certificate:ESKOM NPK, OAO ESKOM NPK, OAO Russia

Manufacturer: & nbsp

ESKOM NPK, OAO Russia

Information update date: & nbsp27.03.2018

Illustrated instructions

Instructions

Mannitol (Mannit)