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

Composition:A 100 mg / ml solution of mannitol contains:
active substance: mannitol - 100.0 mg;
Excipients: sodium chloride - 9.0 mg;
water for injection - up to 1.0 ml.
Theoretical osmolarity is 857 mOsmol / l.

A 150 mg / ml solution of mannitol contains:
active substance: mannitol - 150.0 mg;
Excipients: sodium chloride - 9.0 mg;
water for injection - up to 1.0 ml.
Theoretical osmolarity is 1132 mOsmol / l.

Description:

clear, colorless liquid.

Pharmacotherapeutic group:Diuretic agent.

ATX: & nbsp

R.05.C.B.16 Mannitol

B.05.C.X.04 Mannitol

B.05.B.C.01 Mannitol

A.06.A.D.16 Mannitol

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. Effective mannitol, mainly in the proximal tubules, although the effect is preserved to a small extent 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:

The volume of mannitol distribution corresponds to the volume of the extracellular fluid, since it is distributed only in the extracellular sector. The drug does not penetrate through cell membranes and tissue barriers (eg, blood-brain, placental). 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 tubular reabsorption and secretion. If you inject intravenously 100 g of mannitol, then 80% of it is determined in the urine within 3 hours. In patients with renal failure, the half-life of mannitol may increase to 36 hours.

Indications:Edema of the brain, intracranial hypertension (with renal and / or liver failure); oliguria in acute renal and / or hepatic insufficiency with preserved filtration ability of the kidneys (in the combination therapy), posttransfusion complications after the introduction of incompatible blood, forced diuresis in barbiturate poisoning,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 heart failure (especially accompanied by pulmonary edema), hemorrhagic stroke, subarachnoid hemorrhage (except for bleeding during trepanation of the skull), severe dehydration, hyponatremia, hypochloraemia, hypokalemia.

Carefully:

Pregnancy, lactation, elderly.

Pregnancy and lactation:With caution during pregnancy and lactation.

Dosing and Administration:

Intravenously (slowly drip or drip). Prophylactic dose - 500 mg / kg, therapeutic -1.0-1.5 g / kg; the daily dose should not exceed 140-180 g; for children - 0,25-1,0 g / kg of body weight. Before the introduction, the preparation should be heated to a temperature of 37 ° C (it is possible in a water bath). In operations with artificial circulation, the drug is injected into the unit at a dose of 20-40 g immediately before the onset of perfusion.Patients with oliguria should first be given an intravenous drip test dose (200 mg / kg) for 3-5 minutes. If after this within 2-3 hours there will be no increase in the rate of diuresis to 30-50 ml / h, further administration of the drug should be discarded.

Side effects:

Dehydration (dry skin, dryness of the oral mucosa, thirst, dyspepsia, muscle weakness, convulsions, hallucinations, lowering of blood pressure), violation of water-electrolyte balance (increase in the volume of circulating blood, hyponatremia, rarely - hypokalemia). Rarely - tachycardia, chest pain, thrombophlebitis, skin rash.

Interaction:

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

Special instructions:

When left ventricular heart failure (due to the risk of developing pulmonary edema) should be combined mannitol with fast-acting "loop" diuretics. It is necessary to control blood pressure, diuresis, the content of electrolytes in blood 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.

The repeated administration of mannitol should be carried out under the control of indices 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.

Effect on the ability to drive transp. cf. and fur:No data.

Form release / dosage:Solution for infusion is 100 mg / ml or 150 mg / ml.

Packaging:Solution for infusions of 100 mg / ml or 150 mg / ml for 100, 200, 250, 400, 500 or 1000 ml in polymer containers for infusion solutions of a single use with one or two ports made of PVC or polyolefin film. Each container is packed in a secondary bag made of polypropylene or polyethylene high pressure, with instructions for use applied on it.
It is allowed to put the instructions for use on a separate sheet, put in a box with containers in the secondary packaging in an amount equal to the number of containers.Containers in the secondary packaging are placed in boxes of corrugated cardboard.
A solution for infusions of 100 mg / ml or 150 mg / ml for 100, 200, 250, 400, 500 or 1000 ml in polymer containers for single-use or two polyolefin film infusion solutions is packed in corrugated cardboard boxes ). The box with containers is enclosed instructions for use in an amount equal to the number of containers.

Storage conditions:Store in a dry, dark place at a temperature of 2 to 25 ° C. Keep out of the reach of children. Freezing during transportation is allowed.

Shelf life:3 years.
Do not use after the expiration date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:PL-000898

Date of registration:18.10.2011

The owner of the registration certificate:FIRM MEDPOLIMER, JSC FIRM MEDPOLIMER, JSC Russia

Manufacturer: & nbsp

FIRM MEDPOLIMER, JSC Russia

Information update date: & nbsp08.05.2014

Illustrated instructions

Instructions

Mannitol (Mannitol)