mannitol (Rx)

Brand and Other Names:Osmitrol
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Dosing & Uses


Dosage Forms & Strengths

injectable solution

  • 5%
  • 10%
  • 15%
  • 20%
  • 25%

Cerebral Edema

Reduction of intracranial pressure and treatment of cerebral edema

1.5-2 g/kg IV infused over 30-60 minutes  

Intraocular Pressure

1.5-2 g/kg IV infused over 30-60 minutes  


Test dose: 200 mg/kg IV infused over 3-5 minutes

Load: 500-1000 mg/kg IV x1 dose

Maintenance: 250-500 mg/kg IV q4-6hr  

Bronchiectasis (Orphan)

Bronchitol: Facilitates clearance of mucus with bronchiectasis, and in patients with cystic fibrosis at risk for bronchiectasis

Orphan indication sponsor

  • Pharmaxis Ltd; 10 Rodborough Rd, NSW 2086, Australia

Other Information

Do NOT give simultaneously with blood

Use 15-25% solution

Other Indications & Uses

Brain mass

Dosage Forms & Strengths

injectable solution

  • 5%
  • 10%
  • 15%
  • 20%
  • 25%


0.25-1 g/kg IV initially; maintenance dose of 0.25-0.5 g/kg IV q4-6hr  


Test dose: 0.2 g/kg IV over 3-5 minutes; not to exceed 12.5 g  

Discontinue if no diuresis within 2 hr

Other Information

Treatment of intoxications: Give therapeutic dose as 5 or 10% solution IV PRN



Interaction Checker

and mannitol

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            Adverse Effects

            Frequency Not Defined

            Angina-like chest pains









            Fluid/electrolyte imbalances




            Blurred vision

            Urinary retention




            Hypersensitivity, anuria, severe pulmonary edema or heart failure, severe dehydration, metabolic edema, progressive renal dz, active intracranial bleeding (except during craniotomy)


            Infusion of hypertonic solutions through a peripheral vein, at a concentration of 10% w/v or greater, may result in peripheral venous irritation, including phlebitis; other severe infusion site reactions, such as compartment syndrome and swelling associated with extravasation, can occur; administer, preferably, into a large central vein

            Do not mix with blood

            May cause hypovolemia, headache, polydipsia

            It might be more effective than pentobarbital, but less effective than hypertonic saline in pt w/acute traumatic brain injury

            Renal complications

            • Serious hypersensitivity reactions, including anaphylaxis, hypotension and dyspnea resulting in cardiac arrest and death reported; stop infusion immediately if signs or symptoms of suspected hypersensitivity reaction develop
            • Renal complications, including irreversible renal failure reported in patients receiving therapy; in patients with severe renal impairment, a test dose should be utilized; a second test dose may be tried if there is inadequate response, but attempt no more than two test doses
            • Reversible, oliguric acute kidney injury (AKI) has occurred in patients with normal pretreatment renal function who received large intravenous doses; patients with oliguric AKI who subsequently develop anuria while receiving mannitol are at risk of congestive heart failure, pulmonary edema, hypertensive crisis, coma and death
            • Although osmotic nephrosis associated with therapy is in principle reversible, osmotic nephrosis in general is known to potentially proceed chronic or even end-stage renal failure; monitor renal function closely during infusion; patients with pre-existing renal disease, patients with conditions that put them at high risk for renal failure, or those receiving potentially nephrotoxic drugs or other diuretics, are at increased risk of renal failure following administration of product; avoid concomitant administration of nephrotoxic drugs (e.g., aminoglycosides) or, other diuretics, if possible
            • During and following infusion for reduction in intracranial pressure, monitor patient clinically and laboratory tests for changes in fluid and electrolyte status; discontinue therapy if CNS toxicity develops
            • Administer with caution to patients with impaired renal function
            • If urine output declines during infusion, closely monitor patient’s clinical status for developing renal impairment, and infusion suspended, if necessary
            • Not for administration in patients with renal dysfunction until volume and electrolytes restored

            Central nervous system toxicity

            • CNS toxicity manifested by, confusion, lethargy, or coma reported in patients, some resulting in death, in particular in presence of impaired renal function, CNS toxicity may result from high serum mannitol concentrations, serum hyperosmolarity resulting in intracellular dehydration within CNS, hyponatremia or other disturbances of electrolyte and acid/base balance secondary to mannitol administration
            • At high concentrations, mannitol may cross blood brain barrier and interfere with ability of brain to maintain pH of cerebrospinal fluid especially in presence of acidosis
            • In patients with preexisting compromise of blood brain barrier, risk of increasing cerebral edema (general and focal) associated with repeated or continued use of product must be individually weighed against expected benefits
            • A rebound increase of intracranial pressure may occur several hours after infusion; patients with a compromised blood brain barrier are at increased risk
            • Concomitant administration of neurotoxic drugs (e.g., aminoglycosides) may potentiate neurotoxicity; avoid concomitant use of neurotoxic drugs, if possible

            Fluid electrolyte imbalance

            • Depending on dosage and duration, administration may result in hypervolemia leading to or exacerbating existing congestive heart failure
            • Accumulation of mannitol due to insufficient renal excretion increases risk of hypervolemia; mannitol-induced osmotic diuresis may cause or worsen dehydration/hypovolemia and hemoconcentration; therapy may also cause hyperosmolarity
            • Depending on dosage and duration of administration, electrolyte and acid/base imbalances may also result from transcellular shifts in water and electrolytes, osmotic diuresis and/or other mechanisms; such imbalances may be severe and potentially fatal
            • Metabolic acidosis/alkalosis
            • Pediatric patients <2 years, particularly preterm and term neonates, may be at higher risk for fluid and electrolyte abnormalities following administration due to decreased glomerular filtration rate and limited ability to concentrate urine
            • During and following infusion for reduction in intracranial pressure, monitor fluid and electrolyte status and discontinue therapy if imbalances occur
            • Imbalances resulting from therapy
              • Hypernatremia, dehydration and hemoconcentration
              • Hyponatremia, which can lead to headache, nausea, seizures, lethargy, coma, cerebral edema, and death; acute symptomatic hyponatremic encephalopathy is considered a medical emergency
              • Hypo/hyperkalemia; the development of electrolyte imbalances (eg, hyperkalemia, hypokalemia) associated with mannitol administration may result in cardiac adverse reactions in patients receiving drugs sensitive to such imbalances (e.g., digoxin, agents that may cause QT prolongation, neuromuscular blocking agents)
            • During and following infusion for reduction in intracranial pressure, monitor:
              • Serum osmolarity, serum electrolytes (including sodium, potassium, calcium and phosphate) and acid base balance
              • The osmol gap
              • Signs of hypo- or hypervolemia, including urine output
              • Renal, cardiac and pulmonary function
              • Intracranial pressure
              • Discontinue therapy if renal, cardiac, or pulmonary status worsens or CNS toxicity develops

            Pregnancy & Lactation


            Animal reproduction studies not conducted with mannitol; also not known whether mannitol can cause fetal harm when administered to pregnant woman or can affect reproduction capacity; product should be given to pregnant woman only if clearly needed

            Labor and delivery

            • Studies have not been conducted to evaluate effects on labor and delivery; exercise caution when administering product during labor and delivery


            Not known whether product is excreted in human milk; because many drugs are excreted in human milk, exercise caution when product administered to nursing woman

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.



            Half life: 100 min


            Diuresis: 1-3 hr after IV administration of mannitol. Lowering of

            IOP reduction: 30-60 min

            ICP reduction: 15 min


            IOP reduction: 4-6 hr

            ICP reduction: 3-8 hr

            Other Information

            Metabolism: liver (very slight)

            Metabolites: glycogen

            Excretion: urine (80%)

            Mechanism of Action

            Osmotic diuretic



            IV Incompatibilities:

            Additive: etoposide w/ cisplatin & KCl(?), imipenem-cilastatin (may be used for shorter periods), meropenem (may be used for shorter periods)

            Y-site: cefepime, doxorubicin liposomal, filgrastim

            IV Compatibilities

            Additive (partial list): cefoxitin, cimetidine, furosemide. metoclopramide, ondansetron

            Y-site: allopurinol, cisatracurium, etoposide phosphate, linezolid, ondansetron, propofol, vinorelbine

            IV Preparation

            Infusion only

            Use administration set with filter for infusion of injections containing 20% or more, since crystals may be present

            For transurethral prostatic resection, mannitol irrigation solns are instilled into bladder via indwelling urethral catheter





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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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