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ALIMENTARY TRACT AND METABOLISM › DRUGS FOR CONSTIPATION › DRUGS FOR CONSTIPATION › Osmotically acting laxatives
mannitol
A06AD16
Forms & Strengths
- Intravenous solution: 5%, 10%, 15%, 20%, 25%
Adult Dosing
- Reduction of intracranial pressure: 0.25 to 2 g/kg IV over 30 to 60 minutes, repeated every 6 to 8 hours as needed
- Reduction of intraocular pressure: 1.5 to 2 g/kg IV over 30 to 60 minutes
- Promotion of diuresis in oliguria: 50 to 200 g/24 hours IV, adjusted to maintain urine output of at least 30 to 50 mL/hour
- Test dose for oliguria: 0.2 g/kg (approx. 12.5 g) IV over 3 to 5 minutes
Pediatric Dosing
- Reduction of intracranial or intraocular pressure: 0.25 to 2 g/kg or 8 to 60 g/m² IV over 30 to 60 minutes
- Promotion of diuresis: 0.25 to 2 g/kg or 60 g/m² IV over 2 to 6 hours
Indications
- Reduction of intracranial pressure and brain mass
- Reduction of intraocular pressure when other measures are ineffective
- Promotion of diuresis in the prevention and treatment of the oliguric phase of acute renal failure
- Promotion of urinary excretion of toxic substances
Mechanism of Action
- Acts as an osmotic diuretic agent
- Increases the osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes
- Elevates blood plasma osmolality, drawing water from intracellular and extravascular spaces into the interstitial fluid and plasma
Contraindications
- Well-established anuria due to severe renal disease
- Severe pulmonary congestion or pulmonary edema
- Active intracranial bleeding except during craniotomy
- Severe dehydration
- Progressive heart failure or renal dysfunction after institution of therapy
Adverse Reactions
- Fluid and electrolyte imbalance (hyponatremia, hypernatremia, hypokalemia)
- Dehydration and hypovolemia
- Transient expansion of extracellular fluid volume leading to heart failure or pulmonary congestion
- Nausea, vomiting, headache, dizziness
- Osmotic nephropathy and acute renal failure (with high cumulative doses)
- Local pain, thrombophlebitis, and skin necrosis upon extravasation
Drug Interactions
- Nephrotoxic agents (e.g., aminoglycosides, cyclosporine): increased risk of renal toxicity
- Diuretics (e.g., loop diuretics, thiazides): additive diuretic and volume-depleting effects
- Lithium: increased renal excretion and decreased efficacy of lithium
- Neuromuscular blocking agents: mannitol-induced hypokalemia may potentiate neuromuscular blockade
Curated Content: Needs Vetting Before Put to Clinical Use