D mannitol. Mannitol is an extremely interesting and useful organic substance.

Included in medications

Included in the list (Decree of the Government of the Russian Federation No. 2782-r dated December 30, 2014):

VED

ATH:

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:Osmotic diuretic. By increasing the osmotic pressure of the plasma and filtration without subsequent reabsorption leads to water retention in the tubules and an increase in urine volume. By increasing the osmolarity of the blood plasma, it causes the movement of fluid from the tissues (in particular, eyeball, brain) into the vascular bed. Does not affect glomerular filtration. Diuresis is accompanied by a moderate increase in natriuresis without a significant effect on the excretion of potassium ions. The diuretic effect is higher, the higher the concentration (dose).

It is ineffective in violation of the filtration function of the kidneys, as well as in azotemia in patients with cirrhosis of the liver and ascites. Causes an increase in BCC.

Pharmacokinetics:The volume of distribution of mannitol is low and corresponds to the volume of extracellular fluid, since it is distributed only in the extracellular space. Does not penetrate through cellular and tissue barriers (for example, placental, blood-brain). May be slightly metabolized in the liver to form glycogen.

The half-life is about 100 minutes. Excreted by the kidneys. Excretion is regulated by glomerular filtration without significant involvement of tubular reabsorption and secretion. After the on / in the introduction of 100 g of mannitol, 80% of it is determined in the urine within 3 hours. In renal failure, the half-life may increase to 36 hours.

Indications: swelling of the brain; intracranial hypertension (with renal or renal-hepatic insufficiency); epileptic status, acute attack of glaucoma, oliguria in acute renal (with preserved filtration function of the kidneys) and / or liver failure (as part of combination therapy); post-transfusion complications caused by the introduction of incompatible blood; forced diuresis in case of poisoning with barbiturates and salicylates; prevention of hemolysis during surgical interventions using extracorporeal circulation (in order to prevent renal ischemia and associated acute kidney failure).

VI.G40-G47.G41 Epileptic status

VI.G90-G99.G93.2 Benign intracranial hypertension

VI.G90-G99.G93.6 Cerebral edema

VII.H40-H42.H40 Glaucoma

VII.H40-H42.H40.0 Suspicion of glaucoma

VII.H40-H42.H40.1 Primary open-angle glaucoma

VII.H40-H42.H40.2 Primary angle-closure glaucoma

XI.K70-K77.K72 Liver failure, not elsewhere classified

XIV.N17-N19.N17 Acute renal failure

XVIII.R30-R39.R34 Anuria and oliguria

XIX.T36-T50.T39 Poisoning with non-opioid analgesics, antipyretics and antirheumatic drugs

XIX.T36-T50.T42 Poisoning with anticonvulsants, sedatives, hypnotics and antiparkinsonian drugs

XIX.T80-T88.T80.3 Reaction to ABO incompatibility

XXI.Z20-Z29.Z29.8 Other specified preventive measures

XXI.Z40-Z54.Z48.9 Subsequent surgical care unspecified

Contraindications:Hypersensitivity, violation of the filtration function of the kidneys, anuria against the background of acute necrosis of the tubules of the kidneys, left ventricular failure (especially accompanied by pulmonary edema), chronic heart failure III-IV functional class; hemorrhagic stroke, subarachnoid hemorrhage (except for bleeding during craniotomy), severe forms of dehydration, hyponatremia, hypochloremia, hypokalemia, impaired BBB permeability. For children under 18 years of age, the efficacy and safety of mannitol has not been established. Carefully:Pregnancy, lactation, elderly age, severe renal dysfunction Pregnancy and lactation:There are no adequate and well-controlled studies in humans. No teratogenic effects have been observed in animal studies.

The use of mannitol during pregnancy is possible in cases where the expected benefit to the mother outweighs the possible risk to the fetus.

Data on the release of mannitol from breast milk missing.

Dosage and administration:Intravenously (slow jet or drip) as a 10-20% solution. The dose depends on the age, body weight, condition of the patient and concomitant therapy.

Preventive dose - 0.5 g / kg, therapeutic - 1-1.5 g / kg, daily dose for adults should not exceed 140-180 g. For children - 0.25-1.0 g / kg of body weight.

Before administration, the drug should be heated to a temperature of 37 ° C (possible in a water bath).

Patients with oliguria should first be given an IV drip test dose (200 mg/kg) over 3-5 minutes. If after that within 2-3 hours there is no increase in the rate of diuresis to 30-50 ml / h, further administration of the drug should be abandoned.

With increased intracranial pressure, cerebral edema, the dose of mannitol is from 1.5 to 2.0 g / kg of body weight for 30-60 minutes.

In preparing the patient for surgical intervention should be administered 1-1.5 hours before surgery. In operations with cardiopulmonary bypass, the drug is injected into the device at a dose of 20-40 g immediately before the start of perfusion.

To ensure forced diuresis in case of poisoning with barbiturates, salicylates, post-infusion complications, the dose of mannitol should be adjusted to maintain diuresis at the level of 100 ml/h.

Side effects:From the side of cardio-vascular system: infrequently - a pronounced decrease in blood pressure, thrombophlebitis, rarely - anemia, increased blood pressure, insufficient blood supply in a small circle, very rarely - chronic heart failure.

From the side immune system: rarely - allergic reactions, anaphylactic shock, fever.

From the side of the kidneys and urinary system: rarely - increased diuresis, osmotic nephrosis, urinary retention; very rarely - acute renal failure.

From the side of metabolism: infrequently - disturbances in water and electrolyte balance (increased BCC, hyponatremia, rarely - hypokalemia); rarely - dehydration, edema.

From the side of the respiratory system: rarely - pulmonary edema, rhinitis.

From the gastrointestinal tract: nausea, vomiting, dryness of the oral mucosa.

From the sense organs: rarely - a violation of visual perception.

From the skin and subcutaneous tissue: rarely - skin necrosis at the injection site, urticaria.

From the side nervous system: rarely - headache, dizziness, convulsions, increased intracranial pressure.

Others: chest pain, muscle pain, chills, thirst

Overdose: Rapid administration of high doses of mannitol can lead to its accumulation, excessive increase in extracellular fluid volume, hyperhydrational hyponatremia and hyperkalemia, and cardiac volume overload, especially in patients with acute or chronic renal failure.

Treatment is symptomatic; hemodialysis may be effective.

Interaction: Possible increase toxic action cardiac glycosides (hypokalemia).

Potentiates the diuretic effect of other diuretics.

When used simultaneously with neomycin and other aminoglycosides, it increases the risk of developing oto- and nephrotoxicity.

Increases renal excretion of lithium preparations, vine adjustment may be required.

Patients receiving concomitantly and should monitor kidney function (risk of nephrotoxicity).

May enhance the effects of tubocurarine and depolarizing muscle relaxants, reduce the effectiveness of oral anticoagulants.

special instructions: Apply only in a hospital setting.

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

If headache, vomiting, dizziness, visual disturbances occur during the administration of the drug, the administration should be stopped and the development of such complications as subdural and subarachnoid bleeding should be excluded. When signs of dehydration appear, it is necessary to introduce fluids into the body.

May be used in heart failure (only in combination with loop diuretics) and hypertensive crisis with encephalopathy.

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

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

A 10% solution can be prepared at room temperature, 15% and 20% solutions can be prepared by heating in a water bath to 37 °C. In a 20% solution of mannitol, especially when it is cooled, crystals may form, for the dissolution of which it is necessary to heat the vial in hot water or in an autoclave, shaking occasionally. Cool to body temperature or below before use.

The effect of mannitol on the ability to drive vehicles not studied.

Instructions

1 ml of solution contains:

active substance - mannitol - 150.0 mg;

excipients - sodium chloride, water for injection.

Release form

R solution for infusions 15%

Pharmacotherapeutic group

Solutions with osmodiuretic action.

pharmachologic effect

Osmotic diuretic. The action is due to an increase in the osmotic pressure of the plasma and a decrease in water reabsorption. The diuretic effect is characterized by the release of large amounts of osmotically free water. The drug does not affect glomerular filtration. Diuresis is accompanied by a significant release of sodium, without a significant effect on the excretion of potassium. expressiveness therapeutic effect drug depends on the administered dose and the speed of administration. It is ineffective in violation of the filtration function of the kidneys, as well as in azotemia in patients with cirrhosis of the liver and with ascites. Causes an increase in circulating blood volume. The drug provides increased fluid excretion after perfusion, lowers resistance renal vessels and enhances blood flow in them, promotes the removal of nephrotoxins. After intravenous administration mannitol quickly penetrates from the bloodstream into the extracellular space. Metabolized in the liver to form glycogen. With renal insufficiency, the half-life increases.

Indications for use

Cerebral edema, intracranial hypertension (with renal or renal-hepatic insufficiency); oliguria in acute renal or renal-hepatic failure with preserved filtration capacity of the kidneys (as part of combination therapy); post-transfusion complications after the introduction of incompatible blood, forced diuresis in case of poisoning with barbiturates, salicylates; prevention of hemolysis during surgical interventions using extracorporeal circulation in order to prevent renal ischemia and associated acute renal failure; glaucoma (acute attack); epileptic status.

Dosage and administration

Intravenously (stream slowly or drip). FROM preventive purpose administered in a single dose at the rate of 0.5 g/kg, with a therapeutic dose - 1-1.5 g/kg. The daily dose should not exceed 140-180 g.

During operations with cardiopulmonary bypass, 20-40 g of mannitol is injected into the apparatus immediately before the start of perfusion.

Patients with oliguria should first be given an IV drip test dose (200 mg/kg) over 3-5 minutes. In the absence of an increase in the rate of diuresis up to 30-50 ml / h for 2-3 hours, further administration of the drug should be abandoned.

Side effect

Dehydration (dry skin, dry mouth, thirst, dyspepsia, muscle weakness, seizures, hallucinations, decreased blood pressure), violation of water and electrolyte metabolism (increase in circulating blood volume, hyponatremia, rarely - hypokalemia); rarely - tachycardia, chest pain, thrombophlebitis, skin rash.

Contraindications

Hypersensitivity, anuria against the background of acute necrosis of the renal tubules, severe dehydration, left ventricular failure (especially accompanied by pulmonary edema), chronic heart failure, hemorrhagic stroke, subarachnoid hemorrhage (except for bleeding during craniotomy), hyponatremia, hypochloremia, hypokalemia.

With caution: pregnancy, lactation, old age.

Overdose

Symptoms: nausea, vomiting, weakness, dysfunction gastrointestinal tract, water and electrolyte disorders, pulmonary edema, left gastric insufficiency, respiratory depression, hepatic coma (in patients with cirrhosis of the liver).

Treatment: drug withdrawal, gastric lavage, correction of water and electrolyte balance, hemodialysis, ultrafiltration. There is no specific antidote.

Application features

When using the drug (especially in the case of repeated injections), it is necessary to control the level of blood pressure, diuresis, the concentration of electrolytes in the blood serum (potassium, sodium).

During pregnancy and lactation, the drug is used only in cases where the intended benefit to the mother outweighs the possible risk to the fetus or infant.

Interaction with other drugs

With the simultaneous use of the drug with cardiac glycosides, an increase in their toxic effect associated with hypokalemia is possible.

Precautionary measures

In case of left ventricular failure (due to the risk of developing pulmonary edema), it should be combined with fast-acting "loop" diuretics.

Perhaps the use of heart failure (only in combination with "loop" diuretics) and hypertensive crisis with encephalopathy. Repeated administration of the drug should be carried out under the control of indicators of water and electrolyte balance of the blood.

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

rr d / inf 150 mg / ml: container. 100 ml, 200 ml, 250 ml, 400 ml, 500 ml or 1000 ml Reg. No.: LP-000898

Clinico-pharmacological group:

Osmotic diuretic

Release form, composition and packaging

Solution for infusion transparent, colorless.

Excipients: sodium chloride 9 mg, water for injection up to 1 ml.

100 ml - PVC containers (1) - polypropylene bags (44) - cardboard boxes.
200 ml - PVC containers (1) - polypropylene bags (28) - cardboard boxes.
250 ml - PVC containers (1) - polypropylene bags (24) - cardboard boxes.
400 ml - PVC containers (1) - polypropylene bags (16) - cardboard boxes.
500 ml - PVC containers (1) - polypropylene bags (12) - cardboard boxes.
1000 ml - PVC containers (1) - polypropylene bags (6) - cardboard boxes.
100 ml - polymer containers (1) polyolefin - polypropylene bags (44) - cardboard boxes.
200 ml - polymer containers (1) polyolefin - polypropylene bags (28) - cardboard boxes.
250 ml - polymer containers (1) polyolefin - polypropylene bags (24) - cardboard boxes.
400 ml - polymer containers (1) polyolefin - polypropylene bags (16) - cardboard boxes.
500 ml - polymer containers (1) polyolefin - polypropylene bags (12) - cardboard boxes.
1000 ml - polymer containers (1) polyolefin - polypropylene bags (6) - cardboard boxes.
100 ml - polymer containers (44) polyolefin - cardboard boxes.
200 ml - polymer containers (28) polyolefin - cardboard boxes.
250 ml - polymer containers (24) polyolefin - cardboard boxes.
400 ml - polymer containers (16) polyolefin - cardboard boxes.
500 ml - polymer containers (12) polyolefin - cardboard boxes.
1000 ml - polymer containers (6) polyolefin - cardboard boxes.

Description of the active ingredients of the drug Mannitol»

pharmachologic effect

Osmotic diuretic. Increasing plasma osmotic pressure and filtration without subsequent tubular reabsorption leads to water retention in the tubules and an increase in urine volume. By increasing the osmolarity of the plasma, it causes the movement of fluid from the tissues (in particular, the eyeball, brain) into the vascular bed. It causes a pronounced diuretic effect, in which a large amount of osmotically free water is excreted, as well as sodium, chlorine, without significant excretion of potassium.

Causes an increase in BCC.

Indications

Edema of the brain. intracranial hypertension. epileptic status. intraocular hypertension, acute attack of glaucoma.

Oliguria in acute renal failure. To determine the rate of glomerular filtration in acute oliguria.

Acute liver failure. Acute liver failure in patients with preserved filtration capacity of the kidneys and other conditions requiring increased diuresis.

Poisoning with barbiturates, salicylates, bromides, lithium preparations, forced diuresis in other poisonings.

Post-transfusion complications after the introduction of incompatible blood.

For the prevention of hemolysis and hemoglobinemia during transurethral resection of the prostate gland or when performing surgical procedures such as bypass surgery on the cardiopulmonary system, during operations with extracorporeal circulation.

Dosing regimen

Enter in / in (slow jet or drip). The prophylactic dose is 500 mg/kg of body weight, the therapeutic dose is 1-1.5 g/kg. The daily dose should not exceed 140-180 g. In operations with extracorporeal circulation, it is administered at a dose of 20-40 g immediately before the operation.

Patients with oliguria should be given a test dose of mannitol (200 mg/kg) intravenously over 3-5 minutes. If after that within 2-3 hours there is no increase in the rate of diuresis to 30-50 ml / g, then further administration of mannitol should be refrained.

Side effect

From the side of metabolism: violations of water and electrolyte balance (increased BCC, dilution hyponatremia, hyperkalemia) and their manifestations (muscle weakness, convulsions, dry mouth, thirst, impaired consciousness).

Others: tachycardia, chest pain, thrombophlebitis, skin rash.

Contraindications

Chronic renal failure, violation of the filtration function of the kidneys, left ventricular failure (especially accompanied by pulmonary edema), hemorrhagic stroke, subarachnoid hemorrhage (except for bleeding during craniotomy), severe forms of dehydration, hyponatremia, hypochloremia, hypokalemia, hypersensitivity to mannitol.

Pregnancy and lactation

There are no adequate and well-controlled studies in humans.

The use of mannitol during pregnancy and lactation is possible in cases where the intended benefit to the mother outweighs the possible risk to the fetus or infant.

Application for violations of kidney function

Contraindicated in chronic renal failure, violation of the filtration function of the kidneys.

Use with caution in patients with impaired renal function.

special instructions

Use with caution in patients with severe forms of chronic heart failure, hypovolemia, impaired renal function.

If symptoms such as headache, vomiting, dizziness, visual disturbances appear during the administration of mannitol, the administration should be discontinued and the development of such complications as subdural and subarachnoid bleeding should be excluded.

When using mannitol, it is necessary to control blood pressure, diuresis, the concentration of electrolytes in the blood serum (potassium, sodium).

drug interaction

drug interaction

With the simultaneous use of mannitol with cardiac glycosides, an increase in their toxic effect associated with hypokalemia is possible.

Or mannitol(lat. mannitum, English mannitol) is an alcohol from the group of sugars. Mannitol is widely used in the pharmaceutical and food industries. AT modern medicine Mannitol is considered mainly as an intravenously administered osmotic diuretic, a means that promotes the excretion of fluid from the body. In the recent past, mannitol has been on the list of osmotic laxatives. Currently, there are no medicines registered in Russia dosage form mannitol (mannitol) positioned as a laxative. In pharmaceuticals, mannitol is often used as an auxiliary, inactive substance.

Mannitol - chemical compound

Mannitol (mannitol or d-mannitol) is a six-hydric hydrocarbon alcohol from the group of sugars. Mannitol is a stereoisomer of sorbitol. The empirical formula for mannitol is C 6 H 8 (OH) 6 . Molar mass 182.172 mol -1. The melting point of mannitol is about 167 °C (7.6 mmHg), the boiling point is 295 °C (at 3.5 mmHg).

Mannitol is a drug

Mannitol - International generic name medicinal product. According to the pharmacological index, mannitol belongs to the group "Diuretics". According to ATC, mannitol is included in the following groups:

• B05. Plasma substituting and perfusion solutions”, subgroup “B05BC Osmodiuretics” and has the code B05BC01
• "A06. Laxatives”, subgroup “A06AD Osmotic laxatives” and has the code A06AD16.
• since 2020, mannitol is also included in the group “V04. Diagnostic drugs” and is assigned the code V04CX04.

Mannitol and mannitol, also trade names medicines produced by different manufacturers in the form of a solution for infusion or powder substance for the preparation of such a solution.

Indications for the use of mannitol

Mannitol route of administration and dosage

Mannitol is administered intravenously slowly by stream or drip, in the form of a 10–20% solution at a dose of 0.5–1.5 g per kg of the patient's weight. The daily dose of mannitol should not exceed 140–180 g. The lyophilized mass of mannitol is dissolved without prior preparation with water for injection or 5% dextrose solution. In operations with cardiopulmonary bypass, immediately before the start of perfusion, 20–40 g

Mannitol - gastrointestinal remedy

In large doses, when taken orally over 20 g, mannitol acts as an osmotic laxative. The therapeutic effect of osmotic laxatives is to attract water into the intestinal lumen along the osmotic gradient. This is accompanied by an increase in the volume of contents and facilitating its movement, the consistency of feces becomes softer, and the frequency of defecation increases. The undesirable side of the action of osmotic laxatives is that their action extends throughout the entire intestine and carries the risk of electrolyte disorders, while the point of application of the "ideal laxative" should be the large intestine. In patients with cardiovascular and renal insufficiency, saline osmotic laxatives can provoke an overload of volume and electrolytes (Shulpekova Yu.O.). Osmotic agents are used to treat constipation of unknown origin (American Gastroenterological Association. Constipation. Heart of the Problem).

Long-term use mannitol can cause diarrhea (Belousova E.A., Zlatkina A.R.).

The FDA risk category for the fetus when taking mannitol during pregnancy is C (animal studies have shown an adverse effect of the drug on the fetus, and there have been no adequate studies in pregnant women, however, the potential benefit associated with the use of this drug in pregnant women may justify its use, despite for the risk involved).

Currently, mannitol is not used as a laxative.

Mannitol has contraindications, side effects and application features, consultation with a specialist is necessary.

The use of mannitol in industry

Mannitol (mannitol) - food supplement E421, approved for use in Russia, Ukraine and other countries. In the food industry, mannitol is used as a sweetener and anti-caking agent. Used in the manufacture chewing gum.

Mannitol is used in the production of resins, drying oils, varnishes and other surfactants, in the manufacture of explosives, and in perfumery.

As an excipient, mannitol is present in many drugs.