Mannitol pl. Instructions for use "Mannitol"

Mannitol

International non-proprietary name

Mannitol

Dosage form

Solution for infusion 15% 200 ml, 400 ml

Compound

1 liter of the drug contains

aactive substance - mannitol 150.0 g,

Excipients: sodium chloride, water for injection.

Description

Clear, colorless solution, odorless.

Pharmacotherapeutic group

Plasma substituting and perfusion solutions.

Solutions for intravenous administration.

Osmodiuretics. Mannitol.

ATX code B05BC01

Pharmacological properties

Pharmacokinetics

Mannitol is a hexavalent alcohol that is poorly absorbed when taken orally due to the high polarity of its molecule, which causes the only possible way applications - parenteral administration (in / in). The volume of distribution of mannitol corresponds to the volume of extracellular fluid, since it is distributed only in the extracellular sector. The drug does not penetrate cell membranes and tissue barriers (eg, blood-brain, placental). Mannitol may be slightly metabolized in the liver to form glycogen.

The half-life of mannitol is about 100 minutes. The drug is excreted by the kidneys. Excretion of mannitol is regulated by glomerular filtration without significant involvement of tubular reabsorption and secretion. If you enter intravenously 100 g of mannitol, then 80% of it is determined in the urine within 3 hours.

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

Pharmacodynamics

Mannitol increases plasma osmolarity, causing the movement of fluid from tissues into the vascular bed. Mannitol has a strong diuretic effect. The principle of the diuretic action of mannitol is that it is well filtered in the renal glomeruli, creates a high osmotic pressure in the lumen of the renal tubules (mannitol is little reabsorbed) and reduces water reabsorption. It acts mainly in the proximal tubules, although the effect is preserved to some extent in the descending loop of the nephron and in the collecting ducts. Unlike other osmotic diuretics, mannitol is able to excrete a large number of free water. Diuresis is accompanied by a significant release of sodium and chlorine without a significant effect on the excretion of potassium. It should be borne in mind that the natriuresis that occurs when prescribing mannitol is less than water, which sometimes leads to hypernatremia. Mannitol does not significantly affect the acid-base state.

The diuretic effect of mannitol depends on the amount of the drug filtered through the kidneys. The effect is all the more pronounced, the higher the concentration of the drug and the rate of its administration. If the filtration function of the renal glomeruli is impaired, the diuretic effect of the mannitol solution may be absent.

Indications for use

Cerebral edema, intracranial hypertension

Acute attack of glaucoma

Oliguria in acute renal or renal-hepatic insufficiency with preserved filtration capacity of the kidneys (as part of combination therapy)

Forced diuresis in case of poisoning with barbiturates and salicylates

Prevention of hemolysis during operations with extracorporeal circulation in order to prevent renal ischemia and associated acute renal failure.

Post-transfusion complications after the introduction of incompatible blood

Dosage and administration

Mannitol is administered intravenously slowly by stream or drip. The therapeutic dose of a 15% mannitol solution is 1.0-1.5 g/kg. The daily dose of mannitol should not exceed 140-180 g.

Adults are administered 50-100 g of the drug at a rate that provides a diuresis level of at least 30-50 ml / h.

The usual pediatric dose is 0.25 - 0.5 g / kg, which is administered over 2-6 hours. The maximum daily dose for children is 2.0 g / kg or 60 g per 1 m2 of body surface. The dose and rate of administration of mannitol for children are selected individually, depending on the severity of the patient's condition. With cerebral edema, increased intracranial pressure or glaucoma - 1-2 g / kg or 30-60 g per 1 m2 of body surface for 30-60 minutes. In children with low body weight or exhausted patients, a dose of 500 mg / kg is sufficient. In case of poisoning in children, intravenous infusion is carried out up to 2 g / kg of body weight or 60 g per 1 m2 of body surface.

In case of poisoning in adults, 50-200 g is administered at an infusion rate that maintains diuresis at a level of 100-500 ml / hour. The maximum dose for adults is up to 6 g / kg of body weight for 24 hours.

For the prevention of hemolysis and hemoglobinemia during transurethral resection of the prostate gland, when performing bypass surgery on the cardiopulmonary system or during operations with extracorporeal circulation, the dose (dry powder) is 500 mg / kg of body weight.

In operations using extracorporeal circulation, Mannitol is administered at a dose of 20-40 g immediately before the start of perfusion.

In patients with oliguria, in order to detect a reaction to osmotic diuretics, before starting a continuous infusion, a test dose (200 mg / kg) of mannitol should be injected intravenously over 3-5 minutes. Mannitol is not effective if the diuresis rate has not increased to 50 ml/hour within 3 hours. If a response to a trial dose is obtained, then the introduction of a solution of mannitol (12.5-25 g) should be repeated after 1-2 hours to maintain the urine output at a level above 100 ml/hour.

Side effects

Often

Headache

Dry mouth

Nausea and vomiting

Dry skin

Rarely

Pain behind the sternum

Tachycardia

Skin rash

Thrombophlebitis

Muscle weakness, cramps, hallucinations, decreased blood pressure due to dehydration

Violations of water and electrolyte metabolism (increased blood volume, hyponatremia, hyperkalemia)

With fast intravenous administration

Headache

Nausea and vomiting

Fever

Chest pain

Respiratory failure

Contraindications

- hypersensitivity to drug components

Severe renal failure with impaired filtration process, with anuria for more than 12 hours

Hemorrhagic stroke, subarachnoid hemorrhage (except for bleeding during craniotomy)

Pulmonary edema on the background of acute left ventricular failure

Decompensated cardiovascular insufficiency

Severe degree of dehydration

Hypokalemia, hyponatremia, hypochloremia

Post-traumatic enhancement intracranial pressure with risk of hemorrhage

Drug Interactions

Simultaneous use of the drug with cardiac glycosides may increase their toxic effect due to hypokalemia. The drug potentiates the diuretic effect of saluretics, carbonic anhydrase inhibitors and other diuretic drugs. Simultaneous use with other diuretics enhances their effect. When used with neomycin, the risk of developing oto- and nephrotoxicity increases.

special instructions

In heart failure, especially in left ventricular failure (due to the risk of pulmonary edema), Mannitol should be combined with fast-acting "loop" diuretics. Can be used in heart failure (only in combination with "loop" diuretics) and hypertensive crisis with encephalopathy. During the infusion, it is necessary to monitor renal function, as well as control diuresis to avoid accumulation of mannitol. It is necessary to control blood pressure, the concentration of electrolytes (potassium ions, sodium ions) and sugar in the blood serum. Repeated administration of the drug should be carried out under the control of indicators of water and electrolyte balance of the blood.

Mannitol is not effective for azotemia in patients with cirrhosis of the liver and ascites. It should be borne in mind that initially with the introduction of a solution of mannitol, the volume of extracellular fluid increases and hyponatremia develops.

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.

Simultaneous use with cardiac glycosides may increase the risk of digitalis poisoning and hypokalemia.

Simultaneous use with other diuretics enhances their effect.

There may be cases of crystallization during storage of the drug at a temperature below 20 ° C, in case of crystallization, the solution should be slightly heated in a water bath at a temperature of 50 ° C up to 70 ° C until the crystals disappear, and immediately before the introduction - cool to a body temperature of 36 ° C.

Application in pediatrics

For children and adolescents, the drug is prescribed only for health reasons. There are no data on contraindications for the use of the drug in children and adolescents.

Pregnancy and lactation

There are no data on contraindications for the use of the drug during pregnancy and lactation. The use of the drug during pregnancy and lactation is possible with caution in cases where the intended benefit to the mother outweighs the possible risk to the fetus or infant.

Features of the effect of the drug on the ability to drive vehicle or potentially dangerous mechanisms

The drug is used in stationary conditions where it is not provided for the performance of such an activity as driving a car or working with machinery.

Overdose

Symptoms: signs of dehydration (nausea, vomiting, hallucinations), muscle weakness, convulsions, loss of consciousness.

Treatment: stop the administration of the drug. Carrying out symptomatic therapy.

Release form and packaging

200 ml and 400 ml of the drug in a polypropylene container with one or two ports.

Containers are packed in a cardboard box along with instructions for medical use in the state and Russian languages ​​in an amount equal to the number of containers.

Storage conditions

Mannitol: instructions for use and reviews

Latin name: Mannitol

ATX code: B05BC01, B05CX04

Active substance: mannitol (mannitol)

Producer: Groteks, LLC (Russia), Medpolimer firm (Russia), Biosintez, PAO (Russia), Farmasintez-Tyumen, OOO (Russia), Medsintez plant (Russia), Biosintez, PAO (Russia)

Description and photo update: 27.08.2019

Mannitol is medicine, which refers to osmotic diuretics. The action of diuretics is based on the fact that the active substance of the drug penetrates into the necessary element of the kidney and creates high pressure in it, thereby preventing the absorption of water.

What are the indications for the use of the drug, are there any contraindications, are adverse reactions what is the composition and form of release. Are there analogues of this drug?

Instructions for use

Release form

The medicine is released in the form of a 15% solution for injection. The drug is contained in glass jars with a volume of 100, 200, 400 ml. The solution itself is clear and odorless. It is released in pharmacies by prescription of the attending physician.

Indications for use

Mannitol solution, according to the instructions, is used:

1. With cerebral edema.
2. With status epilepticus.
3. With intracranial and intraocular hypertension.
4. With acute glaucoma.
5. In the presence of renal failure.

In addition to the above diseases, the drug is used as a preventive measure for hemoglobinemia and hemolysis:

1. When there is a transurethral resection of the prostate.
2. When performing operations with extracorporeal circulation.
3. When complex surgical procedures are performed.

Contraindications to the use of the solution

The use of Mannitol is contraindicated in cases where:

• the patient has an individual intolerance to the components of the drug;
• the patient suffers from anuria;
• there is pulmonary edema;
• the patient suffers from chronic heart failure;
• The patient suffered severe dehydration.

Under the strict supervision of the attending physician, Mannitol can be used with extreme caution:

• pregnant women and during lactation;
• people over 50;
• in the presence of hypovolemia.

The composition of the medicine

The composition of the drug Mannitol contains such an active substance as mannitol. Additional substances that provide the desired effect of the drug are and.

How to take Mannitol

The drug Mannitol is not fast-acting, so if the patient needs instant immediate help, it should not be used. The solution is introduced intravenous with a dropper or a simple injection. The dosage of the drug is determined according to the patient's body weight.

For prevention, it is necessary inject 500 mg of the drug per 1 kilogram of the patient's weight. For medicinal purposes, 1-1.5 grams per kilogram of human weight is used. It is important to know and remember that the daily dose of the drug should not exceed 140-180 grams.

Before surgical procedures with extracorporeal circulation it is necessary to administer 20–40 grams of Mannitol to the patient before the operation itself.

Patients who have oliguria first, the so-called trial dosage of the drug in the amount of 200 mg per 1 kilogram of the patient's weight should be administered drip, the drug should be administered within 4-5 minutes. If after a few hours diuresis does not accelerate to 30-50 ml / g, then Mannitol should not be used in the future.

Side effects

Side effects of the drug can be manifested in the form of:

If the patient has exceeded the required dosage of the drug, then in this case it is also possible that side effects. The most common of them are:

• increased intracranial and intraocular pressure;
• hypervolemia;
• violation of the water balance of the patient's body;
• increased extracellular fluid.

Special instructions to be observed

During the use of Mannitol, it is necessary not to forget about the control of diuresis, blood pressure, the level of concentration in the blood of potassium and sodium. Since in the presence of left gastric insufficiency there is a high risk of pulmonary edema, the drug should be taken simultaneously with loop-type diuretics, which have a rapid effect on the human body.

If during treatment with Mannitol the patient develops symptoms such as blurred vision, severe headache and dizziness, then the drug should be discontinued in order to avoid more serious negative consequences.

It is also important to know what a drug is, how Mannitol can quickly increase the effect of drugs intended for the treatment of the heart. If Mannitol is used simultaneously with other diuretics, then the overall diuretic effect increases. If Mannitol is used together with neomycin, then the risk of nephrotoxic and ototoxic effects increases.

How to store medicinal product?

As mentioned earlier, Mannitol is dispensed in pharmacies only by prescription. It is necessary to store the drug out of the reach of children, it is also important that direct sunlight does not fall on the drug, as this can spoil it prematurely. The air temperature in the place where the drug is stored should be at the level of 5-20ºС. You can use the solution for 3 years.

Price

The price of the solution in Russia is in the range of 70–90 rubles, in Ukraine - 30–50 hryvnias.

Analogues

According to the structural content, the main analogue of Mannitol is the drug Mannitol. Mannitol is a decongestant diuretic. The drug is produced in the same form as Mannitol, that is, in the form of a solution for intravenous use, which is contained in glass bottles, the liquid is clear.

Mannitol is the active ingredient in Mannitol. The instructions for use of the medicine indicate the same indications and contraindications as in Mannitol.

For prevention, Mannitol must be taken in the amount of 0.5 grams per 1 kilogram of body weight of a sick person. If the medicine is taken to treat diseases, then the daily dosage of Mannitol should be no more than 140-180 grams. Among the side effects are the following:

1. Skin rash.
2. Dizziness.
3. Breathlessness.
4. Dehydration.
5. The appearance of hallucinations.

The manufacturer of Mannitol is the Russian Federation.