Adult Dosing

Oliguria

Test dose

• Oliguria or suspected renal dysfunction: 0.2 g/kg or 12.5 g as 15-20% solution infused over 3-5 mins. Adequate response is 30-50 mL urine/hr for next 2-3 hours, may repeat one more test dose (not more than 2 test doses)

Note:

• Discontinue if no response to test dose

Prevention of Oliguria

• 50-100 g as a 5%, 10%, or 15% IV solution
• For prophylaxis in surgery, begin administration before or immediately following surgery and may be continued postoperatively

Treatment of oliguria

• 100 g given as a 15 or 20% solution IV

Note:

• Do not repeat doses in patients with persistent oliguria

Reduction of IOP

• 1.5-2 g/kg given as a 15 or 20% solution IV over 30-60 min
• Preoperatively, give 1-1.5 hours prior to surgery

Reduction of intracaranial pressure

• 0.25 g/kg IV given not more frequently than q6-8 hrs

Adjunct therapy for intoxification

• 5%-20% IV x 1; concentration depending upon the fluid requirement and urinary output of the patient

Reduction of intracranial pressure [Non-FDA Approved]

• Loading dose of 0.25-1 gram/kg IV, followed by 0.25-0.5 g/kg IV q4 hrs

Pediatric Dosing

• Safety and efficacy in pediatric patients <12 yrs have not been established

Oliguria

Test dose

• Oliguria or suspected renal dysfunction: 0.2 g/kg or 12.5 g as 15-20% solution IV over 3-5 mins. Adequate response is 30-50 mL urine/hr for next 2-3 hours, may repeat one more test dose (not more than 2 test doses)

Note:

• Discontinue if no response to test dose

Prevention of Oliguria

• 50-100 g as a 5%, 10%, or 15% IV solution
• For prophylaxis in surgery, begin administration before or immediately following surgery and may be continued postoperatively

Treatment of oliguria

• 100 g as a 15 or 20% solution IV

Note:

• Do not repeat doses in patients with persistent oliguria

Reduction of IOP

• 1.5-2 g/kg given as a 15 or 20% solution IV over 30-60 min
• Preoperatively, give 1-1.5 hours prior to surgery

Reduction of intracaranial pressure

• 0.25 g/kg IV given not more frequently than q6-8 hrs

Adjunct therapy for intoxification

• 5%-20% IV x 1; concentration depending upon the fluid requirement and urinary output of the patient

Reduction of intracranial pressure [Non-FDA Approved]

• Loading dose of 0.25-1 gram/kg IV, followed by 0.25-0.5 g/kg IV q4 hrs

[Outline]

• Adult Dosing
• Pediatric Dosing

• Promotion of diuresis, in the prevention and/or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established
• Reduction of intracranial pressure and treatment of cerebral edema by reducing brain mass
• Reduction of elevated intraocular pressure (IOP) when other means have proven ineffective
• Promoting the urinary excretion of toxic substances

• Hypersensitivity to any of the ingredients of the product
• Anuria due to severe renal disease
• Severe dehydration
• Severe pulmonary congestion
• Frank pulmonary edema
• Active intracranial bleeding except during craniotomy
• Progressive heart failure
• Progressive renal dysfunction after mannitol administration

• N/A

Renal Dose Adjustment

• Acute renal impairment: Give test dose; see adult dosing
• Severe renal impairment or anuria: Contraindicated

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Give a test dose in patients with severe renal impairment; may give a second test dose if there is an inadequate response [Max: 2 test doses]
• Rapid infusion may lead to profound diuresis causing excessive loss of fluids and electrolytes; monitor sodium and potassium levels carefully during therapy
• With continued mannitol administration, loss of water in excess of electrolytes may cause hypernatremia
• Closely monitor urine output and discontinue therapy if the output is low. Inadequate urine output results in accumulation of mannitol, which could result in overexpansion of the extracellular fluid that may intensify existing or latent CHF
• Therapy may cause osmotic nephrosis which may proceed to severe irreversible nephrosis; monitor renal function during mannitol infusion
• Connection of flexible plastic containers of IV solutions in series may result in air embolism
• Rapid infusion of mannitol may increase preexisting hemoconcentration
• Sudden expansion of the extracellular fluid after rapid administration may cause fulminant CHF. Carefully evaluate cardiovascular status of the patient before rapidly administrating mannitol
• Shift of sodium free intracellular fluid into the extracellular compartment following mannitol infusion may lower serum sodium concentration and exacerbate preexisting hyponatremia
• Do not give electrolyte free mannitol in conjunction with blood to avoid pseudoagglutination
• When exposed to low temperatures, mannitol solutions may crystallize. Inspect for crystals prior to administration; if present, re-dissolve by warming the solution up to 70°C with agitation

Cautions: Use cautiously in

• Renal impairment
• Labor and delivery
• Elderly patients

Pregnancy Category:C

Breastfeeding: Safety unknown; manufacturer advises caution during nursing.

• CNS: Dizziness, headache, convulsion, CNS depression, seizures
• CV: Hypotension, hypertension, tachycardia, angina-like chest pain, cardiovascular collapse, congestive cardiac failure
• RESP: Pulmonary edema
• GI: Nausea, vomiting, thirst, dry mouth
• EENT: Rhinitis, blurred vision
• DERM: Extravasation necrosis, urticaria, rash
• METABOLIC: Fluid imbalance, electrolyte disorders, dehydration, acidosis
• GU: Osmotic nephrosis, acute renal failure, polyuria
• LOCAL: Pain, thrombophlebitis at the injection site
• MISC: Chills, fever, coma

• Osmotic diuretic; increases the osmolarity of glomerular filtrate, which inhibits tubular re-absorption of water and electrolytes and increases urinary output
• Metabolized minimally in liver
• Renally excreted (100%)
• Half-life: 100 minutes

US Trade Name(s)

• Osmitrol

US Availability

mannitol (generic)

• INJ: 5%
• INJ: 10%
• INJ: 15%
• INJ: 20%
• INJ: 25%

Osmitrol

• INJ: 5%
• INJ: 10%
• INJ: 15%
• INJ: 20%

Canadian Trade Name(s)

• Osmitrol

Canadian Availability

mannitol (generic)

• INJ: 20%
• INJ: 25%

Osmitrol

• INJ: 10%
• INJ: 20%

UK Trade Name(s)

• Only generic available

UK Availability

mannitol (generic)

• INJ: 10%
• INJ: 20%

Australian Trade Name(s)

• Osmitrol

Australian Availability

Osmitrol

• INJ: 10%
• INJ: 20%

[Outline]

Cardiovascular

Diuretic

Osmotic Diuretic