mannitol (systemic)

MAN-i-tol

Therapeutic Classification: diuretics

Pharmacologic Classification: osmotic diuretics

REMS

Reduction of intracranial pressure and treatment of cerebral edema.
Reduction of elevated intraocular pressure.

Increases the osmotic pressure of the glomerular filtrate, thereby inhibiting reabsorption of water and electrolytes.
Causes excretion of:
- water,
- sodium,
- potassium,
- chloride,
- calcium,
- phosphorus,
- magnesium,
- urea,
- uric acid.

Therapeutic effects:

Reduction of intraocular or intracranial pressure.

Absorption: IV administration results in complete bioavailability.

Distribution: Confined to the extracellular space; does not usually cross the blood-brain barrier or eye.

Metabolism/Excretion: Excreted by the kidneys; minimal liver metabolism.

Half-Life: 100 min.

(diuretic effect)

ROUTE	ONSET	PEAK	DURATION
IV	30–60 min	1 hr	6–8 hr

Contraindicated in:

Hypersensitivity;
Anuria;
Severe hypovolemia;
Active intracranial bleeding (except during craniotomy);
Severe pulmonary edema.

Use Cautiously in:

Renal impairment, conditions that ↑ risk of renal impairment, or receiving potentially nephrotoxic medications (↑ risk for renal failure);
Compromised blood brain barrier (↑ risk of rebound cerebral edema);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk (may cause fluid shifts that may cause adverse effects in fetus);
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children 2 yr ( risk for fluid and electrolyte abnormalities).

CV: transient volume expansion, chest pain, HF, tachycardia

EENT: blurred vision, rhinitis

F and E: dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia, metabolic acidosis, metabolic alkalosis, thirst

GI: nausea, vomiting

GU: acute kidney injury, renal failure, urinary retention

Local: phlebitis

Neuro: COMA, confusion, headache, lethargy

Resp: pulmonary edema

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Drug-drug:

Hypokalemia ↑ the risk of digoxin toxicity.
↑risk of renal failure with other nephrotoxic drugs, including aminoglycosides and diuretics; avoid concurrent use.
↑risk of neurotoxicity with other neurotoxic drugs, including aminoglycosides; avoid concurrent use.

Reduction of Intracranial Pressure

IV (Adults ): 0.25–2 g/kg; may repeat every 6–8 hr.
IV (Children ): 1–2 g/kg (30–60 g/m²).

Reduction of Intraocular Pressure

IV (Adults ): 1.5–2 g/kg as a 15–20% solution.
IV (Children ): 1–2 g/kg (30–60 g/m²).

(Generic available)

Solution for injection: 20%; 25%

Monitor vital signs, urine output, CVP, and pulmonary artery pressures (PAP) before and hourly throughout administration. Assess patient for signs and symptoms of dehydration (decreased skin turgor, fever, dry skin and mucous membranes, thirst) or signs of fluid overload (increased CVP, dyspnea, rales/crackles, edema).
Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Report signs of electrolyte imbalance.
Increased Intracranial Pressure: Monitor neurologic status and intracranial pressure readings in patients receiving this medication to decrease cerebral edema.
Increased Intraocular Pressure: Monitor for persistent or increased eye pain or decreased visual acuity.

Lab Test Considerations:

Renal function and serum electrolytes should be monitored routinely throughout therapy.
- May cause false positive results in tests for blood ethylene glycol concentrations.

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Y-Site Incompatibility:

Observe infusion site frequently for infiltration. Extravasation may cause tissue irritation and necrosis.
- Do not administer electrolyte-free mannitol solution with blood. If blood must be administered simultaneously with mannitol, add at least 20 mEq NaCl to each liter of mannitol.
- Confer with health care professional regarding placement of an indwelling Foley catheter (except when used to decrease intraocular pressure).
IV: Administer by IV infusion undiluted. If solution contains crystals, warm bottle in hot water and shake vigorously. Do not administer solution in which crystals remain undissolved. Cool to body temperature. Use an in-line filter for 15%, 20%, and 25% infusions.
Test Dose: Administer over 3–5 min to produce a urine output of 30–50 mL/hr. If urine flow does not increase, administer 2nd test dose. If urine output is not at least 30–50 mL/hr for 2–3 hr after 2nd test dose, patient should be re-evaluated.
Oliguria: Administration rate should be titrated to produce a urine output of 30–50 mL/hr. Administer child’s dose over 2–6 hr.
Increased Intracranial Pressure: Infuse dose over 30–60 min in adults and children.
Intraocular Pressure: Administer dose over 30 min. When used preoperatively, administer 60–90 min before surgery.

Explain purpose of therapy to patient.

Urine output of at least 30–50 mL/hr or an increase in urine output in accordance with parameters set by health care professional.
Reduction in intracranial pressure.
Reduction of intraocular pressure.

Osmitrol

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆