• IV: Reduction of intracranial pressure and treatment of cerebral edema.
• Reduction of elevated intraocular pressure.

GU irrigant:

• During transurethral procedures (2.5–5% solution only).

Contraindicated in:

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

Use Cautiously in:

• Renal impairment, conditions that increase risk of renal impairment, or receiving potentially nephrotoxic medications (↑ risk for renal failure)
• Compromised blood brain barrier (↑ risk of rebound cerebral edema)
• OB: Use 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).

CNS: COMA, confusion, headache, lethargy.

CV: transient volume expansion, chest pain, HF, pulmonary edema, tachycardia.

EENT: blurred vision, rhinitis.

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

GI: nausea, thirst, vomiting.

GU: acute kidney injury, renal failure, urinary retention.

Local: phlebitis at IV site.
Misc: (INCLUDING ANAPHYLAXIS, HYPOTENSION, AND DYSPNEA)HYPERSENSITIVITY REACTIONS .

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.

(Generic available)

• Solution for injection: 5%; 10%; 15%; 20%; 25%;
• Solution for irrigation: 5%;

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).

Transurethral Irrigation

• Transurethral: (Adults): Use 5% urogenital solution as required for irrigation.

Osmitrol, Resectisol

• 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.

• Reduction of intraocular or intracranial pressure.
• Decreased hemolysis when used as an irrigant after transurethral prostatic resection.

Therapeutic Classification: diuretics

Pharmacologic Classification: osmotic diuretics

Absorption: IV administration produces complete bioavailability. Some absorption may follow use as a GU irrigant.

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)

• Explain purpose of therapy to patient.

MAN-i-tol