Mannitol dosage. Overdose of Mannitol. Special instructions to be observed

Mannitol - medicinal product groups of osmotic diuretics.

Indications and dosage:

Mannitol is prescribed for cerebral edema, increased intraocular and intracranial pressure(after past injuries and surgical interventions), oliguria (with severe renal and renal-hepatic insufficiency with normal filtration capacity of the kidneys).

Mannitol is administered if it is necessary to accelerate diuresis in case of poisoning, in particular in case of poisoning with drugs from the salicylates and barbiturates group.

The drug is used to treat complications associated with the introduction of incompatible blood, as well as to prevent renal ischemia, hemolysis and hemoglobinemia during surgical interventions with extracorporeal circulation.

Mannitol is intended for parenteral use. The solution should be administered infusion drip or slowly jet. The solution should be administered pre-warmed to body temperature. The amount of infusion solution is calculated by the attending physician, taking into account the required dose of mannitol and the possible volume of liquid. The recommended dose for prophylaxis is 500 mg of mannitol per kilogram of body weight. Recommended therapeutic dose is 1000-1500 mg of mannitol per kilogram of body weight. It is not recommended to use more than 140-180g of mannitol per day. When prescribing to patients with oliguria, therapy should be started with the introduction of 200 mg of mannitol per kilogram of body weight. The solution is administered within 3-5 minutes, and if the patient's diuresis rate does not increase to 30-50 ml / hour within a few hours, further use of the drug is not recommended. If it is necessary to administer a repeated dose of the drug, the patient's water and electrolyte balance, blood pressure and diuresis should be monitored.

Overdose:

When using high doses of the drug or too rapid administration, hypervolemia, an increase in intraocular and intracranial pressure, as well as cumulation of mannitol, disturbances in water and electrolyte balance and an increase in extracellular fluid may develop. With an excessive increase in the volume of circulating blood, an increase in the load on the heart is noted.

Side effects:

It is possible to develop such unwanted effects with the introduction of mannitol:

Violations by gastrointestinal tract: dyspeptic symptoms, dryness of the oral mucosa and thirst, nausea, vomiting.

Cardiac and vascular disorders: tachycardia, arterial hypotension, attacks of angina pectoris, a significant increase in the volume of circulating blood, in isolated cases, the development of thrombophlebitis is possible.

Electrolyte disorders: Decreased sodium levels and increased plasma potassium levels.

Others: dryness and flaking of the skin, muscle weakness, convulsions, in some cases, the development of hallucinations and pulmonary edema was noted.

In patients with hypersensitivity, the development of skin allergic reactions was noted.

In case of incorrectly performed infusion and the solution enters the soft tissues necrosis may develop.

When using the drug, the development of subdural and subarachnoid bleeding is possible, the first symptoms of which are decreased vision, dizziness, and also headache and vomiting. If these side effects infusion should be interrupted and bleeding should be excluded.

Contraindications:

Individual hypersensitivity to mannitol.

Mannitol is not prescribed to patients suffering from severe kidney damage (in particular, acute tubular necrosis, which is accompanied by anuria), left ventricular failure (including pulmonary edema), chronic form heart failure, as well as hemorrhagic stroke and subarachnoid hemorrhage.

Mannitol is contraindicated in patients with impaired water and electrolyte balance, in particular severe dehydration, a decrease in the level of sodium, chloride and potassium in the blood plasma.

Pregnant and lactating women, as well as patients over 65 years of age, are advised to prescribe mannitol with caution.

Interaction with other drugs and alcohol:

When combined with diuretic agents, there is a significant mutual enhancement of the diuretic effect. The simultaneous use of mannitol with neomycin leads to an increased risk of developing ototoxic and nephrotoxicity. toxic action. Mannitol increases the likelihood of developing the toxic effects of cardiac glycosides.

Composition and properties:

100 ml of Mannitol 10% solution contains: Mannitol - 10g; Excipients.

100ml of Mannitol 15% solution contains: Mannitol - 15g; Excipients.

100 ml of Mannitol 20% solution contains: Mannitol - 20 g; Excipients.

Release form:

Infusion solution of 200 or 400 ml in glass bottles.

Pharmachologic effect:

The drug has a pronounced diuretic effect, due to changes in osmotic pressure blood plasma, the drug promotes the transition of water from the tissues into the vascular bed. Mannitol reduces intraocular and intracranial pressure, increases the excretion of water and sodium by the kidneys. The drug does not significantly affect the level of potassium ions in the blood plasma. The use of Mannitol is not effective in patients with impaired filtration capacity of the kidneys, azotemia in liver cirrhosis and ascites. With the infusion administration of the drug, an increase in the volume of circulating blood is noted. The diuretic effect of mannitol develops within 1-3 hours, and the decrease in intraocular and intracranial pressure within 15 minutes after the start of the infusion. Active ingredient The drug crosses the hematoplacental barrier. The half-life of mannitol reaches 1.5-2 hours.

Storage conditions:

The drug is suitable for 3 years, subject to injury in dry rooms with a temperature not exceeding 25 degrees Celsius. When the solution is stored at a temperature below 20 degrees Celsius, precipitation of crystals of the active substance is noted, in which case the drug should be heated to a temperature of 55-70 degrees Celsius and gradually cooled to a temperature of 35-37 degrees Celsius, if no re-crystallization is noted, the drug can be used.

Ingredients per bottle:

Active substance: mannitol - 60000.0 mg;
excipients: sodium chloride, water for injection.

Description

pharmachologic effect

An osmotic diuretic, by 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, eyeball, brain) into the vascular bed. 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 with ascites. Causes an increase in circulating blood volume. Mannitol does not cross an intact blood-brain barrier.

The osmolarity of the solution is 1130 mOsm/l.

Pharmacokinetics

After intravenous administration mannitol quickly penetrates from bloodstream into the extracellular space. The volume of distribution corresponds to the volume of extracellular fluid. Mannitol (10% of the administered dose) may be metabolized in the liver to form glycogen. The half-life is about 100 minutes. Excreted by the kidneys; with intravenous administration of 100 g of mannitol, 80% of the administered dose is determined in the urine within 3 hours. At kidney failure the elimination half-life can increase up to 36 hours.

Indications for use

Stimulation of diuresis in the prevention or treatment of oliguria;

Decreased intracranial pressure ( intracranial hypertension, cerebral edema);

High drop intraocular pressure with the ineffectiveness of other drugs;

Forcing diuresis in case of poisoning with toxic substances.

- diagnostics: measurement of glomerular filtration rate.

Contraindications

The use of Mannitol-Belmed is contraindicated in organic lesions kidneys with impaired filtration, severe forms dehydration, intracranial bleeding (with the exception of craniotomy), congestion in the pulmonary circulation, pulmonary edema, cardiovascular insufficiency, hypersensitivity to any of the components of the drug, with hypovolemia, hypochloremia, hypernatremia, hyperkalemia, anuric stage of chronic renal failure and acute renal failure, in violation of the blood-brain barrier.

With caution. Pregnancy, lactation (used only in cases where the intended benefit to the mother outweighs possible risk for a fetus or baby); elderly age.

Pregnancy and lactation

Mannitol should not be used during pregnancy unless absolutely necessary.

There is no information on the excretion of mannitol in breast milk. Mannitol should only be used during lactation if absolutely necessary.

Dosage and administration

Mannitol-Belmed should only be administered by intravenous infusion.

The total dose and rate of administration depend on the indication and clinical condition patient. Usual dose for adults is from 50 g to 200 g in a 24-hour period, but in most cases an adequate response will be achieved at a dose of about 100 g / 24 hours (calculated as mannitol). The rate of administration is usually from 30 to 50 ml/hour. The daily dose should be adjusted depending on the clinical situation and side effects. The maximum dose is 140-180 g for 24 hours (calculated as mannitol).

Patients with oliguria should be given a preliminary intravenous drip test dose of 0.2 g/kg body weight (calculated as mannitol) over a period of 3 to 5 minutes. If after that within 2-3 hours there is no increase in the rate of diuresis to 30-50 ml / hour, further administration of the drug should be refrained.

Oliguria: in adults, 300 to 400 mg/kg body weight (21 g to 28 g per 70 kg) as mannitol. Dosing should not be repeated in patients with persistent oliguria.

Reduction of intracranial pressure and treatment of cerebral edema: in adults at a dose of 0.25 to 2 g/kg of body weight, administered over a period of 30 to 60 minutes. In patients with low body weight or debilitated patients, a dose of 0.5 g / kg is sufficient. After the infusion is started, it is advisable to monitor the pressure decrease cerebrospinal fluid with dose adjustment if necessary. Function must be carefully evaluated of cardio-vascular system and kidney function before and during the appointment of Mannitol-Belmed. Special attention should be directed to water-salt balance, body weight, diuresis before and after Mannitol-Belmed infusion.

Decrease in intraocular pressure: in adults, infusion at the rate of 0.25-2 g / kg of body weight (calculated as mannitol) for 30-60 minutes. In patients with low body weight or debilitated patients, a dose of 0.5 g / kg is sufficient.

As part of complex therapy with intoxication: in adults, 50-180 g at an infusion rate that maintains diuresis at a level of 100-500 ml / hour.

Children. In renal insufficiency, the trial dose is 200 mg mannitol/kg body weight (1.3 ml/kg body weight) for 3-5 minutes. The therapeutic dose is 0.5 to 1.5 g/kg body weight (3 ml to 10 ml/kg body weight). If necessary, this dose may be repeated once or twice. With an interval of 4 to 8 hours.

To reduce elevated intracranial and intraocular pressure, the dose is 1.5 to 2 g/kg body weight (10-13 ml/kg bw) given over 30-60 minutes.

Elderly people. Dosage depends on weight, clinical and general condition patient and concomitant therapy. The general dose range is the same as for adults.

50 to 200 g of mannitol over 24 hours (330 to 1320 ml per day), with a maximum dosage of 50 g of mannitol (330 ml) per injection. In the presence of signs of minimal renal insufficiency, caution should be exercised in assessing the patient's status and dose selection.

Glomerular filtration rate measurement: 100 ml of a 20% mannitol solution are diluted in 180 ml physiological saline or 200 ml of a 10% mannitol solution are diluted in 80 ml of saline. The resulting 280 ml of solution is injected at a rate of 20 ml/minute. During certain period time, urine is collected and the excretion of mannitol (mg/min) is analyzed. Blood samples are taken at the beginning and at the end given period time and determine the concentration of mannitol (mg/ml plasma). Normally, the clearance value is approximately 125 ml / min in men and 116 ml / min in women.

Side effect

Dehydration (dry skin, dryness of the oral mucosa, thirst, dyspepsia, muscle weakness, convulsions, hallucinations, decreased blood pressure), blurred vision, impaired water and electrolyte metabolism (increased blood volume, hyponatremia, rarely hypokalemia); rarely - tachycardia, chest pain, thrombophlebitis, skin rash.

The clinical use of osmodiuretics is associated with the risk of developing serious violations water and electrolyte balance. fast zoom BCC, especially with bolus administration of mannitol, can lead to transient hypervolemia, which is dangerous for decompensation of heart failure in patients with pathology of cardio-vascular system and development of pulmonary edema. In the future, as osmotic diuresis increases and with inadequate control water balance, hypovolemia develops, up to severe dehydration. The introduction of osmodiuretics is not recommended for initial plasma osmolality over 320 mOsm/kg and hypernatremia over 155 mmol/L.

Relative contraindications to osmotherapy are congestive heart failure in the stage of decompensation, cardiomyopathy, anuric stage of chronic renal failure and acute renal failure. If a patient with TBI has deep hypovolemia before the administration of mannitol, etc. desirable infusion therapy in order to correct it.

When using high doses of mannitol (> 200 g per day or > 400 g in 48 hours), there is a risk of induced acute renal failure. At the same time, the likelihood of acute renal failure increases if mannitol was used with other diuretics - diacarb, loop diuretics or with the parallel administration of nephrotoxic drugs - for example, cyclosporine A.

The use of mannitol is relatively rarely accompanied by the development of hypersensitivity reactions, such as anaphylactoid shock. This is most likely due to the release of histamine from the depot, provoked by mannitol.

Overdose

Symptoms: nausea, vomiting, weakness, dysfunction of the gastrointestinal tract, water and electrolyte disorders, pulmonary edema, left ventricular failure, 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.

Interaction with other drugs

It is possible to increase the toxic effect of cardiac glycosides (against the background of hypokalemia). Potentiates the diuretic effect of saluretics, carbonic anhydrase inhibitors and others diuretics. When combined with neomycin, the risk of developing oto- and nephrotoxic reactions increases.

The effect of inhibition. Mannitol affects drugs that are largely reabsorbed by the kidneys by accelerating their elimination and shortening their exposure time.

Mannitol increases the urinary excretion of lithium and therefore the concomitant use of mannitol may reduce the effectiveness of lithium.

Patients receiving concomitant ciclosporin therapy should be closely monitored for signs of nephrotoxicity.

Other potential mannitol interactions:

Potentiation of ototoxic effects of aminoglycosides;

Potentiation of the effects of tubocurarine and depolarizing drugs that block nerve transmission;

Mannitol may reduce the effects of oral anticoagulants by increasing the concentration of clotting factors as a result of dehydration;

In the presence of hypokalemia, the use of mannitol increases the risk of digoxin toxicity.

Precautionary measures

For intravenous administration only. Do not administer Mannit-Belmed intramuscularly or subcutaneously.

Do not add Mannit-Belmed to whole blood for transfusion.

Mannitol may increase cerebral circulation and exacerbate intracranial hypertension, which should be kept in mind in traumatized children (during the first 24-48 hours). Mannitol may increase cerebral blood flow and the risk of postoperative bleeding in neurosurgical patients.

With left ventricular failure (due to the risk of pulmonary edema), mannitol should be combined with fast-acting "loop" diuretics. It is necessary to control blood pressure, diuresis, concentration, electrolytes in the blood serum (potassium and sodium ions).

Excessive loss of water and electrolytes can lead to serious imbalances. 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 administration, the administration should be stopped and the development of such complications as subdural and subarachnoid bleeding should be excluded.

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.

Patients with oliguria or with suspected renal insufficiency need to administer a test dose (approximately 200 mg / kg of body weight) over 5 minutes (see "Method of administration and dose"). In the absence of an adequate response, it is possible to re-administer the test dose, if the effect is not achieved even with reintroduction, treatment with mannitol should be discontinued.

Mannitol should be used with caution in patients with impaired renal function. The use and therapy of mannitol can be continued only when adequate diuresis is achieved.

Patients with chronic diseases kidney or those receiving potentially nephrotoxic drugs have increased risk the development of renal failure after the administration of mannitol, therefore, careful monitoring and timely therapy are necessary if signs of deterioration in renal function appear.

During the infusion, it is necessary to monitor renal function, as well as control diuresis to avoid accumulation of mannitol. Accumulation of mannitol may exacerbate existing or latent heart failure. Mannitol should not be prescribed to patients with hypovolemic shock until the volume of fluid is replenished and the electrolyte balance is corrected (plasma-substituting solutions, blood transfusion).

If a patient has an increase in serum osmolarity during treatment, the diuretic effect of mannitol may decrease and a decrease in intracranial and intraocular pressure is not achieved.

Recoil effect: intracranial pressure (ICP) after an initial decrease with mannitol may even increase above baseline (the so-called rebound effect), this is associated with the accumulation of mannitol in the substance of the brain. Consequently, long-term use of the drug should be avoided, since mannitol can damage the blood-brain barrier, accumulate in the extracellular space, which in turn can increase the osmolarity of the brain, thereby exacerbating the growth of ICP and cerebral edema.

Plasma osmolarity must be carefully monitored when using mannitol. Increasing the osmolarity of blood plasma also contributes to the development of renal failure.

The patient's cardiovascular status should be carefully assessed before administration of mannitol, as a sudden increase in extracellular fluid may lead to congestive heart failure.

Storage of mannitol at lower (than recommended) temperatures may cause crystal formation. Do not use if crystals are present. In the case of crystallization, the bottle is heated to 50 °C-70 °C until the precipitate dissolves. Use after cooling to body temperature, if the crystals do not fall out again.

The drug is considered suitable for use if the label is present, the packaging is sealed and the vial is not cracked.

Release form

In bottles of 400 ml. Each bottle, along with instructions for use, is placed in a cardboard box. Packaging for hospitals: 24 bottles with appropriate number of instructions for use in corrugated cardboard boxes.

Self-medication can be harmful to your health.
It is necessary to consult a doctor, and also read the instructions before use.

Description of the drug

Causes an increase in BCC.

List of analogues

Note! The list contains synonyms Mannitol, which have a similar composition, so you can choose a replacement yourself, taking into account the form and dose of the medicine prescribed by your doctor. Give preference to manufacturers from the USA, Japan, Western Europe, as well as well-known companies from Eastern Europe: Krka, Gedeon Richter, Actavis, Egis, Lek, Geksal, Teva, Zentiva.

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Official instructions for use

Mannitol

Pharmacological properties

Indications for use

Contraindications

Dosage and administration

Side effects

Interaction with other drugs

special instructions

Release form

Storage conditions

Best before date

Holiday conditions

The information on the page was verified by the therapist Vasilyeva E.I.

Release form: Liquid dosage forms. Solution for infusion.

General characteristics. Compound:

Pharmacological properties:

Indications for use:

Important! Get to know the treatment

Dosage and administration:

Application Features:

Side effects:

Rarely, hypohydration, electrolyte imbalance, plasma hyperosmolarity, dry mouth, thirst, aggravation of circulatory failure,. If mannitol enters the perivascular tissues, it can also cause edema of the skin.

Interaction with other drugs:

Contraindications:

Overdose:

Storage conditions:

Store in a dry place at temperatures between 5°C and 25°C. Shelf life - 3 years.

Leave conditions:

On prescription

Package:

200 ml, 400 ml (10% or 15% or 20%) solution in a bottle; 1 bottle in a pack of cardboard or in a group package (cardboard box).

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

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 medicine is used in preventive purposes with 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 a patient needs an immediate immediate help it should not be applied. 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 the risk of pulmonary edema is high in the presence of left gastric insufficiency, the drug should be taken simultaneously with loop-type diuretics, which have fast action 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 the drug?

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 transparent.

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 for the treatment of diseases, then daily dosage 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.