Drug Cards

Mannitol

Mannitol 20%
Class:
Osmotic diuretic.
Mechanism of Action:
  • Promotes the movement of fluid from the intracellular space to the extracellular space.
  • Decreases cerebral edema and intracranial pressure.
  • Promotes urinary excretion of toxins.
Indications:
  • Cerebral edema.
  • Reduce intracranial pressure for certain cause (space occupying lesions).
  • Rhabdomyolysis (myoglobinuria).
  • Blood transfusion reactions.
Contraindications:
  • Hypotension.
  • Renal failure.
  • Electrolyte depletion.
  • Dehydration.
  • Intracranial bleeding.
  • Severe CHF with pulmonary edema.
  • Hyponatremia.
Adverse reactions:
CHF, pulmonary edema, hypertension, nausesa, vomiting, headache, seizures, chest pain, tachycardia.
Electrolyte depletion, dehydration, hypotension, sodium depletion.
Drug Interactions:
May precipitate digitalis toxicity when given concurrently.
Adult Dosage and Administration
0.5g-2g/kg IV infusion over 15-30 minutes; may repeat after 5 minutes if no effect.
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Pediatric Dosage and Administration:
0.5-1g/kg dose IV/IO infusion over 30-60 minutes; may repeat after 30 minutes if no effect.
Duration of Action:
  • Onset: 15 minutes for reduction in intracranial pressure; 1-3 hours for diuretic effect.
  • Peak effect: variable.
  • Duration: 3-8 hours for reduction of ICP; 4-6 hours for diuretic effect.
Special Considerations:
  • Pregnancy safety: Category C.
  • May crystallize at temperatures below 7.8°C.
  • In-line filter should always be used.
  • Effectiveness depends upon large doses and an intact blood-brain barrier.
  • Usage and dosages in emergency care are controversial.