Adult: As cap for inhalation: As an add-on therapy: 400 mg bid. Dose must be given in the morning and at least 2-3 hours before bedtime in the evening. Patients must be assessed for bronchial hyperresponsiveness to inhaled mannitol during administration of initial dose (refer to specific Bronchitol® product information for detailed information). Recommendations may vary among countries and individual products (refer to specific product guidelines).
Intravenous Cerebral oedema, Reduction of raised intracranial pressure
Adult: The concentration and rate of infusion must be based on patient's age, weight, and clinical condition. As 10%, 15%, or 20% solution: 0.25-2 g/kg as a single dose via infusion over 30-60 minutes; may repeat dose every 6-8 hours, as necessary. Dose should be administered 1-1.5 hours before surgery when used preoperatively. Dosage recommendations and available concentrations may vary among individual products and between countries (refer to specific product guidelines). Child: The concentration and rate of infusion must be based on patient's age, weight, and clinical condition. As 10%, 15%, or 20% solution: Same as adult dose. Dosage and treatment recommendations and available concentrations may vary among individual products and between countries (refer to specific product guidelines).
Intravenous Reduction of raised intraocular pressure
Adult: The concentration and rate of infusion must be based on patient's age, weight, and clinical condition. As 10, 15, or 20% solution: 1.5-2 g/kg via infusion over 30-60 minutes. Dose should be administered 1-1.5 hours before surgery when used preoperatively. Dosage recommendations and available preparations may vary among individual products and between countries (refer to specific product guidelines).
Intravenous Oliguric phase of renal failure
Adult: The concentration and rate of infusion must be based on patient's age, weight, and clinical condition. As 10%, 15%, or 20% solution: For the promotion of diuresis in the prevention and/or treatment before irreversible renal failure becomes established: 50-100 g via infusion in a 24-hour period. Adjust infusion rate to maintain a urine flow of at least 30-50 mL/hour. Patients with marked oliguria or suspected inadequate renal function should receive a test dose of approx 0.2 g/kg via infusion over 3-5 minutes prior to therapy to produce a urine flow of at least 30-50 mL/hour; may give a further dose if the response is inadequate. Reassess patient if response is still inadequate following the 2nd test dose. Dosage and treatment recommendations and available concentrations may vary among individual products and between countries (refer to specific product guidelines).
What are the brands available for Mannitol in Thailand?
IV: Incompatible with whole blood for transfusion or when given through the same set used for blood transfusion.
Contraindications
IV: Established anuria or impaired renal function who do not respond to a test dose, active intracranial bleeding (except during craniotomy), severe dehydration, severe heart failure, severe pulmonary congestion or pulmonary oedema, progressive renal damage or dysfunction after institution of mannitol (including increasing oliguria and azotaemia). Inhalation: Bronchial hyperresponsiveness to inhaled mannitol. Contraindications may vary among countries and between individual products (refer to specific product guidelines).
Special Precautions
Patient with sepsis, preexisting compromised blood-brain barrier (IV); asthma, history of significant haemoptysis episodes with a volume of >60 mL in the previous 3 months, impaired lung function (FEV1 <30% of predicted), non-cystic fibrosis bronchiectasis (inhalation). Avoid extravasation of IV infusions. IV: Renal impairment. Elderly. Pregnancy and lactation. IV: Concomitant use with nephrotoxic drugs (e.g. aminoglycosides).
Adverse Reactions
Significant: IV: Extravasation (which may lead to compartment syndrome); kidney dysfunction (particularly at high doses); dehydration, haemoconcentration, hypernatraemia, hyper- or hypokalaemia, and other electrolyte disturbances; metabolic acidosis or alkalosis; hypervolaemia, overexpansion of the extracellular fluid, which may lead to or exacerbate existing CHF or pulmonary oedema (at high doses and/or high infusion rate); rebound increase of intracranial pressure. Inhalation: Severe bronchospasm, haemoptysis. Cardiac disorders: Chest pain; chest discomfort (inhalation). Gastrointestinal disorders: Vomiting, nausea. General disorders and administration site conditions: Infusion site reactions (e.g. irritation, inflammation, thrombophlebitis, pain, rash, erythema, pruritus), fever, asthenia, malaise, chills; condition aggravated (inhalation). Nervous system disorders: Headache, dizziness, convulsions. Respiratory, thoracic and mediastinal disorders: Cough, oropharyngeal pain, wheezing, post-tussive vomiting (inhalation). Potentially Fatal: IV: Serious hypersensitivity reactions (e.g. anaphylaxis), hyponatraemia; CNS toxicity (e.g. coma, confusion, lethargy) particularly in the presence of impaired renal function.
Inhalation/Respiratory/Irrigation/IV/Parenteral: C
Monitoring Parameters
IV: Evaluate renal, CV, and pulmonary status, and correct fluid and electrolyte imbalances prior to treatment initiation. Monitor urine output, intravascular volume status, serum electrolytes, serum osmolality, osmolar gap, acid-base balance, serum glucose, intracranial pressure. Closely monitor the infusion site for extravasation. Inhalation: Perform standard spirometry prior to tolerance test. Monitor SpO2 and FEV1 during tolerance test. Assess for signs and symptoms of bronchospasm, haemoptysis (particularly in patients with a history of haemoptysis).
Overdosage
Symptoms: IV: Electrolyte imbalance, hypervolaemia, acute renal failure, seizures, coma. During prolonged administration or rapid infusion of large volumes of solution, circulatory overload and acidosis may occur, initially manifesting as headache, nausea, and shivering without temperature change, followed by confusion, lethargy, convulsions, stupor, and coma. Inhalation: Bronchoconstriction, excessive coughing. Management: Symptomatic and supportive treatment. Institute appropriate corrective measures with particular attention to renal, cardiac, and pulmonary systems. Correct fluid and electrolyte imbalances. Haemodialysis may be performed to protect renal function and enhance mannitol elimination. May administer a β2 agonist if severe coughing and bronchoconstriction occur. Oxygen may be given if needed.
Drug Interactions
IV: May potentiate the therapeutic effect with other diuretics. Increased urinary excretion of lithium. May enhance the nephrotoxic and ototoxic effects of aminoglycosides. May increase the risk of renal failure with ciclosporin.
Lab Interference
IV: May lead to false positive result for blood ethylene glycol concentrations. May cause falsely low results for inorganic phosphorus blood concentrations in some test systems.
Action
Description: Mechanism of Action: Mannitol is an osmotic agent. When administered intravenously, it induces osmotic diuresis by increasing the osmotic pressure of the glomerular filtrate, which prevents the reabsorption of water and electrolytes in the renal tubules, thereby increasing urinary output. The exact mechanism by which mannitol reduces intracranial pressure (ICP) is not fully understood; however, it is believed that it lowers ICP by decreasing blood viscosity which transiently enhances cerebral blood flow and oxygen transport and constricts pial arterioles. As a result, cerebral blood volume and ICP are reduced. Additionally, mannitol draws water from the brain parenchyma and facilitates its excretion through urine. As an inhaled agent, its exact mechanism of action remains unknown; however, mannitol may alter the viscoelastic properties of mucus, enhance hydration of the periciliary fluid, and improve mucus clearance of retained secretions through mucociliary activity. Onset: 1-3 hours (diuresis); approx 15-30 minutes (ICP reduction). Duration: 1.5-6 hours (ICP reduction). Pharmacokinetics: Absorption: Absorbed from the gastrointestinal tract or after inhalation in small amounts. Bioavailability: 59% (inhalation). Time to peak plasma concentration: 1.5 hours (inhalation). Distribution: Crosses the placenta (IV). Remains confined in the extracellular space (except in extreme concentrations). Volume of distribution: 17 L (IV); 34.3 L (inhalation). Metabolism: Metabolised minimally in the liver to glycogen. Excretion: IV: Via urine (approx 80% as unchanged drug). Inhalation: Via urine (approx 55-87% as unchanged drug). Elimination half-life: IV: 0.5-2.5 hours. Inhalation: 4.7 hours (terminal).
Chemical Structure
Mannitol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 6251, Mannitol. https://pubchem.ncbi.nlm.nih.gov/compound/Mannitol. Accessed July 28, 2025.
Storage
Store between 15-30°C. Do not freeze the solution for IV infusion.
B05BC01 - mannitol ; Belongs to the class of solutions producing osmotic diuresis used in I.V. solutions. V04CX04 - mannitol ; Belongs to the class of other diagnostic agents. R05CB16 - mannitol ; Belongs to the class of mucolytics. Used in the treatment of wet cough.
References
Anon. Mannitol (Diagnostic). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 30/10/2024.Anon. Mannitol (Diuretic). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 30/10/2024.B. Braun Mannitol 20% (B. Braun Medical Industries Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 03/12/2024.Baxter Healthcare Pty Ltd. Osmitrol Solution for Infusion 10% and 20% data sheet 2 October 2017. Medsafe. http://www.medsafe.govt.nz. Accessed 20/02/2025.Brayfield A, Cadart C (eds). Mannitol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/10/2024.Bronchitol 40 mg Inhalation Powder, Hard Capsules (Pharmaxis Europe Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/12/2024.Bronchitol Capsule (Arna Pharma Pty Ltd). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/12/2024.Joint Formulary Committee. Mannitol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/10/2024.Mannitol (Oral Inhalation). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 30/10/2024.Mannitol (Systemic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/12/2024.Mannitol 15% w/v Solution for Infusion (Baxter Healthcare). MHRA. https://products.mhra.gov.uk. Accessed 03/12/2024.Mannitol. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 20/02/2025.Osmitrol Injection, Solution (Baxter Healthcare Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/12/2024.Paediatric Formulary Committee. Mannitol. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 30/10/2024.
Sign Out
Continue with Google