mannitol (Osmitrol, Resectisol)
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Introduction
Tradenames: Osmitrol.
Indications
- osmotic diuresis
- prevention &/or treatment of oliguric renal failure
- reduction of increased intracranial pressure & increased intraocular pressure
- irrigation solution for transurethral prostatic resection
- promote diuresis of chemotherapeutic agents
Dosage
- must be filtered prior to IV administration
- never administer SC or IM
- patients with oliguria should receive a test dose of 12.5 g over 3-5 minutes
- a response is considered adequate > 30-50 mL of urine is produced over the next 2-3 hours
- if an adequate response is obtained, additional test doses may be given, up to 50 g in 1st hour
- if response is inadequate, mannitol should not be used
- infusion of 50-100 g of mannitol as a 15-25% solution to maintain urine output of > 50 mL/hr
- intracranial or intraocular hypertension:
- 1.5 to 2 g/kg over 30-60 min
- 50 g over 30 minutes as needed
- hold if osmolality > 315-320 mOsm/kg
- decrease in nephrotoxicity of cisplatin
Injection: 25% (50 mL).
Pharmacokinetics
- onset of diuresis is 1-3 hours
- reduction in intraocular pressure
- onset: 30-60 minutes
- duration: 4-8 hours after discontinuation of infusion
- reduction in intracranial pressure
- onset: within 15 minutes
- duration: 3-8 hours after discontinuation of infusion
- elimination 1/2life is about 2 hours
elimination via kidney
1/2life = 2 hours
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- difficult urination, chills, fluid & electrolyte imbalance*, fluid overload, congestive heart failure, water intoxication, pulmonary edema, dehydration & hypovolemia#, dry mouth, convulsions, tissue necrosis, allergic reactions
- other
- acute renal failure with high doses
* fluid & electrolyte imbalance due to excessive loss of electrolytes
# dehydration & hypovolemia due to rapid diuresis
Drug interactions
- increased urinary excretion of Li+
- increased urinary excretion of aminoglycosides
- drug interaction(s) SGLT2 inhibitors (flozins) with diuretics
- drug interaction(s) of diuretics in combination with Zn+2
- drug interaction(s) of antiarrhythmic agents in combination with diuretics
- drug interaction(s) of calcium channel blockers with diuretics
- drug interaction(s) of diuretics with angiotensin II receptor antagonists
- drug interaction(s) of diuretics with ACE inhibitors
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
Mechanism of action
- osmotic diuretic
- elevates osmotic pressure of glomerular filtrate
- inhibits tubular reabsorption of water
- resorption of solutes is inhibited by increased urine water
- inhibits Na+ & Cl- absorption from the proximal tubule & ascending loop of Henle
- increased excretion of Na+, K+, Ca+2, phosphate
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998