Mannitol Βιοσερ (Mannitol)

Mannitol is an osmotic diuretic used in conditions where reduction of fluid volume or pressure is required.

• Reduction of intracranial pressure: lowers cerebral edema and intracranial pressure in traumatic brain injury or neurosurgical patients.
• Oliguric renal failure: increases urine output to manage acute kidney injury with low urine output.
• Intraocular pressure elevation: facilitates aqueous humor outflow to lower intraocular pressure during ocular surgery.

• Mannitol acts as an osmotically active agent that raises plasma osmolality when administered intravenously. The increased extracellular osmotic pressure draws water from intracellular and interstitial compartments into the vascular space, expanding plasma volume and promoting renal filtration. This osmotic gradient also reduces cerebral and intraocular fluid accumulation, thereby decreasing intracranial and intraocular pressures.

Mannitol may cause a range of adverse reactions, from mild to severe, depending on patient factors and dosage.

Common Side Effects

• Headache: mild to moderate pain often reported during infusion.
• Nausea and vomiting: gastrointestinal upset occurring shortly after administration.
• Dizziness or light‑headedness: related to rapid plasma volume shifts.
• Thirst or dry mouth: due to osmotic water movement.
• Electrolyte imbalance: mild changes in sodium or potassium levels.

Serious or Rare Side Effects

• Pulmonary edema: fluid accumulation in the lungs, especially in patients with cardiac dysfunction.
• Severe electrolyte disturbances: hypernatremia, hyperkalemia, or profound hyponatremia.
• Worsening renal failure: especially in patients with pre‑existing kidney impairment.
• Anaphylactic or severe allergic reaction: rare but requires immediate medical attention.
• Hemolysis: rare destruction of red blood cells.
• Cardiac arrhythmia: associated with electrolyte shifts.

Before initiating Mannitol therapy, clinicians should evaluate patient-specific risk factors and monitor relevant parameters.

• Assess renal function: evaluate baseline creatinine and urine output before administration.
• Monitor electrolytes: check serum sodium, potassium, and osmolality during therapy.
• Avoid in severe dehydration: ensure adequate volume status to prevent hypotension.
• Use cautiously in heart failure: risk of fluid overload and pulmonary edema.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Mannitol can interact with several drug classes, requiring attention to avoid additive or harmful effects.

Major Interactions (Avoid)

• Loop diuretics: additive diuretic effect may cause severe electrolyte loss.
• Insulin: hyperosmolarity may potentiate hypoglycemia.
• Lithium: increased risk of lithium toxicity due to altered renal clearance.
• ACE inhibitors/ARBs: may exacerbate renal impairment when combined.

Moderate Interactions (Monitor Closely)

• Antihypertensives: may enhance blood pressure lowering.
• Nephrotoxic antibiotics (e.g., aminoglycosides): monitor renal function closely.
• Contrast media: increased risk of renal dysfunction when used together.