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{{Drugbox|  
{{DrugProjectFormSinglePage
|IUPAC_name = (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol
|authorTag=
| image=Mannitol structure.png
 
| CAS_number=69-65-8
Gerald Chi
| ATC_prefix=A06
 
| ATC_suffix=AD16
<!--Overview-->
| ATC_supplemental={{ATC|B05|BC01}} {{ATC|B05|CX04}}  
 
| PubChem=453
|genericName=
| DrugBank=APRD01083
 
| C=6 | H=14 | O=6
 
| molecular_weight = 182.172
 
| bioavailability= ~7%
|aOrAn=
| metabolism = [[Liver|Hepatic]], negligible.
 
| elimination_half-life=100 minutes
a
| excretion = [[Kidney|Renal]]: 90%
 
| pregnancy_category = C: ([[United States|USA]])
|drugClass=
| legal_status = ?
 
| routes_of_administration= [[Intravenous]]<br>[[Mouth|Oral]]
 
}}
 
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* Content
 
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|fdaLIADAdult=
 
=====Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
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* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
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=====Condition2=====
 
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=====Condition1=====
 
* Dosing Information
 
:* Dosage
 
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There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
 
<!--Pediatric Indications and Dosage-->
 
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
 
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=====Condition1=====
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Off-Label Use and Dosage (Pediatric)-->
 
<!--Guideline-Supported Use (Pediatric)-->
 
|offLabelPedGuideSupport=
 
=====Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:
 
* Dosing Information
 
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->
 
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=====Condition1=====
 
* Dosing Information
 
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<!--Contraindications-->
 
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* Condition1
 
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|warnings=
 
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====Precautions====
 
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<!--Adverse Reactions-->
 
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======Central Nervous System======
 
 
 
======Cardiovascular======
 
 
 
======Respiratory======
 
 
 
======Gastrointestinal======
 
 
 
======Hypersensitivity======
 
 
 
======Miscellaneous======
 
 
 
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======Central Nervous System======
 
 
 
======Cardiovascular======
 
 
 
======Respiratory======
 
 
 
======Gastrointestinal======
 
 
 
======Hypersensitivity======
 
 
 
======Miscellaneous======
 
 
 
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===Acute Overdose===
 
====Signs and Symptoms====
 
* Description
 
====Management====
 
* Description
 
===Chronic Overdose===
 
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: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
 
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=====Condition1=====
 
* Description
 
<!--How Supplied-->


|howSupplied=


*


'''Mannitol''' or  '''hexan-1,2,3,4,5,6-hexol''' (C<sub>6</sub>H<sub>8</sub>(OH)<sub>6</sub>) is an [[osmosis|osmotic]] [[diuretic]] agent and a weak [[kidney|renal]] [[vasodilator]]. It is a [[sorbitol]] [[stereoisomer]].
<!--Patient Counseling Information-->


It was originally isolated from manna, and may also be referred to as '''Mannite''' and '''Manna Sugar'''.<ref>Cooley's Cyclopaedia of Practical Receipts, 6th ed. (1880)</ref>
|fdaPatientInfo=


==Chemical properties==
There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
Chemically, mannitol is a [[sugar alcohol]], or a [[polyol]]; it is similar to [[xylitol]] or [[sorbitol]].  However, mannitol has a tendency to lose a [[hydrogen]] [[ion]] in aqueous solutions, which causes the solution to become [[acid]]ic. For this, it is not uncommon to add a substance to adjust its [[pH]], such as [[sodium bicarbonate]].


==Uses==
<!--Precautions with Alcohol-->
Mannitol is used clinically to reduce acutely raised [[intracranial pressure]], until more definitive treatment can be given, e.g. after [[head trauma]] (although significant controversy exists over this use), and to treat patients with [[oliguric renal failure]].  It is administered [[intravenous]]ly, and is filtered by the [[glomerulus]] of the [[kidney]], but is incapable of being reabsorbed from the [[renal tubule]], resulting in decreased water and [[Sodium|Na]]<sup>+</sup> reabsorption via its [[osmosis|osmotic]] effect.  Consequently, mannitol increases water and Na<sup>+</sup> excretion, thereby decreasing extracellular fluid volume.


Mannitol fermentation can be used to distinguish species of bacteria from eachother. For this process, MSA Mannitol-Salt Agar could be used, thereby allowing both testing mannitol fermentation and tolerance to salt. In the MSA Agar, phenol red pH indicator turns yellow in the presence of acid by-products of mannitol fermentation. Staphylococcus aureus ferments mannitol. S. aureus changes the color of the medium from pink to yellow due to acid by-products of mannitol fermentation .Staphylococcus epidermidis grows on MSA, but does not ferment mannitol (media remains light pink in color & colonies are colorless.
|alcohol=


Mannitol can also be used to open the [[blood-brain barrier]] by temporarily shrinking the tightly coupled [[endothelial cell]]s that make up the barrier. This makes mannitol indispensable for delivering various drugs directly to the [[brain]] (e.g. in the treatment of [[Alzheimer's disease]]).
* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


Mannitol is also used as a [[sweetener]] for people with [[diabetes]]. Since mannitol has a negative [[heat of solution]], it is used as a sweetener in "breath-freshening" candies, the cooling effect adding to the fresh feel. In doses larger than 20g, mannitol acts as a [[laxative]], and is sometimes sold as a laxative for children.
<!--Brand Names-->


It is sometimes used as an [[adulterant]] or [[cutting agent]] for [[heroin]], [[methamphetamine]]s or other [[illicit drug]]s. In popular culture, when it is used in this manner, it is often referred to as ''baby laxative''.  Many television shows and films depicting drug culture make such references to ''baby laxative'' when in fact they are referring to Mannitol.
|brandNames=


Mannitol can also be used to temporarily encapsulate a sharp object (such as a helix on a lead for an [[artificial pacemaker]]) while it is passing through the venous system. Because it dissolves readily in blood, the sharp point will become exposed by the time it reaches its destination.
* ®<ref>{{Cite web | title = | url =  }}</ref>


Mannitol may be administered in cases of severe [[Ciguatera]] poisoning.  Severe [[ciguatoxin]], or "tropical fish poisoning" can produce stroke-like symptoms.
<!--Look-Alike Drug Names-->


Mannitol is a non-permeating molecule i.e. it cannot cross biological membranes.
|lookAlike=


Mannitol is commonly used in the circuit prime of a [[heart lung machine]] during [[cardiopulmonary bypass]] (CPB). The presence of mannitol preserves renal function during the times of low blood flow and pressure, while the patient is on bypass. The solution prevents the swelling of [[endothelial cell]]s in the kidney, which may have otherwise reduced blood flow to this area and resulted in cell damage.
* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>


Mannitol is also being developed by an Australian pharmaceutical company as a treatment for cystic fibrosis and bronchiectasis and as a diagnostic test for airway hyperresponsiveness. The mannitol is orally inhaled as a dry powder through what is known as an osmohaler. The critical component of the mannitol being the particle size distribution (PSD). The company has marketing approval for its diagnostic in Australia and Europe and is currently applying for approval from the FDA.
<!--Drug Shortage Status-->


Chemical Abstract Registry Numbers for Mannitol are:
|drugShortage=
123897-58-5
}}
69-65-8
75398-80-0
85085-15-0


==Controversy==
<!--Pill Image-->
The three studies<ref>Cruz J, Minoja G, Okuchi K. Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery. 2001 Oct;49(4):864-71. PMID 11564247</ref>, <ref>Cruz J, Minoja G, Okuchi K. Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery. 2002 Sep;51(3):628-37; discussion 637-8. PMID 12188940</ref>, <ref>Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg. 2004 Mar;100(3):376-83. PMID 15035271</ref> which initially found that mannitol was effective in cases of severe head injury have been the subject of a recent investigation<ref>Roberts I, Smith R, Evans S. [http://www.bmj.com/cgi/content/full/334/7590/392 Doubts over head injury studies.] BMJ. 2007 Feb 24;334(7590):392-4. PMID 17322250</ref>. Although several authors are listed, the others had no knowledge of how, where, or even if the patients were recruited, meaning that the papers were essentially conducted by Dr. Cruz, who killed himself in 2005. Further, the Federal University of São Paulo, which he gave as his affiliation, has never employed him. Currently, therefore, the [[Cochrane Collaboration|Cochrane review]] recommending mannitol<ref>Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001049. PMID 16235278</ref> has been withdrawn pending re-evaluation, as there is some evidence that mannitol may worsen cerebral oedema<ref>Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992 Oct;77(4):584-9. PMID 1527619</ref>.


==References==
{{PillImage
{{Reflist|2}}
|fileName=No image.jpg|This image is provided by the National Library of Medicine.
|drugName=
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|drugAuthor=
|ingredients=
|pillImprint=
|dosageValue=
|dosageUnit=
|pillColor=
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==External links==
<!--Label Display Image-->
[http://64.233.183.104/search?q=cache:O61hmwa9_PwJ:www.midlandstech.edu/science/kelleherk/225/LabMaterials/sel_diff_media.html+mannitol+fermentation+distinguish&hl=tr&ct=clnk&cd=4&gl=tr&client=firefox-a Use of Mannitol in Bacteria Differentiation-scroll down to MSA Agar]
* {{RXlist|osmitrol}}
* {{GPnotebook|1724907529}}


{{LabelImage
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
}}


{{LabelImage
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
}}


<!--Category-->


[[Category:Sweeteners]]
[[Category:Cardiovascular Drugs]]
[[Category:Polyols]]
[[Category:Drug]]
[[Category:Sugar alcohols]]
[[de:Mannit]]
[[es:Manitol]]
[[fr:Mannitol]]
[[it:Mannitolo]]
[[nl:Mannitol]]
[[ja:マンニトール]]
[[pl:Mannitol]]
[[pt:Manitol]]
[[ru:Маннит]]
[[sv:Mannitol]]
[[zh:甘露醇]]
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Revision as of 17:53, 6 July 2014

Mannitol
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gerald Chi

Disclaimer

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Black Box Warning

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Mannitol is a that is FDA approved for the {{{indicationType}}} of . There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Mannitol in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mannitol in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Mannitol in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Mannitol in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mannitol in pediatric patients.

Contraindications

  • Condition1

Warnings

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Mannitol in the drug label.

Central Nervous System
Cardiovascular
Respiratory
Gastrointestinal
Hypersensitivity
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Mannitol in the drug label.

Central Nervous System
Cardiovascular
Respiratory
Gastrointestinal
Hypersensitivity
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Mannitol in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Mannitol during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Mannitol with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Mannitol with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Mannitol with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Mannitol with respect to specific gender populations.

Race

There is no FDA guidance on the use of Mannitol with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Mannitol in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Mannitol in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Mannitol in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Mannitol in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Mannitol in the drug label.

Condition1
  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Mannitol in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Mannitol in the drug label.

Pharmacology

There is limited information regarding Mannitol Pharmacology in the drug label.

Mechanism of Action

Structure

This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Mannitol in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Mannitol in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Mannitol in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Mannitol in the drug label.

Condition1
  • Description

How Supplied

Storage

There is limited information regarding Mannitol Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Mannitol |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Mannitol |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Mannitol in the drug label.

Precautions with Alcohol

  • Alcohol-Mannitol interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)


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