Drug reference
Treatment of cystic fibrosis as an add-on therapy to standard care ▶BY INHALATION OF POWDER ▶Adult: Maintenance 400 mg twice daily, an initiation dose assessment must be carried out under medical supervision, for details of the initiation dose regimen, consult product literature
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Bronchial hyperresponsiveness to inhaled mannitol. impaired lung function (forced expiratory volume in 1 second < 30% of predicted). non- CF bronchiectasis
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Asthma. haemoptysis
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Patients must be assessed for bronchial hyperresponsiveness to inhaled mannitol before starting the therapeutic dose regimen; an initiation dose assessment must be carried out under medical supervision—for details of the initiation dose regimen, consult product literature.
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NICE decisions ▶Mannitol dry powder for inhalation for treating cystic fibrosis (November 2012) NICE TA266 Mannitol (Bronchitol ®) dry powder for inhalation is recommended as an option for treating cystic fibrosis in adults: . who cannot use dornase alfa (rhDNase) because of ineligibility, intolerance or inadequate response to rhDNase, and . whose lung function is rapidly declining (forced expiratory volume in 1 second decline greater than 2% annually), and . for whom other osmotic agents are not considered appropriate. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta266 Scottish Medicines Consortium (SMC) decisions SMC No. 837/13 The Scottish Medicines Consortium has advised (December 2013) that mannitol (Bronchitol ®) is accepted for restricted use within NHS Scotland for the treatment of cystic fibrosis in adults as an add-on therapy to best standard of care. Mannitol is restricted to patients who are not currently using dornase alfa due to lack of response, intolerance, or ineligibility and have rapidly declining lung function and in whom other osmotic agents are considered unsuitable.
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▶Common or very common Chest discomfort. condition aggravated. cough. haemoptysis. headache. respiratory disorders. throat complaints. vomiting ▶Uncommon Abdominal pain upper. appetite decreased. asthma. burping. cold sweat. cystic fibrosis related diabetes. dehydration. diarrhoea. dizziness. dysphonia. dyspnoea. ear pain. fatigue. fever. gastrointestinal disorders. hypoxia. increased risk of infection. influenza like illness. insomnia. joint disorders. malaise. morbid thoughts. nausea. odynophagia. oral disorders. pain. rhinorrhoea. skin reactions. sputum discolouration. urinary incontinence
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Manufacturer advises avoid.
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Manufacturer advises avoid.
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The dose should be administered 5–15 minutes after a bronchodilator and before physiotherapy; the second daily dose should be taken 2–3 hours before bedtime.
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There can be variation in the licensing of different medicines containing the same drug. Inhalation powder ▶Osmohale (Mawdsley-Brooks & Company Ltd) Mannitol 5 mg Osmohale 5mg inhalation powder capsules | 1 capsule P s Mannitol 10 mg Osmohale 10mg inhalation powder capsules | 1 capsule P s Mannitol 20 mg Osmohale 20mg inhalation powder capsules | 1 capsule P s Mannitol 40 mg Osmohale 40mg inhalation powder capsules | 15 capsule P s ▶Bronchitol (Chiesi Ltd) Mannitol 40 mg Bronchitol 40mg inhalation powder capsules with two devices | 280 capsule P £231.66 Bronchitol 40mg inhalation powder capsules with device | 10 capsule P £8.27
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Patients or carers should be given advice on how to administer mannitol inhalation powder.
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Maintenance 400 mg twice daily, an initiation
First-line fragment. Read the complete Indications and Dose section above.
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