Names and pronunciation
(man′i-tole) Osmitrol, Resectisol
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Individual generic drug information
Extracted information for mannitol only.
(man′i-tole) Osmitrol, Resectisol
Source page 826
Func. class.: Diuretic, osmotic; GU irrigant
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Chem. class.: Hexahydric alcohol
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ACTION: Acts by increasing osmolar- ity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output
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USES: Edema; promotion of systemic diuresis in cerebral edema; decrease in intraocular/intracranial pressure; improved renal function in acute renal failure, chemical poisoning, urinary bladder irrigation, kidney transplant
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Extracted information for mannitol only.
CONTRAINDICATIONS: Active intracranial bleeding, hypersensitivity, anuria, severe pulmonary congestion, edema, severe dehydration, progressive heart/renal failure, acute MI, aneurysm, stroke Precautions: Pregnancy, breastfeeding, geriatric patients, dehydration, severe renal disease, HF, electrolyte imbalances
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Black Box Warning: Acute broncho spasm (inhalation test kit), asthma Black Box Warning: Bronchospasm/ asthma (inhalation test kit): test for bronchial hyperresponsiveness should not be performed in any person with asthma or baseline pulmonary function test FEV1 <1-1.5 liters or <70% of pre- dicted values • Beers: use with caution in older adults; may cause or exacerbate SIADH
Source pages 826, 828
SIDE EFFECTS CNS: Dizziness, headache, confusion CV: Edema, thrombophlebitis, hypo/ hypertension, tachycardia, angina-like chest pains, fever, chills, HF, circulatory overload ELECT: Fluid, electrolyte imbalances, electrolyte loss, dehydration, hypo/ hyperkalemia GI: Nausea, vomiting, dry mouth GU: Marked diuresis, urinary retention, thirst INTEG: Injection-site reaction
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INTERACTIONS Increase: elimination of mannitol— lithium; monitor lithium level Increase: excretion of imipramine Increase: hypokalemia—cardiac glyco- sides Increase or Decrease: sodium, potas- sium, magnesium Drug/Lab Test Interference: inorganic phosphorus, eth- ylene glycol
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Extracted information for mannitol only.
DOSAGE AND ROUTES Test dose: Administer a test dose to patients with marked oliguria or sus- pected inadequate renal function to establish renal response before therapy is initiated. A response is considered adequate if at least 30-50 mL of urine per hour is excreted over the next 2-3 hr If an adequate response is not attained, a second test dose may be given If a satisfactory response is not obtained after the second test dose, reevaluate patient, and mannitol should not be used Rate of administration: Test dose in adults and children >12 yr: Infuse over a period of 3-5 min to produce urine flow of ≥30-50 mL/hr Treatment of oliguria in adults: Infuse over 90 min to several hours Cerebral or ocular edema in children >12 yr: Usually infuse over 30-60 min Reduction of intracranial or IOP in adults: Usually infuse over 30-60 min Edema and ascites in adults and children >12 yr: Has been infused over 2-6 hr Transurethral irrigation: Sorbitol- mannitol irrigation solution is for uro- logic irrigation only; do not use for injection Administer only by transurethral instilla- tion using appropriate and disposable urologic instrumentation Placing the flexible irrigation container >60 cm above the operating table may increase intravascular absorption of irri- gation solution Oliguric acute renal failure Test dose: Children >12 yr: IV 0.2 g/kg or 6 g/m2 as a single dose Therapeutic purposes: Children >12 yr: IV 2 g/kg or 60 g/m2 Cerebral or ocular edema: Children >12 yr: IV 2 g/kg or 60 g/m2 adminis- tered as a 15% or 20% solution Urinary excretion of toxins: Children >12 yr: IV 2 g/kg or 60 g/m2 adminis- tered as a 5% or 10% solution as needed Edema and ascites: Children >12 yr: IV 2 g/kg or 60 g/m2 administered as a 15% or 20% solution General dosage: Adult/child ≥12 yr: IV 20-100 g 25% solution q24h Test dose: Adult: IV 0.2 g/kg or 12.5 g infused as a 15% or 20% solution (usually 100 or 75 mL of a 15% or 20% solution, respectively) Oliguric acute renal failure—pre- vention: Adult: IV 50-100 g as a 5%, 10%, or 15% solution. Usually, a concen- trated solution is given and then followed by a 5% or 10% solution Treatment of oliguria: Adult: IV 100 g infused as a 15% or 20% solution Management of nephrotoxicity as- sociated with amphotericin B: Adult: IV 12.5 g given immediately prior to and after each dose of ampho- tericin B Reduction of intracranial pressure (ICP): Adult: IV 0.25 g/kg given q6-8h or 1.5-2 g/kg infused as a 15%, 20%, or 25% solution Reduction of intraocular pressure (IOP): Adult: IV 1.5-2 g/kg infused as a 15%, 20%, or 25% solution Urinary excretion of toxins: M Adult: IV Maintain a urinary output of >100 mL/hr, but preferably 500 mL/hr, and a positive fluid balance of 1-2 L; ini- tially, 25 g, followed by infusion of a solu- tion at a rate that will maintain a urinary output of ≥100 mL/hr Transurethral prostatic resection Urogenital irrigation Administer a suffi- cient volume of sorbitol-mannitol irriga- tion solution; volume determined at the discretion of clinician Hyperuricemia (unlabeled): Adult: IV 50 g/m2 per 24 hr
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Available forms: Inj 5%, 10%, 15%, 20%, 25%; GU irrigation: 5%; inhalation capsule challenge kit
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Administer: Intermittent/continuous IV route • Precipitate may occur with PVC • Change IV set q24hr • May warm solution to dissolve crystals • In 15%-25% sol with filter; rapid in- fusion may worsen HF; warm in hot water, shake to dissolve, use in-line fil- ter 0.2-0.5 micron; do not give as direct injection; to redissolve, run bottle un- der hot water and shake vigorously; cool to body temperature before using • Run at 30-50 mL/hr in oliguria; 30-60 min in ICP; increased over 30 min in in- traocular pressure; 60-90 min after surgery • Give 20 mEq NaCL/L of product solu- tion if blood is given concurrently • Assess site for pain, redness, inflam- mation often during infusion
Source pages 827, 828
Extracted information for mannitol only.
Assess: • Monitor I&O, B/P, pulse hourly; report decreasing urine output; monitor weight, electrolytes: potassium, sodium, chlo- ride daily; BUN, serum creatinine daily, blood pH, PAP, CVP, ABGs, CBC • Use urinary catheter in those who are comatose; I&O must be precise • Metabolic acidosis: drowsiness, rest- lessness • Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness, or hyperkalemia • Rashes, temperature daily • CNS toxicity: Confusion, lethargy, coma; risk factors: hyponatremia, im- paired renal function, hyperosmolar- ity, high mannitol level • Fluid shift/dehydration: Hydration in- cluding skin turgor, thirst, dry mucous membranes; provide adequate fluids, mouth care frequently; assess for HF, fluid electrolyte shifts, circulatory overload, (dyspnea, respiratory congestion, dry mouth) • Blurred vision, pain in eyes before, during treatment (increased intra- ocular pressure); neurologic checks, intracranial pressure during treatment (increased intracranial pressure) • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding, unknown if excreted in breast milk
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Evaluate: • Therapeutic response: improve- ment in edema of feet, legs, sacral area daily if medication being used with HF; decreased intraocular pres- sure, prevention of hypokalemia, in- creased excretion of toxic substances; decreased ICP
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To rise slowly from lying or sitting po- sition • About the reason for, method of treat- ment • To report signs of electrolyte imbal- ance, confusion, pain at injection site, hearing loss, blurred vision TREATMENT OF OVER- DOSE: Discontinue infusion; correct fluid, electrolyte imbalances; hemodi- alysis; monitor hydration, CV status, renal function including output/serum creatinine HIGH ALERT
Source pages 828, 829
Extracted information for mannitol only.
PHARMACOKINETICS IV: Onset 1-3 hr for diuresis, ½-1 hr for intraocular pressure, 15 min for cerebrospinal fluid; duration 4-8 hr for intraocular pressure, 3-8 hr for cere- brospinal fluid; excreted in urine; half- life 100 min
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Filter the extracted dose blocks for this individual drug.