Mannitol

Synonyms :
(2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexaol, (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol, D-(-)-Mannitol, D-Mannitol, e 421, e-421, e421, Fraxinine, Manitol, Manna Sugar, Mannit, Mannite, Mannitol, Mannitolum, Osmitrol

Status : approved

Category

Sweetening Agents

Therapeutic Classification

DRUGS FOR CONSTIPATION

ALIMENTARY TRACT AND METABOLISM
DRUGS FOR CONSTIPATION
DRUGS FOR CONSTIPATION
Diuretics, Osmotic

Description

Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. As a result, cerebral edema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure may be reduced. Mannitol may also be used for the promotion of diuresis before irreversible renal failure becomes established; the promotion of urinary excretion of toxic substances; as an Antiglaucoma agent; and as a renal function diagnostic aid.

Used

Used for the promotion of diuresis before irreversible renal failure becomes established, the reduction of intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic substances.

Mechanism Of Action

Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma. As a result, cerebral edema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure may be reduced. As a diurectic mannitol induces diuresis because it is not reabsorbed in the renal tubule, thereby increasing the osmolality of the glomerular filtrate, facilitating excretion of water, and inhibiting the renal tubular reabsorption of sodium, chloride, and other solutes. Mannitol promotes the urinary excretion of toxic materials and protects against nephrotoxicity by preventing the concentration of toxic substances in the tubular fluid. As an Antiglaucoma agent mannitol levates blood plasma osmolarity, resulting in enhanced flow of water from the eye into plasma and a consequent reduction in intraocular pressure. As a renal function diagnostic aid mannitol is freely filtered by the glomeruli with less than 10% tubular reabsorption. Therefore, its urinary excretion rate may serve as a measurement of glomerular filtration rate (GFR).

Dosage

Form Route Strength
Solution intravenous 30; 1.1 mg/80mL; g/80mL
Injection, solution intravenous 12.5 g/50mL
Injection, solution intravenous 20 g/100mL
Injection, solution intravenous 250 mg/mL
Irrigant irrigation 5 g/100mL
Solution intravenous 200 mg
Solution intravenous 250 mg
Liquid intravenous 100 mg
Liquid intravenous 250 mg
Liquid intravenous 50 mg
Injection, solution intravenous 10 g/100mL
Injection, solution intravenous 15 g/100mL
Injection, solution intravenous 5 g/100mL
Liquid intravenous 10 g
Solution intravenous 20 g
Liquid irrigation 5 %

Pharmacodynamics

Chemically, mannitol is an alcohol and a sugar, 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 acidic. For this reason, it is not uncommon to add a substance to adjust its pH, such as sodium bicarbonate. Mannitol is commonly used to increase urine production (diuretic). It is also used to treat or prevent medical conditions that are caused by an increase in body fluids/water (e.g., cerebral edema, glaucoma, kidney failure). Mannitol is frequently given along with other diuretics (e.g., furosemide, chlorothiazide) and/or IV fluid replacement.

Toxic Effect

LD50=1700 mg/kg (rat oral)

Metabolism

Mannitol is metabolized only slightly, if at all, to glycogen in the liver.

Absorption

Approximately 7% of ingested mannitol is absorbed during gastrointestinal perfusion in uremic patients.

Half Life

100 minutes

Protein Binding

None

Elimination Route

It is rapidly excreted in the urine.

Chemical Classification

This compound belongs to the class of organic compounds known as sugar alcohols. These are hydrogenated forms of carbohydrate in which the carbonyl group (aldehyde or ketone, reducing sugar) has been reduced to a primary or secondary hydroxyl group.

Sugar alcohols

Organic compounds

Organooxygen compounds

Carbohydrates and carbohydrate conjugates

Sugar alcohols

Chemical Name

(2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexaol

Brands

name Dosage form Country
Leukosep – Solx A Additive Solution solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol injection, solution US
Mannitol irrigant US
Mannitol injection, solution US
Mannitol 20% solution Canada
Mannitol 25% solution Canada
Mannitol Inj 10% Abbovac liquid Canada
Mannitol Inj 25% liquid Canada
Mannitol Inj 25% liquid Canada
Mannitol Inj 5% Abbovac liquid Canada
Mannitol Injection solution Canada
Osmitrol injection, solution US
Osmitrol injection, solution US
Osmitrol injection, solution US
Osmitrol injection, solution US
Osmitrol 10% Inj USP liquid Canada
Osmitrol 20% Inj USP solution Canada
Resectisol (5% Mannitol Irrigation) liquid Canada

Drug Drug Interactions

  •  Alfuzosin  : May enhance the hypotensive effect of Antihypertensives.
  •  Amifostine  : Antihypertensives may enhance the hypotensive effect of Amifostine.
  •  Amikacin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Arbekacin  : Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
  •  Butabarbital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Butethal  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Diazoxide  : May enhance the hypotensive effect of Antihypertensives.
  •  Duloxetine  : Hypotensive Agents may enhance the orthostatic hypotensive effect of Duloxetine.
  •  Framycetin  : Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
  •  Gentamicin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Heptabarbital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Hexobarbital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Kanamycin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Levodopa  : Hypotensive Agents may enhance the orthostatic hypotensive effect of Levodopa.
  •  Methohexital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Methylphenidate  : May diminish the antihypertensive effect of Antihypertensives.
  •  Neomycin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Netilmicin  : Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
  •  Obinutuzumab  : Antihypertensives may enhance the hypotensive effect of Obinutuzumab.
  •  Pentobarbital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Pentoxifylline  : May enhance the hypotensive effect of Antihypertensives.
  •  Primidone  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Ribostamycin  : Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
  •  Risperidone  : Hypotensive Agents may enhance the hypotensive effect of Risperidone.
  •  Rituximab  : Antihypertensives may enhance the hypotensive effect of Rituximab.
  •  Secobarbital  : May enhance the hypotensive effect of Hypotensive Agents.
  •  Spectinomycin  : Mannitol may enhance the nephrotoxic effect of Aminoglycosides.
  •  Streptomycin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Tadalafil  : May enhance the antihypertensive effect of Antihypertensives.
  •  Tobramycin  : May enhance the nephrotoxic effect of Aminoglycosides.
  •  Vardenafil  : May enhance the antihypertensive effect of Antihypertensives.
  •  Yohimbine  : May diminish the antihypertensive effect of Antihypertensives.

Calculated Property

kind Value Source
logP -2.7 ALOGPS
logS 0.1 ALOGPS
Water Solubility 2.29e+02 g/l ALOGPS
logP -3.7 ChemAxon
IUPAC Name (2R,3R,4R,5R)-hexane-1,2,3,4,5,6-hexol ChemAxon
Traditional IUPAC Name mannitol ChemAxon
Molecular Weight 182.1718 ChemAxon
Monoisotopic Weight 182.07903818 ChemAxon
SMILES OC[C@@H](O)[C@@H](O)[C@H](O)[C@H](O)CO ChemAxon
Molecular Formula C6H14O6 ChemAxon
InChI InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1 ChemAxon
InChIKey InChIKey=FBPFZTCFMRRESA-KVTDHHQDSA-N ChemAxon
Polar Surface Area (PSA) 121.38 ChemAxon
Refractivity 38.4 ChemAxon
Polarizability 16.82 ChemAxon
Rotatable Bond Count 5 ChemAxon
H Bond Acceptor Count 6 ChemAxon
H Bond Donor Count 6 ChemAxon
pKa (strongest acidic) 12.59 ChemAxon
pKa (strongest basic) -3 ChemAxon
Physiological Charge 0 ChemAxon
Number of Rings 0 ChemAxon
Bioavailability 1 ChemAxon
Rule of Five 0 ChemAxon
Ghose Filter 0 ChemAxon
MDDR-Like Rule 0 ChemAxon

Affected organism

Humans and other mammals