MANNITOL

General characteristics. Structure:

Active ingredient: 1 ml of solution contains Mannitolum 0,1 g or 0,15 g or 0,2 g;

excipients: sodium chloride, water for injections.

Main physical and chemical properties: transparent, colourless or with a yellowish shade solution.

Pharmacological properties:

Pharmacodynamics. Drug - aqueous solution of Mannitolum. Osmotically active infusion solution which after intravenous administration causes movement of water from extravasated space in a vascular bed temporarily increases blood circulation volume. Has diuretic properties owing to increase in osmotic pressure of a blood plasma and decrease in a reabsorption of water. The diuretic effect is characterized by allocation of a significant amount of free water that distinguishes drug from other osmotic diuretics (for example, urea). At the same time a significant amount of sodium without significant effect on release of potassium is allocated. Has protivoglaukomny effect, increasing osmotic concentration of a blood plasma and leads to increase in outflow of water from eye tissues in plasma with the subsequent decrease in intraocular pressure.

Use of the drug solutions divorced water for washing at a transurethral prostatectomy reduces the hemolitic effect which is observed when using only of water to a minimum. Intake of gemolizirovanny blood in a system blood stream and expressiveness of the haemoglobinaemia resulting from it decrease.

The resorption and receipt in a system blood stream at a transurethral prostatectomy varies. Mannitolum remains in extracellular liquid. If in a blood plasma very high kontsenration of a mannitol are created or at the patient acidosis is noted, Mannitolum can get through a gematoentsefalichny barrier and cause reactive increase in intracranial pressure.

Pharmacokinetics. The elimination half-life makes about 100 min. The diuretic effect is shown in 1-3 h after introduction, pressure decrease of cerebrospinal fluid and intraocular pressure – within 15 min. after the beginning of infusion. The maximum decrease in intraocular pressure is noted in 30-60 min. after the beginning of introduction. Pressure decrease of cerebrospinal fluid remains during 3-8 h, decrease in intraocular pressure – during 4-8 h after the end of infusion. About 80% of the entered dose are removed with urine during 3 h. Mannitolum passes through a placental barrier. It is not established whether Mannitolum gets into breast milk.

Indications to use:

Drug is used for cerebral decompression (after injuries, operations) that reduces wet brain, and also at acute renal or hepatonephric failure, at ascites, for a bystry conclusion of toxics (for example, at poisonings with barbiturates).

Appoint drug at an intensive care of the convulsive status, at operations with artificial circulation (prevention of ischemia of kidneys), for treatment of intraocular hypertensia (after an injury, operations, at glaucoma).

Route of administration and doses:

The drug is administered intravenously (struyno slowly or kapelno). The general dose and rate of administering depend on indications and a clinical condition of the patient.

At a renal failure with an oliguria enter 0,2 g of Mannitolum on 1 kg of body weight within 3-5 min., watch a diuresis further for 1-2 hours; if it makes more than 30 ml an hour or will increase by 50%, continue administration of drug intravenously slowly so that the diuresis remained at the level of 40 ml of 1 hour.

Daily dose for adult 50-100 g, for children - 0,25-2 g/kg of body weight.

At wet brain, intracranial and intraocular hypertensia for increase in a diuresis Mannitolum enter in a dose 1-2 g/kg of 15% or 20% of solution into the current of 1 hour. With therapeutic effect continue introduction of Mannitolum in a dose of 1,5-2,9 g/kg of body weight with breaks each 8 hours.

Features of use:

Drug is used only in the conditions of a hospital. It is necessary to control a blood osmotichnost, balance of water and ions. After introduction of a trial dose it is necessary to watch a diuresis. It is impossible to do the conclusions, proceeding from the specific weight of urine.

At low temperatures solution can crystallize. In such cases the bottle with solution needs to be heated in warm water at a temperature ^60-70os, periodically strongly stirring up. Before use solution needs to be cooled to 36 ^{° C}.

Side effects:

Seldom - a hydropenia, disturbances of electrolytic balance, hyper osmolarity of plasma, feeling of dryness in a mouth, thirst, aggravation of a circulatory unefficiency, a fluid lungs, a headache, spasms, nausea, vomiting, diarrhea, urticaria, a tremor. Hit of Mannitolum in okolososudisty fabrics can cause hypostasis and a necrosis of skin.

Interaction with other medicines:

Exponentiates diuretic effect of saluretics, inhibitors of a karboangidraza and other diuretic means. At a combination to Neomycinum the risk of development from - and nephrotoxic reactions increases. At simultaneous use with Mannitolum the probability of the toxic effect of drugs of a foxglove caused by a hypopotassemia increases.

Contraindications:

Anury, dekompensirovanny heart failure, dehydration, giperosmolyarny state, end-stage of a chronic renal failure, fluid lungs, pregnancy period, intracranial bleeding.

Overdose:

The expressed symptoms of side effect. At bystry introduction, in particular at reduced glomerular filtering, there can be a hypervolemia, increase in intracranial and intraocular pressure. Introduction in high doses of Mannitolum can lead to its accumulation, excessive increase in volume of extracellular liquid, a hyper hydration hyponatremia and hypopotassemia, and also to a heart overload volume, especially at patients with an acute or chronic renal failure.

Storage conditions:

To store in the dry place at a temperature from 5 °C to 25 °C. A period of validity - 3 years.

Issue conditions:

According to the recipe

Packaging:

On 200 ml, 400 ml (10% or 15% or 20%) of solution in a bottle; on 1 bottle in a pack from a cardboard or in group packaging (a cardboard box).