Mannitol

General characteristics. Structure:

Active ingredients: 150 g of a mannitol.

Excipients: 9 g of sodium of chloride, water for injections.

Pharmacological properties:

Pharmacodynamics. A mannitol - osmotic diuretic. Renders the expressed diuretic effect at which allocation of a large amount of osmotically free water is observed. Increasing osmolarity of plasma, causes movement of liquid from fabrics (in particular, an eyeglobe, a brain) in a vascular bed. Does not influence glomerular filtering. Causes increase in volume of the circulating blood. Increases also sodium removal, without having significant effect on potassium removal. The effect of subjects is more, than concentration of drug in a blood plasma and the speed of its removal is higher. At disturbance of filtrational function of kidneys the diuretic effect can be absent

Indications to use:

Wet brain; craniocereberal hypertensia; epileptic status; glaucoma (bad attack); posttransfusion complications after administration of incompatible blood; an acute renal or liver failure at patients with the kept filtrational ability of kidneys and other states demanding increase in a diuresis; operations with extracorporal blood circulation (for the purpose of prevention of ischemia of kidneys); a poisoning with barbiturates, an artificial diuresis at other poisonings the Mannitol is inefficient at an azotemia at patients with cirrhosis and ascites

Route of administration and doses:

Enter intravenously slowly struyno or kapelno. The preventive dose makes 0,5 g/kg of body weight, medical - at the rate of 1,0-1,5 g/kg of body weight. The daily dose should not exceed 140 - 180.

Before introduction drug should be warmed up up to the temperature of 37 °C (it is possible on the water bath).

At operations with artificial circulation a mannitol enter into the device in a dose 20-40 g just before the beginning of perfusion.

Patients with an oliguria should enter previously intravenously kapelno a trial dose (200 mg/kg) within 3-5 minutes. If after that within 2-3 hours increase in speed of a diuresis to 30-50 ml/h is not noted, it is necessary to refrain from further administration of drug.

Features of use:

At a left ventricular failure (in connection with edematization of lungs) it is necessary to combine the Mannitol with bystorodeystvuyushchy "loopback" diuretics.

Control of the ABP, diuresis, concentration of electrolytes in blood serum (potassium ions, sodium ions) is necessary.
In case of emergence at administration of drug of a headache, vomiting, dizziness, a vision disorder it is necessary to stop introduction and to exclude development of such complication as subdural and subarachnoidal bleeding.

Use at heart failure is possible (only in a combination with "loopback" diuretics) at hypertensive crisis with encephalopathy.

Repeated introduction of the Mannitol has to be carried out under control of indicators of water and electrolytic balance of blood.

Chances of crystallization of drug at storage at a temperature below 20 °C. In case of crystallization the bottle is heated to 50-70 °C (before dissolution of a deposit). Use after cooling to body temperature if crystals do not drop out again.

Side effects:

Dehydration (a xeroderma, dyspepsia, a myasthenia, spasms, dryness in a mouth, thirst, hallucinations, decrease in the ABP), disturbance of water and electrolytic exchange (increase in volume of the circulating blood, a hyponatremia, is rare - a hyperpotassemia). Seldom - tachycardia, pains behind a breast, thrombophlebitis, skin rash.

Interaction with other medicines:

Strengthening of toxic effect of cardiac glycosides is possible (it is connected with a hypopotassemia).

Contraindications:

Hypersensitivity to drug, a renal failure, an anury against the background of an acute necrosis of tubules at severe damage of kidneys, dehydration of heavy severity, a left ventricular failure (which is especially followed by a fluid lungs), chronic heart failure, a hemorrhagic stroke, subarachnoidal hemorrhage (except bleedings during a craniotrypesis), an iponatriyemiya, a hypochloraemia, a hypopotassemia.

With care – pregnancy, the lactation period, advanced age.

Storage conditions:

List B. In dry, the place at a temperature not above 20 °C. In the place, unavailable to children. In case of loss of crystals drug is heated on the water bath at a temperature from 50 to 70 °C. If crystals disappear, solution will become transparent when cooling up to the temperature of 36 °C and crystals will not drop out again, drug is good for use.

Issue conditions:

According to the recipe

Packaging:

Solution for infusions of 150 mg/ml. 200, 400 ml in bottles glass for blood, infusional and transfusion drugs with a capacity of 250, 450 ml respectively, corked by rubber bungs and pressed out by aluminum caps. 28 bottles with a capacity of 250 ml or 15 bottles with a capacity of 400 ml place in boxes from corrugated fibreboard with an investment of application instructions (for hospitals).