Mannitol solution for infusion 15%, 400ml

• Cerebral edema, intracranial hypertension (with renal or renal-hepatic failure);

• Oliguria in acute renal or renal-hepatic failure with preserved filtration capacity of the kidneys (as part of combination therapy), post-transfusion complications after the introduction of incompatible blood, forced diuresis in case of poisoning with barbiturates, salicylates;

• Prevention of hemolysis during surgical interventions using extracorporeal circulation in order to prevent renal ischemia and associated acute renal failure.

Intravenous (slow jet or drip).
The prophylactic dose is 0.5 g / kg of body weight, the therapeutic dose is 1.0-1.5 g / kg; the daily dose should not exceed 140-180 g. Before administration, the drug should be heated to a temperature of 37 ? C (you can use a water bath). In operations with artificial circulation, the drug is injected into the apparatus at a dose of 20-40 g immediately before the start of perfusion. Patients with oliguria should first enter a test dose (200 mg / kg) intravenously drip for 3-5 minutes. If after that, within 2-3 hours, there is no increase in the rate of diuresis to 30-50 ml / h, further administration of the drug should be abandoned.

Active substance: mannitol -150 mg;
Excipients: sodium chloride, water for injection up to 1 liter.

• Hypersensitivity to the drug,

• anuria against the background of acute necrosis of the renal tubules,

• left ventricular failure (especially accompanied by pulmonary edema),

• hemorrhagic stroke,

• subarachnoid hemorrhage (except for bleeding during craniotomy),

• severe dehydration,

• hyponatremia,

• hypo-chloremia,

• hypokalemia.

With care
Pregnancy, lactation, old age.

Trade name: Mannit

International non-proprietary name:

mannitol.

Dosage form:

solution for infusion.

Composition
Active substance: mannitol -150 mg;
Excipients: sodium chloride, water for injection up to 1 liter.

Description: Transparent colorless liquid.

Pharmacotherapeutic group:

diuretic.

ATX code: B05BC01.

Pharmacological action
Pharmacodynamics
Mannitol is an osmotic diuretic, which, due to an increase in the osmotic pressure of blood plasma and filtration in the renal glomeruli, without subsequent tubular reabsorption (mannitol undergoes little reabsorption), leads to water retention in the kidney tubules and an increase in urine volume. Mannitol works mainly in the proximal tubules, although the effect persists to a small extent in the descending loop of the nephron and in the collecting ducts. Does not penetrate cell and tissue barriers (for example, the blood-brain barrier), does not increase the content of residual nitrogen in the blood. By increasing the osmolarity of blood plasma, it causes the movement of fluid from tissues (in particular, the eyeball, brain) into the vascular bed. Diuresis is accompanied by a moderate increase in natriuresis without a significant effect on potassium excretion.The higher the concentration (dose), the higher the diuretic effect. It is ineffective in violation of the filtration function of the kidneys, as well as in azotemia in patients with liver cirrhosis and ascites: Causes an increase in the volume of circulating blood.
Pharmacokinetics
Mannitol is poorly absorbed when taken orally and is therefore administered intravenously. The volume of distribution of mannitol corresponds to the volume of the extracellular fluid, since it is distributed only in the extracellular sector. Mannitol may undergo minor metabolism in the liver to form glycogen. The half-life of mannitol is about 100 minutes. The drug is excreted by the kidneys. Excretion of mannitol is regulated by glomerular filtration, without significant involvement of tubular reabsorption and secretion. If 100 g of mannitol is administered intravenously, then 80% of it is determined in the urine within 3 hours.
In patients with renal impairment, the half-life of mannitol may increase to 36 hours.

Indications for use

• Cerebral edema, intracranial hypertension (with renal or renal-hepatic failure);

• Oliguria in acute renal or renal-hepatic failure with preserved filtration capacity of the kidneys (as part of combination therapy), post-transfusion complications after the introduction of incompatible blood, forced diuresis in case of poisoning with barbiturates, salicylates;

• Prevention of hemolysis during surgical interventions using extracorporeal circulation in order to prevent renal ischemia and associated acute renal failure.

Contraindications

• Hypersensitivity to the drug,

• anuria against the background of acute necrosis of the renal tubules,

• left ventricular failure (especially accompanied by pulmonary edema),

• hemorrhagic stroke,

• subarachnoid hemorrhage (except for bleeding during craniotomy),

• severe dehydration,

• hyponatremia,

• hypo-chloremia,

• hypokalemia.

With care
Pregnancy, lactation, old age.

Dosage and administration
Intravenous (slow jet or drip).
The prophylactic dose is 0.5 g / kg of body weight, the therapeutic dose is 1.0-1.5 g / kg; the daily dose should not exceed 140-180 g. Before administration, the drug should be heated to a temperature of 37 ? C (you can use a water bath). In operations with artificial circulation, the drug is injected into the apparatus at a dose of 20-40 g immediately before the start of perfusion. Patients with oliguria should first enter a test dose (200 mg / kg) intravenously drip for 3-5 minutes. If after that, within 2-3 hours, there is no increase in the rate of diuresis to 30-50 ml / h, further administration of the drug should be abandoned.

Side effect
Dehydration (dry skin, dry mouth, thirst, dyspepsia, muscle weakness, convulsions, hallucinations, decreased blood pressure), impaired water and electrolyte metabolism (increased circulating blood volume, hyponatremia, rarely hypokalemia).
Rarely - tachycardia, chest pain, thrombophlebitis, skin rash.

Interaction with other medicinal products
An increase in the toxic effect of cardiac glycosides (against the background of hypokalemia) is possible.

Special instructions
In case of left ventricular failure (due to the risk of pulmonary edema), it is necessary to combine mannitol with fast-acting 'loop' diuretics. It is necessary to control blood pressure, urine output, concentration of electrolytes in serum (potassium, sodium).
In case of appearance of headache, vomiting, dizziness, visual impairment during the administration of the drug, the administration should be discontinued and the development of such complications as subdural and subarachnoid bleeding should be excluded.
When signs of dehydration appear, it is necessary to introduce fluid into the body. It can be used in heart failure (only in combination with loop diuretics) and in hypertensive crisis with encephalopathy.
Re-introduction of mannitol should be carried out under the control of indicators of the water-electrolyte balance of the blood.
The administration of mannitol in anuria caused by organic kidney disease can lead to the development of pulmonary edema.

Release form
Solution for infusion 150 mg / ml.
100, 200 and 400 ml in glass bottles of MTO brand for blood, transfusion and infusion preparations, with a capacity of 100, 250, 450 and 500 ml, respectively. 1 bottle with instructions for use is placed in a box made of cardboard box. 15 bottles with a capacity of 450 or 500 ml, 28 bottles with a capacity of 100 or 250 ml with 5-10 instructions for use are placed in corrugated cardboard boxes with gaskets and grids - 'nests' made of corrugated cardboard (for hospitals). 15 packs with bottles with a capacity of 450 or 500 ml, 28 packs with bottles with a capacity of 100 or 250 ml with 5-10 instructions for use are placed in corrugated cardboard boxes.

Storage conditions
List B. At a temperature not higher than 20 ? C. Freezing is not allowed. Keep out of the reach of children.

Shelf life is
3 years. Do not use after the expiration date printed on the package.

Terms of dispensing from pharmacies
Dispensed by prescription.