Mannitol injection

【Drug name】

 Common Name：Mannitol injection

 English name：Mannitol  Injection

 Pinyin in Chinese：Ganluchun  Zhusheye

【Ingredients】

 Chemical name: D—Mannitol

 Molecular formula：C₆H₁₄O₆

 Molecular weight：182.17

 Auxiliary material name: water for injection.

【Sexual】This product is a colorless clear liquid.

【Indications】

（1）Tissue dehydration drugs. Used to treat cerebral edema caused by various reasons, reduce intracranial pressure, and prevent brain hernia.

（2）Reduce intraocular pressure. It can effectively reduce intraocular pressure and is used for preparation when other intraocular pressure-reducing drugs are ineffective or before intraocular surgery.

（3）Permeable diuretics. Used to identify oliguria caused by prerenal factors or acute renal failure. It can also be used to prevent acute tubular necrosis caused by various reasons.

（4）As an auxiliary diuretic measure, nephrotic syndrome, cirrhosis, and ascites, especially when accompanied by hypoproteinemia.

（5）For overdose of certain drugs or poisoning (such as barbiturates, lithium, salicylate and bromide, etc.), this drug can promote the excretion of the above substances and prevent nephrotoxicity.

（6）As a irrigation agent, it is used for transurethral prostatectomy.

（7）Preoperative intestinal preparation.

【Specification】250ml:50g

  【Adverse reactions】

（1）Water and electrolyte disorders are most common:

 ①Rapid intravenous mannitol injection can cause the accumulation of mannitol in the body, and the blood volume will increase rapidly and greatly (especially in acute and chronic renal failure), leading to heart failure (especially when there is cardiac impairment), diluted hyponatremia, and occasionally hyperkalemia;

  ②Inappropriate excessive diuresis leads to a decrease in blood volume and aggravates oligouria;

  ③Transferring a large amount of intracellular fluid outside the cell can cause tissue dehydration and can cause central nervous system symptoms.

（2）Chills, fever。

（3）Difficulty in urination。

（4）Thrombophlebitis.

（5）Mannitol extravasation can cause tissue edema and skin necrosis.

（6）Allergies cause rash, urticaria, dyspnea, and allergic shock.

（7）Dizzy and blurred vision.

（8）Hypersoporosis causes thirst.

（9）Osmotic nephropathy (or mannitol nephropathy) is mainly seen during large doses of rapid intravenous infusion. The mechanism has not been fully elucidated, which may be caused by mannitol to cause excessive increase in tubular fluid osmotic pressure, resulting in damage to tubular epithelial cells. The pathology is manifested as swelling of renal tubular epithelial cells and the formation of vacuoles. Clinically, there is a decrease in urine volume and even acute renal failure. Osmotic nephropathy is common in elderly patients with reduced renal blood flow and low sodium and dehydration.

【Forbidden Taboo】

（1）Anuric patients who have been diagnosed with acute tubular necrosis, including those who have no response to trial mannitol, have increased blood volume due to mannitol accumulation, which increases the burden on the heart;

（2）Severe water loss;

（3）In patients with active intracranial bleeding, the bleeding is aggravated by volume expansion, except during intracranial surgery;

（4）Acute pulmonary edema, or severe pulmonary stasis.

    【Drug interactions】

（1）It can increase the toxic effect of digitalis and is related to hypokalemia.

（2）Increase the diuretic and intraocular pressure-lowering effects of diuretics and carbonic anhydrase inhibitors, and the dosage should be adjusted when combined with these drugs.

【Overdose of drugs】

 Gastric lavage should be lactated as soon as possible, supported, treated symptomatically, and blood pressure, electrolytes and renal function should be closely followed.

【Pharmacology and Toxicology】

 Mannitol is a monosaccharide that is not metabolized in the body. After being filtration through glomerularity, it is rarely reabsorbed in the renal tubules, which plays an osmotic and diuretic role.

（1）Tissue dehydration effect. Increase plasma osmotic pressure, causing moisture in tissues (including the eyes, brain, cerebrospinal fluid, etc.) to enter the blood vessels, thereby reducing tissue edema, reducing intraocular pressure, intracranial pressure, and cerebrospinal fluid volume and their pressure. 1g of mannitol can produce an osmotic concentration of 5.5mOsm. Injection of 100g of mannitol can transfer 2000ml of intracellular water to the outside of the cell and excrete 50g of urine sodium.

（2）Diuretic effect. The diuretic mechanism of mannitol is divided into two aspects.

 ① Mannitol increases blood volume and promotes prostaglandin I2 secretion, thereby dilating renal blood vessels and increasing renal blood flow, including renal medulla blood flow. Glomerular afforestation artery dilates, glomerular capillary pressure increases, cortical glomerular filtration rate increases。② This drug is reabsorbed by the renal tubules after glomerular filtration, so it can increase the permeability concentration of fluid in the renal tubules and reduce the reabsorption of water and Na+, Cl-, K+, Ca2+, Mg2+ and other solutes by the renal tubules. In the past, it was believed that this drug mainly acts on the proximal tubules, but after puncture animal experiments, it was found that after the application of large doses of mannitol, the water and Na through the proximal tubules increased by only 10% to 20% and 4% to 5% respectively; while the water and Na+ reaching the distal tubules increased by 40% and 25%, respectively, indicating that the renal tubules reabsorbate water and Na+ decrease play an important role in mannitol diuretic effect. This may be due to increased renal medulla blood flow and increased urea and Na+ loss in medulla, thus destroying the difference in medulla osmotic pressure gradient. Due to the increase in the renal tubular fluid flow after mannitol infusion, when certain drugs and toxic substances are poisoned, the concentration of these substances in the renal tubules decreases, which reduces the toxicity to the kidneys, and the excretion through the kidneys is accelerated.

【Pharmacokinetics】

 Mannitol is absorbed very little orally. After intravenous injection, it quickly enters the extracellular fluid without entering the cells. However, when the blood mannitol concentration is very high or acidosis is present, mannitol can pass through the blood-brain barrier and cause intracranial pressure to rebound. Diuretic effect occurs 1 hour after intravenous injection and lasts for 3 hours. Reducing intraocular pressure and intracranial pressure occurs within 15 minutes after intraperitoneal injection, with a peak time of 30 to 60 minutes and maintaining for 3 to 8 hours. This medicine can produce glycogen from the liver, but because it is quickly excreted through the kidneys after intravenous injection, the amount of metabolization through the liver is generally very small. The T1/2 of this drug is 100 minutes, which can be extended to 6 hours when acute renal failure occurs. When renal function is normal, 100g of mannitol is injected intravenously, and 80% of it is excreted through the kidneys within 3 hours.

【Storage】 Shade and keep in sealed.

【Package】 Glass infusion bottle            250ml×30 bottles/box

【Valid period】 24 months

【Implementation standards】Chinese Pharmacopoeia 2020 Edition Part Two

【Approval number】 National drug approvalH52020413

【Drug marketing authorization holder】/【Manufacturing enterprises】

name：Guizhou Tiandi Pharmaceutical Co., Ltd.

address：No. 6 Baokang Road, Hongxing Pharmaceutical Industrial Park, Dingxiao Town, Xingyi City, Qiannan Buyi and Miao Autonomous Prefecture, Guizhou Province

 postal code：562400

 tel：0859-3119928

 fax：0859-3118152

 website：www.gztiandi.com