20% w/v MANNITOL INTRAVENOUS INFUSION BP Infusion/Solution for

What is 20% w/v MANNITOL INTRAVENOUS INFUSION BP

20% w/v Mannitol Intravenous Infusion BP is a hypertonic solution containing 20 grams of mannitol per 100 ml of sterile water, totaling 100 grams in a 500 ml plastic bottle. Mannitol is a sugar alcohol that functions as an osmotic diuretic, primarily used to reduce intracranial and intraocular pressure, promote diuresis in renal failure, and facilitate the excretion of toxic substances.

• Generic Name: Mannitol
• Concentration: 20% w/v (200 mg/ml)
• Formulation: Sterile, non-pyrogenic solution for intravenous infusion
• Primary Uses:
  • Reduction of elevated intracranial pressure and cerebral edema
  • Lowering of intraocular pressure in acute glaucoma
  • Promotion of diuresis in acute renal failure
  • Adjunctive therapy in the elimination of toxic substances

Due to its hyperosmolar properties, mannitol draws water from tissues into the vascular space, facilitating its excretion via the kidneys. This mechanism is particularly beneficial in conditions where fluid reduction is desired, such as cerebral edema or acute glaucoma.

How to use 20% w/v MANNITOL INTRAVENOUS INFUSION BP

Administration of 20% w/v Mannitol Intravenous Infusion BP should be conducted under strict medical supervision, with careful monitoring of fluid balance, renal function, and electrolyte levels.

• Route of Administration: Intravenous infusion, preferably through a central vein to minimize the risk of phlebitis due to hyperosmolarity.
• Preparation:
  • Inspect the solution for clarity and absence of particulate matter.
  • Warm the solution to body temperature if crystals are present, ensuring complete dissolution before use.
  • Use aseptic techniques during preparation and administration.
• Infusion Guidelines:
  • Administer using a controlled infusion pump to regulate the flow rate.
  • Adjust the rate based on the patient's clinical condition, urine output, and serum electrolyte levels.
  • Monitor for signs of fluid overload, electrolyte imbalances, and renal function deterioration.
• Precautions:
  • Do not mix with blood products due to the risk of agglutination.
  • Discontinue infusion if signs of hypersensitivity, pulmonary congestion, or renal impairment occur.

Proper administration is crucial to maximize therapeutic benefits while minimizing potential risks associated with mannitol infusion.

Mode of Action 20% w/v MANNITOL INTRAVENOUS INFUSION BP

Mannitol acts as an osmotic diuretic by increasing the osmolarity of the plasma and renal filtrate, leading to the movement of water from intracellular and interstitial spaces into the vascular compartment. This process results in increased urine production and reduced tissue edema.

• Renal Effects:
  • Inhibits tubular reabsorption of water and electrolytes in the kidneys.
  • Promotes diuresis, aiding in the management of acute renal failure.
• Neurological Effects:
  • Reduces intracranial pressure by drawing water out of brain tissue.
  • Alleviates cerebral edema, improving neurological outcomes.
• Ophthalmic Effects:
  • Lowers intraocular pressure by reducing vitreous volume.
  • Beneficial in the treatment of acute glaucoma episodes.

The osmotic properties of mannitol make it effective in conditions where rapid fluid reduction is necessary, particularly in neurological and ophthalmic emergencies.

20% w/v MANNITOL INTRAVENOUS INFUSION BP Interactions 20% w/v MANNITOL INTRAVENOUS INFUSION BP

Mannitol may interact with various medications and physiological systems, necessitating careful consideration during co-administration.

• Nephrotoxic Agents:
  • Concurrent use with nephrotoxic drugs (e.g., aminoglycosides, cyclosporine) may increase the risk of renal impairment.
• Electrolyte-Altering Medications:
  • Drugs affecting electrolyte balance (e.g., diuretics, digoxin) may have enhanced effects or increased toxicity when combined with mannitol-induced electrolyte shifts.
• Lithium:
  • Mannitol may reduce lithium levels by increasing its renal excretion, potentially decreasing therapeutic efficacy.
• Blood Products:
  • Should not be mixed with blood due to the risk of hemolysis or agglutination.

Monitoring renal function and electrolyte levels is essential when mannitol is used alongside other medications, especially those with narrow therapeutic indices or renal clearance.

Dosage of 20% w/v MANNITOL INTRAVENOUS INFUSION BP

Dosage of 20% w/v Mannitol Intravenous Infusion BP varies based on the clinical indication, patient age, weight, and renal function. Administration should be individualized and closely monitored.

• Reduction of Intracranial or Intraocular Pressure:
  • Adults: 1.5 to 2 g/kg administered over 30 to 60 minutes.
  • Children: 1 to 2 g/kg or 30 to 60 g/m² over 30 to 60 minutes.
• Promotion of Diuresis in Renal Failure:
  • Adults: 50 to 100 g administered at a rate adjusted to maintain urine output of at least 30 to 50 ml/hr.
  • Children: 2 g/kg or 60 g/m² over 2 to 6 hours.
• Adjunctive Therapy for Toxin Elimination:
  • Adults: 50 to 200 g administered to maintain urine output of 100 to 500 ml/hr.
  • Children: 2 g/kg or 60 g/m² over appropriate duration.

Dosage adjustments may be necessary based on patient response, renal function, and fluid-electrolyte balance. Continuous monitoring is imperative to ensure therapeutic efficacy and safety.

Possible side effects of 20% w/v MANNITOL INTRAVENOUS INFUSION BP

While mannitol is generally well-tolerated, potential side effects may occur, particularly with high doses or rapid administration.

• Fluid and Electrolyte Imbalances:
  • Hyponatremia or hypernatremia
  • Hypokalemia or hyperkalemia
  • Dehydration or fluid overload
• Renal Effects:
  • Acute kidney injury
  • Osmotic nephrosis
• Cardiovascular Effects:
  • Hypotension or hypertension
  • Tachycardia
• Neurological Effects:
  • Headache
  • Dizziness
  • Confusion
• Gastrointestinal Effects:
  • Nausea
  • Vomiting
• Allergic Reactions:
  • Urticaria
  • Fever
  • Chills

Prompt recognition and management of adverse effects are crucial. Discontinue infusion and initiate appropriate interventions if severe reactions occur.

20% w/v MANNITOL INTRAVENOUS INFUSION BP Contraindications 20% w/v MANNITOL INTRAVENOUS INFUSION BP

Certain conditions contraindicate the use of mannitol due to the risk of exacerbating underlying issues or causing harm.

• Established Anuria: Absence of urine output indicates renal failure, where mannitol may accumulate and cause toxicity.

  Storage of 20% w/v MANNITOL INTRAVENOUS INFUSION BP

  Proper storage of 20% w/v Mannitol Intravenous Infusion BP is crucial to maintain its stability, sterility, and therapeutic effectiveness. Being a sterile hypertonic solution, any deviation from the recommended storage conditions may lead to crystallization, contamination, or reduced efficacy.

  • Recommended Storage Temperature:
    • Store at a controlled room temperature between 15°C and 25°C (59°F to 77°F).
    • Do not freeze. Freezing may lead to the formation of crystals, which can compromise safety and effectiveness.
  • Protection from Light:
    • Keep the infusion in its original overwrap or packaging to protect from light.
    • Direct sunlight or prolonged exposure to fluorescent lighting may degrade the solution quality over time.
  • Inspect for Crystallization:
    • Mannitol solutions are prone to crystal formation, especially at lower temperatures.
    • If crystals appear, the solution may be warmed gently to about 70°C until crystals dissolve completely. Cool to body temperature before administering.
    • Do not use the solution if crystals persist or if the solution remains cloudy or discolored after warming.
  • Sterility and Handling:
    • Do not use the container if it is leaking, damaged, or if the solution shows visible particles or discoloration.
    • Use aseptic technique to prevent contamination when connecting the infusion system.
    • Discard any unused portion after opening; single-use only.
  • Expiration:
    • Always check the expiry date printed on the bottle before use.
    • Do not use beyond the expiration date, as the chemical composition and sterility may be compromised.

  Adhering to the recommended storage guidelines helps ensure the safety, effectiveness, and quality of 20% w/v Mannitol Intravenous Infusion BP. Proper storage is especially important in hospital and emergency settings where immediate availability and reliability of the infusion are critical.