マンニトール

使用用途

• Cerebral edema
• Oliguric renal failure
• Cerebral edema
• Oliguric renal failure
• Oliguric renal failure (not anuric)
• Oliguric renal failure (rehydrated, not fluid overloaded)
• Oliguric renal failure (fluid replete)
• Acute glaucoma
• Acute glaucoma (if latanoprost fails)
• Acute primary angle-closure glaucoma
• Increased CSF pressure/cerebral edema
• Increased CSF pressure (critical/deteriorating patient)
• Cerebral edema secondary to trauma

投与方法

考えられる副作用

• Fluid and electrolyte imbalances (especially hypernatremia)
• Volume overload (if oliguria persists)
• Nausea and vomiting
• Pulmonary edema
• Congestive heart failure (CHF)
• Tachycardia
• Dizziness and headache (CNS effects)
• Fluid and electrolyte imbalances
• Circulatory overload (at high doses)
• Acidosis (at high doses)
• Thrombophlebitis
• Extravasation injury (oedema and skin necrosis)
• Diarrhoea (if administered orally)
• Acute renal failure (rare)

注意事項と禁忌

• Anuria secondary to renal disease
• Severe dehydration
• Severe pulmonary congestion or pulmonary edema
• Intracranial bleeding (unless during craniotomy - human label)
• Disrupted capillary membrane in the brain (can leak into interstitium and worsen edema)
• Severe pulmonary congestion
• Pulmonary oedema
• Intracranial haemorrhage (relative contraindication; labelled 'use with care' but commonly used in traumatic brain injury)
• **Important Warnings:** * **Halt therapy** if progressive heart failure, pulmonary congestion, or progressive renal failure/damage (increasing oliguria/azotemia) develops. * **Hydration:** Adequate fluid replacement must be administered to dehydrated animals *before* mannitol therapy begins. Use with caution in hypovolemic patients as it can enhance hypotension. * **Crystallization:** Crystals frequently form in solutions >15%. Be certain crystals are dissolved (by warming) before administering. An **in-line IV filter (5 micron)** is highly recommended. * **Blood Products:** Do not give with whole blood products unless at least 20 mEq/L of NaCl is added, otherwise pseudoagglutination may result. * **Glaucoma:** Relatively contraindicated for treating secondary glaucomas, as it may cross the damaged blood-aqueous barrier and increase IOP.

薬物相互作用

• Lithium: Mannitol can increase the renal elimination of lithium
• Sotalol: Mannitol's effects on potassium and magnesium may increase the risk for QT prolongation
• Potassium-depleting diuretics: May exacerbate diuretic-induced hypokalaemia
• Beta-blockers: Concurrent use with potassium-depleting diuretics requires caution
• Ciclosporin: Nephrotoxicity has been described with concurrent use in humans
• Whole blood: Mannitol should never be added to whole blood for transfusion or given through the same IV set
• KCl or NaCl: Do not add to concentrated mannitol solutions (20% or 25%) as a precipitate may form

よくある質問