Pharmacology

Indication
Used for the promotion of diuresis before irreversible renal failure
becomes established, the reduction of intracranial pressure, the
treatment of cerebral edema, and the promotion of urinary excretion of
toxic substances.
Pharmacodynamics
Chemically, mannitol is an alcohol and a sugar, or a polyol; it is similar
to xylitol or sorbitol. However, mannitol has a tendency to lose a
hydrogen ion in aqueous solutions, which causes the solution to
become acidic. For this reason, it is not uncommon to add a substance
to adjust its pH, such as sodium bicarbonate. Mannitol is commonly
used to increase urine production (diuretic). It is also used to treat or
prevent medical conditions that are caused by an increase in body
fluids/water (e.g., cerebral edema, glaucoma, kidney failure). Mannitol
is frequently given along with other diuretics (e.g., furosemide,
chlorothiazide) and/or IV fluid replacement.
Mechanism of
action
Mannitol is an osmotic diuretic that is metabolically inert in humans
and occurs naturally, as a sugar or sugar alcohol, in fruits and
vegetables. Mannitol elevates blood plasma osmolality, resulting in
enhanced flow of water from tissues, including the brain and
cerebrospinal fluid, into interstitial fluid and plasma. As a result,
cerebral edema, elevated intracranial pressure, and cerebrospinal fluid
volume and pressure may be reduced. As a diurectic mannitol induces
diuresis because it is not reabsorbed in the renal tubule, thereby
increasing the osmolality of the glomerular filtrate, facilitating
excretion of water, and inhibiting the renal tubular reabsorption of
sodium, chloride, and other solutes. Mannitol promotes the urinary
excretion of toxic materials and protects against nephrotoxicity by
preventing the concentration of toxic substances in the tubular fluid. As
an Antiglaucoma agent mannitol levates blood plasma osmolarity,
resulting in enhanced flow of water from the eye into plasma and a
consequent reduction in intraocular pressure. As a renal function
diagnostic aid mannitol is freely filtered by the glomeruli with less than
10% tubular reabsorption. Therefore, its urinary excretion rate may
serve as a measurement of glomerular filtration rate (GFR).
Absorption
Approximately 7% of ingested mannitol is absorbed during
gastrointestinal perfusion in uremic patients.
Volume of
distribution
Not Available
Protein binding None
Metabolism
Mannitol is metabolized only slightly, if at all, to glycogen in the liver.
Substrate Enzymes Product
Mannitol Not Available Glycogen

Route of
elimination
It is rapidly excreted in the urine.
Half life 100 minutes