Mannitol
OSMITROL
What it isOsmotic diuretic drawing water from tissue into plasma; raised intracranial pressure and glaucoma.
Why this oneUnlike hypertonic saline, it draws brain water without adding sodium but causes osmotic diuresis.
What limits itRebound intracranial pressure once the blood-brain barrier is disrupted. It must be filtered for crystals; watch osmolar gap and renal function.
FDA-approved for
- cerebral edema/oliguria (~1964)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Cystic fibrosis (add-on maintenance; patients who pass the BRONCHITOL Tolerance Test) | Adults ≥18 yr | 400 mg (10 capsules) BID inhaled | 400 mg (10 capsules) BID inhaled | 400 mg (10 capsules) BID inhaled |
Renal Undefined
Hepatic Undefined
Instructions
- For oral inhalation only.
- Must pass the BRONCHITOL Tolerance Test (BTT) before prescribing.
- Premedicate with an inhaled short-acting bronchodilator 5–15 min before each dose.
- Administer the 10 capsules individually via the inhaler; take the evening dose ≥2–3 h before bedtime.
- Discard and replace the inhaler after 7 days of use.
Contraindications
- Failure to pass the BRONCHITOL Tolerance Test (BTT)
Cautions
- Bronchospasm (can be severe) — perform BTT, premedicate, discontinue if it occurs
- Hemoptysis — monitor patients with a history; discontinue if it occurs
Adverse reactions
- Cough
- Hemoptysis
- Oropharyngeal pain
- Vomiting
- Bacteria in sputum
- Pyrexia
- Arthralgia
Pregnancy Insufficient human data; no structural alterations in animals; use only if benefit justifies risk.
Lactation Unknown whether excreted in human milk.
NO BOXED WARNINGS
Principal riskRebound intracranial pressure; watch the osmolar gap
Cost, est. cash$20–$1,500/dose or month
Generic entry1982
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.
Mechanism of action: Mannitol ballicule
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decreases serum lithium
