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Identification
NameMannitol
Accession NumberDB00742  (APRD01083, EXPT02246)
TypeSmall Molecule
GroupsApproved, Investigational
Description

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. Mannitol may also be used for the promotion of diuresis before irreversible renal failure becomes established; the promotion of urinary excretion of toxic substances; as an Antiglaucoma agent; and as a renal function diagnostic aid.

Structure
Thumb
Synonyms
(2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexaol
(2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol
D-(-)-Mannitol
D-Mannitol
e 421
e-421
e421
Fraxinine
Manitol
Manna Sugar
Mannit
Mannite
Mannitol
Mannitolum
Osmitrol
External Identifiers Not Available
Approved Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Mannitolirrigant5 g/100mLirrigationB. Braun Medical Inc.1978-02-10Not applicableUs
Mannitolinjection, solution12.5 g/50mLintravenousHospira, Inc.1967-12-22Not applicableUs
Mannitolinjection, solution20 g/100mLintravenousHospira, Inc.1987-01-08Not applicableUs
Mannitolinjection, solution15 g/100mLintravenousHospira, Inc.1987-01-08Not applicableUs
Mannitolinjection, solution10 g/100mLintravenousHospira, Inc.1987-01-08Not applicableUs
Mannitolinjection, solution20 g/100mLintravenousB. Braun Medical Inc.1993-07-26Not applicableUs
Mannitolinjection, solution5 g/100mLintravenousHospira, Inc.1987-01-08Not applicableUs
Mannitol 20%solution200 mgintravenousHospira Healthcare Corporation1963-12-31Not applicableCanada
Mannitol 25%solution250 mgintravenousHospira Healthcare Corporation1970-12-31Not applicableCanada
Mannitol Inj 10% Abbovacliquid100 mgintravenousAbbott Laboratories, Limited1963-12-311999-08-09Canada
Mannitol Inj 25%liquid250 mgintravenousAstra Pharma Inc.1987-12-312000-07-20Canada
Mannitol Inj 25%liquid250 mgintravenousInternational Medication Systems Ltd.1971-12-311997-08-15Canada
Mannitol Inj 5% Abbovacliquid50 mgintravenousAbbott Laboratories, Limited1963-12-311999-08-09Canada
Mannitol Injectionsolution250 mgintravenousFresenius Kabi Canada Ltd2002-04-09Not applicableCanada
Osmitrolinjection, solution20 g/100mLintravenousBaxter Healthcare Corporation1964-06-08Not applicableUs
Osmitrolinjection, solution15 g/100mLintravenousBaxter Healthcare Corporation1964-06-08Not applicableUs
Osmitrolinjection, solution10 g/100mLintravenousBaxter Healthcare Corporation1964-06-08Not applicableUs
Osmitrolinjection, solution5 g/100mLintravenousBaxter Healthcare Corporation1964-06-08Not applicableUs
Osmitrol 10% Inj USPliquid10 gintravenousBaxter Corporation1989-12-31Not applicableCanada
Osmitrol 20% Inj USPsolution20 gintravenousBaxter Corporation1989-12-31Not applicableCanada
Resectisol (5% Mannitol Irrigation)liquid5 %irrigationB. Braun Medical Inc1993-12-31Not applicableCanada
Approved Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Mannitolinjection, solution250 mg/mLintravenousAmerican Regent, Inc.1990-09-30Not applicableUs
Mannitolinjection, solution250 mg/mLintravenousFresenius Kabi USA, LLC2000-03-19Not applicableUs
Mannitolinjection, solution12.5 g/50mLintravenousCardinal Health2010-02-01Not applicableUs
Mannitolinjection, solution250 mg/mLintravenousGeneral Injectables & Vaccines, Inc2010-08-01Not applicableUs
Approved Over the Counter ProductsNot Available
Unapproved/Other Products Not Available
International Brands
NameCompany
AnolAstar
AridolPharmaxis
BronchitolPharmaxis
DeltamannitDeltaSelect
DemanitolMedifarma
DiurecideLusa
IsotolNot Available
ManicolNot Available
ManitPliva
Manitol MeinFresenius
ManitonNot Available
MannigenNot Available
MannisolHuman Co. Ltd.
Mannisol ATeva
MannitNot Available
Mannit-LösungSerag-Wiessner
Mannite ActipharmActipharm
OsmofundinB. Braun
OsmohalePharmaxis
OsmosolBeximco
OsmosterilFresenius
ResectisolB. Braun
Brand mixtures
NameLabellerIngredients
Additive Solution Sodium Adenine Glucose Mannitol (sagm)Maco Pharma
Cystosol W 3% HexitolsBaxter Corporation
Leukosep - Solx A Additive SolutionHaemonetics Manufacturing Inc
Leukotrap Solx A AdditiveHaemonetics Manufacturing Inc
Sag-MHaemonetics Corporation
Sorbitol Mannitol IrrigationHospira Healthcare Corporation
Sorbitol-mannitolHospira, Inc.
SaltsNot Available
Categories
UNII3OWL53L36A
CAS number69-65-8
WeightAverage: 182.1718
Monoisotopic: 182.07903818
Chemical FormulaC6H14O6
InChI KeyInChIKey=FBPFZTCFMRRESA-KVTDHHQDSA-N
InChI
InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1
IUPAC Name
(2R,3R,4R,5R)-hexane-1,2,3,4,5,6-hexol
SMILES
OC[C@@H](O)[C@@H](O)[[email protected]](O)[[email protected]](O)CO
Taxonomy
DescriptionThis compound belongs to the class of organic compounds known as sugar alcohols. These are hydrogenated forms of carbohydrate in which the carbonyl group (aldehyde or ketone, reducing sugar) has been reduced to a primary or secondary hydroxyl group.
KingdomOrganic compounds
Super ClassOrganooxygen compounds
ClassCarbohydrates and carbohydrate conjugates
Sub ClassSugar alcohols
Direct ParentSugar alcohols
Alternative Parents
Substituents
  • Sugar alcohol
  • Secondary alcohol
  • Polyol
  • 1,2-diol
  • Hydrocarbon derivative
  • Primary alcohol
  • Alcohol
  • Aliphatic acyclic compound
Molecular FrameworkAliphatic acyclic compounds
External Descriptors
Pharmacology
IndicationUsed 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.
PharmacodynamicsChemically, 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 actionMannitol 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).
Related Articles
AbsorptionApproximately 7% of ingested mannitol is absorbed during gastrointestinal perfusion in uremic patients.
Volume of distributionNot Available
Protein bindingNone
Metabolism

Mannitol is metabolized only slightly, if at all, to glycogen in the liver.

SubstrateEnzymesProduct
Mannitol
Not Available
GlycogenDetails
Route of eliminationIt is rapidly excreted in the urine.
Half life100 minutes
ClearanceNot Available
ToxicityLD50=1700 mg/kg (rat oral)
Affected organisms
  • Humans and other mammals
PathwaysNot Available
SNP Mediated EffectsNot Available
SNP Mediated Adverse Drug ReactionsNot Available
ADMET
Predicted ADMET features
PropertyValueProbability
Human Intestinal Absorption+0.6525
Blood Brain Barrier-0.5997
Caco-2 permeable-0.8958
P-glycoprotein substrateNon-substrate0.662
P-glycoprotein inhibitor INon-inhibitor0.9535
P-glycoprotein inhibitor IINon-inhibitor0.9551
Renal organic cation transporterNon-inhibitor0.9252
CYP450 2C9 substrateNon-substrate0.8706
CYP450 2D6 substrateNon-substrate0.878
CYP450 3A4 substrateNon-substrate0.7431
CYP450 1A2 substrateNon-inhibitor0.824
CYP450 2C9 inhibitorNon-inhibitor0.9419
CYP450 2D6 inhibitorNon-inhibitor0.9412
CYP450 2C19 inhibitorNon-inhibitor0.9232
CYP450 3A4 inhibitorNon-inhibitor0.9402
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.958
Ames testNon AMES toxic0.9132
CarcinogenicityNon-carcinogens0.7823
BiodegradationReady biodegradable0.8595
Rat acute toxicity1.1260 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.9709
hERG inhibition (predictor II)Non-inhibitor0.9329
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397 )
Pharmacoeconomics
Manufacturers
  • B braun medical inc
  • Hospira inc
  • Miles laboratories inc
  • Abraxis pharmaceutical products
  • App pharmaceuticals llc
  • Astrazeneca lp
  • International medication system
  • Luitpold pharmaceuticals inc
  • Merck and co inc
  • Watson laboratories inc
  • Baxter healthcare corp
Packagers
Dosage forms
FormRouteStrength
Liquidirrigation
Solutionintravenous
Injection, solutionintravenous12.5 g/50mL
Injection, solutionintravenous20 g/100mL
Injection, solutionintravenous250 mg/mL
Irrigantirrigation5 g/100mL
Solutionintravenous200 mg
Solutionintravenous250 mg
Liquidintravenous100 mg
Liquidintravenous250 mg
Liquidintravenous50 mg
Injection, solutionintravenous10 g/100mL
Injection, solutionintravenous15 g/100mL
Injection, solutionintravenous5 g/100mL
Liquidintravenous10 g
Solutionintravenous20 g
Liquidirrigation5 %
Solution0-unassigned
Solutionirrigation
Irriganturethral
Prices
Unit descriptionCostUnit
Osmitrol 20% iv solution0.15USD ml
Osmitrol 10% iv solution0.07USD ml
Osmitrol 15% iv solution0.07USD ml
Mannitol powder0.05USD g
Mannitol 15% iv solution0.04USD ml
Mannitol 20% iv solution0.04USD ml
Mannitol 25% vial0.03USD ml
Osmitrol 5% iv solution0.03USD ml
Mannitol 10% iv solution0.02USD ml
Mannitol 5% iv solution0.02USD ml
Resectisol 5% solution0.01USD ml
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
PatentsNot Available
Properties
StateSolid
Experimental Properties
PropertyValueSource
melting point168 °CPhysProp
boiling point290-295 °C at 3.50E+00 mm HgPhysProp
water solubility2.16E+005 mg/L (at 25 °C)YALKOWSKY,SH & DANNENFELSER,RM (1992)
logP-3.10HANSCH,C ET AL. (1995)
Caco2 permeability-6.21ADME Research, USCD
pKa13.5 (at 25 °C)BUDAVARI,S ET AL. (1996)
Predicted Properties
PropertyValueSource
Water Solubility229.0 mg/mLALOGPS
logP-2.7ALOGPS
logP-3.7ChemAxon
logS0.1ALOGPS
pKa (Strongest Acidic)12.59ChemAxon
pKa (Strongest Basic)-3ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count6ChemAxon
Hydrogen Donor Count6ChemAxon
Polar Surface Area121.38 Å2ChemAxon
Rotatable Bond Count5ChemAxon
Refractivity38.4 m3·mol-1ChemAxon
Polarizability16.82 Å3ChemAxon
Number of Rings0ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleYesChemAxon
MDDR-like RuleYesChemAxon
Spectra
Mass Spec (NIST)Download (9.14 KB)
Spectra
Spectrum TypeDescriptionSplash Key
GC-MSGC-MS Spectrum - GC-EI-TOF (Pegasus III TOF-MS system, Leco; GC 6890, Agilent Technologies) (6 TMS)splash10-0ktb-0931000000-b481d576c5f24dd1b1d5View in MoNA
GC-MSGC-MS Spectrum - GC-EI-TOF (Pegasus III TOF-MS system, Leco; GC 6890, Agilent Technologies)splash10-066s-0942000000-20043a375d72ca08dce9View in MoNA
GC-MSGC-MS Spectrum - GC-MS (6 TMS)splash10-066r-1974000000-38a4beaca17ab8c750b6View in MoNA
LC-MS/MSLC-MS/MS Spectrum - Quattro_QQQ 10V, Positive (Annotated)splash10-014j-9600000000-26f4335f7ef7c81ca261View in MoNA
LC-MS/MSLC-MS/MS Spectrum - Quattro_QQQ 25V, Positive (Annotated)splash10-066r-9000000000-73db1fbd51fb8c061becView in MoNA
LC-MS/MSLC-MS/MS Spectrum - Quattro_QQQ 40V, Positive (Annotated)splash10-05mo-9000000000-45a4dea1d21286c4b8daView in MoNA
LC-MS/MSLC-MS/MS Spectrum - LC-ESI-QTOF (UPLC Q-Tof Premier, Waters) , Negativesplash10-0089-6900000000-961d76d6550bc342ffa1View in MoNA
1D NMR1H NMR SpectrumNot Available
2D NMR[1H,13C] 2D NMR SpectrumNot Available
References
Synthesis Reference

Walter M. Kruse, “Process for preparing mannitol from glucose.” U.S. Patent US4029878, issued August, 1956.

US4029878
General References
  1. Cruz J, Minoja G, Okuchi K: Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery. 2001 Oct;49(4):864-71. [PubMed:11564247 ]
  2. Cruz J, Minoja G, Okuchi K: Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery. 2002 Sep;51(3):628-37; discussion 637-8. [PubMed:12188940 ]
  3. Cruz J, Minoja G, Okuchi K, Facco E: Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg. 2004 Mar;100(3):376-83. [PubMed:15035271 ]
  4. Roberts I, Smith R, Evans S: Doubts over head injury studies. BMJ. 2007 Feb 24;334(7590):392-4. [PubMed:17322250 ]
  5. Wakai A, Roberts I, Schierhout G: Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001049. [PubMed:16235278 ]
  6. Wang YM, van Eys J: Nutritional significance of fructose and sugar alcohols. Annu Rev Nutr. 1981;1:437-75. [PubMed:6821187 ]
External Links
ATC CodesA06AD16B05BC01B05CX04R05CB16
AHFS Codes
  • 36:68.00
  • 40:28.12
  • 40:36.00
PDB Entries
FDA labelDownload (50 KB)
MSDSDownload (72.1 KB)
Interactions
Drug Interactions
Drug
AldesleukinThe risk or severity of adverse effects can be increased when Aldesleukin is combined with Mannitol.
AlfuzosinAlfuzosin may increase the hypotensive activities of Mannitol.
AmifostineMannitol may increase the hypotensive activities of Amifostine.
AmikacinMannitol may increase the nephrotoxic activities of Amikacin.
ArbekacinMannitol may increase the nephrotoxic activities of Arbekacin.
BrimonidineBrimonidine may increase the antihypertensive activities of Mannitol.
ButabarbitalButabarbital may increase the hypotensive activities of Mannitol.
ButethalButethal may increase the hypotensive activities of Mannitol.
DiazoxideDiazoxide may increase the hypotensive activities of Mannitol.
DuloxetineMannitol may increase the orthostatic hypotensive activities of Duloxetine.
FramycetinMannitol may increase the nephrotoxic activities of Framycetin.
GentamicinMannitol may increase the nephrotoxic activities of Gentamicin.
HeptabarbitalHeptabarbital may increase the hypotensive activities of Mannitol.
HexobarbitalHexobarbital may increase the hypotensive activities of Mannitol.
KanamycinMannitol may increase the nephrotoxic activities of Kanamycin.
LevodopaMannitol may increase the orthostatic hypotensive activities of Levodopa.
MethohexitalMethohexital may increase the hypotensive activities of Mannitol.
MethylphenidateMethylphenidate may decrease the antihypertensive activities of Mannitol.
MolsidomineMolsidomine may increase the hypotensive activities of Mannitol.
MorphineThe risk or severity of adverse effects can be increased when Morphine is combined with Mannitol.
MoxonidineMoxonidine may increase the hypotensive activities of Mannitol.
NeomycinMannitol may increase the nephrotoxic activities of Neomycin.
NetilmicinMannitol may increase the nephrotoxic activities of Netilmicin.
NicorandilNicorandil may increase the hypotensive activities of Mannitol.
ObinutuzumabMannitol may increase the hypotensive activities of Obinutuzumab.
PentobarbitalPentobarbital may increase the hypotensive activities of Mannitol.
PentoxifyllinePentoxifylline may increase the hypotensive activities of Mannitol.
PhenelzinePhenelzine may increase the orthostatic hypotensive activities of Mannitol.
PrimidonePrimidone may increase the hypotensive activities of Mannitol.
QuinineQuinine may increase the hypotensive activities of Mannitol.
RibostamycinMannitol may increase the nephrotoxic activities of Ribostamycin.
RisperidoneMannitol may increase the hypotensive activities of Risperidone.
RituximabMannitol may increase the hypotensive activities of Rituximab.
SecobarbitalSecobarbital may increase the hypotensive activities of Mannitol.
SpectinomycinMannitol may increase the nephrotoxic activities of Spectinomycin.
StreptomycinMannitol may increase the nephrotoxic activities of Streptomycin.
TadalafilTadalafil may increase the antihypertensive activities of Mannitol.
TobramycinMannitol may increase the nephrotoxic activities of Tobramycin.
TranylcypromineTranylcypromine may increase the orthostatic hypotensive activities of Mannitol.
TreprostinilTreprostinil may increase the hypotensive activities of Mannitol.
ValsartanThe risk or severity of adverse effects can be increased when Valsartan is combined with Mannitol.
VardenafilVardenafil may increase the antihypertensive activities of Mannitol.
YohimbineYohimbine may decrease the antihypertensive activities of Mannitol.
Food InteractionsNot Available

Enzymes

Kind
Protein
Organism
Pseudomonas fluorescens
Pharmacological action
unknown
Actions
substrate
General Function:
Nucleotide binding
Specific Function:
Not Available
Gene Name:
mtlD
Uniprot ID:
O08355
Molecular Weight:
54497.41 Da
References
  1. Wang YM, van Eys J: Nutritional significance of fructose and sugar alcohols. Annu Rev Nutr. 1981;1:437-75. [PubMed:6821187 ]

Transporters

Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
substrate
General Function:
Xenobiotic-transporting atpase activity
Specific Function:
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells.
Gene Name:
ABCB1
Uniprot ID:
P08183
Molecular Weight:
141477.255 Da
References
  1. Faassen F, Vogel G, Spanings H, Vromans H: Caco-2 permeability, P-glycoprotein transport ratios and brain penetration of heterocyclic drugs. Int J Pharm. 2003 Sep 16;263(1-2):113-22. [PubMed:12954186 ]
Comments
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Drug created on June 13, 2005 07:24 / Updated on September 16, 2013 17:11