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enzymes (1) transporters (1)
for drugs
Identification
Name Mannitol
Accession Number DB00742 (APRD01083, EXPT02246)
Type small molecule
Groups approved
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
Download: MOL | SDF | SMILES | InChI
Display: 2D Structure | 3D Structure
Synonyms
  • Cordycepic acid
  • D-Mannitol
  • mannitol
Brand names
  • Bronchitol
  • d-mannitol extra pure
  • Diosmol
  • Hexanhexol
  • Hexitol
  • Isotol
  • Manicol
  • Maniton-S
  • Manna sugar
  • Mannazucker
  • Mannidex
  • Mannigen
  • Mannistol
  • Mannit
  • Mannite
  • Mannitol 10%
  • Mannitol 10% In Plastic Container
  • Mannitol 15%
  • Mannitol 15% In Plastic Container
  • Mannitol 20%
  • Mannitol 20% In Plastic Container
  • Mannitol 25%
  • Mannitol 5%
  • Mannitol 5% In Plastic Container
  • Mannitol BP
  • Mushroom sugar
  • Osmitrol
  • Osmitrol 10% In Water
  • Osmitrol 15% In Water
  • Osmitrol 20% In Water
  • Osmitrol 5% In Water
  • Osmosal
  • Resectisol
  • Resectisol In Plastic Container
  • SDM-25
Brand name mixtures
  • Cystosol W 3% Hexitols (Mannitol + Sorbitol)
  • Sorbitol Mannitol Irrigation (Mannitol + Sorbitol)
Categories
  • Diuretics, Osmotic
  • Sweetening Agents
CAS number 69-65-8
Weight Average: 182.1718
Monoisotopic: 182.079038180
Chemical Formula C6H14O6
InChI Key InChIKey=FBPFZTCFMRRESA-UHFFFAOYSA-N
InChI
InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2
Plain Text
IUPAC Name
hexane-1,2,3,4,5,6-hexol
SMILES
OCC(O)C(O)C(O)C(O)CO
Plain Text
Mass Spec show (9.1 KB)
Taxonomy
Kingdom Organic
Classes
  • Glycerol and Derivatives
Substructures
  • Glycerol and Derivatives
  • Hydroxy Compounds
  • Alcohols and Polyols
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.
Route of elimination It is rapidly excreted in the urine.
Half life 100 minutes
Clearance Not Available
Toxicity LD50=1700 mg/kg (rat oral)
Affected organisms
  • Humans and other mammals
Pathways Not Available
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
Form Route Strength
Liquid Intravenous
Liquid Irrigation
Solution Intravenous
Prices
Unit description Cost Unit
Osmitrol 20% iv solution 0.15 USD ml
Osmitrol 10% iv solution 0.07 USD ml
Osmitrol 15% iv solution 0.07 USD ml
Mannitol powder 0.05 USD g
Mannitol 15% iv solution 0.04 USD ml
Mannitol 20% iv solution 0.04 USD ml
Mannitol 25% vial 0.03 USD ml
Osmitrol 5% iv solution 0.03 USD ml
Mannitol 10% iv solution 0.02 USD ml
Mannitol 5% iv solution 0.02 USD ml
Resectisol 5% solution 0.01 USD ml
Patents Not Available
Properties
State solid
Melting point 168 oC
Experimental Properties
Property Value Source
water solubility 216 mg/mL PhysProp
logP -3.9 PhysProp
Caco2 permeability -6.21 [ADME Research, USCD] BiGG
Predicted Properties
Property Value Source
water solubility 2.29e+02 g/l ALOGPS
logP -2.68 ALOGPS
logP -3.73 ChemAxon Molconvert
logS 0.10 ALOGPS
pKa 13.38 ChemAxon Molconvert
hydrogen acceptor count 6 ChemAxon Molconvert
hydrogen donor count 6 ChemAxon Molconvert
polar surface area 121.38 ChemAxon Molconvert
rotatable bond count 5 ChemAxon Molconvert
refractivity 38.40 ChemAxon Molconvert
polarizability 17.30 ChemAxon Molconvert
References
Synthesis Reference Not Available
General Reference
  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
  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
  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
  4. Roberts I, Smith R, Evans S: Doubts over head injury studies. BMJ. 2007 Feb 24;334(7590):392-4. Pubmed
  5. Wakai A, Roberts I, Schierhout G: Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001049. Pubmed
  6. Wang YM, van Eys J: Nutritional significance of fructose and sugar alcohols. Annu Rev Nutr. 1981;1:437-75. Pubmed
External Links
Resource Link
KEGG Drug D00062 Link_out
KEGG Compound C00392 Link_out
PubChem Compound 453 Link_out
PubChem Substance 46506446 Link_out
ChemSpider 440 Link_out
BindingDB 50142798 Link_out
ChEBI 16899 Link_out
ChEMBL 16899 Link_out
Therapeutic Targets Database DAP000874 Link_out
PharmGKB PA450320 Link_out
HET AHM Link_out
Drug Product Database 2243176 Link_out
RxList http://www.rxlist.com/cgi/generic4/osmitrol.htm Link_out
Drugs.com http://www.drugs.com/cdi/mannitol.html Link_out
Wikipedia http://en.wikipedia.org/wiki/Mannitol Link_out
ATC Codes
  • A06AD16
  • B05BC01
  • B05CX04
  • V08AC04
AHFS Codes
  • 40:28.12
  • 36:68.00
  • 40:36.00
PDB Entries
FDA label show (50 KB)
MSDS show (72.1 KB)
Interactions
Drug Interactions Not Available
Food Interactions Not Available
Enzymes

1. Mannitol dehydrogenase

Actions: substrate
UniProt ID: O08355 Link_out
Gene: mtlD
Protein Sequence: FASTA
Gene Sequence: FASTA
SNPs: SNPJam Report Link_out

References:
  1. Wang YM, van Eys J: Nutritional significance of fructose and sugar alcohols. Annu Rev Nutr. 1981;1:437-75. Pubmed
Transporters

1. Multidrug resistance protein 1

Actions: substrate

Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells

UniProt ID: P08183 Link_out
Gene: ABCB1 Link_out
Protein Sequence: FASTA
Gene Sequence: FASTA
SNPs: SNPJam Report Link_out

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
Comments
Drug created on June 13, 2005 07:24 / Updated on March 21, 2011 09:29

This project is supported by Genome Alberta & Genome Canada, a not-for-profit organization that is leading Canada's national genomics strategy with $600 million in funding from the federal government. This project is also supported in part by GenomeQuest, Inc., an enterprise genomic information company serving the life science community.