Mannitol Side Effects

Brand Names: Osmitrol

Please note - some side effects for Mannitol may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Mannitol - for the Consumer

Mannitol

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Mannitol:

Increased urination; nausea; runny nose; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; chest pain; chills or fever; confusion; decreased alertness; difficulty urinating; extreme dizziness; extreme thirst or dry mouth; fast or irregular heartbeat; headache; muscle cramps; pain, redness, or swelling at the injection site; weakness.

Mannitol Side Effects - for the Professional

Mannitol Injection

Reactions are infrequent and may include:

Metabolic: fluid and electrolyte imbalance, acidosis, dehydration.

Gastrointestinal: dryness of mouth, nausea, vomiting, diarrhea.

Genitourinary: osmotic nephrosis, urinary retention.

Central Nervous System: headache, convulsions, dizziness.

Special Senses: Blurred vision, rhinitis.

Cardiovascular: pulmonary edema, hypotension, hypertension, tachycardia, angina-like chest pains.

Dermatologic: skin necrosis, thrombophlebitis.

Hypersensitivity: urticaria.

Miscellaneous: thirst, arm pain, chills, fever.

Side Effects by Body System

Cardiovascular

Cardiovascular side effects have included hypotension and tachycardia. Venous thrombosis or phlebitis extending from the injection site and hypervolemia have occurred rarely and are generally associated with the solution or technique used in administration.

Respiratory

Respiratory side effects have included pulmonary congestion and rhinitis.

Metabolic

Metabolic side effects have included fluid and electrolyte imbalance, acidosis, and electrolyte loss.

Nervous system

Nervous system side effects have included headache, convulsions, and dizziness.

Hematologic

Hematologic side effects have included thrombophlebitis.

Other

Eight cases of mannitol IV overdose in patients with preexisting renal failure were reviewed. Symptoms presented in the reviewed cases were CNS involvement out of proportion to uremia, severe hyponatremia, large osmolality gap, and fluid overload. Six patients were treated with hemodialysis, one patient with peritoneal dialysis, and one patient died before initiation of treatment. All patients received large doses over 1 to 3 days with a mean dose of 310 +/- 182.8 g. CNS involvement consisted of CNS depression, confusion, lethargy, stupor, and coma. Two patients recovered cerebral function and continued on lifetime dialysis, 3 patients recovered renal and cerebral function, and 1 patient recovered renal function but had severe cerebral dysfunction.

Other side effects have included dryness of mouth, thirst, edema, arm pain, chills, dehydration, fever, mannitol intoxication, and angina-like pain.

Renal

Renal side effects have included acute renal failure.

Local

Local side effects have included extravasation. This effect is generally attributed to the solution or technique used in administration.

Dermatologic

Dermatologic side effects have included urticaria and skin necrosis.

Ocular

Ocular side effects have included blurred vision.

Immunologic

Immunologic side effects have included infection at the injection site and febrile response. These effects are usually attributed to solution or technique used in administration.

Gastrointestinal

Gastrointestinal side effects have included nausea and vomiting.

Genitourinary

Genitourinary side effects have included marked diuresis and urinary retention.

Psychiatric

A 75-year-old woman with severe major depression experienced a manic episode 30 minutes after initiation of a 20% mannitol intravenous infusion for the treatment of acute angle closure glaucoma. The patient had been started on nortriptyline 50 mg per day for the treatment of depression ten days earlier. She received oral acetazolamide, topical pilocarpine, topical timolol, and topical dexamethasone concomitantly for the treatment of glaucoma. The mania resolved within approximately 1 hour following discontinuation of the mannitol infusion, and the patient returned to a severe depressive state. An extensive lab evaluation, toxicology screening, and medical examination failed to show additional secondary causes for mania in this patient.

Psychiatric side effects have rarely included mania (1 case report).

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