(MAN ga nees)
- Manganese Chloride
- Manganese Sulfate
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral, as chelated:
MN-50: Elemental manganese 16.67 mg
Solution, Intravenous, as chloride:
Generic: Elemental manganese 0.1 mg/mL (10 mL)
Solution, Intravenous, as sulfate [preservative free]:
Generic: Elemental manganese 0.1 mg/mL (10 mL [DSC])
Tablet, Oral, as aspartate:
Generic: 93 mg [elemental manganese 25 mg]
Tablet, Oral, as chelated:
Mangimin: Elemental manganese 10 mg [corn free, rye free, wheat free]
Generic: Elemental manganese 15 mg, Elemental manganese 50 mg
Tablet, Oral, as gluconate:
Generic: 50 mg [elemental manganese 5.7 mg]
Brand Names: U.S.
- Mangimin [OTC]
- MN-50 [OTC]
- Dietary Supplement
- Trace Element, Parenteral
Cofactor in many enzyme systems, stimulates synthesis of cholesterol and fatty acids in liver, and influences mucopolysaccharide synthesis
Concentrated in mitochondria of pituitary gland, pancreas, liver, kidney, and bone
Bile (primarily); urine (negligible)
Use: Labeled Indications
Trace element added to parenteral nutrition (PN) to prevent manganese deficiency; orally as a dietary supplement
There are no contraindications listed within the manufacturer's US labeling.
Parenteral nutrition, maintenance requirement: IV: 150 to 800 mcg/day
Expert recommendations favor the use of lower doses in the range of 60 to 100 mcg/day to avoid neurotoxicity with routine use and those with cholestatic jaundice. However, these recommendations are difficult to follow with the current sources of parenteral manganese (ASPEN [Vanek 2012]).
Refer to adult dosing.
Parenteral nutrition, maintenance requirement: IV: 2 to 10 mcg/kg/day
Expert recommendations suggest decreasing the daily dose for infants and children to 1 mcg/kg/day (up to a maximum of 50 mcg/day). However, these recommendations are difficult to follow with the current sources of parenteral manganese (ASPEN [Vanek 2012]).
Note: Use caution in premature neonates; manganese chloride solution for injection contains aluminum.
Dosing: Renal Impairment
Use caution; manganese chloride solution for injection contains aluminum.
Dosing: Hepatic Impairment
Use caution; dose may need to be decreased or withheld in patients with elevated bilirubin or confirmed cholestatic disease.
Capsule, tablet: May be administered with a meal.
Solution for injection: Do not administer IM or by direct IV injection; acidic pH of the solution may cause tissue irritations and it is hypotonic; administer after dilution in volume of fluid ≥100 mL
Dietary adequate intake (IOM 2001):
0 to 6 months: 0.003 mg/day
7 to 12 months: 0.6 mg/day
1 to 3 years: 1.2 mg/day
4 to 8 years: 1.5 mg/day
9 to 13 years: Males: 1.9 mg/day; Females: 1.6 mg/day
14 to 18 years: Males: 2.2 mg/day; Females: 1.6 mg/day
>18 years: Males: 2.3 mg/day; Females: 1.8 mg/day
Pregnancy: 2 mg/day
Lactation: 2.6 mg/day
Capsule/tablet (dietary supplement): Store in a cool, dry place.
Solution for injection: Store at controlled room temperature of 20°C to 25°C (68°F to 77°F). Compatible with electrolytes usually present in amino acid/dextrose solution used for TPN solutions; after admixture, discard unused portion immediately.
There are no known significant interactions.
• Biliary tract impairment: Use with caution in patients with biliary tract impairment; dose may need to be decreased or withheld.
• Hepatic impairment: Use with caution in patients with hepatic impairment; dose may need to be decreased or withheld.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.
• Appropriate use: Due to its highly acidic pH (pH 2.0), direct IV or IM injection is contraindicated; may result in severe tissue damage.
Periodic manganese plasma level
Pregnancy Risk Factor
Animal reproduction studies have not been conducted. Manganese crosses the placenta and can be detected in placental tissue and cord blood (Osada, 2002).
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• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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