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Mannitol Side Effects

For the Consumer

Applies to mannitol: parenteral powder for injection, urogenital irrigation solution for irrigation

Side effects include:

Fluid and electrolyte imbalance.

For Healthcare Professionals

Applies to mannitol: compounding powder, inhalation kit, intravenous solution, irrigation solution


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.[Ref]


Respiratory side effects have included pulmonary congestion and rhinitis. Respiratory side effects associated with mannitol inhalation have included cough, gagging, wheeze, and decreased forced expiratory volume.[Ref]


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

Nervous system

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


Hematologic side effects have included thrombophlebitis.[Ref]


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.[Ref]

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


Renal side effects have included acute renal failure.[Ref]


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


Dermatologic side effects have included urticaria and skin necrosis.[Ref]


Ocular side effects have included blurred vision.[Ref]


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.[Ref]


Gastrointestinal side effects have included nausea and vomiting.[Ref]


Genitourinary side effects have included marked diuresis and urinary retention.[Ref]


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

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.[Ref]


1. "Product Information. Osmitrol (mannitol)." Baxter I.V. Systems Division, Round Lake, IL.

2. "Product Information. Aridol (mannitol)." Pharmaxis Inc, Exton, PA.

3. Better OS, Rubinstein I, Winaver JM, Knochel JP "Mannitol therapy revisited (1940-1997)." Kidney Int 52 (1997): 886-94

4. Sakemi T, Ikeda Y, Ohtsuka N, Ohtsuka Y, Tomiyoshi Y, Baba N "Acute renal failure associated with mannitol infusion and reversal with ultrafiltration and hemodialysis." Nephron 73 (1996): 733-4

5. Doi K, Ogawa N, Suzuki E, Noiri E, Fujita T "Mannitol-induced acute renal failure." Am J Med 115 (2003): 593-4

6. Edwards JJ, Samuels D, Fu ES "Forearm compartment syndrome from intravenous mannitol extravasation during general anesthesia." Anesth Analg 96 (2003): 245-6, table of contents

7. Navarro V, Vieta E, Gasto C "Mannitol-induced acute manic state." J Clin Psychiatry 62 (2001): 126

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.