Applies to mannitol: inhalation capsule. Other dosage forms:
- intravenous solution
Warning
Inhalation route (Powder)
Mannitol (Aridol (TM)) acts as a bronchoconstrictor and may cause severe bronchospasm. Mannitol bronchial challenge testing is for diagnostic purposes only and should be conducted only by trained professionals under a physician familiar with the test and management of acute bronchospasm (ie, testing area equipped with appropriate medications and equipment). Immediately administer a short-acting inhaled beta-agonist in the event of severe bronchospasm. Do not perform bronchial challenge testing with mannitol in a patient with asthma or very low baseline pulmonary function tests (eg, FEV1 less than 1 to 1.5 L or less than 70% of the predicted values).
Serious side effects of Mannitol
Along with its needed effects, mannitol may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking mannitol:
More common
- Cough
- coughing or spitting up blood
- sore throat
Less common
- Chest discomfort or tightness
- dry heaves
- fever
- runny nose
- trouble breathing
- vomiting
Incidence not known
- Gagging
Other side effects of Mannitol
Some side effects of mannitol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Headache
Less common
- Difficulty in moving
- dizziness
- muscle pain or stiffness
- nausea
- pain in the joints
For Healthcare Professionals
Applies to mannitol: compounding powder, inhalation capsule, inhalation kit, intravenous solution, irrigation solution.
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.[Ref]
Respiratory
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
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
Hematologic side effects have included thrombophlebitis.[Ref]
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.[Ref]
Other side effects have included dryness of mouth, thirst, edema, arm pain, chills, dehydration, fever, mannitol intoxication, and angina-like pain.[Ref]
Renal
Renal side effects have included acute renal failure.[Ref]
Local
Local side effects have included extravasation. This effect is generally attributed to the solution or technique used in administration.[Ref]
Dermatologic
Dermatologic side effects have included urticaria and skin necrosis.[Ref]
Ocular
Ocular side effects have included blurred vision.[Ref]
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.[Ref]
Gastrointestinal
Gastrointestinal side effects have included nausea and vomiting.[Ref]
Genitourinary
Genitourinary side effects have included marked diuresis and urinary retention.[Ref]
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.[Ref]
Psychiatric side effects have rarely included mania (1 case report).[Ref]
