Mannitol

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Mannitol
Clinical data
Trade namesOsmitrol, Bronchitol, others
Other namesd-Mannitol, mannite, manna sugar
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • AU: B2
Intravenous, By mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability~7%
MetabolismLiver, negligible
Elimination half-life100 minutes
ExcretionKidney: 90%
Identifiers
  • D-Mannitol
    (2R,3R,4R,5R)-Hexane-1,2,3,4,5,6-hexol
JSmol)
  • O[C@H]([C@H](O)CO)[C@H](O)[C@H](O)CO
  • InChI=1S/C6H14O6/c7-1-3(9)5(11)6(12)4(10)2-8/h3-12H,1-2H2/t3-,4-,5-,6-/m1/s1 checkY
  • Key:FBPFZTCFMRRESA-KVTDHHQDSA-N checkY
  (verify)

Mannitol is a type of

increased intracranial pressure.[7][6] Medically, it is given by injection or inhalation.[8][9] Effects typically begin within 15 minutes and last up to 8 hours.[8]

Common side effects from medical use include

kidney problems.[8][6] It is unclear if use is safe in pregnancy.[8] Mannitol is in the osmotic diuretic family of medications and works by pulling fluid from the brain and eyes.[8]

The discovery of mannitol is attributed to

Joseph Louis Proust in 1806.[10] It is on the World Health Organization's List of Essential Medicines.[11] It was originally made from the flowering ash and called manna due to its supposed resemblance to the Biblical food.[12][13] Mannitol is on the World Anti-Doping Agency's banned drug list due to concerns that it may mask other drugs.[14]

Uses

Mannitol 15% solution for intravenous use

Medical uses

In the United States, mannitol is indicated for the reduction of intracranial pressure and treatment of cerebral edema and elevated intraocular pressure.[3]

In the European Union, mannitol is indicated for the treatment of cystic fibrosis (CF) in adults aged 18 years and above as an add-on therapy to best standard of care.[4]

Mannitol is used intravenously to reduce acutely raised intracranial pressure until more definitive treatment can be applied,

tight junctions.[17][18]

It may also be used for certain cases of

kidney failure with low urine output, decreasing pressure in the eye, to increase the elimination of certain toxins, and to treat fluid build up.[8]

Intraoperative mannitol prior to vessel clamp release during renal transplant has been shown to reduce post-transplant kidney injury, but has not been shown to reduce graft rejection.[medical citation needed]

Mannitol acts as an osmotic laxative[3][19] in oral doses larger than 20 g,[20] and is sometimes sold as a laxative for children.[citation needed]

The use of mannitol, when inhaled, as a bronchial irritant as an alternative method of diagnosis of

exercise-induced asthma has been proposed. A 2013 systematic review concluded evidence to support its use for this purpose at this time is insufficient.[21]

Mannitol is commonly used in the circuit prime of a

endothelial cells
in the kidney, which may have otherwise reduced blood flow to this area and resulted in cell damage.

Mannitol can also be used to temporarily encapsulate a sharp object (such as a helix on a lead for an

artificial pacemaker
) while it passes through the venous system. Because the mannitol dissolves readily in blood, the sharp point becomes exposed at its destination.

Mannitol is also the first drug of choice to treat acute

vitreous humor and, therefore, lowers the intraocular pressure. However, it requires an intact blood-ocular barrier to work.[22]

Food

Mannitol increases blood glucose to a lesser extent than

hygroscopicity – it does not pick up water from the air until the humidity level is 98%. This makes mannitol very useful as a coating for hard candies, dried fruits, and chewing gums, and it is often included as an ingredient in candies and chewing gum.[25] The pleasant taste and mouthfeel of mannitol also makes it a popular excipient for chewable tablets.[26]

Analytical chemistry

Mannitol can be used to form a complex with boric acid. This increases the acid strength of the boric acid, permitting better precision in volumetric analysis of this acid.[27]

Other

Mannitol is the primary ingredient of mannitol salt agar, a bacterial growth medium, and is used in others.

Mannitol is used as a

cutting agent[28] in various drugs that are used intranasally (snorted), such as cocaine. A mixture of mannitol and fentanyl (or fentanyl analogs) in ratio 1:10 is labeled and sold as "China white", a popular heroin substitute.[citation needed
]

Mannitol is a sugar alcohol "Mannitol has 50-70 percent of the relative sweetness of sugar, which means more must be used to equal the sweetness of sugar. Mannitol lingers in the intestines for a long time and therefore often causes bloating and diarrhea."<https://www.ynhh.org/services/nutrition/sugar-alcohol#:~:text=Mannitol%20has%2050%2D70%20percent,naturally%20in%20fruits%20and%20vegetables.>

Contraindications

Mannitol is contraindicated in people with anuria, severe hypovolemia, pre-existing severe pulmonary vascular congestion or pulmonary edema, irritable bowel syndrome (IBS), and active intracranial bleeding except during craniotomy.[3]

Adverse effects include hyponatremia and volume depletion leading to metabolic acidosis.[10]

Chemistry

Mannitol is an

hydroxyl group on carbon 2.[29] While similar, the two sugar alcohols have very different sources in nature, melting points
, and uses.

Production

Mannitol is classified as a

isomers, the only difference being the orientation of the hydroxyl group on carbon 2.[24]

Industrial synthesis

Mannitol is commonly produced via the

alkaline reaction conditions can slightly increase mannitol yields.[24]

Biosyntheses

Mannitol is one of the most abundant energy and carbon storage molecules in nature, produced by a plethora of organisms, including bacteria, yeasts, fungi, algae, lichens, and many plants.

E. coli in mannitol production. When food-grade strains of any of the aforementioned microorganisms are used, the mannitol and the organism itself are directly applicable to food products, avoiding the need for careful separation of microorganism and mannitol crystals. Although this is a promising method, steps are needed to scale it up to industrially needed quantities.[31]

Natural extraction

Since mannitol is found in a wide variety of natural products, including almost all plants, it can be directly extracted from natural products, rather than chemical or biological syntheses. In fact, in China, isolation from

plane tree. It is a constituent of saw palmetto (Serenoa).[32]

Traditionally, mannitol is extracted by the

diffusive
than normal fluids. This is considered to make them much more effective mass transfer agents than normal liquids. The super- or subcritical fluid is pumped through the natural product, and the mostly mannitol product is easily separated from the solvent and minute amount of byproduct.

Supercritical

subcritical water is even cheaper, and is shown to have dramatically greater results than traditional extraction. It requires only 4.01 g (0.141 oz) water per 1 g (0.035 oz) of olive leaf, and gives a yield of 76.75% mannitol. Both super- and subcritical extractions are cheaper, faster, purer, and more environmentally friendly than the traditional extraction. However, the required high operating temperatures and pressures are causes for hesitancy in the industrial use of this technique.[31]

History

Julije Domac elucidated the structure of hexene and mannitol obtained from Caspian manna. He determined the place of the double bond in hexene obtained from mannitol and proved that it is a derivative of a normal hexene. This also solved the structure of mannitol, which was unknown until then.[33][34][35][36]

Controversy

The three studies

Cochrane review excludes all studies by Julio Cruz, leaving only four studies.[7]
Due to differences in selection of control groups, a conclusion about the clinical use of mannitol has not been reached.

Compendial status

See also

References

  1. FDA
    . Retrieved 22 October 2023.
  2. ^ "Regulatory Decision Summary - Aridol". Health Canada. 23 October 2014. Retrieved 7 June 2022.
  3. ^ a b c d "Osmitrol- mannitol injection, solution". DailyMed. 15 November 2018. Retrieved 28 October 2020.
  4. ^ a b "Bronchitol EPAR". European Medicines Agency (EMA). 17 September 2018. Retrieved 28 October 2020. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  5. ^
    ISBN 9781439876732. Archived
    from the original on 10 September 2017.
  6. ^
    ISBN 9789241547659
    .
  7. ^
    PMID 23918314
    .
  8. ^ a b c d e f g "Mannitol". The American Society of Health-System Pharmacists. Archived from the original on 26 May 2015. Retrieved 8 January 2015.
  9. ^ "BRONCHITOL® (mannitol) inhalation powder Patient Site". bronchitol.com.
  10. ^
    ISBN 9780931292170. Archived
    from the original on 10 September 2017.
  11. hdl:10665/325771
    . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  12. ISBN 9780323461122
    .
  13. ISBN 978-1437735789
    .
  14. ^ "THE 2017 PROHIBITED LIST INTERNATIONAL STANDARD" (PDF). January 2017. p. 5. Retrieved 7 July 2018.
  15. ^ "Mannitol (Intravenous Route)". Mayo Clinic.
  16. ^ Gu, J., Huang, H., Huang, Y. et al. Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials. Neurosurg Rev 42, 499–509 (2019). https://doi.org/10.1007/s10143-018-0991-8
  17. S2CID 20258642
    .
  18. S2CID 199507024
    .
  19. ^ "Select Committee on GRAS Substances (SCOGS) Opinion: Mannitol". FDA.gov. April 2013. Archived from the original on 22 October 2014.
  20. doi:10.1016/S0021-9258(18)72829-9. Archived
    from the original on 10 September 2017.
  21. PMID 21875541
    .
  22. ^ Veterinary Class Notes, Ophthalmology, The Ohio State University, provided by David Wilkie, DVM, DACVO
  23. ISBN 978-1461285229
    .
  24. ^
    ISBN 0470659688
    .
  25. ^ a b Lawson P (2007). Mannitol. Blackwell Publishing Ltd. pp. 219–225.
  26. ^ Weiner ML, Kotkoskie LA (1999). Excipient Toxicity and Safety. Taylor & Francis. pp. 370.
    ISBN 9780824782108
    .
  27. ^ Belcher R, Nutten AJ (1960). Quantitative Inorganic Analysis (2nd ed.). London, UK: Butterworths. p. 194.
  28. ^ "Cut the Shit". December 2005. Archived from the original on 27 September 2016. Retrieved 4 September 2017.
  29. ^ Kearsley MW, Deis RC (2006). "Sorbitol and Mannitol". Sweeteners and Sugar Alternatives in Food Technology. Ames: Oxford. pp. 249–261.{{cite book}}: CS1 maint: location missing publisher (link)
  30. ^
    S2CID 42103028
    .
  31. ^
    doi:10.1016/j.tifs.2009.03.006
    .
  32. S2CID 260249165
    .
  33. PMID 22026131
    .
  34. ^ Domac J (1881). "Über das Hexylen aus Mannit". Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften, Mathematisch-Naturwissenschaftliche Classe (in German). 23: 1038–1051.
  35. S2CID 94940823
    .
  36. doi:10.1002/jlac.18822130107
    .
  37. S2CID 43880412
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  38. S2CID 20678448
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  39. PMID 15035271
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  40. PMID 17322250
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  41. ^ British Pharmacopoeia Commission Secretariat (2009). "Index, BP 2009" (PDF). Archived from the original (PDF) on 11 April 2009. Retrieved 31 January 2010.
  42. ^ "Japanese Pharmacopoeia, Fifteenth Edition" (PDF). 2006. Archived from the original (PDF) on 22 July 2011. Retrieved 31 January 2010.
  43. ^ USP 32 (2008). "Mannitol Injection" (PDF). Archived from the original (PDF) on 6 July 2010. Retrieved 31 January 2010.{{cite web}}: CS1 maint: numeric names: authors list (link)

External links

  • Media related to Mannitol at Wikimedia Commons
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