THERAPEUTICS

Brands

• Osmitrol

Generic?

• Yes

Class

• Osmotic diuretic

Commonly Prescribed for

(FDA approved in bold)

• Reduction of elevated intracranial pressure (ICP)

• Reduction of elevated intraocular pressure

• Diuresis (prophylaxis in acute renal failure)

• Increased excretion of urinary toxins

• Urological irrigation

How the Drug Works

• Mannitol induces diuresis by elevating the osmolarity of the glomerular filtrate, which decreases tubular reabsorption of water

How Long Until It Works

• 15 minutes

If It Works

• Assess effectiveness and need for continued use. Usually used as a short-term measure before more definitive treatment

If It Doesn't Work

• Usually mannitol is a temporary measure for acute increases in ICP before more definitive treatment

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Treatment of increased ICP depends on the etiology

• Causes of increased ICP due to general swelling include liver failure, hypertensive encephalopathy, and hypercarbia. Intervention should consist of treating the underlying medical problem

• In some cases, meningitis can cause increased production of CSF or obstruction of CSF flow

• Increased ICP due to mass effect from stroke (ischemic or hemorrhagic) may require neurosurgical intervention such as an intraventricular catheter, craniotomy, or craniectomy

• Permitting hypertension may increase perfusion and reduce swelling, but calcium channel blockers may also be useful (especially in subarachnoid hemorrhage)

• Analgesia and sedation may be useful

• Hyperventilation, hypothermia, and barbiturate coma are occasionally used, usually in refractory cases

• Hypertonic saline is an alternative to mannitol for acutely increased ICP

• Corticosteroids are often used to reduce vasogenic edema, i.e., brain tumors

Tests

• Carefully monitor serum sodium, potassium, BUN, and urine output during therapy

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Most are related to changes in electrolytes and diuresis

Notable AEs

• Pulmonary edema, hypo- or hypertension, tachycardia

• Headache, thirst, nausea, diarrhea, blurred vision, rhinitis, chills, fever

Life-Threatening or Dangerous AEs

• Severe hypernatremia or renal failure