Mannitol 20% Fresenius leaflet – Poland

How to use Mannitol 20% Fresenius

Patient Information Leaflet: User Information

MANNITOL 20% FRESENIUS, 200 mg/ml, Solution for Infusion

Mannitol

Read the leaflet carefully before using the medicine, as it contains important information for the patient.

Keep this leaflet, you may need to read it again.
In case of any doubts, consult a doctor, pharmacist, or nurse.
This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
If the patient experiences any side effects, including any not listed in this leaflet, they should inform their doctor, pharmacist, or nurse. See section 4.

Table of Contents of the Leaflet

1. What is MANNITOL 20% FRESENIUS and what is it used for
2. Important information before using MANNITOL 20% FRESENIUS
3. How to use MANNITOL 20% FRESENIUS
4. Possible side effects
5. How to store MANNITOL 20% FRESENIUS
6. Contents of the pack and other information

1. What is MANNITOL 20% FRESENIUS and what is it used for

MANNITOL 20% FRESENIUS is a medicine that increases the amount of urine excreted and moves water from tissues to the vascular space. The medicine reduces intracranial and intraocular pressure. It is administered intravenously.

Indications for use:
increased diuresis (increased urine excretion) in the prevention and treatment of oliguria (reduced urine production) in acute renal failure;
reduction of intracranial pressure and reduction of brain edema;
reduction of elevated intraocular pressure when it cannot be reduced by other means;
increased excretion of toxic substances by the urinary system (so-called forced diuresis).

2. Important information before using MANNITOL 20% FRESENIUS

When not to use MANNITOL 20% FRESENIUS:

if the patient is allergic to mannitol;
if the patient has advanced renal failure with anuria;
if the patient has symptoms of pulmonary congestion or pulmonary edema;
if the patient has intracranial hemorrhage, except for hemorrhages during craniotomy (surgical opening of the skull);
if the patient is severely dehydrated;
if the patient develops progressive renal failure with increasing oliguria (significant reduction in urine output) and azotemia (excess nitrogen in the blood) after starting mannitol administration;
if the patient's heart failure worsens or symptoms of pulmonary congestion increase after starting mannitol administration.

Warnings and precautions

In patients with significant renal function disorders before starting MANNITOL 20% FRESENIUS, the doctor will administer a test dose to check the body's reaction to the medicine.

During MANNITOL 20% FRESENIUS administration, the doctor will monitor:
sodium and potassium levels in the blood (whether there is a disturbance in fluid and electrolyte balance);
hourly diuresis (amount of urine excreted per hour);
whether hypovolemia (too little blood in the blood vessels) worsens;
whether congestive heart failure (heart dysfunction characterized by edema in the legs and pulmonary edema) worsens;
renal function.

The medicine must not be administered intramuscularly or subcutaneously, and not in combination with blood.

MANNITOL 20% FRESENIUS and other medicines

Tell your doctor or pharmacist about all medicines you are taking, have recently taken, or plan to take.

Caution should be exercised when using the following medicines in combination with MANNITOL 20% FRESENIUS:
neomycin (an antibiotic used to treat fungal infections) due to the increased risk of hearing loss and kidney damage;
kanamycin (an antibiotic used to treat infections) due to the risk of hearing loss;
digitalis glycosides (medicines used to treat heart failure) due to the risk of digitalis toxicity, especially if the patient has low potassium levels in the blood;
diuretic medicines, as mannitol enhances their effect;
other diuretic medicines, including carbonic anhydrase inhibitors, as they may enhance the effect of reducing intraocular pressure.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, consult your doctor or pharmacist before using this medicine.

Driving and using machines

MANNITOL 20% FRESENIUS has no or negligible influence on the ability to drive and use machines.

3. How to use MANNITOL 20% FRESENIUS

This medicine is administered only by medical personnel. The medicine must not be used by yourself. In case of doubts, consult a doctor.

Using a higher dose of MANNITOL 20% FRESENIUS than recommended

In case of using a higher dose of the medicine, inform your doctor or nurse immediately.

Rapid administration of a large amount of mannitol may cause:
excessive increase in fluid volume in the blood vessels;
heart failure;
pulmonary edema.

Using higher doses of the medicine than recommended may cause excessive loss of electrolytes, especially sodium, potassium, and chlorides. Low levels of these electrolytes may cause:

orthostatic hypotension (decrease in blood pressure when changing position from lying to standing);
tachycardia (rapid, abnormal heart rhythm);
decrease in central venous pressure (due to too little blood in the blood vessels);
disorders of nerve conduction and muscle function (muscle paralysis);
atrophy of the gastrointestinal tract (lack of muscle contraction in the gastrointestinal tract).

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects may occur:

pulmonary congestion (characteristic crackling in the lungs);
disturbances in fluid and electrolyte balance;
acidosis (accumulation of excessive amounts of acidic substances in the blood);
dry mouth, increased thirst;
excessive diuresis (excretion of large amounts of urine), urinary retention;
edema;
headache, dizziness;
blurred vision;
seizures;
nausea, vomiting, diarrhea;
rhinitis;
arm pain;
skin necrosis;
thrombophlebitis (formation of inflammation and small blood clots, characterized by palpable hardening of the vein, redness around it, pain, and tenderness);
chills;
urticaria (bright red, itchy blisters on the skin);
dehydration (excessive loss of fluid from the body);
decrease in blood pressure;
tachycardia (rapid, abnormal heart rhythm);
fever;
chest pain similar to angina (severe pain behind the sternum, radiating to the arms, jaw);
congestive heart failure (heart dysfunction characterized by edema in the legs and pulmonary edema);
vein pain and irritation caused by too rapid administration of the medicine.

Reporting side effects

If you experience any side effects, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Adverse Reaction Monitoring of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: +48 22 49 21 301, fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl. Side effects can also be reported to the marketing authorization holder.

5. How to store MANNITOL 20% FRESENIUS

Store the medicine out of sight and reach of children.

Store in a temperature below 25°C. Do not freeze.
The packaging should not be stored and used again after opening. Unused medicine should not be used.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the specified month.
Do not use this medicine if you notice contamination, color change, or if the packaging is damaged.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the pack and other information

What MANNITOL 20% FRESENIUS contains

The active substance is mannitol. 1 ml of solution contains 200 mg of mannitol. 1000 ml of solution contains 200 g of mannitol.
The other ingredient is water for injections.

The osmolality of the solution is 1098 mOsmol/l.

What MANNITOL 20% FRESENIUS looks like and contents of the pack

The medicine is a clear and colorless liquid.

glass bottle: 100 ml, 250 ml, or 500 ml, and
glass bottle: 20 x 100 ml, 12 x 250 ml, and 12 x 500 ml, in a cardboard box.

Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Fresenius Kabi Polska Sp. z o.o., Al. Jerozolimskie 134, 02-305 Warsaw

Manufacturer

Fresenius Kabi Italia S.r.l., Via Camagre 41, 37063 Isola della Scala - Verona, Italy

Date of last revision of the leaflet:

Information intended for healthcare professionals only:

Dosage and administration

Dosage

The rate of infusion and the amount of solution administered depend on the indication, fluid requirements, and renal function.
The usual dose in adults is 50-200 g/day.
In most cases, the appropriate response occurs after administration of a dose of about 100 g/day.
The rate of administration is usually based on diuresis. The diuresis rate should be maintained at at least 30-50 ml/h.

The above guidelines are only general recommendations for the use of the medicine.

Usually, the medicine is used according to the following scheme:

Adult patients

Test dose in patients with significant oliguria or renal function disorders

The dose is: 0.2 g/kg body weight (75 ml of 20% solution). Administration of this dose over 3-5 minutes should cause diuresis at a rate of at least 30-50 ml/h. If the diuresis rate does not increase, a second test dose can be administered. Lack of the desired effect after the second dose indicates that treatment with mannitol is ineffective.

Treatment of oliguria

Maximum daily dose is about 1.5 g/kg body weight/day (about 100 g/day for a patient with a body weight of 70 kg).

Maximum infusion rate is 0.3 g/kg body weight/h (21 g/h for a patient with a body weight of 70 kg).

The medicine should not be administered again to patients with persistent oliguria.

Prevention of oliguria

To prevent acute renal failure during cardio-surgical and other surgical procedures, a dose of 50-100 g of mannitol is used.

Reduction of intracranial pressure, brain edema

To achieve maximum effect, mannitol is administered intravenously in a dose of 0.25 g/kg body weight, not more frequently than every 6-8 hours.

Reduction of intraocular pressure

A dose of 1.5-2 g/kg body weight (7.5 ml to 10 ml of 20% solution/kg body weight) can be administered over 30 minutes to achieve rapid and maximum effect.

If mannitol is used to reduce intraocular pressure before ophthalmic surgical procedures, the above dose should be administered about 1-1.5 hours before the surgical procedure.

Acceleration of excretion of toxic substances by the urinary system

The dose should be adjusted according to the patient's current diuresis and fluid requirements.

The total dose of mannitol should not exceed 200 g. Loss of water and electrolytes should be compensated.

Children

The efficacy and safety of MANNITOL 20% FRESENIUS in children under 12 years of age are not known.

Reduction of brain edema, reduction of intracranial pressure, reduction of intraocular pressure

Intravenous infusion of a dose of 1-2 g/kg body weight, administered over 60 minutes.

Oliguria

Intravenous infusion of a dose of 0.25-2 g/kg body weight, administered over 2-6 hours.

Before using the medicine, a test dose of 0.75 g/kg body weight should be administered over 3-5 minutes. If diuresis does not increase within 2 hours, the medicine should not be used.

Overdose

Rapid administration of a large amount of mannitol may cause excessive increase in fluid volume in the vascular space, heart failure, and pulmonary edema.

Using higher doses of the medicine than recommended may cause excessive loss of electrolytes, especially sodium, potassium, and chlorides. Low levels of these electrolytes may cause hypotension, tachycardia, and decrease in central venous pressure. Low potassium levels in the blood may cause disorders of nerve conduction and muscle function and atrophy of the gastrointestinal tract.

Interactions with other medicines and other types of interactions

If blood transfusion is necessary during mannitol infusion, blood and mannitol should be administered through separate veins.

Mannitol enhances the diuretic effect of diuretic medicines.

Concomitant use of mannitol with neomycin may increase ototoxicity and nephrotoxicity.

Concomitant use of mannitol with kanamycin may cause hearing loss.

Concomitant use of mannitol with digitalis glycosides may increase the risk of digitalis toxicity associated with hypokalemia.

Concomitant use of mannitol with other diuretic medicines, including carbonic anhydrase inhibitors, may enhance the effect of reducing intraocular pressure. Therefore, dose adjustment may be necessary.

Preparation of the medicine for use

Use only clear solution.

Unused medicine should not be used.

Do not use this medicine if you notice contamination, color change, or if the packaging is damaged.

Follow the principles of asepsis.

Incompatibilities

MANNITOL 20% FRESENIUS should not be mixed with the following medicines due to incompatibility:

erythromycin, tetracycline hydrochloride, cefapirin, ofloxacin, potassium chloride.

Due to the lack of data on interactions between mannitol and other substances, mixing with other medicines should be avoided.

Storage conditions

After opening, the packaging should not be stored and used again.

Store in a temperature below 25°C. Do not freeze.

In low temperatures, MANNITOL 20% FRESENIUS may crystallize in the bottle.

If the solution crystallizes, the medicine should be heated in a water bath to a temperature of about 70°C until the crystals are completely dissolved. Before administration, the solution should be cooled to body temperature.

Disposal of unused medicine

Any unused medicine or waste should be disposed of in accordance with local regulations.

Dr. Yevgen Yakovenko is a licensed surgeon and general practitioner in Spain and Germany. He specialises in general, paediatric, and oncological surgery, internal medicine, and pain management. He offers online consultations for adults and children, combining surgical precision with therapeutic support. Dr Yakovenko works with patients across different countries and provides care in Ukrainian, Russian, English, and Spanish.

Areas of medical expertise:

Acute and chronic pain: headaches, muscle and joint pain, back pain, abdominal pain, postoperative pain. Identifying the cause, selecting treatment, and creating a care plan.
Internal medicine: heart, lungs, gastrointestinal tract, urinary system. Management of chronic conditions, symptom control, second opinions.
Pre- and postoperative care: risk assessment, decision-making support, follow-up after surgery, rehabilitation strategies.
General and paediatric surgery: hernias, appendicitis, congenital conditions, both planned and urgent surgeries.
Injuries and trauma: bruises, fractures, sprains, soft tissue damage, wound care, dressing, referral when in-person care is required.
Oncological surgery: diagnosis review, treatment planning, and long-term follow-up.
Obesity treatment and weight management: a medical approach to weight loss, including assessment of underlying causes, evaluation of comorbidities, development of a personalised plan (nutrition, physical activity, pharmacotherapy if needed), and ongoing progress monitoring.
Imaging interpretation: analysis of ultrasound, CT, MRI, and X-ray results, surgical planning based on imaging data.
Second opinions and medical navigation: clarifying diagnoses, reviewing current treatment plans, helping patients choose the best course of action.

Experience and qualifications:

12+ years of clinical experience in university hospitals in Germany and Spain.
International education: Ukraine – Germany – Spain.
Member of the German Society of Surgeons (BDC).
Certified in radiological diagnostics and robotic surgery.
Active participant in international medical conferences and research.

Dr Yakovenko explains complex topics in a clear, accessible way. He works collaboratively with patients to analyse health issues and make evidence-based decisions. His approach is grounded in clinical excellence, scientific accuracy, and respect for each individual.

If you are unsure about a diagnosis, preparing for surgery, or want to discuss your test results – Dr Yakovenko will help you evaluate your options and move forward with confidence.

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