Amikacin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Mannitol
Osmotic diuretic · Diuretic, Antiglaucoma agent, Agent for cerebral edema
Also known as D-Mannitol, Osmotic Diuretic Solution
START
Raised ICP: 0.25–1 g/kg IV 20% over 15–30 min; oliguria test dose 0.2 g/kg
TYPICAL MAX
~2 g/kg/day; keep osmolality <320 mOsm/kg
STOP IF
No urine response to test dose, osmolar gap/osmolality excessive, fluid overload/pulmonary oedema
WATCH
Serum osmolality + osmolar gap, renal function, electrolytes, fluid balance, neuro status
CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC B05BC01
KDIGO 2024 + manufacturer label
- ONSET
- 30min · ICP/diuresis onset
- PEAK
- 1h · peak osmotic effect
- t½
- 1.4h · plasma t½
- DURATION
- 6h · effect duration
EXCRETION
Renal, rapidly filtered, largely unchanged
route + CYP
INTERACTIONS
11 major
SEVERE in our sources
PREGNANCY
Use only if clearly needed for serious indications — limited data
FDA category + note
Top interactionssee all 12 →
- AmikacinSevereDatabaseDDInter
- DigoxinSevereDatabaseKimi deep-research + Cla
- DroperidolSevereDatabaseDDInter
- GentamicinSevereDatabaseDDInter
Available in India
8 branded formulations and 32 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Freely filtered, non-reabsorbed sugar alcohol that raises plasma and tubular osmolality — extracts water from tissues (brain, eye) into the intravascular space and induces osmotic diuresis with obligatory water and electrolyte loss.
Indications
Raised intracranial pressure / cerebral oedemaAcute glaucoma / pre-ophthalmic-surgery IOP reductionPromotion of diuresis in oliguria / forced diuresis for toxinsGenitourinary irrigation (TURP)
Dosing
- Adult
- Raised ICP: 0.25–1 g/kg IV (20% solution) over 15–30 min, repeat per osmolality/response. Oliguria test dose 0.2 g/kg over 3–5 min.
- Pediatric
- 0.25–1 g/kg IV (specialist).
- Renal adjustment
- Test dose required; do not continue if no urine response (risk of fluid overload).
- Hepatic adjustment
- No specific adjustment.
- Geriatric
- Cautious; monitor volume/cardiac status.
- Max dose
- Up to ~2 g/kg/day; keep serum osmolality <320 mOsm/kg
Pharmacokinetics
Onset
Diuresis 1–3 h; ICP reduction within 15–30 min
Peak effect
~1 h (osmotic effect)
Duration
~3–8 h
Half-life
~1.1–1.6 h (longer in renal failure)
Bioavailability
IV (negligible oral)
Protein binding
Negligible
Metabolism
Minimal (small fraction hepatic to glycogen)
Excretion
Renal — rapidly filtered, largely unchanged
Contraindications
- Anuria due to severe renal disease (not responsive)
- Severe established pulmonary oedema / congestive heart failure
- Active intracranial bleeding (except during craniotomy)
- Severe dehydration
- Progressive renal failure/oliguria after a test dose
Side effects
Common
PolyuriaThirst/dehydrationHeadacheNauseaElectrolyte disturbance
Serious
- Acute kidney injury (high cumulative dose, osmotic nephrosis)
- Pulmonary oedema / fluid overload (initial volume expansion)
- Severe electrolyte/osmolar disturbance, rebound ICP rise
- Extravasation tissue injury
Pregnancy & lactation
Pregnancy
Use only if clearly needed for serious indications — limited data
Lactation
Limited data; short-term acute use — caution
Drug interactions
Digoxin
Severe
Database
Mannitol-induced hypokalaemia potentiates digoxin toxicity
Monitor K+ and digoxin levels
Source: Kimi deep-research + Cla
Droperidol
Severe
Database
Clinical effect not specified
Source: DDInter
Gentamicin
Severe
Database
.
Source: DDInter
Kanamycin
Severe
Database
Clinical effect not specified
Source: DDInter
Neomycin
Severe
Database
Clinical effect not specified
Source: DDInter
Nephrotoxic Drugs
Severe
Database
Additive renal injury (osmotic nephrosis)
Avoid; monitor renal function/osmolality
Source: Kimi deep-research + Cla
Netilmicin
Severe
Database
Clinical effect not specified
Source: DDInter
Plazomicin
Severe
Database
Clinical effect not specified
Source: DDInter
Streptomycin
Severe
Database
Clinical effect not specified
Source: DDInter
Tobramycin
Severe
Database
Clinical effect not specified
Source: DDInter
Lithium
Moderate
Database
Altered lithium excretion
Monitor lithium levels
Source: Kimi deep-research + Cla
Related guidelines
Ask House about Mannitol
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19