VetSheet

マンニトール

Mannitol

浸透圧利尿薬IV犬猫馬牛豚羊ヤギ

別名: Osmitrol · Resectisol · Am-Vet Mannitol · Isotol · Manniject · Osmofundin · Mannitol IV · cordycepic acid · E421 · manita · manitol · manna sugar · mannite · mannitolum · D-Mannitol

VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス

0.25-0.5 gram/kg IV over 5-10 minutesIV· May repeat q4-6 hours or as CRI for first 12-24 hours· 12-24 hours
— 🐕

用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。

動物種別用量

🌎 NA — North America🌍 EU — Europe

犬

適応用量経路頻度期間地域
Oliguric renal failure (not anuric)0.25-0.5 gram/kg IV over 5-10 minutesIVMay repeat q4-6 hours or as CRI for first 12-24 hours12-24 hours🌎 NA
Oliguric renal failure (rehydrated, not fluid overloaded)0.25-0.5 gram/kg IV slowly over 5-10 minutes; repeat dose at 30-40 minute intervals up to 1.5 gram/kg totalIVq30-40minUp to 1.5 g/kg total🌎 NA
Oliguric renal failure (fluid replete)0.5 gram/kg IV over 20-30 minutes; if significant diuresis is accomplished within 30 minutes, may administer as a CRI of 60-120 mg/kg/hr IV or as intermittent boluses repeated every 4-6 hoursIVCRI or q4-6h—🌎 NA
Acute glaucoma0.5-1 gram/kg IV given over 15-20 minutesIVSingle dose—🌎 NA
Acute glaucoma (if latanoprost fails)1-2 grams/kg IV over a period of 20 minutesIVSingle dose—🌎 NA
Acute primary angle-closure glaucoma1 gram/kg of mannitol 20% for injection IV over 20 minIVMay repeat in 4 hours if needed—🌎 NA
Increased CSF pressure/cerebral edema0.5-1.5 grams/kg IV over 10-20 minutesIVq6-8h—🌎 NA
Increased CSF pressure (critical/deteriorating patient)0.25 gram/kg IV bolus over 15 minutesIVAs needed based on ICP—🌎 NA
Cerebral edema secondary to trauma0.5-1 gram/kg IV followed 20 minutes later by furosemide (1 mg/kg IV)IVSingle dose—🌎 NA
  • Oliguric renal failure (not anuric): After correcting fluid, electrolyte, acid/base balance. CRI dose is 8-10% solution.
  • Oliguric renal failure (fluid replete): Contraindicated in patients who are dehydrated, hypervolemic, or anuric.
  • Acute glaucoma: Withhold water for 3-4 hours. IOP reduction begins in 20-30 mins.
  • Acute glaucoma (if latanoprost fails): Withhold water for 1-2 hours.
  • Acute primary angle-closure glaucoma: Chronic use not advised. Withhold water for several hours post-dose.
  • Increased CSF pressure/cerebral edema: Limit to three boluses in a 24-hr period if possible. Monitor osmolality.
  • Increased CSF pressure (critical/deteriorating patient): Equally effective as 1 g/kg but may last a shorter time.
  • Cerebral edema secondary to trauma: Aggressive therapy for dying patients; potential risk for worsening hemorrhage.

猫

適応用量経路頻度期間地域
Oliguric renal failure (not anuric)0.25-0.5 gram/kg IV over 5-10 minutesIVMay repeat q4-6 hours or as CRI for first 12-24 hours12-24 hours🌎 NA
Oliguric renal failure (rehydrated, not fluid overloaded)0.25-0.5 gram/kg IV slowly over 5-10 minutes; repeat dose at 30-40 minute intervals up to 1.5 gram/kg totalIVq30-40minUp to 1.5 g/kg total🌎 NA
Oliguric renal failure (fluid replete)0.5 gram/kg IV over 20-30 minutes; if significant diuresis is accomplished within 30 minutes, may administer as a CRI of 60-120 mg/kg/hr IV or as intermittent boluses repeated every 4-6 hoursIVCRI or q4-6h—🌎 NA
Acute glaucoma0.5-1 gram/kg IV given over 15-20 minutesIVSingle dose—🌎 NA
Acute glaucoma (if latanoprost fails)1-2 grams/kg IV over a period of 20 minutesIVSingle dose—🌎 NA
Acute primary angle-closure glaucoma1 gram/kg of mannitol 20% for injection IV over 20 minIVMay repeat in 4 hours if needed—🌎 NA
Increased CSF pressure/cerebral edema0.5-1.5 grams/kg IV over 10-20 minutesIVq6-8h—🌎 NA
Increased CSF pressure (critical/deteriorating patient)0.25 gram/kg IV bolus over 15 minutesIVAs needed based on ICP—🌎 NA
Cerebral edema secondary to trauma0.5-1 gram/kg IV followed 20 minutes later by furosemide (1 mg/kg IV)IVSingle dose—🌎 NA
  • Oliguric renal failure (not anuric): After correcting fluid, electrolyte, acid/base balance. CRI dose is 8-10% solution.
  • Oliguric renal failure (fluid replete): Contraindicated in patients who are dehydrated, hypervolemic, or anuric.
  • Acute glaucoma: Withhold water for 3-4 hours. IOP reduction begins in 20-30 mins.
  • Acute glaucoma (if latanoprost fails): Withhold water for 1-2 hours.
  • Acute primary angle-closure glaucoma: Chronic use not advised. Withhold water for several hours post-dose.
  • Increased CSF pressure/cerebral edema: Limit to three boluses in a 24-hr period if possible. Monitor osmolality.
  • Increased CSF pressure (critical/deteriorating patient): Equally effective as 1 g/kg but may last a shorter time.
  • Cerebral edema secondary to trauma: Aggressive therapy for dying patients; potential risk for worsening hemorrhage.

馬

適応用量経路頻度期間地域
General diuresis/edema0.25-2 gram/kg as a 20% solution by slow IV infusionIVSingle dose—🌎 NA
Increased intracranial pressure from traumatic brain injury (TBI)Intermittent IV bolus doses of 0.25-1 gram/kgIVIntermittent—🌎 NA
  • Increased intracranial pressure from traumatic brain injury (TBI): Rapid bolus administration preferred over continuous. Monitor to avoid hypovolemia.

牛

適応用量経路頻度期間地域
Cerebral edema1-3 gram/kg IVIVSingle dose—🌎 NA
Oliguric renal failure1-2 gram/kg (5-10mL of 20% solution) IVIVSingle dose—🌎 NA
  • Cerebral edema: Usually given with steroids and/or DMSO.
  • Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

豚

適応用量経路頻度期間地域
Cerebral edema1-3 gram/kg IVIVSingle dose—🌎 NA
Oliguric renal failure1-2 gram/kg (5-10mL of 20% solution) IVIVSingle dose—🌎 NA
  • Cerebral edema: Usually given with steroids and/or DMSO.
  • Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

羊

適応用量経路頻度期間地域
Cerebral edema1-3 gram/kg IVIVSingle dose—🌎 NA
Oliguric renal failure1-2 gram/kg (5-10mL of 20% solution) IVIVSingle dose—🌎 NA
  • Cerebral edema: Usually given with steroids and/or DMSO.
  • Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

ヤギ

適応用量経路頻度期間地域
Cerebral edema1-3 gram/kg IVIVSingle dose—🌎 NA
Oliguric renal failure1-2 gram/kg (5-10mL of 20% solution) IVIVSingle dose—🌎 NA
  • Cerebral edema: Usually given with steroids and/or DMSO.
  • Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。

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概要

マンニトールは、主に救急および集中治療の獣医療で使用される強力な​浸透圧利尿薬​です。細胞内から細胞外へ水分を引き寄せる糖アルコールです。

​主な適応症：​

  • ​急性乏尿性腎不全​の管理（利尿の促進）
  • ​頭蓋内圧（ICP）​および脳浮腫の低下（例：外傷性脳損傷）
  • 急性緑内障における​眼圧（IOP）​の低下
  • 特定の毒素（アスピリン、バルビツール酸系、臭化物、エチレングリコールなど）の尿中排泄の促進

​臨床のポイント：​ マンニトールは急速な体液移動を引き起こすため非常に有効ですが、患者の体液量と水分状態の厳密なモニタリングが必要です。室温で結晶化する傾向があるため、インラインフィルターを使用して投与する必要があります。

作用機序

Mannitol is freely filtered at the glomerulus and poorly reabsorbed in the renal tubules.

  • ​Osmotic Diuresis:​ The presence of mannitol in the tubular fluid increases osmotic pressure → prevents water reabsorption → proportionately increases water excretion along with sodium, uric acid, and urea.
  • ​Neuroprotection & ICP Reduction:​ Increases intravascular osmolarity → draws water from brain parenchyma across an intact blood-brain barrier (BBB) into the intravascular space → decreases cerebral edema and CSF pressure.
  • ​Renal Protection:​ Dilates renal arterioles → decreases vascular resistance and blood viscosity → increases renal blood flow and glomerular filtration rate (GFR). It also minimizes renal tubular swelling and prevents the concentration of nephrotoxins in tubular fluid.

安全性・警告

禁忌

  • Anuria secondary to renal disease
  • Severe dehydration
  • Severe pulmonary congestion or pulmonary edema
  • Intracranial bleeding (unless during craniotomy - human label)
  • Disrupted capillary membrane in the brain (can leak into interstitium and worsen edema)
  • Pulmonary oedema
  • Intracranial haemorrhage (relative contraindication; labelled 'use with care' but commonly used in traumatic brain injury)

有害事象

  • Fluid and electrolyte imbalances (especially hypernatremia)
  • Volume overload (if oliguria persists)
  • Nausea and vomiting
  • Pulmonary edema
  • Congestive heart failure (CHF)
  • Tachycardia
  • Dizziness and headache (CNS effects)
  • Circulatory overload (at high doses)
  • Acidosis (at high doses)
  • Thrombophlebitis
  • Extravasation injury (oedema and skin necrosis)
  • Diarrhoea (if administered orally)
  • Acute renal failure (rare)

注意事項

​Important Warnings:​

  • Halt therapy if progressive heart failure, pulmonary congestion, or progressive renal failure/damage (increasing oliguria/azotemia) develops.
  • ​Hydration:​ Adequate fluid replacement must be administered to dehydrated animals before mannitol therapy begins. Use with caution in hypovolemic patients as it can enhance hypotension.
  • ​Crystallization:​ Crystals frequently form in solutions >15%. Be certain crystals are dissolved (by warming) before administering. An ​in-line IV filter (5 micron)​ is highly recommended.
  • ​Blood Products:​ Do not give with whole blood products unless at least 20 mEq/L of NaCl is added, otherwise pseudoagglutination may result.
  • ​Glaucoma:​ Relatively contraindicated for treating secondary glaucomas, as it may cross the damaged blood-aqueous barrier and increase IOP.

医薬品相互作用

Lithium

Mannitol can increase the renal elimination of lithium

Sotalol

Mannitol's effects on potassium and magnesium may increase the risk for QT prolongation

Potassium-depleting diureticsModerate

May exacerbate diuretic-induced hypokalaemia

Beta-blockersModerate

Concurrent use with potassium-depleting diuretics requires caution

CiclosporinMajor

Nephrotoxicity has been described with concurrent use in humans

Whole bloodMajor

Mannitol should never be added to whole blood for transfusion or given through the same IV set

KCl or NaClMajor

Do not add to concentrated mannitol solutions (20% or 25%) as a precipitate may form

監視

  • Serum electrolytes (especially sodium)
  • Serum osmolality
  • BUN and serum creatinine
  • Urine output
  • Central venous pressure (CVP), if possible
  • Lung auscultation (to monitor for pulmonary edema)
  • Intracranial pressure (ICP) or neurological status
  • Intraocular pressure (IOP)
  • Hydration status and body weight
  • Serum electrolytes (especially potassium and sodium)
  • Renal function (BUN, creatinine)
  • Acid-base balance

薬物動態

吸収

Administered IV in veterinary medicine. In humans, up to 17% of an oral dose is excreted unchanged in the urine.

分布

Distributed to the extracellular compartment. Does not penetrate the eye or the CNS unless the patient has received very high doses, is acidotic, or there is a loss of integrity of the blood-brain barrier.

代謝

Only 7-10% of mannitol is metabolized.

消失

The remainder is excreted unchanged in the urine. Elimination half-life in adult humans is ~100 minutes. Half-lives in cattle and sheep are reported to be between 40-60 minutes.

過剰投与

Inadvertent overdosage can cause excessive excretion of sodium, potassium, and chloride. If urine output is inadequate, water intoxication or pulmonary edema may occur.

​Treatment:​

  • Halt mannitol administration immediately.
  • Monitor and correct electrolyte and fluid imbalances.
  • Hemodialysis is effective in clearing mannitol from the bloodstream.

製品

製剤

  • Injection: 5%, 10%, 15%, 20%, 25%
  • Injectable: 10% solution (50 g/500 ml)
  • Injectable: 15% solution (75 g/500 ml)
  • Injectable: 20% solution (100 g/500 ml)

動物用医薬品

  • Unapproved, veterinary-labeled products may be available.

ヒト用医薬品

  • Mannitol Injection: 5% (50 mg/mL), 10% (100 mg/mL), 15% (150 mg/mL), 20% (200 mg/mL), 25% (250 mg/mL)
  • Mannitol Solution: 5 grams/100 mL
  • Mannitol 10% IV infusion
  • Mannitol 15% IV infusion
  • Mannitol 20% IV infusion

規制ステータス

European Union✓ 承認済み処方箋医薬品EMA
🐕 Dogs🐈 Cats

Available as POM (Prescription Only Medicine).

United Kingdom✓ 承認済み処方箋医薬品VMD
🐕 Dogs🐈 Cats

Available as POM-V.

規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

保管・安定性

Store at room temperature; avoid freezing. Crystallization may occur at low temperatures in concentrations greater than 15%. Resolubilize crystals by heating the bottle in hot water (up to 80°C) and cool to body temperature before administering. An in-line IV filter (5 micron) is highly recommended when administering concentrated solutions.

飼主向け情報

マンニトールは救急薬であり、適切なモニタリングが可能な動物病院の環境で、専門の獣医療スタッフによって投与される必要があります。

体内の水分を急速に移動させる作用があるため、安全性と有効性を確保する目的で、ペットの水分状態、電解質、尿量が注意深く監視されます。

VetSheet医薬品リファレンスは獣医専門家の臨床意思決定支援を目的としており、専門的判断または製造業者の最新医薬品情報の代替にはなりません。