만니톨

Mannitol

삼투성 이뇨제IV개고양이말소돼지양염소

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

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

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

체중— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증	용량	경로	빈도	기간	지역
Oliguric renal failure (not anuric)	0.25-0.5 gram/kg IV over 5-10 minutes	IV	May repeat q4-6 hours or as CRI for first 12-24 hours	12-24 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 total	IV	q30-40min	Up 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 hours	IV	CRI or q4-6h	—	🌎 NA
Acute glaucoma	0.5-1 gram/kg IV given over 15-20 minutes	IV	Single dose	—	🌎 NA
Acute glaucoma (if latanoprost fails)	1-2 grams/kg IV over a period of 20 minutes	IV	Single dose	—	🌎 NA
Acute primary angle-closure glaucoma	1 gram/kg of mannitol 20% for injection IV over 20 min	IV	May repeat in 4 hours if needed	—	🌎 NA
Increased CSF pressure/cerebral edema	0.5-1.5 grams/kg IV over 10-20 minutes	IV	q6-8h	—	🌎 NA
Increased CSF pressure (critical/deteriorating patient)	0.25 gram/kg IV bolus over 15 minutes	IV	As needed based on ICP	—	🌎 NA
Cerebral edema secondary to trauma	0.5-1 gram/kg IV followed 20 minutes later by furosemide (1 mg/kg IV)	IV	Single 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.

고양이

적응증	용량	경로	빈도	기간	지역
Oliguric renal failure (not anuric)	0.25-0.5 gram/kg IV over 5-10 minutes	IV	May repeat q4-6 hours or as CRI for first 12-24 hours	12-24 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 total	IV	q30-40min	Up 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 hours	IV	CRI or q4-6h	—	🌎 NA
Acute glaucoma	0.5-1 gram/kg IV given over 15-20 minutes	IV	Single dose	—	🌎 NA
Acute glaucoma (if latanoprost fails)	1-2 grams/kg IV over a period of 20 minutes	IV	Single dose	—	🌎 NA
Acute primary angle-closure glaucoma	1 gram/kg of mannitol 20% for injection IV over 20 min	IV	May repeat in 4 hours if needed	—	🌎 NA
Increased CSF pressure/cerebral edema	0.5-1.5 grams/kg IV over 10-20 minutes	IV	q6-8h	—	🌎 NA
Increased CSF pressure (critical/deteriorating patient)	0.25 gram/kg IV bolus over 15 minutes	IV	As needed based on ICP	—	🌎 NA
Cerebral edema secondary to trauma	0.5-1 gram/kg IV followed 20 minutes later by furosemide (1 mg/kg IV)	IV	Single 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.

말

적응증	용량	경로	빈도	기간	지역
General diuresis/edema	0.25-2 gram/kg as a 20% solution by slow IV infusion	IV	Single dose	—	🌎 NA
Increased intracranial pressure from traumatic brain injury (TBI)	Intermittent IV bolus doses of 0.25-1 gram/kg	IV	Intermittent	—	🌎 NA

Increased intracranial pressure from traumatic brain injury (TBI): Rapid bolus administration preferred over continuous. Monitor to avoid hypovolemia.

소

적응증	용량	경로	빈도	기간	지역
Cerebral edema	1-3 gram/kg IV	IV	Single dose	—	🌎 NA
Oliguric renal failure	1-2 gram/kg (5-10mL of 20% solution) IV	IV	Single dose	—	🌎 NA

Cerebral edema: Usually given with steroids and/or DMSO.
Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

돼지

적응증	용량	경로	빈도	기간	지역
Cerebral edema	1-3 gram/kg IV	IV	Single dose	—	🌎 NA
Oliguric renal failure	1-2 gram/kg (5-10mL of 20% solution) IV	IV	Single dose	—	🌎 NA

Cerebral edema: Usually given with steroids and/or DMSO.
Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

양

적응증	용량	경로	빈도	기간	지역
Cerebral edema	1-3 gram/kg IV	IV	Single dose	—	🌎 NA
Oliguric renal failure	1-2 gram/kg (5-10mL of 20% solution) IV	IV	Single dose	—	🌎 NA

Cerebral edema: Usually given with steroids and/or DMSO.
Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

염소

적응증	용량	경로	빈도	기간	지역
Cerebral edema	1-3 gram/kg IV	IV	Single dose	—	🌎 NA
Oliguric renal failure	1-2 gram/kg (5-10mL of 20% solution) IV	IV	Single dose	—	🌎 NA

Cerebral edema: Usually given with steroids and/or DMSO.
Oliguric renal failure: Give after rehydration; monitor urine flow and fluid balance.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

만니톨은 주로 응급 및 중환자 수의학에서 사용되는 강력한 삼투성 이뇨제입니다. 세포 내에서 세포 외 공간으로 수분을 끌어당기는 당알코올입니다.

주요 적응증:

급성 핍뇨성 신부전의 관리 (이뇨 촉진)
두개내압(ICP) 및 뇌부종 감소 (예: 외상성 뇌손상)
급성 녹내장 시 안압(IOP) 감소
특정 독소(예: 아스피린, 바르비투르산염, 브롬화물, 에틸렌 글리콜)의 요배설 촉진

임상 팁: 만니톨은 빠른 체액 이동을 유발하므로 매우 효과적이지만 환자의 체액 및 수화 상태에 대한 엄격한 모니터링이 필요합니다. 실온에서 결정화되는 경향이 있으므로 반드시 인라인 필터를 사용하여 투여해야 합니다.

작용 기전

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.

안전성·주의사항

금기사항

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)

부작용

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)

주의

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.

약물 상호작용

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

모니터링

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

약동학

흡수

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

분포

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.

대사

Only 7-10% of mannitol is metabolized.

배설

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.

과다투여

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.

제품

제형

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)

동물용의약품

Unapproved, veterinary-labeled products may be available.

인용의약품

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

규제 현황

European Union✓ 승인됨처방전의약품EMA

🐕 Dogs🐈 Cats

Available as POM (Prescription Only Medicine).

United Kingdom✓ 승인됨처방전의약품VMD

🐕 Dogs🐈 Cats

Available as POM-V.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

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.

보호자 정보

만니톨은 응급 약물로서 적절한 모니터링이 가능한 동물병원 환경에서 전문 수의학 의료진에 의해서만 투여되어야 합니다.

체내 체액의 빠른 이동을 유발하기 때문에, 안전성과 효과를 보장하기 위해 반려동물의 수화 상태, 전해질 및 소변량이 면밀히 모니터링됩니다.

VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.