A fixed-dose combination of two osmotic agents, Glycerin and Mannitol, primarily used for the management of cerebral edema and reduction of intraocular pressure (IOP). Glycerin is a trihydric alcohol and Mannitol is a hexahydric alcohol. In combination, they exert a synergistic osmotic effect, drawing fluid from tissues into the intravascular compartment, thereby reducing edema and pressure. This combination is particularly relevant in the Indian context for managing acute episodes of raised intracranial pressure (ICP) and acute glaucoma, often as an adjunct to other therapies.
Adult: 1 to 2 tablets orally, every 6 to 8 hours, as directed by the physician. The dose must be individualized based on the osmolality gap and clinical response. Maximum daily dose should not exceed 6 tablets (60mg Glycerin + 60mg Mannitol) without close monitoring.
Note: Administer orally with a full glass of water. Can be taken with or without food, but taking on an empty stomach may provide a slightly faster onset. The tablet should be swallowed whole. Patient should be adequately hydrated unless contraindicated.
The combination creates a hyperosmotic state. After absorption, Glycerin increases plasma osmolality, drawing water from extravascular spaces (including the brain and eye) into the intravascular compartment. This reduces brain volume and intracranial pressure (ICP) and lowers intraocular fluid volume, decreasing IOP. Mannitol, when absorbed in minimal amounts, contributes to this effect. Orally, unabsorbed Mannitol exerts an osmotic effect in the gastrointestinal lumen, acting as a laxative, which may indirectly help in reducing straining-induced ICP spikes.
Pregnancy: Category C: Animal reproduction studies have not been conducted. Use only if the potential benefit justifies the potential risk to the fetus. Should be used in pregnancy only for life-threatening conditions like malignant cerebral edema.
Driving: May cause dizziness, lightheadedness, or blurred vision. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Diuretics (Furosemide, HCTZ) | Additive risk of dehydration and electrolyte depletion (hypokalemia, hyponatremia). | Major |
| Lithium | Mannitol may increase renal excretion of lithium, reducing its serum levels and efficacy. | Moderate |
| Nephrotoxic drugs (Aminoglycosides, NSAIDs, Cisplatin) | Increased risk of acute kidney injury. Mannitol may potentiate nephrotoxicity. | Major |
| Cardiac Glycosides (Digoxin) | Hypokalemia induced by this combination can precipitate digoxin toxicity. | Major |
| Antihypertensives | Additive hypotensive effect due to volume depletion. | Moderate |