From the FDA Drug Label
Treatment: ... Urea, mannitol, and aminophylline all produce significant increases in lithium excretion. The role of mannitol in treating lithium toxicity is to increase lithium excretion.
- Mannitol is used to enhance the elimination of lithium from the body.
- It is part of the treatment approach for severe lithium poisoning, along with other measures such as gastric lavage, correction of fluid and electrolyte imbalance, and regulation of kidney functioning 1.
From the Research
Mannitol is not recommended as a primary treatment for lithium toxicity, and its use should be cautious and limited to specific cases where hemodialysis is not available or feasible, as evidenced by the lack of strong evidence supporting its effectiveness in reducing morbidity and mortality 2, 3. The role of mannitol in treating lithium toxicity is largely supportive, and its primary mechanism of action is through osmotic diuresis, which can help enhance lithium elimination. However, the evidence supporting the use of mannitol in this context is limited, and it is not considered a first-line treatment for lithium toxicity. Some key points to consider when evaluating the use of mannitol in lithium toxicity include:
- The primary treatment for severe lithium toxicity remains hemodialysis, which is highly effective in removing circulating lithium and reducing the risk of neurological sequelae 4, 5.
- Mannitol may be considered as an adjunctive therapy in cases where hemodialysis is not available or feasible, but its use should be cautious and carefully monitored to prevent dehydration or fluid overload 6, 3.
- The evidence supporting the use of mannitol in lithium toxicity is largely based on observational studies and case reports, and there is a lack of randomized controlled trials to support its effectiveness in reducing morbidity and mortality 2, 3.
- The use of mannitol should be individualized and based on the specific clinical context, taking into account factors such as the severity of lithium toxicity, renal function, and the presence of other comorbidities 4, 3.